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Approche psychodynamique et medicolegale de la mythomanie constitutionnelle  a propos d’une observation


, : Approche psychodynamique et medicolegale de la mythomanie constitutionnelle  a propos d’une observation.

La mythomanie constitutionnelle pose des probl mes diagnostique, tiopathog nique et m dicol gal pour le m decin. Nous avons discut ces aspects partir de l analyse d une observation. Il s agissait d un homme de 43ans, qui a t examin dans le cadre d une expertise p nale la suite de l mission de ch ques sans provision. l examen, il pr tendait tre, la fois, m decin et avocat. Il a t poursuivi dans plusieurs des affaires d escroquerie. Du point de vue psychodynamique, la mythomanie constitutionnelle entrerait dans le cadre des tats limites. Elle refl te une grande faille narcissique. La th orie de Maleval pourrait galement tre transpos e chez notre malade. Enfin, l attitude de notre patient, comme celles de certains psychotiques, pourrait cadrer avec la cr ation d un mythe personnel afin de r duire la fragmentation du Moi. Sur le plan m dicol gal, on pourrait a priori postuler que le mythomane per oit suffisamment la r alit pour tre consid r comme lucide au sens l gal. En fait, il ma trise avec peine la totalit de ses intentions, tant guid par un automatisme irr pressible qui fait de la mythomanie une maladie grave handicapante dont la premi re victime est le sujet lui-m me. Aucune mesure n est m me de l emp cher d enfreindre la loi, sauf, peut- tre, un contr le administratif permanent, ce qui n est pas sans poser de probl mes pratiques et thiques. Constitutional mythomania presents several diagnostic, aetiopathogenic and forensic problems for the doctor. We have discussed these aspects through the analysis of a case report. The case report relates to a 43 year-old man, who was subjected to a penal expertise following the emission of cheques without provision. During the examination, he pretended being both a doctor and a lawyer at the same time. He was in charge, among other things, of sale contracts dealing sometimes with high value transactions, obviously without following the required legal procedure. He was pursued subsequently for many other affairs of swindle. Data collected from his medical file indicated that he was the only boy of his family. Since his father had suffered from psychotic episodes, his grandfather had reared him; which he did it in a strictly religious way. He spent his childhood isolated. He was 15 years old when his grandfather died. He had then expressed religious and megalomaniac ideas that had motivated psychiatric management. Later on, he expressed imaginative ideas evoking unsystematized delusion (he pretended to have made a trip to America and to have seen a fish flying and turning into a woman). From a psychodynamic point of view, constitutional mythomania is considered as a borderline personality. It reflects an important narcissisic cleavage. The deceitfulness of the mythomaniac allows him to keep in touch with reality and to avoid mental disintegration. The recognition, by others, of these delusions allows the mythomaniac to have access to his proper level of existence. For a while, to the experts our patient appeared to be suffering from schizophrenia. Therefore, we can apply the Maleval theory to him, which identifies four periods as delusion structuring levels in psychosis : P (consequence of the phallic signification deficiency, it includes anxiety, annihilation, perplexity, interrogative attitude), P1 (stage of paranoid delusion), P2 (stage of paranoiac delusion) and P3 (ambitious stage evoking paraphrenia and squaring with mythomaniac behaviour). According to the Maleval theory, our patient would have experimented a repetitive cycle: he tried to escape instable and anxious positions (P, P1) by committing sacrificial acting out (offence), or by reaching stable positions which are P2 and P3. The mythomaniac behaviour would appear during the latest period. The delusional decompensation would indicate a return to the first two periods.

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