Latest news with #Foucault
Medscape
13-06-2025
- Health
- Medscape
France's Prisons Are Overcrowded — With Psychiatric Patients
Eric Kania, MD Eric Kania, MD, who has been a psychiatrist at Baumettes Prison in Marseille, France, for 25 years, has witnessed an increasing proportion of inmates being treated for psychiatric disorders. In an interview with Medscape's French edition, he explains how care teams are organizing treatment in often overcrowded prisons and describes the special monitoring implemented for inmates at highest risk for suicide. How did you become a prison physician? I studied medicine in Marseille and specialized in psychiatry. During my residency, I completed a 6-month internship at Baumettes Prison, which greatly interested me. After completing my thesis and working in hospitals, I returned to the prison because I wanted to continue this work. I now work half-time at Baumettes and half-time in private practice. Why this attraction to prison work? Prison is a place that requires dedication. It sits at the confluence of multiple issues: social, sociologic, medical, and judicial. I'm particularly interested in the criminal responsibility of offenders with psychiatric disorders. Like many of my colleagues, I've read the work of Michel Foucault — particularly his 1975 book Surveiller et punir: Naissance de la prison (Discipline and Punish: The Birth of the Prison) — which helped shape my thinking around justice, mental illness, and social structures. These reflections played a significant role in my decision to work in the prison system. How are psychiatric services organized at Baumettes? We are a team of seven psychiatrists — some of us, like myself, working part-time. We collaborate with a nursing team of eight for level 1 psychiatric care, and a second team handles level 2 care. Baumettes is a very old facility, originally opened in 1930, and it has housed a regional medico-psychological service since 1980. Today, we provide psychiatric care for more than 1000 inmates. The renovated section of Baumettes, which opened in 2017, was designed to accommodate 580 men and 200 women. However, overcrowding became an issue almost immediately. Although the cells were intended for single occupancy, additional fold-out beds had to be added owing to limited space. The older part of the facility previously held up to 2000 inmates in a space built for 1300. Currently, two detention buildings are in use, and three more are under construction, expected to open within 1-2 years. In the long term, the total capacity at Baumettes will once again double. Although we hope this will help relieve overcrowding, experience has shown that any new space tends to fill up very quickly. What are the main psychiatric disorders among inmates? There is an overrepresentation of psychiatric disorders in prisons. Epidemiologic studies show five to eight times more severe psychiatric disorders (bipolar disorder or schizophrenia) among inmates than in the general population. We also manage more common pathologies, such as depression and anxiety. Sometimes, people with no prior psychiatric history develop anxiety reactions owing to the prison environment. Do you have enough resources to care for everyone? Resource availability is a complex issue. It's reasonable to assume that there aren't enough mental health professionals working in prisons. This shortage was one of the reasons behind the creation of specially adapted hospital units, located within public health facilities, to provide care for incarcerated individuals. These units represented real progress, but they also had an unintended consequence: The more mental health staff we place in prisons, the more it appears that mental illness is prevalent in these settings. Is this a reality? The reality is that society, the justice system, and law enforcement are now more likely to send individuals with mental illness to prison, partly because they know that mental health professionals are available there to manage them. I've been practicing in prison since 2000. In the past, it was rare to see a person with schizophrenia incarcerated after committing an offense during an escape from a psychiatric hospital. Today, that scenario has become unfortunately common. Psychiatric patients are being sent to prison because understaffed hospitals are increasingly unwilling, or unable, to take them back. Should we conclude that France's psychiatric crisis is increasing the prison population? Penrose's law, named after an English psychiatrist, suggests that in several countries, reductions in psychiatric hospital beds have been associated with increases in the prison population. In France, the decrease in psychiatric inpatient capacity has coincided with a rise in both overall incarceration rates and the number of inmates with psychiatric disorders. Although correlation does not imply causation, the pattern is worth considering. Of course, other factors may also contribute to the growing number of individuals with mental illness in prison. What are those factors? Many believe that the 1994 reform of the French Penal Code, which introduced the concept of partial criminal responsibility, contributed to an increase in the number of mentally ill individuals in prison. Previously, under the 1810 Penal Code, a person deemed to be in a state of insanity was exempt from criminal responsibility and was transferred to a psychiatric hospital. The 1994 reform amended this principle, specifying that individuals whose judgment is impaired, but not completely abolished, by mental illness can still be held criminally liable. This change led to convictions that might not have occurred under the previous legal framework. Sociologist Caroline Protais has shown that the number of rulings of criminal irresponsibility has decreased since the reform. Another policy that has significantly contributed to the increase in mentally ill inmates is comparution immédiate (immediate appearance), a legal procedure introduced in 1983 and strengthened in the mid-2000s under then-Interior Minister Nicolas Sarkozy. This fast-track process has been a major driver of prison overcrowding, particularly among individuals with serious psychiatric disorders that often go unrecognized at the time of sentencing. By the time their condition is identified in prison, the sentence has already been handed down, making transfer to a psychiatric facility no longer possible. How are inmates cared for? Can a patient request to see you? Are there mandatory check-ups? Every inmate undergoes a medical consultation upon arrival, typically with a general practitioner. If needed — whether due to existing psychiatric care or observed concerns — they are referred the same day for a psychiatric evaluation. If we identify signs of 'carceral shock' (a psychological reaction to incarceration) during this initial assessment, we schedule follow-up and initiate appropriate care. Additionally, if an inmate requests to see a psychiatrist or psychologist at any point during their incarceration, or if someone in their environment alerts us to an urgent situation, we make arrangements to see the patient promptly. What are your main concerns? Are inmates treated differently than other patients? The context for providing care in prison is very specific, and we have to account for that. Inmates often reach out to us because the prison environment intensifies their psychological distress. At times, we need to coordinate with the prison administration to adjust detention conditions, even though that falls outside our formal responsibilities. If an inmate expresses suicidal thoughts, we inform the administration so that special monitoring can be implemented. At night, correctional officers check through the cell's observation window to ensure the inmate is safe. Every 2 weeks, a multidisciplinary committee reviews the cases of these at-risk individuals. How far does this special monitoring go? If inmates are at high risk for suicide or attempt to hang themselves during the night, the prison administration may transfer them to the emergency department. They can also place the individual in an 'emergency protection cell' designed to ensure safety until appropriate care can be arranged. These cells are smooth and free of any anchor points. In many cases, an emergency protection system is also activated, which consists of making the prisoner wear a tear-away gown to avoid any risk for hanging. The following morning, the inmate is seen by the regional medico-psychological service, which determines — based on clinical assessment — whether hospitalization is required. A recent study by the penitentiary administration shows rising suicide rates among inmates. Are you concerned? We have always been concerned about this issue. There have been several suicides at Baumettes in recent years; some involved patients we were actively treating, while others were unknown to us. Each case is a tragedy. Importantly, suicides are not limited to individuals who previously expressed distress; many had no diagnosed psychiatric illness. In some cases, the act may have been a way to protest or attempt to change detention conditions. Fortunately, not all suicide attempts result in death. Psychiatric care for the approximately 80,000 incarcerated individuals in France is organized into a three-tiered system. Level 1 care is available in all 187 prisons across the country and provides outpatient psychiatric services. Inmates leave their cells to attend appointments in the prison's health unit, where they may be seen by a psychiatrist, psychologist, psychiatric nurse, and, when appropriate, a social worker or educator. When level 1 care is insufficient owing to the severity of the condition, inmates can access level 2 care through day hospitals. Twenty-six prisons are equipped with both level 1 and level 2 services, including a day hospital as part of the regional medico-psychological service. If level 2 care is still inadequate — typically when a patient is highly unstable — they may be transferred to level 3 care, which involves full-time inpatient psychiatric hospitalization. This may occur in a nearby psychiatric hospital when the patient is experiencing an acute emergency, such as a psychotic episode or suicidal crisis. The inmate may remain hospitalized for several days and can be admitted to one of the nine specially adapted hospital units located in Lyon, Nancy, Toulouse, Villejuif, Lille, Rennes, Orléans, Bordeaux, and Marseille. These units accept inmates under voluntary or compulsory care, based on a decision by a state representative when the patient is deemed incapable of providing informed consent. These secure facilities — equipped with video surveillance, barbed wire, and security checkpoints — are dedicated healthcare environments. Prison staff only intervene in cases of agitation or violence; otherwise, all care is provided exclusively by medical professionals.
BBC News
02-06-2025
- Entertainment
- BBC News
Five works that reveal the philosophy of Banksy
Banksy's new mural in Marseille is not the first image he has connected to the history of ideas. From Plato to Foucault, a Banksy expert reveals the philosophy behind these popular artworks. Which is the real you, the person you are now or the one you are capable of becoming? It's a heady question, to be sure, and not one you would expect to be confronted with while strolling down a street in Marseille in the waning days of May. Yet it's precisely the existential dilemma that Banksy, who once asserted "being yourself is overrated" – has surreptitiously installed in a cloistered stretch of the quiet Rue Félix Fregier, the site of a new work – the latest installment in the elusive artist's decades-long career as a provocative philosophical prankster. For more than 30 years, Banksy has spiked many of his most iconic works – from his girl reaching hopelessly for a heart-shaped balloon to his masked rioter hurling a bouquet of flowers – with barbed allusions to Old Masters, from Michelangelo to Monet, Vermeer to Van Gogh. But there's more. Beneath his stealthy stencils lies a deep and deliberate engagement with the history of ideas as well, from classical Stoicism to postmodern deconstructionism. On 29 May, Banksy posted on Instagram a photo of his first new piece in more than five months, piquing the internet's interest by withholding its precise location. Discovered shortly thereafter in the major port city in southern France, Marseille, the mural is, at first glance, deceptively simple: a tall silhouette of a lighthouse spray-painted on to a blank beige urban wall; a rusting street bollard positioned nearby; and a painted shadow stretching across the pavement, joining the real-world object to its augmented, if two-dimensional, echo. Stencilled across the black lighthouse are the words: "I want to be what you saw in me." Anyone keen to find a source for the ideas that inform Banksy's new work needs merely to flip open any history of philosophy to Plato's seminal allegory of the cave (from the Fourth-Century BC treatise The Republic), then flip the ancient metaphor on its head. In Plato's parable, prisoners chained inside a cave mistake shadows on the wall for reality, unaware of the truer forms that cast them outside. But here, Banksy, being Banksy, baits us by switching the set-up, reversing the relationship between essence and shadow. In Banksy's mural, the drab bollard casts not a diminished imitation of itself, but something far grander – a lighthouse, a symbol of illumination and guidance. Here, it's the silhouette, not reality, that's true. Banksy's inversion urges us to ask where reality really resides: in what is, or in what might be? His poignant phrase – "I want to be what you saw in me" – is alluringly elastic. Is this the bollard dreaming of being more than it appears? Or the shadow wishing to become light? Or is it all of us – Banksy included – struggling to live up to the better versions imagined by those who believe in us? The answer is surely yes to all of the above. And it's a yes too to the question: 'is this new work a lamp capable of shining light on further levels of meaning in Banksy?' What follows is a brief look back at some of the artist's best-known works and how they too are invigorated by, and often upend, many of the most important philosophical tenets – both social and intellectual – that underwrite who we are and who we might be. Girl with Balloon, 2002 Banksy's new mural in Marseille is not the first to be accompanied by an affecting caption connecting the piece to the history of ideas. Among his most famous murals, Girl with Balloon, which portrays a child reaching towards a heart-shaped balloon drifting away from her, first appeared in 2002 in various locations in London, including on the South Bank, alongside the consoling assertion, "there is always hope". That conviction, which fuels the ceaseless striving for an ideal that is seemingly unobtainable in the mural (there's no way that balloon is coming back) rhymes richly with aspects of 19th-Century German philosopher Arthur Schopenhauer's ideas concerning an unquenchable and irrational "Will" as a fundamental force that drives humanity. When, years later, Banksy mischievously concealed a remote-controlled shredder in the frame of a version of Girl with Balloon that came up for auction in 2018, and sensationally destroyed the work before the eyes of aghast auction-goers, he succeeded in upping the ante on Schopenhauer's belief in the futility of desire by boldly manifesting it himself. Where there's a will there's a fray. Flower Thrower (or Love is in the Air), 2003 Banksy's famous mural of a masked man frozen forever in the instant before he unleashes not a brick or a bomb but a bouquet of flowers may seem, at first blush, to exemplify a pacifist's commitment to peaceful disobedience. The work appears to echo the precepts of Mahatma Gandhi's Satyagraha – a philosophy of non-violence that the Indian ethicist coined in 1919. Banksy's fully flexed figure, incongruously armed with a fistful of beauty, appears to epitomise Gandhi's insistence on wielding moral, not physical, strength. Doesn't it? Or has Banksy slyly subverted the philosophical assertion of pacifistic force by portraying his hero as an enraged rioter? The figure's anger has not been tempered by an appeal to the higher ideals of beauty and truth. Instead, those ideals have been weaponised by Banksy. Here, beauty and truth are not disarming, they are devastatingly explosive. One Nation Under CCTV, 2007 Banksy's mural in Marseille employs a tried-and-true technique to ensure the work protrudes into the urban space in which we'll encounter it – elevating its philosophical potential from something flimsy and flat to something undeniably urgent. It's a tactic he used in a 2007 work that appeared near London's Oxford Street in which he depicts a boy atop a precariously high ladder, spray-painting the penetrating observation that we are "One Nation Under CCTV" in outlandishly outsized letters. Also portrayed within the mural is a uniformed officer and his obedient police dog who surveil the young vandal, while above them all an actual CCTV camera, presumably recording everything, juts out from the wall. The endless layers of surveillance-within-surveillance to which the work attests – as we watch the state watch an officer watch the boy – captures with uncanny precision the philosophical contours of the vast and all-encompassing prison machine in which the French poststructural philosopher Michel Foucault believed everyone in society was now irredeemably enmeshed. In Foucault's study Discipline and Punish: The Birth of the Prison, he resuscitates a blueprint for a prison proposed by the British utilitarian philosopher Jeremy Bentham at the end of the 18th Century, "The Panopticon" (meaning "all seeing"), and uses it as a menacing metaphor for how no one can escape the perniciously penetrating eye of the panoptical state. Mobile Lovers, 2014 Banksy's witty 2014 work Mobile Lovers shines a chilling light on the state of contemporary relationships. The mural depicts a couple whose almost affectionate embrace is interrupted by the deeper fondness they have for the warm glow of their smartphones. The French existentialist philosopher Simone de Beauvoir, who died in 1986, may not have lived long enough to witness the emergence of mobiles. Yet her profoundly influential 1947 book The Ethics of Ambiguity – published exactly 60 years before the iPhone was launched in 2007 – with its exploration of the devastation that detachment and disconnection can wreak on the realisation of our truest selves, is profoundly proleptic of our modern predicament. To be free, de Beauvoir insisted, requires a deep attentiveness to each other. She believed in the authenticity of human encounters, without which life is a futile performance, dimly lit by disposable devices, rather than something profound and meaningful. How Banksy Saved Art History by Kelly Grovier, published by Thames & Hudson, is out now. -- For more Culture stories from the BBC, follow us on Facebook, X and Instagram.
Spectator
27-05-2025
- Politics
- Spectator
What Alasdair MacIntyre got right
Alasdair MacIntyre, who died last week, was one of the most influential thinkers of the past 50 years. It is hard to think of any other philosopher writing in the late 20th-century who has had such an impact. He might be less famous than Foucault or Derrida, but it is his conservative brand of postmodernism that launched a fairly coherent intellectual movement. For a few decades its adherents were mostly academics; now it has become politically influential too. Like those aforementioned Frenchmen, he was a powerful critic of the rational Enlightenment. And like them, his thought was strongly shaped by Marxism, and its critique of liberal political assumptions. But unlike them he decided that it was not enough to be suspicious of all ideologies. The task was to reconstruct meaning, amid the chaos and nihilism of modern thought. This bold proposal is set out in his book of 1981, After Virtue.
Express Tribune
09-05-2025
- General
- Express Tribune
The middleman syndrome
Listen to article This world is, but, a droplet suspended in the cosmic ocean of galaxies, pulsating with one desire echoing with an uncanny consistency from ancient civilisations to contemporary algorithmic societies, from crowded capitals to forgotten hamlets: a desire for change. Change is the only constant, they say. Yet the more things change, the more they remain the same, begging a sobering question: do things really change or is it merely shifting of the masks and choreography of the appearances? What appears on the surface as a transformation is a mere rearrangement of the stage. Only names change; the system remains. If today's world was imagined as a jungle dressed in a semblance of peace, the silence from habituated submission and carefully crafted consensus. Beneath the canopy of the dense trees, every creature follows a rhythm. The donkey bears the burden it did not choose, the predators prey not out of spite but design and the grazers roam. A utopia of equilibrium appears, but balance is a fragile illusion — one graze away from collapse. The 'tragedy of the commons' is inevitable. Free riders graze more than their share, feed beyond their contribution and prey beyond need. They corrode the ecosystem with routine, not revolution. This 'orderly' disorder then becomes the new order. The system crumbles not from above but from within, with a sham of change. Thus, the call for change persists. What keeps the order intact and who profits from its slow unravelling? Is it the crown, the silent ants, or something more elusive in the shadows? The answer hides in plain sight: the middleman. They are the purgatory — between power and truth, between policy and principle. Over time they become invincible not by might, but by proximity. The ruler outsources his senses. He sees what the middleman shows him, and hears what he whispers to him. The governance, thus, drifts into a realm where delegation is dependence. The crown rules but through borrowed senses and padded truths. As Machiavelli suggested to the Prince, "The first method for estimating the intelligence of a ruler is to look at the men who surround him." The middleman syndrome is not just a glitch, it is a pathology — insidious, slow and systemic. Its first prey is competence; then merit is strangulated by convenience. Foucault would cite it as a brilliance of modern power — not coercive but capillary, flowing through institutions, colonising minds. Kafka explored a similar Castle where the messenger cast a shadow longer than the message itself. Orwell's pigs in his Animal Farm, who once cried for change, mirrored the humans they overthrew. The reality bends, the old regime does not die, it moulds. Faces metamorphose and the status quo stays. Repeated whispers transform into standard operating procedures. "All animals are equal, but some are more equal than others." Those "more equal" are not emperors but attendants. The power appears in its most enduring form when it operates without appearance and the myth of reform carries on. It manifests in today's world as each new leader, ruler, or government, riding on the horse of a long-awaited answer, arrives as the purifier of corruption, the bringer of enlightenment and the slayer of red tape. Hirschman's trinity — Exit, Voice and Loyalty — offers three choices: walk away, speak out, or keep quiet out of loyalty. But what if the exit is exile, the voice becomes noise when the middleman language becomes the lingua franca of power, and loyalty is complicity, not principle but paralysis? So, where does one turn in this relentless loop, where end is beginning, and beginning is end? To the crown who has borrowed another's lenses? To the ruled who words vanish like breath on glass? Or to the middleman who is the phantom force of invisibility and control? Perhaps, start with looking inward and inquiring about what we accept as normal, who we entrust to filter our truths. As in this world, middleman's power endures not because of strength but, by being diffused and dispersed — everywhere and nowhere. Maybe the loop persists not because we do not want change, but because we are searching for change where it cannot be found. Think critically, challenge assumptions, get clarity and act wisely.
Atlantic
23-03-2025
- Health
- Atlantic
An ‘Impossible' Disease Outbreak in the Alps
In March 2009, after a long night on duty at the hospital, Emmeline Lagrange took a deep breath and prepared to place a devastating phone call. Lagrange, a neurologist, had diagnosed a 42-year-old woman with amyotrophic lateral sclerosis, or ALS. The woman lived in a small village in the French Alps, an hour and a half drive away from Lagrange's office in Grenoble Alpes University Hospital. Because ALS is rare, Lagrange expected that the patient's general practitioner, Valerie Foucault, had never seen a case before. Snow fell outside Lagrange's window as she got ready to describe how ALS inevitably paralyzes and kills its victims. But to her surprise, as soon as she shared the diagnosis, Foucault responded, 'I know this disease very well, because she is the fourth in my village.' ALS, also known as Lou Gehrig's disease, occurs in roughly two to three people out of every 100,000 in Europe. (The rate is slightly higher in the United States.) But every so often, hot spots emerge. Elevated ALS rates have been observed around a lagoon in France, surrounding a lake in New Hampshire, within a single apartment building in Montreal, and on the eastern—but not western—flank of Italy's Mount Etna. Such patterns have confounded scientists, who have spent 150 years searching for what causes the disease. Much of the recent research has focused on the genetics of ALS, but clusters provocatively suggest that environmental factors have a leading role. And each new cluster offers scientists a rare chance to clarify what those environmental influences may be—if they can study it fast enough. Many clusters fade away as mysteriously as they once appeared. After the call, Lagrange was uneasy; she had a hunch about how much work lay ahead of her. For the next decade, she and a team of scientists investigated the cluster in the Alps, which eventually grew to include 16 people—a total 10 times higher than the area's small population should have produced. Even during that first call, when Lagrange knew about only four cases of ALS, she felt dazed by the implications, and by Foucault's desperate plea for help. If something in the village was behind the disturbing numbers, Foucault had no idea what it was. 'She was really upset,' Lagrange remembers. 'She said to me, 'This is impossible; you must stop this.'' For some people, the trouble begins in the throat. As their muscles waste, swallowing liquids becomes a strenuous activity. Others may first notice difficulty moving an arm or a leg. 'Every day, we see that they lose something,' Foucault said of her patients. 'You lose a finger, or you lose your laugh.' Eventually, enough motor neurons in the brain or spinal cord die that people simply cannot breathe. Lou Gehrig died two years after his diagnosis, when he was just 37. Stephen Hawking, an anomaly, lived with ALS until he was 76. Five to 10 percent of people with ALS have a family member with the disease. In the 2000s, advancements in DNA sequencing led to a swell of genetic research that found that about two-thirds of those familial cases are connected to a handful of genetic mutations. But only one in 10 cases of ALS in which patients have no family history of the disease can be connected to genetic abnormalities. 'What we have to then explain is how, in the absence of genetic mutation, you get to the same destination,' Neil Schneider, the director of Columbia's Eleanor and Lou Gehrig ALS Center, told me. Scientists have come up with several hypotheses for how ALS develops, each more complicated and harder to study than genetics alone. One suggests that ALS is caused by a combination of genetic disposition and environmental exposures throughout a lifetime. Another suggests that the disease develops after one person receives six cumulative 'hits,' which can be genetic mutations, exposures to toxins, and perhaps even lifestyle factors such as smoking. Each time a cluster appears, researchers have tried to pin down the exact environmental hazards, professions, and activities that might be linked to it. After World War II, a neurodegenerative disease that looked just like ALS—though some patients also showed features of Parkinson's and dementia—surged in Guam, predominantly among the native Chamorro people. 'Imagine walking into a village where 25 percent of the people are dying from ALS,' says Paul Alan Cox, an ethnobotanist who studied the outbreak. 'It was like an Agatha Christie novel: Who's the murderer?' Early research tried to pin the deaths on an unlikely culprit: the highly toxic cycad plant and its seeds, which locals ground into flour to make tortillas. Cox and his colleagues hypothesize that human cells mistake a compound called BMAA found in the plant for another amino acid, leading to misfolded proteins in the brain. Peter Spencer, an environmental neuroscientist at Oregon Health & Science University, has argued for a different explanation: The body converts cycasin, a compound also found in the plant's seeds, into a toxic chemical that can cause DNA damage and, eventually, neurodegeneration. Each theory faced its own criticism, and a consensus was never reached—except for perhaps an overarching tacit agreement that the environment was somehow integral to the story. By the end of the 20th century, the Guam cluster had all but vanished. Genetic mutations are precise; the world is messy. This is partly why ALS research still focuses on genes, Evelyn Talbott, an environmental epidemiologist at the University of Pittsburgh, told me. It's also why clusters, muddled as they might be, are so valuable: They give scientists the chance to find what's lurking in the mess. Montchavin was a mining town until 1886, when the mine closed, leaving the village largely deserted. In 1973, it was connected to a larger network of winter-tourism destinations in the Alps. On a sunny December afternoon, the week before ski season officially began, I met Foucault outside of the church in the center of Bellentre, a town of 900 whose borders include Montchavin and neighboring villages. The mountains loomed over us, not yet capped with much snow, as she greeted me in a puffer coat. She led me briskly up a steep hill, chatting in a mix of French and English, until we arrived at her home, which she occasionally uses as an office to see patients. Foucault made us a pot of black tea, then set down a notepad of scrawled diagnoses and death dates on the table beside her. The first person Foucault knew with ALS lived a stone's throw from where we were sitting, in a house down the hill; he had been diagnosed in 1991. The second case was a ski instructor, Daniel, who lived in Montchavin and had a chalet near Les Coches, a ski village five minutes up a switchback road by car. Daniel, whose family requested that I use only his first name for medical privacy, had told Foucault in 2000 that he was having trouble speaking, so she'd sent him to a larynx specialist. When the specialist found nothing wrong with his throat, Daniel was referred to a neurologist in Grenoble, who diagnosed him with ALS. In 2005, after Foucault heard that the husband of one of her general-medicine patients had been diagnosed with ALS, she called her father, a heart doctor in Normandy. 'It's not normal,' he told her. A few years later, she saw one of her patients, the 42-year-old woman, in the village center with her arm hanging limp from her body. Even before the woman received her ALS diagnosis from Lagrange, Foucault suspected the worst. After her call with Foucault, Lagrange assembled a team of neurologists and collaborators from the French government to search for an environmental spark that might have set off the cluster in Montchavin. They tested for heavy metals in the drinking water, toxins in the soil, and pollutants in the air. When the village was turned into a ski destination in the 1970s, builders had repurposed wood from old train cars to build garden beds—so the team checked the environment for creosote, a chemical used in the manufacture of those train cars. They screened for compounds from an artificial snow used in the '80s. They checked gardens, wells, and even the brain of one deceased ALS patient. Years passed, and nothing significant was found. The day after I had tea with Foucault, I visited Lagrange at the hospital. Her voice faltered as she ruffled through the piles of papers from their investigation on her desk. She'd cared for most of Montchavin's ALS patients from their diagnosis to death. She worked in Montchavin on the weekends and took her family vacations there. 'I felt responsible for them,' she said. 'People were telling me, This is genetic. They all live together; they must be cousins. I knew it was not so.' Lagrange's team had tested the genomes of 12 people in the Montchavin cluster, and none had mutations that were associated with ALS. Nor did any of the patients have parents, grandparents, or great-grandparents with ALS. But their lives did overlap in other meaningful ways. The first Montchavin cases worked together as ski instructors and had chalets in a wooded patch of land called L'Orgère, up the mountain. Many of them hiked together; others simply enjoyed spending time in nature. 'We thought they must have something in common, something that they would eat or drink,' Lagrange told me, sitting in her desk chair in a white lab coat and thick brown-framed glasses. She handed me a daunting packet: a questionnaire she'd developed for the ALS patients, their families, and hundreds of people without the disease who lived in the area. The survey, which took about three hours to complete, asked about lifestyle, eating habits, hobbies, jobs, everywhere they had lived, and more. It revealed that the ALS patients consistently ate three foods that the controls didn't: game, dandelion greens, and wild mushrooms. Lagrange's team didn't immediately suspect the mushrooms. But Spencer, the environmental neuroscientist in Oregon, did after he saw one of Lagrange's colleagues present on the Montchavin cluster at a 2017 conference. Having researched the role of the cycad seed in the Guam cluster, Spencer knew that some mushrooms contain toxins that can powerfully affect the nervous system. Spencer joined the research group, and in 2018, he accompanied Lagrange to Montchavin to distribute more surveys and conduct in-person interviews about the victims' and other locals' diets— the pair had particular interest in people's mushroom consumption. From the responses, the team learned that the ALS patients were not the only mushroom foragers in town, but they shared an affinity for a particular species that local interviewees without ALS said they never touched: the false morel. A false morel looks like a brain that has been left out in the sun. Its cap is a shriveled mass of brown folds, darker than the caramel hue of the true morel. One species, Gyromitra esculenta, grew around Montchavin and was especially abundant near the ski chalets in spring if enough snow had fallen the preceding winter. France has a rich foraging culture, and the false morel was just one of many species mushroom enthusiasts in Montchavin might pick up to sauté with butter and herbs. The false morel contains gyromitrin, a toxin that sickens some number of foragers around the world every year; half of the ALS victims in Montchavin reported a time when they had acute mushroom poisoning. And according to Spencer, the human body may also metabolize gyromitrin into a compound that, over time, might lead to similar DNA damage as cycad seeds. No one can yet say that the false morel caused ALS in Montchavin; Lagrange plans to test the mushroom or its toxin in animal models to help establish whether it leads to neurodegeneration. Nevertheless, Spencer feels that the connection between Montchavin and Guam is profound—that the cluster in the Alps is another indication that environmental triggers can be strongly associated with neurodegenerative disease. Once you start looking, the sheer variety of potential environmental catalysts for ALS becomes overwhelming: pesticides, heavy metals, air pollution, bodies of water with cyanobacteria blooms. Military service is associated with higher ALS risk, as is being a professional football player, a painter, a farmer, or a mechanic. Because of how wide-ranging these findings are, some researchers doubt the utility of environmental research for people with ALS. Maybe the causes are too varied to add up to a meaningful story about ALS, and each leads to clusters in a different way. Or perhaps, Jeffrey Rothstein, a Johns Hopkins University School of Medicine neurologist, told me, a cluster means nothing; it's simply a rare statistical aberration. 'Patients are always looking for some reason why they have such a terrible disease,' he said. 'There's been plenty of blips like this over time in ALS, and each one has its own little thought of what's causing it, and they've all gone nowhere.' 'A lot of people look askew to the idea that there are clusters,' Eva Feldman, a neurologist at the University of Michigan, told me. But she sees evidence of clusters all the time in her practice. Once, she saw three women with ALS who'd grown up within blocks of one another in the Grand Rapids area. Her research has shown an association between ALS and organic pollutants, particularly pesticides. Feldman thinks that the importance and scope of environmental triggers for ALS can be pinpointed only by investigating clusters more thoroughly. To start, she told me, doctors should be required to disclose every case of ALS to state officials. Feldman is also planning what she says is the first-ever prospective study on ALS in the U.S., following 4,000 healthy production workers in Michigan. She believes that clusters have significance and that because doctors can't do much to stop ALS once it starts, 'we would be naive to throw out any new ideas' about how to prevent it from occurring in the first place. Even for the people whose lives were upended by the Montchavin cluster, the idea that mushrooms could be linked to such suffering can be difficult to accept. Those who ate them knew the mushrooms could cause unpleasant side effects, but they believed that cooking them removed most of the danger. When I asked Claude Houbart, whose father, Gilles, died in 2019, about his mushroom habits, she called her mother and put her on speakerphone. Claude's mother said she knew Gilles ate false morels, but she never cooked them for herself or the family—simply because she didn't want to risk upset stomachs. Daniel, Foucault's second ALS patient, also kept his foraging hobby out of the home. He never ate false morels in front of his wife, Brigitte, though she knew he picked wild mushrooms with friends. 'I am a bit reluctant when it comes to mushrooms; I would have never cooked them,' Brigitte told me, sitting at her kitchen table in Montchavin, surrounded by photos of Daniel and their now-adult children. After Daniel died in 2008, Brigitte and her family spread his ashes in the woods where he'd spent so much of his time. 'He didn't want a tomb like everyone else,' she said. 'When we walk in the forest, we think about him.' Hervé Fino, a retired vacation-company manager who has lived in the Alps for 41 years, learned to forage in Montchavin. Bundled in a plaid overcoat inside a wood-paneled rental chalet, Fino recalled local foragers telling him that false morels were edible as long as they were well cooked, but he never ate the mushrooms himself, fearing their digestive effects. Fino told me about one of his friends who regularly gathered false morels, and once made himself a false-morel omelet when his wife was out of town. 'He was sick for two days, very ill,' Fino said. Later, that same friend was diagnosed with ALS. He died by suicide. In a gruff voice, Fino speculated about what besides the mushroom might have caused the disease. His friend fell into an icy-cold brook two days before he was diagnosed—'Perhaps the shock triggered the disease?' Another woman owned a failing restaurant next to the cable car—maybe the stress had something to do with it. He shrugged his shoulders. Those events didn't seem right either, not momentous enough to so dramatically alter someone's fate. Maybe no single explanation ever will. Claude told me she understands why people are skeptical. 'Eating a mushroom and then dying in that way?' she said. 'Come on.' Before leaving Montchavin, I walked through L'Orgère, the area where the first ALS patients had their ski cabins. The windows were dark, and below, the village of Montchavin was mostly empty before the tourist season began. Clumps of snow started to fall, hopefully enough to satisfy the skiers. Recent winters in the French Alps have been warm and dry—not the right conditions for false morels. 'There are no more Gyromitra in Montchavin,' Lagrange said. In her view, Montchavin has joined the ranks of ALS clusters come and gone; no one has been diagnosed there since 2019, and it's been longer since Lagrange's team has turned up a fresh false-morel specimen. Even so, on my walk, I couldn't help but scan for mushrooms, nor could I shake the feeling that my surroundings were not as benign as I'd once believed. Fino said he still keeps an eye out for false morels too. He would never pluck them from the ground to bring home, and yet, he hasn't stopped looking. One day in 2023, after he parked his car near a ski lift, his gaze caught on a lumpy spot near his feet. Two dark-brown mushrooms stuck out of the damp soil.
