Des patients sans plainte

Palliative care teams often work under the pressure of demand from families to eliminate their loved one's pain at the end of life. In social work, this demand is seen as the 'right' to a peaceful death. Although current medical practice humbly attempts to relieve patients' suffering, our clinical experience shows to what extent the desire for a quick, painless death often proves elusive. In fact, some patients appear to unwittingly choose a martyr's death; they derive the strength to face this change from the extreme pain resulting from medicine's inability to palliate their physical suffering. In these cases, their suffering elicits, not mere courage, but a transcendent form of enjoyment/jouissance, which merits an analysis of the mystical in contemporary culture with its emphasis on algophobia and organic suffering. Since, in contrast with the glorification of suffering of past eras, the contemporary denial of pain raises the question of pain's potential 'worth', we here attempt to examine this mortification of the body from a psychoanalytical standpoint, particularly in the light of the Lacanian concepts of jouissance and objet a. A clinical study of these martyrish patients reveals the extent to which their experience of terminal illness resembles that of religious martyrs. It also highlights the paradox between the dereliction yet ultimate victory of their bodies. The cruel yet acquiescent death of these patients is apt to incite discussion among medical teams about the limits of any form of pain management.