explorations - nouveaux objets - croisements des sciences

Je suis fou, et vous ?

De la disqualification la prise de parole en sant mentale

par Claude Deutsch

Résumé

L'nigme de cette recherche peut se formuler ainsi : Peut-on considrer que les personnes en souffrance psychique sont des personnes part entire, et non des personnes part ? Cette question part du constat de la disqualification sociale des fous et aboutit la reconnaissance de leur prise de parole. Faire le constat de la disqualification ncessitait qu'on la dfinisse, que l'on s'assure de son existence l'gard des fous et que l'on comprenne le processus d'un triple point de vue existentialiste, critique et psychanalytique. Il nous est apparu, dans un deuxime temps que la mdicalisation n'tait pas une rponse suffisante la disqualification. La spcificit du concept de maladie mentale repose sur la (con)fusion de deux ides : l'interaction du corps et de l'esprit et l'analogie de la souffrance somatique et de la souffrance psychique. Les thories kraepeliniennes sont la base de la psychiatrie postmoderne, pourtant il y des possibilits d'une prise en compte non mdicale de la souffrance psychique. Les "alternatives" du XXe sicle (antipsychiatries, psychothrapie institutionnelle, Deleuze et Guattari, Foucault) ne nous paraissent pas encore suffisantes. Bien qu'elles reconnaissent dans la personne en souffrance psychique un sujet, elles restent l'intrieur d'une pense psychiatrique, l'exception de Foucault qui s'appuie sur la question essentielle des rapports de pouvoir, mais en voquant, non la parole des intresss, mais une suppose "vrit de la folie". Pour prendre en compte les "disability studies" en sant mentale, il faut dfinir les concepts sur lesquels elles s'appuient : la souffrance psychique, la notion d'usager en sant mentale, la situation de handicap, l'empowerment, la notion de personne. Reconnatre la personne en souffrance psychique comme citoyen part entire, ce n'est pas nier la spcificit de sa situation. C'est comme acteur social qu'elle demande tre entendu et c'est dans ce geste-mme qu'elle se rapproprie, dans l'action partage, le sentiment d'exister.

Abstract

The enigma behind this research topic can be summed up in the following question : "Is it possible to consider persons who suffer from mental health problems as equals with us living on the 'inside' of society with full rights and freedoms or - are they really people who are on the 'outside' with lesser rights and freedoms?" This question will be dealt with from the starting point that "mad" persons have been disqualified socially and conclude with the fact that their voice must now be heard today. Understanding their disqualification requires defining what that means, proving how this happens to people with mental health problems considered "crazy" and analyzing a three-fold point of view - existentialist, critical and psychoanalytical. This initial study demonstrates that the medical model does not appear to provide an adequate response to this situation of social disqualification. The specific features of the actual concept of "mental illness" are based on a (con)fusion between two ideas : the interaction between the body and the mind, and the analogy made between physical and mental suffering. Kraepelinian theories are still used as a basis for post-modern psychiatry, whereas it remains possible to take into account mental suffering and anguish from a non-medical standpoint. The "alternatives" found throughout the 20th Century (ranging from the anti-psychiatry movement to institutional psychotherapy, Deleuze and Guattari, as well as Foucault) have not gone far enough. Although they recognize the person with a mental health problem as a "subject" rather than an "object", they remain based on psychiatric theory with the exception of Foucault who looks into the fundamental question of the balance of power, yet who does not rely on the voice of the persons concerned, but rather a supposed "truth about madness". Mental health disability studies also need to be taken into account in order to define the concepts on which they are based: living with a mental health problem, what it means to be a "service user" or a person with a psychiatric disability, the theory of empowerment and fully taking into account each individual for what they are. Recognizing that persons with mental health problems are full-fledged citizens does not mean denying the specific nature of their personal situation. They demand to be heard as members of society and by doing so, they take ownership of their right to exist alongside others who must lend their support.