Santé et pathologie au prisme du milieu : les ambivalences de la pensée de Kurt Goldstein

Abstract

Kurt Goldstein’s thinking on health and disease is based on the concept of milieu [Umwelt], which he inherited from the ethologist Jacob von Uexküll, while at the same time reforming the concept in an original way. Goldstein’s interpretation of the organism-environment relationship emphasises the dynamic nature of this relationship and the reciprocal structuring of the two poles; this hypothesis forms the basis of his original conception of pathology as the shrinking of the patient’s environment. The German neurologist’s position is characterized by the ambivalence that runs through his conceptions of pathology and health, and which gives his thought its richness. On the one hand, ordered behaviour is a necessary condition for the patient’s adaptation to a new relationship with the environment, but it may also be pathogenic if it is aimed at self-preservation only. On the other hand, according to Goldstein, health is, in a first sense, a tendency of the organism to actualise its own capacities, even in a situation of illness; in the second sense, it is a tendency towards expansion and self-actualization that goes beyond the aim of constituting an adequate environment for the organism.