[The problem of contraception in young psychotics treated in a day care hospital]. / Observations sur le problème de la contraception chez des jeunes psychotiques traitès dans un hôpital de jour

ABSTRACT

PIP This presentation about lack of communication on contraception between staff and patients in an outpatient mental hospital consists of 7 parts 1) an exposition of the authors' hypothesis; 2) the subject matter and method of this study, i.e., analysis of recorded staff interviews; 3) a description of the transcripts on a textual level; 4) an inventory of staff opinions classified by the key words "contraception, abortion, mental patient, relatives, psychiatrist and responsibility;" 5) an "analysis of structures" implied by these themes; 6) "incarnations of contraception," i.e., 12 typical histories of mental patients given or denied contraception or abortion; and 7) a conclusion. The hypothesis is that contraception speaks precisely to therapists in the repetitive relationship implied constantly by the psychotic course, in terms of desire, identity, bodily organization and structure of speech. This study is based on 10 recorded conversations between a female intern and individual hospital staff members, prompted by a newspaper article about a young psychotic given oral contraceptives without her knowledge. The transcripts revealed denial of the issue, depersonalization, projection and delegation of responsibility to others. When grouped into the 6 key words, the opinions uncovered a vast somatic field, confusion couched in metonymic figures of speech, such as using the term "woman" for "mental patient," moral, genital and sexual connotations. Mental patients were depersonalized; parental roles were confused in speaking of contraception for the patients; physicians were considered judges; responsibility was denied for the patients and avoided generally. The authors' structural analysis took the form of a diagram with responsibility in the center, always preceded or followed by contraception and abortion, and by the triangle psychiatrist-relatives-patient (or mother, young person or woman). Maternity or relationships were always excluded. The 12 anecdotes included hysteria, schizophrenia, hypochondria, obsession, drug abuse, latent homosexuality, repeated pregnancies, self-induced abortions, sterilization, abortion, pills, injections and castration without the patients' consent, or with their ambivalince toward these procedures. Thus, contraception resulted in structural reversals in both patients and staff, involving the fundamental access to genitality for patients and defensive constructions by staff, which is not surprising in a cultural milieu which confuses sexuality and procreation.^ieng