The Obligation of Care in France: Between legal constraint and therapeutic transformation
In France, mandatory treatment is a legal measure requiring an individual to follow medical or psychological care, often as part of a judicial decision. This constraint, defined in Article 132‑45 of the French Penal Code, may be imposed before or after sentencing and applies to various conditions, particularly psychiatric disorders or addictions. It places the person in a paradoxical position: being sent to therapy without having chosen it.
In my private practice, where many of these patients arrive due to the lack of institutional availability, the first sentence is often the same: “I’m here because I have to be.” It carries resistance, fatigue, sometimes anger — but also a possible opening. Behind the constraint, there is often a story, a symptom, a suffering that has not yet found words.
In 2023, healthcare spending in France reached 325 billion euros, with a significant increase in outpatient care. Yet psychiatric institutions struggle to meet the growing demand. Many patients under mandatory treatment turn to private practitioners, who become the first witnesses of this tension: welcoming someone who did not choose to be there, while offering a space where something meaningful may occur.
Mandatory treatment raises a fundamental question: can we treat someone who did not come willingly? The answer lies in the ability to transform constraint into opportunity. The therapist must acknowledge the imposed nature of the situation without reducing the patient to it. The task is to welcome the person without judgment, allowing space for resistance, defiance, ambivalence. The goal is not immediate adherence but the gradual emergence of a personal need for care.
Philosopher Emmanuel Levinas reminds us that welcoming the other must be unconditional. This resonates with clinical practice: meeting the subject behind the judicial measure, understanding what the obligation reveals about their defences, fears, and unspoken needs.
Mental disorders often involve denial of illness. The patient does not feel unwell, and the law obliges them to seek treatment not for themselves but to protect society. The therapist’s role is to shift the focus back to the patient, working on their own need for healing. Over time, some patients move from “I’m forced to be here” to “maybe I need help,” and sometimes to “I want to understand what’s happening to me.” This subtle shift is at the heart of therapeutic work.
The trajectory of actor Robert Downey Jr., legally compelled to undergo addiction treatment, illustrates this transformation. What began as an obligation became a personal journey. Such examples show that constraint can open a breach through which the subject reclaims agency.
Mandatory treatment raises ethical challenges: how to respect individual freedom while responding to judicial requirements? How to protect society without reducing the patient to a case file? How to balance confidentiality with legal obligations? The therapist often stands at a crossroads between law and clinical ethics.
Transforming obligation into voluntary engagement is a challenge, but also an opportunity. By welcoming the patient with care and exploring the meaning of the constraint, the therapist can help them move toward an authentic request for treatment. As Carl Rogers wrote, “A person cannot change until they feel accepted as they are.” Obligation becomes a starting point rather than an endpoint.
Thus, mandatory treatment, far from being an obstacle, can become a lever for revealing a deeper need, often buried beneath initial resistance. This is the art of therapy: turning constraint into openness, and obligation into possibility.
References
Penal Code, art. 132‑45. Fleury, C. (2019). Le soin est un humanisme. Gallimard. Levinas, E. (1961). Totality and Infinity. Le Livre de Poche. Rogers, C. R. (1961). On Becoming a Person. Houghton Mifflin. Cour des comptes (2024). Healthcare Expenditure in France: Annual Report.
