Francois Ferrero: The Geneva 1980's psychiatry crisis: Psychiatry an Antipsychiatry
Psychiatry and Antipsychiatry Introduction
It is not easy to find an acceptable definition for “antipsychiatry” despite many options, such as, for example, that of the French dictionary Le Robert: “All theories and therapeutics processes that break with classical psychiatry by denouncing the role of society in the origin and treatment of mental illness.”
To broaden this definition, consideration should be given to Edward Shorter’s 2005 A Historical Dictionary of Psychiatry: “Early in the 1960s, as part of the general intellectual tumult of the time, a protest movement arose against psychiatry. Members of the movement whereby no means all in agreement about doctrine; some argued that there was no such thing as psychiatric illness, others that adverse sociocultural conditions exposed members of marginalized groups to political repression conducted under the guise of medical diagnosis, still others that treating mental patients against their will was unethical, and that electroconvulsive therapy was brain-destroying rather than therapeutic. This grab bag of diverse claims and objectives came together under the banner ‘antipsychiatry’.”
In his 1997 History of Psychiatry, Shorter wrote that the advent of effective new medications for psychosis and neurosis may have induced a certain indifferance toward the patient’s need to feel care and that somehow psychiatry’s very real shift to science was associated with an imputed loss of caring. This was a view shared by the antipsychiatrists.
In 1968, the main protest of thousands of young men and woman all around the world was not primarily directed against psychiatry, but against values, morals and ethics inherited from former generations. Another famous slogan, “power to the imagination,” shaped dreams and seemed rich in promises of a better and more fraternal world. Antipsychiatry flourished as a radical questioning of the traditional organization of society, which was nourished by multiple influences, sociological, political, psychological, economical and artistical, i.e., ingredients which would allow a utopia to develop. Antipsychiatry appears also anti-medical, anti-science, anti-methodological and, more generally, anti-intellectual.
Among the enormous amount of literature published on the subject, I suggest a paper by Hagop Akiskal and William McKinney (1973) entitled “Psychiatry and Pseudopsychiatry.” After a presentation of the origins of psychiatry, they discuss the DSM-II (1968), and its limits, focusing on some selected areas “where the most recent psychiatric manual is totally out of rhyme with recent developments: Schizophrenia, Affective Disorders, Neuroses, Heredity vs Environment, Organic vs Functional Dichotomy.” They try to answer the question: are mental disorders as illnesses? They point also to the increasing number of psychiatrists “who have abandoned the medical model during the past few years.”
The antimedical tenants join the anti-psychiatrists arguing that they are not diseases, but problems of living. They explain the schism in US psychiatry is the result of the opposition between science, humanism and psychiatry. Aware of some degree of exaggeration, they propose to classify US psychiatrists (and clinical psychologists) as more or less “soft headed” or as more or less “tough headed,” pointing some characteristics of each camp viewed by the opposite camp.
The two groups, the traditional psychiatrists and the antimedical tenants, refer to the classification of psychiatrists by August Hollingshead and Frederick Redlich (1957): analytical and psychological (AP) vs directive and organic (DO). The “tough-headed” category appears as a rather homogeneous group corresponding to the DO psychiatrists, who are identified as biologically oriented psychiatrists. The soft-headed category is a heterogeneous group which “in addition to the AP (psychoanalytic) group, includes many new schools that are in open rivalry with it.”
Akiskal and McKinney (1973) proposed to:
· include philosophy of science, epistemology and linguistics in the residency programs
· increase the number of “true eclectics,” i.e., those capable of real synthesis, and the number of research-minded psychiatrists.
They concluded that “humanism and science cannot be based on rhetoric and wishful thinking. They require hard work and dedication to both scientific methodology and humanistic concern.”
Unfortunately, such a psychiatric residency curriculum remains quite exceptional. As far as Geneva is concerned, a unified, rich and structured curriculum comprising psychiatry and psychotherapy was finally organized only after 1995 by the author and his colleagues, 15 years after the events - maybe a sign that a long crisis was finally over.
Akiskal HS, McKinney WT. Psychiatry and Pseudopsychiatry. Arch Gen Psychiatry 1973;28:367-73.
DSM-II. Diagnostic and Statistical Manual of Mental Disorders, Second Edition. American Psychiatric Association, Washington DC; 1968.
Holingshead AB, Redlich FC. Social Class and Mental Illness. New York, John Wiley & Sons; 1958, pp 155-167.
Le Petit Robert De La Langue Francaise 2018 (PR1) (French Edition). Le Robert; 2017.
Shorter E. A Historical Dictionary of Psychiatry. Oxford University Press; 2005
Shorter E. A History of Psychiatry. John Wiley; 1997.
November 4, 2021