[Addressing the issue of seclusion and restraint in psychiatry]. / Envisager la question de l'isolement et de la contention en psychiatrie.

In an ever-changing environment, the question of the meaning of care within a caring, ethical framework is of paramount importance. The development of a patient-centred approach relies on an understanding of the Other. Caring and empathy are the essential foundations of this approach. An attempt to analyze practices through a few notions of ethics can be proposed.

[From psychiatric care to psychic care, for an ethic of restraint]. / Du soin psychiatrique au soin psychique, pour une éthique de la retenue.

This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.

Empathy in medicine: A ritualistic healing function?

Marcel Réja (1873-1957) French alienist evokes in his book « Au pays des miracles ¼ this innumerable people of healers, mystics, empirics, magnetizers, mediums and fantasists. All operating "cures more wonderful than each other". This book questions in a very relevant way the role of the power of the spirit, of healing by the spirit and therefore of suggestion. This "art" of healers includes an affective and emotional coefficient which constitutes its essential spring. There is a mysterious force between the sick and the physician that goes "soul to soul". Current medicine is still very much borrowed from its past with a remnant of "magical" thought. Also, the empathetic dimension of the care relationship remains one of the most necessary dimensions for the exercise of the medical profession.

Validation of the Basic Empathy Scale in an Arabic-speaking population: The BES-Ar.

PURPOSE: The aim of this work was to test the psychometric properties of the Arabic version of the BES (Basic Empathy Scale) by establishing its factor structure, its internal consistency and construct validity in the general population. DESIGN AND METHODS: The BES was tested among 526 Tunisian adults. FINDINGS: The two-factor structure of the BES-20 was confirmed. Internal consistency and concurrent validity were very satisfactory. DISCUSSION: This scale will be useful for clinicians in various fields (mental health, psychiatry) in Arabic countries.

[Identification and transfer movements among caregivers in neonatal and pediatric intensive care]. / Les mouvements d'identification et de transfert chez les soignants en réanimation néonatale et pédiatrique.

Acute care in neonatal and pediatric intensive care units calls into play transferential and identificatory movements in caregivers. To combat burnout and protect themselves from this potentially frightening clinic, they implement defense and sublimation mechanisms.

[Correlation between Objective structured clinical examinations (OSCE) and knowledge examination scores and analysis of factors associated with better OSCE success in fourth and fifth year medicine students at Dijon university hospital]. / Corrélation entre les notes obtenues aux ECOS et aux épreuves de connaissances et analyse des facteurs associés à une meilleure réussite aux ECOS chez les étudiants de DFASM1 et 2 au CHU de Dijon.

RATIONALE: Objective structured clinical examinations (OSCEs) were introduced to evaluate students not only on their knowledge, but also on their clinical skills and attitudes. The objectives were to study the correlation between OSCE scores and scores obtained to traditional knowledge examinations and to analyse factors associated with better OSCE performance in DFASM1 and 2 students at Dijon university hospital. METHODS: This was a prospective observational study conducted among all fourth and fifth year medical students in Dijon. The scores on the OSCE elective tests (2022) and the average score on the knowledge tests (2021-2022) were collected and their correlation measured. A questionnaire asked students about their demographic characteristics, their investment in formative and practicum OSCEs, their level of empathy (Jefferson questionnaire) and their personality traits (NEO-Pi-R). RESULTS: Of 549 students, 513 completed all tests. Scores on OSCE and faculty knowledge tests were correlated (r=0.39, P<0.001). Of these, 111 (20%) students responded to the questionnaire, and 97 were analized. We did not observe any significant difference between students who performed better on OSCEs than on knowledge tests and those who did not, regarding their age, their investment in formative tests, their personality traits or their level of empathy. CONCLUSION: Our results underline the need to optimize the evaluation of empathy and clinical skills in OSCE tests, using new tools, in order to better discriminate between students on these skills.

A stenography of empathy: Toward a consensual model of the empathic process.

Empathy has gained popularity in the general population and the scientific world during the past decade. Recently, several researchers found a significant decrease in empathy scores of healthcare students (notably medical students) and recommend promoting empathy skills in several fields of education. The current paper presents a new model of the empathic process: a stenography of empathy compelling scientific data and contemporary conceptions. Indeed, we combined all pioneer researchers' conceptions of empathy (Davis, Decety, Batson, Preston & de Waal) into an integrative model. This model is centered on the empathizer (i.e., a person observing a target experiencing emotions) and displays how all empathy components are articulated, explaining the individuals' general functioning and how the process might become dysfunctional. We illustrated applications of the model with three clinical examples (i.e., burnout, psychopathy, and borderline personality disorders) to display how empathy is related to psychopathological symptoms. We believe this new dynamic and sequential model would be helpful in explaining how empathy works, which is of great interest to healthcare students, clinicians, researchers, and academics.

From dissociation to integration: the value of the 'green factor'.

This paper will focus on what the author calls the 'green factor': the 'plant world's' ability to foster and manifest profound healing and self-healing processes. This factor could be considered an element capable of promoting the analytic couple's journey in individuation through a good enough rhythmical interaction. Such interaction is made possible by creating and maintaining, in therapy, a good level of empathy, mirroring and resonance that - echoing natural cyclical rhythms primarily in non-verbal communication - fosters the passage from dissociation to integration. This dynamic depends mainly on paying constant attention to the various kinds of images referring to nature, both inside and outside ourselves, i.e. attention on the green world that reconnects us with the wider ecosystem of which we human beings form a part. The author suggests that remembering and respecting the profound relationship between 'Mind and Earth' or Psyche and Gaia means developing and cultivating an ecological attitude or eco-oriented epistemology, a theory according to which, individual wellbeing can be considered a fragment of the health of our planet, in the same way as the individual anima is a spark of anima mundi. This theory has been embraced by numerous scholars ranging from Jung to Bateson, Mancuso and Schore.

Cet article portera sur ce que j'appelle « le facteur vert ¼ : la capacité du monde végétal à soutenir et manifester des processus profonds de guérison et d'auto-guérison. Je suggère que ce facteur est un élément capable de promouvoir le voyage du couple analytique en individuation à travers une interaction rythmique suffisamment bonne. Une telle interaction est rendue possible en créant et en faisant la maintenance, dans la thérapie, d'un bon niveau d'empathie, d'émulation et de résonnance, principalement par la communication non-verbale qui fait écho aux rythmes cycliques naturels et qui ainsi soutient le passage de la dissociation à l'intégration. Je décris comment cette dynamique dépend du fait que l'on accorde une attention constante aux images diverses qui surviennent (à la fois en soi et à l'extérieur de soi) à 'le mond vert' qui nous lie de nouveau à l'écosystème plus vaste dont nous les humains formons une partie. Je suggère également que de se souvenir et de respecter la relation profonde entre l'esprit et la terre ou la psyché et Gaïa signifie développer et cultiver une attitude écologique ou une épistémologie éco-orientée. Il s'agit là d'une théorie selon laquelle le bien-être individuel peut être compris comme un fragment de la santé de notre planète, de la même manière que l'anima individuelle est une étincelle de l'anima mundi. Cette théorie a été adoptée par de nombreux chercheurs allant de Jung lui-même à Bateson, Mancuso et Schore.

El presente trabajo se focalizará en lo que denomino 'el factor verde': la habilidad del mundo vegetal para promover y manifestar procesos profundos de curación y de autocuración. Sugiero que este factor es un elemento capaz de promover el proceso de individuación de la pareja analítica a través de una interacción rítmica suficientemente buena. Dicha interacción deviene posible al crear y mantener, en terapia, un buen nivel de empatía, espejamiento y resonancia, principalmente a través de comunicaciones no-verbales, las cuales reflejan ritmos cíclicos naturales, promoviendo de este modo el pasaje de la disociación a la integración. Describo cómo esta dinámica se basa en el prestar constante atención a las diversas imágenes que emergen (tanto dentro como fuera de nosotros mismos) entre la pareja analítica del 'mundo verde' que nos reconecta con un ecosistema más amplio del cual formamos parte como seres humanos. También sugiero que recordar y respetar la profunda relación entre mente y tierra o psique y Gaia significa desarrollar y cultivar una actitud ecológica o una epistemología orientada ecológicamente, una teoría de acuerdo con la cual el bienestar individual puede ser considerado un fragmento de la salud de nuestro planeta, del mismo modo que el anima individual es un destello del anima mundi. Esta teoría ha sido acogida por numerosos académicos, desde el mismo Jung a Bateson, Mancuso y Schore.

[Announcement of the diagnosis of Alzheimer's disease or a related disorder in a geriatric short-stay unit]. / Annonce du diagnostic de maladie d'Alzheimer ou apparentée en service de court séjour gériatrique.

The disclosure of the diagnosis of Alzheimer's disease or a related disorder, or rather the time of the diagnostic disclosure, is a crucial step in the care of people with these neurocognitive diseases. While the disclosure procedures are well defined for practitioners who work in memory consultations, there is a grey area for hospital professionals who work in acute medical units.

[The discourses of the feeling of being oneself]. / Les discours du sentiment d'être soi.

Forms of discourse and practices of caregivers can help a patient who experiences affects of "loss of self". Four effective discourses can be distinguished: "containing" discourse, "empathic-sympathetic" discourse, "image" discourse and "project" discourse. For the first three to restore a person's ability to act in the world, they must be coupled with the fourth.

[Smell and care: from professionalism to emotions]. / Odeurs et soins, du professionnalisme aux émotions.

The sense of smell presents itself to us as a means of forging an opinion of a situation, sending us back to our memories and giving us a form of knowledge of the patient. In addition, besides the obvious repulsion that certain wounds can engender, the sense of smell can also, conversely, lead us into an eroticization of care.

[Welcoming and caring for homeless people]. / Accueillir les personnes sans abri et en prendre soin.

Dedicated care facilities can accommodate homeless people who are in situations that may lead to neglect due to their social insecurity, psychiatric and/or cognitive disorders. This is the case of the reception and hospital care centre in Nanterre (92), in the Paris suburbs. The professionals there provide a humane welcome to people whose physical condition, health and hygiene are often very poor. Taking care of them is the richness of the experience.

Embodying the psychological attitude: types of consciousness in the transformation of culture.

It is time to reclaim C.G. Jung's vision of psychology as the foundational science upon which all sciences and institutions would be based, and as the discipline, theory, and practice necessary for fostering humanity's overall psychocultural development. Jung identified eight distinct 'types' of consciousness through which humankind engages its emerging psychological attitude. Jung's view of psychological development as hingeing on the differentiation of function-attitudes provides the means for understanding not only ourselves and each other, but our society as well. This paper offers an example of such an analysis by focusing on the current conflict within American political culture. The goal is as lofty as it is necessary: the operationalization of Jung's vision of psychology as the powerful influencer of human cultural evolution that it has the potential to be. The immediate goal is to instigate the first step toward this vision of Jung's 'complex psychology' by stimulating conversations among Jungians about how they can foster that vision, leading them towards taking up roles as 'citizen therapists', actively involved in their communities in cultivating greater empathy and the withdrawal of projections in the interest of furthering 'collective consciousness'.

Le moment est venu d'assumer la vision de C.G. Jung de la psychologie en tant que science de base sur laquelle toutes les sciences et institutions seraient fondées, et en tant que la discipline, théorie et pratique nécessaires pour encourager le développement psychoculturel de l'humanité. Jung a identifié huit 'types' distincts de conscience à travers lesquels l'humanité éveille son attitude psychologique émergeante. Jung envisageait le développement psychologique comme articulé avec la différentiation de fonction-attitudes. Ceci fournit les moyens de comprendre non seulement soi-même et les autres mais encore notre société. Cet article offre l'exemple d'une telle analyse en se concentrant sur un conflit actuel au sein de la culture politique américaine. Le but est aussi ambitieux qu'il est nécessaire: rendre opérationnelle et donner tout son potentiel à la vision de Jung sur la psychologie comme influence puissante de l'évolution culturelle humaine. Le but immédiat est d'inciter au premier pas vers la vision de Jung d'une 'psychologie des complexes' en stimulant des conversations parmi les Jungiens sur comment ils peuvent encourager cette vision, les invitant à s'impliquer en tant que 'thérapeutes citoyens', actifs dans leurs communautés, cultivant une plus grande empathie et le retrait des projections, dans l'intérêt de l'avancement d'une 'conscience collective'.

Es tiempo de reclamar la visión de Jung de la psicología como la ciencia fundacional sobre la cual todas las ciencias e instituciones pudieran basarse, y como la disciplina, teoría y práctica necesarias para promover el desarrollo psico-cultural de la humanidad. Jung identificó ocho 'tipos' diferentes de consciencia a través de los cuales la humanidad desarrolla su emergente actitud psicológica. La perspectiva de Jung acerca del desarrollo psicológico como dependiendo de la diferenciación de funciones - actitudes brinda un medio para la comprensión no solo de nosotros mismos y de los demás, sino también de nuestra sociedad. Este trabajo ofrece un ejemplo de dicho análisis al focalizarse en el conflicto actual al interior de la cultura política americana. El objetivo es tan ambicioso como necesario: la operacionalización de la visión psicológica de Jung como una influencia poderosa de la evolución de la cultura humana, la cual tiene el potencial de ser. El objetivo inmediato es instigar el primer paso hacia esta visión de la 'psicología compleja' de Jung, estimulando conversaciones entre Junguianos sobre cómo pueden promover esta visión, conduciéndolos hacia la toma de roles como 'terapeutas ciudadanos', involucrados activamente en sus comunidades, cultivando una mayor empatía y el retiro de las proyecciones con el interés de fomentar 'la consciencia colectiva'.

[Design for quality of life at work for hospital professionals]. / Le design au service de la qualité de vie au travail des professionnels de l'hôpital.

The Hospitality Laboratory of the Paris Psychiatry and Neurosciences University Hospital Group mobilises the skills of design and cultural development. It assists professionals in carrying out their missions by giving concrete form to the vocation of hospitality at the heart of their care ethics.

[Art, empathy and suicide prevention]. / Art, empathie et prévention du suicide.

Empathy for patients is not only learned through reasoning, but also through sensitivity. Art, reflecting the human emotional dimension, has its place as an educational resource in the training of health professionals. Caregivers must be competent to collect the psychological pain associated with suicidal risk, which is a prerequisite for any preventive action. Since facilitating empathy also protects against burn-out, there is much to be gained by promoting educational programs of artistic observation.

Déficits précoces de l'empathie et psychopathologie Early empathy deficits and psychopathology.

Empathy is a complex social-cognitive ability that is best understood by distinguishing its emotional, cognitive and motivational dimensions, which from early childhood interact between the child and her/his social environment. To date, among the many factors that are acknowledged to influence the development of empathy, children's temperament and parenting behaviors have been identified as interacting in predicting the extent to which children demonstrate empathic responses. Recent studies in developmental social neuroscience cast light on the neural networks engaged in the development of each of the dimensions that constitute empathy, which are needed to navigate social interaction and establishing positive social relationships. Indeed, early deficits in empathic processes can lead to difficulties in socialization, particularly associated with reduced attention to others' emotions, especially when they are suffering, a lesser degree of remorse and guilt, and a greater tendency to ignore social norms or break the rules. Difficulties in socialization are particularly visible in two well-known developmental disorders: children with autism spectrum disorders (ASD) and children with conduct disorder and callous unemotional traits (CU). This paper provides a critical and selective review of recent empirical studies in psychopathology and developmental neuroscience by addressing the dimensions underlying empathy, specifically emotional sharing and caring for others. For children with ASD, some studies report that they pay less attention to another person in distress. However, functional neuroimaging studies conducted with ASD adolescents indicate that the emotional dimension appears to be preserved, but a lack of emotional self-regulation may impair them from experiencing empathic concern. Children with conduct disorder and CU traits clearly manifest a reduced autonomic nervous system response to others' distress or suffering. This may account for their disregard or contempt for others' well-being and social norms. Functional neuroimaging studies show that atypical patterns of brain activity at 15 months of age can predict later severe conduct disorder. Neural regions engaged in emotional processing such as the anterior cingulate cortex, insula and amygdala shown reduced activation to empathy-eliciting stimuli in children with CU. Finally, the genetic nature of CU traits is highlighted in several studies. We conclude by proposing several avenues for developmental research to identify biomarkers from an early age and by inviting to focus on psychological interventions with those populations accordingly.

L'empathie est un phénomène complexe dont la compréhension est améliorée par la distinction de ses dimensions émotionnelle, cognitive et motivationnelle, qui interagissent entre I'individu et son l'environnement dès le plus jeune âge. Des déficits précoces dans les processus empathiques peuvent conduire à des difficultés de socialisation qui se manifestent particulièrement chez les enfants présentant des troubles du spectre de l'autisme et le trouble des conduites. Cette revue critique des connaissances en psychopathologie et neuroscience développementale aborde les dimensions sous-jacentes à l'empathie que sont le partage affectif et le souci de l'autre. L'article conclut en proposant des pistes de recherche pour identifier des biomarqueurs précoces.

[Sharing concern for pain in the interaction of care]. / Partager le souci de la douleur dans l'interaction du soin.

Faced with complaints from patients in their day-to-day practice, health professionals are the main actors in the assessment and management of pain. Empathetic listening to the patient is an essential component in the patient's adherence to and participation in the therapeutic project developed by a multidisciplinary team.

[The spiritual dimension in nursing]. / La dimension spirituelle dans les soins infirmiers.

Spirituality refers to that which gives us hope, meaning and purpose. It is naturally part of the holistic nature of the care provided by nurses to people going through life's challenges: health-related accident, serious and incurable illness, chronic disease, end of life, etc. A British advanced practice nurse, who has enriched her training with a doctorate in spirituality in the context of health care, enlightens this dimension, which is less formalized in France than in the United Kingdom, and suggests resources for progressing personally and professionally.

Nivel de satisfacción y fatiga por compasión del personal del 911 / Level of satisfaction and fatigue by compassion for 911 staff / Nível de satisfação e fadiga por compaixão do pessoal do 911 / Niveau de satisfaction et de fatigue compassionnelle du personnel du numéro d'appel d'urgence 911

Resumen Objetivo: Establecer el nivel de satisfacción y fatiga por compasión del personal operador y supervisor del Sistema de Emergencias 911 en Costa Rica. Materiales y métodos: Se realizó un estudio exploratorio que consideró el 53 % del personal operador y supervisor. Para la recolección de la información se aplicaron dos instrumentos, uno por entrevista personal, en el que se indagaban datos relacionados directamente con aspectos sociodemográficos y la identificación del impacto de la tarea que realizan; así como el instrumento Profesional Quality of Life Scale (ProQOL-vIV) para determinar el nivel de satisfacción y fatiga por compasión. Resultados: Se muestra una valoración óptima de la satisfacción por compasión, lo que evidencia una complacencia personal por la realización del trabajo. Conclusiones: El personal de la línea de atención de emergencias en cada turno recibe diferentes tipos de incidentes, unos que le van a afectar más que otros, ello va a depender, además, de sus circunstancias personales, del ambiente en el cual se desempeñan y de la variedad de llamadas que atiende. Se considera primordial la atención psicosocial que se le brinde para evitar el desgaste, la frustración y optimizar la labor que ejecutan mediante estrategias de afrontamiento adecuadas a la realidad que viven y efectivas, para el tipo de trabajo que efectúan.

Abstract Objective. Establish the level of satisfaction and fatigue by compassion of the operator and supervisor staff of 911 Emergency System in Costa Rica. Materials and methods. An exploratory study was carried out which considered 53% of the operating and supervisor staff. For collecting information two instruments were applied, one by personal interview in which we asked data related directly to sociodemographic aspects and related to the impact of the task they perform and, the Professional Quality of Life Scale (ProQOL-vIV) instrument to determine the level of satisfaction and fatigue by comparison. Results. It shows an optimal assessment of satisfaction with compassion which indicate a personal gratification for the work they perform. Conclusions. The staff of the emergency service line on each shift receives different types of incidents, some of which will affect them more than others, this will also depend on their personal circumstances, the environment in which they work and on the variety of calls they answer. It is considered essential the psychosocial care that is given to avoid burnout, frustration and optimize the work they perform through coping appropriate and effective strategies to the reality they live for the type of work they do.

Resumo Objetivo: Estabelecer o nível de satisfação e fadiga de compaixão do pessoal operacional e de supervisão do Sistema de Emergência 911 na Costa Rica. Materiais e métodos: Foi realizado um estudo exploratório que considerou 53% do pessoal operacional e fiscalizador. Para a coleta das informações, foram aplicados dois instrumentos, um por entrevista pessoal, em que foram investigados dados relacionados diretamente aos aspectos sociodemográficos e à identificação do impacto da tarefa realizada; bem como o instrumento Professional Quality of Life Scale (ProQOL-vIV) para determinar o nível de satisfação e fadiga da compaixão. Resultados: Uma avaliação ideal da satisfação da compaixão é mostrada, o que mostra uma satisfação pessoal com o desempenho do trabalho. Conclusões: O pessoal da linha de atenção de emergência recebe diferentes tipos de incidentes em cada turno, alguns que os afetarão mais do que outros, isso dependerá também de suas circunstâncias pessoais, do ambiente em que trabalham e da variedade de ligações necessárias. A atenção psicossocial prestada é considerada essencial para evitar o desgaste, a frustração e otimizar o trabalho que realizam por meio de estratégias de enfrentamento adequadas à realidade em que vivem e eficazes, para o tipo de trabalho que realizam.

Résumé Objectif : Établir le niveau de satisfaction et de fatigue compassionnelle du personnel opérationnel et d'encadrement du système d'urgence 911 au Costa Rica. Matériels et méthodes : Une étude exploratoire a été menée avec 53% du personnel opérationnel et d'encadrement. Pour le recueil de l'information, un entretien personnel a permis de connaitre les données directement liées aux aspects sociodémographiques et d'identifier l'impact de la tâche accomplie ; d'autre part, l'instrument Profesional Quality of Life Scale (ProQOL-vIV) a été employé pour déterminer le niveau de satisfaction et la fatigue compassionnelle. Résultats : Un niveau optimal de satisfaction de compassion a été trouvé, ce qui témoigne d'une satisfaction personnelle dans l'accomplissement du travail. Conclusions : Les membres du personnel du numéro d'appel d'urgence de chaque équipe répondent à différents types d'évènements dont certains les touchent plus que d'autres. Cela dépend, en plus, de leur situation personnelle et de l'environnement dans lequel ils travaillent. Les services psychosociaux qui leur sont proposés sont considérés comme essentiels afin d'éviter l'usure et la frustration, et d'optimiser le travail qu'ils effectuent grâce à des stratégies d'adaptation efficaces et adaptées à la réalité qu'ils vivent, pour le type d'activité qu'ils effectuent.

[From empathy to commitment, the ethical approach in psychiatry]. / De l'empathie à l'engagement, la démarche éthique en psychiatrie.

Ethical questioning and reflection are a requirement for the psychiatric caregiver, a particular discipline which is both clinical and political. Ethics is a safeguard that allows the professional to refocus on the core of their profession. It is not synonymous with morality and is situational. It is a combat sport against oneself and against those who reduce the patient to a human-machine to be repaired.