(In)visibilité dans la clinique de l’AVC du sujet âgé : effets intrapsychiques et intersubjectifs de l’utilisation de l’IRM

Abstract

Context

This paper illustrates a psychodynamic analysis of the intrapsychic and intersubjective effects of the use of MRI in a Neurovascular Unit (NVU) for elderly post-stroke patients, in mainland France. The sudden onset of the stroke and the shift from independence to dependence are juxtaposed with the reality of normal and pathological aging in the elderly, making the boundaries around these two issues difficult to determine.

Objectives

The aim of this paper is to propose a reflection about the intrapsychic and intersubjective effects of the almost automatic use of the MRI results during the hospitalization of elderly post-stroke patients.

Method

This is a theoretical-clinical elaboration based on clinical cases derived from clinical psychotherapeutic sessions with post-stroke hospitalized patients, institutional observations during staff meetings, and transdisciplinary interviews with the patients and their families.

Results

We can conclude, through the cases studied and the theoretical analysis that a more personalized use of MRI is essential, because it may help the patient to visualize his or her stroke, to organize what has been psychologically and physically disorganized, and to create a link with the healthcare professional. However, an automated and mechanized way of showing these results may lead the patient into a psychological impasse, accentuate the psycho-corporal disorganization, and complexify the relationship with others.

Interpretations

MRI is nowadays the main tool for diagnosing strokes, allowing in vivo exploration of the human brain. Despite its relatively recent appearance, MRI seems to be essential in the treatment and monitoring of stroke patients. However, the use of showing the MRI results to the elderly patients in a stroke unit, their families, and the healthcare professionals does not seem to have been thought through, or at the very least, reflected upon consciously.