La position hypocondriaque du sujet souffrant d’une pathologie somatique chronique : un éclairage psychanalytique de la relation médecin–patient

Abstract

Objectives

Considering the psychological rearrangements that accompany somatic pathology in terms of the hypochondriacal position sheds light on the subjective experience of illness and allows for a reconsideration of the care relationship in somatic medicine from a transferential perspective. This article aims to contribute to the dialogue between psychoanalysis and medicine, particularly through applying a psychoanalytic lens to autoimmune diseases, the increasing prevalence of which is a characteristic feature of contemporary societies.

Method

Based on an analysis of Freud's and Ferenczi's observations on hypochondria, the hypothesis of a broad spectrum of plural hypochondrias allows us to define the hypochondriacal position of the chronic somatic patient, by differentiating it from authentically psychopathological hypochondria by the presence of an underlying organic condition. Testimonials from patients suffering from autoimmune diseases provide insights into the dynamics of this hypochondriacal position, enabling the conceptualization of certain issues.

Results

The hypochondriacal position of the chronic somatic patient is a consequence of a verified organic impairment, distinguishing it from psychopathological hypochondria. Whether the underlying pathology is organ-specific or systemic, a symptomatology dominated by pain and fatigue leads to a blurring of the contours of the suffering body in the patient's self-image. Unlike psychopathological hypochondria, it is not a specific somatic site that serves as the fixation of libido, but the somatic body as a whole, experienced as a suffering corporeality. The chronicity of the condition solidifies the hypochondriacal position, given the repetition of medical experiences (auscultations, examinations, consultations, hospitalizations) and the self-monitoring advice received from doctors, along with the concern of loved ones, which engages the patient in a chronicized relationship of self-examination of their body.

Discussion

The role of others — whether medical professionals or close friends and family members — proves crucial in the establishment and persistence of the hypochondriacal position. Diagnostic wandering fosters the patient's hypochondriacal identification. The failures to articulate the reality of their somatic suffering lead them to adopt medical language, potentially alienating themselves by finding expression only in operational terms. The hypochondriacal position may serve as a retreat and refuge against the object loss and self-bereavement that chronic somatic pathology imposes on the patient.

Conclusion

The care relationship in somatic medicine is rarely discussed in terms of transference. The hypothesis of the hypochondriacal position of the chronic somatic patient allows us to approach the transferential investment placed by the patient on their primary physician or a group of caregivers forming their medical team, as extra-psychoanalytic hypochondriacal transference. The trauma of somatic suffering and the diagnosis of a chronic condition with uncertain prognosis, combined with dependence on care from others, promote massive transferential movements in an archaic register. The chronicity of the condition prompts us to listen to the somatic complaint addressed to the doctor or caregiver as a repeated request for reassurance from a subject whose illness disrupts temporal continuity and their “continuity of being” (Winnicott). Addressing this complaint would require the physician or caregiver to provide a presence that is both embodied in a gesture and attuned to the temporal experience of the suffering subject.