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France: Controlling Who Says What To Who
The Proposed French Legislation to Medicalise and Ban Psychotherapy
"This essentially repressive text is clearly inspired by the measures used for the illegal practice of medicine. We rediscover with this amendment, practically word for word, the measures within the field of medicine that permit the harassment of healthcare professionals who are not doctors (nutritionists, healers, naturopaths, osteopaths et al.) for the illegal practice of medicine. This includes the harassment of innovative doctors searching to develop new health systems and who are pursued for "unproven medical practices" or, to use the deliberately stigmatising expression of the Council of the Order of Doctors, for charlatanism. Let us not forget that these measures already make France, in the domain of medicine, a completely backward country compared to other developed countries."
Thanks to Emma Holister for this introduction and the translation into English of the excellent article by Jacques Valentin!
"No freedom, thank you, were French!"
By Jacques Valentin
Translation: Emma Holister
France is getting ready to adopt the most restrictive law in the world to regulate the practice of psychotherapy.
This article expresses the individual opinion of Gestion Santé. Although it defends the free practice of psychotherapy, it does not claim to represent the position of psychotherapists or of their representatives regarding the current plans for regulation.
The context and current situation
For at least the last ten years, a large media campaign has been trying to persuade the French that going to see a psychotherapist puts the security of patients at considerable risk; the reasons given are that many people without qualifications take up the practice of psychotherapy, that the sector has been infiltrated by sects, and finally that many of the methods are not scientifically valid.
It is for this reason that an amendment put forward covertly by the deputy, Doctor Accoyer, vice-president of the UMP group at the assembly (president Chirac's party), was unanimously voted by the 13 deputies present, in accordance with the well-polished technique for passing the sensitive dossiers through without debate, scorning universal and workers suffrage and the work of a parliamentarian. It still has to go before the Senate in January 2003 according to the letter from the psychotherapy journal SNPPSY. He not only reserves the TITLE but also the PRACTICE of psychotherapy exclusively to psychiatric doctors (see text in French), general practitioners and clinical psychologists, by dispensation and by jury, according to function, qualifications and experience, to psychotherapists who have practiced for the last five years. The fact that the right of PRACTICE is reserved is the central issue, but its a point that is too little focused on, even by professionals who rightly oppose the project. This reserved right of practice, which represents the main danger of the project, is a veritable act of war aimed at the non-medical forms of psychotherapy and more generally against all techniques of personal development, of relationship therapy and personal fulfilment.
The text offers no guarantee as to the quality of future psychotherapists; quite the opposite.
No guarantee and no precision are offered by the text as to the minimum training of this new caste of psychotherapists who will benefit from virtually no education in psychotherapy throughout their studies. Furthermore, hardly any training in clinical psychology is envisaged for general practitioners and even psychiatrists, and for the latter it is very brief, taking into account that the training is mainly geared towards physical disorders and the biological sphere.
The author is happy to point out that:
"Psychotherapies constitute therapeutic tools used in the treatment of mental disorders.
The different categories of psychotherapy are fixed by decree of the Minister of Health. Their application can only be undertaken by psychiatric doctors, general practitioners and psychologists with the required professional qualifications stipulated by this same decree. The National Bureau of Health Evaluation and Accrediting offers its examination for the establishment of these conditions."
It is noteworthy that the notion of psychotherapy is not even specifically formulated, as the text does not indicate whether the forms of psychotherapy use psychological techniques in the treatment. This allows for the avoidance of specifying that psychotherapy is distinct from other aspects of medical practice with regard to treating mental disorders and therefore requires specific training.
The text is quite as elusive on other major points. For any other text pertaining to law, regulating a title, and that is furthermore the practice of a profession as in the current case, it would be stipulated that the professionals concerned must have followed training in official schools for a minimum period of so many hours and years, of which the course must have a certain minimum theoretical content. Likewise, the text does not allude at all to the necessity of supervision and continual training, whilst all professionals recognise and agree that this is absolutely indispensable. The "debate" at the assembly, if thats what we can call the few completely destitute paragraphs that accompany the amendment proposal, offers no supplementary information, especially regarding the expected training of the professionals or on the balance between legal text and decree.
There is good cause to wonder whether it occurred to the author(s) of the amendment to consider a few thematic courses in the line of continual training. Perhaps a few sections such as "practice of psychotherapy" in the initial training course, as well as, just for good measure, a course in gardening in a hospital environment, which would be a good enough first step towards becoming a psychotherapist. We here witness the magic that a medical diploma yields (reluctantly extended to psychologists), conceived by some sort of priesthood that magically bestows upon its recipients as much intrinsic competence as a common mortal would have who has undergone the most scrupulous training and who has much personal experience.
Essentially, the proposed legislation represents the management of privilege, very far indeed from a real management of competence. We are therefore heading towards having professionals who benefit from the title, are trained at a discount, and towards major problems of competence for the patients who are being exposed to risk, all whilst claiming to protect them with a title and a reserved right of practice. It took a great deal of nerve, but in this social climate of normalisation the worst ineptitudes pass for a wise and well-considered move.
The list of the authorised forms of psychotherapy fixed by decree!
As if that werent enough, the cherry on the cake is that Dr Accoyer has proposed that, incredibly, the list of the authorised methods of practice in psychotherapy should be set by the State. No other country in the world has ever proposed such measures, not even totalitarian and communist states, but that which the father of the people had not considered, Dr Accoyer thought up and dared to write into law. In fact on reading the text we discover that:
"The different categories of psychotherapy are fixed by decree, by the Minister of Health. Their application can only be undertaken by psychiatric doctors, general practitioners and psychologists with the required professional qualifications stipulated by this same decree."
Thus, by putting into effect or proposing either a form of psychotherapy (if one does not have the title of psychotherapist) or a non State-authorised form of psychotherapy (if one has the title of psychotherapist) it will constitute, de facto, in the first case the illegal practice of psychotherapy and in the second an infraction in the practice of a non-authorised therapy.
This essentially repressive text is clearly inspired by the measures used for the illegal practice of medicine.
We rediscover with this amendment, practically word for word, the measures within the field of medicine that permit the harassment of healthcare professionals who are not doctors (nutritionists, healers, naturopaths, osteopaths et al.) for the illegal practice of medicine. This includes the harassment of innovative doctors searching to develop new health systems and who are pursued for "unproven medical practices" or, to use the deliberately stigmatising expression of the Council of the Order of Doctors, for charlatanism. Let us not forget that these measures already make France, in the domain of medicine, a completely backward country compared to other developed countries.
But the measures used for psychotherapy are, on examination, even more suicidal with regard to freedom than those used for medicine.
In the medical world, the pursuit of charlatanism is initiated by the Councils of the Order, bastion of medical conservatism and of "all medicine". Despite the scandalous arbitrary power of the Councils of the Order, the scope of what constitutes a proven practice remains, at least in theory, open, and is not pre-defined, which is normal, as the field of medical science is in perpetual evolution.
On the contrary, for psychotherapy they want what is proven or not, to be fixed at the States discretion, without consulting those involved, and without any possibility of an appeal. In future, psychoanalysis or any form of psychotherapy can therefore be forbidden by this procedure. Even supposing there were to be a very great liberalism amongst the authorities, which is clearly not the case today, it would be impossible to reference all the forms of therapy within this fast-growing field in perpetual evolution. It is likely however that these very restrictive measures will be fully used to block to the maximum the awarding of a discretionary pass to the therapists who are not doctors or psychologists but have more than five years of experience.
French fantasies concerning the fight against sects
We will now turn to one of the most astonishing taboo subjects in French contemporary culture, the fight against sects. It is a sensitive subject to approach as the simple fact of saying that the fight against sects leads to certain excesses and loss of control in France will result in your being suspected of being a sympathiser. An apparently very efficient threat, as dissent is the exclusive work of alternative personalities who are outside the media and sacred intellectual circles.
However, it is difficult for an objective observer not to notice the large barrier that has progressively been erected over the last twenty years, cutting off certain "sensitive" subjects, and in a remarkable way, subjects that, on first analysis, would seem rather peripheral to the sect issue. In fact, one generally considers sects to be highly structured movements that put forward an imposing ideology often compared to indoctrination. On the face of it, it is nothing to do with psychotherapy and alternative medicine, where in fact it is diversity and creativity that prevail. False! According to the "theoreticians" in the fight against sects, who claim that sects are actually much more supple and informal structures that indeed colonise and infiltrate these therapies, its even one of their priorities. Of course, this is because psychotherapy and the methods in alternative medicine are, in essence, not scientific. They belong to the modern rationale that scientific progress is much too slow to eradicate. In this domain affirmation is worthy of demonstration, and the result is disastrous. We are therefore in a situation whereby the periphery, alternative medicine and psychotherapy, in their hypothetical and unproved relationship with sects, become the centre, the heart of the problem.
It is noteworthy that the question of the fight against sects has a strong connection to the consensus on the politics regarding the frontiers between science and the rest of our culture. The prevailing scientism, subjugated to social, economic and cultural interests, is much more powerful than before. In this context the opponents of sects use social and political repression to extend the field of scientism. They are opposed to respectable cultural manifestations such as alternative medicine and psychotherapy. The former consensus is broken and scientism has launched itself into new politics of territorial annexation.
The constant hammering by the media about the links between psychotherapy, charlatanism and sects has become so insistent and encounters so little resistance that we are witnessing a massive impregnation of the collective and individual unconscious which has taken on considerable proportions during the last few years. All users and practitioners of psychotherapy and personal development can only be struck by the way in which the theme is now omnipresent and it is perhaps a source of worry and anxiety amongst certain patients. It is equally impossible to present a therapy to the press without journalists fretting about legitimising a sect-like approach. This issue can also affect the family environment, being at times the cause of serious conflicts in cases where there is disagreement about continuing the practice. Any problem that a couple may have that turns bad (in a country where 50% of relationships end in divorce) and where a therapist is concerned can therefore add fuel to the anti-sects brigade with juicy stories supplied by a "victim" whose words are of course taken as proof.
It is striking to see how psychotherapists from other countries visiting France are often stupefied when faced with the consequences as well as the general climate, the "atmosphere", that are created by this French speciality: the fight against sects. This fight and the sectarian problem seem not to exist anywhere else to such an outrageous extent.
The sectarian question is, in our opinion, largely beside the point when it comes to the problems posed in undertaking psychotherapy; it gives rise to vague apprehensions and is a source of anxiety fixation of a different origin. It creates a hazy anxiety instead of a questioning process that would be more appropriate for the person involved.
When a person makes contact with a psychotherapist, rather than wondering if the therapy or therapist gives off, like the devil, a "sect-like" odour, it would be more useful for them to ask themselves the following questions. Is the therapeutic method appropriate for them and do they agree with its philosophy and methodology? Is the psychotherapist pertinent in his or her interventions? Is there too big a dissonance between the personality of the therapist and that of the patient? Is the therapist sufficiently firm to be able to put forward his analysis, when faced with the resistance of the patient, without being sharp, aggressive or intrusive? Is he flexible enough to respect both the pace of the patients evolution and the overcoming of their difficulties? Does he adhere to a coherent theoretical framework allowing him to organise his therapy? Is the encounter with the patient for him in fact a chance to go back to the theory in order to adapt it to the patient (and not the opposite)? Etc.
All these questions, if they are dealt with honestly, help avoid many errors (starting with the possible risk of sects), given that dogmatism, incompetence, and psychological violence in therapy are problems that have little to do with the titles and diplomas of the therapist.
Of course, there can be problems with psychotherapy, as with any social activity. One manoeuvre of the French anti-sects campaign, since theyve had psychotherapists in their sights, has moreover consisted of scrupulously gathering all the problems that they can find in order to discredit the profession.
To reason on the failures, the limits, the real or supposed impasses of a psychotherapeutic method and more generally the examination, without prejudice, of a technique from a constructive, critical perspective is very interesting and useful. I am the first to regret that the people interested in psychotherapy are not more often inclined towards this type of work. Furthermore, in order to be useful, they require extended knowledge, probity and a faultless intellectual honesty. We are therefore leagues away from what the anti-sect websites are writing on the subject, leaving, it must be said, a nauseating impression, the prejudice, the doctrinaire attitude, the will to do damage as palpable as it is, polluting the analyses made of them.
All whilst not denying that certain psychotherapists can be dangerous people, incompetent or completely irresponsible. My point is that there are probably not more than in a profession that elects to be hand-picked, such as that of doctors.
It is worth imagining the result if they were to do the same thing to other professions, looking only at the errors, failures, incompetence, and dishonesty that exist in any technical profession that has major consequences for the user, from doctors to car mechanics, from plumbers to accountants. We would obviously all have the same apocalyptic and totally false vision. In fact, compared to the other professions mentioned, the psychotherapists patient has, without a doubt, a much greater chance of judging in good time the quality of the professional that he is dealing with and can pull out of the situation before suffering physical or moral prejudice or irreparable financial damage. Under these conditions as well as a better self-organisation of the profession, anything that moves in the direction of encouraging the user of therapy to be sensible, balanced and unbiased would seem useful and necessary.
Finally, is it necessary to remind ourselves that people follow a therapy above all in order to achieve a better foundation and sense of existential security in their everyday lives? How many specific techniques have such a praise-worthy aim in our society? What extraordinary duplicity and irresponsibility to deliberately present psychotherapy as a high-risk course of action. In any case, there is a very significant inversion of values triumphing everywhere in our society.
But why then this omnipresence of the sect theme?
The fight against sects is a very French phenomenon that has been slowly but surely developing in France since the coming to power of the socialists in 1981, and gaining the dimensions of a veritable national obsession. As far as it is possible to establish, it basically acts as a smokescreen to the corruption and incompetence of the countrys ruling class. A ruling class that is widely discredited in the public opinion, with all parties in a confused mix, especially since the left, once in power, took off to the right in the most unbridled wheeling and dealing. France, and above all its media, culturally and traditionally, associates the left with a certain moral discourse; the result has been an acute and profound moral crisis. The fear of sects has succeeded in rather efficiently distracting the attention of the public from the enormous financial corruption, towards secondary problems related to sects, sometimes real and even dramatic, but most often blown out of proportion or even totally imaginary. But from the outset one wonders if this campaign isnt in order to compensate primarily for a disorientation and loss of bearings most particularly marked amongst journalists themselves.
In France only certain papers specialise in the fight against sects and they publish alarmist articles on the subject fairly regularly. But they all repeat the stereotypical sect-speeches that often revolve around the subjects of contamination, infiltration, that are very revealing of the scapegoat theme so well developed by René Girard. Elsewhere, quite as revealing, is the type of amazement that strikes the press once a problem in society that one could consider, in one way or another, "contaminated" by the sect problem, such as natural or alternative health, or in the present case, psychotherapy, enters the news forum. In other words, there is a remarkable locking away of information in the media.
The theme of the infiltration of sects, through the use of a scapegoat, could also probably itself be viewed as a process of attention displacement. Which is the western country where the political elites have the most difficulty in recruiting new members? Which is the country where the highest rank of the civil service monopolises all of the highest posts within the civil service and private sectors? Hence practising a faultless solidarity amongst themselves to the detriment of the public welfare (e.g. the shipwrecking of the French bank Credit Lyonnais as well as so many other public affairs). Which country has the heaviest presence of Freemasons within the ranks of political and economic power? In which country does the fossilised medical elite clamp down on any progress in the medical world? Which is the country where journalists consort the most with politicians, never criticising them? So here too the theme of sect infiltration seems to be a smokescreen to hide the serious fossilisation process which has beset the leading elite of this country. It encourages people to believe that these leaders are firmly and bravely fighting the infiltration by sects, thus partially restoring, in an illusionary manner, some of these leaders lost virtue.
A Deaf, Mute and Blind Media
The October and November headlines in France amused the gallery with a debate which is all the rage about the wearing of veils to school, an issue concerning probably a few hundred young girls at most.
At the same time, no debate was opened regarding a project to regulate a whole profession, that of psychotherapy, which plays a major role in this country. A project that was nevertheless highly questionable and that, furthermore, had been introduced in the most scandalous manner via an amendment, whereby this event will have a considerable effect on the daily lives of millions of French people. Mention by the press was reduced to, for example in the French newspaper Le Mondes daily references, a few little allusive lines the day before the passage of the amendment, and then nothing more on the subject. With the newspaper Liberation, it was necessary to wait for more than 15 days before an article appeared which didnt really convey the reality of the situation but which at least considered alerting some of the people who would be affected (including yours truly). And it did follow up shortly after with the publication of a response by an organisation representing psychotherapists. There were also a few morsels in the medical press. One might add that no article reproduced the legislative text, which was nevertheless not very long, but no doubt this was in order to avoid having to comment on it. There was even less information about it on the TV, of course. Finally and after interminable hesitations Le Monde finally proposed a dossier on the subject, nearly a month after the vote. Naturally, Dr Accoyer, deputy, promoter of this project, benefited from a particularly deferential interview which totally deprived the reader of any contradictory line of argument. And no chance was given to representatives of psychotherapists to express themselves. The newspaper Le Figaro, shortly after, produced one article (only), which was a much more balanced view than that in Le Monde. Apparently nothing in the Express. Nothing either in the Nouvel Observateur (on checking their titles on the Internet). In Le Point (le bloc-notes de Bernard-Henri Lévy) 21/11/03 there was a condemnation of the Accoyer project which was accurate although it limited itself to the practice of psychoanalysis.
We witnessed therefore, initially, a general blackout, then a few crumbs of news on a subject that must surely interest readers. Furthermore, not one organ of the press expressed indignation that a major issue concerning society be dealt with in almost total secrecy in the form of an amendment. All this whilst considering it useful to organise a commission and long debates concerning the wearing of veils and religious objects in schools.
At the beginning of December 2003, the great majority of people who did not follow the news closely, even cultivated people involved in psychotherapy or personal development, had not heard of this project, or if they had, only very vaguely, and they had no idea of where it was leading.
How can this media blackout be explained? When can something be called deliberate misinformation? Especially with regard to psychological blockages concerning "the sect theme", to incompetence and to the inability to do the work of a journalist, to point out and explain information.
Noteworthy, for example, is the case of the weekly publication Marianne which shortly after the vote on the amendment on psychotherapy came out with a substantial article in one of its editions on the plague of sects. It is difficult to describe this article as anything other than a remarkable show of vulgarity, as it put together totally unrelated information in order to falsely construct an argument on how sectarianism was running a rampage through the minds of the French. Sects may stagnate or regress as organisations, but in a still more insidious fashion, the newspaper Marianne explains, they may be on the point of triumphing, in a Machiavellian fashion, over the laymans valiant antibodies that had until now protected society and our minds. Society is therefore on the point of losing its sanity and of being devoured by sectarian ideologies which are particularly prevalent in . . . yes, guess where . . . of course, in the domain of psychotherapy. Fortunately a courageous deputy has just submitted an amendment . . . In fact this information, which was not a main item in this edition of Marianne, but which appeared in a few lines at the end of one of the articles, was, to the alerted reader, the key theme around which the whole of the weekly edition seemed to be written. It is difficult not to notice that the article is totally circumstantial. Reader-manipulation replaces debate and honest opinions. It is a precise example, and most astonishingly so, of the influence of the anti-sect networks within the press, and what probably constitutes the main danger of this network is its capacity to extract itself from the usual left-right divisions in order to short-circuit all free debate.
There was an even more blatant and brutal example of manipulation in a documentary on the TV channel France 2, November 19th 2003. The psychotherapy journal SNPPsy wrote, "this documentary is a biased piece of reporting, an anthology, manipulating public opinion." You can read for yourselves the request for a right to reply addressed to France 2 from the SNPPsy.
In my opinion this manoeuvre clearly shows that behind the surface politeness towards psychotherapists, who were received by Dr Accoyer and the Health Ministrys councillors, the "ultras" who serve Dr Accoyer still hope not to change one comma of their amendment. They continue to unscrupulously motivate their politically controlled men in the media. Is it really necessary to hold a courteous dialogue with a man who continues unperturbed as he ties the hangmans knot in the rope that you will be hanged with? The psychotherapists unions are doing their best no doubt, but I hope they do so without too much naivety. Dialogue will perhaps end up winning anyway, with the possibility that other players from unexpected intermediaries may arrive.
All this is nevertheless extremely serious as, thanks to the label of sect, forms of treatment for certain social problems have already been denounced. Denounced by the liberal media who are deeply reactionary and participating in an atmosphere of social cleansing with all political orientations in one melting pot.
It is important to stress that beyond the media, there is also a remarkable resignation amongst French intellectuals. Not one voice has been raised in the last 20 years against the consequences of the influence and abuse engendered by the fight against sects in society. Careerism and collusion with the media, a generation crisis, stagnation in intellectual circles, serious disconnection with what the concrete problems in daily life are, outmoded ideas of what the laity is. These are probably the determining elements of this scandalous attitude where cowardice and blindness prevail.
Finally, in considering these people of responsibility (who sometimes have too comfortable a disassociation from responsibility) we can only be struck by their inability to organise themselves in order to defend the people most concerned: the psychotherapists, the specialists in personal development, the specialists in alternative medicine and in natural healthcare and the countless people who use these techniques. Perhaps this is the most worrying sign in this situation, leading us inevitably to pessimism as to the future and the possibility of a resistance to this normalisation process. I emphasise that what is described here reveals above all that France is confronted with a very specific cultural crisis.
Situation in February 2004 after the Senates vote:
From December 2003 (date of the publication of this article), to February 2004, a strong and unexpected reaction swept across French society. Users of psychotherapy, open-minded psychoanalysts, psychologists and psychiatrists came together to warn of the dangers of the proposed Accoyer Law and projects aimed at bringing psychotherapy under State control via a "medicalised" psychiatric system.
Shortly before its passing through to the Senate, reports in the mainstream media, on radio and television, forced as they were to deal with the subject, albeit in an often simplistic and distorted manner, nevertheless allowed opponents of the project to send out an alert, especially on the Internet. It was the biggest public reaction the Senators have seen in years, such was the anxiety amongst voters caused by the Accoyer project.
The government came under pressure and finally decided to abandon the initial Accoyer amendment. However, they did not really have any alternative project to put forward and remain very hostile to psychotherapists. Everything had been conducted in a climate of nervous improvisation.
The most ardent and determined opponents came together very quickly and formed the group Coordination Psy, thus regrouping psychotherapists who are not psychoanalysts and also bringing together the Freudian Jacques-Alain Miller school of psychoanalysts, all of which are represented by JAM.
Many psychoanalysts, scornful as they are of anything that is not strictly psychoanalysis, consider this alliance to be unnatural, despite being unable to suggest an alternative. A number of them were against the project, others were for it, on condition that psychoanalysis be a recognised therapy and that their competitors therapies be eliminated by the new law.
The government sought to divide people by negotiating separately with the psychoanalysts who were not within Coordination Psy. They satisfied the psychoanalysts by excluding them from the initial ruling.
Finally, the result was a vote by the Senate of an amendment originating from the Government, which is particularly badly written and no longer relates to the Accoyer project. It foresees the obligatory registration of psychotherapists at the Prefecture, that psychoanalysts will be sought via their professions directories, but that general practitioner doctors and psychologists are relieved of any registration at all! Absolutely no qualifications in psychotherapy will be required. Application requirements are foreseen although its difficult to see upon what they will be based. Basically its a text that is as confused as it is useless.
In reality the informed observer will understand that this improvised and circumstantial text will be replaced again once it passes before the National Assembly in April. Dr Accoyers supporters, harshly shaken as they were by this unexpected resistance to their manoeuvres, are trying to reorganise in order to support a new version of the Accoyer project. So vigilance remains more than ever necessary.
Coordination Psy supported, unsuccessfully, an amendment in the Senate by Mr Gouteyron who was suggesting the creation of a governmental organisation divided into four departments (psychology, psychiatry, psychoanalysis and psychotherapy) that would have dealt with ethical questions in the domain of psychotherapy. It would have been the mouthpiece and council to the government for all proposed legislation.
Coordination Psy has decided to create an association based on this idea. It already brings together all psychotherapists and attempts to link up with as many psychoanalysts as possible, as well as psychologists and psychiatrists. A difficult but essential task that will consolidate the representatives of the Coordination in order to discuss the situation with the deputies before April.
In fact, just having one recognised non-governmental public interest organisation that brings together the maximum amount of professionals and gets them used to talking to one another, would be acceptable.
It is essential to reject any public organisation where the representatives are nominated by the State (as in the Gouteyron amendment) which could once again be vulnerable to manipulation. It would appear that Coordination Psy has understood this problem and is heading in the right direction by creating this association.
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