by Robert M. Palem (Perpignan, France)
Once upon a time, there were great Masters of Psychiatry...
And one of them was indeed a "monumental" teacher, and as such, a phenomenon of completeness and longevity:
The thing is, there also was -and no doubt the two are linked- a flourishing field of Psychopathology in these times... and there were disciples. A disciple being, as Piaget put it "a man whom another man causes to dream".
A matter very relevant to our own time, and the basis of the problem, for after all, how can one "cause a man to dream", in 1997, with the DSM, our evaluation scales and our PMSI?
The lack of theories (the lack od ideas,"anideísme") but perhaps above all the lack of "historicity" today somewhat upsets our (European) psychiatry students, who are vaguely conscious of a rich past &endash;psychiatry is a Franco-German invention of the 19th and 20th centuries- from which they cannot amputate themselves, even while one well knows that it is the American "complex" about having no past to speak which, by "education by reaction" would now make us believe that no past is necessary. There is a history of concepts as there is a history of ideas. There are historical and genetic ways of understanding concepts and ideas.
Ey was a great psychopathologist. He was extremely close to recognizing the equivalence between psychopathology and a "clinical psychiatry that demands much more than the spirit of geometry, much more intuition than rationality", not merely the exclusively psychological interpretation of the symptoms but the investigation into the "existential meaning" of both the syndromes and the clinical scenarios. All "the deepenings of the comprehensive meanings and modalities" of the psychoses and the neuroses are required here to attain the "structure" that is "the actual form of the levels of organiozation of the conscious being reduced to a state of not being what she/he should be", that is again the dialectic between what is lacking, and what is desired, between the felt deficit and intentionality
But did the theoretician not quench the clinician? some object (Bercherie ). Certainly, Ey defends himself; it is only through clinical experience that the reality of the disorganization of the structures of the conscious being, which furnishes the material for his Organodynamism, can appear.
But beyond the refutability that is always possible for Organodynamic theory (and according to some, to be required: this was confirmed by Ey himself) what this theory offers is a framework of work and coexistence.
The practical value of Ey's theory is that it is sufficiently open and all-encompassing for all other theories and praxes to find their place within it; while fully maintaining their originality, the merit of their own contributions and their praxes. I think particularly of psychoanalysis, about which Ey said that for him, no psychiatry is conceivable that does not include it, yet must surpass it too, on the level of consciousness.
There is in Montevideo a Henry Ey Centre for study and research in Psychiatry, with an impressive work programme on the collected works of Ey and their practical applications (H.Casarotti), who asked himself (1995), among other things, what the works of Ey could contribute to medico-legal psychiatry. He observes that nowadays it is not the neuroses and the psychoses that pose most problems for the psychiatric expert but the character problems ("personality disorders") to be found at the top of Ey's pyramid, not at the foundations of the structure of the self.
"What this self lacks in order to be truly in charge of itself, is the awareness or the ends and purposes ot its existence, that is the transcendental possibility of adopting these as personal ethico-historical values for itself", says Ey .
It is therefore necessary to direct one's attentions to the superstructure instead of always over-privileging the "inferiora". "We must", shrieks C.JBlanc (1995) "stop diving like a suicidal rat for the base: the Oedipus complex, the pregenital phase, the archaic, the primal... and what remains beyond but chaos and nothingness? And if instead one raised his/her sights to the summit? If one climbed the ladder upwards?...
But Ey is no a dualist, he defends himself against that charge with the utmost energy. He thinks in pairs of opposites, fundamentally non-exclusively, like a good Thomist . An experienced humanist, he spent his brightest times (as C.J.Blanc explains , re-knotting broken threads, reunifying what others had divided, (re-constituting) the human being, origin and end of all things.
Ey's great lesson is that the object of psychiatry is not the brain, the neuron, the synaptic gap, the molecule..., the consciousness or the unconscious, or the social, but the human being. Mental illness is not merely the loss of abilities, faculties, or functions, the loss of operational capacites, of salaries or of jobs: it is a dehumanization, a lessening of value as opposed to the growth of being.
If Ey calls for an ontology of the "psychical body" (which is confused with his ontogénesis), it is no doubt due to his "classical" and humanist training on the one hand, his medical training (his biologism) on the other, but it is also because he sees emerging all around him new forms of alienation: by means of techniques or strategies that become operational and that are sometimes effective, but which are elevated to the rank of methods, and then to that of more or less implicit philosophies of life.
"From all sides today images of human nature are arising which correspond to the very paradigm of madness" comments C.J. Blanc, his best exegete, in 1975. The examples range from materialist conceptions (like those of Pavlov or De Clerambault), to the "psychical apparatus" of the Freudians, to the murder of the "structuralist" subject and to the schizological "desire&endash;filled machines" of Deleuze and Guattari. Certanly, not a comprehensive list, either.
Ey explores all the processes of willed intent. He is a thinker who tackles complexity, contradiction, organisations, the process of becoming; a dialectician, a demolisher of reductionist or steady-state dogmas, an architect of life.
When J.Grignon, of Leuven, in 1980 asked us "what is the contribution of organo-dynamic theory and the work of H.Ey to your practice of psychiatry?", we pointed out that many young psychiatrists would be temped to reply that they knew nothing about either, or perhaps, moved by an obscure feeling of bad conscience, or better, by the sense (held by their elders) of the immensity of services rendered , they might take upon themselves the appearances of a certain humano-psychiatric culture through quotations from the Master (psychiatry as the "pathology of freedom", schizophrenia as "a way of not being in the world", psychogenesis as a "theory of the identity between reason and madness", psychical development as the "passage from ontogenesis to ontology", etc...) . But there are still sufficient witnesses to be able to answer the question: What traces has he left in the memory of those who knew him?
Briefly, what have we retained of Ey?
- a great doctor, humane and humanist
- psychiatrist and philosopher ("La conscience")
- a great clinician (Etudes, Encyclopedie Médico-Chirurgical &endash; Psychiatrie, Manuel de Psychiatrie)
- a great theoritician (Organo-dynamism )
- an indefatigable worker and fighter (the syndicate of hospital psychiatrists, the Livre Blanc, the 1968 law of Incapables majeurs, Human Rights: Mexico 1971 &endash; Honolulu 1977)
-a model of constancy, perseverance, "creative fidelity" (to quote, with Claire Jacqueline, an expression of Gabriel Marcel's at Bonneval in 1965)
He was the incarnation of French psychiatry.
With his multifarious forms of practice but united in its stated purpose (the struggle against "mental illnesses") and in the ethics of its interventions (within the strictly medical profession: the problem of limits); and gathered around him, those who shared his life, or who stand in the framework of the organodynamic theory he bequeathed to posterity . In all these domains, he always demonstrated a great ability to listen and to enter into dialogue, and also intellectual courage in certain ideological debates (whether in 1946 with Lacan, with the communists, or in 1970 with the Antipsychiatry movement), and in some politically delicate situations ( in Mexico in 1971 and beyond).
The legacy of his battles in the history of psychiatry:
-against the mechanicism of De Clerambault and the neurological imperialism between the wars.
- against extensive psychoanalysis inmediately afterwards and its paradoxical de-medicalisation, after World War II, Lacan and May 1968.
- against the great misery of the psychiatric hospitals (1945, 1952) and of Psychiatry (Livre blanc, 1965).
- against the abuse of psychiatry for repressive purposes and against "Anti-psychiatry" (1970-77)
It is certainly not our aim, on the pretext of retracing his steps, to re-animate anachronistic conflicts, some of which have no further reason to exist; nevertheless it is worth emphasizing that the resurgence of these is always possible in their inverse forms &endash; always dualism! &endash; those which were the targets of Ey's battles with the psychiatrists of his time: for example....
1- The definition and the limits of "mental illness". Is the object of psychiatry still the latter? .... or is it the "suffering", the "discomfort"? and should it exclude (or not) the suffering, the discomfort of the environment? Is psychiatry just the sum total of psychiatrists and the care of "designated" patients?... All these propositions, relentlessly "antipsychiatric" in nature, were already the object of controversy between Ey and J. Hochmann, B. de Freminville, etc. in 1972. It would seem that some are prepared to reopen that dossier in 1995 . It should be said that the notion, at once so attractive yet vague, of the "pathology of freedom", lends itself to this. We have not the space here properly to develop this essential point of doctrine.
Should one ask, once more, the three questions of Th.Szasz in updated form..?
For whom does the psychiatrist work?
a- for society? in modern terminology: "No more exclusion! no more clochards, schizos, SDF on the streets!..."
b- for the patients? "give me work, give me love, if not give me happiness pills..."
c- for the truth of the subject? It is this third answer, need we be reminded, that Szasz and Lacan prefer. But what would motivate the psychiatrist to this end, except money?... if she/he did not also find in it the secondary benefits of a shared ethic (mirror effect), of an image of the human being that is acceptable, desirable, universal. So the formulation them becomes: "give him back his place, her dignity... and first and foremost, respect also my place, my dignity". Here, Ey's theorising about the "psychical body" and "the coming of consciousness" seems (to us) entirely acceptable.
2- The misdeeds of the dualism (separatism) forced between organicists and psychogenicists. Is one not returning to the concept of "psychic causality", whilst the neuro-mediators and psychotropic drugs sweep the field?
3- The pauperisation of mental medicine in the field as against the more prestigious medical (hospitalocentric) models.
4- The misdeeds of the de-specification of psychiatry by dilution (not integration) into general medicine, and its premature or incongruous codification .
That Organo-dynamism should indeed have become a "medico-philosophical" system (other objections understood), as the works of Pinel and Esquirol in the previous century were labelled before him, neither surprises nor shocks us. It may be taken as a compliment: there are seldom more than one or two men of that stature per century. The doctor-philosopher is equal to a God (Hippocrates). One could also ask whether the human sciences (which include psychiatry) ought really to economise on philosophical reflection?
To judge from what men like K. Jaspers, E Minskowski and H.Ey have produced, one may rightly assume that Psychiaty has thereby been enriched and honored. We have tracked the footsheps of H. Ey in order to read from them a direction, a road, an evolution, a maturation, the fruits of an experience, an example (rejecting the equivocal, concentrating on coherence), the lessons of an exceptionally full life . It is by correlation that we learn from him, not by sticking to his texts of 1936 (more clinical?) or those (more theoretical?) of 1946, which would later become more and more politically, juridically, syndically committed; nor indeed by taking as final his readings and critique of Freud as evidenced by his sole texts of 1895 or 1905.
Beyond all these events, epochs and epics, what we must remember about Ey
is that there is work to continue, there are ideas to reconsider and reaffirm, and developments to pursue and, from a more general point of view,
that there is always a battle to conduct for Psychiatry, always something to defend, although it may not always be the same issue, or the same context....
that nothing to do with the liberty and dignity of the mental patient and his/her psychiatry, is ever definitively won.
The battle for the human being is never over.
At his death in 1977, one could not but appreciate this future -already present- of a divided and subdivided psychiatry, of "parallel exercises....." ... in which the fate of the patient depends less on the present state of science and on the human and professional qualities of the psychiatrist doctor, than on the ideological choices, resistances, ignorances and blind spots of the practitioner whom chance has placed in his/her way.
Henri Ey truly had the dream of "unified psychiatry" , and like all geniuses (or madmen??.......) he tried to make his dream come true. Many have believed in it, and some of us still want to believe in it.
Patients will certainly not complain, who no longer know "where to go": to a private psychiatrist or a public health one, to a Hospital or to a Clinic, to a psychoanalyst who is or is not a medical doctor, to a psychologist, to a dispensary, to ANPE, to Catholic Relief?
"No one has the right to meddle with the nature of thing nor to liberate him/her self on doctrinaire grounds from the obligation of studying in minute detail the nuances and the movements of the clinical picture so as to choose, without prejudice, the means, however diverse, that are capable of healing the patient", said Ey . The approaches and the techniques change, but the ethic remains.
Henri Ey has influenced our practice in every dimension, calling for:
We must think of Ey and re-read his works whenever Psychiatry is in danger of being steamrollered by simplification, denaturation or outrageous reductionism. And whenever it is in danger of being split apart by disjunctive forces of any kind, or of annexation by any intellectual, technological or technocratic oppressor. Examples abound, space here is insufficient, but each of us knows the things we could talk about at length.
Ey reminds us constantly of the human being; the human being in the process of becoming, called to freedom, to consciousness, to transcendence .
Psychiatry is the pathology of the subject and his/her freedom.
All psychiatrists and psychotherapists who demand of themselves and take upon themselves these goals are good.
But "it has its own reality which is nothing other than to be a pathology of liberty and of reality" -our emphasis-.
A person cannot be autonomous if their "reality system" is defective.
To be autonomous is to be free of the tutelage of others...... and in charge of oneself (J.Chateau).
Neither one without the other.
1. Des idées deJackson à un modèle organodynamique en Psychiatrie. 1 vol. Privat 1975,p274 .
2. Histoire et structure du savoir psychiatrique. Les fondements de la clinique 1. Emergences 1991, 216
3. La Conscience, 2ème ed.1968 , pp270-71.
4. Cf son tableau des concepts-clés en fin de Traité des Hallucinations (1973) t.ll, pp1433-1436.
5. Le Traité des Hallucinations de EY,déconstruction, réévaluation et refonte du savoir psychiatrique. Evol.Psychiat.1975 n*1
6. Henri EY, dix ars aprés. Influence de Henri EY. Psychiatries n*79, 1987/4.
7. "Théorie de la relativité généralisée de la désorganisation de l'être conscient et des diverses maladies mentales "(Rapport au Vléme Congrés mondial de Psychiatrie, Madrid,1966. Evol.Psychiat.1970, n*1. Et,vide supra: Des Idées de Jackson à un modèle organodynamique ...
8."Henri EY ou la psychiatrie unifiée" titrait le Concours médical du 7-1-1978 ( C.KOUPERNlK)
9. Discours du Président de la Commission de la Santé mentale au Ministère de la Santé (24 mars 1971) ou Fermes propos (Entretiens psychiatriques n*15, Privat 1972, pp281,292: "...quand la psychiatrie a perdu ses limites, elle a perdu son sens".
10 J.MAISONDIEU: Psychiatrie des limites, limites de la Psychiatrie. Nervure, mars 1995,74-79 et Journées de l'Association française de Psychiatrie, les 12 et 13 mai 95 à Nice.
11. Ethique de la Psychana!yse, Payot 1975,pp,30-31.
12. Cf "La fin de la médecine spécialisée", par A. FROBERT, Synapse déc.1992, n° 91
13. Il a participé à toutes les luttes cornmunes de la psychiatrie et des psychiatres et a été l'âme de la plupart, écrit DAUMEZON. Il a poursuivi ces batailles jusqu'à sa fin..." et le plus frappant est que lui, I'aîné, n 'a jamais <<décroché>>, n'a jamais perdu l'ardeur, alors que l'un aprés l'autre, avouons-le, nous avons tous été usés" (Perspectives psychiatriques 1976, n° 65,p9).
14. titre d'une de ses réponses à un texte de J.CAIN. Evol.Psychiat. 1976, oct-déc.p837.
15. Loc.cit...Faire de la psychiatrie, être psychiatre, c'est se placer de ce point de vue "qui permet de saisir l'unité de cette diversité" écrit-il dans la préface aux 1ers Entretiens psychiatriques, le 22 juin l952.
16."Méthodes et techniques thérapeutiques en psychiatrie". EMC Psychiatries T3,1976
17-Evolution psychiatrique, avril-juin 1971
18.1 vol. Masson, 1977 ;
19. Traité des hallucinations t.ll, p1437.
20. Préface au 15éme volume desEntretiens psychiatriques, Privat, 1971-72, p 14.