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In recent decades, two processes have been crucial for the development of psychotherapy regulation, which are interlinked and mutually reinforcing: efforts to legalise psychotherapy as an autonomous profession, and efforts to academise psychotherapy as an autonomous scientific discipline. While in Europe the European Association for Psychotherapy (EAP) plays a key role in efforts to legalise psychotherapy as an autonomous profession, the academisation of psychotherapy in the twentieth century started at postgraduate level, then, after the Bologna reform, at Masters and Doctoral level and, since 2005 also at undergraduate level, first in Austria and then in Slovenia and Germany. Based on brief descriptions of the regulation of psychotherapy in some European countries – Germany, Sweden, Finland, Austria, Malta and Croatia – it is pointed out that concern for equitable access to psychotherapy and its quality for those in need of such kind of help must be a key criterion and goal in efforts to regulate psychotherapy. The international comparison also shows that psychotherapy will survive but not flourish if it remains only in the hands of doctors and psychologists as a method or specialisation. [ABSTRACT FROM AUTHOR]

Copyright of Etudes Romanes de Brno is the property of Masaryk University, Faculty of Arts and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Many people who are diagnosed with bipolar disorder also have comorbid personality disorder. Few studies have explored how personality disorder may influence pharmacological treatment outcomes. The aim of this study was to conduct a secondary analysis of data from a clinical trial of adjunctive nutraceutical treatments for bipolar depression, to determine whether maladaptive personality traits influence treatment outcomes. Methods: Scores on the Standardised Assessment of Personality – Abbreviated Scale screener were used to classify participants as having bipolar disorder with (n = 119) and without (n = 29) above threshold personality disorder symptoms (personality disorder). Outcome measures included: The Montgomery Åsberg Depression Rating Scale, Clinical Global Impressions and Improvement Severity Scales, Patient Global Impressions–Improvement scale, Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, Social and Occupational Functioning Assessment Scale and Quality of Life and Enjoyment Scale (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form). Generalised estimated equations examined the two-way interactions of personality disorder by time or treatment and investigated personality disorder as a non-specified predictor of outcomes. Results: Over time, the Patient Global Impressions–Improvement scores were significantly higher in those in the personality disorder group. No other significant differences in the two-way interactions of personality disorder by treatment group or personality disorder by time were found. Personality disorder was a significant but non-specific predictor of poorer outcomes on the Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, regardless of time or treatment group. Conclusions: This study highlights the potential impact of maladaptive personality traits on treatment outcomes and suggests that the presence of comorbid personality disorder may confer additional burden and compromise treatment outcomes. This warrants further investigation as does the corroboration of these exploratory findings. This is important because understanding the impact of comorbid personality disorder on bipolar disorder may enable the development of effective psychological and pharmacotherapeutic options for personalised treatments. [ABSTRACT FROM AUTHOR]

Objectives: Physicians and psychologists at psychiatric university hospitals are assigned teaching tasks from the first day of work without necessarily having the prerequisite training in teaching methods. This exploratory survey provides a needs-based analysis for the prospective didactic training of physicians and psychologists at psychiatric hospitals in Germany, Austria and Switzerland. Methods: An online questionnaire was distributed at medical schools via email in German-speaking countries in Europe. All physicians involved in teaching medical students at psychiatry faculties were eligible to participate in the survey. Participants were further requested to recruit eligible participants (snowball sampling). Responses were analyzed descriptively, and differences between groups were calculated using nonparametric Mann-Whitney U tests (p<.05). Results: Overall, 97 respondents (male=55, female=42; mean age= 40.6) from 19 medical schools completed the survey. The respondents consisted of 43 residents, 39 specialists, 6 chief physicians and 9 psychologists. Of the respondents, 97.6% rated didactic competence as either highly relevant or rather relevant for teaching medical students. The highest overall interest was shown for bedside teaching (mode=4; IQR: 2-4) and error culture (mode=3; IQR: 2-4). Respondents expressed the highest training needs for topics regarding presentation and communication (mode=3; IQR: 2-3). Resident physicians were significantly more interested in bedside teaching (U=362.0, p=0.004) and roleplay (U=425.0; p=0.036) than specialist physicians, who were more interested in examination didactics (U=415.0; p=0.022). Chief physicians displayed significantly deeper interest in group dynamics (U=51; p=0.023) than specialist physicians. In-person training was preferred by a majority of respondents, and 27.4% preferred online/web-based training. Conclusions: The majority of physicians and psychologists at psychiatric university hospitals considered professional development for faculty to be helpful for teaching medical students. Bedside teaching and error culture management were the most desired teaching topics for training medical teachers. Tailored educational interventions are recommended, with target-oriented priorities for different hierarchical levels. [ABSTRACT FROM AUTHOR]

Fille de l’anthropologue et criminologue Cesare Lombroso, Gina Lombroso obtient son diplôme en médecine en 1891 avec une thèse sur Les avantages de la dégénérescence. Elle participe au débat culturel et scientifique autour des concepts de « dégénérescence », « atavisme », « délinquance », « stigmates psychologiques », etc. ; et contribue au débat sur l’émancipation de la femme. Elle théorise “l’altérocentrisme”, c’est-à-dire l’altruisme comme caractère féminin inné et s’oppose au concept d’assujettissement congénital et irrévocable de la femme, définissant la condition féminine comme tragique. Cette contribution se concentre sur l’analyse de certains de ses écrits qui montrent l’attention qu’elle portait aux transformations de son époque. On prendra aussi en compte les critiques qui lui sont adressées et les mérites qui lui sont reconnus. On mettra en évidence l’utilisation d’un certain type d’iconographie avec laquelle Gina Lombroso et d’autres intellectuelles du tournant du XXe siècle sont présentées.

A 56-year-old postmenopausal woman (FB) was diagnosed with Grade 1 endometrioid adenocarcinoma but was refusing a hysterectomy. The patient understood she had cancer and understood treatment was required to treat the condition. However, due to a well-entrenched delusion of pregnancy associated with a diagnosis of schizophrenia, FB believed the surgery recommended by her gynecologist would harm the fetus she believed to be developing inside her womb. FB was deemed incapable of consenting to surgery due to her pregnancy delusion, which meant that the procedure could be performed with consent from a substitute decision maker (SDM). In this paper, we describe our team’s approach to the presenting moral dilemma consisting of a choice between forcing surgery on an unwilling patient or allowing her to die of a treatable illness. [ABSTRACT FROM AUTHOR]

Diagnosing a non-epileptic seizure is difficult in the absence of a video electroencephalogram. The expert commission of the international league against epilepsy proposes a diagnostic approach allowing the diagnosis to be made according to a degree of certainty with or in the absence of a video electroencephalogram. Our objective was to determine the hospital frequency of psychogenic non-epileptic seizures in the absence of videoelectroencephalogram. Using the outpatient registry, we identified patients followed for epilepsy with two normal interictal electroencephalographies, between January 2020 and October 2021. A review of the patients' medical records and an assessment of the validity of the diagnosis were carried out. Out of 64 patients evaluated with normal interictal electroencephalogram, 19 were included as suffering from psychogenic non-epileptic seizures, i.e. 26.68%. The average age was 23.94 +/- 9.4 years. Women represented 68.4%. Patients followed in neurology represented 84%. A history of childhood trauma was found in (47.4%). The first crisis was preceded by stressful events in 47.36%. Post-traumatic stress disorder was the most represented with 73.7% of cases. The average age was 20.95 +/- 9.8 years for the first crisis and the average duration of evolution of the crises was 3 years +/- 2 years. This study illustrates the possibility of making a presumptive diagnosis of psychogenic non-epileptic seizure in the absence of video-electroencephalogram. [ABSTRACT FROM AUTHOR]

A recent review of the literature has shown that one of the reasons for excess mortality among people with mental disorders is less access to somatic care (Gandré et al., 2022). This article explores the testimonial injustices by people living with mental health problems and their repercussions on their somatic care, through analyzing the accounts of people affected by mental disorders, psychiatric caregivers and nursing students. It also proposes a device to bring (future) caregivers to question their own practices regarding the testimonial injustices experienced by people with mental disorders. Finally, it is an opportunity to think about addressing this theme in pre- and post-graduate healthcare training to improve the cares of people concerned by this issue. [ABSTRACT FROM AUTHOR]

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Psychiatrie und Psychotherapie sind besonders stark von der herrschenden Kultur abhängig. Im letzten halben Jahrhundert, in der der Autor als Universitätsprofessor, Klinikchef und Therapeut in eigener Praxis tätig war, haben sich Psychiatrie und Psychotherapie vielfältig verändert. Unter Berücksichtigung des gesellschaftlichen Wandels und der damit zusammenhängenden Veränderungen des menschlichen Selbstverständnisses wird auf den Wandel der psychischen Krankheitsformen eingegangen. Schon heute lässt sich eine Tendenz zur Verdinglichung der Gefühle und eine verstärkte Beschäftigung mit dem Selbstwert feststellen. So sind Schuldgefühle bei schwer depressiv erkrankten Menschen heute seltener geworden. Gleichzeitig ringen depressive Menschen häufiger mit Kränkungen und verletztem Selbstwert. Auch das «Selbst» wird hauptsächlich reflexiv wie ein Objekt verstanden. Präreflexive, gleichsam leib-seelische Anteile erhalten auch in Psychotherapien wenig Aufmerksamkeit. Diese Tendenz könnte durch die Digitalisierung mit Big Data noch verstärkt werden. Umso wichtiger ist eine Auseinandersetzung mit der Zukunft von Psychiatrie und Psychotherapie auch in Kenntnis ihrer Geschichte. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic arrived with significant hardship. The secondary impacts of the pandemic and our response with respect to pediatric mental health has been a subject of significant discussion in the lay public, media, and decision-maker groups. The initiatives to control SARS-CoV-2 have become politicized. A narrative emerged early that strategies to mitigate the spread of the virus were harming children’s mental health. Position statements from professional organizations in Canada have been used to support this claim. The aim of this commentary is to provide a reanalysis of some of the data and research methodology used to support these position statements. Some of the direct claims such as “online learning is harmful,” should be supported by a strong evidence base with significant consensus that speaks directly to causality. We find that the quality of the studies and the heterogeneity of the results does not support the strength of the unequivocal claims made by these position statements. In a sample of the current literature examining the issue, we find that outcomes range from improvements to deteriorations. Earlier studies relying on cross-sectional surveys typically have shown stronger negative effects than longitudinal cohort studies, which often have also shown groups of children experiencing no changes to measured mental health characteristics or groups that have experienced improvements. We argue it is imperative that policymakers use the highest quality evidence in making the best decisions. We as professionals must avoid discussing only one side of heterogeneous evidence. [ABSTRACT FROM AUTHOR]

Objective: Mental health problems in children, adolescents, and adults with developmental disabilities (DD) are an underserviced clinical area. Although the Royal College of Physicians and Surgeons of Canada requires that experiences with patients with DD must be included during psychiatry residency training, the type and extent of this experience is not specified. The purpose of this study was to examine the current educational opportunities regarding DD in Canadian psychiatry residency programs. Methods: A survey asking about training in DD was sent to psychiatry residency directors at all 17 medical schools in Canada. The survey consisted of three sections focused on didactic teaching and clinical rotations (required and elective) in DD for residents. Results: Program directors of all psychiatry residency programs noted that their program included didactic teaching specific to DD, although the time dedicated to this differed greatly, ranging from 2 to 20 hours. Although 13 programs offered electives in DD, only five programs required residents to complete a clinical rotation specific to DD. Two programs did not have required or elective rotations in DD. Conclusion: These results suggest that training specific to DD is probably inadequate for most residents. This is likely to result in limitations in knowledge and skills required to assess and treat people with DD, decreased comfort working with them, and ultimately reduced quality and availability of psychiatric care for this underserved population. More specific and comprehensive training requirements and opportunities are needed to ensure that residents receive appropriate training in this area. [ABSTRACT FROM AUTHOR]

Background: Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization.Objective: The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry.Method: This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients.Results: The median score found is 33.4 (±7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old (p=0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score (p=0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up.Conclusion: Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place. [ABSTRACT FROM AUTHOR]

Frantz Fanon Against Alienation in All its Forms ABSTRACT: This article provides an analysis of Frantz Fanon's career. His work is a fight against alienation resulting from the consequences of racism and colonization. His racial and political awareness as well as his experience in psychiatry make up most of his texts. RÉSUMÉ : Cet article propose une analyse du parcours de Frantz Fanon. Son œuvre est un combat contre l´aliénation provenant des conséquences du racisme et de la colonisation. Sa conscience raciale et politique ainsi que son expérience dans la psychiatrie composent la plupart de ses textes.

Introduction: post-traumatic stress disorder (PTSD) is a topical issue due to the increase in armed conflicts and terrorist attacks in recent decades. The PCL-5 scale is used to screen and monitor patients with PTSD. The aim of our work was to validate a literary Arabic version of this scale on a population of Tunisian soldiers. Methods: the translation of the PCL-5 scale into Tunisian literary Arabic was performed according to the back-translation technique described by Werner and Campbell and recommended by Brislin. Cross-cultural validation was conducted in 7 steps according to Vallerand's method. Data collection was conducted at the psychiatry department of the Military Hospital of Tunis from February 2019 to December 2020. Results: we recruited 300 military personnel, 150 of whom were followed for PTSD. Cronbach's alpha was 0.98 indicating good internal consistency. The study of inter-item correlations revealed a total Spearman index of 0.75. This index indicates a good homogeneity of the translated scale items. Construct validity was checked using the Kaiser-Meyer-Olkin index (K-M-O) and Bartlett's test of sphericity. The latter was significant (p<0.000), and the K-M-O index was 0.969, indicating that the correlations between the items were of good quality. Conclusion: our study showed that the Arabic version of the PCL-5 scale has satisfactory psychometric properties comparable to those of the original version. [ABSTRACT FROM AUTHOR]

La psychiatrie a une place à part parmi les spécialités médicales concernant les hospitalisations contre la volonté du patient. Jusqu’en 2012 il s’agissait de privation de liberté à de fin d’assistance. A partir du 1.01.2013 un nouveau Code Civil a été adopté en Suisse. Les articles 426 à 429 mettent en place le placement à des fins d’assistance (PAFA), une mesure de protection pour la personne. Notre étude rétrospective du 2014-2016 a comme objectives (1) d’amener des connaissances de certains paramètres expliquant les hospitalisations non volontaires ; (2) de répondre à la question : Pouvons-nous considérer ce type d’hospitalisation comme une expérience clinique ? Les résultats principaux démontrent : Deux facteurs étaient significatifs à un niveau de valeur p ≤ 0,05 : (a) Vivre dans un établissement d'accueil (foyer), augmente la probabilité d'avoir un PAFA (p = 0,04) ; (b) Le fait d'être diagnostiqué comme ayant des troubles psychotiques, liés à des substances psychoactives augmente la probabilité d'avoir du PAFA (p = 0,01). Trois facteurs supplémentaires sont significatifs : être un homme (p = 0,0655) et vivre seul (p = 0,05) augmente la probabilité d'avoir un PAFA, cependant la variable âge (p = 0,03) diminue la probabilité d'avoir un PAFA (ce qui signifie que plus vous êtes âgé, plus la probabilité d'avoir un PAFA est faible). Les hospitalisations sous contrainte trouvent une place d'exception dans le champ médical de la psychiatrie. Et pourtant ne sont pas une fatalité. Les implications éthiques, légaux, cliniques qui sont lies aux hospitalisations non volontaires amènent une lumière particulière à ce type de prise en charge psychiatrique.

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This paper aims to investigate the impasses in the process of black identification in Brazil and its socio-historical trajectory, shaped by factors of social paranoia inherent in the process of violence and crime. Freudian psychoanalysis recognizes that identification is the primitive and primordial form of affective linkage with an object, i.e., a process deeply rooted in the subject's singularity and our social activities. Furthermore, the psychoanalytic clinic would demonstrate this symptomatic manifestation in the process of identification. [ABSTRACT FROM AUTHOR]

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Au cours des vingt dernières années, plusieurs changements sociaux et politiques ont contribué à la transformation des pratiques d’intervention en psychiatrie. Ces changements sont notamment expliqués par le rapprochement continuel des espaces hospitaliers et de justice. L’objectif de cet article est de discuter de la contribution du concept d’hétérotopie pour l’étude de ce phénomène et s’appuie sur les résultats d’une recherche ethnographique réalisée dans l’un de ces espaces, la Commission d’examen. Les considérations théoriques et méthodologiques de ce projet, de même que le rôle de la Commission d’examen, seront d’abord discutées. La première partie de cet article portera sur la juxtaposition des espaces hospitaliers et de justice et ses conséquences sur les relations existantes entre les acteurs intra- et extra-juridiques. La dernière partie de cet article s’intéressera à la signification clinique de la judiciarisation et plus particulièrement des espaces de justice en santé mentale pour le travail infirmier.

The French psychiatrist Georges Lantéri-Laura used the concept of "paradigm", developed by T. S. Kuhn, to explain the rationality and history of psychopathology. In his essay on the paradigms of modern psychiatry, Lantéri-Laura established three paradigms, situated between the end of the 18th century and the end of the 20th century. The first paradigm has mental alienation as its center of the idea. The second works with the notion that mental illnesses exist. The third uses the structure notion and defines the major psychopathological structures. Thus, this theoretical essay had as its starting point the historical review of psychiatric traditions carried out by Lantéri-Laura, seeking to advance and include contemporary discussions in the proposal to defend a fourth psychiatric paradigm guided by the concept of the syndrome. In this study, it is possible to identify two quite distinct psychopathological logics -- one psychoanalytic and the other behavioral -- on which the Diagnostic and statistical manual of mental disorders (DSM), a manual of the American Psychiatric Association (APA) is based. For this, it was necessary to prepare a brief context of the DSM and its five editions on the main criticisms of this classification system. Finally, it discusses the fate of the DSM system in the face of a new emerging diagnostic system and concludes that psychopathology is a diachronic field in which changes and updates are constant and necessary. [ABSTRACT FROM AUTHOR]

L’objet de notre étude est de situer l’œuvre de Philippe Pinel (1745-1826) : Traité médico-philosophique sur l’aliénation mentale ou la manie, publié en 1801, dans l’histoire de la psychiatrie française et espagnole. Après un rapide rappel de ce qu’était le traitement de la folie depuis l’Antiquité jusqu’au XIXe siècle pour mieux juger de l’importance de Pinel, nous analysons les répercussions de ce traité, non seulement en France mais aussi en Espagne où il fut introduit grâce à la traduction de Luis Guarnerio y Allavena, Tratado médico-filosófico de la enagenación del alma o manía, publiée en 1804. La prise en compte de ces textes permet de configurer, dans une certaine mesure, l’image de la folie au XIXe siècle en France vs. en Espagne, permettant de souligner l’importance de la traduction scientifique et quelques-unes de ses conséquences pratiques dans le pays récepteur.

Der Begriff Kakistokratie bedeutet die Herrschaft der Schlechtesten, am wenigsten Qualifi zierten und Skrupellosesten. Viele US-Amerikaner glauben, dass die Vereinigten Staaten von Amerika unter Präsident Donald Trump zu einer Kakistokratie geworden seien. Von Christinnen und Christen, besonders solchen, die vergleichsweise oft Gottesdienste besuchen, erhält Trump dagegen teils vehemente Unterstützung. Vor allem evangelikale und fundamentalistische Christen tun sich in dieser Hinsicht hervor: Viele von ihnen sehen in Trump sogar ihren ‚Wunsch- und Traumpräsidenten‘. Der vorliegende Aufsatz will dazu beitragen, die Gründe für diese befremdliche und problematische Symbiose besser zu verstehen und aus sozialethischer und theologischer Sicht kritisch zu hinterfragen.

La tragique histoire de la « Séquestrée de Poitiers », qui a défrayé la chronique à la Belle Époque et connu un succès considérable, fascine les écrivains en leur offrant une matrice à la fois onirique et discursive. Un scénario digne du mélodrame : une jeune femme cloîtrée pendant vingt-cinq ans et qui croupit dans sa fange, est miraculeusement retrouvée dans une maison cossue de Poitiers. S’agit-il d’une victime, conduite à la déréliction par une famille oppressive ? Son cas sollicite le droit autant que la psychiatrie. Blanche Monnier constitue un archétype de schizophrène oscillant entre claustration forcée et confinement désiré. L’effroi que suscite la peinture de son hallucinatoire quarantaine spatiale invite à interroger nos propres représentations : la folie, l’enfermement, les postures sociales face à l’altérité, et au plus haut point le langage dans son incapacité à rendre compte de l’innommable. Figure déshumanisée, la jeune femme nous semble portée par une rêverie régressive vers la sanie et l’excrément. En cela elle met en abyme nos vertiges et la hantise d’une conscience qui sombre, mais dont seule la littérature pourrait porter la parole confuse, erratique et mystérieusement poétique.

Motivation can be defined as a function that activates and directs the behavior toward goals. In neuropsychiatric conditions, motivation deficits such as apathy are frequent and interfere with treatment observance and clinical outcome. The current standard approach is to assess motivation deficits with subjective questionnaires that depend on patients' insight and provide no information about underlying pathophysiological mechanisms. Here, I present a novel approach that consists in fitting computational models to the behavior observed in objective tests, so as to infer parameters that specify the patient's motivational state. These computational parameters provide (1) an explanation at the cognitive level (e.g., reduced sensitivity to reward), (2) a dysfunction at the neural level (e.g., altered dopamine release) and (3) a prediction of treatment outcome (e.g., improvement with psychostimulants). Computational fingerprinting may therefore pave the way toward a more personalized medicine. [ABSTRACT FROM AUTHOR]

Copyright of Aporia is the property of University of Ottawa, School of Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La psychiatrie transculturelle s’intéresse à l’impact de la culture sur la santé mentale et la maladie et remet le patient au centre de la relation en respectant ses manières de faire et de penser, individuellement mais aussi collectivement. La culture définit les représentations ontologiques, les théories étiologiques et les logiques thérapeutiques qui influencent l’expression symptomatologique de la souffrance et les modes de résilience des individus, tout aussi variés que les cultures desquelles elles émergent. Or la psychiatrie occidentale est de la même manière indissociable de la culture dans laquelle elle est née, ce qui pose la question de la souffrance psychique et des soins en situation transculturelle. La psychiatrie transculturelle amène le clinicien à se remettre en question et à élargir la clinique aux questions sociales, géopolitiques et historiques qui teintent les liens du tissu social, les relations de pouvoir et l’accès aux soins pour les individus des communautés culturelles. Comment faire que notre rencontre avec les patients venus d’autres mondes et ne partageant pas la même langue que nous soit éthique? Comment soigner face à l’altérité culturelle? Et quels impacts pour la santé mentale des jeunes d’aujourd’hui qui grandissent dans ces sociétés mondialisées aux défis identitaires complexes qui peuvent mener à des radicalités? Nous proposons dans cet article quelques réponses à ces défis éthiques et cliniques, en passant par le métissage des représentations, gage d’un meilleur vivre ensemble et d’une créativité renouvelée, pour un « ethos de la solidarité » dans les soins en santé mentale.