mandag, 29-11-2021

Francois Ferrero: Inquiry of the Geneva 1980’s Psychiatry Crisis: Forced Hospitalization, ETC and Sleep Therapy
David S. Janowsky’s Comment


          Dr. Tom Ban has kindly asked me to comment on Francois Ferrero’s essay, “Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ECT and Sleep Therapy.”  I found the article to be most interesting, especially from my point of view as a psychiatrist trained in the USA in the mid-1960s.  I have known nothing of the events that occurred in Geneva in the 1970s and 1980s, but these events have a remarkably familiar ring to them.  This is in part because I believe that at that time I stood soundly in the middle of the themes and conflicts of the times and was a centrist in my point of view.  In my time as a young psychiatrist, I ran two “therapeutic communities,” attended on a conventional ward and served as director of a crisis emergency service in a public hospital.  I practiced as a psychotherapist and as a biologic and pharmacologic practitioner and researcher.  Here are some of my impressions:

The 1970s were a very interesting time.  Psychiatrists located in the community had traditionally practiced psychotherapy and/or psychoanalysis, giving psychiatric drugs as needed with some trepidation.   Others practiced as inpatient doctors in public and private facilities, for the most part being biologically oriented, usually having large caseloads consisting of patients who for the most part remained chronically ill and who experienced long hospital stays. 

As biologic psychiatry and psychopharmacology evolved over the 1960s and 1970s, a schism evolved and grew, with ardent supporters of what each group believed consisting of acceptable treatment and point of view.  I believe there was, overall, mutual tension between those who believed in the biologic psychiatry revolution (clinicians and researchers in and out of academia) wherein discovery of the right molecule and/or the right drug would be a cure-all for mental illness.  These biological practitioners and researchers considered themselves to be   purveyors ofthe truth and looked with some disdain, maybe even contempt, on their psychodynamically/psychoanalytically oriented peers. Similarly, at the other extreme, those who believed in the power of psychotherapy and psychoanalysis (those who initially were the predominant group) considered their biologically-oriented brothers and sisters to be shallow, rigid, the antithesis of the humanism that psychiatry was supposed to represent. 

To add to the mix, psychiatry, at least in my eyes, was considered somewhat of a joke of a medical specialty, thought of by fellow non-psychiatric physicians to consist of pseudo physicians who were fuzzy headed and impressionistic, practicing more of a religion or a cult than a scientifically-based endeavor and looking to cure their own problems. I personally was subjected to such pressure from peers and family as a medical student, as well as to the irony of being told I was too sane to be a psychiatrist. Developing a medical model based on neuroscience and psychopharmacology offered the hope of legitimacy and peer respect;it gave structure to what seemed more mystical than objective. Finally, psychiatry was to be a science.

Furthermore, the growing influence of clinical psychologists and clinical social worker psychotherapists presented a growing threat to the psychotherapy-practicing psychiatrists, edging psychiatrists toward a niche as drug dispensers at the extreme.  

All of this was also reflected in the “revolution” of the times: the schism between the “hippy generation” and those of a more conventional bent.  The cultural revolution of the 1960s and 1970s reflected a contempt for the “establishment”—freedom, a focus on the   experiential which often included experiencing the hallucinatory effects of drugs, the brotherhood of mankind and a revulsion to the Vietnam war.  It would be natural that those who identified with such concepts would on average be attracted to more humanistic and socially oriented treatments,those focused on self-actualization, whereas the more cognitively-oriented might be more interested in the miracle of psychotropic drugs, biological remedies and the treatment of named and identifiable diseases, rather than in states of mind.  The therapeutic community, with its blurring of roles, its delegating of influence and decision-making to patients and decision-making by consensus, reflected an extension of the humanistic point of view.  This contrasted with the pyramidal structure of the usual psychiatric inpatient units which predominated and predominate to this day. 

Adding to the mix was an anti-psychiatric bias by a sector of the pubic and some patients and their families, as well as organizations such as NAPA (NetworkAgainst Psychiatric Assault) and scientology, which were strongly against such treatments as ECT, antipsychotic medications,forced hospitalization and involuntary drugging.  These groups and individuals were able to exert strong political pressure and to accomplish regulatory legislation to control the purported “abuses.”

My hypothesis is that the above influences and the differing personalities which tended to align with each side of the divide, led to the difficulties Dr. Ferrero describes.  Here, and I will speculate I am relatively sure that Dr. Tissot was a hard-core biologist, actually a would-be neurologist who had a more authoritarian, analytic and judging personality.  I would guess that Drs. Garrone and Haynal were relatively more inclined toward having more flexible, feeling, open-to-change, nonjudgmental personalities and   perspectives.  Having to work together within the format of a sectorization organization based on a continuum of care probably proved very difficult.  This was especially true in the case of the Genevacrisis, since there was no obvious strong leader to integrate the opposing perspectives, or mandate that one or the other go along with the leader’s philosophy or go elsewhere. 


August 16,2018