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590
Original article
Our daily helplessness: its presence and experience in the outpatient
operation room of the Assisted Reproduction Clinic
Márcia Christina Gonçalves Gusmão1, Roberto de Azevedo Antunes1, Marcelo Marinho de Souza1, Ana Cristina
Allemand Mancebo1, Brunna Stumpo Vaz1, Flávio Faria de Freitas1, Maria do Carmo Borges de Souza1
1Fertipraxis - Human Reproduction Center, Rio de Janeiro, RJ, Brazil
ABSTRACT
Objective: To identify the feeling of helplessness in
assisted re production patients, along with the experience
in the out patient surgical center of an assisted reproduction
clinic.
Methods: A prospective study of care and psychological
interventions performed in the outpatient surgical center
(OSC) of the assisted reproduction clinic from January
2019 to December 2022. Patients are rst seen by the
nursing sta. After an interview with the anesthesiologist
and the attending physician, the psychotherapist presents
herself and asks consent for listening/speaking, before,
during and after the procedure.
Results: 1011 interviews were performed by the
psychotherapist, which correspond to 47% of 2149 OSC
procedures performed in the clinic during the study
period. The psychotherapist was present in 595 IVF/ICSI
(60%) of 1,000 procedures and 110 from 396 oocyte
cryopreservation (28%), 306 (41%) from 753 transfers.
The patients’ observations were written in their medical
records. Relevant points were shared and discussed with
the sta directly.
Conclusions: The patients’ speeches addressed to
the psychotherapist or to the multidisciplinary team in
this environment contains the utterance of their feelings,
conscious and unconscious, that aect their psyche. So,
the feeling of helplessness, expressed and enunciated in
the statements and conducts of patients as well as the
team, may go unnoticed and not receiving the necessary
care. In the OSC environment they are confronted with
the reality that they would so much like to avoid, that is,
to use the AR technique to achieve an unconsummated
desired– pregnancy.
Keywords: psychotherapy, helplessness, operating room,
assisted reproduction, IVF/ICSI, oocyte cryopreservation
JBRA Assisted Reproduction 2024;28(4):590-596
doi: 10.5935/1518-0557.20240082
INTRODUCTION
Many studies and articles have already dealt with the
frustrations, anxieties, losses and anguish experienced by
patients who look for the assisted reproduction clinic to
form their families (Braverman et al., 2024; Golombok,
1992; Rooney & Domar, 2018). But, what about helpless-
ness? At what moment can it be perceived, felt and heard
in the ART clinic? Clinical practice has shown that listen-
ing to the experience and the feeling of helplessness has
sometimes been left behind or even unnoticed.
Reect on the experience of helplessness is important
because “it makes it possible to think about its develop-
ments in the processes of subjectivation, making it pos-
sible to analyze the form of psychic organization of the
subjects and the possible vicissitudes for helplessness”
(Passos et al., 2018).
We can see that the notion of helplessness appears at
dierent times in Freud’s writings, as well as in several
articles and texts by contemporary psychotherapists and
other theoretical approaches.
As this notion is fundamental for the constitution and
understanding of the human psyche, we consider it relevant
to know and understand its implications in the speeches,
experiences of patients who enter the Outpatient Surgical
Center (OSC) in the assisted reproduction clinic.
The term helplessness, according to Pereira (1999),
should be considered more as a notion, and not as a
well-dened concept in Freudian work. He mentions that
Freud did not make a specic study on the subject. How-
ever, the non-formalization of a concept about this term
would not remove its importance and relevance, consider-
ing that Freud made references to helplessness throughout
his theoretical path, considering it vital for the constitution
of the human psyche.
Patients desiring to have a child and build a Family may
be faced with a feeling of helplessness since the beginning
of ART. Although this search can provide a desired and sat-
isfactory result, it does not, by itself, avoid an unscathed
position for the patient. When faced with injectable med-
ications and procedures (IVF/ICSI, oocyte cryopreserva-
tion, embryonic transfer) that will be performed at the
OSC, they will be faced with their weaknesses. These may
reactivate unique conditions of their state of helplessness,
since the “requirement of the external world refers to the
internal, to the psyche, emphasizing human vulnerability
as a point that refers to helplessness” (Kislanov, 2002)
(p. 6).
We used psychoanalytical theory and technique as a
basis for understanding the notion of helplessness and
its application in listening to patients who enter the AR
clinic to undergo the procedures performed at the OSC.
We consider as a reference for the context of helpless-
ness, texts of Freudian metapsychology, such as: Proj-
ect for a scientic psychology (Freud, 1977), Inhibition,
symptom and anguish (Freud, 1926), The future of an
illusion (Freud,1974a), Civilization and its Discontents
(Freud,1974b); and contributions from other contempo-
rary psychotherapists.
Building a family, having a child, is the desire and
project of many couples and individuals. Since they fail
to generate naturally, ART emerges as a possibility to
achieve this desire and objective. Expectations, hopes
are then created (terms that have an etymological rela-
tionship with the word hope) and hope that the child-de-
sire will be fullled and the uterus lled. However, they
do not imagine that along the way, or even during the
procedures, they face frustrations, dissatisfactions and
a feeling of helplessness.
Received February 24, 2024
Accepted August 30, 2024
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JBRA Assist. Reprod. | v.28 | no4 | Oct-Nov-Dec/ 2024
The psychotherapist Suy (2022) considers that “our ex-
periences with life always leave an unsatisfying remainder,
a tone less satisfaction than we would like” (p. 70). On a
daily basis, in the unbridled search for satisfaction caused
by internal demands and the idealized contemporary me-
dia world, from which few escape, it is necessary to listen
to “our daily helplessness”, including in the relationships
established in the ART clinic.
OBJECTIVE
To identify the feeling of helplessness in assisted re-
production patients, along with the experience in the out-
patient surgical center of an assisted reproduction clinic.
MATERIALS AND METHODS
The OSC resting room was identied in our group
as a space for listening and welcoming the demands of
patients (Gusmão et al., 2020). Based on this experi-
ence, the psychological care and follow-ups performed
by the same psychotherapist at the Outpatient Surgical
Center (OSC) of the Fertipraxis clinic, the patients were
prospectively studied, from January 2019 to Decem-
ber 2022, during the procedures of oocyte collection,
whether for IVF/ICSI, cryopreservation of oocytes, or
for embryonic transfers. Fertipraxis Centro de Repro-
dução Humana is a private clinic located in Barra da
Tijuca and Ipanema, Rio de Janeiro, Brazil.
All the patients, since beginning their medical care,
whichever the indication of the procedure, receive detailed
information about the stages of treatment, including the
presence, performance and follow-up performed by the
psychotherapist to the patients in attendance and/or in the
OSC; they also receive contact numbers for the three di-
rectors and the nursing manager, to solve any doubts. Fur-
thermore, there is clear information that any of the team’s
physicians can be asked to clarify or resolve doubts during
ultrasound control.
The clinical sta is made up of specialist physicians
who perform attendance, ultrasound monitoring and are
part of the procedures within the ASC. During the journey
inside the clinic, a multidisciplinary team works: doctors,
the therapist/psychologist, the nursing manager, nursing
technicians, four embryologists and the pharmacist. In ad-
dition to its own patients, the clinic receives patients from
associated physicians who use the OSC and ART laborato-
ries. During this journey, meetings and clinical discussions
are held for the purpose of uniformity of conduct and the
adoption of continuing education measures.
All patients sign an informative consent form. The OSC
complies with Brazilian operating regulations, according to
the recent update brought through the Technical Standard
on good practices in human cells, tissues and embryos,
published on 12/26/2022 (Brazil, Ministério da Saude,
ANVISA, 2022). The clinic has an operating license from
ANVISA (National Surveillance Agency) and is Accredited
by the Latin American Network of Assisted Reproduction
(REDLARA).
The care performed by the psychotherapist at the OSC
takes place on the days of the IVF/ICSI procedures, oocyte
cryopreservation and embryo transfers, according to the
schedule of the professional at the clinic. Each observa-
tion is recorded after in an electronic medical record and
shared with the team, directly, when necessary.
The patient is initially assisted by the nursing team,
which checks the vital signs, conrms the medications and
previous tests performed. After contacting the anesthesi-
ologist and the doctor who will perform the procedure, the
psychotherapist introduces herself and asks for permission
to have moments of listening/speaking, before, during and
after the procedure. All attendance and data collected are
recorded in an electronic medical record and shared with
the team, directly, when necessary.
RESULTS
A total of 1,011 patients were seen and monitored by
the psychotherapist at the clinic’s OSC, from January 2019
to December 2022, when it was possible to identify situa-
tions in which the feeling of helplessness became evident.
The psychological interventions carried out at the ASC, in
a number of 1,011, corresponded to 47% of the total of
2,149 attendances in this period. At the time of oocyte
aspiration in IVF/ICSI procedures, the presence of the pro-
fessional enabled her to listen to 60% of the patients (595
cases attended), in relation to the total of 1,000 performed
during this period. In the oocyte aspiration for cryopres-
ervation, the percentage was 28% (110 cases), in a total
of 396 procedures. Embryo transfers had a total of 753
undergoing psychological assistance 41% of the time (306
cases).
As a result of Covid-19 – an infectious disease caused
by the SARS-CoV-2 coronavirus – the clinic’s activities
were interrupted in March 17, 2020, with a gradual return
on May of the same year, with cases selected by women’s
age, serious male injuries or oncological procedures. The
psychotherapist’s return to activities only took place as
of July 2020, when the transfers were also progressively
restarted. The psychotherapist was present in 238 cases,
corresponding to 79.5% of the total of 299 performed by
the clinic in 2021, and there was an increase in the number
of embryo transfers performed in 2022; where 197 cases
received psychological assistance (83.47% of the total of
236 embryo transfers). The data are expressed in Table 1
and Figure 1.
DISCUSSION
“Is there anyone who doesn’t get nervous in this
place?”
“I feel like I’m in the delivery room, I wish my
mom was here.”
“May our Lord protect and sustain you all!”
Upon arriving at OSC of the assisted reproduction clin-
ic, the patient initially faces the need to get undressed. Na-
ked, she is “completely or partially desnuda (unclothed)”,
“she allows her state of mind to be shown”. What initially
was a contact, a relationship when the patient rst enters
the clinic having her rst attendance with a doctor, turns
to be dierent contacts, once, from now on, she will be
assisted by a multidisciplinary team, made up of doctors,
nurses, psychotherapists, nursing technicians, pharma-
cists, receptionists, maids and general service assistants.
Nothing will stay out with the patients’ clothes. Their sto-
ries, experiences, subjectivities and, above all, their psy-
chological reality, will come with them into the surgical
center.
“There are many emotions, they all come togeth-
er!”
(Patient’s speech addressed to a psychotherapist
in the OSC environment)
We observe that anxieties, fears, insecurities, frus-
trations, fantasies, anguish and the feeling of help-
lessness, “all come together”. The emptiness of the
womb that has not been occupied for a period, or for
a long time, and facing this condition, in view of the
procedures performed at the OSC, makes present, for
some patients, the feeling and experience of helpless-
ness. With the intention of supporting and welcoming
the patient in what she is able to enunciate and reveal
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Figure 1. Procedures in the OSC without or with the
intervention of the psychotherapist.
Table 1. Presence of the psychotherapist. (2019-2022 Procedures).
Procedure
2019 2020 2021 2022 2019-2022
n/Intervention n/Intervention n/Intervention n/Intervention n/Intervention(%)
ICSI 238/161 179/132 299/238 284/64 1000/595(60%)
Oocyte cryopreservation 81/33 78/19 130/30 107/28 396/110(28%)
TE 169/30 116/27 232/52 236/197 753/306(41%)
Total 488/224 373/178 661/320 627/289 2149/1011(47%)
through her speech, we have observed that, some-
times, listening to the feeling of helplessness has been
placed aside.
We see, therefore, a paradox: the one who is aiding, if
not aware of the request for support, may be an agent of
helplessness. Reis (2004) argues that “clinical experience
is based on a request directed by someone who suers
for another, so that this one reveals the nature of the evil
that torments him. [...] No one leaves unscathed from this
process initiated by such request, once the protagonists
aect each other in a delicate game of forces although in
dierent places and roles” (p. 13).
The patient who comes to the ART clinic, especially to
the OSC, desires and delivers her symptom – the diculty
to conceive –with the expectation of an oer of care and
diagnose. However, the course of this process is a two-way
path where both patient and team, participants of her ex-
perience, will be involved.
Ansermet (2003) states that “the clinic, at its core, is
at the same time the practice of knowledge and a path of
research that contributes to establishing knowledge from
practice” (p. 7). It highlights some counterpoints, in our
view, complementary, the interface between medicine and
psychotherapy. According to this author, “while medicine
is based on image, psychotherapy bets on speech. It is
guided by what the person declares. Where medicine is a
science of the body, as an object captured by the look, psy-
chotherapy aims to be a clinic of the person supported by
listening”. A non-passive listening, but an active listening,
sensitive to what is said and not said by the other, which is
able to withstand uncertainties. As the plastic artist Mana
Bernardes (2019) says, “listening can be a useful womb
that carries the sound and words of the other like a fetus”.
We can consider, then, that analytical listening “becomes
a fundamental instrument in the intervention of situations
of helplessness and psychic pain” (Dockhorn et al., 2007)
(p. 25).
By oering listening to support, assist and accompany
patients in the OSC of the ART clinic, the psychotherapist
can identify, from the speeches of the patients, the feeling
of helplessness, whether in progress or precipitating be-
fore, during or after the IVF/ICSI procedure, cryopreserva-
tion of embryo transfer. When directing her speech to the
psychotherapist or the team, the patient transfers contents
and aections, making it possible to observe and identify
the feeling of helplessness also experienced by the multi-
disciplinary team, especially when waiting for the results,
number of aspirated oocytes and in the face of negative
outcomes. Therefore, in the OSC environment, patients
will often be faced with their weaknesses, faults, psychic
realities and the uniqueness of their stories. As a result of
this experience, they will be confronted with a reality that
they would so much like to avoid, that is, using the ART
technique to fulll an unconsummated desire – pregnancy.
“I came to Rio, to this clinic, by recommendation
of someone I met in my city who lives here in Rio.
This person has a colleague who underwent FIV
here and it worked. He said he’d come with me
and stay here with me, but at the last minute he
backed out. I’m here alone, very anxious. My par-
ents are doctors. I told them I would do the proce-
dure. My mother supported me, my father did not.
Now, I’m here without them and also without the
support of the person who would be here with me.
My father was always with me in the procedures I
needed to do throughout my life; he stayed with
me, he supported me. Now, I’m here without him
knowing. Talking to you, I remembered my father,
who supported me”. (Patient’s speech addressed
to a psychotherapist in the OSC environment).
The presence of helplessness can be observed from
birth and in the rst expressions of life of the human baby,
“as a result of the incompleteness of the organism, its need
to exchange with the world and its extreme dependence on
the help of others”. (Oliveira et al., 2014). Helplessness,
dened in the dictionary of the Portuguese language as the
“lack of support, aid or protection; abandonment”, help-
lessness or the state of helplessness undeniably puts us in
a relationship with the other, establishing bonds and social
interactions.
In Freud, the notion of helplessness is present since
the beginning of his work (Freud, 1977). We nd the word
helplessness in the text Project for a Scientic Psychology
discovered 50 years after his death, where he deals with
the “experience of satisfaction”. In this context, Freud talks
about helplessness, explaining that
The human organism is, at rst, unable to promote
this specic action. It is carried out by others’ help,
when the attention of an experienced person deals
with a childish state by discharge through change
of path. This outlet thus acquires the important
secondary function of communication, and the
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Figure 2. Patients’ tensions inside the OSC and
Helplessness.
initial helplessness of human beings is the main
source of all moral reasons.
Freud (1977) also comments that “to say that helpless-
ness is at the base of morality is to support how the gure
of the other interferes from the beginning in the formation
of the person” (p. 336).
Pereira (1999) highlights the presence of the feeling
of helplessness since birth in the newborn. He points out
that the theme of helplessness was placed at the beginning
of Freud’s work “in very concrete terms of the newborn’s
objective inability to satisfy, by its own strength, the re-
quirements of its vital needs, to, later, be resumed and
re-elaborated [...]” (p. 127). Following this, Resstel (2015)
stated that “the baby needs to have the other to perform
specic actions, mobilizing in the other a feeling of asking
for help to satisfy his needs” (p. 93), which would lessen
the tension, provide a sense of relief and avoid the state
of helplessness. Therefore, when the mother or a person
who takes the place of the baby caregiver or someone else
is unable to observe, interpret and above all support their
needs, the baby may fall into disrepair.
In this sense, in a similar way, we can consider that,
when a patient enters the OSC to perform her procedure,
endogenous and psychological stimuli may aect her or-
ganism; the expected “specic action” will be the support
of their tensions and fantasies by “others ‘help”, that is, by
a psychotherapist, a doctor and a multidisciplinary team,
thus avoiding tension, frustration and the feeling of help-
lessness, as shown in Figure 2.
Also considering the context of the rst days of a baby’s
life, psychotherapist Ana Suy states that:
we come to life without a body, although we have
an organism. we don’t know who we are, we do not
recognize ourselves in the mirror [...]. We come to
life so fragile that we depend on someone to adopt
us to survive. [...] It is the desire of another that
we exist that connects us to our esh as an eect
of the bet on that rst other (or rst others) who
will love us (Suy, 2022) (p. 35).
Suy (2002) considers that “being welcomed into life
with love is a question of life or death for human beings”
and that “without human acceptance there is no chance for
us, because someone’s love provides the foundation of life”
(p. 24). When someone desires us, it involves us with life.
However, love and care, experienced in dierent ways
in relationships with others, sometimes fail to accom-
modate the helplessness and anguish present in a given
person. In this way, helplessness and anguish will be ad-
dressed by social relations, to the bonds established with
others, to complete and deal with the experience of dissat-
isfaction caused by the lack of support felt by the subject
in question.
It is worth mentioning Besset’s considerations, when
she states that:
“if we speak of helplessness, we designate a state
and when we speak of anguish, we refer to the af-
fection of that person. Therefore, it is a primordial,
rst anguish, which is supposed at the base of the
person’s birth, which would be about helplessness.
Not an anguish-signal, which has a function, to
prevent the I from the threat of a danger linked to
the trauma” (Besset, 2002) (p. 212).
When the patient looks for the AR clinic to deal with
something that she lacks and becomes distressed, result-
ing a state of helplessness, she does so in the expectation
of feeling supported by the presence and clinical manage-
ment of other types of knowledge. When the multidisci-
plinary team is aware of this demand, they will be able to
welcome and listen to this patient in her uniqueness in the
face of her desire – to have a child.
“I get anxious because of the sedation”
(Patient’s speech addressed to the anesthesiologist
and the psychotherapist in the operating room).
“Nobody likes to lose control. But, here we have no
control It is very important to be welcomed here”.
(Patient’s speech to the team, before being sedated.
The team waits for a while, listens and supports the pa-
tient’s feelings before starting the procedure).
The patient expresses and explains in words, or in her
behavior in general, her helplessness and addresses it to
the team, which, therefore, to support her, will have to
deal with her own helplessness, as shown in Figure 3.
The notion of helplessness gained greater prominence
in Freud’s text Inhibition, Symptom and Anxiety (Freud,
1926). The psychological apparatus at this point in Freud’s
work had already been reformulated in terms of id, ego
and superego. In this text, Freud uses of the term helpless-
ness, when he begins to investigate the origin of anguish;
he notes that “the ego is reduced to a state of helplessness
in the face of excessive tension due to need, as occurred in
the situation of birth and that anguish is then generated “
(p. 165). Laplanche & Pontalis (1992) (p. 112) wrote that
helplessness would be “the prototype of the situation that
generates anguish”.
Dangerous situations of psychological helplessness, de-
terminants of anguish, originating from the various stages
of psychological development, may also arise in later situa-
tions throughout a person’s life. It will not be dierent with
patients who look for an ART clinic to undergo procedures
that will or will not allow the birth of a child. There will be
uncertainties and lack of absolute guarantees, which both
patients demand to obtain and hear from the team and will
be confronted with their anxieties, anguish, helplessness
and many other feelings. These can be experienced and
felt in a unique way by patients, at each stage of the pro-
cedures, that is: in the application of medications; during
the monitoring of follicular evolution; on the day of gamete
aspiration; in response to monitoring the evolution of the
embryo; on the day of embryo transfer; waiting for the
result of the BHCG exam and waiting for the positive or
negative response to a pregnancy. All these moments may
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JBRA Assist. Reprod. | v.28 | no4 | Oct-Nov-Dec/ 2024
Figure 3. Helplessness deal with patients and the teams.
be sources of feelings of helplessness for some patients
and may even trigger psychopathological defenses.
“I struggled a lot to be here at this moment. It’s all
very exhausting. After a lot of waiting and trying,
I had a natural pregnancy, but I lost it. It was a
miscarriage, and it was just this year... Everything
is on the surface, but... time passes, we get de-
pressed, frustrated, recover and come back. Be-
cause there is a dream, because of age, because
there was a loss and then I had to do the IVF to
be able to do the PGT-A... Oh, I’m (sic) very tired
of everything... especially the weather. I’m here
for lack of options, but I found support, clarity and
transparency... it’s a little lighter”.
(Patient’s speech addressed to a psychotherapist in the
OSC environment)
In his text The Future of an Illusion, Freud (1974a)
states that
the terrifying impression of helplessness in child-
hood aroused the need for protection - for protection
through love, which was provided by the father; the
recognition that this helplessness lasts throughout
life made it necessary to cling to the existence of a
father, but this time a more powerful one. Thus, the
benevolent government of a divine Providence miti-
gates our fear of the dangers of life (p. 43).
Therefore, once helplessness exists in children and
adults, the search for a gure of a divine father in reli-
gions would ensure the subject’s protection for his state of
helplessness. However, for Freud, religions are considered
illusions, and religious ideas arose from the need to de-
fend against the grandeur of Nature. Thus, the condition
of helplessness would accompany the subject throughout
his/her existence.
“I never give up on what I want, I’m very per-
sistent, but I let time pass too much. After I n-
ished my master’s degree, I decided to get preg-
nant. I thought I could, but now I see that I have
my age as an enemy. I never thought it would be
so dicult. I will use donor semen. I already did a
cycle that didn’t evolve. Due to my age, the ideal
would be a donor egg, but I don’t want it. Take
good care of my eggs! I believe in God and Sci-
ence!! May Our Lady help us!”
(Speaking of the patient addressing Science (team)
and religion with her request for support in the face of her
state of helplessness in the OSC).
In the text Civilization and Discontents, Freud (1974b)
investigates and writes about the vicissitudes of the human
being facing the social, the civilization. He points out that
in order to live in society, human beings must make sacri-
ces, deprive themselves of pleasure and aggressiveness.
By acting in this way, he would avoid losing the love of the
other, the feeling of guilt, the risk of being abandoned, and
he would not be abandoned by the divine Father. When
referring to helplessness, he considers that it is inherent to
the human condition and that the relationships established
between human beings and civilizing forces can place the
subject facing his social helplessness.
Birman (2000) summarizes very well the paths that
Freud took in his texts when he mentions helplessness
when he tells us that he “outlined the position of structural
fragility of the subject, by relating this to his corporeality,
to the threats of nature and to the horrors generated in
the ambivalent relationships with others [...]” (p. 36). He
points out that “the psychological record of helplessness
is something original, marking human subjectivity forever
and ever, in an indelible and indisputable way” (p. 37).
Birman (2000) also considers that “abandonment would be
what creates malaise in modernity” (p. 43).
Crossings of a time of social helplessness, from the
Covid-19 situation, were present in the life of the multidis-
ciplinary team and in the experience of patients, as we can
see in the report below.
“I’m going to transfer two fresh embryos. Because
of my age I didn’t take the PGT-A. I really wanted to
have twins or triplets. I lost my parents to Covid-19,
my aunt and godmother, who is here with me, gives
me the strength I need. I’m very happy and excited.
I am hopeful that everything will be alright!”. (The
patient sought the clinic to perform the embryonic
transfer shortly after the clinic’s recess period due to
Covid-19. She reported to the psychotherapist her
hope of getting pregnant and rebuilding her family,
given the loss of her parents to Covid-19).
The idea of contemporary individual lives in a time of
helplessness is present in Oliveira et al. (2014) as dis-
cussed by many other authors. The modus operandi of cur-
rent relationships (see social networks) marked by greater
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JBRA Assist. Reprod. | v.28 | no4 | Oct-Nov-Dec/ 2024
Figure 4. Would the procedure be understood as an
attack on the patients’ ego?
exposure, lack of privacy and individualism, can imprint a
state of helplessness on the subject, as the greater num-
ber of contacts or likes does not guarantee her a condition
of support, in view of the weaknesses of the relationships
established in these social ties. “The subject nds herself,
on the one hand, with greater freedom for possibilities of
being and contemplating the singularity of her desire and,
on the other hand, she nds herself in a situation of help-
lessness in the face of the uncertainty and insecurity that
such a state of aairs can cause” (Oliveira et al., 2014).
Psychotherapist Fabio Belo (2022) points out that it is im-
portant to understand the notion of helplessness beyond a
biological dimension. He mentions that helplessness concerns
the “ego”. He considers that “it is not before the world, civ-
ilization, social demands, that the subject is distressed, but,
yes, before his desire”. He points out that helplessness is the
instinctual attack on the “ego” – a feeling of anguish arising
from an instinctual attack towards her, He emphasizes that
helplessness is the instinctual attack on the “ego” – a feel-
ing of anguish arising from an instinctual attack towards the
“ego”. As the attack is no longer inherent to the baby’s psy-
chophysiological surfaces, it will concern something that the
subject locates as an attack on his “ego”, on his unconscious
desire. It is the adult who gives meaning, welcomes the baby
into his fantasy that he is helpless, passive. It is this passiv-
ity produced in this scene of meaning, in this libidinal scene,
which comes back to all of us a while later as helplessness
that we live, in fact, without having been there. A passivity
that we do not experience in the self, but we experience it as
a body, someone who was beginning to constitute himself as
a subjectivity” (Belo, 2022).
Based on the above considerations, could medications,
tests and procedures performed by patients in the AR clinic
be understood as an “attack” on the patient’s “ego”? Would
they cause the patient’s ego to become helpless? Since
these procedures may or may not indicate paths to the
condition of becoming pregnant, in which the uncertain-
ty of previous results, sometimes, may produce anguish,
would they put patients in front of their ego-desire-help-
lessness? Worth the thought! (Figure 4)
“Hold my hand because I can’t handle it. Take care
of me!”
(Patient’s speech addressed to the psychotherapist
in the OSC)
It will be due to what makes her helpless, in the face of
his lack, that the patient will mobilize her desire, making
choices and seeking destinations that can account for her
existential helplessness. The ART clinic can be a destina-
tion chosen by patients to face their state of helplessness,
experienced in the face of the impossibility of fullling their
desire – to have a child.
We observed a counterpoint: if, on the one hand, clinic
professionals as a whole need to place themselves in a place
of continent (womb), in order to be able to accommodate the
emotional and aective experiences of patients; on the other
hand, they also need to be aware of and be supported in the
face of their own helplessness. See the eects of the nega-
tive outcomes experienced in the team. Therefore, we believe
that attention directed towards helplessness can produce a
greater understanding of its eect on a person, on relation-
ships and on the destiny that each one will try to give to their
existential helplessness.
“Everyone has to cling to something to keep living”
(Passos, 2022) (p. 116).
CONCLUSIONS
From a psychoanalytical clinical practice, it was possi-
ble to identify and give way to listening to the feeling of
helplessness experienced by patients and the team in the
ASC of an Assisted Reproduction clinic.
The speech of the patients addressed to a professional
or a multidisciplinary team, in the ASC environment, con-
tains the statement of their feelings, loaded with conscious
and unconscious contents that aect their psyche. In this
context, the feeling of helplessness, expressed and stated
in the speeches and behaviors of patients, as well as the
team, can go unnoticed and sometimes, not receive the
necessary care.
Attention directed towards helplessness can produce a
greater understanding of its eect on subjects, on rela-
tionships and on the destiny that each one will try to give
to their existential helplessness. Faced with the diculty
of getting pregnant, the helplessness of the self, in the AR
technique can be a way to go.
The psychoanalytic intervention carried out in the outpa-
tient surgical center of the assisted reproduction clinic can
reect and enable the understanding of “our daily helpless-
ness”, both in patients and in the team, based on the sensitive
listening of the subjects involved in this scenario.
CONFLICTS OF INTEREST
The authors have no relevant nancial or non-nancial
interests to disclose.
CORRESPONDING AUTHOR:
Marcia Christina Goncalves Gusmao
Fertipraxis - Human Reproduction Center
Rio de Janeiro, RJ, Brazil
E-mail: marciaggusmao@gmail.com
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