[Efficacy of psychotherapy: contextual and structural ingredients].
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Biomedical subjects
Publications and source records attributed to R Pelsser.
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The author presents a synthesis of the theoretical and clinical work of Gisela Pankow on psychosis. The reading of works of this psychoanalyst is fascinating for a number of reasons : she provides a detailed and lively look at numerous clinical cases, she accepted patients in analysis with whom other methods had failed. But this spectacular character may distract the reader from the essence of the work, which is an original theorizing and practical approach concerning psychosis. The resume of the Pankow's theses is all the more necessary because the latter does not always take the time to present her works in a clear, organized fashion. The main contributions of Pankow are the following : the use of non-traditional techniques (face to face, drawings, models, family contacts) in the treatment of the psychotic, the redefinition of the concept of forclusion (Lacan) as a defense mechanism directly implying the body image. The present text may serve as an introduction to the reading of Pankow's works, by putting the ideas in order to a certain extent.
Schizophrenia is caused above all, by a biochemical disorder, and, consequently, the treatment should be primarily of a psycho pharmacological nature. The author examines the most important researches related to this subject to demonstrate the gaps both at the level of actio-logical theories and of treatment methods centered, above all, on biochemical aspects. Schizophrenics are not cured and they are hardly treated, since delusional thoughts and the psychotic life style remain present many years. Schizophrenia stymies the knowledge and the power of therapists as a result of its inexplicable and irréductible character.
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The author is looking into the problem of multidisciplinarity in mental health : through a theoretical conception of mental disease and from a more practical point of view through the actual functionning of a treating team in mental health. He tries to develop two thesis : 1) physical or social criteria cannot define madness, it has to be studied from a psychological point of view : madness is a personal as well as a psychical fate, a difficulty in facing the different levels and crisis of existence where the physical and social factors are secondary : the specific character of mental health resides in its psychological dimension; 2) the functioning of the treating team is analyzed according to three main models : autocratic, anarchic and democratic : the concept of a treating team in mental health can only be understood if each of its members express himself in an autonomous way and according to his own competencies with regard to the public : this would protect the multidisciplinary team from the dangers of an autocratic leadership or of an anarchic functioning.