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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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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Impressions from a closed psychiatric ward

“When suffering from a mental illness one no longer has a free will.”

A floor plan of the ward should have been included here, illustrating the conditions in which patients are being forced to ‘live’. However, to ensure I am not legally compromised (trade and corporate secrets etc.), I have been advised against including this. In the hope of enabling some insight here is a brief description:

The ward’s capacity is 30 patients, though this is frequently surpassed. Patient rooms range from approx. 8㎡ to 20㎡, most of them double rooms, each with a toilet and shower. Some rooms can be locked from the inside, most cannot. The total garden space is less than 500㎡, divided into smaller segments, one length no longer than 25m. The total community space is approx. 60㎡, in which patients eat, relax, socialise and watch TV.

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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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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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Einführung in die Psycholyse

„Halluzinogen-unterstützte Psychotherapie ist in mancher Hinsicht ein Unikum: Sie ist wohl das einzige Heilverfahren, das durch das Gesetz verboten ist; und das einzige, das nicht erlernt werden darf, aber von jedem Unkundigen leicht missbraucht werden kann; und schliesslich das einzige, bei dem in der fachlichen wie in der öffentlichen Diskussion zwischen dem sorgfältigen legalen Gebrauch lege artis und dem Missbrauch noch so wenig unterschieden wird (vgl. Baumann 1986, 2202).“

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One last call for the legalisation of cannabis

Although considered acceptable on an individual basis by many, little has changed to the cannabis laws across most of Europe over the last few years. Not, actually, since its reclassification in Britain from Class C to Class B drug in May 2008[1], moving it up the scale away from ‘soft drugs’ like anabolic steroids, and towards the ‘harder drugs’ of the Class A crack and cocaine, amongst others.[2] In the aftermath of this change in policy, Professor David Nutt was sacked from his position as head of the Advisory Council on the Misuse of Drugs (the UK government’s official advisory body) for outing criticism against the decision in light of scientific evidence.[3] It is my belief that this is just one example of politicians refusing to reflect upon the state of cannabis legality from a neutral standpoint, and I will now attempt to bring some transparency into the picture.

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