Un soin psychique sans Psyché ? Idéologies identitaires, psychophobie généralisée et pratiques en santé mentale

Abstract

Psychiatric care practices have long been inspired by humanist conceptions of psychic life, which attribute an anthropological depth to the human being, and an intentionality to symptoms. However, in recent decades, there has been a shift towards a reeducational approach. We propose to link this evolution with the emergence in society of ideological identity movements, characterized by their psychophobia and distrust of unconscious psychic life. Drawing on psychoanalytical concepts, we examine the extent to which these ideologies are rooted in a two-dimensional anthropological conception: a human being without psychic depth or internal conflictuality, perfectly identified with his or her discourse. The unconscious is denounced as the source of discrimination. It must therefore be condemned and neutralized, in favor of an ideal of transparency, purity, and homogeneity. Secondly, we argue that this generalized psychophobia has inspired normative and reeducational practices in mental health over the past half-century. In particular, we look at psychoeducation for psychotic patients, the recovery approach to schizophrenia, and activist clinical practices whose political and ideological commitments are detrimental to neutrality and an unconditional acceptance of subjectivity. Finally, we recall how psychoanalysis provides mental health professionals with ethical benchmarks for thinking about their practices, against the temptation to totalize.