Nowadays, we cannot deny the spectacular advances in medicine. Medical interventions are increasingly controlled and trivialized. Medical technicians move back and challenge the limits of life and death. Patients with life-threatening diseases such as chronic kidney disease are denied survival, finding themselves in the situation of a survivor (Cupa, 2002). Organ transplantation is sometimes the only possible outcome for certain diseases that lead to the loss of a vital function. Their organic failure forces them to be dependent on the care they need. After many attempts, it was in 1964 that the first successful kidney transplant worked (Le Breton, 2008). Over the years, operations have become medical routines, but it should not be forgotten that transplants are far from safe. In addition to being a complex operation, they require having to live with someone else’s organ.
What are the psychological problems encountered by the patient with end-stage renal disease? We will discuss different issues of a kidney transplant, which is above all a psychic transplant.
First of all, the body becomes an open “envelope” where the body can break into organs, but the transplantation will break a physical integrity, which will be compensated by our psychological system to maintain identity cohesion (Vaysse, 1993). It is therefore necessary to rethink our body through psychological elaboration work that can be difficult for some transplanted patients (Vaysse, 1994). Indeed, in the majority of transplanted patients, the integration of the graft leads to an identity crisis. It can last more or less long or be more or less acute, everything will depend on a set of factors such as: the psychological conditions of the transplant, the quality of support for relatives and the medical profession but also on the subject’s ancient history (Le Breton, 2009).
Moreover, the graft is the entry path to the imagination and fantasies as the dream is the entry path to the unconscious. Indeed, it disrupts the subject’s body image and personal limits (Le Breton, 2009). It can refer to a fantasy of self-growth, i.e. the graft is experienced as a new birth, it is like a cure for youth (Cupa, 2002). This rebirth can be explained by the return of desire, sexual power and finally the possibility of procreating again, we can say that it is a “rephallicization” in men and a “refertilization” in women (Cupa, 2002). But also, the foreign presence of a new organ can make a part of oneself escape. Here are some fairly common statements that reflect it (Le Breton, 2009): « I feel the presence of someone in my body, it is stronger than me », « I feel like my body is changing ».
In conclusion, although transplantation may seem magical and erase chronic disease, it should not be forgotten that the transplanted patient will remain a monitored individual, will still depend on care and will always be sick (Cupa, 2002). There are many psychological issues when a new organ is integrated and there are major conflicts against its natural incorporation. Finally, transplantation will allow patients to have new life plans: return to work, have a child, do more activities… While keeping in mind that he is not cured but that he is pushing the limits of his death. The progress of medicine is a feat and a miracle for many. The history of therapeutic conceptions in the 20th century has led to changes in ethics and morals. Medicine has been able to change our minds, it allows us to recognize the complexity of the biological process and psychology allows us to recognize the complexity of the psychological process. It is in this sense that psychology must evolve at the same time as medicine, defying the laws of life and death brings new psychological conflicts every day, but how far can you follow it?
Words :
Kidney : Rein
End-stage renal disease : insuffisance rénale terminale
Psychic transplant : transplantation psychique
The graft : la greffe
Self-growth : croissance personnelle
Ressources:
Cupa, D. (2002). Psychologie en néphrologie. Paris : EDK.
Le breton, D. (2008). La chair à vif. Paris : Métailié.
Le breton, D. (2009). Entre douleur et souffrance : approche anthropologique. L’information psychiatrique, 85(4), 323-328. https://doi.org/10.3917/inpsy.8504.0323
Vaysse, J. (1993). Coeur étranger en corps d’accueil. Communications, 56, 175-181. https://doi.org/ 10.3406/comm.1993.1856
Vaysse, J.(1994). Effraction corporelle, échanges d’organes et image du corps. Psychologie médicale, 24(3), 313-316.
Marie Dupau
Domitille Front
Julie Pesty