[Delusional disorder in a chronic renal dialysis patient--deprivation and reclaiming of body and narrative].
We report a female case treated with hemodialysis over 20 years who demonstrated good social functioning, until she suffered from delusional disorder with persecutory delusions involving medical staff performing the dialysis and also auditory hallucinations involving them. We examined the bio-psycho-social invasiveness of the renal dialysis treatment, especially concerning the effects on the patient's self-image of her body resulting in the loss of a feeling of unity between her mind and body, or the sense of her body belonging to her, referring to J. Lacan's concept of "corps imaginaire= imaginary body". We supposed the situation of "body deprivation" on the ground of the patient's behavior when she developed persecutory delusions that the medical staff were trying to deprive her of her ideal body. In this case, her persecutory delusions should be regarded as a reclaim for her right not to be deprived of her self-body. We pointed out the general situation which the hegemony of modern medicine over patients brings about, where patients are deprived of chances to express their personal feelings about their illness and be listened to attentively by medical staffs. We recognized such a situation in the present patient and described the situation as "narrative deprivation". Her delusions seemed to have the aspect of the claim for her rebelling against the narrative deprivation. We emphasized the role of psychiatric staff to confirm the existence of the body-narrative deprivation situation on the side of the patient and listen attentively to the patient's personal narrative of illness in the practice of consultation-liaison psychiatry, especially when performing therapy in patients with persecutory delusions involving medical staff.
Otsuka
Koichiro
K
School of Nursing, Jichi Medical University.
Kato
Satoshi
S
Yamauchi
Mina
M
D001828:Body Image; D003702:Delusions; D004644:Emotions; D005260:Female; D006212:Hallucinations / Q000209:etiology* / Q000523:psychology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology*; D008875:Middle Aged; D033262:Narration; D011610:Psychosocial Deprivation; D006435:Renal Dialysis / Q000009:adverse effects* / Q000523:psychology*; D012563:Schizophrenia, Paranoid / Q000209:etiology* / Q000523:psychology; D012649:Self Concept