Clinique de l’obésité : entre (re)construction de l’enveloppe psychique et intériorisation de la fonction contenante

Abstract

ContextObesity is a chronic nutritional disease, the treatment of which is carried out medically or surgically. However, whatever the treatments offered, this clinic of obesity can be considered as a clinic of resistance to weight loss, where psychopathological swings and psychosomatic collapses are regularly observed. In this context, the concept of a psychic envelope can be structuring to think about the treatment from the beginning, or to propose an explanation of their failures. ObjectiveIllustrate and underline the interest of the concept of psychic envelope in the clinic of severe obesity, based on two clinical vignettes from our practices. MethodAs part of a research partnership between France and Turkey, we present two clinical vignettes of patients with obesity and wishing to lose weight. The first is the story of the psychotherapy of a French patient, who wishes to lose weight using a medical approach. The second is a comparison before and after bariatric surgery in a Turkish patient, based on data from the clinical interview and the Rorschach projective technique. ResultsThe concept of psychic envelope appears particularly enlightening to think about the clinic of eating disorders and obesity. From the traumatic history of the subject and/or his/her family, it seems relevant to identify whether these events have led to an alteration of the psychic envelopes, and then characterize the psychic meaning to be given to eating disorders and obesity. ConclusionWe propose recommendations for the psychological treatment of obesity and eating disorders. The psychotherapeutic objective, in parallel with the medical and surgical approaches to weight loss, will be to reconstruct the psychic envelopes, by internalizing the containing function, and (re)activating the work of mentalization.