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Belfort - Journées Nationales 2005

Psychiatrist and citizen

The psychiatrist’s political function

The concept of equality of rights seems to progressively change to a claim for equality of « comfort », the corollary of a consumerist « have-it-all ». This trend comes along with the explosion of numerous pathological signs. As a consequence, the psychiatrist is invited more and more often to answer two recurring questions: do individuals suffer from their social maladjustment ? Or do they project their suffering and demand onto that field ?

The psychiatrist benefits from a privileged observation post, opened onto the patient
s inmost being. His educational training enables him/her to report the psychodynamic or psychopathological motives involved in those reactions of adjustment or collapse that are related to social disruptions. However, this specific, widely recognized competence of the psychiatrist is often diverted and even reduced to its mere function of expertise.

The social command is putting an increasing pressure. The psychiatrist is thus requested to bring modifications to the individual behaviour in the fastest, most efficient way and at a lower cost. The practitioner
s independence and his/her therapeutic invention would be imposed protocols of care designed in a caricatured way for a troop of clones reduced to their molecular dimension and their behavioural reflexes.

Will the patient
in search of an interlocutor able to give him support and to listen to the singularity of his suffering be given standardized health care with a purpose to comply to norms set out by society ? Will the psychiatrist become a simple intermediary subject to a good administrative governance ? On the contrary, will he carry on with his specific work, thus running the risk to be put offside of the social field ?

In our function as caregivers and experts, should not we question our clinic and our practice when faced with society evolution and with requests it is making to us ? Between a demand for health care and a social command, between a medical responsibility and a socially aware responsibility, where should the cursor be set, so as to make sure that the psychiatrist, and especially the psychiatrist in private practice, does not break the tacit agreement that he has with his patients: standing as a guarantee for each of them to be heard and to get access to the most appropriate health care.