1 00:00:00,720 --> 00:00:04,400 IN THE DEPOT NEUROLEPTIC SERIES 2 00:00:04,560 --> 00:00:08,160 FLUPHENAZINE ENANTHATE AND DECANOATE 3 00:00:08,360 --> 00:00:10,360 SQUIBB PRESENTS 4 00:00:15,960 --> 00:00:21,000 PSYCHOTICS IN THE CITY 5 00:00:29,720 --> 00:00:33,240 A COLLABORATION BETWEEN MENTAL HEALTH AND COMMUNITY 6 00:00:33,400 --> 00:00:36,240 (BRON, VILLEURBANNE, MEYZIE & VAULX-EN-VELIN) 7 00:00:36,400 --> 00:00:39,400 AND PROF. GUYOTAT'S UNIVERSITY HOSPITAL DEPARTMENT 8 00:00:39,560 --> 00:00:41,000 VINATIER HOSPITAL (LYON) 9 00:00:41,240 --> 00:00:44,640 WITH THE COLLABORATION OF A PSYCHIATRIST, A GP, 10 00:00:44,800 --> 00:00:47,640 PSYCHOLOGISTS, SOCIAL WORKERS AND NURSES 11 00:00:57,560 --> 00:01:02,520 IMAGES: R. GOSSET SOUND: J. COURTINAT 12 00:01:03,320 --> 00:01:07,440 EDITING: A. LUZUY 13 00:01:07,640 --> 00:01:12,720 DIRECTOR: ERIC DUVIVIER 14 00:01:12,920 --> 00:01:17,920 PRODUCTION COMPANY: SCIENCEFILM 15 00:01:41,680 --> 00:00:00,000 16 00:02:24,360 --> 00:02:27,600 The dangerous ones need to be locked up, 17 00:02:27,760 --> 00:02:29,360 while still being treated. 18 00:02:30,240 --> 00:02:34,160 The dangerous ones, they often perpetrate acts... 19 00:02:34,320 --> 00:02:36,640 They commit crimes and other things. 20 00:02:36,800 --> 00:02:39,880 If you set them free, they'll go at it again. 21 00:02:40,360 --> 00:02:42,000 And if they have families... 22 00:02:42,560 --> 00:02:45,240 The mentally ill can't be cured, Sir. 23 00:02:45,400 --> 00:02:48,800 Because... It depends on their illness, you know? 24 00:02:49,240 --> 00:02:50,400 So... 25 00:02:50,560 --> 00:02:53,680 They stay ill. You can't cure them, whatever you do. 26 00:02:53,960 --> 00:02:57,080 If they're incurable, why would you let them out? 27 00:02:57,240 --> 00:02:58,840 They might... 28 00:02:59,600 --> 00:03:01,440 It could frighten people. 29 00:03:01,600 --> 00:03:05,080 They could meet children if they walk down the street. 30 00:03:05,240 --> 00:03:06,240 It's dangerous. 31 00:03:06,440 --> 00:03:09,640 I think... I'm not a doctor, right? 32 00:03:09,800 --> 00:03:12,960 Some cases... I've seen a few in the neighbourhood, 33 00:03:13,120 --> 00:03:16,400 we're close to Vinatier here, going out for a walk. 34 00:03:16,560 --> 00:03:20,640 There was this gentleman. They said he was from Vinatier. 35 00:03:20,800 --> 00:03:23,480 He looked OK, just walking down the street. 36 00:03:23,640 --> 00:03:25,640 His behaviour was a bit weird. 37 00:03:25,800 --> 00:03:26,760 But, 38 00:03:27,600 --> 00:03:29,200 he had a right to be here. 39 00:03:29,760 --> 00:03:33,560 I'm sure some of them could live at home. 40 00:03:33,840 --> 00:03:36,680 In their families, they recover better. 41 00:03:37,680 --> 00:03:38,640 I think so. 42 00:03:39,040 --> 00:03:41,640 By all means, if they are minor cases, 43 00:03:41,800 --> 00:03:47,160 sending them back to their families would help them recover faster. 44 00:03:47,720 --> 00:03:51,520 But if they're very ill, they should stay in hospital. 45 00:03:51,720 --> 00:03:54,120 If the doctors think it's useful, 46 00:03:54,280 --> 00:03:56,520 I think it's very useful too. 47 00:03:56,680 --> 00:04:02,600 Precautions need to be taken though, to keep dangerous ones away. 48 00:04:02,760 --> 00:04:04,840 I trust them. They must do that. 49 00:04:05,120 --> 00:04:07,760 Maybe it's the best solution to... 50 00:04:08,840 --> 00:04:10,560 At least for some of them. 51 00:04:11,520 --> 00:04:13,720 To allow them a more normal life. 52 00:04:14,120 --> 00:04:16,480 Ultimately, they're locked-up... 53 00:04:16,640 --> 00:04:20,920 They're difficult to cure if they don't lead normal lives. 54 00:04:21,400 --> 00:04:25,360 I'm half for, half against it. There are pros and cons. 55 00:04:25,520 --> 00:04:29,480 You need to realise that it can be a lot for the family. 56 00:04:31,440 --> 00:04:34,520 I know some cases... 57 00:04:35,000 --> 00:04:39,080 In the family, it's... It's no picnic for the family. 58 00:04:39,320 --> 00:04:43,280 I don't know. There's little hope for rehabilitation. 59 00:04:43,440 --> 00:04:46,200 You can't put them back in normal life. 60 00:04:46,720 --> 00:04:49,440 It's dangerous because they're never cured. 61 00:04:50,040 --> 00:04:52,720 - I can't say. - You don't have any opinion? 62 00:04:53,720 --> 00:04:55,160 - No. - About the... 63 00:04:55,560 --> 00:04:56,800 The mentally ill. 64 00:04:57,040 --> 00:04:58,720 No. No opinion. 65 00:04:59,440 --> 00:05:01,600 - What do you think? - Well... 66 00:05:02,680 --> 00:05:03,880 What do you think? 67 00:05:04,040 --> 00:05:07,760 Let me tell you, there are more lunatics outside than inside. 68 00:05:08,440 --> 00:05:09,240 Say what? 69 00:05:09,840 --> 00:05:13,240 There are more sick people out here than up there. 70 00:05:13,400 --> 00:05:15,720 Yes, I was going to say it myself. 71 00:05:16,200 --> 00:05:17,320 I wanted to say it. 72 00:05:17,480 --> 00:05:21,040 I've noticed that... Many things I've noticed... 73 00:05:21,400 --> 00:05:23,120 In hospitals, 74 00:05:23,480 --> 00:05:25,720 the sick aren't nursed properly. 75 00:05:26,880 --> 00:05:28,360 I'm telling you. 76 00:05:29,240 --> 00:05:31,600 We have many victims in France, 77 00:05:32,320 --> 00:05:34,000 'coz they lack... 78 00:05:35,040 --> 00:05:37,600 For the sick, they lack staff, etc. 79 00:05:37,760 --> 00:05:41,000 Efforts should be made. Lots of them. 80 00:05:41,760 --> 00:05:45,800 I'll even tell you my name: Mr Soldini, 22 Ravanel Street. 81 00:05:45,960 --> 00:05:48,200 'Coz I've just lost my wife. 82 00:05:49,080 --> 00:05:51,360 At Vinatier, they treat them well. 83 00:05:53,080 --> 00:05:54,680 And a lot of sick people 84 00:05:55,560 --> 00:05:57,920 are better than those on the outside. 85 00:05:58,080 --> 00:06:00,760 Some are really... They don't let them out. 86 00:06:00,920 --> 00:06:03,000 They don't let them go out at all. 87 00:06:03,160 --> 00:06:06,040 Some sick people, some I know... 88 00:06:06,560 --> 00:06:10,280 Their thoughts are better than those of people outside. 89 00:06:10,640 --> 00:06:12,760 But they're sick, sometimes they... 90 00:06:13,200 --> 00:06:15,680 Some of them... How can I say it? 91 00:06:15,920 --> 00:06:17,520 Some have no relatives. 92 00:06:17,680 --> 00:06:20,040 - There's no responsibility. - No family. 93 00:06:20,200 --> 00:06:24,440 So they're put in there. It's like a death sentence. 94 00:06:25,400 --> 00:06:30,200 If it's interesting for them, it's good, but it shouldn't become... 95 00:06:31,320 --> 00:06:35,640 Don't let it become dangerous for the neighbourhood. 96 00:06:36,760 --> 00:06:37,760 Because 97 00:06:38,800 --> 00:06:40,240 lunatics can be a danger. 98 00:06:40,400 --> 00:06:44,880 If it cured them, it could be interesting. 99 00:06:45,040 --> 00:06:46,800 What a fine mess! 100 00:06:47,720 --> 00:06:50,280 For the minor cases, maybe. 101 00:06:52,720 --> 00:06:54,360 There are dangers. 102 00:06:54,800 --> 00:06:56,200 Don't you think? 103 00:06:58,200 --> 00:07:01,040 And they'd spread out all over the place? 104 00:07:01,200 --> 00:07:04,960 They were institutionalised for a reason, weren't they? 105 00:07:05,120 --> 00:07:08,440 Depressed people, that's one thing but lunatics, really. 106 00:07:12,840 --> 00:07:14,120 What a strange idea! 107 00:07:15,720 --> 00:07:16,960 I haven't heard of it. 108 00:07:17,160 --> 00:07:22,680 Put them in a special village or a secluded area, maybe, 109 00:07:22,840 --> 00:07:27,560 and let them be with people devoted to them, 110 00:07:27,720 --> 00:07:29,400 to get them back on their feet. 111 00:07:29,560 --> 00:07:33,880 But don't let them go around town with just anyone... 112 00:07:34,480 --> 00:07:40,480 POLICE STATION 113 00:07:43,160 --> 00:07:47,760 As police superintendent and for all police officers, 114 00:07:47,920 --> 00:07:52,720 the mentally ill fall within our duties 115 00:07:53,240 --> 00:07:57,200 of public safety and peace. 116 00:07:57,760 --> 00:08:02,000 In Villeurbanne, we are very lucky to have 117 00:08:02,160 --> 00:08:06,320 the Mental Health and Community association. 118 00:08:06,480 --> 00:08:10,600 It brings together doctors, 119 00:08:10,760 --> 00:08:13,360 town councillors, families, 120 00:08:13,520 --> 00:08:17,160 and police officers who wish to partake. 121 00:08:17,320 --> 00:08:18,120 I'm a member. 122 00:08:18,280 --> 00:08:23,560 So are my colleagues from Bron and Villeurbanne. 123 00:08:23,720 --> 00:08:26,080 Some of us are even on the board. 124 00:08:26,280 --> 00:08:32,080 That's how, in regard to the mentally ill, 125 00:08:32,240 --> 00:08:35,640 we can implement 126 00:08:35,800 --> 00:08:41,200 a more nuanced and sometimes more efficient policy. 127 00:08:41,360 --> 00:08:45,640 I don't think institutionalizing them is always necessary. 128 00:08:45,880 --> 00:08:49,960 I've repeatedly called upon the doctor 129 00:08:50,120 --> 00:08:53,040 from the outpatient unit, from the association, 130 00:08:53,200 --> 00:08:57,200 thinking I needed to commit someone. 131 00:08:57,360 --> 00:09:00,600 After examination, the doctor convinced me 132 00:09:00,760 --> 00:09:03,160 that the fit was only temporary, 133 00:09:03,320 --> 00:09:05,720 and that committing them was unnecessary. 134 00:09:05,920 --> 00:09:08,880 TOWN HALL 135 00:09:09,080 --> 00:09:12,960 As the president of the association Mental Health and Community, 136 00:09:13,120 --> 00:09:17,480 I'd like this collaboration to develop 137 00:09:17,640 --> 00:09:21,120 with the population via social centres. 138 00:09:26,640 --> 00:09:30,920 - What's a psychotic person for a GP? - It can be 2 things. 139 00:09:31,080 --> 00:09:35,160 Either an emergency or a psychotic with his family. 140 00:09:35,320 --> 00:09:38,920 The emergency is often an embarrassing one, 141 00:09:39,080 --> 00:09:42,400 a psychotic person we may or may not have been aware of, 142 00:09:42,560 --> 00:09:46,720 and for whom we are called at any time of day and night. 143 00:09:46,880 --> 00:09:49,880 And we struggle to bring them under control 144 00:09:50,040 --> 00:09:52,360 and to have them admitted to hospital. 145 00:09:52,520 --> 00:09:56,960 It's always a tedious situation, 146 00:09:57,120 --> 00:10:01,160 because we need to restrain them, 147 00:10:01,320 --> 00:10:04,040 we need to... 148 00:10:04,200 --> 00:10:09,240 It reminds you of prison a little, of an obligation. 149 00:10:09,400 --> 00:10:12,000 It's unpleasant, 150 00:10:12,160 --> 00:10:14,360 because even for the family, 151 00:10:14,520 --> 00:10:19,040 it makes us look like policemen 152 00:10:19,200 --> 00:10:20,920 coming to lock people up. 153 00:10:21,160 --> 00:10:24,360 There's another, more interesting side to this though, 154 00:10:24,520 --> 00:10:29,800 with issues that are a lot more... A lot less acute. 155 00:10:29,960 --> 00:10:32,600 This is the psychotic person with his family, 156 00:10:32,760 --> 00:10:36,840 who may or may not fit into the family. 157 00:10:37,000 --> 00:10:38,440 I know families 158 00:10:38,600 --> 00:10:41,800 who can tolerate a psychotic family member, 159 00:10:42,560 --> 00:10:45,760 not all the time though. 160 00:10:45,920 --> 00:10:51,720 There are periods of time when he isn't well regarded. 161 00:10:51,880 --> 00:10:54,880 And some families just can't bear him, 162 00:10:55,040 --> 00:10:57,480 even if he comes home only for the weekend. 163 00:10:58,040 --> 00:11:01,160 For a psychiatrist, a psychotic's condition 164 00:11:01,320 --> 00:11:04,960 can be sketched in a simplified way as follows. 165 00:11:05,120 --> 00:11:08,640 I'm representing 166 00:11:09,520 --> 00:11:12,720 the environment here, the surroundings, the community. 167 00:11:12,880 --> 00:11:16,080 Here's the individual. 168 00:11:16,640 --> 00:11:20,280 For a psychotic, the boundary I've drawn here 169 00:11:20,440 --> 00:11:24,240 is blurred and of very unsound constitution. 170 00:11:24,720 --> 00:11:27,040 You could say that for him, 171 00:11:27,200 --> 00:11:29,600 the boundary separating us from the world 172 00:11:29,760 --> 00:11:31,280 has holes in it. 173 00:11:31,440 --> 00:11:33,520 His psyche resembles a sieve. 174 00:11:33,800 --> 00:11:35,280 As a result, 175 00:11:35,440 --> 00:11:39,440 each input from the environment feels like an intrusion to him. 176 00:11:39,600 --> 00:11:44,280 Hence, a notion of being persecuted, of his own body being tempered with. 177 00:11:44,440 --> 00:11:47,200 At the same time, what's inside him 178 00:11:47,800 --> 00:11:51,280 feels like it's pouring out. 179 00:11:51,440 --> 00:11:55,840 Hence the feeling of becoming empty, of suffering losses, 180 00:11:56,280 --> 00:12:00,760 and the vague impression of hemorrhaging out. 181 00:12:01,320 --> 00:12:06,480 So that's our psychotic person in his environment. 182 00:12:07,040 --> 00:12:11,400 What's the origin of this psychosis-environment system? 183 00:12:11,560 --> 00:12:15,320 There is a general consensus that there's a huge problem 184 00:12:15,480 --> 00:12:19,120 between the psychotic and his mother, the mothering figure rather. 185 00:12:19,280 --> 00:12:21,480 What matters is how he views her. 186 00:12:21,640 --> 00:12:24,920 I'm going to draw our patient here. 187 00:12:26,360 --> 00:12:28,720 This is the mother. 188 00:12:30,240 --> 00:12:33,600 You could say that the patient 189 00:12:33,760 --> 00:12:37,240 has an extreme desire of fusion with his mother, 190 00:12:37,400 --> 00:12:39,560 a desire to go back into her womb. 191 00:12:39,720 --> 00:12:44,040 However, this desire feels utterly dangerous to him, 192 00:12:44,480 --> 00:12:47,240 hence the feeling that the mother is dangerous, 193 00:12:47,400 --> 00:12:49,080 that she's a persecutor. 194 00:12:49,320 --> 00:12:52,520 Then he transfers this feeling to his environment. 195 00:12:53,480 --> 00:12:57,040 There are several explanations for this system. 196 00:12:57,200 --> 00:13:01,440 There can be biological causes. 197 00:13:01,720 --> 00:13:07,320 Thus the effect of treatment with neuroleptics, for example. 198 00:13:07,480 --> 00:13:12,280 Apart from potentially faulty biological equipment, 199 00:13:12,720 --> 00:13:16,200 there's the issue of the mother's attitude, 200 00:13:17,760 --> 00:13:20,920 which may feed into the psychotic's anxiety. 201 00:13:21,080 --> 00:13:25,280 Indeed, the mother appears as an almighty, dangerous character, 202 00:13:25,440 --> 00:13:28,440 with the children and father around her, 203 00:13:29,000 --> 00:13:33,440 maybe the doctors, the GP might be pulled into the system. 204 00:13:34,280 --> 00:13:37,000 The mother looks like the manipulator 205 00:13:37,160 --> 00:13:40,280 of all the satellites that are around her. 206 00:13:40,600 --> 00:13:44,920 It may be possible to intervene on this level, 207 00:13:45,080 --> 00:13:50,880 provided that some of the mother's manipulations can be stopped. 208 00:13:51,320 --> 00:13:54,360 We can also intervene 209 00:13:54,520 --> 00:13:59,440 in the relationship between the mother and the psychotic person. 210 00:14:00,360 --> 00:14:03,440 This is the basis for family therapy, 211 00:14:03,600 --> 00:14:07,640 that works with the whole group, 212 00:14:07,800 --> 00:14:12,160 the child or patient, the mother and the whole family. 213 00:14:12,600 --> 00:14:14,360 I was all alone in Lyon, 214 00:14:14,520 --> 00:14:17,880 taking a walk, and suddenly I felt ill. 215 00:14:18,040 --> 00:14:19,320 I didn't feel well. 216 00:14:20,240 --> 00:14:21,480 But I feel better now. 217 00:14:22,120 --> 00:14:27,120 The medication I took in Vinatier has helped, 218 00:14:28,320 --> 00:14:31,880 but there's something else, something psychological. 219 00:14:32,800 --> 00:14:34,400 I had a major blow. 220 00:14:35,400 --> 00:14:36,840 I mean... 221 00:14:37,000 --> 00:14:40,280 My mother didn't really know my real father. 222 00:14:40,440 --> 00:14:41,240 She... 223 00:14:42,000 --> 00:14:43,640 I don't know how to put it. 224 00:14:44,160 --> 00:14:47,280 I didn't really know my real father. It was... 225 00:14:48,400 --> 00:14:50,800 My mother met a boy, she was 19. 226 00:14:50,960 --> 00:14:51,920 19 1/2. 227 00:14:52,240 --> 00:14:55,040 They had sexual intercourse. 228 00:14:55,480 --> 00:14:56,600 It was fast. 229 00:14:56,760 --> 00:14:58,600 They made me the second time. 230 00:14:59,160 --> 00:15:00,560 And then... 231 00:15:01,880 --> 00:15:05,080 My stepfather... My father abandoned my mother. 232 00:15:05,640 --> 00:15:07,440 I'm going to top myself off again. 233 00:15:07,880 --> 00:15:09,400 I feel bad these days. 234 00:15:09,840 --> 00:15:11,320 And... 235 00:15:13,120 --> 00:15:15,200 I was saved. 236 00:15:15,360 --> 00:15:17,960 They saved me. That disgusts to me. 237 00:15:18,120 --> 00:15:21,280 What I find disgusting is our society, really. 238 00:15:21,720 --> 00:15:26,680 So you said that you've been writing poems these days. 239 00:15:26,840 --> 00:15:28,000 I have. 240 00:15:29,400 --> 00:15:34,000 It's about the parable, about the parable, 241 00:15:34,640 --> 00:15:35,880 where... 242 00:15:36,560 --> 00:15:38,640 The Gospel parable. 243 00:15:38,800 --> 00:15:41,960 Christ gives back sight to the blind. 244 00:15:42,840 --> 00:15:45,400 He meets a blind man on his way, 245 00:15:45,560 --> 00:15:47,160 and, 246 00:15:48,120 --> 00:15:51,120 he puts water and dirt on his eyes. 247 00:15:51,440 --> 00:15:54,160 In the poem I analyse this, 248 00:15:54,320 --> 00:15:59,200 as if the natural was coming back, and suffering. 249 00:15:59,360 --> 00:16:02,360 Suffering and the habit of suffering. 250 00:16:05,000 --> 00:16:08,160 And I'm like the One who gives back sight to the blind 251 00:16:08,320 --> 00:16:10,240 Who claims to be on this earth for them 252 00:16:10,400 --> 00:16:13,080 For water and earth are neither in the sinner, 253 00:16:13,240 --> 00:16:14,640 nor in those around him 254 00:16:14,800 --> 00:16:19,360 He must know the purity of water and the pain of the earth, his Mother 255 00:16:19,520 --> 00:16:22,920 Oh Lord, let me be more faithful to the justice of water, 256 00:16:23,080 --> 00:16:25,200 and to my offering to the earth 257 00:16:25,360 --> 00:16:28,160 For I am like the blind carrying the duty of all 258 00:16:28,320 --> 00:16:31,200 Thoroughly washed with water and mud 259 00:16:31,360 --> 00:16:33,320 Designed for him: Water and salt 260 00:16:33,480 --> 00:16:37,160 Purity and bitterness Anesthesia and anti-suffering 261 00:16:37,320 --> 00:16:40,520 Education from our Mother Earth 262 00:16:40,680 --> 00:16:43,360 For you are like the swimming pool or the fishpond 263 00:16:43,520 --> 00:16:47,320 You contain us all like the loving, triumphant mother 264 00:16:47,480 --> 00:16:50,120 And you like to see your creation, 265 00:16:50,280 --> 00:16:52,000 Angular and graceful 266 00:16:52,160 --> 00:16:53,720 I never knew my mother. 267 00:16:55,520 --> 00:16:57,080 And my father... 268 00:16:58,120 --> 00:17:00,040 He left me with my grandmother. 269 00:17:00,200 --> 00:17:04,320 I look upon my mother, my grandmother as my mother. 270 00:17:05,240 --> 00:17:09,160 Until I was 12, I lived with my grandmother. 271 00:17:09,600 --> 00:17:12,200 I spent my whole childhood with her. 272 00:17:13,160 --> 00:17:17,800 And I say it at work, I can say it now, my father was a swine. 273 00:17:18,000 --> 00:17:20,640 It could... You could... For the mentally ill, 274 00:17:20,800 --> 00:17:24,480 you could speak of a new kind of sociology. 275 00:17:24,640 --> 00:17:28,000 It wouldn't be against the others but it could be... 276 00:17:28,160 --> 00:17:31,200 It'd be accepted, let's say. Not impossible after all. 277 00:17:31,440 --> 00:17:34,400 But then there are always some patients against doctors. 278 00:17:34,560 --> 00:17:37,800 They move, they have to act, with a lot of means, 279 00:17:37,960 --> 00:17:41,720 more, to do better, the best they can. 280 00:17:42,280 --> 00:17:45,720 And the outpatient unit's role in the therapeutic system? 281 00:17:45,880 --> 00:17:47,920 Historically, 282 00:17:48,160 --> 00:17:52,720 the hospital represented a kind of fortress, 283 00:17:54,040 --> 00:17:57,720 between the patient and the outside world. 284 00:17:58,320 --> 00:18:00,800 The patient arrived in the hospital. 285 00:18:00,960 --> 00:18:02,960 It was like a second skin to him. 286 00:18:03,120 --> 00:18:05,400 It gave him boundaries he lacked. 287 00:18:05,800 --> 00:18:08,680 The hospital has a therapeutic role here, 288 00:18:08,840 --> 00:18:12,200 in that it provides this kind of security. 289 00:18:12,360 --> 00:18:15,280 The major drawback is that with prolonged stays, 290 00:18:15,440 --> 00:18:19,960 the relationships with the caregivers, let's draw them here, 291 00:18:20,120 --> 00:18:24,800 those relationships normalize, tensions are reset to zero. 292 00:18:26,080 --> 00:18:29,080 Outside, everybody's happy because the patient's inside. 293 00:18:29,240 --> 00:18:32,440 He doesn't disrupt the public order anymore. 294 00:18:32,960 --> 00:18:36,440 And this situation tends to go on indefinitely. 295 00:18:36,600 --> 00:18:39,640 Patients stay in hospital for 10, 15, 20, 30 years, 296 00:18:39,800 --> 00:18:42,640 although it is no longer necessary, 297 00:18:42,800 --> 00:18:47,480 because of the way this system is designed. 298 00:18:49,000 --> 00:18:51,800 When a patient tries to leave this system, 299 00:18:51,960 --> 00:18:53,320 it may go off smoothly, 300 00:18:53,480 --> 00:18:58,080 but if he goes back to the same tensions with his family or surroundings, 301 00:18:58,360 --> 00:19:03,040 he'll tend to return to the hospital to be back in its protective envelope. 302 00:19:03,200 --> 00:19:08,920 Some relapses happen for this reason alone. 303 00:19:09,440 --> 00:19:13,120 How does the outpatient unit fit into this? 304 00:19:13,280 --> 00:19:17,200 The outpatient unit represents, let's draw it here, 305 00:19:18,560 --> 00:19:22,920 a potential fulcrum for the patient who is outside. 306 00:19:23,080 --> 00:19:24,760 It's like an extension, 307 00:19:24,920 --> 00:19:29,280 an approach, a new protective envelope, 308 00:19:29,440 --> 00:19:33,160 a minor one, blended into the community, 309 00:19:33,320 --> 00:19:36,040 more flexible than this very rigid one. 310 00:19:36,240 --> 00:19:38,080 That's what it is. 311 00:19:38,240 --> 00:19:41,040 So the patient going outside 312 00:19:41,200 --> 00:19:45,800 can lean on this second axis, as it were. 313 00:19:46,720 --> 00:19:49,960 At the same time, it provides the patient 314 00:19:50,120 --> 00:19:53,360 with precisely two axes to function. 315 00:19:53,520 --> 00:19:56,480 In the treatment of psychotic patients, 316 00:19:56,640 --> 00:20:00,520 care by two entities seems to be absolutely crucial. 317 00:20:00,680 --> 00:20:04,240 Here's the hospital again, 318 00:20:04,440 --> 00:20:07,600 and here's the patient. 319 00:20:08,120 --> 00:20:10,880 If he's better, 320 00:20:11,040 --> 00:20:12,920 if he's turned the corner, 321 00:20:13,080 --> 00:20:16,240 he's going to be able to lean on two axes, 322 00:20:16,400 --> 00:20:17,960 the outpatient unit, 323 00:20:18,120 --> 00:20:19,840 and the hospital. 324 00:20:20,120 --> 00:20:23,080 Of course, some patients never go to hospital, 325 00:20:23,240 --> 00:20:25,480 and some will never go back to it. 326 00:20:25,640 --> 00:20:30,240 That's why in a second phase or sometimes even straightaway, 327 00:20:30,400 --> 00:20:32,360 what we call co-therapy, 328 00:20:32,520 --> 00:20:34,920 i.e. therapy supported by 2 axes, 329 00:20:35,080 --> 00:20:36,920 can start at once. 330 00:20:37,080 --> 00:20:39,320 This results in a system 331 00:20:39,480 --> 00:20:43,680 with a therapeutic axis here and another there, 332 00:20:43,840 --> 00:20:48,520 which could be independent from either unit, in a second phase. 333 00:20:48,680 --> 00:20:50,960 This could be a psychiatrist, 334 00:20:51,120 --> 00:20:52,520 and here a GP, 335 00:20:52,680 --> 00:20:55,960 acting as co-therapists for this patient. 336 00:20:56,120 --> 00:21:00,000 Or we'd have a psychiatrist and a nurse, a nurse and a GP. 337 00:21:00,160 --> 00:21:02,400 All combinations are possible. 338 00:21:02,680 --> 00:21:05,240 So here we have the co-therapy system, 339 00:21:05,400 --> 00:21:08,520 which seems very helpful with psychotic patients. 340 00:21:08,680 --> 00:21:11,960 However this system has trouble getting set up, 341 00:21:12,120 --> 00:21:15,800 because once outside, the patient tends to reproduce 342 00:21:15,960 --> 00:21:18,520 the system he knew within the hospital. 343 00:21:18,680 --> 00:21:21,520 Even if he didn't know it, that's how he functions. 344 00:21:21,680 --> 00:21:26,320 He views anything within the envelope as good, 345 00:21:26,480 --> 00:21:27,880 and outside as hostile. 346 00:21:28,040 --> 00:21:33,080 When he's back out, he tends to divide the world into 2 parts: 347 00:21:33,240 --> 00:21:35,280 good and bad people. 348 00:21:35,440 --> 00:21:38,320 And so, one of the therapeutic axes 349 00:21:38,480 --> 00:21:42,360 can be continually viewed by the patient as bad, 350 00:21:42,520 --> 00:21:44,200 and the other as good. 351 00:21:44,360 --> 00:21:45,640 As you can imagine, 352 00:21:45,800 --> 00:21:49,840 it's hard to be viewed as bad by a patient you're caring for. 353 00:21:50,000 --> 00:21:54,760 This may cause difficulties between the therapeutic systems, 354 00:21:54,920 --> 00:21:57,760 the outpatient unit and the hospital, 355 00:21:57,920 --> 00:22:00,160 or between two therapists. 356 00:22:00,320 --> 00:22:05,520 That's why co-therapists should meet and share their experience often, 357 00:22:05,680 --> 00:22:08,560 to offload the hostility that may arise, 358 00:22:08,720 --> 00:22:12,800 because of the patient's dichotomy between good and bad. 359 00:22:16,040 --> 00:22:19,120 One of these centres is the outpatient clinic. 360 00:22:19,280 --> 00:22:22,640 It is located in the housing project where its users live. 361 00:22:39,720 --> 00:22:42,560 Social workers, doctors, psychologists, nurses, 362 00:22:42,720 --> 00:22:46,680 meet to talk and coordinate the work with patients at home. 363 00:22:48,000 --> 00:22:51,960 During a first, smaller meeting, an update on home care is made. 364 00:22:52,120 --> 00:22:56,320 ... from North Africa. Can you picture him in this? 365 00:22:56,480 --> 00:22:58,320 - Him? No. - Not at all. 366 00:22:58,480 --> 00:23:03,160 It's not only about Villeurbanne. We just don't know what to do. 367 00:23:03,320 --> 00:23:06,840 Maybe try to spend an hour with them? With Kamel and Irène. 368 00:23:08,360 --> 00:23:10,160 I'm not sure about the result, 369 00:23:10,320 --> 00:23:15,720 seeing as he perceives any intrusion like a persecution, 370 00:23:15,880 --> 00:23:18,040 He's defined the good and the bad. 371 00:23:18,800 --> 00:23:20,920 The bad people are at the hospital, 372 00:23:21,080 --> 00:23:25,160 the good is mainly Kamel, 373 00:23:25,320 --> 00:23:26,960 who's taking care of him. 374 00:23:27,120 --> 00:23:29,240 The clinic and I, we're in the middle. 375 00:23:29,880 --> 00:23:34,000 I give him medicine for free, medicine from here. 376 00:23:34,240 --> 00:23:36,600 That's how I'm good. 377 00:23:37,760 --> 00:23:41,520 He calls you Dr. Cardine. He won't call you Marie. 378 00:23:42,680 --> 00:23:45,840 - Rejecting the female part of my name. - Indeed. 379 00:23:46,000 --> 00:23:47,800 Quite fitting for his issues. 380 00:23:48,320 --> 00:23:51,600 It looks like a progressive family deterioration. 381 00:23:51,760 --> 00:23:53,200 They despise one another 382 00:23:53,360 --> 00:23:56,240 because one is more damaged than the other. 383 00:23:56,400 --> 00:24:00,120 The whole family is kind of deteriorating. 384 00:24:01,280 --> 00:24:02,480 I'm not sure... 385 00:24:02,640 --> 00:24:06,800 The line we're following now would be 386 00:24:07,640 --> 00:24:11,120 to act in the neighbourhood, like Kamel does, in the family... 387 00:24:11,280 --> 00:24:13,480 He visits the educator, everybody else, 388 00:24:13,640 --> 00:24:16,760 and he receives medicine in the clinic. 389 00:24:16,920 --> 00:24:20,000 There's no real psychotherapy in place. 390 00:24:20,200 --> 00:24:23,920 That day, they were discussing the social workers' absence. 391 00:24:24,400 --> 00:24:26,800 Absence caused not only by our cameras. 392 00:24:26,960 --> 00:24:28,040 It should be... 393 00:24:28,200 --> 00:24:31,600 We'll decide later on the date. Let's contact the families. 394 00:24:31,760 --> 00:24:34,880 - To see whether they agree. - Yes. 395 00:24:35,520 --> 00:24:38,960 To care for a patient, you need to invest in him, 396 00:24:39,120 --> 00:24:40,800 spend some energy, 397 00:24:40,960 --> 00:24:43,920 take some interest in that work. 398 00:24:44,080 --> 00:24:46,720 Or several people can work together. 399 00:24:46,880 --> 00:24:51,280 I remember several of us caring for Timothée for over a year, 400 00:24:51,440 --> 00:24:52,280 2 years even, 401 00:24:52,440 --> 00:24:55,040 before he went to hospital. 402 00:24:55,320 --> 00:24:58,600 From the day he was in hospital, I liaised with them. 403 00:24:58,760 --> 00:25:01,000 I shared with you what was happening. 404 00:25:01,160 --> 00:25:03,800 He came to the clinic once. 405 00:25:03,960 --> 00:25:06,080 But it happens in the hospital. 406 00:25:06,280 --> 00:25:09,160 The role of the psychiatrist can be perceived badly. 407 00:25:09,320 --> 00:25:14,400 It's still perceived as repressive anyway, 408 00:25:14,560 --> 00:25:16,120 more or less. 409 00:25:16,280 --> 00:25:21,120 The role of the community, of social work is perceived as... 410 00:25:58,760 --> 00:26:02,000 Sometimes I feel as if I'm forever listening to people, 411 00:26:02,160 --> 00:26:04,760 because my technique is different from yours. 412 00:26:04,920 --> 00:26:06,680 Our backgrounds are different. 413 00:26:06,840 --> 00:26:10,960 Listening feels harder than being. 414 00:26:11,120 --> 00:26:15,720 One is said to care for the unconscious, 415 00:26:15,880 --> 00:26:17,240 fantasies and all that. 416 00:26:17,400 --> 00:26:22,160 The other is said to care for reality. We're always afraid of both. 417 00:26:22,360 --> 00:26:25,040 Patients and nursing staff meet 418 00:26:25,280 --> 00:26:27,480 in a support and decision group 419 00:26:27,880 --> 00:26:30,920 It helps solve recurring conflicts, 420 00:26:31,640 --> 00:26:34,600 and serves as a go-between with society. 421 00:26:35,000 --> 00:26:38,400 We agreed you wouldn't go back to work before a set date. 422 00:26:38,560 --> 00:26:39,400 Am I wrong? 423 00:26:40,000 --> 00:26:43,320 That getting in contact with the employer was important, 424 00:26:43,480 --> 00:26:46,560 but that we still had things to discuss. 425 00:26:46,760 --> 00:26:48,120 I'm sick, OK, 426 00:26:48,280 --> 00:26:50,720 but give me work, even hard, never mind. 427 00:26:50,880 --> 00:26:53,760 - No, you can't work now. - December 28th. 428 00:26:54,480 --> 00:26:56,800 You realise how you are, don't you? 429 00:26:57,200 --> 00:26:59,600 - I do. - You're pale, exhausted. 430 00:26:59,760 --> 00:27:02,640 - You need to rest. - I show you, from my boss. 431 00:27:02,800 --> 00:27:04,280 He still has perfusions? 432 00:27:04,480 --> 00:27:07,120 The family unit needs to be treated too. 433 00:27:07,280 --> 00:27:09,880 This is through home psychotherapy. 434 00:27:12,240 --> 00:27:14,040 For others, it doesn't work. 435 00:27:14,280 --> 00:27:16,600 I'm here to see how you're doing. 436 00:27:16,840 --> 00:27:21,080 I prefer the clinic over the hospital. 437 00:27:21,480 --> 00:27:23,120 It was the opposite before. 438 00:27:23,280 --> 00:27:25,800 When Ottmann was in the hospital, that was good. 439 00:27:25,960 --> 00:27:27,640 - It was good for you. - Yes. 440 00:27:27,800 --> 00:27:30,520 - Not for your brother. - I found a job. 441 00:27:30,680 --> 00:27:32,760 For your brother, it didn't work. 442 00:27:32,920 --> 00:27:35,840 We trapped you today, we wanted to see you. 443 00:27:36,240 --> 00:27:38,640 - Annette said you were furious. - What? 444 00:27:38,800 --> 00:27:40,360 She said you were furious. 445 00:27:40,520 --> 00:27:41,880 Yes, I shouted at her. 446 00:27:42,040 --> 00:27:44,840 - You didn't like being trapped. - I didn't. 447 00:27:45,680 --> 00:27:47,480 But I knew it. 448 00:27:48,160 --> 00:27:50,800 Because she said: "Well, tonight..." 449 00:27:52,680 --> 00:27:55,480 It resembled the hospital, talking like that. 450 00:27:55,640 --> 00:27:58,200 It's what 451 00:27:58,360 --> 00:27:59,960 some psychiatrists do. 452 00:28:00,200 --> 00:28:01,640 See what I mean? 453 00:28:02,840 --> 00:28:04,320 I swear it's the same. 454 00:28:04,480 --> 00:28:06,800 Why? I don't quite get it. 455 00:28:06,960 --> 00:28:08,520 I don't know. 456 00:28:09,840 --> 00:28:12,080 Anyway, I don't like it. 457 00:28:12,560 --> 00:28:15,200 We're forcing you to do something, 458 00:28:15,360 --> 00:28:17,600 pushing a sword in your back. 459 00:28:21,120 --> 00:28:24,040 When I left the hospital... 460 00:28:25,160 --> 00:28:27,400 For that psychiatrist... 461 00:28:30,520 --> 00:28:32,160 You don't care to name him. 462 00:28:33,760 --> 00:28:34,920 That one, yes. 463 00:28:35,080 --> 00:28:38,280 We've said it a thousand times. 464 00:28:38,960 --> 00:28:41,520 It's registered now. 465 00:28:41,680 --> 00:28:43,920 You know, the juggler. 466 00:28:44,080 --> 00:28:47,280 If he ever falls on the... That'll please him. 467 00:28:47,440 --> 00:28:48,880 He's Adolf Hitler. 468 00:28:50,400 --> 00:28:53,400 We've talked about that psychiatrist a lot. 469 00:28:53,560 --> 00:28:57,040 What about trying to think about what's happening here? 470 00:28:57,200 --> 00:28:59,600 I love the letter he sent me... 471 00:28:59,800 --> 00:29:02,800 I'm so glad to see you. I have a problem. 472 00:29:02,960 --> 00:29:05,400 Can you remember the kid living with Mrs. Poudret? 473 00:29:05,560 --> 00:29:09,960 I sent her to you 6 or 7 months ago. 474 00:29:10,120 --> 00:29:11,880 You took her on for psychotherapy. 475 00:29:12,080 --> 00:29:15,600 When she feels better, that's why she didn't come back, 476 00:29:15,760 --> 00:29:17,200 she rejects psychiatrists. 477 00:29:17,360 --> 00:29:18,960 She says she's fine. 478 00:29:19,120 --> 00:29:21,760 Indeed, she was ok for some time. 479 00:29:21,920 --> 00:29:24,840 She didn't even consult me for little things. 480 00:29:25,000 --> 00:29:29,440 She introduced her fiancé to me. They seemed to be doing fine. 481 00:29:29,600 --> 00:29:31,880 Now I feel that something is off. 482 00:29:32,040 --> 00:29:35,920 The family doesn't want... There's a problem with the wedding. 483 00:29:36,080 --> 00:29:38,920 The family... They're Pieds-Noirs. 484 00:29:39,080 --> 00:29:43,600 They don't really accept... They don't really like the boy. 485 00:29:44,200 --> 00:29:46,200 I think it's going to rupture. 486 00:29:46,360 --> 00:29:49,480 I wonder how I'm going to bring her to you, 487 00:29:51,480 --> 00:29:52,560 willingly. 488 00:29:52,880 --> 00:29:56,840 The person causing a fuss sometimes forces the social worker 489 00:29:57,000 --> 00:29:59,440 to act as the neighbours' psychotherapist. 490 00:29:59,880 --> 00:30:03,600 - I phoned you about Mr. Martin. - That's it. 491 00:30:03,760 --> 00:30:05,480 - Anything wrong? - Yes. 492 00:30:05,640 --> 00:30:09,040 He's been very noisy lately. Tenants are complaining. 493 00:30:09,200 --> 00:30:10,480 When did it start? 494 00:30:10,640 --> 00:30:12,920 About a week ago. 495 00:30:13,080 --> 00:30:16,880 - Is it substantial? - I think so. 496 00:30:17,040 --> 00:30:19,560 Actually, here's one of our tenants. 497 00:30:19,720 --> 00:30:20,520 Good morning. 498 00:30:20,680 --> 00:30:24,760 I'm a social worker. I'm here about Mr. Martin. 499 00:30:24,920 --> 00:30:26,120 He's not well. 500 00:30:26,280 --> 00:30:29,280 He's very noisy again. He bangs on the walls. 501 00:30:29,440 --> 00:30:31,800 He turns on the taps very loudly. 502 00:30:31,960 --> 00:30:33,840 - And it bothers you. - It does. 503 00:30:34,000 --> 00:30:37,200 Not as much as the first time, when they took him away, 504 00:30:37,360 --> 00:30:39,040 but it's close. 505 00:30:39,280 --> 00:30:40,640 I should go see him. 506 00:30:40,800 --> 00:30:42,360 He's probably in. 507 00:30:42,520 --> 00:30:46,640 It may not be serious. He may have missed his medication. 508 00:30:46,800 --> 00:30:47,680 Home visits 509 00:30:47,880 --> 00:30:51,920 allow conflicts to be discussed in their actual environment. 510 00:30:52,080 --> 00:30:56,000 That's where fantasies and reality reveal their dual faces. 511 00:30:56,680 --> 00:30:58,200 I found something anyway. 512 00:31:00,000 --> 00:31:03,720 - And you still work as a... - A truck driver. 513 00:31:04,840 --> 00:31:07,640 - And your room? - I live alone. 514 00:31:07,800 --> 00:31:09,480 No friends to room with? 515 00:31:09,640 --> 00:31:11,760 Well, I have buddies. 516 00:31:11,920 --> 00:31:13,760 But I like being alone. 517 00:31:13,960 --> 00:31:16,200 What about friends from the hospital? 518 00:31:16,360 --> 00:31:18,520 Those who left at the same time. 519 00:31:18,680 --> 00:31:21,120 At one time, we talked about the possibility 520 00:31:21,280 --> 00:31:23,200 of you going to a post-cure flat. 521 00:31:23,360 --> 00:31:25,680 Yes, I was supposed to go. 522 00:31:26,360 --> 00:31:27,280 Hello, Doctor. 523 00:31:27,440 --> 00:31:31,960 I'm here about the letter you sent me, 524 00:31:32,120 --> 00:31:34,280 about this new injection. 525 00:31:34,440 --> 00:31:36,880 You mentioned it on the letter. 526 00:31:37,040 --> 00:31:38,040 That's it. 527 00:31:38,200 --> 00:31:40,120 What's this injection? 528 00:31:40,280 --> 00:31:43,040 What does it do for my treatment? 529 00:31:43,200 --> 00:31:46,240 I'd like to sort it out once and for all. 530 00:31:46,400 --> 00:31:51,880 That's precisely why we suggested this injection to you. 531 00:31:52,040 --> 00:31:56,480 It's the same medicine you've been taking as a potion. 532 00:31:57,320 --> 00:32:02,200 But instead of taking your potion daily or several times a day, 533 00:32:02,360 --> 00:32:04,960 you'll receive one injection fortnightly. 534 00:32:05,120 --> 00:32:09,840 And this injection, the good it's going to do to me, 535 00:32:10,000 --> 00:32:12,440 is it going to hurt my stomach? 536 00:32:13,000 --> 00:32:13,800 Not at all. 537 00:32:13,960 --> 00:32:18,080 On the contrary. The treatment's going to be lighter. 538 00:32:18,240 --> 00:32:21,240 You won't have to remember anymore 539 00:32:21,400 --> 00:32:23,800 to take your drops, to count them, 540 00:32:23,960 --> 00:32:26,800 to count and take pills several times a day. 541 00:32:26,960 --> 00:32:29,440 Instead you'll come over here to see us, 542 00:32:29,600 --> 00:32:33,440 we can talk for a little bit, see how you're doing, 543 00:32:33,600 --> 00:32:35,520 you'll see the people you know. 544 00:32:35,680 --> 00:32:37,440 And then... 545 00:32:37,600 --> 00:32:39,320 You'll get your injection. 546 00:32:39,480 --> 00:32:41,640 What about my spasms? 547 00:32:41,800 --> 00:32:46,560 Yes. You'll still have to take a tablet against them. 548 00:32:46,720 --> 00:32:50,080 The same you've taken until now. OK? 549 00:32:50,240 --> 00:32:53,240 What if I forget inadvertently? 550 00:32:53,400 --> 00:32:57,320 We have created a little card for that purpose. 551 00:32:57,480 --> 00:33:00,000 You'll carry it in your wallet... 552 00:33:00,160 --> 00:33:01,280 This treatment card 553 00:33:01,480 --> 00:33:05,400 will say that the patient is on depot neuroleptics. 554 00:33:06,400 --> 00:33:08,960 So you've found a job, they helped you. 555 00:33:09,120 --> 00:33:13,680 The aim is not to turn the psychotic into a perfectly adapted fellow. 556 00:33:14,120 --> 00:33:17,200 It is important to prepare him 557 00:33:17,360 --> 00:33:20,280 to accept some kind of return to reality. 558 00:33:20,520 --> 00:33:24,520 But the image of the other, the assigned or spontaneous therapist, 559 00:33:24,680 --> 00:33:26,320 remains a necessary mirror. 560 00:33:26,480 --> 00:33:29,480 - I have to go to work because, look... - Yes? 561 00:33:30,000 --> 00:33:33,760 I used to have a stoop. I was very withdrawn. 562 00:33:33,920 --> 00:33:37,600 When I went to work, I stood upright and stuff. 563 00:33:37,800 --> 00:33:39,640 But through the looking-glass, 564 00:33:40,240 --> 00:33:42,280 there is no Wonderland to be found. 565 00:33:42,680 --> 00:33:44,760 Returning to work remains hard. 566 00:33:44,920 --> 00:33:48,760 ... ready to collaborate with us. He's genial. 567 00:33:48,920 --> 00:33:52,840 He's young but I think he's interested. 568 00:33:53,000 --> 00:33:57,480 - The others too, the staff... - Yes. 569 00:33:57,640 --> 00:34:01,880 The loss of a job is often felt as an additional wound. 570 00:34:02,640 --> 00:34:06,400 The social environment often has to be adjusted. 571 00:34:09,320 --> 00:34:12,720 However, we've even met understanding employers, 572 00:34:12,880 --> 00:34:16,400 flowered factories, true bedroom communities, 573 00:34:16,560 --> 00:34:18,680 and adjusted psychotics, 574 00:34:19,120 --> 00:34:21,040 whether workers or managers. 575 00:34:22,200 --> 00:34:24,400 ... his coworkers, they started... 576 00:34:24,560 --> 00:34:29,240 - They accepted him well. - They even mentioned him to the head... 577 00:34:29,400 --> 00:34:31,000 - The shop manager. - Yes? 578 00:34:31,160 --> 00:34:33,760 He told the doctor, the social worker. 579 00:34:33,920 --> 00:34:36,200 There's cohesion around him. 580 00:34:36,360 --> 00:34:39,880 - Maybe even too much. - You can't tell them that. 581 00:34:40,040 --> 00:34:41,960 What do outpatient units do? 582 00:34:42,840 --> 00:34:47,240 Some view it as a close, skilfully concealed police control. 583 00:34:47,400 --> 00:34:52,400 For others, it's the medical and technocratic alibi of a civilization 584 00:34:52,560 --> 00:34:54,960 looking for a cure for its discontent. 585 00:34:56,840 --> 00:34:59,320 It's foremostly a practice. 586 00:34:59,960 --> 00:35:02,640 Betwixt individual and social, 587 00:35:02,800 --> 00:35:05,880 its aim is to prevent a breaking off. 588 00:35:06,960 --> 00:35:11,960 However, between the psychotic, the city and their relationship, 589 00:35:12,120 --> 00:35:14,480 who or what needs to be rebuilt? 590 00:35:16,960 --> 00:35:19,880 THE END SCIENCEFILM 591 00:35:20,040 --> 00:35:22,000 Subtitles: Élisabeth Fuchs