Cooper, D., & Braudeau, M. (1970). Psychiatrie et anti-psychiatrie. Editions du Seuil. 185 pages.
- Introduction
In this reading report, I rely mainly on reading the « Introduction » (from page 6 to 13) to the book written by Cooper in 1967 entitled « Psychiatrie et anti-psychiatrie » in which the author sets out his arguments in favor of antipsychiatry, the movement against traditional institutionalization.
Book writing context.
The book by David Cooper, translated from English into French by Michel Braudeau in 1970, is written in the context of the May 68’s movement in France, a period of general revolt characterized by strikes and violent demonstrations from the leftist people.
Several authors reject the methods of tradional psychiatry, such as Delacampagne (1974): “Antipsychiatry : the ways of the sacred” or Jervis and Fréminville (1977) : “The myth of anti-psychiatry“.
The first claims of the 1970’s about the conditions of institutionalization in psychiatry laid the foundations for later reflections. Indeed, beyond wondering how to invent care internally, we are now asking the question of how to develop external care : which is called “the deinstitutionalization”. It provides benefits as much as negative consequences. Indeed, at present, we want to make patients more and more autonomous and actors in their care but we must first explore all the environmental factors (family, professional, social). For example : Bungener (2001) : “Vivre hors des murs de l’hôpital psychiatrique : le rôle incontournable de la famille en ce début de siècle (Commentaires)“.
Targeted audience.
Without being explicitly stated, we can guess that the book is aimed at professionals in the psychiatry field : doctors and especially psychiatrists, nurses, psychologists, social workers, in order to question their practices.
On the other hand, it is advisable to read this book in adulthood, not to shock the most sensitive ones and when discernment abilities are possible. For example : “Sartre, in his book on J. Genet (page 29), describes a once flourishing industry in Bohemia. “Normal” adults took small children, split their lips, compressed their skulls and imprisoned them day and night in boxes to prevent them from growing up. By this means, they obtained monsters that could be publicly displayed against money. ” P. 24.
Author’s references.
The author relies on his experiential knowledge of adult psychiatry to argue his words. In fact, by conducting interviews with the patient (first type of interview), his family (second type of interview), then the patient and his family at the same time (third type of interview), he realized that during the third type of interview, there is an interesting group interaction situation. “… It is from this experience that the hypothetical formulations presented in this essay have developed.” P.7.
Thus, the author’s work underlie of studies on « the system » and family studies done in the US.
- Summary of the author’s work
1. What is the book about ?
The subject.
The book deals with the institutionalization of psychotic patients, especially “schizophrenics”, by questioning the classic methods of sectioning : during the last ten years (1960-70) there were two types of approach to schizophrenia.
- On one side, the traditional approach : nosological entity (listed among all diseases) called schizophrenia whose causes must be explained. There are symptoms and observable signs on the person. Induce a diagnosis for prognosis and treatment.
- On the other hand, an approach based on the remark that this pathological entity is in no way established, that this “model” is perhaps not the most appropriate for addressing the “schizophrenic field”.
The author’s opinion.
For the author, the distinction of a nosological entity of schizophrenia, resulting from the traditional approach, is not appropriate to understand this field of study because it could be in contradiction with the very nature of it. “On the one hand, the traditional approach, which declares, or more often supposes, without feeling the need to declare it, that there exists a nosological entity …” P.6.
However, according to David Cooper, schizophrenia is a term that makes sense and he defines schizophrenia as : “A situation of microsocial crisis, in which the acts and experience of a certain person are invalidated by others, for some understandable cultural and micro cultural (usually familial) reasons, which ultimately make this one is elected and more or less accurately identified as “mentally ill” and then confirmed (according to a specifiable but highly arbitrary labeling procedure) in the identity of “schizophrenic patient”, by medical or by quasi-medical agents“. P.6.
2. Reflections and arguments of the author
To advance in his reflection, the author begins by explaining the construction of a human science by comparing it to an experimental science. “Consider the stages in which the experimental nature’s science proceeds, and then see if these steps are relevant and applicable in a “science of people “”. P.7.
He leads to the conclusion that in the natural sciences, the possibility of verifying or invalidating hypotheses depends on the possibility of repeating situations. In human sciences, the repetition of an individual situation or of the group life’s history is in principle impossible. Thus, the author continues in his thoughts saying that we must see things differently. Indeed, when the repetition of historically experienced situations is impossible, the criteria of verifiablility and invalidity are not relevant. For that, we must distinguish between two types of rationalities ; each is appropriate to a different field, and more particularly to each discourse. These rationalities are called “analytic” and “dialectic”. The analytic rationality that exists in the natural sciences excludes by definition any understanding of the relationships of interiority that exist between individuals (what is called intersubjectivity) whereas dialectic rationality is its actual functioning in the world of real entities.
- Critical evaluation
The text has been translated but the writing style is very accessible and clear, the ideas are well connected allowing the reader to follow the thread of thought to understand the purpose of the thesis. Plus, one of the major quality of this book is that the author resorts to examples to better understand complex concepts such as the notion of “dialectic” defined by an reciprocal interiority’s relationship that is exemplified with the observation of the observer himself, so there is subjectivity between the two people.
However, the treatment of the subject was not objective because the author directly gives his point of view on the question of the mentally ill’s institutionalization. He denounces the invention of schizophrenia by redefining it not in terms of pathology but in social and cultural terms.
So, the author only describes the institution that seems “ideal” but fails to take into account the risks incurred by the institution when considering the other as perfectly healthy in the place where patients and caregivers live. Indeed, we cannot be sure that one of the patients doesn’t commit dangerous acts for himself or for others when he goes through a crisis. To remedy this significant problem, Morel, in the nineteenth century, already offereds an interesting compromise : the management of these risks which consists of not permanently monitoring patients but providing profiles of at-risk population from a “probabilistic and abstract combinatorial risk factors” which defined on the computer. Thus, it is not necessary to intervene physically and immediately when there is a risk, in fact, it is not because there is a risk that there is a danger with a specific individual (Castel, 2016).
At the time, the author and his collaborators had disturbing reflections for the medical and social fields. But, he puts his ideas into action by isolating a place the “Pavilion 21” within the institution in which he works where he develops the methods and practices resulting from his thought, in a collaborative approach between caregivers and well-groomed. So today, he has raised awareness among the professionals and some therapeutic approaches are come from this model in modern medicine. We can say that the author was able to convince us by putting into practice his theory and observing the considerable results experientially.
The author marked a turning point in the world of psychiatry, he allowed the questioning of methods and practices of care generating an important awareness and helping to disrupt the practices in a spectacular and revolutionary way. So, we can say that the objective of the book has been achieved.
- Conclusion
« Rain Man »…
Charlie Babbitt, cars’s dealer’s young of Los Angeles and in struggling financial, learns of his father’s death. In cold with him since his 16 years, Charlie relies heavily on the legacy left by his late father to get out of problems. During the reading of the will, he inherited only his father’s old car and learned that his father’s fortune estimated at 3 million of dollars would be given to a psychiatric pension in Cincinnati. After a short investigation, Charlie discovers that one of the residents of this institution is none other than Raymond Babbitt, his older brother, autistic, whose existence he was totally unaware. Furious, Charlie removes Raymond in order to recover the part of inheritance that he considers to return to him. Then begins a trip across the United States to California, where the two brothers will get to know each other …
After this synopsis, we can question the patient’s care’s evolution consequences today with more lightness! From the “closed” institution to the deinstitutionalization, what are the risks and benefits of the evolution of practices ?
The care must be articulated between caregivers of the institutions and external actors. Hence the major role of caregivers in consultations to help families, the establishment of adapted professional backgrounds, social and educational referents (for example : social workers, specialized educators, psychologists and neuropsychologists, etc.).
The new ways of inventing care in psychiatry deserve to be in perpetual questioning…
