Cet article interroge les effets d’aliénation produits par l’usage courant du terme « administration » à l’hôpital, et propose des façons alternatives de penser les relations entre le soin et la gestion. Plutôt que de désigner une catégorie fonctionnelle ou des individus, nous montrons que le terme « administration » condense des oppositions symboliques qui empêchent de penser le pouvoir autrement que sur le mode du clivage entre un soin qui en serait dépourvu, et une direction qui le possèderait totalement. En s’appuyant sur un processus abductif déclenché par un entretien à propos de la gestion de crise COVID, puis en revisitant plusieurs années de matériaux qualitatifs issus d’un dispositif mêlant recherche-action, observation participante et auto-ethnographique ( memory work ), nous mettons en évidence la manière dont « l’administration » fonctionne comme une métonymie condensant des signifiés historiques, fantasmatiques et organisationnels. Nous utilisons un exemple issu du terrain en relatant le sens métonymique des « moquettes » comme désignation des bureaux de l’administration d’un hôpital de taille moyenne à partir du revêtement de son sol. Nous montrons comment un détail apparemment anecdotique peut être analysé comme le produit d’un imaginaire clivant deux mondes supposés inconciliables : celui du soin et celui de la gestion. Nous proposons ensuite un déplacement conceptuel à partir des élaborations de la psychothérapie institutionnelle concernant la « fonction de direction ». En mobilisant, dans une perspective élargie, l’intuition d’E. Kantorowicz au sujet du « double corps » du roi, nous soutenons qu’il ne s’agit pas tant de personnaliser le pouvoir que de lui donner une forme symbolique d’incarnation permettant à l’Institution de répondre. L’analyse d’un dispositif mis en place durant la pandémie — les messages quotidiens dits « all users » — illustre comment une adresse située, portée par la direction, peut soutenir un travail de symbolisation, de contenance et de désaliénation. Penser la direction comme fonction — et non comme attribut d’un individu — ouvre ainsi un espace où le pouvoir peut cesser d’être un objet imaginaire assigné à une personne, pour redevenir un opérateur symbolique au service du travail institutionnel.

In the hospital world, the word “administration” is omnipresent, yet rarely questioned. Used to designate both a set of tasks and a vague group of people who “decide,” the term is loaded with pejorative connotations of bureaucracy and managerialism, and fuels a symbolic divide between those who “care” and those who “administer.” In this paper, we argue that the category of “administration” constitutes a socially and psychically alienating signifier that obscures how power is actually exercised in hospitals. Drawing on institutional psychotherapy and psychosocial approaches to organizations, we propose a conceptual and practical shift: moving from thinking in terms of “administration” to thinking in terms of the incarnation of the “function of direction”. The article begins by showing how the term “administration” functions as a metonymy that condenses a multiplicity of signifieds — historical, political, and affective — while masking the symbolic and institutional processes that shape daily life in hospitals. We briefly revisit the long-standing opposition between magistère (the clinical and Hippocratic authority of physicians) and ministère (the administrative function of serving the public), and describe how this opposition continues to structure imaginaries and relational patterns in contemporary hospitals. The metonymic use of “administration” invisibilizes the human dimension of hospital leadership and fuels a form of institutional transference which hinders meaningful reflection on power and governance. Empirically, our argument is grounded in an abductive process initiated by a surprising interview conducted in 2021 during a research program on hospital governance. This triggered a memory work on several years of qualitative materials (2020–2025) gathered through ethnographic and auto-ethnographic involvement in a medium-sized French public hospital, combining participant observation, clinical interventions. We treat this hospital as a generalizable case of the dialectic of alienation/disalienation at stake in public institutions. A first set of findings illustrates the alienating character of the category “administration” through an emblematic example: the designation of the hospital's management wing as “the carpets.” This spatial metonymy designated the administrative area because its floors were carpeted. We show this signifier condensed fantasized representations of power, prestige, opacity, and detachment from care. Analysed through the lens of institutional psychotherapy, this spatial metaphor reveals how hospital spaces act as symbolic operators: they distribute meaning, organize affects, and sustain the imaginary split between clinical purity and administrative contamination. To break with this alienating logic, we propose to use the concept of the “function of direction” which pertains to the institutional psychotherapy movement, for it shifts focus from the individual person holding a managerial title to the symbolic position through which the institution speaks. Drawing on Ernst Kantorowicz's theory of the King's Two Bodies, we suggest that hospital directors are expected to embody an institutional body — beyond their personal, biological self — in order to provide symbolic anchoring and institutional presence. We extend this reasoning to digital forms of presence that emerged during the pandemic, with novel modes of institutional incarnation in the absence of physical contact. Describing the case of an “all users” mailing list sending messages which were co-constructed by multiple actors and only signed by the director, we show how these informative and supportive emails constituted a form of minimal yet symbolically powerful presence that provided containment, coherence, and a shared frame of reference at a time of institutional chaos. In the discussion, we argue that a clinical approach to power in hospitals requires deconstructing the fantasy of power as a place which is possessed by a person. Instead, we conceptualize power as a structural and symbolic empty place that must remain unoccupied for institutional elaboration to occur. Supporting directors in not identifying with the imaginary fullness of power — and instead caring for the institutional “vacant center” where collective symbolization becomes possible — constitutes an act of disalienation. This perspective reframes leadership development not as empowerment of individuals, but as an organizational hygiene that protects the symbolic space necessary for democratic, thoughtful, and non-captured governance. Ultimately, we argue that abandoning “administration” as a discursive category in favor of “function of direction” enables a more lucid, less alienated relationship to power in hospitals. This shift opens conceptual and practical pathways for revitalizing institutional life, supporting organizational robustness, and sustaining the ethical mission of public healthcare institutions.