Psychoanalysis in the community in France.

There has been a long tradition of psychoanalysis in the community in France. The first psychoanalysts working in public institutions did so in places such as the network of the Offices publics d'Hygiène sociale (OPHS), initially intended to treat tuberculosis, infant mortality, etc., after the Second World War. The introduction of psychiatric care in the community mobilized a genuine interpenetration of psychoanalysis and psychiatry. In 1953, the SPP founded the Centre de Consultations et de Traitements Psychanalytiques, and in 1955 Victor Smirnoff created a children's centre. In 1958, Philippe Paumelle created the Association de Santé mentale du 13ème arrondissement de Paris (ASM 13), a pilot project, implemented in 1960 as "district psychiatry", which is France's national policy of community psychiatry. In the consultation centres of these psychiatric districts, called centres médico-psychologiques (CMP), psychotherapy is provided by clinical psychologists, who are largely psychoanalytic in orientation. In 1972, Pierre Marty and Michel Fain created what would become the Institut de Psychosomatique in 1978. In 1974, ASM 13 created its own Centre de psychanalyse with Jean and Évelyne Kestemberg, specialising in psychotic and borderline pathologies. The activities and theoretical contributions of these psychoanalytic public centres are presented in this paper, with attention to: the distinction between treatment and consultation; the introduction of a new approach to psychosomatics; the description of a psychotic relation to the object as fetish; the research about free treatment and its implications. Currently, the situation of psychoanalysis in France is divided between the medical authorities who reject psychoanalysis in the name of evidence-based medicine, and the persistence of psychoanalysis in both public and private practice. More generally, it appears that the central issue at stake is the conception of the 'psychic human being' and psychic causality in Western societies.