Acompanhamento terapêutico e psicose: um articulador do real, simbólico e imaginário / Therapeutic Accompaniment and Psychosis: inTerrelAting the Real, the Symbolic and the Imaginary

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

The overall purpose of this doctoral thesis is to problematize the Therapeutic Accompaniment (TA) of psychotic patients by drawing on the thought of Sigmund Freud and Jacques Lacan. It initially characterizes the TA through depictions of experiences from reforms in the mental health care (therapeutic communities in England, democratic psychiatry in Italy and institutional psychotherapy in France) aimed at determining the function of TA in the psychoanalytic clinic, the contribution of which to the Brazilian reform merely consists in promoting a clinic of circulating psychotics around the town. Next, two theoretical chapters revisit the Freudian approach to psychosis and Lacans rereading of it. These circumscribe a first clinical indication for the possible treatment of psychoses, in this case, the listening to the delusions in the position of secretary to the alienated. This clinical indication is deemed pertinent to enable working with specific aspects of the function of TA in the clinic, such as that of its being a privileged strategy for the installation of the treatment device and that of the ethical procedure called networked gaze a procedure that follows the times of the subject in his or her clinical path. As for the former, the installation of the treatment device, patients in a crisis, wounded by brutal suffering, are known to face the other as someone terrifying, which imposes challenges when the therapeutic escort has to deal with transference whilst respecting the subjects times (in a crisis when an other is the persecutor until the condition of erotomania) in order to install the treatment device. Concerning the issue of a networked gaze, this work proposes to problematize it from its institutional roots to its use in the TA, by analyzing the creation of the TA in an institutional framework, along with several clinical passages, in which the subject is always considered under the ethical perspective of psychoanalysis. This networked gaze is of great value to building a therapeutic project for the TA. The next theoretical chapter presents a second clinical indication arising from Lacans formulation of the Borromean knot and the construction of the sinthome, which knots together the three registers - real, symbolic and imaginary and is considered the fourth element of the signifying chain, the Name-Of-The-Father. In psychosis, however, this fourth element is foreclosed, in which case the subject is convoked to build possible supplementations to the Name-Of- The-Father or build his/her own sinthome. Finally, another clinical function of the TA is defined, i.e., its contribution to the construction of the sinthome; a function that evolves into an interrelation among the three registers referred. The AT, therefore, takes on a psychoanalytical statute, insofar as it allows the psychotic subject to build a favorable supplementation to its approximation to the social link, which leads to the conclusion that the TA is an important strategy in the possible treatment of psychoses.

ASSUNTO(S)

therapeutic accompaniment psicanálise transference (lacan) psychiatric reform psychoanalysis transferência (lacan) psicose reforma psiquiátrica acompanhamento terapêutico psychosis

ACESSO AO ARTIGO

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