De la lecture à la pratique : Idées noires et tentative de suicides

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Les professionnels de l’orientation travaillent de concert avec différents clients de multiples milieux dans ce qu’ils ont de plus intimes : leurs pensées. Durant un tel accompagnement, la relation d’aide se bâtit et peu à peu, le client prend confiance envers le professionnel et lui permet d’aborder avec lui des détails plus intimes. C’est avec cette exploration de la psyché que le professionnel de l’orientation travaillera auprès de son client.Or, acquérir ainsi une telle confiance dans l’exploration de son quotidien peut conduire à des révélations positives certes mais également plus troubles, plus sombres. Et peut-être un jour, un client fera assez confiance au professionnel pour dévoiler qu’il ressent des idées de plus en plus noires qui pourraient être révélatrices d’un intense désespoir. Bref, il peut s’agir d’idées suicidaires.Le suicide est une réalité malheureusement trop commune pour la passer sous silence dans le cadre professionnel des conseillers d’orientation. Comme le dit Granier (p.19), « le suicide est devenu un problème majeur de santé dans la plupart des pays occidentaux et développés ». Celui-ci nous propose d’ailleurs un livre basé sur son expérience de clinicien d’urgence dans un hôpital de France. Bien que ses propos soient particulièrement illustrés en fonction de cet état, le lecteur peut y retrouver de multiples informations intéressantes et faciles à saisir pour comprendre les tenants du suicide mais également quels sont les points à tenir compte dans une relation d’aide envers une personne suicidaire et quelles sont les actions pouvant être posées à cet égard.Ce texte propose un résumé du livre Idées noires et tentatives de suicide. Réagir et faire face. du Dr Emmanuel Granier, publié à Paris en 2006.Qui est le Dr Emmanuel Granier?
Le Dr Emmanuel Granier est un conférencier et psychiatre français spécialisé dans l’approche comportementaliste. Il a travaillé plus de 9 ans à l’Unité d’accueil des urgences psychiatriques du centre hospitalier d’Avignon (Granier, 2006) avant d’œuvrer en clinique privée. Il a également publié le “Petit Guide de Thérapie Comportementale à l’usage des patients”, référencé par plusieurs psychiatres français ayant un intérêt envers les thérapies comportementales. Il est également participant à « l’action nationale des formations à l’intervention de crises suicidaires » (Granier 2006).

Peu d’informations se trouvent sur la personne d’Emmanuel Granier car Idées noires et tentatives de suicide, Réagir et faire face est son premier livre. Il a décidé de l’écrire afin de parler de son expérience à titre de psychiatre d’urgence et d’accompagner d’autres personnes en contact avec le suicide. Il raconte d’ailleurs, dans l’avant-propos de son livre, l’histoire de son premier contact avec une petite fille suicidaire, lorsqu’il faisait son internat comme médecin généraliste. C’est suite à ce contact qu’il s’est dirigé vers la psychiatrie.

Compte-rendu du livre de Granier (2006)
Le livre comporte 330 pages divisées en 4 parties : Comprendre le  geste suicidaire, comptant les chapitres 1, 2, 3, 4 et 5, où le thème principal dégagé est de comprendre les mécanismes et les tenants liés au suicide, Comment aider : parler, principalement axé sur la relation d’aide avec une personne suicidaire, abordée par les chapitres 6, 7 et 8, Que faire?, englobant les chapitres 9, 10, 11, s’intéresse aux actions à entreprendre lorsqu’une personne évoque ses projets suicidaires et finalement, Les tentatives de suicide chez les adolescents aborde plus spécifiquement les idées suicidaires chez cette catégorie d’âge grâce aux chapitres 12 et 13. Ainsi, ces parties sont divisées en plusieurs courts sous-chapitres abordant différents thèmes, allant de la description du suicide jusqu’à des actes concrets pour aider une personne en proie aux idées suicidaires. Tel que précisé par l’auteur, les chapitres ne se suivent pas nécessairement et pourraient être lus dans l’ordre désiré par le lecteur, selon ses besoins et ses intérêts.

L’auteur semble s’être assuré de bien vulgariser le suicide afin que les concepts puissent être facilement accessibles et faciles à lire. De plus, tel que mentionné dans l’avant-propos du livre, ce dernier se base sur des cas cliniques concrets que le psychiatre a rencontrés au sein de sa pratique. Chaque élément théorique est ainsi appuyé par un exemple concret permettant de bien cerner le concept à comprendre.

Dans le chapitre 1, Tentatives de suicide et gestes suicidaires, le lecteur pourra se renseigner sur tous les thèmes liés au suicide tels qu’abordés par l’auteur comme conduites suicidaires, idées suicidaires, suicidant, de même que tentatives de suicide. À travers des cas cliniques, il fait ressortir les différences d’un individu à l’autre mais soulève un point commun, la sensation d’un désarroi si profond que la personne cherche par tous les moyens d’arrêter de souffrir, peu importe les conséquences. Il explique également que toute tentative de suicide devrait être considérée comme grave et devrait recourir à une hospitalisation, surtout qu’il semble exister, tel qu’abordé dans le chapitre sur différentes statistiques, une relation nette entre le nombre de tentatives, le nombre de pensées suicidaires et le risque de décès par suicide.

En tant que conseillers d’orientation pouvant être moins habitués avec les actes autoagressifs, l’auteur propose de différencier tentatives de suicide, automutilation et comportements à risque. L’automutilation est un besoin de calmer un malaise intérieur extrême en les transformant en douleurs physiques, sans atteinte à la vie. C’est seulement si les automutilations ont une visée contre la vie qu’on parlera de tentative de suicide. Il aborde également les relations entre les conduites à risque et le suicide, particulièrement chez les adolescents. Les adolescents peuvent avoir des comportements dangereux pour leur vie ou pour leur santé qui viennent les confronter dans leur désir de se sentir vivant lorsqu’ils survivent à ce comportement dangereux. Bien que cela ne soit pas toujours en lien avec l’idée de suicide, ils peuvent cacher un mal-être plus profond qui lui peut être lié. Dans tous les cas, l’auteur affirme que la catégorisation est peu importante, l’essentiel étant d’interroger la personne sur l’intention derrière le geste. Là est la clé d’une intervention adéquate et ajustée de la part d’un professionnel et ce vers quoi devrait tendre une relation d’aide lorsqu’il y a présence d’actes autoagressifs.

Dans le chapitre 2 intitulé Qu’est-ce qui conduit au suicide?, l’auteur mentionne qu’il n’existe pas de raison particulière pour penser au suicide et passer à l’acte mais qu’il s’agit davantage de la présence de facteurs de risque qui peuvent augmenter les possibilités, sans toutefois être capables de réellement prédire le suicide. Un intervenant en counseling doit rester à l’affût lorsque ces facteurs sont présents sans toutefois conclure à un suicide imminent. Une personne pourrait avoir des risques élevés mais ne jamais penser au suicide alors qu’une autre ne pourrait en avoir aucun et avoir tout de même des idées suicidaires. Ces facteurs sont divisés en 3 catégories. Les facteurs de risque primaires sont liés à l’individu même comme les antécédents personnels, la génétique, les maladies psychiatriques, des désordres biologiques pouvant causer des troubles ou des comportements agressifs et la communication d’une intentionnalité suicidaire qui a son importance puisqu’il existe une gradation entre les idées suicidaires et le passage à l’acte. Les facteurs de risque secondaires concernent plutôt l’environnement d’un individu, par rapport à son histoire personnelle (voir le chapitre 5 sur Le rôle de l’enfance) ou sa perception du soutien actuel de son entourage. À noter qu’un intervenant aura peu d’intervention permettant d’agir directement sur ce point mais il peut aider un suicidant à vivre différemment ces événements ou à mieux gérer les événements qui l’entourent. Finalement, les facteurs de risque tertiaires comprennent davantage les statistiques entourant les personnes à tendance suicidaire.

Granier présente également un modèle de description de la crise suicidaire qui se divise en trois états où à chaque étape, le suicidant se sentira de plus en plus dépassé par les événements. La première étape est l’état d’équilibre, stable, avant que la situation s’envenime. Vient ensuite l’état de vulnérabilité croissante où l’individu se sent surpassé par les événements et voit l’apparition possible des pensées suicidaires. Lorsque que la personne n’arrive plus à y faire face, l’état de crise apparaît et il y aura augmentation du désespoir et de la surcharge. Les idées suicidaires évoluent à chaque étape jusqu’à ce que la personne les trouve acceptables. C’est à ce moment qu’elle pourrait passer aux tentatives de suicide. Trois facteurs environnementaux affectent également ce modèle : une perception déformée de l’événement déclencheur, le sentiment de manque de maîtrise de la situation et l’impression d’un manque de soutien de l’entourage, le tout affecté par les différents facteurs de risque. En résumé, les professionnels de l’orientation devraient être à l’affût des étapes et des éléments pouvant influencer la venue d’une crise suicidaire afin d’agir à temps, tout en gardant un œil critique sur le fait que ce sont des influences possibles mais non une garantie d’une crise suicidaire.

Le chapitre 3, intitulé Les maladies psychiatriques qui se cachent derrière le suicide, se penche sur la question de l’influence de la maladie mentale sur les risques suicidaires. L’auteur commence par préciser que l’éventail des dysfonctions psychologiques possibles se regroupent sous le terme de trouble mental qui peut être de divers ordres tels que biologique, génétique, historique, etc. Ces troubles mentaux peuvent venir accentuer les risques d’apparition d’idées suicidaires qui peuvent conduire au suicide. Selon l’auteur, la dépression est le trouble le plus fréquent lié au suicide. Il est d’ailleurs possible qu’un client en soit victime et que c’est cet état d’esprit qui emmène à consulter un conseiller d’orientation. Il est donc important que ce dernier garde une oreille attentive aux idées noires qui pourraient être abordées. La dépression est caractérisée par une perte d’énergie et d’envie, elle cause également divers problèmes accentuant le mal-être de la personne, notamment en la privant d’un sommeil réparateur, en causant des troubles d’appétits et des difficultés de concentration, en la rendant plus agressive ou en lui faisant ressentir de la culpabilité envers son manque d’énergie. Le suicide pourrait être envisagé lorsqu’une personne éprouve une trop grande difficulté à supporter ces troubles par elle-même. Le conseiller d’orientation devrait donc tenir compte de ce contexte pour intervenir et ne pas, entre autres, exacerber cette culpabilité. Les autres troubles de l’humeur peuvent également jouer un rôle, notamment les troubles bipolaires et les états mixtes.

D’autres troubles psychologiques peuvent également jouer un rôle. Les troubles anxieux sont également propices à accentuer les risques suicidaires lorsque combinés à un épisode dépressif, notamment le trouble panique, caractérisé par des crises d’angoisses aiguës qui peuvent être difficiles à tolérer pour la personne qui en souffre, les phobies spécifiques à une situation ou un objet, l’anxiété généralisée et le trouble obsessionnel compulsif. D’autre part, la schizophrénie, caractérisée par des hallucinations et la survenue d’idées étranges allant jusqu’au délire, peut tout autant causer des gestes suicidaires soient par la maladie elle-même (avec des attentes illogiques venant appuyer l’idée du suicide) ou par la réalisation d’éprouver une telle maladie. Finalement, bien qu’il ne s’agisse pas de troubles à proprement parler, l’abus de drogues et d’alcool peuvent venir aggraver l’une ou l’autre de ces maladies psychiatriques, accroissant ainsi les risques de suicide. Ces abus témoignent également du désir de fuir la réalité que peuvent éprouver ceux qui les consomment.

Le chapitre 4, Certains sont-ils prédisposés au suicide? Ou le rôle de la personnalité, aborde les troubles de la personnalité les plus susceptibles de recourir au suicide. Le professionnel de l’orientation doit donc être vigilant avec ce type de clientèle. L’auteur explique d’abord qu’une personnalité est un ensemble de comportements stables et permanents avec lesquels un individu réagit face à une situation. Ainsi, si un individu avait comme schéma un état dépressif, il aborderait tous ses problèmes avec ses lunettes de dépression, augmentant ainsi les risques de suicide puisque sa perception est stable. Tous les troubles de personnalité sont à risque de causer des idées suicidaires s’ils handicapent la vie d’une personne. Cependant, les troubles abordés particulièrement dans ce chapitre sont les troubles de la personnalité limite, histrionique et antisociale puisqu’ils sont ceux qu’on retrouve le plus fréquemment dans cette situation. Le suicide est une possibilité envisagée par les troubles de personnalité limite puisque cela leur apporterait un soulagement pour eux et leurs proches puisqu’ils vivent des périodes successives d’émotions trop vives ou trop vides. Les personnalités histrioniques ont tendance à réagir avec flamboyance pour se faire accepter et remarquer des autres. Lorsqu’elles sont blessées suite à une déception en lien avec cette acceptation, elles peuvent agir avec colère contre les autres mais également contre elles-mêmes, voulant exprimer « leur souffrance et leur colère au prix de leur propre vie » (p.106). Les personnalités antisociales ont tendance à réagir avec impulsivité, en posant un acte agressif, voire avec violence et brutalité, au lieu de vivre des émotions. Elles réagissent au moment présent, sans penser aux conséquences de leurs gestes ni à leur entourage. Elles utilisent alors souvent leur corps pour évacuer cette violence, allant de l’abus de substances toxiques jusqu’aux tentatives de suicide. Tous ces troubles ont des points en commun : une relation impulsivité-agressivité, possiblement causée par un problème biologique de gestion de la sérotonine et un sentiment fréquent de désespoir.

Le chapitre 5 parle du développement des risques suicidaires en abordant notamment Le rôle de l’enfance. Lors d’un processus de counseling, le rôle du professionnel consiste entre autres, à revenir dans le passé de son client afin de mieux comprendre son fonctionnement psychologique. Il se peut, à ce moment, que le client révèle une enfance difficile. Le Dr Granier mentionne d’ailleurs que plusieurs études ont pu mettre en relation que des événements de l’enfance difficiles ou douloureux peuvent accentuer les risques de tentatives de suicide, sans toutefois y faire référence. Cela est dû, entre autres, au fait que l’enfance est un moment d’apprentissages où l’enfant met en place des attitudes et des comportements qui seront développés pour faire face à diverses situations. Il y développe également son sens de sa propre valeur grâce au sentiment d’attachement développé par sa proximité envers ses parents et leur habileté à combler ses besoins, ce qui déterminera sa relation envers les autres. Associées à cette interaction valeur-attachement se trouvent les émotions qui en découlent. Ces trois éléments gravent un type de fonctionnement dans la mémoire de l’enfant et lui enseignent des règles de vie, des schémas cognitifs et des croyances auxquels il aura recours dans divers événements lorsque ceux-ci lui rappelleront les émotions et les valeurs associées à des événements connexes survenus dans le passé. Une tentative de suicide surviendrait quand un événement douloureux ferait résonner un souvenir négatif en émotion, en valeur et en sentiment. Les souvenirs évoqués négatifs effacent alors tous les événements positifs de la vie actuelle de la personne. C’est pourquoi il peut être difficile de travailler sur une réussite passée ou un souvenir positif avec une personne dépressive ou sujette à une forte tendance suicidaire. D’ailleurs un exemple concret et bien expliqué de ce concept se trouve dans le livre à la page 123. Ce chapitre n’est pas sans rappeler la théorie de la construction des schémas cognitifs et de la personnalité, sujets propices à l’approfondissement pour les professionnels de l’orientation.

La deuxième partie abordant la relation d’aide commence avec le chapitre 6 intitulé Créer la relation. Comme le mentionne Dr Granier, « cette relation sera le seul rempart immédiatement actif contre le suicide » (p. 131) puisque les thérapies et les médicaments agissent à plus long terme. Il est donc primordial d’établir cette relation, quoique cela sera difficile puisque la personne n’a plus conscience des liens qui l’entourent mais d’autant plus efficace qu’une relation nouée dans un tel état peut être considérée comme la seule planche de salut par cette personne. Le but de cette relation est de substituer une volonté de mort contre l’établissement de cette relation en se basant sur la volonté de déceler la souffrance derrière les idées de mort. L’établissement de cette relation doit compter sur deux facteurs : la personne est réticente à recevoir de l’aide et elle est submergée par les émotions. Il faut donc agir avec prudence, en étant ni trop empressé, ce qui aura pour effet de la rebuter, ni trop distant, ce qui aura pour effet de ne pas accrocher la personne à la relation. L’auteur suggère donc d’user d’empathie, d’authenticité, de bienveillance, de démonstration d’une capacité d’aider et d’harmonie, soit la capacité à se synchroniser sur les propos et les gestes de la personne tout en respectant le bon moment, et ce, avec exemples à l’appui. Ainsi, l’établissement de la relation d’aide avec une personne suicidaire s’effectue de la même façon qu’en contexte de counseling d’orientation, à l’exception près que celle-ci doit être faite avec davantage de prudence, de douceur en commençant par parler de soi, de son rôle et de son inquiétude face à la douleur de l’autre pour dériver sur ce qu’on sait de cette personne afin d’emmener tranquillement la conversation vers le suicide. L’auteur propose d’ailleurs un exemple de fil de conversation possible (p. 149) qui peut être un outil pratique pour le conseiller d’orientation vivant une situation d’urgence avec le client. En somme, le but est de créer une relation coopérative qui permettra à l’intervenant et à la personne en détresse de travailler ensemble à trouver une solution pour sortir de cette impasse.

Le chapitre 7 propose d’Explorer la crise suicidaire. De prime abord, tel que mentionné par l’auteur, tout intervenant essayant d’établir ou de conserver une relation d’aide dans un contexte suicidaire doit savoir aborder directement le suicide, sans tourner autour du pot. Oser dire le mot suicide permet de confronter la réalité en face, de mettre en lumière les risques concrets et palpables de même que trouver des solutions. Puis, la prochaine étape est de comprendre la crise, c’est-à-dire ce qui fait mal, l’élément déclencheur et vérifier si la situation est une accumulation de problèmes ou une surcharge du même problème que la personne n’est plus capable d’endurer. L’auteur fait également la différence entre l’élément déclencheur et l’élément précipitant qui est « la goutte d’eau qui fait déborder le vase » (p. 159) et qui fera en sorte que la personne commettra une tentative de suicide. Procéder de cette façon permet à la fois de mieux connaître la personne mais également de permettre à celle-ci de faire le point sur sa situation. Une fois le portrait global obtenu, l’auteur mentionne d’explorer les idées suicidaires en elles-mêmes, en déterminant le degré des facteurs immédiats (présence d’un désir de mort, de désespoir, d’une crise d’angoisse ou d’un plan) ou à plus long terme (concernant les chapitres précédents), l’urgence de la situation (élevée, moyenne ou faible) et la dangerosité de ces idées sur la personne elle-même (un plan précis dont la personne a tous les éléments en main versus un plan non défini). À la fin de ce processus, il suggère ensuite de se renseigner sur l’état de vulnérabilité de la personne dans son contexte de vie et dans son histoire personnelle mais également sur ses ressources disponibles pour l’aider ainsi que sur ses projets futurs. Dans ce chapitre, l’auteur inclut des outils pratiques tels qu’une grille d’évaluation des risques, une autre sur la gravité des gestes suicidaires de même qu’une liste d’éléments de réponses à aller chercher lors du premier entretien qui pourrait permettre un degré d’évaluation de la dangerosité de la situation par le professionnel intervenant.

Le chapitre 8 aborde de façon plus précise comment Travailler sur les idées suicidaires. Tel que vu précédemment, les idées suicidaires sont les éléments les plus importants à comprendre afin de mieux aider la personne vivant ce genre de pensées et constituent le plus gros chapitre du livre. L’auteur aborde de façon concrète plusieurs moyens pour aider la personne en crise et donne des pistes d’intervention pratiques et intéressantes afin d’aider un professionnel en relation d’aide grâce à sa spécialité : l’approche cognitivo-comportementale.

L’auteur commence le chapitre en abordant le fait qu’un intervenant en relation d’aide ne doit pas tomber dans le piège de démontrer que la personne a tort et que la vie vaut la peine d’être vécue. Cela risquerait d’effriter la relation d’aide puisque la personne n’est pas rendue à ce stade et pourrait même la renforcer dans son isolement. Il propose plutôt d’analyser l’interrelation Pensée – Émotion – Comportement avec le but de briser le cercle vicieux des pensées automatiques noires en visions plus réalistes, moins douloureuses et offrant plus de possibilités pour la personne. La thérapie cognitive devrait être appliquée davantage dans un contexte où l’intervenant a du temps, qu’il n’est pas trop ébranlé par ce qui se passe et que la personne sait parler de ses pensées et de ses émotions, sans oublier les compétences relationnelles.

Il propose pour ce faire une thérapie cognitive en quatre étapes. Premièrement, le professionnel intervenant en contexte de crise doit faire venir « les idées de suicide à la conscience » (p.196), c’est-à-dire en allant creuser davantage les intentions derrière le geste. Il doit aussi prendre conscience qu’il existe une différence entre une crise suicidaire aiguë, où l’intervenant doit demander de décrire avec précision ses pensées lorsque la personne a voulu commettre le geste en remontant le fil des événements, et les crises sur le long terme, où l’intervenant doit favoriser la reconnaissance des idées de mort à la personne aidée afin qu’elle puisse prendre conscience de cette réalité. Deuxièmement, l’intervenant doit aborder la signification des idées de suicide du client. L’auteur propose d’utiliser la technique de la « flèche descendante » (p.202), c’est-à-dire de carrément poser la question « qu’est-ce que cela signifie pour vous » à chaque réponse donnée par la personne jusqu’à trouver la véritable pensée qui cause le désespoir de la personne. Une fois cette raison trouvée, l’auteur propose une troisième étape qui consiste à « remettre en cause la justification des idées suicidaires » (p.206). Pour ce faire, l’intervenant doit débattre de la vision du monde de la personne avec cette dernière. L’auteur propose d’ailleurs des questions personnelles que toute personne pourrait se poser pour voir les choses différemment et plus réalistement, sans être teintées par leur propre vision des choses. Cela constitue d’ailleurs une théorie intéressante pour briser les croyances erronées des clients qui se perçoivent différemment de la réalité en plus d’avoir des questions propres sur le prix de la vie et les conséquences d’un suicide. Finalement, la quatrième étape consiste à la réévaluation de la situation, en comparant comment la personne la voyait au moment de la tentative ou des idées de mort et comment elle voit la situation une fois la remise en cause effectuée.

L’auteur termine ce chapitre en mentionnant le fait que l’intervenant ne devrait pas gagner contre son patient dans ses idées de mort mais bien l’accompagner pour qu’il se rende compte de la situation lui-même. Il fournit également un exercice inspiré de la thérapie cognitive appelée « la fiche à 5 colonnes » (p. 224) afin d’outiller l’intervenant à aider son client dans l’analyse de ses pensées. De plus, il termine sur les difficultés pouvant ébranler la thérapie cognitive et des moyens d’y faire face comme les émotions trop intenses, le blocage sur les idées de mort, se tromper de pensée à travailler ou la trop grande facilité à laquelle une personne semble être convaincue. La fiche à 5 colonnes peut d’ailleurs être pratique dans différents domaines où le professionnel de l’orientation souhaiterait changer les croyances erronées d’un client.

Le chapitre 9 concerne la première partie davantage axée sur l’action et s’intitule Je vois quelqu’un en crise suicidaire : que dois-je faire?. L’auteur propose différents types d’action en fonction des étapes de la crise suicidaire tel qu’abordé au chapitre 2. Lors de l’apparition des idées suicidaires, Granier propose de s’informer sur les idées suicidaires afin de s’assurer qu’elles ne cachent pas quelque chose de plus profond et d’expliquer les risques liés au suicide. Lorsque la personne a déjà des projets suicidaires, le danger est plus imminent. Il est d’autant plus important de bâtir une relation de confiance tout en évaluant les risques de suicide concernant l’urgence et la dangerosité. En cas d’urgence faible ou modérée, la personne est prête à se laisser du temps pour réfléchir et ne nécessite pas une intervention hospitalière immédiate. Mais si le risque est élevé, c’est-à-dire que la personne a un plan précis, plus elle risque de se suicider dans les prochaines 48 heures. Il est alors demandé d’accompagner la personne le plus rapidement possible auprès de professionnels adéquats. Il ne faut alors surtout pas laisser la personne seule et on doit l’accompagner. Ce sera la même évaluation à effectuer si une personne révèle avoir fait une tentative de suicide car elle est en risque de récidive. Il faut donc vérifier si elle est en train de se sortir de la crise ou si elle y est encore soumise. D’ailleurs, en cas de récidive, l’auteur mentionne que le but des professionnels de la santé est de trouver d’autres moyens pour aider la personne puisque ceux abordés précédemment n’auraient pas porté fruits. Finalement, l’auteur tient à rappeler que lorsque nous recevons une confidence d’un geste suicidaire, il n’y a « aucune trahison possible quand la vie de l’autre est en danger » (p.248) et que le secret peut être lourd à garder. Il ne faut pas hésiter à aller chercher de l’aide en ce cas. De plus, il mentionne qu’une tentative de suicide ou un suicide doit être abordé avec l’entourage de la personne et dans ses groupes de relations diverses afin d’assurer une bonne compréhension des événements, avec notamment des cellules de postvention suicidaire.

Le chapitre 10 aborde plus directement le type de soins à apporter à une personne suicidaire et se nomme Comment peut-on soigner les personnes en crise suicidaire?. Pour l’auteur, soigner ne signifie pas d’essayer de guérir la maladie ou d’en atténuer les effets négatifs mais bien de prendre soin de la personne et de s’occuper d’elle en lui procurant des soins. Les personnes les plus aptes à soigner dans de tels cas sont bien entendu les psychiatres, les psychologues et les travailleurs sociaux, particulièrement si la crise survient dans un contexte difficile comme des difficultés financières, de la difficulté à se nourrir et se loger, problèmes judiciaires, etc. Régler ces difficultés de survie pourrait aider la personne à se placer dans un climat plus près d’accueillir une relation d’aide qui explorerait les causes de ses idées suicidaires. Les professionnels de l’orientation ne devraient donc jamais hésiter à référer les clients plus fragiles à ces intervenants ou même les mener directement à ces personnes en cas de crise plus avancée. Par ailleurs, l’auteur mentionne la possibilité que les psychothérapeutes puissent également agir en ce sens. Avec l’arrivée de la loi 21, les conseillers d’orientation pourraient être appelés à agir à ce titre en allant chercher leur permis auprès de l’Ordre professionnel des conseillers et conseillères d’orientation. L’auteur recommande d’ailleurs que le professionnel soit d’abord formé à intervenir avec des personnes suicidaires et parle plus particulièrement des approches analytiques, cognitivistes, comportementalistes et de thérapie familiale. Finalement, il aborde comme autre outil d’aide la prise de médicaments pour les personnes suicidaires, c’est-à-dire les médicaments adaptés à différentes problématiques (dépression, trouble de l’humeur, etc) et en dernier lieu, le recours à l’hospitalisation.Le chapitre 11, L’hospitalisation, aborde justement la délicate question du retrait de l’individu de son environnement afin de permettre de le soigner. Il peut arriver dans la pratique des conseillers d’orientation d’arriver face à une possibilité d’hospitalisation qui pourrait être nécessaire et imminente ou encore à un client qui se verrait obligé d’aller en hospitalisation. Bien que le rôle des conseillers d’orientation ne soit pas de demander une telle chose, ceux-ci devraient être au courant de la dynamique existant entre les différents acteurs pour au moins comprendre le processus derrière l’hospitalisation. Dr Granier aborde en effet l’interrelation individu, entourage et personnel soignant dans la prise de décision d’une hospitalisation et des conséquences si un ou plusieurs des différents acteurs entrent en conflit. Le personnel soignant a une vision médicale de la situation, la personne aura une perception de sa propre condition et l’entourage consiste en l’apport affectif qu’une personne aura besoin. Une décision d’hospitalisation devrait se faire lorsque les trois acteurs sont d’accord avec la situation et plus cet accord sera manifeste, plus la personne a de la chance d’améliorer sa condition et diminuer sa souffrance. Cependant, parfois il y a réticence d’un acteur ou de l’autre. Parfois, le personnel soignant n’évaluera pas un danger imminent alors que les deux autres acteurs insistent pour l’hospitalisation. Ou encore, l’entourage pourrait décourager la personne à se faire hospitaliser, ne voyant pas où est le problème. Finalement, il se peut que ce soit l’individu lui-même qui sera rébarbatif à se faire soigner. C’est à ce moment qu’on parle d’hospitalisation sans consentement. Il est à noter cependant que les lois abordées dans le livre concernent les lois françaises et ne sont donc pas tout-à-fait comparables aux lois québécoises. Cependant, vous pourriez vous renseigner sur le site de Justice Québec en ce qui a trait aux troubles mentaux pour plus d’informations à ce sujet. En somme, l’hospitalisation sans consentement devrait être une solution de dernier recours car souvent, elle ne résout rien en soi et ne devrait être faite que lorsqu’elle est indispensable. Elle marque cependant un temps d’arrêt important et l’implantation d’outils psychologiques pour venir en aide à l’individu. L’auteur mentionne que selon les grilles proposées au chapitre 7, l’hospitalisation devrait être nécessaire avec un score supérieur à 25.Les deux derniers chapitres parlent plus spécifiquement du suicide chez les jeunes. Dans le chapitre 12, Les tentatives de suicide chez les adolescents, l’auteur aborde une liste de 10 points à retenir pour venir en aide à un jeune suicidant avec des explications sur chacun d’entre eux. En contexte scolaire ou en communautaire axé sur la jeunesse, ce chapitre peut être précieux pour un conseiller d’orientation car les risques de suicides sont particulièrement élevés chez cette tranche d’âge. En premier lieu, l’intervenant doit se rappeler que la fragilité d’un jeune suicidant est plus grande que pour les autres catégories d’âge et qu’il peut avoir un plus grand désir de se replier sur soi. Il faut donc être proactif, tout en étant authentique, empathique et en harmonie. Ensuite, le jeune peut se sentir dévalorisé d’être dans cet état. Il est important que l’intervenant lui rappelle la valeur qu’il a à ses yeux afin de susciter une plus grande confiance, ce qui peut résulter en de meilleures confidences. De plus, l’auteur revient sur le fait de parler simplement du suicide, sans mot détourné mais progressivement et avec tact. Pour continuer, l’auteur met en garde l’intervenant à ne pas se faire rassurer trop vite par le jeune sur sa capacité à fonctionner et aller bien. L’entourage de l’enfant peut aider à ce propos car il est témoin du comportement du jeune. En outre, l’auteur mentionne qu’un désir de mourir vécu chez un jeune ne doit pas être pris à la légère en l’associant à une crise d’adolescence, qu’il ne s’agit pas d’une étape normale de cette période. Il affirme également que l’intervenant doit essayer de maintenir un lien fort avec le jeune, même si celui-ci n’est pas prêt à s’ouvrir, quitte à utiliser les nouveaux moyens de le rejoindre, tels les courriels ou les textos, ou encore de sortir d’un cadre traditionnel de bureau. Toutefois, il précise aussi de ne pas tout accepter et de savoir imposer des limites dans cette situation. Finalement, il mentionne que l’intervenant doit accepter les risques encourus envers cette situation, qu’il doit tolérer l’instabilité, autant dans les suivis que dans les comportements de la personne et surtout, de savoir faire face à l’échec car il est possible que malheureusement, malgré toutes les bonnes volontés du monde, que cela ne fonctionne pas. L’intervenant doit donc savoir analyser ses sentiments de culpabilité en se remémorant ses bons coups, toujours avec l’intention d’avoir voulu aider le jeune.Finalement, l’auteur se positionne face à l’utilisation de médicaments chez les jeunes dans le dernier chapitre intitulé Quel traitement pour les enfants et les adolescents? Faut-il donner des médicaments? Selon lui, donner des médicaments à un enfant en proie à la dépression est tentant pour un soignant étant donné l’efficacité chez les adultes, la réduction du risque suicidaire et l’apaisement qu’ils suscitent. Toutefois, selon une recherche citée et expliquée par l’auteur avec ses avantages et ses inconvénients, les antidépresseurs ne seraient pas aussi efficaces chez l’enfant et l’adolescent, à moins d’être combinés à une psychothérapie. Ces médicaments peuvent causer une levée d’inhibition pouvant augmenter le risque suicidaire mais davantage lié à un arrêt trop rapide du médicament que de la prise de celui-ci. La marche à suivre, selon lui, serait de commencer par une psychothérapie et si les résultats sont trop lents à apparaître, de recommander des médicaments, en s’assurant d’expliquer au jeune les conséquences et les démarches derrière la prise de ceux-ci.Pertinence pratique 
Le docteur Granier possède une expertise dans le domaine de l’intervention psychiatrique dans un contexte de clinique d’urgence d’un établissement hospitalier. Son écriture, ses cas cliniques et ses outils le reflètent particulièrement. Il pourrait donc donner l’idée que ce livre est peu utile dans un contexte d’orientation. Or, la vulgarisation du contexte et des termes entourant le suicide permet de bien comprendre les enjeux liés à cette situation. Il permet également de donner des outils de première ligne pour un intervenant ou un conseiller d’orientation qui serait confronté à l’aveu d’idées suicidaires de la part d’un client.

 Dans un contexte de counseling individuel ou de groupe, une fois la relation de confiance bâtie, il se peut que le conseiller d’orientation devienne la perche que l’individu a besoin pour se sortir du noir. En effet, en allant explorer l’histoire personnelle du client, il peut faire face à plusieurs facteurs de risque pouvant avoir une incidence sur l’apparition d’idées suicidaires, sans toutefois oublier qu’ils ne sont pas nécessairement prédicteurs pour autant. Le conseiller d’orientation, de par sa formation et son expérience, possède les compétences relationnelles permettant de bâtir la relation d’aide envers une personne suicidaire mais peut se sentir débordé par l’urgence du moment. Ce livre permet notamment d’avoir une idée pour effectuer une certaine évaluation de la gravité d’une situation et de pouvoir catégoriser les gestes autoagressifs entre ce qui peut causer du tort à la vie de la personne ou pas. Encore une fois, le conseiller d’orientation devrait toujours aller creuser l’intention derrière le geste pour mieux comprendre la situation. Les grilles d’analyse, les outils pratiques et les moyens d’intervention peuvent permettre aux professionnels de ce milieu d’être mieux préparés à l’éventualité de faire face à l’aveu d’idées noires ou de tentatives de suicide.

Finalement, l’auteur mentionne à plusieurs reprises des faits précis en lien avec une clientèle adolescente, deux chapitres y étant d’ailleurs directement dédiés. Ce livre peut donc être particulièrement utile envers une clientèle plus jeune, en milieu communautaire ou en milieu scolaire.

Compte rendu de l’ouvrage

Granier, E. (2006). Idées noires et tentatives de suicide. Réagir et faire face. Paris, France : Odile Jacob. ISBN : 2-7381-1725-2

Recension d’ouvrage réalisée par :

Jennifer Desbiens, étudiante à la maîtrise en carriérologie, UQÀM

Sous la direction de :

Louis Cournoyer, Ph.D., c.o.

Professeur (counseling de carrière)

Université du Québec à Montréal

Références
AFTAD. Association française des troubles anxieux et de la dépression. (2013) Récupéré le 13 octobre du site http://www.anxiete-depression.org/files/fiches-pratiques/TCC.pdf.

Granier, E. (2006). Idées noires et tentatives de suicide. Réagir et faire face. Paris, France : Odile Jacob.

IRCCADe. Institut de Recherche Comportementale et Cognitive sur l’Anxiété et la Dépression. (2013) Récupéré le 13 octobre 2013 du site http://www.irccade.com/s%C3%A9minaire-du-samedi-10-octobre-2009-par-le-docteur-emmanuel-granier-strat%C3%A9gies-comportementales -et-c

IRCCADe. Institut de Recherche Comportementale et Cognitive sur l’Anxiété et la Dépression. (2013) Récupéré le 13 octobre 2013 du site http://www.irccade.com/s%C3%A9minaire-du-samedi-10-octobre-2009-par-le-docteur-emmanuel-granier-strat%C3%A9gies-comportementales -et-c

AFTAD. Association française des troubles anxieux et de la dépression. (2013) Récupéré le 13 octobre du site http://www.anxiete-depression.org/files/fiches-pratiques/TCC.pdf.

A propos de Louis Cournoyer 215 Articles
Professeur-chercheur (Counseling de carrière) / Directeur de la Clinique Carrière / Directeur des programmes de premier cycle en développement de carrière / Conseiller d'orientation et superviseur clinique Université du Québec à Montréal

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