Hibon, Antoine <br/><br/>
Towards an Analytical Pedo-psychiatry with Imprisoned Minors 

 -  2005.<br/>							 
<br/><br/> 100 
<br/><br/> This paper presents and supports a research-action conducted for two years by a team of analytical pedo-psychiatrists at the “Quartier des mineurs” (areas for minors) of the Aix-en-Province prison (cohort size: 33 adolescents). This team claims to have assembled the significant elements required to state that it is possible to build a potentially therapeutic relation with almost all of the imprisoned adolescents. It argues that such an approach requires a given deontological and technical method structured on the independence of the sanitary with respect to the judiciary-penitentiary complex. We can also read this paper from a public health angle if we focus on the often broken stories of these adolescents, their issues with subjectivation, the dangers they are exposed to and exposed others to, and their reticence concerning seeing a psychiatrist out of the prison context. The author describes the material context of the work of the team. Encounters are made at the very areas of detention which are close to the adolescents and other adults involved (superintendents and teachers especially). This framework makes it possible for group transferences to be made from the adolescents to the psychiatrists, and for counter-transference to occur from the psychiatrists to the delinquent adolescents. In contradiction, this proximity that eases encounters also makes them difficult in terms of their feasibility, since it excites the various levels of conflict between the pedo-psychiatric team and the penitentiary administration which can be pinpointed and dealt with. This material framework is the basis for an extensive approach (almost all) to the imprisoned adolescents. This possibility of an extensive approach and its therapeutic potential was verified by the team at some stage of the research. This is reported in two clinical vignettes which are important in that they concern adolescents with whom contact is difficult and whose psychic functioning is difficult to penetrate. Two limits of the extensive approach are studied. The first is related to Winnicott’s theory of “antisocial tendency”: an increase in the population of the “Quartier des mineurs” (beyond a threshold of 20–25 adolescents) leads to a sort of abandonment of adolescents who used to receive sufficiently continuous care, and this abandonment can lead to a resurgence of antisocial tendencies. The team therefore has to function below what it knows to be possible and desirable, while waiting to be granted extra means by unsupportive supervisory authorities. The strange opening up to the other by imprisoned adolescents, most of whom often vehemently refuse to meet psychiatrists in the open, is explained by what the author calls the “healing side of prison.” This healing side follows a meta-psychological model in which items follow each other in an ideal type: reintroduction of the real dimension through arrest-imprisonment; clash with a robust, external excitement-blocking state force; reduction of unconscious guilt by the lived experience of the sanction; de facto triangulation of the mother-son relationship by the justice and the penitentiary administration; replacement of neglect and abuse with the positive side of supervision and authority. A series of clinical vignettes supports each of these items. One vignette shows the absolute limit of the model, that in which prison is not tolerated, especially due to a feeling of unbearable loss. The relative limits of the model (that can be reformed) are mentioned. The author is opposed to the catastrophist depiction by abolitionists (those opposed to prison for minors) due to the global experience the team has of the evolutions of imprisoned adolescents and their experiences. The exposé of the deontological-technical methodology of the team is preceded by a close analysis of sanitary, penitentiary, and judicial protection of youth literature concerning what is commonly called multi-disciplinarity in the “Quartiers des mineurs.” The author shows that these texts and their resulting practices (which are actually mono-disciplinary) are anti-deontological and anti-subjective; he highlights the subjectivizing importance of a method which offers the adolescent a high level of guarantee of the confidentiality of exchanges, their actual involvement in any contact between the team of pedo-psychiatrists and those they deal with. The common idea of the need for indispensable mediators for psychiatrists approaching these adolescents is thus relativized. The team has great confidence in the therapeutic couple (or at least binomial), which guarantees a better transference and counter-transference relation than the dual relation. The central hypothesis is that this couple functions like an attractor-reorganizer of elements of the “primitive stage” which were so chaotic or violent that the patient had to break away or give up. A clinical example shows this technique at work in the light of its increasing use in the difficult adolescent one year after incarceration. Research-action perspectives are developed. The position of the team is specified with respect to the new situation characterized by the continuous presence of “Youth Judicial Protection” educators in the “Quartiers de mineurs.” An important notes mechanism provides the main theoretical references of the approach and permits clinical and meta-psychological developments. The author and his team are conscious of the fact that juvenile delinquencies and their treatment are the subject of socio-political constructions, relayed by the media, which weigh heavily on practices. This notes mechanism also permits the reader to get acquainted with the context, the current trend of “all prison” totally contrary to a measured approach which must tackle the unacceptable lack of funding for extra-institutional activity while at the same time improving the functioning of existing “Quartiers des mineurs .” The history of the treatment of juvenile delinquents has shown that any quick move in one direction was often followed by counter arguments.