Saturday, 31.10.2020

FrançoisFerrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis. Forced Hospotalization, ECT and Sleep Therapy 

Jean Garrabé’s comments

 

          Professor François Ferrero’s essay is very interesting for a French psychiatrist of my generation because I knew Julian de Ajuriaguerra at the end of my medical studies in Paris before his departure to Geneva in 1959. I was also in contact with him after 1976 and his return to Paris at the College de France. Like many other French psychiatrists, our contacts occurred mainly at the occasion of de Ajuriaguerra’s participation in the Société de l’Evolution Psychiatrique. This society had suspended its activities during the German occupation in order to protect its Jewish members, for example Eugène Minkowski, from deportation. After the war, its activities resumed.

          De Ajuriaguerra has written many articles in the society’s journal, alone or in collaboration. Société de l’Evolution Psychiatrique is one of the French societies that organized the first World Congress of Psychiatry in 1950 in Paris under the leadership of Henry Ey who was my mentor. This congress is the origin of the WPA. The second congress was organized in 1957 in Zurich, under the Presidency of Jean Delay.

          I learned psychiatry from the Manuel de Psychiatrie published by Henry Ey, Paul Bernard and Charles Brisset (1960) and from the Handbook of Child Psychiatry and Psychology by de Ajuriaguerra (1970). I noticed that in both manuals, next to the important parts devoted to the clinic and to psychopathology, important chapters were devoted to juvenile delinquency, including psychiatric procedures of forced hospitalization. In France the 1838 law devoted to these procedures remained in force until 1990. I don’t know if Switzerland or the different Cantons have such a law.

About sectorization in France

          In France a simple ministerial circular dated March 1960 introduced the politic of “sector,” attributing to a medico-social team the responsibility of psychiatric care to a population of about 60,000 inhabitants. “Intersectors” were also created for child and adolescent psychiatry. Many years later, this circular was followed by a law. The sectorization was implemented progressively in all the French health regions with MDs, nurses, psychologists, social workers, etc.; the sectors teams were attached to psychiatric hospitals, general hospitals, and/or to university hospital centers.

          It has to be noted, from a chronological point of view, that the sectorization coincides more or less with the anti-psychiatric movement.

          From my point of view, as chief doctor of a fully sectorized psychiatric hospital service since 1968 in the Yvelines department near Paris, I never had to face such an anti-psychiatric movement.

Jean Delay, the Société Médico-Psychologique and the origins of WPA

          Jean Delay (1907-1987), a student of Pierre Janet, replaced Professor Joseph Levy-Valensi during World War II at the Clinique des Maladies Mentales et de l’Encéphale in Paris. When Levy-Valensi was released from Buchenwald by the Red Army in 1945, we were informed that he passed away immediately after arriving at the camp. Then, Jean Delay was titularized in 1946 and in 1950 he was the President of the first World Congress of Psychiatry which was organized by French societies such as the Evolution Psychiatrique, the Société Médico-Psychologique and the “Paris Psychoanalytical Society.” Delay was elected as the first President of WPA.

          During my psychiatric training, I spent one semester in the Centre Psychiatrique d’Orientation et d’Accueil (CPOA ), created by Dr Georges Daumézon with the aim to improve the orientation of psychiatric patients admitted to Paris’ Sainte-Anne Hospital from the respective sectors from the Seine Region.

          The Société Médico-Psychologique, which was recognized as a public utility under Napoléon III, is one of the founding societies of the WPA. With Jean Delay as President in 1960, then with Henri Baruk in 1968, the Société Médico-Psychologique doesn’t seem to have been disturbed by antipsychiatry. I was the President in 2000 when the WPA jubilee congress was organized in Paris with psychiatrists coming from all over the world; eight came from Switzerland (six from Geneva), including François Ferrero, chairman of the Geneva University and Hospital Department of Psychiatry. The department includes the Bel-Air Hospital, renamed Belle-Idée, where Julian de Ajuriaguerra came in 1959 to reorganize the psychiatric department before returning to Paris in 1976 as chairman of the Neuropsychology Department of the College de France. Retired in the Basque County, he passed away in 1993.

Consequences of May 1968 on French Psychiatry

          Regarding some consequences of May 68, Ferrero says nothing about the separation of neuropsychiatry into two distinct specialties, including their teaching. At the University of Paris, instead of one service, 10 neurological or psychiatric services were created with professors of neurology or psychiatry who had to choose between the two specialties. The medical doctors working in psychiatry became hospital practitioners. I don’t know if such reorganization also touched Switzerland.

2016-2018: Sainte-Anne Hospital

          An out of trade and richly illustrated book was published in 2016 entitled L’hôpital Sainte-Anne, Pionnier de la psychiatrie et des neurosciences au coeur de Paris (“The Sainte-Anne Hospital, Pioneer of psychiatry and neurosciences in the heart of Paris”). Among the many chapters, I wrote one with a young philosopher entitled Genèse et histoire de la chaire de Clinique des maladies mentales et de l’Encéphale (CMME) et enseignement de la psychiatrie à Sainte-Anne (Genesis and History of the Chair of Mental Illness and Brain Disease Clinic [CMME] and Teaching of Psychiatry at St. Anne's).

          It should be noted that the monthly sessions of the Société Médico-Psychologiques in which I try to participate are still organized at the Saint-Anne Hospital, currently in the Pierre Deniker amphitheater in the new Jean Delay building. His memory is not forgotten. The CMME is also organized in a new building which was named “Joseph Levy-Valensi” where two portraits of him adorn the entrance hall.

 

December 26, 2019