François Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis: Forced Hospitalization, ETC and Sleep Therapy
François Ferrero’s reply to Luc Ciompi’s Comments
I am grateful to Luc Ciompi for having understood that one of the main purposes of my paper is to remind the younger generation of this drama.
Nonetheless, teaching some dark memories of the history of psychiatry remains difficult and it is usually received with some ambivalence by academics.
The Geneva psychiatric crisis developed relatively late by comparison to many other places. The reason is essentially due to the moral authority and human qualities of the chairman at that time, Julian de Ajuriaguerra.
Ciompi’s comments present a good opportunity to introduce some of his major achievements, for example his well-known research on the long-term course of mental illnesses, especially schizophrenia. Ciompi’s study with Müller (1976) showed that schizophrenic patients, reexamined more than 36 years after their first admission, had a long-term course more favorable and more variable than believed. At that time, if I am correct, the results of only two or three other longitudinal studies were already published: by Manfred Bleuler (1968, 1978) over a 23-year period and by Huber, Gross and Schüttler (1975) over a 20-year period.
Ciompi (1988) has also proposed an alternative model of the evolution of psychosis, referring to the stress-vulnerability concept by Zubin and Spring (1977) and on the interplay between unfavorable environmental and biological factors. He also underlined the role of pathogenic interactions between emotions and cognitions.
This study was followed by other important contributions to social psychiatry and in particular, the development of alternative treatments. Among them, a small therapeutic community, the Soteria Bern, started 1984 in reference partly to Loren Mosher pilot project in San Francisco (Ciompi, Dauwalder, Maier et al. 1992; Mosher and Menn 1978). It focuses on a non-drug or low-drug treatment for acute schizophrenics in a small, relaxing and protected environment.
Going back to the Geneva crisis, regardless the choice made to treat Alain with a sleeping cure, it appears that almost all requirements for an appropriate therapeutic setting were missing: isolation instead stimulus-protecting therapeutic environment; absence of close collaboration with the family and with other important persons of reference; lack of information to the patient, family and staff on the treatment and on the existing risks and chances; absence of any elaboration of common realistic goals for the future, etc. This statement has nothing to do with the merits or limitations of one or another psychiatric school - it points to a tragic and incomprehensible example of a very poor psychiatry. Such tragedy could be helpful for the teaching of residents and nurses as an example of inappropriate therapeutic setting with, in that case, its tragic consequences.
References:
Bleuler M. A 23 year longitudinal study of 208 schizophrenics and impression in regard to the nature of schizophrenia. In: Rosennthal D, Kety S, editors. The Transmission of Schizophrenia. Oxford: Pergamon Press; 1968, 3-12.
Bleuler M. The Schizophrenic Disorders: Long-term Patient and Family Studies. Nee Haven: Yale University Press; 1978.
Ciompi, L: The natural history of schizophrenia in the long term. Brit J Psychiat 1975; 132: 1237-47.
Ciompi, L. The Psyche and Schizophrenia. The bond between Affect and Logic. Cambridge: Harvard University Press;1988.
Ciompi L, Dauwalder HP, Maier C, Aebi E, Trütsch K, Kupper Z, Rutishauser C. The pilot project 'Soteria Berne'. Clinical experiences and results. Br J Psychiatry Suppl. 1992; 18)\:145-53.
Ciompi L, Müller C. Lebensweg und Alter der Schizophrenen. Berlin: Springer Verlag; 1976.
Huber G, Gross G, Schuttler R. A long term follow-up study of schizophrenia: Psychiatric course of illness and prognosis. Acta psychiatr scandinavica, 1975;52: 49-57.
Mosher, L. Menn, AZ. Community residential treatment for schizophrenia: two-year follow-up data. Hosp and Community Psych 1978; 29: 715-23.
Zubin J, Spring B. Vulnerability--a new view of schizophrenia. J Abnorm Psychol 1977; 86:103-26.
June 13, 2019