Call for paper – L’éclatement des dispositifs de santé mentale. Regards croisés France-Angleterre

L’objectif de la journée d’étude est de réunir des chercheurs venant de différentes disciplines des sciences sociales et travaillant sur les conséquences sociales des troubles psychiques. Si de nombreux travaux ont contribué à une meilleure compréhension des politiques de déhospitalisation psychiatrique en France et en Angleterre, ils sont le plus souvent centrés sur les recompositions professionnelles qui en découlent. Peu se sont intéressés à la multiplication des dispositifs de prise en charge et à l’imbrication complexe des pratiques de soin et des pratiques d’insertion sociale. Si des travaux récents
ont étudié le quotidien des personnes souffrant de troubles psychiques, ils ne visaient pas à interroger systématiquement les nouvelles articulations avec le secteur de l’action sociale et avec les nouveaux acteurs concernés. La journée entend donc fournir un lieu de réflexion collective autour de ces nouvelles configurations des politiques psychiatriques et d’action sociale.

L’organisation sociale de la prise en charge des troubles psychiatriques s’est considérablement transformée depuis un demi-siècle, et ce, dans la plupart des pays qui avaient developpé comme solution l’internement asilaire. Parmi les nombreuses raisons de cette transformation se trouvent les critiques, notamment provenant des sciences humaines, du traitement et de la place sociale donnés aux malades qui étaient amenés à vivre de manière chronique dans les établissement de soins. Les politiques de déhospitalisation ont transformé la place sociale des personnes souffrant de troubles psychiques. Celles-ci ne sont plus éloignées de manière definitive de la vie sociale. Les troubles psychiques et leurs conséquences sociales sont dès lors régulés autrement, non seulement par des professionnels de la psychiatrie, mais aussi par de nombreux autres acteurs de la vie sociale. Pour autant, la question de la place sociale des personnes souffrant de troubles psychiques demeure plus que jamais problématique. La multiplication des dispositifs de prise en charge a une importance considérable dans la vie des personnes confrontées à  ces troubles qui se rencontrent bien souvent dans les différents mondes sociaux qu’ils traversent, des “mini-institutions” ou des lieux semi-institutionnels censés leur apporter une aide, mais qui de fait participent plus à une multiplication  des formes de stigmatisation. Comment alors saisir cette nouvelle configuration de l’articulation des politiques psychiatriques, sociales qui expriment non seulement des recompositions affectant les acteurs de la psychiatrie, mais aussi et surtout des évolutions dans la place donnée aux dépendances et à l’autonomie des personnes?

Les transformations observées sont concomitantes dans différents pays, alors même que les contextes culturels et sociaux varient. Pour appréhender ces recompositions, la journée entend faire place à trois types d’approches :
– Une approche comparative – En raison du contraste fort dans le rôle de l’Etat dans les politiques sociales et de santé, et des transmissions de pratiques existent entre les deux pays, les comparaisons France/Angleterre seront particulièrement privilégiées, notamment la discussion du rôle et de la portée des notions de “sectorisation” et de “community care”;
– une approche socio-historique – Si le contexte des politiques de déhospitalisation est connu, la progressivité de leur mise en oeuvre l’est moins.  On s’interrogera ici sur le devenir pratique des politiques de déhospitalisation en observant particulièrement  comment elles se sont confrontées aux politiques d’insertion (emploi, logement, etc.), aux différents acteurs concernés (les proches, les familles), à l’importance prise par les “usagers”, mais aussi à la politisation des enjeux sécuritaires;
– une approche ethnographique – Les questionnements sur la place sociale prise par les personnes souffrant de troubles psychiques passe par une observation du vécu des personnes confrontées à ces multiples institutions et à l’usage qu’elles en font dans leur parcours.

Afin de décentrer le regard, les échanges entre praticiens, usagers et chercheurs seront d’ailleurs encouragés par l’invitation pour chaque session de la journée d’un discutant scientifique et d’un témoin.

Pour plus d’information, cliquez ici.

International Conference on the History and Heritage of Psychiatry – Dangerously young

The 3rd International Conference on the History and Heritage of Psychiatry (28 and 29 April 2011)

Dr. Guislain Museum, Ghent, Belgium

Dangerously young – Child and Adolescent Psychiatry from a Historical Perspective

Children and youth take up a special position in today’s society. On the one hand they are described as ‘the future generation’, on the other hand they are increasingly regarded as a threat and a danger to society. As a result, children are constantly examined with an incessant question in mind: ‘Is this child normal?’.

The 3rd International Conference wishes to place this topic within a historical perspective with lectures on the history and evolution of child and adolescent psychiatry. Internationally renowned speakers from various disciplines will share their insights from a historical, medical, pedagogical, psychological and cultural angle.

The Dr. Guislain Museum opens the debate during a two day conference in Ghent. The museum owns a fascinating compilation on this theme, including: a medical collection, a photo collection and a collection of outsider art.

Lectures will be simultaneously interpreted in Dutch, French and English.

For more information, click here.

Jacques Côté – Dans le quartier des agités

Une nouvelle série policière choisit l’histoire de la psychiatrie à la fin du 19e siècle comme cadre. L’éditeur présente la série et le premier volume comme suit:

La série

Cette série se déroule de 1885 à 1918. Elle a comme personnage central le docteur Georges Villeneuve, un aliéniste montréalais qui fut l’un des pionniers de la médecine légale au Québec. La série met en scène le lieutenant Lafontaine, policier de la ville de Montréal, qu’on retrouvera, tout comme le docteur Wyatt Johnston, dans quelques enquêtes. Chacun des romans met l’accent sur une affaire principale, mais le lecteur découvre également ce qu’est la vie asilaire, les morgues du XIXe siècle, les avancées et les lacunes de la médecine en matière médico-légale, la vie à Montréal durant la Belle Époque, etc.

Le premier tome

Dans le quartier des agités Paris, juillet 1889. Villeneuve a complété ses études en médecine. Désireux de se spécialiser en médecine légale des aliénés, il se rend à l’asile Sainte-Anne de Paris pour étudier sous Magnan et à la Salpêtrière avec Charcot. Il en profite pour assister au cours de Brouardel à la morgue de Paris et suit les formations de Mégnin en entomologie judiciaire.

À la veille d’un congrès de médecine mentale, le docteur Magnan confie à son jeune interne le suivi d’un malade que l’on croit être l’égorgeur d’une prostituée, et qui se réfugie dans le silence et refuse de s’alimenter. Magnan, qui a la réputation de protéger les aliénés contre une justice expéditive, doit freiner les ardeurs du commissaire Goron qui croit détenir l’assassin surnommé le coupeur de nattes. Villeneuve se met en quête de l’identité de l’aliéné, mais aussi du bon Samaritain qui a conduit l’homme à l’asile et qui en sait peut-être beaucoup sur le meurtre. Cette enquête le mènera sur le chemin d’un être fascinant et décadent…

New issue – History of Psychiatry

The March 2011 issue of History of Psychiatry is now out and includes the following articles:

“The mental health sector and the social sciences in post-World War II USA. Part 1: Total war and its aftermath” (Andrew Scull)

This paper examines the impact of World War II and its aftermath on the mental health sector, and traces the resulting transformations in US psychiatry and psychology. Focusing on the years between 1940 and 1970, it analyses the growing federal role in funding training and research in the mental health sector, the dominance of psychoanalysis within psychiatry in these years, and the parallel changes that occurred in both academic and clinical psychology.

“From social pathologies to individual psyches: psychiatry navigating socio-political currents in 20th-century Latvia” (Agita Luse)

The paper explores psychiatry’s responses to the twentieth-century socio-political currents in Latvia by focusing on social objectives, clinical ideologies, and institutional contexts of Soviet mental health care. The tradition of German biological psychiatry in which Baltic psychiatrists had been trained blended well with the materialistic monism of Soviet psychoneurology. Pavlov’s teaching of the second signal system was well suited to Soviet ideological needs: speech stimuli were seen as a vehicle for moulding the individual’s mind. The transformation in diagnostic practices during the 1970s and 1980s reflected the demise of optimism about the capacity of the self to model itself to the needs of the society. Latvian psychiatry was prepared to embrace more individualistic and pessimistic theories of the self.

“‘Good in all respects’: appearance and dress at Staffordshire County Lunatic Asylum, 1818-54″ (Rebecca Wynter)

Dress was integral to the ideals and practice of Staffordshire County Lunatic Asylum, an institution catering for all social classes. Lunatics’ appearance was used to gauge the standard of care inside the asylum and beyond. Clothing was essential for moral treatment and physical health. It helped to denote social and institutional class: clothes were integral to paupers’ admission; rich patients spent time and money dressing; for disturbed inmates and those who destroyed asylum attire, the consequence could be ‘secure dress’, which was fundamental to therapeutics. Later, when an ethos of non-restraint was introduced, the superintendent used patients’ appearance to propagate an image of his enlightened care.

“Sexuality and psychoanalytic aggrandisement: Freud’s 1908 theory of cultural history” (Patricia Cotti)

In 1908, in his article ‘“Civilized” sexual morality and modern nervous illness’, Freud presented neuroses as the consequence of a restrictive state of cultural development and its ‘civilized morality’. He found the inspiration for this idea by expanding upon previous formulations in this area by his predecessors (notably Christian von Ehrenfels) that focused on a cultural process earlier introduced by Kant, while also integrating in his analysis the principles of Haeckel’s evolutionism (history of development, recapitulation) which eventually re-defined the psychoanalytic theory of neuroses. These new theoretical elements became the basis of psychoanalytic theory and thereby influenced subsequent thinking in the cultural process itself and in human sciences. This transformation of underlying theory provided a unique historical and analytical framework for psychoanalysis which allowed Freud to claim for it a pre-eminent position among the human sciences.

“Infanticide in Mecklenburg and Western Pomerania: documents from four centuries (1570—1842)” (Günther Häßler and Frank Häßler)

In this study we present an unprecedented comprehensive overview of cases of infanticide in the region of Mecklenburg-Western Pomerania, from the end of the 16th century to the middle of the 19th century. Using the Faculty of Law’s verdict files stored in the University of Rostock’s archives, we analysed and evaluated 362 cases. Changes in the prosecution of this crime, in the way the trials were conducted and in the passing of sentences illustrate the judicial conceptions of the academics, as well as being of great social interest. For the almost exclusively female defendants, behavioural patterns occurred repeatedly: shame, confusion and hopelessness triggered concealment of the pregnancy and ultimately the deliberate or negligent killing of the newborn child.

“Vitamins for the soul: John Bowlby’s thesis of maternal deprivation, biomedical metaphors and the deficiency model of disease” (Eduardo Duniec and Mical Raz)

In 1951 John Bowlby, British psychoanalyst and child psychiatrist, published his now famous report, Maternal Care and Mental Health, commissioned by the World Health Organization. In this report, Bowlby coined the term ‘maternal deprivation’, which quickly permeated into Western psychiatry and psychology. The implications of Bowlby’s writings, while widely criticized and contested, generated a considerable amount of research and brought about significant changes in perceptions of separation between children and their mothers. This article examines the origins of the ‘maternal deprivation’ hypothesis, focusing on how the deficiency theory of disease influenced psychiatric discourse, and framed Bowlby’s theory of maternal care. We argue that developments in paediatric medicine, and particularly in the field of nutritional deficiencies, provided Bowlby a prototype for conceptualizing his early views on the psychological needs of children and the development of psychopathology.

A complete table of content can be found at http://hpy.sagepub.com/content/vol22/issue1/?etoc

New issue – History of the Human Sciences

hist human sciencesThe February 2011 issue of History of the Human Sciences is now out and includes an article by Anne Sealey entitled “The strange case of the Freudian case history: the role of long case histories in the development of psychoanalysis”. The abstract reads:

Sigmund Freud’s five long case histories have been the focus of seemingly endless fascination and criticism. This article examines how the long case-history genre developed and its impact on the professionalization of psychoanalysis. It argues that the long case histories, using a distinctive form that highlighted the peculiarities of psychoanalytic theory, served as exemplars in the discipline. In doing so, the article extends John Forrester’s work on ‘thinking in cases’ to show the practical implications of that style of reasoning. The article illustrates how the form disappeared once the theoretical basis of the movement was set. The genre never became institutionalized, although the content of the five long case histories did, because of Freud’s accepted role as theoretician of psychoanalysis.

Another article, by Stewart Justman, is entitled “From medicine to psychotherapy: the placebo effect” and its abstract reads:

If placebos have been squeezed out of medicine to the point where their official place is in clinical trials designed to identify their own confounding effect, the placebo effect nevertheless thrives in psychotherapy. Not only does psychotherapy dispose of placebo effects that are less available to medicine as it becomes increasingly technological and preoccupied with body parts, but factors of the sort inhibiting the use of placebos in medicine have no equivalent in psychology. Medicine today is disturbed by the placebo effect in a way psychotherapy is not. Psychotherapy does not have to grapple with such a disconcerting paradox as successful sham surgery, and unlike those physicians who once pretended to treat the patient’s body while actually attempting to treat the mind, the psychotherapist can treat the mind in all frankness. Perhaps it is because psychotherapy is less burdened by doubts about the placebo effect that it was able to come to its aid when it was orphaned by medicine. It is vain to expect something with so long a history as the placebo effect to disappear from the practices of healing.

More information, as well as a complete table of contents, can be found at here.

The Tucson Shooter and Media Coverage

Psychiatric Times has posted the monthly installment of our contribution from H-Madness.  This month, co-editor of H-Madness Greg Eghigian discusses debating the impact of media coverage of Jared Loughner’s lethal shooting in Tucson, AZ.   We post it here below, with minor revisions, for your convenience.

Jared Loughner, Mental Illness, and the Media:  Debating the Potential Impact of Media Coverage

By Greg Eghigian

On January 24, Ronald Pies posted a thoughtful piece here entitled “Who Can Forgive Jared Loughner,” advocating the importance of relinquishing hatred in cases like the ones in Tucson and transforming “our revulsion and rage into something higher and nobler.”  The piece represents one of among many – albeit, among the more considered and deliberate – responses to the events in Tucson.  As we all have witnessed, Jared Loughner’s lethal violence sparked a wave of highly publicized reactions from journalists, government officials, political activists, the public-at-large, and, of course, mental health professionals.   Whenever horrendous and shocking events like these occur, it is perhaps not altogether surprising that people search for meanings and explanations.  Officials and the public, in particular, are often prone to look for “lessons” to take away from such tragedies, hoping to pin blame or responsibility on something (not just someone), so that it can be legislatively eliminated or regulated.  A peculiar logic stamps our political culture, by which exceptions tend to make the rules.

Among my colleagues and friends, Jared Loughner and the shooting in Tucson provoked a rather passionate debate.  The issue that triggered this debate was the media’s coverage of the situation – in particular, its treatment of Loughner’s mental status.  As reports started coming out chronicling Loughner’s verbose texts, unsettling social interactions, and odd videos, the question of whether he suffered from a mental illness was raised.   For a number of my colleagues, this led them to raise (often rhetorical) questions about the quality of mental health care in the country and in Arizona in particular.  To be sure, most everyone I know regarded the case as more evidence for the need to place greater controls over the distribution and ownership of guns.  But in light of the recent political fights over health care, the fact that a mentally ill man was allowed to carry on in the way Loughner did for years without any apparent medical intervention was perceived as a travesty.  And, in fact, one colleague of mine accused reporters of being equally complicit in neglecting the matter of mental health care, because they were not discussing Loughner in clinical terms, but rather referring to him in colloquial terms such as “odd,” “extremist,” and “unstable.”

I must admit, my reaction was more along the lines of Vaughan Bell’s, a clinical and research psychologist at King’s College London and a blogger at mindhacks.com, who lamented in a piece he wrote for Slate:

For many, the investigation will stop there. No need to explore personal motives, out-of-control grievances or distorted political anger. The mere mention of mental illness is explanation enough. This presumed link between psychiatric disorders and violence has become so entrenched in the public consciousness that the entire weight of the medical evidence is unable to shift it.  Severe mental illness, on its own, is not an explanation for violence, but don’t expect to hear that from the media in the coming weeks.

Like Bell, I was worried by (1) how quickly reporters and the public were willing to categorize Loughner as mentally ill and (2) how easily those same observers found it to assume a connection between mental illness and the commission of violent acts. With little and potentially unreliable information about him to go on, pundits and other observers felt free to attribute Loughner’s behavior to a psychopathology (most appeared to quickly fix on schizophrenia).  Now, I was certainly willing to concede that it might well turn out that he was, indeed, suffering from a diagnosable mental illness. But my experience with clinicians over the years tells me that responsible professionals would be loathe to apply a diagnosis to someone (1) with only incomplete, hearsay information to go on and (2) without an opportunity to directly meet with the individual.

I therefore read Bell’s piece as a cautionary, not a categorical, statement.  As the media has historically shown time and again, they and the public are prone to seeing things in the simple terms “strangeness = instability = crazy = threat = menace,” much to the detriment of those suffering from mental illnesses and any variety of other disabilities. Bell reminds us that the vast majority of those suffering from mental illness pose no threat to others: on the contrary, they are more likely to be victims of crime and abuse than perpetrators.  Moreover, as Dave Cullen has masterfully shown in his book Columbine, early reports on shocking events like those in Tucson are often pockmarked with errors – errors which get repeated so often and so quickly, that they remain largely insusceptible to correction.  So, it seems to me, especially in the frantic immediacy of fast-moving, troubling events, it is critical that we approach these matters in a restrained fashion, insisting on careful analysis and guarded conclusions based on evidence from multiple sources.

One of my colleagues, however, disagreed with my (and Bell’s) perspective.  As someone with a family member diagnosed with schizophrenia, she argued that Bell’s and my position did a disservice to those battling serious mental disorders.  A study of high-profile or celebrity shootings over the last fifteen years, she insisted, would invariably show that the perpetrators were mentally ill.  By neglecting this reality, by de-pathologizing people like Loughner, she continued, I was playing in the hands of retributive prosecutors, reinforcing their self-serving image of Loughner and others like him as evil monsters.  Thus, the position I and Bell have staked out presumably serves only to promote ignorance about mental illness.

I have tried to take these comments to heart.  Mulling this over, I think my colleague has hit on something.  To not raise informed mental health concerns in the immediate aftermath of situations like the one in Tucson runs the risk of ceding valuable media time and space to other, potentially stigmatizing outlooks.  That said, psychopathologizing behavior has not consistently led to the acceptance of vulnerable populations: in this regard, one need only look at the modern history of homosexuality for an historical precedent.  What I feared was that the one “lesson” Americans would come away with from Jared Loughner’s story was that the mentally ill were dangerous.   And sure enough, as frenetic discussions simmered down, in the wake of the funerals of Loughner’s victims and the rise of other breaking news stories, the conversation shifted to the question of how we should keep guns out of the hands of the mentally ill.   As psychiatrist Jonathan Metzl concluded in his opinion piece in the New York Daily News about these events, “Ultimately, the way we frame these connections tells us as much about our own cultural biases and blind spots as it does about the acts of a lone, and obviously troubled, individual.”

I now have come to think that in this debate with my colleague over the possible impact of media coverage about Jared Loughner, we both may well be right/wrong.  Perhaps being proactive in getting the message out about mental illness and being more reserved about expressing judgments both carry the potential for encouraging the spread of longstanding stereotypes about those with struggling with psychiatric disorders.  If so, this may be a reflection of just how deeply engrained and unassailable the stigma of mental illness remains.

New issue – Medical History

med histThe January 2011 issue of Medical History is now out and includes an article by John C. Burnham entitled “Transnational History of Medicine after 1850: Framing and Interrogation from Psychiatric Journals”. The abstract reads:

Communication amongst medical specialists helps display the tensions between localism and transnationalisation. Some quantitative sampling of psychiatric journals provides one framework for understanding the history of psychiatry and, to some extent, the history of medicine in general in the twentieth century. After World War II, extreme national isolation of psychiatric communities gave way to substantial transnationalisation, especially in the 1980s, when a remarkable switch to English-language communication became obvious. Various psychiatric communities used the new universal language, not so much as victims of Americanisation, as to gain general professional recognition and to participate in and adapt to modernisation.

More information, as well as a complete table of contents, can be found  here.

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