Francois Ferrero: The Geneva 1980's psychiatry crisis: Psychiatry an Antipsychiatry
Psychiatry and Politics in Geneva: History of an Ambivalent Relationship
The impact and consequences of the events of 1980 did not come out of the blue and deserve to be understood from a historical perspective, the local dimension of which is important. Indeed, if the history of Genevan psychiatry is often evoked by emphasizing certain personalities who have marked it, it is worth proposing another reading, centered on the ambivalent and sometimes conflictual relationship between psychiatry, politics and society.
What can explain, for example, why this city, so receptive to the ideas of the Enlightenment, postponed for several decades any project to build an asylum?
Despite the commitment to build an asylum by some exceptional personalities such as Abraham Joly (1748-1812), sometimes considered by some of the Swiss a precursor to Philippe Pinel (1745-1826), Etienne Dumont (1759-1829) and Gaspard De La Rive (1770-1834), all early asylum proposals to build an asylum had been refused because the cost was considered too high. When the first asylum finally opened in 1838, the government entrusted its management to Dr. Charles Coindet (1796-1876), a psychiatrist trained in Edinburgh, Scotland, and a member of an influential Geneva family. His dismissal 18 years later represented the first scandal in a series that struck the first four doctors in charge of psychiatry.
Coindet was dismissed in 1856 by a new radical government (which had overthrown the liberal oligarchy) on the pretext of the wrongful internment of a 14-year-old girl. He was replaced by Marc Olivet (1821-1897), a doctor without any psychiatric skills but close to the government, who then held the position for 35 years. In 1876, he became the first professor of psychiatry at the new Faculty of Medicine, although he had written nothing about psychiatry. Under his leadership, the asylum's reputation became so deplorable that he was eventually forced to resign in 1891following the murder of a patient by his cellmate.
The situation improved at the end of the 19th century thanks to the appointment of Joannès Martin (1851-1939), a doctor of Geneva origin who had benefited from the remarkable psychiatric training he acquired partly in Zürich with Auguste Forel (1848-1931). Martin introduced important transformations in the organization of asylum and its care, creating continuous observation rooms and developing treatments by clinotherapy that allowed him to reduce the use of restraint and isolation. In charge of the project of the new asylum, he was unfortunately forced to resign in 1899 because the government accused him of being responsible for the significant overrun of the construction costs of the new psychiatry hospital called “Asile de Bel-Air.”
Rodolphe Weber (1866-1937), who succeeded Martin, was another young and talented psychiatrist who had a brilliant career and became dean of the Faculty of Medicine and then rector of the University of Geneva. After two-three years, however, he was confronted by the hospital’s powerful administrative commission that did not appreciate his liberal innovations and that systematically rejected his proposals such as, for example, his plan to create a specialized unit for criminal patients. He, too, became a victim of political conflicts and was forced to resign in 1924 following accusations made against his closest associate doctor by the socialist party, which wrongly accused him of being in the pay of a pharmaceutical establishment.
Considering the tormented careers of the first leaders of Geneva psychiatry over the course of almost a century, the reasons for dismissal or resignation are striking. Some classic ingredients that have underpinned the complex relations that psychiatry maintains with the political world and, more broadly, with society are ubiquitous:
· The question of freedom: when one will accuse another of exercising too much surveillance by referring to abusive internment or, on the contrary, not enough control, resulting in a murder.
· The relationship to money: in this austere city influenced by Calvinism, the authorities hesitated for years to build an asylum, to install heating or to implement the training of psychiatric nurses.
· A distrust of biological psychiatry: when one is suspected of being influenced by the pharmaceutical industry.
· And two subjects that can be found everywhere: interpersonal and ideological conflicts.
The Zeitgeist influences many decisions, with two remarkable exceptions during the first half of 20th century: a very modest influence of eugenic theory and the refusal of psychosurgery. Should the observation that society has tried to respond to the fears inspired by madness by the exclusion of the mentally ill patients or, at the opposite, by the negation of madness, be seen as a kind of an insoluble question?
November 11, 2021