Institute for Research and Information in Health Economics, Paris, France.
Soc Sci Med. 2010 Dec;71(12):2117-29. doi: 10.1016/j.socscimed.2010.09.028. Epub 2010 Nov 4.
As in other European countries, specialised psychiatric hospitals were established throughout France during the 19th Century. The construction of these hospitals can be considered as the concrete expression of a therapeutic innovation which recognized insanity as an illness that could be treated in such specialised institutions. The spatial diffusion of these innovative institutions through 19th and 20th century France is analysed and we explore how far this can be understood through theories of diffusion of innovations including geographical models of hierarchical and expansion diffusion (or whether other conceptual models are more appropriate). The research reported here particularly focuses on the period 1800-1961. It involved the construction of an original historical database of both psychiatric hospitals and information on the cities where these institutions were located. This was used to examine and interpret the different phases of development of psychiatric institutions and the parts of the country and types of geographical setting where they were concentrated. A multiple correspondence analysis was then performed to examine the connections between different aspects of the diffusion process. The study shows the limitations of classical models of spatial diffusion, which are found to be consistent with some, but not all aspects of the development of psychiatric institutions in France. An alternative political ecology approach seems more appropriate to conceptualise the various processes involved; national policies, social representations, medicalisation of care of mental illness, and urban and economic growth all seem to be associated with the emergence of a variable and complex pattern. This paper also opens a large field of research. Compared with other western countries, the geography of French psychiatric care is relatively under-researched, although there has been a strong spatial dimension to mental health policy in the country. This analysis provides a context for studies of more contemporary processes of French deinstitutionalisation, which is strongly structured by the past heritage of these large asylum facilities.
与其他欧洲国家一样，19 世纪期间法国各地都建立了专门的精神病院。这些医院的建设可以被视为一种治疗创新的具体表现，这种创新将精神错乱视为一种可以在这些专门机构中治疗的疾病。通过分析 19 世纪和 20 世纪法国这些创新机构的空间扩散，并探讨通过创新扩散理论（包括等级和扩展扩散的地理模型）是否可以在多大程度上理解这一现象（或者其他概念模型是否更合适），我们研究了这一现象。这里报告的研究特别关注 1800-1961 年期间。它涉及到一个精神病院和这些机构所在城市信息的原始历史数据库的构建。该数据库用于检查和解释精神病院发展的不同阶段，以及该国的各个地区和地理环境类型集中的程度。然后进行了多次对应分析，以检查扩散过程的不同方面之间的联系。研究表明，经典的空间扩散模型存在局限性，这些模型与法国精神病院发展的某些方面一致，但与其他方面不一致。一种替代的政治生态方法似乎更适合概念化所涉及的各种过程；国家政策、社会代表性、精神疾病护理的医学化以及城市和经济增长似乎都与可变且复杂的模式的出现有关。本文还开辟了一个广阔的研究领域。与其他西方国家相比，法国精神卫生保健的地理研究相对较少，尽管该国的精神卫生政策具有很强的空间维度。这种分析为研究法国去机构化的更现代进程提供了背景，这些进程强烈受到这些大型庇护设施过去遗产的影响。
