Cet article propose un éclairage des remaniements du champ psychiatrique actuel à partir d’une réflexion épistémologique sur la notion de « santé mentale ». L’espace discursif et pratique de la santé mentale se distingue de l’aliénisme et de la médecine psychiatrique. Historiquement, il semble avoir suivi, pour partie, les sillages discursifs tracés par son ancêtre, l’hygiène mentale. La santé mentale a élargi son champ d’adresse à des interlocuteurs qui ne sont plus les seuls médecins et spécialistes, mais tout citoyen. Au milieu du xix^e siècle, la dimension de l’être bien et sain devient en effet une question de « santé publique ». De par son maillage aux Droits de l’Homme, la santé mentale s’est progressivement érigée comme constituant lexical d’une culture citoyenne du soin adossée à plusieurs autres espaces discursifs tels que le droit, l’économie et la politique. Désormais portée au rang d’organisatrice des pratiques, elle se soutient d’une coexistence délicate entre singulier et universel, entre subjectivité, discours et organisation collective. Son extension et ses diverses ramifications au xxi^e siècle ont des effets dans les champs cliniques, effets qu’il est crucial de toujours interroger, dans la mesure où bénéfices sociaux et effets subjectifs ne sont pas superposables. Autrement dit, si les quêtes relatives aux droits citoyens sont importantes et actuelles, elles ne devraient pas conduire à remplacer et à évacuer les questions cliniques, qui nécessitent la subtilité d’une écoute et d’un repérage psychopathologique fondé sur la rencontre.

This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.

From an epistemological point of view, the author reviews several writings about mental hygiene going back to the nineteenth century. It clarifies the common roots between mental hygiene and mental health. Then, the article examines the first World Health Organization's reports, that shed light on psychiatric and political issues in the middle of the twentieth century, which allows to reach out the foundations of mental health as a discursive practice.

The review of the developments from “mental hygiene” to “mental health” highlights a general climate of redesign on many points: Mental health as a discursive space is characterized by an expansion of its address field. It is not only addressed to specialists, psychiatrist and psychiatric patients, but also, and above all, to every citizen. Psychic suffering, as far as mental illness, is part of a larger whole including what preserves or deteriorates the proper functioning of an individual, within society. Mental health is at the crossroads of financial, political, citizen's rights and social interests. Contemporary mental health relies on the objectives of prevention and promotion. Clinical practices are organized by some discourses with mental health as a key word. At the turn of 2000s, French psychiatry has been impacted by many shuffles in health policies. However, the roots of these restructuring are not new, as they update an old interest in safeguarding public health, funds and welfare. Psychic suffering and mental illness recently enter the field of “psychic disability”. It brought social benefits such as financial assistance from the state. It may also contribute to the campaigns of awareness-raising and destigmatization among the public opinion. However, financial and subjective effects do not perfectly match. In other words, the benefits listed above should not lead to desert the listening of the users’ experience in its singularity.

The developments of mental health point out a reorganization in the psychiatric field and open new clinical challenges. If the spaces of singularity and universal are in a permanent relationship, the political and economic sides cannot answer or evacuate the subjectivity posed by the subject and his suffering. It should lead to focus on a clinical practice driven by a subtle listening, which does not exclude psychopathology and recognizes the importance of alterity.