"Pequeno nada": uma leitura psicanalítica da perda gestacional de repetição na medicina reprodutiva

Abstract

This thesis was motivated by the authors clinical practice as a psychologist in a reproductive medicine team, a fertile ground for subjective projects, which lead to the creation of femininity, motherhood and family concepts. It presents a psychoanalytical approach of Recurrent Pregnancy Loss (RPL) that leads women with this diagnosis to follow a personalized assistance including a personalized support of Tender Loving Care (TLC), recommended by Evidence-based Medicine (EBM). A qualitative descriptive-exploratory research was developed in the Aroldo Fernando Camargos Human Reproduction Laboratory at Hospital das Clínicas of UFMG, which consisted of six recorded and transcribed semi-structured interviews, being three of them directed to the professionals and three directed to the patients with RPL, but without an apparent organic cause. One of these patients started psychological assistance and remained until the ending of the research. The interviews and the psychological session notes were analyzed, considering the Freudian interpretation method proposed by Miller (2015), based on the approach-avoidance conflicts theory (repetition, convergence and avoidance). The focus was rather a hypothetical disease that could cause RPL, than the psychological discontent in this field, where the desire and the anguish comes into play for each individual patient as well as for the professionals who strive to accomplish the demands of the patients as well. With the reproductive medicine, procreation was separated from sex and it has become explicit that the desire of pregnancy does not translate or is not equal to the desire of having a child. The multifaceted fragmentation present in motherhood walks alongside with the difficulty to deal with being a woman, which cannot be represented neither for women nor for men. For women it is structural, having them been able or not to conceive and take a child as a son/daughter, with or without science help. Therefore, our hypothesis considered that the permanent condition of incompleteness or inconsistency of the feminine signifier would place motherhood, for women, as an idealized position of filling the feminine lack. When investigating the motherhood impossibility of representation, our study pointed out to the role that a son can occupy in the libidinal economy of a woman. Being it related to death or the feminine, the term procreation does not have a representation for the speaking being. Being a mother does not cover being a woman and the search for disguise the impossibility of representation with a son benefits a position of excesses. Motherhood can appease uncertainties about femininity, but there is not a mother without a woman, and the later adduced the effects of semblance or incompleteness in a particular way. The success of the TLC approach is related to the effects of listening to the patients and their "little nothing", which allows the presence and the incidence of a subjective approach of the technique, not allowing its replication. Nevertheless, with TLC, there is a risk of maintaining the deathly circuit of pregnancy loss for some patients. For that reason the interface between psychoanalysis and medicine is important, as a psychoanalyst can offer an ethical quality contribution, that is, he/she can contribute to this "little nothing", by pointing out and sustaining the place of singularity and anguish within the team.