Saturday, 26.09.2020

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

 

Thomas A. Ban’s Comment

New Ideologies

 

        Several comments in the course of this exchange  have implicated that the Geneva1980s’ psychiatry crisis was intimately linked to the antipsychiatry movement that  emerged   during the 1950s simultaneously with the introduction of the first set of psychotropic drugs with demonstrable therapeutic efficacy.

        In my monograph, “Schizophrenia, A Psychopharmacological Approach,” based on a presentation delivered on January 15, 1971, at the Clarke Institute of Psychiatry in Toronto, I addressed concerns about “antipsychiatry” in a section titled “New Ideologies” (Ban 1972).  An extract of this section is presented below:

New Ideologies

        “Schizophrenia is a common disease. Its incidence per year is about 0.15 percent, its prevalence 0.3 percent and the lifetime probability for any individual to suffer a schizophrenic breakdown about r to 2 percent. There are approximately 600,000 schizophrenics in the United States (70,000 in Canada) and more than 200,000 Americans (20,000 Canadians) are presently hospitalized with one or another form of schizophrenia (Lehmann1969; Mosher 1969) .  There has been no change in these figures in the psychopharmacological era. There is sufficient evidence that at least certain productive psychopathological symptoms can be controlled by  drugs, while first year relapse rates can be cut from 40 to 75 to 5 to r 5 percent with maintenance treatment.  Neuroleptics, together with the improvement of milieu in psychiatric hospitals, have considerably transformed the prevailing manifestations of the disease, while the changes in social attitude, together with neuroleptic treatment, have produced an absolute and relative increase in schizophrenic patient population in the community. The reflection of these changes in consciousness led to new ideologies of mental illness in general and schizophrenia in particular. Among the first ideologists was Szasz (1961), a professor of psychiatry, who argued that psychiatry, which deals with "problems in living" is inappropriately subsumed under medicine and that behavior that we call "sick," e.g. schizophrenic behavior, is  not physiologically determined.

        While Szasz (1961) considered mental illness a myth, Scheff  (1970), a professor of sociology, asserts that mental illness is nothing but a label for a wide "residual" category of social offenders. According to him, every society provides its members with a set of explicit norms (understandings governing conduct) and offenses against these norms have conventional names, e.g. theft, perversion. Beyond the explicit norms and their "conventional'' offenses, every society has a countless number of unnamed understandings and offenses against these unnamed residual understandings are usually lumped together in a residual category. He considers mental illness as the residual category in contemporary society and conceives the symptoms of mental illness in general and schizophrenia in particular as offenses (violations) against implicit social understandings. Scheff (1970) interprets the disordered speech and communication of  schizophrenics as offenses against culturally prescribed roles of language and expression. Schizophrenic withdrawal, in his interpretation, assumes a "cultural standard, concerning the degree of involvement and the amount of distance between the individual and those around him." Furthermore, Scheff (1970) suggests that the societal reaction against these offenses of implicit social understandings is denial (i.e. ignoring or rationalizing) or labeling. If labeling occurs, the offender is labeled as mentally ill and is launched on a career of chronic punishment.

        Similar views were expressed by Laing  (1967), a psychoanalyst, who defined schizophrenia as a label which some people pin on other people under certain social circumstances. He believes that schizophrenia is not an illness but "a social fact” and the status quo by "treating as medical patients certain individuals who, assumedly because of the strength of their inner perceptions and experiences, are exceptionally eloquent social critics" (Siegler, Osmond and Mann 1969). Besides accepting schizophrenics as rebels, Laing (1967) also offers them a status above normal people. In his essay, "Politics of Experience," he redefines schizophrenia and suggests that it is a "natural way of healing our own appalling state of alienation called normality." Accordingly, schizophrenia is not an illness, but a "voyage  of inner exploration" during which "often through quite ordinary  people," now called schizophrenics, "the light  begins  to  break  through  the cracks in our all-too-closed minds."

        The view that schizophrenia is not so much a breakdown as a breakthrough is shared by Dabrowski (1964, 1967), also a psychiatrist. He called it "positive disintegration" and considered it as a natural reaction to stress, which replaces usual problem-solving techniques in severe life crises. Furthermore, Silverman (1970), a psychologist, asserts that neuroleptics, by reducing the clarity of ordinary experience, interfere with schizophrenia's problem-solving process.

        A common characteristic of these ideologies is that they adopt a view in opposition to the medical model.  Nevertheless, they reflect a period in which the majority of schizophrenic patients can and are living outside of hospitals, a period in which schizophrenia is losing its "physiogenic" character and in which the progress of the schizophrenic process can be prevented and psychopathological symptoms alleviated. Social-environmental changes were instrumental in this evolution of events, but without neuroleptics, the present state of affairs could not have been reached. Still, the problem is that even with neuroleptics, very little has been achieved. To exaggerate the little we have achieved and claim that schizophrenia now does not exist  is more than ideology, it is a falsehood which is corrected in the  context of an alleged "truth" represented by an alleged "objective social interest." Nevertheless, if this falsehood would ever prevail, it would withhold progress towards an understanding of schizophrenia and the schizophrenic patient and could lead to a situation which is contrary to any social interest.”

        Since the time of the “psychiatry crisis” in Geneva, well over three decades have passed but in so far as I know François Ferrero’s essay is first to examine it in a historical context. As, in the course of the exchange that followed the presentation of Ferrero’s  essay,  a possible role of the antipsychiatry movement was implicated in the incident, it would be important to clarify whether this was the case.

 

References:

Ban TA. Schizophrenia A  time  Psychopharmacological Approach. Springfield: Charles C. Thomas; 1972, pp. 62 - 4.

Dabrowski K. Positive Disintegration. Boston: Little Brown; 1964.

Dabrowski K. Personality Shaping Through Positive Disintegration. Boston: Little Brown; 1967.

Laing RD. The Politics of Experience. London: Pelican Books; 1967.

Lehmann HE. The impact of modern pharmacotherapy on the prognosis of psychiatric patients. Transactions of the Life Insurance Medical Directors of America 1969; 53: 31 47.

Mosher LR. The center for studies of schizophrenia. Schizophrenia Bulletin 1969; 1: 4-6.

Scheff TJ. Schizophrenia as ideology. Schizophrenia Bulletin 1970; 2: 15-9.

Siegler M. Osmond H and Mann H. Laing’s model of madness. British Journal of Psychiatry 1969; 115: 947 -58.

Silverman J. When schizophrenia helps. Psychology Today 1970; 4: 62 -70. Szasz TS. The Myth of Mental Illness. New York: Harper Brothers; 1961.

 

September 12, 2019