Les discussions sur les classifications psychiatriques à la Société Médico-Psychologique (1860–2014)

The Société Médico-Psychologique has devoted in the 19th century two series of discussions during several months about psychiatric classification. In 1860–1861, the discourse of Jules Falret recommends to use the evolutive criteria rather than the psychological one (Delasiauve). It allows the transition from unitary mental alienation to several psychiatric diseases and the decline of the monomanias. The aetiological criteria of Morel are discussed. In the same way, in 1888–1889, the classification of Magnan, axed on mental degeneracy, presented by his pupil Paul Garnier, is not admitted by all. Its opponents propose symptomatic (Dagonet, Ball) or anatomic classifications (Voisin, Luys). The discussion came to nothing, but the word psychosis begins to be currently used. Only 75 years later, the Société Médico-Psychologique debates again about the nosology. Between 1966 and 2014, seven discussions, each during one day (two days in 1994), are brought by clinical innovations or by the publication of official classifications, either French, or international. In 1966, are discussed the progresses involved by psychopharmacology and statistics. In 1978, the French classification of the Inserm is compared with the ICD-9 and the DSM-III, in preparation. In 1988, the clinical applications of the DSM are discussed, but there are always communications about the French classification of delusional disorders and about the paraphrenias. In 1994, the transnosography tries to open the way from a “categorical” classification to a “dimensional” one. In 2001 and 2010, two revised versions of the CFTMEA (French Classification of Mental Disorders of Child and Adolescent) are presented. In 2014, a discussion is devoted to the DSM-5. There is an agreement since 50 years about the interest of “mixed” classifications (symptomatic, evolutive and aetiological), about the necessity to avoid too frequent revisions, to obtain a consensus and to simplify the nosology.     

La mondialisation de la psychiatrie et la Société Médico-Psychologique

Ever since the first World Congress of Psychiatry was organized in Paris in 1950, the French Société Médico-Psychologique, who played an important part in its organization, has kept profitable exchanges of views with national societies who are members of the World Psychiatric Association. These exchanges revolved around the main issues which have marked the history of psychiatry in the second half of the twentieth century and the beginning of the twenty-first: The rise of pharmacology in psychiatry, ethics, classifications of mental diseases, protest movements, clinical research, family and mental patients associations, legislation, medicine of the person and so on. These questions were debated in following world meetings, including the sixteenth congress which recently took place in Buenos Aires, but also during symposia organized by national societies in their own capital cities. Minutes of such meetings were often published in the Annales Médico-Psychologiques. It is to be hoped that the Société Médico-Psychologique, being one of the world's oldest psychiatry societies, will be able to make present French psychiatry known in the world, since it carries the legacy of a long tradition of research in psychopathology. The present circulation of the Annales Médico-Psychologiques shows that readers in distant and often unexpected countries are curious to discover it.     

Pierre Pichot et la Société Médico-Psychologique

Pierre Pichot, born in 1918, is a member of the Société Médico-Psychologique since 1949 and has, as such, participated in the organization of many national and international psychiatric events. He has been particularly active in the World Congresses of Psychiatry, from the first organized in Paris in 1950 to the 7th organized by the APA in Hawaii in 1977 where he was elected president of the WPA. Professor at the CMME Chair at Sainte-Anne Hospital, he has published, alone or with collaborators, several important works on medical psychology or the history of psychiatry in the twentieth century, and in particular he has supervised the set of translations in the Latin languages of the DSM-III published in 1970. During a tribute session organized by the Société Médico-Psychologique on May 28, 2018 in Sainte-Anne, several of his collaborators or confreres, who knew him in France or during one of his many trips to the foreigner, have mentioned certain aspects of his teaching and work.     

Eugène Dally (1833–1887) et les liens historiques entre la Société Médico-Psychologique et la Société d’Anthropologie de Paris

The Société Médico-Psychologique (SMP) was founded in 1852, while the Société d’Anthropologie, with the later addition “de Paris” (SAP), was founded in 1859 under the auspices of Broca. Several of its members, including some of the more eminent ones, came from the SMP. These two societies remain very active to this day.ObjectivesThe objectives of these two societies and the issues, which concerned the scientific world, are researched in the work and philosophical options of Dr. Dally (1833–1887), who was an active member and president of the two societies.Materials and methodsThe work of Eugène Dally has been compiled in the collections of the Annales Médico-Psychologiques and in the Bulletins et mémoires de la Société d’Anthropologie de Paris.ResultsEugène Dally followed in the footsteps of his father Nicolas Dally as both physiotherapist – propagating in France the benefits of gymnastics – and polygraph. A disciple of Littré and an intransigent defender of the positivist doctrine, he was also a convinced anticlerical and he defended his ideas within these two societies which he joined the same year, at the age of 27 years. His career in the SAP was brilliant (he held its chair in ethnology) in the footsteps of Broca, of whom he was a fervent disciple. After his translation of Man's Place in Nature by Th Huxley, which allowed him to defend Darwin's ideas, he introduced the concept of transformism to France and shifted Broca's anti-evolutionist stance. He defended the close links between Man and the higher apes more consequently than Huxley, anticipating the modern works of the primatologists (Frans de Waal). At the SAP he was also a critical adversary of the extrapolations made from dubious anomalies discovered upon examining the brains of criminals with the aim of considering them ill and thus explaining their acts. His arrival in the SMP coincided with the opening, which had been agreed (in sign of goodwill to the new conservative power) to non-medical members from the fields of philosophy, law, history and even religion. His work and his interventions were those of a polemicist battling in the clan of physiologists and materialists against the spiritualists and metaphysicians. Hence he took clear-cut, violently anticlerical positions when the issue of the soul was put on the agenda. The deadlock in the debates on such subjects most likely explains the gradual abandoning of multidisciplinarity within the SMP membership. During discussions in 1863, which brought together all the leading lights of the SMP on the issue of criminal responsibility, Dally equally supported an unequivocal position, setting hardened criminals alongside the ill. Thus he defended – in a conscious manner – a theoretical position which considered social defence only.ConclusionsEugène Dally is the most committed representative of a generation of anticlerical doctors obstinately pursuing the Voltairien combat. His positivist, scientific convictions most likely met with the approval of several members of the SMP who found in him their spokesman. He can be considered to be a forerunner of the movement for social defence and his position on the close ties between Man and the higher apes has more recently proved its relevance.     

L’histoire de la psychiatrie légale à la Société Médico-Psychologique

ObjectivesThis paper seeks to establish the contribution of the discussions of the Société Médico-Psychologique (SMP) to the history of forensic psychiatry in France during the century following its birth in 1852.MethodsWe summarize the discussions held during the Second Empire and the beginning of the Third Republic, about the criminally insane, the dangerously insane, the insane with consciousness and about assistance. Synthesis articles published from the middle of the 20^th century on the law of 1838 (Desruelles), psychiatric forensic medicine (Heuyer), assistance from 1789 to 1838 (Bollotte) and from 1838 to 1939 (Demay), are analyzed.ResultsThe principal themes of forensic psychiatry have been treated in depth at the SMP, in their clinical, juridical and philosophical aspects. The paper contains three chapters: (1) dangerous lunatics: the association between insanity and criminality, the responsibility of delinquent insane persons, the criteria of dangerous behavior in “reasoning” lunatics and in lunatics with consciousness; (2) inpatient and outpatient care: patient activities, colonies and family placements, chronicity in asylums, incurable lunatics, and the first open-door services; (3) the law of 1838 and its projects of reform: the respective roles of administrative and judicial authorities, private establishments and religious hospitals, the integration in the law of open-door services and outpatient follow-up after 1945.DiscussionIn the 19th century, the economic value of the patients’ work (generally agricultural) was put forth and took precedent, over its therapeutic function. After 1880, the great debates over several months and sessions ceased to deal with specific forensic themes. At the end of the 19th century and the beginning of the 20th, the prevalence of degeneracy and the theses about criminals of the Italian Cesare Lombroso eclipsed the philanthropic concerns of the previous period. During the years just prior to World War I, the theme of responsibility is treated in other forums than by the SMP. After the Second World War, mortality due to starvation in asylums for lunatics was only slightly alluded to.ConclusionIn the ideological context of the period in which they were published, decisive contributions were made between 1852 and 1946 by the SMP in several domains, and which will have a bearing on psychiatric legislation and care up to the present day: on the one hand, the organization of hospital services for the mentally ill patients, occupational therapy, forms of outpatient follow-up care, the beginnings of a sectorial organization of care and ergotherapy in the institutions. On the other hand, criminology, knowledge about dangerous behavior and the responsibility of psychiatric patients, and in forensic expertise.