Cognitive Optimisation and Schizophrenia: Assembling Heterogeneity, Overcoming the Precariousness of Life, and Challenging Public Health Policies in Psychiatry in France.

Cognitive remediation therapy (CRT) aims to optimise cognitive abilities of people who suffer from schizophrenia in order to improve their social adaptation. This therapeutic orientation was developed in psychiatry in the 1980s and 1990s, at a time when the disorder was being redefined as a neurocognitive deficit disorder. In this article, I describe CRT as an assemblage that lies at the intersection of multiple, overlapping theories and spaces of mental disorders and psychiatric care. To do so, I draw on 18 months of ethnographic research conducted in a French hospital unit dedicated to the development of CRT. I argue that the focus on cognitive health and cognitive abilities (or deficits) is not only redefining the logics of care and reshaping medical conceptualisations of schizophrenia, but it is also opening up to a new understanding of people's precarious life conditions, where emotional, biological, and cognitive fragility is intertwined with social and economic uncertainty. I then examine the extent to which psychiatrists have extended the goals of CRT to include psychosocial rehabilitation in order to mitigate not only the effects of cognitive deficits, but also the effects of limited social and professional integration encountered by patients. Finally, I conclude with a consideration of how CRT has become, for its proponents in France, a means to develop a policy and organisational project for French psychiatry.

The Psychiatric Neuromodulation Unit: Implementation and Management.

The proven effectiveness of neuromodulation and stimulation techniques for the management of psychiatric disorders has brought strongly needed innovation in psychiatry, given the high prevalence and high costs of treatment resistance. Although evidence-based guidelines in neuromodulation have been implemented to improve the clinical efficacy, safety, and research procedures, practical suggestions on how to design a psychiatric neuromodulation unit (PNU) are not available in the scientific literature. In this contribution, we have combined the results of a literature search with the suggestions of clinical psychiatrists, managers, and bioethicists who have had firsthand experience in building a PNU. Eleven key issues concerning the implementation and management of a PNU were identified: general context, team composition, environment, basic technical equipment, clinical versus research activities, target clinical population, education and training, interdisciplinarity, ethical aspects, regulatory and reimbursement issues, fund-raising, and partnership development. Moreover, a business plan comprising pragmatic solutions and recommendations for designing an efficient PNU was laid out.

[The history of the clinical research settlement in French hospitals]. / L'implantation de la recherche clinique à l'hôpital en France : histoire de la création des centres d'investigation clinique.

Since 1992, French clinical research centers (CRC) allow physicians and researchers to develop clinical and therapeutic research on humans in public hospitals. Created by the National institute for health and medical research (Inserm) in collaboration with public hospitals, their history give us the opportunity to describe the complex interactions in France between fundamental and clinical research. Why does therapeutic research need CRC? What can be done in these structures that cannot be done in hospital wards? Medical research is an hybrid practice torn between fundamental and clinical methodologies and objectives. To solve this tension, CRC are << trading zones >> (Galison, 1997): intermediate areas where physicians and researchers can develop -common languages and methodologies to coordinate their practices and objectives. CRC also become essential to support the ethical, legal and administrative constraints of therapeutic research. double dagger.

Animal Models and Animal Experimentation in the Development of Deep Brain Stimulation: From a Specific Controversy to a Multidimensional Debate.

In this article, we explore a specific controversy about animal experimentation and animal models in the recent history of deep brain stimulation (DBS), and we question its ramifications. DBS development intertwines clinical practice with fundamental research and stands at the crossroads of multiple legacies. We take up the various issues and controversies embedded in this rarely addressed dispute, from a standpoint that combines socio-anthropological and legal aspects. Our starting point is a debate on the role of animal experimentation in the development of DBS between Jarrod Bailey, a researcher promoting the abolition of animal experimentation, and Alim Louis Benabid, Marwan Hariz, and Mahlon DeLong, three key figures in the area of DBS and neuroscience. By clarifying the positions of the different protagonists and retracing the issues raised in these discussions, our objective is to show how this specific debate has extended from its initial space and how it provides an object of study with heuristic scope. We first present this partially polemic discussion about the history of DBS, and its link with a more general debate on the validity and use of animal models and the need for animal experiments. Then, we raise the issue of the relations and interactions between experiments on animals and on humans in the logics of biomedical innovation. The third step is to situate the discussion within the wider framework of opposition towards animal experimentation and the promotion of animal' rights. Finally, combining these interweaved issues, possible implications emerge regarding the future of DBS. We show that behind these several controversies lie the question of translational research and the model of medicine upheld by DBS. We describe how the technology contributes to blurring the lines between research (fundamental, preclinical and clinical research) and care, as well as between humans and animals as substrates and objects of knowledge. The dynamics of DBS future development might then become a point of convergence for neuroscientists and animal rights defenders' interests.

Neuromodulation Technologies and the Regulation of Forms of Life: Exploring, Treating, Enhancing.

Deep brain stimulation (DBS) is one of the most innovative treatments for a range of neurological and psychiatric conditions. As the practice spreads worldwide, this invasive neurosurgical technology has become the subject of major social, scientific, and ethical concerns about its regulation. In this article, I describe its implementation in a French neuroscience ward and the different forms of practice that structure and promote the development and circulation of this neuromodulation technology. I explore how alternative experimental uses of DBS and deviations from its original therapeutic objectives both interfere with and promote its dissemination. At first, it appeared that neuroscientists could use DBS as a powerful tool to create reproducible experimental human models of emotional or behavioral symptoms so as to explore the functions of the human brain in vivo. In parallel, implanted patients influenced the care program by viewing DBS as a potential technology of self-enhancement for a wide range of personal situations. These alternative uses of DBS have challenged its modes of regulation and standardization and have raised new medical, scientific, and moral controversies. These concern not only ethical and methodological norms of medical and scientific practices but also the anthropological tensions raised by the forms of life that are emerging from neuroscience and experimental practices.