[On medical responsibility in geriatric psychiatry]

In recent years, three new disciplines have progressively emerged, namely geriatric psychiatry, psycho-geriatrics and psycho-gerontology. At this time, problems of responsibility in geriatric psychiatry have tended to make physicians hesitate between two extremes: one the one hand, a refusal to take seriously the care of the elderly mentally ill, and on the other hand, a tendency towards activism and a medical ideology characterized by globalization and reductionism. It must be said, in the physician's favour, that, not only had he to learn to free himself from the ideological strangle-hold of a pseudo-scientific line of thought, but also he was having to cope with the reemergence of his own existential preoccupations as a result of his own contact with the elderly patient. It is in this difficult endeavour that a number of situations are described and discussed; these situations are of interest to psychiatry in general from the point of view of medical responsibility. Some of these are to do with the use the physician makes of concepts he has created and diffused without controlling their implementation. Others cast doubt on care management. Finally, others enable us to question more effectively the current drift in thinking amongst professionals and consumers.