Philosophy of Clinics In Neuroscience And Psychiatry



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About Philo-CINAPs

Philosophy of Clinics In Neuroscience And Psychiatry

Philo-CINAPs’ project investigates the contemporary transformations of psychiatric semiology. Its aim is to clarify the methods, the principles and the concepts which guides – or better, should guide – clinicians during the diagnostic procedure.

The project is based on two main axes.

The first one is built upon the theory of symptom. What is a symptom in psychiatry? When clinicians listen to their patients and observe signs for delivering a diagnosis, what is their evaluation based on? How can this judgment differ from those made by neurologists, psychologists or psychoanalyst? What can neuroscience, psychopharmacology and brain imaging teach us about mental symptoms?
Our work aims at bringing a clearer epistemological view on the big challenges of today’s psychiatric semiology, such as the 
RDoC project [Research Domain Criteria] funded by the NIMH (USA), the HiTOP project [Hierarchical Taxonomy of Psychopathology] or the integrated approaches based on a symptoms’ network analysis.

Philo-CINAPs will therefore make en effort into clarifying how concepts like those of domain, criteria, endophenotype, molecular signature, trait etc. could bring to the diagnostic process

The second main axis of the Philo-CINAPs project deals with the technological transformations of data collection in clinical psychiatry. The traditional interview, which was based on the “singular colloquium” of the doctor with his patient, is going through a deep crisis in medicine in general, and this crisis does not spare psychiatry.

  • The prolific development of clinical instruments (scales, standardized or semi-standardized interviews, symptomatologic inventories, etc.), throughout the 20th century, has made it possible to better objectify and therefore compare symptoms. However, their scientific validity is far from being established and all these instruments carry concepts, sometimes common (for example, sadness, anxiety, etc.) and sometimes technical (anhedonia, hallucination, etc.), whose definition is not always clear or operational. Above all, the primacy now placed on the self-evaluation of symptoms raises fundamental philosophical questions concerning the patient in his reflexive relationship to his mental health, and in the way he integrates the psychological norms set by social life.
  • The promotion of E-mental health, accelerated by the current health crisis, has resulted in the multiplication of smartphone applications that aim to collect a new type of clinical information, in real time and in real-life situations. The commercial interests and the new dangers they pose to the quality of care are obvious, and they offset the not-so-obvious epistemological benefits they could bring. We will seek to provide a critical and rigorous appreciation of what is at stake behind this mutation, which for the moment affects only research, but which could tomorrow concern the most common psychiatric practice.
  • Finally, the refinement of functional exploration methods (MRI, EEG, MEG, etc.), the search for biological markers (blood markers, genotypes, etc.) and the multiplication of databases (Big Data research) continue to offer the promise of a future redefinition of psychiatric classifications and diagnoses. What is the state of knowledge in this field? What are the distant promises offered by so-called “precision” psychiatry? Should it be seen as a new scientific paradigm (cf. T. Kuhn), or rather as a scientific ideology (G. Canguilhem) that would “squint” at the remarkable but very specific progress made in oncology? 
© J. Lichtman, Brainbow