De la bouche au nez : les effets psychiques des techniques de chirurgie bariatrique

Abstract

ObjectivesThis study aimed to investigate the new practices of bariatric surgery in the clinical treatment of obesity, since the effects produced by these procedures are organically enigmatic, sometimes problematic, and may cause treatment failure. Thus, in many operated patients, the psycho-sensory changes following surgery, such as olfactory and taste mutations (from “pleasure” to “displeasure”), show that these technical transformations of the body cause organic, and also psychic reorganizations. These disturbances in instinctual organization and in libidinal investments, underpinned by profound bodily changes, seem to originate from the updating of the mechanism of “organic” repression in the patient. Derived from clinical practice, this forgotten Freudian concept raises points of interest for the theoretical understanding and improvement of the psychic management of patients with obesity undergoing bariatric surgery. MethodThe patients investigated were treated with bariatric surgery, including Sleeve gastrectomy or Roux-en-Y Bypass. They were asked to comment on their experience of bariatric surgery and on the impact of the body changes on their eating behaviours, their relationship with the body and with the others. ResultsIn most of the patients, bariatric surgery brought about olfactory and taste changes. These psycho-sensory changes seem to attest to an updating of the process of “organic” repression and to a restructuring of the associated instinctual organization. In these patients, cutting into the reality of the body appears to have an impact on “organic” repression, which is reshaped, updated and reinforced for most of the operated subjects. Consequently, the representations that, before surgery, brought the subject organic, psychic, self-erotic pleasure appear to be repressed from the field of consciousness because the conditions underpinning access to this erotic pleasure have been altered. Therefore objects, in particular food items, which are bound by association to these repressed representations, could be consciously perceived by the operated subject as vectors of displeasure. These objects, previously providing erogenous pleasure, will thus become sources of disgust and repulsion following the bodily changes. DiscussionThe olfactory and gustatory modifications in the perceptions of food observed after bariatric surgery underline the impact of this procedure on the psychic life of these patients. Behind the “disgusting” foods now pushed away could lie what was repressed when the “organic” repression was updated. These selective psycho-sensory changes and the dietary relationships affected by these changes seem to be regularly linked by the patients themselves to certain aspects of their personal and intimate history, including memories or representations of events in which infantile sexuality was confronted with the pitfalls of relationships with the others. The verbalization of these screen-memories, appearing after these selective perceptive changes and resulting from the updating of “organic” repression, could thus open a new way of access to the elaboration of an unconscious subjective truth, which may be linked to the elaboration of the symptomatic construction of obesity. ConclusionThis study underlines the importance of the notion of “organic” repression to approach these psycho-sensory changes after bariatric surgery and to understand the psychic reorganization leading to these changes in eating behaviour. It is important to consider the impact on the process of “organic” repression of the specific elements present in the symptomatic construction of obesity (orality, body image, family structure), according to their different modes of expression for each subject, following surgical modification of the body. In addition, it is important to understand the forms originally taken on by “organic” repression, before its reshaping or updating by the effects of bariatric surgery, in the light of the specificity of the symptomatic construction of each subject. These two pre- and post-operative steps are essential in the understanding of the psychic elements leading to therapeutic failure in the surgical treatment of obesity, in order to improve quality of care and to limit relapses.