PIPOL 5
Mental health: a questioned concept
At the Square Brussels Meeting Centre
2 and 3 July 2011
For the first time, PIPOL will be unrolled under the praise of the European Federation of Psychoanalytical Schools (EFPS). It will be the occasion both to re-establish the EFPS, and to put psychoanalysis on the map in Europe. The choice of Brussels, the capital of Europe, as the scene of this meeting, conjugated to our wish to question the concept of mental health is not without a bond with this ambition. The antinomy between mental health and psychoanalysis is not a new idea. It finds its origins in the foundations of both ethics.
Whereas mental health aims at serving the public order[7], psychoanalysis tries to fit out a place for the “craziness” of each. Whereas mental health tends to standardize desire to adjust it to the common sense, psychoanalysis supports a claim of the right of a “not like everybody”[8].
While mental health embodies the nastiness of the Other that wants the best for us, if we like it or not, psychoanalysis on the contrary relieves the subject of the enjoyment of this Other. Notwithstanding this opposition, psychoanalysis nevertheless finds a shelter in the middle of institutions that carry the label of the mental health very often. Why then, question a concept that doesn't prevent a certain tolerance towards psychoanalysis? We do notice that de discourses of the official instances that promote this concept via the society are coloured more and more by a tendency of eliminating not only psychoanalysis, but also the “psy” clinical field in its totality, that uses speech as primary material. A sign that doesn't deceive: the World Federation of Mental Health, an organ attached to the WHO, published a document last year that was preparatory to the campaign that was organized in the context of the yearly conference on mental health in 2009, entitled “Mental health in primary care: improving treatment and promoting mental health”[9]. It is consisted of a program that aims at the application of a treatment of mental illness by general practitioners, nurses and other paramedical technicians. This would not be a priori a problem if it would mean that these practitioners would be trained in the clinical practice of speech. A rapid lecture of this program though, shows us that the training doesn't include clinical training, but it is rather consisted of an assessment training. An example. This document presents a computer operated evaluation tool (Global Mental Health Assessment Tool), developed in Great Britain. After the answers of the patients to a standardized questionnaire are put into the system, it gives “a synthesis report about the symptoms and their scores”, a diagnosis, an assessment of the risk of automutilation and advise for treatment. Besides this great novelty, in some cases a short term cognitive-behaviouristic psychotherapy is suggested etc. Not a word about psychoanalysis. Criticized nor attacked overtly, it is simply inexistent in this document and it is forclosed, just like the subject and its responsibility is. In another register, the DSM V that is expected to come to light in 2013 will significantly increase the population considered as being pathologic. One could start to believe that the group of experts of the American Psychiatric Association (APA) converge towards the lacanian formula “everybody is crazy”. This is not the case at all of course, because the DSMs in their successive versions, more and more clearly affirm that not “everybody is crazy” but “everybody is ill”. This new paradigm certainly will make the pharmaceutic societies very happy, because it makes us all a candidate for the consumption of medication. But this movement is not the only one. Since its origins, the DSM was created under the praise of a dream that should relieve us of any theory. The reference to a “non-theoretical” psychiatry rejects any causality, any point of enounciation[10] from where a theory could be uttered. Supporting a theory, taking position in relation to things, is marking a difference, which is embarrassing, because it means one is always vulnerable to being judged as “non-egalitarian” or “anti democratic”. It is more appropriate to speak about things by non-refutable statistics. The decisions thus aren't any longer based on the encounter with the speech of the patient, but on an observation of his behaviour, and on a comparison of it with the statistical norm. Hence the proliferation of the classified disorders in the DSM without any theoretical reference leads to a forclusion of the real of the clinic. The pathology is dissolved in an undifferentiated mass about which one can say anything and from time to time it reduces us to silence. It drowns us progressively in a world without differences: all the same, all normal, all ill, all in front of making an effort to be in good mental health. To invest the political field is an urgent necessity if we want to save the clinic. The PIPOL 5 meeting is organized as an event that is supported by these two posts: the first clinical, the other political. In the meanwhile we will hold on to the questioning of the concept of mental health. PIPOL NEWS is one of the tools to make it possible and to favour it. On the one hand we have to accumulate information about the Other of mental health in Europe or elsewhere, and on the other hand we have to sharpen our reflection on the ethical and epistemological contradictions this concept is hiding. Everyone who's inscribed at PIPOL NEWS is thus invited to write short texts of maximum 6000 signs, in order to spread information about existing decisions and projects related to mental health in the countries of the 4 EFPS Schools (ECF, ELP, SLP, NLS) and to support a debate concerning our relation to this concept as practitioners of psychoanalysis. One can find inspiration in one of the proposed themes, without this list having to be exhaustive: – History of mental health – Science, scientism and psychoanalysis – Is there a mental disease to psychoanalysis? – Psychoanalysis and medication – Contemporary psychiatry – Crime, law and mental health – Clinical cases that can learn something about the practices of mental health – Testimonies on the work in mental health institutions – Reviews of books or articles published in the press on this theme
