Francois Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced
Hospitalization, ECT and Sleep Therapy
Ambros Uchtenhagen’s comments
Thiswell-informed and documented paper (including a list of limitations) highlights a period of passage in Swiss psychiatry during which our federal system had different fates in different cantons.
If I allow myself to contribute a comment, itis not based on an adequate knowledge of the Geneva dynamics at that time nor of the main personalities involved.
My visits to Professor Garrone in the early ‘70s were helpful for my task to build up social psychiatry in the Zurich area. Psychiatric reform in democratic western countries coincided with the youth unrest movement of 1968 resulting in an effort to accept new societal values, more liberty of choice for individual lifestyles andmore interactive educational concepts replacing the dominant paternalistic model. For psychiatry, it meant moving from mainly custodial hospital regimes to community-based outpatient and intermediate services. Different strategies became implemented in order to reach that goal: creating new sub-specialties with academic positions, collective leadership, dividing catchment areas into regions or sectors for a better continuity of care, etc.
Extreme positions resulted in theremoval ofpublic hospitals (Italy) or even toabandoning all psychiatry’sdiagnostic and therapeutic tools (anti-psychiatry) but could not pass the reality test. Others redefined psychiatry as an instrument to reeducate dissident citizens, a blatant abuse of our field.
The fate of these reforms depended not so much on conceptual orientation, but on political and professional competence to avoid the neglect of any of the newly developed treatment approaches – bio-psycho-social – and to care for an adequate division of labor and power among those in charge. It is essential to keep in mind the goals and mandate of psychiatry: to care for the health and wellbeing of patients;to guarantee availability and access for those in need of care;and for the information and safety of the population at large about what is done and how it is done.
Exposing the dynamics in Geneva in that critical period is not only of historical interest. We live today in another period with major changes and challenges: the scarcity of medical students opting for psychiatry;a predominance of neuroscience;a pressure to cut down on tariffs opening up controversies;and a distant threat that psychiatrists may be replaced by mental health workers. We are asked to avoid past mistakes, for the sake of our great goals,
October 11, 2018