2001 - N° 2
N° 2 : Drogues et remèdes
Tobie Nathan : The function of things and objects in therapeutic settings clic
Bruno Latour : From the notion of network to the notion of attachment clic
Sean Hsiang-lin Lei` : From Changshan to the development of a new drug against malaria clic
Olivier Ralet : The raptures of Lalla Hlayqia clic
Julien Bonhomme : On the ritual use of hallucinogenic psychotropic drugs (substances, settings, worlds) clic
Henri Grivois : Psychopharmacology and incipient psychosis clic
Philippe Pignarre : What is a psychoactive drug ? Psychotherapists and prescribers faced with the mysteries of depression clic
Vinciane Despret : In the world or in the body ? William James wager clic
Jacques Brandibas, Georgyus Gruchet : Ethnopsychiatry in the Reunion Island clic
The function of things and objects in therapeutic settings
If one defines psychotherapy as the art of the technical handling of influence, then one can study "scientific" therapies as a specific instance within a body of practices in use around the world whose purpose is to alter people, groups and situations through a technical procedure. The term "therapy" can thus be clarified : it applies to any setting which constructs the truth in reference to objects of the physical world, where the term "object" is to be understood in its tritest meaning.
The main function of objects is to prove therapists theories. Change may take place only along the line of flight of a becoming, from a becoming-human, here, towards a becoming-heterogeneous, most of the time, non human. This line of flight is drawn thanks to the appearance of a "thing", to be understood here as a being of unprecise nature, which produces that which is observed and captures he who approaches it. The therapeutic work will therefore strive to deepen ones knowledge of the thing. The obvious consequence of the existence of technical objects is to render the therapist-patient relationship instrumental, mechanical, thereby evacuating compassion and sympathy. In therapeutic settings, the objects principal function is to allow the speculative theory to develop, prove itself and spread through contagion. The object offers a double garantee: it forces the therapist to bet on the intelligence of the patient; it allows the patient to locate precisely the theory of his therapist. With each application of the therapeutic procedure, the therapist lays out the totality of the metamorphic becoming it offers.
If therapy is an intellectual adventure, a bet for the patient, and for the therapist, a commitment to mobilize the thing for the benefit of the patient, then the consequences of the patients consent gravitates towards three points of tension: towards the success of an impossible metamorphosis, with the hope of a surplus of knowledge and imagination, and an improvement of his state; towards the comprehension and the mastery of a technique, the expert handling of technical objects and methods; towards a degree of aggregation to the universe of the therapist, through learning, initiation or conversion.
Therapeutic techniques, influence, theories, objects, thing, becoming- human, becoming-heterogeneous.
From the notion of network to the notion of attachment
The author pursues his exploration of the conceptual limits of a theory of "factishes" (faitiches) which he defines as resulting from both facts and fetishes, a combination of the reduplication in the French expression faire faire (to have something done or make someone do something) and the work of human construction which would neither be a fact object of a positive discourse of verification, nor fetish object of a critical discourse of denunciation. This theory of "factishes" is faced with several conceptual obstacles, at once logical, theological and political. Claiming as theirs the modernist ideal of a subject free of ties, in terms of freedom or alienation, the social sciences usually explore a part of the concept of attachment, in the form of a specific distribution between the individual actor and the structures of society. Rather than paying attention to individuals and societies, the author offers to look at the multitude of what makes individuals and societies act, defining a sociology of means, mediations, attachments, in other words of "factishes": the very sources of attachments, in other words the proliferation of objects, commodities, beings, techniques. It is not sufficient, however, to distribute the sources of action among the different mediators, actors and specificities that partake in the setting in motion. It is also necessary to modify the nature of the action. Therein lies the limit of the notion of network: a network distributes the action among the different actors, but does not afford the possibility of redefining the action itself. In order to understand the setting in motion of subjects, their emotions, their passions, one must therefore look to that which attaches them and sets them in motion. Exploring networks of attachments should make it possible to preserve the distribution effect of the network while recasting entirely the nature and the source of its action. The task remains of defining different types of attachment.
Attachment, sociology of networks, factishes, action, faire-faire, attachment networks
Sean Hsiang-lin Lei`
From Changshan to the development of a new drug against malaria
The author examines the case of Changshan, a new remedy against malaria in the forties, thereby analyzing the " Scientific Research Program on Nationally Produced Drugs " developped in the thirties in Shanghai by Western-trained Chinese physicians, in opposition to Chinese remedies stemming from Chinese medical theories. He shows how Changshan, and Chinese remedies in general, far from being simple raw materials, are constructed objects, created through a long practice which draws its meaning from the technical and social network of Chinese doctors.
The process of " discovery " of Changshan, the scientific study of the drug, was a process of constricting the latters circulation within a network, through which Western-trained physicians detached Changshan from its traditional Chinese network in order to include it in their own. Both the concrete nature of Changshan and its conceptualization underwent considerable change, stabilized by modern technology and practice, and the inclusion in a new homogeneous and closed network.
Changshan, malaria, networks, Western medicine
The raptures of Lalla Hlayqia
Wine : remedy or poison ? Sin or priviledge ? The old Moroccan woman, holding open court in the shade of a fig tree, funny, frightening, good and fearsome, wily and blissful, half-crazy saint - majduba, half-witch with her storytelling talent, Hlayqia was a master at blending verses from the Koran, the words of the Prophet, with her own intimate experience of popular shrewdness. The argumentation strategy was based entirely either on excess or asceticism, and, before her fascinated and questioning audience, she was so bold as to defend, with the help of appropriate verses, the equivocal nature of wine, in turn excellent nourishment and work of the devil, bitterly denouncing the Doctors of the Law, who transform the same verses into laws and rules of conduct, using brutality and political force: by confusing the restrictions on wine with the prohibition on hallouf (pork), she argued that they overlooked the subtlety of the Book. Luckily, the jurisconsults merely emit opinions which go somewhat unheeded by habits and customs, the latter incarnating a more sophisticated, or at least more pragmatic, reading of the Book! At sundown, the public discussion was drowned out by the urgent calls to prayer of the muezzin.
Morocco, wine, sin or food, law, Koran verses, public debate.
On the ritual use of hallucinogenic psychotropic drugs (substances, settings, worlds)
The author questions some of the concepts of anthropology: the determinism of culture, the symbolic efficiency of rites, the physical efficiency of technology. He shows, through examples of the use of substances, that it would be simplistic to theorize the hallucinogenic experience according to the dividing lines of biochemistry, physiology and sociology. Defining the hallucinogenic setting as including all observable elements psychoactive substances but also techniques, practices, experiences, beliefs, actors and objects , he advocates a global, contextual study free of ethnocentrism.
He suggests that ritual uses of hallucinogens, in a very general manner, form communication techniques to transmit information, have relations with, be in touch with, be bonded through a passage with the dead, with divinities, ancestors or a psyche, according to the location, as well as knowledge techniques produce knowledge stemming from and in relation to certain dimensions of reality and certain categories of beings. Thus, hallucinogenic rituals convey entire worlds. In a sense, they constitute an act of metacommunication: they indicate and at the same institute the communication situation, a specific context where the human enunciator is not the source of the utterance. The ritual hallucinogenic experience can thus be described phenomenologically according to three modes: the modification of the relationship to the perceived world (perception), of the relationship to oneself (intentionality), of the relationship to others (communication). Hallucinogenic rituals, as cognitive practices, imply theories of knowledge (ontology and epistemology), and theories of the person (soul, double, body, life force, witchcraft, intentionality, etc. and the relationships between these).
Hallucinogenic psychoactive substances, rituals, communication techniques, knowledge techniques, worlds
Psychopharmacology and incipient psychosis
According to the author, psychosis can be defined as universal madness, schizophrenic in the USA, psychotic in France, an opaque, uncertain, elusive illness, the spearhead of which remain neuroleptic drugs. The idea of an inaugural event for psychosis disappeared in the nineteenth century, with the development of chronicity in psychiatry. The absence of an identified beginning is in keeping with the pessimism which shrouds the psychiatry of psychosis.
Critical of the practice of psychiatry centered around long-term massive sedation of patients in emergency situations, the author describes his clinical choice to meet with patients at the onset of their first episode, appropriately sedated with neuroleptic medication allowing the possibility of a dialogue with the patient. The therapeutic goal of the first interview is to encourage patients to reflect on their connection to others, on the apparently indiscernible coherence of their behaviors, to think back on this first experience while exploring with them the concept of centrality, defined as a mistaken attribution of intentions, actions and thoughts.
Alongside the incompatibility, in the early stages of the disorder, between psychosis and language, manifested through mutism, there is a clinical invariant in the onset of psychosis. The phenomenological dimension of this experience develops in overlapping phases, and the coexistence of various symptoms hides this sequence. The authors uses one of the theoretical models of socialization and continuous interaction, the usual regulation of which is made up of subliminal sensori-motor mecanisms. The experience of the onset of psychosis may be triggered by the transformation of this reciprocal system.
Incipient psychosis, neuroleptic drugs, phenomenology, centrality, delusion
What is a psychoactive drug ? Psychotherapists and prescribers faced with the mysteries of depression
With the example of depression and the invention of antidepressant medication, the author demonstrates how the concepts of biological psychiatry have drastically changed social relationships. He points out how antidepressants, like other psychoactive drugs, are defined not by biology which can only be predictive of pathological behaviors, but in the social arena, in other words their propensity to create larger and larger patient groups: as such the biological exists only through social confirmation, and the social receives its ultimate strength via a chemical operation. Underscoring the absence of reliable controls in the pharmacology of psychoactive drugs, he rediscusses the theoretical articulation between psychoactive drugs, psychotherapies, prescribers and psychotherapists. Inventiveness may be found not in the observation and classification of mental disorders, nor even in locating reliable controls which could make up good diagnostic tools or pharmacological tests on animals, but in the abundance of new molecules, the clinical trials of which will determine later on whether they are socially useful. The only active difference between psychoactive drugs and psychotherapies is relative to permanent invention and innovation and not to the etiology of mental disorders. The only common ground between psychoactive drugs and psychotherapies may thus be defined according to the following statement: "to treat is to modify". The instability and artificiality of the biological and physical foundation of mental disorders may thus permit the invention of new treatment settings, caracterized by a clinical multiplicity, and also by a multiplicity of references and becomings.
Antidepressants, depression, ethnopsychiatric method, psychoactive drugs, psychotherapies, reliable controls, double-blind lab, clinical trials, patient groups
In the world or in the body ? William James wager
Sociological and anthropological theories of the sixties of the concept of emotion were constructed in reaction to William James somatic model (1903) according to which emotions such as sadness, fear, rage, love are merely quantifiable physical alterations. Experiments on joy and anger by social psychologists Schachter and Singer (1962) shed light on the ways in which the social sphere might be essential to emotion. The author takes these results further by offering new propositions: the misunderstanding with James may reside not in the fact that his theory gives rise to a simplistic cause and effect interpretation, but that it invents a new approach of experience making possible a new relationship with oneself and the world. James constructs this new experience to test the notion of "emotion", thereby enriching the concept and developing it. In turn, this experience will act on the world in a new way. By defining emotion as an undetermined experience, James gives rise to the experience of this undetermination, using experience both as a model of apprehending the world, and as tools of induction of experience itself. As such, he proposes a methodological foundation to the development of an ethnopsychology of emotions, co-constructed by the social world, the social sciences and the laboratory.
Emotions, biological, anthropological and social theories, experimentation in the social sciences, ethnopsychology.
Jacques Brandibas, Georgyus Gruchet
Ethnopsychiatry in the Reunion Island
The authors, clinical psychologists in a public outpatient psychiatric clinic in the Reunion Island, having noted that the resistance of patients to psychiatric and medical treatments compelled them to revise their theoretical stances, developed a modern therapeutic setting inspired by transcultural psychiatric theory. Through clinical observations, they show how this therapy uses the reframing of family history and myths. Establishing links between past and present, bringing to light relationships and associations, articulating various etiological hypotheses within the transgenerational logic make up operative therapeutic tools. The patients then attempt to analyze their disorders in terms that can fit within the Reunion world, which is specifically a mixed one.
Transcultural Psychiatry, divinity, death, ancestor, therapy
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