Dispositif de médiation thérapeutique par le son, la musique et la vibration : sentir, ressentir, entendre l’inaudible du corps dans les anorexies mentales

Abstract

ObjectiveBased on the theoretical foundations of psychoanalysis, this article outlines the clinical problem at the origin of the conception and the implementation of a therapeutic mediation platform using sound, music, and vibration for adolescent patients with anorexia nervosa. After a description of the platform, the results of a pilot experience carried out in the adolescent and young adult psychiatry department of the Institut Mutualiste Montsouris are presented. They open up new perspectives for understanding the singularity and the relevance of this platform with respect to the difficulties encountered in clinical work with these young patients. MethodThe disaffectation of the body and the refusal of links in the relation to the object behind the relation to the other present themselves as modalities of psychic defense responding to threats coming from the experience of instinctual overflow, reactivated by the metamorphoses of puberty. The framework of therapy based on speech and associativity, supported by the transference, often reinforces the anxieties and, consequently, the defenses of patients organized around anorexic symptoms. In order to promote the progressive defusing of defenses and the activation of psychic movements through associativity, an innovative clinical platform for therapeutic mediation through bodily contact with vibrations linked to sound and music has been designed and proposed. Eight adolescents, a boy and seven girls, aged 14 to 19, hospitalized for anorexia nervosa participated in this clinical experience. During five workshop sessions, the patients explored their bodily sensations in the presence of two clinical psychologists. The bodily sensations were provoked by the play of sound and musical sequences perceived through contact with four audiovibrotactile objects : a table, a balloon, a blanket, and a neck pillow. ResultsThe speech, gestures, and actions of the patients during the workshop sessions revealed the ways in which they psychically invested the sensory objects of the platform. The sound sequences of heartbeats and aquatic events associated with the sea (several representations of which have been explored), with their vibrations, were the site of special investments. The objects were explored through a variety of body postures. The sensations called up by the psycho-corporeal relationships with these objects brought to light representations and affects linked to life experiences that patients had expressed in speaking with psychologists. The patients’ verbal and non-verbal expression allowed us to identify three main categories of analysis: the expression of different types of difficulty in engaging with the platform; the expression of the bodily sensations aroused and the relationship of patients to the pleasure or displeasure associated with these sensations; the expression of contents related to their experience of disease, to the family, to the unknown, to loneliness, fear and anxiety, death, and affect, among others. In this sense, the experimental objects fulfilled a projective function, as shifters of an associative dimension and possible clinical work. DiscussionThis clinical mediation platform, through its audiovibrotactile objects, is attractive to adolescents. However, it introduces into the subject a surprising and unfamiliar, potentially disturbing sensory experience, bringing out the uncanniness of the intimate drive that subject cannot control. The subject experiences intense bodily sensations that can reactivate buried primary experiences. In this sense, the interest but also the risk of this platform is that it touches the deepest areas of the body, thus allowing it to overcome the barriers of the defensive mechanisms and to bring up psychic contents with a strong emotional charge. This is why this platform cannot be put in place without the clinician, who by his/her presence supports the ability to pay attention to the psychic effects provoked by these bodily sensations and to recognize them. The clinician's anaclitic function also means that patients are not left to their own devices. ConclusionThe singularity of this platform consists in that it offers the subject a constellation of malleable objects of different types as vectors of her/his relationship to own instinctual objects. In this sense, this platform is thought of as mediation with a therapeutic aim which can encourage, depending on the psychic possibilities of the patients, the libidinal reinvestment of disaffected body areas in anorexia nervosa. The bodily experiences aroused and reactivated by contact with the different types of object update memory traces that it is essential to recognize in the context of the transferential link between the clinician and the patient, especially in discursive exchange.