Inhibition.

This article explores the notion of inhibition at a theoretical and clinical level in psychoanalysis. The first part follows the development of the notion in Freud's work, from the "Project" (1950a [1895]) to Inhibitions, Symptoms and Anxiety (1926d). It identifies the two approaches to inhibition, the first from an energetic point of view, the second from the angle of its relations to anxiety. The second part of the article is devoted to the links between inhibition and Freud's thoughts about death, in particular in Inhibitions, Symptoms and Anxiety and the links to the death drive. It draws on some of Jones' notes and presents a brief clinical illustration. The third part focuses more particularly on general inhibition, especially in depression and melancholia. Based on the treatment of one patient, the author shows how the slow process of overcoming general inhibition is achieved through the gradual use of negation. From an economic point of view, it is suggested that psychoanalytic treatment, through the transference and associative speech, has an effect on the depletion of energy by diverting the "suction" of stimuli, paving the way for the formation of drive representatives, or inhibitions as symptoms, which will need to be dissected.

Fonctions de la sensorialité dans la prise en charge thérapeutique de l'autisme infantile / Funções da sensorialidade no manejo terapêutico do autismo infantil / Functions of sensoriality in the therapeutic management of infantile autism / Funciones de la sensorialidad en el manejo terapéutico del autismo infantil

La sensorialité tient plusieurs fonctions dans l'élaboration psychique de l'individu autiste et dans son évolution psychique au cours de sa prise en charge thérapeutique. Nous suivons dans cette recherche l'idée de la transformation d'un usage défensif de la sensorialité en un processus mutatif, d'une construction du moi corporel, ainsi qu'un travail de symbolisation primaire, d'inscription, de représentation et de figurabilité.Avec la psychothérapie d'un enfant autiste en institution, nous explorons les fonctions de la sensorialité sur la base de l'attention particulière portée aux éprouvés corporels dans la dimension transférentielle et contre-transférentielle. Celle-ci permet au thérapeute d'éprouver les angoisses en lien avec des expériences sensorielles primaires. En s'appuyant sur la résonnance contre-transférentielle des différentes angoisses du patient, une sensorialité partagée aide à la métabolisation des éprouvés de catastrophe primitive ayant entravé l'organisation d'un sentiment continu d'exister. Cette dynamique thérapeutique ouvre sur de nouvelles perspectives psychiques et relationnelles.

Resumos A sensorialidade assegura várias funções na elaboração psíquica do indivíduo autista e em seu desenvolvimento psíquico durante os seus cuidados terapêuticos. Nesta pesquisa perseguimos a ideia da transformação de um uso defensivo da sensorialidade em um processo mutativo, de uma construção do eu corporal, bem como de um trabalho de simbolização primária, de inscrição, representação e figurabilidade. Na psicoterapia de uma criança autista em instituição, exploramos as funções da sensorialidade se concentrando mais particularmente nas experiências corporais a partir da dimensão transferencial e contra-transferencial. Esse trabalho permite que o terapeuta experimente angústias ligadas a experiências sensoriais primárias. Com base na ressonância contra-transferencial das diferentes angústias do paciente, uma sensorialidade partilhada ajuda na metabolização das experiências de catástrofe primitiva que impedem a organização de um sentimento contínuo de existência. Esta dinâmica terapêutica abre novas perspectivas psíquicas e relacionais.

Sensoriality has several functions in the psychic elaboration of the autistic individual and in his psychic evolution during his therapeutic care. We follow in this research the idea of the transformation of a defensive use of sensoriality into a mutative process, of a construction of the bodily self, as well as a work of primary symbolization, inscription, representation and figurability. With the psychotherapy of an autistic child in an institution, we explore the functions of sensoriality based on the particular attention paid to bodily experiences in the transference and counter-transference dimension. This allows the therapist to experience anxieties related to primary sensory experiences. By relying on the counter-transferential resonance of the patient's various anxieties, a shared sensoriality helps to metabolize the experiences of primitive catastrophe that have hindered the organization of a continuous feeling of existing. This therapeutic dynamic opens up new psychic and relational perspectives.

La sensorialidad tiene varias funciones en la elaboración psíquica del individuo autista y en su evolución psíquica durante la asistencia terapéutica. Seguimos en esta investigación la idea de la transformación de un uso defensivo de la sensorialidad en un proceso mutativo, de una construcción del yo corporal, así como de un trabajo de simbolización primaria, inscripción, representación y figurabilidad. Con la psicoterapia de un niño autista en una institución, exploramos las funciones de la sensorialidad a partir de la particular atención prestada a las experiencias corporales en la dimensión transferencial y contratransferencial. Este trabajo le permite al terapeuta experimentar ansiedades relacionadas con las experiencias sensoriales primarias. Apoyándose en la resonancia contratransferencial de las diversas angustias del paciente, una sensorialidad compartida ayuda a metabolizar las experiencias de catástrofe primitiva que han impedido la organización de un sentimiento continuo de existir. Esta dinámica terapéutica abre nuevas perspectivas psíquicas y relacionales.

Psychosocial and clinical factors of probands impacting intrafamilial disclosure and uptake of genetic testing among families with BRCA1/2 or MMR gene mutations.

OBJECTIVE: Intrafamilial disclosure of hereditary cancer predisposition in BRCA1/2 and mismatch repair gene (MMR) syndromes allows appropriate prevention strategies in at-risk relatives. We previously showed in a nationwide study that the uptake of genetic targeted testing (GTT) in these families was only 30%. We aimed to identify the clinical and psychosocial factors affecting the probands' intrafamilial disclosure and relatives' uptake of GTT in BRCA1/2 or MMR syndromes. METHODS: We assessed clinical variables, family history, and psychosocial variables of probands (depressive symptoms, anxiety, alexithymia, optimism, coping, family relationship, perception of cancer risks, and of hereditary transmission), together with disclosure and uptake of GTT within 103 French BRCA1/2 or MMR families. RESULTS: Among relatives eligible for GTT, 68% were informed of the predisposition, and 37% underwent GTT, according to probands' reports. Intrafamilial disclosure was inversely associated with the degree of kinship (P < .01). In multivariable analysis, disclosure increased with time since probands' genetic diagnosis (P < .01) and probands' feeling of family cohesion (0.01). GTT uptake increased with probands' depressive symptoms (0.02) and decreased with probands' perception of cancer risks (0.03). BRCA1/2 and MMR groups did not differ concerning family information and GTT uptake. CONCLUSIONS: This study identified factors affecting disclosure to relatives and GTT uptake in BRCA1/2 and MMR syndromes and gives new insights to improve probands' follow-up and intrafamilial sharing of genetic information.

Level of emotional awareness in the general French population: effects of gender, age, and education level.

The Levels of Emotional Awareness Scale (LEAS) developed by Lane et al. (1990) measures the ability of a subject to discriminate his or her own emotional state and that of others. The scale is based on a cognitive-developmental model in which emotional awareness increases in a similar fashion to intellectual functions. Because studies performed using North American and German populations have demonstrated an effect of age, gender, and level of education on the ability to differentiate emotional states, our study attempts to evaluate whether these factors have the same effects in a general French population. 750 volunteers (506 female, 244 male), who were recruited from three regions of France (Lille, Montpellier, Paris), completed the LEAS. The sample was divided into five age groups and three education levels. The results of the LEAS scores for self and others and the total score showed a difference in the level of emotional awareness for different age groups, by gender and education level. A higher emotional level was observed for younger age groups, suggesting that emotional awareness depends on the cultural context and generational societal teachings. Additionally, the level of emotional awareness was higher in women than in men and lower in individuals with less education. This result might be explained by an educational bias linked to gender and higher education whereby expressive ability is reinforced. In addition, given the high degree of variability in previously observed scores in the French population, we propose a standard based on our French sample.

Alexithymia and emotional awareness in females with Painful Rheumatic Conditions.

OBJECTIVE: Research about the deficit of emotional regulation in Painful Rheumatic Conditions (PRC) indicates that these patients have alexithymic characteristics, as revealed by the Toronto Alexithymia Scale (TAS-20). However, the use of a unique measure to assess alexithymic trends has been questioned. The aim of the present study is twofold: to compare the levels of alexithymia and emotional awareness in females with and without PRC; and to test the predictive validity of alexithymia measures beyond negative emotions. METHOD: Thirty-nine women with PRC of diverse etiology and twenty-two healthy females responded to the TAS-20, the Levels of Emotional Awareness Scale (LEAS) and questionnaires of anxiety and depression. RESULTS: The total score, factor 1 (difficulty identifying feelings) and factor 2 (difficulty describing feelings) scores of TAS-20 were significantly higher among women with PRC than controls. Females with PRC had lower scores in the subscale "self" of the LEAS (capacity to describe their own emotional experience) than the control group. Only the LEAS significantly predicted the status group after adjusting for anxiety and depression. CONCLUSION: Our results highlighted the impairment of emotion processing in patients with PRC and the importance of using a multimodal assessment of emotional regulation in future research.

[Emotions and affect in psychoanalysisis]. / Émotions et affects en psychanalyse.

The goal of this paper is to give some indications on the concept of affect in psychoanalysis. There is no single theory of affect, and Freud gave successive definitions, which continue to be deepened in contemporary psychoanalysis. We review some steps of Freud works on affect, then we look into some present major questions, such as its relationship to soma, the nature of unconscious affects and the repression of affect, which is particularly developed in the field of psychoanalytic psychosomatic. From Freud's definitions of affect as one of the drive representative and as a limit-concept between the somatic and the psychic, we develop some major theoretical perspectives, which give a central place to soma and drive impulses, and which agree on the major idea that affect is the result of a process. We then note some parallelism between psychoanalysis of affect and psychology and neurosciences of emotion, and underline the gaps and conditions of comparison between these different epistemological approaches.

Emotional awareness in substance-dependent patients.

We explored emotional awareness in substance-dependent patients and its relationships to self-reported alexithymia. Sixty-four outpatients with drug dependence or alcohol dependence were evaluated before the beginning of treatment with the Hamilton Depressive Scale and the Covi Anxiety Scale, and they completed the Toronto Alexithymia Scale (TAS-20) and the Levels of Emotional Awareness Scale (LEAS). Subjects exhibited low levels of emotional awareness and TAS-20 scores were high. Both measures were not related to depressive and anxious symptomatology. This research is the first to provide LEAS results with substance-dependent patients and highlights their deficits in emotions' differentiation and complexity. The lack of a relationship between LEAS and TAS-20 is discussed from the methodological and theoretical points of view.

[Consciousness and emotion]. / Conscience et émotion.

This article focuses on the processes that lead to awareness of our own emotions, which deserve particular attention in contemporary models of emotional consciousness. The subjective component of emotion, or emotional experience, was for a long time the most neglected aspect in the study of emotions although it already constituted the initial point of discussion in the famous William James still asked question : What is an emotion? More than a century later, contemporary theories debate about this heritage. We examine the successive historic contributions to the question of the determinants of our own emotional experience: from James-Lange bodily changes to cognitive appraisal theories, also relating the major role that the fundamental emotions theory attributed to facial expressions. Twenty years after the debate about primacy of cognition or emotion, both physiological-somatic and cognitive components are integrated in contemporary approaches to emotions. However, their respective degree of implication varies according to the different levels of emotional consciousness which are modelized. It is on the last level that present models focus, level that leads to consciousness of our emotional experience, benefiting from the contributions of cognitive neurosciences. Models differ according to the role devoted to neuronal substrates in determining emotional experience, but they converge on the specification of a last level of consciousness, which is the only one that allows the subject to be conscious of emotion as it is experienced (feeling) and that what he is experiencing is an emotion. Then, different models of emotional consciousness account for different varieties of emotion experience and also for various cases of << unconscious >> emotions, that is occurrence of emotion with a lack of awareness.