Nouveaux concepts en sante mentale

Abstract

To what extent can one speak to-day of new concepts in the mental health field? There have existed for a long-time (since, for example, the Mental Hygiene Movement and the tendency Preventive Psychiatry in the United States) new programmes for the administration of care which aim at going beyond the 'repair model' (Goffman) of classical psychological medicine, and at developing a 'positive concept' of health (after William A. White in 1930). In the same spirit, psychoanalysis has promoted a dynamic concept of psychic disturbance which transcends the static opposition of health and illness. Finally, the insistence on systematic prevention of risks also follows the tendency to transcend the medical relationship. Thus, the conditions for bringing about, conserving and developing mental health have long ceased to be susceptible to thinking out from the base of clinical psychiatric concepts. These important transformations in the conceptions of mental health do not, however, guarantee their establishment in practice. We have chosen to emphasize here the point of view of the application (or non-application) of 'new concepts' in effective policies, rather dealing only with the theoretical text from which they have emerged, or declarations of intention that proclaim their merits. This article attempts firstly an evaluation of the reform movements that have developed since the end of the Second World War, mainly in the United States and in France with the following question as point of departure: "To what extent have modern mental health policies been innovative in relation to classical psychiatry dominated by a medical conception of mental health, that is to say a model that is "repair-oriented" or curative rather than positive or preventive"? Firstly, the achievements of the Community Health Centres in the United States and the Policy of the Sector (politique de secteur) in France is analysed. In both cases the 'theoretical' programmes of the promoters are compared to that which has been accomplished in fact. What, concretely, has happened to the will to "enlarge the conception of mental health to include concepts that no longer include mental disorder", as proclaimed by Leonard J. Duhl in summing up the spirit of the Community Mental Health Centres and Retardation Act? The article attempts this evaluation on a three-fold level: new theoretical models envisaged, new forms of intervention put into practice and the institutional transformations that have been introduced during the last 30 years.(ABSTRACT TRUNCATED AT 400 WORDS)