La mélancolie : de la psychiatrie à la métaphysique

The concept of melancholy covers a conjunction of very diverse revelations, which include phenomenons of philosophical or spiritual nature. We will study this problem, questioning in what melancholy refers to the difficulties of metaphysical nature, maybe to understand a little better the mental pathology. We will refer ourselves to the notion of totality, which answer to the intuition as a primary phenomenon in the relation which the other, maybe like an actualised expression of the ideal-ego, a totality of which the reasoning has to pass by; like the language has to exclude an object, which has to be repaired maybe in the field of art. We will see how the artist, the philosopher and the religious, also anybody concerned by the psychical suffering, follow different ways. They are all concerned by the desire of an unreachable absolute of which each theory is just a reflect despite their hegemonical temptations. That will be the matter of a thought about the intuition considered as a primary movement of the relation to the other, a movement, which precedes its creative organisation.     

Déficit de mémoire autobiographique et d’estimation du temps après une anoxie cérébrale

A case of episodic amnesia with impairment of time perception is described; it illustrates the link between time perception and autobiographical memory. This woman suffered from a Sheehan syndrome with anoxia at the age of 36 and since that date has had a strong and isolated difficulty to estimate the date and duration of events in a range of weeks, months or years. Conversely, short duration time spans are correctly evaluated. The patient's complaints also involve episodic memory. She reports many events from her biography very imprecisely while the semantic autobiographical data are preserved. The patient has difficulty in recalling the date of public events and the period of celebrity of well-known people. That observation confirms the specificity of time organization for long periods and the link with the episodic memory where the context of the dating task is crucial. The results are discussed in reference to autobiographical memory that involves mental wandering in time-space and the constitution of self over a time continuum.     

La révolution des neurosciences

About 50 years ago, three discoveries marked the beginning of revolutions in biology and neurosciences; namely, the tri-dimensional structure of DNA, the action of temporal hippocampus in long-term episodic memory, and the proof of an innate neurological organization. Since then, subsequent work in these three fields has always made scientific improvements on the front page. It is time to evaluate consequences, not only in the field of rehabilitation, but also in renewed humanistic culture. DNA analysis drove to minimizing gene contents and to emphasizing the true construction process from the embryo in an activity-dependent development, with the result that there is no aspect of psychism at birth. Temporal hippocampal activity by the way of synaptic modifications gives a brand new light to what is long-term episodic memory. Innate cerebral organization specifies radical constructivism.     

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”.     

Bruno et le fou sacré : Mythe, Mimesis et la transmission des mémoires traumatiques

Interest in PTSD and traumatic memory extends beyond psychiatry. Over the last two decades, “trauma theory” has emerged as an influential discourse within the humanities and social sciences. The theory is based on an unlikely combination of sources: Freud's accounts of traumatic neurosis in Beyond the Pleasure Principle and Moses and Monotheism; Bessel van der Kolk's research into the neurophysiology of PTSD and somatic memory; and post-modern writing on collective memory. Trauma theory writers are intensely interested in explaining how traumatic memories are transmitted between and within generations. Explanations focus on the roles of contagion as a mode of transmission and the Holocaust as a shared collective trauma. This chapter argues that the clinical and cultural phenomena that are being explained by these writers are better understood in terms of mimesis or imitation. The argument is illustrated with the help of a fraudulent Holocaust ‘memoir’ by Benjamin Wilkomirski, and an analysis of audience responses once the fraud was exposed. This chapter underlines important concerns regarding the clinical epistemology of posttraumatic stress disorder.     

Gilbert Ballet et la médiumnité. Contribution à l’histoire de la psychose hallucinatoire chronique et à celle des divisions subjectives

The mediumnistic state played a central role in the history of psychopathology, but it was often ignored or barely commented upon in psychiatric reports. The example of Gilbert Ballet’s introduction of the concept of chronic hallucinatory psychosis in 1911 provides us with a means of determining the social, clinical and epistemiological context at the time and of showing the pregnance concerning the construction of the normal or manic mediumnistic state. In fact, a certain examination of the mediumnistic trance offers elements and a model for a psychopathological approach to subjective, neurotic or psychotic divisions. This recourse to history is justified by the new upsurge of subjective divisions connected with current New age mediumnistic states.     

Note sur le parcours thérapeutique des toxicomanes traités à la méthadone

The authors are describing a group of 74 heroin addicts who receive methadone treatment. Two sub-groups of 37 subjects are compared. In the first group, methadone treatment was initiated 10 years ago or more; in the second group, methadone treatment was initiated more recently, one year ago or less at the time of the study. The study confirms that methadone treatment - in both groups - occurs very late in the treatment history of the subjects.     

Connaissance des nouveaux mots de la langue française dans les troubles cognitifs légers de type amnésique et la maladie d’Alzheimer

Introduction

The first decline in cognitive performance in Alzheimer's disease can appear when assessing semantic memory and can be detected long before the typical symptoms of Alzheimer's disease (AD), appearing with Mild Cognitive Impairment (MCI).

Patients and method

We propose the French version of the New Words Interview (fNWI) using 22 words to investigate semantic knowledge. The fNWI uses 11 words, which entered the French dictionary between 1996 and 1997, and 11 other words, which entered between 2006 and 2007. Words were paired according to orthographic and semantic criteria. Each word was associated with three sub-tests: free evocation, discrimination of the best definition from three propositions, and recognition of the accurate word context (two sentences were proposed). Regarding evocation, we distinguished conceptual definition, life situation examples or examples by use. We tested 12 patients with AD, 12 patients with amnesic Mild Cognitive Impairment (aMCI) and 72 controls (12 were paired with patients for age and education level).

Results

MCI patients and AD patients exhibited lower performance than controls in the three sub-tests and for the words of both periods. From the early stage of MCI, the patients were more impaired in the fNWI than in the context recognition task, and they failed to provide conceptual definitions of new words. Therefore, MCI patients suffer from semantic impairments before obvious clinical signs of AD.

Conclusion

In patients with AD, performance worsened on all subtests, and more strongly in the definition discrimination task, which suggests the impairment of stored semantic knowledge. They provided fewer conceptual definitions and failed to use the strategy observed in MCI patients, who compensated for conceptual difficulties by providing examples.     

Le voyage de Victor Hugo aux Pyrénées, un voyage dans la mémoire

1843 can be considered as a turning point in the life of Victor Hugo. Certainly in the middle of his life he had experienced dramatic events specifically the failure of his play Les Burgraves, the wedding of his daughter Leopoldine and more importantly her tragic death by drowning in the Seine at Villequier in September of the same year. These events had important psychological and emotional effects on him. We have tried to identify what affected Victor Hugo's unconscious thought processes by analysing different texts linked to these happenings, primarily the account of the journey referred to as Pyrenees by the executors of his will. This analysis leads us to establish a link with the drawings of Victor Hugo in which unconscious processes are already expressed by « l’homme ocean ». But if the purpose of our study is above all a psychoanalytical understanding of the process leading to involuntary memory, the « proustian memory », we are trying to replace this process in Victor Hugo's existential context, in the moment between the before and the after.     

Traitement de l’information à contenu émotionnel et représentation de soi chez des patients bipolaires de type I après traitement combiné médicamenteux et comportemental-cognitif

Objectives

Bipolar disorder currently affects around 1 % of the general population. Despite mood stabilizers, 37 % of patients continue to present mood fluctuations. Moreover, psychotherapeutic approaches, together with prophylactic treatment, have been developed over the past 10 years, including the behavioural and cognitive approach. Lam's behavioural model has thus become a major reference. Bipolar patients who have undergone cognitive behavioural therapy (CBT) based on this program experience fewer manic and depressive recurrences as well as fewer hospitalizations, thus improving the quality of their relations with others, reducing their dysfunctional beliefs and attitudes, and enhancing their self-esteem. However, no study has evaluated the effects of CBT on cognitive functions in this disorder, such as memory, nor on its connection with cognitive patterns, among bipolar patients. Previous research has suggested the existence of many disturbances of cognitive functions. Several studies have demonstrated memory disturbances in a free recall task among type I bipolar patients, even during periods of remission. However, none of these studies focused on explicit-memory recall bias for words with affective valence during remission, nor did they investigate the connection between self schemata and bias in memory processes. The goal of this study was to explore the cognitive vulnerability of bipolar I patients in remission by linking self schemata with recall bias for words with affective valence, and to compare these variables among patients who underwent CBT, and patients who did not.

Materials and methods

The study included 24 bipolar I patients, 12 were in the control group (mood regulating treatment) and 12 were in the experimental group (CBT in conjunction with a mood stabilizer), according to the DSM-IV criteria. The free recall tasks for words with distinct affective valences (positive, neutral, negative) allowed us to assess the performance and recall bias for affective information. In addition, the lexical assessment enabled us to study the cognitive schemata with reference to self-representation.

Results

The results do not indicate any signs of depression, mania or anxiety among the two groups at the time of their inclusion in the study. The cognitive results show that not only is the experimental group significantly more likely to recall words with positive affective valence (F1, 22 = 5.770; P = 0.025) and significantly less likely to recall those with negative affective valence (F1, 22 = 6.629; P = 0.017) than the control group, but that it also presents a specific recall bias for words with a positive connotation as compared to neutral words (t11 = 4.722; P = 0.001) and negative words (t11 = 5.777; P < 0.0001). Furthermore, the experimental group uses a vocabulary which is less focused on the disorder mood and cognitive symptoms.

Conclusion

The results demonstrate the various recall biases between the two groups, with a specific bias for the positive words and a self-representation which is less focused on bipolar illness in the experimental group. Learning the cognitive and behavioural coping strategies based on the Lam et al. model may lead to a modification of bipolar patients’ cognitive schemata. This modification may itself contribute to a better recall of positive stimuli. Just as, according to Bower, the activation of a negative emotion may facilitate the recall of negative information, a better management of emotions seems to result in a better recall of positive information.     

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.     

Certitude anticipée du passage à l'acte

Acting takes place at a time when the subject's act literally puts down in reality the logical necessity of a loss. The loss is equal to attesting a signification which has been achieved - the subject being altered to a “fallen object” and imposing on the Other a loss of his enjoyment. This can only be established while reaching an anticipated certainty answering the question : ‘What am I for the Other?’. It goes along with the downfall of the subject, contrary to the principle of altering afterward which is at play in Fantasy. Committing suicide illustrates this decision and so, after Lacan, entails the alteration of the subject through the act. An examplary clinical case (the “case of Marie” by D. Lagache) which is revisited here allows us to ascertain clinically the coordinates of the subject's resorting to act. Studying teenagers' suicides (in increasing numbers and a current illustration of the general feeling of discomfort) on the one hand and on the other the martyrs of idealized political causes will throw a new light on psychopathological cases whose reasons are not made the clearer for a sociological approach which is too often the only point of reference used.     

Métamémoire, remémoration et familiarité dans la maladie d’Alzheimer

Introduction

The main objective of this review is to present a new approach to the memory deficit in Alzheimer's disease. Recent memory models suggest that information is recovered either on the basis of recollection or on the basis on familiarity. Recollection, unlike familiarity, requires the retrieval of contextual details related to the encoded information.

State of the art

This review suggests that recollection is particularly affected in Alzheimer's disease. In contrast, familiarity seems to be relatively preserved. A related deficit in metamemory is observed when recollection is required; a decrease in recollection in Alzheimer's disease could explain the pattern of metamemory problems. The deficit in recollection could be explained by a disconnection between medial temporal areas and frontal areas.

Perspectives

This novel approach to memory gives research perspectives concerning both early diagnosis and rehabilitation strategies of Alzheimer disease.

Conclusion

This overview showed deficits in conscious memory processes conceived of as recollection. These novel insights should provide new explanations for the deficits observed in Alzheimer's disease, particularly metamemory.     

Dopage, limites et transgression. Rapports à l’individuel, à l’institutionnel et au juridique

The evolution of contemporary practices allowed us to consider doping as a new object of social discourse, placing this transgressive practice within the borders of medical, sociological and juridical prospects. The development of a legislation framing sporting practices leads to the installation of new institutions like to the emergence of concepts, such as “medical monitoring of sportspeople”, contributing to the introduction of new social control devices.     

Le dilemme du réfugié

The experiences of trauma, displacement, and forced migration faced by refugees raise profound questions about the relationship of self and community. This article explores some ways in which the intrapsychic dynamics of refugees' suffering and remembering interact with the larger social dynamics of refugee communities and host societies. The narrative construction of the self constitutes the pivot between the realms of the social and the psychological and rests on cultural meta-narratives. In Euro-American folk psychology two of the meta-narratives or concepts of the self can be compared in terms of their root metaphors: the adamantine self, characterized by its integrity, coherence, autonomy, self-definition, self-determination and self-control; and the transactional self, characterized by its fluidity, sensitivity to context, deference to authority, multivocality, deference and yielding to or accommodating others. These two accounts of the self shape how we view people who have suffered wrenching transformations of their worlds through violence, dislocation and loss. The changes produced through the therapeutic process can be understood as the development of a form of dialogue that is at once, within and without, personal and transcendental, rooted in communal tradition and in the open confrontation of the face of the other. The ethics of storytelling has its necessary counterpart in the ethics of listening, of witnessing and taking part in the creation of community through copresence.     

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.     

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.