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Prescrire dans la parole : écoute analytique et prescription médicamenteuse

Abstract : Prescribing medication is one of the main therapeutic tools used by physicians. If somatic medicine clinically acts according to a 'symptom-diagnosis-treatment' model, psychiatry does not follow this linear pathway. Although it has copied the medical model since the discoveryof psychoactive drugs in 1952, it possesses a specific clinical approach. First of all, in psychiatric care, the symptom is an address to the Other, it contains an essential social dimension. Moreover, it implies the subject's active participation, each therapy also being a self-therapy. Neuropharmacology, in full expansion since 1952, has taken a therapeutic scheme aiming at more scientificity by moving away from clinical psychopathology. Hence psychiatrists are seen as technicians of psychoactive drugs prescription, drugs being considered as self sufficient therapeuticaly. With regard to this evolution in psychiatric care, how can a clinical approach be maintained ? In practice, the act of prescribing can free itself from being exclusively technical. Prescribing psychoactive drugs can indeed, under certain conditions, be a true psychotherapeutic act. To guide us through this reflection, we used the pharmakon paradigm to make the issue of prescribing more complex. Clinical practice suggests a possible alliance between patients'words and medication. Beyond molecular action, prescribing through talking qualifies the substance by words, so it becomes a clinical-interaction-specific drug. The molecule, guided by the magic of words, will be more efficient. The act of prescribing is thus conceived as a creation made possible by two people, that must be reinvented at each encounter. The moment for prescribing is rather the fruit of the clinician intimate decision process. Thus, far from excluding each other, analytical therapy and pharmacotherapy would gain much from sharing their views on the issue of prescribing. Integrating both the pharmacological effect and the clinical interaction would allow clinicians to engage in an authentic human encounter with patients. Psychopathology may then open up to new therapeutic perspectives.
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Yves Guillermain. Prescrire dans la parole : écoute analytique et prescription médicamenteuse. Psychologie. Université Nice Sophia Antipolis, 2013. Français. ⟨NNT : 2013NICE2044⟩. ⟨tel-00977346⟩

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