Psychanalyse et médecine : ce que l’écoute de l’inconscient permet. L’exemple de la résistance thérapeutique dans la fibromyalgie

Abstract

ContextThis article is based on S. Hertzog's doctoral research. It focuses on therapeutic resistance in fibromyalgia, i.e. the lack of pain relief despite a medical treatment. We explore causes and effects of this, through the prism of medical knowledge, but also through the psychoanalytical prism, which can shed light on both the doctor–patient relationship and on the unconscious stakes anchored in the history of the subject. AimsThis article aims to illuminate the ways in which psychoanalysis allows for a singular reading of the dominant discourse in the healthcare system, given the neoliberal context promoting productivity and quantifiable efficiency. Furthermore, the identification and analysis of the unconscious issues emerging in medical care allow us to understand what is at stake in such a context for the patient, who is likewise caught up in the issues of her/his history. MethodOn the basis of research interviews and content analyses of patients’ discourse, we have explored the different aspects outlined above. In this article we will expose a clinical case. ResultOur results are based initially on the study and effects of the neoliberal discourse. We have observed that the patient is asked to be autonomous in their choices and responsible for their behavior, while the healthcare system disarms the subject from the symbolic, structuring laws of the Other (heteronomy). The second part of our results allows us to focus on the question of the subject, specifically in relationship to illness and to the doctor, but also her/his demand for subjective appreciation, which is deeply rooted in a conflictual past, specifically in terms of identity. Interpretation/conclusionOur interpretation underlines how the individual deals with the social discourse that impacts the subject of the unconscious. In this sense, the psychoanalytical approach enriches our understanding of the effects of social and medical discourses, linked to the unconscious “stage”.