Self-sampling may improve participation in cervical cancer secondary prevention programs by women who do not respond or respond irregularly when invited to contact a health professional for the collection of a cervical specimen. It could also help resolve access problems in areas with a low physician density. The present qualitative study examined barriers to screening, effective screening strategies, and the advantages and disadvantages of sending women urine or vaginal self-sampling kits in two medically underserved administrative departments in France (Mayenne and Sarthe) showing low cervical screening coverage. As part of the CapU4 randomized trial, a team of psychologists investigated the attitudes and experiences of 59 healthcare professionals (gynecologists, general practitioners, and midwives) through semi-structured interviews. Results indicated that health professionals believe that self-sampling may address the issues of low physician density and underscreening by removing logistical, organizational, financial, and psychological obstacles. They confirmed trust in the use of vaginal self-sampling, with urine self-sampling as an alternative solution (e.g., for women with vaginismus). The health professionals also identified several limitations of the self-sampling kit that will need to be addressed in future screening campaigns (incomplete kit, complex instructions, poor anatomical knowledge, and obesity).

La psychologie clinique du vieillissement permet de dresser un tableau du grand âge bien plus contrasté que celui proposé par les tenants de l’idéologie du super-vieillissement. Deux cas cliniques, celui d’un centenaire très sthénique résidant en institution et celui d’une femme hyperactive d’un peu plus de 50 ans, permettent d’aborder le sens du maintien à tout prix de la performance dans le vieillissement. Si l’existence de potentialités humaines sortant de l’ordinaire, support de toutes les convoitises et de tous les fantasmes de généralisation, n’est pas rejetée, l’exigence de l’endurance et de l’exceptionnel, si souvent portée par les médias, vient questionner le fonctionnement psychique de ceux qui se l’approprient au-delà d’une certaine dose où le raisonnable se fait porteur d’élan. L’idéalisation de la performance, l’arrogance de l’exception, le mépris de la différence et du handicap, le déni de la perte et du manque, une tentative de défense contre une dépressivité consécutive aux altérations et un refus de la mort ressortent comme des motifs communs de cette identification individuelle au super-vieillissement.

Claude Balier’s narcissistic theory of ageing may be one of the pillars of French psycho-gerontology, but it is certainly not set in stone. On closer inspection, instead of being just minor variations on the same theme, the three stages of its development are structured around different references and make different assumptions. Some even contradict each other. Balier’s theory nevertheless finds unity in its non-involutionary view of ageing. Narcissism and narcissistic destiny are given a central role, thus calling into question the notion that the paradigmatic function of transference neurosis can account for neurosis in old age. For more than 40 years, Balier’s innovative notions have been the subject of many and sometimes divergent extensions in French psycho-gerontology.

Développée en premier par Balier (1976), la théorie du vieillissement narcissique constitue une clef de compréhension incontournable des enjeux psychopathologiques du vieillissement et de la question de l’humeur sénescente en particulier. Alors que l’abord contemporain (American Psychiatric Association, 2013) produit une mise en forme catégorielle des troubles de l’humeur toujours plus affinée qui est loin de correspondre aux spécificités de la sénescence (Batelaan et coll., 2012 ; Calvet et Clément, 2014), la théorie narcissique du vieillissement permet de restituer une cohérence explicative aux troubles du vieillissement en rendant compte de leurs liens. À travers sa prise en compte des larges conséquences des atteintes subies par le narcissisme au cours de la vieillesse, elle donne au narcissisme un rôle central dans le fonctionnement psychique sénescent. La reprise de la pensée de Balier à la lumière de ses sources (Kestemberg et Kestemberg, 1966) et des éclairages les plus contemporains (Beatson et coll., 2016) permet d’approfondir la théorie en la prolongeant et d’isoler une « désorganisation limite sénescente partagée » et ses différents destins. La prise en compte clinique de ce fonctionnement limite au cours du vieillissement et de son devenir est d’une importance centrale dans la prise en charge psychothérapeutique des troubles du vieillissement.

Cervical cancer (CC) was diagnosed in 3159 women in France in 2023, and 1117 died from it. Organized screening for cervical cancer is potentially very effective for participating women. However, reaching under-screened populations remains a major challenge. The present qualitative study explored women’s opinions on what discourages or encourages them to participate in CC screening and assessed the acceptability of two experimental strategies (urinary or vaginal self-sampling kits) to increase the screening coverage in three rural French administrative departments with low medical density and/or low screening participation rates. Forty-eight semi-structured interviews and four focus groups were conducted by a team of psychologists. Results showed that the participants accepted at-home self-sampling to reach non-participating women in medically underserved areas. However, they suggested that the type of kit sent should be adapted to the patient’s profile (embarrassment from earlier exams, cultural aspects, fear of invasiveness, etc.), and that kits should be simple to use (in understandable language taking sociocultural aspects into account). Women wished to be assured that testing on self-samples is accurate and needed information about further actions in case of a positive result.