Psychiatrie médico-légale et méthode psychopathologique au cours de la première partie du XX siècle

Epistemological analysis is used for studying forensic psychiatry in xxth century. Clinical analysis with psychodynamical and psychoanalytical approaches have build specifical analysis used for clinical studies. Epistemological analysis is used for studying forensic psychiatry process.     

Du déni de grossesse au néonaticide : hypothèses diagnostiques autour d’un cas

Neonaticide and pregnancy denial concepts have to be more precisely defined. These concepts do not give us any information about the psychical status of mothers during their acting-out. The history of court sentences, showing a wide disparity ranging from acquittal to life sentences reflects the difficulties in analysis of these concepts.This case study reports on the psychic state of a young woman at the time of her committal of neonaticide, after she had denied her pregnancy. The report discusses the hypotheses of brief psychotic trouble, dissociative trouble or acute stress state during her heteroaggressive act.     

L’exercice de la psychiatrie libérale, hier et aujourd’hui

Authors relate the history of a “clinique” (private hospital) run by Dr Blanche,where many celebrities of the 19th century were treated. They show how Blanche and his son were forerunners in this field of private psychiatric practice and hospital treatment. Having retraced the development of private psychiatric practice over the last 40 years,they stress its importance in the present system of care delivering.     

Le Cannabis en France au xix siècle : une histoire médicale

This text draws a history of cannabis (hashish) in xixth century France, based on the study of medical, pharmaceutical and psychiatric texts. First is recalled the state of knowledge concerning cannabis at the beginning of the century. Are distinguished the geographical origins of such a knowledge, with paths leading from India, Near-East and North Africa until mid-xixth century. The work of the alienist Joseph Moreau de Tours (1804–1884) is then exposed, as well as the preceding contributions of Alexandre Brierre de Boismont (1787–1881). The travel of Moreau in Orient is evoked, and the cultural context of Romanticism. The acceptance of Moreau's book of 1845 by contemporary medical readers is commented. This book gives a general theory concerning mental illness, and a proposal for curing such illnesses with cannabis. The subsequent history of cannabis, considered as a medical remedy in the second half of xixth century is drawn as rise and fall of therapeutical hopes. The role of French chemists for the extraction of active principles is detailed, focused on the 1848 cholera epidemic. Cannabis as a psychiatric treatment after 1845 is specially analysed. Cannabis will then be progressively considered as a poison, responsible of public health problems. From the 1870 years is outlined a new nosographical category: toxic psychoses, among which “folies hachichiques” (cannabic madnesses). A brief sketch is drawn, of cannabis considered as a tool for psychological investigation at the beginnings of scientific psychology, with Charles Richet. At the end of xixth century is built the new frame of drug addictions (toxicomanias), in which cannabis addiction will take place. Psychiatry will then be involved in the treatment not only of the consequences but of the psychological causes of drug consumption. The role played by medicine in the diffusion of cannabis use in Occident is finally underlined.     

L'évolution des conceptions psychopathologiques des désorganisations psychiques aiguës dans la première moitié du XX siècle

The psychopathological approach to the understanding of acute psychiatric disorders was very productive in this first part of the 20th century. Studying the evolution of the different concepts, we can show the main theories that contribute to an understanding of these disorders. The main theories are based on a structural, process or developmental approach. Various clinical examples illustrate these theories.     

La médicalisation de l'intuition charitable : de saint Jean de Dieu à Philippe Pinel

To shed some light on the medicalization movement that has pervaded psychiatry for more than a decade, the authors focus on the origin of our discipline in France from a historical point of view. They compare the work of Philippe Pinel, founder of French psychiatry and the work of the brothers of Saint John of God in the 18th century. These brothers began admitting the mentally ill in five of their French hospitals (Cadillac, Charenton, Château-Thierry, Pontorson and Senlis). They provided sympathetic and compassionate care derived from their Christian humanism and inspired by their founder saint John of God (1495-1550). They materialized the charitable intuition that he had had towards the insane. They gave primacy to compassion in their approach to caring. During the French revolution, as the order of Saint John of God was dissolved and dispersed Philippe Pinel was appointed “Doctor in charge of the infirmaries” at the Bicêtre hospital in Paris in 1793. Pinel, who had studied theology, subscribed to the charitable instinct but he transformed it by introducing scientific and empirical philosophic dimensions. He suggested a medical approach based on observation and analysis of large numbers of the mentally ill. As an example of this medicalization process, the authors propose a comment on one of Pinel's articles entitled “Medical Thoughts on the Monastic Life”. This view of the history of psychiatry allows a renewed understanding of our scientific and medical approach in psychiatry. On the other hand, it seems to raise some questions about the place given to subjectivist dimensions, such as empathy, in our daily caring practice.     

Évolution du champ de la psychiatrie moderne : frontières et contenu

The author pays homage to J. Postel by providing a commentary on the history of contemporary psychiatric medicine seen from the viewpoint of its legitimacy and the limits thereof. He shows that during the first half of the 19th century, this field covered mental insanity, a unique disease according to Philippe Pinel and accepted as a disease category by all those in the field of psychiatry at the time. This domain became more extensive and less clearly delimited with the reference to mental disorders between 1854 and 1926, date when the Geneva-Lausanne congress on schizophrenia took place. Such a domain could be determined on the basis of the concept of psychopathological structure, with its neurotic and psychotic structures. It thus acquired a certain unity that it did not have beforehand. The author then shows the relatively imprecise extension that has existed in this domain since the end of the 20th century, and critically comments on the lack of precise limits.     

Vaslav Nijinski : de la danse à la schizophrénie, parcours à travers l’histoire de l’art et de la psychiatrie

Vaslav Nijinski, born at the end of 1889, from Polish origin, was one of the most famous dancers of his time with the Russian Ballets. At the beginning of century in Paris, by the intervention of Diaghilev, this great show organizer, this famous company of dance crystallized all the creative forces of the time. The career of dancer and choreographer of Nijinski lasted hardly 10 years (1908 to 1917). He created ballets as famous as Petrouchka, Le spectre de la rose. He was also the choreographer of four ballets: L’Après-midi d’un faune, Jeux, Le Sacre du printemps and Tills Eulenspiegel. Vaslav Nijinski’s history is that of a patient suffering from a schizophrenia with schizo-affective features at the beginning and negative symptom afterwards. This disease made him meet the most famous specialists of the first half of the twentieth century (Bleuler, Adler, Binswanger, Sakel, etc.). He was treated with psychoanalysis, insulin shock therapy and institutional psychiatry. He died on April 8, 1950, from a kidney deficiency associated with arteriosclerosis and arterial high blood pressure. He is now buried in the Montmartre cemetery near Vestris, the other god of dance.     

L’hallucination télépathique ou véridique dans la psychopathologie de la fin du xix siècle et du début du xx siècle

Recent research on the process of autonomisation of psychology at the end of the xixth century could show how objects which appear illegitimate to us today took part in an institutionalization of the knowledge and discipline. The telepathic hallucination was one of these objects; it then constituted a field of division and exchange between incipient psychology and sciences known as psychic but also mental medicine. At the time of the debates around this concept, it caused criticisms of the mental specialists as psychopathologists insofar as this lived hallucinatory were supposed to exist at the healthy subjects and, moreover, did not correspond by no means to the traditional definition esquirolian of the hallucination but was affirmed on the contrary like signal of an external object (anguish of a close relation) being given to perceive. However these debates were contemporary those proceeding in the field of alienism which sought with better specifying the concept even of hallucination, in particular by releasing the category of the onirism. Consequently, one will try to show in what the telepathic hallucination constituted a object-border within the social sciences and spirit, transitory object of division for an adjustment of the speeches and an assertion of the conceptualizations. Its rejection, its marginalisation, its psychiatrisation soon, were the signs of another division, segregative that one, between what became legitimate and illegitimate in these sciences, not without leaving the rest which took name of parapsychology, then of metapsychic.     

Alix Joffroy (1844-1908), titulaire de la chaire des maladies mentales et de l'encéphale de 1893 à 1908, vu par Jean-Martin Charcot

The title of chair for the mental illness clinic was created in 1879. Benjamin Ball was the first chair holder. The other chair holders are well known: Gilbert Ballet, Ernest Dupré, Henri Claude, Laignel-Lavastine, Lévy-Valensi, Delay, Pichot… and Alix Joffroy (1844-1908)? This name does not sound familiar as do the names of Baillarger, Morel, Magnan, Seglas, Falret, Voisin and so many others. He had three masters who deeply marked his career: Vulpian, Duchenne of Boulogne and Charcot. Intern in 1868, doctor in 1879, obtaining an advanced training degree in 1880, he succeeded Benjamin Ball as chair for the mental illness clinic in 1893. Pioneer in his research in neuropathology on progressive muscular atrophy, infantile paralysis and glosso-labio-pharyngeal paralysis, Joffroy demonstrated that the common and fundamental character of these diseases is the lesion of the nerve cells of the moto-neuron. In his work on Basedow's disease, he defended the thyroid's role in this disease against the bulb's partisans. Joffroy was the first to establish the existence of generalized amyotrophy in primitive neuritis without spinal lesions and was the first to shed light on the chronic process of an ischemic nature as a cause of neuritis. He reoriented himself gradually to the study of mental pathology with a strong interest in all the mental disorders with organic components. As an experienced experimenter, he undertook many works on the toxicity of alcohol proving the disastrous consequences that it has on the nervous system. His results contributed to the development of mental hygiene. If hysteria, hallucinations and fugue were the subject of his studies, nevertheless he also undertook many works on General Paralysis resulting in a posthumous publication with R. Mignot. Opposed to A. Fournier, Joffroy stated that General Paralysis is often of syphilitic origin and never of syphilitic nature. Joffroy held the title of chair for the mental illness clinic for 15 years and yet he remains a forgotten pioneer of psychiatry. In this present article, we will try to explain this collective amnesia following Alix Joffroy's career via the report Charcot submitted on him while he was competing with Gilbert Ballet and Valentin Magnan for the succession of Benjamin Ball as chair.     

Maladie de Parkinson : de la physiopathologie des troubles psychiques à la maîtrise du traitement dopaminergique

Introduction

Behavioral changes in Parkinson's disease are complex and their pathophysiology is not yet fully understood. The dopaminergic system seems to play a major role and most of the behavioral disorders in Parkinson's disease can be classified into either hypodopaminergic if related to the disease itself or hyperdopaminergic if related to dopaminergic treatment.

State of the art

Subthalamic stimulation, which enables withdrawal of dopaminergic medication at an advanced stage in the disease, provides a model for the study of certain nonmotor, dopamine-sensitive symptoms. Such a study has shown that apathy, which is the most frequent behavioral problem in Parkinson's disease, is part of a much broader hypodopaminergic behavioral syndrome which also includes anxiety and depression. Nonmotor fluctuations - essentially fluctuations in the patient's psychological state - are an expression of mesolimbic denervation, as shown in positron emission tomography. Drug-induced sensitization of the denervated mesolimbic system accounts for hyperdopaminergic behavioral problems that encompass impulse control disorders that can be alternatively classified as behavioral addictions. The association of impulse control disorders and addiction to the dopaminergic medication has been called dopamine dysregulation syndrome. While L-dopa is the most effective treatment for motor symptoms, dopamine agonists are more effective in improving the nonmotor levodopa-sensitive symptoms. On the other hand, L-dopa induces more motor complications and dopamine agonist more behavioral side effects. There is increasing data and awareness that patients’ quality of life appears to be dictated by hypo- and hyperdopaminergic psychological symptoms stemming from mesolimbic denervation and dopaminergic treatment rather than by motor symptoms and motor complications related to nigrostriatal denervation and dopaminergic treatment.

Perspectives

Better management requires knowledge of the clinical syndromes of hyper- and hypodopaminergic behaviors and nonmotor fluctuations, a better understanding of their underlying mechanisms and the development of new evaluation tools for these nonmotor symptoms.

Conclusions

The neurologist who strives to gain mastery of dopaminergic treatment needs to fine tune the dosage of levodopa and dopamine agonists on an individual basis, depending on the presence of motor and nonmotor signs respectively.     

La dissociation : un concept central dans la compréhension du traumatisme

Understanding dissociation is central to the treatment of trauma. Although the importance thereof is recognized in the international literature, the actual definition remains a source of confusion in the French terminology. The purpose of this article is to review the concept from its origins in the work of Pierre Janet to contemporary diagnostic classifications. In addition, modern conceptions of dissociation will be discussed, particularly in the field of psychotrauma. Finally, psychometric tools used in the evaluation of dissociation will be presented as well as the questions arising when treating dissociated patients.     

Expériences dissociatives sévères relevées dans un groupe d'étudiants français : à propos de la dépersonnalisation

Objective. - The link between dissociative experiences and psychical health is not systematic, these experiences have been encountered into general population with many degrees. The authors have studied stern dissociative experiences in a french student sample (subjects which DES. score is over psychiatric level).Method. - Authors used the Dissociative Experiences Scale (DES.) in french version. After extraction of high scores (psychiatric level) from a group made of students, distribution of the components of DES (Imaginative involvement, Depersonalization-derealization, Dissociative amnesia) is studied in order to understand the nature of severe dissociative experiences in this group (34 subjects aged 18 to 25 years).Results. - Results show that Depersonalization-Derealization component appears as a good clinical indication of psychic suffering, comparatively to other dissociative disorders (particularely dissociative amnesia). DES composant ”Imaginative involvement” does not appear to be specific of dissociative disorder.Conclusion. - A reflection is suggested, in the point of view of psychopathology, about the status of depersonalization disorder: is it specific of dissociative disorders or is it an expression of various forms of psychopathology. The psychopathological register of depersonalization disorder is being debated.     

La surmortalité des malades mentaux à la lumière de l'Histoire. L'exemple de l'hôpital Saint-Jean-de-Dieu de Lyon pendant la deuxième guerre mondiale

In 1981, M. Lafont suggested that there was a possibly excessive mortality during the Second World War of subjects with mental disorders (amounting to about 40,000 individuals), a question which continues to be the focus of studies and scientific articles. The historical issue is clear: was this excessive mortality the result of a deliberate action on the part of the authorities to authorize the “soft” extermination of mentally maladjusted citizens, or was it due to the difficult living conditions of the German occupation these persons were exposed to? In reply to this question, the psychiatric historian, C. Quétel, has advocated recourse to the archives of this period (medical and administratrive documents). With this in mind, we considered that it would be interesting to examine the medical and administrative report of the Saint-Jean-de-Dieu Hospital in Lyon (for the years 1939-1945). Although the incidence may have been less important than in other institutions, the excessive mortality is here analyzed in a concrete and objective manner. Faced with the difficulties connected with the nazi occupation and with the indifferent attitude concerning mentally disabled individuals fostered by eugenistic scientific trends, the humanistic approach of the Brothers of Saint John of God was the only means of finding alternative solutions, thereby limiting the excessive mortality of individuals placed in their care. In this context, this historical example placed in parallel with the challenges confronting psychiatry today provides a means of analysis in which ethical considerations are not lacking.     

Trouble déficit de l'attention-hyperactivité de l'enfant et l'adolescent : du diagnostic à la prise en charge

What is the scientific evidence to support ADHD as a disorder? What are the risks of the use of stimulant medication? These questions are frequently discussed and often with passion. The objective of this article is to present the conclusions and recommendations relative to these questions. The International Diagnosis criteria retained are those of DSM-IV which describe three subtypes of ADHD : ADHD primarily of the inattentive type ; primarily of the hyperactive-impulsive type and a combined type. Establishing a diagnosis of ADHD requires a rigorous strategy, and it should be operated by stages: one to receive requests, one to collect information, and one to confirm the diagnosis. The use of scale is a clinical option but cannot be a substitute to clinical diagnosis. A therapeutic approach must combine several modes of intervention such as the use of stimulants and psychosocial treatment. The treatment will have to be revised regularly according to beneficial effects.     

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.