Institutional Psychotherapy

[Editor’s note: this is an addendum to the article ‘Demystifying phenomenological and social psychiatry’ (Isolatarium, 1/2019). Although it is published separately here, it has also been integrated into the aforementioned article]

Commonly considered as conceptional founders of Institutional Psychotherapy (IP) [1] are François Tosquelles, Jean Oury, Hermann Simon, Frantz Fanon and George Canguilhem. Their work built upon the theory of Jacques Lacan, which was later complemented by Félix Guattari and Gilles Deleuze. Many of these individuals were heavily influenced by the experience of occupation during World War Two; of totalitarian oppression on either side of France. Such personal experiences of incarceration engendered the rethinking of institutional confinement within the psychiatric field, which became a central element to IP. Likewise these individuals had a shared conviction that social and psychological problems should be simultaneously broached, and not studied or treated independently. Within the institution this was addressed through a horizontal, radically democratic therapeutic approach. Two important examples are Saint-Alban in southern France, where IP was initially conceptualised, and La Borde Clinic south of Paris — founded by Jean Oury in 1951 and still open today.

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Being-towards-suicide (Sein-zum-Suizid)

[Editor’s note: an abridged version of this essay was published on Mad in America – https://www.madinamerica.com/2019/07/being-towards-suicide]

‘There is but one truly serious philosophical problem and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.’ [1]

Albert Camus’ opening sentence to his work ‘The Myth of Sisyphus’, unmistakably emphasising the eminence of the topic at hand, is a fitting start to the thoughts and considerations to follow. For this sentence, concisely as it may deliver its underlying message, imbues the reader with an ethical dilemma: it confines suicide to the philosophical realm, thereby negating manifold alternate reasons which necessitate its rumination. How does one decide how to act if one’s reasoning is philosophically incoherent yet psychologically lucid? Or philosophically incoherent yet circumstantially logical? In this essay I seek to trace the lines of suicide through small excerpts of literature from the past century which grasp the zeitgeist of post-war peace; a century in which individualism, elsewhere favourably labelled self-determinism, has been reproachfully dismissed as the crude fetish of several generations. Finally, in assembling the loose ends, I will seek to rethink suicide in times of technological advancement, consequently liberating it, (indeed) as an autonomous act by a self-determined agent, from philosophical, moral and medical chains of restraint. Herein I will come to a different conclusion to Camus, and ultimately reject his call to refuse suicide [2] on the basis of revolt: an individual’s perpetual confrontation with their own absurdity, which is in essence an eternal, futile search for clarity and worldly meaning of the human condition. [3]

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Demystifying phenomenological and social psychiatry

Contents

Introduction

Theoretical aspects (Philosophical considerations: phenomenology and anthropology; Anti-Psychiatry; Neuropsychiatry; Terminology: ‘social psychiatry’ vs. ‘socialpsychiatry’; Embodied and enactive cognition)

Institutional and methodological aspects (Milieu therapy; Therapeutic community; Soteria; Institutional Psychotherapy; Open dialogue; Trialogue, incl. psychosis seminars)

Conclusion

Recommended literature

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Envisioning a future for psychiatric care

T. F. Main coined the term therapeutic community (TC) [1] as both a manner and method of psychiatric care shortly after World War Two, highlighting institutional deficits of conventional hospitals which may thus be addressed: “The concept of a hospital [means] that patients are robbed of their status as responsible human beings […] making them ‘patients’ […] in a state of retirement from society.” [2] However, it was only under Maxwell Jones’ influence in the 1950s that the TC concept gained support, becoming a replicable method with certain characteristics [3] — small size of no more than 100 persons, daily community meetings, [4] and the psychodynamic hypothesis as an underlying philosophy.

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Effect of cannabis potency on the consumer

Cannabis is the most widely used illegal drug in the world, with the predicted number of users exceeding 200 million people (UNODC, 2015). Within Europe, it is estimated that a quarter of the population aged between 15-64 years have tried cannabis, with nearly 7% indicating they have consumed it in the past year (EMCDDA, 2016). This frequency of use far surpasses the use of other illegal drugs: cocaine, the second most frequently used drug, is reported to have a lifetime use of 5.1%, with only 1.1% claiming to have consumed the drug in the past twelve months (EMCDDA, 2016).

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On the perils of an artificial superintelligent species

When an existential risk induces a state of intolerable anguish it can no longer be ignored. The potential extinction of humankind by the creation of a superior technological species is by now not only feasible, but highly probable, and must be scrutinised in this light. I hope, for the future of humanity, to reignite a contemplation of this basic premise. To do so I hope that many of you take the time to read these words carefully, perhaps sacrificing several minutes otherwise used pointlessly on your smartphone, for by the end of the essay you may well wish to get rid of it.

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The Ethics of Amputation

Certain phenomena in the medical realm are kept in abeyance; concealed from the public discourse in the hope that future research may provide more clarity. As appealing as this strategy of eschewal may be, it does little to relieve those individuals currently affected by the respective phenomena, and such force of circumstance thus requires a prima facie consensus to be found. One such phenomenon is a desire for the amputation of an otherwise functional limb, or else to sever the spinal cord resulting in paralysation. Medically speaking this desire has been attributed to a variety of conditions, ranging from Body Dysmorphic Disorder (BDD) to a form of paraphilia, and the most likely explanation: Body Integrity Identity Disorder (BIID) [1].

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Should a basic income be unconditional?

An unconditional basic income would see every citizen receive a monthly ‘salary’, irrespective of all other factors. Benefit schemes, thereafter redundant, would hence be abolished. Although suggestions regarding the income level vary greatly (a pilot study [1] in Finland has begun with €560 a month, while a referendum last year [2] in Switzerland attempted to introduce a basic income of around €2250 a month), this idea has superseded the traditional division of ‘left’ and ‘right’ policies; indeed, it has triggered enthusiasm from representatives across the political spectrum.

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Guilt and responsibility, or: on travelling through foreign places

Four, five, six, no, seven children are crouching under that tree, jostling for a slither of shade. Do they belong to the same family, or are they friends from across the tracks, just visiting to pass the time? Or, perhaps, are they only here to elicit empathy from the many travellers — men, women and children, with their brightly coloured, overflowing suitcases — standing at the edge of the platform? Behind the children, unprotected from the glaring afternoon sun, I can see three women, all bent over a small pot from which steam is escaping. A few metres to the left, fastened between two trunks and a shopping cart filled with clothes, a ragged tarpaulin hangs above a few thin mattresses. A baby is sprawled in the middle, suckling on an item I cannot make out. Two chickens are there, too, bouncing through the yellow grass, dodging bits of glass and plastic. This is their home. Exposed to the dirt, the heat, the insects and the noise; dependent on the magnanimity of strangers. But even here, confronted with the plight of these poor people, I do not go over to them. I do not give them the last samosa wrapped up in my bag, nor the few coins jingling in my pocket as I shuffle uncomfortably from one foot to the next. I do not even glance back as I step out of the shade. After all, my train is about to leave. I, the tourist, am not condemned to stay.

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Counterproductive radicalism

In the following I want to outline some examples epitomising what I will call a ‘radical’ mindset.

Across American colleges, large-scale protests have been taking place in recent months with the aim of protecting students from potentially wounding or controversial remarks. Asking a Latino American “Where are you from?” is considered a ‘microaggression’, as it could be seen to imply doubt in their American heritage. To combat such microaggressions, students are seeking the implementation of ‘trigger warnings’; alerting consumers to content which may result in a strong emotional response. For example, Kant’s ‘Critique of Pure Reason’ is said to contain discriminating views towards minorities, and thus professors are required to forewarn their students prior to reading.

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