Expérience subjective de la perte d’autonomie chez les hémiplégiques d’avc : une approche phénoménologique interprétative en psychologie clinique

Abstract

Our study is entitled: "subjective experience of loss of autonomy in stroke hemiplegics: an interpretative phenomenological approach in clinical psychology". Research on loss of autonomy in stroke hemiplegics focuses mainly on the pejorative lexicon of illness and disability, on post-stroke psychological and biological pathologies, and on coping difficulties and ways of overcoming them. During an internship at the Hôpital Militaire de Région N°1 in Yaoundé, we observed the case of a lady who had suffered an ischemic stroke with hemiplegia. After losing her autonomy, she experienced post-stroke depression and gave a first name (L) and a pronoun (she) to the paralyzed part of her body. This finding is in line with psychopathological studies on somatoparaphrenia. Somatoparaphrenia is a disorder of the right hemispheric syndrome, characterized by the unsympathetic personification or "chosification" of the paralyzed part, which is said not to belong to the subject. However, somatoparaphrenia provides no information on the loss of autonomy, or on the experience of loss of autonomy induced by the immobility of the paralyzed part, from the point of view of the person experiencing it. Phenomenological theory could fill this void, as it describes and seeks to understand the meaning of the experience for the person who lives it on a daily basis, according to his or her own perception of it. With this in mind, this study focuses on the subjective experience of loss of autonomy. The research question arising from this problem is: What does it mean for the hemiplegic stroke victim to live with a loss of autonomy? The aim in this study is to apprehend the intentional modes of thinking and feeling that stroke hemiplegics have about the loss of their autonomy. This involves understanding the meanings (perceptions and interpretations) associated with the subjective experience of this loss. To achieve this, we used the clinical method, more specifically the case study. Data were collected through semi-structured interviews with four hemiplegic stroke patients treated at the Yaoundé Central Hospital. Thematic content analysis and phenomenological interpretative analysis were used to analyze the data. The results indicate that loss of autonomy is defined by the participants as a motor imbalance due to paralysis. It is experienced as the coming of death or witchcraft. It induces: the cessation of activities or work, loss of relationships, a state of helplessness and dependence on those around you, as well as feelings of fear, embarrassment and anger. What's more, the body is no longer the same. Participants are no longer able to direct, control or decide on the accomplishment of a task; nor can they do pleasurable or enjoyable things as they did in the past. This subjective experience of loss of autonomy can be a risk factor for psychological pathologies. Hence, the clinical scope of our study is the accompaniment of stroke hemiplegics to autonomy, as well as psychological management.