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Résumé L’erreur fait partie d’une réalité en médecine. Afin d’améliorer les pratiques et la sécurité des soins, les professionnels sont amenés à s’inscrire dans une démarche de révélation de l’erreur. Toutefois, la littérature met en avant une réelle difficulté des professionnels à révéler leur erreur. Différents freins sont décrits, à la fois personnels, institutionnels et sociétaux. Mais l’erreur correspond également à une perte des repères professionnels et confronte les soignants à des émotions intenses où se mêlent honte et culpabilité. Dans le cadre de cet article, nous soulignerons les freins psychologiques à la révélation qui peuvent jouer un rôle dans la capacité du professionnel à s’inscrire dans un processus de révélation de l’erreur. Le vécu psychologique du professionnel face à l’erreur permet de dresser des pistes de réflexion sur l’accompagnement des professionnels dans le processus de révélation et du chemin qu’il reste encore à accomplir. Error disclosure is now an ethical and professional obligation for health professionals and seeks to improve quality and safety in healthcare. Literature has highlighted the numerous benefits of error disclosure and several authors have described the options for handling this situation. However, it is not quite that simple to be honest and open and follow a protocol that instructs professionals to explain, support and apologise in situations where they are subject to criticism. While the many personal, institutional and social factors that hinder open disclosure have been identified, little attention has been paid to the obstacles associated with the psychological impact of disclosure, thereby limiting the debate on how professionals might be supported in their efforts to cope with error disclosure. The psychological impact of error on professionals is a well-established fact. Physicians are “second victims” likely to be emotionally affected by medical error. Emotional distress, anger, isolation, fear, guilt and shame can be intense, suggesting that, far from being an isolated act in professional practice, a medical error is a life event that modifies the psychological balance of a professional. Studies in the humanities have shown how work shapes individuals’ identities. The choice to heal and care for is indicative of the ideals related to professionals’ life histories, cultures, family models and representations of health and disease. Work and, more specifically, recognition at work from their peers, patients and relatives enables health professionals to support their ideals and establish a coherent identity, and to belong to a workgroup. The error foreshadows a rupture which plunges the professional and the team in a state of vulnerability that rules out the professional's or the team's possibility to be part of a process of disclosing the error. In these conditions, a policy of security of care also involves a guarantee of the caregiver's and the team's psychological security. The term psychological security was developed by the psychoanalysis who emphasised the individual's need to evolve in a “sufficiently good” protective environment that allows him/her to contain his/her emotions, while giving the individual the possibility to express and discuss them. This space implies a relation of trust between individuals. Trust refers to the idea that the individual can trust someone, it is based on the capacity to create relations. It is only through trust that the professional will be able to open him/herself to others and construct a space where the errors and the doubts that he/she has in the context of work are shared. But if trust is essential, it is also dangerous because it implies accepting the risk of being dependent on those considered as trustworthy and the risk that they will not live up to the professional's expectations. As a consequence, the professional will only have trust when he/she has evaluated the possibility of cooperation and more precisely, as stated by Hardin, a cooperation in which the professional's interests are “encapsulated interests”, in other words the interests of others. Therefore, this cooperation depends on each member of the team seeing his/her interests as being partially those of the others. Cooperation within a service reveals the relations of trust between the professionals and shows the relations of dependence that each one maintains with the others for the good administration of care. Thus the creation of relations of cooperation between the team members proves to be an important indicator to determine the professional's possibility to adhere to a process of disclosing the error. This approach shows that professionals must address multiple rather than single disclosures: to the self, and to others (colleagues, hierarchy, patients and families) who will mobilise specific knowledge, emotions and psychological defences. To avoid cases where disclosure takes on dimensions as tragic as the actual errors committed, it is important to pay attention to the psychic state of healthcare professionals by offering a space of free expression that enables them to better understand their feelings and gain a sense of support in order to restore their ideals and professional identities. Finally, it's important to emphasize that disclosure also depends on the preservation or restoration of the relations of cooperation within the team. Disclosure cannot be prescribed, it must emerge within a workgroup who allows the error to be thought over, communicated and shared. In this context, disclosure becomes a group rule that is known to all. A health professional who feels sufficiently supported might, in turn, support a patient and/or his/her relatives and engage in meaningful disclosure. [ABSTRACT FROM AUTHOR]

Résumé Objectif L’objectif de cette étude est de mettre en exergue les effets de l’utilisation de lieux d’échanges virtuels sur l’adaptation psychologique des patientes à la pathologie cancéreuse et notamment au cancer du sein. Méthode Pour ce faire, une revue de littérature a été effectuée. Les bases de données Cairn, Wiley Online Library, Taylor and Francis, ScienceDirect, Journal of Medical Internet Research (JMIR), Communication organisation, PubMed Central NCBI, APA PsycNET, Cross Ref, Oxford Journals, Persee, et Link Springer ont été explorés. Nous avons inclus toutes les études quantitatives et qualitatives portant sur l’utilisation de technologies ou de ressources en ligne en lien avec le cancer et plus particulièrement le cancer du sein. Résultats Cinquante-deux articles ont alors été sélectionnés. Quarante incluaient exclusivement des femmes atteintes du cancer du sein, et 12 incluaient différents types de cancer (sein, prostate, reins, poumon, sang…). La plupart des études ont rapporté des résultats significatifs en termes d’adaptation psychologique : une amélioration du bien-être émotionnel, psychologique et général ; une diminution de l’anxiété et du stress ; un meilleur optimisme ; une meilleure qualité de vie, ainsi qu’une meilleure participation à la santé. Conclusion Les résultats suggèrent une relation positive entre les lieux d’échanges pour les patientes et les résultats concernant la gestion de leur vécu par rapport à la maladie. Objectives We want to know the effects of virtual exchanges places, on psychological adaptation of women patients to cancer pathology, and especially breast cancer. Patients and methods A literature review was made. Databases Cairn, Wiley Online Library, Taylor and Francis, ScienceDirect Journal of Medical Internet Research (JMIR), Communication organisation, PubMed Central NCBI, APA PsycNET, EBSCOST, Cross Ref, Oxford Journals, Persee, and Link Springer were explored. We included all quantitative and qualitative studies on the use of technologies and online resources related to cancer, especially breast cancer. Results Fifty-two articles were selected. Forty only included women with breast cancer and 12 included different types of cancer (breast, prostate, kidney, leukemia…). Most of the studies have reported significant results in terms of psychological adaptation: improved emotional, psychological and general well-being; a decrease in anxiety and stress; a greater optimism; a better quality of life and a better participation in health. Conclusions Results suggest a positive relationship between spaces of exchange for women patients and outcomes related to their experiences in relation to the disease. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Fight against discrimination and stigmatization of people living with mental health disorder has become one of the most important political public health objectives. It has been identified as one of the five priorities of the 2008 European Pact for Mental Health and Well-Being. Stigmatization impacts the quality of life and jeopardizes the social integration. It has been shown that compliance to medical care was also impacted by individuals’ perception of their stigmatization. Numerous international programs targeting general population have been elaborated since the last decades, but those communication strategies haven’t raised the interests of researchers and academics. Hence, very few data are available to set new objectives to lower the social impact of stigmatization in people living with mental health condition. Material and methods: This paper examines the rational and effectiveness of different anti-stigma campaign targeting mental health. By reviewing the scientific literature and policy documents on different strategies to address and lower stigmatization, we identified a typology of stigma-orientated actions and policies. Communication campaigns are the most common instrument used to address stigmatization. They are sometimes associated with communication programs targeting representations in general population through campaigns as well as representations in subgroups, through local and/or national actions. Specific information and training for journalists have also been experienced. Results: Very few researches have observed convincing effects of anti-stigma campaigns in general population. Evaluations of the communication campaigns have revealed that they had a limited impact on representations. Attitudes towards people living with a mental disorder were still negative 5 years after the Changing Mind campaign, although there was an impact on the perceived distance by the respondents (how people living with mental health condition feel different from us). Actions targeting media and journalists led to ambivalent results, with a rise of positively connoted journal articles as well as negatively connoted papers. Conclusions: Campaigns targeting general objectives have not been proven to be effective. Some authors state that they should be replaced by local actions and programs, orientated to specific subgroups and should (a) associate the psychiatric services users and their families, (b) empower people living with mental health conditions, (c) be developed upon the experience of people who are been stigmatized. The rational of past communication campaigns as well as global communication programs were impaired by the absence of an operational definition of the problem addressed (discrimination, stigma, and stigmatization). Lack of empirical data on stigmatization jeopardizes the effects of these campaigns and their potential development. Conflict of interests in people managing the campaigns and the absence of systematic evaluation are also pointed as limitation for future developments. [Copyright &y& Elsevier]

Abstract: An increasing amount of studies have demonstrated the existence of visual, auditive and motion integration deficit in individuals with autism, especially when movement is rapid. Since visual motion is intrinsically involved in social interactions through movements of the body and face, visual motion processing deficit could therefore account for their verbal and non-verbal comprehension and social interaction disorders. Besides, other studies have revealed the existence of speech integration deficit in this population which could also account for their verbal comprehension deficits. The aim of our study is to test whether slowing down sound flow and facial movement enhance facial recognition and imitation by autistic children compared to normal control children. Results show that a slow dynamic presentation enhances recognition and imitation of facial expressions by autistic children. Our perspective is to elaborate software that could simultaneously slow down facial movements and speech flow, and to assess its impact on the comprehension of words and instructions by autistic children. [Copyright &y& Elsevier]

Abstract: We study the process of acting through the analysis of violence being only from the fact of emergency. Medical technicality and effectiveness are paradoxically binded to confusion and communication problems in emergency rooms. This place becomes thus favourable with an acting out in the reality, of phantasms, family scenes, dramas whose acts unfolding the knowledge of the patients, their family and the practitioners. The scene of emergency should not be that of a wild psychodrama. The urgentist must hold account of the opacity of the psychic fact to try to prevent violent acts, which not always emanate from its patients. [Copyright &y& Elsevier]

The authors report results from a sample survey in a university hospital in connection with the aspects of communication in medical team about paliative situations. The questionnaire, made from a paliative care group, consults the usual practices and during crisis just as patient is dying, in a curative medical care. Hospital is not a place to die. Difficulty in survey are probably in keeping with individual and collective defences opposite to dying patient.

Every psycho-affective disorder may be a factor of language constitution and communication disorders. The study of it, particularly in psychosis is a major sign for diagnosis. Linguistic troubles are correlate with mind perturbations and the psychotic language is symptomatic. The most suggestive example is schizophrenia. Rythm and sound stay, yet semantics and syntactics expressions are down.

How do subjects construct shared meaning during an actual exchange? This question is treated through the study of dialogical behaviours of three psychiatric patients during a clinical interview (Two psychotics and one psychopathic). The analysis of their different ways of linking utterances shows difficulties that concern the construction of a common discursive ground. These difficulties, that can be considered either from a deficitary point of view or from a creative one, appear on the repetition of unexpected changes, of communication blocking or of inadequate indication of the way utterances mean.

What we suggest as a concept is "The sequence of communication" which is accessible to experimenting excluding the concept of "black box". The sequence of communication point out the print of sensations their coding, and a scheme of action as well. This concept enables us to treat information in its unicity taking into account its reception, its analysis and its emission all together. It's a way to avoid the differentiation, or even the clash between "what is felt", "what is said" and "what is acted". From the semiological point of view this approach allows us to stress an analogy between symptoms, which until now have been listed in different pathologies. From the methodological point of view, some hypothesis of work concerning anguish are drawn. On the therapeutic point of view, taking into account the "affects" in a logical context, enables the patient to master his own behaviour.

To apprehend the integrality of the psycho-pathological problems of the human being, the use of a paradigm is necessary. The epistemological paradigm, based on the study of the principles which govern any dynamic system, seems very useful. Applied to the human being, it raises questions of energy, semantics, organization of functions, environments, and it can lead to a better comprehension of the psychism. In psycho-pathology, this paradigm puts in evidence the innumerable interrelations which intervene at all the levels to create disturbances in the functions, inducing troubles of communications with the consciousness resulting in diminution or non-function of the latter, type psychosis, or in its activation, type neurosis.

According to ethological procedures and concepts, the author tries to describe the shape and the functional value of stereotyped movements in disabled children. These pathological behaviors are not a fixed response, they take place within an intricate behavioral sequence which associates many items; they are one aspect of a pathological answer to social stimulation. They prove the disabled child's intense motivation to communicate, but show the impossibility for him to do so. The inability to generate an adapted behavioral sequence shows that the deficit concerns an essential interaction process.

In the western contemporary society, employment is above all the premise for social integration. Thus, the alcoholic will play on the professional scene the complex question of that which associates him with the community of mankind and that which distinguishes him. The role of the "model worker" allows him to conform to the mass opinion and at the same time to mark his difference. Nevertheless, the excesses that characterizes his game and the lack of faith, that he places on his principal partners will lead to his secretly sought after exclusion. It remains for the physician to receive his commentaries, his work often being the last point in which he can still speak of himself.

From a rigorous clinical methodology, the author describes an interaction of a particular pattern between mother and child, the behavior of attunement, which appears around 8 months. It is a matching, more than an imitation, that is cross-modal, each partner using a mode of expression different, unconsciously the most often. The reference for the match is the internal state and not the external behavioral act. Attunement is felt like an unbroken process in the time and leads to define a new quality of feeling, vitality. The quality of the relation of attunement determines probably the ulterior level of the inter-subjective relatedness of the ability to "be-with", to share.

The output and presentation of unauthentic symptoms, or more or less roughly exaggerated, effected intentionally, can only create conceptual and semantic difficulties to the observer when, well informed by the context, he suspects a utilitarian objective from the individual person. The problem of malingering, seed of pathology, refers to questions on the expert's role and his way of collaboration with the petitioning authority.

The foundations of the modern psychopathology of pictorial expression were laid more than a half-century ago by a Frenchman, Marcel Réja (1907), à Swiss, Morgenthaler (1921), and a German, Prinzhorn (1922). In the early days, this was a matter of marginal interest for a handful of psychiatrists and it attracted little official attention. Since the last war however, and especially since the establishment of the S.I.P.E., this special branch of psychopathology has won the recognition to which it is entitled. In French-speaking and other Latin language countries, Volmat's book (1956) provided a powerful stimulus to research. Numerous studies were also undertaken in German-speaking countries. A Swiss psychiatrist, living in a polyglot country, surrounded by some of the world's major linguistic zones, is especially well situated to follow the evolution of ideas. He soon comes to realize that these language areas are sharply separated by very real barriers. In the past few years, the lack of communication between French and German-speaking investigators has become increasingly apparent. Within the limits of a single report, it is impossible to cover all of the work that has been published in German since the time of Prinzhorn. The author has restricted himself to a selection of studies which he personally regards as important. He has sought to retrace and bring into view a line of thought which has proved to be productive and which has not received the attention it deserves in the French-language literature.

This study describes the collaboration effort between professionals of different institutions who are engaged in a multifocal therapeutic framing of an at-risk family. Detriangulation of the professionals out of the family system is emphasized, through the progressive establishment of internal and external communication rules, and through the progressive reduction of the team's dimension. Reference is made to a systemic evolutive model.

Socio-psychological contributions can improve the systemic approach to family therapy. For instance, the notions of "role", "status" and "norm" discussed in this paper, can be applied to the concept of "identified patient". This appears to be the only pathological designation, as role assignment per se is not necessarily abnormal. It is suggested that pathogenic mechanisms playing a part in psychotic families, can also be used therapeutically. Family therapy tends to confirms the principle that small group norms are more readily modified than those of single individuals.

The kraepelinian conception which still prevails in contemporary psychiatry no longer allows us to express all the diversity of observed mental disorders. Moreover, some classical resistances and innovations had foreshadowed the necessity of its renewal. Nowadays the quantitative studies using statistics and the computer, as well as the application of scientific theories to the qualitative aspect of disorders have until now failed in improving the situation. However the theory of communication, cybernetic, the general system theory have shown the possibility of seeing mental disorders as dysfunction of systems. Likewise a new method of operatory observation has permitted to result in an integrated system of permanently open functional models. Moreover the transformations of the disorders among some patients lead to evoke the abstract notion of psychopathologic continuum. The latter allows to view mental pathology, no longer as syndromes and entities, but as functional disorders of a same psychodynamic whole. Consequently, the disorders are the evidence of dysregulations of various mental organizations and the result of a dysfunction in the integration of the latter. Their expression in terms of integrated functional models better shows their diversity, polymorphism, and mobility. What is at stake in such a debate is not only theoretic but also practical and therapeutical.