FRAL - Programme franco-allemand en SHS

Psychiatric fringes. An historical and sociological investigation of early psychosis and related phenomena in post-war French and German societies – PSYFRING

Psychiatric Fringes

An historical and sociological investigation of early psychosis and related phenomena in post-war French and German societies

Grey Zones: Understanding the constitution and effects of categories located at the boundary between the normoal and the pathological

Early psychosis is used today as a label for a condition of being mentally healthy and at the same time having a strong probability of developing a severe mental illness. It represents a space of liminality or, as we call it, a “grey zone” between pathology and health, illness and non illness. This project aims at analyzing the construction and function of this grey zone as a way of negotiating the boundaries between the normal and the pathological. The constitution of this rather new psychiatric category is based on an assemblage of psychological test procedures, epidemiological methods, and risk analysis, combined with screening and prevention measures. How this assemblage deploys itself and how it reflects contemporary biomedicalization processes are the leading questions of this project, in which we trace the emergence and development of early psychosis over the last fifty years. The investigation will help in understanding the consequences of this assemblage both for psychiatric practice and for the individuals concerned confronted to conditions outside the realm of the normal without having a chance to reach a new normal. While their pervasiveness today is related to the contemporary development of notions of risk, prevention, treatment, and chronicity, we hold that these grey zones, which are fraught with practical and existential uncertainties, form constitutive third spaces which bring stability to dichotomies in contemporary social practices, cultural habits, etc. Early psychosis thus offers an opportunity to develop an analysis of the shifting boundaries of psychiatric practice and categories in contemporary societies. The project aims at both explaining current changes in psychiatry’s approaches to its objects at the interplay of local and global processes. Eventually it will contribute in important ways to to ongoing debates in the social studies of psychiatry.

To reach these goals the project relies on a comparative methodology and will be undertaken by an interdisciplinary team of historians, sociologists, psychologists and anthropologists. It is divided into two parts which share the same methodological ambition: understanding the production, circulation and use of clinical knowledge as practices. Part A will rely on analyzing patient hospital records and other archival sources in psychiatric hospitals and research institutions, on reviews of psychiatric journals as well as on oral history. It aims at exploring both the development of ideas about early psychosis and their implication for clinical practice from World War II on in both countries. Part B will explore how early psychosis is brought to life in the daily practice of specialized consultations and what it means for the protagonists of these consultations. It will rely on ethnographies to be conducted in Paris and Berlin clinics, consisting of observations of consultations and staff as well as interviews with professionals, patients and families. Altogether, the research is divided into 11 work packages, two of which are common to both parts. All the analyses will rely on inductive methods derived from Glaser and Strauss's Grounded Theory.

With this project we hope to constitute a history of early psychosis since World War II and highlight its social life today in France and Germany. More precisely, we will highlight the specific ways in which knowledge on underlying phenomena are produced in different historical and social contexts through the analysis of concrete research practices. We will also demonstrate how in those contexts clinicians develop clinical judgment in a situation – the early diagnosis of severe mental disorders – that is characterized by both profound epistemic uncertainties and deep ethical tensions. We will finally show how clinicians and patients interpret those diagnostic labels to undertake treatments or think over personal and collective identities. With this research, we will thus be able to show some mechanisms at work behind the current biomedicalization process, understood as a diversification of the sources of norms in contemporary biomedicine. Specifically, we will test the following hypothesis: whereas the international social science literature on those issues has stress a decline in the normativity of the clinics, we rather think that the clinics remain at the chore of the production of medicine today, even if it is in a new position today facing new norms produced by biological sciences, industry, administration and society at large.

This project will contribute to highlight contemporary debates on notions of risk, pre-disease, early diagnosis and treatment in psychiatry, as well as the social aspects of the psychiatry of adolescents and young adults. The multiplication of research and treatment facilities targeting these problems calls for a better understanding of the ways in which these institutions work and their effects on people concerned. As we will highlight a series of social and moral questions posed by these practices – such as: what is at stake in making clinical judgments in such an uncertain situation, how do people construct their identity based on such unstable categories -, we will contribute in important ways not only to the thinking of clinicians themselves but also and more largely to the social debate on the transformations of psychiatry. Within the social sciences, finally, our research participate to the renewed interest in the social studies of psychiatry – an interest which is no longer focused on the question of how is socially constituted the experience of being severely mentally ill, but more generally deals with the production of psychiatry as a social and cultural system.

The output of this project will include a series of publications in peer reviewed psychiatry and social science journals, as well as an international conference organized in Berlin in october 2014.

Early psychosis is used today as a label for a condition of being mentally healthy and at the same time having a strong probability of developing a severe mental illness. It represents a space of liminality or, as we call it, a “grey zone” between pathology and health, illness and non illness. This project aims at analyzing the construction and function of this grey zone as a way of negotiating the boundaries between the normal and the pathological.
The constitution of this rather new psychiatric category is based on an assemblage of psychological test procedures, epidemiological methods, and risk analysis, combined with screening and prevention measures. How this assemblage deploys itself and how it reflects contemporary biomedicalization processes are the leading questions of this project, in which we trace the emergence and development of early psychosis over the last fifty years. The investigation will help in understanding the consequences of this assemblage both psychiatric practice and for the individuals concerned confronted to conditions outside the realm of the normal without having a chance to reach a new normal. While their pervasiveness today is related to the contemporary development of notions of risk, prevention, treatment, and chronicity, we hold that these grey zones, which are fraught with practical and existential uncertainties, form constitutive third spaces which bring stability to dichotomies in contemporary social practices, cultural habits, etc. Although such grey zones have been analyzed in other fields of non psychiatric medical practice, the example of psychiatry has never been addressed. Early psychosis thus offers an opportunity to develop an analysis of the shifting boundaries of psychiatric practice and categories in contemporary societies.
The project sets as its goals the following: 1) to explain current changes in psychiatry’s theoretical perspectives concerning the nature of its objects; 2) to analyze psychiatry’sits relationships to transformations in contemporary biomedicine; 3) to outline an analytical framework for understanding the interplay between local and global processes in the construction of psychiatric knowledge and practice; and 4) to contribute to ongoing debates in the social studiesof psychiatry. To reach these goals the project relies on a comparative methodology and will be undertaken by an interdisciplinary team of historians, sociologists, psychologists and anthropologists. It is divided into two parts: Part A will rely on analyzing patient hospital records and other archival sources in psychiatric hospitals and research institutions, on reviews of psychiatric journals as well as on oral history. It aims at exploring both the development of ideas about early psychosis and their implication for clinical practice from World War II on. Part B will explore how early psychosis is brought to life in the daily practice of specialized consultations and what it means for the protagonists of these consultations. It will rely on ethnographies to be conducted in Paris and Berlin clinics, consisting of observations of consultations and staff as well as interviews with professionals, patients and families. Altogether, the research is divided into 11 work packages, two of which are common to both parts. Output from the project will include two international and interdisciplinary workshops, one of which will be organized in cooperation with psychiatrists, as well as a series of publications in peer-reviewed journals.

Project coordinator

INSTITUT NATIONAL DE LA SANTE ET DE LA RECHERCHE MEDICALE - DELEGATION REGIONALE PARIS XI (Divers public)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.

Partner

INSTITUT NATIONAL DE LA SANTE ET DE LA RECHERCHE MEDICALE - DELEGATION REGIONALE PARIS XI

Help of the ANR 249,267 euros
Beginning and duration of the scientific project: December 2011 - 36 Months

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