THE IMPACT OF SYMPTOMS AND OF MEDICAL CONCEPTIONS

If the physical outings of disease have the psychic experience as an origin and if recovery starts after this modification of the past experience, being the solution of the conflict, it is true that psychic life does not stop and that the "experience" of the patient remains sensitive to every possible new shock. The matter is that we must pay attention to the way the patient is going to live his disease and especially his recovery phase, which is often harder to live than the conflictual phase.

A first possibility concerns the impact on the disease of this own symptoms he would thus experience on a conflictual basis. If the subjective experience of those symptoms is of the same nature as the initial conflict, there may be a vicious circle, which is even more difficult to solve. Examples: helplessness of an articular affection reviving the conflict of lack of agility; paralysis strengthening the conflict of not being able to flee one’s situation; the appearance of a cutaneous lesion reviving the conflict of impurity, etc..; And if life experience brings shocks of another nature, it will add to the complexity of the clinical table. The risk of a vicious circle has little direct relation with the medical impact in itself but it may be influenced by the patient’s belief in the matter. The knowledge of these beliefs starts during childhood ("Dress well so you will not catch a chill"; "Do not kiss X who has a cold"; "Your uncle died of a severe disease, a cancer"). It especially takes roots through inundation by the written and audio-visual media where one always shows more severe diseases without ever referring to the patient’s life experience.

Even more frequent and important is the impact of the medical conceptions of psychism and of the individual, what we call the iatrogenous impact (from the Greek iatros meaning doctor). The so-called civilised populations inheriting from scientific knowledge already brew a whole series of medical hauntings: arteriosclerosis, vascular accidents, cerebral degenerescence, various microbes with HIV at the top of the list, etc… And especially cancer: this invading tumour, of unknown origin, multiplying everywhere and justifying the most incisive therapies. All those fears form a back drop on which the worst conflicts following certain diagnoses originate.

One has to be aware that words such as "cancer" do not at all have the same subjective colouring for the doctor and for the patient. To the doctor the exercise of his profession, it is a diagnosis among others in the descriptive catalogue of pathologies. But his honesty in the "objectivity" of this diagnosis and his wish to help the patient to assume it does not prevent the fact that to a patient, cancer is synonymous with severe threat, suffering, mutilation, death.

Let us take as a first example the itinerary, as sad as frequent, of a woman with a mammary tumour following a sentimental drama. If this tumour entailed breast removal and if the woman does not overcome the shock of this amputation, the conflict of devalorisation in her femininity will find expression in bone cancer. This has nothing to do with the breast lesion but arises from a new conflict of an entirely different nature. Considering the intensive follow-up this patient is subjected to, these bone lesions will often be detected long before the solution of this second conflict, entailing the painful characteristics of the repairing bone. An additional treatment is justified for this unfortunate extension of her cancer, being those "bone metastases". Then there is a third shock still different: the fear of dying before the progression of a disease for which everything she has endured proves to be in vain. This fear conflict induces proliferation within the alveoli of the lungs. If she does not have the luck (or, more exactly the resources) to rapidly develop a pneumonia, witnessing a microbial cleaning of her lesions after the solution of this last conflict, the diagnosis of new metastases, in the lungs this time, will announce the beginning of the end. We are confronted here with a reactivation of the third conflict that will set ablaze the corresponding lesions to the lungs.

The end of this first example is the introduction to a simple rule the reader has undoubtedly already deducted: if the psychic impact of the diagnosis is of the same nature as the initial conflict lying at the origin of the diagnosed disease, this diagnosis worsens this very disease; otherwise it will induce other conflicts and thus other affections. Let us take another very typical example her: multiple sclerosis. At the origin of this pathology lies a conflict of not being able to bear the situation and especially of not being able to get out of it. The frequency and the intensity of the attacks are depending on the hazards of the conflict and the patient generally fully recovers. As the diagnosis often escapes the medical sagacity, this first period may take years. But, one day, the verdict is brought in beyond all discourse and the life experience of the patient can be resumed in a few words: "I am affected with a progressive degenerescence of my nervous system. No one knows where it comes from. It is incurable.". It concerns here a conflict of the same nature: how bear the haunting of the wheelchair and how escape from it as science is unanimous?

We have especially invoked the iatrogenous impact about severe pathologies, but it has to be taken into consideration in all the cases: the feeling of being diminished to see oneself classified as an "arthrosic" when one has just succeeded in solving the devalorisation conflict; the fear for one’s heart because one was struck with an infarction which is only a forced passage after a conflict of having to fight; the morbid anxiety concerning one’s immunity because one had a period of conflicts solved each time and having appealed to the microbial help, etc…

This leads us to reflect on the "sense" and the danger of a purely descriptive diagnosis. The diagnoses such as infarction, cancer, cerebrovascular accident, multiple sclerosis, A.I.D.S., make us automatically plunge into our memory to pick out the most terrifying cases we have seen or heard; what will only amplify the fear for the disease. With an elementary good sense, a classical diagnosis should at least be completed with a sufficiently precise severity quotation. And, in this case, one would, by far, prefer to have a multiple sclerosis or a "cancer" the conflict of which having lasted only one week rather than an arthrosis crisis or a bronchitis, the conflict of which having lasted six months … and to the condition of having understood the process of disease in general.

One more remark on detection for which the publicity campaigns are increasing with the medical profession, leading the public to apply to it more and more frequently. This practice is logical when considering that the majority of the tumours remain a long time without clinical manifestations and that a tumour recognised as being cancerous – and, as such, not being able to stop by itself – must be removed from the body to have a chance to cure. But the biological laws make us understand other realities: the "cancers" are perfectly reversible as soon as the conflict is solved and they then often transform into well encysted, harmless and inactive tumours. Here too, the presence of antibodies witness of the contact with a micro-organism but this contact, be it for having given rise to an infectious work or for having been a simple passage without any consequences, is most often only a memory of our organism which identifies all its visitors. On the other hand, among people having lived several decades, who did not live one or another conflict lasting several weeks or months and that, at that time, passed more or less unnoticed? And who does not have somewhere in his body a polyp, a cyst or some kind of tumour having the same significance… as the crater of a bomb five months or ten years after the explosion having taken place during a war. For those patients having suffered at a time in their lives but having recovered their cruising rhythm, this detection (more and more performing in the finding of "abnormalities") plunges them brutally in a nightmare of anxiety and often of mutilation and exacting treatment. Concretely, these tumours, evolving in an active conflictual phase, will finally show up clinically and, in that case, the essential gesture is to help the patient solve his conflict. And the majority of tumours mainly show up in the solution phase following the inflammatory and/or infectious phenomena accompanying this reparation. If one clings to being screened, then it should be done, lucidly by first trying to know if the eventually detected abnormality is really evolutive or if it is only a simple residual sequel. The best screening is to make an overview of the patient’s present existence and to explore his psychic, nervous and general state.