Psychology & Society

When Darkness Draws Us In: What Crime Stories Reveal About Us

There is something profoundly human in our fascination with crime novels, true‑crime series, and stories that venture into the darkest corners of the mind. We watch them late at night, sometimes to distract ourselves, sometimes to soothe ourselves, sometimes without knowing what we are really seeking. As if, by observing the unthinkable in another, we were trying to tame what remains opaque within us. Freud noted that crime, even in fiction, awakens archaic echoes. He wrote that human beings carry aggressive impulses they prefer not to acknowledge, and that fiction offers a safe space to approach them. Lacan later insisted that acting out emerges where speech fails, where the subject can no longer find an address for their suffering. Perhaps this is what fascinates us: the attempt to understand what, in another, broke the symbolic thread. In crime stories, the act is never just an act. It is an enigma. An enigma that reassures us because it promises resolution. An enigma that soothes us because it stages what we fear without forcing us to live it. An enigma that allows us to look at human violence from a distance, as if through glass. Reality is never so clear. During my work contributing to psychiatric assessments at the Infirmerie Psychiatrique de la Préfecture de Police at Sainte‑Anne in Paris, I encountered acts that arrived raw, unfiltered, sometimes terrifying. And yet, even there, something was trying to speak. It is in such places that the legacy of De Clérambault becomes strikingly alive. Working at Sainte‑Anne himself, he described with almost surgical precision the mechanisms of delusion, mental automatisms, and inner compulsions. He showed that behind even the most bewildering act lies a logic, an internal coherence, a psychic necessity. This is not justification. It is an attempt to understand what, in the subject’s economy, made the unthinkable possible. The role of the psychiatric or psychological expert is not to judge. It is to illuminate. To understand what, in a subject’s history, in their psychic structure, in their collapses, made an unthinkable act possible. Bénézech, in his work on forensic psychiatry, reminded us that expertise is neither defense nor accusation, but perspective. It situates the act within a trajectory, a delusion, a disorganization, a fracture. In several trials, expert testimony has been decisive. It has distinguished a psychotic break from deliberate intent. It has revealed the mental disorganization of someone who, at the time of the act, no longer had access to reality. It has shown that a violent gesture was sometimes the last attempt to escape an internal collapse. Where the press speaks of monsters, expertise speaks of structure, delusion, fragmentation, desubjectivation. Where media narratives simplify, expertise complicates. Irvin Yalom wrote that understanding is not forgiving, but understanding soothes. Perhaps this is what we seek in crime stories: a form of soothing. A way to look at human violence without being swallowed by it. A way to believe that the enigma can be solved, that chaos can be ordered, that meaning can be found. In real life, meaning is never given. It is built. It is searched for. It is worked through. The expert does not deliver an absolute truth. They offer a reading, a hypothesis, a perspective. They attempt to restore to the subject a part of their humanity, even where the act seems to have erased it. Perhaps we love crime stories because they offer a bearable version of this work. A version where the investigation ends, where the culprit is identified, where truth can be grasped. A version where we can close the book or turn off the screen believing order has been restored. Life is never so simple. But that is precisely why clinical work exists: to welcome what cannot be resolved in forty‑five minutes, to hear what cannot be said, to illuminate what remains obscure. To remind us that behind every act, even the most unthinkable, there is a subject, a history, a wound, a fracture. And perhaps that is what draws us so deeply to crime stories: the possibility of looking at the shadow without losing ourselves in it. The possibility of understanding, just a little more, what in each of us still seeks a form of light. REFERENCES  Bénézech, M. (2004). Legal Psychiatry and Criminology. Paris: Masson. De Clérambault, G.-G. (1942). Psychiatric Works. Paris: PUF. Freud, S. (1916/2010). Introductory Lectures on Psychoanalysis. New York: Norton. Lacan, J. (1955/2013). The Seminar, Book III: The Psychoses. New York: Norton. Lacan, J. (1966). Écrits. London: Routledge. Racamier, P.-C. (1992). The Genius of Origins. Paris: Payot. Yalom, I. D. (1989). Love’s Executioner. New York: Basic Books.

The Fart as a Language of the Body: Between Psychoanalysis, Culture, and Everyday Clinical Practice

Sometimes it’s helpful to shift our gaze toward the most ordinary gestures to better understand the invisible dynamics that shape us. Observing behavioral differences between ourselves and others—and the internal tension this can provoke—can become an opportunity for learning and introspection. What we perceive as discomfort or provocation, such as a simple fart, may in fact reflect our personal history, our inner state, and that of others. Exploring this interaction, even in its triviality, helps us better situate ourselves in relation to others and opens the door to a form of everyday clinical practice, where the body speaks as much as words do. Claude Lévi-Strauss, in his work on rites and symbolic structures, did not address farting directly, but his analyses allow us to consider this act as meaningful within cultural systems. In The Way of the Masks and Mythologiques, he shows how fundamental oppositions—pure/impure, nature/culture, visible/invisible—are expressed through codified bodily practices. The fart, as an invisible yet perceptible emission, could be read as a reversal of polarity between inside and outside, between the hidden and the revealed, between the private and the social. Lévi-Strauss emphasized that rites and myths reflect universal mental structures, and that bodily practices, even the most trivial, participate in this organization of meaning. In some cultures, farting is integrated into social life without particular shame. In Papua New Guinea, it may be part of ritual games or informal communication. In rural China, public toilets are sometimes doorless, and it’s common to see children defecating in public, wearing split pants with an opening at the crotch. This practice, linked to natural infant hygiene, shows that bodily emissions are not necessarily taboo in these contexts. Bodily sounds are not systematically repressed, unlike in Japan, where toilets are often equipped with sound-masking devices that play music or water sounds to conceal bodily noises. This technology reflects a deep-seated social discomfort, especially among women, and a desire to preserve modesty and bodily control in public spaces by erasing any audible trace of intimacy. From the perspective of clinical psychology and psychoanalysis, farting can be read as an expression of internal conflict, psychic defenses, and modes of expressing discomfort. Freud identified the anal phase as central to the development of the relationship to the body, authority, and control. Farting, as an uncontrolled expulsion, can be a failed act, a discharge of instinctual energy, or a passive provocation. It may express an unconscious conflict between the desire to transgress and the social prohibition. Wilhelm Reich, in his character analysis, saw bodily relaxation as a release of muscular defenses, allowing repressed affects to surface. Farting can thus function as a defense against anxiety, a way to regulate internal tension without using language. Jacques Lacan, although he did not address farting directly, considered the body as a surface of jouissance and language. The fart can then be seen as an involuntary signifier, a rupture of the symbolic order, a bodily event that disrupts discourse. It can also be interpreted as disinhibition, reflecting a loosening of internalized norms, or regression to earlier developmental stages. In romantic relationships, it may signal a break in the seduction pact, a trivialization of the body, or even neglect of the emotional bond. The odor it emits evokes a primary, archaic olfactory trace that allows the subject to feel they exist—for themselves and for others. It conjures fecal matter, rejection, animality, but also proximity and intimacy. It can awaken family memories, childhood atmospheres, domestic practices. Some patients in therapy describe families where farting was common, tolerated, even joked about. Others recall environments where any bodily sound was repressed and associated with shame. The fart then becomes a symptom: it speaks of the subject’s history, their relationship to the body, to law, to desire. Even cinema has taken up this sound. In The Nutty Professor (1996), Eddie Murphy plays an entire family farting at the dinner table in a burlesque scene that became iconic. Beneath the humor, one can read a collective disinhibition, a transgression of social norms, and a portrayal of the body as a site of pleasure and chaos. To propose a new perspective on farting is to take a step sideways. It’s to consider that it can be an object of analysis within an everyday clinical framework, where the most banal gestures become carriers of meaning. This reflection invites us to listen to the body in its most trivial yet revealing expressions. And what if, in the end, it’s not the subject who speaks… but the fart that takes the floor? A breath from deep within, saying what the mouth cannot, asserting itself where language hesitates. Because sometimes, in the silence of social conventions, it’s the most unexpected sound that lets the unconscious be heard. References Freud, S. (1901). The Psychopathology of Everyday Life. Paris: PUF. Freud, S. (1905). Three Essays on the Theory of Sexuality. Paris: Gallimard. Reich, W. (1933). Character Analysis. Paris: Payot. Lacan, J. (1966). Écrits. Paris: Seuil. Lévi-Strauss, C. (1979). The Way of the Masks. Paris: Plon. Lévi-Strauss, C. (1964–1971). Mythologiques (4 volumes). Paris: Plon. Shadyac, T. (Director). (1996). The Nutty Professor [Film]. Universal Pictures.

The Louvre Theft: A Silent Address

Sometimes an external event, almost unreal, sheds light on our most intimate questions. This autumn, the announcement of a jewel theft at the Louvre rippled through the public space like a bright wave: the French crown, its stones, its brilliance, gone like a bird we believed too heavy to fly. People were moved, amused, incredulous. It was as if a star had been removed from the sky: everyone thought it immutable, and suddenly it was no longer there. Such events remind us that theft is never a simple act. It touches value, lack, debt, filiation — the very fabric of what constitutes us. It speaks of the one who takes, but also of the one from whom something is taken. Theft can take multiple forms. There are trivial, compulsive thefts where the object has no importance: a pen, a shawl, a lighter. In kleptomania, the object is merely a pretext, a fleeting relief of inner tension — what Winnicott might have described as a desperate attempt to restore a sense of continuity of being. At the opposite end, grandiose thefts target symbols: diamonds, crowns, works of art. As if the coveted object carried a promise of narcissistic repair, a way to rise to the height of a lost ideal. Stealing a symbol is sometimes an attempt to appropriate an inner power that feels missing. Racamier would have seen in it a struggle against the “geniuses of origins” haunting certain subjects. There are also everyday micro-transgressions: skipping a metro fare, cutting in line, cheating on a subscription. What matters is not the money saved but the feeling of escaping a constraint perceived as arbitrary. Large-scale frauds — Madoff being the archetype — belong to another register: a megalomaniac staging. Green would have called it an extreme form of the “work of the negative”: destroying links, erasing debts, constituting oneself as absolute origin. And then there are survival thefts: stealing to eat, to make it to the end of the month. Here, the act is not a challenge to the law but an attempt to preserve life. Dolto would say the subject seeks to maintain minimal narcissistic integrity. Looting during riots or natural disasters — such as after Hurricane Katrina — belongs to yet another dynamic: group-based, archaic. The crowd becomes a single organism driven by survival, vengeance, or symbolic reappropriation. Contrary to common belief, a child’s theft is not a miniature version of adult theft. It does not predict delinquency or pathology. It is often a language — a gesture speaking where words are still too fragile. Between four and seven, stealing can be a way of exploring boundaries: testing the line between “mine” and “not mine.” Around seven or eight, theft may seek attention. A little girl who takes a pen from her teacher is not seeking the object; she is seeking the teacher. Later, theft may repair a narcissistic wound. A ten-year-old boy who steals Pokémon cards from a classmate is not seeking transgression; he is seeking to feel “like the others.” In clinical practice, some children quietly take an object from the therapy room. Winnicott would have spoken of a transitional object — a bridge between two worlds. We often forget the other side of theft: the one who is stolen from. Being stolen from is experiencing a sudden lack, an intrusion, a breach in psychic continuity. I think of Maya, a patient whose father’s watch and two rings were stolen days after his death. The objects represented a link, a memory, a filiation. The theft reopened an older wound: the wound of losing again. Whether spectacular like a jewel or discreet like a pen, theft always raises a question: what is this gesture trying to say, and to whom. Behind every stolen object lies a story, a lack, a desire, an address. In the end, theft speaks of the fragility of bonds, of the circulation of objects and affects, of what is transmitted and what is lost. Perhaps this is the silent lesson of the vanished crown: objects shine, but it is the stories they carry that illuminate us. References  Dolto, F. (1985). Lorsque l’enfant paraît. Gallimard. Green, A. (1993). Le travail du négatif. Minuit. Racamier, P.-C. (1992). Le génie des origines. Payot. Winnicott, D. W. (1971). Playing and Reality. Tavistock Publications.

When the Night Looks Back at Us: What Serial Killers Reveal About Our Imaginary

There is something unsettling and profoundly human in our fascination with serial killers. We observe them through documentaries, series, and podcasts, as if trying to understand what, in them, has tipped over. As if, by approaching the extreme, we were attempting to grasp our own shadows more clearly. It is not raw violence that draws us in, but the enigma. The enigma of a subject who crosses a boundary we will never cross, yet whose transgression questions us despite ourselves. Freud reminded us that human beings carry within them aggressive impulses they prefer not to acknowledge. The figure of the serial killer, in its radicality, becomes a distorted mirror: it allows us to look at human violence without being swallowed by it. Lacan wrote that acting out emerges where speech fails, where the subject can no longer find an address for their suffering. In this perspective, the serial killer is not a monster but a subject whose symbolic thread has long since broken. In crime narratives, what fascinates us is not the act itself but the repetition. Repetition as a desperate attempt to master an anxiety, to seal a psychic breach, to replay an inner scene that refuses to fade. De Clérambault, at Sainte‑Anne Hospital, described with almost surgical precision these mechanisms of mental automatism, these inner compulsions that can drive a subject to act under the pressure of a psychic necessity that exceeds them. He showed that behind horror lies a logic, an internal coherence, an economy of delirium. During my own work contributing to psychiatric assessments at the Psychiatric Infirmary of the Paris Police Prefecture (Infirmerie Psychiatrique de la Préfecture de Police) within Sainte‑Anne Hospital, I encountered acts that arrived raw, unfiltered, sometimes terrifying. And yet, even there, something was trying to speak. Forensic psychiatric expertise does not aim to excuse. It aims to understand. To situate the act within a trajectory, a structure, a fracture. Bénézech, in his work on forensic psychiatry, emphasized that expertise is neither defense nor accusation, but perspective. It allows us to distinguish psychotic violence from perverse violence, mental disorganization from structured intentionality. In certain trials, this distinction has been decisive. It has revealed that a subject, at the time of the act, no longer had access to reality, or that they acted under the grip of a delusion that held them captive. Where the press speaks of monsters, expertise speaks of structure, delirium, fragmentation, desubjectivation. What fascinates us in serial killers is not cruelty. It is the attempt to understand what, in another, has broken. It is the possibility of approaching the unthinkable without losing ourselves in it. It is the promise—perhaps illusory—that the enigma can be solved. That chaos can be ordered. That meaning can be found. In reality, meaning is never given. It is built. It is searched for. It is worked through. The expert does not deliver an absolute truth. They offer a reading, a hypothesis, a perspective. They attempt to restore to the subject a part of their humanity, even where the act seems to have erased it. Perhaps we are drawn to stories of serial killers because they offer a bearable version of this work. A version where the investigation progresses, where clues align, where truth can be grasped. A version where we can close the book or turn off the screen believing that order has been restored. Life is never so simple. But that is precisely why clinical work exists: to welcome what cannot be resolved, to hear what cannot be said, to illuminate what remains obscure. To remind us that behind every act, even the most unthinkable, there is a subject, a history, a wound, a fracture. And perhaps that is what draws us so deeply to these narratives: the possibility of looking at the night without being consumed by it. The possibility of understanding, just a little more, what in each of us still seeks a form of light. REFERENCES  Bénézech, M. (2004). Legal Psychiatry and Criminology. Paris: Masson. De Clérambault, G.-G. (1942). Psychiatric Works. Paris: PUF. Freud, S. (1916/2010). Introductory Lectures on Psychoanalysis. New York: Norton. Lacan, J. (1955/2013). The Seminar, Book III: The Psychoses. New York: Norton. Lacan, J. (1966). Écrits. London: Routledge. Racamier, P.-C. (1992). The Genius of Origins. Paris: Payot. Yalom, I. D. (1989). Love’s Executioner. New York: Basic Books.

Inner Space: Mental Health and Subjectivity in Orbit

A long time ago, in a galaxy not so far away, men and women left Earth to explore the edges of the cosmos. But in the silence of the capsules, where outer space meets inner emptiness, another journey begins: that of the psyche in weightlessness. Since 2023, I have been conducting research on the psychological effects of extreme confined environments, in collaboration with Université Paris Cité. This emerging clinical field draws on psychology, psychiatry, psychoanalysis, and neuroscience. Extreme environments and confined isolation This field concerns astronauts, but also submariners, solo sailors, and researchers isolated in polar stations — such as those at Dome C in Antarctica, where a single habitation shelters teams for several months in near-permanent darkness. These situations share a common structure: isolation, close quarters, disruption of sensory and social reference points, and the need to maintain function within a constrained setting. Research conducted by NASA, ESA, and the Canadian Space Agency shows that prolonged orbital flights carry increased risks of psychological disorders: anxiety, depression, irritability, sleep disturbances, interpersonal tensions. A comparative study suggests that orbital missions — particularly aboard the International Space Station — generate more psychological complications than stays on lunar or planetary bases, where gravitational and environmental reference points are partially restored. Microgravity and floating identity Microgravity affects the body, but also the sense of identity. The floating subject, deprived of verticality, experiences altered sensory and symbolic reference points. The 90-minute day/night cycle aboard the International Space Station disrupts circadian rhythms, impacting mood and concentration. Living with three or four people for two years aboard a Mars-bound shuttle requires stable relational dynamics, emotional regulation, conflict negotiation, and cohesion without fusion. Selecting profiles is not enough: it's their arrangement, compatibility, and relational plasticity that matter. Remote connection and terrestrial families On a Martian mission, the communication delay between Earth and the shuttle is estimated at 25 minutes. Such temporal lag makes emotional exchanges difficult, even frustrating. Studies in space psychology show that this type of communication alters the sense of presence, increases loneliness, and can affect emotional stability. Psychoanalytic contributions and symbolic anchoring Psychoanalysis offers valuable tools. It invites us to consider space as a mirror of inner space: what we project into the stars is also what we flee or seek within ourselves. By symbolic anchor, I mean the psychic function that Earth plays as a stable reference point — an imaginal matrix, a place of origin and return. In orbit, this anchor dissolves. This loss can provoke deep disorientation, an altered sense of existence, even an identity crisis. Clinical analogy: birth and separation A clinical analogy can be made with the infant's passage from intrauterine life to birth. At birth, the reference disappears abruptly — the infant must breathe, regulate temperature, seek the breast, adjust to a world that no longer contains them in a fused way. Similarly, the astronaut in orbit loses their "terrestrial placenta." They must reinvent forms of psychic continuity in an environment that no longer naturally contains them. How to maintain an inner Earth when the body floats, when time dilates, when connection diffracts? Cultural metaphors and psychic care In Star Trek: The Next Generation, the character of Deanna Troi, counselor aboard the Enterprise, embodies this psychic function within the crew. In the episode "The Loss," she suddenly loses her empathic abilities — a metaphor for burnout, loss of meaning, and the need to redefine oneself beyond function. These fictional figures reflect a collective intuition that space exploration cannot proceed without psychic care. Outer space becomes the stage for inner emptiness — and sometimes, its traversal.

Marie Nussbaum
01 Sep, 2025

Culture, Ritual and Healing

Through a transcultural and psychoanalytic lens, this article explores how collective rituals can serve as therapeutic frameworks for processing trauma. Drawing on diverse cultural examples — from Congo Square in New Orleans to Siberian shamanic ceremonies — it argues that psychological healing is not confined to clinical settings. It can emerge in shared cultural spaces where body, speech, and community are activated together. Introduction In his documentary When the Levees Broke (2006), Spike Lee captures not only the devastation caused by Hurricane Katrina, but also the invisible wound left by institutional abandonment. Through testimonies, music, and gatherings, he shows how culture becomes a space for memory, resistance, and healing. This cinematic gesture reveals a fundamental truth: healing is not limited to the individual. It is cultural, communal, and at times sacred. Congo Square: A Model of Community-Based Healing Congo Square in New Orleans is a historic site where freed slaves gathered every Sunday from the 18th century onward to dance, sing, and practice African rituals. These weekly gatherings preserved cultural memory while transforming suffering into symbolic expression. Congo Square can be viewed as a genuine community-based therapeutic space, where movement, rhythm, and collective presence allow emotions to be expressed and processed. It functions as a shared psychic stage, much like the ancient Greek theater, where emotions are experienced, externalized, and transformed. Other Rituals of Healing Saintes-Maries-de-la-Mer: Pilgrimage and Identity Each year, travelling communities — Roma, Gitans, Manouches — gather in Camargue to honour Saint Sara the Black. The procession to the sea, accompanied by music and dance, is a ritual of familial transmission and communal recognition. Though often marginalised in public discourse, this pilgrimage offers a powerful symbolic framework for reworking internal conflicts through collective ritual. Durga Puja in India: Feminine Power and Social Cohesion In India, the Durga Puja festival celebrates the goddess Durga, a figure of strength and protection. Processions, dances, and communal rituals reaffirm social bonds, especially in regions affected by violence or disaster. The ritual becomes a space of transformation, where trauma is narrated, shared, and symbolized through protective archetypes. Siberian Shamanic Ceremonies: Healing Through Symbolic Journey Among Indigenous peoples of Siberia, shamanic rituals are used to restore psychic and social balance. The shaman enters trance to communicate with spirits and reestablish harmony after traumatic events. These ceremonies allow chaos to be symbolized and reintegrate the subject into a cosmic and communal order. Native American Talking Circles and Sweat Lodges Indigenous communities in North America practise talking circles and sweat lodges as rituals of purification and healing. These practices offer a structured space for narrating trauma, where body, speech, and group are engaged together. Greek Theater: A Foundational Model of Catharsis Aristotle defines tragedy as the imitation of actions that evoke pity and fear, leading to catharsis — a purification of emotions. Ancient Greek theater provided a collective space where spectators could experience intense emotions through tragic heroes, within an aesthetic and ritualized framework. This therapeutic function of classical drama anticipates modern communal healing practices. Culture as Therapeutic Mediation As Marie-Rose Moro emphasises, culture is a therapeutic resource. It allows the subject to be understood within their context, history, and affiliations. It offers symbolic mediations where verbal language may fall short. In transcultural clinical practice, the therapist becomes a mediator of connection, a guardian of structure, and a witness to narrative. Culture, Healing, and the Commons Informal and community-based healing rituals represent a form of resistance to the privatisation of connection and the fragmentation of meaning. They affirm that psychological healing cannot be separated from the cultural and social fabric in which it is embedded. In the face of trauma, collective ritual acts as a stage for catharsis. Whether at Congo Square, Saintes-Maries-de-la-Mer, Durga Puja, or in sweat lodges, these practices show that healing is also a matter of culture, memory, and connection — and as such, it must not be reduced to a commodity or economic transaction.

Parent in Residential Care Facility

The admission of a parent into a Residential Care Facility for Dependent Elderly People (EHPAD) can act as a catalyst in family dynamics. Sibling relationships undergo reevaluation. The responsibilities surrounding elder care — including emotional management and major decisions — can intensify existing family tensions or generate new conflicts. Aging is a natural process, but it is often accompanied by loss of autonomy and the need for appropriate care. When home-based support becomes insufficient, facility placement emerges as a necessary option, though it creates emotional turbulence involving guilt, grief, and occasionally relief. Guilt and the Decision to Place The decision to place a parent in a facility frequently generates guilt. Therapeutic intervention helps families clarify motivations, examine alternatives, and accept their choice with compassion. Psychological support proves invaluable during this demanding transition. The therapeutic approach involves: thorough assessment of each family's circumstances; clear, empathetic communication about admission necessity; creating non-judgemental spaces for expressing intense, often contradictory emotions; and validating feelings as foundational relief work. Anxieties of Transformation "The parent's transfer to the facility can raise deep anxieties related to the fear of no longer recognising one's parent." This transition also prompts adult children to contemplate their own mortality and reassess parent-child relationships. Therapists additionally guide relatives in preparing meaningful conversations with their parent entering the facility, facilitating connection during this significant life stage.

The Obligation of Care in France

In France, the obligation of care is a legal measure that requires an individual to undergo medical or psychological treatment, often as part of a judicial decision. This mandate, outlined in Article 132-45 of the Penal Code, can be imposed before or after a trial and applies to various conditions, particularly psychiatric disorders or addictions. But what does this obligation represent for the therapist welcoming such a patient into their private practice? And more importantly, can someone truly be treated if they are forced to be there? Statistics and Context In 2023, healthcare spending in France reached €325 billion, with a notable increase in outpatient care. However, psychiatric institutions are struggling to meet the growing demand, leaving many patients under an obligation of care to turn to private practitioners. These patients often arrive with a phrase heavy with meaning: "I'm obliged to be here." The Ethical and Therapeutic Challenge The obligation of care raises a fundamental question: can someone truly heal if they are not there by choice? The answer lies in the art of transforming this constraint into an opportunity. The therapist must welcome the patient without judgement, acknowledging the obligation while creating a space for dialogue. The goal is to evolve the obligation into a felt need, and ultimately into an active request for care. The philosopher Emmanuel Levinas, in his ethics of responsibility, reminds us that "welcoming another should be done without preconditions, respecting their individuality." This approach is mirrored in clinical practice: it is about deciphering what the obligation reveals about the patient — their resistances as well as their unspoken needs. From Obligation to Need: A Pathway One of the challenges of mental health conditions is that the individual often does not perceive themselves as being unwell. The law may enforce treatment, not for their benefit, but for the impact it could have on others. The therapist's role is to refocus care on the patient, addressing their own need for healing. Actor Robert Downey Jr., mandated by the courts to undergo treatment for his addictions, provides a well-known example of how an initially imposed pathway can become a personal journey of rehabilitation — demonstrating how obligation can be transformed into a process of self-betterment. Legal and Ethical Considerations The obligation of care brings forth complex issues:Respect for Individual Freedom: A mandated medical intervention can be perceived as an infringement on fundamental rights. Collective Responsibility: The measure aims to protect society, but the therapist must ensure the patient is not reduced to merely a "case to be managed." Professional Confidentiality: Practitioners often navigate between judicial requirements and the medical confidentiality owed to the patient.Conclusion: The Art of Therapy Under Constraint Transforming an obligation into a voluntary process is both a challenge and an opportunity. By welcoming the patient with compassion and working on the meaning of this constraint, therapists can help them progress toward an authentic request for care. As Carl Rogers once said, "The curious paradox is that when I accept myself just as I am, then I can change." The obligation of care, far from being an obstacle, can become a lever to uncover a deeply buried need. This is the art of therapy: turning constraint into openness, and obligation into suggestion.

Marie Nussbaum
01 Jun, 2024

Overcoming What?

As caregivers, can we truly talk about fighting against a disease or an emotion? Often, we hear or see posters using this term in the context of battling autism, cystic fibrosis, cancer, or diabetes. On a smaller scale, we hear it in speeches addressing fears or loneliness. Does this warrior-like language not contribute to a dichotomous view of the world, dividing the strong and the weak, the winners and the losers, the survivors and the deceased? Can such rhetoric imprison illness or emotion in a binary narrative, where those who succumb are perceived as having fought poorly? It would imply that courage can be measured, endurance quantified, and that death, in the most severe cases, represents failure. The inability to overcome one's fears or loneliness would then be solely attributed to the individual, without considering their context, history, and what their symptom reveals. For example, must cancer or diabetes only be perceived as a war against an external adversary seeking to annihilate the patient? Could it also represent a part of oneself that has gone astray, a defect within oneself? Naturally, this does not mean one should submit to it, but it is important to view this transformation for what it is: a brutal upheaval that requires reevaluation. The real question would be to think of the symptom as something that does not define the person in their entirety, but as a testimony, a call initiating questioning. It would then be a matter of knowing how to coexist with this part of oneself in imbalance while continuing to move forward. Are illness or emotion immutable, or can health and well-being be reimagined otherwise? Not as a return to the previous state, but as a newfound serenity, a capacity to face uncertainty without being entirely defined by it. Health then becomes a way of being, a balance that does not depend on organic or emotional perfection but on the calmness of the mind and faith in the future — or at least giving meaning to something that sometimes appears abruptly in our lives. Illness often represents to our patient a defect of something, a sudden rupture in the natural course of events, a crack in our daily sense of security. It destroys our illusion of constancy and confronts us with a reality that sometimes defies initial logic. However, at the heart of what may seem like absurdity, there lies a freedom: the freedom to determine how to live with this new reality, to understand it in order to move forward. These trials and upheavals do not define us. It is essential to delve into the details of life, to linger on those suspended moments where everything changes silently. After the collapse, one learns to walk towards oneself again, sometimes with the slowness of those who relearn or discover something intimate — to come out stronger. Thus, without being a victory, it becomes part of an affirmed and meaningful life story.