The psychiatry is a medical speciality. It deals of the diagnosis, the prevention and the treatment of the mental turbid which assign to the mental health or physical children (Pédopsychiatrie), Adulte S and elderly. The specialized doctors are called Psychiatre S. Their formation requires that they achieved the complete cycle of the studies of medicine, then a training specialized in psychiatry. They can exert either in the public system (psychiatry of sector, CHU), or as a liberal (cabinets, private clinics), or still in various associative structures.

Elements of history of psychiatry

See also: History of psychiatry

It is since the French revolution that psychiatry set up in medical discipline and that, of the statute of " fou" , one passed to that of patient. The word psychiatry goes back to 1808 (Johann Christian Reil, 1759-1813) and is recorded in 1842 but there remains little used until the 19th century; one spoke then about medicine of the Aliénés . The mentally ills were regarded as lunatics, i.e. foreign, not only with the remainder of the company but also with their own nature. The specialists who studied and treated their pathologies were known under the name of mental specialists.

The evolution of the discipline particularly was done in Europe with the French school which goes from Philippe Pinel to Henri Ey while passing by Charles Lasègue, the German school with Wilhelm Griesinger until Emil Kraepelin. Of these authors, one will retain the first great systems of classification of the mental diseases.

One will retain, during the Second world war, almost the extermination of the lunatics of France because of deprivation of food in the psychiatric hospitals. That is in spite of very moderating. It is at that time that the hospitals developed a policy of life in autarky. Indeed, in many hospitals appeared a farm, vegetable gardens, various breedings. In certain areas one thus ate better with the Asile than outside, the patients " contentant" of savings and not of wages, the whole related to light needs.

In the years 1970, partly because of the current of the Antipsychiatry, the question of the " fou" and of his report/ratio in the city was reconsidered. Whereas up to that point the dogma of enfermement of the patients prevailed, a process of externalisation and desinstitutionnalisation was undertaken, succeed in France with the creation of the system known as of Psychiatrie of sector, with services equipped with much less beds, but of more alternative structures to the hospitalization.

Currently, the situation of psychiatry in France is considered to be alarming by a great number of professionals, because if the recourse to the psychiatrist were justified formerly only in the event of proven mental disease, one asks him today more and more often to deal with the social distresses, the accidents of the life, the prevention, etc In other words, the request increases, whereas medical demography knows a spectacular fall of the number of psychiatrists which should still continue during years. France is one of the psychiatrisés countries of Europe: the report/ratio of the number of psychiatrists to the total population is higher in France than in the other European countries.

One of the answers could be this one: psychiatry like institution, system of public care referred which is not any more in one imperative method and which is this: that one looks after sick people and not the people in evil existential being. It is in this semantic fog that psychiatry has evil to impose its rêgles.

Approaches in psychiatry

There exist several great models in psychiatry:
  • the biological model is based on the idea of disordered states organic, biological, in particular on the level of the cerebral operation, and which would have to be corrected;
  • the psychological model in which one is interested in psychism of the individual;
  • the social model which is interested in the interaction of the patient with his medium, like at the level collective and social of the disorders that it presents.
  • One more and more often evokes the bio-psycho-social Modèle , which would be a form of integration of the three preceding models.
  • the movement antipsychiatry appeared with the beginning of the year 1960, of critical interrogations calling into question traditional psychiatry. According to Ronald Laing and David Cooper, “psychiatry manufactures the madness, if it were not there, it would not have there the insane ones. ”

Various disciplines in psychiatry

Classically, one distinguished: Various news specialities emerged little by little, insofar as a specificity emerged from their practice:
  • the Psychiatry of the baby and psychiatry mother - baby
  • the psychiatry of the teenager
  • the transcultural Psychiatry
  • the Addictologie
  • the Psychiatry in humane situation
  • the Psychotraumatologie.

Therapeutic methods used in psychiatry

In practice, these methods are often associated by the psychiatrist.

Medicamentous treatments

One calls psychotropic Médicament a drug intended to look after the psychiatric disorders. These drugs are of discovered and use relatively recent, since the years 1950 and work of Henri Laborit. There are five big families: It should be noted that, following a resounding lawsuit, in the United States the pharmaceutical laboratories were forced to register, on the boxes of antidepressants which their products could push their consumer to be committed suicide. One wonders whether they are the " disorders psychiques" or the antidepressants which are the cause of the dramas which occur in the families whose member is treated with medicamentous psychiatry (without speaking about the treatments of shock: E.C.T. or therapy of the aversion).

Psychotherapies

See also: Psychotherapy

Psychotherapies are techniques which aim taking a care and at producing a change at the patient through the relation by the word, or by the use of mediations. There are various types. Most known are the therapies of psychoanalytical inspiration, the cognitive and behavioral therapies, the systemic and phenomenologic approach.

The hospitalization

In France

There exist three methods of hospitalization. For two of them (HDT and HO), the administration (prefectoral or hospital) has the legal capacity to lock up the patient. The first law having legislated on the hospitalization in psychiatry, which for historico-ideological reasons and of share the singular nature of the mental disease, is different from that of the hospitalization relating to the somatic diseases, goes back to 1838. It was innovating because it evoked the possibility of care and the terminology, although today abandoned (one spoke about the lunatics), the concept of subject with implied what that implies of respect of the person (the French revolution was not far…) and of its rights. It should have been waited more than 100 years, 199O exactly, so that a new law comes to replace the first, and this to correct the imperfections of them, in particular on the level of the abuses, until the old law did not guarantee. Thus, a battery of formal tools (commissions of recourse, higher guarantee for the diagnosis. .etc), makes it possible today to guarantee at the same time the freedom of the sick person and her safety in (with?) glance of the disease of which it always doesn't accept reality (what, generally, can endanger it, to even endanger others)? But this is not a small matter…

However, the bill of prevention of the delinquency presented by the ex-minister of the Interior Nicolas Sarkozy, envisages to modify the conditions of the hospitalization under constraint. It will be easier to be interned: a doctor's certificate necessary, instead of two certificates, established in the 72 hours instead of 24,… On the other hand, it will be more difficult to leave: need for two concordant prefectoral expertises,…

Lastly, it will be created a national file of the lunatics, which makes think of some that the interned people will be stigmatized with life.

Shock therapy

See also: Shock therapy

The shock therapy , still called électroconvulsivothérapie (ECT) or electric shock (this last name is disadvised by the ASSES because it would harm the credibility of the method…) is a therapeutic technique discovered by Italian Ugo Cerletti at the time of fascistic Italy, which consists in running a short electric current in the brain of the patient under General anesthesia in order to cause a Crise comitiale there. The use of this technique is very discussed in the psychiatric mediums and, when it is used, it is for specific indications. The cure generally comprises from 8 to 12 meetings, at a rate of 2 or 3 per week.

This therapy can be at the origin of transitory losses of memory, sometimes over a long period, and exceptionally of death. The risk of death (1 per 10.000 patients) or of Morbidity (1 " accident" for 1300 or 1400 meetings) is comparable with the figures found in the other anesthesias carried out for minor disorders. Although this treatment is disadvised in the children, because its effects on their brain under development are not known, one can have recourse in certain exceptional cases there.

In France, after a history rather charged since its invention, shock therapy with fact the object in 1998 of a joint conference of consensus of ANAES and French federation of Psychiatry (Conference of consensus on the shock therapy). It remains despite everything the object of much of always not justified but significant mistrust.

The theory on which the shock therapy is based is that if one causes a crisis comparable with epilepsy on a mentally sick subject, it would recover. This is based on the observation that the patients epileptics formerly interned in the lunatic asylums were not prone to crises of madness. The experts of the time thus thought that by causing a disorder such as the epilepsy at a patient known as " fou" , its madness disappears. The logical bond between the report and the conclusion appears non-existent.

Methods given up today

They are many and sometimes whimsical. their use is abandoned today.
  • the Cure of Sakel
  • the malaria therapy

The question of the diagnosis: need for classifying

Normal and pathological

The standard can be under consideration in several way in psychiatry, historically of the dogmas managed this problem (example: the standard is the not décompensée nevrotic structure). At present the sick individual is regarded as a full citizen some is his degree of disease; what was a fantastic progress is being turned over against its fragile people who are the mentally ills with nonthe recognition of specificities of the mental disease and it quasi disappearance of the penal irresponsibility of the mentally ills.

Great systems of classification and their limits

There exist two great classifications of the mental diseases: the international Classification of the diseases of WHO and DSM. The method used to define a mental disease is the vote: the various psychiatrists brought together for the creation of the DSM vote according to the existing symptoms and medicinal products for " traiter" these symptoms. There exist also the classifications used only in one determined country, like the French Classification of the mental disorders of the child and the teenager.

These classifications are prone to revision regularly, as the " indicates it; Tr" (revised text) of DSM-IV TR. They rest on a model catégoriel of the mental disease borrowed from Kraeplin and are thus known as néokraepliniennes. They supplement old classifications which used not scientifically validated models (like that of Freud, Jung or Adler) which preserve their relevance in the singularity of clinical maintenance but which is completely unusable with an aim of research, even epidemiologic. The case of the homosexuality which disappeared recently from classifications, including in its egodystonic form (which generates a suffering), watch the limits of this systems which is more sensitive to the lobbying, however the disappearance of this term of psychiatric classifications shows an opening which can be only beneficial with all.

List symptoms studied in psychiatry

See also: psychiatric Semiology

Principal hoop nets dealt with

Various crises of psychiatry in France

demonstrations of 1997

One of the first revealing ones was the end of the diploma of psychiatric Infirmier of sector (ISP). Many demonstrations took place without success to obtain equivalence DEI/DISP. July 2001

Piel/Roelandt Report/ratio: Of psychiatry towards health mentale' gives an alarming a report of the places and the proposals. In spite of its success in the profession, it will not have continuations. Many other calls will not be heard and the shortage of psychiatrists worsens the situation. In parallel, the tasks of the psychiatry, which it is required to answer all the evils of a company in difficulty, increase, whereas the means decrease (budgetary restrictions, closing of beds, misses alternative structures).

December 18th, 2004

The drama of Pau, where two nurses are assassinated under horrible conditions by a former patient, will reveal with the general public the worrying situation which psychiatry to France crosses.

Year 2005

- In January the Minister for Health, Mr. Douste Blazy, reveals his mental health plan (disputed by the professionals). This plan is currently set up

- The incapacity to answer the requests generated by the current society, the security issues in psychiatric hospital (increase in the hospitalizations under constraint, exponential multiplication of the aggressions, escapes from dangerous patients) involve an emergency meeting of 140 directors of establishments with the Minister for health Xavier Bertrand.

- On August 18th, the minister posts his will to accelerate the mental health plan at an other meeting with the Santé federations of the principal central trade-unions.

However, psychiatry is still, in France, a protected profession which counts 12000 experts (1 per 5000 inhabitants, is much more than in our European neighbors), although one starts to engage here or there general doctors for lack of psychiatrists.

December 14th, 2006 : The National Assembly votes on the private bill on the establishment of a Ordre male nurse. He concerns all the male nurses, including the psychiatric male nurses of sector.

General bibliography

  • J.D Guelfi, F. Rouillon: Manual of Psychiatry , ED. : Masson, 2007, ISBN 229402107X
  • Lucien Israel (psychiatrist): " Initiation with the psychiatrie" , Masson Editions; 2003, ISBN 2294014030
  • the psychiatric Evolution (re-examined)
  • Michel Hanus: " Psychiatry of the étudiant" with Olivier Louis ED.: Maloine, 2003, 10th ED., ISBN 2224027710
  • Jeanson F. (under dir it.): " Which formation for which psychiatry? " , Eras, 2004, ISBN 2749203627
  • Jacques Postel, David F. Allen: " Basic texts: Psychiatrie." ED.: Larousse, 2006, ISBN 2037410123
  • Jacques Postel: " Dictionary of psychiatry and Psychopathology clinique" , Larousse, 2006, ISBN 2035752035 (recent, very clearly and complete)
  • Jacques Postel & Claude Quetel (under dir it.), New history of psychiatry , Paris, Dunod, 2002,647p.
  • Michel Foucault: " The capacity psychiatrique". Course with the collêge of France.1973-1974. ED. Gallimard-threshold. October 2003.
  • Henri Ey: " Neurology and psychiatrie" , ED. : Hermann, 1998, ISBN 270566372X
  • Marcel Gauchet: " The subject of the madness. Birth of the psychiatrie" , preceded " Of Philippe Pinel with Freud " , Calamann-Levy
  • Gladys Swain, Marcel Gauchet: " Dialog with the foolish one - In the search of another history of the folie" ED.: Gallimard, 1994, ISBN 2070739082
  • Gladys Swain, Marcel Gauchet: Practice of the human spirit. The Institution asilaire and the revolution démocratique" , ED: Gallimard 1980 ISBN 2070205401
  • Ian Goldstein: " To comfort and classify. The rise of psychiatry française" , Préf. of Jacques Postel, ED: Hinderers to think in round, 1997, Translated by Francoise Bouillot, ISBN 2843240069
  • Georges Lanteri Laura: " Chronicity in psychiatrie" , ED. : Hinderers to think in round/Synthélabo, 1997, ISBN 2843240077
  • Georges Lanteri Laura: " History of the Phrenology " , PUF, 2000, ISBN 2130456472
  • Georges Lanteri Laura: " Test on the paradigms of psychiatry moderne" , Time Editions, 1998, ISBN 2842740548
  • Georges Lanteri Laura: " Research psychiatriques" box, 3 vol., Sciences in situation, 1998, ISBN 2908965097
  • Georges Lanteri Laura: " Psychiatry and connaissance" , Sciences in situation, 1998, ISBN 290896502X
  • Georges Lanteri Laura: " The time of the psychose" with coll Franca Madioni, Harmattan, 2000, ISBN 2738472192
  • Georges Lanteri Laura: " Hard test the discordance in psychiatry contemporaine" with coll Martine Gross, EPEL, 1992, ISBN 2908855054

Bibliographies sets of themes (urgencies, crisis)

  • Michel De Clercq: " Psychiatric urgencies and health policies mental: A prospect internationale" , Masson Editions, 1998, ISBN 222583279X
  • Nicolas de Coulon, Préf. Pierre Fédida: " The Crisis. Strategies of therapeutic intervention in psychiatrie" , ED.: Gaëtan Morin, 1999, ISBN 2910749282

See too

Related articles

External bonds

  • Site of the ministry for health concerning the Mental health plan 2005-2008
  • the World Health Organization
  • the good use of the antidepressants and the psychotropic ones: http://pelissolo.over-blog.com/
  • the mental health in Belgium on Wikinations.be
  • Site of the service of psychiatry of adult CHU Angers
  • Another site on the Mental health Plan 2005-2008
  • Pages of bonds in psychiatry, hospital and psychosocial readjustment
  • SERPSY very complete site on the psychiatry and forum of exchange
  • Diary of trainings and congress in psychology and psychiatry
  • Internet site of the optional module Mental health of the school of male nurse of Orleans, Functions with WikiNi 0.4.3 (interwiki)
  • ACpsy site of exchange in psychiatry
  • French-speaking Bulletin of psychiatry
  • French Association against the abuses psychiatry

Simple: Psychiatry

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