[Chronicity: chronicization or chronification? Or, the disease evolution in relation to therapy]

The state of chronicity in the psychiatric patient questions the psychiatrist's sense of responsibility as well as his guilt feelings due to therapeutic failure. On the other hand, chronicity revives the psychiatrist's curiosity and interest in discovering more affective means to counteract a process which seems, apparently, inevitable. The author, after demonstrating that chronicity cannot be defined in accordance with psychiatric nosology, not simply in opposition to an acute state, proposes a definition that takes into account the process as one developing in the interaction between the patient, his environment and his therapist. This long and morbid evolution, which we call chronicity, corresponds to the patient's existential equilibration which is characterized by dependency and ruptures with his personal history, where the perception of time is altered and where all desires are given up. The true representative of this state can thus be perceived only through the relationships that are established. The author therefore defines this evolution as a process developing in the interaction with a given environment (hospital or other), and/or the therapeutic relationship. It becomes thus necessary to question the structures that generate chronicity, whether it be the hospital, the social services which might foster child-like dependance, chemotherapy, or negative attitudes resulting from a therapeutic relationship. A more adequate healing attitude permits a modification of the precarious compromises which the patient tends to establish, and serves to encourage his possibilities to gain more freedom of action.