La question du diagnostic psychologique en clinique de la douleur

Abstract

Classically, the medical approach focuses on the close fit between the site, intensity, type of pain and objective tissue damage. The medical position is interested in what is objective. The psychological position has little interest in the symptom, it is interested in the subject. Medicine is interested in the body, the psychologist is interested in what the patient says about his body, the way he feels this body leaving him, abandoning him, making him suffer. For the psychologist, the body is subjective, there is no telling of a subject that is valid for another subject. The question therefore lies in what the patient presents to us and not in the reality of a disease. Pain has a definite anchoring and bodily appearance for everyone. Then the complexity for the clinical pain psychologist will be to articulate what is objective, i.e. the symptom, with what is subjective, i.e. the subject. It is not the medical sense that we are going to seek but the meaning of the subject, which makes sense for the subject. Nevertheless, what we learn or relearn from the pain clinic is that there is no physical pain without psychological counterpart and it is essential to think reciprocally: that is, there is no mental disorder without physical correlation. During his clinical activity in a chronic pain department, the psychologist performs the functions of evaluation psychological and psychopathological diagnosis. This process of tracking the places and functions of pain in the history and psychic organization of the patient in pain is essential for the care of the suffering body in a necessary somato-psychic round trip. However, the nosographical reorganization led to a renaming through which it may be hard to find one's way. This confusion is also maintained by the medical care of the psychic symptomatology, when provided by “somatic” medicine. To make a diagnosis questions the place and purpose of the approach: how it settles inside the therapeutic relationship, which goal is adapted to what type of care, who is sharing this goal, who discusses it… many questions that maintain humility and make room for what can happen. Hence the diagnosis opens and does not close, it helps to give meaning to what does not make sense, or not anymore. But the diagnosis also can sterilize thoughts and care if given with no preoccupation of its purpose and address. Thus, it would probably be more accurate to speak about a process of diagnosis, as it takes time to reach the registered painful trace, taking space in the internal space, and to get out of the “organicity” in which the patient settled down. When psychologists, who perform psychological and psychopathological evaluation functions, are absent or if the psychologist does not participate in this process, how is the psychic dimension understood, or even what can be understood of the psychic dimension? A subsidiary question arises: and who occupies this place?