M, Touraine P (eds): Transition of Care: From Childhood to Adulthood in Endocrinology, Gynecology, and Diabetes. Endocr Dev. Basel, Karger, 2018, vol 33, pp 10–16 (DOI: 10.1159/000487522)
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“Child-Adult” Transition – Adolescence: When Illness Appears…
Sabine Malivoira, b, d · Karinne Guenichec, e
aReference Centre for Rare Endocrine Growth Disorders, Hôpital Robert-Debré and Hôpital Pitié-Salpêtrière, bEcole des Psychologues Praticiens, and cReference Centre for Rare Endocrine and Gynaecological Disorders, Hôpital Universitaire Necker Enfants Malades, Paris, dHealth Education Laboratory, UFR SMBH, Paris 13 University, Bobigny, and eClinical Psychology and Psychopathology Laboratory, EA 4056, Paris Descartes University, Boulogne-Billancourt, France
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Abstract
Considering the patient’s transition from child to adolescent to adult and its psychological aspects in endocrinology and diabetology, it is necessary to recall the child’s psycho-affective development when he enters adolescence. Indeed, adolescence appears paradigmatic of the “child-adult” transition; it is a specific and decisive psychic process which allows the child to become an adult, that is to say autonomous and subject to his desire. In our paper, we study the resonance of a chronic disease in young people; type 1 diabetes is chosen.
© 2018 S. Karger AG, Basel
Perhaps talking about the psychological aspects of patients monitored using endocrinology and diabetology who are embarking on the “child-adolescent-adult” transition principally means remembering that it is a matter of the psycho-emotional development of the child as they enter adolescence. We actually see adolescence as a paradigm of the child’s transition to adulthood, in so far as it is a required and necessary passage that the child has to go through to become an adult, i.e. independent and with their own free will. It also involves assessing what “being pubescent” means psychologically in order to consider a suitable multidisciplinary support for the young person. In fact, we now know indisputably that adolescence is a specific and decisive process in child development. All too frequently called a “crisis,” adolescence is as worrying for young people themselves as for their families. Here we must not think only of the negative signs of opposition and sometimes verbal abuse. The crisis should be understood as the end of a way of functioning that has become ineffective in the situations to be faced. The normal reference points disappear and simultaneously give way to the anxiety of loss and an active search for new foundations. After describing the psychological changes that drive the child’s development to adulthood, we will consider the resonance of the presence of a chronic illness in the young person by taking the example of type 1 diabetes.
Psycho-Emotional Development of the Child
Children are not miniature adults. They are beings undergoing both physical and psychological development, and their growth is a process that does not always run smoothly and that happens in a series of stages. Furthermore, any psychopathological symptoms in the child must still be put in the perspective of maturing [1]. Children are beings dependent on their families. While also grappling with their family, their functioning can only be understood in the light of its emotional and relational organization.
Sigmund Freud put forward the hypothesis that, based on their vital needs, children seek to undergo and relive pleasurable experiences. Thus, the need/desire dialectic comes to make an impression on the child and organizes the entire psycho-emotional development. The Oedipus complex (between the ages of 2 or 3 and 6 or 7) is one of its universal features. Because it plays a key part in the emotional future of the child, the Oedipal conflict leaves its mark on the childhood story as well as the journey of adulthood.
When they manage to become less involved in the passions (with incestuous and parricidal overtones) of their infancy linked to their father and mother, based on both love (affection, tenderness, etc.) and hate (aggression, desire, jealousy, etc.), the child enters a “latent” period, by which their socio-educational and cognitive investment becomes central. Psychological energy is displaced and invested in the learning (reading, writing, etc.) that, around the age of 7 or 8 and beyond, occupies a special place in the child’s life. Simultaneously, the child learns to love other individuals (teachers, leaders, peers, etc.) using the yardstick of an internalized emotional parental model. For example, for the little boy, love for the internalized mother figure remains a trace, a residue that serves only to prepare for the future love choice. This latency is nonetheless a particularly fertile period for the child’s psycho-emotional development in that it also implicitly prepares for the changes specific to puberty, both physical and psychological. It is during this journey that adolescence constitutes the “afterwardsness” of childhood.
Psychological Challenges of Physical and Pubertal Transformations
Puberty is considered as one of the subjective crisis moments in life associated with biological upheaval. This essential moment in the process of adolescence is characterized by a series of transformations, the outcome of which is not prewritten. This “process” is determined by what has gone before (childhood) and is a determining factor in what will follow. This process is a second chance to deal with childhood conflicts that have not been resolved. Adolescence enables children to become the subject (of their story and their life), to be able to take control of their own body and thoughts and to be capable of making a choice of object, particularly a sexual one.
While “adolescence” constitutes a period in life defined by an age range (11–12 years to 18–20 years nowadays), it nonetheless remains superimposed on a period of physiological and anatomical changes referred to by the term “puberty.” Adolescent psychoanalysts (P. Gutton, P. Jeammet, C. Chabert, F. Marty, etc.) describe the psychological upheavals inherent in this period as “pubertal,” demanding real psychological work of the young person to prepare for puberty.
While the child was protected from carrying out any incestuous and parricidal desires, in particular because of his/her physical immaturity, the protective immature infantile body is transformed by the appearance of secondary sexual characteristics. The body image is modified, as is the importance given to it. This change in body image is reflected in behaviour such as the need for activity, a desire for knowledge, the refusal of maternal care, etc. With the arrival of puberty, children suddenly find themselves undergoing a great upheaval that they can neither control nor master. Their body is changing, and they recognize neither their emotions nor sometimes their thoughts. They even have the feeling that adults no longer look at them in the same way, and this is not wrong; the boy’s body becomes that of a man and the girl’s body becomes that of a woman. The body’s “betrayal” requires them to leave the protective cocoon of childhood [2]. This body attracts the attention of adults and peers, causing reactions, comments, and looks. Simultaneously, libidinous impulses sexualize their relationships with others. Relationships with those around them become difficult. Even physical contact with parents, brothers, and sisters becomes a source of discomfort, or even anxiety. Hugs are given rarely; they must keep their distance.
In this context, incest and parricide, desires from the Oedipal period, become achievable. Faced with the threat of these impassioned possibilities, the adolescent erects a protective defensive barrier. This “defence crisis” sometimes takes unusual forms: a wall of sound (adolescents shutting themselves up in their
