Anne M. Lovell

La violence envers les personnes atteintes de troubles mentaux : revue de la littérature et des notions connexes

BACKGROUNDnPeople with severe mental disorders tend to be seen as authors rather than as victims of violence, while mental illness is associated with violence and danger. French policy focuses on individuals with mental illness as authors of violence, to the detriment of evidence-based public health regarding such individuals when they are victims.nnnMETHODSnThis article reviews knowledge concerning violence towards people with severe psychiatric disorders, clarifies what is meant by violence and raises the question of the need for local and national studies. The first part compares definitions and operationalisation of main variables, sampling, methods and results of studies published since 1990 on violence towards adults with severe psychiatric disorders. The second part draws on qualitative studies to clarify conceptual problems that arose in the review.nnnRESULTSnRates of victimisation for individuals with severe psychiatric disorders are shown to be high and far greater than those for the general population, despite the heterogeneity of studies in terms of sample characteristics, measures, methods and analyses. Certain types of factors - clinical, treatment, contextual - raise the probability of becoming a victim, as does the fact of having already been the author or the victim of a misdemeanour or crime. However, the cross-sectional designs used in these studies and the frequency of traumatic antecedents among psychiatric patients make it difficult to know whether violence precedes mental illness or vice-versa.nnnCONCLUSIONnThe relationship between life conditions and victimisation among people with severe psychiatric disorders points to areas in which public health can already intervene. But geographical variation in results may require more local and national studies. The relationship between author and victim and between violence, discrimination and stigma requires more research.

Commentary on “The Need for Patient-Subjective Data in the DSM and the ICD”

Anne M. Lovell, PhD, is a member of the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioral Disorders. The views expressed in this commentary are her own and do not represent the views or policies of the World Health Organization or the Advisory Group. Address correspondence to Anne M. Lovell, Ph.D., CERMES 3 x96 Equipe CESAMES, INSERM 988, Universite de Paris Descartes, 45 rue des Saints-Peres, 75270 Paris Cedex 06, France. E-mail : anne.lovell@univ-paris5.fr. How can patient-subjective data improve clinical utility? Lovell

Psychiatry with Teeth: Notes on Coercion and Control in France and the United States

‘‘Psychiatry with teeth’’: with just three words, a head psychiatrist in Lyon, France, captures the confined spaces and internal discipline of a new type of intensive treatment center for ‘‘difficult patients’’ (Velpry and Eyraud 2014). His pithy phrase provides a vivid yet disconcerting image for the ‘rough edge’ of psychiatry where, as the editors of this issue of Culture, Medicine, and Psychiatry devoted to emergent forms of care and control remind us, constraint and coercion signal a fundamental division between patients and clinicians (Velpry and Brodwin 2014). At the level of institutions and the state, it is through constraint that the larger social ‘‘will’’ (to power, to social order) shows its teeth. We can understand ‘‘teeth’’ at the material level as the community supervision, restraints, locked units, quiet rooms, involuntary hospitalizations, and (in some cases) medications through which the will of clinicians and the power of institutions are enacted upon the bodies of psychiatrically defined individuals. Each of these papers offers a close reading of some aspect of this enactment at the local level. In the relationships constitutive of psychiatric practice, constraint and coercion mark the sites of greatest conflict between patient, clinician, and institution—the places where teeth are most likely to be bared in disputes over the moral status of the patient and the legitimacy of the institution. ‘Teething pains’ afflict those involved in this dynamic, pains of growth as individual clinicians learn to accept constraint as a necessary aspect of their work.

Les enjeux de la révision

ipe.2011.0753 Auteur(s) : Jean-Luc Roelandt, Pierre-Henri Castel, Anne Lovell, Patrice Desmons, Brigitte Chamak, Vincent Garcin, Massimo Marsili, Nicolas Daumerie, Nicolas Henckes La 11e version de la Classification internationale des maladies de l’OMS (CIM-10) est en cours d’elaboration au niveau international. Elle a demarre en mars 2007 et la conclusion des travaux est prevue pour 2012. Elle concerne bien evidemment aussi le chapitre V de cette classification traitant des troubles mentaux [...]