Stoma and shame: engaging affect in the adaptation to a medical device

Abstract

Objective: The objective is to understand difficulties some patients have with their adaptation to a medical device, specifically a stoma and an ostomy appliance, following gastro-enterologic surgery. A partial or total colectomy is typically performed in cases of digestive cancers, Crohn’s disease, or anal incontinence. A psychotherapeutic application deduced from this understanding is described. The therapeutic approach is informed by Lacanian psychoanalysis. Setting: The setting is the digestive surgery services section of a large public teaching hospital in France. The clinical team conducting the interventions described perform their work with patients post-operatively. Subjects: Selected cases are chosen to provide brief illustrations of the analysis and the psychotherapeutic approach developed. Primary argument: This study focuses on the impact of the stoma and the ostomy appliance on the subjectivity of the patient and shows how the affect of shame can appear. It is noted that the affect of shame in the adaptation to an ostomy appliance has not been investigated to date. This affect can in turn have psychological effects on the gastroenterologist treatment itself, even to the point of the patient’s abandonment of ongoing care. The analysis reported here explores the recognition of shame when it might be present, and the process of accompanying the patient therapeutically, engaging the logic of the transference. Conclusion: Shame cannot be treated by ignorance or by indifference. A psychotherapeutic application engaging the transference between the patient and members of the nursing and psychotherapeutic team, helps patients support shame and adapt well to the ostomy bag.