“French psychiatry has deteriorated in part because of American influence” – .

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“French psychiatry has deteriorated in part because of American influence” – .



As the French government launches a new mental health campaign including reimbursement of the cost of therapy sessions, psychiatric professionals are scrutinizing a sector they say has gone from “pioneering and innovative” to falter – and that the American hegemony is partly responsible for the French decline.

“The state of French psychiatry is catastrophic,” laments Marie-José Durieux, child psychiatrist in a Paris hospital. It’s a diagnosis shared by many others in his profession, and one of the reasons why the French government this week organized a two-day conference on mental health and psychiatry with industry professionals ( the Assises of Mental Health and Psychiatry) in an attempt to rejuvenate a failing branch of the French medical profession.

“Just 30 years ago, psychiatry was practiced with great interest and enthusiasm,” says Durieux. “We have associated psychiatry with imaginative sciences such as philosophy, psychoanalysis, sociology and literature, and we have taken the field further. “

Then the use of drugs was introduced in the area. “They brought with them undeniable progress, but drugs alone are not enough to solve existential problems,” she says.

“In the 1980s, American ways of thinking and treatment were adopted in France. French psychiatry, world-famous, innovative and pioneering, gradually began to decline under the influence of America.

At the heart of this showdown between French and American practices is the bible of the profession: the “Diagnostic and Statistical Manual of Mental Disorders” or DSM. This manual, compiled by the American Psychiatric Association, lists psychiatric disorders, diagnoses, and statistics, and began to be used in France in the 1980s. “Over time, the standards described in this book have taken hold. not on what was previously the norm in French psychiatry, ”explains Durieux.

The reference manual – used in the United States by physicians, researchers and governing bodies as well as insurance companies and pharmaceutical companies – is regularly updated with new data. But its latest update in 2013 sparked the backsliding of French mental health professionals, many of whom believe the manual’s classification systems – though extensive – don’t leave enough room for subjectivity in a diagnosis.

Many also believe that the manual is increasingly pushing professionals to resort to medication and that it is brainwashing psychiatrists early in their careers. “Human beings were born with a search for meaning that cannot be suppressed by an injection of antipsychotics or a few antidepressants,” says Durieux.

But an authoritarian approach to medication is not just an American phenomenon: French doctors are known to prescribe freely. France has the highest rate of antibiotic consumption per capita in Europe. A recent study showed that French doctors prescribed too many drugs to children, with half of children under 2 taking more than nine drugs per year. Regarding the prescription of drugs for psychiatric disorders, a 2014 study showed that one in three people in France was taking psychotropic drugs, including antidepressants. Indeed, France regularly ranks among the world’s leading consumers of antidepressants.

An aging profession, neglected by young professionals

So, are the US diagnoses to blame? Durieux says that the French health authorities are also responsible for the decline of this sector.

“Several decades ago, we started removing patients with mental health problems from hospital wards. It was a great thing because they shouldn’t all have been there. Today, specialized psychiatric services have gradually disappeared from hospitals, but they have not been replaced by outpatient services or follow-up care ”, deplores Durieux.

The French public authorities have on several occasions slashed funding for the psychiatric sector. As a result, tight budgets have resulted in lower salaries and key vacancies. When the last round of young doctors in the country chose their specialization, 71 psychiatric positions were not filled. Durieux says even those in the psychiatric profession itself are to blame because there is a lack of energy and innovation in the sector. “The average age of psychiatrists is quite high and many of them are retiring soon. In just 40 years, the profession has lost 40% of its workforce, ”says Durieux.

These problems are clearly visible in health centers across the country. Patients face a one-year waiting period before a first consultation in a psychological health center. This trend is even more apparent in rural areas of France or in densely populated areas such as the Parisian suburbs, where there are simply not enough trained health workers to meet growing demand. According to the latest data from an ongoing government survey on mental health during the Covid-19 pandemic, 15% of French people show signs of depression (a five point increase from before the pandemic), 23% show signs of depression. signs of anxiety and depression. 10 percent have had suicidal thoughts in the past year (double pre-pandemic levels).

While it is promising that the French are increasingly turning to psychologists and psychiatrists for help when struggling with mental health issues, we need to be serious about providing the necessary funding for the sector. , said Durieux.

This is exactly what the government is trying to do. French President Emmanuel Macron announced a series of measures intended to revitalize the struggling sector, including reimbursement of consultation fees with psychologists, the creation of 800 jobs in psychological health centers, and additional funding and support to the research. But the unions fought back, saying the measures are not only insufficient, but threaten the independence of the sector.

One aspect of the new measures particularly irritated psychologists: patients must be referred by their general practitioner to benefit from reimbursed consultations with a psychologist.

” It’s scandalous. It is a total contempt for our profession and for the population ”, estimates Patrick-Ange Raoult, the secretary general of the National Union of Psychologists (SNP).

Christine Manuel, also of the SNP, told the French news agency AFP that the reforms were decided without consulting health professionals. “We would like to be involved and we are not. They decide everything without our contribution, with the doctors.

The French Hospital Federation responded more positively to the announcements. In a statement, she said the reform was “essential to end the historic underfunding” of public psychiatry.

“These measures are going in the right direction, believes Durieux. “But Macron alone will not be able to fix the industry. Health professionals also need to take an interest in psychiatry again and breathe new life into the sector so that France can once again excel.

This article has been adapted from the original in French.

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