[Clinical knowledge as anthropological knowledge: Reflections on the care pact]

A discomfort pervades current Psychiatry: striving to be linked and identifed with Neurology, it cannot however ignore the subjectivity of patients. Moreover, the practice of Psychiatry as a Know-How, should also be subject to a political and ethical dimension. It must rely on justice and politics to the extent that it receives social demands, articulating the attention to vulnerable people with fair institutions (Ricoeur), but also it has to include them in society through their abilities. In this ethical dimension, it should seek to reform assistance institutions so that patients are protected and their rights respected. In this sense, it is necessary to consider the concept of therapeutic alliance (Paul Ricoeur), alliance that is only possible if it takes the form of a mutual promise, from both the therapist and the patient. It is a pact of care, even in situations where the skills and abilities are disproportionate. Clinical knowledge is somehow an anthropological knowledge about man as subject of disease, as homo patiens, but also about he who wants to accompany him in his suffering.