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mandag, 29-11-2021

Francois Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis:
Forced Hospitalization, ECT and Sleep Therapy

 

François Ferrero’s reply to Thomas Jamieson Craig

 

       I am grateful to Tom Craig for his personal and very stimulating comment. Tom was fortunate to learn, to practice and to teach Psychiatry surrounded “by the relative equanimity of the English character.”

       I wondered what influence British psychiatry had on my early training in the 70s and the answer is no influence. The French reference book upon which I relied was that of Henry Ey, Textbook of Psychiatry (Ey, Bernard and Brisset 1974), which proposes an original synthesis of biological, social and psychological theories called “organodynamics.” In this book, Ey quotes many authors from German, English and American schools. Nevertheless, British influence was practically absent in France and in Geneva, partly due to the fact that my mentors at that time were mostly oriented toward France and they did not speak English. Moreover,  we were not encouraged to complete our training abroad contrary to what was happening in most other departments.

       By contrast the influence of English psychoanalysis was much more pronounced and some important authors like Winnicott, Balint, Bowlby and others were quickly translated into French.

       There may probably have been other efforts to try to bridge the gap between British and French Psychiatry right after World War II. I would at least like to recall an article by Jacques Lacan which introduced the work of Bion in France. In September 1945, Lacan was in London and he met Wilfrid Bion and John Rickmann who had jointly published a paper in the Lancet, “Intra-group tensions in therapy. Their study as the task for the group” (1943). Due to their influence, Lacan soon wrote an enthusiastic paper in the journal L’Evolution Psychiatrique, which was directed by his friend Henri Ey, “La psychiatrie anglaise et la guerre” (“English Psychiatry and War”) (1947). He wrote: “We can consider that in these two men the flame of creativity shines.” He considers them “as pioneers of a revolution that transport all our problems to the collective scale” and he underlines the importance and originality of British psychiatry and the influence of psychological sciences, suggesting that in France, “everyone will have to find out.” Is it so surprising? Both Lacan and Bion were interested in the functioning of the human mind and Bion had a good knowledge of French, a language he had learned in France before studying medicine.

       (Lacan doesn’t mention Joshua Bierer nor Maxwell Jones, two other pioneers of group psychotherapy [Shorter 1997]).

       Unfortunately, Lacan was not followed by many of his French colleagues. I wonder if one could find a possible explanation for this lack of interest in Pierre Pichot’s influential book, A Century of Psychiatry (1983). Indeed, Pichot expressed an opinion shared by the majority of French psychiatrists at that time: “During the entire 19th Century, British Psychiatry has occupied an honorable but modest place” or, “Sir Aubrey Lewis’ judgment on the weak international influence of British psychiatry undoubtedly corresponds to the facts.”

       Later, when I looked for answers to the continued increase in social problems in my service, I began to become aware of certain limits of Sectorization. I discovered the 1976 work of Christine Vaughn and Julian Leff and I conducted a research project on “Expressed Emotion.” This project led to successful exchanges which helped me broaden my vision of social psychiatry which was essentially based on French authors. It helped me develop a strong collaboration with families and service users.

       Tom Craig reminds us that the major drivers of the policy of the closure of hospital asylum and expansion in community care were moral, therapeutic and fiscal. The same drivers apply also to Geneva psychiatry, with a fourth one being the influence of personal family problems. At the end of the 70s some politicians, including state ministers, were affected in their own families by mental illness and became convinced that time had come to make changes.

       Since the first years of public Psychiatry in the 19th century, the relationship between Psychiatry, Society, Finances and Politics was characterized by ambivalence and tensions toward the mission of social control and the ideal of freedom. Despite the fact that such a characteristic is not unique to Geneva, we have to recognize that conflicts have sometimes contributed to important progress.

       In conclusion, I would echo Tom Craig: “I hope that Luc Ciompi is right in his optimism for a future synthesis of biological and social psychiatry.” It will be one of the responsibilities of our successors.

 

References:

Bion WR, Rickman J. Intra-Group Tensions in Therapy Their Study as the Task of the Group. 1943; 6274(242):678-682.

Ey H, Bernard P, Brisset Ch. Manuel de Psychiatrie. Paris: Masson et Cie; (4th ed)1974.

Lacan J. La psychiatrie anglaise et la guerre (English psychiatry and war). L'Évolution Psychiatrique, 1947, III: 293-312.

Pichot P. A Century of Psychiatry. Roche, 1983.

Shorter E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley, 1997, pp 231-232.

Vaughn  C, Leff J. The Measurement of Expressed Emotion in the Families of Psychiatric Patients. The British Journal of Social and Clinical Psychology, 1976;15(2):157-65.

 

March 25, 2021