Making Sense of the ‘Chemical Revolution’. Patients’ Voices on the Introduction of Neuroleptics in?the 1950s

The so-called chemical revolution has produced a vast historiographical corpus. Yet the patient’s voice remains surprisingly absent from these stories. Based on the archives of the Institut de Psychiatrie (Brussels), this paper traces the introduction of Largactil as recounted in patient letters, physician records and nurse notes. The paper thus contributes to the history of therapies from below, but also participates in the historiographical debate about whether the introduction of neuroleptics can indeed be considered a revolution.     

Sur les classifications des troubles mentaux et le pouvoir des langues

About CFTM R-2015, seen from the point of view of a French psychiatric language, we discussed various theoretical, historical and current points concerning the impact of language on how to understand and think about our discipline and beyond the psyche. This article is not intended to demonstrate the superiority of the French language but rather to emphasize the dangers of any hegemonic or linguistic supremacy. The adoption of the term psychiatric language introduces a distinction between language and language (almost absent in English and German) and refers to the verbal corpus by which every psychiatrist thinks of his or her discipline and communicates with other psychiatrists in a given language. The authors of the CFTM R-2015, although polyglot, speak, think and write in their mother tongue. The links between CIM 10 and CFTM R-2015 revitalize notions, categories, words that they can each day experience relevance and effectiveness in their classificatory task. Thus, the fate of a few words, expressions, propositions… has been critically examined, sometimes at the risk of tendentious positions, in the construction of today's dominant classifications. Some reality and literary examples of corruption of language, going beyond the technical framework of psychiatric classifications, illustrate the general problem of the power of words and the more or less clearly intentional consequences of their manipulation. A “micro-reading” of the DSM 5 chapter entitled “Somatic Symptom and Related Disorder” aims to demonstrate how, in its form and content, this new chapter not only “blurs the maps” of a problematic field of psychopathology (the place of the body in psychiatry) but deconstructs the conceptual basis of the patient–physician relationship, in other words, of medical psychology.     

Souffrance psychosociale et risque suicidaire, quelle articulation entre médecine de ville et psychiatrie hospitalière ? Résultats d'une étude qualitative

Mental disorders are now becoming the first reason for consulting a general practitioner. These mental disorders include pathologies identified by psychiatry as well as a series of complaints linked to psychosocial distress. This latter, on the border between social field and medicine, does not benefit of a specialised clinical approach. Nevertheless, suicidal behaviour constitutes one of the complications of psychosocial distress which general practitioners have to face, though they have scant academic knowledge of it. A qualitative study examining an important oral material and 202 medical letters was realized in three of four Breton geographical departements. This study describes and analyzes the clinical attitude of general practitioners and their answers. Based on this study this article approaches the question of the articulation between private practice and hospital psychiatry.     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Introduction : gouverner et soigner

French psychiatry was born in a particular political context: that of the revolutionary and post-revolutionary period. From its beginning, at the end of the 18th century, it was linked to the political realm. We will start with a pre-revolutionary text: The 1785 Colombier and Doublet memorandum containing a genuine program of organization and of care originating from the philanthropic ideas of the Enlightenment philosophy. This program contained the seeds of the very possibility of the birth of a new discipline, the medicine of the insane linked to the curability of madness, a medical version of the notion of degeneracy the 18th century philanthropic current was fond of. Later, the imbrication of politics and psychiatry may be studied by way of the parallel evolutions of psychiatry and of the successive political regimes of the 19th century, and also through some expressions of clinical psychiatry itself, as may be seen by the presence of the political in the mental representations found in some forms of delusion. The study of links between the political and psychiatry leads us to consider the secularization of discourse and of psychiatric institutions, and to examine the origin and consequences of the 1838 law as well as the criticisms rapidly leveled at it. The political stakes of classifying illnesses, the relations of psychiatry with justice and the eventual repressive uses of psychiatry should also be considered. Finally, the organization of care and the design of the architectural environment and more generally of the therapeutic environment are also related de facto to political choices.     

Nosographie et classifications des maladies mentales dans l’histoire de la psychiatrie

Objective

Retrace the history regarding the classification of diseases, notably mental diseases, from the birth of psychiatry at the beginning of the 19th century and up to the 10th revision of the International Classification of diseases published by the WHO (in 1993).

Method

Study the classifications proposed successively by the nosographists during this period.

Results

In the 18th century, physicians classified diseases in the same way as animal and vegetal species (Carl von Linné). In the 19th century, following several attempts in France and Germany to classify mental diseases according to known or suspected aetiological and pathogenic factors (B.-A. Morel, Griesinger), psychiatrists classified psychosis and neurosis according to their clinical symptomatology and their development over time, from their onset up to the terminal stage. In 1893, J. Bertillon proposed a “Nomenclature of diseases” during the International Congress of Statistics in Chicago that permitted their classification, so as to classify-collect statistical epidemiological data on international level. Revisions were made between the two world wars by the Office of Health of the Society of Nations (Geneva). Following the foundation in 1948 of the WHO, it was the latter that continued the revisions of the International classification of diseases (ICD), Chapter V (F) of which is dedicated to disorders.

Discussion

The debate on the question of classifications in psychiatry has always taken place during the World Congress on Psychiatry since its initiation in Paris in 1951. In 1976, during the sixth congress in Honolulu, a resolution was adopted requesting the national psychiatric societies that had a classification of mental diseases to revise the latter so that they tallied with Chapter V(F) of the ICD. The American Psychiatric Association revised its Diagnosis and Statistical Manuel of mental disorders (DSM) and published the DSM III. In France, a group of pedopsychiatrists published a French classification of Mental disorders in children and adolescents (Classification Française des Troubles Mentaux de l’Enfant et de l’Adolescent- CFTMEA), the last revision of which was published in 2012 (CFTMEA R 2012).

Conclusion

This study shows that it is not possible to propose a classification of mental diseases, in particular according to the development of psychiatry at the time it is drawn up; it can only be of value within the cultural context of the country in which it is to be used.