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Making People Autonomous: A Sociological Analysis of the Uses of Contracts and Projects in the Psychiatric Care Institutions

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Abstract

This article aims at describing the tensions arising from working on and with someone in psychiatry, in order to make this person more “autonomous”. First, through the example of the recovery, it acknowledges, the normative horizon of what is considered today as “good care”: a negotiation between partners, aiming at increasing the possibilities for everyone to follow their own lifestyle. It then seeks to describe how this definition of good care is endorsed and applied in two institutions (in Belgium and in France) hosting people with severe mental health issues where the care teams are using three words (“contract”, “project” and “autonomy”). The article analyses the difficulties encountered while putting into practice these demanding ideals and shows how and to what end the care teams take action in defining the “good” projects and, in a more general way, what patients can or should expect from themselves and from their future.

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Notes

  1. Systemic psychotherapy implies working not at the level of the individual, but at the level of the relational system in which the patient evolves.

  2. In this article, people being treated for mental health issues and staying in institutions, where the fieldwork has been done, will be called “patient” or “resident” to apply the indigenous terms used within the institutions where the study was done. This designation is in no way a value judgement.

  3. The author would like to sincerely thank the two anonymous reviewers of Culture, medicine and psychiatry as well as Nicolas Henckes for their useful comments on previous versions of this paper.

  4. Even if the movements of the institutional psychotherapy are advocating such ideas for a while (cf. Clinique de La Borde, etc.), their perspective mainly stayed dissenting..

  5. For a very clear example of this consequence, see the way the CRPD was included into the Brussels law, in the decree “Inclusion” (Marquis 2015).

  6. The role of the caregivers can maybe include helping with formalizing decisions to be made (what do I really want to do?) and assessing these decisions (what are the conditions to make it happen?), with tools such as the CASIG (Client Assessment of Strengths lnterests and Goals) scale, for example.

  7. Comité d’Evaluation Ethique de l’INSERM (IRB00003888, n° 15-268, France) and Comité d’Ethique Hospitalo-Facultaire (CEHF) UCL-Saint-Luc (IRB00001530, 2016/10FEV/046, Belgium).

References

  • Adams, Jared R., Robert E. Drake, and George L. Wolford (2007) Shared Decision-Making Preferences of People with Severe Mental Illness. Psychiatric Services 58(9): 1219-1221.

    Article  Google Scholar 

  • Austin, John Langshaw (1975) How to Do Things with Words, Vol. 88. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Barrett, Robert J. The Psychiatric Team and the Social Definition of Schizophrenia: an Anthropological Study of Person and Illness. Cambridge: Cambridge University Press, 1996.

    Book  Google Scholar 

  • Blanc, Alain. Sociologie du handicap. Éditeur: Armand Colin, 2012.

    Google Scholar 

  • Bloor, M. J. Social Control in the Therapeutic Community: Re‐examination of a Critical Case. Sociology of Health & Illness 8.4 (1986): 305-324.

    Article  Google Scholar 

  • Bloor, Michael J., and Neil P. McKeganey (1986) Conceptions of Therapeutic Work in Therapeutic Communities. International Journal of Sociology and Social Policy 6(3): 68-79.

    Article  Google Scholar 

  • Bloor, Michael, Neil P. McKeganey, and Dick Fonkert. One Foot in Eden: a Sociological Study of the Range of Therapeutic Community Practice. London: Routledge, 1988.

    Google Scholar 

  • Bourdieu, Pierre. Méditations Pascaliennes. Paris: Le Seuil, 1997.

    Google Scholar 

  • Brodwin, Paul. Everyday Ethics: Voices from the Front Line of Community Psychiatry. Berkeley: University of California Press, 2013.

    Book  Google Scholar 

  • Campling, Penelope, and Rex Haigh, eds. Therapeutic Communities: Past, Present and Future. Vol. 2. Chichester: Wiley, 1999.

    Google Scholar 

  • Coleman, Ron, and Mike Smith. Working with Voices. London, UK: Keepwell, 2002.

    Google Scholar 

  • Corin, Ellen E. (1990) Facts and Meaning in Psychiatry An Anthropological Approach to the Lifeworld of Schizophrenics. Culture, Medicine and Psychiatry 14(2): 153-188.

    Google Scholar 

  • Crossley, Michele L., and Nick Crossley. (2001) Patients’ Voices, Social Movements and the Habitus; How Psychiatric Survivors ‘Speak Out. Social Science & Medicine 52(10): 1477-1489.

    Article  Google Scholar 

  • Crossley, Nick. Contesting Psychiatry: Social Movements in Mental Health. London: Routledge, 2006.

    Book  Google Scholar 

  • Davidson L, Rakfeldt J, Strauss JS, éds. The Roots of the Recovery Movement in Psychiatry: Lessons Learned. Chicester: Wiley-Blackwell, 2010.

    Google Scholar 

  • Delmar, Charlotte. (2012) ‘The Excesses of Care: a Matter of Understanding the Asymmetry of Power’. Nursing Philosophy,13(4): 236-243.

    Article  Google Scholar 

  • Douglas, Mary. Evans-Pritchard. London: Routledge, 2010.

    Google Scholar 

  • Douglas, Mary. How institutions think. Syracuse: Syracuse University Press, 1986.

    Google Scholar 

  • Drake, Robert E. and Patricia E. Deegan (2015) Shared Decision Making is an Ethical Imperative. Psychiatric Services, 60(8), 1007.

    Article  Google Scholar 

  • Ehrenberg, Alain 2005 La plainte sans fin. Réflexions sur le couple souffrance psychique/santé mentale. Cahiers de recherche sociologique 41-42: 17-41.

    Google Scholar 

  • Ehrenberg, Alain. La société du malaise. Paris: Odile Jacob, 2010.

    Google Scholar 

  • Ehrenberg, Alain. La Mécanique des passions: Cerveau, comportement, société. Paris: Odile Jacob, 2018.

    Google Scholar 

  • Ehrenberg, Alain, and Anne Lovell 2001 La Maladie mentale en mutation: Psychiatrie et société. Paris: Odile Jacob.

    Book  Google Scholar 

  • Estroff, Sue E. Making it crazy: An ethnography of psychiatric clients in an American community. Berkeley: University of California Press, 1985.

    Book  Google Scholar 

  • Floersch, Jerry. Meds, money, and manners: The case management of severe mental illness. New York: Columbia University Press, 2002.

    Book  Google Scholar 

  • Foucault, Michel 2014 (1961) Histoire de la folie à l’âge classique. Paris: Gallimard.

  • Gale, John, Alba Realpe, and Enrico Pedriali, eds. Therapeutic communities for psychosis: Philosophy, history and clinical practice. London: Routledge, 2013.

    Google Scholar 

  • Goffman, Erving 2017 (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. London: Routledge.

  • Hamann, Johannes, Stephan Leucht, and Werner Kissling (2003) Shared decision making in psychiatry. Acta Psychiatrica Scandinavica 107(6): 403-409.

    Article  Google Scholar 

  • Jacobson, Nora, and Dianne Greenley (2001) What is recovery? A conceptual model and explication. Psychiatric Services 52(4): 482-485.

    Article  Google Scholar 

  • Kreyenbuhl, Julie, Ilana R. Nossel, and Lisa B. Dixon (2009) Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophrenia Bulletin 35(4): 696-703.

    Article  Google Scholar 

  • Lovell, Anne M., Aurélien Troisoeufs, and Marion Mora (2009) Du handicap psychique aux paradoxes de sa reconnaissance: éléments d’un savoir ordinaire des personnes vivant avec un trouble psychique grave. Revue française des affaires sociales 1: 209-227.

    Google Scholar 

  • Manning, Nick. The therapeutic community movement: Charisma and routinisation. London: Routledge, 1989.

    Google Scholar 

  • Marquis, Nicolas 2018 La résilience comme attitude face au malheur: succès et usages des ouvrages de Boris Cyrulnik. In SociologieS.

  • Marquis, Nicolas (2015) Le handicap, révélateur des tensions de l’autonomie. Revue interdisciplinaire d’études juridiques 74(1): 109-130.

    Article  Google Scholar 

  • Marquis, Nicolas. Du bien-être au marché du malaise. La société du développement personnel. Paris: Presses universitaires de France, 2014.

    Book  Google Scholar 

  • Massé, Gérard. Pour une réhabilitation psychosociale à la française. L’information psychiatrique 82.4 (2006): 291-296.

    Article  Google Scholar 

  • Morrison, Linda J. Talking back to psychiatry: The psychiatric consumer/survivor/ex-patient movement. London: Routledge, 2013.

    Book  Google Scholar 

  • Ogien, Albert. Le raisonnement psychiatrique. Essai de socioanalytique. Paris: Méridiens-Klincksieck, 1989.

    Google Scholar 

  • Oury, Jean. Psychiatrie et psychothérapie institutionnelle. Paris: Champ social Editions, 2001.

    Book  Google Scholar 

  • Pachoud, Bernard. Se rétablir de troubles psychiatriques: un changement de regard sur le devenir des personnes. L’information psychiatrique 88.4 (2012): 257-266.

    Article  Google Scholar 

  • Pachoud, Bernard (2018) La perspective du rétablissement: un tournant paradigmatique en santé mentale. Les Cahiers du Centre Georges Canguilhem 7(1):165-180.

    Article  Google Scholar 

  • Pols, Jeannette. (2003) Enforcing patient rights or improving care? The interference of two modes of doing good in mental health care. Sociology of Health & Illness 25(4): 320-347.

    Article  Google Scholar 

  • Potter, Jonathan (2001) Wittgenstein and Austin. In: M. Wetherell, S. Taylor, S. Yates (Eds.), Discourse Theory and Practice: A Reader (pp. 39–48). London: Sage.

    Google Scholar 

  • Ravaud, Jean-François, and Henri-Jacques Stiker (2000) Les modèles de l’inclusion et de l’exclusion à l’épreuve du handicap. Handicap 86:1-18.

    Google Scholar 

  • Rhodes, Lorna A. Emptying beds: The work of an emergency psychiatric unit. Berkeley: University of California Press, 1995.

    Google Scholar 

  • Romme, Marius AJ, and Alexandre D. Escher (1989) Hearing voices. Schizophrenia Bulletin 15(2): 209-216.

    Article  Google Scholar 

  • Sass, Louis A. The paradoxes of delusion: Wittgenstein, Schreber, and the schizophrenic mind. Ithaca: Cornell University Press, 1994.

    Google Scholar 

  • Sassolas, Marcel. La psychose à rebrousse-poil. Paris: Erès, 2009.

    Book  Google Scholar 

  • Schütz, Alfred. Le chercheur et le quotidien. Paris: Meridiens-Klincksieck, 1987.

    Google Scholar 

  • Sharp, Victor. Social control in the therapeutic community. Brooksville: Saxon House, 1975.

    Google Scholar 

  • Sicot, François. La maladie mentale, quel objet pour la sociologie? Déviance et société 30(2) (2006): 203-232.

    Article  Google Scholar 

  • Strauss, Anselm, Léonard Schatzman, Danuta Ehrlich, Rue Bucher et Melvin Sabshin. Psychiatric Ideologies and Institutions. New York: Free Press, 1964.

    Google Scholar 

  • Tarot, Camille (1999) De Durkheim à Mauss, l’invention du symbolique. Paris: La Découverte.

    Google Scholar 

  • Théry, Irène. (2003). La notion de division par sexes chez Marcel Mauss. L’Année sociologique, 53(1), 33-54.

    Article  Google Scholar 

  • Troisoeufs, Aurélien. (2009) La personne intermédiaire. Hopital psychiatrique et Groupe d’entraide mutuelle. Terrain. Anthropologie & sciences humaines 52: 96-111.

    Google Scholar 

  • Turner, Victor, Roger D. Abrahams, and Alfred Harris. The ritual process: Structure and anti-structure. London: Routledge, 2017.

    Book  Google Scholar 

  • Velpry, Livia. Le quotidien de la psychiatrie: sociologie de la maladie mentale. Paris: Armand Colin, 2008.

    Google Scholar 

  • Winnicott, Donald W. Play and reality. London: Tavistock Publication, 1971.

    Google Scholar 

  • Wittgenstein Ludwig. Recherches philosophiques. Paris: Gallimard, 2010.

    Google Scholar 

Download references

Acknowledgements

Funding was provided by FP7 People: Marie-Curie Actions (Grant Number PIEF-GA-2013-624697).

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  1. Centre d’anthropologie, sociologie, psychologie – études et recherches (CASPER), Université Saint-Louis – Bruxelles (USL-B), Boulevard du Jardin Botanique, 43, 1000, Brussels, Belgium

    Nicolas Marquis

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Correspondence to Nicolas Marquis.

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Conflict of interest

This research was funded by a FP7 Marie-Curie Actions Grant (PIED-GA-2013-624697) awarded to Nicolas Marquis. Nicolas Marquis declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research was approved by the Comité d’Evaluation Ethique de l’Inserm (France, avis n°15-268), and by the Comité d’Ethique UCL-Saint-Luc (Belgium, avis 2016/10fev/046). This article does not contain any studies with animals.

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Marquis, N. Making People Autonomous: A Sociological Analysis of the Uses of Contracts and Projects in the Psychiatric Care Institutions. Cult Med Psychiatry 46, 248–276 (2022). https://doi.org/10.1007/s11013-019-09624-x

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