Psychiatrie au-delà du Rhin-I: obsessions et compulsions dans la psychiatrie de langue allemande

Résumé

La notion d’obsession s’est forgée lentement en France comme dans les pays germanophones. Mais elle a trouvé, dans ces derniers pays, un statut plus autonome qu’en France (notamment grâce à Westphal qui en a donné une description exemplaire en 1877). Après la description de celui-ci, l’amplitude symptomatique de l’obsession a considérablement varié, allant jusqu’à s’étendre aux sphères intellectuelles, émotionnelles et motrices. Les rapports avec d’autres maladies varient en fonction des auteurs. Considérée comme dépourvue de base émotionnelle par Westphal, d’autres auteurs trouvent l’obsession fondée sur l’angoisse; les rapports sont étroits avec la mélancolie, plus lâches avec la paranoïa et l’hystérie. Après les bouleversements nosologiques dus à Kraepelin, à Bleuler et à Freud, la question s’est posée des rapports de la « névrose obsessionnelle » avec la « folie maniacodépressive », la schizophrénie, les troubles de la personnalité. Ces problématiques conservent aujourd’hui encore leur acuité.

Abstract

The notion of obsession was built late in France. The same is true in German-speaking countries (first occurring in 1867). But obsessional disorders have kept a more autonomous nosographic position in these latter countries than in France, where obsession has long been connected with the idea of degeneration, which is not given emphasis in Germany. Mentioned for the first time by Krafft-Ebing in 1867 and by Griesinger in 1868, obsession (Zwangsvorstellung) has been the subject of an exemplary clinical description by Westphal, in 1877, who defined it as an autonomous pathology radically different to “paranoia” (Verrücktheit) and melancholia; according to him, obsessions never change into delusions. This field has varied considerably in its symptomatic area: some authors going so far as to introduce the idea of obsession, sensations, feelings, impulses, and actions; obsession, according to Löwenfeld, encompass the intellectual, emotional, and motor functional spheres. Other authors, notably Bumke, keep to a more strictly defined area, within the direction defined by Westphal. Fundamental emotional disorders are either rejected or identified with anxiety. Connections with other illnesses have given rise to a number of concepts. Considered autonomous by Westphal and Bumke, obsessional symptomatology has been thought of, by other authors as primary or secondary to other pathologies, originating in melancholia or changing into it. The nosographic position varies. Either obsession is considered an autonomous illness or it is connected to other pathologies (neurasthenia, degeneration, Verrücktheit). Connections with other illnesses are dominated by relationships to melancholia; connections to paranoia are much more problematic; those with hysteria are seldom mentioned. After setting up frameworks for manic-depressive psychosis and schizophrenia (Kraepelin, Bleuler) and for hysteric neurosis (Freud), the nosographic position of obsessions, which have become “obsessional neurosis”, varies according to these pathologies and becomes complex. Kraepelin has it as an anxiety disorder connected to phobias but links some obsessions with “manic-depressive insanity”. The followers of Kraepelin insist on the connection with manic-depressive illness. Bleuler connects the obsessions to schizophrenia-schizothymia. These relations between obsession and schizophrenia give rise to abundant literature. Their links are located at a psychopathological level (“Spaltung,” the defense, slowing down, repairing and recovery from schizophrenia), at a symptomatological level (pedantry-mannerism, schizophrenic autism-closed aspect of the obsessed, their motor disorders-catatonia), or at a clinical level (obsession-schizophrenia association). Obsessions are considered by other authors as personality disorders. Notably by Kretschmer (sensitive reaction) or by Schneider as a psychopathic personality: anancastics, second subgroup of the self uncertain psychopaths. As for the anthropological-existential point of view, it tackles the patient with obsessive disorders in his or her totality and analyses the transcendental constitution of his or her world.