Student Number : 7916069 - MA research report - School of Human and Community Development - Faculty of Humanities / This qualitative study set out to explore the idea of a good death through in-depth interviews with six terminally ill patients with cancer aged between thirty-seven and fifty-two, in other words in mid-life. Thematic content analysis was used to examine overt and covert themes revealed in semi-structured interviews that had been transcribed verbatim. Significant fear of dying was revealed and although respondents did not seem to have a conscious idea of a good death, they had a clear concept of good dying. Two key components of good dying were not being in pain or distress from physical symptoms, and wanting to drift off into a final “sleep” rather than being fully alert until the end. It was noticeable that, whether or not patients had religious convictions, relatively little attention appeared to be paid directly to what might or might not follow the moment of death itself, for example an afterlife. Preparation for good dying included completing a will, sorting out financial affairs and, for some patients, planning a funeral. At times this preparation also included trying to mend conflicted relationships and make plans for the ongoing care of family members. It is postulated that these preparations helped re-constitute a sense of order that had been shattered by the chaos of being declared terminally ill at a time of life when this was non-normative. Moreover, taking care of practical needs re-established a sense of agency, helped achieve some sense of closure and symbolised a measure of acceptance of their dying status. Respondents did not seem to experience external pressure from others to die in a certain way, although two people were particularly aware of their influence on how others in the family felt and thus tended to pretend to feel better than they did.

L’« enfant perturbateur » dérange et déçoit un espoir de réussite par de mauvaises notes, ou perturbe ses parents, sa famille, ses enseignants par son agitation. Dans un tel contexte, l’adulte, qui l’accompagne dans un lieu de soin, évoque à son propos une « hyperactivité », un « trouble de la concentration », ou un « trouble du comportement ». En quelques décennies, ces motifs de consultation sont devenus majoritaires au Centre Médico-Psychopédagogique de Montpellier. Sans remettre en cause les apports de la neurobiologie, nous constatons que l’« instabilité infantile psychogène transitoire » est devenue une épidémie. A partir de notre expérience clinique, de la métapsychologie freudienne, des études de sociologie, et de celles des sciences politiques, nous soutenons la thèse suivante : l’ « enfant perturbateur » souffre d’un « complexe de déprivation » (Winnicott) qu’il traduit en termes de « peur de mourir », et si la turbulence s’exprime, c’est en tant qu’elle attire l’attention d’un adulte potentiellement secourable et que les systèmes sociaux contemporains la rendent facilement repérable. L’approche psychanalytique individuelle de l’ « enfant perturbateur » est pertinente mais peut parfois rester en suspens pendant de longues périodes, cédant le pas à l’attitude de « management » décrite par Winnicott. Ceci rend possible un mouvement de régression permettant à l’enfant de renouer avec la continuité du sentiment d’exister. Dans le transfert, l’analyste occupe alors la place de « médium malléable » (Milner, Roussillon) soumis à l’omnipotence de son patient. / The agitation of “disruptive children” disturbs or upsets their parents, family and teachers, and bad marks at school lead to disappointment in terms of hope for success. In such a context, the adults who take them for treatment mention terms such as “hyperactivity”, “concentration disorder”, or “behaviour disorder”. In just a few decades, these reasons for consulting have started to dominate at the Centre Médico-Psychopédagogique (Psychoeducational Health Centre) in Montpellier.Although we do not question the contribution of neurobiology, we have observed that“transitory psychogenic infantile instability” has become an epidemic. On the basis of our clinical experience, Freudian metapsychology, sociology and political science studies, we support the following thesis: “disruptive children” suffer from a what Winnicot calls a “deprived complex” and which he translates in terms of “fear of dying”. If there is manifest unruliness, it is to attract the attention of a potentially helpful adult and because the contemporary social systems make it easily detectable.The individual psychoanalytic approach to “disruptive children” is relevant but canremain suspended over long periods of time, giving way to the “management” attitude described by Winnicott. This makes regression possible, allowing the child to return to the continuity of a sense of being. In the transference, the psychoanalyst then plays the role of the “pliable medium” (Milner, Roussillon) subject to his patient’s omnipotence.