Le primat du phallus, talon d’Achille de l’appareil psychique ? Réflexions autour du cancer de la prostate

Abstract

ContextThe clinical study of prostate cancer, particularly from a psychopathological perspective, remains relatively underexplored yet it serves as a site for serious and often lasting questioning of the erectile capacities of the penis, and thus potentially of the phantasmatic investments it is subject to. Moreover, this common cancer is particularly linked to the issue of aging, which radically tests the fragilities and narcissistic resources of patients. Power, performance, endurance, and counter-investment against passivity and depression become particularly acute issues in the relationship to oneself, to women, and to men. It then appears essential to delineate the psychological stakes of phallic demand in the articulation between the psychic reality of infantile sexuality and the external realities of aging, illness, and social representations. ObjectivesThis study aims to understand how the traumatic experience of prostate cancer—an acute realization and embodiment of aging and vulnerability—reveals fault lines not only shaped by the primacy of the phallus but also reinforced by societal phallic logic, balancing constraints and ideals. It seeks to discern the fragilities and resources of male narcissism related to phallic demands and their implications. The primacy of the phallus and its associated infantile sexual theory are thus questioned in their organizing or disorganizing roles. MethodThe study is based on a multifaceted methodology: an examination of the taboo surrounding the representation of the male sex in painting, semi-structured interviews, and projective tests conducted with twenty men in their sixties who have been treated for prostate cancer. A case study allows for a thorough and heuristic articulation of theoretical and clinical questions. ResultsHonor and virility emerge as particularly significant narcissistic issues, contributing to a hypomanic masculinity that enables men to shift the stakes of various anxieties (death anxiety, passivity anxiety, and castration anxiety) into the form of another anxiety: a narcissistic death anxiety rooted in virility, the dread of no longer existing as a man in the eyes of others. At the intersection of social, psychosexual, and somatopsychic spheres, prostate cancer thus uncovers a taboo Achilles’ heel. This is composed of unconscious interactions and loyalties between the phallic demand (both internal and external) and a partial dependency on the sensory dimension of erection, necessitating a reevaluation of masculinity, the phallus, and erection independent of sensory perception. InterpretationsSociety reinforces the confusion between the sensory perception of erection and the sense of virility and masculine reassurance on a psychological level through a collective and cultural imagination that associates characteristics of power, endurance, and vigor with a “good” virility, and attributes of vulnerability with a “crisis of virility.” These observations, beyond the scope of organic pathology, could contribute to the broader debate on gender issues, the formation of ideologies, and ultra-virilist movements.