« Reconnaissance » et « réparation » des troubles psychiques de guerre : le point de vue des patients. Partie 1 : analyse lexicale du discours de 15 militaires blessés psychiques de guerre

Abstract

BackgroundThe Army Health Service continues to develop action plans for posttraumatic stress disorder caused by war and at the same time, several administrations have deployed resources to better support the psychologically wounded soldiers. Even though these psychological war disorders led to many epidemiological, clinical and therapeutic studies, we have not found any referenced studies evaluating the perception of the medical and social actions by soldiers themselves. ObjectiveThe purpose of this work is to explore the subjective perception of French soldiers suffering from PTSD attributable to service in order to evaluate how their condition is recognized and supported by society. Materials and methodsWe conducted a qualitative exploratory study based on 15fifteen semi-structured interviews to achieve a lexical discourse analysis by the software “ALCESTE©”. During the interviews, the investigator followed a general frame designed to address the themes of “repair”, “recognition” and “information” about war mental injuries. These semi-structured interviews were based on open questions inciting details and more information from soldiers. ResultsThe wounded soldiers we consulted confirmed their commitment and loyalty to their military values (cohesion, duties, recognition of the chief), despite the presence of their psychological injuries and its consequences. However, both event and posttraumatic syndrome cannot, for psychopathological reasons, neither spontaneously nor fully integrate into the social discourse. The wounded verbalized a fear of being excluded from their community, or of not being supported in spite of their military injury, which again refers to “normal” trauma psychopathology. On the substance and form, the wounded's speech evokes the clinic of trauma marked by ineffability, repetition and depressive affects. In the speeches of wounded subjects, the “repair” seems to be primarily a social and psychological restoration, or at least an appeasement, which takes the road of access to care. Otherwise, the perception of financial compensation is sidelined after a psychological and social reconstruction. If the word of “repair” – certainly legal but with reifying accents – has been broadly rejected by patients to benefit of the word “reconstruction”, psychological war wounded gladly accept the help offered to them in the fields of medical and psychological cares, and of professional reintegration. DiscussionIn this research, we identified a number of general facts and also highlighted how each clinical case is unique, thanks to the interviews we conducted and their textual analysis. Medical and psychological cares, just like any other type of care, must be adapted or tailored to meet the requirements that each case presents. Each case is thus unique and different patients can require different kinds of help, depending on their career and yearnings.