The Symptom as Ally,not Enemy

The practice of the Western medicine often identifies the symptom with the disease itself, but a current of thought and medical practice considers it as the important message of an organic imbalance. In fact, in standard therapies symptoms are usually suppressed, thus interrupting a normal physiological process and risking severe reactions due to the organic imbalance. Dr. Hahnemann, the father of homeopathy, founded his diagnostic and therapeutic model on the interpretation of the symptoms and maintained that symptoms are an expression of altered physiology. The same concept is to be found in Dr. Reckeweg's “reactivity” and homotoxicology; he believed that diseases are the expression of the struggle of the body against toxins. Reckeweg's contribution was particularly important in considering the inflammation process as a biologic process through which the body restores its health. Also PNEI (psycho-neuro-endocrino-immunology) proposes a model where the symptom is interpreted as information and as the result of an imbalance. Several other medical approaches address particular attention to the meaning of symptoms. The Bach Flower Therapy, for instance, is guided exclusively by the negative moods, which can become the cause of functional and organic diseases; balance is restored thanks to superior harmonic energetic vibrations conveyed by the superior energy living in some flowers. This interpretation of the nature of symptoms is becoming a more and more relevant issue among both the specialistic and the general public.     

Can psychoanalysis help us to understand the causes and prevention of violence?

As the most adequate theory of human personality yet created, including our propensity for irrational, self-defeating, and self-destructive behavior patterns, psychoanalysis is in a unique position to help us solve the most serious crisis that the human species has been confronted by at any point in its evolutionary history: the threat to its own survival that is caused by its own behavior, namely the compulsion to engage in violence on the largest scale that its technology makes possible, even when that causes the death of the self as well as of others. This continually expanding behavior pattern, which reduces even genocide to a minor footnote compared with the self-extinction of our whole species, is created not only by “apocalyptic” fundamentalism and terrorism (“suicide bombers”), but also by the increasing and only partially preventable proliferation of thermonuclear weapons to national rulers of questionable sanity, and the apparently unpreventable continuation of industrial/economic policies and practices that will, if not reversed, make our own small planet uninhabitable. What makes people place a higher value on the continuation of these behaviors than they place on their own physical survival (or that of their children)? That is the question to which this article proposes at least the beginnings of an answer: that when a person feels shamed and humiliated to a degree that threatens the survival of that fragile and vulnerable psychological construct called his “self” (or of the religious or cultural group with which his self has identified), he will eagerly sacrifice his body (and other peoples’) in the attempt to, as he sees it, save his soul, i.e. his self and his self-esteem. The question then becomes: what are the social and psychological determinants of overwhelming shame and humiliation, and how can we protect people from being exposed to those conditions, or at least enhance their ability to respond to them in ways that are life-preserving rather than life-destroying?     

Information in the Universe and in the Organism

There is a branch of modern medicine that relies on information rather than on biochemical substances to maintain health and cure disease. Known as information medicine, it offers an important complement to the dominant biochemical approach of mainstream medicine. This note offers a few reflections on the potentials of information medicine in reference to what is currently known regarding the role of information in the universe, and in the living organism.     

Nerve/Nurses of the Cosmic Doctor: Wang Yang-ming on Self-Awareness as World-Awareness

In Philip J. Ivanhoe’s introduction to his Readings from the Lu-Wang School of Neo-Confucianism, he argues convincingly that the Ming-era Neo-Confucian philosopher Wang Yang-ming (1472–1529) was much more influenced by Buddhism (especially Zen’s Platform Sutra) than has generally been recognized. In light of this influence, and the centrality of questions of selfhood in Buddhism, in this article I will explore the theme of selfhood in Wang’s Neo-Confucianism. Put as a mantra, for Wang “self-awareness is world-awareness.” My central image for this mantra is the entire cosmos anthropomorphized as a doctor engaged in constant self-diagnosis, in which effort s/he is assisted by an entire staff of the nerves/nurses—individual humans enlightened as Wangian sages. In short, I will argue that the world for Wang could be meaningfully understood as a mindful, self-healing body within which humans are the sensitive nerves, using our mindful awareness to direct attention to the affected areas when injury or disease occurs. We are, and must thus recognize that we are, the bold but sensitive nervous system of the cosmos, sharing (like neurons) our loving excitement, carrying out (like a medical nurse) the doctor’s orders for the self-care of our cosmic body/medical corps.     

Sciences médicales et droit

How does Law unravel and seize Medicine? The relationship between Law and Medicine is tremendously complex. At first sight, Law understands medicine as being a medical science, an applied science, and imposes requirements in this regard, such as respect for the “established scientific knowledge” or “tested medical knowledge”. But Medicine turns out to be “Art”, a clear and authentic expertise which requires techniques reiteration. Seen by Law, Medicine is not classified into either both of these scientific or technical dimensions. Borrowing from human sciences also allows to set requirements for medical humanism.     

Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19

Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic.     

Measurement Error-Corrected Estimation of Clinically Significant Change Trajectories for Interventions Targeting Comorbid PTSD and Substance Use Disorders in OEF/OIF Veterans

In randomized control trials (RCTs), a focus on average differences between treatment arms often limits our understanding of whether individuals show clinically significant improvement or deterioration. The present study examined differences in individual-level clinical significance trajectories between Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) and Relapse Prevention (RP). Eighty-one treatment-seeking veterans with a comorbid PTSD/SUD diagnosis were randomized to COPE or RP; data from an additional n = 48 patients who did not meet criteria for both disorders was used to establish a normative threshold. A newly developed, modernized approach to the Jacobson and Truax (1991) clinically significant change framework, using (a) moderated nonlinear factor analysis (MNLFA) scale scoring and (b) measurement error-corrected multilevel modeling (MEC-MLM) was used; this approach was compared to other approaches using conventional total scores and/or assuming no measurement error. Using a conventional approach to estimating the Reliable Change Index (RCI) yielded no differences between COPE and RP in the percentage of patients achieving statistically significant improvement (SSI; 88.9% for both groups). However, under MNLFA/MEC-MLM, higher percentages of patients receiving COPE (75.0%) achieved SSI compared to RP (40.7%). Findings suggest that, even though COPE and RP appear to reduce the same number of PTSD symptoms, MNLFA scoring of outcome measures gives greater weight to interventions that target and reduce “hallmark” PTSD symptoms.     

Intelligence artificielle et médecine : quelles règles éthiques et juridiques pour une IA responsable ?

Combining AI and medicine means talking about the medicine of the future, but even more about improving the quality of care. Its fields of application: predictive medicine, precision medicine, decision support, prevention, computer-assisted surgery, robotic support for the elderly, etc. are all related concerns: the possibility of maintaining human contact with the patient, the explicability of the algorithm - the collection of health data - and the improvement of the health care system. AI applications are already improving the quality of care. Its deployment at the heart of the medicine of the future is in constant evolution. To be acceptable and legitimate, the decisions of any algorithm must be understood and therefore explained. Only a good understanding of the diagnoses and therapies proposed by the AI application will allow doctors to discuss with their patients and to explain the possible alternatives. In the opposite case, the doctor risks to dismiss the use of algorithms because he will not be able to justify the decisions which will pose problems in terms of liability research in particular.