Objectivation du corps en médecine et incidences subjectives

Abstract

The medical body and the body as experienced by the subject him–herself cannot be considered the same, and are sometimes even incompatible. The first one is the product of a constant process of objectification in the history of medicine, and is correlated to the extraordinary development of knowledge and techniques in this discipline. The second one, on the contrary, refers to a subjectivation process grounded in the world as experienced by the patient, with a special emphasis on notions such as the body proper and inter-subjectivity. Despite substantial improvements in the prognosis of some serious illnesses, this objectification has important effects on the patient's and on the physician's subjectivity, as well as on their relationship. This mechanization of the human body is strongly linked with the advent of science, as characterized by the philosophy of Descartes and by the first anatomical dissections by Vesale, it established a real epistemological rupture by separating man from his body. This break gave birth to three separate dimensions: the world, others, and oneself. Indeed, before Vesale, man was considered as a part of the world, inseparable from it, and an expression of God's will as any other part of the world. Anatomy thus introduced the human body as a particular study object, independent from its symbolic or material environment. Before, man was also a member of a strong community, defined by its values and by its laws. By contrast the anatomical body was then a desocialized one, without any of the usual signs that could demonstrate its membership of a given community. Finally, man was separated from himself, by the identification of his body to a machine, an object that could be reduced to a simple catalogue of organs. This separation between the anatomical body in medicine and the lived body of the patient leads to profound changes in the physician-patient relationship, detrimental to the subjectivity of both. In order to restore a real inter-subjectivity in this relationship, empathy could then be an important dimension to enhance the communication process in medical settings. Nevertheless, empathy, according to Husserl, is not only a capacity to represent or to infer the other's mental state, but is more profoundly based on the analogy between the bodies. The physician's body is then, in some way, implied in the apprehension of his patient's distress. A core dimension for a clinical psychology in medical settings could then be the fact of giving its proper place to this subjectivity, and more particularly to the subjectivation process within the illness experience proper. In this context, clinical psychology, without ignoring the contributions of medical sciences, is of particular importance in sustaining the subject and his singularity beyond his illness.