published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Este estudo epidemiológico teve por objetivo investigar a prevalência de injúria orofacial em dois grupos de atletas. O primeiro grupo foi de atletas integrantes do Fluminense Futebol Clube, em Xerém, e o segundo de atletas praticantes do jiu-jitsu em diferentes academias ou que participaram do Campeonato Brasileiro em 2011, no Rio de Janeiro. Um examinador calibrado, auxiliado por um assistente, preencheu os questionários com todos os atletas, seguido do exame clínico de todos. Grupo I: 260 atletas do Fluminense Futebol Clube com idade média de 14,08 (DP 2,71) anos de idade, todos do gênero masculino. Grupo II: 315 atletas de diversas academias de jiu-jitsu com idade média de 26,86 (DP 8,99), dentre esses indivíduos, apenas 10 eram do gênero feminino. A prevalência de injúrias orofaciais encontrada para o Grupo I foi de 47% (n=122; IC 95% 40,94% a 52,99%) e no Grupo II de 74,6% (n=235; IC 95% 69,52% a 79,09%). Considerando-se a prevalência de trauma apenas no elemento dentário, a prevalência diminuiu de 147 injúrias para 57 traumas dentais no futebol e de 289 injúrias para 93 traumas dentais no jiu-jitsu. Foi observada uma menor prevalência de injúria orofacial nos goleiros quando comparados aos outros jogadores de futebol. A maior parte das injúrias ocorreu durante o período do treino (n=42; IC 95% 26,59% a 43,22%) e apenas 4 desses atletas usavam protetor bucal. Por outro lado, no jiu-jitsu, a prevalência de injúria variou de acordo com a cor da faixa do uniforme do atleta. Os atletas da faixa preta exibiram mais injúrias (n=83). Atletas que treinavam de 7 a 15 horas por semana, sofreram mais injúria (n=109). A maioria das injúrias ocorreu durante o treino. Somente 28,57% dos atletas (IC 95% 23,86% a 33,79%) usavam protetor bucal. Nos dois esportes, a maioria dos atletas sofreu apenas uma injúria, sendo o tipo mais frequente em tecido mole. O dente mais atingido foi o incisivo central superior. Estes dados ressaltam a importância de incentivar o uso de protetores bucais em esportes de contato como o futebol e o jiu-jitsu, onde o seu uso não é obrigatório, apesar da prevalência de injúria orofacial ser alta. / This epidemiological study aimed to investigate the prevalence of orofacial injury of two groups of athletes. The first group included athletes who were part of the Fluminense Soccer Club in Xerém, and the second group included athletes from different brazilian jiu-jitsu academies or who participated in the Brazilian Championship in 2011, in Rio de Janeiro. One calibrated examiner, with the help of the assistant, completed the forms of all athletes followed by the clinical examination of them. Group I: 260 male athletes from the Fluminense Soccer Club, mean age of 14.08 (SD 2.71). Group II: 315 athletes from a variety of brazilian jiu-jitsu academies, mean age of 26.86 (SD 8.99), among these individuals, only 10 of them were female. The prevalence of orofacial injuries found for Group I was 47% (n=122; IC 95% 40,94%; 52,99%) and for Group II was 74,6% (n=235; IC 95% 69,52%, 79,09%). When the prevalence of trauma was evaluated individually per tooth, it decreased from 147 injuries to 57 dental traumas in soccer and from 289 injuries to 93 dental traumas in brazilian jiu-jitsu. A lower prevalence of orofacial injuries in goalkeepers was observed when compared to the others soccer players. Most injuries occurred during the training period (n=42; IC 95% 26,59%; 43,22) and only 4 athletes used to wear mouthguard. The prevalence of injury in brazilian jiu-jitsu varied according to their uniform belt colour. Black belt athletes suffered more injuries (n=83). Athletes who trained between 7 to 15 hours per week experienced more injury (n=109). Most injuries occurred during training. Only 28,57% of the athletes (IC 95% 23,86%; 33,79%) used to wear mouthguard. In both sports, most of the athletes have suffered only one injury, and the most frequent type was in soft tissue. The tooth that was injured the most was the maxillary central incisor. These data reveal the importance of encouraging the use of mouthguards in contact sports such as soccer and brazilian jiu-jitsu, where its use is not mandatory, although the prevalence of orofacial injury is high.

Made available in DSpace on 2014-06-11T19:27:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-21Bitstream added on 2014-06-13T19:36:12Z : No. of bitstreams: 1 pereira_alp_me_araca.pdf: 556236 bytes, checksum: 813123fc195762e6557fa1b6003a934b (MD5) / Universidade Estadual Paulista (UNESP) / Este trabalho tem como finalidade apresentar um método para estudo do traumatismo dentoalveolar, utilizando um dispositivo capaz de promover a mesma intensidade e sentido de aplicação da força sobre molares de ratos, e dessa forma, ser utilizado como um modelo de estudo experimental na movimentação dentária induzida de dentes previamente traumatizados. Para a realização desse traumatismo foi utilizado um tensiômetro, com uma das suas extremidades adaptada para exercer um impacto sobre o primeiro molar superior. O tensiômetro foi fixado em um suporte de metal com a finalidade de padronizar a direção da aplicação da força e posicionar corretamente sua extremidade sobre o primeiro molar superior. Aplicou-se um trauma no sentido ocluso-gengival de 600 gramas sobre a região oclusal do primeiro molar superior direito de 10 ratos, correspondente à aproximadamente 600cN. Em seguida os animais foram mortos e a maxila direita coletada para análise microscópica do tecido pulpar e o ligamento periodontal da raiz mesial do primeiro molar superior. A análise microscópica demonstrou que a força de 600cN não se mostrou efetiva para promover alterações no ligamento periodontal, polpa e raiz. Por outro lado, demonstrou que um trauma de intensidade menor como a concussão, não promove alterações no ligamento periodontal, e por sua vez não representa um problema para o ortodontista. / This study has as purpose to present a method for study of the dentoalveolar traumatism, using a device capable to promote a traumatism maintaining the same intensity and sense of application of the force on molars of rats, and in that way, to be used as a method of experimental study in the induced movement of teeth previously traumatized. For the accomplishment of that traumatism a gauge was used, with one of their extremities adapted to exercise an impact on the first superior molar. The gauge was fastened in a metal support with the purpose of to standardize the direction of the application of the force and to position his extremity correctly adapted on the first superior molar. A injury was applied in the ocluso-gingival sense on the vestibular crest of the first right superior molar of 10 rats with force of 600 grams, corresponding to the approximately 600cN. Soon afterwards the animals were died and the right maxillary bone collected for histological analysis of the pulpal and the periodontal ligament of the root mesial of the first superior molar. The histological analysis demonstrated that the force of 600cN was not shown executes to promote alterations in the periodontal ligament, pulp and root, on the other hand it demonstrated that a trauma of smaller intensity as the concussion, doesn't promote alterations in the periodontal ligament, and for his time it doesn't represent a problem for the orthodontist.

Este estudo epidemiológico teve por objetivo investigar a prevalência de injúria orofacial em dois grupos de atletas. O primeiro grupo foi de atletas integrantes do Fluminense Futebol Clube, em Xerém, e o segundo de atletas praticantes do jiu-jitsu em diferentes academias ou que participaram do Campeonato Brasileiro em 2011, no Rio de Janeiro. Um examinador calibrado, auxiliado por um assistente, preencheu os questionários com todos os atletas, seguido do exame clínico de todos. Grupo I: 260 atletas do Fluminense Futebol Clube com idade média de 14,08 (DP 2,71) anos de idade, todos do gênero masculino. Grupo II: 315 atletas de diversas academias de jiu-jitsu com idade média de 26,86 (DP 8,99), dentre esses indivíduos, apenas 10 eram do gênero feminino. A prevalência de injúrias orofaciais encontrada para o Grupo I foi de 47% (n=122; IC 95% 40,94% a 52,99%) e no Grupo II de 74,6% (n=235; IC 95% 69,52% a 79,09%). Considerando-se a prevalência de trauma apenas no elemento dentário, a prevalência diminuiu de 147 injúrias para 57 traumas dentais no futebol e de 289 injúrias para 93 traumas dentais no jiu-jitsu. Foi observada uma menor prevalência de injúria orofacial nos goleiros quando comparados aos outros jogadores de futebol. A maior parte das injúrias ocorreu durante o período do treino (n=42; IC 95% 26,59% a 43,22%) e apenas 4 desses atletas usavam protetor bucal. Por outro lado, no jiu-jitsu, a prevalência de injúria variou de acordo com a cor da faixa do uniforme do atleta. Os atletas da faixa preta exibiram mais injúrias (n=83). Atletas que treinavam de 7 a 15 horas por semana, sofreram mais injúria (n=109). A maioria das injúrias ocorreu durante o treino. Somente 28,57% dos atletas (IC 95% 23,86% a 33,79%) usavam protetor bucal. Nos dois esportes, a maioria dos atletas sofreu apenas uma injúria, sendo o tipo mais frequente em tecido mole. O dente mais atingido foi o incisivo central superior. Estes dados ressaltam a importância de incentivar o uso de protetores bucais em esportes de contato como o futebol e o jiu-jitsu, onde o seu uso não é obrigatório, apesar da prevalência de injúria orofacial ser alta. / This epidemiological study aimed to investigate the prevalence of orofacial injury of two groups of athletes. The first group included athletes who were part of the Fluminense Soccer Club in Xerém, and the second group included athletes from different brazilian jiu-jitsu academies or who participated in the Brazilian Championship in 2011, in Rio de Janeiro. One calibrated examiner, with the help of the assistant, completed the forms of all athletes followed by the clinical examination of them. Group I: 260 male athletes from the Fluminense Soccer Club, mean age of 14.08 (SD 2.71). Group II: 315 athletes from a variety of brazilian jiu-jitsu academies, mean age of 26.86 (SD 8.99), among these individuals, only 10 of them were female. The prevalence of orofacial injuries found for Group I was 47% (n=122; IC 95% 40,94%; 52,99%) and for Group II was 74,6% (n=235; IC 95% 69,52%, 79,09%). When the prevalence of trauma was evaluated individually per tooth, it decreased from 147 injuries to 57 dental traumas in soccer and from 289 injuries to 93 dental traumas in brazilian jiu-jitsu. A lower prevalence of orofacial injuries in goalkeepers was observed when compared to the others soccer players. Most injuries occurred during the training period (n=42; IC 95% 26,59%; 43,22) and only 4 athletes used to wear mouthguard. The prevalence of injury in brazilian jiu-jitsu varied according to their uniform belt colour. Black belt athletes suffered more injuries (n=83). Athletes who trained between 7 to 15 hours per week experienced more injury (n=109). Most injuries occurred during training. Only 28,57% of the athletes (IC 95% 23,86%; 33,79%) used to wear mouthguard. In both sports, most of the athletes have suffered only one injury, and the most frequent type was in soft tissue. The tooth that was injured the most was the maxillary central incisor. These data reveal the importance of encouraging the use of mouthguards in contact sports such as soccer and brazilian jiu-jitsu, where its use is not mandatory, although the prevalence of orofacial injury is high.

Orientadores: Mario Mantovani, Gustavo Pereira Fraga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T17:58:25Z (GMT). No. of bitstreams: 1 Silveira_HenriqueJoseVirgili_D.pdf: 1825654 bytes, checksum: 21235a597528aaba03e13e883055a983 (MD5) Previous issue date: 2008 / Resumo: Embora incomuns, lesões traumáticas do pâncreas estão associadas a significativos níveis de complicações e mortalidade. O objetivo deste estudo foi definir os fatores preditivos de morbidade e mortalidade em pacientes vítimas de trauma pancreático. Nesta casuística, foram estudados 131 pacientes atendidos pela Disciplina de Cirurgia do Trauma no Hospital de Clínicas da UNICAMP no período entre janeiro de 1994 a dezembro de 2007, com seus parâmetros epidemiológicos, fisiológicos e anatômicos registrados em protocolo específico prospectivamente e, comparados e analisados aos fatores preditivos de evolução, com estudo estatístico. Trauma penetrante, com predomínio de ferimentos por projétil de arma de fogo ocorreu em 64% dos casos. A maioria, 91,6% era do sexo masculino e a idade média de 29,8 anos. A morbidade global foi de 64,9%, com 29% de complicações diretamente relacionadas ao pâncreas, como fístulas e sangramento. A mortalidade foi de 27,5%, principalmente em decorrência de choque hipovolêmico e falência de múltiplos órgãos e sistemas. Houve maior morbidade e mortalidade em pacientes com lesões complexas (graus IV e V) do pâncreas quando comparados com lesões menos graves (graus I e II), porém a morbidade e mortalidade neste grupo não foi desprezível, devido a valores alterados de RTS, valores elevados de ISS e ATI. Pacientes com valores alterados de RTS, pressão arterial sistólica menor que 90 mmHg, valor de ISS maior ou igual a 25 e valor de ATI maior ou igual a 25 apresentaram maior incidência de complicações mórbidas e maior mortalidade. Pacientes com valores elevados de TRISS ainda apresentaram complicações mórbidas e óbito. O presente estudo conclui que lesões complexas do pâncreas, pressão aterial sistólica inferior a 90 mm Hg, RTS com valor alterado, ISS maior ou igual a 25 e ATI maior ou igual a 25 são preditivos de maior morbidade e mortalidade em pacientes traumatizados com lesão pancreática / Abstract: Although uncommon, traumatic pancreatic injury is associated with significative index of morbidity and mortality. The objective of the study was to define the predictors' factors of increase in the morbidity and mortality in patients with pancreatic trauma. In this casuistic 131 patients were studied, since January 1994 through December 2007, with theirs epidemiological, physiological and anatomic parameters compared and the analysis of the predictive values for the occurrence of bad evolution, with an appropriate statistical study. Prospective coorte study. Penetrating trauma occurred in 64% and blunt trauma in 36%, and 91,6% was male. The mean age was 29,8 years.The global morbidity in this series was 64,9% with 29% prevalence of pancreas related complications, such as pancreatic fistula and bleeding occurrence. The overall mortality was 27,5% and occurred by hemorrhagic shock and multiple organs and system failed. Higher morbidity and mortality was related with complex injuries of the pancreas (grade IV and V), but morbidity and mortality in the group of injuries grade I and II are not minimal in patients with changed values of RTS and high values of ISS and ATI. Systolic blood pressure lower 90 mmHg, changed values of RTS index, values of ISS higher 25 and values of ATI higher 25 are predictive factors of morbidity and mortality. This study conclude complex injuries of pancreas, systolic blood pressure lower 90 mmHg, changed values of RTS, values of ISS and ATI higher 25 are predictive factors of elevation morbidity and mortality / Doutorado / Cirurgia / Cirurgia

D.Ed. / Art lecturers affiliated to a tertiary institute observed the occurrence of negative emotional content and expression in the artwork of their students. These students are also inclined to manifest negative behavioural and interaction patterns. The lecturers appealed for this research as a method to determine what the content of the expressed artwork indicate. The request was for the research methods to proceed within an art framework in order for it to be applied as a class project. The research proceeded with the use of art as a projection medium, applied during the process of facilitative interaction. The aim was to determine the degree to which the projected content in the young adults' artwork correlate with their personal life- and experiential world. The young adults were requested to write spontaneous sketches depicting the story of their life. The information was passed on to a graphologist for the analysis of their handwriting. The findings of the graphologist was later applied as external triangulation in order to verify the identified themes obtained from the analysis. With the aid of art as projection medium during facilitative interaction, it has been determined that the young adults struggle with unresolved trauma as a result of abuse. The exposure to abuse resulted in barriers influencing their relationships with others as well as themselves. The barriers manifest as experiences of pain and confusion; mistrust and isolation; aggression and depression. The research resulted in the development of a model for educational psychologists equipping them to identify and address unresolved trauma with young adults through the use of art as projection medium during facilitative interaction. The development of the model proceeded in four stages. During stage one concepts were identified, defined and classified after completion of the fieldwork. The sample included 30 respondents from different cultures ranging from ages 18 to 24. The collection of data proceeded with the use of art as projection medium involving the following - a Gestalt-therapeutic exercise: the drawing of a rosebush, in-depth interviews, the analysis of cartoons and the writing of spontaneous sketches on unlineated paper for graphological analysis. The model of Guba was used to ensure trustworthiness in qualitative methodology. This refers to the credibility, transferability, reliability and verification of the research. In step two the relationship between concepts was drawn, after which step three followed, involving the description of the model. Guidelines in operationalising the model, are stated in step four. The model aims at the empowerment of young adults suffering from unresolved childhood trauma, with the use of art as projection medium during facilitative interaction. During this process the young adults are guided to an enhanced self-awareness in order for self-insight and self-empowerment to develop so that mental health can be obtained. The power of the model lies in the continuous plotting taking place through the use of art as projection medium during facilitative interaction.

Au cours de la traversée du cancer, et parfois bien après, certains patients se mettent à écrire à propos de leur maladie. Et avec internet, il n’est plus nécessaire d’être un écrivain professionnel pour publier en ligne le récit de cette épreuve. C’est ce recours à l’écriture dans le cadre du cancer que cette thèse a choisi d’examiner dans une optique psychanalytique : le cancer et la mort sont pour le sujet des rencontres avec ce que Lacan qualifie de "réel". Nous posons que cette rencontre vient parfois déchirer la réalité psychique, faisant alors trauma, et pousse le sujet à tenter de réparer l’accroc ainsi formé. Quelle place prend l’écriture dans ce traitement du réel traumatique ? Bien que la littérature scientifique, à travers les protocoles d’"expressive writing", ne retrouve pas de bénéfice clairement démontré de la pratique d’écriture dans le champ de l’oncologie, les patients écrivent, pourtant, parfois au-delà de toute recherche de bien-être. Qu’est-ce qui les pousse à écrire quand même ? Qu’est-ce que leur écriture vise ? A qui s’adressent-ils quand ils écrivent ? Pourquoi s’arrêtent-ils d’écrire, ou ne peuvent-ils pas s’arrêter d’écrire ? A travers la lecture de productions écrites de patients, de blogs, de sites de témoignages et d’entretiens avec des patients engagés dans une pratique d’écriture, nous verrons que l’écriture est multiple dans ses formes et dans les fonctions qu’elle occupe pour chacun. Elle nous enseigne sur la manière dont le sujet répond du réel rencontré : en le revoilant, ou parfois, plus rarement, en s’y affrontant sans le recouvrir, usant de la fonction de la lettre, concept dont Lacan a montré le lien avec le réel. Plusieurs conséquences pratiques sont formulées dans le champ de l’oncologie, et plus globalement sur la place de l’écrit dans le champ clinique. / Upon occurrence of cancer, or sometimes even after, it’s frequent that patients start writing about their disease. And with internet, it is no more necessary to be a professional writer to publish on line the history of this trial. This thesis has chosen to examine this resort to the writing, in a psychoanalytic approach: cancer and death are for the subject some encounters with what Lacan defined as the « real ». We assume that this encounter, sometimes, comes to tear the psychic reality, like a trauma, and leads the subject to repair the tear which has been made. What is the place of writing, in this treatment of the traumatic real? Although scientifical studies, through expressive writing protocols, do not show evidence for benefits in writing in oncology, patients nevertheless do write, sometimes beyond all search of wellness. What leads them to write? What is the aim of their writing act? Who do the write to? Why do they stop writing, or cannot stop writing? Through the reading of written productions of patients, blogs, sites of testimonies and interviews with patients committed in a practice of writing, we will see that writing has many forms and functions for each one. It teaches us the way the subject answers to the real encountered: veiling it again; or quite rarer, it deals with the real without veiling it, using the letter, a concept Lacan showed the links with the real. Some practical consequences are drawn for oncology, and more widely for the function of the written in the clinical practice.

Cette thèse s’attache à dégager les effets spécifiques des expériences traumatiques de nature sexuelle, et plus largement à modéliser le déploiement de tout traumatisme. L’informité traumatique y est particulièrement mise en évidence dans la façon dont l’expérience est atteinte au-delà de son contenu dans sa substance, ses contours et sa forme. Devant cette clinique de l’extrême où le patient se débat dans une économie le plus souvent paradoxale, le clinicien doit faire face à l’enchevêtrement des scènes traumatiques de l’histoire de son patient, d’un sujet n’abandonnant jamais véritablement le projet de configurer son expérience et de la situer topiquement. Pour rendre compte à la fois des effets du traumatisme et de son appel à former l’expérience, il convient de penser une topique au sein de laquelle peuvent se jouer et l’errance des éléments psychiques et la façon dont ils sont attractés pour arriver à configurer l’expérience, la symboliser. Cette topique est représentable par un cylindre développable en rubans de Möbius, cylindre contenant l’identité du sujet et dans lequel des zones de plis figurent les points où la matière psychique se forme et se spatialise. Ce cylindre où se joue l’expérience traumatique organisée en couple d’opposés, où se lisent également les efforts du sujet pour la circonscrire, n’est pensable que dans un modèle intersubjectif. Dans cette optique, et parce que l’économie traumatique impose plus que d’autres une réflexion sur le dispositif de soins et l’implication du thérapeute, on saisit mieux l’intérêt d’une double écoute (par deux psychologues cliniciens). Une part importante de ce travail de recherche concerne l’étude de la congruence de cette « copensée » avec la nouvelle modélisation du traumatisme. Ce travail de recherche laisse une large place à la clinique par l’exposé de longues vignettes retraçant le récit d’expériences traumatiques de patients, en replaçant ce déploiement (parfois sur plus de dix ans) dans l’épaisseur des séances, des échanges et des interactions entre les deux psychologues et leur patient. / The present thesis focuses on finding out the specific effects of a sexually traumatic experience and more generally on modelling the broadening of any trauma. It especially discusses the notion of traumatic informity by which an experience is impacted not simply in terms of its content, but also in terms of its essence, outline, and shape. Faced with these extreme clinical situations where the patient struggles in a most often paradoxical situation, the clinician must deal with the muddle of traumatic scenes characterizing his or her patient’s background, when the latter never completely gives up configurating his or her experience and topically situating it. In order to unearth the effects of the trauma as well as its ability to shape the experience, it is necessary to imagine a topique at the core of which the wandering psychic elements as the way they are attracted to each other - in such a way as to configurate and symbolize the experience - are at stake. This topique can be represented as a cylinder which can be unfolded into Möbius strips, and it contains the patient’s identity. The creases symbolize the places where psychic matter takes shape and broadens out. This cylinder, where the traumatic experience is at stake in opposed pairs and where the patient’s efforts to define it can be read, can only be envisioned as part of an intersubjective model. In this perspective, because traumatic economies necessitate pondering on health care measures and on the therapist’s level of engagement, it is easier for one to see how much more valuable a consultation with two clinical psychologists is. A significant part of this research work involves the study of the congruity of this “co-thought” with the new way of modelling a trauma. This research work leaves much room for clinical practice through long accounts retracing the patients’ history of traumatic experiences, as the two psychologists resituate the patient’s trauma’s broadening (sometimes over the course of ten years) during the intensity of the sessions, exchanges, and interactions.

Cette recherche émane d’une réflexion sur la pratique clinique et institutionnelle et a trois objets d’étude ; la maltraitance familiale, le traumatisme et l’institution. Elle questionne leur articulation au regard d’un vecteur commun : la violence. Elle se situe dans le contexte institutionnel d’évaluation des situations de maltraitance familiale et cherche à appréhender les discours et les pratiques des institutions confrontées à la mise en scène de la violence dont un tiers se trouve victime. L’hypothèse générale soutient l’existence d’un lien entre maltraitance familiale et violence institutionnelle. Le dispositif de recherche est envisagé à partir de la prise en charge développée par les institutions du système de la protection de l’enfance. L’analyse qualitative des données est réalisée à partir de la méthode des cas et de l’observation systématique des événements et des individus en situation (Pedinielli et Fernandez, 2007 ; Marty, 2009). Cette recherche met en discussion la problématique de la violence dans l’institution, envisagée dans sa relation avec l’emprise (Ferrant, 2006). Elle articule sa réflexion sur les effets désubjectivants de la prise en charge des familles marquées par la violence du lien (Houssier, 2002). Elle questionne la place de l’agir envisagé comme une manifestation du vécu traumatique et les risques qu’il comporte dans l’inscription d’un processus de répétition et de destruction de sens (Penot, 2001 ; Bokanowski, 2005). Elle répond à la mise en évidence d’un impact traumatique sur les institutions et articule sa réflexion autour de son influence sur la qualité de la prise en charge. Parallèlement, elle discute de la fonction d’exclusivité du dispositif de la protection de l’enfance dans les pratiques institutionnelles, au détriment de la culture du réseau. / This research is based on a study on clinical and institutional practices and focuses on three points; domestic violence (family abuse), trauma, the institution; it is meant to analyse their common point: violence. It is part of the institutional context family abuse. It studies the discourse and practices of institutions confronted with violence. The general hypothesis supports the idea that there is a link between domestic violence and violence within the institution. There are two aspects in this research; one clear specific institution: “Centre Maternel” (Mother Care institution), responsible for the taking into charge of the family so to avoid a child placement procedure and institutions for the protection of children as part of a clinical process. The qualitative analysis of the data relies on the methodology of situations and systematical observation of events and individuals in situation. (Pedinielli, Fernandez, 2007; Marty, 2009). This research raises the questions of violence within the institution itself and its close relationship with the family situation (Ferrant, 2006). It links up with the effects of the de-subjectivation while taking in charge of the family (Houssier, 2006). It questions the place of action seen as a sign of the traumatic experience and the risks incurred in the process of repetition which leads to a gradual loss of significance (Penot, 2001; Bokanowski, 2005). It shows the obvious impact on institutions and its influence on the quality of the taking into charge of the institution. Broadly speaking, it raises the question of the child protection system, underlining its function of exclusivity as regards institutional to the detriment of the network.

L’objet de cette thèse est de penser le corps à partir de l’expérience particulière qu’est l’accident.L’enjeu s’avère triple : i) élaborer un questionnement philosophique sur le corps en situation de handicap accidentel ; ii) replacer ce questionnement dans le champ des théories du handicap et des notions d’« identité » et de « reconstruction de soi » ; iii) traiter du corps en tant que suppor tidentitaire à la fois « naturel » et « construit » et envisager ainsi de manière renouvelée la question de la représentation et du rapport au corps. Cette approche conçoit le handicap non seulement à partir de ses conséquences mais aussi à partir de ses causes, et en particulier d’une cause possible : l’accident. Les questions fondamentales qui la sous-tendent sont les suivantes : qu’est qu’un accident ? Quel est le rapport entre la volonté, la responsabilité, et l’accident corporel ? Qu’est-ce qui rend le corps accidenté si insupportable ? L’impact des blessures sur le grand accidenté ouvre en effet un questionnement spécifique : Comment ce corps abîmé va-t-il être perçu et accepté par les autres et par l’individu lui-même ? Comment ce dernier va-t-il éprouver le passage d’un corps « valide » à un corps« handicapé », d’un corps « normal » à un corps « différent » ? Un individu peut-il concilier deux acceptions de son corps correspondant à un « avant » et à un « après » accident ? Comment vivre avec, dans, par un nouveau corps ? Pour traiter ces questions, ce travail philosophique mobilise les points de vue sociologique, anthropologique, éthique et médical sur le handicap accidentel. / The purpose of this thesis is to think about the body in light of the particular experience that is theaccident. The aim is threefold: i) to develop a philosophical inquiry on the accidentally disabled body;ii) to situate this inquiry with respect to theories of disability, of "identity", and of "selfreconstruction";iii) to treat the body as a medium of identity that is both "natural" and "constructed",and thus consider the question of the representation of the body from a new perspective. Thisapproach looks at disability not only from the point of view of its consequences, but also of its causes,and in particular of one possible cause: the accident. The fundamental questions in this investigationare the following: What is an accident? What is the relationship between the will, responsibility, andpersonal injury? What makes the injured body so unbearable? The impact of the damage on theseverely injured opens a specific line of questioning: How will the injured body be perceived andaccepted by others and by the individual itself? How will that person experience the transition from an"able" to a "disabled" body, from a "normal" body to a "different" body? Can a person reconcile thetwo senses of the body corresponding to a "before" and an "after" the accident? How to live with andin a new body? To address these issues, this philosophical work brings to bear views on accidentaldisability from sociology, anthropology, and medical ethics.