Arnaud Plagnol

Outcome, recovery and return to work in severe mental illnesses

The assessment of outcomes of severe mental illnesses has become recently an important line of research in psychiatry, leading to distinguish different levels of outcomes and a diversity of underlying factors. The focus has shifted from a traditional medical notion of ‘disease outcome’ to a wider notion of ‘functional outcome’, and even to an inquiry about the fate of the person and its determinants. Recovery, rather than cure or remission, is regarded as the good outcome, with its own underlying factors. Return to work, as a vocational outcome, represents in research one of the good functional outcomes. It is generally understood as a sign of social recovery. But may work be regarded as a good outcome in its broader sense, i.e. as a means of full recovery? Several theoretical and empirical arguments are in favor of considering work as a privileged way toward recovery, but this does not mean it is the only way.

Peine, douleur et dépression

Resume Kierkegaard opposait la peine , liee a un malheur destinal depassant l’individu, et la douleur , issue de l’interiorisation de la souffrance a travers la memoire subjective. Cette analyse peut inspirer une nouvelle approche de la depression utilisant la theorie cognitive de la representation. Nous introduisons un cadre conceptuel permettant de construire un espace de representation en tant qu’univers subjectif defini par la memoire. La douleur morale peut etre comprise comme le reflet d’une dechirure irreversible de l’espace de representation. Le ralentissement correspond a une retraction defensive de cet espace dont la topologie devient celle d’un puits . Au-dela du malheur apparent, la retraction n’est explicable que par l’atteinte d’une zone fondatrice de l’espace de representation, renvoyant a une peine originelle. Plusieurs degres de melancolie sont definissables dans ce cadre conceptuel. Nous soulignons les dangers de l’extraction de la peine originelle lorsque celle-ci unifie tout l’espace de representation.