Le nouveau management public de la santé et les politiques du secret

Abstract

Crossing a survey of literature in sociology of health and her own inquiries in the field of mental health, the author studies the historical change in policies of secrecy in health domains and specifically, in modern democracies, practical aporias opposing rights and duties to and towards secrecy, rights and duty to and towards transparency. The paper describes weakening of medical secret regarding legitimization of standards of transparency, coordination and evaluation supported by the New Public Management (NPM). Two forms of resistance against technocratic enforcement to publicizing are suggested. The first of these forms is the historical exception, nowadays vilified as out of date, of psychoanalysis bound to strict secret of the singular interview and building there a space for emancipation, preventing any governance of behavior by healthiness. The second one: some intentional and paradoxical break of secret can result in symbolic reversal against domination and shame.