Author Thesis
Object
In the first place, the authors ask the question about the teenager care in psychiatric institution [IdS] as well as the IP which is a therapeutic strategy qualified as necessary considering that the disconnection with the usual living environment became unavoidable.
The aim is to clarify the necessary conditions to establish the « health care » around two key functions : [2] the container function and [3] the mediator function.
[1] Institution necessity
Argument 1 ➔ The paradoxe of the teenager’s attitude towards the institution
↓
against (sens 1) = rebellion, « opposite to »
The teenager is also
against (sens 2) = leaning on, using environment and social relationships as a support…
In a health care institution, he relies on it to overcome the threats towards his relational life. Through this paradoxe, Jeammet shows the institutions necessity.
Argument 2 ➔ The institution as a conflit mediator
The institution fulfill its purpose when she allows the teenager to go out of his environment, which he broke with. That is to say go away from the constant conflit between his environment and himself as well as his parental ideals in contradiction with his real parental picture. It allows the care where the ordinary world can’t, which is valid for all individuals.
[2] The institution’s container function
To ensure the patient’s care, the institution must complete the container function. The concept is not only about the care place (closed or opened), it also contains the caregivers (nurses, psychologists, psychiatrists, doctors, cleaning agents, teachers, educators, etc…) as well as the place’s rules.
Argument 1 ➔ The permanence of the setting : The container function allows to break the natural surrounding of the individual, through the fosterling. We implicitly understand that the institution exists before the individual existence and arrival [permanence]. This proper characteristic of the institution makes it reliable for him [avoid anguish].
Argument 2 ➔ The reference of the setting : This permanence gives the individual a reference frame which will allow him to bound with the external reality. Existing already, the institution is stable and organized. In that way, it is not « submitted to the patient desires », and can answer the care necessity on an individual basis. More precisely, the surrounding must allow the patient to restore the balance between his fantasy world and his reality. Consequently, the individual will be able to distinguish his desires and his actions from the real social in order to restore the the real in a serene manner. The restoration of the reality seems to be the most efficient way to thwart the « fantasy illusion ».
[3] The mediator function of the institution
The mediator function is completing the container function. The institution’s permanence preserves its stability. It’s through the permanent existence of the caregiver staff that it can be arranged to provide individualized care. Thanks to the permanent frame the mediator function allows the institution to be flexible and individualized.
Argument 1 ➔ The frame « good » enough : Winnicott concept of the « sufficiently good mother ». This comparison makes explicit for the institution the necessity of a singular care. This flexibility of the frame allows to welcome the « fantasy illusions » while staying permanent in order to reinvest the external reality. It’s this investment of the frame in the social relations, conflicting and with the external objects that will allow the individual to stay a subject. In this meaning, the frame’s objective is to restore the subject.
Argument 2 ➔ Frame as a transition space : J & A illiterate this idea by the institution as a mediator of the teenager’s conflicts with his entourage and his environment. Those destructives relations will be freed form the greatest part of the conflicts to let the teenager to have interpersonal relationships the sanest possible. It’s through this that the therapeutic link will be possible. J & A write about transitional spaces as Winnicott conceived them.
These spaces brought by the institution can maintain separated the internal and external reality on a continuum. On of the means to achieve this is the psychodrame, it can play with stressing experiences and take distance with them to allow elaboration.
Conclusion
Jeammet & Aubin text makes explicit the necessity for the « care frame » to fulfill a container function and a mediator function to ensure the care. A psychiatric service must recall regularly these fundamental notions of frame containing and mediator in the care exercice.
Biblio :
Jeammet Ph & Aubin J.P. (1976). Réflexions sur les conditions d’une utilisation thérapeutique des institutions pour adolescents. Revue de Neuro-Psychiatrie et d’hygiène Mentale de l’Enfance, oct-nov, n°10-11, pp. 501-600.