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(1)

Jean-Marc Scholl

Liège-Belgique

Jean-Marc.Scholl@chu.ulg.ac.be

«Unease in the Situation of Being Alone» and Separation Anxiety:

Semeiology from Early Childhood to Adolescence.

« Unease in the Situation of Being Alone »

and

(2)

« Unease in the Situation of Being Alone »

and A new concept of time

1. A semeiological study

2. Results of the study

3. A new concept of time

4. The permanence of the feeling of self

5. Comorbidity with the "Unease in the

(3)

« Unease in the Situation of Being Alone »

and A new concept of time

1. A semeiological study

Clinical phenomenon :

 Certain children have a more pronounced predisposition to feel a sense of

unease when they are left alone.

Objective :

To work out

 a more precise semeiology of “Unease in the Situation of Being Alone"  a age-sensitive developmental pattern of the condition.

Method :

 Detailed collection semeiological data by means of clinical case studies.

Population :

 170 children

 from 2 to 12 years of age

 in consultations for children’s mental health issues  data gathered between 2002 and 2007.

(4)

« Unease in the Situation of Being Alone » and A new concept of time

1. A semeiological study

2. Results of the study

2.A) Developmental pattern of "Unease in the Situation of Being Alone" in children :

 Already as an infant, the subject requires the presence of another person in

order to be able to fall asleep;

 At around 2.5 years, with the beginning of schooling away from home, the

child has difficulties accepting this separation from his or her parents;

 At around 5 years, the child shows an aversion to playing alone without the

presence of another person or an animal; if he or she does play alone, then he or she will constantly ask where the adult is;

 With the onset of sleep, the child often calls out to his or her parents, and

will sometimes even leave his or her bedroom or ask to sleep with the parents;

 At around 8 years, he or she will have no difficulties leaving the house and

the immediate presence of his or her parents, for example to go to play with neighbourhood friends. Nevertheless, he or she will be ill at ease if one of the parents should leave the house temporarily.

(5)

1. A semeiological study

2. Results of the study

2.B) “Unease in the Situation of Being Alone”

in adults:

The adult has trouble verbalizing this feeling, which is in

fact unaccompanied by any representational content. He

or she speaks of an empty “void” or a “nothingness”;

tries to delay going to sleep;

reads in bed in order to avoid this feeling;

seeks to generate fatigue in order to be able to fall

asleep quickly

.

(6)

1. A semeiological study

2. Results of the study

2.

C) If this “Unease in the Situation of Being Alone” is

present during day:

The adult who feels this sense of unease during the day

will try counter it by one or more of the following 4

means:

1. various activities;

2. sensory input (leaving the radio and TV on in various

rooms);

3. filling up of his “internal world” (say by reading);

4. a pet.

(7)

1. The semeiological study 2. Results of the study

3. A new concept of time

3.1.) “Unease in the Situation of Being Alone” seems to be

correlated with a delay in the “apprehension of time.”

The specificity of this delayed “apprehension of time”:

It is

not

a difficulty in acquiring a notion of temporal

sequence;

It is

not

a difficulty in acquiring a sense of rhythm;

Rather, it is

a difficulty

in the apprehension or

"foretaste" of temporal duration

.

(8)

1. The semeiological study 2. Results of the study

3. A new concept of time

3.2.) A new concept of time :

“The internal gauge by which we anticipate temporal duration”

This sense of time is a capacity:

 to “savor” the duration of time;

 to feel how long a period of time will last before it unfolds;  to locate oneself within this period of time;

 to have a sense of time which consist in a “feeling” of the time;  N.B. This sense of time is a “feeling” that is UNACCOMPANIED by

representations (mental images)

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1. The semeiological study 2. Results of the study

3. A new concept of time

3.2.) The semeiology of a deficient ability to anticipate

temporal duration

causes

the 5-year-old child

(even if the child has

acquired the rational notion of sequential time)

to ask repeatedly when a given activity will occur during

the day, even though he or she already knows the

answer;

to feel a constant need to revisit the day’s schedule;

to be confused or disoriented if there is a change in the

organization of the day;

to have difficulty identifying his or her temporal location

within the structure of the day.

(10)

1. The semeiological study 2. Results of the study

3. A new concept of time

3.2.) The semeiology of a deficient ability to anticipate temporal duration

When the child is older (for example around 12 years old), he or she:

 has difficulties estimating correctly the time needed to perform a

given activity;

 cannot adequately structure the time required to complete a given

activity;

 has trouble choosing which of a given range of activities is best

suited to filling a given interval of free time (for example, the 45 minutes between the completion of homework and the start of dinner);

 exceeds time limits;

 is unaware of the passage of time;

because he or she is incapable of estimating, gauging, and intuitively anticipating a given stretch of temporal duration

(11)

1. The semeiological study 2. Results of the study

3. A new concept of time

3.2.) The semeiology of a deficient ability to

anticipate temporal duration

If “Unease in the Situation of Being Alone” is

present during the day

, it can engender:

a feeling of “nothingness” or of “emptiness”;

a tendency in the child to cling to his or her

mother, in order to avoid the uncomfortable

feeling of “nothingness,” “emptiness,” and

“boredom.”

(12)

1. The semeiological study 2. Results of the study

3. A new concept of time

3.4.) Hypothesis 1:

“Unease in the Situation of Being Alone”

seems to be correlated with a defective

capacity to get a “taste” for the duration

of a stretch of time in the future.

This is a clinical observation!

(13)

1. The semeiological study 2. Results of the study

3. A new concept of time

3.5.) Hypothesis 2 :

“Unease in the Situation of Being Alone” is

connected with a deficiency in the

neurophysiological platform that enables the

subject to estimate temporal duration, that is,

“the internal gauge by which we anticipate

temporal duration.”

Clinical observation: Not all babies present an “Unease

in the Situation of Being Alone”

(14)

1. A semeiological study 2. Results of the study 3. A new concept of time

4. The permanence of the feeling of self

4.1.) Hypothesis 1:

The defective capacity to anticipate the “flavor” of

temporal duration can lead a feeling of “nothingness”

or “emptiness.”

This deficiency prevents “mental representations” from

generating a feeling of permanence. By themselves,

such “representations” are insufficient. As a result, if

the subject is bereft of a “physical presence” (say of

another person or of a pet) or of sensory

“stimulation”, he or she tends to experience a feeling

of “nothingness” or of “emptiness.”

The baby experiences a feeling of distress when he or

she finds himself or herself alone.

(15)

1. A semeiological study 2. Results of the study 3. A new concept of time

4. The permanence of the feeling of self

4.2.) Hypothesis 2:

The feeling we have been describing is a sense

of unease UNACCOMPANIED by representations.

The adult finds it

hard to verbalize

the feeling of

unease, which is

unaccompanied

by any

representations; he or she will sometimes speak

of it as a feeling of

“nothingness,” or

“emptiness”.

The unease we are describing is

too basic for words.

(16)

4. The permanence of the feeling of self 4.3.) Hypothesis 3:

 “Mental representations” by themselves are insufficient to give the subject a sense of his or her own permanence; such representations need to be bolstered by the feeling for time we have been

discussing. Otherwise, the sense of being “stuck” in a kind of temporal “void” will continue.

This suggests the following hypothesis. Freud famously observed an

infant playing with string on a bobbin. Freud interpreted this game as a symbolic representation of the child’s capacity to acquire a mental representation of the mother that enabled it to endure her temporary absence. By contrast, our work suggests that Freud’s emphasis on mental representations as guarantors of the sense of

permanence is insufficient by itself to account for the phenomena. In sum: Mental representation alone does not yield the sense of

permanence; it needs to be complemented by the feeling for time

that we have been discussing, a feeling that is itself

non-representational, since it resides in the capacity to “savor” temporal duration by way of anticipation.

(17)

4. The permanence of the feeling of self 4.4.) Hypothesis 4:

 A feeling of “nothingness” or “emptiness” may be offset by activity, sensory stimulation, or the presence of another being, such as a pet.

The subject, who feels empty and ill at ease, especially during the day, spontaneously seeks to offset this feeling by one or more of the

following five methods:

 1. External activities (taking a walk, cleaning, and so forth);  2. Internal activities that fill up one’s “inner world” (reading,

intellectual activity, the computer);

 3. External sensory stimulation (a radio or TV switched on in every

room; stimulation of the five senses);

 4. Proprioceptive stimulation (proprioception connected with sports,

bulimic satiation, a sensation of hunger, autostimulation, or automutilation);

 5. A pet to keep one company

(18)

4. The permanence of the feeling of self 4.5.) Hypothesis 5:

 When the condition we are describing reaches a sufficiently serious degree of intensity, it undermines the permanence of the feeling of self. This may in turn dilute the solidity of one’s selfhood and hinder the process of individualization.

In one subgroup, the feeling of “nothingness” or “emptiness” can cause momentary a loss of the sense of the permanence of the self. In this case, “Unease in the Situation of Being Alone” can occur

even in crowded places (the cinema, a conference room, etc.) when the subject is separated from anyone he or she knows. The adult is visited by a sudden feeling of unease when he or she loses sight of the person who had accompanied him or her and he or she no

longer knows where to locate that person. The subject experiences this “unease” as a void of representation and a loss of the feeling of the permanence of the self.

(19)

4. The permanence of the feeling of self 4.6.) Hypothesis 6:

 The basic challenge in meta-psychology would not be for the subject to go through a process of “individuation through separation”, but to attain more fully to his selfhood and to a sense of the permanence of the self.

Daniel Stern has demonstrated that the normal infant has «the “sense of an emergent self” already at the age of 2 months. Stern also shows that the “sense of a core self” develops between 2 and 7 months of age. “The sense of a core self” includes the experience of self-agency, self-coherence, self-affectivity, self-history, as well as the sense of

one’s own enduring permanence, of a continuity with one’s own past. Thanks to this sense, one is sure that one continues to exist, and

even that one can change while remaining the same.»

« Unease in the Situation of Being Alone » and A new concept of time

The basic challenge, then, would not be to achieve separateness, but to live out one’s selfhood in the ensemble of one’s perceptions, as well as to acquire a sense of enduring individuality.

(20)

1. The semeiological study 2. Results of the study 3. A new concept of time

4. The permanence of the feeling of self

5. Comorbidity with

the "Unease in the Situation of Being Alone"

“Unease in the Situation of Being Alone” is present:

systematically in cases of bipolarity

, though without

being pathognomic for bipolarity.

The condition is present at threshold levels in

“maniacal temperaments”.

It can become more pronounced with the

appearance of a

depressive state

.

in other nosological entities (e.g.,

borderline,

schizoaffective, and psychotic

disorders).

in an isolated state

as a simple

personality characteristic

of a given person.

(21)

1. The semeiological study 2. Results of the study 3. A new concept of time

4. The permanence of the feeling of self

5. Comorbidity with

the "Unease in the Situation of Being Alone"

"Unease in the Situation of Being Alone"

can

appear suddenly

during childhood, adolescence,

or adulthood:

In that case, it may constitute a subgroup of

"school anxiety" or

"school phobia".

It is also found in connection with the

appearance of

"negative symptoms".

(22)

Jean-Marc Scholl

Liège-Belgique

Jean-Marc.Scholl@chu.ulg.ac.be

«Unease in the Situation of Being Alone» and Separation Anxiety:

Semeiology from Early Childhood to Adolescence.

« Unease in the Situation of Being Alone »

and

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