[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. Copyright 2010 Elsevier Masson SAS. All rights reserved.