Quels soins pédopsychiatriques proposer aux enfants de parents présentant une pathologie psychiatrique ? Réflexions à partir d’une situation clinique

Abstract

This paper initiates a theoretical-clinical reflection on the specificity of child psychiatric support for children of psychotic parents or those suffering from severe personality disorders, at the time of the psychotherapeutic follow-up of a five-year-old child presenting psychomotor agitation. Over and above the multiple biopsychosocial risk factors, these complex situations require child psychiatrists to clarify their support and public health role in order to guarantee coherent care and expertise. Indeed, the various players involved (child welfare, justice, education, adult psychiatry, neuropediatric, etc.) may ignore one another or take on a role that exceeds their field of competence : the result is sometimes a certain confusion of roles, or even confusing measures and contradictory positions. When a child's symptomatology and that of his or her family preclude the use of classic, standardized interviews, it seems to us that narrative work is best carried out as close as possible to the subject's spontaneous enunciation (spoken or acted). We can then attempt to identify the operative stages of care and postulate that it is only when the child names his own impulsivity (his “crazy” part) that he will be able to recognize it in his parent. This opens the possibility of a certain representation of parental psychopathology and of putting it into narrative form. First postulated as a subject, this child is invited to name his psychomotor excitement, then that of his parent: “volcano”. The loss of a concrete object, a “blue pebble”, between two sessions, opens the space for representation and graphic expression. This object of reality becomes an object of mediation between him and his therapist and is presented as the support for a signifier, “blue”: in this way, a process of encryption and symbolization begins, an attempt to put the world in order. The signifier “blue” (which cools and extinguishes fire) is articulated with the signifier “red” (which burns and excites) in complex constructions, but not without effect on the patient's body and symptoms. These clinical elements could be passed on to the various partners and could support their care, educational, rehabilitative and expert missions.