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

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


Heterotopia

presence of a particular

tissue/organ/structure at a site where it

should normally not be


Hétérotopies

Des espaces autres

Conference held at

Cercle d'études

architecturales

14 mars 1967


History of space

Middle AgesSpace of localization

The Galilean RevolutionLocalization → extension

Modern timesExtension → arrangement


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


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


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


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


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


Heterotopias


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


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


Attractor A Attractor B

Instability

Stability Stability

Stability vs instability

Service d’addictologie - Département de Santé Mentale et Psychiatrie


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


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


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


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)


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)


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


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


Environment

We are different in different places

De B

ott

on

, 2

00

6


Environment Patients are different in different places

De B

ott

on

, 2

00

6


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


Environment

largely determines

what we are able

to believe


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?


Service d’addictologie

Centre collaborateur OMSpour l’enseignement et la recherche sur les addictions

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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