Citation

Romano H, Baubet T, Moro MR, Sturm G. Ann. Med. Psychol. (Paris) 2008; 166(9): 702.

Copyright

(Copyright © 2008, Societe Medico-Psychologique, Publisher Elsevier Publishing)

DOI

10.1016/j.amp.2006.09.017

PMID

unavailable

Abstract

The authors work lies within the framework of medicopsychological emergency activities and of specialized consultation the vocation of which is to insure the care of victims of traumatic events that they be of a deliberate (violence, wars) or non-deliberate nature (natural disasters, accidents). Interventions led close to the events with grown-up victims are well organized nowadays whereas the specific coverage of children is still not envisaged in immediate interventions. Nevertheless, children may be affected as much as the adults by the trauma and can present disorders, which must be tracked down, estimated and taken care of. We propose a reflection on a symptom of reviviscence susceptible to be expressed by children victims of traumatic events: The post-traumatic game. We suggest envisaging the post-traumatic game as a clinical entity testifying of a symptom of reviviscence, which can express itself at three levels: The traumatic game, the abreactive game, the re-enactment. - 1 - The traumatic game: Rather than the 'post-traumatic' expression because in this activity the child is still in the trauma without being able to get free of it. The traumatic game is to be understood as a symptom situated close to reviviscence because the child 'plays' by repeating the traumatic scene, which was lived through, as a kind of automatic, repetitive and monotonous production that can become a real compulsion, without any decrease of the fear. This expression, to which no pleasure is attached, is due to the complete overwhelming of the mechanisms of defence, to the failure of the psychic devices in metabolising the influx of excitements, in the fixation of the psyche at the moment T of the trauma. The child, in a state of 'emotional petrifaction', is the prisoner of a deadly activity from which it cannot release itself. The traumatic game is a game in 'white'. - 2 - The abreactive game: This activity marks an evolution with regard to the traumatic game because here, the child is capable of developing it's scenario until some kind of end without being blocked in a compulsion of rehearsal of the trauma. Each rehearsal staged in the abreactive game is accompanied with feelings, thoughts, sensations and a physical recall of the initial state of distress but here the child succeeds in partially freeing itself of it and sometimes in avoiding suffering. The dimension of auxiliarity of the processes of symbolization is partially restored. The abreactive game has a dimension of emotional discharge, exorcizing the suffering and allowing the restoration of the capacity to support the processes of representation and symbolization. Contrary to the post-traumatic game, which testifies to the failure of any possibility of elaboration, the abreactive game authorizes the reorganization of the psychic contents and restores temporality: the child is not petrified in an instant T of the trauma any more but succeeds in reaching beyond in an 'after traumatic' mode. The child repeats with the same intensity and in an active mode, via the game, the trauma it experienced passively so as to succeed in mastering it. The abreactive game authorizes the reorganization of what it lived passively on an active mode so as to succeed in mastering it and this reproduction of the experience, by modifying its status, allows its assimilation. The abreactive game then allows the child to resume control over what it underwent and to assimilate its own reactions and feelings: Its mechanisms of defence are not overwhelmed any more: They are restored. - 3 - Re-enactment play such as defined by Terr is characterized by the expression a posteriori of traumatic traces through the game and by the investment of the child. This acting of the traumatism it lived through a posteriori intervenes while the child recovers a certain psychic balance. It is not an automatic rehearsal of the event in its global nature but only a rehearsal of certain aspects of the trauma. The child spends a period of intense stages of psychic suffering through certain activities and by recalling the ancient traumatic memories encrypted in its unconscious. The expression of the re-enactment does not present the rigidity of the traumatic game but is more difficult to track down. We shall then discuss the interest of observing the game for the diagnosis and for the understanding of the child's psychodynamique traumatic traces. These various modalities of expression show the intensity of 'the after-effect activity of the traumatism' and the underlying dynamic processes. They are to be understood as symptoms giving evidence of the persisting suffering in the symbolization of these traumatic traces. Distinguishing between the various meaningful activities of the child after a traumatic event offers us the possibility of observing the child to better estimate the impact of the trauma and to perceive if what he/she shows can likely or not play the role of 'psychic prosthesis' for certain psychic functions having failed due to the event. The distinction between these three post-traumatic expressions is still easy because the child can, on the basis of the same post-traumatic scenario, appeal to these various modalities of expression. This is particularly the case for the children victims of serious and repeated violence (sexual violence, war). We will discuss what it is in the traumatic game, in the abreactive game and in re-enactment, in the process at work in the passage from the passivity in front of the traumatic experience to the activity of the game that aims at cancelling the loss undergone and at retroactively giving meaning to the traumatic scene.

Language: fr