Paris, 16th May 09: Protecting the public from the State

Fifteen people met in Paris on Saturday 16th May, to sit together in a room and begin a new conversation. English speakers from London, Belgium, Bordeaux, Rouen, and of course Paris gathered at the University of Chicago on rue Thomas Mann to listen to five people speak about the British Experience of state regulation of the psys. All of us practise in some form or another – about half of us were psychoanalytically inspired, many were also psychologists, one a psychiatrist, one or two had done their training in the UK, and there was even a member of the UKCP present. Many work independently running their own private practices, and most were also linked in some way to state or voluntary projects. One was new to the field, nearly finished training, and wanted to know how the regulatory revolution was going to affect her future work.
There is something very precious about speaking in another country – shifting through subtle changes of culture and a different way of life often brings a change of perspective. So, first, I would like to thank Victoria for the invitation, and to thank the people who gave up a Saturday afternoon to hear about the British experience. The event was an initiative of the Simply Speaking section of a small group of English Speaking practitioners called Healthwise, Paris. - a group that knows how difficult it can be to navigate through the twists and turns of another culture’s systems.

The afternoon session was divided into 5 short presentations – Victoria opened up by reminding everyone of the events in France. Bernard Accoyer, a medical doctor and member of the Union for a Popular Movement, the conservative Party of which Jacques Chirac is a member, introduced legislation to restrict the practice of psychotherapy to psychiatrists and clinical psychologists. Although the bill was passed without debate, and apparently without objection in the Assembly (it was business done in the middle of the night!) there has been a mixed but on the whole vociferous public response since which has reversed many of the restrictions he tried to impose. [see The Pathology of Democracy edited by Jacques-Alain Miller with Bernard Burgoyne and Russell Grigg, Karnac 2005)

Victoria drew attention to the subtleties of language that become more obvious to non-native speakers living in another’s land and was able to maintain a pun through much of the afternoon’s discussion. What is the difference between a hole and a whole? This was a theme that Jean-Pierre Klotz later elaborated. She thought that Accoyer had made a fundamental mistake by drawing the public’s attention to what he called a hole in the law, and that this had boosted a move towards creating the state system as whole. Her underlying point was the rise of State Intervention in the most private aspects of life: who is responsible for who we speak to, she wanted to know.

This question nicely framed Roger Litten’s presentation. Roger works as a counselling psychologist in the British NHS and is well placed to comment on the massive changes in the context of the various ‘psy’ practises sparked by Government policies over the last decade. Not only is there the IAPT (Increased Access to Psychological Therapy) programme which promises computerised CBT in every local Doctor’s surgery, but also the Evidence Based Approaches of NICE (the central planning agency – National Institute of Clinical Excellence) which require psychotherapists to greet new clients with the words – this has no evidence to support its efficacy! Then there is the attempt to codify and equalise NHS jobs via Skills for Health (A Department of Health initiative that collaborates with Business ideology to create a skilled workforce rather than an educated population), and finally the HPC – a giant database that purports to regulate the character and behaviour of all the new ‘skilled’ health professionals.
Elizabeth Gurnicki (Clinical psychologist, with a Freudian Field DEA) posed the question: why do our European governments want to regulate and monitor the practice of psychotherapy – surely not for the sake of the economy. She reflected that national identities and ideologies were less attractive since the totalitarian catastrophe of the 1940-45 war, and that since the fall of the Berlin wall choice in approach to the economy was now effectively redundant. This leaves those of us in the rich world with little more to do than develop more riches, to manage mass consumption, and to control the population flow. This was interesting, as it puts politicians more in the role of managers and makes governing more a question of governance. Couple this with the developments in cybernetics and management-information-systems, and we have a strong move towards Big Brother.

This helped to situate the topic I had chosen to speak about: the Fitness to Practise (FTP) process as played out in the Health Professions Council. The HPC is a new invention and a flag-ship of New Public Management in Britain. It is staffed entirely by administrators, with a handful of professionals invited on to the periphery to deal with tricky problems of practice as and when they arise. My observations of some FTP hearings had easily discovered the anomalies that such an approach throws up. The lack of sensible experience and attention to the realities of practice tend to mean that FTP hearings resemble the figments of Kafka’s imagination (see HPCWatchdog.blogspot.com).

Bordeaux psychoanalyst and psychiatrist Jean Pierre Klotz carefully sketched the important differences between British and French culture, and reminded us of the tendency of centralised politics and generalisations to ride rough shod of these essential details of everyday life. He argued that the French revolution gave them an experience that makes it more difficult to forget why the State and the Citizen should be held as separate entities. The French culture pays attention to the space between the two which effectively protects the citizen from the overbearing power of the state. The French state is created and upheld by law, and the individual is protected from it by human rights. This essential space is precisely what is being removed by the British reliance on regulation. Regulation does not function in the same way as the law. It is, in a funny way, the inverse of the law.

Victoria summed up with a question about the way that Europe as an idea was changing the context for us all. It is providing some people with an opportunity to quietly invent what they call 'European standards' from which to establish themselves as the reference point to control. See project europsy for a glimpse of that new venture.