Résumés
Résumé
Un peu plus d’un siècle après la publication de Deuil et Mélancolie de Freud, l’impact du deuil sur la santé des proches du défunt, et particulièrement dans le cas de formes pathologiques de deuil ou de deuils compliqués, a été largement établi et étendu à des manifestations psychiques et/ou somatiques variées. La causalité des maladies auto-immunes de l’adulte reste mal comprise, et il est souvent fait état d’une origine multifactorielle avec des facteurs environnementaux variés et génétiques dont le poids respectif n’est pas connu. À côté des facteurs infectieux, toxiques, médicamenteux, hormonaux, des facteurs psychologiques ou « stress » sont aussi régulièrement observés avant le déclenchement d’une pathologie auto-immune. Cet article propose d’étudier l’hypothèse d’une relation causale entre les deuils compliqués et la survenue de maladies auto-immunes de l’adulte. Dans une première partie, les données issues de travaux de recherche qualitative menés auprès de patients souffrant principalement du lupus systémique sont analysées, à savoir les données du Brief Illness Perception Questionnaire des patients de l’étude multicentrique PSY-LUP (Psychosocial Consequences of Systemic Lupus Erythematosus), celles d’une enquête spécifique sur le deuil compliqué (Lupus Mourning Survey) utilisant l’Inventory of Complicated Grief Revised et menée auprès des membres d’une association de patients lupiques, et enfin les données de l’étude INSIDE, investigation psychosomatique de 50 patients souffrant de pathologies auto-immunes variées, réalisée conjointement par un médecin interniste et un psychologue et/ou hypnothérapeute. Dans une seconde partie, nous proposons une revue de la littérature scientifique interdisciplinaire impliquant les champs de la médecine, de la neuro-immunologie, de l’éthologie, de l’anthropologie, de la psychologie et de la psychosomatique, organisée selon les 9 critères de causalité de Hill. Enfin, nous discutons, sous l’angle du modèle biopsychosocial, les implications possibles et les perspectives de notre travail en termes de pistes de recherche et de prise en charge des patients souffrant de pathologies auto-immunes, mais également d’autres pathologies dysimmunitaires telles que le cancer.
Mots-clés :
- maladies auto-immunes,
- lupus,
- deuil compliqué,
- deuil pathologique,
- recherche qualitative,
- causalité
Abstract
A little more than a century after the publication of “Mourning and Melancholia” by Freud, the impact of grief on the health of the deceased’s relatives, particularly in the case of complicated grief, has been widely established and extended to various psychological and/or somatic manifestations. The causality of autoimmune diseases in adults remains poorly understood and it is often stated that they have a multifactorial origin, with various environmental and genetic factors whose respective weights are unknown. In addition to infectious, toxic, medicinal and hormonal factors, psychological factors or “stress” are also regularly observed before the onset of an autoimmune disease. This article studies the hypothesis of a causal relationship between complicated grief and the occurrence of autoimmune diseases in adults. In the first part, data of interest from qualitative research carried out with patients suffering mainly from systemic lupus are analyzed, namely the data from the Brief Illness Perception Questionnaire from PSY-LUP multicenter study (Psychosocial Consequences of Systemic Lupus Erythematosus) patients; those from a specific survey on complicated grief (Lupus Mourning Survey), using the Inventory of Complicated Grief Revised and carried out among members of a lupus patients’ association; and, finally, the data of the INSIDE Study, a psychosomatic investigation of 50 patients suffering from various autoimmune diseases, carried out jointly by an internist and a psychologist/hypnotherapist. The second section includes an interdisciplinary scientific literature review involving the fields of medicine, neuro-immunology, ethology, anthropology, psychology and psychosomatics, organized according to Hill’s 9 criteria of causality. Finally, from the perspective of the biopsychosocial model, we discuss the possible implications and perspectives of our work in terms of avenues of research and management of patients suffering from autoimmune diseases, but also from other dysimmune pathologies such as cancer.
Keywords:
- autoimmune diseases,
- lupus,
- complicated grief,
- pathological grief,
- qualitative research,
- causality
Resumen
Poco más de un siglo después de la publicación de Duelo y Melancolía de Freud, la repercusión del duelo en la salud del doliente, y en particular en el caso de las formas patológicas de duelo o de los duelos complicados, ha sido ampliamente establecida y extendida a diversas manifestaciones psicológicas y/o somáticas. La causalidad de las enfermedades autoinmunes en los adultos sigue siendo poco conocida y a menudo se afirma que el origen es multifactorial con diversos factores ambientales y genéticos cuyo peso respectivo se desconoce. Además de los factores infecciosos, tóxicos, medicinales y hormonales, también se observan regularmente factores psicológicos o de «estrés» antes de la aparición de una enfermedad autoinmune. Este artículo propone estudiar la hipótesis de una relación causal entre el duelo complicado y la aparición de enfermedades autoinmunes en adultos. En la primera parte, se analizan los datos de una investigación cualitativa realizada con pacientes que padecen principalmente lupus sistémico, concretamente los datos del Brief Illness Perception Questionnaire de los pacientes del estudio multicéntrico PSY-LUP (Psychosocial Consequences of Systemic Lupus Erythematosus), los de una encuesta específica sobre el duelo complicado (Lupus Mourning Survey) utilizando el Inventory of Complicated Grief Revised y realizado entre los miembros de una asociación de pacientes de lupus, y por último los datos del estudio INSIDE, una investigación psicosomática de 50 pacientes que padecen diversas patologías autoinmunes, realizada conjuntamente por un internista y un psicólogo y/o hipnoterapeuta En la segunda parte, proponemos una revisión de la literatura científica interdisciplinaria que involucra los campos de la medicina, la neuroinmunología, la etología, la antropología, la psicología y la psicosomática, organizada según los 9 criterios de causalidad de Hill. Por último, discutimos, desde la perspectiva del modelo biopsicosocial, las posibles implicaciones y perspectivas de nuestro trabajo en cuanto a la investigación y el manejo de los pacientes que padecen enfermedades autoinmunes, pero también de otras enfermedades disinmunes como el cáncer.
Palabras clave:
- enfermedades autoinmunes,
- lupus,
- duelo complicado,
- duelo patológico,
- investigación cualitativa,
- causalidad
Parties annexes
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