For Juan Pablo Zito-Cart
appreciate the invitation of Dr. Carlos Damonte and the other organizers to participate in this symposium ; along with other colleagues here today.
The topic of that talk ("The training of psychologists a team of fertility ") is an interesting theme as the work of the psychologist in a clinic as specialized as it is one of RA is set in a border area and requires training or rather a particular position.
When it comes to training the first thing we think is in knowledge related to their profession that a person should have to do your job the right way. At present this is not enough and is also required to have competence, understood as "expertise, capacity or ability to make or participate in something" (RAE). Thus a professional "Formed" is the one with the expertise needed to "know-how. Is this enough? Taking into account that every profession is necessary that we respond Ethics. The knowledge and skills without ethics or ethics without good guidance, can give a harmful result. Why do we think are necessary ethics committee?
fertility A team consists of professionals from different specialties such as gynecologists, obstetricians, nurses, biologists , embryologists, andrologists and psychologists, among others. I mentioned before that the psychologist takes place in a border area, a meeting point between the physical and psychological. Where is this meeting? In the patient, because it is addressed from two different discourses: the positivist medical and psychological.
The definition according to the SAR limit is interesting because it talks about "a real or imaginary line separating two lands, two countries and two territories" . We must ask what is the real line that separates the subject of the somatic psychic? Or better yet how think of an imaginary line between them?
The high degree of specialization of modern medicine leads to medical procedures are segmented and each professional work on a sequence of treatment, the patient's body also falls within the logic of fragmentation, is working on organs or living matter that can be separated from the patient. This requires that all proceedings be encrypted, tagged and measured for the "specialist" who is next in line of work can step of the protocol to know what action should take.
But what happens subjectivity? Where we locate the subject who suffers from his condition? The list of medical protocols is no place for the patient, only there for the proceedings. Subjectivity is thought of as what is opposed to the objective, also referred to this term in our thinking or feeling, not the object itself. For the objective positivist science is the only evidence, therefore no room for what one thinks or feels. From this we can draw a first conclusion on the formation (not just the psychologist) in a team of fertility: The knowledge, skills without a governing ethics that results in a direct intervention of the technical the body, removing the patient as a subject of the scene making it an object.
The relationship between psychologist (or doctor as well) and the patient establishing a call transfer link: "... transfer is linked not so much as the illusion of love with that of existing subjects they know. Once there, somewhere, the subject supposed to know ... no transfer " says the French psychoanalyst J. Lacan. Infertility raises questions that lead the sufferer to seek a knowledge that provides meaning.
At this point I consider essential to make a clarification: There is no doubt that solutions "reproductive medicine" brings in cases organic cause of infertility, this is something that is beyond question. However, between 5 and 15% of the cases that come to clinical cases of infertility reproduction are called "source unknown" or "idiopathic", meaning that there is no organic cause that justifies this symptom.
These cases raise a lot of confusion in medical equipment and distress in the patient, the former because they also believe that there is a causal variable at play that can not be located in the body and in the latter because its enigma not find an answer, the discomfort can not be named. This could be an optimal time to apply for inter-consultation with the psychologist but not always is, it is necessary that the patient demand addressed to the doctor is of sufficient magnitude to cause an awkward affection in this distress.
What is the relationship between the lack of response and the anxiety of the doctor?
As mentioned before, the transfer between doctor and patient is held on an assumption of knowledge, since knowledge is power. The doctor "should" know the answer, the cure to the malaise of the patient and if it does not its supposed knowledge "is" placed "in issue and its power is transformed into impotence, hence the anguish.
We are therefore in a territory other than the purely physical that takes the body as a real on there that psychological intervention or where there is a predominance of the imagination, full of fantasies that suggest restore normality. We are in the realm of the symbolic, more specifically in the field of language. There is no more than words that go to another and coming from the other, which contain one or more generating equivocal meanings, relationships and effects on the subject. How else do we learn from the suffering of the patient if not for what it says? The man speaking is the ability that differentiates us from other animals, but for what? We could quickly say that it does to be represented, to show his subjectivity, that some of its shows through desire to be loved, hated or cure. This includes your complaint, his suffering led to another like a puzzle to find answers to what is not working in your life, what they do not represent, as unrecognized. From this perspective we must take the symptom Freud postulated as "neurotic symptoms are formations of the unconscious and are the compromise between conflicting desires (...) contain a knowledge"
As mentioned earlier, if there is no place for the word of the patient in the medical device Consultation or psychologist, if the discomfort is silent, there is a shift and reappears in another way.
Paternity raised doubts, fears, rejection, jealousy. Both men and women are not indifferent to the question of paternity, both are involved in different ways. On the side of man the question arises to occupy the place and exercise the paternal function, an event that will necessarily change the game with your partner's wishes; the women's side the change is even more intense as they risk their female identity and the place imaginarización "mother." In both cases there is an element to think it is the function that comes to meet the child they want and where it will occupy in the psychic economy of the pair, which requires a particular response can build
Finally I should take up the proposed significant I think today with the training you must be a psychologist working in a team of fertility.
Much of the psychological literature of assisted reproduction is based on two concepts such as Anxiety and Depression and mood effects of infertility, this leads to the formation of the professional psi, are trained in handling strategies to help patients cope with situations of stress, reduce anxiety with various tricks and change the mindset not to fall into depression. This field is very limited and repetitive as it is also notarized. What is the ethics that govern these skills? We can say that is the "corresponding legislation, the patient should be, feeling and thinking as the "idea" that has the psychologist, this is not without havoc on many occasions. It is the logic of the welfare state in which "all" have to be well and offered "all the same" as the solution.
A question I ask myself when writing this paper is whether all patients "seeking a response by the side of knowledge, knowledge unconscious? Definitely not. a couple seeking a child who say they want in a fertility clinic without an organic cause, demanding an answer coming from the other, a real response, indicating that the symptom infertility (of unknown origin) has not been established as a question for them to point to, what happens to us as a couple in relation to parenthood and sexuality?.
position training ethic I propose is to privilege the subjectivity of the patient leading to his word, holding a free-floating listening, without hurry to heal and the patience to listen to what the subject we meant what we are saying. This requires being willing to transfer knowledge to the patient, it is he who knows the causes of their suffering and resort to us for orientation. Create a space where they lie outside the competence of psychologists (Know-how) and can appear "knowing" a patient, unconscious knowledge that encloses the enigma of the ways in which the individual suffers and enjoys her sexuality and the effects this has on procreation.
Paper presented at Venice, October 29, 2010
Symposium of the Society of Psychosomatic Obstetrics and Gynecology.
