Friday, 25.09.2020

Francois Ferrero: Inquiry of the Geneva Psychiatry Crisis; Forced Hospitalization, ECT and Sleep Therapy
Barry Blackwell’s comment

 

      Ferraro’s essay about the 1980s Geneva “Psychiatry Crisis” is interesting and thought provoking although clearly ongoing. Realistically, however, it is also an incomplete and unresolved glimpse into the micro-climate of the capital of a Swiss Canton at the time of worldwide turmoil, as psychiatry struggled to define its relationship to its biological, psychological and social building blocks.

       Obviously, the final analysis will be related to the personas of the principle actors in the drama and the local social, political and scientific climate. Some of these are described in detail but are not yet clearly linked to the distress and dilemmas they created.

       In a nutshell, this scenario is similar to the Osheroff case in America which erupted in the mid-1980s over the psychiatric patient’s right to effective treatment – psychodynamic psychotherapy or medication for depression (Klerman 1990).

      History suggests 1980 also marked a worldwide watershed between psychoanalytic, biological and biopsychosocial paradigms. In America it was the year DSM III delivered a multi-axial diagnostic system based on consensus definitions that neglected classical etiologic and descriptive syndromes. Biological enthusiasts considered it a definitive triumph for an ego-inflating integration of psychiatry into the mainstream of medicine although doubts about its validity are prevalent and persist (Wakefield 2010).

       Well before1980 there were disturbing controversies about the role of specific psychiatric treatments,including insulin coma therapy, and the need for informed consent (Sharma 2015). In France Jean Delay’s impeccable career and world-famous Institute were disrupted by student riots fed by Communist innuendo that it was abusive and inappropriate to treat schizophrenia with medication (Blackwell 2014).The telltale fate of Delgado’s advocacy for electrical brain stimulation ruined his career in America (Blackwell 2013). Finally, worldwide ECT has endured scrutiny and denigration that Kellner (2011) compares to abortion. His references from 1982 on support the contention that, “Almost all the controversy about ECT is anecdotal, unsupported by evidence.”

       Perhaps the real purpose and questions posed by Ferrero’s Geneva crisis are to what extent it is just another interesting example of the influence of an evolving and confusing Zeitgeist or does it have unique and wider implications for psychiatry worldwide?

References:

Blackwell B. A biography of Jean Delay on INHN.org in Biographies 05.30.2013.

Blackwell B. Jose Delgado: A distinguished but controversial career on INHN in Biographies 02.27.2014.

Kellner CH. ECT: The second most controversial medical procedure. Psychiatric Times 2011; 28(1).

Sharma S. Insulin Coma treatment, facts and controversies on INHN.org in Controversies 11.19.2015.

Wakefield JC. Diagnostic issues and controversies- DSM 5: return of the false positive problem Annu Rev Clin. Psychol 2010;.12: 105-32.

 

August 2, 2018