Por uma clínica psicanalítica possível na esclerose lateral amiotrófica.

Abstract

The Thesis “For a Possible Psychoanalytic Clinic in Amyotrophic Lateral Sclerosis” reflects on the possibility of a clinic, from a psychoanalytic perspective, with people with the neurodegenerative disease Amyotrophic Lateral Sclerosis (ALS), also called syndrome of incarceration. From a listening clinical position, erected through the historical invention of psychic suffering and under the theoretical-epistemological framework of Fundamental Psychopathology, we face the pathos - the subject's experience of suffering - in the context of physical illness in order to consider the silenced body as a pathic body. Considering the psychoanalytic care of neurological patients, we place among the neurological disorders in the category of Motor Neuron Diseases, the dramatic diagnosis of ALS as a destination that perspective for the subject the condition of “prisoner in his own body”. Then, from the point of view of psychoanalysis and clinical psychology, we raise the issues of communicability in the follow-up of patients whose advanced condition often imposes speech loss. As it is a qualitative research in Fundamental Psychopathology and Psychoanalysis, we seek to promote a transdiscursive dialogue between the different approaches about the psychopathological given in the body condition in ALS. Thus we started from the objective of investigating the possibilities of a psychoanalytic clinic with subjects affected by ALS in situations of incarceration syndrome. The study participants were six professional therapists, four psychoanalysts and two psychoanalytic / psychodynamic oriented psychologists, with experience of clinical care of people affected by ALS. The sampling was based on convenience criteria and included psychoanalysts and clinical psychologists who stated that they were acting on a psychodynamic / psychoanalytic basis who have already treated or are attending patients diagnosed with ALS with dysarthria / anarthria. These professionals were residents of the cities of Maceió, Recife, São Paulo and Rio de Janeiro who through a semi-structured interview gave a free statement from triggering questions such as: a) in their experience with the care of subjects affected by ALS in condition of dysarthria / anarthria do you act with the psychoanalytic method? How?; and b) considering the techniques / methods / strategies you use with these patients, what can be identified as being proper to psychoanalysis? Because? The statements were analyzed in the light of a reflection with some theoretical contributions of Psychoanalysis such as Freud's method and transference, Ferénczi's technical innovations as touch and sensible presence, and language, the Symbolic and the Real in Lacan, plus the notion of scopic drive. Finally we consider that the possible psychoanalytical clinic for subjects affected by ALS is a “mosaic clinic”, whose singular assembly implies the articulation of different resources and strategies where the technique is supported by the transference. We conclude that it is a psychoanalytical look and a psychoanalytic listening as a welcome, which presuppose the construction of this possible clinical mosaic in ALS where the look itself is heard in the absence of the word.