Aspects de la co-construction de sens dans une unité hospitalière tête-cou

RésuméLes atteintes sévères de la tête et du visage comportent des dimensions traumatiques spécifiques qui peuvent obérer les processus de résilience liés à la recherche de sens. À travers l’évocation de fragments de rencontre avec cinq sujets, nous montrons que la notion de co-construction de sens peut orienter le travail psychothérapeutique dans de telles situations et nous en dégageons quelques aspects : rôle clé du premier entretien, impact d’un traumatisme révélateur, intensité du désir de sens sous-jacent, créativité psychique au-delà de la valeur défensive, mise en cohérence d’une histoire singulière, limites de la co-construction aux abords de la mort. Nous resituons la co-construction de sens en tant qu’émergence de la subjectivité dans le contexte technique de la médecine actuelle.

ObjectivesSome contexts of severe organic diseases seem to alter the chances of rebuilding a subjective unified story after the shock of the illness or the accident, in particular when the subject must confront a disfiguration with a wrenching impact on the self-image and the social interactions. The objective of this article is to show that in such contexts, the concept of co-construction of meaning is still relevant to direct the clinical work. First we clarify the concept of co-construction of meaning during psychotherapeutic interactions in case of traumatic situations. Our analysis draw on the concept of subjective representational space and we clarify the links between a co-construction of meaning and a resilience process. As many sensorial, cognitive, relational and symbolic dimensions are associated to the face and the head, the co-construction of meaning could be hampered by the traumatic aspects that are specifically involved when a patient is hospitalized within a “head-neck” unit with severe damages of this bodily area. Moreover, the traumatic impact can be increased by the pathogenic circumstances, the painful and complex steps of the surgical treatment, and the medical focusing on the organic lesions.Patients and methodWe present key-moments of psychological support of subjects encountered within the context of a head-neck unit. Five different clinical situations are involved: jaw fracture (female, 16 years old), face crush (male, 54 years), brain tumor (male, 33 years), jaw tumor (male, 28 years), terminal phase of a tongue cancer (male, 44 years).ResultsEach of the five cases unveils a central dimension of the process of co-construction of meaning that can be developed between the patient and the clinician despite of the tragical circumstances: key-role of the first encounter, impact of a revealing trauma, intensity of the underlying desire of meaning, mental creativity beyond the defensive value, setting up of the coherence of a singular story, limits of the co-construction near the death.ConclusionsA co-construction of meaning can direct the clinical work of psychologists or psychiatrists within such a hospital unit. The co-construction of meaning should be considered from the point of view of the emergence of the subjectivity within the technical context of the present-time medicine.