Tordjman S
Pôle hospitalo-universitaire de psychiatrie de l'enfant et de l'adolescent (PHUPEA), centre hospitalier Guillaume-Régnier, Université de Rennes 1, 35000 Rennes, France; Integrative Neuroscience and Cognition Center (INCC), CNRS UMR 8002, University of Paris Cité, Paris, France.
Encephale. 2022 Sep;48 Suppl 1:S44-S55. doi: 10.1016/j.encep.2022.08.006. Epub 2022 Sep 9.
A multiphasic time model, integrating the past, present and future in close interrelations, is first presented and offers a contextual approach to the perceptions and responses of an individual according to his/her personal history and environment. The present and future prospects are in continuity with the past and its consequences and effects. The past, even when it is not or no longer expressed, influences the present and the future, and this over several generations. Past life events and experiences, as well as psychological and biological states previously experienced by the individual (such as emotional states, illnesses, etc.) and his/her previous responses (adaptive or maladaptive responses, leading to failures or successes, etc.) modify, according to the individual' s personal history, his/her current perceptions and reactions to life events and environmental stimuli. In addition, some variables influence a person's current perceptions and reactions such as environmental moderator variables (social, cultural, physical environment), current psychobiological states of the individual (emotions, motivation, etc.), and characteristics of life events and environmental stimuli (depending on whether these life events are, for example, single or repeated, predictable or unpredictable). What matters is less the life event or environmental stimulus in itself, than the individual's perception and reactivity to this event/stimulus according to the context of his/her personal history, as well as his/her current environment and psychobiological state. Moreover, the perception of the present depends not only on the traces of the past but also on our ability to project ourselves into the future and to envision it. Thus, dreams of the future allow one to escape by introducing another temporality allowing a person to disconnect from the present, to create an internal reality replacing the external reality, and to live the present differently. But the memory of the past and the representations of the future are constantly constructed and reconstructed in the present according to the emotions of the individual and his/her environment. Based on the integrative approach proposed in the multiphasic time model, the trace of the past, as well as the dream of the future, contribute to writing the present and influence the future, but the nuances of the present participate also in the reconstruction of past memory and the projection into the future, with interrelationships where all times are closely intertwined in the individual's current representations. By relying on this multiphasic time model, new perspectives for understanding and treating traumatic violence are proposed. Indeed, the representations of time that we construct are sometimes related to the perception of a frozen time that no longer flows, especially after an experience of traumatic violence. The trauma breaks into the psychic life of the individual by causing a rupture, and the perception of time is then altered. Time stops, this is the time of trauma. There is no longer multiphasic time, but there remains monophasic time frozen on the traumatic event. It can then be difficult, if not impossible, to project oneself into the future or to remember the past prior to the traumatic event. The definitions of trauma are recalled in this article and the contribution of the media to the development of trauma is, in particular, questioned. Then, from the multiphasic time model previously described, the frozen time of the trauma is reconsidered by emphasizing the interest of summoning the past and the future in the therapeutic process in order to put the temporality of the individual back in motion and continuity. More precisely, the therapy and counseling work of the therapist allow, among other things, to pass from a monophasic suspended time in which it is often necessary to welcome the individual in his/her sensoriality and corporality, to a multiphasic dynamic time in which it becomes possible for the individual to project himself/herself into the future and remember the past. The role of the group, as a containing envelope, and collective memory in the (re)construction of individual memory and self-consciousness, is also discussed. Finally, the passage from sensory fright to narrative, from traumatic sensory "cyst" to psychic elaboration, from the frozen time of trauma to the time of psychic mobilization, is developed. It is necessary to have available various therapeutic tools adapted to these different times in order to be able to reestablish a temporal, psychic and existential continuity. The effectiveness of a therapeutic approach will depend on its coherence, both for the individual and the therapist, in the context of their temporalities, resources and singularity, and of the therapeutic alliance that can develop.
首先提出了一种多阶段时间模型,该模型将过去、现在和未来紧密联系在一起,为根据个人历史和环境来理解个体的感知与反应提供了一种情境化方法。当下与未来前景与过去及其后果和影响相互连贯。过去,即便未被表达或不再被表达,也会影响当下和未来,且这种影响会历经几代人。过去的生活事件与经历,以及个体先前经历过的心理和生理状态(如情绪状态、疾病等)及其先前的反应(适应性或适应不良的反应,导致失败或成功等),会根据个体的个人历史,改变其当前对生活事件和环境刺激的感知与反应。此外,一些变量会影响一个人的当前感知与反应,如环境调节变量(社会、文化、物理环境)、个体当前的心理生理状态(情绪、动机等),以及生活事件和环境刺激的特征(取决于这些生活事件例如是单一的还是重复的、可预测的还是不可预测的)。重要的并非生活事件或环境刺激本身,而是个体根据其个人历史背景、当前环境和心理生理状态对该事件/刺激的感知与反应能力。此外,对当下的感知不仅取决于过去的痕迹,还取决于我们将自己投射到未来并设想未来状况 的能力。因此,对未来的梦想使人得以逃避,通过引入另一种时间性,让人从当下脱离,创造一个取代外部现实的内在现实,并以不同的方式体验当下。但是过去的记忆和未来的表象会根据个体的情绪及其环境在当下不断被构建和重构。基于多阶段时间模型中提出的整合方法,过去的痕迹以及对未来的梦想有助于书写当下并影响未来,但当下的细微差别也参与到过去记忆的重构和对未来的投射中,在个体当前的表象中,所有时间紧密交织,相互关联。基于这种多阶段时间模型,提出了理解和治疗创伤性暴力的新视角。的确,我们构建的时间表象有时与对不再流动的凝固时间的感知有关,尤其是在经历创伤性暴力之后。创伤通过造成断裂闯入个体的心理生活,进而改变对时间的感知。时间停止了,这就是创伤时刻。不再有多阶段时间,只剩下凝固在创伤事件上的单阶段时间。那么,即便不是不可能,个体也会很难将自己投射到未来或回忆创伤事件之前的过去。本文回顾了创伤的定义,并特别质疑了媒体对创伤发展的影响。然后,从先前描述的多阶段时间模型出发,重新审视创伤的凝固时间,强调在治疗过程中唤起过去和未来以恢复个体时间性的连续性和动态性的重要性。更确切地说,治疗师的治疗和咨询工作尤其能使个体从常常需要接纳其感官性和肉体性的单阶段暂停时间,过渡到个体能够将自己投射到未来并回忆过去的多阶段动态时间。还讨论了团体作为一个容纳性环境的作用,以及集体记忆在个体记忆和自我意识(重新)构建中的作用。最后,阐述了从感官恐惧到叙事的转变,从创伤性感官“囊肿”到心理阐释的转变,从创伤的凝固时间到心理动员时间的转变。为了能够重建时间、心理和存在的连续性,需要有适用于这些不同时间的各种治疗工具。一种治疗方法的有效性将取决于其在个体和治疗师的时间性、资源和独特性背景下的连贯性,以及可能发展起来的治疗联盟。