Trauma, deuil et principe d’intégrité

Abstract

ObjectiveThe paper examines the clinical characteristics of trauma using a differential approach, particularly in human disaster situations (terrorist attacks, slaughter, genocide), and their specificity compared to natural disasters is explored. MethodThe author draws on the specialized literature on trauma. After reviewing the notion of trauma in Charcot, Freud and Ferenczi, definitions of mental trauma are drawn from contemporary authors: Maria Torok, Claude Nachin Pierre Benghozi Guy Briole, Olivier Douville, etc. The conventional notions of cleavage and dissociation are discussed, as well as the more recent concepts of “psychological revisionism” and “catastrophic mourning.” ResultsTrauma is closely linked to accidental occurrences and even more to disaster, especially where it concerns the barbaric killing of other humans. These realities raise questions on hatred and murder. The world wars, torture and genocide have changed our way of looking at death, particularly as a result of the irreversible mutilation of bodies. Experience confronting and listening to people struggling with the devastating effects of disasters leads the author to posit the existence of an “integrity principle”, completing the pleasure principle and reality principle posed by Freud: integrity seen as both a wish and a process, not as an instinct for self-preservation or withdrawal, nor as a defensive fixation or a fantasy of totality; integrity rather as an ethical desire, linked to the fact that the subject is positioned as belonging to the human race. Consideration is then given to the therapeutic possibilities arising from the identification of these concepts in the context of the psychoanalytic cure and an empathetic approach by the practitioner. The post-traumatic symptom profiles and the resulting therapeutic strategies confirm the relevance of this new concept of an “integrity principle.” DiscussionThe psychoanalytical approach, lending an ear to the subject's singularity, is quite distinct from behavioral protocols, including “debriefing”. Classic notions from the psychoanalytic corpus need to be supplemented by elements stemming from contemporary practice, particularly in disaster situations. ConclusionDifferential studies on traumatic shock and its aftermath can enable a personalized approach to the distressed subject and the resumption of the individual's “subjectivation” process.