Etiology, Pathogenesis, and Therapy According to Pierre Janet concerning Conversion Disorders and Dissociative Disorders
Bühler, Karl-Ernst, Heim, Gerhard, American Journal of Psychotherapy
Pierre Janet's works on conversion disorders or dissociative disorders has mainly fallen to the wayside in favour of Freud's works. In the first part of this paper, Janet's conception of hysteria is discussed and his place in French psychiatry described. Different aspects of Janet's diathesis-stress approach are presented (particularly the pathogenic concept of fixed ideas), which refer not only to a conception of hysteria but also to traumatic (stress) disorders and other psychological disturbances. The second part of the paper details the varieties of Janetian therapeutic treatments of these disorders: the "liquidation" of fixed ideas by hypnosis and suggestion, confrontation techniques, which resemble contemporary cognitive behavioural approaches, and special cognitive ("logagogic") interventions. Finally, we discuss the various treatment strategies based on psychoeconomic considerations such as physical or psycho-phyical therapies, psychoeducation, treatment through rest, and simplification of life for dealing with basic disturbances of psychic disorders.
KEYWORDS: Pierre Janet, hysteria, dissociation, fixed ideas, liquidation, simplification of life
In the last few decades the formation of theories concerning conversion disorders or dissociative disorders was mainly determined by Freudian thought or its derivatives, whereas Pierre Janet's works had fallen into oblivion (though Janet took up his scientific career as philosopher, psychologist, and psychotherapist long before Freud and continued to practise it longer than Freud did). The reason for this disuse may be that Janet's scientific endeavours - like scientific theories in general - was not the starting point for a wider movement. His works were less speculatively conceived than Freud's, which is why they now are appropriate as a starting point at which to reformulate the scientific explanation and treatment of conversion disorders and dissociative disorders (see: Bühler and Heim, 2001).
In the Diagnostic and Statistical Manual of Mental Disorders ([DSMIV-TR] APA, see: Sadock, B. J. and Alcott Sadock, V., eds., 2003) conversion disorders belong to the somatoform disorders whereas dissociative disorders were classified in a category of their own. This split is justified because the symptoms (or deficits) of voluntary motor or sensory function and seizures or convulsions are the essential pathognomonic features of conversion disorders. The psychological factors are assumed to be converted into the bodily symptoms or deficits. In dissociative disorders, however, only psychological symptoms are affected, for example, the memory in dissociative amnesia, the unified consciousness in dissociative fugue, dissociative stupor, or dissociative trance, and identity in dissociative identity or depersonalisation disorder.
JANET'S INTELLECTUAL BACKGROUND AND HIS PLACE IN FRENCH PSYCHIATRY AND MEDICAL PSYCHOLOGY
Janet's intellectual background is marked, first, by his training as to teach philosophy in the tradition of French spiritualistic philosophy. This school of philosophy had an enormous influence in 19£ century France and the politics of science. The principal exponent was Maine de Biran (1766-1824), who stressed - in his "subjective" conception of psychology - emotional and volitive aspects of mental life in contradistinction to contemporary sensualistic conceptions of this science (see: Heim, 2006; Carroy, Ohayon, & Pias, 2006; Sjövall, 1967).
Secondly, positivism, represented by philosophers like Hippolyte Taine and Théodule Ribot, strongly influenced Janet. Particularly, Ribot's contributions, e.g. his treatises on British and German psychology, strengthened the "pathopsycholgical" orientation of French psychology. Ribot believed that Claude Bernard's approach to research in physiology was the model for the new "objective" psychology. In addition, Ribot made G.H. Spencer's evolutionistic philosophy public in France (see: Brooks III, 1998). …