One Woman’s Encounters With Psychoanalysis

New York Times contributing writer Daphne Merkin has just published a piece in the New York Times magazine, chronicling her encounters with numerous psychotherapists – primarily psychoanalysts – over four and a half decades.  As Merkin puts it,

To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office. What I do know, aside from the fact that the unconscious plays strange tricks and that the past stalks the present in ways we can’t begin to imagine, is a certain language, a certain style of thinking that, in its capacity for reframing your life story, becomes — how should I put this? — addictive. Projection. Repression. Acting out. Defenses. Secondary compensation. Transference. Even in these quick-fix, medicated times, when people are more likely to look to Wellbutrin and life coaches than to the mystique-surrounded, intangible promise of psychoanalysis, these words speak to me with all the charged power of poetry, scattering light into opaque depths, interpreting that which lies beneath awareness. Whether they do so rightly or wrongly is almost beside the point.

Does Alcoholics Anonymous Work? How Would We Know?

Since its founding in the U.S. in the 1930s, Alcoholics Anonymous (AA) has proven to enjoy the support of a wide range of individuals, authorities, professionals, and civic organizations.  According to AA, it was estimated in 2007 that worldwide there were over 116,000 AA groups, with more than 2 million members.  Yet for all its popularity, relatively little is known about how and the extent to which AA actually works.  The organization’s insistence on anonymity has made research about members difficult, and estimates of its success rate have ranged wildly, from 5% to 75%.

Wired magazine and the blog neuroanthropology.net offer up two articles, attempting to explain the draw of Alcoholics Anonymous. Brendan I. Koerner’s “Secret of AA: After 75 Years, We Don’t Know How It Works” examines the history of AA in a critical, yet balanced, fashion, discussing both the successes and shortcomings of the group’s approach. Mark Flanagan’s “Hard Drinkers Meet Soft Science” is interested in addressing the question, “Why do so many science-based medical providers recommend AA?”  His answers: it’s free, it’s convenient, and it comes with passionate anecdotal evidence to support it.

Review – Quétel Claude, Histoire de la folie de l’antiquité à nos jours, Paris, Tallandier, 621 p., 2009.

Pour les historiens francophones, Claude Quétel demeure l’auteur d’une thèse volumineuse sur l’hôpital psychiatrique du Bon-Sauveur, dans la région de Caen, ville de cette Normandie contée par Gustave Flaubert et Guy Maupassant et largement meurtrie au XXe siècle par les années de guerre auxquelles il s’est intéressé par la suite. L’auteur reprend l’étude de la folie après plusieurs années d’absence sur ce terrain bien que l’on se souvienne de son ouvrage de synthèse écrit en collaboration avec le psychiatre Jacques Postel – que les historiens ont eu souvent l’occasion d’apprécier pour ses écrits et ses observations1.

Ce volumineux livre a de nouveau l’ambition d’être une synthèse du traitement de la folie dans un espace qui n’est cependant pas vraiment défini. Les sources concernent la France dans la très grande majorité des cas bien que certains médecins évoqués par Cl. Quétel fassent partie du panthéon de l’histoire de la psychiatrie européenne. Plusieurs événements ayant eu lieu hors de France sont évoqués – l’émergence de la psychanalyse, la stérilisation des malades en Allemagne, l’antipsychiatrie en Italie ou en Angleterre, l’impact du DSM américain – sans que l’auteur ne se réfère aux travaux des collègues européens ou nord-américains sur les sujets traités. Des articles issus des revues relevant de son objet (Frenia, Gesnerus, History of Psychiatry, Medical History, Medicina e Storia etc.) ne sont jamais cités. De la même manière, Cl. Quétel méconnaît les travaux les plus récents réalisés en France et accomplis par de jeunes chercheurs. Sans doute parce que l’auteur ne quitte jamais sa thèse: l’histoire de la psychiatrie est en France sinistrée depuis que Michel Foucault a traversé ce domaine de recherches. Ce n’est que récemment que l’on pourrait reprendre en toute liberté le travail de recherche. Ce n’est toutefois pas à cela que Cl. Quétel s’emploie. Son objectif est tout aussi idéologique que l’intention prêtée à Foucault. On comprend dès lors mieux le titre donné par Quétel à son ouvrage : c’est une anti-Histoire de la folie à l’âge classique. A force de critiquer Michel Foucault – ce que d’autres ont déjà fait avec beaucoup plus de force et de finesse – Cl. Quétel n’évite pas les propos caricaturaux et on ne voit pas très bien quelle serait l’urgence à déterrer la hache de guerre.

On parviendra ici ou là à prendre quelques informations et observations utiles dans les chapitres concernant ce que l’auteur connaît le mieux et qu’il a parfois déjà publié (les exemples issus de l’hôpital du Bon Sauveur sont sollicités à plusieurs reprises.) On trouvera également quelques références parfois peu connues rappelant que l’auteur savait trouver des documents pertinents et adéquats. Ces aspects ne suffisent pas cependant à faire oublier les erreurs factuelles, les interprétations insolites sur tel ou tel point d’une histoire de la psychiatrie qui à force de vouloir tout couvrir rate souvent sa cible. Le chapitre intitulé « Les antipsychiatries » est de ce point de vue tout à fait exemplaire. L’historien se transforme ici en avocat des psychiatres français qui n’en demandaient pas tant et leurs collègues italiens sauront apprécier les propos tenus !

Mon espoir est de pouvoir convaincre nos collègues européens que ce livre n’est pas représentatif de la recherche française dans le domaine de l’histoire de la psychiatrie ni des travaux de sciences sociales explorant la santé mentale et de les rassurer sur la possibilité de travailler dans une ambiance sereine en France. Les nuages planant sur la psychiatrie d’aujourd’hui ne sont sûrement pas lancés par Michel Foucault ni par son fantôme.

Jean-Christophe Coffin.

1 Cl. Quétel et J. Postel Nouvelle histoire de la psychiatrie, Paris, Dunod, 1994.

The Pharmaceutical Industry Leaving Psychiatry?

As noted by Vaughan Bell over at the blog Mind Hacks, Science magazine correspondent Greg Miller has just published a piece entitled “Is Pharma Running Out of Brainy Ideas?” Miller notes that GlaxoSmithKline has announced it is getting out of drug development in some areas of neuroscience, including pain and depression. At the same time, AstraZeneca has announced it is closing facilities in the U.S. and Europe and ending its drug-discovery research on schizophrenia, bipolar disorder, depression, and anxiety. According to Miller,

These cutbacks by two of the top players in drug development for disorders of the central nervous system have raised concerns that the pharmaceutical industry is pulling out, or at least pulling back, in this area. In direct response to the cuts at GSK and AstraZeneca, the Institute of Medicine Forum on Neuroscience and Nervous System Disorders organized a meeting in late June that brought together leaders from government, academia, and private foundations to take stock. But the biggest problem, researchers say, is that there is almost nothing in the pipeline that gives any hope for a transformation in the treatment of mental illness. That’s worrying, they say, because the need for better treatments for neurological and psychiatric disorders is vast. Hundreds of millions of people are afflicted worldwide. Yet for some common disorders, like Alzheimer’s disease, no truly effective treatments exist; for others, like depression, the existing drugs have limited efficacy and substantial side effects.

Miller also discusses the topic in the magazine’s podcast here.

Séminaire d’histoire de la psychiatrie (Sainte Anne)

Séminaire d’histoire de la psychiatrie

Coordonné par le Pr J.D. Guelfi et le Dr F. Bing

Sous l’égide du Dr J. Postel

Ce séminaire aura lieu le deuxième mardi de chaque mois à 20h.

Petit amphitéâtre de la CMME, Service du professeur F. Rouillon

Centre Hospitalier Sainte Anne

100 rue de la Santée 75014 Paris

Programme 2010-2011

12 octobre 2010

Introduction à l’histoire de la psychiatrie (J. Postel)

9 novembre 2010

Histoire du concept de démence précoce (J. Sinzelle)

11 janvier 2011

Le crime et la folie (D. Zagury)

8 février 2011

Corps et psychiatrie (F. Giromini)

8 mars 2011

Sommes nous les créateurs de notre vie? (P. Bruckner)

5 avril 2011

Histoire des addictions (M. Valleur)

10 mai 2011

Folie et maladie mentale (C. Imbert)

16 juin 2011

Histoire du concept de psychose (A. Vanier)

Dworkin: The Rise of the Caring Industry

Ronald W. Dworkin – Frank Henry Sommer Professor of Law and Philosophy at New York University and Jeremy Bentham Professor of Law and Philosophy at University College London – has a piece entitled “The Rise of the Caring Industry” in the June 2010 issue of Policy Review.  The essay can be accessed online here.  The author of the 2006 book Artificial Happiness: The Dark Side of the New Happy Class considers how the growth of the helping professions (particularly those concerned with mental health) represents not simply an institutional change, but a shift in ethos.  As he puts it:

In this way the caring industry exercises a double fascination — on the one hand as a sounding board for lonely, unhappy individuals, and on the other as emblematic of a new ethos of civilization. The age of caring is a more skeptical age, but also a more tolerant one, expressing a distrust of authority and an antipathy to old enthusiasms that wavers between laughter and disgust. It would be wrong to say that people today deny the world; they simply prefer to ignore it, presenting a blank wall of indifference to how people live and what they believe. They prefer meeting their psychological needs through a therapy session rather than through a community of blood brothers.

The topic has been of particular interest to observers in the United States, and, over the past fifteen years, a number of scholars and writers have written on the subject, including Ellen Herman (The Romance of American Psychology: Political Culture in the Age of Experts, 1995), Eva Moskowitz (In Therapy We Trust: America’s Obsession with Self-Fulfillment, 2001) and Barbara Ehrenreich (Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America, 2009).

New Issue of International Journal of Mental Health

The latest issue of the International Journal of Mental Health is dedicated to Mental Health in a Time of Economic Contraction. One article is specifically dedicated to the recent history of this problem.

Economic Contraction and Mental Health. A Review of the Evidence, 1990-2009 by Sidra J. Goldman-Mellor, Katherine B. Saxton, Ralph C. Catalano (School of Public Health, University of California, Berkeley). The abstract reads:

Background: Theory and empirical evidence suggest that economic contraction predicts increased incidence of psychological disorder. The extent to which this relation can be causally attributed to the economic experiences of individuals remains uncertain. Methods: We critically examine literature concerning the impact of economic contraction, measured at the individual or ecological level, on four mental health outcomes (depression, suicide, substance abuse, and antisocial behavior) from the past two decades. Studies at the individual level use job loss, transition to inadequate employment, or welfare as the independent variable. Studies at the ecological level primarily use the unemployment rate. Results: In the studies that best establish causality, research indicates a moderate but significant adverse effect of job loss on individual depression symptoms, but the net population effect remains speculative. For suicide and antisocial behavior, individual- and ecological-level studies converge to suggest a moderate positive association with economic contraction. Although some research on substance abuse suggests procyclical effects, the majority indicate that job loss significantly increases the risk of heavy drinking and symptoms of alcohol abuse. For all outcomes, various characteristics of the population or the specific economic exposure studied can modify the overall association. Conclusions: The studies reviewed suggest that adverse economic transitions predict increased mental health problems, particularly depression, suicide, and substance abuse. The strength of the association, particularly when measuring the response of populations to contracting economies remains unclear.

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