Francois Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ECT and Sleep Therapy
Edward Shorter’s comment
Written by François Ferrero, a distinguished figure in European psychiatry, thisessay is an indictment, not just of Genevan psychiatry in the late-1970s and -80s, but of an entire epoch in the history of psychiatry. In those years, psychoanalysis was waning, although by no means vanished, and social-and-community psychiatry was in the ascendancy. Biological psychiatry, as understood in Geneva, seems to have had about the same moral valence as Nazism. If you had a serious psychiatric illness, such as melancholic depression or acute psychosis, you could pretty well forget about receiving effective treatment.
And so, if you did fall grievously ill in Geneva in those years, what was on offer? The clinicians were timidly attempting "sectorization," which is a code word for outpatient treatment in day clinics and halfway houses. Astonishingly, in 1980 they were still offering Jakob Klaesi's "deep sleep cure," and not just with classical barbiturates but with antipsychotics. And the death of poor Alain seems due not to his "bronchopneumonia," but to acute toxicity from the interaction of a frightening list of medications. So, polypharmacy, for sure, was on offer in Geneva, despite the routine incantations against "biological treatments."
And what was not on offer? The clinicians (and probably the nursing staff) seem to have been hysterically opposed to convulsive therapy. The two ECT devices were "stolen" in 1980 and deposited symbolically in some public place. The message, "See what awful things they're doing at Bel-Air!" The ECT devices were never replaced and when, years later, Ferrero made inquiries about the status of ECT in the university psychiatric hospital, he was told that the prohibition of ECT in Geneva "is similar to a custom which somehow has the force of law." In other words, community opinion is so strongly opposed to ECT that we needn't bother formally outlawing it. It is unclear how these clinicians might have treated patients with melancholia, psychotic depression, delirious mania and lethal catatonia -- evidently with the resources of social-and-community psychiatry. In retrospect, this constitutes a flagrant violation of the moral obligation to provide effective treatment.
Ferrero is very interested in local political issues, such as who is in charge of what service. And to the people of the time, this doubtless appeared to be of vast importance. Yet with the perspective of 40years, these matters are trivial. The main point is that the social fashions of the 1970s and ‘80s -- rather than medical science -- guided the therapeutic choices of these Genevan clinicians. And the social fashions were profoundly anti-therapeutic.
Today, Swiss psychiatry is embroiled in another of these convulsions, this time inveighing against the drug trials of the 1950s and ‘60s as somehow ethically deficient. No signed consent forms! No videotaping of patient agreement to take part in psychopharmacological investigations! The horror! Even today, the Swiss succeed in shooting themselves in the foot.
October 4, 2018