[精神病学中的不适及其历史]

[Malaise in psychiatry and its history].

作者信息

Chebili S

机构信息

Centre hospitalier d'Orsay, domaine du Grand-Mesnil, 2, rue Charles-de-Gaulle, 91440 Bures-Sur-Yvette, France.

出版信息

Encephale. 2016 Apr;42(2):185-90. doi: 10.1016/j.encep.2015.12.011. Epub 2016 Jan 12.

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.

摘要

本文的主要假设是精神病学存在困境。这种困境有两个方面:一方面,精神病学霸权的终结,这种霸权在20世纪90年代之前一直主导着精神病学的理论领域。精神分析影响力的丧失是由于它无法接受任何形式的评估。另一方面,神经科学占据主导地位。我们的观点不是低估神经科学的重要性,而是要确认它们占据了精神病学的整个理论领域。这是一种特定于我们这个时代的不寻常情况。的确,这种一元论取代了贯穿精神病学历史的认识论二元论。在本文中,我们将尝试梳理精神病学中的二元论历史。首先,在皮内尔那里,我们发现了形而上学哲学极点与生理学极点之间的张力。皮内尔的哲学与孔狄亚克的思想有关,因为皮内尔将分析方法应用于精神疾病。在卡巴尼斯的影响下,卡巴尼斯是著名的《论人的肉体与精神的关系》的作者,这种思想受到了生理主义的压力。作为一名唯物主义者,他赋予大脑重要地位,大脑将信息传递到全身,因为他认为精神影响肉体。其次,二元论存在于加尔所捍卫的定位学说与马尼亚所阐述的退化理论之间。加尔在《神经系统的一般解剖学和生理学》中,试图了解颅骨上发现的隆起或凹陷是如何形成的。加尔支持非定位理论。他是马尼亚的对立面,马尼亚写了一本关于《退化者》的著作,他的著名退化理论属于生理学趋势。对他来说,退化意味着一个人的大脑功能明显处于不完美状态时其主体的不完美状态。第三,在亨利·埃那里,二元论开始变得不那么重要。的确,他倾向于一种一元论的综合,其在《从杰克逊的思想到精神病学的器官动力学模型》中描述的器官动力学模型。的确,他受到英国神经学家杰克逊的启发,断言存在意识结构层次,消极症状通过其消解而出现。当前神经科学占主导地位的一元论提出了基本的认识论问题。也许神经科学在遵循尚热的直觉时设定了一项无法完成的任务。在《神经元人》中,尚热提出了这样一种观点,即对于每一种心理功能,都可以关联一个神经元。这是一种回归加尔的方式,但在我们看来加尔的观点并无启发性。的确,让我们首先介绍这样一个事实,即正如最新研究所示,不存在特定的皮质区域。因此,说一个脑区与一种症状或一种功能相关,只不过是依赖于平行论理论。因此,我们进行分析所依据的柏格森表明了这样一个概念的徒劳以及它所导致的困境。对精神疾病中涉及的精确脑区的研究尽管很重要,但却留下了意义问题。疾病的意义引发了许多经济、文化、心理和社会因素。因此,我们可以提出这样一个假设,即精神病学应该处于两个互补的极点之间。第一,神经科学极点,其研究对于疾病病因学研究和新药开发至关重要。第二,存在一个更加多样的极点,它将处理意义问题。我们认为这些极点中的每一个都应该有自己的研究领域和特定方法。我们捍卫这样一种观点,即创建诸如神经精神分析这样的学科是一种幻想。

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