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submission by the truth and justice collective for Nathalie


The United Nations Committee on the Rights of Persons with Disabilities has just put online the submissions of 112 individual and collective contributors on DESINTITUTIONALIZATION. https://www-ohchr-org.translate.goog/en/calls-for-input/2022/call-submissions-draft-guidelines-deinstitutionalization-including-emergencies?_x_tr_sl=en&_x_tr_tl=fr&_x_tr_hl=fr&_x_tr_pto=sc

These submissions visibly reflect the perception of this complex process on a planetary scale by actors who work, according to their means and postures, for the transformation of institutional logics and their paternalist and bureaucratic heaviness, which have become obsolete, and yet generate forms of violence that are passed off as "good practices", into emancipatory logics inscribed in the perspective of autonomy and self-determination.
The contribution of the collective, as modest as it may be, is inscribed in an epistemic framework, nourished by the contributions of experiences and updated research data, to legitimize a break with the psychiatricization of cognitive and mental functioning and of the dimensions of intelligence. As a process, the deinstitutionalization engages this conscientizing transformation in the way of the reappropriation of the cognitive identity of the stigmatized person of handicap and of his destiny in time and space. As a product, it constitutes the basis of deactivation of all the pathological attributions of psychiatric and sociological obedience, become interoperable and deployable in a systemic tragedy. In this perspective, An attempt to articulate deinstitutionalization to depsychiatrization, depathologization, deprofessionalization and deinstallation carried out in a conceptual and methodological caution constitutes the central core of this submission.







Title of the contribution





For a break with the psychiatricization of cognitive and mental functioning



It is true that the interpretation and evaluation of the concept of deinstitutionalization in France generate misunderstandings in the scientific psychiatric environment and in the management bodies of "representations of disability", which, through their disciplinary reductionism of biomedical obedience, emphasize deficiency rather than interactions. Its articulation to those of depsychiatrization, deprofessionalization and depathologization of cognitive and mental functioning would help to attenuate these misunderstandings by opening breaches to leave the managerial and institutional logics of invisibilization. As a transformative process, it is necessary to put an end to the confinement and expulsion to marginal spaces of people transiting through the psychiatric system and its failing and crisis-ridden aftermath of past "mental health" best practices. If we look closely, it turns out that they are generators of suffering, abuse, stigmatization and exploitation of people who are systematically broken into "diagnoses" and entrusted to "care and research programs" that play around with the processes, inscribed in the paradigm of research-innovation and "recovery", that depend on certain hospital structures such as the one in Marseille. These paternalistic programs hinder any individual and collective process of autonomy, self-consideration, self-determination and the right to be different and not a crumbling object. These are the main lines that emerge from the Draft Guidelines on deinstitutionalization, including in emergency situations1.


The non-subsidized collective contributes to the dissemination of declarative and procedural knowledge based on experiences, without personal and professional ambitions, inspired by the spirit of the principles of Human Rights, the UN CRPD2 and multiple experiences. It has provided support to families, women and individuals caught up in the endless escalation and irreversibility of deprivation of the right to life and freedom. In the same way, it supports people fleeing France to escape the psychiatric constraints amplified by systemic discrimination. Many are simultaneously victims of violent psychiatric practices in the name of "care" and forms of deprivation in the name of "protection". Human intelligence is a dynamic, multiple and complex quality that should not be entrusted exclusively to psychiatry and its technologies to "judge and confine" it. Its blossoming is nourished by human and ecological interactions and not by confinement and isolation. An effective accompaniment of the people under psychiatric constraints and their close relations held by the collective during periods of confinement related to the pandemic of the covid-19 oversized in the fear to lock up the humanity in anguishing uncertainties. "Isolate, stay home and distance yourself" are against the nature of humans as relationships with meaning. They have also affected people in institutions despite the April 01, 2020 joint statement of the CRPD Chairperson and the UN Special Envoy3.


Living experiences in the integral support of a close pulverized in 2014 by imposed psychiatric measures and medicated treatments and forced hospitalizations despite warnings at all levels of responsibility, are not yet obliterated by time. If we look closely, it turns out that the relations between the psychiatrist and his "patient" are impermeable, they unconsciously reflect a social and political tension that is grafted onto subjectivities inscribed in the constraints imposed by the institution. They are conditioned by the very relationship to the institution as a system of abstract norms, symptomatic of a given historical sequence of dominant ideas, to which the "patient" is invited by all coercive means to conform, including isolation, deprivation of liberty, of the family, and the legalization of torture practices, soft and hard. No matter how harmful the consequences on the patient's identity. They are "justified" without legal and moral basis and against even the reference values of care and protection.



Deinstitutionalization and cognitive dissonances


What characterizes the reflections and cognitive efforts deployed in fields such as "mental health" where the stakes are enormous, and which, because of their anthropological weight, must engage the whole of society and its institutional and non-institutional actors, is their profound and complex inscription in dichotomous logics: For and against, pro and anti, yes but no, etc. When an effort of overcoming or nevertheless of articulation is manifested or requested, it is experienced in nervousness and rhetoric, to land in situations of cognitive dissonances*, notably in the perfection of rationalizations of low-level contradictions, emerging as a form of implicit recognition of a denial or of a theorized impotence, highly presented as an exception that organizes these dichotomies by organizing themselves.


The case of the deinstitutionalization of the universe of disability in its different variants and dimensions, especially in the psychosocial universe, called in a stigmatizing language of "mental disability" is symptomatic of this dichotomy. See the case of the petition against deinstitutionalization of February 01, 201944.


It is obvious that the practices of the institutional actors are not devoid of forms of psychological, moral and physical violence ordered according to levels and sex: men and women, gender and origin... intimidations and threats are daily batches when people claim their basic rights, the right to be listened5 to and understood in their cries, their sufferings and in their personal identity. Forms of isolation and deprivation of the space-time of freedom: leaving the room, walking in the closed space...are immediately held as a common response. Consequences: running away as a solution to be free and taking the risk of exposing oneself to other forms of violence from society itself, especially for girls and women, wrongly accused of "dangerousness". "Similarly, French society has little awareness of the right of people with disabilities to live independently within it."6


However, these actors do not perceive their acts as violence and torture because they are automated and transformed into habits protected by the institution as a system of abstract norms, and any possibility of recognizing them is eclipsed in the ideology of the exception. To denounce them in the logic of law and even of the internal rules of the institution is automatically sanctioned, even punished. In order to clear themselves, these actors interpret them as "good practices and security measures".



Crisis of functioning and crisis of evaluation


It is necessary to note the existence of a complex crisis in the functioning of institutional logics in the field of the treatment of persons placed in psychiatric or "mental health" establishments, in conditions of degrading and humiliating constraints, without independent control in conformity with the logics of human rights and universal charters and conventions such as that of the CRPD, in spite of the recommendations and reports of the CGLPL7.

Initially, this crisis refers to another more problematic one, that of internal and external evaluation, due to the absence of objectives in these establishments and of goals in their functioning. These are the logics of control and stifling that prevail in the professional practices in psychiatry, which have gone from a serious situation to a catastrophe8.



Obstacles to deinstitutionalization


Deinstitutionalization is far from taking place in the collective mentalities used to heavy bureaucratic and hierarchical burdens of a paternalistic and ideological order, amplified by the Top-Down logic, systematically maintained in its violence of institutional interpretation in all the spheres of decision and places of power. The deinstitutionalization has to do with processes, with life, it is even the process that liberates and humanizes in the pursuit of the objectives displayed and stated by the convention: To conform to the model of crpd and human rights in the field of disability and its treatment.




It is the entry in an ecological paradigm in rupture with the one of the paternalistic medical doxa, generator of constraints and institutional violence9, fiercely defended in the name of care and security. It is the image of the institution and of the health professional that takes precedence, not the process, the subject, the person concerned and his or her future10.


Deinstitutionalization is a transformative cognitive revolution


Beyond the conceptual and disciplinary limits within which the concept of deinstitutionalization can be situated, it remains a source of interrogation as long as it is not understood and grasped as a complex process that goes beyond the play of centrifugal and centripetal forces that characterize and specify the functioning of institutional actors. Through these deployments in horizontal and vertical dimensions in the world of disability, especially the psychosocial one, it opens the way to a cognitive revolution11 that breaks with conceptions contaminated by preconditions inherited from a normative vision with institutional heaviness based on the criteria of power and paternalism and not on the criteria of right, equality and difference.


In order to give meaning to this cognitive revolution that places the person concerned at the heart of any approach and process in the world of psychosocial disability, it is important to invalidate all research in the field of "mental health" that uses people in situations of psychological fragility for personal and professional interests. A form of abuse and violence disguised in the postures of unbearable professional researchers. These researches with references to the ideology of innovation and social engineering are carrying major risks on the persons concerned and even to the idea of research, because they have deactivated the principle of precaution and prudence. They are uncontrolled practices hidden in existing services and networks that preach "good practices" without realizing that this necessarily involves rethinking the dogmas of the bio-medical paradigm, which has become the alpha and omega in the approach to the cognitive and mental processes of the people who cross the threshold of the psychiatric space, willingly or unwillingly, to see themselves assigned in many cases a forced designation without epistemological hygiene, of bearers of "neurodegenerative and neurocognitive disorders and others", however, they are only uncontrolled mental12 and cognitive activities, delivered to pathological interpretations of the dimensions of these activities which do not correspond to the psychiatric model, and we know since almost a century, that "the intelligence organizes the world by organizing itself "13.



Deinstitutionalization as deinstallation of the attributions of psychiatric identities


Deinstitutionalization as a cognitive revolution is part of a salvific horizon and has the objective of replacing the psychosocially handicapped persons under the control of the institutional psychiatric system in their true initial identity, purged of the attributions of pathological order of the system of cognitive parasite of the psychiatric practices organized around the "medical care", which by their amplification in time and space, become impassable obstacles by the effects of dependence and the destructive consequences on the physical, social and psychological identity of the patient The identity of the person concerned is not reduced to the language of psychiatry and its communication tools in diagnoses not based on the decontextualized subject. It is a multidimensional process shaped by complex interactions like every human identity.



Deinstitutionalization and reparation


Deinstitutionalization is necessary as a process with ecological and human dimensions to shake up, and even modify, the functioning of institutional logics and the way we look at disability in the name of protecting the vulnerable in society from changes with uncertain horizons and for the reparation of the damage inflicted on the victims and survivors of psychiatry14 and their loved ones, who have been strongly exposed in online testimonies and in complaints filed for voluntary/intentional homicide and abuse, which have been treated in blocks to be dismissed without any further action, in spite of the overwhelming chronological evidence15. Moreover, we know that one of the advantages of the facts of institutional abuse is that they help us to lift the veil by which the system hides and conceals its shadowed modes of oppression in stratagems of high institutional fabricality of the no-go zones, and of exclusion of the lights on the black boxes that the public power and its actors pretend to fight them elsewhere. It is an idea of justice and right to be conquered in conformity with the CRPD and the observations16 of its special reporters in their effectiveness, and also of opening towards a human society in solidarity in its similarities and differences, turned towards benevolent considerations of its members in situation of handicap whatever its degree and its nature, visible and invisible.




Key words






Basic references




1. Call for submissions: Draft Guidelines on Deinstitutionalization, including in emergencies Committee on the Rights of Persons with Disabilities. (2022). https://www-ohchr-org.translate.goog/en/calls-for-input/2022/call-submissions-draft-guidelines-deinstitutionalization-including-emergencies?_x_tr_sl=en&_x_tr_tl=fr&_x_tr_hl=fr&_x_tr_pto=sc



3. Joint Statement: Persons with Disabilities and COVID-19 by the Chair of the United Nations Committee on the Rights of Persons with Disabilities, on behalf of the Committee on the Rights of Persons with Disabilities and the Special Envoy of the United Nations Secretary-General on Disability and Accessibility. 01 April 2020. (Consulté 01/07/2022). https://www.ohchr.org/en/statements/2020/04/joint-statement-persons-disabilities-and-covid-19-chair-united-nations-committee


*. Festinger, L. (1957). A Theory of Cognitive Dissonance. Stanford, CA: Stanford University Press.


5. Alfred Vanessa. (1995). Écouter l'autre. Tant de choses à dire. Chronique Sociale.


6. Observations préliminaires de la Rapporteuse spéciale sur les droits des personnes handicapées, Mme Catalina Devandas-Aguilar au cours de sa visite en France, du 3 au 13 octobre 2017. (2017). (Consulté 01/07/2022).



7. Rapport de la Contrôleur Générale des Lieux de Privation de Liberté. (2016). Isolement et contention dans les établissements de santé mentale. (Consulté 03/07/2022). https://www.cglpl.fr/wp-content/uploads/2017/04/Rapport-2016-3es_web.pdf


Rapport de visite de la CGLPL (2020) : 6 au 17 janvier 2020 – Première visite Assistance publique-Hôpitaux de Marseille(Bouches-du-Rhône). (Consulté 03/07/2022). https://www.cglpl.fr/wp-content/uploads/2021/02/Rapport-de-visite-du-p%C3%B4le-de-psychiatrie-de-lassistance-publique-des-h%C3%B4pitaux-de-Marseille-Bouches-du-Rh%C3%B4ne.pdf


Rapport de visite de la CGLPL du centre hospitalier Montperrin à Aix-en-Provence (Bouches-du-Rhône). (2019). (Consulté 03/07/2022). https://www.cglpl.fr/2020/rapport-de-visite-du-centre-hospitalier-montperrin-a-aix-en-provence-bouches-du-rhone/


9. Tomkiewvicz, S. (1999). L'adolescence volée. Kalmann-Levy.


10.Gilly, M. (1980). Maître-élève : rôles institutionnels et représentations . PUF.


11. Gardner, H. (1993). Histoire de la révolution cognitive. La nouvelle science de l’esprit. Payot.


12. Richard, J.F. (1990). Les activités mentales Comprendre, raisonner, trouver des solutions. Armand Colin.


13. Piaget, J. (1937). La construction du réel chez l'enfant. Paris, Delachaux et Niestlé.


14. Tina Minkowitz. Center for the Human Rights of Users and Survivors of Psychiatry. http://www.chrusp.org/home/about_us


15. M'hamed EL Yagoubi. (2015). (Consulté 02/07/2022). Aix-en-Provence. Chronologie d'une maltraitance psychiatrique et socio-judiciare .


16. Comité des droits des personnes handicapées. Observations finales concernant le rapport initial de la France. (2021). (Consulté 03/07/2022).



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