[Psychosomatic aspects of protein-calorie malnutrition in early childhood in a tropical environment. Facts and hypotheses].

After a brief look at the clinical descriptions of marasmus and kwashiorkor, and a summary of the physiopathological concepts of these protein calorie malnutritions (PCM), the author looks at arguments which suggest there is a change in the mother-child relationship at the onset of PCM, excluding, however, those malnutritions which appear in conditions of famine or catastrophe. These arguments are drawn principally from studies done in Africa, and are based on clinical, sociological, and ethnopsychiatric data. The contributing factor of maternal depression and that of relational characteristics of the child are considered, and an analysis is made of how these factors might converge at the onset of PCM. The author attempts to demonstrate the important role of a psychomotor retardation in the tableau of psychological troubles which present themselves during the course of Kwashiorkor. The role and importance of weaning, of the separation and the psychomotor retardation in the genesis of the "situation of malnutrition" are discussed. Finally, a parallel is established between PCM and early psychosomatic syndromes observed in the west, principally the anorexias and insomnias during the first year of life. The point in common between these situations and PCM is perhaps the onset of conditions having an upsetting and distorting effect on the mother-child relationship. The family and the entourage use certain collective representations in Africa ("Nit-KuBon", "Tjid-a-Paxer") to try and explain the onset of PCM. The description of these traditional representations is utilized as a materialization, by the mother and the social group, of an alteration of the mother-child relationship, and can be compared to representations which play the same role in the west.