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Dejerine and psychoneuroses - 28/01/17

Doi : 10.1016/j.neurol.2016.12.024 
Philippe Mazet, Pr
 34, rue Olliffe, 14800 Deauville, France 

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The book written by Jules Déjerine and Emmanuel Gauckler Les Manifestations fonctionnelles des pychonévroses. Leur traitement par la psychothérapie1 (in the original French). The way of curing them through psychotherapy”, published by Masson in 1911, the year in which J. Déjerine took up his post in Jean Martin Charcot's chair, is a real psychopathology and psychotherapy treaty, through the clinical study of physical, functional manifestations. The treaty is composed of three parts:

– analytical study of functional manifestations tackles “the persistent disorders and symptoms accused in neuropathic patients and being created in those patients without any previous somatic lesion” in the various tracts and systems: digestive, urinary, reproductive in men and in women, respiratory, cardio-vascular, skin manifestations, neuromuscular system, diffuse or localized sensitivity disorders, sensory organs disorders, nervous and psychic manifestations in themselves, sleep disorders, headaches, reflex disorders etc. Thanks to multiple vignettes or even thanks to real clinical observations, the book tackles this entire field accurately and in a refined way.

– within the synthetic approach of psychoneuroses, Déjerine highlights the important role of emotion and emotionality and their role in psychoneuroses genesis; he tackles thus emotional excitations coming from the outside world, emotional shocks and emotional excitations coming from the inside. In his opinion, psychoneuroses are mainly represented, on the one hand, by neurasthenia and, on the other hand, by hysteria. Besides, it's interesting to note that he classifies psychic asthenia as described at the time by Janet outside the field of psychoneuroses. Here is what Déjerine writes at the end of his book: “We will say: all functions may be disturbed by the psyche's illegitimate intervention. Thus are created functional manifestations; – this psyche’ s intervention is caused in most of the cases by an emotion – emotion can act repeatedly, it thus creates neurasthenia, a syndrome manifested by an emotional worry – emotion may act brutally with a dissociation mechanism; in these conditions, it consequently leads to hysterical accident. Emotion is only acting to create psychoneurosis and secondary incidents on an emotive background. But while the potential neurasthenic is mainly an obsessive patient, the hysterical patient, by definition, is an instable and an uncoordinated patient. If for their after effects psychoneuroses may admit various therapies, they only recognize one pathogenic treatment, that is to say psychotherapy”. Let's note that Déjerine is only leaving little room for mental unconscious representations in the real genesis of disorders;

– there is only legitimate psychotherapy, that is to say persuasive psychotherapy which has to tackle both the accidents and the mental and moral background which enables them to establish. Déjerine highlights the importance of faith of the patient towards his psychotherapist. The real efficacy of the treatment is only possible thanks to the quality of the relationship (transfer?) the availability of the therapist and thanks to his persuasion skills. Isolation is only a mean to ensure the realization of conditions external to the psychotherapeutic work undertaken with the therapist; besides, it can vary greatly as well as rest and over-feeding. We all know its’ within the Salle Pinel that Déjerine and Gauckler, assisted by an entire team of interns and nurses have performed this therapeutic work. “We give them the will to cure themselves but they are cured by themselves” (Figure 1).

Let's note Déjerine remark: “we will neglect deliberately the psychotherapeutic analysis study: Breuer-Freud method (Studies on hysteria, 1895); if it may be of some interest on a psychological point of view, it appears to us incontestably dangerous in terms of therapeutic applications. Regarding the conclusions drawn out of this approach – psychoneuroses originated from genitalia – (rather caused by something sexual?) are not appearing as admissible to us and we have been thinking that they should not find an echo in there”. Obviously, it's also interesting throughout the reading of this remarkable book to see how those who have used and are still using hypnosis are sometimes the target of critical remarks to unite in the end, on a specific point of view Charcot and Déjerine through one of the last of Charcot's articles: “faith is the cure” and a remark made by Déjerine at the end of his foreword: “the opportunity is there or never to remind the eternal saying which goes: it's faith that saves or… cures”.

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 Meeting abstract Jules Dejerine: Bilingual publication (English version).

© 2016  Publié par Elsevier Masson SAS.
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Vol 173 - N° S1

P. S25-S26 - février 2017 Retour au numéro
Article précédent Article précédent
  • Dejerine et les psychonévroses
  • Philippe Mazet
| Article suivant Article suivant
  • Les Dejerine pendant la guerre de 1914–1918
  • Olivier Walusinski

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