Résumé Les pratiques d’évaluation et de soutien à l’insertion professionnelle des personnes en situation de handicap psychique, même si elles sont en grande partie assurées par des cliniciens, ont besoin d’un cadre théorique qui fasse droit à la pluridimensionnalité des facteurs jouant un rôle dans la réinsertion professionnelle, et ne peut donc se limiter au cadre référentiel clinique et psychopathologique. Les recherches empiriques portant sur les facteurs prédictifs du retour à l’emploi ou sur l’évaluation du retentissement fonctionnel des troubles psychiatriques soulignent que l’évaluation psychopathologique et celle des performances cognitives sont insuffisantes pour rendre compte des possibilités de réinsertion professionnelle, ce qui renvoie à la nécessité de spécifier les autres dimensions pertinentes. D’autres travaux, portant sur la notion de réhabilitation ou les facteurs aidant à surmonter le handicap, insistent sur le besoin d’un modèle propre du handicap, distinct du modèle médical, attentif à son caractère situationnel et aux ressources de la subjectivité des personnes. Nous évoquerons à partir de la littérature quelques autres dimensions à prendre en considération. Cette pluridimensionnalité des facteurs impliqués dans la réinsertion exige pour la recherche une approche pluridisciplinaire, mais requiert également pour la pratique de l’évaluation et du soutien à la réinsertion des prises en charge pluridisciplinaires.
The first part of this article describes a model of disorganization of representations in schizophrenia. We assume that subjects with schizophrenia have some interfering activity in memory. Such an interfering activity induces a functional decontextualization of information and the reciprocal is true. This model accounts for different classes of cognitive troubles that have been observed in schizophrenia. In the second part, we describe a text-comprehension experiment that studies two paradigmatic cases of episodic and semantic contextualization of information: the "compartmentalization" and the "thematization" of fictional narratives. Compartmentalization refers to the way in which representations of different narratives are separated in memory; thematization refers to the way in which representations of one narrative are structured in function of a theme. In our experiment, compartmentalization and thematization are assessed by a method of priming in word recognition. In agreement with our model, the results show that subjects with schizophrenia are impaired in compartmentalization and thematization when compared with anxious-depressed subjects.
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.
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