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Scientific journals : Article
Social & behavioral sciences, psychology : Treatment & clinical psychology
Hypothèse idiographique concernant la médiation cognitive à partir du Rorschach « non valide » d’un patient schizophrène en phase de stabilisation symptomatique
[en] Idiographic hypothesis about the cognitive mediation from an “invalid” Rorschach of a Schizophrenic patient in symptomatic stabilization
Englebert, Jérôme mailto [Université de Liège - ULiège > Département de personne et société > > >]
Evolution Psychiatrique
Yes (verified by ORBi)
[en] Psychosis ; Schizophrenia ; Rorschach (Comprehensive System) ; Projective test ; Cognitive mediation ; Psychotic symptomatology ; Clinical case ; Theorical study ; Cas clinique ; Étude Théorique
[fr] Psychose ; Schizophrénie ; Rorschach (Système Intégré) ; Test projectif ; Médiation cognitive ; Symptomatologie psychotique
[en] Introduction
The author recalls the setting for the Rorschach test meets the conditions of validity to be interpreted in accordance to the Comprehensive System. Since the work of JE Exner consensus is established to identify two categories of invalid protocols: the protocols collected from subjects who are temporarily in a serious state of disarray for contextual reasons and the brief protocols. Regarding the brief protocols, the rule is clear and precise: research findings indicate that the overwhelming majority of records of less than 14 responses will not have the level of reliability prerequisite to the assumption of interpretive validity. The test will be considered invalid if the subject does not give at least one answer to each of the cards.
For the presented protocol, it is not fair to detect any structural and psychopathology data. The author's hypothesis is to propose an unique and phenomenological study of the test and to formulate an hypothesis regarding the psychological functioning of the subject. The subject is a patient of 32 years old showing a paranoid schizophrenic disorder in symptomatic stabilization for six months. The patient receives a treatment with neuroleptics and follows therapy based on knowledge of the disorder and the recognition of associated symptoms. The patient's Rorschach is invalid (less than 14 answers and no response and 3 rejections of cards).

Protocol analysis
From the 10 responses, each perception is reviewed, either directly or during the inquiry. Finally, each answer was rejected by a perceptual justification that will give "evidence" to challenge the response ("but not a ... because ... ") or by a simple assertion ("because it does not look like", "it cannot be right" or "it's not that").
Cognitive mediation - the process between the information processing and ideation - can be analyzed in depth for this protocol. The cognitive mediation reflects the mental operations involved in the translation or the identification of the data collected. The process requires some reconciliation (mediation) between the image that has been stored and available items from the memory of the individual so as to accomplish the task of responding to the question "What might this be?". In this protocol, the cognitive mediation responds to a simple and repetitive logic which seems to reflect an idiosyncratic psychological functioning. In general, in the Rorschach’s situation, the subject must give a "wrong" answer because the only absolutely correct answer is "the inkblot". The Rorschach’s test requires that the person to "misperceive" the stimulus (to "violate reality"). For the protocol of this study, each response – each "false perception" - is systematically reviewed by the subject and ultimately rejected with contradictory perceptual justification or arguments unsophisticated.

Discussion and hypothesis
An idiographic hypothesis is formulated by the author from this tendency to systematic doubt. This means identifying, through this subject, the use of a form of "methodical doubt" in the cognitive mediation. This mechanism would fit in a paradoxical context that may reflect the state of the schizophrenic patient in a symptomatic stabilization situation. This hypothesis shows that the stabilization should not be confused with any remission or "cure" (suggesting a return to a previous state to psychosis). If the subject learns to explicitly doubting against ambiguous stimuli, it is hardly possible to tolerate a moderate degree of violation and therefore meet the paradigmatic principle of the Rorschach.
Finally, the analysis of the Rorschach’s test gives us an interesting information about symptomatic stabilization situation and residual component of the schizophrenic disorder. These observations appear to be incompatible with homeostatic hypothesis and demonstrate the usefulness of residual schizophrenia diagnosis. The rule of "misperception" if it is tolerable and implicit for the non-psychosis individual, it is intolerable and always explicitly questioned by our schizophrenic patients. The relation between implicit and explicit is a complexed dialectical conflict that seems to characterize the psychological functioning on a continuum showing schizophrenic subject and non-psychosis person.
[fr] Après avoir rediscuté les notions de protocoles « courts » et « non valides » au Rorschach selon le Système Intégré, l’auteur propose de réaliser une analyse du protocole d’un sujet schizophrène en phase de stabilisation. Le Rorschach présenté ne répond pas aux critères de validité (moins de 14 réponses et refus de planche à 3 reprises) et ne permet donc pas de réaliser une analyse structurale complète à portée psychopathologique. L’hypothèse de cette contribution est de réaliser une étude phénoménologique de ce protocole en centrant l’analyse sur le processus de médiation cognitive que le sujet semble employer de manière idiosyncrasique lorsqu’il est confronté à la consigne du test. La démarche implicite de « fausse perception » qui est suggérée au sujet (« qu’est-ce que cela pourrait-être ? ») semble difficilement tolérable et pourrait, en partie, expliquer les refus de planches mais aussi la remise en question systématique des réponses et finalement leur rejet lors de la phase d’administration ou lors de l’enquête. Le recours à ce « doute méthodique » est superposable aux exercices de remédiation cognitive basés sur la connaissance de la maladie et la reconnaissance des symptômes associés auxquels a été soumis le patient. Finalement, l’analyse du Rorschach nous donne des informations intéressantes sur la stabilisation symptomatologique de notre patient et sur la composante résiduelle de son trouble schizophrénique. Ces observations semblent incompatibles avec des hypothèses homéostatiques et la possibilité d’un retour à un état antérieur à la schizophrénie, et démontrent l’utilité du diagnostic de schizophrénie résiduelle.

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