L’épreuve du corps

A philosophical approach to the body sheds light on how certain aspects of modern medicine can contribute to destabilizing our relationship with our body and our bodily relation to the world and to others. We consider this destabilization, as well as some concrete remedial measures, in light of the concept of “buoyancy” [portance]. Buoyancy includes the structuring supports that we can find in other bodies, in an enduring relationship to matter and nature, and in communal action.     

Le soignant face au corps de l’adolescent et du jeune adulte

Two studies conducted with the help of staff in an AYA Unit show that carers spontaneously touched upon the importance of sexual development and identity that defined puberty’s psycho-physical changes on an individual. Taking this into account makes them aware that they are dealing with a person, and not only a patient. Being addressed these dimensions asks the carers to get more involved as a person themselves. As a consequence, the traditional asymmetry of the caring relationship is questioned and this modifies the professional distance frame.     

L’ombre de la mort dans l’information du patient

What role does the specter of death play when the patients are informed about their condition? By observing medical consultations in the hospital environment, we can highlight the role played by death in doctors’ decisions concerning what can be said to patients. In this article, we examine the motivations behind the information and show that, beyond the psychological explanations generally provided, the logics that underpin doctor behavior come from various other registers: ethical, therapeutic, and social.     

Impact de la modulation d’intensité dans l’irradiation des aires ganglionnaires du cancer du sein

Irradiation of node areas is still a complex challenge in external radiotherapy for breast cancer. Acceptable target coverage is always balanced by protection of organs at risk and patient morphology. Intensity-modulated radiotherapy increases the quality of dose distribution on the planning target volume, but modifies dramatically the irradiation coverage of critical structures in a different way compared to 3D treatment. In this paper we analyze this new technique in breast treatment with node regions, its expected gain and potential risks.     

L’information du patient : un pilier dans la prise en charge du cancer

Patient information is a key issue in management of cancer patients as it can influence their attitude towards medical care.We describe the first survey in Morocco which investigated this chapter. Less than half patients expressed their satisfaction about given information (42.5%). There was a lack of information regarding diagnosis, treatment and prognosis. Parents of children, younger patients and those with higher education were seeking more detailed explanations. In the light of these findings, our medical team tries to develop some solutions; we have created a patient rubric in our website and we are editing first information booklets.     

Actualité sur la chirurgie robotique du cancer du rectum

The use of robotics in rectal cancer surgery is relatively new. Several teams have reported on their experience with favorable early outcomes. We have reviewed the main publications on this topic and reported our own preliminary experience.     

Actualité de la chirurgie du cancer du pancréas

Since Whipple et al. described the technique of cephalic duodenopancreatectomie in 1935; the surgical treatment of pancreatic cancer has made gains in quality of resection. The excision of the retroperitoneal margin with first approach of the superior mesenteric artery allows complete pancreatic surgery and gives a clearer idea about the prognosis, the impact of this technique on survival remains to be assessed.     

L’impact du cancer pelvien sur la sexualité et le couple: ce que nous apporte la littérature

This psychological literature review has been completed in order to make a census about actual theorical ideas and methodology in pelvic cancer impact on couple relationship and female sexuality. This study reveals an incomplete definition of sexuality, which flouts the erotic and sensual aspects underlain by psychological and sociocultural mechanisms leading to a bias for the research. Pelvic cancer and its treatments have anatomophysiological consequences leading to an objective functional damage of sexuality. Though, studies on this subject are guiding us to problems beyond somatic. Pelvic cancer impact on sexuality causes specific phantasms and awakes myths and beliefs about feminity. Real body and imaginary body are hit by treatments against cancer aiming at a highly symbolic organ, where becoming a woman and a mother begins. The diagnosis shock and the cancer’s traumatism both call factors determining the adaptation abilities of the female patient and her husband and trigger a specific psychopathological symptomatology. The couple is described as an active support but also as one of the most impacted spheres. The couple sexual dysfunctions, frequent in this situation, are indirectly induced by psychic repercussions of the physical consequences of the pathology. The couple’s organization is mostly exacerbated and psychic representation reorganizations take place for the woman and her husband. The couple’s sexuality is the symptom of its own dynamics, submitted itself to the psychic states of the spouses, modified by the cancer.     

Lier l’histoire du sujet à l’histoire de son corps : un principe psychothérapeutique de base en oncologie

Two clinical cases are detailed between three clinical psychologists with a psychoanalytic training. The discussion is about the principles of psychoanalysis with a cancer patient. The tools of psychodynamic psychotherapy are usual: understanding the unconscious origins of the demand, waiting for the narration of the patient, allowing historisation, make subjectivation easier. But when the ego unity has never been done and when the identifications are fragile or ambivalent, when the psychical envelopes have never been containing, the psychotherapist needs to re-create an intersubjective therapeutic space. This intersubjective space will permit the narration held by the transferance. The transferance is like an immersion in the first language (listened by the patient as coming from his progressive unification or coming from the mirroring of the therapist).     

Représentations du corps malade et symbolique du mal: maladie, malheur, mal ?

Objectives

In cancer treatment, conventional medicine faces an ideological debate about what constitutes the true nature of the disease. Should it focus on the objective view offered by medical technology, the suffering of the patient or the cultural dimensions of a disease shaped by its representations as an evil entity?

Main points

With therapeutic effectiveness as a goal, medicine favours a biochemical perspective, dispensing with the cultural dimensions that can nonetheless play a role in treatment acceptance. We would like to demonstrate that the imagery of this disease created by the individual and society allows cancer patients to advance from dependence to subjectivation of the disease that is so profoundly transforming their lives. More broadly, cancer treatment is fostering the development of a new symbolism of evil in a secularised society.

Future prospects

We brought to light the active role played by the imagery of cancer and the symbolism of evil. Although we must view the effects of phantasms with care, they can clearly lead to the development of a wider, richer and assimilated interpretation of the suffering self. The symbolism of evil is not a parasite against which medicine must struggle, but rather a revealer of the heuristics of the imagery of evil at the core of medical explication.