Résultat de la recherche
City Avoidance in the Early Phase of Psychosis: A Neglected Domain of Assessment and a Potential Target for Recovery Strategies
Background: A considerable amount of research has explored the link between living in an urban environment during childhood and the increased risk to develop psychosis. However, the urban milieu is more than a risk factor as it is also a place for socialization and enrichment. The aims of the current study were to explore, in a large sample of early psychosis (EP) patients, their pattern of use of the city, their perception when exposed to various critical stressors, and their sensitivity to diverse forms of stimuli. Methods: We sent a questionnaire (based on previous work conducted in a group of patients, including video-recorded walk-along in the city and a literature review) to 305 EP patients and to 220 medical students. Results: Response rate in patients was low (38%). City avoidance and negative perceptions towards the urban environment increased in patients after onset of psychosis. Patients’ tendency to avoid city center correlates with both problematic social interactions and stimuli perceived as unpleasant. Patients seemed less likely to enjoy urban spaces considered as relaxing, suggesting a lower capacity to benefit from positive aspects of this environment. Conclusions: The development of psychosis influences the way EP patients perceive the city and their capacity to feel at ease in the urban environment, leading to a high rate of city avoidance. Considering the possible influence of city avoidance on social relations and the recovery process, the development of strategies to help patients in this regard may have a significant effect on their recovery process.
Reconquérir la ville après un épisode psychotique : pratiques, espaces et temporalités
Cette recherche porte sur rôle de l’environnement urbain dans le processus de rétablissement de la psychose. Elle explore les pratiques, les espaces et les temporalités du processus de reconquête de la ville chez des jeunes personnes ayant vécu un premier épisode psychotique dans la ville de Lausanne, en Suisse. Cette analyse examine le rétablissement dans une perspective écologique qui considère la ville dans sa dimension systémique, comme un ensemble d’interactions entre les êtres vivants et les milieux spatialement et temporellement situés. Je propose d’analyser la façon dont le rythme des troubles agit sur les pratiques et sur les formes d’engagement avec l’environnement urbain et la manière dont cela se traduit par la mobilisation de ressources matérielles, sociales, sensorielles et affectives particulières. Dans un premier temps, mon analyse retrace le processus progressif de reconquête de l’espace urbain au cours du rétablissement. Je mets en évidence la grande variété et diversité d’espaces mobilisés par les jeunes personnes dans leurs trajectoires quotidiennes qui incluent tant des espaces institutionnels de soins comme les hôpitaux ou les centres de consultation que des espaces de soins plus informels comme des parcs urbains ou des cafés. Dans un deuxième temps, à l’aide du concept “d’intensité d’engagement” développé par Laurent Thévenot (2006), j’examine la façon dont les personnes modulent leur engagement avec les ressources matérielles, sociales, affectives et sensorielles de l’environnement, en fonction du rythme d’apparition et de l’intensité des troubles. Mon analyse montre l’alternance entre les pratiques spatiales de retrait et d’engagement avec l’environnement en fonction de cycles de manifestation des troubles courts ou longs. Dans un troisième temps, je développe une réflexion plus générale qui porte sur les stratégies et les tactiques développées par les personnes vivant avec un diagnostic de psychose lors de situations de stress en milieu urbain. Je m’intéresse tout particulièrement aux techniques de “mise en confort” de l’environnement qui sont employées dans les pratiques quotidiennes de rétablissement. Enfin, en guise de conclusion, mon analyse développe quelques pistes de réflexion destinées à la fois aux professionnels de la santé mentale et aux spécialistes de l’aménagement urbain, permettant de repenser l’habitabilité de nos villes et d’améliorer la qualité de vie de ses habitants. Plus largement, ce travail s’inscrit dans un projet de recherche interdisciplinaire entre la psychiatrie et la géographie humaine, financé par le Fonds national suisse de recherche (FNS), et vise à mieux comprendre le rôle de l’environnement urbain dans l’émergence des troubles de la psychose. Cette analyse a été menée avec des jeunes patients appartenant au programme de traitement et d’intervention précoce dans les troubles psychotiques (TIPP) du centre hospitalier universitaire vaudois (CHUV). Ce travail se base sur une ethnographie menée dans une institution thérapeutique lausannoise avec des personnes appartenant au programme TIPP, ainsi que sur des “go-alongs”, des entretiens et des “focus groups” avec un autre groupe de patients de ce même programme., The aim of this research is to investigate the role of the urban environment in the recovery process of psychosis. I look at the practices, spaces and temporalities of reconquering the city. I focus particularly on young people having recently experienced a first psychotic episode in the city of Lausanne, Switzerland. This analysis examines recovery from an ecological perspective that considers the city in its systemic dimension as a set of interactions between living beings, and spatially and temporally located milieus. I look at the way the constantly wavering temporal dynamics of psychosis affect people’s practices. I show how these temporal dynamics imply various levels of involvement with the urban environment, which translates into the use of specific material, social, sensory and affective resources. First, my analysis outlines the process of reclaiming urban space while recovering. I highlight the great range and diversity of spaces mobilized by young people in their daily trajectories, which include institutional care spaces such as hospitals, community care centers or outpatient clinics, as well as more informal care settings such as parks or coffee shops. Second, I draw on the concept of "intensity of engagement" developed by Laurent Thévenot (2006), in order to point out how participants are constantly adjusting their involvement with the material, social, emotional and sensory resources of the environment, according to the frequency and intensity of symptoms. I argue that the temporal recovery dynamics of psychosis involve a short and a long cycle, implying an alternation of practices between withdrawal and reconquest of the urban space. Third, I develop a broader analysis that touches upon the strategies and tactics developed by people living with a diagnosis of psychosis when facing stressful situations in the city. In my concluding discussion, I show how the knowledge of practices, temporalities and spatialities of the recovery process provides a new line of thought for care professionals and urban planners, in order to rethink the livability of our cities and the quality of life of their inhabitants. More generally, this work is part of an interdisciplinary research project between psychiatry and human geography, funded by the Swiss National Research Foundation (SNSF), which aims to better understand the role of the urban environment in the emergence of psychosis. This analysis has been conducted with patients of an early intervention program for psychotic disorders called TIPP (Traitement et intervention précoce dans les troubles psychotiques) belonging to the Vaud University Hospital Centre (CHUV). My work is based on an ethnography conducted in a community care service with participants involved in the TIPP program, as well as on go-alongs, interviews and focus groups with another group of patients from the same program.
Unpacking ‘the City’: An experience-based approach to the role of urban living in psychosis
Primarily on the basis of epidemiological studies, recent research in psychiatry has established a robust link between urban living and psychosis. This paper argues first, that an experienced-based approach, moving beyond epidemiology, is needed in order to enable more fine-grained understandings of the city/psychosis nexus. The second part of the paper presents preliminary fieldwork results based on video-elicitation sessions with first-episode patients with psychotic disorders. These results lead to the generation of a series of hypotheses for further research on the role of density, sensory overload and social interaction as factors in the onset of non-affective psychoses. The conclusion discusses the insights gained from viewing the city as an experiential milieu rather than as a set of substances. We argue that such insights enable, on the one hand, observation of the role of specific places and situations - and thus to unpack ‘the city’; and, on the other, to envisage the urban milieu as a nexus of possible sites of recovery.