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L’éveil de coma confronte à une énigme. Comment entendre la souffrance du patient dans cette confluence de détresses organiques et psychiques, et comment accompagner le malade dans son cheminement vers l’éveil ?Cet article rend compte de la nécessité de penser les mécanismes psychiques de l’éveil de coma au plus près du patient et de son environnement. Il propose de faire le lien entre l’état de précarité vitale et la question de la dynamique psychique en ouvrant sur la question du perceptif, du délire et de la mémoire. Enfin, il met en évidence le travail de lien et la place du psychologue comme élément de l’équipe de soins en réanimation.

Coma: an absence of one to one ?The awakening of coma confronts the subject as its environment with an enigma requiring a somatic and psychic reorganization.This article suggests to make the link between the state of vital precariousness and the psychic dynamics of the awakening of coma. The demonstration concerns the somato-psychic articulation of the subject and the delirious potentiality of the awakening as the element of joint between the period of coma and the current period.The point of view defended in this work concerns the creation of elementary parts structuring the awakening of coma and essential to the frenzy.These elementary parts arise from the collision of perceptual memory traces in the history of the subject and the current stimuli addressed in the body during the period of coma.The frenzy is then a construction allowing the Ego to make a bridge between the absence of memories of the period of coma and the reality making return at the awakening.Finally it highlights the work of link and the place of the psychologist as the element in the team of intensive care. This reflection is inscribed in a larger research concerning an elaboration of metapsychology of coma’s arousal.