Déchirure et reprise. Une articulation trauma/fantasme/cancer

RésuméLa survenue du cancer est souvent assimilée à un traumatisme psychique pouvant aller jusqu’à produire un syndrome de stress post-traumatique (Post-Traumatic Stress Syndrome, PTSD). Ce travail interroge la systématisation de ce lien dans le discours courant, pourtant non établi dans les publications scientifiques. La prévalence du PTSD dans l’intégralité de son tableau sémiologique est en effet relativement rare dans la littérature ; sont plus couramment observées des pensées intrusives à propos du cancer. Pour interroger ce lien entre cancer et effet traumatique, nous allons voulu reprendre une articulation originelle dans la psychanalyse, présente dès 1897 dans la correspondance de Freud à Fliess : celle du traumatisme et du fantasme. Nous cherchons à comprendre, au-delà de la violence de l’événement, ce qui est plus particulièrement traumatique pour un certain nombre de sujets confrontés au cancer et qui ont fait appel à nous comme psychologue. Le fantasme est l’instance psychique qui nous semble impliquée dans l’effet traumatique : voile sur le réel, cadre de la réalité, il peut se trouver déchiré lors de l’irruption du réel de la maladie. Plusieurs occurrences de cette déchirure sont présentées. Puis, c’est au point même de cette effraction que chaque sujet devra entamer un travail de reprise, qui se fait également à travers la dimension fantasmatique, notamment par la production d’un roman de la maladie, d’un scénario, d’une image, qui permettent d’atténuer la rupture majeure. Une limite à ce travail de reprise est aussi abordée.

Being diagnosed with cancer is quite often assimilated with a psychological trauma, which may cause a post-traumatic stress disorder (PTSD). However, this is not an established fact for the scientifical literature on PTSD and cancer, in spite of this common belief. Indeed, prevalence of the PTSD in his complete semiology is quite rare, but intrusive thoughts about cancer (a part of the PTSD) is more frequently observed. This is that link between cancer irruption and psychological trauma reaction that the present work wishes to investigate. For this purpose, we worked with two notions, which have been very soon connected in psycho-analysis: trauma and fantasy. This connection is made by Freud from his correspondence with Fliess in 1897. We tried to understand, beyond the violence of the cancer-event, what is more particularly traumatic for the patients (for those who were referred to the psychologist). Fantasy is the psychic agency which seems involved in traumatic effect: Cover on the real, reality's frame, it may be teared to pieces by the cancer-real irruption. Several clinical cases are presented: Fantasy of immortality, may be the most frequent of the fantasies, broken by an information found on the Internet; fantasy as an answer about the other's desire, and inefficient to answer in a post-surgical context; fantasy and the freudian “uncanny”, especially for patients in intensive care, discovering their colostomy and body functions usually veiled by fantasy; finally the Hilflösigkeit, a very deep feeling of helplessness, leaving the patient absolutely alone, disconnected from his fantasy, from the others and the Other. Then, we show that every patient had to begin a reconstruction work, towards fantasmatical dimension, for integrating this “real signifier” which is the traumatic signifier. Some may elaborate a “disease novel” (a sexual theory of the somatic event, as described by Del Volgo and Gori), a scenario to attenuate the rupture. This reconstruction work starts at the exact point of the “break-into” of the disease, and tends to border the real through fantasy (i.e., symbolic and imaginary), sometimes by giving a cause, fictional, to cancer. Through this psychic elaboration, trauma may be inscribed in a subjective history, in a memory. A limit of this reconstruction work is also approached with the writer P. Forest, who outstandingly writes about the untreatable, about what literature and writing can’t treat of the trauma. Finally, an another type of subjective treatment, by the use of an image, is detailed.