Réflexions sur les rapports entre l’histoire et la psychiatrie

Abstract

ObjectiveThis paper aimed to study the relationships between history and psychiatry, approaching psychiatry within its history and analysing the epistemological, clinical and methodological challenges involved. MethodHistory and psychiatry have strong relationships. Three points are considered: the relationships between the evolution of psychiatric ideas and practice and the historical context from the beginning of the 19th century to the present day, the relationships between historical epistemology and the epistemology of psychiatry, both based on single events and not on the founding of laws, and the use of narrative in psychiatric and especially institutional care. ResultsThe study of this history shows that, unlike the rest of medicine, psychiatry does not evolve according to a logic of increasing knowledge. Psychiatry accompanies social change and the history of ideas, and is subject to liberal advances and authoritarian withdrawals. DiscussionAt present, psychiatry has more to gain from a rapprochement with the social sciences than with medicine and neurobiology. According to Paul Veyne's epistemology, several points in common can be identified: psychiatry and history are both based on singular events and not on the edification of laws. Causality in psychiatry as in history is “retrodictive”. Diagnoses are mere abstractions, categories, provisional hypotheses, which cannot claim to possess the value of scientific fact held by a lesion in medicine. ConclusionPsychiatry, like history, is based on narrative principles, as expounded by Paul Ricoeur. Narrative is what all psychotherapeutic interventions have in common and in particular it underpins institutional psychotherapy. Clinical practice is inseparable from the narrative shared by caregivers and receivers, which carries with it both the pleasure of thought and consolation for loss.