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A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization

Current psychological research on contemporary medicine, and in particular genetics, often targets the underpinnings of patients’ attitudes and behaviors with respect to biomedical knowledge and healthcare practices. But few studies approach these underpinnings as manifestations of the unconscious,...

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Autores principales: Potier, Rémy, Putois, Olivier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221934/
https://www.ncbi.nlm.nih.gov/pubmed/30443227
http://dx.doi.org/10.3389/fpsyg.2018.02021
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author Potier, Rémy
Putois, Olivier
author_facet Potier, Rémy
Putois, Olivier
author_sort Potier, Rémy
collection PubMed
description Current psychological research on contemporary medicine, and in particular genetics, often targets the underpinnings of patients’ attitudes and behaviors with respect to biomedical knowledge and healthcare practices. But few studies approach these underpinnings as manifestations of the unconscious, while so doing could (in particular) help understand patients’ apparent difficulties to understand information, and to subsequently act accordingly (e.g., in making therapeutic decisions, etc.). We hypothesize that Lacan’s (1966) remarks (“The place of psychoanalysis in medicine”) on the transferential nature of the demand addressed by the patient (or his family) to the doctor can help account for these issues: demand filters medical information received from the practitioner, and thereby motivates subsequent decisions. In this paper, we try and shed light on this thesis, and focus on pediatric genetics. We start by describing the manifest doctor-patient-family relationship in the pediatric genetics consultation, in order to show where unconscious determinants can come to play a role (1). We then explain Lacan’s theory of demand: what the patient unknowingly demands is knowledge (savoir), the object of which is the body of jouissance – the libidinal experience of one’s body through the first libidinal exchanges with the Other of early infancy, whereby the subject is assigned by the Other (subjectification) a specific fantasmatic status organizing his desire. Patients’ understanding and attitudes thus vary so greatly because of this pre-existing filter. Healing and cure are merely apparent objects of the medical demand, which is an invocative drive seeking knowledge on the cause of one’s desire: medical demand is an instance of transference. Doctors should thus enable patient subjectivization, i.e., help them realize that their demand’s genuine object lies in their pre-existing subjective coordinates (2). In pediatric genetics, apparently paradoxical family attitudes heavily draw on what G. Raimbault, drawing on Lacan, called implicit demand, the object of which is knowledge about the family fantasy giving shape to the guilt of possibly transmitting the disease. We give a clinical example, then show how the concept of demand helped us elaborate the core of a research project on the subjective effects of a genetic deafblindness handicap (3).
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spelling pubmed-62219342018-11-15 A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization Potier, Rémy Putois, Olivier Front Psychol Psychology Current psychological research on contemporary medicine, and in particular genetics, often targets the underpinnings of patients’ attitudes and behaviors with respect to biomedical knowledge and healthcare practices. But few studies approach these underpinnings as manifestations of the unconscious, while so doing could (in particular) help understand patients’ apparent difficulties to understand information, and to subsequently act accordingly (e.g., in making therapeutic decisions, etc.). We hypothesize that Lacan’s (1966) remarks (“The place of psychoanalysis in medicine”) on the transferential nature of the demand addressed by the patient (or his family) to the doctor can help account for these issues: demand filters medical information received from the practitioner, and thereby motivates subsequent decisions. In this paper, we try and shed light on this thesis, and focus on pediatric genetics. We start by describing the manifest doctor-patient-family relationship in the pediatric genetics consultation, in order to show where unconscious determinants can come to play a role (1). We then explain Lacan’s theory of demand: what the patient unknowingly demands is knowledge (savoir), the object of which is the body of jouissance – the libidinal experience of one’s body through the first libidinal exchanges with the Other of early infancy, whereby the subject is assigned by the Other (subjectification) a specific fantasmatic status organizing his desire. Patients’ understanding and attitudes thus vary so greatly because of this pre-existing filter. Healing and cure are merely apparent objects of the medical demand, which is an invocative drive seeking knowledge on the cause of one’s desire: medical demand is an instance of transference. Doctors should thus enable patient subjectivization, i.e., help them realize that their demand’s genuine object lies in their pre-existing subjective coordinates (2). In pediatric genetics, apparently paradoxical family attitudes heavily draw on what G. Raimbault, drawing on Lacan, called implicit demand, the object of which is knowledge about the family fantasy giving shape to the guilt of possibly transmitting the disease. We give a clinical example, then show how the concept of demand helped us elaborate the core of a research project on the subjective effects of a genetic deafblindness handicap (3). Frontiers Media S.A. 2018-11-01 /pmc/articles/PMC6221934/ /pubmed/30443227 http://dx.doi.org/10.3389/fpsyg.2018.02021 Text en Copyright © 2018 Potier and Putois. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychology
Potier, Rémy
Putois, Olivier
A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization
title A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization
title_full A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization
title_fullStr A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization
title_full_unstemmed A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization
title_short A Lacanian Approach to Medical Demand, With a Focus on Pediatric Genetics: A Plea for Subjectivization
title_sort lacanian approach to medical demand, with a focus on pediatric genetics: a plea for subjectivization
topic Psychology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221934/
https://www.ncbi.nlm.nih.gov/pubmed/30443227
http://dx.doi.org/10.3389/fpsyg.2018.02021
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