The rapid expansion of (mainstream) health psychology in France: Historical foundations

Abstract

This article traces the historical evolution of ongoing theoretical debates in psychology in France from the 1940s until today. Its aim is to show how the conjunction of certain conditions led to a rapid expansion of American-derived mainstream health psychology during the 1980s. The authors describe the French context in the post-World War II period and outline the implementation of ‘clinical psychology in health settings’ in the 1950s, under the influence of Daniel Lagache. The strong critiques of the new psychology profession in the 1950s, 1960s and 1970s are examined. Our conclusion reflects upon future implications of ongoing rivalries between different approaches to psychology.

Keywords

critical psychology health psychology history of psychology psychology in health settings theoretical psychology

Introduction

The history of the establishment of health psychology in France closely parallels the developments and debates that have taken place within the discipline of psychology as a whole during the past 50 years. This process can also be situated at the interface of the debates between the approach of experimental psychology and the increasing demand for concrete applications in psychology. This history follows French psychology’s own system of principles or (knowledge-generating) ‘logics’, different from those dominant within the United States and the English-speaking world. It was not until the arrival of the field of ‘health psychology’ in France, directly inspired by the US culture, that the two divergent discourses confronted one another: two logics underpinned by different epistemologies and methods. This importation took place within a context of profound transformations regarding the university psychology curricula in France, which saw both the rapid increase in student numbers and the introduction of new legislation in 1985 on the qualifications regarding the title of psychologist and the practice of the profession. Below, we present this debate and situate it within its historical context following the end of World War II. During that period, new branches of psychology appeared in universities, and also epistemological and pedagogical tensions arose between experimental and clinical orientations in psychology, involved with training clinical psychologists. Within the complex changes that characterised this post-war period of disciplinary re-organizations, it is possible to explain, at least partially, the ‘easy and rapid’ introduction of mainstream health psychology from the United States into France (and other European countries) where this discipline had initially developed with a qualitative, clinical and, specifically in France, a psychoanalytic tradition.

We therefore first present the context for the introduction of university studies – courses and degree programmes – in psychology at the end of the 1940s. This post-war period of reconstruction in France and Europe demanded the rapid establishment of new professionals in the field to deal with urgent mental and broader health and social issues, leading to the introduction of psychology both as a science and as a profession, in the universities after 1947. We then consider the passionate conflicts in which this ‘new’ profession was entrapped. Such tensions came at the same time from physicians who feared the loss of their power over patients; philosophers who questioned the epistemological foundations of psychology; and psychoanalysts, who considered the profession of psychology as an impoverished version of psychoanalysis. We will show that despite these oppositions, a specific French approach developed: ‘psychology in health settings’ (Lagache, 1955), under the influence of psychosomatics (see also Herzlich, 2018). This approach played an increasingly important role in hospitals from the beginning of the 1960s and eventually would collide with American ‘mainstream health psychology’. We next examine the dynamics during the 1980s, when the introduction of the title ‘psychologist’ and a large increase in the number of students combined, during circumstances of strong disagreement between psychoanalysts and non-psychoanalysts. Such a conjuncture led to an impasse occasioned by the rise of a particularly utilitarian orientation in psychology, pragmatic-oriented and little interested in theoretical psychology or epistemological debates. We will analyse the current situation regarding these debates and the role played by the successors and newer generation within the contemporary academic landscape. Finally, we will underline the implications for the future of health psychology in France involving this young generation of researchers, teachers, and clinicians.

Historiographically, the article relies on archival and historical accounts but is supplemented by ‘internalist’ knowledge of the authors who are currently participants in the discipline itself. Thus, as a student, the senior (and first) author was part of the first generation in France to benefit from the 1985 law that certified and protected the title of psychologist. She witnessed the rise of health psychology, a field that appeared in the 1990s as an ‘alien’ discipline, given the general situation at the time. As she participated academically in the French context, her examination of the historical ‘facts’ will no doubt be affected by her encounters, specialised studies, and her vision and values, both as a student and a professor. The historical content has been shaped by ideas of two professors during the first author’s university studies: Annick Ohayon (1999), historical psychologist, and Emile Jalley, developmental psychologist. Some of her professors had, themselves at various times, been disciples of Daniel Lagache (1903–1972), Didier Anzieu (1923–1999), Juliette Favez-Boutonnier (1903–1999) or Jacques Lacan (1901–1981). After the 1980s, she began developing her own reflection. This article can be read in parallel with Claudine Herzlich’s (2018) paper. In her text, she describes her own experience as a PhD student and researcher, from the 1960s onwards, while our article reflects experiences as a student and researcher two decades later.

Introducing psychology courses at the university level: theoretical and methodological quarrels underpinned by political frictions

This section describes the context within which the implementation of psychology courses occurred at the university in France towards the end of the 1940s. The post-war period of re-development in France was focussed, in particular, on an urgent need for new professionals who were trained to work with health, childhood and juvenile issues from a scholarly and professional orientation. It was under these specific circumstances that psychology would become both a science and a profession during the 1950s.

Experimental psychology and concrete psychology during the inter-war period: Piéron versus Politzer

Between the two World Wars, strong social needs contributed to the rise of a particular demand for ‘applied’ psychology, given that this discipline had until then been mainly limited to laboratory work (Santiago-Delefosse, 2015a). Under the influence of Henri Piéron (1881–1964), director of the experimental psychology laboratory at the University of Paris, the course on career counselling became the first branch of applied psychology officially acknowledged in 1938. A great part of the academic and research work in this laboratory was put to the service of the applications of the discipline. Until the 1960s, this process contributed to the advancement of working people. However, the first critical remarks on the theoretical and methodological dimensions of this kind of psychology also began to appear, mainly from philosophy, in the 1930s.

In his work, Critique of the Foundations of Psychology, published in 1928, Georges Politzer (1903–1942) resisted this version of psychology, which according to him was disembodied. In turn, he suggested the implementation of a ‘concrete’ psychology, aimed at focussing on the individual and his or her singularity. In Politzer’s view, human experience resulted from the synthesis of behaviour and the meaning given to such behaviour. Concrete psychology was composed of both, and its research method and field-oriented practice both took everyday life into account. This vision of psychology would influence other psychologists and philosophers later on, including Daniel Lagache (1903–1972), Maurice Merleau-Ponty (1908–1961), Jean-Paul Sartre (1905–1980), Georges Canguilhem (1904–1995), Louis Althusser (1918–1990) and Michel Foucault (1926–1984).

The beginning of the Second World War, however, put an end to these debates, at least temporarily. And after the war, a degree in psychology was established in 1947 at the Sorbonne in Paris by Lagache to address the urgent psychological needs created by the war. The traumatic consequences of the war led to an increased demand for help that psychiatrists could not manage alone. The creation of this new profession became the solution.

The dawn of psychology at the university facing political differences: Fraisse versus Lagache

During the 1950s, academic conflicts became more complex because of the impact of the Second World War upon everyday thought and political engagement. Theoretical rivalries were exacerbated, underpinned by different political backgrounds of those who declared themselves as communists, pétainists or gaullists.¹ Internal conflicts within psychology can be related to these political disagreements, either between communists and gaullists or between those who actively resisted the war and those who were more passive, even pétainists (Ohayon, 1999). It is difficult to judge from a distance, and lacking historical texts about the real situation, it seems that the theoretical and methodological conflicts taking place at the time may have been connected with a number of personal quarrels about individual commitments during the Second World War. As well as these political differences, there were also disciplinary ones, as from the 1950s onward, the academic course of psychology split from philosophy under the influence of two opposed trends. One was defined by experimental psychology under the direction of Paul Fraisse (1911–1996). This trend aimed to be acknowledged as truly ‘scientific’. The other trend, under the influence of Lagache, involved academics from clinical psychology and psychopathology who wished to develop their own profession. Their two laboratories were coordinated by strong personalities who followed distinct political orientations (Drouard, 1983). Fraisse was a leftist compared to Lagache, who was a centrist. However, Lagache was also very influenced by Georges Politzer’s communist ideas (Herzlich, 2006, 2018). In social psychology, Jean Stoetzel (1910–1987) inherited Lagache’s Chair of social psychology from 1955 to 1978 and amplified the experimental research approach (Drouard, 1983, 1989). This had already begun in the Laboratory of Social Psychology attached to Lagache’s Chair, when Robert Pagès became head of the laboratory and later director from 1952 until 1986 (Herzlich, 2018). Like Lagache, parts of Stoetzel’s work and teachings were about psychology applied to health and illness, but social psychology, in particular. Claudine Herzlich (1932- ) describes her contact with Lagache and the Laboratory at this time but completed her PhD under Stoetzel’s supervision (Herzlich, 2006, 2018), opening up a social psychology that was applied to health and illness and later to more inter-disciplinary and epidemiological research at the National Institute for Health and Medical Research (INSERM). Nevertheless, despite the birth of alternative approaches during this period, the two main characters who influenced the institutional trends in psychology at the university remained Fraisse and Lagache.

Fraisse was a disciple of Henri Piéron, and therefore was an ardent defender of experimental and scientific psychology, whose applications could help society at that time. In contrast, Lagache was more inspired by Politzer’s ideals of a concrete social psychology that, from his perspective, should also be clinical. Lagache had a multi-disciplinary viewpoint as a psychiatrist, philosopher and psychoanalyst who played a key role in the development of French psychology. In the late 1940s and the early 1950s, he established psychology both as a science – by creating new curricula in universities – and as a new profession. By establishing and directing a Laboratory of Social Psychology, in which clinical researchers were welcomed, he argued that psychology should be unified, despite the existence of the two major contrasting methods – experimental and clinical. This effort implied important negotiations with Fraisse, head of the experimental psychology laboratory on the one hand, and on the other hand, with psychiatrists who did not wish to support the psychology profession, because of its potential rivalry to them. To Lagache (1949), clinical psychology could not be reduced to mere applied psychology. Rather, it should be both a research method and a professional practice able to generate, altogether, new specialised knowledge through experimental and clinical methods.

Inspired by Lagache’s approach to psychology, his disciples were the precursors of much innovative thinking. One of the most salient figures was Foucault, who he mentored for many years, and was one of the jury members of his thesis ‘Madness and Civilisation: History of Insanity on the Age of Reason’. Lagache also trained the first generation of mentors in psychology, precursors of who would later become leaders of new branches of the discipline, namely, Robert Pagès (1919–2007) and Serge Moscovici (1925–2014) in social psychology,² Didier Anzieu (1923–1999) in clinical psychology and Juliette Favez-Boutonnier (1903–1999) in clinical-social psychology. Besides the evident disputes over the definition of territories within psychology, this period saw a rash of new definitions referring to its new ‘branches’. The encounter with the first theories on psychosomatics stemming from medicine and psychoanalysis, mainly through the Paris School of Psychosomatics,³ seems to have introduced an interest in psychology in health and medical settings, regardless of its specialisation (clinical, social, or social and clinical). Lagache (1955), both as theoretician and founder of this field, was also a visionary precursor. Indeed, he was able to predict the branches where psychology would later have an influence – society, criminology, work, childhood, delinquency, health and so on. Among his contributions, we discuss below his new orientation of psychology, rather close to ‘medical psychology’ (which at the time was strictly limited to physicians. See Murray’s (2018), this issue, discussion of the important role of early ‘medical psychology’ in paving the way for health psychology in the United Kingdom).

Psychology in health settings: an emerging field

From 1955, Lagache supported the new orientation that he established as a sub-discipline or branch in psychology: ‘psychology in health settings’ (Lagache, 1955). The definition that he gave in 1955 seems close to the aims later established by the American Psychological Association (APA) when they began to define mainstream health psychology and create a ‘division’ in 1978. But there was a major difference – Psychology in health settings was seen as a part of clinical psychology in France. This branch was built upon a clinical method, as well as psychoanalytic foundations (Santiago-Delefosse, 2000, 2002). Its aims were to bring psychological care to patients suffering from somatic illnesses; to understand the relationship among physician, patient and family; to identify the impact of values and beliefs on the patient’s compliance with prescriptions and preventive recommendations; and finally, to develop a differential psychology of somatic illnesses. Lubek et al. (2017) show how these goals in the United States were split in the late 1970s among ‘health psychologists’, largely drawn from social psychology, and ‘behavioural medicine’ practitioners, drawn from behaviouristic clinical psychology.

By the late 1950s, clinical psychologists in health settings were hired in general hospitals. They had a background in clinical psychology and more particularly in the clinical method and in psychosomatic psychoanalytic theory. The analysis of articles which appeared in French journals of psychology from 1947 to 1957 shows over 150 articles that are interested in psychosomatics.^4,5 However, practitioners in this field did not consider themselves as part of ‘applied psychology’. Clinical psychology was not seen as ‘application’ but as ‘concrete practice’, with its own epistemological foundations and methods (Santiago-Delefosse, 2015a). Little by little, after World War II, psychology had become a profession in its own right, with its different orientations and sub-disciplines, among which now appeared ‘psychology in medical settings’. The applications of this branch could be either clinical or social, including many nuances in between, and within, the two.

A new profession and its opponents: psychologists versus psychiatrists versus philosophers versus psychoanalysts

The growing profession of psychology and its different orientations led to numerous critiques and strong oppositions. A foremost issue during the 1950s and the beginning of the 1960s concerned the relationship between psychologists and physicians. Criticisms towards this new post-war generation of professionals, who were neither philosophers, nor psychoanalysts, nor physicians, nor psychiatrists, were wide-ranging at this time, coming from psychiatrists and physicians (with a group involved in the journal of psychiatric evolution, Evolution Psychiatrique), and also from philosophers (e.g. Foucault and Canguilhem) and psychoanalysts (Jacques Lacan). While Lagache wished to establish a new unified discipline incorporating opposing trends (see his seminal work on this topic, ‘L’unité de la psychologie’, Lagache, 1949), he was confronted in the negotiations first by certain practical matters with psychiatrists and physicians, so they could accept the new profession and did not feel threatened, then by experimental psychologists, so they could accept a ‘clinical’ method different from their own, and finally with psychoanalysts, so they could accept their own field as being part of the larger psychological discipline. These negotiations were complex and Lagache did not fully succeed at the time, as we shall see.

The first challenge had already appeared in the early 1950s, when the courts had to judge whether the clinical practice of Ms Clark-Williams was illegal or not, since she was not a physician but a psychologist and psychoanalyst.⁵ The parents of a child who was her patient had complained, supported mainly by psychiatrists who were eager to exercise control over the psychology curricula but also over psychologists’ clinical practice, and whom they considered ‘medical assistants’. Alternative titles including ‘medical subalterns’ and ‘auxiliaries of psychoanalysts’ were proposed but with little success (Perron, 1990, 2001). Nevertheless, students in clinical psychology and, subsequently, psychology in health settings defended their status as psychologists and refused to be regarded as ‘medical assistants’ or as ‘second rank psychoanalysts’ under the control of psychiatrists–psychoanalysts, or as mere ‘technicians for applying tests’ (Carroy et al., 2006; Ohayon, 1999).⁶

The second challenge came from the philosophical field that also criticised Lagache’s attempt to establish a new psychology. Canguilhem argued that the new discipline lacked theoretical foundations and that it represented a mix of philosophy with little rigour, ethics without any exigency and medicine without control (Canguilhem, 1958). The third challenge began near the end of the 1950s and into the 1960s, with the rise of structuralism in philosophy and psychoanalysis. Lacan and Althusser showed scepticism towards the use of references from hermeneutics, existentialism and humanism in psychology. In addition, psychology at that time did not have as good a reputation compared to psychoanalysis, which had become highly prestigious in France during that period. Clinical psychology was considered as an impoverished derivation of psychoanalysis, and this belief was related to a deep division between Lagache and Lacan in the early 1960s (Arbisio et al., 2002) and then between Anzieu⁷ and Lacan (Anzieu and Allouche, 1990). The links between these scholars deserve to be further studied, given the major contribution of their thinking to the development of psychology and psychoanalysis. At the same time, their relationship was complex and led to personal disputes between them, beyond their scientific influence in the field (Anzieu, 1979). Notwithstanding, these relational issues had a certain impact on how psychology was taught at the university by their former students.

By the end of the 1960s, the confluence of these criticisms and conflicts had several consequences. On the one hand, there was an increased polarisation of debates between experimentalists responsible for applications in psychology and clinicians who mainly referred to psychoanalysis. On the other hand, this polarisation implied a growing idealisation of psychoanalysis within the discipline. Psychology in health settings was inspired by psychoanalytic authors such as the psychosomatics advocate Pierre Marty (1979) (1918–1993), who belonged to the Paris Psychoanalytic Society (Société Psychanalytique de Paris), or Ginette Raimbault (1976) (1924–2014) and Jean Guir (1983), followers of Lacan. In any case, clinical psychologists and psychologists in health settings referred most exclusively to psychoanalytic backgrounds, given their university training. Certain approaches in psychology such as humanism, phenomenology and clinical perspectives were gradually erased from the landscape of the new discipline, almost disappearing for three decades.

Aware of the debates during the 1960s and the 1970s, Anzieu, from his position as both former student of Lagache and analysand of Lacan, wrote of the risks of falling into a ‘generalised psychoanalisation’ (Anzieu, 1979). He was mainly concerned by the fact that university courses proposed to students at the time were discrediting to the discipline (Anzieu, 1979). Indeed, the risk was that clinical psychologists or psychologists in health settings became ‘pseudo’ psychoanalysts or so-called ‘psychoanalysts’, between quotation marks. Their ‘de-psychologisation’ made them attractive in the eyes of the young Lacanian generation, whose premises found an important echo within this turn. At the same time, this process made them increasingly suspicious in the eyes of both the so-called scientific psychology and the defenders of the medical field. Finally, this de-psychologisation exposed clinical psychology to many missed opportunities, and also to many dangers (Anzieu, 1979). We can interpret these considerations as a precursor of the transformations that clinical psychology and psychology in health settings would go through with the arrival of the Anglo-Saxon cognitive-behavioural trends, and of ‘mainstream health psychology’. The latter was more likely to be accepted by medicine because it did not question its ideals; it also accepted the generalised medicalisation of life (in some countries, ‘Behavioural Medicine’ rivalled ‘Health Psychology’, for exactly this reason of medical acceptance).

The professionalisation of psychology in the 1980s: arrival of a pragmatic approach from the United States

In the 1980s, there was a particular conjunction of transformations in the French context, which made it possible for a pragmatic approach in psychology to have an important effect. These events, as we shall describe below, concerned the implementation of the professional title of psychologist, the inter- and intra-disciplinary disputes, and the massive increase in the number of university students. But accepting an imported pragmatic, utilitarian version of the discipline would leave little room for any philosophical, epistemological or even methodological debate.

Historical and cultural conditions in France having shaped the rapid introduction of mainstream health psychology

While theoretical and methodological dissentions among academics continued, the 1980s were marked by important changes at the universities in France.⁸ Three major phenomena can be highlighted in this regard. First, many students from middle and/or lower social classes had access for the first time to higher education. This democratisation of studies led to the substantial increase in the number of students interested in social sciences in general, and more particularly in psychology. Nevertheless, this growth must be put into perspective, given the first economic crises at the end of the 1980s and the increase in unemployment after the ‘Glorious Thirty’ years following the war. Very rapidly, students in higher education planned and ‘invested’ their studies with the aim to obtain a decent job after university. Second, the law that ruled the exercise of the profession in 1985 shaped the role of practitioners and participated to the institutionalisation of psychology and a creation of a professional Code of Ethics.⁹ The discipline restricted access to the title ‘Psychologist’ exclusively to those who had taken courses and had at least 5 years of university training (Master’s degree). It specified high standards in education, requiring extensive training in research and in intervention. The creation of this professional status or title addressed concerns stemming from professional associations regarding this profession, and also was in reaction to the greater number of enrolments in psychology. However, the psychology titles with the most status and recognition were mainly those in occupational psychology, child psychology and clinical psychology (the three most popular degree programmes for students). Hence, academics doing experimental research in laboratories shifted their attention to more applied dimensions in their research work.¹⁰ Third, relationships between clinical psychoanalytic psychologists and experimental psychologists remained conflicting, the former willing to support the role of the psychoanalytical orientation in higher education. During those years, tensions were exacerbated because of the growing interest in clinical work among students, so there were conflicts between orientations that were in competition for teaching positions. Each orientation defended its own interests – clinicians highlighted the fact that the great majority of students were enrolled in their field, while experimentalists claimed to be the only ones who were truly scientific. In addition to this difficult situation, academics adopting cognitive-behavioural approaches called themselves clinicians as well.

Within this turbulent context characterising the beginning of the 1990s, academics adhering to the American trend of social cognitive psychology and/or to occupational psychology succeeded in introducing a specific orientation of health psychology.¹¹ These academics had followed for many years the international work focussing on stress and coping.¹² This is how they found themselves at the heart of the rise of American health psychology, underpinned exclusively by a socio-cognitive framework. Health psychology was perceived as a perfect opportunity to develop new courses, original research programmes and, importantly, new career opportunities for their students. The main authors who introduced this mainstream health psychology into France were Marie-Lou Bruchon-Schweitzer (1996), Gustav Nicolas Fischer (1998) and Robert Dantzer (Bruchon-Schweitzer and Dantzer, 1994) who published excellent reviews, articles and books on this new field. Their work was clear, coherent and scientifically rigorous, with extensive bibliographies, precise citations and so on. However, the way in which Anglo-Saxon work was presented by these authors gave the illusion of a unified perspective in health psychology. Interestingly, these same authors seemingly did not agree on the priority areas of health psychology. From a background in differential and socio-cognitive psychology, Bruchon-Schweitzer worked on the development and the legitimation of mainstream health psychology in Bordeaux, while Fischer had a background in social and community psychology in Metz. To Fischer, this sub-discipline appeared as an approach able to integrate psychology’s different contributions, in particular those made by social psychology and clinical psychology, by stressing the role of contexts and of psychosocial aspects related to illness, including the family, and institutional and cultural contexts involving personal, social and doctor–patient relationships (Fischer, 1998: 40). While Fischer’s definition focused on psychological and social psychosocial aspects, Bruchon-Schweitzer was more interested in bio-physiological aspects of health psychology. In her view, this sub-discipline involved two paradigms. One of them, the traditional one, was concerned primarily with psychological variables (e.g. cognitive, emotional, behavioural, psychosocial and psychophysiological). The second one was ‘bio-psycho-social’, implying interactions between different systems (e.g. psychological and biological) and requiring the collection of not only psychosocial data but also medical and physiological data, such as the heart rate and the arterial tension and the consideration of neuro-endocrine and neuro-immunitary parameters (Bruchon-Schweitzer, 2002: 108).

However, within clinical psychology, few researchers were interested in health psychology at that time and their perspective was hardly critical. In their view, health psychology was an extremely interesting field for research, able to offer new career perspectives that could renew the roles and the position of clinical psychologists (Widlöcher et al., 1996: 106).¹³ It is important to note that in 1996, a special issue of Psychologie Française was dedicated to health psychology, faithfully integrating different standpoints defended by French psychologists and physicians interested in this field. Distinct perspectives inspired by American health psychology were identified: those highlighting behavioural and bio-physiological aspects (Bruchon-Schweitzer, 1996), those driven by psychosocial dimensions (Fischer, 1998), those who attempted to reconcile psychosomatics and health psychology (Consoli, 1996) and finally, those who defended a medical psychology (e.g. psychiatrists) (Jeammet et al., 1996).

Mainstream health psychology versus psychology in health settings: the rise of resistance among practitioners and a few academics

A few French researchers who were familiar with mainstream health psychology from the United States began to question the steady dissemination of concepts from the medical field to the social and human sciences (Giami, 1997; Sidot, 1997). Some clinical psychologists working in general hospitals, often with a psychoanalytical approach, also showed certain scepticism towards a particular way of thinking with which they were not familiar. These groups represented the stream most critical towards health psychology. They underlined the gap between research conducted both in university settings and in research centres, such as INSERM, or the National Centre of Scientific Research (CNRS), and the practical work in the field of health populated by psychologists in health settings. It is important to note that these psychologists (clinicians) were a group most closely involved with patients and medical practices, while also the most distant from Anglo-Saxon theoretical trends (Giami, 1997).

By the end of the 1990s, many psychologists in health settings, as well as the unions they belonged to, were concerned by the medicalisation of their profession, and being focussed in medical care and practice (Sidot, 1997). The debates that took place in journals on occupations and careers provide a good indicator of the collision between two very different cultures – the French and the Anglo-Saxon. But beyond this division, two fundamental questions raised by psychologists in health settings remained. The first question concerned the curriculum of studies in psychology, that is, how to become a psychologist. Was it necessary to stream the courses depending on the application fields? Did psychology need to look at statistical aggregates rather than focussing on individuals? Did it have to become increasingly close to biology, leaving little room for language and narratives (Sidot, 1997)? The second question concerned the ethics code in psychology, as applied to a certain kind of health psychology. While the latter was under growing medical control, the Code of Ethics stated respect for the psychological dimension, stressing the role of the symbolic dimension of language, the independence of the profession and the importance of avoiding reductive approaches.¹⁴

Criticisms stemming from French practitioners were very similar to those developed during that period by critical psychologists from Anglo-Saxon countries, even though French practitioners were not aware of debates taking place in English-speaking cultures.¹⁵ Their criticisms can be situated at different levels – theoretical, methodological, professional and ethical. To them, mainstream health psychology relied on the following: an individualist and reductive definition; a belief in linear causality; a loss of all reference to subjectivity and to subconscious mechanisms; an absence of a psychological theory of human beings; the application of academic theories produced by socio-cognitive experimental research with little relationship to the field; increasing gaps between theories and practices; the medicalisation of the profession, at the service of medical practice and support, in order to improve their control; the reduction of practitioners in psychology to mere ‘appliers’ of theories with biomedical foundations; and finally, the absence of ethical questioning regarding the profession of psychology.

This typical French dissention was not overlooked by the mainstream Anglo-Saxon trend, when in 1997, the president of the European Society of Health Psychology questioned the way this trend could be received in France:

With our first conference in France, we are making another significant step towards becoming a Society that truly represents all health psychologists in Europe […]. Since France has been underrepresented in our Society so far, I am curious about the long-term effects of the meeting in Bordeaux. (Schwarzer, 1997: 1)

Conclusion: building the future

Psychology in health settings remains the dominant approach across hospitals and other health care centres. Practitioners’ main struggles have focused on political and financial difficulties, rather than theoretical oppositions. In academia, courses in health psychology have evolved in a differential way; each university having specific interests depending on the academics in charge. Some of them continue to promote mainstream health psychology, but the majority integrated courses with psychosocial and/or clinical perspectives, that is, more comprehensive epistemologies.¹⁶ Nevertheless, theoretical and methodological rivalries are far from reconciled. Practitioners are often most active about supporting their professional practice, perceived as bearing knowledge and not merely applying theories or statistical measurements. In 2006, they formulated a public declaration supported by a petition titled ‘Halte à la médicalisation des psychologues et à la standardisation des pratiques’ [Stop medicalisation of psychologists and standardisation of practices],¹⁷ where they recalled once again their definition of psychological practices and their refusal to move towards the medicalisation of psychology. To them, psychology stems from philosophy and therefore should develop from practices involving language, speech and social interactions. Moreover, psychologists who do interventions in the health sector proposed re-establishing links between the somatic and the psychological dimensions among patients and to respect the singularity of their personal history. Their last claim states that medicine and psychology are two radically opposed disciplines; they can sometimes be complementary but are not capable of replacing each other, nor can one be subordinated to the other.

Psychology in health settings, shaped by a specific French culture and history, continues to evolve, although it interacts very little with most Anglo-Saxon contributions. We can highlight how many clinicians in academia are increasingly interested in qualitative methods and critical perspectives in psychology emerging in English-speaking cultures. These practitioners in France seem to find in recent Anglo-Saxon trends elements that support their own position: being committed to a discipline that respects the singularity in human development, embedded in specific psychological, cultural and social contexts.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Notes

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