[The loss of human autonomy: utilization and imitative behaviors]

In 1981, when François Lhermitte described utilisation behaviour, his experience was based on 40 patients with bilateral frontal lesions and 5 cases of unilateral lesions. This behaviour was never observed in normal subjects or in patients whose lesions spared the frontal lobes. The description of imitation behaviour followed shortly after. In 1986, of the 125 patients studied, 40 presented an imitation behaviour without utilisation behaviour, 35 had both types of abnormal behaviour and 50 had neither. Continuing his study of patients presenting a frontal syndrome, Lhermitte showed that dependence on objects and dependence on individuals can be prolonged in the form of a dependence on social context which ultimately characterises the loss of autonomy. Lastly, in 1993, he noticed that certain major depressive states gave rise to an utilisation and imitation behaviour similar to the type of behaviour resulting from a frontal syndrome of organic origin. The concept of loss of autonomy must be discussed in relation to the notion of intentionality of the various manifestations of loss of autonomy. Pathological prehension and the grasping reflex no longer provide a satisfactory explanation. Electrophysiology and the study of regional activity in the cerebral cortex associated with the preparation and execution of the movement have led to these phenomena being viewed in a new light. With the concept of loss of autonomy, the distinction between the mechanisms underlying intention and those which modulate actions in response to external demands is now seen to be well-founded. François Lhermitte opened the way.