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Si mener des entretiens avec des personnes malades est pratiquement devenu un passage obligé de toute recherche sur la santé mentale en sciences sociales, la réflexion sur le statut du discours recueilli par ce biais et sur les analyses que l’on peut en faire dériver est singulièrement peu développée dans les publications méthodologiques. Pourtant, la plupart des chercheurs constatent que la maladie mentale, parce qu’elle porte atteinte à la capacité des personnes à entrer en relation, met à mal le cadre de l’entretien. En confrontant la lecture d’une série de manuels de méthodologie de sciences sociales d’une part, et, d’autre part, la caractérisation proposée dans un corpus d’ouvrages cliniques de la forme de vie spécifique qu’est la psychose, cet article donne quelques pistes de réflexion pour identifier plus précisément ces difficultés et pour les dépasser. Plus largement, il cherche à développer un cadre pour des recherches en sciences sociales qui mobilisent les savoirs cliniques sur la maladie mentale sans verser dans leur dénonciation ni s’y soumettre. While conducting interviews with sick people has practically become mandatory for any piece of social science research dealing with mental health issues, there are few if any methodological developments in the literature about the status of this discourse. Yet most field researchers are confronted with the fact that mental illness, because it alters the ability of people to enter into proper relationships, undermines the framework of the social science interview. By comparing a series of textbooks on social science methodology on the one hand, and writings by clinicians seeking to characterize psychosis as a form of life on the other hand, this article tries to identify more precisely these difficulties and possible ways to overcome them. More broadly, we ask whether it would be possible to set up a framework within which social scientists would be able to use clinical knowledge on mental illness without adopting a denunciative or, on the contrary, a submissive stance towards this knowledge.

International audience; To a large extent, the history of psychiatric therapy is the history of incomplete cures, defeated hopes, and ever enduring chronicity. Yet while the historiography of psychiatry has paid much attention to the therapeutic successes claimed by psychiatrists, it has had only little to say about its failures. This article offers both a framework for analyzing therapeutic failure in the aftermath of the mid-twentieth century psychiatric revolution and an exploration of the ways in which it has been problematized in three corpuses of publications from families of people with mental illness, psychiatric survivors, and nurses, respectively. I suggest that failure should be understood as a situated concept that emerged, historically, from the complex set of transactions among psychiatrists, their clients, and the wider society. Specifically, I highlight three levels of analysis when addressing therapeutic failure. The first relates to the broader system of expectations surrounding medical practices. At the second level, failure emerges in the course of the administration of a given treatment from the observation that a cure or at least some relief has not been obtained for a given patient. At the third and last level, failure refers to the inability of a clinician to perform his prescribed role. The changing dynamics of treatment administration in the wake of the neuroleptic revolution, the evolving dangers of therapy, and the transformations in the relationship between therapists and patients is then highlighted to offer a broad understanding of failure as an experience and a concept for the various protagonists of the psychiatric drama.

International audience

International audience; Si mener des entretiens avec des personnes malades est pratiquement devenu un passage obligé de toute recherche sur la santé mentale en sciences sociales, la réflexion sur le statut du discours recueilli par ce biais et sur les analyses que l’on peut en faire dériver est singulièrement peu développée dans les publications méthodologiques. Pourtant, la plupart des chercheurs constatent que la maladie mentale, parce qu’elle porte atteinte à la capacité des personnes à entrer en relation, met à mal le cadre de l’entretien. En confrontant la lecture d’une série de manuels de méthodologie de sciences sociales d’une part, et, d’autre part, la caractérisation proposée dans un corpus d’ouvrages cliniques de la forme de vie spécifique qu’est la psychose, cet article donne quelques pistes de réflexion pour identifier plus précisément ces difficultés et pour les dépasser. Plus largement, il cherche à développer un cadre pour des recherches en sciences sociales qui mobilisent les savoirs cliniques sur la maladie mentale sans verser dans leur dénonciation ni s’y soumettre.

L’epidemie de coronavirus est une epreuve pour la democratie, au sens ou elle lui impose des contraintes, mais en revele aussi les forces et les faiblesses, auxquelles une dizaine de chercheurs ont accepte de reflechir.

L’habitat inclusif cherche a repondre a un enjeu fondamental dans les politiques actuelles d’accompagnement de la souffrance psychique, de la maladie mentale et du handicap psychique : favoriser la pleine participation sociale des personnes concernees. Il s’adresse en particulier a une demande nouvelle exprimee par les personnes comme par l’ensemble de la societe : satisfaire le droit a un logement personnel. Jusqu’a quel point le dispositif effectivement deploye sur les territoires est-il arme pour cela ? Ce sont quelques elements de reponse a cette question que voudrait apporter cet article. Il s’appuie pour cela sur une reflexion sur les organisations a l’œuvre pour delivrer les services.

International audience; This article uses the concept of infrastructures of diagnosis to propose a framework for telling the history of schizophrenia as a global entity in the twentieth century. Infrastructures of diagnosis include the material and architectural arrangements, legal prescriptions and professional models that organize the way patients come to clinics and navigate in the world of schizophrenia, as well as clinicians organize their diagnostic work. They organize the way schizophrenia was identified as a disorder. The article then explores three moments in the history of the infrastructures of the diagnosis of schizophrenia in the twentieth century. The first is German psychiatrist Kurt Schneider's discussion of first and second rank symptoms in the interwar period. The second is the work on the criteria for defining schizophrenia in the framework of the WHO International Pilot Study of Schizophrenia at the turn of the 1970s. The last moment concerns recent discussions on deconstructing psychosis the in the framework of the development of the fifth edition of DSM.

International audience; Background : Psychiatric care is a fruitful setting for exploring the rise of surveillance medicine, which shapes gray zones of uncertainty between health and illness. Predicting psychosis has become a priority in the international mental health field, but French psychiatrists appear reluctant to refer their young patients for standardized assessments or disclose their risks to them. Aim : This research addressed French psychiatrists’ attitudes towards risk disclosure about psychosis to adolescents presenting symptoms that might reflect either typical teenager unease or the first signs of psychosis onset. Methods A mixed-method design included 12 in-depth qualitative interviews followed by an online survey with responses from 487 psychiatrists. Results French psychiatrists' reluctance to engage in risk disclosure emerges from a professional norm: a belief in the self-fulfilling prophecy. They — especially those with a Background : in social science and psychology — believe in the optimistic self-fulfilling prophecy. They fear the consequences of pessimistic predictions, struggle to maintain functional optimism, favor long-term inconspicuous medical watchfulness, and systematically understand favorable outcomes as a consequence of medical care, independent of the accuracy of risk detection.

International audience; This special issue of History of the Humane Sciences intends to shed light on a series of psychopathological entities that do not target well defined conditions and experiences, but rather Aim : at delimiting zones of uncertainty that defy psychopathology’s order of things: mild diagnoses or subthreshold disorders, borderline conditions, culture bound syndromes, or ideas of dimensions and dimensionality. While these categories have come to play an increasingly central role in psychiatric and psychological thinking during the last 50 years, historians and social scientists have had remarkably little to say about how they have been created, what they have been used for, and what kind of realities they have helped to shape. In this introductory article we propose the concept of ‘psychopathological fringes’ to refer to these categories that are located somewhere at the border of psychopathological classifications and refer to zones of conceptual underdetermination. The notion of fringes serves to highlight both the conceptually and the socially marginal nature of the conditions, personal identities, and worlds delimited by these categories. The fringes of psychopathology are zones of vagueness, of epistemic uncertainty, and moral ambiguity. This introduction proposes a first incursion in these zones. It suggests some of the reason why they might have had attracted little interest in the past and why they may be more salient recently. It follows some analytical clues that might help chart a way through it and proposes a map through the collection of articles included in this issue.

International audience; In the 20th century, the boundaries of psychosis emerged as an area in which psychiatric judgement faced numerous and profound uncertainties. Between obvious neuroses and personality and reactive disorders on the one hand, and unquestionable psychoses on the other, psychiatrists faced a world of suspected cases of schizophrenia, doubtful personality disorder diagnoses or probable cases of psychosis constituting a garden of equivocal clinical presentations in which both individual psychiatrists and the discipline as a whole were confronted with the limits of their knowledge. This article examines how psychiatrists from two German university clinics managed the multiple uncertainties involved in diagnosing cases of early psychosis between 1950 and 1980. Based on the analysis of a sample of records, we propose a pragmatic interpretation of the ways in which these uncertainties were recorded by psychiatrists. How were uncertainties and doubts expressed in the records and managed by clinicians? What means were used to dispel doubt? What were the consequences for patients of these diagnostic uncertainties? The article defines an uncertainty diagnosis as a diagnosis expressed with reservations by its author and recorded as such in a medical file. Depending on the nature of the uncertainty, the types of evidence used by the professionals and how this evidence was dealt with, we have identified three types of uncertainty diagnoses: suspicion, plausibility and probability diagnoses. The article then reflects on the role of the patients themselves in shaping these uncertain situations.

International audience; This chapter examines the emergence and rise of a rhetoric of revolutionary change in western Psychiatry from the postwar period to the 2000s. It traces the roots of this rhetoric in the transformations of psychiatry and society in the immediate postwar period and examines the development of competing vision of revolutions in diverse segments of psychiatry in subsequent years. The chapter also offers a survey of the historiography of biological treatments and deinstitutionalization in the second half of twentieth century.

International audience; Objectif. La création à la fin des années 1990 de la catégorie d'état mental à risque pour caractériser des présentations cliniques susceptibles d'évoluer à échéance de quelques mois vers la psychose est à l'origine d'une nouvelle psychiatrie du jeune adulte, organisée notamment autour du dépistage et de la prise en charge de ces états. Cet article analyse les attentes et les promesses de cette nouvelle psychiatrie. Méthode. L'article mobilise une approche de sociologie de la connaissance mettant en évidence les intérêts, les contextes institutionnels et les pratiques qui contribuent à façonner les savoirs et catégories psychiatriques ainsi que les débats que ces savoirs et catégories font naître. Résultats. Les débats et recherches sur les états mentaux à risque au cours des vingt dernières années ont considérablement fait évoluer la vision des cliniciens sur cette catégorie. Les difficultés à stabiliser le risque de transition psychotique chez les patients concernés ont amené les promoteurs de cette catégorie à en proposer une interprétation nouvelle : sans être le signe nécessairement d'une évolution vers la psychose, les états mentaux à risque seraient indicatifs d'un devenir pathologique à la fois ouvert dans ses développements et certain dans son accomplissement. La communauté psychiatrique est divisée entre deux façons d'aborder ces résultats : affiner la catégorie pour la rendre réellement prédictive ou en faire le point de départ d'une nouvelle stratégie de santé publique orientée vers la santé mentale du jeune adulte. Discussion. Les états mentaux à risque sont à l'origine d'une clinique de l'attente paradoxale caractérisée par l'indétermination des perspectives et des promesses qui y sont attachées. C'est cette indétermination qui pourrait expliquer son succès auprès d'un large ensemble d'acteurs issus de la clinique, de la recherche et de la politique aux intérêts divers. Conclusion. Une meilleure compréhension des dynamiques d'innovation et de réforme en psychiatrie devrait prêter attention aux conditions sociales des promesses psychiatriques.

Henckes offers a survey of mental health policy and deinstitutionalisation processes in France from 1945 to 2010. Although innovative policies were launched in the mental health field in the early 1960s, French authorities proved unable to anticipate and, subsequently, monitor the decrease in the number of psychiatric inpatients observed after 1970. Focusing on negotiations between the psychiatric profession and the state in the creation of French mental health policies, Henckes also examines the role of psychiatric hospital construction standards in shaping the transformation of the psychiatric system. In the end, ‘French Deinstitutionalisation or the Irony of Success’ argues that the shortcomings of French mental health policies were a consequence of its very success.

International audience; Background : Over the last twenty years, predicting psychosis has become a priority of both research and policies. Those approaches include the use of the At Risk Mental State category (ARMS) and of standardized predictive tools. In comparison to most developed countries, early interventions programs are only little developed in France. However, cases of young patients presenting unclear symptoms that might be a beginning psychosis or might as well reflect some adolescent unease are commonplace in psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding psychosis risk management. Do they anticipate mental disorders? Method The Grounded Theory is an agreed-upon qualitative method in social science field that links subjective experiences (individual narratives) to social processes (professional norms and mental health policies). 12 French youth psychiatrists were interviewed about psychosis early management and their daily prognosis practices with teenagers. Results If all participants were aware of early intervention programs, most of them did not make use of standardized scales. Psychiatrists’ reluctance toward a psychosis risk standardized assessment was shaped by three difficulties: first the gap between theoretical knowledge and practice; second their impossibility to make reliable prognoses; and third, the many uncertainties surrounding medical judgment, adolescence and the nature of psychosis. Nevertheless, they provided their young patients with multiple months follow up without disclosing any risk category. Conclusion Anticipating a psychosis onset remains a highly uncertain task for psychiatrists. In France, psychiatrists’ inconspicuous risk management might be supported by the universal costs coverage that is not conditional on a diagnosis disclosure.

International audience

This is the first case report about a transgender professional diver. The purpose of this article is to show the professional adaptations to help him to continue occupational dive and to raise the question of the impact on diving risks of hormonal treatment in this case. He was a 39-year-old man when he began his transition. He had worked as a diver for 9 years before his transition. When he changed to look like a woman, there were a few difficulties in continuing his professional activity. The main difficulty was that he looked like a woman while working with men. Modesty was a crucial issue in the enterprise. There were other problems such as the organisation of premises, the physical workload and the interaction between treatments and diving. There is a lack of a law to guide the employer. French legislation does not address the issue of transsexuals for this profession. The medical recommendations do not specify contraindications or adaptations for diving safely. Because of his transition, he lost muscle mass. The occupational physician helped to adjust his activity: decreasing the weight of his diving suit, creating a female-like locker room etc. Finally, the question of the risk of decompression illness arose. Legal hormonal medication seems not to significantly increase the risk of decompression illness, but this diver was taking illicit treatment to speed up the transition. The occupational physician recommended taking the legal hormonal medication.

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International audience; This article sheds new light on the debate over the legislative reform of the assistance to insane people between 1870 and 1914 in France. It demonstrates that this debate was shaped around two issues brought in by two different configurations of actors. Until the end of the 1880s, Members of the Parliament, jurists, alienists, and administrative officers focused on the civil status of insane people, as well as the tutelage that should be provided. After 1890, the issue of insane people’s access to institutions that might alleviate their vulnerabilities started to emerge. This issue of access related to a broader preoccupation with public assistance. In the world of mental health, it was promoted by psychiatrists-reformers from a newly created group of Parisian alienists, who proposed to create “open” hospital wards, which avoided the constraining confinement of asylums. Finally, the article renews understanding of the failure of the Parliament to conclude the debate before World War I. In addition to the complexity of issues at stake, and the diversity of interests involved in psychiatrists-reformers’ indecisiveness about which problematization to privilege created a deadlock.; Cet article propose un nouvel éclairage sur le débat concernant la réforme de l’assistance aux aliénés entre 1870 et 1914. Il montre que ce dernier a été dominé successivement par deux problématisations portées par deux configurations d’acteurs différentes. Jusqu’à la fin des années 1880, c’est avant tout sous l’angle du statut civil des aliénés et des protections notamment tutélaires à leur apporter que parlementaires, juristes, aliénistes et administrateurs abordent ce débat. À partir des années 1890, une nouvelle problématisation s’ajoute à la première lorsque l’intérêt des réformateurs se déplace vers la question de l’accès de ces mêmes personnes aux institutions susceptibles d’apporter un soulagement à leurs vulnérabilités, qu’ils proposent de faciliter par la création de services d’hospitalisation « ouverts », soit en dehors du système de contraintes et de protections qui caractérise l’internement à l’asile. Le moteur de cette évolution est à la fois l’essor du champ de l’assistance publique et, à l’intérieur de la médecine mentale, celui d’un segment de médecins réformateurs issus du groupe nouvellement formé des médecins des asiles psychiatriques de la Seine. L’article propose finalement une explication supplémentaire à l’échec du débat au Parlement à la veille de la Première Guerre mondiale. Si celui-ci s’explique par la complexité des questions et la diversité des intérêts en jeu, l’impossibilité pour les réformateurs de trancher entre ces deux problématisations s’impose comme un point de blocage majeur.

International audience; Is there a European sociology of health, illness and medicine – or, in short, a European medical sociology? While the answer to this question would certainly have been negative just a few years ago, this chapter argues that over the last thirty years a series of new analyses have emerged in the field which have laid the groundwork for a medical sociology at the European level. These examine how health issues are increasingly framed as consumer goods, public issues and existential concerns by a complex dynamics of global and local forces related to the globalization of scientific communication, the expansion of health markets and the wider circulation of individuals. The first part of the chapter discusses the institutional parameters that account for the development of medical sociology in the various European countries over the last fifty years. We then review the work conducted by European scholars regarding three major research issues present at the core of medical sociology throughout its history: the experience of illness and risk, the organization of medical work and the regulation of the production of biomedical entities.

International audience; This article uses narrative analysis to understand how mental health professionals working in a pilot experiment in community psychiatry in France between 1960 and 1980 made sense of their work experiences. Based on a collection of essays written by these professionals as part of their training as well as on other archival materials, the article explores writing practices in post-war French psychiatry as ways of constructing and negotiating moral commitments to work. The first three sections of the article give some background on mental health nursing in France in the immediate post-war period. The subsequent three sections examine how the professionals elaborated on their experiences in their writings, focusing on three different levels: first, the narrative voice used in the essays; second, the learning processes described by trainees; and finally, the ways in which they negotiated discursively the requirement to do emotionally well at work.

International audience; Cet article examine le discours développé entre le années 1960 et 1980 par l’Unafam, la principale association de familles de personnes souffrant de troubles mentaux en France, sur le rôle que celles-ci devraient prendre auprès de leurs proches. A rebours des analyses en termes de biosocialités qui suggèrent l’émergence de formes sociales toutes entières traversées par un discours biomédical, il suggère qu’au sein des pratiques discursives de l’Unafam coexistent deux façons de problématiser ce rôle : d’un côté un discours informé par la biomédecine, de l’autre une série d’énoncés mettant en jeu une rhétorique de l’espoir empruntant à la religion. Au final cet article suggère que ces derniers viennent combler les lacunes laissées béantes par les incertitudes de la biomédecine.

This report examines the role of the Union Nationale des Familles et Amies de Malades Mentaux (UNAFAM) in the evolutions of mental health and disability policies in France between 1960 and 1980. In the early 1970s, UNAFAM launched a program of nursing homes to address the needs of individuals suffering from chronic mental disorders outside psychiatric hospitals. As UNAFAM got recognition for its program in the 1975 disability law, strong critiques were raised among psychiatrists against this initiative. Indeed psychiatrists argued that such a program would in fact contribute to the chronicization of patients rather than help them. In the end, the program was cancelled and the French disability policy no longer mentioned mental illness. Three factors explain this outcome: an ambiguity if not an ambivalence of psychiatric thinking regarding chronicity; the emergence of a new divide between the social and the medical in French social policies; and a conflict between users and professionals in the elaboration of health and social policies in 1970 France. Drawing on archival material and documents from UNAFAM and from the French ministère des Affaires sociales, the report develops this analysis in two parts: the first part examines the history of UNAFAM and the creation of its discourse on psychiatric patients and their families; the second part focuses on the attempts by UNAFAM to create a series of measures for chronic mental patients in the 1975 disability law., Ce rapport examine le rôle de l'action menée par l'Union nationale des Familles et Amis de Malades mentaux (UNAFAM) dans les évolutions des politiques de santé mentale et des politiques du handicap des années 1960 aux années 1980. Au tournant des années 1970, l'Unafam lance un programme de foyers pour malades mentaux chroniques au sortir de l'hospitalisation psychiatrique qui obtient une reconnaissance dans la loi de 1975 d'orientation en faveur des personnes handicapées. L'initiative suscite cependant une réaction d'ampleur parmi les psychiatres, qui estiment qu'elle risque de contribuer à la chronicisation des personnes plutôt que les aider. A l'issue d'un débat qui couvre toute la seconde moitié des années 1970, les psychiatres obtiennent finalement l'annulation de fait de ce programme. Le prix en est cependant l'invisibilisation des problèmes des personnes concernées : parce que l'idée même de handicap psychique renvoie désormais à une zone de pratiques et de discours que l'on ne peut plus rattacher à la psychiatrie sans pouvoir pour autant l'en détacher complètement, celui-ci devient littéralement impensable pour les protagonistes. Trois éléments expliquent ce dénouement : 1. une ambiguïté sinon une ambivalence concernant les catégories psychiatriques concernées ; 2. l'émergence d'une nouvelle division entre le médical et le social dans les années 1970 et ses conséquences pour la psychiatrie ; 3. le conflit entre usagers et techniciens dans l'élaboration des politiques sociales et de santé. La recherche, qui s'appuie sur un important travail d'archive et documentaire, développe ces différents éléments dans deux parties : la première analyse la constitution de l'Unafam et son discours sur les familles ; la seconde, les manières dont les politiques du handicap ont rencontré les politiques de santé mentale dans les années 1960 et 1970 autour de l'enjeu des foyers pour malades mentaux chroniques.

International audience; This article explores the transformations in the regime of practice and discourse concerning chronic mental illness in French psychiatry in the postwar period and the role played by chemotherapy in these transformations. From the 1950s and 60s on, chronicity was reconstructed as a new experience, involving a new set of expectations, of dilemmas and negotiations, and involving new types of actors giving a new meaning to what they were doing with patients. While some psychiatrists thought that neuroleptics could open the way to active treatment of these pathologies, in effect this project faced a series of obstacles: some came from psychiatric ideologies, others from the conditions of psychiatric work. As a result chronicity acquired a new uncertain and elusive shape. Based on an examination of the interplay of meaning and action in psychiatrists' recourse to neuroleptics in the treatment of their chronic patients, this article seeks to highlight the difficult construction of the idea of chemotherapy in postwar French psychiatry and, more generally, the transformations in its notion of therapy.

International audience; La psychiatrie de secteur, née d’une circulaire en 1960, était une psychiatrie militante, voulant redonner aux malades leur dignité de citoyens en associant santé mentale et insertion sociale. Aujourd’hui cependant, avec l’éclatement du paysage de la maladie mentale, le secteur n’est plus le seul pourvoyeur de soins, sans pour autant que se dessine une nouvelle cohérence de la prise en charge.

International audience

This thesis analyses the reform of psychiatric hospitals in France from the end of World War II until the mid-seventies. It uses symbolic interactionism's notion of trajectory in order to examine the work engaged in by a variety of actors to constitute the problem of the psychiatric hospital, to advance their reformist agenda, to orient and reorient it. Specifically, the research develops an analysis of reform as a singular form of commitment, one which involves the elaboration of a world view, the construction of reform enterprises, the constitution of majorities and efforts at swaying different publics. Relying on an extensive reading of the leading professional journals, on the studying of important archives and on interviews with noteworthy actors, the thesis examines the diverse projects elaborated during the period. These include those initiated by professionals, by the state or the joint work of people from different social worlds with a view to understanding how the interaction of the actors affected their evolution. Two main themes run across these projects: the question of how to care for the chronic mentally ill and efforts at defining the mandate of psychiatry. Eventually, the post-WW II reform of psychiatric hospitals reflected a conception of psychiatric intervention and a vision of responsibility based on the commitment of professionals toward their patients. Its trajectory can thus be analyzed in the context of the transformation of the expert regulation mode of certain sectors of society throughout the 20th century., Cette thèse analyse le processus de réforme des hôpitaux psychiatriques en France du lendemain de la Seconde Guerre mondiale au milieu des années 1970. Empruntant à l'interactionnisme symbolique une analyse en termes de trajectoire, elle étudie le travail réalisé par les acteurs autour du problème des hôpitaux psychiatriques pour le constituer, le faire avancer, l'orienter ou le réorienter au cours de différentes phases. Elle développe spécifiquement une analyse de l'engagement réformateur comme forme d'engagement singulier reposant sur l'élaboration de visions du monde, la construction d'entreprises réformatrices, la constitution de majorités et le travail sur des publics. Reposant sur le dépouillement des principales revues professionnelles et de plusieurs fonds d'archives d'administrations de la santé, ainsi que sur une série d'entretiens menés avec des protagonistes de l'histoire, la thèse s'attache à saisir les différents projets élaborés au cours de la période, qu'ils émanent des professionnels, de l'Etat ou du travail conjoint d'intervenants en provenance de mondes sociaux différents, et à comprendre leur évolution à travers les interactions des acteurs. Deux thèmes principaux traversent l'ensemble de ces projets : la question du mode de prise en charge des malades mentaux chroniques et la définition du mandat de la psychiatrie. En dernière analyse, la réforme des hôpitaux psychiatriques a été travaillée au lendemain de la Seconde Guerre mondiale à partir d'une conception de l'intervention psychiatrique et d'une vision de la responsabilité fondées sur l'engagement des professionnels face à leurs patients. Sa trajectoire doit ainsi être analysée dans le cadre des transformations des modes de régulation experts ou professionnalisés de certains secteurs de la vie sociale au cours du XXe siècle.

This thesis analyses the reform of psychiatric hospitals in France from the end of World War II until the mid-seventies. It uses symbolic interactionism's notion of trajectory in order to examine the work engaged in by a variety of actors to constitute the problem of the psychiatric hospital, to advance their reformist agenda, to orient and reorient it. Specifically, the research develops an analysis of reform as a singular form of commitment, one which involves the elaboration of a world view, the construction of reform enterprises, the constitution of majorities and efforts at swaying different publics. Relying on an extensive reading of the leading professional journals, on the studying of important archives and on interviews with noteworthy actors, the thesis examines the diverse projects elaborated during the period. These include those initiated by professionals, by the state or the joint work of people from different social worlds with a view to understanding how the interaction of the actors affected their evolution. Two main themes run across these projects: the question of how to care for the chronic mentally ill and efforts at defining the mandate of psychiatry. Eventually, the post-WW II reform of psychiatric hospitals reflected a conception of psychiatric intervention and a vision of responsibility based on the commitment of professionals toward their patients. Its trajectory can thus be analyzed in the context of the transformation of the expert regulation mode of certain sectors of society throughout the 20th century., Cette thèse analyse le processus de réforme des hôpitaux psychiatriques en France du lendemain de la Seconde Guerre mondiale au milieu des années 1970. Empruntant à l'interactionnisme symbolique une analyse en termes de trajectoire, elle étudie le travail réalisé par les acteurs autour du problème des hôpitaux psychiatriques pour le constituer, le faire avancer, l'orienter ou le réorienter au cours de différentes phases. Elle développe spécifiquement une analyse de l'engagement réformateur comme forme d'engagement singulier reposant sur l'élaboration de visions du monde, la construction d'entreprises réformatrices, la constitution de majorités et le travail sur des publics. Reposant sur le dépouillement des principales revues professionnelles et de plusieurs fonds d'archives d'administrations de la santé, ainsi que sur une série d'entretiens menés avec des protagonistes de l'histoire, la thèse s'attache à saisir les différents projets élaborés au cours de la période, qu'ils émanent des professionnels, de l'Etat ou du travail conjoint d'intervenants en provenance de mondes sociaux différents, et à comprendre leur évolution à travers les interactions des acteurs. Deux thèmes principaux traversent l'ensemble de ces projets : la question du mode de prise en charge des malades mentaux chroniques et la définition du mandat de la psychiatrie. En dernière analyse, la réforme des hôpitaux psychiatriques a été travaillée au lendemain de la Seconde Guerre mondiale à partir d'une conception de l'intervention psychiatrique et d'une vision de la responsabilité fondées sur l'engagement des professionnels face à leurs patients. Sa trajectoire doit ainsi être analysée dans le cadre des transformations des modes de régulation experts ou professionnalisés de certains secteurs de la vie sociale au cours du XXe siècle.

International audience; This article uses archival as well as published materials to trace the development of psychiatric epidemiology in France from 1945 to 1980. Although a research programme in this field was launched in the early 1960s at the National Institute of Medical Research (INH, later renamed INSERM), psychiatric epidemiology remained an embryonic field in France during the next two decades. French researchers in this field were hampered by limited resources, but their work was primarily characterized by a deep engagement with the epistemological challenges of psychiatric epidemiology. The history of French psychiatric epidemiology in the 1960s and 1970s can be seen as an attempt to create a specifically French way of doing psychiatric epidemiology research. In the first part of this article, the author relates this unique history to internal professional dynamics during the development of psychiatric research and, more broadly, to the biomedical institutional context in which epidemiological work was being done. The next part of this article examines the conditions under which the INH research team framed epidemiological research in psychiatry in the 1960s. The last part focuses on INH’s flagship psychiatric epidemiology programme, developed in cooperation with pioneers of French community psychiatry in Paris’s 13th arrondissement in the 1960s.

In her wide ranging and thoughtful article Rzesnitzek (2013), recalls the long, conflicting and at times convoluted history of attempts to describe and delineate the beginnings of schizophrenia. As Rzesnitzek shows us, this history is at once scientific, clinical, and political. It involved practitioners from all over the Western world as well as from what used to be called the Eastern world. The reader is struck by the range of the debates, the number of conflicting positions as well as the size of the research effort involved in these debates. In a way, the debates over the beginnings of schizophrenia were merely an abridged version of those over the nature of the disorder itself. In fact, while Rzesnitzek herself does not clearly make this point, her article demonstrates quite convincingly that the debates over the beginnings of schizophrenia were debates over the very definition of the disorder. What was seen as the manifestation of an early form of schizophrenia or what was rather understood as a predisposing condition clearly reflected divergent visions of the nature and symptoms of the disorder. As a sociologist and social historian, I would add that these visions should in turn be associated with the settings and practical conditions in which psychiatrists saw patients.

International audience; Malgré leur omniprésence, les maladies mentales demeurent mal connues quant à leurs mécanismes et leurs définitions nourrissent d'âpres débats. Une même âpreté caractérise la contestation de la place occupée en France par la psychanalyse, suite au nouvel essor des neurosciences. La politique territoriale de la maladie mentale et sa prise en charge enregistrent aussi des évolutions, les découpages de la sectorisation psychiatrique étant contestés au profit de réseaux plus larges mieux accordés aux bassins de population. On constate par ailleurs une prise en compte accrue des malades psychiatriques dans les politiques sociales et sanitaires, et cet article insiste enfin sur le statut de la maladie mentale, devenue aujourd'hui un vecteur privilégié de la souffrance et de la conflictualité sociale.

International audience; This article analyzes the controversy raised among psychiatrists by the law of the 30 June 1975 in favor of disabled people in France in the second half of the 1970s. This controversy played a major role in stabilizing definitions and representations of categories of disability and mental disorder, which still bear a strong influence on today's French debates upon “handicap psychique”. The first part of the article shows how the controversy emerged within the reform dynamics that dominated French health and social policies in the 1960s and 1970s. The second part examines the specific debate concerning a project of nursing homes for long-term mentally disordered people that took place within this controversy in order to show how it contributed to the redefinition of psychiatric chronicity.; Cet article analyse la controverse suscitée par la loi du 30 juin 1975 d’orientation en faveur des personnes handicapées parmi les psychiatres français au cours de la seconde moitié des années 1970. Cette controverse a joué en effet un rôle déterminant pour stabiliser et imposer une définition et des représentations des catégories de handicap et de maladie psychique qui marquent encore aujourd’hui le débat sur le « handicap psychique » en France. Dans un premier temps, l’article éclaire les conditions de la controverse en la situant dans la trajectoire d’ensemble de la dynamique réformatrice dans le domaine sanitaire et social au cours des années 1960 et 1970. Le second temps de l’article examine le débat spécifique autour d’une mesure de la loi d’orientation, la création de foyers de post-cure pour malades mentaux chroniques, pour montrer comment celui-ci a participé à redéfinir les enjeux de la chronicité psychiatrique. This article analyzes the controversy raised among psychiatrists by the law of the 30 June 1975 in favor of disabled people in France in the second half of the 1970s. This controversy played a major role in stabilizing definitions and representations of categories of disability and mental disorder, which still bear a strong influence on today's French debates upon “handicap psychique”. The first part of the article shows how the controversy emerged within the reform dynamics that dominated French health and social policies in the 1960s and 1970s. The second part examines the specific debate concerning a project of nursing homes for long-term mentally disordered people that took place within this controversy in order to show how it contributed to the redefinition of psychiatric chronicity.

International audience

International audience

National audience; "...but names will never hurt me?" Psychiatric classification and stigmatization In the International Classification of Diseases revision process, proposed modifications of a classificatory term can be justified by arguments about stigma. To shed light on whether scientific terms affect stigmatization, this paper presents Goffman's classical model and recent findings from its operationalization in surveys on public attitudes towards people with mental illness. It then turns to the use of classification in the diagnostic process. Finally, it draws on socio-linguistics and Hacking's concept of classificatory looping to suggest how changing psychiatric categories might affect stigma.; Dans le processus de révision de la CIM-10, les propositions de modification de termes classificatoires peuvent être justifiées par des arguments portant sur leurs effets stigmatisant. Cela invite à interroger la relation entre catégories scientifiques et stigmatisation. Pour éclairer cette question, cet article présente le modèle classique de Goffman et les résultats récents d'enquêtes d'opinion s'en inspirant sur les attitudes envers les personnes souffrant de troubles mentaux. Il s'intéresse ensuite à l'usage des classifications dans les pratiques diagnostiques. Dans un dernier temps, en s'appuyant sur la sociolinguistique et sur le concept de boucle classificatoire de Hacking, l'article suggère comment une modification des catégories psychiatriques pourrait affecter la stigmatisation.

International audience; This article explores the transformations in the regime of practice and discourse concerning chronic mental illness in French psychiatry in the post-war period and the role played by chemotherapy in these transformations. From the 1950s and 60s on, chronicity was reconstructed as a new experience, involving a new set of expectations, of dilemmas and negotiations, and involving new types of actors giving a new meaning to what they were doing with patients. While some psychiatrists thought that neuroleptics could open the way to active treatment of these pathologies, in effect this project faced a series of obstacles: some came from psychiatric ideologies, others from the conditions of psychiatric work. As a result chronicity acquired a new uncertain and elusive shape. Based on an examination of the interplay of meaning and action in psychiatrists’ recourse to neuroleptics in the treatment of their chronic patients, this article seeks to highlight the difficult construction of the idea of chemotherapy in post-war French psychiatry and, more generally, the transformations in its notion of therapy.

La 11e version de la Classification internationale des maladies de l'OMS (CIM-10) est en cours d'élaboration au niveau international et la conclusion des travaux est prévue pour 2012. Très directement liée au chapitre V de cette classification traitant des troubles mentaux et du comportement, elle donne lieu à de nombreux débats car les entités décrites par la classification sont utilisées internationalement pour la définition des troubles psychiques, les comparaisons internationales et les remboursements des assurances maladies. Ce numéro spécial est consacré aux débats des experts.

International audience; On parle facilement de psychiatrie militante dans les années suivant la dernière guerre. Qu'est-ce qui a changé aujourd'hui ? Psychiatrie militante, l'expression a-t-elle encore un sens aujourd'hui ?

International audience

International audience

International audience

International audience; Petit retour historique sur la construction de la psychiatrie contemporaine, particulièrement dans les années 1950-1975, avec la diffusion des psychotropes et l'extension de nouvelles pratiques thérapeutiques. Ce qui s'accompagne d'un changement en profondeur du vécu des patients ou des professionnels

International audience; Borrowing the view of institutions developed by symbolic interactionism and the adopting the point of view of reform process trajectories, this article proposes a framework for analysing psychiatric hospital reform during the 20th century. It objects to the idea that the reform was linked to an institutional crisis and emphasises, on the contrary, the work required to create the conditions under which a certain number of problems can be raised and discussed by the actors at the various moments in history; Empruntant à l'interactionnisme symbolique sa vision des institutions et une perspective en termes de trajectoire des processus réformateurs, cet article propose un cadre d'analyse de la réforme des hôpitaux psychiatriques au cours du XXe siècle. Il discute l'idée que celle-ci ait été liée à une crise de l'institution et insiste au contraire sur le travail nécessaire pour créer les conditions dans lesquelles un certain nombre de problèmes peuvent être posés et abordés par les acteurs aux différents moments de l'histoire

International audience; Historique de la psychiatrie du 19e siècle à nos jours. Les évolutions des représentations de la maladie mentale ont participé à la construction de l'hôpital psychiatrique d'aujourd'hui et à la mise en place d'une nouvelle politique de santé mentale en France.

Ce rapport de recherche examine les premières années de « l’expérience du treizième arrondissement », expérience phare de psychiatrie communautaire à la française des années 1960 à 1980. Elle met en évidence la participation du treizième arrondissement à l’élaboration d’une « psychiatrie de secteur » tout analysant les enjeux locaux de la construction de son dispositif. La première partie retrace le contexte générale de la création du « treizième arrondissement », au croisement de l’élaboration d’une politique nationale de santé mentale et des transformations de la psychiatrie dans la région parisienne. La seconde partie analyse l’évolution du programme institutionnel du treizième arrondissement, depuis un programme de traitement actif de la psychose jusqu’à leur transformation en dispositifs de gestion de la chronicité. La troisième partie examine les transformations du centre de santé mentale du treizième arrondissement, et met en évidence les deux modèles organisant ses pratiques. La quatrième et dernière partie analyse les transformations du rôle des cadres soignants dans l’élaboration et la gestion du dispositif.