La théorie du néo-organodynamisme : une nouvelle classification pratique des maladies mentales

Background

Dogmatically conflicting psychological and biological theories make the foundations of psychiatry fragile.

Methods

Traditional and Henri Ey's classifications of mental illness are discussed and the neo-organodynamism is proposed. The principle of the accessory pathway is also proposed.

Results

The acute phase of disease may only be a temporary modification of the basic mental illness, the nature of the latter can be expressed in terms of the depth of the organic degeneration. The psychotic state consists of the basic disorder and its acute aggregative phase that is in proportion to the degree of abnormal excitations of neural network. In my classification, mental illness is classified from a normal stage N to X. The degree of acute aggravation is staged from 0 to 7. The twelve stages of organic degeneration multiplied by the eight stages of acute aggravation results in a product of 96 mental stages. By applying this, we can accurately represent the conditions of psychiatric patients that change neo-organodynamically over time. At the same time, clinical comparative research, such as the effects of medicine and of biochemical changes at one time becomes possible. The mental automatism, the mechanism of acute psychosis and treatment concept are discussed with this theory. And this theory may explain what the mental illness is, what the delusion is and what the endogenous psychosis is. Mental pressures or ritual acts promote construction and the reorganization of neural network, and it is fixed by repeating itself. Coding to the subconsciousness of a new neural network namely bypass will be made, and it is immobilized as an accessory pathway like the bundle of Kent of the Wolff–Parkinson–White syndrome. This is the principle of the accessory pathway. When the accessory pathway is dominant, the patient cannot consider anything like himself. This condition shows the low level of his psychic energy (psychasthénie). The history of a mind hierarchy that is constructed with the accessory pathways may be a history of mind. And the history of a mind hierarchy should be what the psychic body is.

Treatment concept

From the viewpoint of the neo-organodynamism, the conception of organic degeneration is consisted of 1) tissue degeneration literally and 2) generation of accessory pathway by the reorganization of the synapse. The symptoms may be irreversible in the case of the tissue degenerations. But the symptoms that are induced by the accessory pathway may be reversible. If the conductivity of the main pathway becomes dominant as before, the symptom by the accessory pathway has a possibility of the improvement. But the accessory pathway will be remained even if the conductivity of the main pathway becomes dominant as before. One's usual personality is defined as a predominant state of the main pathway. Healing is to return to one's usual personality from the accessory pathway predominant state. In the organic degenerations that are the essence of mental illness, rehabilitation (psychotherapy, cognitive behavioral therapy, mental counseling, etc.) is essential to recuperate lost functions. For the positive symptoms, which are the secondary effects of organic degenerations, medication that focuses on the synaptic neurotransmitters will be effective. Theoretically, the anti-epileptics may be might be designated as the fundamental treatment for the acute aggravation phase because of the abnormal firings of the neuronal network.

Conclusions

Neo-organodynamism is proposed as a minimum clinical classification of mental illness for psychiatrists. By using this, we can understand that the psychosis is not the special disease, but everyone has the possibility of onset. Neo-organodynamism will eliminate the prejudice against mental illness.     

Reconnaissance visuelle des émotions faciales au cours d’un trouble dépressif majeur de type mélancolie délirante

Background

Abnormal recognition of facial expressions (ARFE) is associated with poor inter-relational difficulties. Among depressive patients, the difficulties in recognising facial expressions lead to errors in emotionally charged information.

Objectives

To evaluate ARFE following the Analysis method and the search for emotional integration (MARIE). This tool uses a continuation of fictive portraits created from two real portraits and in varying proportions (Professor Eckman's portraits with his agreement). This is an emotional series, which can be either unipolar or bipolar (neutral/emotion, emotion/emotion). The subject has to choose between two possibilities for each portrait. The programme comprises nine series of 19 pictures of three different faces (a fair-haired woman, a dark-haired woman and a man).

Statistical analysis

An average between the two evaluations (X² test) can be compared according to the patient's answers. Comparison of results between patient's answers before and after the treatment and results before and after of a standard reference, which is, by definition, 100%. Comparing the averages of time answering between the two evaluations (Student test) by logarithms.

Results

The joy would be the emotion most sensitive to improve the mood and thus therapy. Conversely, recognition of fear and surprise would be the less sensitive. There would be a gradient answer of qualitative (type of emotion) and quantitative (intensity score) over treatment. The patient hardly recognizes the sadness at the opposite of the anger. There would be a hypo-sensibility to sadness or hypersensitivity to anger in a major depression. However, the disorder varies according to the face presented.

Discussion

We report the results of a unique case and we must remain critical. However, the results are in the line with most writers. It credits the interest of the measurement tool. The graduation in the intensity of the scores does not suggest a single system but seven emotional subsystems separated which intensity of the response is proportional to the mood disorder. This work should be extended to a homogeneous population of patients with more tests faces to avoid the idiosyncrasie and to better study the interactions between emotions and mood.     

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.     

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”.     

Psychiatrie et médecine fondée sur les valeurs

Some scholars, assessing psychiatry as still scientifically immature, call it to join the project of a medicine-based purely on facts as the Evidence-Based Medicine may be the current model. However, there is a classical contrast between the facts – that would be the realm of science – and the values: psychiatry seems to be desperately infiltrated by values as the concept of mental disorder highlights it. We present here the Values-Based Medicine (VBM) developed by the psychiatrist and philosopher K.W.B. Fulford. By contrast with the EBM, the VBM acknowledges the irreducible role of values in medicine. Far from being a symptom of immaturity, the values load inherent to psychiatry mirrors the complexity of its field. In the VBM, taking into full consideration the values becomes the driving tool for the decision-making (complementary to the EBM). By the very advances in science, all the medical fields will increasingly have to take into account the complexity of values. We underline the convergence of the VBM with other conceptual frameworks that have emerged around the concepts of recovery, care, person-centred practice and narrative medicine.     

La mélancolie pied-noire. Transmission transgénérationnelle

In July 1962, the five French provinces (départements) of Algeria in North Africa became an independent state. A million French people (the Pieds-noirs) were suddenly uprooted and repatriated. They then had to rebuild their lives in France. Most of them suffered from psychological trauma and depression. This is a study of the second and third generations of these families. Most of the descendants of these families adapted to their new surroundings but in a minority of them we have tracked a transgenerational transmission of melancholia and of psychological scars. The study also includes a comparison with identical situations and problems amongst other displaced people.     

L’« hyperdatation » et sa fonction défensive dans la psychose

The question of time in psychoses has been studied more often as lived time (perceived) than as discursive time (abstract). The specificity of lived time in psychosis can disturb the modes of “intrigue setting” (‘mise en intrigue’ according to Ricœur seems to translate lived time into a narrative process), particularly as concerns lack of dating or excess of dating. In this paper, the authors study the phenomenon they have named “hyperdating” and its defensive function in psychosis. “Hyperdating” would be a function of overdating, illustrating the distance between the patient who “hyperdates” and the affective charge he feels. “Hyperdating” would then consist in a radical lack of the dating function. The purpose of dating would not be to tag events temporally in order to organize the narrative chronologically, but to proceed to evacuate the meaning out of the event by designating only its date. In fact, we suppose that the affect would be shifted onto this date, and thus disconnected with the representation of the event for which there are representational deficiencies and probably a very intensive original affective load. Dating is a vehicle of chronology, and is the manifestation of a faculty for the narrative of self to become an autobiography as temporal experience. We suppose that in psychosis, this process is inefficient. In fact, there is either a lack of dating of narrative events, or a “hyperdating” which overloads narrative with temporal pseudo-indicators, in particular through quasi-sacred dates. “Hyperdating” would therefore be a defensive psychic process against the traumatic load connected to the remembrance of the event, transferring the central characteristics to the date itself, which would then be exterior to any meaningful chronology. The authors propose to define this “hyperdating” phenomenon, and to investigate its psychic function. The methodology is qualitative, and based on two clinical cases, one of schizophrenia, the other of mania.

A single case of schizophrenia

We think that in schizophrenia the “hyperdating” phenomenon could be underlain by a schism between affect and representation. This is an isolating process which fits into a psychotic dissociation, recalling the break characterising schizophrenic temporality. The speech is centred on a time-based accuracy to the detriment of experience narration and its affective expression. It then seems that “hyperdating” enables the person to avoid the huge traumatic load related to the factual content in order to shift the affective load on the dating itself.

A single case of mania

Here “hyderdating” would be the expression of a game with dates in an omnipotent process. This game appears as a mosaic, a disjointed and blurred control attempt lacking a linear temporal trajectory. In mania, a cumulated series of dates does not ensure either temporal links or any necessary “temporalisation” for “intrigue setting”. Time is one of the forms of “discontinuity and hopping” frozen in instantaneity. “Hyperdating” reveals a need to control the temporal flux which can only fail and it is, under a chronological appearance, an expression of a temporality frozen on the return of the same. The lack of temporal succession and of alternatives to “temporalisation” of events by means of a date which freezes them and removes their affective dimension can only render the reflexive capture of an identity through a biographic narrative problematic.

Conclusion

Thus, other than the discrepancies related to the specificity of the “hyperdating” process in the psychic economy of psychotic patients, there would be some similarities concerning “hyperdatation” in psychoses such as abortive attempts of intrigue restoration, deadlock of the chronological function of dating, but also freezing of temporalisation on a number. These illustrate the schism or the instantaneity, devoid of any temporal flux and therefore of any link with “withholding” (apprehension of what has just occurred) and with “protention” (intuition of the immediate future), which characterise time experience according to Husserl. The limits of our study are rooted in the difficulty of identifying this phenomenon as it seems to occur less often than those concerning forgetting or lack of dating. Furthermore the links between “hyperdating” and the affect management process as well as the differences of those links within the different types of psychosis will need to be investigated more thoroughly. That is why the prospects of this study could be the following ones: interrogating the links between “hyperdating” and memory in psychoses. (Is the “hyperdating” phenomenon a failed attempt to recover memories, and/or an attempt to shape raw mnesic traces?); further investigations of the psychotic temporality issue; therapeutic contributions in the management of time and affects could be based on these previous points as far as it seems that it is only through the flexibility of such a defence that the patient will reach the affects and integrate them in an intersubjective relationship with the therapist.     

Stimulation magnétique transcrânienne répétée : efficacité et tolérance dans le traitement des dépressions chez le sujet âgé

There are more and more data suggesting efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depressions in older patients. Thus, the authors found useful to realize an up-to-date review of studies which examined the efficacy and safety of rTMS to treat depressive disorders in aged. Several parameters might be associated with greater antidepressant efficacy: higher intensity pulses of rTMS of the left dorso latéral préfrontal cortex (DLPFC), 90 to 110% of motor threshold; higher total number of stimulations (more than 1000); higher number of total rTMS sessions (10 to 20). Poorer responsiveness to rTMS may be related to several patients’ factors, including older age and lesions of the central nervous system. Literature data globally confirm that rTMS is safe and does not produce cognitive deficits, even among highly vulnerable patients with clinical evidence of cerebrovascular disease.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

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.     

Tentative de suicide médicamenteuse : la quadrature du cercle des poètes non disparus

In November 2008, the suicidal gestures met in a general hospital in Lyon were within 79.9% of cases of acute drug overdoses (n = 174). These behaviors have a function that cannot be summarized in one simple search of death. The overdose is designed to immobilize a suffering process. In this, it can be compared to the writing process. The commentary on Plato's Phaedrus by J. Derrida, shows a Pharmakon (medication/poison) function of writing. By analogy, it is informative on the choice of using drug for suicide attempters. Writing and suicide are seen by the subject who commits them, as remedies for memory. But they are also its poison. The reversibility of the drug powers hints the fact that suicide attempt obeys a rollover process. The psychiatrist's role may be to subvert this process by causing the patient to rebel against the role of scapegoat (Pharmakos) of his own suffering. The choice to take refuge in the medication is an evidence of the transfer from the patient to the doctor (Pharmakeus). If we want to catch to the original principle of reversibility that we see at work in the drug committed suicide, we must consider the question of time. The overdose would represent the quest of a safe place away from time. The issue of suicidal psychiatric care then becomes the creation of spaces where reversibility is negotiable, sometimes manageable. Of places such as speech, movement which is to balance a network of ambiguities.     

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.     

Marcel Proust : le temps ne fait rien à l'affaire

As the art historian Daniel Arasse emphasised [1], ‘The anchorage of the artistic drive in the sexual drive was known throughout antiquity, before Christian and ‘Humanist’ theories of art would occult and repress that primary reality’. The too copious Proustian activity of association, beyond masking and revealing crude sexual images poetically, those very same which he qualified as ‘inevitable’, and which may have persecuted him all his life, fully marks out the abyss hollowed out by those who dying abandoned he who was a four year old boy for too long, and then the ‘eternal young man’. This absence was at once the painful and ecstatic lifting of their silence on his strange behaviour. The sadism, covered over with heavy but delectable and syrupy contrition, nestling in the heart of the work or in the many letters of condolence in his correspondance, is undoubtedly the erotisation of a grief otherwise inconsolable. The grief of being separated from Mummy, but not necessarily for the reasons we think. In Search of Lost Time will be the research for lost reasons. The famous reminiscences are less likely to deliver to the author the keys of happiness in ‘pure time’ than the reasons for his unhappiness (all-powerful mother, absent father), are less the traces of a lost intimate paradise than those of a break-down in a small, personal world of nothingness. That childhood innocence is never rediscovered and that grief lasts longer than love are two discoveries made in The Research. The reminiscences will only give in fine a specious sentiment of ephemeral eternity; as soon as they stop, the abyss of the unlived will open … of the real time lost. The time of the child's waiting for the Mother , in the mirror of which will be reflected the time spent waiting for death and to be reunited. To stop time in order to find illusory intimate happiness in the Mother-world fusion will have been Marcel Proust's viaticum. To contain the intolerable suffering of absence by negating time and space, and finding the here and now , even for one moment only, but body and soul, and so the lost object in the memory; this will have been his epic. The Research is the story of an allergic adult who scratched passionately at his childhood wounds and adolescent warts, thus reactivating a past which would not pass since it did not take its place. The only real memories which resist infantile amnesia, are those of disagreement with the object, the only restitutive memory and that of absence, the memory of the absence of the body of the child separated from the object, insofar as it is true to say that there is more difficulty renouncing a source of wounding than a source of happiness.     

La fragilité de la ;Chair dans la clinique et la psychopathologie de la schizophrénie. Approches de la relation chez Bin Kimura et Erwin Straus

We are trying to study in what way schizophrenia would be a pathology of the Flesh connected with the inability of some patients to Feel. Feeling is a pre-intentional act which cannot be restricted to the simple passivity of receptivity. It is also a noetic act which introduces distance and differentiation between the Self and the Other. This act at the fundament of one's link with the world and the relationships to the others is weakened among the patients suffering from schizophrenia. In reference to Merleau-Ponty, the Flesh refers to the capacity or the incapacity the patient has in keeping with being-in-relation with the Self, the others and the world. As an external space, it refers to the world and as an internal one it refers to the living. One speaks about ‘own body’ or ‘living body’ or Leib, according to Husserl. Flesh and Leib, belong to what is felt before what is thought, to the world of life. This dual link to the living and to the world allows us to compare these two notions to the notion of Aida that we find in Kimura's work. Aida is a virtual space of relationship on the level of the constitution of a Self as well as on the level of the constitution of the world. According to Kimura, schizophrenia is a ‘pathology of Aida’, coming from a failing relation between the Self and the core of life and altering consequently the relationship the patient can have to the others and to the world. It is this essential link at the core of life which, according to Kimura, enables the constitution of the ipseity. But in schizophrenia, this first link does not allow a satisfactory constitution of the Self inducing a disturbed temporality and spatiality. First, the intentionality of consciousness suffers from some distortions; then the modes of spatialization are blending. This confusion between two spaces would be, according to Straus, on the one hand, the beginning of the autistic turning in on the patient's own world or idios cosmos and on the other hand, the beginning of morbid rationalism. These two phenomena lead to losing the Feeling as the mode of relation to the common world or koinos cosmos and consequently a difficulty of being in the Flesh of the world. These phenomena certainly visible with a clinical approach are significantly identifiable with the Rorschach test. On the clinical level, this approach opens onto the setting up of the therapeutic Aida making it possible for the patient to redefine the space and the time which would enable him to be in the field of Feeling and thus in a common space of relation that the therapist brings at the same time as the patient. This is why we will be able to see the specific modes of constitution characterizing the schizophrenic-being and what a proper understanding can bring to the clinical study of schizophrenia.     

Gestion de l’anxiété de performance orale et représentations mentales: Les propriétés structurales des représentations mentales comme outil de changement

Many techniques used in brief psychotherapies are based on the activation of mental representations and images. For example, cognitive-behavioural therapists confront the subject at their mental representation of the phobogenic situation. Exposition techniques and desensibilization method (Wolpe) used by cognitive-behavioural therapists activate visual mental representations and verbal representations through the medium of auto verbalizations or self-statements. The strategic therapeutics or hypnotherapists invent metaphors or suggestions that solicited the patient’s cognitive style. So, psychotherapists can learn from lot specific researches about mental representations, particularly analytic conceptions of visual imagery elaborated by Kosslyn and studies about auditory imagery (Reisberg) because these researches demonstrate that the cognitive capacities concern many « sub-capacities » in which the subjects manifest different abilities.Objective.- This investigation examines the effects of modifications of the structural properties of verbal, visual, and somesthetic representations in oral performance anxiety. The goal of the present study is to identify the structural properties (visual, auditory and somesthetic) capable of producing the greatest reduction in oral performance anxiety.Structural properties encompass the auditory characteristics of self-statements (e.g. volume, rhythm, and distance from stressful event); the characteristics of the visual image (e.g. size, brightness, and distance from stressful event); and the somesthetic properties (e.g. intensity, location, and area of uncomfortable feelings associated with social anxiety).Results. - Concerning the visual representation of the stressful event, the distancing from the image tended to reduce anxiety more than the other modifications (i.e. size or brightness). Concerning negative self-statements, our results indicate that reducing volume tend to diminue anxiety than the slowing down of the rhythm. Finally, the instructions encouraging a reduction of the intensity of sensations were more effective than other modifications (displacing and area of unpleasant sensation) in reducing anxiety.