Influence des croyances et des représentations de la psyché dans l’après-cancer du sein

For some, the announcement of a cancerous illness awakens or reinforces representations linked to the presumed power of the psyche over the body. Different psychosomatic theories underline the importance of a specific psychic functioning as the guarantor of good somatic health. In our view, confusion in the understanding of such concepts has effects on the aftermath for women with breast cancer. Our study was carried out by six women with breast cancer and focused on the influence of beliefs and representations of breast cancer on how they experienced the acute post-treatment phase of an oncology care pathway. We identify a possible link between beliefs and representations held by the patient, his or her family, and/or caregivers, and the possible reinforcement of defensive psychic movement we call “Transient Secondary Obsessional Movement” (TSOM). Longitudinal qualitative research using a combined approach involving non-directive clinical interviews and a projective test, the Szondi. A study focusing on two specific phases of the oncology care pathway: treatment (T1) and acute post-treatment (T2). An individual and cross-sectional analysis of the twelve Szondi protocols and a thematic analysis of non-directive clinical interviews were carried out. The results corroborate the identification of specific psychic movements for these six women. At T1, we observe a major need to cling, a psychic lability favoring the fixation of reassuring discourse and repression of effects. At T1 and T2, we identify a decathexis of the Ego and the presence of obsessional traits independent of the women’s psychic structure. At T2, there is a lifting of repression, a heightened sense of injustice, and a gradual new psychic cathexis. The psychic movement that takes place at T2 is the transition from the desire to “stay as before” (T1) to “I thought I’d go back to being as before”. The post-cancer period often reflects a dissonance between psychic time and medical time: an announced “healing” of breast cancer does not necessarily imply a psychic recovery for the women concerned. The TSOM represents a transitory psychic bridge, reflecting psychic vulnerability and after-effects. In a process of transition from the world of the sick to that of the healthy, each woman is seeking and/or attempting to control the uncertainty of the risk of the disease returning.