Intervention OF Lille Institutional psychotherapy
June 3 2010 May 31, 2010 version
June 3 2010 May 31, 2010 version
Destigmatisation , deinstitutionalization and community life: towards a psychiatry popular
by Serge Drylewicz.
week Mental Health with the theme destigmatization takes place at a time which seems crucial for the public health system. HPST law is set up, and reforms are announced, which if confirmed could put into question the very principles of organization based psychiatry sectorization.
reforms that are taking up surfing on a very special atmosphere that affect psychiatry, with full force. We talk about stigmatization, but it seems especially with the debate over national identity, the prominence of security priorities that are racist trivializes the soundbites, rejection, humiliation, guilt in respect of this which seems unlike the "traditional French body.
the occasion of miscellaneous, the press, but unfortunately officials of the state, practicing the amalgam between mental illness and dangerousness.
Vision genetic, innate, fatalistic attitudes and life trajectories, seems to become official truth justifying the repressive dominance of the questioning of social processes pathogenic. Alas, too, public authorities, surfing Fear effects, announce retrograde and repressive measures on the organization of psychiatric care. It's everyday that we must fight against the pressures to make caregivers of Psychiatry guarantors of public order, become a priority in relation to the goals of care. This pressure is accompanied by guilt teams, and a great discomfort of those on this mission, including support and rehabilitation in the city.
What occurs in psychiatry is part of an attempt to change deeply collective values of our society, including inherited the National Council of Resistance, with its emphasis on solidarity, responsibility being shared, a demanding concept of social justice. These challenges to the public hospital, the psychiatric sector, find themselves in different fields, educational, health, social mobilization, and to resist the tens of thousands of professionals and users, are found especially in the appellants' appeal led by psychoanalyst Roland Gori.
de-stigmatizing mental illness and insanity, it must yet be accomplished in today's climate of heightened stigma and may rely on the experience gained since that Bonnafé Lucien (1912 -2003, he was one of the inventors of the area) called the psychiatric revolution after the war. This movement was made of inventiveness, enthusiasm, incisive criticism against what oppresses , Dehumanizes the institutions referred to segregative. The current reforms are against the opinion of the overwhelming majority of professionals, without consultation, and in haste. But it seems the reforms will experience a break in late 2011 ...
Among the main achievements of this revolution psychiatric association's place in psychiatry is absolutely central.Il is likely that the role of associational life in service, is a decisive indicator of the degree of practice dealienating of this team. I do not think I've seen this test there in the project evaluation and acreditation who, with the VAP and pricing activity are central to the reform project financing services. By cons in the criteria, the role of isolation rooms is particularly valued: it is likely that you will do more days of isolation room, the better your ways!
The psychiatric association is directly related to the movement of institutional psychotherapy that developed during and waning of the war in a critique of the asylum world whose modus operandi and even the logic operation in isolates had trained during the war in psychiatric hospitals effects of concentration camps with an excess mortality of 40,000 patients related to malnutrition. The experience of the hospital of St. Alban lozere where there had been no such excess, organizing other than in shelters everyday life by restoring patients to a place of active subject, actor fully in community life This experience then led to review all of the expression of diseases such as expression of environmental conditions in which they develop. The agitation, delusions, depression is also an expression of the mood of an environment, and their evolution depend on environmental factors, daily life in a service. Diseases are also pathoplasties, which, to be treated must be accompanied by treatment of the institution itself. An active life of the institution becomes a prerequisite to effective care. From the establishment of workshops, movement of money and their therapeutic effects, it became necessary to make them legal and have them recognized. This has led to the circular dated 4 February 1958 determining the conditions of use of the therapeutic work and remuneration in the hospital. The hospital committee, the clubs may have therapeutic and official recognition.
this in the post war boom and implementation of reform projects that cross the marine hospital was officially founded in 1952, particularly from the experience of St Alban, where worked Tosquelles, Oury, Torrubia, Bonnafé. The Navy Cross were created as a federation of all these internal movements to psychiatric hospitals tending to change the conditions of operation, located in the current institutional psychotherapy. The Navy Cross federation was mutual support, a place of theory and experience exchange allowing the establishment and development of hospital committees. It supported the establishment of sectorization in the 70s. It brings together associations, institutions, services, covering most of the health or social structures of mental health as indicated by the website of the federation to help the Navy Cross mental health.
In the central region for over twenty years, regional coordination, led by doctors at the clinic of La Borde, held monthly in various establishments in the area of training days which are also moments of exchange experience and support to participating teams. One feature of these meetings is its multi professional quite unique: doctors, nurses, educators, psychologists, social workers, managers of Guardianship lawyers but also local politicians, members of associations such as UNAFAM, meet and participate in this effort to understand each other's fields of action and their specific languages. These meetings have involved thousands of professionals play an important role in de-stigmatizing mental illness and the point of view.
acquired a relatively recent through the work of Cross Marine has been the law of 4 March 2002 on patients' rights and quality health system which provides for establishment of associations governed by the provisions of the Act of July 1, 1901 referred for care, prevention, rehabilitation of patients under agreement with public hospitals. The relationship between the hospital and the partners are governed by agreements which include the participation of hospital staff on their work time, which is absolutely critical.
It seems to me very important that this formalization of the voluntary in institutions within or outside hospital is found in a statute that says solemnly:
art 1 "the fundamental right to health protection must be implemented by all available means for the benefit of everyone. professionals, institutions and health systems, insurance agencies or other organizations involved in prevention and care, and health authorities contribute with users, to develop prevention, guarantee access for everyone care, and ensure continuity of care and the best safety possible.
art 2 ill person is entitled to respect for his dignity
art 3 no person may be discriminated against in access to prevention or care.
intentions to reality there is probably significant differences that associations, including those affiliated with Navy Cross to help bridge, giving careful and caregivers the opportunity to fight against over-alienation induced by the institutions, which are added consequences of psychiatric disorders. These associations are fundamental interfaces between what is happening within the network care specified, and the city.
The life within the hospital service, by the responsibilities which it distributes to carers and cared beyond their association is already a de-stigmatization of status incompetent, irresponsible, dangerous attached too long to madness and mental illness. The functions of president, board member of the club, club member attending the meeting and votes are the recognition of a subject performing a function of citizenship. The development of collective projects (trips, discuss: ion, shows, articles in a newspaper) may also be the opportunity to do with associations outside of psychiatry, for example by investing a home for all (an exhibition of paintings and sculpture at The Rich, alongside artists), committing to an event in the City (the development of a setting of 10 m high for a festival in the city of towers), a combination of choral writing a diary in common with high school students, an opportunity to exchange visits and internet exchanges, etc. .... filming Place in the media of these events reflecting the activity of associations affiliated with Navy Cross, is also an opportunity to demonstrate the richness activities of those who are too often presented in a condescending fashion and deficit. In Tours, the CATTP louis Pergaud has been particularly noticeable in the neighborhood of sanitas in symbiosis with the local associations. Hospital associations in Tours also operate associative apartments are an opportunity to meet some contexts, often banal and de-stigmatize the neighborhood merchants.
The different associations affiliated to the Navy Cross, have broadly similar goals. The association ARCHIPELAGO Roubaix expresses his project
1) facilitate the practical operation of the various therapeutic workshops offered by health care teams with people with disabilities to psychological causes. These workshops are very diverse in nature: social therapy, development and cultural practices, preparation for reintegration into the world of work, participation in social activity.
Their aim is the active participation of users, their direct involvement in their organization and conduct, taking responsibility for their progressive management, including financial, according to their access speeds and opportunities within decision-making bodies of the association ...
2) support the development of recreation for users within and outside the hospital sector psychiatry and animation, to fight against the inertia and stagnation in the only places of care. They allow for mental disability living in the city, still struggling to participate in alternatives to the city to support and fight against the tendency to isolation, the organization of clubs, meeting point, sports and cultural exchanges with other associations to inform ... the resources of the city's recreation
3) support and project support for social rehabilitation
assisting in the release of the admitted poor through loans ... facilitating access to housing in the rental of apartments associative ... bringing users of psychiatry to know and participate in the workings of the association. The commitment to the associative allows the user to find a citizen to exercise option to extend interress then in other associations of the city
4) promote the use of various artistic productions users
5) provide information to the general public of the terms of psychiatric care by organizing or participating in conferences, forums, information days or any other means of communication.
this broad agenda is imbued with a desire to support, certainly, but also to restore a place full of users within the city, especially emphasizing the dimension of citizenship restored, acknowledged in his full value of contributions to the community of equals by other citizens.
destigmatizing madness, mental illness already happening by destigmatization the stigmatized, who becomes aware of his dignity, and as in a mirror, the stigmatizing gaze of others, which is often a guilt towards his own folly which no longer feed themselves. For those who would watch the designated crazy with scorn, condescension or fear, to rub shoulders and see the accomplishments that bear testimony to his humanity is surely both educational and therapeutic its own fears. This experience may make him go to a design of his own existence deeper, more able to take the big existential questions of meaning of life, death. It is there that makes sense affirmation françois Tosquelles "Without recognition of the value of human folly is the same man who disappears. ..."
This openness to the humanity of the lessons of mental illness, madness, as she reminds us Normopathy or sick on the same ship, or labyrinths, that means worrying territories Lucia Bonnafé to appeal to human solidarity activists:
"but we are country of fear. things about madly, do not let the serenity watching, including those whose destiny and vocation led to work in this world apart ... alienism is dominated by its complicity with the practices of segregation, rejection, exclusion. The question of dealienating (is) deeply imbued with Freudian lesson "what could I do for you ?"... dealienating perspective can be defined as research or detained limitless ways to unleash the potential caregivers contained in the people ... we must first free themselves from this poverty that is reducing the meaning of "care" or "treat" the only area of techniques learned in medical school or psychology ... It is trite that to promote own awakening in the other, its own capabilities, as to understand what is at stake and master the problems of the troubled relationship, it takes much more time to seize the person and their problems and to monopolize the "treatment "in a" support "more or less institutionalized .... The greatest service to pay him is to accompany him in his emancipation, against pressures that pushed conduct discharge, at the sign which we feel guilty. Is to do with the potentials that are contained in it, without coercion or restraint, as to do as much as possible, of all his business. "
Bonnafé talking about a popular psychiatry, it refers to this as emblematic of revealing the functioning of a society the way it treats the plight of standards and particularly the effects of mental illness, madness . Rejection and stigma of insanity, mental illness is the unwillingness to recognize the complexity and contradictions of the human, of what they bring as thick as a rich man's destiny. It should do with hatred, jealousy, the ideal utopia, the finitude, the body another.
This goes without doubt these thoughts of Martin Buber in The Life Dialogue: "Just as freedom and destiny, and fate are arbitrarily related to each other ... The free man is he whose will is not arbitrary. He believes in the reality, that tell the real link that joins the real duality of the I and UT. He believes in destiny, he thinks she needs him, she does not hold the edge, she waits, he must go to her with all his being, he knows it. What will happen will not be like that imagines its resolution, but this can come about only if next is committed to wanting what he can to try .. . He watches what is going to develop on the merits of being It monitors the progress of what is essential in the world; ...(( not to realize himself as essentially wants to be directed by the man he needed,)) by means of human mind and human action, human life and human death. He believes, as I have said, that is to say: he offered to meet. "
Tours March 16, 2010
Dr. Serge Drylewicz
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