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Foucault, Laing et le pouvoir psychiatrique
Abstract
Résumé
Dans cet article, je montre la pertinence toujours actuelle d’ Histoire de la folie de Michel Foucault et de ses cours sur le pouvoir psychiatrique pour analyser le système psychiatrique d’aujourd’hui. Cette pertinence tient au fait que les analyses de Foucault font moins l’histoire que la généalogie de la psychiatrie ; elles montrent que nos façons de poser l’existence de ce que nous appelons folie se rattachent au même mouvement historique qui a créé la psychiatrie en tant que savoir pouvant désigner et gérer les fous. J’explore la relation ambiguë entre Foucault et « l’antipsychiatrie » des années 1960 et 1970, notamment dans le cas des travaux de R. D. Laing. J’examine aussi dans quelle mesure les cours de Foucault sur les anormaux et le pouvoir psychiatrique nous aident à analyser une psychiatrie qui oeuvre à l’extérieur de l’asile, qui s’appuie sur les neurosciences moléculaires et qui est dominée par la psychopharmacologie. Je soutiens que l’héritage le plus radical de Foucault n’est ni une critique du modèle médical, ni une négation du réel de la folie, ni non plus une dénonciation du pouvoir psychiatrique, mais plutôt l’argument voulant que les sujets de la psychiatrie aient le droit, le pouvoir en fait, de décider des formes de traitements qu’ils reçoivent.
... Associated with this movement were the names of Foucault, Szasz, Basaglia, Cooper, Laing, and others. Although there are several "antipsychiatries, " the common denominator is the fight against the psychiatric institution synthesized in the figure of the doctor and his power (18,19). Criticism of repressive psychiatric power is the essential point of the movement, being the criticism of the concept of mental disorder and pharmacological therapies derivatives of this fundamental position. ...
... (31), pp. [18][19]. ...
There are several reasons why a definition for mental disorder is essential. Among these are not only reasons linked to psychiatry itself as a science (nosology, research) but also to ethical, legal, and financial issues. The first formal definition of mental disorder resulted from a deep conceptual analysis led by Robert Spitzer. It emerged to address several challenges that psychiatry faced at the time, namely to serve as the starting point for an atheoretical and evidence-based classification of mental disorders, to justify the removal of homosexuality from classifications, and to counter the arguments of antipsychiatry. This definition has been updated, with some conceptual changes that make it depart from the main assumptions of Spitzer’s original definition. In this article, we intend to review the factors that substantiated the emergence of the first formal definition of mental disorder that based all its later versions.
... Elle se réalise à l'intérieur d'un dispositif de pouvoir. Par exemple, les pratiques discursives de la psychiatrie se développent au sein du dispositif de pouvoir de la clinique (Rose, 2006). La pratique discursive contribue à la formation discursive dans le sens où elle permet d'établir des systèmes de relations sociales concrètes (p. ...
... From the outset, Castel dedicated himself to the study of the field of psychiatry and the principal mental health reforms. His genealogical analysis of the transformation of American and European psychiatric environments is a reference, both in sociology and in health sciences (Rose, 2006). Castel wrote about various subjects, including the "moral" treatment of mental illness, the social control based on psychiatric power, and the transversality of so-called abnormal and deviant populations (e.g., psychiatrized persons, homeless and stigmatized individuals, and the drug-dependant and young delinquents). ...
Robert Castel is an eminent figure in the social sciences because of his innovative contributions to various social and health fields. The seminal work of this poststructuralist author and social activist has influenced several research disciplines, but has not yet had a significant impact on nursing. In this article, we will present the thinking of this man, who considered himself a sociologist, philosopher and “historian of the present.” We will examine the most important issues he explored during his career, including the psychiatric apparatus, the management of risk and the social vulnerability. We believe that this thinker's perspective on diverse social issues is very relevant to nursing practice and research and to the health sciences in general. The concepts he developed and utilized with finesse provide us with a critical reading of many contemporary health issues, particularly in mental health and psychiatric nursing. Castel's critical and engaged approach incites mobilization for social justice and greater protections for marginalized and vulnerable persons. These principles of advocacy and social justice are also at the heart of the nursing profession.
... Although there are several antipsychiatries, the common denominator to all of them is the struggle against the psychiatric institution synthesized in the figure of the physician and his power (Foucault, 1967;Rose, 2006). In this, anti-psychiatry met the anti-establishment movements of the time. ...
In the 18th and 19th century, the Western World went through dramatic changes in the understanding of mental health and in provision of services. William Tuke (1732 - 1822) in the UK and Philippe Pinel (1745 - 1826) in France were in the forefront of a humanizing movement known as “moral treatment”.
This humanization of services lost ground through the 19th and 20th centuries, giving rise to the maintenance and spreading of large mental health institutions where people suffering mental distress were severely separated/segregated from external reality and not given the rights of “normal” (adapted) people. A positive idea of asylum (with certain downsides – see below under “Critical Movements as base for a Humanistic Psychiatry”) was replaced with segregation.
During the Second World War, a number of British doctors started the Therapeutic Community movement in the UK, in many ways returning to the ideas of Tuke and Pinel. They observed that transforming the environment of the “mentally ill” would also dramatically change their condition. A number of similar movements spread through Europe and the US giving rise to a new understanding of mental illness, sometimes even contesting the term illness itself, and often attempting treatment without medication.
Alongside the growing therapeutic community movement and the humanization of services another dominant trend was rising: the “technologization” and commodification of interventions based on value-free science. Whilst not the aim of that trend, it often dehumanized relationships. There is an implicit tension between “being-with” (humanistic values) and “doing-to” (technical expertise).
A “doing-to” stance has often been rooted in psychiatric manuals like DSM (Diagnostic and Statistical Manual of Mental Disorders) or ICD (International Statistical Classification of Diseases and Related Health Problems) which suggest the existence of objective states which are value-free and where concepts such as “autistic” or “schizophrenic” entered daily discourse and gained legitimacy. Increasingly we find ourselves in a “quick fix” culture dominated by a technical-rationality model of science, a change nicely termed by some authors as the “McDonaldization of Society” (Ritzer, 1993).
How can Being and Doing coexist in the service of patients and families? The relational paradigm and the scientific postmodern era arose at the same time that positivism and empiricism are growing. There are disparate movements of integration and sectarianism; important differences between affective and cognitive neuroscience; large gaps between theory and practice; contradictory evidence for and against “broken-brain” models. Is it possible for science to go back to “the ordinary” and start being human again, acknowledging the impossibility of separating figure from ground?
Neurobiology can be significantly modified through medication and psychotherapy, but also through play and occupational therapy, and by diet and lifestyle. The right weighting of the components of mental health, and the right measures of it, can only be known through secure and trustworthy therapeutic relationships, helping to give meaning to interventions. The establishment of epistemic trust within psychologically enabling relationships is perhaps the only non-controversial ingredient of change, as research and practice consistently confirm (Pereira and Debbané, 2018; Norcross, 2002).
With this volume, we propose to open the debate between three main themes: psychotherapy (including psychological and philosophical influences), neurobiology (including cognitive and affective neuroscience) and psychopharmacology. The three main themes are clinically applied in what we call the “Intervention Triangle”. The book is first focused on epistemologically distinct frameworks and gradually attempts to consider the integration of these three fundamental vertices of practice.
The volume will be particularly relevant to practitioners working towards integrative frameworks. Although unidisciplinary integration has been a theme in several research and theoretical publications, this book offers an interdisciplinary, comprehensive and reflexive view of mental health problems and approaches, avoiding developing into mere eclecticism.
Following a number of congresses, international meetings and the publication of Schizophrenia and Common Sense (Hipólito, Gonçalves and Pereira, eds. 2018) the first editor has decided to put together a second volume, grounded on the discussions undertaken during the Second International Mental Health Congress of Romão de Sousa Foundation. Several authors from this congress, and several others with an interest on the subject of integration and common sense mental health, agreed to publish and contribute towards the humanization and democratization of mental health services. This volume results from the honest effort of all the authors, editors, reviewers and assistants. We hope it can contribute towards common sense in 21st century mental health.
Os pesquisadores Ana Teresa Venancio e Allister Dias se cercaram de um grupo seleto e muito rico de especialistas para levar a cabo um de esses trabalhos específicos e concretos. Esta história do Hospital Nacional de Alienados (anteriormente Hospício de Pedro II), assim como trabalhos prévios de alguns dos autores participantes, situa-se em uma linha de investigação com repercussão internacional. Como os próprios coordenadores do livro indicam, a emblemática instituição brasileira já tem sido objeto de numerosos estudos, mas, neste caso, as contribuições tanto metodológicas como de conteúdo fazem deste livro coletivo um produto novo e original.
La participation des personnes concernées (par une situation, un traitement, une condition de santé) à la recherche, l'enseignement et l'élaboration des services se retrouve dans les der-nières années sur le devant de la scène. À partir d'une enquête sur un programme de réinser-tion au travail dans le domaine psychiatrique, se réclamant d'une approche de la "pleine ci-toyenneté", le contenu de cette dernière est problématisé. Les propos des participant×e×s à l'étude parlent surtout d'exclusion sociale et de désir d'appartenance communautaire. Les écrits officiels et de recherche se réfèrent de leurs côtés plutôt aux rapports aux institutions, respectivement à la participation civique et sociale. Cette opération discursive de traduction d'expériences dans un cadre d'analyse interroge la place faite au savoir expérientiel des per-sonnes concernées, dont la reconnaissance est un enjeu non seulement de démocratie sani-taire, mais de rapports entre différentes formes de connaissance. Mots-clés: savoir expérientiel; citoyenneté; réinsertion; psychiatrie; santé mentale
Cet article fait état des résultats d’une recherche empirique réalisée auprès de membres de familles ayant un proche atteint de troubles mentaux sévères. Le recours à un cadre théorique poststructuraliste a été préconisé et, à cet égard, les travaux de Jacques Donzelot et de Michel Foucault ont été mobilisés. Les principaux constats issus de cette recherche qualitative indiquent que le gouvernement des familles s’effectue par l’entremise de mécanismes complexes. Nous avons aussi constaté que les membres de l’entourage, à risque de violence et en situation de grande vulnérabilité, doivent recourir au système judiciaire afin d’obtenir une aide psychiatrique formelle. Enfin, cette recherche nous a permis d’analyser qu’un double mandat (prise en charge du proche et contrôle social) est imposé aux familles, considérées à la fois comme objet et sujet de pouvoir. Dans ce contexte, le rôle de la femme se voit, dans bien des cas, surinvesti par les milieux psychiatriques et judiciaires. Par conséquent, des inégalités liées au sexe biologique risquent de se produire.
Okazało się, że wielokrotnie wyrażane ostrzeżenie przed nową „psychofarmakotyranią” ma swoje rzeczowe podstawy. Prowadzą ku niej z konieczności wpierw globalne procesy „medykalizacji”, „psychiatryzacji” i „psychofarmakologizacji”. Dotyczą one nie jakiegoś peryferium człowieka, ale samego naszego człowieczeństwa (istoty człowieka), bo sprowadzają problemy moralne - a tylko te dotyczą człowieka jako człowieka – do problemów zdrowotnych, „leczonych” psychofarmaceutykami. Prowadzi to zmian w funkcjonowaniu człowieka w jego człowieczeństwie, bo modyfikuje działanie ludzkiego rozumu, woli i uczuć. Identyfikacja tej manipulacji – kluczowa wpierw dla etyki, zajmującej się dobrem i złem moralnym, czyli dobrem i złem człowieka jako człowieka - jest jednak utrudniona, czy nawet uniemożliwiona na gruncie rozpowszechnionych dzisiaj modeli psychiatrii, dogmatycznie zamkniętych na klasyczną antropologię filozoficzną i klasyczną etykę. Autor ukazał ten antropologiczny i etyczny redukcjonizm u podstaw rozpowszechnionej w środowiskach psychiatrycznych (ale nie wszystkich) akceptacji psychofarmakologicznej manipulacji masami, jakoby dla ratowania ich zdrowia (zwłaszcza przed epidemią depresji) i „poprawienia” jakoby ułomnego człowieczeństwa.
The article analyzes two opposing views of the formation of the psychiatric field: the Foucauldian perspective, which holds sway in Brazil, and the perspective of Gauchet and Swain. Two works by Foucault (History of Madness and Psychiatric Power) are contrasted with Madness and Democracy, by the latter authors. It is argued that a society's political and assistance strategies about madness are shaped by the conceptual bases defining what constitutes the field of psychiatric theory and how it was formed. The article calls attention to the diverse consequences that these two approaches may have on the reform of Brazilian psychiatry.
Mais le malheur a voulu que les choses soient plus compliquees. (132) So I have kept just one rule and method, the one contained in a passage by Rene Char which can be read as both the most exacting and the most restrained definition of truth: ‘I will take from things the illusion they produce to save themselves from us, and let them keep the part of themselves which they offer us.’(x).
Buchausg. s. Foucault: Histoire de la folie à l'âge classique. Nouv. éd. 1972. Paris, Diss.
Le pouvoir psychiatrique
- M Foucault
Études de psychologie médicale
- J Delay
The Power of Psychiatry
- P B Miller
- N Rose