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The Clinic of Disability

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This publication brings together eleven articles on the clinical treatment of disability from French researchers in the fields of psychology, anthropology, psychiatry, and philosophy. The authors all have practical experience in the field and most are clinicians sharing a common psychoanalytical epistemology.The diverse nature of their contributions opens a window onto the mental life of people affected by various deficiencies, be they cognitive, motor, sensory or even multiple, and of those close to them, at all ages.The work provides English-speaking readers with an insight into the way French authors raise the relevant issues, elaborate theories relating to clinical disability management and implement innovative practices.Each of the authors develops an original approach, affording recognition to the subjectivity and intersubjectivity of the disabled person and those dear to them, intimating that the disability (as with all human experience) is all about the relation existing between the person concerned and their life story, and also their relations with others - with the society and culture in which the condition emerges and evolves throughout life.

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Chapter One - Virility, Masculine Identity, and Disability

ePub

Pierre Ancet

Introduction: virility and masculinity

What exactly is masculinity, when not confused with virility? Can one be manly without being virile, or should the very image of virility be revised in order to integrate it within new forms of masculinity? These questions are not anodyne, since they relate to sexual identity, a part of identity that is socially constructed in a deployment of sexuality. Masculinity-virility intervenes therein not in the sense of sex, as a descriptive concept (“a male individual”), but in the sense of gender (“a real man”), which is an evaluative and prescriptive notion: “being a man” means having to show muscle power, strength, daring, or even aggressiveness. These characteristics, to which must be added genital potency, are traditionally attributed to the male. Virility places individual masculine identity within the dimension of social gender and its attributes. This issue can thus be seen to affect all men, not just physically disabled man, supposedly devoid of virility. Many men would like to correspond to the virile heterosexual ideal of the dominant male, but many of them must content themselves with being merely male individuals. Each man will probably admit that he possesses only some of the characteristics of virility. How then could such relative virility be denied to men with disabilities? Is it not possible to play a masculine role (e.g., sexually or in the workplace) without having the stereotypical attributes of virility? Are not modern-day fathers themselves far removed from the traditional image of the father (Korff Sausse, 2009), in a masculine role that is, therefore, also accessible to a disabled man?

 

Chapter Two - The Traumatic Effects of Encountering Disability: The Bond and Psychic Transmission Put to the Test

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Albert Ciccone

Encountering their child's disability represents an especially traumatic experience for the parents. For the subject primarily concerned, the child, discovering their disability is also potentially traumatic.

In this chapter, I consider the traumatic effects of encountering the disability from the perspective of the bond and psychic transmission. I investigate the effects of failure in transmission as induced by the disability, as well as the specific features of bonds and transmissions that it generates, permits, or reveals over time.

The term disability here includes the somatic, cognitive, relational, and psychic fields. Clearly, each situation poses specific problems that have to be differentiated, but I attempt to distinguish and cover a certain number of sufficiently common issues.

First, I describe the effect of the break in filiation, the effect of the primal disappointment, with the host of violent feelings that accompany it (guilt, shame, and hatred), and also the effect of sudden and early psychic separation.

 

Chapter Three - Cultural Interpretation of Disability

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Charles Gardou

This chapter is devoted to the cultural productions that determine how disability is viewed and that inform behaviour and practice. It derives directly from a trip made with researchers from twenty different countries (Gardou, 2011) to the Oceania continent (the Kanak region and the Marquesas Islands, where we lived for a number of years), to North America with the Inuits in the far north and Canada, South America (Brazil and the Amerindian territory, Surinam and Guyana), the Asian continent (China and the Lebanon), Africa (Senegal and Brazzaville in the Congo, Algeria and the Island of the Reunion), and the European continent (Italy, Norway, Germany, the United Kingdom, Portugal and France).

Our investigation sought to respond to three essential and closely interrelated questions. How is disability actually seen in daily life across the different continents? How can sense be made of the maze of conceptions surrounding disability? Finally, beyond cultural diversity, is there a central unity behind these different visions?

 

Chapter Four - Prediction, Disability, and Genetics

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Marcela Gargiulo

Introduction

Genetic science is both fascinating and disturbing. It can spark enthusiasm, but it can also feed fear. By delving into the possibly inherited genetic factors in the body, genetics sheds new light on what was previously regarded as an ungraspable and mysterious field of knowledge. Hence, genetic science makes a significant change in symbolic references.

A genome-based prediction possibility is more than mere scientific information. A test needs to be considered in the light of the patient's reality, lest its results spawn an “informative illusion” regarding the notions of body, time, and death.

DNA testing can reveal genetic mutations. Those mutations can be responsible for a considerable range of genetic disorders. We shall particularly confine our focus to late onset neurogenetic diseases leading to severe disabilities and dependencies. Some of these diseases are associated with cognitive impairment that can evolve into dementia.

 

Chapter Five - The Psychoanalytical Approach to Disability

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Simone Korff Sausse

Until recently, disabled people had seemed to have eluded psychoanalytical investigation and treatment, with very few psychoanalysts taking an interest in them. Why was this? The first reason is the general tendency to misunderstand the psychic life of subjects affected by a disability. Also, as objects of study, analyses, and commentary, the idea that they may have self-knowledge is rarely entertained. Little interest is taken in their subjectivity. Faced with the suffering induced by the disability, we prefer to think that the person is not aware of their condition and imagine that they do not have the intellectual capabilities to think out their own situation. As a result of this, it is thought that they cannot benefit from psychotherapy. This resistance derives from the dual nature of the disability that, on the one hand, is irremediable and, on the other, is inscribed in organicity, both insurmountable obstacles for conventional psychoanalysis, as they counter the ideal of the therapeutic vocation. As a result, few psychoanalytical research works have been devoted to these fields of investigation. The impact of a traumatised and traumatic reality, whose mesmerising effect causes a sideration or rejection, produces a blockage of the thinking processes. Clinical work on disability is neglected by psychoanalysts, hurt as they are in their narcissism by these patients who arouse an “uncanny strangeness” and produce the effect of a broken mirror (Korff Sausse, 1996) within which we fear to recognise ourselves.

 

Chapter Six - The Normality of the Abnormal: Disability, Norms, and Normality

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Roger Salbreux

The abnormal has always inspired fear; “sameness” reassures. Clearly, everyone needs to assert their identity, their uniqueness, and, thus, by opposition recognise the difference of otherness, but at the same time, we all experience the need to feel included in a system of belonging, a linguistic community, a group of peers, a family, a filiation.

We suffer when we see another with the same style, the same clothes, the same look as us. At the same time, racial, religious, cultural, and social class differences worry us and make us ill at ease, even if we are convinced that there is really no reason to consider those other people as belonging to a different form of humanity, to another species.

Herein lies the whole question of the same and the different that underscore the notion of otherness and that has so largely influenced the (sometimes contrasted) place occupied by disabled people in our societies according to the prevailing religious, epochal, and cultural functions (Stiker, 2006). Now, the contemporary movement in favour of integration and inclusion tends to erase the border between the normal and the pathological as studied so pertinently by Canguilhem (1991).1 This necessarily poses questions around the issues of rights, identity, and reality.

 

Chapter Seven - The Enigma of Disability: Talking about it with Children, Listening to them, Letting them Talk to Each Other

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CHAPTER SEVEN

The enigma of disability: talking about it with children, listening to them, letting them talk to each other

Régine Scelles

While many works address the impact of the way parents’ view their disabled children, few seek to analyse what happens between children themselves in their constant and step-by-step discovery of their deficiencies and the ensuing consequences on the real, phantasmatic, and imaginary levels. To subjectivate the reality of the pathology and its consequences and share the images and the thoughts it gives rise to, the child sees it reflected in other people's eyes, first almost exclusively in those of adults who are supposed to know, then, more and more, in the eyes, the ways of doing and saying, of their peers. This chapter focuses precisely on such co-construction of meaning and representations between children.

It is, first, adults who let children know the questions they may ask others and ask themselves and those that are not to be formulated before other people. Each child, then, imagines the reasons for such prohibitions and restrictions when it comes to talking and knowing of such matters.

 

Chapter Eight - Bodies Lost and Bodies Gained: The Major Periods in the History of Disability

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Henri-Jacques Stiker

Introduction

History sidles forward crab-like and we can never step into the same river twice. These two images argue that a linear presentation (suggesting that there is a rectilinear progression) might be misleading and forewarn against what are too loosely called the lessons of history. In each period, there are tensions and counter-currents. Each era reorganises things in its own manner, meaning that talk of progress or regression remains largely meaningless. The terms mutations and metamorphoses strike me as being more apposite. This view renders its full significance to history as the current patterns can only be understood if we look back over the path that led us to where we stand today. The historian, though, loves chronological order, as making time's sequence of events easier to understand and no one in their right mind would try to put the pharaohs after the French Revolution.

My second preliminary remark is in terms of anthropology. Infirmity is the broken mirror of one's positive self-image. Facing infirmity, individual and group alike feel ill at ease, afraid, tend to shy away from misery and deviance, and are confronted by the finitude and fragility of their condition. From this disturbed psyche may arise fantastic mythologies, archaic or highly elaborated symbolisms, and more or less random ways of tackling the issues. Each society or culture constructs its universe of the disabled body.

 

Chapter Nine - Prenatal Diagnosis and Handicap

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Sylvain Missonnier

On the basis of my clinical experience in a French maternity ward and in an institution for early medico-social action (CAMSP, Centre d'Action Médico-Sociale Précoce), prenatal diagnosis (PD) seems to me to deserve our full attention for at least two reasons.

The first is that PD today has shaped the process of parenthood and the prenatal genesis of the identity of the child to be born in a singular manner. It now has an essential role in what I have called the “first chapter” in the biography of every individual, whether afflicted with a disability or not. This first pre-birth chapter is all too often forgotten, and PD is in indeed an essential component.

It seems to me that PD is at once a set of technical procedures used to screen for foetal anomalies, and, at the same time, a window on to the complexity of becoming a parent, on to the human birth process and on to the essence of caring in perinatal settings. Any attempt to separate these two facets, technical and psychological, is a denial of the singleness of the entity involved.

 

Chapter Ten - Your Child is a Vegetable! Ethical Requirements for all Clinical Practices in Dealing with Severe Disability

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Georges Saulus

“It is impossible!”

“Impossible, yes, but do it”

(Dostoyevsky, 2012)

The principles which, as a general rule, inform our notion of clinical practice are proving inadequate in cases of severe disability.

Indeed, with respect to severe disability, the only consideration given to subjectivity in the sense in which it is generally understood (that is to say, taken to mean the status of the subject as the limitation of a psychological maturation process) cannot provide an effective enough framework for our response as clinicians. For we are called on to respond not only to a psychological deficiency (as implied by the notion of defective development), but also primarily and of necessity to address the ontological deficiency compounded by the circumstances of severe disability. Concern for psychological subjectivity, a familiar subject, should, therefore, coincide with concern for ontological subjectivity, which is less often discussed. In other words: concern for an intersubjective psychological dynamic should be expanded to embrace concern for its necessary circumstance: the instilling of what can be referred to as an ontological intersubjectivity.

 

Chapter Eleven - Adolescence: Psychic Process or a Mere Stage in Biology?

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Denis Vaginay

What exactly are we talking about when we associate adolescence and mental deficiency?

Do we accept the idea of seeing anything other than the evocation of a given age, meaning a real orientation towards a subjectivity defined by an oedipal affect, or do we rather yield to the overtly well-meaning attitude that, having first recognised the difference, involves denying it without further ado, assimilating it within the norm, to the common and unique measure of things?

To answer this question, we first need to come to an agreement as to the meaning of the terms used and also on the social context in which we deploy them, a context that determines the adolescent's fate in our society.

A few definitions as markers

Puberty is easy enough to understand for a consensual definition of it to be accepted. It corresponds to a physiological phenomenon that makes the child able to procreate. It emerges suddenly and evolves rapidly.

 

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