A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

Abstract

Abstract Research on psychiatry in the United States has shown how, since the 1980s, the discipline has sought to increase its prestige and preserve its jurisdiction by embracing biomedical models of treatment and arguing it is a medical specialty like any other. While this strategy is consistent with what the literature on professions would expect, this paper analyzes an alternative case: French public psychiatry, which has remained in a position of marginalized autonomy, combining low status and economic precarity with state recognition of its specificity. Drawing on Bourdieu’s theory of fields, I analyze how the persistence of specialized psychiatric hospitals in France—most of which have closed in the United States—has shaped the conflict between psychiatrists favoring autonomy and actors in university hospitals and the Ministry of Health seeking to reduce it. These specialized hospitals have functioned as institutional anchors that contribute to maintaining the discipline’s autonomous position in the medical field in three ways: by socializing psychiatrists into viewing themselves as a distinctive branch of medicine, linking psychiatry to powerful actors in the state interested in maintaining the discipline’s distinctive role in social control, and concentrating a population of chronically ill persons not amenable to traditional medical interventions. This analysis expands on the literature on professionals and field theory by emphasizing the role of institutions in structuring the reorganization of jurisdictions and relationships between fields.