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PSYCHO-TRAUMA (PT) IN CHILDREN AND ADOLESCENTS, A SPECIAL AGGRESSOR

Autor: Ştefan Milea
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The article presents the author’s own definitions of the psycho-pathogenic factors, of the psycho-trauma and of the concept of potentially psycho- traumatogenic factors (and not psycho-pathogenic). At the same time, six peculiarities which make psycho-trauma a special aggressor are described namely:

  1. The fact that it is the product of individual subjectivity and of its uniqueness.
  2. The subjective nature.
  3. Strictly personalized character.
  4. Implication of a socio-cultural dimension.
  5. Involvement of thinking, memory and affection.
  6. Temporal disparities between the moment when the potentially psycho-traumatogenic factor is present and that when the psycho-trauma is constituted and it starts to act – temporization, persistence in time and anticipation.
  7. Implication of certain autogenetic mechanisms meant for the constitution of psycho-traumas.

From the beginning it must be stated that the concept of psycho-trauma (PT) is not individualized clearly enough, being often erroneously synonymous with the more general psycho-pathogenic factor or context or event, namely that of mental distress.

Psycho-pathogenic factor, context, or event, respectively mental distressing factor. All of them are synonymous terms.

Definition. Although very widely used, surprisingly, the term psycho-pathogenic factor is missing both from DEX (1984) and from available specialized dictionaries. We believe that it encompasses everything that causes psychobiological dysfunction 1 through psychological mechanisms. Of course, a broader sense may be addressed to that also includes factors which may directly harass the brain such as physical, chemical or biological agents. They constitute a category of aggressors that are very different from those that act through psychological mechanisms.

As we will see, some external or internal factors:

  • can be a real danger, just potential or may be wrongly assessed as harmful;
  • may be recognized as pathogens both by the victim and by the environment, or only by one party;
  • Although real pathogens, some of them can be ignored by the victim and, as such, may remain neutral, or conversely, may be active;
  • may be in sight for both the victim and the community, just for the victim or just for the others or even for neither of them;
  • can be countered either by assimilation or by discharge into the unconsciousness;
  • may act pathogenically, either by involving the individual’s subjectivity and their transformation into psycho-trauma or by other psychological mechanisms.

In this context, a special place is held by authentic psycho-pathogenic factors (such as hyper protective education) which, though they are harmful acts, instead of being rejected, on the contrary, they are often approved by the individual’s subjectivity and often by his entourage, as well.

Potentially psycho-traumatogenic factors. We need to emphasize that they are not psycho-pathogenic. We propose a new concept, that is intended to delineate those factors of the external or internal environment, which do not act harmfully, or directly or automatically, but only after being passed through the filter of the individual’s subjectivity and only if it had metamorphosed these factors into psycho-trauma. They vary from individual to individual; the subjectivity is that which, after processing and assessing the external or internal reality, attributes the status of threat to some of its components. Hence, it is understood that the individual’s subjectivity is the one that identifies the potentially psycho-pathogenic factors. Primarily, it chooses, of course, from the broader frame of psycho-pathogenic factors. In addition, because not infrequently an individual’s subjectivity can be deluded and it sees inevitable and unacceptable dangers even where these are missing (children may provide many examples), the sphere of the potentially psycho-traumatogenic factors is broader than that of psycho-pathogenic ones because it includes situations, which, by their nature, do not have an adverse character.

Psycho-trauma, psycho-traumatic factor, trauma or psychic traumatism. The term of psycho-trauma cannot find place its place in dictionaries, either. Other names are preferred such as: psychic trauma (Lafon -1973, Laplanche and Pontalis -1988, C. Barrois – 1997); psychological trauma (Talaban Andrucovici – 1992), or simplified, trauma or traumatism (Popescu – Neveanu -1978, DEX-1984, Sillamy -1996 , Chemama 1997).

When they are formulated and not substituted with descriptions and examples, definitions focus on: particularly intense emotions that cause a permanent change of personality (Popescu – Neveanu -1978), or on violent emotions which alter the personality (DEX -1984); or on the event that produces intense shock (Talaban Andrucovici -1992); or on the violent character of the shock likely to onset the mental disorders (Sillamy -1996. In the literature with psychoanalytic orientation, depending on the context, the focus is on the energetic overload, on the disturbance of the emotional balance, on the frustrations, the sexual fantasies of various stages of libido, on deprivation, on unacceptable or unbearably intense desires and pulsion impulses.

Typically, events that the individual is faced with are targeted and their brutal, unexpected, or violent character is pointed out. In this respect, Kammerer (1974), a prominent French psychiatrist, believes that the lack of these features excludes the idea of psychic trauma.

We prefer to call it psycho-trauma (PT) and define it as: Negative (mental) experience that generates disorders, and is built by the current or future subjective processing of external or internal reality, which is perceived as source of damage and is considered as inevitable and unacceptable.

We prefer this definition because:

  • It is a more direct formulation.
  • It consists of psychic suffering, respectively, a spiritual wound. It is not a simple situation but one regarded as hopeless and unacceptable.
  • It is a product of individual subjectivity, a retort that, following the assessment and processing of internal and external environmental factors, either gives them their meaning of generating spiritual wounds or not. This means that PT is not the event that the individual has faced, but only what and how much the individual’s subjectivity appreciates it to be, after processing and assessing not only the event but also his/her means to cope with it. So PT and the potentially psycho-traumatogenic factors that initiate it are two distinct, interactive and mutually dependent realities. This is because the first reality initiates the second one, but only through the individual’s subjectivity. Since along the chain made up of environment – psycho-trauma – disorder, the latter has got the last word, it means that the reality, respectively its mental representation, subjectively invested with the status of PT and not the internal or external environmental factors that generate it is what determines the disorders.
  • It is an experience and therefore it is itself a subjective structure.
  • The subjectivity of the individual differs from one individual to another and the same thing happens to the significance to be attributed to internal or external factors. This explains why authentically psycho-pathogenic external or internal realities may remain neutral or conversely, while others, devoid of any danger, take the meaning of a drama. Here, it is not only about the feelings that are characterized by brutality, special intensity, incomprehensibility, dramatic or unexpected character, as it is commonly considered, but also the huge number of those that, in spite of their apparent modesty and even subliminality, are distinguished by their persistence in time, repetitive character and cumulative action, ability to associate with each other to reinforce each other or to be influenced by vulnerabilities, by certain age periods, by individual peculiarities or circumstantial situations that give them their meaning and amplify their negative significance, or conversely, as protective factors that mitigate their significance. It is the merit of Kahn (1963), cited by Fischer and Riedesser (1998/2001) – for introducing the concept of cumulative trauma of subliminal events or circumstances.
  • We do not believe that the impairment of personality should be a defining condition since it may be a further possible consequence and not a constitutive feature.
  • It emphasizes as necessary the care required to reserve the formula “psychic trauma” or PT, only for the mental representation generating suffering, respectively, psychological wound. It should not be confused with the potentially psycho-traumatogenic factors that initiated it and even less with all those that:
  1. in spite of involving the individual’s subjectivity and putting him/her to test, he/she may face the test. This means that within certain limits, of course individual ones, those which can be, in some way, overcome, dealing with potentially psycho-traumatogenic factors is without risks. Moreover, it is even necessary, having a maturation role on multiple levels. This is also why we feel it necessary to accept to make, for example, a distinction between eustress and distress or between aggression and combativeness, incorrect formulations, often substituted with the approximate phrase of “aggression in a good sense of the word” ;
  2. in order to determine the psychobiological dysfunction employ other mechanisms than the psycho-pathogenic subjectivity as appropriate, first of all the physical, chemical or biological noxae.
  3. although acting pathogenically through the individual’s subjectivity, out of whatever reasons, the latter does not recognize their harmfulness. Here, a special place is held by those psycho-traumatogenic factors which the individual subjectivity, despite their unquestionable harm and the mental disorders that they determine, not only does it transform these factors into psycho-trauma but also it agrees with them. For example, due to their large number and their particular importance in terms of child and adolescent psychiatry, being commonly encountered and very difficult to counter, we should mention everything that is represented by hyper-protective education and its harmful efects (See Milea – 2006 p.140) This type of education, without being perceived as danger and even less as inevitable and unacceptable both by the child and, not infrequently, by those around him/her, gradually distorts the self-image, the way to perceive the reality and finally it will influence the individual personality forever. Moreover, the child not only does he/she realise its harmfulness but he/she prefers it, being interested and fully satisfied by its immediate benefits.

Seven peculiarities that make psycho – trauma (PT) a totally special aggressor. Of course PT bears also the influence of quantitative and qualitative parameters which the factors of external or internal environment have in common with other types of aggressors (psychological, biological, physical or chemical) like for example: nature, intensity, number, duration of action, acute, subacute or chronic character, direct or indirect action, primary or secondary damage. But these are overshadowed by the fact that it is the expression of individual subjectivity and of its unique character that make the PT to be remarkable through:

 

1. The fact that it is the product of individual subjectivity and of its uniqueness.

Indeed, as mentioned above, individual subjectivity is that which attributes to the internal or external environmental factors the significance of present or future hazards or obstacles with the unavoidable and unacceptable consequences. This means that whatever the nature of internal or external factor or the form in which it is presented to the subject, they do not become PT as long as they are not given a menacing significance regarded as hopeless. The subjectivity of the individual is the one that can “see” a greater threat, even where there is no real basis for it and, thus, it turns into psycho-trauma even what for the other individuals does not have such a character. Conversely, it is also the subjectivity that reduces the meanings, that ignores real dangers or consciously accepts risks based on, for example, certain beliefs or hopes of certain advantages, be they only in a future life.

Involvement of subjectivity is by far the most important feature of this type of aggression. Indeed, it:

  • gives PT a unique character of subjective experience,
  • modulates meanings and response modalities giving them an individual character,
  • contributes to the major obstacles in the way of seeking to decipher the full meaning and
  • as we shall see, it puts its mark on the other peculiarities.

 

2. The subjective nature. Product of individual subjectivity, PT is itself a subjective structure. As such, it is not represented directly by external or internal factors with potentially psycho-traumatogenic factors, as it is not infrequently considered, but by the significance of the threat or of the obstacle with inevitable and unacceptable consequences attributed to them by individual’s subjectivity and lived in the mental plan by the latter. It is a particularly important aspect to note. It is not an absolute novelty being suggested by:

  • the wording of some definitions concerned with the character of shock or violent or intense emotion;
  • C. Barrois (1997) who, in the lines of more than five pages where he refers to the psychological trauma makes a very short statement (p.638) concerning the fact that he is considering a process that responds within the area of the subject to a traumatic situation;
  • Fischer and Riedesser (1998/200 ), too. We should mention that the latter two scientists point out that trauma is not an event as such and neither is it a safe characteristic of an external objective process. They stress that it is essential to recognize the fact that PT reflects the interaction between the external and internal perspectives. As such, to cover the duo consisting of objective and subjective components, namely by the potentially psycho-traumatogenic factors and their subjective assignments, Fischer and Riedesser propose the name of traumatic situation. Considering it a synthesis of subjective and objective perspectives and the basic unit of observation of the psycho-traumatology, they define it (p. 77) as “vital experience of discrepancy between threatening situational factors and individual capacities of control, which is accompanied by feelings of helplessness and abandonment devoid of defence and which leads thus to a lasting collapse in understanding the self and the world.”

 

3. Psycho-trauma, a strictly personalized aggression. It is understood that, passed through the filter of individual subjectivity and being its expression, PT has a strongly individual character. Subjectivity is not only the one that places a particular situation at the origin of a PT, but also the one that makes it unique and dictates its size. She makes what for a particular individual is a drama, for another it is a mere misadventure, a funny or even a beneficial instance. For example, for a family member, death of a parent can be a drama while for others, the chance to inherit. Moreover, as I pointed out above, customization can go so far as the individual may perceive a threat as insurmountable even where he has no real basis for this or conversely, he may exclude the threat that is obvious to someone else or even more, he may accept it as a deserved punishment or as something necessary or justified. That is a formidable obstacle for the clinician, researcher or loved ones who want to understand the situation, to evaluate, to compare and to anticipate developments and in some cases even to identify it. It is what Adam Mickiewicz very plastically stresses in his poem “The Sailor”, where he remarks the risk of being considered a hog the one who, driven by his own despair, prefers to dive into the waves:

 

“What I feel when it strikes under his ruthless spear,
There’s no way another to feel like me! Nobody but the Lord
Is called to judge, what makes us suffer,
Who wants to be my judge, they should not be
Beside me, let them be within me.
I’ll walk on my way forward, but you’ll go home.”

 

Of course, there are even greater difficulties in understanding, assessing and even identifying psycho-traumas in children, who, it is known, operate with their own tools, different from those of adults. Cognitive and emotional immaturity, concrete thinking and at the same time impregnated emotionally and magically mark the children’s subjectivity and make them not only understand reality in a different way from the adults but also react in their own way to various threats. Moreover, the children have their own types of psycho-trauma. The most important one of them is the failure to assure the essential psychological complex support that is indispensable to mental development and to the transformation of the newborn into an adult adapted to social life. It is about the need to have someone to attach to, the need for affection, support, protection, and for intervention at the same time mediating and shaping, the need for positive role models and here we consider mother’s patho- or sanogenic role or of her valid available substitute, the father, and of the family as a whole; the role of education, kindergarten and school, of the peers, the community and the economic and cultural factors, and of course the interaction of all these factors with the child’s personality. The child needs to be taught to share, to wait, to merit, to love, to have compassion or to learn that some things that are required from him (e.g. to eat), he just does them for himself while there are not only rights and but also obligations. Here are some of the basic and precocious needs of child.

Not only has the child his/her own types of PT but also periods of increased natural and selectively increased vulnerability and a dynamics that continually transforms his/her ability to assess and react to hazards.

3- Strictly personalized character.

4- 6- Temporal disparities between the moment when the potentially psycho-traumatogenic factor is present and that when the psycho-trauma is constituted and it starts to act – temporization, persistence in time and anticipation.

 

4. Implication of a socio-cultural dimension. The individual’s subjectivity makes him perceive the significance of the relationship with the surrounding reality and react to potentially psycho-traumatogenic factors employing not only the present but also his entire personality and life experience, the quality of the attachment relationship, the moral norms and the social values they adhere to. At least six levels are employed here, namely:

The first level is considering the opinion of the others on the situation that the individual is facing, their offer for support or the lack of it, from the community or the law, a feeling of pity, of compassion, of guilt or, on the contrary, contempt or, for example, satisfaction of those who believe that there is a God and that his turn has come to pay for his deeds.

The second level relates to the feeling of guilt or shame for what happens to someone, to the consciousness that troubles one’s thoughts, to mercy and even to pain for the suffering caused by one’s pains to one’s entourage.

The third level deals with situations perceived as stigmatizing – being a member of a particular social group, the presence of a disability, the situation as illegitimate child, orphan, social inequality, etc. .

A fourth is constituted by the threat to one’s own beliefs, certainties, expectations or moral values, and even to the presence or just becoming aware of the violence and injustice inflicted to one or to one’s entourage.

The fifth level is represented by the shame and suffering caused by the actions of one’s parents or of the close ones.

In the sixth level gathers the situations where the child realizes the danger only by adult reactions to it.

All these categories attest the fact that PT is not only individual but one facet of a social, cultural, moral and economic right background that cannot be disregarded.

 

5. Involvement of thinking, memory and affection

This is a fundamental aspect that distinguishes PT from other types of aggressors. Thinking, the emotional charge that accompanied the anterior experiences, be they traumatic or not, and their memories, directly contribute to the sorting out and the proper assessment of present afferents and of their consequences. With their help, solutions are chosen from the available ones to resolve certain situations and their ability to cope with such situations is assessed, too, a process that is completed with their transformation, rightly or wrongly, into psycho-traumas (or not). As outlined in the 2012, normal anxiety and its connotations (reaction of warning us to unexpected or new stimuli or the attitude of prudence) derived from the instinct of defence is the main support of what we call feeling of the imminent presence of a threat even before the existence of a clearly defined object of this threat. In addition, it is also is the trigger of alertness and of the mobilization of defence. Moreover, Teodorescu (1999) highlights the possibility of the intervention of interpretive distortions in thinking. This intervention can predict a risk even where it is not even wrong to judge the situation as uncontrollable. This does not mean that anxiety, in turn, can fully prevent rational thinking while memories of previous experiences can exaggerate or reduce the significance of the hazard. We should add other phenomena of distortion of memory of events, frequently presented in the context of psycho-traumatic states. However, there are aspects that individualize and complicate the situation even further, contributing to dramatizing or alleviating the subjective dimension of the threat and to the assessment of the capabilities to overcome it. In this context two aspects need to be emphasized:

The first aspect refers to the phenomenon of sequential traumatisation described by Keilson (1979 – quoted by Fischer and Riedesser -1998/2001) and opening of earlier wounds in case of current psycho-traumatic experiences (a fact which proves that the former ones were not completely forgotten) make that traditional rule formulated by Jaspers (useful in clinical diagnosis) on the relationship between comprehensible content of the PT and the clinical picture should not be always strictly observed.

The second aspect is a consequence of the above situation, especially the personalised nature of PT, and has important implications on the forensic level, in cases of mental aggressions. In such cases, the court is obliged to determine whether the fault of the aggressor is proportional to the size of the consequences or if it is necessary to consider also, not without excluding the existing difficulties, the contribution of previous vulnerabilities, of previous psycho-traumas, of wilful or accidental dramatization of the situation or of amnesia errors.

– temporization, persistence in time and anticipation.

 

6. Temporal disparities between the moment when the potentially psycho-traumatogenic factors are present and that when the psycho-trauma is constituted and thhhe moment when PT starts to act. Involvement of the individual’s subjectivity , of his thinking, affection and memory triggers multiple types of temporal inconsistencies between the moment when the factors with psycho-traumatogenic potential are present and the one when PT is established and its action starts. Some of these disparities are totally new .

a. The delay in the conversion of the potentially psycho-traumatogenic factors into PT and the onset of disorders. Of course, the existence of an incubation period, i.e. a gap between the moment of the presence of the pathogenic factor and the emergence of the disorders is common in medicine and therefore in the case of psychological aggression, too. Concepts of resistance and resilience are also well known. This time, however, at least two distinct situations should be taken into account, which are characteristic to psycho-traumatology.

First of all, it is the case with all harmful potentially psycho-traumatogenic factors which, for various reasons, are not acknowledged, or accepted by the individual for a longer or a shorter time. We know that finding a real threat and an assessment of its capacity are not always at hand to anyone, at anytime. Here we have to consider: chronological and mental age, life experience, education, entourage, context, or different other factors. This is the case with some unusual events, subtle or too complex for children and even for teenagers to appreciate them properly, much less to anticipate consequences, sometimes for very long periods of time. They are irrelevant as long as they do not constitute into PT or make use of other pathogenic mechanisms. We exemplify by sexual abuse and its various forms: small child who faces well hidden manifestations under the mask of affection, even the voluntary accepted ones, out of whatever reasons. In all cases, the PT is established; it amplifies and starts to operate in adolescence and even sometimes after it. In addition, in the case of sexual abuse, psychological trauma is further amplified by guilt, especially in those who have consented but also there are family consequences arising as a result of measures imposed by the court in the case of incestuous sexual abuse.

A second mechanism engaged in the temporization of the harmful effect of psycho-traumas is represented by the well- known psychoanalytic concept of protecting by repression, respectively, through what Sillamy (1996) calls “unconscious psychological defence mechanism of the Ego, through which the unpleasant feelings, memories and impulses or those in disagreement with the social person are kept outside the field of consciousness.” Here they, on the one hand, weaken the individual’s ability to cope with new attempts and on the other hand, they are waiting, even into adulthood, for some great opportunities to resolve or to affirm by externalizing as symptoms of pathological manifestations.

b. Remanent character respectively, the prolongation of pathogenic action of PT long after the factors that initiated it ceased to exist. It is not just the usual confrontation with direct negative result of the drama already outdated. This time a number of complex mechanisms are employed of conscious and unconscious psychological self maintenance and reactivation, which sometimes may be present throughout the whole life. Primarily memory, thinking, emotional sphere and the moral norms are involved here. After the assault was consumed, everything around that keep the memory of events alive, the reunion with people, objects, places, words, gestures, or similar events recounted, intrusive reliving painful memories and even protective care that the victim is often surrounded with maintain the past suffering awake. To these we should add the dreams that can become real nightmares. It is obvious that from case to case, other factors may be added: pride, reproaches, guilt whether justified or just mistakenly assumed, shame loss of self-esteem, fear that it may happen again, fear that the sensitive issues may be disclosed, or fear to lose the others’ confidence. Depending on the situation, the moral dimension, social and economic consequences are also to be noted. All these are associated psychological constructions favoured by anxious- depressive background that is part of the normal consequences of any psycho-traumatizing experiences that contribute to the building of vicious circles that in their turn contribute greatly to further suffering and are formidable obstacles in the path of oblivion. Therefore, it is not enough to be told even to repeat to oneself “Now it is all over” , “Well it was just that and hopefully that it hasn’t been worse,” “It has just been a terror” or “I must forget ( you must forget) everything.”

c. Anticipatory. It is a different matter, and it is specific to psycho- traumatology. It covers both the pathological area and that of normality. We know, that individual subjectivity, based on the prospective character of thinking, on the self- defence instinct and on the memory is capable to foresee dangers and ability to cope with them and to call for a defensive behaviour. But such predictive ability is a double-edged sword. This is because on the one hand, it is a major protective factor as it gives time to prepare behaviours marked by prudence, and employ defence solution. On the other hand, as the size of the assessment of the risk that we expect and the stalk or the ability to control them are not always adequate. Thus, there are many situations where danger is oversized or the ability to cope is undervalued which means that the individual subjectivity can exaggerate and future threats and confer them the character of uncontrollable situations to those that can be fully resolved and that are even less likely to happen. In fact, sometimes the mere expectation of an unpleasant event or of a punishment, the uncertainty about the future or just thinking on the need or just the possibility to take a risk without the certainty of success are sufficient to transform into artificial psycho-traumas, disturbing the psychological balance, causing unrest and even suffering based on less significant even necessary events. As a result, for fear of failure, measures of defence can be exaggerated or be totally inadequate, actually useful actions can be blocked without reason, and behaviours meant for developing different skills or abilities to overcome obstacles and to assert oneself might be abandoned. In this category fall those overly cautious natures, avoidant, resigning, excessively conceited, too timid, fearful of failure, of public censure, unable to take risks even if they are less important. Here fall hyper-protective parents forbidding their children to take the most mundane risks and in fact preventing them to assert and to know themselves. Also the well known behaviours of adolescents who for fear of punishment which they suppose is waiting for them at home as a result of low marks, for example, postpone the return home and thus aggravate the situation further.

 

7. Involvement of specific auto-genetic mechanisms for the constitution of psycho-trauma. This aspect is not unique in medicine and, in this respect, the autoimmune pathology is an example. There are, however, peculiar mechanisms, too.

A first, very active, mechanism is the one already mentioned. It refers to the fact that individual subjectivity can be deceiving and it assigns a status of psycho-trauma to controllable realities. In addition, prospective thinking is able to be deceived even when referring to future events and here comes the well-known story of the lump of salt as a good example.

Moreover, we must not ignore the ability of thinking to anticipate and consider the falsely motivated possibility of the occurrence of future hypothetical insurmountable hazards.

A second mechanism involves the complex domain of the intra-psychic conflicts, namely the opposition between what Laplanche and Pontalis (1988) call reversed internal demands. These, as pointed out by Chemama (1997), are of two kinds, manifest and latent.

Of course, as pointed out by Houzel (1998), too, conflicts are not only inevitable but also necessary and structuring. Only the unresolved ones constitute themselves as true psycho-traumas.

At the origin of intra-psychic conflict, there is the specifically human ability to judge not only the other but also oneself and to come into conflict not only with the former but also with a part of one’s inner self. This generates qualms of conscience, feelings of shame, of guilt, loss of self-esteem or of social prestige which together or individually represent authentic psycho-traumas.

It is also the merit of the psychoanalytic concept of having described and insisted on both the opposition between different instances of the personality and on the existence of desires, motivations and pulsion impulses that are totally or partially incompatible, unacceptable or unbearable. For Jung, conflicts occur between the conscious and the repressed component of the unconscious. In this context, the well-known complexes were identified. Unsolved, they constitute themselves as true psycho-traumas. Let us add the self-evident fact that, during growth and development, the child and then the adult will learn, continuously not only to discern what constitutes a real danger but also ways to defend him/herself and overcome a situation which encourages them, satisfies egos and hardens him/her. Nevertheless, there is also a reverse side represented by learning, respectively, the conditioning of negative processing of reality.

All of the above are intended to emphasize that if modern medicine today is mainly concerned with generalizations, and systematization, with the building of diagnostic and therapeutic guidelines and simplifications meant to make the information as easy to digest and its use as covered with rules as possible, it should not be forgotten that not overly exaggerate and simplify reality, this aspect should be coupled with caring for deepening the knowledge and understanding of details, for the accuracy of definitions and of their content. This is more so, as the Hippocratic precept “There is no sickness, only sick people” is especially true as we speak of mental disorders and, of course, as today’s modern genetics and the practice of personalized medicine support him with more and more arguments. Otherwise we run the risk, for example, to accept DSM, a useful tool of administrative psychiatry (Milea -2009), too easily as a substitute for clinical psychiatry textbooks, with all the impediments of this fact. Or, even the fact that DSM has an aetiological character, highlights its limitations. Among the risks, let us just point out the following: simplification of the diagnostic significance both in content and in form, limiting causal thinking and thereby marginalizing the primary psycho-prophylaxis centred, as it is well known, on identifying and combating psycho-pathogenic factors, facilitating the transformation of the various complications of certain diseases into real co-morbid entities. Let us also mention here the naturalness with which the notion of autism spectrum disorder has penetrated the clinic environment. In reality, no one knows for sure what the autistic disorder is actually, or perhaps just because of this ignorance, we prefer a general formula, the all inclusive but in fact heterogeneous and lacking clearly delineated boundaries. In fact, in the latter case, the negative consequences were not left waiting for too long: the statement is supported by troublesome differences and overly large amounts of data aimed at the prevalence of autistic disorder in the population today.

 

 

Bibliography

 

  1. Barrois C (1997) Traumatisme Psychique . In: Dictionnaire de Concepts. Les Obijects de la Psychiatrie, pg. 637-643, Sub Red. Pelicier Y Ed. L`esprit du Temps
  2. Chemama R (1997) Conflict psihic. In: Larousse. Dicţionar de Psihanaliză. Ed. Univers Enciclopedic. Bucureşti.
  3. Fischer G, Riedesser P. (2001/1998) Tratat de Psihotraumatologie. Editura Trei
  4. Houzel D (1998) La valeur structurante du conflit. Neuropsihiatr. Enfance Adolesc. (7-8): 361-365
  5. Kammerer Th. (1974) Traumatisme et réaction . In vol. La notion de réaction en psychopathologie. Confrontation Psychiatriques. Nr 12 pg. 81-91
  6. Khan M (1977) The concept of cumulative trauma. In: Khan, The privacy of the the self. Hogarth, London
  7. Lafon R. (1973) Vocabulaire de Psychopédagogie et de Psychiatrie de L`Enfant
  8. Laplanche J., Pontalis J-B (1988) Vocabulaire de la Psychanalyse. PUF
  9. Milea Şt (2006) Psihoprofilaxia Primară a tulburărilor psihice la copil şi adolescent. Vol. 1. Educaţia neadecvată. 136-148
  10. Milea Şt. (2009) Psihiatrie Clinică şi/sau Administrativă. Pg :78-98 În vol III: Orientări şi Perspective în Gândirea Psihiatrică Românească Actuală. Sub redacţia: Cornuţiu şi Marinescu. Ed. Un iversităţii din Oradea
  11. Milea Şt. (2011) Anxietatea şi faţetele sale inconsecvent delimitate. Revista de Neurologie şi Psihiatrie a Copilului şi Adolescentului. vol 14, nr 3, 17-25
  12. Popescu-Neveanu P, (1978) Dicţionar de Psihologie. Ed Albatros, Bucureşti
  13. Sillamy N. (1996) Dicţionar de Psihologie. Universul Enciclopedic, Bucureşti
  14. Talaban Andrucovici I. (1992) Traumă psihică In: Dicţionar Enciclopedic de Psihiatrie. Sub red. : C Gorgos, Ed. Medicală, Bucureşti.
  15. Teodorescu R (1999) Un model cognitiv al anxietăţii. In vol: Actualităţi în tulburările anxioase . Sub red. R Teodorescu. Ed. Cris.

  We mean psychobiological dysfunctions and not psychic disorders, since the latter are also associated with somatic pathologic manifestations, endocrine sensorial neurological ones or neurovegetative manifestations which cannot be minimised. The more so that, especially in children, they are often situated in the foreground of the clinical picture or even hide the psychic disorders, which is a very important aspect for the diagnosis and for the assessment of the consequences which the PSPG factors determine. In short, it is about a whole pathology covered by the classical, unfortunately almost forgotten, concept of psychogeny.