http://addictologie.hug-ge.ch The psychiatric institution of tomorrow Cell or sauna? Prof. Dr.med. Daniele Zullino Médecin chef de service Service d’addictologie Département de Santé mentale et psychiatrie Hôpitaux Universitaires de Genève Faculté de médecine, Université de Genève
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Http://addictologie.hug-ge.ch The psychiatric institution of tomorrow Cell or sauna? Prof. Dr.med. Daniele Zullino Médecin chef de service Service d’addictologie.
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http://addictologie.hug-ge.ch
The psychiatric institution of tomorrow
Cell or sauna?
Prof. Dr.med. Daniele ZullinoMédecin chef de serviceService d’addictologieDépartement de Santé mentale et psychiatrieHôpitaux Universitaires de GenèveFaculté de médecine, Université de Genève
http://addictologie.hug-ge.ch
Heterotopia
presence of a particular
tissue/organ/structure at a site where it
should normally not be
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Hétérotopies
Des espaces autres
Conference held at
Cercle d'études
architecturales
14 mars 1967
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History of space
Middle AgesSpace of localization
The Galilean RevolutionLocalization → extension
Modern timesExtension → arrangement
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The middle ages
celestial places vs terrestrial
places
places where things could be
found because they had been
shifted there by violence and
places where things found their
natural position and rest
Hierarchical system of places
sacred spaces and
profane spaces
protected areas vs open
and defenseless areas
urban places and rural
places
for
the
re
al l
ife o
f m
en
in co
smo
log
ical th
eo
ry
space of localization
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The Galilean Revolution
Space of localization opened up by Galileo Galilei, a real scandal: assertion of an infinite and infinitely open space
localization replaced by extension
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Modern times
Arrangement = relationships of neighborhood between points and elements
Arrangement has taken over from extension
Problem of position
what are the relations of vicinity
what kind of storage of human elements
what type of circulation
what type of classification
... should take preference in a given situation, according to the objective
that is being sought
• In our era, space presents itself to us in the form of patterns of ordering
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Utopias
arrangements which have no real space
arrangements which have a general
relationship of direct or inverse analogy with
the real space of society
represent society itself brought to perfection
or its reverse
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Heterotopias
real and effective spaces, outlined in the very institution of
society
constitute a sort of counter arrangement
sort of place that lies outside all places and yet is actually
localizable
all the real arrangements, all the other real arrangements that
can be found within society, are at one and the same time
represented, challenged, and overturned
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Heterotopias
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Six principles1. Constant feature of all human groups
2. Over the course of its history, a society may make it function in different
ways
3. It has the power of juxtaposing in a single real place different spaces and
locations that are incompatible with each other
4. Within them, there exists a heterochronism, i.e. a rupture with real time
5. They always presuppose a system of opening and closing that isolates
them and makes them penetrable at one and the same time
6. They have, in relation to the rest of space, a function that takes place
between two opposite poles: (1) they create a space of illusion; (2) they
form another real space
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First principle Heterotopias a constant feature of all human groups
occupied by individuals whose behavior deviates from the current average or standard
rest homes, psychiatric clinics, prisons
Heterotopias of crisis
privileged, sacred, forbidden places, reserved for iindividual in a states of crisis with respect to the society/environment (adolescents, women during the menstrual period or in labor, the old, etc)
In our societies boarding schools, military service,
honeymoon
Heterotopias of deviance
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Attractor A Attractor B
Instability
Stability Stability
Stability vs instability
Service d’addictologie - Département de Santé Mentale et Psychiatrie
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Second principle A society may take an existing heterotopia and make it function in a very different way E.g. cemetary
until end of 18th century: located in the very heart of the city, near the church
hierarchy of every possible type of tomb
ossuary individialtombas
slab of marble mausoleum with statues
from the 19th century on: cemetery began to be shifted to the outskirts of the city
individualization of death and bourgeois appropriation of the cemetery
obsession with death as "sickness" has emerged
they no longer constituted the sacred and immortal wind of the city, but the "other city," where each family
possessed its gloomy dwelling
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Third principle
heterotopia has the power of juxtaposing in a single real place
different spaces and locations that are incompatible with each other
e.g.theater/cinema alternates as a series of places that are alien to each other
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Fourth principle
Heterotopias enter fully into function when men find themselves in a sort of total breach of
their traditional time
Fairs, holiday village
heterotopias of time which accumulate ad infinitum
museums, libraries etc heterotopias in which time does not cease to accumulate desire to enclose all times, all eras, forms, and styles
within a single place making all times into one place, and yet a place that is
outside time, inaccessible to the wear and tear of the years
heterotopias linked to time in its more futile, transitory and precarious aspects
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Fifth principle Heterotopias always presuppose a system of opening and closing that
isolates them and makes them penetrable at one and the same time
one is forced (barrack, prison)
or one must submit to rites of purification
Heterotopias also exist that are entirely
devoted to practices of purification
(hammams, saunas)
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Sixth principle have, in relation to the rest of space, a function that takes place
between two opposite poles:
(1) They perform the task of creating a space of illusion that reveals
how all of real space is more illusory
(2) They form another space, another real space, as perfect,
meticulous, and well-arranged as ours is disordered, ill-conceived, and
in a sketchy state (heterotopia of compensation)
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Heterotopias of crisis Heterotopias of deviance
We know what is wrong We will know what could be right
We have to do right: control
Patient has to do right: compliance
Both have to find wanted possibles:
engagement
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EngagementCompliance
Significantly better for creative behavior
Best for normalized, repetitive behavior
with clear, stable objectives
Can be rewarded
Can be punished
Can be rewarded
Can‘t be punished
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Environment
We are different in different places
De B
ott
on
, 2
00
6
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Environment Patients are different in different places
De B
ott
on
, 2
00
6
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What we think is important and we need to be reminded
Makes it clear to us what we could be
Embodies / recalls feelings and ideas we respect
Corresponds to our vision of things and legitimizes this vision
→ to feel “at home”
Architecture/environnement
De B
ott
on
, 2
00
6
(1) Shelter, stock
(2) Talk to us
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Environment
largely determines
what we are able
to believe
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What psychiatric institution for future ? Heterotopia of crisis or deviation? What spaces ? What time organization? What boundaries? Rites of purification? How to foster possible selves? Among patients? Among institutions?
The psychiatrist: stabilizer or destabilizer?
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Service d’addictologie
Centre collaborateur OMSpour l’enseignement et la recherche sur les addictions