Making People Autonomous: A Sociological Analysis of the Uses of Contracts and Projects in the Psychiatric Care Institutions

Virtual Reality Therapy in France: A Therapeutic Innovation Between Technology and Care

The latest form of cognitive behavioral therapy, virtual reality therapy has been developing in France since 2012, in both university hospitals and private practices. Patients receiving this therapy are immersed in a digitally created environment, using a virtual reality headset, in order to be exposed to their phobias. How does the introduction of technical objects such as the virtual reality headset affect and transform the care relationship between the patient and the therapist? Based on an ethnographic study conducted between 2012 and 2018 in the psychiatric unit of a French university hospital, this article outlines the emergence of virtual reality therapy, describes how it operates, and analyzes how it shapes the patient-therapist relationship. I argue that this device-namely virtual reality therapy-promotes a new therapeutic style in psychiatry, whose format and therapeutic indications align with the requirements of evidence-based medicine.

Cognitive Optimisation and Schizophrenia: Assembling Heterogeneity, Overcoming the Precariousness of Life, and Challenging Public Health Policies in Psychiatry in France

Cognitive remediation therapy (CRT) aims to optimise cognitive abilities of people who suffer from schizophrenia in order to improve their social adaptation. This therapeutic orientation was developed in psychiatry in the 1980s and 1990s, at a time when the disorder was being redefined as a neurocognitive deficit disorder. In this article, I describe CRT as an assemblage that lies at the intersection of multiple, overlapping theories and spaces of mental disorders and psychiatric care. To do so, I draw on 18 months of ethnographic research conducted in a French hospital unit dedicated to the development of CRT. I argue that the focus on cognitive health and cognitive abilities (or deficits) is not only redefining the logics of care and reshaping medical conceptualisations of schizophrenia, but it is also opening up to a new understanding of people's precarious life conditions, where emotional, biological, and cognitive fragility is intertwined with social and economic uncertainty. I then examine the extent to which psychiatrists have extended the goals of CRT to include psychosocial rehabilitation in order to mitigate not only the effects of cognitive deficits, but also the effects of limited social and professional integration encountered by patients. Finally, I conclude with a consideration of how CRT has become, for its proponents in France, a means to develop a policy and organisational project for French psychiatry.