Chailles - Journées Nationales 2006
Hospitalizing ?
What are the characteristics of that tool of health care, whether hospital or private clinic, which we resort to for some of our patients? Hospitalisation in medicine is based on a “hotel” and human device which serves techniques that are heavy to carry out, for exploration as well as therapeutic purposes. In psychiatry, hospitalisation has its own specificity as a symbolic and physical container, as a refuge, as a protection against internal persecuting motions, as a way to distance from oppressive emotional productions. The pluriprofessional and collective synergy of the care-giving institution is of a major importance here. This dynamics may have irreplaceable therapeutic effects when it is elaborated and implemented, it could have uncontrolled developments if neglected, it may be unbearable for some patients.
The organization of health care depends on ideologies of the day and on administrative decisions which often produce illogical effects. Undertaking an historical and political analysis of the situation, redefining our expectations, is more than ever a priority.
For what kind of patients do we plan it ? The expression of pathologies changes, so do habits according to shortage and waiting lists. Quite obviously, hospitalisation is a sovereign remedy for some acute collapses. Sometimes a few days are enough, sometimes it requires more time, but in all cases, it will be time-consuming. When some say that the institution turns patients into chronic ones, aren’t they denying then the chronic component of the mental illness ? This chronicity does not mean excluding the necessity of the care.
Asylum is suggestive of rejecting and forgetting those who are disturbing and whom we hide, whereas «right of asylum» is a beautiful expression ! Is hospitalisation more stigmatising than confrontation with a false integration, the outcome of which is too often the prison and the street ?
Each time, the same questions arise: When to hospitalise ? Where to hospitalise ? What kind of hospitalisation ? For what purposes ? How to negotiate hospitalisation with patients and/or their families ? How to co-ordinate therapeutic action with hospital colleagues ? How to organize what comes afterwards ?
Answering is not always easy, to say the least. A healthcare coordinated upon referral by attending practitioner, “networks”, “evaluations”, will all this make our task easier ? What are we expected to believe ?