Prof. German E. Berrios
Cambridge University, United Kingdom
| Talk | "Non-responsiveness", "Treatment-resistance", "Pseudo-resistance" |
| Date | Thursday, April 25th, 2019 |
| Time | 16:15 to 16:45 |
BIOGRAPHY
Education:
Neuropsychiatry and clinical, conceptual and historical aspects of psychopathology. More than 450 papers and book chapters on matters neuropsychiatric, conceptual and historical and 15 books; amongst the latter are his History of Clinical Psychiatry (with Roy Porter) (London, Athlone Press) London; Delirio: Historia, Clinica & Metateoria (with F. Fuentenebro); Memory Disorders in Psychiatric Practice, Cambridge, Cambridge University Press) (with J. Hodges) and Reinventing depression (Oxford University Press) (with C Callahan). His History of Mental Symptoms. Descriptive Psychopathology since the 19thC century (Cambridge University Press) was awarded the 1997 British Medical Association Prize as the Best Book in Psychiatry. In 2011 he published Towards a New Epistemology of Psychiatry (Buenos Aires, Polemos, 2011) (Italian translation: Per una nouva epistemologia della psichiatria, Roma, Giovanni Fioriti, 2013; Portuguese Translation: Rumo a uma nova epistemologia da psiquiatría, 2015).
Sources:
http://en.wikipedia.org/wiki/G_E_Berrios
http://www.neuroscience.cam.ac.uk/directory/profile.php?berrios
- Psychology and Philosophy at Corpus Christi College, Oxford University (under J.O. Urmson, B Farrell, R Hare, E. Anscombe, G. Ryle)
- History & Philosophy of Science (under C. Webster, A. Crombie, R. Harré, and B. Farrell)
- Medicine, Neurology & Psychiatry (Oxford University and Oxford United Hospitals)
- Statistics (Lecturer to Professor Max Hamilton at Leeds University)
- Didactic Analysis (Harry Guntrip, Leeds University).
- 1977-2007 Lecturer, Reader, Professor of Neuropsychiatry and the Epistemology of Psychiatry (Cambridge University)
- 1978-1998 Director of Medical Studies and Tutor of Admissions, Robinson College Cambridge.
- 1977-2007 Consultant Head of Neuropsychiatry, Addenbrooke's Hospital, University of Cambridge
- 1985-1995 Honorary Librarian and Officer of the Royal College of Psychiatrists
- 1989-1998 Assistant Editor of the British Journal of Psychiatry.
- 1987-2003 Founder and Chairman of the History of Psychiatry Special Group, Royal College of Psychiatrists
- 1988-1997 Chairman, Board of Department of History and Philosophy of Science, University of Cambridge
- 1987-2007 Chairman, Research and Ethics Committee, University of Cambridge and Cambridge Health District
- Doctorates Honoris causa: University of Heidelberg (Germany), San Marcos (Peru), Barcelona (Spain), Buenos Aires (Argentina), Cordoba (Argentina), Chile (Chile).
- 2006 Chair of Psychopathology “German E. Berrios” founded in the University of Antioquia (Colombia)
- 2007 Order of the Sun (Gran Officer) awarded by the Peruvian Government
- 2008 ‘Ramon y Cajal’ Neuropsychiatry Award, International Neuropsychiatry Association.
- 2010 Honorary Fellowship awarded by Royal College of Psychiatrists of UK.
- 2016 Life Achievement Award, Sociedad Española de Psicogeriatría.
- 2017 Honorio Delgado Medal, Lima, Peru
- Visiting Professor to the Universities of Hong-Kong, Heidelberg, Würzburg, Cayetano Heredia, Nagoya, Jerusalem, Cornell, Adelaide, Chile, Buenos Aires, Keio (Japan), etc.
- Emeritus Professor of the Epistemology of Psychiatry, University of Cambridge
- Emeritus Consultant Neuropsychiatrist & Head of Neuropsychiatry, Addenbrooke’s Hospital, University of Cambridge
- Fellow of: 1) British Psychological Society; 2) Academy of Medical Sciences; 3) Royal College of Psychiatrists, etc.
- Life-Fellow, Robinson College, Cambridge
- Editor, History of Psychiatry
- Chairman, History of Psychiatry Section, World Psychiatric Association
Neuropsychiatry and clinical, conceptual and historical aspects of psychopathology. More than 450 papers and book chapters on matters neuropsychiatric, conceptual and historical and 15 books; amongst the latter are his History of Clinical Psychiatry (with Roy Porter) (London, Athlone Press) London; Delirio: Historia, Clinica & Metateoria (with F. Fuentenebro); Memory Disorders in Psychiatric Practice, Cambridge, Cambridge University Press) (with J. Hodges) and Reinventing depression (Oxford University Press) (with C Callahan). His History of Mental Symptoms. Descriptive Psychopathology since the 19thC century (Cambridge University Press) was awarded the 1997 British Medical Association Prize as the Best Book in Psychiatry. In 2011 he published Towards a New Epistemology of Psychiatry (Buenos Aires, Polemos, 2011) (Italian translation: Per una nouva epistemologia della psichiatria, Roma, Giovanni Fioriti, 2013; Portuguese Translation: Rumo a uma nova epistemologia da psiquiatría, 2015).
Sources:
http://en.wikipedia.org/wiki/G_E_Berrios
http://www.neuroscience.cam.ac.uk/directory/profile.php?berrios
ABSTRACT
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.
REFERENCES
[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.