“French psychiatry has deteriorated partly because of American influence”

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As the French government launches a new mental health campaign that includes reimbursing the cost of therapy sessions, psychiatric professionals are scrutinizing a sector they say has gone from “pioneering and innovative” to wavering – and that the American hegemony is partly responsible for the French decline.

“The state of French psychiatry is catastrophic,” says Marie-José Durieux, a child psychiatrist in a Parisian hospital, bluntly. It’s a diagnosis shared by many others in his profession, and one of the reasons why the French government organized a two-day conference on mental health and psychiatry this week with industry professionals (the Assizes of mental health and psychiatry) in an effort to rejuvenate a failing branch of the French medical establishment.

“Barely 30 years ago, psychiatry was practiced with great interest and enthusiasm,” says Durieux. “We combined psychiatry with imaginative sciences like philosophy, psychoanalysis, sociology and literature, and pushed the field further.”

Then the use of drugs was introduced into the sector. “They brought with them undeniable progress, but drugs alone are not enough to solve existential problems,” she says.

“In the 1980s, American ways of thinking and treating were adopted in France. French psychiatry, world-renowned, innovative and pioneering, gradually began to decline under American influence.

At the heart of this showdown between French and American practices is the bible of the profession: the “Diagnostic and Statistical Manual of Mental Disorders” or DSM. This manual, compiled by the American Psychiatric Association, lists psychiatric disorders, diagnoses and statistics, and began to be used in France in the 1980s. “Over time, the standards described in this book have taken on the not on what was previously the norm in French psychiatry”, explains Durieux.

The reference manual – used in the United States by doctors, researchers and governing bodies as well as insurance companies and pharmaceutical companies – is regularly updated with new data. But its latest update in 2013 caught the attention of French mental health professionals, many of whom believe the handbook’s classification systems – while extensive – don’t leave enough room for subjectivity in a diagnosis.

Many also believe the manual is increasingly pushing professionals to resort to drugs and is brainwashing early career psychiatrists. “Human beings are born with a search for meaning that cannot be suppressed by an injection of antipsychotics or a few antidepressants,” says Durieux.

But the authoritarian approach to medication is not just an American phenomenon: French doctors are known to prescribe freely. France has the highest rate consumption of antibiotics per capita in Europe. A recent study showed that French doctors were prescribing too many drugs to children, with half of children under 2 taking more than nine drugs a year. Regarding the prescription of drugs for psychiatric disorders, a 2014 study showed that one in three people in France took psychotropic drugs, including antidepressants. Indeed, France regularly ranks among the world’s leading consumers of antidepressants.

An aging profession, neglected by young workers

So are American diagnoses to blame? Durieux says French health authorities are also responsible for the decline of this sector.

“Decades ago, we started removing patients with mental health issues from hospital wards. It was a great thing because they shouldn’t all have been there. Today, specialized psychiatric services have gradually disappeared from hospitals, but they have not been replaced by outpatient services or follow-up care,” says Durieux.

The French public authorities have repeatedly reduced funding for the psychiatric sector. As a result, tight budgets have resulted in lower salaries and key positions remaining vacant. When the country’s last round of young doctors chose their specializations, 71 psychiatrist positions went unfilled. Durieux says even those in the psychiatric profession itself are to blame as there is a lack of energy and innovation in the sector. “The average age of psychiatrists is quite high, and many of them will soon be retiring. In just 40 years, the profession has lost 40% of its workforce,” explains Durieux.

These problems are clearly visible in health centers across the country. Patients face a one-year waiting period before an initial consultation at a psychological health center. This trend is even more apparent in rural regions of France or in densely populated areas such as the Paris suburbs, where there are simply not enough qualified health personnel to meet the growing demand. According to the latest data according to an ongoing government survey on mental health during the Covid-19 pandemic, 15% of French people show signs of depression (a five-point increase from before the pandemic), 23% show signs of anxiety and 10% had thoughts in the past year (double pre-pandemic levels).

While it is promising that the French are increasingly turning to psychologists and psychiatrists for help when struggling with mental health issues, we must be serious about providing the necessary funding to the sector, says Durieux.

This is exactly what the government is trying to do. French President Emmanuel Macron announced a series of measures to boost the struggling sector, including reimbursing the costs of consulting psychologists, creating 800 jobs in psychological health centers, and additional funding and support to the research. But unions have hit back, saying these measures are not only insufficient, but threaten the independence of the sector.

One aspect of the new measures has particularly irritated psychologists: patients must be referred by their general practitioner to benefit from reimbursed consultations with a psychologist.

“It’s scandalous. It’s a total disregard for our profession and for the population,” laments Patrick-Ange Raoult, the secretary general of the National Union of Psychologists (SNP).

Christine Manuel, also from the SNP, told French news agency AFP that the reforms were decided without consulting health professionals. “We would like to be involved and we are not. They decide everything without our contribution, with the doctors.

The French Hospital Federation responded more positively to the announcements. In one Press releasehe said the reform was “essential to end the historic underfunding” of public psychiatry.

“These measures are a step in the right direction,” says Durieux. “But Macron alone cannot fix the industry. Health professionals must also take a new interest in psychiatry and breathe new life into the sector so that France can once again excel.

This article has been adapted from the original in French.

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