Search Results

SUMMARYOfficial médecine, as we know it now, is about one hundred and fifty years old. By the same token, the origins of the real traditional médecine are lost in far away times. More than a century ago, we have seen doctors trained in a university setting involved in serious power games of allopathic orientation so that restrictive laws would sanction their control and their near total monopoly in the dispensation of health-care. It is therefore normal to be surprised at the emergence of other types of médecine which also appear effective in the treatment of disease and in the preservation of health. First of all, certain key words need to be clarified: «soft médecine», «traditional médecine», «holistic médecine», «official medicine». There are seven main ideas behind the holistic approach and five therapeutic currents linked to it: Chinese energetics, homeopathy, osteopathy, energetic strategies and psychological strategies. Beyond the basic data, some guidance is provided as to their scientific value and validity. Finally, the application of these «new médecines» in the hospitals is reviewed, taking into account the needs of the population, legal and legislative aspects and the competence of the professionnals involved.

SUMMARYThe individual reactions to traumatic factors affecting the psychological welfare in the field of work are not limited to a mental symptomatology. To account satisfactorily for matters of health at work in relation to psycho-social factors one needs to refer to a theoretical frame which goes beyond the psyche-soma dichotomy. To do so, the author introduces the main ideas of P. Marty's psychosomatic theory relating them to a general model of work related pathogenesis.

AbstractFor the past decades, in a world of high competition, firms struggle to regain an advantage over foreign competition. Thus, new management trends, usually based on price reduction, high quality products and speed production are now part of strategic reorganization plans of high impact on work organization particularly in terms of large demands put on workers, and take a heavy toll on workers. Thus the incidence of mental health problems in the work place has risen sharply in recent years and currently counts as one of the leading causes of work absenteeism. A study based on the psychodynamic of work was conducted among machine operators working in a high-technology company in the aviation sector. Important management and technological transformations were recently introduced in the factory. The content analysis of the study shows that the work organization places the operator in a double bind situation. They are caught between an injunction where the capacity of making a high quality product is directly opposed to that demanding speed production. Moreover, severe and arbitrary sanctions are applied when the operators do not comply with either injunction. The operators are put in a deadlock situation that creates fear and anxiety. They are obliged to turn to defensive psychological strategies such as individualism and cheating. Those defensive strategies have negative impacts on social relationships.

AbstractAmong the actual rehabilitation programs offered to patients with schizophrenic disorders, the IPT (Integrated Psychological Treatment) is one paradigm which combines cognitive and psychosocial strategies. A solid body of evidence, derived from controlled studies, indicates that IPT improves cognitive and social functioning and reduces symptoms severity. Nevertheless, little is known about its efficacy in routine clinical conditions. In this article, the authors address this issue. Our clinical experience with IPT in an ambulatory psychiatric service is presented. The results show that only few patients find useful to participate to all IPT strategies. Patients who refuse or accept to be enrolled in this rehabilitation program share the same demographic, clinical., symptoms and cognitive characteristics. After two years, the outcome of these two groups is similar when we consider the rate of readmissions, the number of hospitalisations, the length of stay and the number of suicides. These observations suggest that IPT strategies in clinical routine are probably less efficient than in well controlled studies. They also raise the question to define an individualised rehabilitation program that fits particular patients' needs.

ABSTRACT The authors describe the evolution of mental health services put in place in Trieste over the last 25 years. They identify the principles that have led to institutional transformation and to the replacement of the traditional psychiatric hospital with a complete organization of services across the Trieste territory. By defining the spirit presiding over these transformations, the authors describe the variety of services offered. Finally, while the Trieste experience is linked to social and historical conditions favoring its emergence, the authors draw general principles in order to guide and transform the practice of community psychiatry.

ABSTRACTThe authors propose an overview of the practice of assertive community treatment, from the perspective of its values, its inherent functioning as well as its generic way. Going beyond different models, the authors try to illustrate what distinguishes assertive community treatment from other external or community services. They then present its application with the Service d'accompagnement et de soutien communautaire (SASC) of Pierre-Janet hospital. A vignette written by a client, illustrates the daily and clinical aspects, while structural and organizational aspects are discussed in relation to the regional organization of mental health services.

AbstractThis article examines the socio-demographic profile of general practitioners (GPs), their role in the management of (transient/moderate, severe/chronic) mental health disorders in different areas (urban, semi-urban, and rural) of Quebec as well as if their clinical practice and collaboration are oriented towards integration of mental health services. This crosswise study is based on 398 GPs representative of all Quebec GPs who answered a questionnaire. The study shows that GPs play a central role in mental health. According to territories, they have different socio-demographic and practice profiles. The types of territory and the degree of severity of mental health illnesses influence the propensity of GPs to integrate mental health care. Finally, GPs practiced mostly in silo, but they support greater integration of mental health services. The authors conclude that to improve mental health services integration, more proactive incentives should be favoured by political elites, adapted to the severity of the case and environments (urban, semi-urban or rural). However, the shortage of resources that is particularly striking in rural areas as well as inadequate mechanisms for clinical decision, reduce inter-relations and seriously limit the integration of healthcare.

SUMMARYSeven years after the interruption of his analysis, Norbert comes back to see his analyst. He tells him what happened during the seven years before asking him a question. Having heard this account of wandering and of the discovery of a certain equilibrium, the analyst remembers certain "moments" of the analysis of Norbert, the transferential activity, the family structure. He has a beginning perception, through associations, of new theoretical perspectives on the question of time in psychoanalysis, on that of the father in the psychoses, the cystic-like growth of the psychotic process. Finally he questions himself on his place in relation to the question of the "father's name" when Norbert asks him, in ending, if he will still be there when he will want to take up his analytic journey again.