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  • Title: [Malaise in psychiatry and its history].
    Author: Chebili S.
    Journal: Encephale; 2016 Apr; 42(2):185-90. PubMed ID: 26796559.
    Abstract:
    The main hypothesis of this paper is the presence of malaise in psychiatry. The malaise has two sides: on one hand, the end of psychiatry hegemony that dominated the theoretical field of psychiatry until the 1990s. The loss of influence of psychoanalysis is due to its inability to be submitted to any kind of assessment. On the other hand, the supremacy of neurosciences. The idea is not to underestimate the importance of neurosciences but rather to affirm that they occupy the whole theoretical field of psychiatry. This is an unusual situation that is specific to our time. Indeed, this monism has succeeded to an epistemological dualism that has existed throughout the history of psychiatry. In this article, we'll try to draw a history of dualism in psychiatry. Firstly, with Pinel, we find a tension between a metaphysical philosophical pole and a physiological one. Pinel's philosophy has something to do with Condillac's ideology as Pinel applies the analytical method to mental diseases. Under Cabanis's influence, the author of the famous Rapports du physique et du moral de l'homme, this ideology is under pressure with physiologism. As a materialist, he gives an essential part to the brain that distributes pieces of information throughout the body because he thinks that mind influences body. Secondly, dualism lies between the doctrine of localizations defended by Gall and the theory of degeneration elaborated by Magnan. Gall, in Anatomie et physiologie du système nerveux en général, seeks to know how bumps or hollows that are found on the skull are shaped. Gall is for the theory of delocalizations. He is the counterpart of Magnan who wrote a work about Les Dégénérés, that takes its part in the physiological trend with the famous theory of degeneration. For him, degeneration means the imperfect state of a subject whose cerebral functions are in a noticeably imperfect state. Thirdly, with Henry Ey, dualism starts to be less important. Indeed, he tends a monist synthesis with its organodynamic model described in Des idées de Jackson à un modèle organodynamique en psychiatrie. Indeed, he is inspired by the English neurologist Jackson to assert that there are levels of conscience structuring where negative symptomatology appears through its dissolution. Current monism with neuroscience domination sets fundamental epistemological issues. Perhaps neurosciences were setting an impossible task to achieve while following Changeux's intuition. In L'homme neuronal, this latter was developing the idea that to each psychic function, one could associate a neuron. This is a way to go back to Gall who doesn't seem to us to be heuristic. Indeed, let's first introduce the fact that there is no specific cortical area just as the most recent works have shown. Therefore, saying that a cerebral area is correlated to a symptom or a function is no more than relying on parallelism theory. Thus, Bergson, from whom we took the analysis, showed the futility of such a concept and the apporias to which it leads. The research of precise cerebral areas implied in mental diseases, as important as it is, leaves open the question of meaning. The meaning of the disease raises many economic, cultural, psychological and social factors. Thus, we can formulate the hypothesis that psychiatry should be between two complementary poles. First, the pole of neurosciences whose researches are fundamental for research in disease etiology and the development of a new medicine. Second, there is a pole which is more polymorphous and that would deal with the question of meaning. We think that each of these poles should have their own investigation field and their specific methods. We defend the idea that creating subjects such as neuropsychoanalysis is an illusion.
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