Pratique clinique et pluralismes en psychiatrie

IntroductionThe consideration of a plurality of perspectives is highlighted in a various number of medical and scientific disciplines. For example, in psychiatry, many attempts claiming to be pluralism have been carried out over the course of the discipline, e.g. Kraepelinian and Meyerian approaches, biopsychosocial model, Jasperian approach or Freudian psychoanalytic model. At the same time, the starting point for Jean Garrabé’s views on psychiatric nosology refers to his consideration for the existence of different perspectives in the psychiatric landscape. The objective of this article is to highlight possible continuities between the Jean Garrabé’s developments and contemporary nosological issues. We will start from one of his leitmotifs, i.e. “History can inform the construction of psychiatric classifications”.MethodIn the first part, we present the diversity of perspectives in Philosophy of Psychiatry and in Philosophy of Science. In the second part, we will see how Jean Garrabé was able to discuss, in a more or less structured and explicit manner, three axes currently and widely studied in the proposals for contemporary models of psychiatry.ResultsIn a first part, we analyze the integration of Jean Garrabé into the general debates of the philosophy of science and modelisation. We will thus develop three examples of modelisation, based on contemporary psychiatric classifications, to testify this integration. The first example corresponds to staging models, which consider that psychiatric disorders could be better understood as subgroups of evolving elements – rather than as fixed categories in time. Indeed, staging models allow a sub-classification of psychiatric disorders according to their dynamical progression. The second example concerns the Hierarchical Taxonomy of Psychopathology project, which describes psychiatric disorders according to a continuum of quantitative variations, hierarchized in several dimensions. The third example concerns the Research Domain Criteria initiative, which targets some dimensions of mental functioning, i.e. areas of research from contemporary cognitive neurosciences allowing to organize psychiatric research on specific neuroscientific constructs. In a second part of this article, we analyze three axes developed both within the proposals of contemporary models and classifications and the Jean Garrabé’s views, namely dynamics, hierarchy and dimensionality of psychiatric disorders.Discussion and conclusionJean Garrabé’s conceptions seem marked by the footprint of pluralism and the three identified axes. The first axe concerns his interest for the temporal dynamics of psychopathological phenomena, evolving in time in a synchronic and diachronic manner. The second concerns his interest in the hierarchy of disorders and semiological elements, e.g. through validity or statistical analyzes. The third axe corresponds to the Jean Garrabé’s interest for the dimensionality, which considers elements underlying psychiatric disorders, whether they are phenomenological or physiopathological.