The clinic nursing care to the psychotic subject based on psychoanalysis

Abstract

Objective: to understand the clinical approach of psychosis performed through Nursing from the psychoanalytic referential. Method: this was a theoretical essay based on the works of Freud and Lacan in addition to publications in the field of mental health nursing. Results: we identified the concepts of listening, subject, and uniqueness as assumptions for this clinical approach. Conclusion: psychoanalysis can guide the clinical practice directing it to reflection about how events experienced by the subject are meant in his uniqueness; and how each one can represent their own psychic suffering. The intervention is made possible by listening the psychotic subject, welcoming his productions, writings, papers, and inventions; assisting in the process of building something that can function as a support for this subject to deal with his grief. Descriptors: Nursing; Mental Health; Psychosis; Psychoanalysis. RESUMO Objetivo: compreender a abordagem clinica da psicose realizada pela Enfermagem a partir do referencial psicanalitico. Metodo: ensaio teorico, realizado a partir de obras de Freud e Lacan, alem de publicacoes da Enfermagem no campo da saude mental. Resultados: identificaram-se enquanto pressupostos para esta abordagem clinica os conceitos de escuta, sujeito e singularidade. Conclusao: a psicanalise pode nortear a pratica clinica, direcionando-a para a reflexao acerca de como os eventos vivenciados pelo sujeito sao significados em sua singularidade; e como cada um vai poder significar seu sofrimento psiquico. A intervencao e possibilitada pela escuta do sujeito psicotico, acolhendo suas producoes, seus escritos, seus documentos, suas invencoes; auxiliando-o no processo de construcao de algo que possa funcionar como suporte para esse sujeito lidar com seu sofrimento. Descritores: Enfermagem; Saude Mental; Psicose; Psicanalise. RESUMEN Objetivo: comprender el abordaje clinico de la psicose realizado por la Enfermeria a partir del referencial psicanalitico. Metodologia: ensayo teorico, escrito a partir de las obras de Freud y Lacan, ademas de publicaciones de Enfermeria en el campo de salud mental. Resultados: fueron identificados como presupuestos para este abordaje clinico los conceptos de escucha, sujeto y singularidad. Conclusion: el psicanalisis puede guiar la practica clinica, proporcionando la reflexion sobre como los sucesos vividos por el sujeto son significados en su singularidad; y como cada persona podra significar su sufrimiento psiquico. La intervencion es posible a traves de la escucha del sujeto psicotico, en que sus producciones, sus escritos, sus documentos, sus invenciones, ayudandolo en el proceso de construccion de algo que pueda funcionar como soporte para que el sujeto pueda lidiar con su sufrimiento. Descriptores: Enfermeria; Salud Mental; Psicosis; Psicanalisis. Nurse, PhD student in the Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil. E-mail: eryjosy@msn.com; Nurse, PhD in Nursing, Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil. E-mail: silveiralia@gmail.com; Nurse, Master degree in Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil.E-mail: camarottib@gmail.com; Nurse, PhD student in the Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil. E-mail: alcivan_nunes@yahoo.com.br REFLECTIVE ANALYSIS ARTICLE Guerreiro EM, Silveira LC, Cunha BMC et al. The clinic nursing care to the psychotic... Portugues/Ingles Rev enferm UFPE on line., Recife, 8(1):192-200, jan., 2014 193 DOI: 10.5205/reuol.4843-39594-1-SM.0801201427 ISSN: 1981-8963 Psychosis is the manifestation of psychic distress that causes the emergence of a disintegrated person unable to cope with the real in confrontation with his psychic distress. In general, it is manifested by delusions and hallucinations. Unconscious ideas determine the operating mode in which the subject tries to modulate the external reality to his psychic reality. Thus, during delirium, the words are taken by things themselves. It is then, through the delusional construction, that the psychotic can articulate reality to his own psychic reality, making the second reality his own reality. Traditionally in health services, psychosis is addressed through measures of physically restraining the subject associated with a pharmacological treatment. These actions are based on the biomedical referential that arose around the 18 century, organized by the assumptions of modern science: scientific objectivity, generalization, and neutrality. In this referential, the seizure of psychic suffering is limited to a mental illness that requires medication and rebinding measures between subject and the reality in which he is inserted. The diagnosis is formulated from a professional reasoning, by framing the subject in a nosological category, a disease situation, considering him incapable of dealing with his mental condition without these interventions.Another consequence of this model is the fact that the professional, being a doctor or a nurse, is located on the side of a predetermined knowledge that will be applied to the patient. A multiplicity of theoretical concepts exists to guide the nursing clinical practice in the same institutional space. The nurse takes the place of the knowledge holder in relation to the subject in psychic distress. This knowledge gives the nurse the authority to interpret and classify complaints from those subjects based on external and objectifying knowledge. The coexistence of different and sometimes contradictory conceptions subsidize the nursing clinical practice; practice that is configured as pedagogical, prescriptive, and normalizer of the subject in relation to health services. It is noticed that the biomedical model, when addressing the psychic suffering, excludes the subjectivity inherent in this condition. With respect to the psychotic subject, this model produces an approach that disqualifies this subject as someone who can engage and commit in the caregiving relationship because he is devoid of reason. In addition, this model presents the physical restraint and pharmacological approaches as the only alternatives. Does this form of addressing the psychotic subject actually meet his unique care needs? How to care for this subject in a singular form, tending to his demands that are beyond the plane of rationality? Thus, we discuss the possibility of reworking the nursing clinical practice together with the psychotic patient based on the psychoanalytic referential. This research aims to understand the clinical approach of psychosis based on the psychoanalytic referential, performed by the nursing team. It is assumed that psychoanalysis, by proposing the recognition of the divided subject and the subject of the unconscious, producing other ways to deal with the psychotic considering the uniqueness of each case, and rescuing the dimension of subjectivity of the patient from the act of listening. It also proposes to subvert the current position of the patient (object) by returning his position to that of the speaking subject. Therefore, this study is relevant to contribute to the construction of new knowledge and practices for the nursing clinical practice in the approach of psychosis considering the psychoanalytic referential as a theoretical tool for the clinical practice. This was a theoretical essay based on psychoanalysis as a theoretical central referential that used as a source of research the complete works of Sigmund Freud, which address important elements of the clinic of psychosis, and some concepts proposed by Jacques Lacan, such as the subject Name-ofthe-Father and exclusion.  The transition of the nursing clinical paradigm in mental health Nursing arises as a professional practice in the psychiatry field, and as the subsidiary knowledge in the medical practice. In the asylum assistantial model, the nurses were responsible for guarding, punish, and control behaviors of subjects labeled as crazy.In this context, the scientific knowledge for the fundamental tasks of nursing were considered unnecessary. The goal of treatment was to eliminate symptoms that, in the case of psychosis, were characterized by delusions INTRODUCTION