Narcissisme et relations d’objets dans l’expérience de la maladie d’Alzheimer. Éclairage des méthodes projectives

Context

This doctoral research, carried out at the Univeristé Paris Cité, is interested in the possibilities of meeting the elderly person who have the singular experience of Alzheimer's disease and living in a geriatric institution, in his or her psychic interiority.

Objectives

Despite a change in outlook, the social representations attached to Alzheimer's disease remain strongly marked by the seal of the loss, deficit, lack and dependence. The complementarity of the approach of cognitive neurosciences with that of psychoanalysis proves fruitful for thinking about the person in his subjectivity. Without denying the reality of neurological and cognitive damage, this work aims to qualify the deficit vision that still persists today.

Method

A qualitative longitudinal study makes it possible to appreciate the effect of the aggravation of the disease on the representational capacities and the processes of symbolization of the elderly suffering from Alzheimer's disease. The methodological device provides for a clinical interview, a neuropsychological assessment and the proposition of three projective tests (Rorschach, Thematic Apperception Test, Sceno-test).

Results

The support of the object in these figurative and sensory qualities and the modalities of relational investment, subject to a measured affect, proves conducive to the resumption of the work of liaison. From this reseach, a certain number of limits due to the disease also emerge: the transitory character of these recovered capacities indicates the great dependence of the sick persons on their environment. The figurative qualities of the object appear as a support but also as a limitation of the thought of the person who struggles to free herself from the perception identity. The presence of the real object contains and retains the expression of the sick person's internal world.

Conclusion

This research opens up valuable perspectives in the adaptation of life skills, particularly for caregivers in institutions, but also for family members. The potential for encounters that it highlights supports their empathic and identification capacities and reduces the disturbing “uncanny” sometimes experienced. Finally, the recognition of subjectivity in spite of the severity of the disorders supports a humanistic vision of the ill person and invites us to think of disturbed behaviors as being both a deficit sign linked to the illness but also, potentially, an attempt to express subjectivity.