Francois Ferrero: The Geneva 1980's psychiatry crisis: Psychiatry an Antipsychiatry
François Ferrero: Preface
The starting point for this project was a question Thomas Ban asked me a few years ago about the events that took place in Geneva in June 1980 when he was there working at the World Health Organization. Stimulated by his curiosity and enthusiasm, I began to search for documents to try to reconstruct the story of the death of a young patient at the Geneva University Psychiatric Hospital, leaving little room for my own memories. At first, I relied solely on written sources, without taking sides, which gave this text a bit of a journalistic investigation. A first version was published on the INHN website and, in view of the interest it aroused, the project of making it into a book gradually became possible.
That night in June 1980, when the nurse on duty comes to check on Alain, a young patient in his cell, it is not clear if he is sleeping. However, for 10 days, he has been subjected to a very heavy treatment for a sleep cure decided by the hospital director. When the nurse returns at 06.30 am, he finds him dead. A sleep cure is a surprising choice which can be explained, in part, by the fact that a few months earlier the electroshock devices were stolen by anti-psychiatric activists. Given the socio-political context of that time, these devices were not replaced.
Alain’s death was both the detonator and the revealer of a major crisis in the psychiatric institutions.
How is it possible to explain that a tragic event, however far from being exceptional led to such consequences on psychiatry, influencing politics and academics as well? To try to answer this question, several hypotheses will be proposed based on certain political and social characteristics of Switzerland and more particularly of Geneva, a city whose psychiatric history had already been marked by several crises.
In 1980, I was a senior resident in another ward of the hospital, and I have never forgotten these events which deeply affected me. However, when it came to putting together a few memories dating back over 40 years and subjecting them to less subjective historical verification, the undertaking turned out to be particularly difficult. I tried to gather as much information as possible, from newspaper articles, official documents, and other sources to reconstruct this tragic story, without taking sides, except to underline the fact that the dosage of drugs administered to Alain deviated from all uses and appeared totally excessive.
Although this work focuses specifically on Geneva’s psychiatry in the late ‘70s and early ‘80s, it is necessary to refer to the situation in a few other countries, thus, to remind that the difficulties encountered by psychiatry at the time were found practically everywhere. The prevailing climate was characterized by the radical questioning of the social order and by the rejection of any hierarchy as indicated by the famous slogan, Il est interdit d’interdire. How could Geneva psychiatry not have been carried away sooner or later by such a questioning of the organization of society? How could it have avoided responding to criticism and a rethinking of its practices after years of stability that it undoubtedly owed to the personality of a charismatic director?
Even before 1968, many books radically questioning psychiatry had met with exceptional success, and some are still considered "classics." Examples include The Divided Self (1960) by Ronald D. Laing; Asylums by Erving Goffman (1961); The Myth of Mental Illness by Thomas S. Szasz (1960-1961); Histoire de la folie à l'âge classique by Michel Foucault (1st ed. 1964, English translation, Madness and Civilization, 1965); or L'Istituzione Negata by Franco Basaglia (1968, English translation, The Denial of the Institution, 1968). All these books have been translated into many languages and have reached impressive, and certainly nowadays unimaginable print runs. They represent witness to a time when it was believed that ideas could change the world.
In Europe, the most radical protest developed in Italy with the adoption of the "Law 180" which led to the closure of asylums. In Germany, antipsychiatric protest was sometimes taken to the extreme and highly politicized forms focused on the issue of treatments by Electroconvulsive Therapy (ECT).
In France, where the 1968 movement originated, the undisputed "patron" of university psychiatry was Jean Delay, archetype of the "Mandarins" in the eyes of the protesters, and his authority was suddenly questioned. Driss Moussaoui, who was an intern in his department, referred to this episode as a "thunderclap in a blue sky" (Moussaoui 2002). By May ‘68, the chaos was indescribable.
A motley crowd of more than 500 protesters invaded Delay's ward and office, with plans to release patients considered prisoners, victims of the system. After long discussions, a psychiatrist, Lucien Bonnafé, managed to convince the crowd to return the next day and, finally, this assault was abandoned. However, the Clinique des Maladies Mentales et de l'Encéphale, which was the beacon of Francophone psychiatry, did not survive these events. The Clinic was subsequently divided into a dozen services and, two years later, due to his health, Jean Delay resigned.
Other services were also occupied, such as that of Georges Daumézon in Sainte-Anne, and in the sector of the 13th arrondissement of Paris, yet at the forefront of a new psychiatry, even the seminary of Jacques Lacan was disrupted - the antipsychiatry challenge did not differentiate between theoretical models. Among countless demands, three of them concerned the organization of psychiatry: the first called for the separation of psychiatry from neurology, which was done the following year; the second called for a reform of the training curriculum, which was also carried out; and the third required the exit of psychiatry from medicine, which, fortunately, was not followed up.
The book has four parts:
The first part presents this tragedy and analyzes:
-its causes and repercussions on the Geneva psychiatric institutions,
-its political impact and its exceptional coverage by the media,
-the power conflicts within the institution in the context of the succession of a master admired and respected for his scientific skills, open-mindedness and human qualities,
-the social context of the post ‘68 era and the influence of the anti-psychiatric movement.
The second part gathers all the comments, reactions and testimonies posted to the INHN website, without modification, and my replies.
The third part, under the title "Psychiatry and Antipsychiatry," widens the debate, thanks to the contributions gathered.
The fourth part, “Background”, comprises three short chapters: the first is devoted to the French model of sectorization, the second evokes some characteristics of the Swiss political organization relevant to Psychiatry and the third seeks to understand the ambivalent relationship that Geneva, a city otherwise so cultured, in love with freedom and open to the world, has long maintained with Psychiatry.
Conclusion
How will readers react to this book? They probably will be surprised by the violence and passion which then marked the debates regarding Psychiatry. Among other questions, how to explain the absence of women in the discussion? What about the belief that ideas could change the world?
Beyond the controversies, can we ignore that our relationship to madness, depends on time, space, political and social context, and many other factors?
This publication is undoubtedly unique in its form as well as in its substance, thanks to the richness of the exchanges in which personal stories, anecdotes, memories and original reflections mingle. Many contributors have been witnesses and major players in Psychiatry since the 1950s and 1960s. These psychiatrists have held important positions, published numerous works and taught extensively. All remain passionate about debating ideas.
May the thoughts and energy contained in this book inspire the younger generations and help them to continue their commitment to this demanding and exciting profession of Psychiatry.
And finally, may psychiatrists never forget a principal precept of Hippocrates: primum nil nocere (First, do no harm).
February 3, 2022