Esquisse d’une théorie du soin en psychanalyse

Abstract

Objectives“Mental health” is today a crucial issue for our societies. But the clinical understanding of the disorders concerned is still under debate, making it more difficult to assess which therapies are to be recommended. This article is part of the current controversies. Its objective is to clarify the conceptual operators of a psychoanalytical theory of care/cure, and to situate them in relation to those of other approaches – focused on the brain, symptoms, or individual experiences. MethodDrawing on an epistemological perspective attentive to clinical practices and basing our reflexion on a review of the case reports in Freud's complete works (1886–1939), we propose to extract the “operator schemes” of Freudian psychoanalysis, seen as a renewed form of psychotherapy. ResultsThese “operator schemes” can be divided into two groups, according to the two sides of Freudian practice: the schemes of “caring” and those of “curing”. The first make it possible to focus clinical attention on the universality, typicality and uniqueness of each patient. The second, enabling the identification of the onset and genesis of disorders provides dynamic starting-points to achieve improvements or even recoveries, in the psychic sense. DiscussionDefining a Freudian care/cure theory makes it possible to reopen the debate on the different forms of therapy. A clinician focusing on the brain or symptoms alone may neglect the historical, social and above all psychological contextuality (linked to the individual's life history) of so-called “mental” disorders. Focusing on immediate individual experiences, the clinician may likewise neglect the unconscious part, as well as the typical nature of the sufferings addressed – thus disqualifying his/her listening, despite the fact that listening is the foundation of cure/care. ConclusionsGiven these two obstacles, Freudian psychoanalysis provides a holistic and integrative approach. Focusing on the psychodynamic dimension, it offers tailored, pragmatic, inventive and surprising treatments – the efficiency of which is today measurable and also measured. Even if its concepts are part of the human (and not experimental) sciences, this is why psychoanalysis remains an attractive reference tool for clinicians in training and for a large part of the most experienced practitioners.