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Kurt Goldstein, the milieu and the clinic

Special issue of Philosophia Scientiæ 28/3 (November 2024)

Editors: Agathe Camus, Marco Dal Pozzolo, Charlotte Gilart de Keranflec’h

Submission Deadline: June 1st 2023

Acceptance Notification: October 1st 2023

Final Version due: April 1st 2024

Address for submission:agathe.camus@u-paris.fr, marco.dal-pozzolo@u-bourgogne.fr, charlotte.gilartdekeranflech@hesav.ch

Call for papers

This special issue aims to explore the multiple facets of the work and practice of neuropsychiatrist Kurt Goldstein (1878-1965) through the prism of the notion of milieu, central to him, both at the conceptual and theoretical level and in his practice of neurorehabilitation. Related to this notion of milieu, of particular attention will be Goldstein’s clinical approach and the role he made clinical data play as a starting point for any theorization.

We aim to approach Kurt Goldstein’s work from various philosophical perspectives and approaches (history and philosophy of science, epistemology, ethics, philosophy of care and medicine, etc.), insisting on their necessary articulation. We will emphasize the originality of his approach and his concepts and of making them the object of new readings. In this sense, it will be interesting to mobilize some of these theoretical resources and to test their topicality and fecundity in contemporary fields of reflection, in continuity with the suggestion made by Marie Gaille, according to which Goldstein’s thought can, “contribute to questioning the so-called obvious in the field of the clinic today, of the socio-political organization of care and the raising of anthropological questions.” (Gaille, in Goldstein 2021, p. 23)

The figure of Kurt Goldstein escapes labels. His work remains today a fertile source of questioning. One of the most eminent neurologists of Weimar Germany (Borck, 2020), he is notably known for his work on aphasia and his complex relationship to cerebral localization, but also for his singular approach combining meticulous clinical examinations of individual patients with far-reaching theoretical conclusions, which fed into his magnum opus Der Aufbau des Organismus and are extended into a philosophical anthropology (Gaille in Goldstein, 2021). Although he was not himself a philosopher, Goldstein’s thought and work inspired philosophers and he himself drew on the philosophical heritage to develop his holistic conception of the organism and of human nature. His work also influenced American psychiatry and psychology, an influence reinforced by his forced emigration to the United States and the need to reestablish his professional position in a new intellectual and scientific landscape.

Without being limited to these themes, contributions may explore the following axes:

1. Goldstein and the cerebral injury clinic: scientific foundation of neurorehabilitation

Goldstein’s work in neurorehabilitation concerns the whole of neurological life from a pathogenic perspective. Whatever the neurological disorder studied (aphasia, apraxia, acalculia, hemianopia, neglect, amnesia, dysexecutive syndrome, etc.), Goldstein describes it in the totality and extent of its behavioral expression in the individual patient. Contributions with a focus on the links between the accumulated knowledge in neurology, neurosurgery, neuroanatomy, neurorehabilitation and Goldstein’s holistic perspective are therefore welcome. At the Institut zur Erforschung der Folgeerscheinungen von Hirnverletzungen at the Sommerhoff hospital, Goldstein and his colleagues are working to find empirically based therapeutic solutions and support for brain-damaged patients in their quest for a good life. These contributions may explore the articulation between the different methodological modalities of empirical research carried out at the Institute and their translation into care modalities.

Finally, Goldstein’s practice at the Sommerhoff opened medicine to the definition of a new form of care: rehabilitative care. At the Institute, Goldstein led neurology to become an “interdisciplinary” field requiring the deployment of broadened competencies (psychiatry, psychotherapy, neurosurgery, nursing, etc.) to accompany the experiences of chronic disabilities affecting the physical, cognitive, psychic, affective or social capacities of patients with brain injuries. These contributions will explore the links between research in rehabilitative care, care plasticity and care theories.

2. The milieu from a theoretical and practical point of view

Goldstein participates in the German anti-positivist turn of the concept of milieu, which is constituted in reaction to the French perspectives of the previous century (such as those of Auguste Comte or Hippolyte Taine). In particular, it takes up the concept of Umwelt of Jacob Von Uexküll (Von Uexküll, 1965) and the distinction between the geographic and behavioral environment of Kurt Koffka (Koffka, 1935) in an original way and proposes a plastic conception of the milieu: structurally coupled to the organism, it is continuously reworked by the behaviors of this one, according to a relationship of co-implication. The organism-environment complex may be questioned in order to shed light on the concepts of health and disease, as a conceptual device that makes it possible to grasp the originality of the Goldsteinian position. It would also be welcome to develop the relational, even dialectical, conception of the relationship between the living being and its environment, according to the model of the debate (Auseinandersetzung).

This conception has largely influenced the French reception of Goldstein and creates environmental interpretations of his work, as well as to reflections integrating the philosophy and the engineering of techniques in the service of the neuro-disabled, or the philosophy of care. Contributions in this area would be welcomed, as well as those that question the rich semantics that designate the relationship of the organism to the milieu. The dynamic character of the idea of adequacy (Adäquatheit) and the plurality of situations to which it is applied in Goldstein’s work could be the object of interrogations concerning epistemology, ethics and conceptual history.

3. Psychiatry, psychology and psychoanalysis

Trained in psychiatry, known for his attention to the psychological effects of brain injury, Goldstein has a close and evolving relationship with psychiatry, psychology, but also psychoanalysis. The place that these play in Goldstein’s clinical practice and work can be questioned, given that it has largely evolved over time (Ferrario and Corsi, 2013), his emigration to the United States in particular marking an inflection in his relationship to psychoanalysis. The reception of his work in these different fields can be studied. The importance of Goldstein for psychotherapy, for example, and the use of certain concepts developed by Goldstein - such as that of “self-actualization” - by American psychologists can be questioned. Contributions on Goldstein’s dialogue with psychology and psychiatry prior to his arrival in the United States, on the complex relationship between Goldstein and Gestalt psychology, or on the influence of his work and his critique of Freud on currents such as French anti-psychiatry or institutional psychotherapy are welcome.

4. Towards an ethics and a philosophical anthropology?

The approach adopted by Goldstein and his colleagues at the Institute, which was focused on research into brain injuries but also on the care of brain damaged patients in a therapeutic perspective in the broadest sense and in relation to the idea of a life “worth living,” despite the incurable nature of certain after-effects and the shock created by war wounds, testifies to a clinical requirement that we would readily describe today as ethical (Gilart de Keranflec’h in Goldstein, 2021). Goldstein’s ethical position towards medical practice, and more broadly towards science (Ferrario and Corsi, 2013), may be questioned.

Goldstein’s casuistic approach carries an ethical requirement in medicine. Research could focus on the importance of emblematic cases that influence, enrich or confront the work with its own epistemological or ontological postulates. Finally, Goldstein is also seen by some as a “clinician-philosopher” who exemplifies “what science and practice can be when both are undergirded by a deep philosophical understanding of human nature.” (Pickren, 2003) Goldstein’s relationship with philosophical thought, and the extension of his thought, particularly in his American period, into a ”philosophical anthropology" (Goldstein, 1959; Thermoz, 1978) may also be explored.

This call for papers follows a seminar held on May 13, 2022 at the University of Dijon, organized by Marco Dal Pozzolo (LIR3S UMR 7366, Université de Bourgogne) and Agathe Camus (SPHere UMR 7219, Université Paris Cité/CNRS). This workshop was supported by the Healthcare Values Chair at the University Lyon III, the laboratories LIR3S UMR 7366 (Université de Bourgogne - CNRS) and Sphere UMR 7219 (Université Paris Cité - CNRS), the doctoral school Sept UBFC and the Epiphinore project n°ANR-20-CE36-0007-01

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