Splitting of the ego, a lack in the sense of self and subjectivity of the patient: implications on the medical relationship

At the moment when the dreaded cancer word is mentioned, there is a state of mental shock so strong that the ego can no longer cope. What is traumatic in the life of the subject when the word cancer is mentioned, is prototypical of an intrusion in the reality of an event, which is likely to be subjective. This echoes Ferenczi's trauma theory as measured as the equivalent of the destruction of the sense of self, and of the ability to resist. By this he means that an individual's ability to suffer exceeds the inner strength of that person, and that to stop the suffering, the subject ceases to exist as a whole ego. Observing patients teaches us that the psychological dynamic at work can be superimposed on that traditionally described in Die Spaltung: that of loss, followed by the attribution decision allowing the acceptance of loss, grief and finally, the so called return to health and which is, in fact, more of an anchorage, like a turning point. The shock of the thought following the announcement, and the fragmentation of part of the ego secondary to trauma, produce what Ferenczi called narcissistic splitting of the ego. Despite all the good intentions from the therapist, there is a risk of taking over, of making a decision on behalf of the patient, of alienation. We believe that, as a minimum, the patient should have a freedom to think. This paper will hopefully open the eyes of the clinical practitioner to a truly therapeutic attitude, while concluding that there is no ideal way to make the cancer announcement. To cite this journal: Psycho-Oncol. 5 (2011).