A Psychiatrist’s Week in Paris
- Author:
Henry Harris, M.D., D.P.M.
Below, I give my impressions of five days?a working week?spent in Paris, investigating institutions and clinics of psychiatric interest: with a special emphasis on mental deficiency.
These remarks must necessarily be impressions; at the same time, first impressions are often the most acute. Some delay was due to ” red tape ” and ignorance of the various authorities granting permission to visit; but on the whole a considerable amount was seen in the time.
I propose to mention arrangements made for mental defectives in the first instance by the educational authorities, in the second instance by medical authorities. I then propose to discuss clinics of more general psychiatric in- terest: and lastly, one important and typical neurological clinic.
The provisions made for mental defectives by the educational authorities in Paris affect no more than about 220 children.
Of these about 100 are accommodated at the ” Institut Departemental des Sourd-Muets et des Arrieres ” at Asnieres, a suburb of Paris. About 600 boys and girls are accommodated here on a residential basis, the parents being allowed to take their children home over the week-end. Of these, 500 are deaf-mutes and about 100 are defectives of a fairly high grade, corresponding roughly to the ” feeble-minded ” of our Mental Deficiency Act.
The defectives are graded into three classes. Reading is taught in each class and more emphasis is placed on it than is the case in England or America. In the workshops, defectives work side by side with deaf-mutes; the boys at tailoring, carpentering and boot-making; the girls at sewing and domestic work.
The general aim of the institution is to fit the defective individual?be he deaf-mute or feebleminded?for some degree of economic independence: and those who are unlikely to achieve that are not accepted.
The remaining 120 defective children are provided for, by special “classes de perfectionnement ” or special classes attached to the schools. There are eight of these in Paris, each accommodating 14 to 16 children. This compares badly with London, which allows special training, I understand, for 1^2% of the total school population.
Of these classes I visited two: the one for boys and the other for girls. In each case the children seemed to be rather high grade types, and again I was struck by the comparatively greater emphasis placed on reading. Decroly methods were popular but otherwise there was nothing of note in the actual methods of teaching.
Mental hospital accommodation for certified defectives is available in two places: for girls in the ” Hospice de Bicetre,” for boys at the ” Asile de Vaucluse.” Of these, I had only time to visit the former.
Permission to visit was obtained at the “Service des Hopitaux,” 3 Avenue Victoria, near the Hotel de Ville.
The ” Hospice de Bicetre ” is an extremely large Poor Law Institution of which an isolated block known as the ” Fondation Vallee ” has been devoted to the institutional care of about 250 mentally defective girls. These were mainly of imbecile and idiot grade for whom obviously little could be done. As it had been raining, they were being allowed to romp in a large hall bare of furniture. The school rooms were not in use at the time; and were very neat and formal with pictures and diagrams, of which many seemed more suitable for brighter children. Older girls do housework under supervision.
The “Asile de Vaucluse ” has, I understand, accommodation for a similar number of boys of somewhat higher grade who are able to benefit from workshop and colony training.
At Vitry there is a rather large private institution for comparatively low grade cases, the ” Institut Medico-Pedagogique ” which is controlled by Dr. Paul Boncour. But despite two arduous journeys to the far suburbs of Paris, a telephone call and a letter of introduction, permission to visit was refused on various pretexts. I was presented, however, with a sumptuously illustrated prospectus.
The inadequacy of accommodation for mental defectives is obvious and generally realised and is presumably related to economic conditions. The training employed follows along lines advocated by French, Belgian and Swiss pedagogues, such as Claparede, Decroly, Descoeudres and others. The spear point of French psychiatry is the ” Hopital Psychiatrique Henri Rousselle.” Founded in 1921 by the ” Departement de la Seine “? which corresponds to our L.C.C.?its nearest analogue in this country is the Maudsley Hospital. From the beginning, however, it was organised as a ” Service de Prophylaxie Mentale and was placed under the direction of Dr Toulouse, who since 1900 has been the pontiff in matters of Mental Hygiene in France.
Deriving considerable impetus from the work of Clifford Beers and the American National Committee of Mental Hygiene, the organisation has naturally tended to place considerable emphasis on the social aspect of its work.
It embodies 1. A Dispensary. Several clinics are held daily: in general psychiatry; in special psychiatry, i.e., mental deficiency, epilepsy, pedagogic psychiatry, alcoholism, drug addictions, etc.; and finally in general medicine and surgery and in the specialities.
A Hospital Service of over 100 beds for uncertified cases.
3. A highly developed Social Service. With it is associated a dom- iciliary service which permits the sending of a visiting psychiatrist to the homes of cases which would otherwise be inaccessible or only accessible after certifica- tion. 4. Clinical and Research Laboratories, physiological, pathological and psychological.
A School of Mental Prophylaxis.
The latter is affiliated to the ” Ecole des Hautes Etudes,” and to the University of Paris. In this way it is hoped to integrate its work with that of advanced workers in allied fields. Propaganda work is undertaken by the League of Mental Hygiene which has its headquarters at the hospital and which issues a quarterly journal ” La Prophylaxie Mentale.” The total organism constitutes the ” Centre de Prophylaxie Mentale de la Seine.”
I was shown round the hospital by the indefatigable Secretary, Madame Lebas, who?incidentally?speaks fluent English: and I also interviewed Dr, Toulouse, the Director, and Dr Targowla, one of his assistants, The colour scheme in red, brown and orange tints had been specially designed to create a cheerful atmosphere. To British eyes accustomed to drab greys, these would not have been sufficiently sedative, but possibly for the Parisian they were more suitable.
From a perusal of French psychiatric literature one might well conclude that French psychiatry?like so many other branches of French culture and knowledge?tends to be obstinately national and reluctant to acknowledge or utilise foreign sources. Psychoanalytic theory?for example?in so far as it is of value at all, is considered to have been discovered in France and in any case to be somewhat vieux jeu : and so on. One is left generally with the im- pression that French psychiatry is delightfully lucid but lamentably limited.
At the Henri-Rousselle, at any rate, this view is not borne out. There is a more receptive atmosphere. Austro-German psychiatry is tolerated and even appreciated. Considerably more attention, however, is paid to the social applications of psychiatry as made by the Americans. At the same time the need for strict economy has imparted a distinctly French bias to methods largely American in origin and this is all to the good. One feels, however, that French psychiatry has not completely realised that the psychiatry of to- day?including that of America?is largely Austro-German in origin: with the possible exception of that based on Behaviorism, which is derivative from the work of a Russian physiologist. And that the Americans?with their superior opportunities for social experimentation?have excelled only in the social applications of principles originally European and largely Austro-German.
The example of the ” Departement de la Seine ” might well be copied by the London County Council and a London Centre of Mental Prophylaxis founded around the Maudsley Hospital to enhance and extend its already ex- tensive activities. And a rich philanthropist might do worse than endow a chair of ” Preventive Psychiatry ” in the University of London. The inclusion of this subject among those studied for the Diploma of Psychological Medicine would also be valuable. The benefit to the community were such steps taken would undoubtedly be great.
An example of an older school of psychotherapy is to be found in the clinic of Dr Berillon at 49 Rue Saint-Andre-des-Arts, near the Sorbonne. Here Dr Berillon, pupil of Dumontpallier and once contemporary with Charcot, has carried on for forty years the older French tradition of hypnosis. Small, of indefatigable energy despite his age, and bearing a remarkable resemblance to photographs of Freud, whom he detests, hypnotism is for Berillon not only the beginning but also the end of psychotherapy. It is used by him?shrewdly withal?for every minor mental ailment and such major ones as come his way.
Unfortunately, ” les grands hysteriques” of Charcot’s days are lacking and results so sensational are not to be seen. But with his own particular technique, consolidated by so many years of practice, Berillon is inimitable and well worth observing.
It is possible that modern psychiatry?under the fertilising influence of psychoanalytic and other schools?has reacted too strongly away from the suggestionists and hypnotists and may ultimately return part of the way. Certainly recent work by Schilder, Kauders and others seems to suggest that they are approaching Berillon’s technique from a somewhat different view- point and that hypnotism is entitled to a legitimate place in the psychological Pharmacopoeia.
The last visit was paid to the Charcot clinic of the ” Salpetriere ” where Professor Guillain brilliantly expounds neurology. A typical Burgundian? short, sturdy, with greying hair closely cropped?Guillain says little, but his eyes twinkle eternally.
The case of the day was discussed at length by the clinical clerk, die Professor made a brief examination and the discussion began. Unlike the members of an English class, each one who took up the thread, spoke eloquent- ly for several minutes, using all the tricks of the experienced public speaker. It struck one forcibly how little the average Frenchman needs to study public speaking. Whatever profession he adopts he just grows into it. All roads lead to eloquence and easy speech.
The case was one of hysterical astasia-abasia in a man of peasant type. After the examination he was withdrawn from the room and soon his shadow could be seen through the opaque glass partition separating the room from an outside corridor. With extremely energetic help he was seen to be walking up and down the corridor. The door was then opened and he staggered into the room to the amusement of the class.
A typically neurological mode of psychotherapy, no doubt, but perhaps the best with a patient of such mental calibre; and undoubtedly effectual. It is hoped that these few remarks may be of slight assistance to psychi- atrists visiting Paris, who are not averse to devoting a little of their time to ” shop ” and who wish to make the most of whatever time they can spare. I also hope these few personal impressions?which to my mind would be valueless if they were not frank and informal?will not be regarded as in the least unfriendly. With one exception only, I was treated with exceptional courtesy, despite my apparent youth, personal unimpressiveness and compar- ative unimportance, and made many friends.
I was considerably impressed and very happy in Paris. It is a city one can’t help loving even if perforce for a time one’s love must remain platonic. I look forward to the next opportunity of visiting and possibly studying less superficially French psychiatric methods and viewpoints.
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