all contact with parents), intellectualization (defence involving great philosophical debates, big questions on the state of the world, “who am I?”), verbal aggression (projection dispels the anxiety that “anyway, it’s all my parents’ fault” or even “it’s because of doctors that I am like this”), etc. These characteristic changes show the extent to which, for the adolescent, the enemy is the body (now sexual, genital, and leading to fantasies), capable of pleasure in the sexual act. This defensive crisis is necessary to absorb the shock of puberty, considered as a necessary trauma.
It is a matter of the young person undergoing one of the greatest tests in their life by having to escape the authority, love, and tenderness of their parents. This necessary emotional shedding of the figures of guardianship and love ultimately allows the young person to make other commitments to the outside world and to others (parental substitutes, peer groups). Meanwhile, we see a dual change. It is not uncommon to see the adolescent enter a depressive period, marked by sadness; simultaneously, the adolescent dedicates him/herself to an intense love (particularly glances in the mirror), a normal and necessary narcissistic preoccupation.
Finally, we should emphasize that a pubescent adolescent becomes capable of procreating, consequently gaining access to a new power until then available only to parents. The imbalance between adults and children is reduced because the generation gap as well as the differences (physical, psychological, cognitive, etc.) are smaller. In reality, the adolescent gains certain adult powers; in their imagination, de facto, adults become rivals.
Relationship disputes arise to highlight the young person’s status as a differentiated individual, capable of personal ideas and not subject to influence. Simultaneously, they enable them not to be isolated and therefore rejected; time spent in discussion is time when one is not alone, so the link is maintained. Thus, self-assertion is expressed by putting others at a distance: the adolescent repels the adult to feel more as if existing separately. Likewise, parents also assert the difference between themselves and their child: generational difference, difference in tastes, difference of ideas, etc. The confrontation with frustrations punctuates this period, during which anxiety and doubt invade the psyche; the adolescent can lose confidence. They would already like to lead an adult life but are not ready yet, either psychologically or materially. Maintaining parental authority reassures the adolescents, showing them that they are loved, that they are important and that they can count on others. They must feel the need for independence and the need for attachment at the same time.
The psychological effort that underpins the whole process of “adolescence” is achieved by development work. This development with its crises, conflicts, and distancing enables the adolescents to familiarize themselves with their imaginary life and intrinsic passions. Through this development work, it becomes possible to form a generation, pair up and have a child. Thus, after abandoning the Oedipal phase, the pubertal renunciation of incestuous passions enables the young adult to consider the prospect of creating his/her own origins and to have children, by pushing the parents back into an older generation. For young persons, this means making their own place in the world and making plans with the possibility of breaking free of parental authority by leaning on it.
When Diabetes Appears…
There are sometimes situations in which adolescence is coupled with limitations imposed by a chronic illness; such is the case with diabetes, particularly when it comes to gaining independence.
For the adolescent with type 1 diabetes, the body limits, unable to live without insulin, may be obstacles over and above the normal psychological process at this time. They think of their body in terms of health. They need time to learn about this “new body” that can lose control: low blood sugar levels, feeling faint, etc. Injections and blood sugar tests are both aggressive and intrusive procedures that reinforce the fragility of a body image undergoing change and in which confidence must be found.
Type 1 diabetes is an unseen illness rarely revealed by symptoms. The adolescent is limited to mentalizing it to justify treatment at a time in development when verbalization is inhibited. Rather, behaviour and acting out are what matter at this age. Getting up in the morning and feeling great requires a mental effort from the adolescents so that they can treat themselves. The psychological denial mechanisms are encouraged by the failure to feel symptoms. The adolescents come out of their childhood period, during which they conveyed a powerful self-image; this is represented by drawings where the child depicts him/herself as a sports champion or they show themselves in highly valued physical activities, such as a firefighter or a dancer. “Mourning” the forgotten all-powerful body requires significant psychological work. During childhood the body is looked after by one’s parents, whether in terms of nourishment or health. At this stage, the young individual puts boundaries between him/herself and another person’s body to be more possessive of it.
Conflicts sometimes arise with those around them as the adolescent has to work at gaining independence and at the same time accept the compulsory dependence on treatment. There are “limitations on their body and a hold over its psychological function” according to Jeammet [3]. To this is added the relational care dependence on the doctor. Knowledge of the illness and the doctor’s ability to treat it offer the adolescent a model to follow for involvement in their treatment, often for several years. “Medical authority” represents an additional obstacle that the adolescent has to overcome to show they are becoming independent, self-assured, and able to make decisions about themselves through their treatment. Keeping this ascendant care relationship, with its strong maternal association (more generally parental), at a distance is superimposed on the distancing effort made during this period. Emotional projection also occurs, sometimes making separation difficult; this takes the form of opposition, flight, and resistance to the treatment or forgotten appointments.
It therefore means separating oneself, but above all not feeling rejected. In adolescence, you are preparing to leave your parents, leave the family, leave school, leave some of your friends, and leave your paediatric diabetes specialist. You keep your diabetes. In this quest for freedom and independence, the “diabetes” illness requires the adolescents to keep and maintain restrictive habits that mark every day of their life and define their bodily experience [3].
Once again it is difficult for the young persons on the one hand to face up to their independence and on the other hand to accept, as is demanded of them, a typical situation of dependence: the treatment of diabetes. The daily obligation to inject oneself confirms a paradoxical act: on the one hand their dependence on medicines, and on the other their independence from their parent or care giver, since they gain the ability to treat themselves. To this effect, simultaneously with internal psychological resolutions, diabetes can help the adolescent feel all-powerful with regard to themselves and others: “I am master of my body by dosing and injecting myself with insulin, and I decide whether or not to involve the adult.”
Adolescents are aware of their diabetes but at the same time they do not want to know about it; this knowledge hinders the construction of their “ego ideal,” which in some ways is the template to which the individual is seeking to conform. They become caught up between knowing “I have diabetes” and not knowing “I don’t feel anything, I don’t feel ill, I am not ill” [4]. The lack of traditional disease symptoms in diabetes focuses and facilitates this denial. A compromise is needed between knowledge and ignorance; it is doubtless with this in mind that we should understand missed treatments (forgotten injections, incorrect blood sugar tests, etc.). Ignoring certain aspects of their treatment is a way for the adolescents to separate themselves from their condition and to maintain part of their idealized self-image. Neglecting treatment is a deceptive way of separating themselves from their illness.
While asserting their difference from another person, the adolescents need models to
