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.

Context

This article is the result of a doctoral research that proposes to question the possible links between the suffering at work caused by managerial practices stemming from neoliberalism and the occurrence of somatic disorders in the individual.

Objectives

More and more studies reveal links between work organization/conditions and somatic decompensation, including severe. In the continuity, we propose to reflect on the psychic stakes mobilized in certain forms of cancerous pathologies in subjects invested professionally.

Method

Following the work psychodynamicians who place work as central in the life of the subject, the authors sought to understand how work can be structuring for the subject and what psychic functions it has in his life. The authors also analyzed, through the analysis of several clinical situations, what is at play in the work for the individual, what keeps his balance both psychically and somatically and what, on the contrary, can “destroy” it (in the literal sense of the term).

Results

The case studies showed that, out of twenty subjects interviewed, constants appeared: these subjects tended to avoid conflicts because of their inability to treat them psychically resulting in repression, inhibition of their affects, especially those of anger or hostility. This disability has its origin in their childhood history and in the pre-western trauma experienced in the primary relationship with the mother.

Interpretations

The authors have highlighted the effects of (ob)scenalization in the work implying that the highly invested subject projects, plays or acts his intimate scene on the professional scene and on the metaexecutives of the institution that perform various functions (metadefensive instance, subject affiliation and violent impulse movement capacity). It follows that a failing institution causes the bankruptcy of this metaframework and the psychic elements formerly contained and/or metabolized are likely to return to the subject in the form of severe somatization. The limits of this study lie in the small number of subjects interviewed and in the impossibility of generalizing such processes due to the multifactorial complexity involved. Neoliberalism at work in societal evolutions invites us to continue these investigations on the deleterious effects of this on the health of professionals.