Vers une gestion autonome de la médication en psychiatrie ? Approche anthropologique Towards an autonomous management of medication in psychiatry? An anthropological approach - HAL Accéder directement au contenu
Article dans une revue Annales Médico-Psychologiques, Revue Psychiatrique Année : 2008

Vers une gestion autonome de la médication en psychiatrie ? Approche anthropologique Towards an autonomous management of medication in psychiatry? An anthropological approach

Vers une gestion autonome de la médication en psychiatrie? Approche anthropologique

Résumé

From the patient’s viewpoint, a good quality of compliance supposes a good relationship with his/her doctor; this relationship is directly linked to the heeding and the interest shown to the patient, and not to his/her symptoms alone. If individual motivation plays an important part at the outset, it will nevertheless be seriously influenced by the relationship between the doctor and his/her patient. It is one of the rare factors for which a positive correlation with compliance can be observed, as shown by practically all medical psychological research. These well-known classical medical notions meet with average values of non-compliance, which may vary widely. These data are proof of the wide gap existing between what is expected and what is actually achieved. This discrepancy is felt by the patient as well as by his/her therapist, and involves many other factors linked to culture, to the medical and religious background, to medical anthropology, and to the real or supposed proprieties of the Pharmakon. Our study aims at synthesizing the most recent data concerning this issue, which is still at the core of numerous debates and hardly ever tackled in French language literature. Based on the summary of these data and on the testimony of 135 persons involved in this dynamic (patients, families, doctors, nurses, members of pharmaceutical industry), we shall try to obtain a better understanding of what happens between the patient and his/her therapists from an anthropological viewpoint. Social isolation remains one of the greatest losses in mental disease. For many authors, people with schizophrenia can have no friends, no spouse, and sometimes no family. Two thirds of the patients with schizophrenia return to their parents’ house when discharged from a hospital after the first psychosis. Family members generally receive very little education as to what they can expect. They may not even know the importance of medication compliance. Family members are the primary victims of violence from psychotic individuals, usually their own son or daughter, and most families cannot believe their own son or daughter would be capable of such violence. Although families are usually the main care givers at the beginning of schizophrenia they often find their experience very frustrating for a number of reasons, and consequently relationships suffer. Family education and support have been shown to improve outcomes considerably and family education is the second strongest factor in relapse prevention. Without education and good relapse prevention families often disintegrate. Most of the homeless mentally ill in downtown city cores have lost their family relationships. It is not a reflection on their families so much as the lack of adequate treatment and support. The families tried again and again but finally lost their sick relative. These reflections show how information of and about the psychiatric patient is necessary, and underlines the importance of the relationships between the patient and his family. Our article also insists on this theme which is rarely developed in the literature.
Du point de vue du patient, la gestion autonome de la médication passe par l’obtention d’une bonne relation avec son médecin ; cette dernière est directement liée a` l’écoute et a` l’intérêt accordes au malade, et pas seulement a` ses symptômes. Si la motivation individuelle joue un rôle important au départ, elle va être elle-même fortement influencée par la relation médecin–malade. C’est l’un des rares facteurs pour lequel on observe une corrélation positive avec le respect de l’ordonnance, comme ont pu le constater pratiquement toutes les recherches en psychologie médicale. Mais, de telles données témoignent du fossé existant entre ce qui est attendu et ce qui est effectivement réalisé. Cette divergence intervient autant pour le patient que pour son thérapeute, et fait intervenir de nombreux autres facteurs appartenant a` la culture, au contexte médicoreligieux, à` l’anthropologie médicale, aux propriétés réelles ou supposées du Pharmakon. . . Notre travail se propose de faire la synthèse des données les plus actuelles concernant cette problématique, encore objet de nombreux débats et quasiment pas abordée au sein de la littérature francophone. Grâce à` la synthèse de diverses données théoriques et aux témoignages de 135 personnes impliquées dans cette dynamique (patients, familles, médecins, infirmiers, membres de l’industrie pharmaceutique), nous essayerons de mieux comprendre ce qui se passe entre le soigné et ses soignants, d’un point de vue anthropologique
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halshs-01736683, version 1 (06-02-2020)

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J. Palazzolo, N. Midol, Joël Candau. Vers une gestion autonome de la médication en psychiatrie ? Approche anthropologique Towards an autonomous management of medication in psychiatry? An anthropological approach. Annales Médico-Psychologiques, Revue Psychiatrique, 2008, 166 (9), pp.717 - 726. ⟨10.1016/j.amp.2006.02.013⟩. ⟨halshs-01736683⟩
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