In Analysis最新文献

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.

Context

Whether medical or surgical, the management of obesity faces significant resistance to weight loss. In this context, Bruch's work (1973) on the concepts of developmental and reactive obesity is foundational for clinical practice. However, in the most severe cases of obesity, these concepts can be reductionist and can limit the complexity observed when caring for these patients. These questions are particularly present in hospital services that handle third-level care, especially in Specialized Obesity Centers.

Objectives

Using a clinical vignette, we will illustrate the utility of the concept of complex obesity and emphasize the therapeutic challenges in the management of patients requiring third-level care, as defined by the Health Authority.

Method

In the context of research on obesity and trauma, we present a clinical vignette of a patient treated in a specialized obesity service. We rely on data collected during clinical research interviews.

Results

This singular case highlights the challenge regularly faced by clinicians in differentiating developmental and reactive types of obesity. Indeed, listening to the life stories of patients with severe obesity often reveals a construction of this chronic disease through successive layers. Thus, including patients in a single typology would overlook fundamental aspects involved in the onset of their obesity. Faced with this difficulty, we suggest introducing the notion of complex obesity, which would precisely account for situations at the intersection between developmental and reactive obesity. The relevance of developing this third typology becomes clinically meaningful, allowing questioning of the proposed accompaniments, particularly for level 3 interventions.

Conclusion

The use of this third typology is now necessary to consider issues of resistance to weight loss and to highlight the complexity of the psychogenic origin of this disease in interdisciplinary exchanges. These reflections also question the relevance of treatments that prioritize urgent weight loss. Thus, we emphasize the importance of focusing on individuals’ intrapsychic functioning of and on promoting long-term historical work. Finally, we propose several perspectives to address the challenges encountered in the transformations of hospital and healthcare institutions in France, and suggest research perspectives to demonstrate the long-term effectiveness of a comprehensive approach to individuals with obesity.

Context

By imposing techniques, reporting, efficiency, and profitability on hospital practices, New Public Management has considerably altered the role of psychologists in medical departments, as well as their relationship with teams and administrative staff.

Objective

The aim of this reflection is to highlight the positions that appear most appropriate for continuing to promote the activity of hospital clinical psychologists in this disrupted context.

Method

The author traces the evolution of the place of psychologists in medical settings, and draws on his own experience in the face of the disruptions encountered to examine what makes it possible to hold one's place as a clinical psychologist in a hospital institution.

Results

Positioning oneself as “carried by” an intention or a meaning, rather than “against” someone or a hierarchy, is necessary for one's clinical practice. By enabling us to continue questioning our subjectivities, the clinical approach has become an “authority” in relationships, transcending hierarchies. While accompanying the interlocutor, it naturally opens the way to joint elaboration. In addition to seminars, supervisions, and affiliations with psychoanalytic schools or groups, psychologists must also join psychologists’ collectives, such as colleges of psychologists or inter-colleges, in order to think about, discuss, and elaborate clinical possibilities.

Conclusion

The work of clinical psychologists in hospitals is an act of resistance in itself. However, it is a natural outcome of our activity and should not become a goal in itself. It's about continuing to reflect on the complex situations we deal with, so that the obvious can emerge. Continually focusing on analyzing requests with tact allows us to modernize the authority inherent in the clinical approach itself, and to establish the autonomy of psychologists without them behaving like loose cannons, instead truly asserting their expertise. If valuable qualitative links are thus established with the interlocutors, the approach requires fully accepting the constraint of these links and of the debate which takes place throughout this analysis, whose finality is uncertain.

Psychiatric care practices have long been inspired by humanist conceptions of psychic life, which attribute an anthropological depth to the human being, and an intentionality to symptoms. However, in recent decades, there has been a shift towards a reeducational approach. We propose to link this evolution with the emergence in society of ideological identity movements, characterized by their psychophobia and distrust of unconscious psychic life. Drawing on psychoanalytical concepts, we examine the extent to which these ideologies are rooted in a two-dimensional anthropological conception: a human being without psychic depth or internal conflictuality, perfectly identified with his or her discourse. The unconscious is denounced as the source of discrimination. It must therefore be condemned and neutralized, in favor of an ideal of transparency, purity, and homogeneity. Secondly, we argue that this generalized psychophobia has inspired normative and reeducational practices in mental health over the past half-century. In particular, we look at psychoeducation for psychotic patients, the recovery approach to schizophrenia, and activist clinical practices whose political and ideological commitments are detrimental to neutrality and an unconditional acceptance of subjectivity. Finally, we recall how psychoanalysis provides mental health professionals with ethical benchmarks for thinking about their practices, against the temptation to totalize.

Objective

Our aim is to examine the relationship between the place of psychoanalysis in hospitals and the current crisis among care professionals, which is itself more broadly linked to the crisis in society, where identity issues seem to be at the forefront.

Methodology

Looking at the clinical encounter through the two lenses of diagnosis and transference opens up discussion of the issues of identity and identification that are also involved.

Results

These two axes intersect in any clinical encounter, but the current temptation is to reduce this encounter to the reasonable dimensions of the first.

Conclusion

By trying to avoid the difficulties associated with taking the second axis into account, not only is a whole part of therapeutic effectiveness lost, but it is also one of the possible causes of the deleterious effects on those in the caring professions of a clinical encounter whose central issue is primarily evaluative, thus losing its complexity and depth. As such, it is one of the possible causes of the current crisis in hospitals.

Context

Psychoanalytic collectives and institutions that adhere to the psychoanalytic approach seem to be built around a patriarchal Oedipal logic referred to here as “hetero-patriarchal-oedipal.” The emergence of feminist currents in the social sciences and humanities offers new perspectives for understanding the dynamics and mechanisms present in this type of collective structuring exposed to constant conflicts and ruptures.

Objectives

This work aims to investigate the ways in which psychoanalytic collective bonds of Oedipal essence are constructed and to propose the creation of generative and heterogeneous psychoanalytic kinships that are not solely a reproduction of patriarchal, hierarchical, and defensive family structures subject to the domination of “fathers.”

Method

The author supports her reflection using the qualitative ethnographic method (common in the social sciences and humanities), specifically drawing from her personal experience within psychoanalytic groups and institutions. The data collected from this fieldwork are connected to psychoanalytic theories, critical studies, and feminist perspectives.

Results

The author's personal experience within psychoanalytic schools and associations attests to the numerous difficulties faced by these training places, which are determined by traumatic “family” fantasies and not, as proposed by Donna Haraway, by symbioses and affinities among the members. Freud turns the Oedipus myth into a familial and social paradigm based on various fantasies: murder, incest, jealousy, rivalry, etc. The laws of the Oedipal father and the structures they generate seem to be reproduced in authoritarian psychoanalytic institutions, resulting in the repression of heterogeneous knowledge. The cyborg model (Donna Haraway) offers a new perspective at the intersection of biology, envisioning institutions that generate new affinities through encounters between different species, implying the breakdown of boundaries between the organic and machinic, human and animal, material and informational, etc.

Interpretation

This problematic context suggests the necessary creation of affiliative and generative psychoanalytic connections based on heterogeneous theoretical connections that are not tied to an immutable authority, infantilism, fear of abandonment and exclusion, or the inhibitions of representations trapped within Oedipal complexities.