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Current mainstream psychiatric discourse and practice rely mostly on a dominant technological paradigm where mental distress is understood as a “faulty mechanism” which needs “fixing” through medical means. As such, evidence-based medicine (EBM), a recent medical concept which encourages technological knowledge and hence technological understanding and interventions, was embraced by contemporary psychiatry. EBM is a proposition which seeks to regulate clinical decision-making by putting forth the idea of a hierarchy of evidence, where information yielded from randomized controlled trials (RCTs) and meta-analyses have definite precedence over other forms or sources of information. Thus, because EBM favors these evidence-producing tools, RCTs and meta-analyses, it purports that the knowledge that counts is that which is measurable and specific; necessary conditions for its detection by such tools. In doing so, EBM devalues and arguably even ignores other forms of evidence and warrants for clinical decision-making. From the standpoint of ethics, it purports that the “right” thing to do is to apply the evidence produced by EBM in a clinical setting. Other forms of evidence and relevant information regarding clinical decision-making which cannot be produced or measured by EBM are ethically devalued. Reviewed literature in the field of philosophy of psychiatry thus argues that EBM is ill-suited for psychiatry. It has a reductive view of the epistemological and related ethical issues regarding psychiatric practice. It cannot, by design, account for the specificities of psychiatry, notably in terms of diagnoses; their complexity easily renders the evidence created by EBM of questionable validity. It also cannot account for the specificities of psychiatric therapeutics. Outcomes related to the mind are incorrectly translated into specific and measurable results, and amongst other points, non-specific therapeutic factors, the ones discredited by EBM, are core to mental health care: nonsense. This leads the current critical review to consider that psychiatry would perhaps benefit from the development of its own evidentiary framework, taking into account its unique epistemological position, where subjectivity, context and values cannot be downplayed in the hierarchy of evidence, in the hierarchy of warrants for decision-making. This discussion inevitably raises the question of the object of study of psychiatry, which appears to be somewhat different than that of medicine. It also forces a conversation on the goals of psychiatry; they appear more complex than the achievement of measurable and specific health outcomes. Although a definite alternative to EBM in psychiatry has yet to be established, the literature, and this paper, point towards the idea of a more flexible evidentiary framework for psychiatry, one where ethical issues, including the ethics of what counts as evidence, should be of crucial importance.

Keywords: psychiatrie basée sur les évidences, épistémologie, éthique, données probantes, evidence-based psychiatry, epistemology, ethics

This article provides results from doctoral research concerning how mothers experience having lost a child in a case where death cannot be foreseen… the case of sudden infant death. The specificity of this loss as well as the characteristics of this grief will be covered first and foremost. The purpose of the study and the methodology used will then be made clear. Lastly, as results, meanings that mothers have attached to practices dealing with the death report and to causes of death will be described and analyzed.

Keywords: mort subite du nourisson, constat de décès, causes, deuil, mère, sudden infant death, death report, causes of death, grief, mother

In Ontario, as elsewhere in Canada, a discourse of prevention aimed specifically at young people permeates the fields of health and social services. This discourse encourages the use of evidence-based approaches, including psychotherapy, to intervene with children and adolescents whose behaviors are perceived to be problematic or at risk. The use of these approaches is often prescribed to prevent mental health problems in young people. In this perspective, this article analyzes the processes that lead social workers in French-language secondary schools in Ontario to apply intervention techniques to manage the behaviors of students. Based on a theoretical and critical approach that combines the notion of bio-power with labeling theories, the microsociological analysis focusses on the discourses of social workers and the roles of various actors in the recent implementation in schools of the Ontario government's mental health strategy.

Keywords: santé mentale, école secondaire, biopouvoir, théorie de l'étiquetage, intervention, travail social en milieu scolaire, mental health, high school, biopower, labeling theory, intervention, school social work

This article provides an introduction to educational intervention, a concept with ‟chargedˮ origins, a term that is not neutral and includes necessarily the definition of the role and posture of the researcher in the human and social sciences. The intervention is a conception of reality, a plural relation (to oneself, to the other and to the world), a complex practice where the subject and the object are intertwined and dialectalised throughout the interaction that binds them, etc. Several authors (Lenoir, Larose, Deaudelin, Kalubi et Roy, 2002 ; Couturier, 2004 ; Larose, Couturier, Bédard, Larivée, Boulanger, Terrisse, 2013 ; Lenoir, 2009, 2011, 2014 ; Lenoir, Rey et Fazenda, 2001 ; etc.) emphasized its polysemic, if not polyphonic, nature which is presented briefly in this introduction. In education and training, the dialectic between teaching and learning presupposes interactions and mediations, introduces regulations, illuminates the dynamic nature of the decision-making process of teachers, and produces change, all of which provide an opportunity to approach the question of educational intervention according to three perspectives: notional, epistemological and empirical/praxical. The issues that are developed in the six articles of this thematic issue are presented with the shared ambition of examining teaching-learning processes and debating the concept of intervention, via a critical approach.

Keywords: intervention éducative, enseignement-apprentissage, interactions, médiations, régulations, pensée critique, educational intervention, teaching-learning, interactions, mediations, regulations, critical thinking, intervención educativa, enseñanza-aprendizaje, interacciones, mediaciones, regulaciones, pensamiento crítico

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.

Following a brief review of theoretical and clinical principles underlying the notion of “frame,” the author presents original clinical material which jostles these principles and demonstrates the need for a lucid questioning and reexamination of this notion. The clinician is at times confronted with situations which require a modification of directives and working “outside the frame.” Particular clinical encounters force the therapist to rethink the frame in line with their unique characteristics and conditions. An ongoing “reinvention” of the frame then appears necessary. Requiring great care and flexibility, this process is a craftsman's work, particularly in times of emergency or crisis.This clinical vignette illustrates the type of encounter which calls for a setting aside of classical postulates regarding the frame and the need for a type of “meta-container.” This “meta-frame” must ensure containment on three levels: psychic, visual and auditory.

Keywords: urgence, cadre, hors-cadre, méta-cadre, patient de passage, crisis, frame, out-of-frame, meta-frame, short-term patient

Inspired by the English poet John Keats, W. R. Bion saw negative capability as the most important quality a psychanalyst should have, and, for the patient, as one of the main objectives when undergoing therapy. This negative capability can be linked to the concepts formulated by different authors, including Freud (erogenous masochism), Rosenberg (masochism as gardian of life), De M'Uzan (permanent concern), Press (the building of a passive position), Green (passivity and passivation), Ribas (life passivity), as well as Phillips (being an embarrassment, being lost, or being helpless). Four clinical case vignettes show how negative capability can be lacking for some subjects, notably in its articulation with temporality, making them particularly intolerant to ordinary suffering, as described by Freud, and impeded in the exploration of their internal life. According to Press, it is suggested that soliciting negative capability can reactivate an individual's fear of breakdown and can, as a result—in the process of therapy—cripple the therapist's negative capability. The latter will then have to accept to take the place—by transfer—of the defective object in the patient's mind, so that the null and void negative (« le négatif du non-advenu », Press) is actualized. Finally, we address the factors that—therapist's education or culture—can foster or cripple the building of their negative capability.

Keywords: capacité négative, temporalité, crainte de l'effondrement, négatif, negative capability, temporality, fear of breakdown, negative

The clinical encounter with “the other stranger” often gives rise to reactions that can take the form of cultural countertransference. The purpose of this paper is to identify a few forms of cultural countertransference that were frequently represented among the participants of this research (seven psychologists of the psychodynamic approach). Emphasis is then placed on the most conflicted or potentially problematic forms of cultural countertransference. Participants were met twice. During the first interview, they were asked to comment on drawings of children from different cultural backgrounds. In the second interview, participants answered questions about their practice in the intercultural context. The qualitative analysis of the data highlighted three forms of cultural countertransference: the reluctance to consider the cultural origin of the patients, the discomfort around ethno-racial inequalities and feelings of anger or of being stricken by certain attitudes of patients of cultural minorities. Explanatory hypotheses of the results are discussed and, after careful consideration, conditions for overcoming problematic forms of cultural countertransference are proposed in the discussion.

Keywords: contre-transfert culturel, psychothérapie interculturelle, approche psychodynamique, dessins d'enfants, racisme, cultural countertransference, intercultural psychotherapy, psychodynamic approach, children's drawings, racism