Un corps guéri, une âme en sursis : le travail de la guérison chez l’adulte guéri d’un cancer

Abstract

Context

Over the past several years, psychological research has explored the mental life of illness, particularly during the experience of cancer. This approach rejects the duality between a damaged body and an intact psyche in the face of illness (Le Blanc, 2006). Cancer, with its traumatic potential, affects both the body and psychological balance (Reich, 2009). Pedinielli's (1994) hypothesis on the “work of illness” illustrates the inherent psychological processes of the illness experience. This mental work is not limited to the treatment period, as cancer recovery also involves a psychological reorganization, akin to a “work of recovery.” Research shows the persistence of psychological difficulties and a sense of vulnerability years after cancer onset (Esplen et al., 2018). While medicine declares a physical cure, it may clash with patients who struggle to perceive themselves as “cured” (Dhomont, 2004). For some individuals, this medical recovery may not be integrated psychologically, hindering their sense of healing.

Objectives

This study aims to describe the transitional process from the “work of illness” to the “work of recovery” in adults who have been cured of cancer. This description will illustrate the psychological dynamics that facilitate or hinder access to a sense of healing.

Methodology

Fourteen participants, who were medically declared cancer-free, were divided into two groups based on their sense of healing. The subjects presented with different types of cancer, but all had advanced-stage cancers (Stage 3 or 4) and had undergone at least chemotherapy. Individual interviews were conducted, recorded, and transcribed. The corpus was analyzed using an inductive thematic analysis, identifying themes and subthemes to develop a thematic analysis grid, validated by inter-rater reliability analysis (Paillé and Muchelli, 2012).

Main results

The work of illness acts as a protective factor against the traumatic potential of cancer. We have observed that when patients engage in this psychological work during treatment, it promotes the development of a psychic life around the disease. This process makes it possible to attribute meaning to the cancer experience and helps restore a sense of control over the treatment trajectory. These psychological processes facilitate the integration of the cancer experience, helping individuals to overcome its traumatic impact. “Healing work” can then unfold as the losses associated with the disease are gradually integrated, allowing the cancer to be situated in the past and making the experience of healing possible. In people who feel healed, a narrative process becomes accessible, in which cancer is no longer experienced as a radical rupture but as a sequence integrated into the continuity of their life history. Conversely, detachment from the patient's identity may be hampered by unresolved trauma. In this case, the narrative process is hampered by a psyche still in a state of shock. The cancer remains at the forefront of the patient's psychic life, often manifesting itself in a persistent fear of recurrence. It is by mourning the losses caused by the disease that the subject can integrate the medical reality of recovery, and finally achieve a true sense of recovery.

Research limitations

The administration of a scale such as the Post-Traumatic Stress Disorder Checklist Scale (PCLS) would enable a more objective assessment of traumatic impact, and provide valuable information about the patient's experience with greater nuance and precision. In addition, prospective, longitudinal research would enable us to observe the healing process as it unfolds, rather than relying on retrospective reconstruction.

Conclusion

This study explores the mechanisms that facilitate or hinder the feeling of healing after cancer, by describing the healing process itself. Viewing cancer recovery as a grieving process with identifiable stages from the treatment phase onwards provides a framework for healthcare professionals to guide and support patients in this work. The feeling of healing is part of a deep psychological process, a process of mourning that enables individuals to integrate the traumatic potential of cancer.