Paola Juan

Thèse sous la co-direction d'Irene Becci, UNIL et Aude Fauvel IHM, CHUV-UNIL

Supervision de Prof. Tanya Luhrmann lors de séjour de mobilité à Stanford, US (2023)

Résumé

This research explores caring relationships and affects at the interface between psychiatric users/patients, communities, the voluntary sector, and healthcare spaces in the Swiss Alps. It looks at how forms of freedom emerge in spaces where constraint is so much present otherwise. How are freedom and constraint entangled in these caring relationships, and how do they participate in shaping divergent ideological views regarding what constitutes good care for people diagnosed with mental illnesses? What does freedom mean in relation to madness, psychiatric care, and forms of constraint? This research delves into these questions in relation to a specific philosophy of care developed within a psychiatric institution in a deeply Catholic region. Heterogeneous visions of care and freedom are explored in relation to local catholic, anarchist and counter-hegemonic cultures, as well as legal, medical and users/patients’ perspectives. 

The project is based on participant observation in services based on “humanistic” forms of healthcare and non-biomedical principles for recurring psychiatric users/patients, often diagnosed with forms of psychosis. The field is centred around a public open-door psychiatric hospital that doesn't use physical restraint, and around smaller structures surrounding this institution: associations, psycho-education programmes, artistic spaces for recurring patients and their families. 

This research offers new insights regarding the way relations of care, love, and dependencies between patients in psychiatry, their families, and psychiatric services come to be organized around a space that inherits such practices and traditions. It shows how spaces of freedom emerge within these relations of dependency, generally centred around psychic and social suffering, and how the very definition of freedom, and what the notion entails, differs depending on the positionality of each actor in this web of affective territories. The dissertation explores different facets of the term freedom that become visible on the ethnographic level. These views form a typology of some sort. The dissertation shows how they depend on the social and affective structures in which one is enmeshed, and how they lead to different consequences regarding what good care consists of. They can thus become contradictory in some instances but are always created in relation to each other.