[Antidepressants, psychedelics and psychotherapies: ecological validity and opacity in mental health]

In mental health care, attributing improvement to a specific treatment often remains difficult, a phenomenon that we propose to describe here as "therapeutic opacity." Moreover, the conditions under which many clinical studies are conducted often differ substantially from those of routine clinical practice, raising questions about their ecological validity. Drawing on debates surrounding antidepressants, psychedelics, and psychotherapies, this article argues for an approach to care that takes into account the contexts, individual trajectories, and relational factors that shape therapeutic outcomes.