Philosophie, histoire et sociologie de la médecine mentale

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For approximately twenty years, mental medicine has gone through a major shift affecting its paradigms, its therapeutical techniques and its fundamental concepts. This shift can be characterized as follows : the classical questions of psychiatry (focused on mental illness and its possible treatment) were gradually replaced by much larger issues grouped under a new chapter : "mental health". In the mental health paradigm, issues pertaining to the normal mind (e.g. its potential achievements, and even the positive enhancement of our quality of life through various forms of mental management) count at least as much as the traditional focus on the abnormal mind. Within this general framework, two major tendencies can be specified. 

On the one hand, the neurosciences, which were originally interested in the normal functioning of the mind, gave birth to psychiatric neurosciences, which have now become, along with neuroimaging, the scientific standard for research in all kinds of psychopathologies. In turn, age-old problems in clinical psychiatry, such as autism, affective disorders, schizophrenia, impulsive and compulsive behavior, have now turned into major problems for the many naturalistic theories of intentionality, of social cognition, and of emotions, which are currently being tested (see for example the idea that we are endowed with a "theory of mind" as a particular module of our cognitive equipement selected by evolution). On the other hand, mental health has become a major political and ideological challenge for policymakers in all developed countries. Well-being is increasingly being thought of in terms of mental health, and, conversely, the language of mental health offers new ways to manifest the individuals’ ill-being and ideals of moral autonomy (self-help, care vs. cure, etc.).

New forms of empowerment emerge : patient advocacy groups reclaim not only the right to actively take part in psychiatric research on their conditions, but even promote, and this is a new trend, new lifestyles based upon them (e.g. the "neurodiversity" movement). The standards of effective, ethical, scientifically grounded psychotherapies have become a highly polemic topic, especially in France. Worldwide, psychiatric epidemiology, torn apart between genetics and social sciences, confront many epistemological dilemmas (for example, should we talk again about "race" ?), which turn into politically loaded issues. But everywhere, norms and values, be they moral, sexual, or professional, are routinely evaluated according to mental health standards, as if it were a new mandatory way to manifest one’s ill- or well-being. Thus, mental health is one of the major sites in which the contemporary self is being shaped.

Mental health, for all these reasons, is not only an epistemological issue in the field of mental medicine, it is also a socio-anthropological one. Historically speaking, one of its most noticeable implications is the gradual recess, and even the decline of traditional psychology. For, either psychology is but a subdivision of neurosciences, and it is brain-based, or psychology dissolves into a broader spectrum of relational practices and techniques, the intelligibility of which is ultimately sociological.

Such a shift in mental medicine is well-documented in the international literature, and it has been the object of an intense scrutiny abroad. Many interdisciplinary programs are being launched, for example in the UK or in the USA, putting to work together clinicians, philosophers, sociologists and anthropologists, in order to address the many challenges of the new mental health paradigm. For these intellectual issues have a strong practical impact on public policies (What are, for example, the prospects for psychiatry services in the 21st century ? How are we to define the boundaries of illness in relation to the need to treat mental illnesses, and how much can we afford to treat them ? How is mental health to face the effects of globalisation ?).

But in France no concerted effort has been launched so far in order to turn all these questions into a coherent interdisciplinary and problematic framework. We regard this as unfortunate, for France has a long tradition of intellectual commitment to the philosophical, sociological, and historical problems of mental medicine (from Pinel to Foucault). It also benefits from a clinical culture different from the Anglo-American one, because it still incorporates many aspects of the German psychiatric thought (notably, psychiatric phenomenology) and of psychoanalysis.