La psychiatrie strasbourgeoise à l’heure allemande (1871-1918) : un précédent de l’hygiène mentale française ?

De 1871 jusqu’à la fin de la Première Guerre mondiale, l’Alsace-Lorraine fut intégrée à l’Empire Allemand. Pendant l’annexion, la loi française du 30 juin 1838 (loi dite « sur les aliénés ») resta en vigueur. Mais, conçue pour les grands asiles départementaux, la loi fut progressivement adaptée aux exigences de la jeune psychiatrie académique allemande. Par rapport à l’administration française, l’assistance psychiatrique de la région fut plus différenciée et capable d’étendre son périmètre d’intervention à d’autres catégories de malades. En particulier, le « service ouvert » de la clinique psychiatrique de Strasbourg et sa policlinique, très fréquentée, accueillaient des patients ne relevant pas de la loi de 1838. Nous nous proposons alors une analyse du système de soins psychiatriques établi sous l’administration allemande sous la forme d’une anticipation (ignorée) de la réforme réclamée en France entre la Première et la Seconde Guerre mondiale par les promoteurs de l’hygiène mentale.Von 1871 bis zum Ende des ersten Weltkrieges gehörte das Reichsland Elsass-Lothringen zum Deutschen Kaiserreich. Während dieser Zeit blieb das 1838 eingeführte französische Gesetz für Geisteskranke in Kraft. Das Gesetz, das auf große Irrenanstalten zugeschnitten war, wurde zunehmend an die Bedürfnisse der jungen deutschen Universitätspsychiatrie angepasst. Unter deutscher Verwaltung (und im Vergleich zu Frankreich) war die psychiatrische Versorgung in der Region ausdifferenzierter und weitgreifender. Die „offene Abteilung“ der Straßburger Universitätsklinik und ihre gut besuchte Poliklinik nahmen Patienten auf, die nicht in die Kategorie der „aliénés “fielen. Das psychiatrische Versorgungsystem, das sich dadurch in der Region entwickelte, nahm, so die These hier, in beträchtlichem Masse die Reform vorweg, die zwischen dem ersten und dem zweiten Weltkrieg in Frankreich diskutiert und zum Teil realisiert wurde.Between 1871 and the end of World War I, Alsace-Lorraine was part of the German Empire. During this period of assimilation, relevant bits of the pre-existing French legislation, most notably the 1838 “loi des alienées” (“law of the insane”), remained in force. The law, designed for large departmental asylums, was gradually adapted to the requirements of the young German academic psychiatry. Compared to the (prior) French administration, the psychiatric care of the region was more articulated, reaching a wider range of patients. The “open ward” of the newly-founded university clinic of Strasbourg and its well-attended policlinic accommodated patients not belonging to the category of “aliénés”. The present article proposes to read the resulting psychiatric care system as an (ignored) precursor of the French “mental hygiene” reform between the World Wars

The role of the woman in Daseinsanalyse by Ludwig Binswanger

Il seguente articolo si propone di analizzare il ruolo della donna negli studi condotti da Ludwig Binswanger. In particolare si cercherà di far luce sui motivi che spinsero lo psichiatra svizzero a preferire soggetti femminili per le sue ricerche sulla schizofrenia. Binswanger infatti, negli studi condotti sulla schizofrenia, mostra una netta preferenza per i casi clinici femminili, nonostante la patologia dimostri di non avere una maggiore incidenza nelle donne rispetto agli uomini. Come si cercherà di mostrare, la schizofrenia a differenza dell’isteria, non è correlata al ruolo subalterno della donna nella società primonovecentesca. La scelta di soggetti femminili non è dunque dettata da motivazioni cliniche, ma piuttosto dalla tendenza della comunità scientifica a considerare la donna un soggetto naturalmente più adatto a illustrare certe patologie.The following article aims to analyze the role of women in the studies conducted by Ludwig Binswanger. In particular, we will try to shed light on the reasons that led the Swiss psychiatrist to prefer female subjects for his research on schizophrenia. In fact, Binswanger, in the studies conducted on schizophrenia, shows a clear preference for female clinical cases, despite the disease proving not to have a greater incidence in women than in men. As we will try to show, schizophrenia, unlike hysteria, is not related to the subordinate role of women in early twentieth-century society. The choice of female subjects is therefore not dictated by clinical reasons, but rather by the tendency of the scientific community to consider women a naturally more suitable subject to illustrate certain pathologies

The General Public and Young Adults’ Knowledge and Perception of Palliative Care: A Systematic Review

Background: As a result of demographic change, chronic and oncological diseases are gaining importance in the context of public health. Palliative care plays a crucial role in maintaining the quality of life of those affected. International guidelines demand access to palliative care not only for the elderly but also for younger people who face severe illnesses. It can be assumed that palliative care will become increasingly important for them. In order to develop public health strategies which are able to promote palliative care, it is important to assess the knowledge of, and attitude towards, palliative care as found among members of the general public and its specific target groups. In particular, little is known about young adults’ knowledge and perceptions of palliative care. Objectives and design: This work aimed to assess the understanding and viewpoints regarding palliative care among the general population and among young adults aged 18 to 24. We therefore conducted a systematic review, which, for this target population, could be seen as a novel approach. Methods: Exclusion and inclusion criteria were developed using the PICOS process. Literature was researched within MEDLINE (via PubMed), Google Scholar and Web of Science. A search string was developed and refined for all three databases. Grey literature was included. Duplicates were excluded using Mendeley. The literature was independently screened by two researchers. Narrative synthesis was used to answer the main research question. Results: For the general public, palliative care is still associated with death and dying and comforting sick people towards the end of their lives. Multiple social determinants are linked to better knowledge of palliative care: higher education, higher income, female gender, having relatives that received palliative care, and permanent employment. The population’s knowledge of palliative care structures increases, the longer such structures have been established within a country. Young adults are familiar with the term palliative care, yet their understanding lacks nuance. They associate palliative care with death and dying and perceive palliative care to be a medical discipline primarily for the elderly. Nevertheless, young adults demand participation within the planning of interventions to destigmatize palliative care. Conclusions: The general public still lacks a detailed understanding of palliative care. Palliative care faces stigma at multiple levels, which creates barriers for those who set out to implement it. However, addressing young adults as a crucial peer group can help break down barriers and promote access to palliative care

Treatment Decision-Making Capacity in Forensic vs Non-forensic Psychiatric Patients: A European Comparison

Background: Consent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms. Study Design: In this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores. Study Results: In total, 55 forensic (34.4%) and 58 non-forensic patients (41.7%) showed high treatment-related decisional capacity, defned as scoring ≥75% of the maximum scores for the understanding, appreciation and reasoning, and 2 for expressing a choice. Forensic patients showed differences in their capacity to consent to treatment across countries. Of all socio-demographic and clinical variables, only “social support” was directly relevant to policy. Conclusions: Forensic patients have treatmentrelated decisional capacities comparable with their non-forensic counterparts. Social contacts might provide a substantial contribution towards enhancing the decisional autonomy of both forensic and non-forensic patients, hence improving the overall quality and legitimacy of mental health care