Schizophrénie et rétablissement : analyse phénoménologique d’un cas de retrait positif

Abstract

ObjectivesThe recovery paradigm has emerged in mental health over the last thirty years, referring to the subjective and dynamic process by which a person achieves a satisfying life, relying on his/her strengths, his/her values, and the very experience of his/her psychiatric illness. The understanding of the experience of people living with schizophrenia and engaged in a path of recovery is undermined by an objective and categorical psychiatric approach, targeting symptoms and deficits to be compensated. We propose a phenomenological approach to a clinical situation of positive withdrawal, as developed by Corin and Lauzon, as a form of recovery for the schizophrenic subject, in order to shed light on the first-person experience of what psychiatric semiology refers to as negative symptoms, apragmatism and social withdrawal. MethodWe develop the single case of Sam, 39 years old man who has been treated for schizophrenia for about 10 years. He talks about his “spiritual schizophrenia”, which has in the past generated a demon above his head guiding his aggressive behaviors. Since he was discharged from hospital three years ago, Sam has become an “ordinary person” again, according to him. His daily routine is ritualized by a weekly activity at the day hospital, daily nursing visits at home, television, and visits from two friends on weekends. He explains that he needs peace and quiet around him and like to be aware of his neighbourhood and village lives and events. He listens to his spiritual guides and his gift of clairvoyance, which predicted him, more happiness from his forties onwards by getting a job and by a love encounter. We propose a phenomenological analysis of his experience of recovery and positive withdrawal. ResultsSam's embodied experience was previously characterized by a confusion between the intentional and sensitive flesh (Leib) and the objectified body (Körper), disembodied and materialized as if on the outside by a demon on top of his head. Today, it seems to be re-articulated in a dialectic harmony between Leib and Körper. Sam inhabits his body in an embodied life, as an interface between himself, his history and the world. His relationship to space is characterized by the paradox of an opening to the shared world by keeping a distance from others. Sam gets punctually and cyclically involved in selected spaces that do not require any intimate social commitment, and stays on the lookout, from his home, for events in his neighborhood, his village, and world news. The Others participate in his distant integration into the community: his link with the mayor of the village validates his identity as a fully-fledged citizen, his family regularly invoked in his self-narrative is kept at a distance by monthly digital contacts, the neighbor's daily life must not be disturbed under penalty of divine punishment, etc. Sam claims a necessity of calm both inside and outside, as a support for a controlled intersubjectivity allowing the reconstruction of the self. Finally, the patient's temporality is structured by patience. À slow-now allows him to synchronize private and public paces. His esoteric beliefs give meaning to the cyclical repetition of events; his spiritual guides direct his life trajectory, promising him professional and relational dynamism from the age of forty. ConclusionÀ phenomenological approach as close as possible to the subjective experience of the person living with schizophrenia has made it possible to break loose from the social withdrawal symptom pointed out by psychiatric semiology. Positive withdrawal, as an active positioning of the subject both inside and outside the society, illustrates a process of recovery from the illness. By supporting an identity reconstruction through a dialectical tension between proximity and distance with the Other and the world, positive withdrawal reveals the importance of considering the paradoxical shape of recovery processes. It invites clinicians to free oneself from normative interventions motivated by a restrictive psychiatric empiricism.