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Objectives: Moral treatment is a psychological approach that contrasted sharply with a treatment of constraint, beatings, immersion in cold water, diet, or repeated heavy bleeding. In response to the violent treatment that was common in asylums of late 18th century, Philippe Pinel conceived a ‘medical moral treatment'. This paper considers the roots of the recovery paradigm in the pioneering work of Philippe Pinel and Jean-Baptiste Pussin. The aim is to discuss the early 19th century moral treatment to identify some key principles that can also inspire citizenship-oriented mental health care, but we also suggest that a simple equating of citizenship-oriented practice with moral treatment overlooks some of the central aspects of the recovery paradigm.Methods: One of the main sources for this discussion is Pinel's “Memoir on madness” (Pinel, 1794), offered for the first time to the English-speaking reader by Dora Weiner. This analysis also draws on the “Observations of Citizen Pussin” that Pinel asked him to write for both of them to articulate fully several of the key principles of their humanistic approach.Results: Looking back on the humanistic principles that were at the core of the pioneering work of Philippe Pinel and Jean-Baptiste Pussin, we suggest that the “moral treatment” they were advocating, more than 200 years ago, was in some ways based on a genuine patient partnership, especially on peer support. The contemporary recovery movement, that might also be centered on the full exercise of citizenship, and the older “moral treatment” have in common that they both insist that people with mental illness be treated with dignity and respect. However, while the “moral treatment” was taking place within the asylum, the goal of citizenship-oriented mental health care is one of a life in the community for everyone. We suggest, nevertheless, that Pinel and Pussin have formulated ideas probably so forward thinking that we are just beginning to understand and try to apply them to our post-asylum practices.Conclusion: Pinel's philosophy of psychiatry both undergirded moral treatment and can be useful in shaping contemporary patient-centered and citizenship-oriented practice. The insights and lessons offered by Pinel and Pussin are far from being limited to the place and time of their creation. Recent advances in mental health care have been based on insights identical to those of Pinel and Pussin regarding the episodic nature of the illness, the rarity of the illness becoming all-encompassing, the reality of recovery, and the valuable roles that employment and peer mentoring can play in promoting it. We have now seen in the two hundred years that followed the publication of Pinel's Treatise the failures of asylums to provide moral treatment to persons with mental illnesse. In contrast, citizenship-oriented care stresses the importance of self-determination and the active role of the person in recovering a sense of efficacy and agency as a foundation for full citizenship for all.

Keywords: Pinel et Pussin, naissance de la psychiatrie, traitement moral, psychiatrie citoyenne, rétablissement, Pinel-Pussin, roots of psychiatry, moral treatment, citizenship-oriented mental health care, recovery

Taking note of the analogy proposed by Chrysippus between medicine and philosophy, I would like to use the study of chapter 15 of book 2 of Epictetus' Diatribai to show how it exposes what can be likened to a “clinical case”. This means betting on the blurred polysemy of a term (“clinical”) that is rarely found in ancient writings (klinikos/klinikê) and whose current meanings can nevertheless open up new avenues for reading texts that cannot be limited to a parenetic function, aiming at the moral “transformation” of disciples. In sum, I would like to question the prevalent use of a “school model” of reading, by proposing, in order to understand certain Stoic texts, a model attentive to a praxis that refers at least as much to care as to philosophical training.

Background: The Computer-based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgement test (SJT) adopted by medical schools to assess applicants’ interpersonal skills. CASPer applicants must compose their responses to ethical dilemmas, thereby highlighting the applicant’s rationale for ethical decision-making. Minority applicants usually lack access to a network of individuals who can offer guidance and expertise on ethical decision-making. As such, this study investigated the impact of a CASPer coaching program designed for minority applicants. Methods: A free online intervention was designed to help minority applicants prepare for the CASPer test. The program consisted of 35 learners and three medical student tutors. Important attributes of the 4-week program included free access to a medical ethics book, feedback provision to in-class and homework student responses, and facilitation of a mock CASPer. Course feedback was collected. Additionally, a pre and post-program survey was administered to assess learners’ competence and confidence surrounding CASPer test-taking. Results: Our pre and post-program survey showed significant student improvement in familiarity with the test, increased competence, confidence and preparedness, as well as reduced anxiety (p < 0.05). Conclusions: Through peer-to-peer teaching and access to medical student mentors, our program addresses socioeconomic barriers that several minority applicants face when applying to medical school.

The French Parliament is forgotten by the extensive work on “medical deserts.” However, on this subject, many parliamentarians are going against the flow of presidential programs, the administration and interest groups, and are openly advocating binding measures. This parliamentary innovation raises a question : are French parliamentarians policy entrepreneurs ? The analysis is based on parliamentary records from 1998 to 2019. The qualitative analysis shows the existence of a parliamentary innovation in favour of binding measures. However, the quantitative analysis answers in the negative : parliamentarians are not entrepreneurs because of their voluntary subordination to the executive power and to medical interest groups.

Keywords: désert médical, Parlement, entrepreneur, innovation, action publique, medical desert, Parliament, entrepreneur, innovation, public policy

AbstractThe concerns surrounding the good death partake in a strain of thought prevailing in the new millennium characterised by a general disenchantment towards science and technology as by a spiritual vacuum. The reality of dying does not necessarily reflect what is happening in palliative care. Most deaths occur in general hospitals' acute care units or in long-term care hospitals where alleviation of suffering may be far from perfect. The characteristics of a good death are primarily defined by control and autonomy, eminently individual values. Use of these criteria for assessing of end of life trajectories is not unanimously agreed upon as is the necessity to provide all patients the accessibility to good palliative care services.

Keywords: soins palliatifs, souffrance, critères, organisation des services, palliative care, suffering, criteria, health services organisation

In a context of scarce resources, strong pressures are bearing upon the medical profession. Must it abjure its traditional patient-centered approach, and adopt a public interest-centered approach, which is a cost containment attitude? And what could be the consequences of this latter choice on the medical practice? While insisting that the doctors must only do acts that are medically necessary, the author speaks out in favor of the patient-centered ethic, the only way for the profession to preserve its integrity.

Une intégration de la médecine traditionnelle dans un système de santé publique africain peut contribuer à l’amélioration de la santé des enfants de diverses manières. Jusqu’à ce jour, plusieurs études réalisées dans le domaine de la santé se sont déjà intéressées à la médecine traditionnelle africaine. Mais rares sont celles qui ont examiné sa place dans les systèmes de santé publique en Afrique et peu d’entre elles ont étudié scientifiquement les relations éventuelles entre son intégration et la santé des enfants. Cette thèse explore l’univers de la santé des enfants qui vivent dans un milieu rural au Togo afin d’examiner la problématique de l’intégration de la médecine traditionnelle togolaise dans le système de santé publique du pays. Pour ainsi dire, il est question d’examiner la …

AbstractWithin the context of illicit drug control, harm reduction is often regarded as the third avenue beside the traditional responses that represented the prohibitionist model and the therapeutic model oriented towards abstinence. Through a comparative analysis of the three approaches, the authors challenge the notion that harm reduction represents a rupture regarding the traditional perspectives on drug use. On the contrary, an examination of how harm reduction strategies are implemented in the field of drug regulation illustrates instead a widening of the apparatus of control. Following a presentation of the cohabitation between these three approaches, the authors then outline a sociological framework for understanding the political appeal of harm reduction strategies. Several reasons for the success of these strategies are then proposed.

There are many physician writers worldwide, but the ties that bind a health professional's experience to his/her fiction writing have been studied more extensively in the English-speaking Literary and Medical world than in its French language counterpart. Based on an examination of four novels written by a French physician writer, first published in 1989, and on an exclusive interview with the author, this paper addresses the ways throug which a caregiver's professional experience feeds his fictions and how they, in turn, carry the author's views of healthcare ethics.