addictologie.hug-ge.ch

1. 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 http://addictologie.hug-ge.ch

2. Heterotopia • presence of a particular tissue/organ/structure at a site where it should normally not be http://addictologie.hug-ge.ch

3. Hétérotopies Des espaces autres Conference held at Cercle d'études architecturales 14 mars 1967 http://addictologie.hug-ge.ch

4. The Galilean Revolution Localization → extension Modern times Extension → arrangement Middle Ages Space of localization History of space http://addictologie.hug-ge.ch

5. space of localization for the real life of men in cosmological theory The middle ages Hierarchical system of places • 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 • sacred spaces and profane spaces • protected areas vs open and defenseless areas • urban places and rural places http://addictologie.hug-ge.ch

6. 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 http://addictologie.hug-ge.ch

7. Modern times • Arrangement = relationships of neighborhood between points and elements • 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 Arrangement has taken over from extension http://addictologie.hug-ge.ch

8. 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 http://addictologie.hug-ge.ch

9. 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 http://addictologie.hug-ge.ch

10. Heterotopias http://addictologie.hug-ge.ch

11. Six principles • Constant feature of all human groups • Over the course of its history, a society may make it function in different ways • It has the power of juxtaposing in a single real place different spaces and locations that are incompatible with each other • Within them, there exists a heterochronism, i.e. a rupture with real time • They always presuppose a system of opening and closing that isolates them and makes them penetrable at one and the same time • 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 http://addictologie.hug-ge.ch

12. First principle • Heterotopias a constant feature of all human groups Heterotopias of crisis Heterotopias of deviance • 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 • occupied by individuals whose behavior deviates from the current average or standard • rest homes, psychiatric clinics, prisons http://addictologie.hug-ge.ch

13. Instability Stability Stability Stability vs instability Attractor A Attractor B http://addictologie.hug-ge.ch

14. Service d’addictologie - Département de Santé Mentale et Psychiatrie

15. until end of 18th century: located in the very heart of the city, near the church • individial • tombas ossuary • slab of marble • mausoleum with statues Second principle • A society may take an existing heterotopia and make it function in a very different way • E.g. cemetary hierarchy of every possible type of tomb • 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 http://addictologie.hug-ge.ch

16. 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 http://addictologie.hug-ge.ch

17. Fourth principle • Heterotopias enter fully into function when men find themselves in a sort of total breach of their traditional time heterotopias of time which accumulate ad infinitum heterotopias linked to time in its more futile, transitory and precarious aspects • 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 • Fairs, holiday village http://addictologie.hug-ge.ch

18. Heterotopias also exist that are entirely devoted to practices of purification (hammams, saunas) or one must submit to rites of purification one is forced (barrack, prison) Fifth principle • Heterotopias always presuppose a system of opening and closing that isolates them and makes them penetrable at one and the same time http://addictologie.hug-ge.ch

19. 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) http://addictologie.hug-ge.ch

20. Heterotopias of deviance Heterotopias of crisis 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 http://addictologie.hug-ge.ch

21. Compliance Engagement Best for normalized, repetitive behavior with clear, stable objectives Significantly better for creative behavior Can be rewarded Can be punished Can be rewarded Can‘t be punished http://addictologie.hug-ge.ch

22. Environment • We are different in different places De Botton, 2006 http://addictologie.hug-ge.ch

23. Environment • Patients are different in different places De Botton, 2006 http://addictologie.hug-ge.ch

24. Architecture/environnement (1) Shelter, stock (2) Talk to us De Botton, 2006 • 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” http://addictologie.hug-ge.ch

25. Environment largely determines what we are able to believe http://addictologie.hug-ge.ch

26. 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? http://addictologie.hug-ge.ch

27. Service d’addictologie Centre collaborateur OMS pour l’enseignement et la recherche sur les addictions http://addictologie.hug-ge.ch