Réflexions éthiques sur les interventions médicopsychologiques auprès des victimes

RésuméLa reconnaissance de la réalité des blessures psychiques potentiellement induites par un événement traumatique a conduit à la multiplication des prises en charge des personnes impliquées (victimes, familles, responsables sauveteurs) au plus près de l’événement. Les interventions d’urgence médicopsychologiques sont conçues pour des événements potentiellement traumatogènes c’est-à-dire des événements soudains, violents, imprévisibles impliquant des expériences de menace de vie pour la personne impliquée. La confrontation au réel de la mort entraîne une annihilation des mécanismes de défense habituels et une incapacité à pouvoir élaborer ce qui est en train d’être subi. La confrontation avec le trauma peut avoir des conséquences multiples et difficiles à prévoir, d’où la mise en place de soins psychiques précoces pour les personnes impliquées au même titre que les soins somatiques. Si ces dispositifs permettent des prises en charge adaptées aux manifestations cliniques des blessés psychiques, elles peuvent conduire à de multiples dérives dont leur utilisation pour des faits non traumatiques. Ceci conduit en particulier à la psychiatrisation de réactions pourtant adaptées à des événements critiques ; à des prises en charge préformatées et standardisées ; à l’illusion qu’une unique intervention suffirait à endiguer tous les risques de troubles post-traumatiques. Les soins au plus près de l’événement traumatique ne sont qu’une réponse à apporter aux personnes impliquées dans un événement traumatique et ne peuvent être organisées sans cadre, sans limite et sans réflexion éthique des professionnels qui y participent. Notre propos vise à faire part de notre réflexion sur les enjeux éthiques des interventions d’urgence médicopsychologiques à la lumière de notre expérience de coordination de plus de 300 interventions d’urgence médicopsychologique.

Recognition of the psychic injury potentially inferred by a traumatic event's reality led to cares reproduction for the persons concerned by the event (victims, families, rescuers). These “urgence medicopsychlogiues” interventions are conceived for potentially traumatic events, meaning sudden, violent, unpredictable events leading to life threatening experiences. Being confronted to death's reality leads to the annihilation of the usual defence mechanisms and to an incapacity to be able to elaborate what is being experienced. Confrontation with the trauma can have multiple and unpredictable consequences. Premature psychic cares for the persons implied are therefore implemented, as are somatic cares. If these processes allow coverages (care) adapted to the clinical demonstrations (appearances) of the psychic injured (wounded) persons, they can lead (drive) to multiple drift of which their use for not traumatic facts. If these processes allow care to be adapted to the clinical demonstrations of the psychic injured persons, they can lead to multiple drift, among them, being treated for non traumatic events. This, in particular, may lead to “psychiatrisation” of reactions nevertheless adapted to critical events, to standardized cares and to the illusion that a one and only intervention could be enough to dike all risks linked to post-traumatic disorders. Cares as close as possible to the traumatic event are only one of the many answers to be brought to the persons involved and can not be organized without frame, limit and an ethical position of the professionals who participate in it. Our comment, which is based on our experience in coordinating more than 300 medical psychological emergency interventions, aims at announcing our thinking about what ethic is at stake when taking care of these psychic victims. The current situation is paradoxical: on one side there is a bigger recognition of the reality of the psychic wounds and the potential consequences caused by a traumatic event and of other, this systematic consideration leads to a collective identical demand of the traumatic fact transforming it into a political stake. The social and political recognition of the psychic traumatism is parallel to its instrumentalisation and exploitation. That leads inevitably to maintaining the subjects involved in a state of dependence, vulnerability and psychic incompetence, that of the victim. In the absence of ethical reflection on early psychological care, the medical psychological emergency diversion of care is inevitable with its main consequence: the stake in the show of the psychic suffering is leading to the fact that every implied person is dispossessed of its own history. The traumatic fact having become a social and political stake, the medias do participate in the overbid with, for some, drift which lead to the systematic call to the psychiatrics and psychologist in order to comment on the slightest event, to a psychiatrisation of demonstrations of distress, to a stigmatization of people involved into the reducing category of the traumatized “victims”, to a focus on a one and only type of suffering, to a generalization of traumatic events and to an attempt of instrumentalisation of the medical psychological emergency devices. The traumatism has to remain a clinical event, which requires specific care joining a medical logic and must not become an object of demand joining a social and political logic.