Cette thèse est orientée vers les souffrances ressenties par les sujets avec un phénomène psychosomatique (PPS). Ma pratique clinique en chirurgie à l’hôpital public fonde l’intérêt des PPS dans une maladie somatique. Le caractère énigmatique du phénomène évoque la butée des discours médical et psychologique. Généralement, ces discours buttent sur le PPS. Ces patients sont rapidement diagnostiqués comme psychosomatique. Ce diagnostic évite la question du soin. Ces patients sont disqualifiés (défaut de pensée ou émotion inadaptée), sans solution de traitement. C’est un problème de santé publique. Beaucoup de théories considèrent que les psychotiques ne peuvent avoir des troubles somatiques. De quoi meurent ils alors ? Pour discuter ces positions théoriques et descriptives, cette thèse revient à la pratique, avec des patients souffrant de PPS. Généralement, les interprétations des PPS sont centrées sur le signifiant ou l’objet a, un objet pulsionnel. Quelque chose s’écrit inconsciemment, sur la répétition en nombre. La problématique conduit à l’hypothèse : « avec un sujet de structure psychopathologique, psychose ou névrose, la clinique des PPS à l’hôpital est une clinique du trait unaire, qui peut se transformer en une clinique de la lettre ».La méthodologie adoptée est une praxéologie, une articulation entre pratique et théorie. Des études de cas illustrent ce chemin. Le paradigme est la psychanalyse. L’hypothèse est mise à l’épreuve par la clinique. Une autre interprétation est efficace pour le PPS, le trait unaire. La répétition en nombre s’arrête et le PPS disparaît. Cette psychothérapie préserve la réponse subjective du PPS, limite la Jouissance et autorise une autre position subjective, avec des structures psychopathologiques différentes. / This thesis is orientated by the suffering felt by the subjects with a psychosomatic phenomenon (PSP). My clinical practice at the surgery unit of the public hospital is basis toward PSP on a somatic disease. This enigmatic character of the phenomena evokes well the abutting of medical and psychological discourses. Usually, these discourses bump into PSP, and these patients are rapidly qualified, like psychosomatic. This diagnosis avoids the caring, and patients are disqualified (deficit of mentation or maladapted emotion), without care’ solution. More this reality is a problem for Public Health. Some theories considered psychosis unable to have some somatic troubles. But how explain they died ?To discuss theses theoretical and descriptive positions, this thesis has decided to turn back to the practice, with some patients suffering from PSP. Usually about PSP, the interpretations are focusing on the signifier and the object “a”, which is an object of Pulsion. Something is writing unconsciously, in the repetition in number.Problematic leads us to posit an hypothesis: “With a subject of psychopathologic structure, psychosis or neurosis, the clinical practice of PSP at the hospital, is a clinical practice of “trait unaire” which can moved in clinical practice of letter”.Methodology adopted is praxeology, an articulation between practice and theory. Studies of cases illustrate this way. The paradigm is psychoanalysis.Hypothesis is corroborated by the clinical practice. An other interpretation is efficiente with PSP, “trait unaire”. The repetition in number stop and PSP disappears. This psychotherapeuty preserv the subjective answer of PSP, limit to the Jouissance and authorize an other subjective position, with the different psychopathologic structures.

Made available in DSpace on 2016-04-04T18:28:03Z (GMT). No. of bitstreams: 1 Claudia Mezzarano Faria.pdf: 515723 bytes, checksum: 0a4f508dfa9e9c03f903b1a3eb2bac59 (MD5) Previous issue date: 2012-02-24 / The aim of this study was to clarify Winnicott s understandings of the psychosomatic problems, especially those related to the genesis, dynamics and potential treatment, thus contributing to the development of his psychosomatic theory. Several cases and clinical vignettes with psychosomatic symptoms and references, scattered in his work, were gathered, organized and classified. Data analysis was based on these references in relation to the theory. Beginning with the notions of integration psyche-soma and personalization, Winnicott considers the real psychosomatic disorder related to primary (early) development processes. He assumes the commonly called psychosomatic disorder phenomenon is only the body-psyche connection (linkage). Furthermore, he assumes that in several cases, the physical manifestations of psycho-emotional difficulties are natural phenomenon of human life and part of the maturation process. The classification of cases and clinical vignettes was proposed as follows: False psychosomatic disorder versus True psychosomatic disorder , in order to distinguish the phenomenon that is routinely taken as a psychosomatic disorder, but that only indicates the psyche-soma intimate relationship, from the true psychosomatic disorder, in Winnicott?s concept, and the False psychosomatic disorder subcategories Natural reaction versus Pathological symptom , to separate natural physical manifestations of emotional difficulties from some kind of psychopathology, although not characterized as a real psychosomatic disorder. The genesis, dynamics and potential treatment of a psychosomatic symptom depends on the category it fits. By analyzing and systematizing the Winnicott material (work), we intended to contribute to deepening his theory and to solving the empiric-clinical problem of the psychosomatic phenomena. / Essa pesquisa objetivou explicitar a compreens?o que Winnicott teve dos problemas psicossom?ticos, principalmente em rela??o ? g?nese, din?mica e possibilidade de tratamento, contribuindo para o desenvolvimento de sua teoria psicossom?tica. Procurou-se reunir, organizar e classificar diversos casos e vinhetas cl?nicas, dispersos na obra de Winnicott, nos quais h? refer?ncia aos sintomas psicossom?ticos. A an?lise dos dados se deu a partir da rela??o desses com a teoria winnicottiana. A partir das no??es de Integra??o psiquesoma e Personaliza??o, Winnicott considera que o dist?rbio psicossom?tico verdadeiro est? relacionado com falhas em processos primitivos do desenvolvimento, e ressalta que o fen?meno que comumente ? chamado de dist?rbio psicossom?tico refere-se apenas ?s vincula??es entre o corpo e o psiquismo. Al?m disso, Winnicott afirma que, muitas vezes, as manifesta??es f?sicas advindas de dificuldades psicoemocionais s?o fen?menos naturais que fazem parte da vida e do processo de amadurecimento. Dessa forma, foram propostas as seguintes classifica??es para os casos e vinhetas cl?nicas: Falso dist?rbio psicossom?tico versus Verdadeiro dist?rbio psicossom?tico , com o intuito de diferenciar o fen?meno que corriqueiramente ? chamado de dist?rbio psicossom?tico, mas que apenas indica a ?ntima rela??o entre psique e soma, do dist?rbio psicossom?tico verdadeiro, na concep??o winnicottiana, e as subcategorias Rea??o natural versus Sintoma patol?gico , dentro da categoria Falso dist?rbio psicossom?tico , que indica que algumas manifesta??es f?sicas devem ser caracterizadas apenas como modos de se reagir ?s dificuldades inerentes ? vida, enquanto que outras indicam a presen?a de alguma psicopatologia, ainda que n?o se caracterize como um dist?rbio psicossom?tico verdadeiro. A g?nese, a din?mica e a forma de se tratar um problema psicossom?tico depende da categoria na qual ele se enquadre. Ao sistematizar e analisar esse material apresentado por Winnicott procurou-se contribuir para o aprofundamento de sua teoria e para a resolu??o do problema emp?rico-cl?nico dos fen?menos psicossom?ticos.