À chaque guerre son syndrome, à chaque syndrome sa guerre

RésuméUn nouveau syndrome ne survient jamais par hasard, mais s’épanouit au sein d’un contexte culturel et social. Le Post-Vietnam Syndrome qui s’est secondairement restructuré en Post-Traumatic Stress Disorder a permis à la société américaine de faire l’économie d’une réflexion sur son rôle dans la guerre. Quelques décennies plus tard, le syndrome de la guerre du Golfe vient dénier la possibilité de souffrances psychiques de guerre pour finalement constituer un modèle d’inconduite à transmission épidémique. Plus récemment, le syndrome subjectif des traumatisés crâniens (ou syndrome post-commotionnel) est redécouvert grâce aux avancées de la technique médicale qui permettent de voir les « gueules cassées » invisibles de naguère. Alors qu’une entité nosographique nouvellement décrite possède un sens dans l’histoire collective, le traumatisme psychique détient un sens dans l’histoire biographique d’un sujet. Vers sa reconstruction, un autre combat attend le blessé psychique de guerre : la rétrospective sur sa trajectoire de vie qui permettra seule de donner un sens à l’événement traumatique, initialement vécu comme insensé.

The clinical is not fixed within immutable guidelines; the uniqueness is the very interest of this clinical. A new syndrome does not occur by chance, it blossoms within a cultural and social context. Following an armed conflict, the description of a new illness has a social meaning. War-related mental disorders have been known since Antiquity. In the first edition of the DSM, the American classification introduced the term Gross stress reaction. This category then disappeared in the following edition to re-emerge under the aegis of Post-traumatic stress disorder in 1980 following the publication of DSM-III. The successive denominations of the “Post-Vietnam syndrome” then post-traumatic stress disorder were criticized by a few authors who considered their existence from an anthropological point of view. Far from new semiotics, the neologisms successively formulated are used for causes other than that of the clinical. Why change the signifier? Renaming a disorder enables its medical and social treatment to be changed. A few decades later, the Gulf war syndrome has again come to repudiate the possibility of psychological suffering of war to finally constitute a model of epidemic misconduct. In the weeks and the months that followed the operation, a certain number of soldiers developed nonspecific, multi-systematised functional symptoms. Numerous aetiopathogenic hypotheses were put forward attempting to incriminate the exposure to multiple poisons and vaccines. But despite the extremely in-depth scientific investigations, no marker of objective physical suffering was revealed. The media disinformation of this possibility may have finally had an effect just as deleterious as if a few chemical weapons had been used: minds have been poisoned. To spare the bother of a group psychological reflection, the scientific and political authorities chose to investigate the implication of environmental factors in the genesis of the disorder. Rather than toxic exposure to such and such a substance, the nonspecific syndrome called “Gulf War Syndrome” is the result of exposure to the eponymous operational theatre. Finally, post-concussion syndrome is rediscovered thanks to the progress in medical techniques, which enable the “invisible broken faces” of days gone by to be seen. There again, if numerous subjects were brain-injured, others were shocked by the fighting and found a socially acceptable expression of their pain through a syndrome named for that purpose. Yet a return to individual subjectivity would enable a soldier to escape the functional symptoms… For civil society, calling into question “the somatic word” of veterans is difficult: why were they sent to face these hardships? It would be better to grant a pension to these men to spare an overall reflection, societal reflection on the war and psychopathological reflection on the subject who enlists. What could we learn from these soldiers that we do not want to listen to? The horror of the war, the aggressive impulse of man, the confrontation with death. How can the inexpressible and the unimaginable be recounted, particularly if the social context does not allow it? Another obstacle to this reflection is the idea of stress being the unique source of the psychological trauma. This theoretical orientation, which considers that the psychotraumatic disorder is a normal reaction to an abnormal situation, leads finally to discrediting the subject and society and disempowering them by freezing them in a passive status of victim. This approach, which represents in our opinion an additional denial acquired throughout history, increases the risk of appearance and chronicity of a repetition syndrome in the absence of the introduction of psychotherapy. The notions of stress and trauma are by no means equivalent. A new nosographic entity can thus spread throughout the population like an epidemic through mechanisms of identification, imitation and suggestion. Such acknowledgement could help prevent the risk of diffusion of other unexplained syndromes, which may occur following future armed conflicts. This will enable discussions to be refocused on the suffering subject. If a new nosographic entity has meaning in mass history, the psychological trauma holds meaning in the subject's life history. Another fight awaits the psychological casualty of war on their route to reconstruction: a retrospective of themselves, which will bring meaning to the traumatic event, itself initially, experienced as insane. Far from being purely the normal reaction to an abnormal situation, the psychological trauma is incorporated in a singular life course. A single event experienced by numerous individuals will only be traumatic for a few of them. If however the same traumatising event can lead to a trauma in two control subjects, the themes of the repetition syndrome will be different and the sensory perceptions of the revivifications will be far from identical. You are never psycho-traumatized by chance. The psychotraumatised subject is subjectively involved in the scene they experienced. Sometimes the scene imposes itself on him, but more often the subject pre-empts the traumatic risk himself. The biographical overlap is the core of the trauma, which again brings the subject face to face with a previous impasse concerning death and its consequences: paternity, bereavement and access to sexuality. Through this echo of intimacy, the traumatic event imposes itself on the individual who was involved in the scene they experienced. Self-reconstruction thus takes time, due to individual but also social defence mechanisms, as we have seen. If a new nosographic entity has meaning in collective history, the psychological trauma holds meaning in the life history of a subject. Towards their reconstruction another fight awaits the psychological casualty of war: a retrospective of himself, which will bring meaning to the senselessness of the trauma.