Vécu de l’hémodialyse et image du corps chez les patients souffrant d’insuffisance rénale chronique

Abstract

This research work concerns the experience of hemodialysis and the image of the body in patients with chronic kidney failure. The objective of this research is to apprehend the psychic mechanisms interfering in the safeguarding of the body image in patients in the CHU Yaoundé during their hemodialysis experience. The fact that death very often imprints its marks during the experience of hemodialysis in patients, a category of these is distinguished by some criteria for saving the image of the body. The trauma generated by this therapeutic process does not seem too affected their somato-psychic balance unlike the vast majority of patients whose survival rarely reaches the three years of dialysis as evidenced by the data collected and the literature on hemodialysis survival. For these patients, dialysis represents the end of life, it is death in an illusory form of maintaining life. This is why the narcissistic loss manifested in the form of a feeling of inferiority, shame and guilt (Cupa, 2002; Aubrée, 2015) is observed in their discourse and their behavior, while in a minority of patients, there is quite remarkable survival. This mortality is justified by the theoretical predictions of Freud (1914) on the question of drive energy. Indeed, Freud maintains that as long as there is no healing, the ego cannot reflect energy with the body, all the more since the subject has removed his libido from the objects of the world because of his organic affection and supervestite the body, this self is in the difficulty of taking up this energy because it no longer recognizes this shred and fragmented body. However, some patients succeed in prolonging their survival beyond 4 years of dialysis out of the 164 patients identified. They manage to resume fairly the feeling of their bodies, assume social roles, maintain projects, see the benefits of therapeutic observance, signs that testify to a form of vitality. Curious to know what would explain such a contrast in the experience of patients when they are all subject to the same treatment, which is why we have opted for the exploration of psychic mechanisms likely to justify the safeguard of the image of the body in this minority of patients. The collection of data from 5 hemodialyses subjects with a semi-structured interview guide allowed us to understand that the subjects opt for a work of the negative by replacing the psychic vacuum (Panos Aloupis, 2017) created by the trauma of the disease by places such as the beliefs which help to deny the suffering inflicted by dialysis (Green, 1993). To evade the danger of death or frustration, the subject proceeds by the construction of the absence of the threat, the psychic reality thus taking over on material reality. But beyond this conception of the work of the negative centered on belief, the subjects encountered also express a particular experience which integrates a set of very specific predispositions, namely the absence of neuroticism, extraversion and a sharp state of consciousness. Keywords: .