L’acceptation de sa maladie : un processus adaptatif ou mortifère ?

Abstract

ObjectivesStarting from a clinical description of the way a patient is diagnosed with an incurable condition, this paper then explores the intimate and inner impact of this announcement (such as the beliefs and the fears related to the fatal outcome) while more specifically questioning the place of acceptance within the mental process of integration. MethodAfter a reflection on patients’ experiences of terminal illness, clinical vignettes allow us to deepen our understanding, offering a singular perspective on the way in which disease can be experienced, from the day of its announcement to its terminal phase. ResultsSuffering from an incurable pathology implies, for each patient, an inner “rereading” of all their previous perceived sensations, even before the announcement made by the physician. These sensations would have a predominant role in the process of the mental integration of the reality of the disease. They, indeed, participate in the materialization of a reality that would have been ignored or concealed so far. Uncertainties and inner feelings are two fully subjective aspects that nurture one another. The announcement, as an objectification of the patient's suffering, will give meaning to a grim reality. Nevertheless, integration of the information doesn’t necessarily mean acceptance. DiscussionIf it, indeed, happens that refusing this upsetting reality is the only coping mechanism available to the patient, then acceptance would be deadly, rather than an adaptive, process, since it would deprive the subject of their power of thinking and desiring. The possible acceptance of the incurable condition – as well as the “dead object” that it contains – could lead to a fusion of subject and disease, of Eros and Thanatos, thus resulting in the loss of the subject's vital spark, or even their sensations of being internally alive. ConclusionIf subjects’ beliefs enable them to alleviate and soothe its sudden violence, the pain and the suffering that a serious condition implies remain, and force the subject to find other coping strategies. We cannot underestimate the part of the unconscious in this inner journey. The final peacefulness observed after a long and ongoing battle with illness can look like a form of acceptance for some people whereas it is most often the expression of the subject's sense of inevitability or resignation, of allowing the disease to fulfill its destiny unhindered.