À quatre pour un rapport sexuel. Anatomie de la quatrième personne, à partir des trois autres

Repeatedly, in 1917 and 1925, Freud reminds three humiliations lived by the humanity, considering them as cosmological with Copernic, biological with Darwin and psychological with himself and its discovery and theorization on the unconscious. It will be a question, guided by Thomas Laqueur's work, and of its reading by Guy Le Gaufey, of showing that these epistemological referents come in turn to make scansion in the Freudian doctrine dealing with the psychic development of both sexes, and more generally with the difference of the sexes. From three authors, Platon and the speech of Aristophane in Le Banquet, Schopenhauer and his Métaphysique de l'amour, Fließ and his conception of the bisexuality, we shall try to seize how Freud, according to the periods when he writes, by joining in the line of thought of each of these authors, finally comes to break with these three referents. Getting free of cosmological then biological perspectives, we shall see the implementation, in a “psychological” perspective, of what we can then name subjective positions with regard to sex, leaving aside the postulate of a complementarity of the sexes to introduce the option of a non-report.     

Du quantitatif et du qualitatif dans l'observation en psychiatrie

The orientation of contemporary psychiatry is eminently quantitative. This prompts a reflexion on its relations with a qualitative orientation. The problems of observations focused on the quantitative and the use of measurement are reviewed. The following items are emphasized : the limitations of the quantitative approach in clinical practise, the qualitative character hidden behind a quantitative test that implies symmetries and permutations, the uncertain character of a diagnostic based only on the quantitative dimension. The principle of measurement is implied in this discussion. In the first place it is evaluated in a general epistemological perspective. Its possible applications are then studied in a restricted epistemological perspective proper to psychiatry. These studies are concerned with the necessary segmentation of the observed facts, the conditions to be respected, and the previous realizations. In conclusion, the necessity of not reducing the observation to the quantitative or the qualitative perspective only seems obvious and it suggests matching the two obeying three conditions : an empathic attitude, registration of the data in an order that conforms to the observed realities, use of logico-mathematical matrices of fuzzy sets and of virtual signposting of functions which help forming a sensible and equilibrated rational clinical course.     

La psychologie de l'adolescence

It can be considered that the first book specifically devoted to a scientific psychological study of adolescence is the one written by Granville Stanley Hall (1844-1924), initially published in the United States in 1904. The text that has been reproduced here, which appeared in France in 1906, in the Revue Philosophique (volume LXI, pages 345 to 377), provides a detailed account of this innovative work. It bears witness to the positive reaction on the part of educational theoreticians in our country, to the new ideas provided by the American psychologist regarding adolescence and also the methods developed for studying it. The text thus includes a discussion that is full of praise for, albeit somwhat critical of, the themes that were dear to Stanley Hall, the founder of genetic psychology, who was also a philosopher, sociologist and teacher: the carrying out of large-scale surveys and research into facts; a general anthropological evolutionist approach, in the footsteps of Herbert Spencer; philosophical monism, and for the study of human psychology, rather than placing emphasis on introspection, focusing more on the body and its development: a view that was shared in France by the psychophysiological school of thought at the time, from Théodule Ribot to Alfred Binet. Jules-Gabriel Compayré (1843-1913) was an educational theoretician, one of the individuals who helped to develop the French ‘Republican School’ under the Third Republic, and not only the author of a large number of books on education, but on the history of education as well. His works were widely distributed and much read, and he held prestigious university posts (Rector of Lyon University, Member of the Institute). Regarding Stanley Hall, Compayré felt obliged to criticize the former's unduly atavistic approach, based on the theory of the primacy of ontogenesis over phylogenesis. However, in agreement with the some of the arguments of the American psychologist, he shared the idea that an efficient and intelligent educational approach should be based on firmly established prior knowledge of child and adolescent psychology, a ‘psychopedagogical’ view that was to be further developed by Maria Montessori, Édouard Claparède, Ovide Decroly and later by the New School.     

Évolution historique du concept de somatisation

The concept of somatization is one of the notions that is frequently utilized both in psychiatry and in the medical field. However, it still suffers from a lack of precision that renders difficult and equivocal any reading of scientific articles on the subject. The authors of this article have focused on the historical development of the concept of somatization in an effort to elucidate the issue. The concept can be interpreted in two ways, one etiological and the other nosological. The former stems from the psychoanalytical movement, is principally etiological, and can be viewed as a synonym for conversion. The disturbed circumstances surrounding the creation of the term partly is account for the current confusion regarding its meaning. The latter meaning, which is derived from American liaison-psychiatry, has a mainly nosological character. It is at the very center of an epistemological turning point for the development of considerations on hysteria and its psychopathology, with the decline in importance of American psychoanalysis and the development of the neurosciences during the second half of the twentieth century. In fact, hysteria, a pathology that constituted the basis of psychoanalysis, has thus changed epistemological status to become an exclusive diagnosis, with a partial rejection of the contributory role of the psychopathology involved.     

« Secondes personnes ». Une anthropologie de la relation

The goal of the article is to put to the fore the importance and the relevance of the « second persons » in the framework of a relational ethics where the person as being related has a primacy over the individual as an isolated subject. While using the psychiatric work of the urgency team E.R.I.C (in french : Equipe Rapide d'Intervention de Crise) as a leading thread, we seek to show the anthropology of being related which underlies the practical ethics of such an urgency team. Such an anthropology is revealing of a change of epistemology which goes hand in hand with the taking into account of the method of the phenomenology, the épochè. The latter corresponds to a radical transformation of the way the subject looks at the world : from the individual to the person, you leave loneliness in order to reach relatedness. Nevertheless, the latter requires not to be understood as an immanent or transversal relatedness (with a tendency to anonymity) but as a self-transcendent dynamics, which alone lets the person emerge in its plenitude, that is, as a primordial place of relationships. Hence the necessity, in order to confirm the epistemological relevance of such a practical phenomenology, to start with the emergentist, enactive and neurophenomenological methodology of the cognitive sciences, which puts to the fore the co-generative relationship between the first, the second and the third persons. On the basis of such a taking into account of the second person, as an intersubjective validation of objectivity in the cognitive neurosciences, it is possible to reveal the specificity of the phenomenological ethics of relatedness which is at the core of the post-psychiatry at work in ERIC.     

Matière et esprit : la théorie du parallélisme moniste psychiatrique

Macroscopic defects of psychopathologists should be compensated by brain science and philosophy. Although the state of mind changes, psychiatrists frame patients’ mind state like snapshots; they make their diagnoses using the patients’ current mind state that they would think as if it was all he had as equipment diagnosis, because it is difficult to grasp the mind's dynamism. I have previously reported a new classification of mental illness using the theory of neo-organodynamism. However, organic and psychiatric degeneration are revealed only after the mind influences the brain. This article proposes the theory of psychiatric monistic parallelism, explaining how the non-material mind causes a neo-organodynamic change in matter. Gilles Deleuze proposed that virtuality (virtualité) would be realized (réalité) when it becomes an eternal object (intensité) through an event. The effect of intensity (intensité) on the noetic aspect is considered; the difference of intensity is not one of numerical multiplicity, but of qualitative multiplicity, produced by duration (i.e. intensity is duration). Intensity changes with fluctuations in qualitative multiplicity. If qualitative multiplicity does not reach a certain level (D), intensity would have no effect on the noetic aspect. If qualitative multiplicity exceeds D, the noetic aspect would fail with intensity. A difference in D may affect the noetic aspect. If one's qualitative multiplicity reaches D easily, individual mental vulnerability is declared. We first take the case with no impediment to the noetic aspect. Virtuality becomes intensity through an event at the contact point S (the vinculum between the noematic and noetic aspects). This intensity causes a delay in the cycle of perception and motion (Gestaltkreis) and becomes the intention of saying (vouloir-dire) at the noetic aspect. Simultaneously, the field of consciousness (actualité) is constructed at the noematic aspect through S and is fixed as the reality (réalité). Once a neuron network is constructed, the cycle of perception and motion (Gestaltkreis) is not delayed. Acting unconsciously for the repeated event is then possible. We next consider a failure of the noetic aspect. Virtuality becomes intensity and influences the noetic spect by exceeding a threshold, which becomes a noetic and metanoetic trouble. The delay in the Gestaltkreis would not occur at the vinculum and vouloir-dire would not occur. This leads to abnormal firings in the neural network on the noematic aspect, and the psychopathological cycle will begin to revolve according to the theory of neo-organodynamism. We also examine the mechanism of consciousness generation. The mind can be divided into two fields: where the self exists (consciousness) and where the self is absent (unconsciousness). Unconsciousness is controlled directly by the mind; the self and the world are completely united. Spontaneous symmetry is upheld in this field. However, when unconsciousness is limited by an event, spontaneous symmetry is broken, leading to a difference in intensity. This is the origin of consciousness. The collapse of spontaneous symmetry hinders the movement of an elementary particle with no mass; a Higgs boson would provide mass for the elementary particle. Thus, intensity generates consciousness from unconsciousness. Virtuality is the foundation of all mental disorders (monism) and becomes intensity through event. If its effects exceed the threshold, it would not delay the Gestaltkreis at S. Abnormal firing in the neural network occurs at the tangible (matter) end; metanoesis and noesis are impaired at the intangible end (mind). Hence, matter and mind do not interact directly but influence each other through « intensité » (parallelism), and the psychopathological cycle begins to revolve according to the theory of neo-organodynamism. I term this concept “psychiatric monistic parallelism”.     

La médicalisation de la sexualité. Foucault et Lantéri-Laura : un débat qui n'a pas eu lieu

Lanteri Laura's book : Reading perversion : a history of its medical appropriation (Lecture des perversions : une histoire de leur appropriation médicale) was published in 1979, three years after Michel Foucault's first volume of The History of Sexuality. These two books deal with the history of sexuality in the XIX° century, yet strangely Lanteri Laura does not cite Foucault. A close reading of both texts demonstrates two points. (1) While Foucault was mainly concerned with the relationship between sexuality and truth, power and knowledge, Lantéri-Laura worked more specifically on sexual perversions and the way in which psychiatry redefined them by withdrawing them from the fields of religion and law. (2) Moreover, Foucault did not undertake a critical analysis of psychoanalysis. Instead, he used the psychoanalytic model to construct the model of of the “apparatus of sexuality” based on language. For his part, Lanteri Laura provided evidence of the limited withdrawal of Freud reagrading the sexological categories of his time and a return within lacanian psychoanalysis to categories that were anchored in the dominant social morality of the time. Finally, whereas Lantéri-Laura attempted to objectify psychoanalysis and to place it within a historical and ideological perspective, Foucault was in the end actively inspired by the psychoanalytical model and used it in the social and historical construction of sexuality.     

La psychiatrie à l’ère des modèles

Based on an intuition by Gladys Swain, this article develops two paths in an epistemological research on modern psychiatry. We try to reinvestigate the concept of neuroleptic under it's most mythical form: the Largactil, not only as a molecule but as the very object of a discipline, founding a new notional cartography. A second path consists in interpreting this new epistemological deal and its structural patterns, mainly by questioning psychiatry as a “science of systems”; only then, can we ask the notion of meta-model the very problem it was basically meant to solve: a possible unification in psychiatric regions and areas.     

Secteurs psychiatriques et circuits de l'information en matière de précarité

The public service for mental health has been facing a conjuncture with necessary modifications to be made. In this context, we felt that it would be appropriate to carry out a survey in 2000, and then in 2002, on how much psychiatric districts know and are informed about access to general medical care and rehabilitation. Psychiatric staff seemed indeed to pay particular attention to those who may benefit from existing social systems and not only in connection to new legislations. According to our estimates, 19 % of patients under psychiatric care benefit from the Universal Medical Coverage (Couverture Médicale Universelle, CMU). The CMU was considered to be a good measure for patients by most medical and social partners polled. The latter emphasised the relevance of covering hospital fees and making access to general medical and dental care, which is otherwise often disregarded, easier. Moreover, districts themselves suffer from institutional “precariousness”. Tensions occur in the first place when, despite their willingness to deal with issues or problems, they are unable to do so.     

La bipolarité épistémologique de la psychiatrie française

In this paper, we focus on the diversity of scientific approaches in French psychiatry, using several concepts inspired by the philosophy of sciences. The feeling of an internal crisis, regularly expressed on a public stage, alongside with the developments of neurosciences who contested a psychoanalytical supremacy amongst French psychiatrists suggest the beginning of a scientific revolution. However, several points indicate that French psychiatry has been evolving in a continuous paradigm since its emergence at the turn of the 19^th century. Since then, this discipline has been consistently suspended between two different scientific rationales. On the one hand, it relies on an explicative, experimental and generalizing approach. On the other hand, it refers to a comprehensive, inducitivist and singularity-orientated rationale. We coin the expression “epistemological bipolarity” to describe this specific scientific organization.     

La psychiatrie phénoménologique du XXI siècle ; psychosomatique et nosologie

Phenomenology, modus operandi of epistemological research in psychiatry is today rich of a great number of anthropological texts. Facing the XXIst century, it looks at its singular ability to criticize and to make links between natural sciences and human sciences so that it aims to raise the question of unity, while reconsidering the psychosomatic question, through a reaxamination of nosology.     

Remédiation cognitive de la schizophrénie. Présentation du programme RECOS

The importance of neurocognitive deficits in schizophrenia has motivated the Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois in Lausanne (DP-CHUV) to develop a cognitive remediation program for patients with a schizophrenia spectrum disease (RECOS). This program investigates cognitive deficits using a detailed neuropsychological battery and contains targeted training modules for their remediation. RECOS particularly investigates the cognitive deficits that may be implicated in the development of clinical symptoms. Functional outcome and psychoeducation are also important elements of the program. The progresses of the different stages of the program are presented.     

La « folie à deux » dans l'œuvre de Clérambault

In this text, the author presents G. Gatian de Clérambault's interventions concerning « folie à deux ». These are viewed from a historical perspective from a draft of a nosography of mental diseases. The evolution of his different contributions shows de Clérambault's concern with the concept of mental automatism in his nosography, which, as it is based on the clinical identification of a supposed psychoses-generating mechanism, is similar to a structural approach. To that extent, de Clérambault's work brought a new vision to psychotic disorders in small groups and deserves recognition.     

De la schizographie dans les écrits de Joseph Lévy-Valensi

In between both wars, Joseph Lévy-Valensi (1879–1943) published numerous texts on the history of medicine and/or on mental pathologies that he signed or co-signed with younger collaborators. One of his early works, his Précis de psychiatrie, had two editions in 1926 and in 1939 during his lifetime. Later works were also published with P. Migault and J. Lacan in the Annales Médico-Psychologiques in 1931 on a specific language disorder that they named “Schizography”. Lévi-Valensi mentioned it in his second edition of his Précis. In it he described other novelties since the first edition. He also refers to J. Lacan's thesis in 1931 De la psychose paranoïaque dans ses rapports avec la personnalité, and links this texts to surrealists writings. When he reprints much later his thesis (1973), J. Lacan will add the articles that were published in the Annales co-signed with this professor. Lévi-Valensi was chosen in 1942 by the faculty council to occupy the position of professor at the clinic of mental illnesses. Unfortunately, the Vichy laws at the time prohibited the teachings of Jews. Refuged in Nice, he was caught in 1943 by the German army in a roundup and deported on the 20th of November to Auschwitz’ concentration camp. He died there three days later. The third edition of his Précis was published in 1948 posthumously but identical to the 1939’ edition.     

Causalité et pensée médicale : un cas en controverse

Questions of method in medicine are always posed in situations that are empirically difficult. The etiological model, undoubtedly still the dominant model in medicine, including in psychiatry, finds its justifications in the method, which proceeds from causality. The author recalls the history of the concept of causality, which, from the time of the Aristotelian and Arabic traditions (astrology and mathematics), was founded on the idea of a necessary order of the world, an order in which all events are linked. This conception was taken up by Renaissance philosophers and integrated into the epistemology of modern sciences since Copernicus, Kepler and Galileo, along with some notions of neoplatonic and medieval schools, that is, that of order and first cause. In the history of philosophy, it may be acknowledged that two traditions distinguish themselves on these questions: that of the rationalist and analytic tradition (according to the terms used by Descartes), and the empirical tradition. The rationalist principle becomes, with the Romantic movement, the inspiration for a priori and idealist doctrines; leading the way in medicine are Laplace and Claude Bernard. The empirical current of causality found its bases in the philosophy of Al Ghazali in the 11th century. However, it is to Hume that we owe a theory of causality that excludes an a priori deductibility of things and affirms the method of the proof of the link. Contemporary scientific epistemology is dominated by a neo-Humean conception of causality. The empirical method of causality significantly influenced the evolution of medicine and neurological and psychiatric conceptions of the brain. Suffice it to evoke, among others, pioneers such as Gall, and also Broca and Wernicke. The author articulates these historical considerations with neurological and psychological clinical data of a particular case. A controversial case, Parkinson's disease, illustrates the limits of the causality method in clinical practice. The author shows the value of considering the contradiction between the interpretation of clinical signs and technical investigations and the diagnostic certainly represented by an autopsy. The latter permits the establishment of a linear explanation of cause and effect, that is, a precise lesion corresponding to a known disease. The etiological model is thus confirmed thanks to the autopsy model; hence the need to reconsider clinical practice, its epistemology, and the validity of causal reasoning. We may observe that the debate between “topographical” and “functional” diagnoses arises, doubtless, from an old medical quarrel, which remains open despite the present finesse of tools at our disposal. We would be permitted to think that, without agreement between “topographical” and “functional” diagnoses, the interpretation of data should make these two fields interact in some other way. The author supports her argument by a phenomenological and psychoanalytical approach and identifies a clinical humanist episteme founded on indeterminism and which therefore takes into account that the observer and the observed define a field of experience that is limited and relative, always subject to double inference. The epistemological proposition, which follows, suggests leaving behind reasoning according to diagnostic categories and rather basing clinical practice on the understanding of the “course of the particular case through the disease”. The categorical method in medicine could give way to the more qualitative concept of the patient's experience and of his condition of being-in-the-world in its intersubjectivity. This would lead the clinician to leave behind etiology in favour of quantum, that is, probabilist, causality.     

Traitement, réadaptation, réhabilitation, rétablissement

This article is a complement of another article published in Annales Médico-Psychologiques in June 2006. It covers briefly again the topics of treatment, rehabilitation and recovery specifying the definitions and bringing some examples. Several questions and comments were raised during the meeting of the Société Médico-Psychologique and outlines of answer are brought here.     

Célébration du 170 anniversaire de la naissance des Annales Médico-Psychologiques. Allocution d’ouverture par la présidente,le professeur Évelyne Pewzner-Apeloig

In her opening address, the President emphasizes the links between the French National Academy and the Annales Médico-Psychologiques journal, which was the first psychiatric journal in France and in the world. Three young alienists, J. Baillarger, L. Cerise and F.-A. Longet, working in the steps of their Professor Philippe Pinel, managed in 1843 to found a journal exclusively dedicated to mental pathology. The publication of the journal occurred nine years before the foundation of the Société Médico-Psychologique. Journal and society are inseparable and complementary. The articles published by the Annales contributed from the very beginning in a large part to the corpus of clinical and theoretical approach of Western psychiatry. The journal includes debates and social and political realities. Keeping a balance between tradition and modernity, the members of the Société Médico-Psychologique pay special attention to all theoretical and therapeutic innovations. This is precisely what we are speaking of with today's program: “Lithium, yesterday, today and tomorrow”.     

Schémas dépressogènes et espace subjectif

The concept of schema used in cognitive psychotherapy is an heuristic tool that has more a metacognitive value than a psychological value: it doesn't involve directly the cognitive processes and the representations in memory. Therefore, the understanding of the therapeutic action is limited and insufficient for a satisfying account of the complex clinical data observed during the course of treatment of resistant depression. To overcome this problem, we propose a conceptual framework that describes a subjective universe as a representational space that is displayed from memory. From this point of view, depression is equivalent to a retraction of the subjective space. This retraction is primed by the reactivation of some past traumatic events. We show the influence of early painful situations on the Home Image, which is an essential area for the unification of the representational space. This conceptual framework allows us to define the representational structures underlying the cognitive model of learned helplesness of Abramson et al. [1]. Two levels of schemas are specified: (1) the symbolic structures that constitute the “web” of the subjective space and correspond to the schemas of the cognitive psychology; (2) the metaschemas that are the constructs of the therapist. The formation of the depressogenic schemas during the personal story is linked to the development of metaschemas of vulnerability, gratitude, and control. A therapeutic block is defined as a closing of the therapeutic space - that is, the intersubjective world constructed between the patient and the therapist. Such a block indicates the necessity of a global restructuration to release the memory from a depressogenic metaschema. In this case, the therapeutic strategy requires a technical adaptation to mobilize the mass of the subjective space. The therapeutic medium needs to resonate with the core of the depressogenic metaschema that is deeply buried in memory. The patient should also actively grasp the processes of the symbolic structuration of his/her subjective space. This conceptual framework allows us to account of the concept of insight as a spatial feeling of unification and widening that is associated to a restructuration. Thus, a cognitive therapy can be analyzed as a succession of phases that mirrors in reverse order the development of the depressogenic metaschemas. A case study confirms the relevance of this approach and we underline the crucial function of the therapist's creativity to overcome the therapeutic blocks. We insist also on the carefulness that is necessary to approach the early painful situations deeply buried in memory.     

Philosophie de l’esprit et théorie de l’esprit: Une approche de l’épistémologie clinique comparative

The notion of philosophy of the mind has a connotation which throws back to different theoretical elaborations depending on whether we are interested in the European contribution or in the English-American contribution. In recent years, the central problem has been thought by many to be a basic distinction between mind and body, mind and matter. This paper provides an overview of recent developments in philosophy and theory of mind and an epistemological analysis of the successive North American conceptions of the philosophy of the mind.