science, but not without conscience

What’s up Doc? : You are probably the doctor whose books are most often reviewed by our colleagues at Magazine of Philosophy. Does that say anything about you?

Lionel Naccache. : I did not do it never did the thought! But it is true that I write essays that are at the intersection of neurology, neuroscience, and many fields related to the human mind in all its aspects. Without claiming to be a philosopher, I am led to ask questions about, for example, representation, consciousness, the unconscious, etc. Therefore, there is an overlap in philosophical approach.

In your career, what came first: your desire to do medicine or your desire to understand the human mind?

LN. : I’m still a little suspicious of reconstructions, and then I passed the baccalaureate in 1986, everything that happened was quite a long time ago now. But without betraying too much of my approach, I think what interests me is the mind, and its intersection with the physical realm: in other words, what is the biology of the mind? It seemed to me that a path through medicine would give me a rather panoramic vision of the person… Without knowing before what psychiatry or neurology was, for all that it was in this direction that I wanted to go .

In other words, medicine is not a goal for you, but a path?

LN. : In fact, in any case I am not in a vocational process. I’m not a misanthrope! As soon as we discover the possibility that medicine offers to be closer to people affected by the disease, it clearly releases an incredible power… But this is not the first thing that focuses me in the direction this. I think I mostly got the impression that medicine would give me a fairly wide repertoire of possibilities, and that it would allow me to find myself in 1001 professions without having to change my training.

What was medical school and internship like at that time, between the late 1980s and early 1990s?

LN. : I was at Necker College, which has a reputation for being the most science-oriented. I have very good memories of the first year: great teachers, very interesting courses… It is never pleasant to pass a competition, but at Necker, this competition is less focused on “by heart” than in a different place. In the following years, it was mainly the discovery of internships that was very interesting. Moreover, at the end of the second year, I passed the Normale Sup exam, I had to do a course in biology and biochemistry, which allowed me to avoid the internships that I found the most servile for me. focus on mental and nervous disorders: in internships in psychiatry, pediatric neurosurgery and especially in neurology in Salpêtrière, which I like the most.

At the time of your internship, did you decide to do neurology, or were there other possibilities for you?

LN. : At that time, it was fixed. Psychiatry had interested me for some time, but I found that the patient was not very touched by it. I am passionate about being able to address mental issues, including the most immediate aspects of the body, tapping into reflexes, for example… I went through the internship twice to get neurology in Paris. The first time, I was not ranked well, so I did an exciting year of neurology in Lens and Lille.

And during your internship, do you want to have a university course?

LN. : Yes, before the internship, through Normale Sup, I did a master’s degree in biochemistry focusing on neurobiology. I also did an internship in California in molecular neurobiology… And from the internship I became closer to cognitive neuroscience, especially through my meeting with Stanislas Dehaene, with whom I continued my science thesis at INSERM.

Cognitive science is now part of the landscape, but at the time, did you feel like you were doing something that would be important?

LN. : This is the beginning. And in any case, I had the impression that this was exactly what I wanted to do: approach a psychological phenomenon, dissect it with the tools of cognitive psychology, and connect it with the tools of neuroscience. This detour through the brain allows us to reformulate the phenomena we are dealing with in an original way. Take, for example, memory. When we discover that some disorders can affect some forms of memory and not others, that it refers to different brain systems, it changes our concept of memory, which is no longer thought of as monolithic , but plural. So yes, I felt that I was in something very rich, very stimulating, that was quite new.

You have done a lot to introduce the general public to this new field of research, where you are often considered one of the main popularizers. Is it voluntary?

LN. : This is more than a misunderstanding. I admire quality popular science, but I’ve only actually produced one popular science book, which I wrote with my husband: Are you talking brain? This is a proposal following a column I did one summer in the morning of France Inter. My other books are not popular works. It is simply a form of research, which frees itself from the academic side, giving me the opportunity to explore areas outside my areas of expertise. I meet my gaze there, coming from cognitive neuroscience and the question of consciousness, with different questions. In The New Unconsciousit is a matter of inquiry in Freudianism, in The Networkable ManI compared the epileptic seizure of a brain to the phenomenon of globalization… These are not books whose purpose is to explain neuroscience, but go through them to explore other questions.

Sure, but you still have a certain appetite for media, which is not for all hospital-university students…

LN. : It’s true that I respond to the media, but more than the dots. At first I was asked for my books, and I was often asked to come back because I seemed to understand quite a bit (laugh). This probably comes from my way of looking at teaching: I always try to explain what I understand of the phenomenon I’m talking about, of course fitting the time that allows but without straining the discourse.

https://www.whatsupdoc-lemag.fr/article/le-mime-pour-learn-la-neurologie

You have also had some activities in the field of ethics. Why did you choose to get involved in this way?

LN. : I haven’t sat on the National Consultative Ethics Committee (CCNE) since 2021, but it’s been a lot of fun. I did two 4-year terms there. At first they came to take me not as a neurologist, but as a participant who claims to belong to Judaism. In the second term I participated as a neuroscientist. In particular, I participated in debates related to the revision of bioethics laws, and it was fascinating. There is a very important long-term culture at CCNE, which has obviously become somewhat rough during the organization of the general assembly of bioethics law and during the Covid period.

And the upkeep of it all? You are known for your research and books, but do you see patients consistently?

LN. : Of course ! I have a neurology consultation focused on neuropsychology, every week. I would say that this is the clinical activity that I love the most, from the beginning, and it feeds the others. Moreover, while I was working on consciousness, I was able to do an activity on the border between research and medicine, with patients who were awake but not communicating. Finally, I run the clinical neurophysiology department, where we perform functional explorations, and where I do electroencephalography sessions and take care of HDJ.

And how do you see the situation in which the hospital finds itself? Would you encourage your children, for example, to go into medicine?

LN. : My husband and I have two sons who are not doctors, but that is not avoidance. In general, I prefer to encourage people who do medicine, a field where the question of the meaning of what you do is usually not too difficult to resolve. There is some evidence. So, if only from a “selfish” point of view, making medicine remains something very interesting. Beyond that, whenever I have the opportunity, I talk about the current situation of the public hospital, which is dramatic. And I confess that in this matter, I do not know where we are going: I have the impression that we are all a little lost.

Do you think that your type of career, which is so varied, is still possible for today’s young doctors, who are sometimes confined to the corridors?

LN. : It’s quite possible, and even I think that approach is likely to do more than what I’ve done. The awareness of the human sciences during medical studies, for example, is much richer today than it was in my time. On the other hand, gateways and other double courses are more numerous. But I’m not saying it’s simple, especially with the current public hospital anxiety…