de Kernier N, Canouï P, Golse B
Service de pédopsychiatrie, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
Arch Pediatr. 2010 Apr;17(4):435-41. doi: 10.1016/j.arcped.2010.01.002. Epub 2010 Feb 21.
Teenagers' suicidal gestures are a major problem of public health and it is important to understand its meaning. A global taking care of teenagers hospitalized after a suicide attempt or a suicidal threat by the pediatric teams and by the team of child psychiatry, having links with each department, is essential in the Necker - Enfants Malades hospital in Paris. The protocole of care has been recently strengthened by the integration of a deep psychological checkup with the projective tests Rorschach and Thematic Apperception Test (TAT) during the hospitalization, a psychological follow-up from a distance of the suicidal gesture and a second psychological checkup one year later in order to observe the evolution of the psychic functioning. The projective tests offer a special way to express the own intimate problematic while respecting the subject's need to remain hidden. These tests, analyzed with a psychodynamic interpretation, help the clinician to precise the psychic diagnosis, which is very important for the future therapeutic orientation, and offer to the patient a medium to express the hidden meaning of his gesture. To consider suicidal gesture not only as a dead end of identificatory process but also as an attempt to start up again this process may favor a therapeutic mobilization of psychic resources. Self-attack may signify a struggle against melancholy, the prospect of death appearing less frightening than those of madness. Suicidal gesture may express a transitory developmental breakdown but identificatory process may be revived if the suffering of the teenager may be listened, contented, elaborated and linked to meaning.
青少年的自杀姿态是一个重大的公共卫生问题，了解其含义很重要。在巴黎的内克尔 - 儿童医院，由儿科团队和儿童精神病学团队对自杀未遂或有自杀威胁后住院的青少年进行全面护理，并与各科室建立联系，这至关重要。最近，护理方案得到了加强，在住院期间增加了深度心理检查，包括罗夏墨迹测验和主题统觉测验（TAT），对自杀姿态进行远程心理随访，并在一年后进行第二次心理检查，以观察心理功能的演变。投射测验提供了一种特殊方式，在尊重受试者隐藏需求的同时表达其内心的问题。这些测验通过心理动力学解释进行分析，有助于临床医生明确心理诊断，这对未来的治疗方向非常重要，并为患者提供了一种表达其姿态隐藏含义的媒介。将自杀姿态不仅视为认同过程的死胡同，还视为重新启动这一过程的尝试，可能有利于调动心理资源进行治疗。自我攻击可能意味着与忧郁作斗争，死亡的前景似乎比疯狂的前景更不可怕。自杀姿态可能表达了一种暂时的发育障碍，但如果青少年的痛苦能够被倾听、满足、阐释并赋予意义，认同过程可能会恢复。
