Démence et résilience : Narration ou retour du passé ?

Abstract

Certains résidents, atteints de maladies neurodégénératives, manifestent vouloir rentrer chez eux et cherchent à se soustraire du lieu où ils résident, vécu comme lieu d’enfermement. Confrontés aux systèmes de sécurité qui les empêchent de mettre leur vie en danger, ils peuvent alors manifester des comportements agressifs. Afin de comprendre l’ampleur de ces sorties intempestives et leurs répercussions psychiques, les auteurs convoquent, dans un premier temps, l’appareil théorique freudien pour éclairer, au travers de vignettes cliniques, les processus en jeu, les mécanismes mis en place à cet instant. Ils situent leurs réflexions en références à des travaux sur la question pour proposer des pistes thérapeutiques dans la prise en charge de ces patients. L’analyse des accompagnements prodigués insistera sur l’importance d’une clinique ayant pour pierre d’angle la relation à l’Autre. Des pistes thérapeutiques dans la prise en charge de ces états seront dégagées tout au long de cette réflexion.Various behavior disorders can occur during Alzheimer's disease, in particular unexpected outings. This article aims at understanding the diverse mechanisms present during a “runaway” episode, which can manifest in an acute way. The authors bring to light through clinical examples what is at work from a psychological perspective in order to create new accompaniment methods.First, the authors reviewed the literature on runaway episodes in order to point out necessary themes for reflection. Then, from a Freudian theoretical model, they brought to light four fundamental mechanisms: hallucinations, false recognition, non-recognition, and recognition. These are mainly, although not exhaustively, understood from perceptions, memory-traces, indications of quality, and memories. This theory was questioned by means of presented clinical cases. Various post-Freudian models allowed the authors to emphasize the pathological experience in the role of perceptions and the functions, which come into play in the psychic economy. By going back and forth between theory and clinical cases, the authors underline the importance of perception in the phenomenon of unexpected outings. Finally, the Lacanian psychoanalytical theories provide a framework to question clinical cases but also provide answers to the criticisms found in the diverse reserved models.Through this study the authors hypothesize that the runaway episodes are not senseless but result from the interaction between the effects of the brain damage and the anxiety, which they arouse in the subjectivity of the person suffering from Alzheimer's. Leaning on false-recognitions, hallucinations, and non-recognitions such as were described in “Project for a scientific psychology”, the authors put forward the hypothesis that these mechanisms express themselves in an imaginary relation, as in psychosis.The question of whether the runaway episodes of Alzheimer's sufferers can be classified as psychotic breakouts with a loss of touch with reality, or if the runaway episodes could be prevented by offering enough reassurance and support, is open to further debate.