Decrease of anxio-depressive disorders in cancer with non drug psychotherapies

Background/Purpose: Cancer is well known for its psychological and psychiatric aftermath. About 40% of cancer patients present psychological or psychiatric troubles. First in contrast with the survival stakes, the psychopathological symptoms have been then ignored because they were confounding factors with the illness effect such as sadness, psychomotor slowing down or cognitive impairment. These troubles are now well known in international classifications (ICD, DSM-5) : from miss adaptation to delusion and especially anxio-depressive troubles.With its increasing worldwide frequency cancer has become a prominent figure of modern misfortune. Psycho-oncologyis the new branch of scientific knowledge that links cancer somatic consequences to their psychological expressions. Psycho-oncology opens a large area in psychopathology. But psycho-oncology is also interested in psychosociology. Cancer social representations interfere individually as with the group in cancer prevention and cancer detection.To decrease excessive anxiety in people cancer screening, countries must adapt their messages and work out a discourse that speaks to everybody. Furthermore, each gender, generation and personality has his specific prejudices. This reflexion introduces first  attempts of setting limits to psychotraumatism in cancer disclosure. Many symptoms could be avoided with a right training of doctors and caregivers. To begin a specific way to announce cancer will be exposed with authentic and empathic progressive approach of truth.Methods: Qualitative methods are preferentially used to expose somebody to what the majority consider as a death threat. With the humanization of healthcare, doctors can not announce cancer anymore in a corridor nor by phone neither with an email.  This first step of the « working alliance » between doctor and patient realizes the conditions of what Jimmie Holland calls the « patient total care » : a holistic approach of the patient in his environment. The second step is the restoration of the continuous identity of the patient despite the illness. The narration of his story is necessary to integrate the breach of the diagnosis. Listening to this story is often the task of the psychologist. Sometimes doctors or nurses try to consolidate the patient personality but it takes special skills and a lot of time. For example some specific questions like « What is difficult for you at this moment ? » or « what are your life priorities ? » can build a clinical approach, deeply in trapsychic more than humanistic. It’s an ethic matter.  Some psychopathological symptoms may impair patients global state. The clinician may wonder about present symptoms as well as previous crisis disruptions. He will take into account the transference upon him, the caregivers and all the institution. Transferanceisa freudian concept thatincludesun conscious feelings usually reserved to parents but shifted on doctors or caregivers. The positive part of the transference will help patients to trust and accept to be cured by the oncology team.Results: Announcing cancer is the doctor’s work. In psychotraumatic conditions, a psychological accompanying is useful to help the patient to bind the traumatic disclosure to his emotional life. The psychodynamic therapy (PT) is a deep in trapsychic work while the cognitivo-behavioral therapy (CBT) is a way to adapt patient to illness and treatment. In PT patient is deeply committed to change his way of mentalizing (connecting affects to behaviors). Both are helpful without additional drugs.Conclusion: Psycho-oncological approach of cancer recognizes multi-factoriality of cancer aetiology and cure. Beyond simple understanding of psychological states it offers an integrative approach of the patient as a unique person in his culture and interpersonal environment.-----------------------------------------Cite this article as:  Bacqué M. Decrease of anxio-depressive disorders in cancer with non drug psychotherapies. Int J Cancer Ther Oncol 2015; 3(4):3403.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.

Decrease of anxio-depressive disorders in cancer with non drug psychotherapies

Background/Purpose: Cancer is well known for its psychological and psychiatric aftermath. About 40% of cancer patients present psychological or psychiatric troubles. First in contrast with the survival stakes, the psychopathological symptoms have been then ignored because they were confounding factors with the illness effect such as sadness, psychomotor slowing down or cognitive impairment. These troubles are now well known in international classifications (ICD, DSM-5) : from miss adaptation to delusion and especially anxio-depressive troubles.With its increasing worldwide frequency cancer has become a prominent figure of modern misfortune. Psycho-oncologyis the new branch of scientific knowledge that links cancer somatic consequences to their psychological expressions. Psycho-oncology opens a large area in psychopathology. But psycho-oncology is also interested in psychosociology. Cancer social representations interfere individually as with the group in cancer prevention and cancer detection.To decrease excessive anxiety in people cancer screening, countries must adapt their messages and work out a discourse that speaks to everybody. Furthermore, each gender, generation and personality has his specific prejudices. This reflexion introduces first  attempts of setting limits to psychotraumatism in cancer disclosure. Many symptoms could be avoided with a right training of doctors and caregivers. To begin a specific way to announce cancer will be exposed with authentic and empathic progressive approach of truth.Methods: Qualitative methods are preferentially used to expose somebody to what the majority consider as a death threat. With the humanization of healthcare, doctors can not announce cancer anymore in a corridor nor by phone neither with an email.  This first step of the « working alliance » between doctor and patient realizes the conditions of what Jimmie Holland calls the « patient total care » : a holistic approach of the patient in his environment. The second step is the restoration of the continuous identity of the patient despite the illness. The narration of his story is necessary to integrate the breach of the diagnosis. Listening to this story is often the task of the psychologist. Sometimes doctors or nurses try to consolidate the patient personality but it takes special skills and a lot of time. For example some specific questions like « What is difficult for you at this moment ? » or « what are your life priorities ? » can build a clinical approach, deeply in trapsychic more than humanistic. It’s an ethic matter.  Some psychopathological symptoms may impair patients global state. The clinician may wonder about present symptoms as well as previous crisis disruptions. He will take into account the transference upon him, the caregivers and all the institution. Transferanceisa freudian concept thatincludesun conscious feelings usually reserved to parents but shifted on doctors or caregivers. The positive part of the transference will help patients to trust and accept to be cured by the oncology team.Results: Announcing cancer is the doctor’s work. In psychotraumatic conditions, a psychological accompanying is useful to help the patient to bind the traumatic disclosure to his emotional life. The psychodynamic therapy (PT) is a deep in trapsychic work while the cognitivo-behavioral therapy (CBT) is a way to adapt patient to illness and treatment. In PT patient is deeply committed to change his way of mentalizing (connecting affects to behaviors). Both are helpful without additional drugs.Conclusion: Psycho-oncological approach of cancer recognizes multi-factoriality of cancer aetiology and cure. Beyond simple understanding of psychological states it offers an integrative approach of the patient as a unique person in his culture and interpersonal environment.-----------------------------------------Cite this article as:  Bacqué M. Decrease of anxio-depressive disorders in cancer with non drug psychotherapies. Int J Cancer Ther Oncol 2015; 3(4):3403.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.]</p

Deuil post-traumatique sous l’empire de la terreur

Le nazisme a initié la systématisation de la terreur dans le cadre du génocide des Juifs : violences sur les civils, mutilations, désintégration des corps, disparition des restes. Les terroristes développent eux aussi la stratégie de la terreur totale, ajoutant aux victimes des attentats (blessés et morts), celles du traumatisme (les survivants et les endeuillés). Il ne s’agit donc plus seulement de tuer, mais aussi d’organiser l’horreur par la violence, l’aspect aléatoire de la mort, l’innocence des victimes. Cette hypothèse est vérifiée par le nombre de deuils post-traumatiques qui en découlent. L’absence de corps ou leur destruction empêchent une phase essentielle du travail de deuil : la prise de conscience de la réalité puis l’acceptation de la mort. Seule la vengeance peut émerger d’autant de douleur. Mais n’est-ce pas la menace du terrorisme : développer la spirale mortifère d’une guerre de position basée sur la rétorsion ?Nazism has initiated systematization of terror in the Jewish genocide: violences on citizens, mutilations, disintegration of corpses, disparition of mortal remains. Terrorists develop total terror strategy too, adding to the victims of the attacks (wounded and deads), those of the traumatism (survivors and bereaved). They are not only killing people but they are organizing horror through violence, aleatory death and guiltlessness of victims. This hypothesis is verified by the importance of post-traumatic grieves. The lack of corpses or their destruction prevents essential stages of grief work: the awareness of reality then the acceptance of loss. Can only revange come into view of so much pain? Is’nt it the principal threat of terrorism: to develop the mortifying spiral of a position war based on retaliation

Leucémie aiguë : fonctionnement mental de dix patients. Apport des projectifs et comparaison avec les échelles d'évènements et d'anxiété-dépression

Bacqué Marie-Frédérique. Leucémie aiguë : fonctionnement mental de dix patients. Apport des projectifs et comparaison avec les échelles d'évènements et d'anxiété-dépression. In: Bulletin de psychologie, tome 44 n°398, 1990. Pathologies corporelles. pp. 55-62

Prévention du suicide chez l’adolescent en deuil

Vorbeugung des selbstmordes beim jugendlichen in trauer Der Selbstmord der Jugendlichen in Frankreich wird als eine Priorität im Bereich der geistigen Gesundheit und der Gesellschaft angesehen. Die Rolle der Beziehungen innerhalb der Familie wird jedoch selten behandelt obwohl die Verluste und Trennungen, die dort erfolgen, den Übergang zur Tat der Jugendlichen stark beeinflussen. Mit internen Bewegungen sowohl hormoneller als auch triebhafter Art konfrontiert versucht der Jugendliche sich zwischen zwei Gruppen zu positionieren : der Gruppe des Kinder und der Gruppe der Erwachsenen. Die Abwesenheit der alten Übergangsriten und die Gewalt der neuen kollektiven Übergänge (Drogenkonsum, Rodeos mit Autos, Vergewaltigungen, Studentenscherze) erleichtern nicht die geistige Verinnerlichung der Änderung. Die therapeutischen Gruppen von Jugendlichen, die um einen Elternteil oder um das Elterpaar in Trauer sind, werden hier als eine psychoanalytische Behandlung der bedeutenden Schwierigkeiten der Jugendlichen dargestellt.The prevention of suicide for the adolescent in grief The young people‘s suicide in France is considered as a major issue for mental health services and the society as well. The role of the interfamily relationships is however barely tackled when losses and separations occur and have a great influence on the adolescent taking action Confronted to both hormonal and instinctual internal changes, the adolescent tries to place himself between two groups : the children’s and the adults’. The lack of ancient rites of passage and the violence of new collective transitions (drug use, car rodeos, rapes, ragging) do not make it easy for the mental to fix these changes. The therapeutic groups of young people in mourning for one parent or both parents are presented here in a psychoanalytical approach of the young people’s major difficulties.Le suicide des jeunes en France est considéré comme une priorité sur le plan de la santé mentale et de la société. Le rôle des relations intrafamiliales est cependant rarement abordé alors que les pertes et les séparations qui s’y déroulent influent largement sur le passage à l’acte adolescent. Confronté à des mouvements internes aussi bien hormonaux que pulsionnels, le jeune tente de se situer entre deux groupes : celui des enfants et celui des adultes. L’absence des anciens rites de passage et la violence des nouvelles transitions collectives (usage de drogues, rodéos en voiture, viols, bizutages) ne facilitent pas la mentalisation du changement. Les groupes thérapeutiques de jeunes en deuil d’un parent ou du couple parental sont présentés ici comme une approche psychanalytique des difficultés majeures des jeunes. (Prevención del suicidio entre los adolescentes de luto El suicidio de los jóvenes en Francia se considera como una prioridad en el ámbito de la salud mental y de la sociedad. El papel de las relaciones intra familiares, sin embargo, se enfoca raramente, mientras que las perdidas y las separaciones que ahí se desarrollan influyen ampliamente en el paso al acto adolescente. Confrontado a unos movimientos internos tanto hormonales como impulsivos, el joven intenta situarse entre dos grupos : el de los niños y aquel de los adultos. La ausencia de los antiguos ritos de paso y la violencia de las nuevas transiciones colectivas (uso de drogas, cabriolas en coche, violaciones, novatadas) no facilitan la mentalización del cambio. Los grupos terapéuticos de jóvenes de luto por uno o ambos padres se presentan aquí como un enfoque psicoanalítico de las dificultades mayores de los jóvenes.Bacqué Marie-Frédérique. Prévention du suicide chez l’adolescent en deuil. In: Agora débats/jeunesses, 34, 2003. Les jeunes face à la mort. pp. 50-58

Avant-propos

Les émotions ne concernent pas seulement la part animale de notre existence, même si nous partageons ces expériences viscérales avec les animaux, les émotions apportent le relâchement nécessaire à la rationalisation de l’existence humaine. Les émotions sont parties prenantes des lointaines émergences culturelles, telles qu’elles nous reviennent quand nous nous remémorons les peurs de notre enfance à l’écoute des grands mythes ou les joies ressenties lorsque nous partageons des danses collectives

Mentalisation de la dépression au Rorschach et au TAT : comparaison dans le cadre d'une maladie grave et d'un épisode dépressif majeur

Psychosomaticians are now studying constants in mental functioning. Mentalization is characterised by amplitude of representations, fluidity of their circulation and permanence of preconscious assessment. Mentalization can be identified by projective methods. To illustrate correspondances of Rorschach and TAT indicators, let us compare one group of serious disease patients and one of major depressive episode. The mentalization of their depacksive affects may be a pronostic argument for a potential psychosomatic reorganization. Key-words : Mentalization - Preconscious - Rorschach - TAT - DepressionLes psychosomaticiens étudient désormais les invariants du fonctionnement mental. La mentalisation est caractérisé par l'épaisseur des strates de représentations, la fluidité de leur circulation et la permanence du rôle du préconscient. Elle est repérable dans les épreuves projectives. Pour illustrer les correspondances entre les indicateurs Rorschach et TAT et les modifications de la mentalisation, nous comparons un groupe de malades somatiques graves et un groupe de patients hospitalisés pour un accès dépressif majeur. La mentalisation de leurs affects dépressifs est un argument pronostique de leur réorganisation psychosomatique potentielle. Mots-clé : Mentalisation - Préconscient - Rorschach - TAT - DépressionBacqué Marie-Frédérique. Mentalisation de la dépression au Rorschach et au TAT : comparaison dans le cadre d'une maladie grave et d'un épisode dépressif majeur. In: Bulletin de la Société française du Rorschach et des méthodes projectives, n°36, 1992. pp. 77-91