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“Not all mental patients should be subject to security stigma”

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The tragedy shook the country and unleashed a political and media bubble. On the night of Monday to Tuesday, a 38-year-old nurse was murdered at the University Hospital Reims by a man with mental disorders.

When did madness stop being a political issue?

A few days later, political rhetoric on the right appeared in the media linking the lack of means in psychiatry to the potential for increased insecurity. This is a caregiver He also died under the rubble of French psychiatry, which sets free the dangerously insane.In particular, Senator LR Bruno Retailleau wrote on Twitter.

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Link It reappears regularly when the news is about a person suffering from a mental illness. But what are the risks of transmitting such a powerful stereotype? Mathieu Belahsen, former head of the psychiatry sector in the Parisian suburbs and author of The Psychiatric Revolution. Responses to the Director’s Disaster” (La Découverte 2020), provides some answers to “The Obs”.

What do you make of this political discourse linking psychiatry to growing insecurity?

Matthew Bilahsen It is a complete throwback to Sarkozy’s 2008 sequence in which a student is murdered by a patient on vacation in Grenoble. This hierarchy of security was suspended by psychiatry somewhat under Hollande and immediately returned under Macron’s generalization of Collomb. The latter created Dossier to accommodate people admitted to hospital without consent – by the governor or at the request of a third party – and S-files. The former Home Secretary also instructed the governors to be more stringent in obtaining patient permission requests.

But it’s a vicious circle: the more security you create, the fewer people you welcome. The less we welcome them, the worse they go. When they are not taken care of, they are likely to take action, above all on themselves, with suicide attempts.

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In psychiatry, we know that zero risk does not exist and never will. Crazy killer actions, they will always be there. But not all mental patients should be stigmatized. Solidarity with the victim, his family, colleagues and loved ones is important, as is solidarity with all patients hospitalized in psychiatry who suffer from security stigma.

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Where does the stereotype that all psychopaths are dangerous come from?

The history of asylum in psychiatry has been a history of dismissal and confinement. Before the French Revolution, letters of cachet were drawn up so that the vagabonds, the insane, and the poor would be placed in what was called the “General Hospital.” After the French Revolution, specific places developed to confine people who no longer had reason: asylums. In the popular imagination since 19H Century, insane – that is, deprived of reason – return “ordinary” people to horror. Madness refers to the irrationality that drives us all, which we may want to camouflage or bring to the other. There is a very projective experience for the madman.

And they have a good back, the mentally ill, in these expectations because they are more often victims than abusers. They are more vulnerable and therefore more vulnerable to attack. Moreover, 99% of crimes are committed by the so-called “ordinary” people. Crimes committed by schizophrenics have been publicized more because they are witches. They refer to this dimension that frightens him, the dimension of his madness. On the other hand, there are several hundred murders of women a year and this does not raise any more questions than that.

But eventually, everyone has relatives who have gone to see a depressed, been hospitalized in a clinic, had moments of depression or taken medication. People have the impression that it does not matter to them but it is not true, they are all affected from near or far.

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What are the health risks of this stigma?

We often hear the phrase “You are schizophrenic,” “You are paranoid,” or “Kindly autistic.” This social imagination creates representations. Psychiatry is porous in the air of society. In the dynamic of openness (60s and 70s), the mentally ill personality is supported by artistic but also political currents. The idea was to bring these people back from the world to the world. But with withdrawal into the self and the rise of the alt-right, psychiatry is taking a direct hit. Caregivers who take care of patients, for example, are safer.

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Three things highlight the current catastrophe: lack of means, lack of training and social representation built around mental health. Sometimes there are people who can only express themselves through violence. Our role is to help them do things differently. We will turn violence into aggressiveness, that is, into something we can work on. But when there are teams that are understaffed, poorly trained, and dismay that they are putting these perceptions into play, what they are asking is that these behaviors be managed through restraint or overmedication.

Added to this is that patients know the stigma, and sometimes even exercise it on people who are sicker than themselves. It creates shame, and many hide and limit access to their rights and self-care.

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What do you say to caregivers who fear being attacked when they go to work in the morning?

The best therapy is group! Clusters of psychiatry have been destroyed. When I was the chief physician, in the adult psychiatric service, I saw the arrival of temporary workers, temporary workers. People the patients don’t know and neither do the team. When you get used to a patient, the first time he gets angry, it’s hard, and then you figure out how to do it, and you create a story with him. And if we are afraid of a particular patient, we can rely on colleagues. Fear can be shared collectively. If all caregivers are relegated to their inner fear, mathematically this leads to burnout.

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