Discussion de l’association signifiante de psychose hystérique comme problématisation de la terminologie psychiatrique classique de la « névrose » et de la « psychose »

Abstract

Background and objectivesThe apparently oxymoronic significant association of “hysterical psychosis” has regularly been the subject of intense debate : this question of incoherence or existence of hysterical psychosis remains very topical, as reflected by recent French publications. Why is this question recurrent in the literature? What does the use of the term hysteric psychosis mean? What conceptual guidelines does it raise? Materials and materialsThe joint study we carried out concerning the historical determinants relating to this question, the distinction between the French and English descriptions, and discussions about the different theoretical models used to attempt to conceive the concept of hysterical psychosis reveal a common problem concerning the definition of “neurosis” and “psychosis”. ResultsIf Freud used the term “hysterical psychosis” on a few occasions, the clinical was clearly defined by Follin, Chazaud and Pilon in 1961. From brutal beginnings, often in reaction to a triggering factor of rupture or loss, appears a loosely structured multi-figured delusion, enough however to create an unstable, partially criticised neoreality. Whilst the mechanisms are multiple, the delirious theme is established around a mystic-sexual polarity associated with the “theme of the double”, which is expressed notably via elements of depersonalisation. Hallucinations are frequent, mainly visual, giving the impression that the subject is a spectator of their own delirium, spectacle sometimes veering towards a real fascination for this oneiroid state. This clinical description has often been used on the other side of the Atlantic in the American Journal of Psychiatry yet without this clinical entity being validated by operationalised criteria and without it being retained in the third edition of American Nosography. The absence of official designation in modern nosography does not impede the implicit perpetuation of the question of hysteric psychosis in epidemiological research. Furthermore, several French clinicians continue to show an interest in this question they have taken up as being that of “hysterical psychosis”. Contemporary French articles on the subject attest to the interrogations of practitioners without any real etiopathogenic structure or nosographic discussions being established. ConclusionsInnovative theories justifying the existence or incoherence of hysterical psychosis are rare and descriptive work is more frequent, yet a common problem unites the authors consulted: is it possible and/or useful to accurately define the signifiers of neurosis and psychosis, integrating the question of their relationship of continuity or opposition? In reference to the question of “hysterical psychosis”, the schools of psychopathology and epidemiology have not been able to clarify this question.