Conclusion :

Alors que dans les derniers stades de la maladie, les ravages neurologiques semblent détruire en grande partie le cerveau, mettant à l'épreuve l'hypothèse du maintien d'une vie psychique, surtout dans les derniers stades, le déroulé de l'accompagnement réalisé vient augurer de la persistance d'une structure psychique. Bien que celle-ci paraissait se dessiner, se lire sur le corps de la malade, c'est par le biais de séances, aussi brèves soient les manifestations subjectives, que nous pouvons repérer les éléments structuraux propres à la psychose. L'investissement du corps pensant et surtout habités par les mots s'illustre encore au travers du rapport corporel et langagier dans la psychose alors que les facultés intellectuelles semblent pour le moins entièrement défaillantes. Le sujet parait toujours s'exprimer que ce soit par son corps ou par les mots si l'autre vient lui permettre de dicter son désir.

Nowadays, the Alzheimer's disease seems to question the neurological aspect much more than the psychic aspect. Even though it is often admitted that its breeding ground for development remains the neural network, the psychic apparatus is also part of this pathology. Since we know that for the patients the words seem non-existent and that the body doesn't have the capacity to respond, the clinical meeting can become a real challenge. Far from the typical cure, the psychic support brought to the patient will help the clinician to interpret the psychological effects and the difficulties expressed in the last stages of the disease. At this stage, the “behavior disorders” often give the feeling of a deep neurological disorder. The patient may shout, use imitative or stereotypic gestures and the patient's behavior can become very confusing for the clinician. We are going to set up our hypothesis from these stereotypic gestures. We support and defend the idea that the patient intentionally sends us signals which mean something to the Other.

Objectives:

Nowadays, the Alzheimer's disease seems to question the neurological aspect much more than the psychic aspect. Even though it is often admitted that its breeding ground for development remains the neural network, the psychic apparatus is also part of this pathology. The treatment offered against the effects of the pathology very often includes how to approach and support the patient in his environment or promoting cognitive stimulations, but the psychic life of the patient is not taken into account. As if brain function was the sole root for the patient's anxiety. Since we know that for the patients the words seem non-existent and that the body doesn't have the capacity to respond, the clinical meeting can become a real challenge. Far from the typical cure, the psychic support brought to the patient will help the clinician to interpret the psychological effects and the difficulties expressed in the last stages of the disease. At this stage, the “behavior disorders” often give the feeling of a deep neurological disorder. The patient may shout, use imitative or stereotypic gestures and the patient's behavior can become very confusing for the clinician. We are going to set up our hypothesis from these stereotypic gestures. We support and defend the idea that the patient intentionally sends us signals which mean something to the Other.

Method:

Within the framework of a Phd in psychoanalysis, four clinical support tests were carried out over a period of time going from a few weeks to approximately two years. We would like to share the results of one particular support session which came to us as a surprise. It takes place over a period of two months and includes eleven sessions. This patient lives in a retirement home where the clinician works as well. Each session lasts between fifteen to twenty minutes. Since the patient has reduced mobility, the sessions take place in the resident's room. After each session, a thorough report of what happened during the session is written. Because the patients have usually lost the capacity to give the clinician their oral or written agreement, family members or legal tutors have been asked to sign a document in order to comply with ethical issues. The stereotypical gestures recorded during the session will be deciphered and interpreted later through a psychoanalytical approach.

Results:

We will analyze these stereotypic gestures first from a gerontological and neurological point of view and then from a psychoanalytical point of view through several authors who studied this problematic. At some point in psychoanalytical history, these stereotypic gestures were a research subject that could lead to controversies. From the psychic causes and criteria defining the pathonevrotical stereopatic gestures we will look for their presence during the sessions based upon Ferenczi's article. These gestures could be signs for protecting the Ego following a physical trauma. The patient often covers her eye with her hand. Last year, her eye was operated on for a cataract. In addition, we noticed that she also has some narcissic tics. Ferenczi identified these gestures and we were able to match some with the same criteria. We found similarities between Ferenczi and Abraham's analysis. But he refuses to call these tics stereotypic gestures. According to him, stereotypic gestures belong to the tenuous frontier between hysteria, catatonia and schizophrenia. Unlike Ferenczi, Abraham distinguishes categorically the tics as being part of neurosis whereas stereotypic gestures would rather belong to the domain of psychosis. We will compare our study with a clinical case presented by Jung (1908), who was still a disciple of Freud at that time. Jung mentions the case of an old lady showing the evolution of stereotypic gestures over a 30 year period of time where he managed to establish the psychic origin of stereotypic movement disorder. Her movements represented the lost memory of the object, according to Freud's object residu, but was a manifestation of an ongoing psychic activity. In 1911, Freud confirmed the relevance of Jung's analysis about the old lady's case. The patient uses her body to send messages which will remain impossible to transmit to any recipients. We observe a definite articulation between stereotypic gestures and verbal stereotypes. By studying verbal stereotypes, we will be able to bring meaning to stereotypic gestures. If the verbal productions, no matter how small they are, come to testify that language is still present, more surprising is the fact that stereotypic movements bring substance to the words. Like in the case presented by Jung, where movements become accurate definitions of the words, through a process that we will see later, more recent studies (Grosclaude, on 1987; Herfray, on 1988) reveal interesting links between body and language. We could easily say that the body is really taken at its word. But if this hypothesis looks plausible, it also comes to show another possible aspect: the subject is limited to being a signifier. From a Lacanian point of view, we can discuss the consequences and forecast such psychic blocking (Lacan, 1997, 2007, 2013). However, our study shows that, contrary to what was expected, words and language come back and confirm our basic hypothesis.

Conclusion:

Even though the neural devastation tends to destroy the brain massively in the later stages of the disease, putting to a test any psychic life preservation, our support sessions clearly confirm the existence of a psychic structure. During the support sessions, we managed to read through the sick person's body, no matter how brief the subjective occurrences were, and we were able to identify the structural elements which are representative of psychosis. The thinking body is inhabited by words and testifies for the presence of physical and linguistic connections while the intellectual faculties seem to be massively failing. The subject still manages to express himself either through the body or the words when the other allows him to express his desire.