Psicopatologia e disfunção eretil : a clinica psicanalitica do impotente
AUTOR(ES)
Maria Virginia Filomena Cremasco Grassi
DATA DE PUBLICAÇÃO
2002
RESUMO
This psychoanalytically oriented paper is based on the author s clinical and analytic practice with males complaining of erectile dysfunction, and suggests that there should be an interface dialogue between psychoanalysis and andrology. The text is addressed to readers who have had sufficient clinical experience to allow them to understand the theoretical dynamics and examine the pertinence of the proposals presented. Clinical cases are described to illustrate basic psychopathological aspects of erectile dysfunction. Our approach is that the subjects symptom is seen as erectile dysfunction, whereas impotence is considered the expression of its subjective implications in the appearance of their symptom, their pathos , their psychic pain . Our hypothesis was that impotence occurs in subjects with erectile dysfunction (the impotent subject?symptom), as the expression of psychopathological aspects related to failures in the process of assuming male identity, as related to phallic attribution. Is there a generalized "permanent mode" by which impotent men constitute their objects? Can one speak of a psychic structure of impotent men, or of a psychopathological model of impotence? The present thesis took into consideration the 1998 introduction onto the market of the oral medication known as Sildenafil citrate, produced by Pfizer Laboratory, and its clinical implications. With the pharmacological remission of the symptom, what happens to the supposed underlying psychopathological questions? We established a method of analytic investigation which led us from the clinical data to theoretical elaboration, using interviews and psychotherapeutic treatment involving patients complaining of erectile dysfunction, some under medication and others not. Eighty-seven patients were interviewed, and 25 were to chosen to receive the aforementioned medication for a period of six months. They were then followed up in psychotherapy for two years. Focus was given to those cases which indicated symptomatic persistence of the sexual problem. In other words, even though the medication had enabled the return of erections, the patients continued to be dissatisfied or insecure regarding their sexual performance. We concluded that hysteria, as a structure, or trait, is a valid model for understanding the psychopathology of impotent subjects. The hysterical structure of these subjects is related not only to dys-function, but also to impotence in erectile dysfunction, that is, its implication for the subject as failure of masculinity. Hysteria as a paradigm indicates points in common with impotence in different psychic structures. Our theoretical position is that, in hysteria, castration failed to function, in the sense that it was unable to fulfill its aim of structuring phallic pleasure and providing the possibility of having access to sexual pleasure as a limit to the impossible jouissance of the Other, the jouissance of being. Hysterical patients refuse to have (only) pleasure and to respond genitally to arousal in order not to have the phallus, in which case they would have to admit to the limits of castration. The hysterical patient s castration anxiety is the result of the castration s not having been fully or truly established and subjectivized for them; it remains adrift and cannot be repressed. It is therefore insufficient to implement genital potency, as it represents a threat that is all too real.With his impotence, the hysterical man presents a theater of jouissance for the other in order to dramatize his refusal of castration. He says no to arousal and to sexual pleasure in order to live with the nostalgia of jouissance, often nearly eliminating himself as a subject in the process of self-alienation into physical symptoms
ASSUNTO(S)
impotencia sexual masculinidade (psicologia) psicanalise psicopatologia
