Psychose post-traumatique: contribution à une théorisation dynamique du traumatisme aigu post-immédiat

A second theoretical approach makes it possible to promote this immediate psychotic-type post-traumatic psychopathology. Four considerations of fundamental psychopathology support our contribution : 1) Pictogramic inscription. The severe traumatism does not produce the polarity required for the process of « self-fathering » described by P. Aulagnier in connecting with original processes. Traumatic adhesiveness does not separate the victim from the trauma. It splits the necessary mediation spaces and distance for the emergence of representation processes. 2) Pain affect. The pain affect generated recalls the first experiences of the newborn, primitive agony and anaclitical collapse ; the « narcissistic contract » is broken and the patient lives without a secure base or a sufficiently good and supporting psychic container (D.W. Winnicott). 3) Anxiety status. The anxiety is not of neurotic nature but truly annihilating. It is often similar to anxieties caused by disasters, psychoses due melancholy (H. Ey) or more « archaic » anxieties that have been observed in hebephrenic pathologies. 4) Body dismantling. The trauma results in « mute somatizations that cannot be symbolized » (M. Bertrand). They appear in sensory outward signs such as dermatosis, pruritus, diarrhea, hemorrhagic periods or persistent headaches for example. These two clinical and theoretical aspects of the severe forms of trauma confirm the unconscious traumatolytic aim of the victim's psychological destruction. The semiological forms most impervious to thera-peutic processes seem to be, in reference to hostage-takings or terrorists acts, those where the patient was conformed with a trauma « that was not carried out » like mock hangings or executions. Suicidal dimension seems to be the ultimate recourse so as not to sink into insanity and to keep a subjective position when faced with barbarian figures.