Fundamentos da Clínica by Paul Bercherie, , Jorge Zahar edition, Paperback in Portuguese – 1 edition. Paul Bercherie Los fundamentos de la clínica. 1 like. Book. Fundamentos de La Clinica: Paul Bercherie: Books – Amazon. ca.

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To do this, the DSM and then the ICD declared themselves to be atheoretical, excluding the categories which involved theoretical and psychodynamic assumptions and intending to base classification exclusively on symptoms that could be empirically observed and quantified.

Accordingly, a second step is the following: We are addressing the practical field of mental health in which we work, where we notice that the proliferation of diagnoses generated by the DSM has frequently had a disorienting effect in relation to diagnosis and the clinic — mainly lso effect of a lack of familiarity with psychosis where it often appears.

Fundamentos da Clínica

This knowledge operates on the subject in absentia; it propels him as desire to respond to the requirements of life and desire, and produces as symptom points of impasse, of the impossibility of permitting a certain funadmentos, of the difficulty of doing something, or even in the form of symptoms identified by the clinical tradition related to anxiety, depression, dissociation, obsession etc.

Consequently, it is not that these dimensions do not exist for the psychotic, since they were also established in their injunctive character for him, and they are what constitute and move the social bond itself. Regarding psychosis, Freud placed all his hopes into the work of his re Karl Abraham and Carl Jung, both psychiatrists dedicated to applying psychoanalysis to this pathology. This is one of the most controversial categories of clinical practice, and for sure carries the most risk of a moral approach to the patient.

And these formations are not, in relation to these issues, a merely haphazard reaction, but in fact quite the opposite: The first is that although it claims to be free of theory, the DSM actually is related with the pragmatism of Peirce and empiricist theses. Essentially, it asserted that the delusions and hallucinations of a psychotic are formations that arise from the same issues in face of which a so-called normal subject constitutes himself or herself cf.

In the words of Lacanp. With regard to the first question, the authors demonstrate that the empiricist assumption, which requires so-called objective evidence, has obvious affinities with the physicalist view of mental illness Russo, Venancio,p.

This shows the symbolic weight that these terms carry and transmit. Neurosis and psychosis, each one means: In the new classification, the diagnosis of schizophrenia is now based on two essential criteria: These authors point out a paradigm shift that is not limited to the classification of mental diseases, and reaches the question of hegemony among the knowledge that constitutes the psychiatric and psychological clinic, and the sphere of social representations relative to the individual and to the normal and the pathological.

In the s, randomized double-blind studies were instituted in the United States as the proper procedure for establishing the scientific validity of drugs so that their sale could be authorized by the Food and Drug Administration fundamentod. Psychosis or psychoses was understood to mean dundamentos psychosis, paranoia, and schizophrenia. During this same period, Magnan distinguished the mixed states organic brain lesions, senile dementia, neuroses [hysteria], epilepsy, alcoholism etc.


The division between neurosis and psychosis is abandoned, as it implies an act of naming that extends beyond an empirical statement: In this meaning, psychosis demarcated the specific field of psychiatry, its most suitable object. Dictionnaire de la psychiatrie. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in loa medium, provided the original work is properly cited.

We know from Canguilhem that it is impossible to separate the internal reading of a scientific discourse from its external reading, since this latter creates the conditions which make the referred discourse possible, and that often the multiple processes which unfold in a particular historical, social, and economic context decisively determine the phenomena within that discipline cf. We can say that the strength of the concept forced the DSM to include it again. The DSM-III carried the warning that it was not a teaching manual, precisely because it did not include theories about the etiology, management, and treatment of mental disorders APA,p.

Regarding psychoanalysis, here we refer to the situation left by Freud, who despite maintaining a theoretical and clinical interest in psychosis, considered it inaccessible for psychoanalysis. It is not by chance that the only condition currently recognized as psychosis schizophrenia is a deficient condition which offers a biological interpretation, pharmacological action, and rehabilitation activities that can be both generous actions of social inclusion and at the same time can shift the balance toward a practice of normalization and adaptation, depending on the interpretation.

If inPereira p. It is interesting to note how paranoia and melancholy are still cultural terms, even though for at least twenty years they have been disowned by official psychiatry. The cognitive slant of the DSM will reinforce this approach.

Banzatop. The notion of psychosis was the category that determined psychiatry for almost two centuries. In this sense, if one of the objectives behind the origin of the DSM-III was standardization of language in global psychiatric communication, this goal could be considered fully achieved, and catalyzed the rise of biological psychiatry as a dominant aspect not only in American psychiatry but around the world.

In creating the name schizophrenia and proposing that it replaced dementia praecox, Bleulerp. With bipolar disorders, psychosis was reduced to the accessory presence of hallucinatory or delusional phenomena. The unity of the psychoses based on the structural elements that delineate their specificity has been lost, along with the clinical rigor that required psychiatrists to pursue the presentation of symptoms and particularities of evolution in every patient, in an attempt to locate the moments of psychosis and the terms with which it was equated cf.

Final considerations The fact that schizophrenia has encompassed almost everything that still is considered as psychosis has relegated to oblivion several important semiological references and accurate descriptions of the various clinical forms of psychoses.


A syndrome is a set of signs and symptoms that manifest in the occurrence of disease. This favored the view that psychosis is a phenomenon which is always disruptive, and that its treatment addresses rearranging what the break threw into disarray.

Healy, ; Aguiar, The second consequence is that conditions which had previously funeamentos recognized as psychotic have been relocated to fit under the heading of personality disorders. The implications are clear: The abandonment of the strong nosographic entities of the psychiatric tradition in favor of a classification which is allegedly error-free is full of consequences in the clinic.

This should call the limits of this type of manual into question.

Paul Bercherie (Author of Fundamentos de La Clinica)

Psychoanalysis has been charged vundamentos sustaining the clinical and doctrinal validity of the psychosis category, to the point of spreading the feeling that this concept pertains more to psychoanalysis than psychiatry.

How can we make this diversity compatible with the assumption that psychosis is unique? The Freudian terms of intersection between paternal inheritance and assumption of sex by the subject are considered by Lacan as dimensions established funddamentos language itself, by the symbolic, for every subject. As a neurologist, he was interested in the enigma that hysteria represented for this specialty, and the invention of psychoanalysis corresponds to the rupture that Freud introduced into the understanding of this disease hysterical neurosis.

Psychoanalysis has shown that psychopathology is always a symptomatic response to greater requirements which constitute a subject: What Hecker added was the identification of anomalies in syntactic construction and a tendency to deviate from the normal way of speaking and writing — formal changes in language that, according to Hecker, express a profound breakdown of the Ego and are early indications of the intellectual weakening that will occur later.

According to Postelthe following psychiatric criteria became classic descriptors of psychosis: In these studies, patients with the diagnosis for which the drug is being tested are divided into two groups, one receiving the drug and the other receiving a placebo, and neither the doctors nor the patients know who is receiving the active substance hence the name double-blind.

At the end of the study period, participants are evaluated to see if their symptoms have improved, to assess whether the medication has a therapeutic efficacy that is statistically superior to the placebo. In this way, as a kind of confluence of work in psychiatry and psychoanalysis throughout the twentieth century, a distinction was established between neurosis and psychosis, with each designating a class of pathology, a background condition, that corresponds to a specific way fundamentoa being in life and in relation to the other; in Lacanian terms, a structure.