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Introduction

Introduction: The Revival of Francophone Research on Justice and Mental Health

Camille Lancelevée, Caroline Protais, Tristan Renard et Sébastien Saetta
Cet article est une traduction de :
Introduction : « Un renouveau des recherches francophones sur les relations entre la justice et la santé mentale » [fr]

Texte intégral

1In France, the relations between the justice system and psychiatry first attracted attention among scholars of the social sciences in the 1970s. At that time, these relations were studied mainly from one particular angle: that of the encounter between judges and psychiatric experts, often in a criminal court, as so often depicted in the media, in books and on film. With Bernard Tavernier’s film The Judge and the Assassin1 as a cinematographic reference, the French media displayed a frequent and recurring interest for cases involving mentally disturbed individuals who had committed acts deemed especially “shocking” by public opinion. The media exposes the details of these crimes, but also expert decisions considered as implausible or contradictory, often out of step with public horror at the facts exposed and with the victims’ need for reparation.2

2In the social sciences, the reference in this area is Michel Foucault, who argues that in its role as an auxiliary of justice in the 19th century, psychiatry found a fertile ground for imposing its knowledge and justifying its hold over the realm of “human folly”. Foucault’s critique also extends to the epistemological foundations of forensic psychiatry. In its encounter with justice, expert psychiatric knowledge is presented as “grotesque”, “ubuesque” (Foucault, 1999, 12), below the epistemological level of psychiatry, despite – until recent times in France – holding power of life or death over defendants in the dock. It invents the criminal to be punished on the basis of moral bias dressed up as science. Analysing the case of Pierre Rivière,3 Michel Foucault and Robert Castel (Foucault, 1984) examine how experts construct their social legitimacy. Once expertise has been “established”, it becomes the “establishing” force of a socially, or even ideologically, constructed reality (Castel, 1985).

3The work of Michel Foucault and Robert Castel opened up a fertile new field of research on forensic psychiatry. An initial wave of research, building on the work of pioneers and based on the analysis of series of expert assessments (Montandon, 1978; Théry, 1985; Bonis (de), 1986; Thys, Korn, 1992; Laberge et al., 1997) was followed, from the early 2000s, by studies that applied more diverse methods and/or theoretical stances (Bensa, 2010; Bourcier, Bonis (de), 1999; Dumoulin, 2013; Chaperon, 2013; Fernandez et al., 2011; Giuliani, 2013; Holstein, Baudouin, 2015; Peerbaye, 2001; Pélisse et al., 2012; Protais, 2013, 2015, 2016a; 2016b; Saetta, 2012a). A further set of studies focused more generally, and in a historical perspective, on the encounter between psychiatric expert and judge (Renneville, 2003; Guignard, 2010). This literature points up several issues underlying the relationship between the justice system and the world of psychiatry.

4First, it reveals that relations between judges and experts have become much closer, and that the experts’ role has changed, assuming an ever greater importance in legal proceedings (Bensa, 2010; Guignard, 2010; Saetta, 2011, 2012b, 2013; Saetta et al., 2010; Protais, 2011). These authors show how the experts’ mandates have evolved, shifting from a mission of expert assessment initially centred on the question of mental irresponsibility, to a broader “criminological” mission to assess the defendant’s dangerousness, fitness for penal sanction, capacity for rehabilitation and moral responsibility. This general transformation is expressed not only in the rules defining the expert’s mission,4 but also in the way forensic psychiatrists undertake their work, gradually setting aside the question of mental irresponsibility to encroach, in some cases, into the field of criminology with a focus on the dangerousness of individuals (Protais, 2016a).

5This literature also continues to document the power relations between judges and psychiatric experts, while pointing up their complexity. Applying the approach developed by Laurence Dumoulin (2000, 2007) to analyse the relations between judges and legal experts, Sébastien Saetta (2011) shows that the former use the reports produced by the latter as a reservoir of arguments to produce a “judicial truth” which, for other authors, is at least partly founded on a “moral construction” of the defendant (Fernandez et al., 2011). Far from seeing “the power of experts” as an unequivocal force, these sociologists analyse the way in which specialist knowledge “challenges the monopoly of law in the construction of justice” (Dumoulin, 2000), providing judges with a set of resources, but also of constraints.

6Last, challenging the epistemological status of expert knowledge, this literature demonstrates the hybrid nature of this knowledge (Callon, Rip, 1992), combining not only the expert’s values, but also judicial representations and certain ethical and epistemic norms laid down by the profession. For example, Caroline Protais (2016b) shows that expert report is based on evolving “repertoires” of arguments (Lascoumes, Bezès, 2009; Barbot, Dodier, 2014), imbued with these three levels of discourse. Moreover, through their complex interplay of recurrent interactions, experts and magistrates mutually enhance their respective knowledge and representations (Guibet-Lafaye et al., 2016).

7Stepping aside from this original scenario of the encounter between expert and judge while drawing upon the research insights it has engendered, this issue of Champ pénal aims to broaden the perspective to encompass a research field that has emerged in France over the last two decades and which focuses on the relations between the justice system (understood as the actors responsible for exercising judicial power and those subject to judicial sanction) and the mental health system (understood as a “social world” [Bucher, Strauss, 1992] of professionals whose main object of investigation is the psyche of the person(s) receiving care). Indeed, the relations between justice and mental health are not limited to forensic expertise alone.

8To begin with, the role of mental health care professionals has broadened considerably. They intervene repeatedly throughout the judicial process, from initial police custody to early prison release decisions, from supervision orders to the pronouncement of child protection measures.

9At the same time, justice professionals are occupying new territories, such as psychiatric hospitals, previously dedicated to mental health care, through their role in the judicial supervision of involuntary placement. Conversely, hospital psychiatric services have been available in prisons since the 1980s. Growing numbers of mental health care workers are employed by the prison services, and care provision for patients under compulsory treatment orders is increasing.

10Last, the relations between justice and mental health are not limited to encounters between forensic psychiatrics and magistrates or judges, but involve a wide range of actors at different levels, who cross paths occasionally or on a regular basis (prison guards and psychiatric nurses for example), in varied contexts (assessment of a defendant, monitoring of medical practices, prison healthcare provision, public lectures or conferences, etc.) and whose relations, attitudes and practices may be transformed as a result, be it at local or more general level.

11The six articles in this issue illustrate the broad variety of research fields and of approaches deployed. This pluralism is both disciplinary, drawing upon anthropology, demography, history, sociology and political science ; and methodological, applying both quantitative and qualitative approaches based on wide-ranging empirical evidence (archives, observations, interviews, criminal records, expert assessments, etc.). Presenting these texts together reveals the interest of defining the contours of a research field that focuses on the meeting points between mental health and justice, and that refuses to be subsumed under the label of “criminology” in the sense of a discipline whose object is the phenomenon of criminality and the responses it elicits. On the contrary, this research field both draws upon and contributes to the abundance and diversity of research avenues explored by the social sciences and humanities.

12While the inductive approach adopted in these articles offers limited scope for generalization, juxtaposing these different fields will, we hope, reveal common perspectives and, by suggesting approaches for analysing the developments jointly affecting the worlds of justice and mental health, deepen our understanding of an area of public action which exerts a powerful hold over individuals. The first perspective concerns mutual influences in the institutional remodelling of the two fields of intervention charged with the management of deviance (understood here as the transgression of social and legal norms whose boundaries are themselves an object of debate between justice and mental health). The aim is to explore the boundaries and lines of continuity, but also the areas of separation between these two institutions via a central question on their co-dependent evolution and their growing hybridization. The institutional arrangements point to the emergence of new hybrid rationales. The second perspective concerns the professional arenas in which these institutional changes enter practical experience in the form of coordination and organizational approaches, relations of power and autonomy, but also knowledge development and legitimation. The aim here is to focus attention on the way in which institutional changes reshape professional groups, both from within (emergence of new “professional segments” or new “professionalisms”) and across different groups (division of labour, delimitation of professional boundaries). The third approach concerns the effects of these changes on the people served by these two institutions. How does their interaction shape the outcomes and trajectories of the people under their supervision ? Here, the aim is to examine the forms of subjectification produced at the intersection between justice and mental health, and to study the social function of these two sectors of public action from the perspective of individual life trajectories.

1. Institutional remodelling: between tighter security and promotion of rights

13Over the last few decades, the health and justice sectors have been reshaped by profound social and societal transformations that have altered the relationship between them. Two of these changes are especially salient: first, a trend that analysts refer to as the “security revolution” (révolution sécuritaire) or the “punitive shift” (virage punitif); second, a movement towards greater openness to the outside world (désenclavement) of prisons and psychiatric hospitals (Darley et al., 2013).

1.1. Mental health and justice in a “security tornado”?

14The term “security tornado” (tornade sécuritaire) refers to the spread of a new “punitive common sense” that emerged in the United States and then spread to Europe, France especially, in the last two decades of the twentieth century. This shift took the form of a “dismantling of the welfare state and a criminalization of poverty against a backdrop of growing economic disparities and the spread of social insecurity” (Wacquant, 2010, 138). France, for its part, underwent a “security revolution” (Bourgoin, 2013) which strengthened during the 2000s, qualified by some as a “security frenzy” (Mucchielli, 2008), in which a whole series of measures particularly detrimental to individual freedom were brought into law.

15One of the first symptoms of this revolution was a sharp rise, a “boomˮ even, in prison populations (Carrier, 2010, 6). In France, the imprisonment rate started increasing in 1975, rising from 50 per 100,000 in 1974 to 80 per 100,000 in 1985 and 100 per 100,000 in 2010 (Raoult, Harcourt, 2017). This growth coincided with a decrease in the number of psychiatric hospital beds, which fell over the same period from 120,000 to 55,000 (Coldefy, 2007). Following on from Bruno Aubusson de Cavarlay (2008), Sacha Raoult and Bernard Harcourt analysed the parallel evolution of imprisonment and hospitalization rates over a period of 150 years. They found a troubling and consistent pattern: a constantsymmetry of imprisonment and hospitalization rates, already identified in 1939 by the British physician Lionel Penrose (Penrose, 1939). While the authors refute the hypothesis of a simple population transfer,5 prison observers have issued warnings about the “worrying phenomenon of interconnected flows between the two institutions” (Fassin, 2015, 84; Bérard, Chantraine, 2008). The large proportion of prisoners with psychiatric disorders,6 the growing tendency to consider individuals affected by mental illness as penally responsible (Protais, 2016a, 2016b) and the emergence of rapid sentencing procedures which leave no time for detecting mental health issues among the massive numbers of offenders receiving custodial sentences (Mucchielli, Raquet, 2014), suggest that a part of the hospital population has been transferred to prisons.7 The article in this issue by Camille Allaria and Mohamed Boucekine, who conducted the first quantitative survey on this subject in France, sheds light on one facet of the process. With the aim of understanding the imprisonment risk for homeless people judged in immediate appearance and who mention mental health problems, the authors show that people living in insecure accommodation or in the street and who also appear to have severe psychological difficulties are almost twice as likely to be imprisoned as others.

16This tendency to imprison people with mental disorders has developed in parallel with an increase in psychiatric provision for prisoners.8 Mental health care workers have thus been transferred from hospitals to prisons, to the point, perhaps, where prisons are now expected to provide a sort of protective asylum (Lancelevée, 2017). In this issue, Caroline Protais examines the development of an experimental prison-based facility designed to “rehabilitate” drug users and which illustrates this transformation of the prison into a place providing care. She shows how a culture of physical and mental health can be promoted in prison, in this case through the adoption of care practices by the prison staff. The prison is becoming a hybrid institution, serving both to punish and to treat. We can thus draw conclusions for France similar to those presented in this issue by Lorna Rhodes for the United States, namely that the prison system is starting to resemble a general hospital as described by Michel Foucault: a low-cost institution serving a heterogeneous population.

17This “punitive shift” is also characterized by the development of a “post-disciplinary” penal system, in which the normalization and rehabilitation objective is no longer central (Carrier, 2010, 8-9). The aim is not simply to punish and imprison more, but also to punish differently. This shift is approached via a “new penology” (Feeley, Simon, 1992) that focuses on the management of population groups deemed to be at risk, or via “actuarial justice” (Mary, 2001; Harcourt, 2011). While these concepts were initially forged in the United States, authors have shown that they are also applicable, notwithstanding certain national singularities, to Canada (Quirion, 2007; Chantraine, 2006), Europe (Mary, 2001), and even France (Cliquennois, 2006; Gourmelon, 2012). The emergence of a series of security and risk management tools such as electronic tagging (2005); social and judicial supervision (1998); social and judicial surveillance (2005); creation of a sex offender database (2004, 2005); and, as the “pinnacle” of this “security frenzy”, supervised confinement9 (rétention de sûreté) (2008) (Wyvekens, 2010), all provide evidence of this evolution in France. Along these same lines, on the European continent, Belgium, Switzerland, Italy and France are also witnessing a “renewal and transformation of social defence” (Van de Kerchove, 2010, 479), and the return of a doctrine of this type in its original form, i.e. focusing more on neutralization than on rehabilitation.

18Under this “new penology”, the role of the mental health sector appears to be changing. For example, supervised confinement (retention de sûreté) is meant to take place in a “secure socio-medical-custodial facility”, whose functions include “providing continuous medical, psychological and social care aiming to reduce the dangerousness of the individuals concerned so that the confinement measure can be lifted” (articles 706-53-13 and R.53-8-55 of the French Code of Criminal Procedure). Likewise, the multidisciplinary prisoner assessment committee (commission pluridisciplinaire des mesures de sûreté) responsible for assessing offenders one year before their release includes a forensic psychiatrist and an expert psychologist to assess the prisoner’s dangerousness and risk of reoffending, and whose opinion is decisive. This practice is not specific to supervised confinement; therapists and/or forensic psychiatrists or psychologists are habitually involved in most of the procedures presented above (see Gautron et al., 2017 for compulsory treatment orders). This is precisely what leads Claude-Olivier Doron (2010, 296) to assert that “care” has become “the central component of a system of assessment and differentiation of individuals throughout their imprisonment and after their release”. In addition to its original functions in the normalization process, the notion of care now serves to assess subjects on a continuous basis, to monitor their attitudes, their evolution, their potential for reoffending, thereby becoming “a bestower of knowledge that can be used to revise detention and surveillance measures, or to extend them indefinitely” (Doron, 2010, 299).

19In this issue, the articles by Aude Leroy, Tristan Renard and Caroline Protais, which focus, respectively, on the place of psychiatric experts in prison, the creation of new systems for managing sex offenders, and the development of a prison program for drug users, all provide insight into the role of “care” and psychological assessment in the context of this “new penology”. While Aude Leroy studies the centrality of psychiatric assessment in sentence reduction decisions, Tristan Renard and Caroline Protais analyse systems that are strongly underpinned by an ideology of risk management and prevention of reoffending.

20This “security tornado” also appears to be blowing specifically through the field of mental health. Robert Castel identifies a major shift in this field and the emergence of a “post-disciplinary” order (Castel, 1981, 1983) with three main directions of movement: a return to medical objectivism and scientific positivism; the promotion of new expert technologies for managing populations deemed problematic; and the development of psychological intensification techniques beyond the boundary between normal and pathological (Castel, 1981). The expression “security psychiatry” (psychiatrie sécuritaire) was also coined in the 2000s by professionals and campaigners.10 It is defined as a shift in the field of psychiatry characterized by an “increase in measures of restraint, a sort of amalgam between mental disease and dangerousness, between 'care' and medication at the expense of relational support”,11 as revealed by the activity reports of the departmental committees for psychiatric care (Coldefy, 2007, 205-209) which show an increase in involuntary hospitalizations between 1997 and 2003).12 While a lack of survey data prior to 2000 makes it impossible to confirm the hypothesis of a long-term increase in practices of solitary confinement and restraint, the proportion of patients placed in solitary confinement has risen in recent years from 6.6% in 2011 to 7.2% in 2013 and 8.3% in 2015 (Senon, 2016).

1.2. A democratic departitioning of mental health and justice?

21This issue and some of the articles it contains describe a different set of changes affecting the justice and mental health sectors and which include the development of ambulatory care, the democratization of rights and their recognition as fundamental, and the questioning and monitoring of restraint and confinement procedures.

22A first aspect of these changes in the criminal justice and psychiatric sectors is the development, over recent decades, of alternatives to confinement (Darley et al., 2013). In the criminal justice system, this includes the introduction of community service (1983), electronic tagging (1997), and a new form of probation (contrainte pénale; 2014). Aude Leroy’s article shows that sentence reduction has become a “politico-legislative watchword”. In fact, a large and growing number of offenders now serve their sentences in open custody (161,400 in open custody versus 71,710 in secure custody on 1 March and 1 July 2019, respectively), with some authors speaking of a “continuous upsurge in non-custodial sentences” (Bellebna et al., 2014). In psychiatric care, notable changes have occurred since the late 1960s and early 1970s, with the development of outpatient services and the decline of the psychiatric hospital (Henckes, 2015). Local initiatives are emerging here and there, as in the 13th arrondissement of Paris (Henckes, 2015), or at the Vinatier hospital in Lyon (Eyraud, Velpry, 2012). More recent initiatives include services centred on the notion of “recovery” (“Emilia”, “Un chez soi d’abord”), mutual support groups (Groupes d’entraide mutuelle, GEM), crisis care centres (Centres d’accueil et de crise, CAC), and mobile teams, all designed to offer an alternative to medical care and hospitalization.

23Furthermore, hospitals and prisons are now overseen by a wide range of external bodies. These include, since 2008, the Controller General of Prisons (Contrôleur général des lieux de privation de liberté, CGLPL), in charge of inspecting prisons and detention centres and who handles a growing number of prisoners’ complaints (Durand, 2014); liberty and custody judges (juge des libertés et de la détention, JLD), instituted by a law of 200013 and who, since 2011, rule on compulsory treatment orders; the Human Rights Defender (Défenseur des droits) who receives around 4,000 files from prisoners each year (Défenseur des droits, 2013); the National Health Authority (Haute autorité de santé, HAS) in charge of certifying health facilities, and notably their respect for patients’ rights. These bodies are complemented by a number of supra-national organizations, such as the International Observatory of Prisons (OIP), which has been monitoring respect for prisoners’ rights in France, Argentina and Belgium since 1990; the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT, 2017; Snacken, 2014); and the Convention on the Rights of Persons with Disabilities, adopted in 2006 by the General Assembly of the United Nations and which is opposed to the confinement of persons living with a mental illness (Béal et al., 2018).

24This recognition of fundamental rights is accompanied by the development of a judicial framework and the definition of legal principles, as manifested in 2016 by an article of law defining restraint and solitary confinement as practices of last resort and requiring each establishment to keep a register. The judiciary is also becoming anchored in prisons (Rostaing, 2007) and in psychiatry, notably via the role of the liberty and custody judges who have the power to ratify or overturn compulsory treatment orders. In this issue, Cristina Ferreira, Delphine Moreau and Ludovic Maugué explore how the “deprivation of liberty for purposes of assistance” emerged in response to this process of recognition of fundamental and judicial rights. In 1978, to bring the country into line with European law, Switzerland adopted a law to abolish legal administrative confinement and to guarantee legal rights to the individuals concerned.

25These contradictory developments, oscillating between security concerns and the promotion of rights, can be analysed within a framework where security exercises a form of precedence over democratic progress. In this perspective, applying the concept of “post-disciplinary prison”, Gilles Chantraine (2006) explains that “new ideas, sometimes born out of external combats and dissenting claims become embedded in a system because this system succeeds in expressing these new ideas in terms of its own rationality, which thus remains unchallenged”. The authors of a feature on imprisonment (Darley et al., 2013, 17-20), conclude with an overview of this perspective whereby the development of ambulatory measures reflects not so much a process of opening as a widening of the penal net; they argue that the lifting of restraint and/or the improvement of living conditions for certain groups of prisoners is counterbalanced by more secure conditions of imprisonment for others; the greater comfort and respect for prisoners’ rights in new prisons makes up for the absence of prospects for rehabilitation. This same perspective is found in work on psychiatry, where “ʻpost-asylum’ psychiatry […] still represents a form of social control, more diffuse and less visible, but no less real, via outpatient follow-up structures, neuroleptic drug treatments, and potential and effective recourse to involuntary hospitalization” (Moreau, 2008).

26However, in the field of psychiatry, as in that of justice, the main effect of these contradictions is to produce complex movements of “institutional disengagement and re-engagement” (Rostaing, 2009) and to create tension between different types of norms.14 These contradictions become especially flagrant when the focus shifts to the professional arenas: normative tensions affect the daily work of mental health care and justice professionals and modify the relations between these two categories of actors.

2. A restructuring of the professional arena

27Far from the essentialist standpoint which sees “mental care” as the left hand of the state and “justice” as its right hand, these two worlds interact in highly diverse contexts (prisons, courts, hospitals, probation, ambulatory care) that represent very varied working conditions and produce a broad array of positions within the professional groups as to how this division of labour should be approached and how professionals should exercise their role. In the restructuring of the professional arenas, this diversity must be taken into account in order to grasp the ambivalences discussed above. The challenges are of several types: some concerning the division of labour and the negotiation of professional boundaries; some relating to professional autonomy constantly challenged by rationales of conflict or cooperation; and others linked to the emergence of hybrid knowledge and the rationales of professional segmentation that ensue.

2.1. Challenges surrounding the division of labour: collective construction and practical realization

28The institutional relationships between the actors of justice and mental health give rise to numerous dilemmas (Darley, Lancelevée, 2016; Velpry et al., 2018) resulting from the contradictory demands that may be placed upon them, and the forms of “institutional schizophrenia” that this entails (Mouhanna, 2016). If not thwarted by material constraints, be it staffing shortages (Gautron, 2016) or increased bureaucracy (Milburn, Jamet, 2014), the desire to “humanize” the treatment of patients or prisoners very often clashes with demands for security and control of dangerousness.

29Professional groups may be affected by public policies and their potential perverse effects. For example, analysing the effects of introducing hospital staff into French prisons, Marie-Hélène Lechien highlights the unanticipated effects of a penal reform that has reactivated “systems of entrenched antagonism that exercise a structuring effect on care provision for the most disadvantaged working-class sections of the population” (Lechien, 2001, 15). Jean Bérard and Gilles Chantraine point up the growing numbers of mental patients who now find themselves in prison to highlight the “suffocation of therapeutic care through a penal system of control and maximum security” (Bérard, Chantraine, 2008, 94). That said, professional groups can act to control the effects of public policies, as in the case of the prison psychiatric care units (Unité hospitalière spécialement aménagée, UHSA), developed in association with psychiatrists to minimize the risk of stigmatization (Contrast, 2015), or that of the prison health professionals who have engaged with the problem of sex crime in France to defend a professional stance based on a psychodynamic theoretical approach (Gourmelon, 2012). In a similar vein, the consequences of institutional changes on professional stances are highly diverse, as shown by the typologies of prison’s healthcare workers (Bessin, Lechien, 2000; Milly, 2001). Last, the changes specific to one professional group may also affect others. For example, Caroline Protais shows how the knowledge of forensic psychiatry has increased the tendency of magistrates to consider mental patients as criminally responsible (Protais, 2016a, 2016b). These various examples clearly show that the relations between justice and mental health cannot be seen purely as simple logics of “instrumentalization” or “contamination”.

30The division of labour between mental health and justice thus fluctuates across different contexts and raises a “boundary problem”, an area of uncertainty rather than a clear frontier (Ost, 1997; Abbott, 2016). This border zone is very concrete, materialized in the places where the various professionals operate at the intersection between these two worlds. For example, Lechien (2001) describes the arrival of health care workers in prisons as part of a “redeployment” strategy (Lechien, 2001), taking over premises previously occupied by prison staff. For these health care personnel, the symbolic power play associated with this redeployment took the form of a practical denunciation of premises deemed unfit for purpose (Young, 2016) and seen as an “assault” on their professional sensibilities (Lechien, 2001, 16). These symbolic battles are also materialized in the circulation of personnel within prison buildings. In response to the dynamics of differentiation (disciplinary, psychiatric) that emerge, the various professionals involved feel the urge to take control over the organisation (Lancelevée, 2016).

31The frontiers are not only physical, but also moral, with the new division of labour challenging the positioning of each group in the prison environment. Christopher Young points out that “therapeutic activities challenge the identity and position of prison staff by placing them under the scrutiny of newly arrived medical personnel and reducing the symbolic distance between themselves and the prisoners” (Young, 2016, 61). These new frontiers within the prison system have thus led to a disqualification or depreciation of certain professional skills, notably those of prison guards (Bessin, Lechien, 2001; Lancelevée, 2016; Young, 2016). Conversely, Caroline Protais analyses in this issue how, through the acquisition of certain care-related skills, the presence of prison guards in a care setting may serve to redefine their profession and their relations with prisoners.

32This issue offers new insights and gives examples of the frictions between the two institutions at the most grass roots level. Through observations on multiple levels, the article by Cristina Ferreira, Delphine Moreau and Frédéric Maugué examines how the roles of psychiatrists and judges have been redefined over recent decades, and how this affects their daily interactions. Tristan Renard, for his part, reveals how the work environment gives rise to specific cross-cutting skills that are shared by the different professional groups. He also shows how practical work contexts generate habits that reveal the porosity of professional frontiers.

2.2. Conflict and cooperation: professional autonomy under threat?

33These issues surrounding the division of labour are linked to a power play between the various professional groups, each seeking to defend its individual autonomy. These conflicts of authority run through public policies, notably those seeking to develop psychiatric hospitalization in the prison environment (Bellanger, 2014; Contrast, 2015; Lancelevée, 2016) or healthcare in prison more generally (Bessin, Lechien, 2000; Milly, 2001, among others). The psychiatric hospital is also a jurisdictional “battleground” between health professionals and the justice system: the article by Cristina Ferreira, Delphine Moreau and Ludovic Maugué in this issue traces the development of relations between justice and mental health in the context of deprivation of liberty for purposes of assistance. More generally speaking, the articles in this issue reveal how the scope of intervention of psychiatry is constantly being extended towards that of mental health (Ehrenberg, 2004), with psychiatrists losing their “monopoly over care of the spirit” (Sicot, 2006, 206), and finding themselves in competition with other professional groups.

34The relations between the various professional groups are by no means purely conflictual. There is considerable interdependence in decision-making, between experts and magistrates in particular (Dumoulin, 2000; Saetta et al., 2011). The article by Aude Leroy in this issue shows how the post-sentencing psychiatric assessment often helps the sentence enforcement judge to avoid taking risks. In a similar vein, the articles in this issue show how professional groups rely on each other to attenuate the impact of detention. In the article by Cristina Fereira, Delphine Moreau and Ludovic Maugué, psychiatrists sometimes appear to use court detention orders as a means to provide medical care, as advocated by certain psychiatrists for the treatment of sex offenders (see the article by Tristan Renard). In the article by Caroline Protais, it is the prison guards who take advantage of their work with social and health care workers to reorient their professional approach towards a greater ethic of care. In these three articles, the authors also examine the origins of the systems they observe. This enables them to describe in detail how the modes of cooperation between justice and mental health have evolved over time, and to analyse the present-day situation from a historical perspective.

2.3. From hybrid knowledge to rationales of professional distinctiveness

35The development of standardized knowledge (notably via actuarial scales) and its depreciating effect on the value of professional judgement (Jendly, 2012) is a cross-cutting problem affecting all professional groups, creating a “fuzzy, shared space devoted to a psycho-social and educational treatment approach” (Gourmelon, 2012, 385). The question of professional knowledge and its circulation thus provides insight into the rapprochement between the fields of justice and mental health, be it through the development of standardized knowledge, or the application of psychological knowhow in the practices of the justice profession (Razac et al., 2014, de Larminat, 2012, Lancelevée, 2016). Lorna Rhodes shows how, for example, in an extreme prison environment such as the Supermax units in the United States, the actors of justice make use of mental health professionals and their classification tools to distinguish between prisoners who are “bad” and those who are “mad” (interview by Lorna Rhodes in this issue). Likewise, certain authors highlight the extent to which psychiatric or psychological knowledge are contributing to a change in the practices of the justice profession. For Nicolas Sallée (2016), this knowledge is used as a tool to legitimize the growing use of restraint against minors facing criminal prosecution.

36The propensity to produce cross-cutting knowledge is especially strong with regard to “dangerousness” which, while concerning both professional fields (Cartuyvels et al., 2012), does not necessarily call for identical approaches. Livia Velpry shows, for example, that in units for difficult patients, the definition of what constitutes a dangerous patient is based much more on contextual than individual criteria (Velpry, 2016). This raises the question of how this knowledge is appropriated by professionals in their daily work. It may provide a resource enabling professionals to improve certain aspects of their practice. In the article by Tristan Renard, prison rehabilitation and probation counsellors working in reoffending prevention programmes use their psychological knowledge to adapt their individual interview techniques with offenders. Caroline Protais, for her part, shows how knowledge from outside the prison environment serves to “enhance” the skills of prison guards in areas which, while essential, are not highly valued by the institution. These include the social aspects of their role and the care and emotional management skills that they require.

37Moreover, this knowledge is socially situated, providing a marker of the class and gender characteristics of the people who use it. As such, it may be deployed in strategies of distinction, both within and outside the professional groups concerned. This dimension is especially salient in studies of prison life. The knowledge used by carers may contribute to a certain disqualification of other types of knowledge, notably that of the prison guards. Marie-Hélène Lechien highlights the perception among young prison guards that their virile man-skills are of little worth in comparison to a school education. This sense of inferiority is rekindled in their interactions with nurses for example (most of whom are women), with whom they must frequently negotiate (Lechien, 2001). But the use of knowledge may also serve to create distinctions within a single professional group. In a female prison in Germany, for example, Camille Lancelevée describes how certain social workers refuse to apply their psychological knowledge, in order to “establish a critical distance with respect to the excessive influence of psychological expertise, or to defend the specific nature of their professional role” while others, on the contrary, deploy this knowledge because it helps them to deal with practical constraints (Lancelevée, 2016, 105). In a similar vein, Cristina Ferreira, Delphine Moreau and Ludovic Maugué show that judges are working more closely with psychiatrists as their social profile evolves towards greater professionalization.

38These rapprochements between professional groups, and the different attitudes to knowledge deployment within these groups shed light on emerging forms of professional practice. The circulation of knowledge produces potential long-term effects, such as the still tentative development in France of a specialist criminological segment within the judicial system, but also in the field of mental health – which in turn raises important questions, notably regarding the non-specificity of the knowledge applied (Mucchielli, 2010).

39It appears that the very identity of the justice and mental health professionals at the intersection between the two worlds is being challenged by institutional developments that are reshaping the habitual division of labour and giving rise to new forms of professionalism. And what about the people whose trajectories bring them face to face with these worlds of mental health and justice?

3. Between justice and mental health: towards a better understanding of populations and their life trajectories

40In recent years, the social science literature has revealed a growing interest in the experiences and trajectories of individuals who pass through the mental health and justice systems. This interest forms part of a broader sociological focus on trajectories (Bessin, 2009), i.e. the subjective meaning that individuals give to their life course and personal experiences (Bertaux, 2010), but also the norms and constraints that shape these social trajectories (Martuccelli, de Singly, 2009). In mental health, interest in personal experience of illness now accompanies the study of its medical definition, and many authors have focused on the testimonies and trajectories of people affected by chronic mental illness (Estroff, 1985; Verhaegen, 1985; Lovell, 1997; Darmon, 2003; Velpry, 2008; Grard, 2011) or on the construction of psychiatric patients’ subjective experience (Barrett, 1999; Biehl et al., 2007; Angermeyer, Schulze, 2003; Velpry, 2010). In the field of justice, following the first pioneering studies conducted in the United States,15 the French-speaking world has engaged in wide-ranging research on prison experience (Rostaing, 1997; Le Caisne, 2000; Marchetti, 2001; Chantraine, 2004; Touraut, 2012). An approach to justice through the lens of defendants’ “practical consciousness” of the law is also developing (Ewick, Silbey, 1992; Pélisse, 2005; Durand, 2014). However, few studies have analysed the trajectories and experience of individuals grappling with both the justice and mental health systems, to shed new light on the nature and complexity of the relations between these two worlds.

3.1. Trajectories through the intersecting worlds of justice and mental health

41A growing number of people have dealings with both the mental health and justice systems over their life course. Epidemiological studies have shown that psychiatric patients are four times more like to be imprisoned than others (Plancke et al., 2019), that around 30% of prisoners are affected by at least one “serious psychiatric disorder” (Falissard et al., 2006) and that certain mental illnesses, such as bipolar disorder, are associated with frequent “re-imprisonment” (Fovet et al., 2015). The high proportion of prisoners affected by mental illness suggests, as we have seen, that today’s prisons play an increasing role as “asylums” (Lancelevée, 2018). The article by Camille Allaria and Mohamed Boucekine in this issue confirms one of the hypotheses put forward by prison observers to explain the presence of “insane” men in prison: the existence of a vicious circle between homelessness, hospital and prison for vulnerable men with severe and chronic disorders. Their analysis, based on data compiled during “brief social surveys” of defendants brought for immediate appearance before the courts, also points up a central issue for research on these populations at the intersection between psychiatry and justice: the difficulty of obtaining reliable statistical data.

42The close interplay between the two institutional systems also produces some unexpected encounters. For example, psychiatric patients now frequently cross paths with justice professionals when placed, for instance, under involuntary hospitalization orders (Depardon, 2017;16 Lancelevée, Protais, 2018; Tartour, Barnard, 2018), or under supervision or guardianship orders (Eyraud, Vidal-Naquet, 2008; Minoc, 2019), via procedures that change continuously over time (as shown in the article by Cristina Ferreira, Delphine Moreau and Frédéric Maugué for involuntary hospitalization in Switzerland). Offenders, on the other hand, have numerous encounters with justice professionals throughout their passage through the criminal justice system, from initial police custody up to the execution of their sentence. The article by Aude Leroy in this issue examines a largely unexplored area, that of post-sentence justice, where, in a growing number of situations defined by law, the decisions taken must be approved by a forensic psychiatrist. Some studies have explored these increasingly frequent encounters, from the viewpoints of both defendants and/or convicted prisoners. Fabrice Fernandez (2010) retraces the life histories of 108 “drug users”, focusing on the adjustment mechanisms deployed by those who spend time in prison. He shows that the most socially integrated drug addicts manage to continue their controlled consumption in prison. Others make use of their prison stay to rein back a drug habit that was spiralling out of control, while the most alienated users fall into a vicious cycle of unrestrained multiple drug abuse, stigmatized by the institution. Guillaume Brie (2014), for his part, analyses the contrasting attitudes of convicted paedophiles to their compulsory treatment in prison. He studies the social determinants underlying the cooperation of some (who adopt the role of patient or engage in introspective analysis of their behaviour) and the negative attitudes of others, who withdraw into resignation or social condemnation of the system. Broadening the approach to “lifers”, Aude Leroy examines prisoners’ attitudes to the institutional “curriculum” to which they must conform. She shows that some seek to interiorize the expectations weighing upon them by turning them into their own experience, while others tend towards distance and detachment (Leroy, 2016, 31).

3.2. Trajectories under institutional influence

43Social scientists' growing interest in individual trajectories is accompanied by a focus on the institutions themselves and their users. The mental health and justice sectors are undergoing a process of democratization, with key importance placed upon the participation of the individuals concerned, but also of their families. Hospitals and prisons now offer a range of services for listening to the grievances of prisoners (Charbit, 2016, 2018; Durand, 2018) or psychiatric patients (Fauquette, 2017). These include quality units and users’ committees in public mental health institutions, and social life councils in health and social care establishments. Patients hospitalized in these institutions receive welcome booklets explaining their rights and fill in questionnaires designed to measure their level of satisfaction and record their opinions. At a more fundamental level, prisoners and patients are today also seen as citizens who have rights and are entitled to express themselves.

44However, this process is occurring in parallel with the “punitive shift” (see above), and these rights are associated with new forms of constraint and obligation. As “users” of health and prison services, the people caught up in the justice and mental health systems are also enjoined to follow a normative path of active participation (Castel, 1995; Astier, 2007). Via “care pathways” and “sentence pathways”, individuals are increasingly expected to give shape and meaning to the institutional intervention of which they are the object, at the risk of being held responsible for their own trajectory – and for the obstacles encountered. Here we observe a transfer of responsibilities, or even a deresponsibilization of the institutional actors who are themselves subject to managerial and security constraints that limit their room for manoeuvre (Quirion et al., 2012). Such transfers of responsibility are exacerbated when the risk (of reoffending in particular) is perceived as intolerable: in cases of sexual violence (Adam, 2012; Renard, 2013), or when dealing with the “fantasy figures” of the “monstrous criminal” or the “dangerous madman” (Moreau, Protais, 2009, Protais, 2016b). The pathway as a tool of self-government (Vrancken, Macquet, 2012) thus appears to both promote and encourage autonomy, to transform the mode of control over individuals, but also, in some cases, to recreate an artificial continuity that masks disruptions, instability of support and vulnerability of status (Robin, 2016).

45The articles in this issue thus contribute to existing analyses of the numerous ways in which institutions intervene in the shaping of social trajectories. First, they consider the diversity of institutional spaces. The levels of support provided within certain spaces (such as the prison rehabilitation unit for drug users (URUD) studied by Caroline Protais) contrast starkly with the idle time spent in prison (article by Aude Leroy) or with the social alienation characterizing the trajectories of men with mental disorders and judged in immediate appearance (article by Camille Allaria and Mohamed Boucekine). Oscillating between rationales of care and control, institutional support is constantly evolving to include new populations, such as sex offenders in the 1990s (article by Tristan Renard), or, conversely, to exclude others who do not fit in with the institutional system, such as the prisoners with personality or behavioural disorders studied in the excerpt of the book Total Confinement, Madness and Reason in the Maximum Security Prison (by Lorna Rhodes) featured in this issue. Between psychiatry and justice, the figure of the “bad patient” thus emerges, combining psychiatric illness, addiction and transgressive behaviour. This problematic figure, sometimes too crazy, sometimes too violent, is a permanent misfit in the institutional framework, shuttled between psychiatric hospital and prison, according to the latest label of “deviance” or “disease” pinned upon him.

46While the focus on one or other segment of the population evolves in response to the concerns of the period or the capacity of institutional actors to “gather around aproblem” to use the words of Lorna Rhodes, it is also governed by institutional timeframes. The timeframes of justice and care sometimes appear to be out of phase, here, leading to the involuntary hospitalization of a person no longer in crisis (Ferreira, Moreau, Maugué in this issue), or there, to the continued imprisonment of an offender with mental health issues whose sustained positive response to treatment suggests that he or she might be fit to rejoin the outside world (Leroy in this issue). These long and short timescales sometimes clash, as shown, for example, by the study of prisoners serving long sentences. The interminable wait for a potential early release that hangs on an expert assessment of the prisoner’s success in “working on himself” is sometimes followed by a period of urgency (“now or never”) when the end of the sentence approaches and the pressure to prepare psychologically for this outcome seem to produce a dangerous resignation.

47Taken together, these different articles portray an institutional landscape in mental health and psychiatry that is full in parts but empty in others and which produces individual trajectories marked by forms of engagement and abandonment, of control and neglect, of support and exclusion. Far from concluding that madness has been criminalized, that deviance has been medicalized, that mental health has become a judicial matter, or that justice has been sanitized, this issue shows how these multiple contradictory developments have led to a major reshaping of our institutions and a rethinking of the practices and trajectories of the professionals and individuals at the intersection between these two worlds.

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Camille Lancelevée, Caroline Protais, Tristan Renard et Sébastien Saetta, « Introduction: The Revival of Francophone Research on Justice and Mental Health »Champ pénal/Penal field [En ligne], 17 | 2019, mis en ligne le 05 mars 2020, consulté le 29 mars 2024. URL : http://journals.openedition.org/champpenal/11549 ; DOI : https://doi.org/10.4000/champpenal.11549

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Auteurs

Camille Lancelevée

Docteure en sociologie de l’Institut de recherches interdisciplinaires sur les enjeux sociaux (Iris, EHESS, Paris)
Chargée de recherches à la fédération régionale de recherches en psychiatrie et en santé mentale (F2RSM Psy, Lille)
camille.lancelevee[at]gmail.com

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Caroline Protais

Chargée d’études à l’OFDT, chercheure associée au Cermes 3
caroline.protais[at]ofdt.fr

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Tristan Renard

Sociologue
CRIAVS-Midi Pyrénées, 7, rue du colonel-Driant, 31400 Toulouse, France
tristan.renard[at]hotmail.fr

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Sébastien Saetta

Sociologue
Ingénieur de recherche à l’École des Hautes Études en Santé Publique/UMR 6051 Arènes, et à la Plateforme de Recherche sur la Santé Mentale et le Handicap Psychique (PRSM-HP)
saetta.sebastien[at]gmail.com

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