Francois Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis:
Forced Hospitalization, ECT and Sleep Therapy
Comments by Luc Ciompi*
It is highly commendable that François Ferrero reopened the historical crisis of 1980's Geneva psychiatry and recall edit to the younger generations. Back then, this crisis caused a stir far beyond Geneva and beyond the narrow field of psychiatry. The news papers were full of articles with contraindicatory reports and personal attacks and counter-attacks on all those directly or indirectly involved, political authorities and controlling or supervising institutions included. The emotional waves continued for several months and eventually settled only with considerable delay. For some insiders, they haven’t even completely vanished today. Why all this turmoil?
In my opinion, there were two distinct clusters of factors that combined in this affair with a cumulative effect: the current local and personal circumstances on the one hand; and an increasing, nearly worldwide, long-term “antipsychiatric" protest and reform movement against traditional psychiatry and its narrowly “medical” or “cerebro-organic” understanding of psychiatric diseases on the other.
The local circumstances and personalities involved have been described extensively by François Ferrero. As for the historical background, some supplements may be useful. The "antipsychiatric" wave of reforms started in the post-war period and reached a first peak in the late 1960s in certain countries. In the 1970s and 1980s, more or less radical reform efforts of a socio-psychiatric nature started quite simultaneously not only in other places in Switzerland, such as Lausanne, Berne and Zurich, but also in other western countries, especially in England, the USA, Germany and Italy. Reformers mainly questioned the predominantly medical and brain organic models of mental illness, by drawing attention to unfavorable social, social and institutional circumstances as at least equally important causal factors. In practice, they sought to open and reduce the size of the old prison-like mental psychiatric hospitals by reformingor even replacing them by a whole range of new community-based facilities, such as day and night hospitals, out patient clinics, rehabilitation centers, sheltered homes, etc. Especially in France and Italy, geographical decentralization and sectorization of the mental health care system was systematically developed. Thus, the Geneva crisis of the 1980s can be seen as a relatively late but virulent manifestation of a wave of criticism which had its origins, in some places, in the 1960s
In an even broader historical context, the Geneva crisis appears as a partial manifestation of a conflict which started, practically, with the beginnings of psychiatry itself as a special branch of medicine in the 19th century: The conflict between those whothe Germans used to call Psychiker (“psychists”) and the Somatiker (“somaticists”), e.g., between a more psychodynamic/sociodynamic approach tomental troubles on the one hand, and a biological and psychorganic approach on the other. The antagonism between these two points of view has beengoing on forat least 150 years, with a more or less alternating dominance of one or the other during this time. In the middle of the 19th century with its “moral treatment,” then again in the ‘20s and ‘30s of the 20th century with the “mental hygiene” movement, and again in the ‘70s and ‘80s with its widespread reforms of the psychiatric care systems, the psychodynamic/sociopsychiatric approach led in many Western countries. Since the “decade of the brain” (1990-2000), however, up to the present day, it is clearly “biological psychiatry,” which dominates the scene.
In spite of the fact that discussions on this matter have at least temporarily receded in the public field, the old antagonism between a mainly organic-biological and a psycho-sociodynamic- oriented understanding of mental troubles remains relevant even today. Thus, not only committed professionals, but especially also patients and associations of family members increasingly complain that both in the brain-centered understanding of mental illness as well as in therapy, the currently dominating biological psychiatry severely neglects the patient as a person, his biography and his social and familial context.
A new synthesis between social and biological psychiatry may, however, be emerging from the underground in relation, on the one hand with the mentioned complains, but on the other hand with recent discoveries in the brain sciences concerning neuronal plasticity, the so-called epigenetic effects of the environment on genetic factors, as well as research on the effects of distress and psychic traumata which all show that environmental factors have profound effects on brain functions.
A limitation of Ferrero's account of the "Geneva crisis” to which he is himself pointing is the fact that his presentation is mainly based on media reports and subjective personal experiences only, but less on original documents such as case histories, internal reports or faculty files. It is to be hoped that future psychiatric history research will be able to fill in these gaps, given that the Geneva crisis was certainly paradigmatic for many similar conflicts both in Western Europe and in the US, and that many details of this crisis remain still quite obscure.
January 3, 2019