[Some difficulties in the "paternalization" process in medically assisted reproduction]. / Quelques difficultés du processus de "paternalisation" dans des cas de procréation médicalement assistée.

Based on the observation of a child born by IAD, suffering of depression and presenting a school phobia, the author discusses the feeling of impotency experienced by the legal father. In another case, the grand-father-to-be is ready to donate his sperm so as to avoid issues on genetics: it is doubtful that such birth conditions would permit a healty organization of fatherhood. Included in the article are references on the literature concerning psychopathology of children born by IAD.

[Implementation and evaluation of a program of prevention against abuse in at risk infants]. / Mise en oeuvre et évaluation d'un programme de prévention de la maltraitance chez le nourrisson à risque.

Teams of pediatricians and psychiatrists led a joint action-research in public health institutions for infants which intended to evaluate original modes of prevention of abuse concerning infants with medico-psychosocial high risk factors. The framework of this study was a randomized controlled trial on the modes of prevention. The sample, consisting of children selected according to risk indicators appearing on their health certificate of the 8th day, was divided into two groups: the treated group who benefited from specific prevention interventions and a control group who benefited from classic surveillance. The research was longitudinal and was centered on the study of mother-infant interactions at 3 months, 1 year, 2 years and 3 years of age. The dynamics of early interactions was studied very precisely on the occasion of each examination. The first results concern the 161 children (72 in the "intervention" group, 89 in the control group) who were evaluated at 1 year of age. Although a real change in practice could be observed (the treated group profited by a mean number of 7.5 actions, while the control group on the average profited by only 1 action), the efficacy of those actions could not be demonstrated. No significant differences were observed between both groups with respect to height and weight growth and psychomotor development, their somatic status and the quality of early interactions, except with respect to a better quality of interactions in the action mode for the treated group. The difficulties inherent in such a type or research are analysed (children lost to follow-up, contamination of the control group by actions intended only to the treated group, difficulty in disposing of reliable criteria of estimation).

[The theory of attachment and contemporary psychoanalysis]. / La théorie de l'attachement et la psychanalyse contemporaine.

Bowlby considers attachment as a universal bond. It is based on internal models which are often viewed as subject to transmission. Representations of attachment nonetheless must be described together with representations of the object. Intersubjective relationship can be described on a neuro-biological basis but constitution of the Self is also determined by representations and fantasies produced by the mother's mental scripts.

[Interactions of the infant with its partners: evaluation of preventive and therapeutic approaches]. / Les interactions du nourrisson avec ses partenaires: évaluation et modes d'abord préventifs et thérapeutiques.

Interactions between the infant and its partners are defined and described on three levels: behavior, affect, fantasy, with a special focus on the functioning of the infant. The dynamics of the parent/infant relationships are analyzed along transactional theories: the infant and its partners influence each other in a constant process of developing and changing. Together with acknowledging the baby's active role in the relation, we seek better understanding of how the infant shapes up throughout transactions. Different assessment methods of the interactions are analyzed both within a clinical framework and a research framework, and examples of assessment format are given. The transactional perspective in clinical practice with the infant introduces a new model for understanding the pathogenesis of relational disturbances. It appears necessary to conceptualize a specific nosology of interactive pathology, beyond the reference to parental or infant pathology; we thus propose a classification of interactive disturbances by integrating the three levels (behavior, affect, fantasy). The aim of this investigation of interactions, based on an attempt to synthetize anglo-saxon and european research in the field, is to outline a new perspective in clinical concepts and practice which is not solely focused on the description of behaviors in infant interactions with its partners. This viewpoint, resolutely psychopathological in its orientation, implies an empathic approach which leads to important therapeutic changes and legitimizes early preventive interventions.

[The breast and the breasts]. / Le sein et les seins.

Is the breast taken into the mouth the same as both breasts as seen by the infant? In no way does taking the breast into the mouth exclude a certain erotic pleasure for both parties as has been shown by several studies that try to claim that the breast is no longer significant merely as a so-called "partial" object. This is what the iconography in Roman and Christian charity confirms.

[The psychoanalyst and the development of mental representations]. / Le psychanalyste et le développement des représentations mentales.

After a careful reading of the recent book by Daniel Stern on a theory of how the intersubjective world begins for a baby, we offer a careful analysis of the cognitive theories regarding the genesis of mental images. Amodal sensoriality and vitality affects stand at the roots of interactivity and take into account memories. The baby will soon be using a meta-theory of the mental functioning of its partners. The author agrees with Daniel Stern in this progression, which seems to question psychoanalytical theory on the genesis of objects, but this work shows that resorting to the concept of fantasy interaction is unavoidable.

[Action-research on the prevention of abuse in the very young child. Methodology and initial results]. / Recherche-action sur la prévention de la maltraitance chez le très jeune enfant. Méthodologie et premiers résultats.

Teams of pediatricians and psychiatrists are leading a joint action-research in public health which intends to develop and evaluate original modes of prevention of abuse and grave neglect concerning infants with medico-psychosocial high risk factors. The framework of this study is a randomized controlled trial on the modes of prevention. The sample, consisting of infants under one year of age and selected from their health certificate of the 8th day and 9th month, is divided into two groups: the treated group who benefited from specific preventive interventions and the control group who benefited from classic surveillance. The research was longitudinal and was centered on the study of mother-infant interactions at 3 months, 1 year, 2 years and 3 years of age. The dynamics in the action-research is illustrated by the evolution of the tool for assessment of early interactions and the refocusing of the research. From the analysis of the data from the phase of feasibleness, which included 114 infants, three main results have come out: definition of a "danger" pointer: dysharmonious mother-infant interactions at 3 months; a new risk factor was brought to light: "disrupted grand-parental family"; father's role in mother-infant interactions. These first results have had a major impact on the method for the active phase which is now in progress and intends to evaluate the new modes of prevention.

[Note apropos of the classification of mental disorders in child psychopathology]. / Note à propos de la classification des troubles mentaux en psychopathologie de l'enfant.

The need for a classification of problems observed in child psychiatry goes hand in hand with the desire to standardize diagnostics. This classification must be reliable, valid, broken down into various criteria and supplemented with a glossary. The triaxial classification used at the Alfred Binet Center, the changes suggested by WHO (ICD-10) are brought up because of their unquestionable advantages. Review of DSM-III. Critical study of the usefulness of suggested scales to explain the clinical approach to cases.

[Apropos of Gilles de la Tourette's disease]. / A propos de la maladie de Gilles de La Tourette.

The observation of a young north african afflicted with a tic disorder suggests an underlying meaning in the apparently confused motoric discharges, thanks to psychodrama and to ethnopsychoanalytic consultations with the family. Thus, at a time when the Gilles de La Tourette syndrome is described as a neurological disorder, while recognizing the limited utility of chemotherapy, we believe that neurobiological studies, whatever their merit, do not exempt us from thinking about the specific psychopathology of tics and their evolving relationship with neurotic symptoms. That is, to go from motor discharge to the elaboration of conflicts.

The origins and development of the Oedipus complex.

The universality of the Oedipus complex indicates that the oedipal situation is at the heart of the mental life of man. Usually, one finds oneself with two opposing situations, in reading the psychoanalytic literature published in the French-speaking countries and that of the English-speaking countries. Some people accuse psychoanalysts of 'oedipalization' of the study of the mental life and the behaviour of man. Others, such as the followers of Melanie Klein, consider the problem of relations with internal objects is there from the first year of life and imply a division between good and bad objects, followed by a split that dominates the mental life of man throughout his life. After several anthropological references, I have tried to study how clinical themes permit me to distinguish the approach to the Oedipus complex from the triangulation of object relations, and how the Oedipus complex today appears to find an outlet in the destiny and the vicissitudes of narcissism.