LA REACTION DE CATASTROPHE CHEZ LE VIEILLARD DEMENT (COMPARAISON AVEC LES REACTIONS CATASTROPHIQUES SECONDAIRES AUX LESIONS FOCALES DE L'ADULTE)

The aim of the work is to classify the relationship existing between the concept of 'catastrophic reaction' and that of 'pathological reaction to an event'. After recalling Goldstein's description of catastrophic behaviour, the author criticises as not flexible enough the interpretation given by Goldstein to the phenomena observed and especially his theory of anguish. He wonders whether an analytical study of the conduct observed in an old person suffering from organic cerebral lesion may not help the better understanding of the nature of catastrophic behaviour and the meaning of catastrophic distress. The author thus seeks firstly to make some kind of inventory of the conduct that can be observed when the senile individual is confronted by a task which seems likely to be beyond him and leads him to suffer from a catastrophic reaction. He then studies the relationship between catastrophic behaviour and the level of demential deterioration on the one hand, and on the other, the laterality of the lesion (in the focal regions of the brain), and finally the premorbid personality of the patient. The collected observations appear to indicate that in general the 'catastrophic reaction' arises from many factors, organic as well as psychic in character. The cerebral organic disease appears to be responsible for the force of the emotional outburst 'in short circuit', which gives its specificity to the clinical symptomatic concept of the 'catastrophic reaction', but the anguish thus released is not a simple neurophysiopathological event. In contrast, it is a question of an actual, personal anguish, which is derived not only from the objective effects of a lesion in real circumstances, but also from subjective consequences arising from affective needs and from conflicts which are unresolved by the subject.