FrançoisFerrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis.

Forced Hospitalization, ECT d Sleep Therapy - Collating

Hector Warnes’ comment with special reference to Ferrero´s summary of Alsain´s autopsy 

        I have no comments on the excellent precis of Eugenio Aguglia (2020) on this project.

        However, after giving further consideration to the additional information following Ferrero’s original post, I have been wondering about the dichotomy which ended up becoming a cartesian one: between the biological and the socio-psychological-oriented psychiatrists, between the left and the right wing or even the establishment and the socialist-oriented psychiatrist (behind the Geneva inquiry). Indeed, it became a calamity of sorts in the 60s but still persists. Even during Freud's times, his disciples were from both the left and right which led to different interpretations of psychoanalysis. We are therefore plagued by ideological and political bent, not by scientific single-mindedness.

        I am well acquainted with Hasan Azima’s sleep therapy because I worked under his guidance. He was trained by Jean Delay and knew intimately the work of Henri Ey on the subject. We had no casualties nor did Ewen Cameron, as far as I know. I was also acquainted with Jakob Klaesi's original publication. None of these authors ever gave the staggering high doses of psychotropic agents that Dr. Tissot did to Alain. In Ferrero’s report Alain received for 10 days:

trifluoperazine 60 mg a day

Levomepromazine 600 mg a day

Promethazine 300 mg a day

Tuinal 1800 mg a day (a combination of secobarbital and amobarbital sodium which was later withdrawn from the market).

Flunitrazepam 12 ml

Trihexyphenidyl (the dose was not stated but it is indicated likely for the parkinsonism induced by trifluoperazine).

It was also disclosed that at times Alain was given for a period of 24 hours:

Flunitrazepam 4 mg

Levomepromazine 200mg

Promethazine 100 mg if necessary

Promazine 100 mg

"Some" Chloral Hydrate

        It was not clear whether this additional medication was given independently of the others or in addition to the others. Alain could have had an aspiration pneumonia due to the aspiration of food or vomit. It is the leading cause of death in Parkinson Disease which may cause severe dysphagia. I have seen cases with high doses of incisive neuroleptics who had difficulties in swallowing.

        No clinical notes were reported that justified the very high doses of medication nor the nursing care regarding positioning the patients, close observation and recording of the vital signs or his developing status during the 10 days.

        This very unusual overdose of medication was likely to produce adverse effects or put the patient at risk for a complication such a respiratory depression (Tuinal 1800 mg) or severe dystonia or muscle rigidity (trifluoperazine 60). We know that respiratory depression causes a desaturation of the levels of O2 and an increase of carbon dioxide levels in blood. I would suggest that the patient had a nosocomial infection due to the over sedation and immune dysfunction. Since it was not treated in an intensive care unit it probably lacked the strict medical controls inclusive blood tests and chest X rays.

        I am afraid that these incidents only serve to detonate the anti-psychiatric movement.

Reference:

Aguglia D. Eugenio Aguglia’s comment. François Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ECT and Sleep Therapy. inhn.org.controversies. January 23, 2020.

May 28, 2020