Psicossomática na infância: um estudo de criança com artrite reumatóide

Abstract

This research aims to study the personalization process and its disturbances in cases of children who suffer from juvenile rheumatoid arthritis (JRA). For this purpose the method used was a qualitative analysis of four selected cases among twelve children with JRA. These children were seen in the Juvenile Rheumatology Clinic of the Instituto Central do Hospital das Clínicas de São Paulo. The instruments used were: patient data files, the "Childhood Health Assessment Questionnaire", interviews with doctors, family and the children. The method used in the interviews with the children inc1udes play therapy section, graphic tests (HTP and Family) and thematic or free drawings, that had both a diagnostic and a psychotherapeutic value. Based on Winnicott's theory, five criteria were used to analyse the cases: mother care; dependence; personal identity: transitionality; self integration and psycho-somatic dissociation. In the self integration process partial arrests were found, as well as the presence of gaps, related to psycho-somatic dissociations. These dissociations had two maio disorders: a dissociation in the personality and a dissociation organized in mind in relation to the psycho-soma. It was observed an emphasis on the dissociation of the artiGo in the world, for lhe child was predominantly submissive or reactive. Consequently, there were damages in lhe living capacity in a free way, in other words, the spontaneous gesture related to lhe self experience. The degree of personal identity corresponded to the success in mother care, the possibility of experiencing the dependence on the environmental provision, and to the exercise of creativity and spontaneity ("transitionality"). Conceming the arthritis, the children presented the following conditions: restricted locomotion, difficulty or impossibility to sustain themselves, lack of flexibility, body deformations and pain. On the other hand,in all cases there was a manifested hope in the accomplishment of the integration process.It was possible to conc1ude, in the studied cases, that the children presented a fragile personal integration, due to an incomplete or partial personalization process, although there were observed different degrees and dynamics