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Abstract

The psychopathological and clinical approach to the psychic processes at play in the coma-awakening phase allows for a singular exploration of the processes of subjectivation. This relatively recent approach is linked to the presence of clinical psychologists in resuscitation services. However, this clinical practice of awakening has its roots in the psychiatric practices of the beginning of the 20th century, which made use of “therapeutic comas” such as the so-called “insulinic comas” where the moment of awakening was thought of as a “therapeutic event” allowing a psychic reorganization. We suggest thinking of the psychic processes engaged in waking up from coma as mobilizing the register of primary symbolization articulating experienced and intersubjective exchanges within a relationship that includes an element of dependence on the reactions of the environment. On the one hand, the study of what patients say when waking up from a coma allows us to define several functions with so-called “delirious” productions: a protective function, a transitional function, an organizing function, a function of appropriation/evacuation. On the other hand, the inability to experience a tolerable sensation of pain allows a first re-anchoring in the body; whereas the impossibility of feeling pain leads to the investment of hallucinatory productions. This study concludes with the need to listen clinically to what is being said during coma awakening phases.