Cette thèse porte sur les dynamiques interculturelles et la réactivité des institutions dans les contextes pluralistes. Le contexte clinique, un exemple parmi tant d’autres, sert à saisir les enjeux des rencontres entre personnes d’origines différentes. Le milieu de la réadaptation physique apparaît particulièrement intéressant pour étudier les enjeux induits par les rencontres interculturelles, car les interventions y sont d’une durée relativement longue en comparaison avec les soins aigus, et ce type de pratique demande une grande collaboration de la part des clients. Cette recherche sollicite trois acteurs essentiels dans ce contexte : clients immigrants, intervenants et agents tiers payeurs (CSST) ont pris la parole lors de groupes de rencontre (focus group). La recherche d’un cadre théorique pertinent en anthropologie interculturelle revisite les courants moderniste et postmoderniste, à partir d’une approche critique, et propose une épistémologie interactionniste. Ces courants qui traversent l’anthropologie sont étudiés à la lumière de la clinique, ce qui engendre un dialogue entre les intervenants et les anthropologues. Le contexte ethnographique permet de cerner différents enjeux concernant les politiques de santé dans les contextes pluriethniques, ce qui permet de saisir, à partir de la gestion, des rapports d’emboitement entre le macro et le micro. Le fonctionnement de la réadaptation physique au Québec sert de toile de fond pour comprendre les discours des acteurs sollicités par cette recherche. L’ethnographie met en lumière les convergences et les divergences entre ces trois acteurs dans les contextes pluriethniques. Selon une méthode caractéristique des relations interculturelles, je présente d’abord l’intervention dans les institutions de réadaptation. Les clients immigrants sont mis en scène avec l’intervention dans les contextes pluriethniques. Les discours de tous ces acteurs mettent en lumière des barrières dites objectives et des facteurs liés à la culture. L’analyse s’intéresse à la communication et à la circulation de l’information dans les contextes pluriethniques; elle étudie les rapports entre l’information, la connaissance et les préjugés. L’analyse offre quelques pistes qui aident à comprendre l’imperméabilité du système de santé dans les contextes pluralistes. La conclusion propose une approche complémentariste pour établir un dialogue entre les modèles de discrimination et l’interculturel. Les anthropologues sont alors interpellés en vue de répondre aux nouveaux défis générés par le néolibéralisme. / This thesis is based on the intercultural and institutional dynamics of health care in pluralistic contexts. The clinical context makes it possible to understand what is at stake in encounters between people of different ethnic and religious backgrounds. The field of physical rehabilitation is a particularly interesting context for understanding these dynamics because interventions require long-term assessment and sustained collaboration on the part of clients. The current research examines three types of actors in this context: immigrant clients, health care specialists (or practitioners), and third party payers (CSST). In order to elaborate an intercultural theoretical framework, the thesis critically examines modernist and postmodernist orientations in anthropology, and through an epistemological approach proposes an interactionist orientation. These differing epistemological orientations are studied from a clinical standpoint and, the resulting analysis prepares the way for a dialogue between practitioners and anthropologists. The ethnographic context sheds light on various themes concerning the politics of healthcare in pluralistic contexts, but also the policies that influence different relationships between macroeconomics and local-level encounters in organizational settings. The system of physical rehabilitation in Quebec serves as a canvas to understand concerns and expectations of the different types actors solicited by this research. The ethnographic data presented here highlights the convergence and divergence between those who are involved in administering and receiving care. After describing the conditions and terms of intervention in the field of physical rehabilitation, there is a discussion of the specificity of immigrant clients and healthcare in pluriethnic contexts. Data collected from different actors highlights the difference between objective barriers to adequate services and factors which can be linked to culture. Analysis of the data focuses on communication in an intercultural or pluriethnic context and the flow of information, carefully examining the relationship between information, expertise and prejudice. The analysis also offers certain pathways to better understand the lack of reactivity in pluralistic contexts. The conclusion proposes a complementary approach which is intended to facilitate a dialogue between models based on discrimination and those on interculturalism. Anthropologists are presented as being particularly well positioned to answer new challenges generated by intercultural situations in an era of neoliberalism.

Ces prolégomènes étudient l’évolution conceptuelle et politique de l’intégration scolaire comme introduction à l’analyse de la construction de la légitimité de la politique de l’adaptation scolaire. Ils s’intéressent d’abord au mouvement des courants de scolarisation des élèves handicapés ou en difficulté d’adaptation ou d’apprentissage (EHDAA) et à leurs mutations au regard de leurs fondements. Puis, ils les explorent dans le contexte du Québec, à partir de l’étude de l’évolution de la Politique de l’adaptation scolaire de 1978 à 1999 et des changements intervenus dans l’orientation, l’organisation des services et l’identification des catégories d’élèves concernés par cette politique. Ces changements sont également mis en perspective avec la question de la mise en œuvre de la politique par les acteurs scolaires, considérée comme un espace de redéfinition des problèmes et de légitimation de la politique. Il montre que l’évolution de la Politique de l’adaptation scolaire se situe entre la permanence et le changement dans la conception de scolarisation des élèves HDAA sous-tendus par une difficile mise en œuvre et légitimation de la politique. / These prolegomena inquire on the political and conceptual evolution of school integration as a mere introduction to the analysis of the making of a legitimized policy regarding special education. It first explore the different schooling trends, and their evolutive core, designed for students with handicaps, social maladjustments or learning disabilities; then situate it within three frame of reference unique to Quebec : the study of the evolution between 1978 and 1999 of the policies on special education and their positioning, the management of such services as well as the grouping and labeling of any student concerned by those policies. These variations are later questioned by the application of such policies by the different players, as their application is considered to be the mold for any problem diagnosis as well as a legitimising podium. Ultimately, the highlights of this particular evolution of policies on special education is positioned between changes and durability of the schooling approach for special students, and is underlained by a difficult implementation and legitimization.

Cette thèse porte sur les dynamiques interculturelles et la réactivité des institutions dans les contextes pluralistes. Le contexte clinique, un exemple parmi tant d’autres, sert à saisir les enjeux des rencontres entre personnes d’origines différentes. Le milieu de la réadaptation physique apparaît particulièrement intéressant pour étudier les enjeux induits par les rencontres interculturelles, car les interventions y sont d’une durée relativement longue en comparaison avec les soins aigus, et ce type de pratique demande une grande collaboration de la part des clients. Cette recherche sollicite trois acteurs essentiels dans ce contexte : clients immigrants, intervenants et agents tiers payeurs (CSST) ont pris la parole lors de groupes de rencontre (focus group). La recherche d’un cadre théorique pertinent en anthropologie interculturelle revisite les courants moderniste et postmoderniste, à partir d’une approche critique, et propose une épistémologie interactionniste. Ces courants qui traversent l’anthropologie sont étudiés à la lumière de la clinique, ce qui engendre un dialogue entre les intervenants et les anthropologues. Le contexte ethnographique permet de cerner différents enjeux concernant les politiques de santé dans les contextes pluriethniques, ce qui permet de saisir, à partir de la gestion, des rapports d’emboitement entre le macro et le micro. Le fonctionnement de la réadaptation physique au Québec sert de toile de fond pour comprendre les discours des acteurs sollicités par cette recherche. L’ethnographie met en lumière les convergences et les divergences entre ces trois acteurs dans les contextes pluriethniques. Selon une méthode caractéristique des relations interculturelles, je présente d’abord l’intervention dans les institutions de réadaptation. Les clients immigrants sont mis en scène avec l’intervention dans les contextes pluriethniques. Les discours de tous ces acteurs mettent en lumière des barrières dites objectives et des facteurs liés à la culture. L’analyse s’intéresse à la communication et à la circulation de l’information dans les contextes pluriethniques; elle étudie les rapports entre l’information, la connaissance et les préjugés. L’analyse offre quelques pistes qui aident à comprendre l’imperméabilité du système de santé dans les contextes pluralistes. La conclusion propose une approche complémentariste pour établir un dialogue entre les modèles de discrimination et l’interculturel. Les anthropologues sont alors interpellés en vue de répondre aux nouveaux défis générés par le néolibéralisme. / This thesis is based on the intercultural and institutional dynamics of health care in pluralistic contexts. The clinical context makes it possible to understand what is at stake in encounters between people of different ethnic and religious backgrounds. The field of physical rehabilitation is a particularly interesting context for understanding these dynamics because interventions require long-term assessment and sustained collaboration on the part of clients. The current research examines three types of actors in this context: immigrant clients, health care specialists (or practitioners), and third party payers (CSST). In order to elaborate an intercultural theoretical framework, the thesis critically examines modernist and postmodernist orientations in anthropology, and through an epistemological approach proposes an interactionist orientation. These differing epistemological orientations are studied from a clinical standpoint and, the resulting analysis prepares the way for a dialogue between practitioners and anthropologists. The ethnographic context sheds light on various themes concerning the politics of healthcare in pluralistic contexts, but also the policies that influence different relationships between macroeconomics and local-level encounters in organizational settings. The system of physical rehabilitation in Quebec serves as a canvas to understand concerns and expectations of the different types actors solicited by this research. The ethnographic data presented here highlights the convergence and divergence between those who are involved in administering and receiving care. After describing the conditions and terms of intervention in the field of physical rehabilitation, there is a discussion of the specificity of immigrant clients and healthcare in pluriethnic contexts. Data collected from different actors highlights the difference between objective barriers to adequate services and factors which can be linked to culture. Analysis of the data focuses on communication in an intercultural or pluriethnic context and the flow of information, carefully examining the relationship between information, expertise and prejudice. The analysis also offers certain pathways to better understand the lack of reactivity in pluralistic contexts. The conclusion proposes a complementary approach which is intended to facilitate a dialogue between models based on discrimination and those on interculturalism. Anthropologists are presented as being particularly well positioned to answer new challenges generated by intercultural situations in an era of neoliberalism.

This study, BLACK COMMUNITY ATTITUDES TOWARDS THE DISABLED - EDUCATIONAL IMPLICATIONS, set out to investigate the attitude of the black community towards the disabled. Literature was consulted to provide a backdrop against which the empirical surveys could be measured. The study used systematic observation interviews for data collection. Appointments were made to conduct the interviews. The study obtained responses from 70 interviewees from four African cultures namely the Vend~ Pedi, Tsonga and Ndebele, who were divided into seven groups, ten per group, i.e. parents of the disabled, the disabled themselves, siblings of the disabled, parents of non-disabled, youth, old people and professional workers. Findings indicated that disabilities such as cerebral palsy, orthopaedic disabilities, blindness and deafness are undesirable and constitute problems in the life of a disabled, their families in general perspective and the community at large. Disabilities constituted different attitudes and were identified as varying from total rejection to acceptance which are brought about by the components of the TRIPARTITE MODEL I A B C MODEL being cognitive, affective and behavioural. Education of the whole black community concerning the issue of disabled people seems to be the only answer to bring about a change of attitude towards the disabled. Therefore a number of recommendations were included to serve as guidance and counselling so that myth and witchcraft ideologies and negative attitudes can be uprooted. The researcher hopes that the effort that went into this· study will be beneficial in the process of educating the black community about the disabled with the ultimate goal of changing existing negative attitudes towards the disabled into positive attitudes of acceptance and support. / Psychology of Education / D Ed. (Psychology of Education)

Objectif : Le suivi néonatal introduit une classification des enfants selon leur niveau de handicap : aucun, léger-modéré ou sévère. Les critères de classification, déterminés par des médecins et chercheurs, ne tiennent pas compte des opinions parentales. Lors de ce projet de maîtrise, les perspectives parentales concernant leur enfant prématuré à 18 mois d’âge corrigé ont été explorées. Hypothèse : L’hypothèse formulée était que les perspectives parentales différeraient des normes établies par les professionnels de la santé. Méthode : 190 enfants prématurés <29 semaines ont eu une évaluation standardisée, permettant la classification selon leur niveau de handicap. Les parents ont répondu aux questions : « Quelles sont vos inquiétudes concernant votre enfant? » et « Nommez les meilleures choses à propos de votre enfant. » Leurs réponses ont été analysées en ayant recours à une méthodologie qualitative et corrélées au niveau de handicap présenté par leur enfant. Résultats : Dans cette cohorte, 49% des enfants n’avaient aucun problème de développement, 43% avaient une atteinte légère à modérée et 8% une atteinte sévère. Les principaux thèmes positifs invoqués par les parents incluaient la personnalité (61%), le bonheur (40%), le développement et les progrès (40%), ainsi que la santé physique (11%). Les inquiétudes parentales principales comprenaient le développement (56%) et la santé physique (24%). Il n’y avait pas d’association entre les thèmes positifs et le niveau de handicap. Les parents d’enfants ayant une atteinte légère-modérée étaient davantage inquiets du développement de leur enfant. Conclusion : Les perspectives parentales concernant leurs enfants prématurés sont balancées, et en majorité positives. L’inclusion des perspectives parentales dans la recherche concernant le devenir des enfants prématurés est importante. Ce projet a permis la création d’un questionnaire quantitatif présenté à un plus grand groupe de parents, subventionné par les IRSC. / Objective: Measuring outcomes of premature birth is essential for quality control, research, patient care and information. At 18 months corrected age, children are classified into categories of severe, mild-moderate or no neurodevelopmental impairment (NDI). Outcomes of interest have been chosen by physicians and researchers, never including parental perspectives. The aim of this thesis was to explore parental perspectives regarding their preterm child. Hypothesis: The hypothesis was that parents’ perspectives and concerns would differ from those assessed by professionals. Method: This survey included 190 infants born <29 weeks of gestational age in one tertiary university health center. Infants underwent detailed developmental assessment and were classified according to NDI. Parents were asked two open-ended questions: “What concerns you most about your child?” and “Please describe the best things about your child”. Open-ended questions were analyzed using qualitative methodology, then correlated with level of NDI. Results: In this cohort, 49%, 43% and 8% had no, mild to moderate, and severe NDI. The main positive themes invoked by parents included their child’s personality (61%), happiness (40%), developmental outcome/progress (40%) and physical health (11%). Main themes regarding parental concerns included: neurodevelopment (56%) and physical health (24%). There was no association between positive themes and categories of NDI, but parents of children with mild-moderate NDI reported more concerns about development. Conclusions: Parents of preterm infants have a balanced perspective of their children, mostly positive. Neonatal outcome research would benefit from incorporating parental perspectives regarding their child, balancing prognostic information about preterm birth. This thesis project has led to the creation of a qualitative questionnaire which is now deployed through a CIHR Child-Bright initiative considering parent-important outcomes.

Ce mémoire offre un nouvel éclairage sur la transition en cours de l’institution pénale contemporaine d’une fonction essentiellement morale et symbolique vers la gestion effective des risques dans la société. Nous estimons que c’est en juxtaposant ses différentes pratiques – pratiques discursives entourant la responsabilité criminelle des accusés atteints de troubles mentaux non psychotiques, pratiques en matière de criminalisation préventives et nouvelles pratiques en matière de peine – que cette transformation fonctionnelle est la plus appréciable. Afin d’illustrer ces différentes pratiques, nous proposons de suivre le parcours pénal réservé par l’institution pénale aux sujets autistiques. Tout en étant fortement déterminés dans leur développement moral, social, sexuel et émotionnel et dans leur capacité à se conformer à la loi pénale, ceux-ci demeurent toutefois minimalement réceptifs aux technologies pénales. Nous pensons que leur incorporation à l’intérieur de la logique pénale résulte essentiellement de cet attrait utile de la peine au prix même de la déformation de nos principes fondamentaux collectifs de justice. Ce mémoire offre la première analyse systématique de la jurisprudence concernant la responsabilité criminelle et la peine des personnes autistes au Canada ainsi qu’une synthèse des plus récentes découvertes juridico-cliniques sur l’autisme. L’intégrité physique et psychologique des personnes autistes étant menacée comme jamais auparavant par l’inflation du quantum des peines en raison de l’arrêt Friesen et des réformes du gouvernement Harper, nous invitons les juristes, les avocats, les experts cliniques à s’intéresser davantage à l’intervention de l’institution pénale envers ces personnes hautement vulnérables. / This thesis sheds new light on the ongoing transition of the contemporary penal institution from a moral and symbolic function to the effective management of risks in society. We believe that it is by juxtaposing its different practices – discursive practices surrounding the criminal responsibility of defendants with non-psychotic mental disorders, preventive criminalization practices and new sentencing practices – that this functional transformation is most appreciable. To illustrate these different practices, we propose to follow the penal circuit reserved by the penal institution for autistic subjects. While being strongly determined in their moral, social, sexual, and emotional development and in their ability to comply with penal law, they nevertheless remain minimally receptive to penal technologies. We think that their incorporation within the penal logic results from this useful attraction of the penalty at the very price of the deformation of our collective fundamental principles of justice. This thesis offers the first systematic analysis of the case law concerning the criminal liability and sentencing of persons with autism in Canada as well as a synthesis of the most recent legal and clinical findings on autism. As the physical and psychological integrity of people with autism is threatened like never before by the inflation of the quantum of sentences due to the Friesen decision and the legislative reform by the Harper government, we invite jurists, lawyers, clinical experts to take a greater interest in the intervention of the penal institution towards these highly vulnerable individuals.

Na história do pensamento geográfico há um grande equívoco na maneira pela qual é concebida a teoria do determinismo geográfico/ambiental. Isso significa que o tema tem sido tratado sob estereotipada roupagem, empobrecendo a Geografia e difamando e subestimando inúmeros geógrafos, bem como suas obras e idéias. O primeiro grande objetivo é o de demonstrar a importância histórica, científica e filosófica da idéia das influências ambientais que subjaz ao determinismo ambiental, a inevitabilidade de sua existência enquanto hipótese básica, e a impossibilidade epistemológica de se negá-la como uma hipóteses básica da Geografia, com ênfase em alguns autores rotulados de deterministas, como Hipócrates, Montesquieu, Semple e Huntington. O segundo grande objetivo é realizar uma crítica da crítica, minando algumas generalizações e equívocos dentre tantos que historicamente têm permeado o temário geográfico, e explicar o emaranhado semântico, filosófico, conceitual e epistemológico do tema das influências ambientais sobre a esfera humana, com ênfase na falsa dualidade determinismo/possibilismo. Assim, deve ser concebida como não mais que um mero prolegômeno, essencial, todavia, ao estudo da relação homem-ambiente, e em particular, ao estudo da história do pensamento geográfico, da idéia das influências ambientais e do determinismo ambiental. Ao final da pesquisa foi possível demonstrar a insustentabilidade da suposta dicotomia entre a escola determinista e a escola possibilista; a confusão conceitual, semântica e filosófica dos textos que comentam os autores deterministas; a impertinência, a leviandade e imprecisão da crítica ao determinismo, baseada mais no rótulo criado do que nas idéias em si; a riqueza de idéias de autores como Huntington e Semple, o pioneirismo possibilista de Hipócrates e Montesquieu e outros autores; a importância do modelo de modos de narrativa e dos estratagemas erísticos de Schopenhauer para a análise textual dos autores deterministas e de seus críticos, culminando com a elaboração de vinte e dois problemas essenciais de pesquisa, lançados como propostas metodológicas e epistemológicas iniciais ao estudo da história da Geografia e de suas idéias / Environmental determinism has been a controversial theme within human sciences and geography. There has been much misunderstanding and understatement concerning this fundamental explanatory hypothesis. A varied assortment of geographical works and authors have been incorrectly labeled and suffered from biased criticism and general misconceptions. The long-standing debate around environmental determinism is marked by a chaotic semantic tangle which shades its real and proper meaning. The first objective is to show the historical, philosophical and scientific importance of environmental determinism in terms of its underlying principle and hypothesis, called the idea of the environmental influences and point to its relevance as a craddle of modern geography and as valid approach to the man-milieu relationships.The second objective is to lauch a counter-criticism on those who irresponsibly dismissed environmental determinism without recognizing its underlying and unavoidable basic hypothesis and who did not read the labeled works in full. Criticism has been frequently incomplete, biased, crude, distorted, unscientific, politically oriented or naïve. The third objective is to disentangle the semantic, epistemologic and philosophic traps that threaten any attempt of covering the theme in full perspective and detail. The fourth objective is to analyse some environmentalists, such as Semple and Huntington, in order to deny the wrong labels attached to them. The fifth objective was to deconstruct the false determinism/possibilism dualism and to present a new way of interpreting this issue. The last objective was to bring a preliminary discussion of the literature of the theme, a short history of environmental ideas from the Greeks to the modern geography in the United States. After a careful analysis some myths were proven incorrect, or misleading and inaccurate at best, and as a final evaluation, twenty-one epistemological and methodological devices were listed as a contribution to the research in history of geography.

Na história do pensamento geográfico há um grande equívoco na maneira pela qual é concebida a teoria do determinismo geográfico/ambiental. Isso significa que o tema tem sido tratado sob estereotipada roupagem, empobrecendo a Geografia e difamando e subestimando inúmeros geógrafos, bem como suas obras e idéias. O primeiro grande objetivo é o de demonstrar a importância histórica, científica e filosófica da idéia das influências ambientais que subjaz ao determinismo ambiental, a inevitabilidade de sua existência enquanto hipótese básica, e a impossibilidade epistemológica de se negá-la como uma hipóteses básica da Geografia, com ênfase em alguns autores rotulados de deterministas, como Hipócrates, Montesquieu, Semple e Huntington. O segundo grande objetivo é realizar uma crítica da crítica, minando algumas generalizações e equívocos dentre tantos que historicamente têm permeado o temário geográfico, e explicar o emaranhado semântico, filosófico, conceitual e epistemológico do tema das influências ambientais sobre a esfera humana, com ênfase na falsa dualidade determinismo/possibilismo. Assim, deve ser concebida como não mais que um mero prolegômeno, essencial, todavia, ao estudo da relação homem-ambiente, e em particular, ao estudo da história do pensamento geográfico, da idéia das influências ambientais e do determinismo ambiental. Ao final da pesquisa foi possível demonstrar a insustentabilidade da suposta dicotomia entre a escola determinista e a escola possibilista; a confusão conceitual, semântica e filosófica dos textos que comentam os autores deterministas; a impertinência, a leviandade e imprecisão da crítica ao determinismo, baseada mais no rótulo criado do que nas idéias em si; a riqueza de idéias de autores como Huntington e Semple, o pioneirismo possibilista de Hipócrates e Montesquieu e outros autores; a importância do modelo de modos de narrativa e dos estratagemas erísticos de Schopenhauer para a análise textual dos autores deterministas e de seus críticos, culminando com a elaboração de vinte e dois problemas essenciais de pesquisa, lançados como propostas metodológicas e epistemológicas iniciais ao estudo da história da Geografia e de suas idéias / Environmental determinism has been a controversial theme within human sciences and geography. There has been much misunderstanding and understatement concerning this fundamental explanatory hypothesis. A varied assortment of geographical works and authors have been incorrectly labeled and suffered from biased criticism and general misconceptions. The long-standing debate around environmental determinism is marked by a chaotic semantic tangle which shades its real and proper meaning. The first objective is to show the historical, philosophical and scientific importance of environmental determinism in terms of its underlying principle and hypothesis, called the idea of the environmental influences and point to its relevance as a craddle of modern geography and as valid approach to the man-milieu relationships.The second objective is to lauch a counter-criticism on those who irresponsibly dismissed environmental determinism without recognizing its underlying and unavoidable basic hypothesis and who did not read the labeled works in full. Criticism has been frequently incomplete, biased, crude, distorted, unscientific, politically oriented or naïve. The third objective is to disentangle the semantic, epistemologic and philosophic traps that threaten any attempt of covering the theme in full perspective and detail. The fourth objective is to analyse some environmentalists, such as Semple and Huntington, in order to deny the wrong labels attached to them. The fifth objective was to deconstruct the false determinism/possibilism dualism and to present a new way of interpreting this issue. The last objective was to bring a preliminary discussion of the literature of the theme, a short history of environmental ideas from the Greeks to the modern geography in the United States. After a careful analysis some myths were proven incorrect, or misleading and inaccurate at best, and as a final evaluation, twenty-one epistemological and methodological devices were listed as a contribution to the research in history of geography.