[Taking care of teenagers hospitalized after a suicidal gesture or a suicidal threat]

Teenagers' suicidal gestures are a major problem of public health and it is important to understand its meaning. A global taking care of teenagers hospitalized after a suicide attempt or a suicidal threat by the pediatric teams and by the team of child psychiatry, having links with each department, is essential in the Necker - Enfants Malades hospital in Paris. The protocole of care has been recently strengthened by the integration of a deep psychological checkup with the projective tests Rorschach and Thematic Apperception Test (TAT) during the hospitalization, a psychological follow-up from a distance of the suicidal gesture and a second psychological checkup one year later in order to observe the evolution of the psychic functioning. The projective tests offer a special way to express the own intimate problematic while respecting the subject's need to remain hidden. These tests, analyzed with a psychodynamic interpretation, help the clinician to precise the psychic diagnosis, which is very important for the future therapeutic orientation, and offer to the patient a medium to express the hidden meaning of his gesture. To consider suicidal gesture not only as a dead end of identificatory process but also as an attempt to start up again this process may favor a therapeutic mobilization of psychic resources. Self-attack may signify a struggle against melancholy, the prospect of death appearing less frightening than those of madness. Suicidal gesture may express a transitory developmental breakdown but identificatory process may be revived if the suffering of the teenager may be listened, contented, elaborated and linked to meaning.