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Background The recovery processes of persons with complex mental health needs take a slow and unpredictable course. Despite the fact that a number of essential building blocks of recovery in this population have been identified (e.g. social relationships, treatment, personal beliefs), the actual process of recovery in persons with complex mental health needs largely remains a black box. The aim of this study was to gain insight into how the recovery processes of persons with complex mental health needs take place, by applying a relational geographical approach and scrutinizing the place-making dynamics of one low-threshold meeting place in Belgium engaging with this group. Methods Data collection took place during the height of the COVID-19 pandemic by means of 11 in-depth interviews with different involved actors (service users, staff members, volunteers) and analyzed thematically. Results Results showed how the daily practice of the meeting place is continuously reproduced through place-making rituals that create an inclusive space of hospitality, are fueled by creative processes and form an indispensable counterweight for service users’ mental health needs. Conclusions To further open up the ‘black box’ of recovery in persons with complex mental health needs, it is vital to focus our analytic gaze onto recovery as a dynamic and relational practice.

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties ‘medicalised’. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims’ narrative and their lived experiences. We will use Paul Ricoeur’s phenomenological reflections from ‘Suffering is not the same as pain’ for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering.

Anxiety is found to play an important role in the severity complaint of tinnitus patients. However, when investigating anxiety in tinnitus patients, most studies make use of verbal reports of affect (e.g., self-report questionnaires and/or interviews). These methods reflect conscious appraisals of anxiety, but do not map underlying processing mechanisms. Nonetheless, such mechanisms, like the automatic processing of affective information, are important as they modulate emotional experience and emotion-related behaviour. Research showed that highly anxious people process threatening information (e.g., fearful and angry faces) faster than non-anxious people. Therefore, this study investigates whether tinnitus patients process affective stimuli (happy, sad, fearful, and angry faces) in the same way as highly anxious people do. Our sample consisted out of 67 consecutive tinnitus patients. Relationships between tinnitus severity, pitch, loudness, hearing loss, and the automatic processing of affective information were explored. Results indicate that especially in severely distressed tinnitus patients, the severity complaint is highly related to the automatic processing of fearful (r = 0.37, p < 0.05), angry (r = 0.44, p < 0.00) and happy (r = -0.44, p < 0.00) faces, and these relationships became even stronger after controlling for hearing loss. Furthermore, in contrast with findings on the relation between audiological characteristics (pitch and loudness) and conscious report of anxiety, we did find that the audiological characteristic, loudness, tends to be in some degree related to the automatic processing of fearful faces (r = 0.25, p = 0.08). We conclude that tinnitus is an anxiety-related problem on an automatic processing level.

Tinnitus has been defined as a phantom auditory perception. Research indicates the necessity to make a distinction between the physical symptom and the subjective severity of the tinnitus symptom, since especially the latter seems to vary among patients. The relationship between tinnitus severity and psychological variables has been well established. Anxiety is considered to be an important variable for understanding the differences in the subjective tinnitus severity. Although many studies confirm the relationship between anxiety and tinnitus severity, most studies do not take the possibility of shared method variance and content overlap between questionnaires into account. Furthermore, anxiety is a broad concept and contains both a cognitive and somatic dimension. Research including both dimensions of anxiety in tinnitus population is rare. According to us two conditions must be fulfilled before theorization on the relation is useful: (1) the presence of clinically relevant cognitive and/or somatic anxiety, (2) evidence of a substantial or "real" relationship. In our sample, almost 60% reported more than average cognitive anxiety and 40.8% reported clinical relevant somatic anxiety. After controlling for content overlap between the questionnaires used, the relation between tinnitus severity and cognitive and somatic anxiety remains significant. Two hypothetical models concerning this relationship that deserve future research attention are described.

Help-seeking preferences and therapeutic relationship in unexplained chronic fatigue Research indicates that in functional somatic disorders the request for therapeutic help is related to either medical symptoms or interpersonal problems. We test whether a specific type of request for help is present in a sample of primary care patients with either chronic fatigue syndrome; a chronic cardiovascular or auto-immune disease; or a minor medical condition. In this study 155 primary care patients were recruited through 52 primary care practitioners: 52 chronic fatigue syndrome (CFS) patients; 52 patients with a cardiovascular or auto-immune disease; 51 patients with a minor medical condition. Interpersonal problems were assessed by means of the Inventory for Patients’ Request for Help (HLV). Chronic Fatigue Syndrome was measured with the Checklist Individual Strength (CIS); alexithymia was assessed by means of the Toronto Alexithymia Scale (TAS-20); and the driven and impatient interpersonal functioning by the Jenkins Activity Survey (JAS). Results indicate that CFS patients have a significantly more consumer related request for help with the emphasis on symptom reduction. Prolonged and debilitating fatigue was significantly related to a request for medical and liaison-psychiatric help; a help request in a more impatient functioning is related to higher complaint behavior; and alexithymia was related to a request for specific medical aid. We found no specific therapeutic relationship in Chronic Fatigue Syndrome. We conclude that the exact status of the therapeutic relationship in CFS and cardiovascular or auto-immune disease remains undecided, but clearly the request for consumer help and symptom reduction is related to CFS as a population.

Psychoanalysis can be considered from three different viewpoints: first as a science and a theory of psychic functioning, secondly as an ethical system, and thirdly as a clinical practice. In this paper, we argue that these three perspectives are deeply inter-related, since they have everything to do with a fundamental structural underlying lack. We discuss why and how psychoanalytic ethics need to assume this lack, how the original contribution psychoanalysis can make to science is related to the study of it, and how psychoanalytic practice is faced with the continuous challenge of starting from the lack as a source of creativity.

Background: GPs’ subjectivity is an intrinsic instrument in their daily work. By offering GPs a platform to present and discuss difficult interactions with patients, Balint group work be might provide them an opportunity to explore and articulate aspects of their subjectivity. In order to get a more profound understanding of what participation in a Balint group can offer, we focused on the process of change that can be observed during Balint group meetings. To that end, this study scrutinized two Balint group case discussions on a micro-level. Method: Two cases were selected from a larger data set of 68 audio-taped case discussions in four Balint groups. In order to shed light on the type of change that characterizes the presenter’s narrative, we used Lacan’s theoretical distinction between imaginary and symbolic modes of relating to the other. Results: In both case discussions, the GPs presenting the case initially appeared to be stuck in a fixed image of a situation, referred to as ‘imaginary relating to the other.’ Through a range of interactions with the group, the presenters were encouraged to explore different subject positions, which allowed them to broaden their initial image of the situation and to discover other issues at stake. This was referred to as a more symbolic way of relating to the other. Conclusion: This study throws light on the type of change Balint group participation allows for and on the way this might be achieved. We conclude that Balint group work is potentially beneficial to the participating GPs as well as to the relationship with their patients.

Burn-out is een populair begrip in onze hedendaagse cultuur. Dit artikel gaat van start met een korte situering van het concept in de maatschappelijk-culturele en wetenschappelijke context. Vervolgens wordt ingegaan op twee psychoanalytische interpretaties van het fenomeen: de klassieke procesvisie (Freudenberger, Fischer) wordt aangevuld met een visie op burn-out als resultaat van een conflict. Voor de ontwikkeling van het conflictmodel wordt een beroep gedaan op de theorieen van Freud en Lacan. De dynamiek van het conflict wordt geillustreerd door middel van een casus.