xxAACP Newsletter, Volume 14, Number 4, Fall 2000

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Hello travelers. Last issue I described what I found on my "Gulliver’s Travels" to the low countries. Before leaving the continent I thought you ought to know what I found in the beautiful and exotic country to the south. To find out if the world I live in is the real one or if there is another more healthier one somewhere, I went to France. Here everything is really old and what seems to matter most is what happened back then. After spending a few days in Paris at the World Congress of Psychiatry Paris Jubilee and after speaking with some of my French colleagues in psychiatry my story begins at St. Anan in the Loire Valley . Here, existing amid another culture, thinking and speaking and dreaming in another language, and hanging out among people who appear very similar looking to us but who happen to have completely different assumptions about things, is a good place to start. Here from this immersion, pretending as if I were living at a point in history corresponding to but somewhat different from "en Amerique" (in the US) perhaps I can gain some perspective so that I can see things closer to how it ought to be. In this little town in the Loire valley there is an ancient crypt below the Romanesque church of St Anan where there are frescos from the 12th century which depict typical scenes from the death of Christ and also from healing miracles by St. Gilles who in one scene gives his cloak to a paralyzed man who puts it on and suddenly is able to walk.

Miraculous events are depicted everywhere in France. Another favorite of mine is the story of a thorn from the crown of thorns. In the year 1453 the French defeated the English General John Talbot at the battle of Castillon thereby ending the hundred years war. On the body of General Talbot was found a relic which he had used to protect himself from harm. Only this time (sacre bleu!) it did not work! One of the Pontbriands who owned Montreal castle (the city of Montreal was named in 1535 by Claude de Pontbriand who sailed with Jacques Cartier) took it back and installed it in the chapel of the castle where it remains to this day. It is said to be a thorn from the crown of thorns worn by Jesus. Someday perhaps 550 years later the modern John Talbott (otherwise known affectionately as the Baron D’Talbott) will return to the castle in the Dordogne region (near Mussidan) and steal back the relic. We don’t know when. Un peu personnes savez comment prenner la relic. Soulement moi.

In France there are lots of ideas and few generally accepted truths. Here, if you want to know the truth, you ask the experts. If they agree then you are in good shape. So I came to talk to some experts and perhaps I can find out what mental health should be like if it were done right. Lots of beliefs and disbeliefs here and among them is the small obscure category known as science. Now science matters to some in France but not too many. Tradition is more important. Further, most don’t think of psychiatry as science, and to many it is simply nonsense (or at least some of my non psychiatrist Paris friends while hanging out at their maison in the Loire feel that way)." It just doesn’t exist, we don’t talk about it , it is a shame, and if we have to deal with it we will handle it in the family or we will just drink. We don’t / won’t go to psychiatrists!" ( Although some of them secretly do go).

Those that take it seriously (There are many psychoanalysts still in Paris) however disagree vociferously about what it means (200-300 distinguished societies each espousing somewhat different points of view). Nevertheless, I discovered that most do agree on one thing. They don’t believe in the (American) DSM. It may be the single most unifying force in intellectual French society. Of course, who can blame them? Why should anyone believe in such a thing. After all, it really has only a little to do with real science and quite a bit to do with group process and compromise ( a word not absent from the French vocabulary but seldom used). ICD 9 or 10 is the bonne way to think, je croix.

Now what do they say about the system there. Psychiatric treatment in France is free and may be better for the poor than the rich. There are private clinics for the rich which according to my sources are not as good as those for the poor. Paris attracts a lot of mentally ill persons but police find them and bring them to hospital not jail. There is an emergency car for the homeless going about with a psychiatrist and a social worker. There are more than ample beds available in short and long stay hospitals. In fact there are some people who really should be in prison who get taken to the psychiatric hospital. Apparently, it is easy to be transferred from the jail to the hospital. Drug dealers often wind up in jail waiting for trial, but not innocent mentally ill people. On the other hand, sometimes people stay too long in Hospital because there is not much housing available. There are some step down beds but more are needed.

There is also not a lot of case management available but they can get someone to come in to clean the house for them. Sophisticated vocational programs such as Bob Drake’s IPS have not yet developed. Instead they still have old style day treatment. Perhaps the biggest problem there from our perspective is that there are not enough psychiatrists and nurses in either the hospital or the community. This is because the government put a cap on the number of psychiatrists that can be trained. There are only 15-20 new psychiatrists / year graduated in Paris when 5 years ago there were 150.

A while back I visited the Hospital Marcel Riviere which is available to all persons who work in the education system in France. It is free and you can stay a few months on the grounds of a chateau there near Versailles where there is pleasant college dorm style housing, a hydrotherapy building ( includes hot and cold water), a lovely theater where patients put on their own plays, and a marvelous French restaurant. I wanted to check in there for a while. So there you have it. Not a bad place to be mentally ill. Just think you could go to a lovely spa in the country to take the cure, maybe do a little acting, take a dip now and then, and have some good food. Who needs ACT. I’ll take the mental hospital.

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