Prof. German Berrios
Cambridge University, Regne Unit
| Ponència | "Manca de resposta", "Resistència al tractament", "Pseudo-resistència" |
| Data | Dijous, 25 d'Abril, 2019 |
| Hora | 16:15 a 16:45 |
BIOGRAFIA
Al Presente
- Catedrático Emérito de la Epistemología de la Psiquiatría, Universidad de Cambridge
- Fellow Vitalicio, Robinson College, Universidad de Cambridge
- Fellow de la Academia de Ciencias Médicas del Reino Unido
- Fellow del Colegio Real de Psiquiatras del Reino Unido.
- Fellow de la Sociedad Británica de Psicología
- Director de la revista internacional “History of Psychiatry”
Hasta 2007:
- Jefe del Departamento de Neuropsiquiatría de la Universidad de Cambridge (31 años)
- Presidente del Comité de Investigación y Ética de la Universidad de Cambridge (20 años)
- Presidente del Comité de Medicina Psicológica del Hospital de Addenbrooke's (10 años)
- Bibliotecario Mayor del Colegio Real de Psiquiatras del Reino Unido (10 años)
- Encargado del material de lectura de los residentes psiquiátricos del Reino Unido (10 años)
Honores recientes
- Dr. Medicina Honoris Causa, Universidades de: Heidelberg (Alemania); San Marcos (Perú); Barcelona (España); Buenos Aires (Argentina); Córdoba (Argentina); Chile (Chile)
- Cátedra de psicopatología "German Berrios" fundada en Universidad de Antioquia (2006)
- Condecorado por el Gobierno Peruano con la Orden del Sol, grado "Gran Oficial" (2007)
- Premio Ramón y Cajal, International Neuropsychiatric Association (2008)
- Fellow de Honor, Royal College of Psychiatrists, UK (2010)
- Otras 17 "Fellowships Honorarias' de Asociaciones Médicas y Psiquiátricas Mundiales.
Educación
Medicina & Filosofia (San Marcos, Perú); Filosofía, Psicología, Neurología, Psiquiatría e Historia y Filosofía de la Ciencia de la Universidad de Oxford (bajo la tutela de G. Ryle, C. Webster, A. Crombie, R. Harré, E. Anscombe, B. Farrell, M. Gelder, R. Russell). Como Profesor Asistente en la Universidad de Leeds se entrenó en técnicas estadísticas y modelación matemática con el Profesor Max Hamilton y recibió psicoanálisis didáctico con el profesor Harry Guntrip. Por 10 años fue primer asistente del Profesor Sir Martin Roth en Cambridge.
Contribución académica
Ha publicado más de 440 artículos y 17 libros sobre neuropsiquiatría, psicopatología descriptiva, y la historia y epistemología de la psiquiatría. En 1997, su libro sobre la "Historia de los síntomas mentales" ganó el premio nacional de la Asociación Medica Británica al mejor libro en psiquiatría (traducido al castellano en 2008 FCE, Coreano 2009, etc.). En 2011 publicó "Hacia una Nueva Epistemología de la Psiquiatría" (Buenos Aires, Polemos)
Para más detalles biográficos ver:
http://en.wikipedia.org/wiki/G_E_Berrios
http://www.neuroscience.cam.ac.uk/directory/profile.php?berrios
- Catedrático Emérito de la Epistemología de la Psiquiatría, Universidad de Cambridge
- Fellow Vitalicio, Robinson College, Universidad de Cambridge
- Fellow de la Academia de Ciencias Médicas del Reino Unido
- Fellow del Colegio Real de Psiquiatras del Reino Unido.
- Fellow de la Sociedad Británica de Psicología
- Director de la revista internacional “History of Psychiatry”
Hasta 2007:
- Jefe del Departamento de Neuropsiquiatría de la Universidad de Cambridge (31 años)
- Presidente del Comité de Investigación y Ética de la Universidad de Cambridge (20 años)
- Presidente del Comité de Medicina Psicológica del Hospital de Addenbrooke's (10 años)
- Bibliotecario Mayor del Colegio Real de Psiquiatras del Reino Unido (10 años)
- Encargado del material de lectura de los residentes psiquiátricos del Reino Unido (10 años)
Honores recientes
- Dr. Medicina Honoris Causa, Universidades de: Heidelberg (Alemania); San Marcos (Perú); Barcelona (España); Buenos Aires (Argentina); Córdoba (Argentina); Chile (Chile)
- Cátedra de psicopatología "German Berrios" fundada en Universidad de Antioquia (2006)
- Condecorado por el Gobierno Peruano con la Orden del Sol, grado "Gran Oficial" (2007)
- Premio Ramón y Cajal, International Neuropsychiatric Association (2008)
- Fellow de Honor, Royal College of Psychiatrists, UK (2010)
- Otras 17 "Fellowships Honorarias' de Asociaciones Médicas y Psiquiátricas Mundiales.
Educación
Medicina & Filosofia (San Marcos, Perú); Filosofía, Psicología, Neurología, Psiquiatría e Historia y Filosofía de la Ciencia de la Universidad de Oxford (bajo la tutela de G. Ryle, C. Webster, A. Crombie, R. Harré, E. Anscombe, B. Farrell, M. Gelder, R. Russell). Como Profesor Asistente en la Universidad de Leeds se entrenó en técnicas estadísticas y modelación matemática con el Profesor Max Hamilton y recibió psicoanálisis didáctico con el profesor Harry Guntrip. Por 10 años fue primer asistente del Profesor Sir Martin Roth en Cambridge.
Contribución académica
Ha publicado más de 440 artículos y 17 libros sobre neuropsiquiatría, psicopatología descriptiva, y la historia y epistemología de la psiquiatría. En 1997, su libro sobre la "Historia de los síntomas mentales" ganó el premio nacional de la Asociación Medica Británica al mejor libro en psiquiatría (traducido al castellano en 2008 FCE, Coreano 2009, etc.). En 2011 publicó "Hacia una Nueva Epistemología de la Psiquiatría" (Buenos Aires, Polemos)
Para más detalles biográficos ver:
http://en.wikipedia.org/wiki/G_E_Berrios
http://www.neuroscience.cam.ac.uk/directory/profile.php?berrios
RESUM
The word
Preserving its (agential) meaning of 'active opposition', the term 'resistance' has over the centuries moved freely between mechanics, politics, theology and biology. A metaphorical derivative of the old Greek Antititemi ('set against'), it was translated into Latin as resistentia and it is in this form that it was incorporated into some European vernaculars (French, Spanish, Portuguese, English, etc.). The metaphorical trope has also been preserved by the German Widerstand (stand against).
The concept
Acute and chronic diseases were considered as unrelated entities until the 19th century. By the 1820s, 'acute' and 'chronic' were redefined on the basis of their 'duration' (time) and 'response to treatment' (resistance). This meant that any 'acute' disease could become 'chronic' if it lingered on and did not respond to treatment. In 1895 Freud added to this meaning when he used Widerstand to name the lack of response to hypnosis shown by Lucy R., an English patient being treated for a hysterical rhinitis. Although this usage preserved the original meaning of the concept it did set its agency beyond the control of awareness. The concept has been used since in both dynamic and conventional psychiatry. Since WW2, as confidence grew in the efficacy of biological therapies, those mental disorders that did not respond to treatment also started to be called 'treatment- resistant'.
Ambiguities
A large literature has since accumulated on 'treatment-resistance' but many issues remain unclear: 1) who does the resisting (patient or disease)? 2) is the 'resisting' agential or does it result from intermediate variables alien to the agent? 3) are there many different forms of 'resistance'- if thus, should a taxonomy be constituted? 4) can 'resistance' be meaningfully applied to all forms of therapy or only to biological ones? 5) positive responses considered to be due to placebo (and not to the main treatment) should be considered as forms of resistance? 6) what aspect of the diseased individual should be evaluated to determine 'response' or 'resistance' (symptoms, functionalities, etc.)? 7) what level of certainty should the therapist entertain in regard to the truth of the science underlying both 'treatment' and 'diagnosis' before deciding that the lack of response is due to 'treatment-resistance' rather than to 'pseudo-resistance'?
The future
'Treating' is not an asymmetric act. It does not refer to the action of one empowered agent 'curing' a passive recipient. It is a symmetric process whereby two persons: 1) exchange explanatory narratives about a set of clinical and social problems; 2) when indicated, biological agents may be prescribed. This process takes place against a context imposing upon the negotiators legal, ethical, scientific, emotional, statistical and even aesthetic demands. If this is the case, then the actors should have clear criteria to decide when the 'lack of response to treatment' (description) is in fact 'treatment-resistance' (explanation). These criteria seem clearer in general medicine than in psychiatry. Thus, and given that “non-responsiveness”, “treatment-resistance”, and “pseudo-resistance” carry a different descriptive, explanatory and ethical burden, it should be incumbent upon psychiatry to develop its own regional criteria.
Preserving its (agential) meaning of 'active opposition', the term 'resistance' has over the centuries moved freely between mechanics, politics, theology and biology. A metaphorical derivative of the old Greek Antititemi ('set against'), it was translated into Latin as resistentia and it is in this form that it was incorporated into some European vernaculars (French, Spanish, Portuguese, English, etc.). The metaphorical trope has also been preserved by the German Widerstand (stand against).
The concept
Acute and chronic diseases were considered as unrelated entities until the 19th century. By the 1820s, 'acute' and 'chronic' were redefined on the basis of their 'duration' (time) and 'response to treatment' (resistance). This meant that any 'acute' disease could become 'chronic' if it lingered on and did not respond to treatment. In 1895 Freud added to this meaning when he used Widerstand to name the lack of response to hypnosis shown by Lucy R., an English patient being treated for a hysterical rhinitis. Although this usage preserved the original meaning of the concept it did set its agency beyond the control of awareness. The concept has been used since in both dynamic and conventional psychiatry. Since WW2, as confidence grew in the efficacy of biological therapies, those mental disorders that did not respond to treatment also started to be called 'treatment- resistant'.
Ambiguities
A large literature has since accumulated on 'treatment-resistance' but many issues remain unclear: 1) who does the resisting (patient or disease)? 2) is the 'resisting' agential or does it result from intermediate variables alien to the agent? 3) are there many different forms of 'resistance'- if thus, should a taxonomy be constituted? 4) can 'resistance' be meaningfully applied to all forms of therapy or only to biological ones? 5) positive responses considered to be due to placebo (and not to the main treatment) should be considered as forms of resistance? 6) what aspect of the diseased individual should be evaluated to determine 'response' or 'resistance' (symptoms, functionalities, etc.)? 7) what level of certainty should the therapist entertain in regard to the truth of the science underlying both 'treatment' and 'diagnosis' before deciding that the lack of response is due to 'treatment-resistance' rather than to 'pseudo-resistance'?
The future
'Treating' is not an asymmetric act. It does not refer to the action of one empowered agent 'curing' a passive recipient. It is a symmetric process whereby two persons: 1) exchange explanatory narratives about a set of clinical and social problems; 2) when indicated, biological agents may be prescribed. This process takes place against a context imposing upon the negotiators legal, ethical, scientific, emotional, statistical and even aesthetic demands. If this is the case, then the actors should have clear criteria to decide when the 'lack of response to treatment' (description) is in fact 'treatment-resistance' (explanation). These criteria seem clearer in general medicine than in psychiatry. Thus, and given that “non-responsiveness”, “treatment-resistance”, and “pseudo-resistance” carry a different descriptive, explanatory and ethical burden, it should be incumbent upon psychiatry to develop its own regional criteria.
REFERÈNCIES
[book] Nemeroff CB (ed) (2012) Management of Treatment-Resistant Major Psychiatric disorders. Oxford, Oxford University Press.
[book] Kim YK (ed) (2019) Treatment Resistance in Psychiatry. Berlin, Springer.
[book] Tyrer P, Silk R (2008). Cambridge Textbook of Effective Treatments in Psychiatry. Cambridge University Press
[book] Sánchez-Planell Ll. (2005). Patologías resistentes en psiquiatría. Ars Medica.
[book] Kim YK (ed) (2019) Treatment Resistance in Psychiatry. Berlin, Springer.
[book] Tyrer P, Silk R (2008). Cambridge Textbook of Effective Treatments in Psychiatry. Cambridge University Press
[book] Sánchez-Planell Ll. (2005). Patologías resistentes en psiquiatría. Ars Medica.