Toulouse - Journées Nationales 2003
Tablets of insanity
The day-to-day treatment of psychoses
Always unique is the meeting, for a doctor who intends to answer for the treatment of patients who call him to witness to their certainties that cannot be shared in or to their perplexity that cannot be spoken.
Clinical practices make us understand that a " clinical better-being " obviously does not necessarily go together with a " psychic better-being " for psychotic patients who embody, sometimes tragically, the existential vertigo. This fragile thread, tightened between the objectivity of nosography and the subjectivity of what is psychic, is the place where the therapeutical modalities of psychosis are likely to appear.
One of the psychiatrist’s challenges is often to have a demand, or at least an interest, emerge in the patient, even though the first contact very often originates in the treatments made under constraint (HO: hospitalization officially decided, HDT: hospitalization asked by a third party, judicial order of therapy …). Even if psychiatrists sometimes try to deny it or to forget it, psychiatry is still linked, more or less, to its historical mission of maintaining social order. It has been fifteen years now since neuroleptics changed the modes of ideic and behavioral constraint of patients. At the same time, they also participated in the spreading of institutional psychotherapies and psychoanalytic approaches of psychoses. Does the possibility of a psychic work not presuppose the possibility for the patient to get involved in his/her own change ?
The important development of neurosciences and their possible therapeutical applications, is of a great concern to the evolution of psychiatric practices, provided that limits, drifts and actually clinical interests are made clear. For the psychiatrist in private practice as for any other, there is no therapeutical approach to psychosis without paying a close attention to the overlapping of those numerous epistemological fields that psychosis is concerned with. Whether legal, social, political, economic, biological, psychological and even psychoanalytic, none of these fields can be tackled separately by the psychiatrist without taking the risk of reducing the psychotic subject to a nonsense. The controversy of the fields involved appears to us as the only possible mode that can deal with the issue of psychoses treatment and, to that effect, it seems to us that the individually achieved, daily clinic of psychoses can bring support to such a controversy.