De l’Université du rétablissement

Résumé

La neuro-imagerie permet d’observer et de comparer des groupes d’individus réagissant différemment lorsqu’exposés, en laboratoire, à des images provocatrices ou à des situations particulières. Pour certains, cette réaction impliquera des zones cérébrales davantage associées à l’émotivité, ce qui peut expliquer des déficits dits cognitifs ou d’attention faisant obstacle à leurs capacités d’apprentissage, d’abstraction et d’adaptation. On peut ainsi comparer des schémas de réactions qui ont été assez souvent répétés et observés pour que l’on puisse tirer certaines conclusions statistiques : en présence d’un même stimulus ou en situation de stress, le cerveau des personnes présentant par exemple un trouble obsessif-compulsif réagit différemment de celui de la population en général. Pour certains d’entre nous il est rassurant de constater, images à l’appui, que c’est telle partie du cerveau plutôt qu’une autre qui est surtout sollicitée dans une situation donnée. Cela « prouverait » que ce n’est pas intentionnellement que la réaction est plus émotive que rationnelle, le cas échéant. Par contre, pour d’autres, il est important d’être informés au moins autant des possibilités du rétablissement que d’identifier les dysfonctions et les causes apparemment anatomiques d’un problème de santé mentale. Dans un cas comme dans l’autre, cet accès à de l’information médicale et la possibilité pour les étudiants en rétablissement de dialoguer avec un scientifique sont à la base de tout un programme dit d’éducation thérapeutique et cette « Université du rétablissement » est ici introduite pour la première fois.

Mots clés : Université du rétablissement, métacognition, trouble obsessif-compulsif, neuro-plasticité, éducation thérapeutique

Abstract

On the University of Recovery

Objectives Located at the heart of a mental health university institute in Montreal, Canada, the University of Recovery (UR) is a peer-run agency of service users who came together as a private non-profit organization to promote their experiential knowledge in science and public health, and to transform the academic milieu as an inclusive work environment conducive to recovery and full citizenship. UR students can thus have access to scientific conferences and classes on various topics and invite scientists or other professionals to further discuss new discoveries and techniques, and possible ways of improving healthcare from a patients’ and service users’ perspective. Our conversation with a scientist specialized in obsessive-compulsive disorders triggered this collective reflection on neuroimaging in terms of psychiatric diagnoses, prognoses, recovery opportunities and meta-cognition.

Method At the core of the UR as a therapeutic education program is the Projet Citoyen, an adaptation and a transposition in Montreal of the Yale Citizens Project, which has been developed in New Haven, USA, over the past fifteen years. The Projet Citoyen is comprised of four main components: bi-weekly group discussions, individualized peer support, involvement and practicum in the community, and participation in public events and debates. UR students therefore evolve in the academic and scientific milieu, here regarded as a translational community and human laboratory towards social inclusion and full citizenship. UR students can be involved as auxiliaries of medical training to always promote and illustrate recovery opportunities when psychiatric ‘dysfunctions’ or ‘disorders’ are the topics of a medical class. In April 2016, UR students invited Dr Marc Lavoie to discuss is work on obsessive-compulsive disorders (OCD). The content of this group discussion is herein reported.

Results UR students learned, among other things, that neuroimaging can be used to identify patterns of brain reactions to various stimuli and situations, reactions that can be different from one psychiatric condition to another and to the rest of the ‘normal’ population. For example, bright red, green, or blue shades of color can show an over-activation of the thalamus for persons with OCD. This difference can be indicative of a so-called cognitive impairment, with some people reacting more ‘emotionally’ to an image than other persons for whom the reaction would imply parts of the brain which are normally rather associated to ‘rational’ thinking (e.g.: the cerebral cortex). Such a difference, when it appears through a neuroimaging technique like EEG or MRI, does not lead to the enunciation of a particular diagnosis for an individual, but can give some complementary indications to be used in conjunction with other observations and can inform the choice for a therapeutic approach. Cognitive Behavioural Therapy, for instance, has been statistically shown to be associated with anatomic changes in the human brain. Through some quite spectacular images of parts and subparts of the brain in action, UR students were able to admire all this beautiful neurodiversity. Then we discussed the concept of neuroplasticity: we now know that many aspects of the brain remain changeable or “plastic” even into adulthood, which contrasts with the previous common consensus that the human brain develops during childhood, then remains at once unchangeable afterward and “static.”

Conclusion Diverse neurological conditions appear as a result of normal variations in the human genome and in affect, the concepts of neurodiversity and of neuroplasticity go much beyond the prevailing prior conceptual conditioning of neurological differences as being inherently pathological and an irreversible “error of Mother Nature.” There may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli, and a psychotherapy could then consist of recognizing this conditioning and learning how to think and react differently to a triggering stimulus. The University of Recovery is thus first and foremost a principle of mutuality among its members – the students in recovery – who are allied through self-help as a basis for metacognitive therapeutic education.

Key words: University of Recovery, metacognition, neurodiversity, neuroplasticity, therapeutic education