Le medecin et sa rencontre avec le patient-vih : une relation qui questionne l'identite professionnelle
Institution:
Paris 7Disciplines:
Directors:
Abstract EN:
The research concerns the confined space of the relationship physician and the hiv infected patient and psychological process put in cause to this opportunity. Theoretical references use the sociology, concepts of the psychoanalysis, and works on the identity. The medical profession is studied : its evolution, its social function, its report to sexually transmitted disease, and the place granted to the invalid in the practical professional. The hiv infectedpatient is presented : traditional representation of the invalid, and specific defense position of the user, as well as the role of the patient as partner of the physician, who puts causes some traditional relationships. The hypothesis of the research is that a crisis of the professional identity, and a shaking of defense mechanisms, which were organized during the construction of the professional identity. The method is : the clinic step, a small sample of physicians have been met in maintenance. Results show : the confrontation to the death, and the symbolic castration of the desire of all power, the mourning in the face of the death of young persons. A relationship of proximity institutes, feed by the sexual curiosity, roused as impulse. To attend hiv infected patient is for the physician the opportunity to relive a process of identification and differentiation. The patient is recognized as expert in the sickness, in the knowledge of the desire, and also in the negotiation with the death. The professional identity is found questionned in the course of the encounter.
Abstract FR:
La recherche concerne l'espace restreint de la relation medecin-patient vih et les processus psychologiques mis en cause a cette occasion. Les references theoriques utilisent la sociologie, les concepts de la psychanalyse, et des travaux sur l'identite. La profession medicale est etudiee : son evolution, sa fonction sociale, son rapport aux maladies sexuellement transmissibles, et la place accordee au malade dans la pratique professionnelle. Le patient vih est presente : representation traditionnelle du malade, et position specifique de defense de l'usager, ainsi que le role du patient de partenaire du medecin qui met en cause les relations traditionnelles. L'hypothese de la recherche est celle d'une crise de l'identite professionnelle, et d'un ebranlement des mecanismes de defense organises lors de la construction de l'identite professionnelle. La methode est celle de la demarche clinique, un echantillon restreint de medecins ont ete rencontres en entretien. Les resultats montrent : la confrontation a la mort, et la castration symbolique du desir de toute puissance, le deuil face a la mort d'etres jeunes. Une relation de proximite s'instaure, alimentee par la curiosite sexuelle reactivee dans sa dimension pulsionnelle. Le suivi des patients vih est pour le medecin l'occasion de revivre un processus d'identification et de differenciation. Le patient est reconnu comme expert dans la maladie, dans la connaissance du desir, et aussi dans la negociation avec la mort. L'identite professionnelle se trouve questionnee au cours de la rencontre.