Modèle structural du polyhandicap, ou: Comment le polyhandicap vient-il aux enfants?

Abstract

A structural conception of the polyhandicap is presented in its synchronic and diachronic aspects. The notion of the diachronic structural gradient serves as a basis for a structural conception of the genesis of the polyhandicap. This is conceived to be the genesis of a structure of structures. The idea of what could be a sort of «generative grammar of the polyhandicap» is evoked : a combination of generative, elementary (etiological, neurological, neurophysiological) and psychodynamic units. This combination accompanies the interactive disturbances of primordial functions which are : the setting into place of the first cognitive competences, the capacity to organize sensations, the protective shield system and the alpha function. On one hand, these disturbances account for difficulties of emergence, of stabilization and of going beyond the capacity of proto-representation and, on the other hand, of a specific inability to experience the whole self as an entity and a specific precariousness of the experience of self. These developmental risks organize themselves in fundamental psychodynamic structures which are characteristic of the three prototypical forms of polyhandicap. The contents of these three forms of polyhandicap obey the principal of the somato-psychological hierarchy of structural complexity.