I. Contents of the Videotapes
Videotape n1, 50’
Getting in Touch
Why Seeing and Showing;
Reception, discovery or intrusion;
The three recommended ultrasound testings;
The parents' psychological preparation to the discovery of a possible pathology;
Foetus, subject of study or of desire ?
Anatomic checking, the waiting for the verdict.
1. « Echomaton » ? (8' 40)
The ultrasound to reassure;
The mistake in ultrasound testing : not to see;
How to see everything ? the impossible exhaustiveness;
Doctors' emotions , the fear of making a mistake;
The ultrasound tester is not a robot;
Pregnancy, social phenomenon; initiative ritual;
Positive commentary or, on the contrary, threatening one;
It is the doctor's look that reflects what there is to see;
Connection, disconnection;
To see if everything is all right : for the doctor and for the future mother: two
apparently similar processes, that are very different in reality;
The medical discourse can either allow, or go against maternal reverie;
Who is afraid of malformation ?
The revenge of maternity;
Profanation of the sacred; the ultrasound unveils the mystery;
What can be spotted and the ignorance of personal history.
2. The Excluded Third (30' 23)
The ultrasound illustrates premature interactions;
The place of the father : triangulation;
How to go from two to three?
The ultrasound reveals paternity;
There is a tenant in the conjugal territory;
Paternal reactions toward the intruder;
What forces men to function on a feminin mode.
3. Images and Resonances (37' 21)
Imaginary child, real child;
Understanding the image as a process;
The image gathers the community around a mystery;
This being that is half me, half other;
The ultrasound can reactivate more or less encysted old wounds and archaic conflicts;
The torment that is put into the parents' mind;
Medical interrogations lead to some roundabouts, justified ones though, but that
will leave psychological traces in the parents, even when everything ends well;
A clinical illustration: the story of a deviation.
Videotape níŸ“í°°2, 50’
Ultrasound Testing or the Uncanny
1. The Conception of the Foetus and the Image of its Conception (0' 25)
The woman wonders about her capacity to be a mother;
The ultrasound partly destroys the myth of the woman who makes her foetus;
The program of the genome inexorably unrolls and can make some mistakes;
The ultrasound is a first stage to attempt to think (to symbolise) the mystery of
birth;
We have the illusion to be envelopped by an image that would be the same for everybody.
2. Appropriating the Image (5' 50)
The ultrasound is the paradigm that Freud was looking for to illustrate the concept
of the uncanny;
Worry from an uncertainty : is the foetus animated or unanimated ?
The automaton represents the climax of the uncanny;
By its very perfection the automaton threatens its inventor, who can be tempted to
destroy it in order to protect himself;
The ultrasound forces a reification of the foetus;
The return of the inhibitted of the ultrasound tester (his vocation) is related to
his curiosity of child for the contents of the maternal belly, that is to say for his parents' sexuality.
3. The Stakes of the Announcement (11' 40)
The stakes of the announcement exist for each ultrasound;
It is only after it is done , and eventually controled, that we know if the test
is normal or not;
The announcement is not a result, it is a process that concerns each ultrasound,
even the most common one;
We are dealing with major, singular, serious situations, that each time are new stories;
The vocabulary of disorientation that mixes jargon, hesitations and difficulties
of the exercice, can take the turn of a pseudo morbid announcement.
4. The Weight of Fate (19' 45)
Group of preparation of the parents to the ultrasound at the "maternité
des Bluets";
The pratician who is not an ultrasound tester is led to take the role of an administrator
of the diagnosis;
The right to uncertainty ; a culture of the risk to take again in our society;
Classical obsetrics only explored the mother , the ultrasound opened the way to foetal
medecine;
Technique prevails over the human, the clinical test is depreciated;
The ultrasound focalizes so many expectations that were not specified till then that
the woman watches above all in the doctor's look for a non contradiction of her maternal reverie;
In twenty years, we went from the age of secret to the age of revelation, justified
by the prevailing of technique;
Technique is rushing ahead of ethics; we have to ask ourselves questions.
5. The Rivals (29' 10)
The ultrasound, a familial event;
What is that announcement to all these people who are here ?
The ultrasound tester must save his concentration;
The very crude exposure of the result of the sexuality of his mother is not insignificant
for the eldest, all the more in case of difficulty;
It is sure that the eldest experiences something very intense at this moment when
the parents cannot take their essential part of counter-excitation;
Children' faculty to understand must not be underestimated.
6. Hatred Toward the Foetus (38' 15)
Talking about the baby when it is an embryo or a foetus is a matter of idealisation,
but any relation of object is necessarily ambivalent, made of love and also of very agressive feelings
of hatred and of wishes of destruction of the object;
The imaginary child and the real child;
Biological hatred and fundamental violence;
Placenta, a mediator that protects the foetus;
Noticing of a nonconformity of the foetus provokes a resurgence of maternal agressivity
that can go as far as the wish of death;
Understanding the place of hatred in the counter transference must help the teams
of the maternity to live some situations that are sometimes very difficult.
Videotape n3, 68’
Bad News
The ultrasound tester plays a maternal role, most often welcoming and reassuring,
but in case of abnormality, he transforms into the fairy Carabossa.
1. The Tragedy (2' 50)
Changing registers, from full to empty;
The plunging submarine;
Double announcement : movements first, words after;
What are they hiding from me?
The point of no return, stupor;
" Ifs " and " maybes ";
Finding the words we know as impossible to say, impossible to associate with;
The announcement in several steps;
Forces have to be restabilized.
2. Taming the Bad News (19')
The carryer of the bad news must protect himself;
Technical competence is endangered by affective interferences;
Pain and violence are unbearable;
There is no happy announcement;
Losing a malformed child, it is above all losing a child;
The seriousness (objectivizable) of malformation does not lighten the loss;
Each time, the announcement is a " first time ";
Coming out of the rolling mill.
3. The Right to Live, the Right to Die (27')
From diagnosis to prognosis, the three steps of announcement;
The mother's anxiety : is it serious , or can we do something;
The representation of action : if that is what they call living…;
The specialist's anxiety : therapeutic failure seen a posteriori as a trickery
The law on abortion , collegiate decision
The temptation to suppress the " problem " that also suppresses the juridical
risk.
4. Dead End or Prospects (37' 40)
Everything is is not decided when the diagnosis is stated;
Obstetrical ultrasound testing , a mined field;
The relation must rely on the support of the most flexible mecanisms of adaptation;
The ultrasound tester's loneliness; the myth of omnipotence; mistakes;
Judges , responsibility proceedings;
The ultrasound tester, technician or philosopher;
Where the biography of the protagonists is met with a potentially tragic resonance;
The enlightenned consent , duty of a careful information;
How far has the information of the child gone?
Clinical example : a complex cardiopathy which prognosis is uncertain at long term
5. The Medico-legal Context (54' 15)
This context favours the parcelling of the imagined child; who reassemblies him?
The ultrasound tester facing his judge : the expert;
Obligation of means, obligation of result.
6. The Ultrasound Tester Between Transference and Counter-transference (60' 40)
The relation is inevitable in such an intimate and private situation as the one that
has developed between the ultrasound tester and the pregnant woman;
The transferencial relationship consists in conscious and unconscious elements of
the projection of desires, of needs, of thankings, of satisfaction, of hatred… aimed at someone who
is in position to know;
Talking about the counter-transference of the ultrasound tester, as the one who welcomes
and receives the request of the other (request to check the integrity of the child);
It is the meeting of two subjectivities;
We can systematically talk about more or less conscious and controlled acted manifestations
of the ultrasound tester. These are the counter-attitudes (temper movements , extreme language etc.);
The counter-transference appeals more to an internal actual experience than to actions
or attitudes;
It can certainly be wished that ultrasound testers control their counter-attitudes.
It is obviously not a matter of asking every ultrasound tester a personnal analysis.
Videotape n4, 66’
Cases
The parents' testimonies are presented in this tape, these accounts were fully collected
and they illustrate the difficulties of some cases after an ultrasound testing announcement.
1. The Announcement (0' 50)
A malformation of the heart is discovered in a hospital of the center of France.
A checkup will be asked in a reference center before being able to take a decision. The patient's discourse
expresses great confusion. Yet medical undertaking took place as needed. The distress experienced by this
woman is the illustration of the psychological conflicts provoked by the annoncement.
2. The Deviation (16' 40)
The announcement of a slightly abnormal measurement of the nape of the neck of the
12 weeks old foetus will lead to numerous misunderstandings and events that are going to disrupt the progress
of pregnancy and delivery. How to repair ?
3. The Impossible Waiting (31')
During the first pregnancy, a " thick nape of the neck " that frightened
to be a chromosomal abnormality was detected with the ultrasound testing. The foetal caryotype proved
to be normal. The parents had been considerably worried by this abnormal nape of the neck, but the pregnancy
and the delivery had went off smoothly. Yet, at the age of seven months, the child started having convulsive
fits and a deepened neurological checkup did not allow to conclude… Keeping their hope the parents
, decide to trust the future. During the next pregnancy, as soon as the first ultrasound testing a "
thick nape of the neck " that leads to the prescription of a caryotype is found. The father flares
up and declares that it is impossible to wait for the results since a normal caryotype does not garanty
anything. The parents are considering having an immediate abortion . They are persuaded to wait …
Meanwhile the eldest has more and more frequent fits.
4. The Flaw and the Imprint (47' 05)
The father of a trisomic child expresses his incomprehension in front of the failure
of antenatal detection despite an irreproachable medical monitoring . The next pregnancy reactivates such
an anxiety that it generates identity confusions between the two children in the father's discourse. He
makes concrete proposals in order to make the test uncommon and for a non " quaint " practice
of ultrasound testing. There is not only a need for pernickety specialists , but also for men that are
able to communicate and to establish a relationship with the parents. Plea for a flawless ultrasound testing…(End
at 66’ 40)
II. Contents of the Book
The collection At the Dawn of Life. General presentation, Bernard Golse and Serge
Lebovici
Introduction, by Michel Soulé
Nature and implications of scopical pulsion, by Jacques Bril;
The psychological aspects of ultrasound testing during pregnancy seen by an obstetrician
who practices ultrasound testing in maternities, by Luc Gourand
Impact of the image in ultrasound testing and role of the ultrasound tester,
by Paul Denis
"What do they see ? " or the triple envelope of the ultrasound testing
situation, by Serge Tisseron
Eye of the inside, eye of the outside, by Marie-José Soubieux
Obstetrical ultrasound testing : a secular ritual of initiation to "parenthood"?,
by Sylvain Missonnier
From paediatrics to foetal psychiatry, by Michel Soulé
The image of the foetal heart : a convergence…, by Laurent Fermont
Hatred for the foetus, by François Sirol
Is there a place for ultrasound testing in the monitoring of a normal pregnancy
?, by Bernard Golse
The deep wickedness of ultrasound testers, by Michel Soulé and Marie-José
Soubieux
Glossary
Ambivalence, Aménorrhée (semaines d'), Amniocentèse, Angoisse
signal et angoisse automatique, Automate, Calendrier des échographies « systématiques »,
Capacité de rêverie maternelle, Caryotype, Complexe de castration, Conflits archaïques,
Contenant-contenu, Diagnostic, Enfant imaginaire (fantasme d'), Entretiens de préparation à
l'échographie, Fantasme de profanation, Fausse couche, IVG, IMG, Fotus, Embryon, Enfant, Générationnel
(trans et inter), Groupe de réflexion sur le diagnostic prénatal, Groupe « paroles
d'hommes », la Haine, le Souhait de mort, Inquiétante étrangeté (l'),
Instances, Interaction mère-bébé, Interruption médicale de grossesse (IMG),
Malentendu fondamental, Médico-légal, Métapsychologie, Névrose infantile,
Nostalgie, Organisateur psychique, Parentalité, Pronostic, Décision, Psychanalyse développementale,
Psychiatrie fœtale, Psychiatrie périnatale, Pulsion scopique, Relation d'objet : mi-moi,
mi-autre, le Repérable, discours apparent et latent, Rituel, sadisme médical, Scène
primitive, Signes d'appel à l'échographie, Statistiques des malformations, structuration
versus destructuration, Symbolisation, Transparence psychique de la grossesse, Traumatisme, Triadification
et triangulation.
Bibliography
III. Contents of the CD-Rom
The Debate
It gathers six specialists around some great themes raised in the videodocuments
: Practice of the ultrasound tester;
Ethics and ultrasound testing;
Signs of appeal and consequences;
The enlightened consent;
Ultrasound testing and "parenthood";
The announcement of abnomalities;
The training of ultrasound testers;
Pluridisciplinarity;
Ultrasound testing and genetics.
Testimonies
Little Femur, text by a mother
The hypertext Glossary
It includes about fifty definitions, with illustrations and video extracts. It constantly
refers to the book, the four videotapes and to the bibliography.
The Bibliography
It gathers over three hundred and fifty references and presents, in addition to
classical bibliographical elements, covers,summaries and contents of most of the books and periodical
indexes.
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