Title 2
The Act of June 30, 1838 at Circular sectorization of March 15, 1960
The circular of 28 October 1902 is the first statutory instrument relating to the professionalization of guardians to care of fools. But it was not until the decree of May 26, 1930 for the designation of guardian is replaced by a nurse (e) the lunatic asylums.
Under the leadership of the Popular Front, asylums become county psychiatric hospitals. The distinction between general hospitals and psychiatric hospitals becoming official, and with it the distinction, which we will discuss, among nurses in general nursing, with degree of state since 1922, and specialized nurses asylums.
Successor to the Popular Front years, the drama of the Second World War: 1939 and the entry of France into the war against Nazi Germany on September 3, the French capitulation in June 1940, the years of occupation and collaboration of the Vichy regime until the armistice dedicating the victory of the Allies against the Nazis, 8 June 1945.
People with psychiatric disorders and staying in care facilities during this terrible period are mostly depleted.
In Germany, the Nazi ideology of a healthy person takes a form of systematic eradication towards the sick and disabled people and condemns them to death by euthanasia. On this unspeakable tragedy, books were written, and films, I think the film Amen by Costa Gavras. The figures show that about 50% of chronically ill or 70 000 people were murdered in Nazi Germany by the gas and that 20 to 30 000 have been abandoned to their fate without assistance to die.
In France, the "slaughter of Fools" is estimated at 40,000 people died of starvation, neglect, cold in asylums. Some names are known as that of Camille Claudel, sculptor and sister of Paul Claudel, Rodin's pupil and mistress, who died in poverty in 1943 at the hospital in Montfavet, near Avignon, where she had been imprisoned 30 years earlier September 9, 1914.
This tragic period comes highlight a third fundamental constant when you think the organization of psychiatry: the question of the value of human lives.
ideology of man "biologically superior" to hear a healthy man, orders some lives unnecessary and costly for the economy of the national community. Victor von Weizsäcker, neurologist and philosopher, states clearly: "The excitement of life as a pure biological product demonstration ideal conditions for the elimination of lives that represent a lower biological value."
Do you know that two French Nobel prize, Alexis Carrel and Charles Richet, have publicly urged the removal of "tainted" and "useless"?
Do not naively believe that those days are forever behind us: the price of health, and therefore its negative form the disease is one of the current challenges of globalization and the economy of France in particular through the acceleration of shipments of Health supported the to the medico-social, and financial viability of public hospitals with a tariff to the act and the concept of hospital-business. Of course, it is not there to eugenic policies. But today there is a real revival of creationist theories and degeneration through genetic research aimed at finding a way scientistic causes certain psychiatric disorders. Scientific advances on cloning, artificial reproduction, breeding techniques of physical characteristics or gender of unborn children have a real risk of eliminating human labeled "imperfect" that would not have the right to be born.
Chemical castration criminals rapists is also a real resurgence of ideologies of the perfect order and the rule of the superior man.
In his book The extermination of the mentally ill in Nazi Germany Alice Ricciardi von Platen relates the words of Prince Philip von Hessen who tried to assert his opposition to euthanasia: "Despite my Burning recriminations, he was told that I should resolve to act with the necessary firmness and I needed to understand the general situation of the economy that did not support in time of war patients without hope. "
Patients without hope, the terminally ill do not report anything in terms of productivity in the economy but to play only in terms of spending on the fiscal balance of a nation. Clearly, they cost more than they relate. Their existence is it worth the price it costs the community? Alain Minc has placed recently on this subject on the elderly.
But there is no darkness without light. During the years when the troubled World War II, hospitals are also places Home and protection for those who are ruthlessly hunted down and hounded by the Nazi occupiers zealously helped by the Vichy government.
Thus begins the extraordinary human adventure and a hospital clinic, the Hospital of St. Alban, in Lozere. There, at 1000 m, the development of therapeutic tools and first class club as therapeutic space initiatives and responsibility for the sick, aid and complicity of the village's population, have Permit no patient died of starvation or abandonment. The arrival in 1941 of English Catalan psychiatrist sentenced to death by Franco, Francois Tosquelles, would give impetus to this concept is sometimes called community psychiatry, a pivotal experience in creating the movement of institutional psychotherapy 1950s.
the Liberation, minds are reeling from the discovery of the concentration camps and extermination. Physicians and caregivers deportees survived the tragedy, show the horror of concentration camps and desolation of the world of human relationships that they have faced.
All the psychiatric service was detained and questioned by the logic of the camps and concentrations of people deported. The eyes and minds open to the terrible consequences of confinement, the shunned, the stigma of the depersonalization, lack of dignity and, more generally, the deprivation of basic human rights .
solidarity with politically organized Orders of 4 and 19 October 1945 establishing the Social Security that are emerging under the leadership of the reflections of the National Council of Resistance integrating into its program a comprehensive social security referred to national solidarity.
In this context of political reconstruction, economic and human psychiatry began actively looking for another clinical practice from what is already happening in many parts of the territory under the guidance of doctors. Some rely on the experience of St. Alban and practices referenced psychoanalysis. These practices highlight the importance of the meeting to organize the therapeutic management peculiar to each individual patient.
At the national level, the walls and the organization of asylum are challenged, brick walls and walls of prejudice still highest in the shade which protects those big monsters like Clermont segregating the oise and 2000 patients, White House crowded neighborhoods with 5 500 people each, the most frequently trapped, isolated, contained.
Circular No. 61 of 1 March 1949 introduced the concept of open services for hospital patients whose medical condition does not justify recourse to the provisions of the Act of 1838.
Circular No. 61 of 1 March 1949 introduced the concept of open services for hospital patients whose medical condition does not justify recourse to the provisions of the Act of 1838.
The thesis presented by Dr. Philip Hinge in 1952 on the collective treatment of district agitated White House is the final piece of evidence of consideration of an issue as difficult as agitation, before the intervention of neuroleptics. How? For occupations of all orders for each (the flag hinges, flag 6 is a pavilion of women) to leave his bed and that bed rest stops continuous constraints which patients were often kept tied. Soon the flag ceased to be a hell, the weight of patients was high, they have helped build a basketball court, volleyball. The atmosphere has changed.
"We are entitled to ask, Philippe Koechlin wrote in the preface to the thesis of hinge, which could have developed into the" asylum "if the Largactil had come to stymie attempts of this kind, which 1950-1952 were rare, but far from exceptional and isolated. Indeed, he says, the advent of neuroleptics which one would expect that they promote the direct doctor-patient relationship has been, it seems, a paradoxical effect: while the agitation was decreased but the 'said The Guillant services have become sad, sad, and frankly less alive. Everything seems past as if they were active chemotherapy for caregivers, a way to avoid the melee confrontation with aggression, and escape the existential angst. "
So in effect from the year 1952 that develops high-speed psycho pharmacology as evidenced by the story of "potentiating 4560 Rhone Poulenc (RP)" I have chosen because the amazing science fiction title of this discovery.
We are at the Hospital Sainte-Anne in Paris in the department of university hospital Professor Delay, specifically in the pavilion Joffroy which is the service of men stirred the Clinic of Mental Illness and the Brain, whose head is then Pierre Deniker clinic.
Jean Delay and Pierre Deniker establish the therapeutic properties of "4560 RP" used only in psychotic patients, after an initial phase where the "4560 RP-en-injection was associated with an" artificial hibernation "of placing the bladders Ice on the body of patients.
The 4560 Rhone Poulenc will be from the late 1952 sold under the name of LARGACTIL.
The name of this drug is of "wide action," according to the authors or because of the difficulty to identify its specific effects (J. Postel) or the "width" (extent) of its pharmacodynamic action (Huguenard) or because of its effects extensive, covering a variety of symptoms: psychotic agitation, delusions, hallucinations, anxiety, aggressiveness.
In 1955, Delay and Deniker create the generic name of neuroleptics, "taking", "seizing" the nerve, or "having a neurological action." And in 1957, the Swiss psychiatrist Roland Kuhn discovered the first antidepressant, imipramine.
The search is not always so happy. It sometimes takes dramatic twists like this barbaric surgical practice came from the United States and will be practiced in France after the Second World War: lobotomy. It is an American named Walter Freeman, who will implement this method, called time, surgical psychiatry: the practice of ice pick. The tool is pressed, with or without anesthesia, in the orbital lobe of patients after lifting the lid. The operation is referred to cut or alter the white matter of a cerebral lobe. An estimated 100,000 worldwide, between 1945 and 1954, the number of victims of torture, absolutely no therapeutic efficacy, on the contrary even.
I have not found a statute prohibiting the lobotomy in France. She declined only gradually because of drug development. A report of IGAS evaluates to 32, the number of people affected by this technique between 1980 and 1986 in our country.
The 1950s were years of abundant and fertile clinical work and organizational forms that allow it to unfold. The burst ethics that has seized the minds of the Liberation turns into a movement for implementation of a healthcare practice that questions the effects of structures on the quality of life of psychotic patients: hierarchy, status, rigid regulations, asylum concentration, absence of activity, lack of accountability and initiatives.
ministerial texts accompanying the movement in progress: Eugene Aujaleu, Director General of Health, with colleagues, Jean Pierre and Marie-Rose Mamelet are the source of the orders and circulars, demonstrating the benefits that they grant to the daily lives of patients. It Moreover, in these enlightened people, Aujaleu, John, and we will Mamelet the circular of 15 March 1960 on the sector policy.
Circular 148 dated 21 August 1952 back their married name for women in institutions, it can make their own clothes to patients (insane), it allows cutlery on the tables. Previously
in February 1951, a circular reiterates and emphasizes the need for services called open to the psychiatric hospital for those who do not fall under a regime of limited capacity and civil liberty. This text opens February 28, 1951 the user called to duty free admission and insists that will not install on this occasion a financial discrimination by a calculation of pricing autonomous free service that excluding patients with the lowest resources.
in February 1951, a circular reiterates and emphasizes the need for services called open to the psychiatric hospital for those who do not fall under a regime of limited capacity and civil liberty. This text opens February 28, 1951 the user called to duty free admission and insists that will not install on this occasion a financial discrimination by a calculation of pricing autonomous free service that excluding patients with the lowest resources.
The name of "institutional psychotherapy" is due to Daumezon Georges and Philippe Koechlin (1952). The first is to "treat" collectively places of segregation by a new structuring of human relationships between patients and staff including the physician and administration. We must "cure" the hospital of all its statutory and rigidities of the partitioning compassionate care, which places the latter in a subordinate relationship, sometimes even submitting to the staff and creates environments of sedimentation of pathologies. Why should we care hospital? Because the phenomena asylums are not only walls, but also places and for a very important part in the atmosphere generated by the practices of care that is to say, human relations, respect of the subject as being speech recognition and protection of human dignity in his movements and encounters of everyday life, its capabilities and skills initiatives. The essential work of psychiatry is to fight against confinement one hand and the other against the pressure "aliénatoire" any institution (John Oury) which organizes the relationship between patients and caregivers on a statutory supervisor mode.
institutional Psychotherapy is a clinical psychosis. So, to quote Alain Buzaré, a psychiatrist at Angers, in the very title of his book, psychiatry. Another way of saying that "institutional psychotherapy, psychiatry is" is to assert that psychotherapy is not institutional.
Jean Oury founded the clinic Borde at Court-Cheverny near Blois in 1953.
The organization relies on a structural collective Life means of tools associative hospital committee articulated the club for the daily treatment of psychotic patients to enable them to exist in a less precarious than in ordinary society or a traditional property. Patients suffering from psychosis have responsibilities and take initiatives that allow them to move between surfaces of multiple investments and secure whatever activities or acquaintances.
This device comes with an institutional analysis Permanent collective particularly through cultural associations, met today in a cross cultural associations Federation (FIAC) and Institutions magazine.
Extract from the speech of Dr. Serge Drylewicz, a psychiatrist at Tours, in the University Diploma in institutional psychiatry led by Professor Peter Delion in Lille:
"The experience of the Hospital of St. Alban in Lozere where there was no such excess, organizing other than in asylums everyday life by restoring patients to a place about active player fully in community life. This experiment 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 development depends on environmental factors, daily life in a service. Diseases are also pathoplasties which, to be treated, treatment should be accompanied by 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 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. "
It is through the transference significance of links forged by the patient and institutional psychotherapy refers to the psychoanalytic discipline founded by Freud in the early Twentieth Century. Psychotherapy is as institutional clinical approach to understanding of psychosis based on discoveries from the Freudian neurosis.
Jean Ayme said that "the psychoanalytic model (...) must adapt to the conditions of this work in a group setting where the population is composed mainly of psychotic patients, particularly those that can not be supported by one therapist. We know that this is where Freud had left things as is, stumbling on the issue of transfer in what he called the narcissistic neurosis. Psychotherapy support for taking everyday life and feel with schizophrenia is the need to tackle this task, be innovative and cons gather in part the effects of this new clinical trainers. Hence the concept of transference constellation, taking into account transfers, investments in libidinal sense, partial, differentiated psychotic patients who have no access because of their disease transfer "mass" on one person (the analyst the cure) of the neurotic Freudian.
The fundamental difference with the traditional organization of care facilities is to organize the clinic around concepts psychoanalytic account of the uniqueness of each person taken with psychosis: what is essential to work on "relational failure" inherent in the disease, what are the differences (distinctiveness) or subjective hierarchies, hierarchies and non statutory. The transference constellations of the patient consists of people who rely for her, regardless of their status in writing on their payroll. A psychologist or nurse are not involved in their status, but because the patient is able to be with them a little relationship, and much confidence, so that bits of history shared emerge. Constellations are a therapeutic tool to work at the collective partial transfers of psychotic patients. Why? Because of the disease: "When social alienation is too demanding, they (the psychotic patients) risk their lives. They are indeed confronted with a chronic banal human existence, but threatened by the "sedimentation", which puts them at risk of "falling out of the world." This exclusion alters, unwittingly, the humanization of the "healthy" forgetful who think themselves enrolled in a life worth living. In psychiatry, prevention is not reduced a corporation to which, knowingly, everyone should abide by to avoid falling ill. But it is the result of an ethic which is acute care collectively to implement those whose balance has been upset by the emergence of the disease, "said Dr. Michel Lecarpentier, a psychiatrist at the clinic of La Borde. Hence the importance of considering transference relationship the patient weaves in his desire-to-be-with-others, person or business that are not interchangeable at the option of timetables and schedules, venues and activities, but whose presence and maintain the required continuity of existence psychosis that is the feeling of being the same person from one place to another, sense of continuity so weakened by the schizophrenic dissociation.
The club is a therapeutic community operator that transforms the atmosphere and works in a relationship of parity between people, patients and caregivers. The hospital committee, association loi 1901, is a management interface between the club that organizes activities and the institution administering the funds at all care. A contract is signed between the committee and the institution. It specifies the operating conditions interface. Patients and staff members, and to discuss gender issues related to administrative and financial functioning of the club.
The movement of institutional psychotherapy clinic was involved in accelerating the training of psychiatric nursing through CEMEA, the Centers for Training for Active Teaching Methods and activism of psychiatric professionals. CEMEA have emerged with the creation of summer camps and the need to train instructors and managers, led People's Front (paid leave). Dissolved in 1944 by the Vichy government, they participate in organizing and hosting in 1949 nurse training courses initiated by Dr. George Daumezon, psychiatrist and director of Fleury and Germaine Aubrais The Guillant Permanent CEMEA.
The decree of 23 July 1955 regulates the first degree for nurses Psychiatric Hospitals issued after a 2-year training at regional training centers attached to the county health facilities.
Dr. George Daumezon always attach great importance to the role of nurses in this new therapeutic strategy that is institutional psychotherapy. Nurses who are accommodated in courses CEMEA "live in an inverse relationship, group activities and creative, they refer to their return on their relationship with patients. They also discover new ways of interaction with physicians who supervise these placements. They are introduced to techniques related to group dynamics or psychodrama. It is true that they sometimes feel a certain disappointment when they return to their service, they face the conservatism of the medical or nursing supervision. Daumezon then organizes training courses for managers, supervisor, and then decides to meet the doctors themselves for days of reflection and study to be held at the School Experimental de Sevres, "says Jean Ayme in his Essay on the History of Psychotherapy institutional.
In 1954, the International Federation of CEMEA is recognized as an NGO by UNESCO. Still active today she has a very interesting review "Social Life and Treatments."
The Navy Cross movement, movement of associations and institutions to help Mental Health, was born in reports at start Ethics and Liberation movement of institutional psychotherapy. It will actively support the hospital committees and clubs therapeutic Navy Cross. Why
Navy Cross? In reference to that other great humanitarian movement and Red Cross because it was not much color to choose for this new mission: to better act to support mental suffering. Found among the founders in 1949 in Clermont-Ferrand, Jean Oury, Tosquelles, Sivadon Pierre Doussinet Ms. Delaunay first president.
In 1952 the Federation is created Aid to Mental Health Navy Cross grouping associations and affiliated hospitals, Navy Cross.
in Clermont-Ferrand in 2003 to mark the 50th anniversary of the Federation, Jean Oury said: 'It must be said that the Navy Cross was an extraordinary movement. Was the only place where there was heterogeneity, with a very large proportion of nurses. There were also school principals, social workers, psychologists, educators, psychiatrists. And that was the only place that was heterogeneous (...) '
The MDTF Navy Cross, headquartered in Paris, still exists, holds training days at the national level and in regions led by regional coordination. It has been recognized as a charity in 1986.
Soon the Navy Cross movement was associated with CEMEA for cross-training, and worked on the establishment of hospital committees and clubs therapeutic Navy Cross.
His actions are organized around major themes, relating to the operation of psychiatry
• Promote and gather the associative movement in different regions in the health sector, social and social and health care for people with mental illness.
• Develop training for multidisciplinary professionals
• Support the sector and the continuity of acute care
• Work with families and Guardianship Services
• Defending the place of people with mental disabilities in the City and given the right to work protected (ESAT) or not.
In the Central Region, the Regional Coordination Navy Cross led by Dr. Michel Lecarpentier, a psychiatrist at the clinic of La Borde, organized since 1990 at least once every two months, training days, open to professionals in the fields of health, medico-social and social area and sometimes beyond. The association Navy Cross Loir et Cher has 5 houses that allow associations to host more than 25 people tenants in the city of Blois. Since 2009, a community grocery store with host tables emerged involving people who meet in independent accommodation because of disease problems in their daily lives particularly nutrition and physical activity. In Orleans
Pleyades association is affiliated to the Federation Navy Cross, as Arbrapalabre, Green House services for children 0-4 years with their parents in Romorantin-Lanthenay the heart of the Sologne.
Until the Second World War, the asylums have worked with paltry per diem. Mental patients provided a valid work not only to combat idleness but mostly regarded as consideration for a debt they contracted with the community for their support. They provided to schools and a cheap labor for their economic services.
In the 1950s, with the evolution of the hospital to acute care, increased Sick pay corollary of increased social insurance, labor issues and organization needs to be rethought in recognition of his considerable therapeutic value.
is the purpose of the circular dated February 4, 1958 (not published in the Official Journal).
This very important text provides the physician, without government intervention, standing to decide the "making work" of a person being cared for, to choose the type of work given to her and lay down the conditions for performance and remuneration. On this point, the circular stresses the subjective element to take into account the very effort to know performed by the patient and can not be assessed by the physician, "according to everything he knows about the mental state of the subject." Compensation is thus composed of two elements: the nest egg base proportional to the duration of work and the task performed, the pay supplement taking into consideration the efforts made in its therapeutic dimension. Moreover
this text provides the possible involvement of a solidarity fund operating within each service component and material assistance to the exit.
And he says the work organization is one aspect of the organization of social life, which is an essential element of therapy. This circular
devotes Chapter 3 to "the intervention of an association in the organization of therapeutic work."
The question of the role of associations in psychiatry is a question not only practical but also ethical in that within a group of associations, and vertical relationships hierarchical doctor-patient, doctor-nurse, gave way to relationships horizontal equal humanity equal humanity, as defined in an even voice a voice of any democratic system parity.
In the 1990s, almost all associations will be charged with management accounting made by the ECA and its regional branches and as dissolved. Social life for sick people will pay the price will gradually fade and hospital services. Already
Circular of 1958 issued a few warnings about various accounts of experiments is irregular: "Until now, only large copréhension manifested by the high court and the public accounting services to the for these experiments has temporarily averted these problems. "
Despite these observations, Circular recognizes a possible role of associations, "as a" Friendship of patients and former patients "of a" society of patronage, "a subsidiary organization existing at a higher level (subsidiaries of French League for Mental Hygiene or the Federation of Societies Navy Cross, for example). The association thus formed must have entered into an agreement with "the establishment to determine with precision the powers of the body created and to clearly define the division of labor ".
These principles will be incorporated in the 2000s as part of the proposal par la Fédération Croix-Marine en collaboration avec l'ADESM (association des directeurs d'établissements en santé mentale) pour introduire dans les dispositions du code de la santé publique, dans sa dernière version, un article autorisant le recours à la formule des associations type 1901 dans les services de psychiatrie avec passation d'une convention avec l'Etablissement dont ils relèvent (article 93 du CSP)
Pleyades association is affiliated to the Federation Navy Cross, as Arbrapalabre, Green House services for children 0-4 years with their parents in Romorantin-Lanthenay the heart of the Sologne.
Until the Second World War, the asylums have worked with paltry per diem. Mental patients provided a valid work not only to combat idleness but mostly regarded as consideration for a debt they contracted with the community for their support. They provided to schools and a cheap labor for their economic services.
In the 1950s, with the evolution of the hospital to acute care, increased Sick pay corollary of increased social insurance, labor issues and organization needs to be rethought in recognition of his considerable therapeutic value.
is the purpose of the circular dated February 4, 1958 (not published in the Official Journal).
This very important text provides the physician, without government intervention, standing to decide the "making work" of a person being cared for, to choose the type of work given to her and lay down the conditions for performance and remuneration. On this point, the circular stresses the subjective element to take into account the very effort to know performed by the patient and can not be assessed by the physician, "according to everything he knows about the mental state of the subject." Compensation is thus composed of two elements: the nest egg base proportional to the duration of work and the task performed, the pay supplement taking into consideration the efforts made in its therapeutic dimension. Moreover
this text provides the possible involvement of a solidarity fund operating within each service component and material assistance to the exit.
And he says the work organization is one aspect of the organization of social life, which is an essential element of therapy. This circular
devotes Chapter 3 to "the intervention of an association in the organization of therapeutic work."
The question of the role of associations in psychiatry is a question not only practical but also ethical in that within a group of associations, and vertical relationships hierarchical doctor-patient, doctor-nurse, gave way to relationships horizontal equal humanity equal humanity, as defined in an even voice a voice of any democratic system parity.
In the 1990s, almost all associations will be charged with management accounting made by the ECA and its regional branches and as dissolved. Social life for sick people will pay the price will gradually fade and hospital services. Already
Circular of 1958 issued a few warnings about various accounts of experiments is irregular: "Until now, only large copréhension manifested by the high court and the public accounting services to the for these experiments has temporarily averted these problems. "
Despite these observations, Circular recognizes a possible role of associations, "as a" Friendship of patients and former patients "of a" society of patronage, "a subsidiary organization existing at a higher level (subsidiaries of French League for Mental Hygiene or the Federation of Societies Navy Cross, for example). The association thus formed must have entered into an agreement with "the establishment to determine with precision the powers of the body created and to clearly define the division of labor ".
These principles will be incorporated in the 2000s as part of the proposal par la Fédération Croix-Marine en collaboration avec l'ADESM (association des directeurs d'établissements en santé mentale) pour introduire dans les dispositions du code de la santé publique, dans sa dernière version, un article autorisant le recours à la formule des associations type 1901 dans les services de psychiatrie avec passation d'une convention avec l'Etablissement dont ils relèvent (article 93 du CSP)
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