Relationship to Societal Disease
CC = Advisory Committee
PTI = Vise
à s'assurer de la cohérence et de la bonne articulation des politiques
publiques et initiatives conduites par le Conseil départemental et ses
partenaires
CEP = Multidisciplinary Team Council
This work was done between 2019 and 2022 by 13 people
who belong to the CC, PTI and CEP of Hérault, France
In summary:
It would be for the CC to develop the frame of a workshop to
be tested internally first, then to export it to the other CCs, then more
widely to other interested structures.
The purpose of this
workshop would be to get people to
express themselves on their relationship to the disease and to seek
together how to get out of conditioning
and beliefs, in order to acquire
more autonomy. Simultaneously, to bring to light the structural problems in society that induces conflict that
can result in illness, such as endemic unemployment, the deterioration of
human relations within employment, etc.
The main idea is that our health is first of all our
responsibility, individual and collective. But to be able to take on this
responsibility, collective work is needed to change the common cultural
narrative. (as we did for "work")
This approach is not
“against” or “on the sidelines” of medicine and health practitioners. It aims,
on the contrary, to relieve them of the enormous burden which consists in
having to manage what should be managed by the patient: the “taking charge” of his own internal conflicts and of the conflicts
induced by the social organization. The doctor can only really
"help" the one who helps himself first, and he cannot resolve
socially induced conflicts and illnesses on his own.
Starting from
observations of the lived reality, made both by recipients and by social
workers, the CC of Béziers proposes to broaden
its reflection and its proposals (2018-2022) on "work vs employment and
representations" to the dimension of the physical and mental health of
recipients in particular, and of people in precarious situations in
general.
Indeed, the problem of
"health" is generally approached by the institutions, within the
framework of integration, "from the angle of the difficulty or the
obstacle to employment, as a strictly medical problem calling for a response
curative care. (PTI 2017-2021 ) The discussions during the work of the PTI
2017-2021 have changed this trend and given rise to a different orientation:
"The reflections undertaken within the ad hoc groups have led to a change
of posture, which now consists to apprehend the person in the process of
integration as a whole, taking into account his environment, and to rely on his
abilities and skills to promote his development, within the framework of social
progression. (PTI 2021-2025)
• Findings
The current social
organization around employment, and the representations resulting from it,
contribute to precipitating more and more people into precariousness (even
while having a job), into unemployment or into the RSA system.
The responses at the
national institutional level are based more on increased control and repression
vis-à-vis recipients than on proposals for new ways or permanent solutions to
avoid non-employment.
Recipients suffer from
both isolation and a lack of social recognition. Not everyone has the same
capacity for resilience in the face of these two problems. Many are then forced to find in the status of “sick” a means of
escaping both the pressure exerted by institutions and the pressure they impose
on themselves to acquire a recognized social status. They don't fake it:
they develop real illnesses. The status of "sick" justifies not being
able to respond to pressure from outside, in the eyes of the institution which
then releases the pressure, and in the eyes of the recipient who can attribute
the reason to his illness. The inability to register in employment (= a
recognized social status) which he encounters and thus discharge his feeling of
guilt. The disease then constitutes a shield of protection essential to the
psyche to resist: it is then necessary and useful.
The statistics of state
organizations that monitor health are also formal: the unemployed and
precarious have a life expectancy much
lower than the national average age:
“Not only have
scientists discovered that unemployed people have a higher suicide mortality rate than working people, but also that
the loss of work promotes the onset of cardiovascular pathologies. The
unemployed thus have a risk of stroke
and heart attack increased by 80% compared to the assets. They are also more
likely to die of cancer. The finding is the same for women and men. » (..)
“there is a specific effect associated with
unemployment independent of other risk factors,” emphasizes Pierre Meneton,
public health researcher at Inserm. An excess mortality that is not well
explained, probably linked to the
psychological dimension of unemployment, with phenomena such as depression
or lack of sleep." As the epidemiologists write, in conclusion of their
study, " Killing jobs means killing people, figuratively and
literally."
Paradoxically, while the
demand for care is increasing, we are simultaneously witnessing the dismantling of the health service in France,
particularly in rural areas where the medical deserts are widening, and the
hospitals - which must consequently absorb more patients - are increasingly
deprived of means and personnel.
Being sick therefore
becomes a “luxury” that soon few will be able to afford.
Consequently, dealing
with the question of the disease appeared to us to be essential. Our role is NOT
to assume its individual medical dimension (role of doctors and psychologists),
it is the collective cultural dimension
of health and illness that concerns us.
• What does the “collective dimension” of health and
illness mean?
We are conditioned, in
our Western culture, to think that illness is individual, and therefore to
treat individuals. At a certain level of reality this is quite true: if Mr X
develops diabetes, the whole collective does not have diabetes. But at another
level of reality, Mr X's diabetes, Mr Y's cancer, Mr Z's alcoholism, etc... are
possibly linked to a common factor which may be, for example, anxiety and the
loss of a recognized social identity, due to unemployment.
Similarly, many diseases
are caused by the consumption of junk food, itself caused by common factors,
industrial agriculture, precariousness, or by inherited cultural habits.
Another common cultural heritage is a fear-based relationship to
illness and death. Decades of efficient social security and health care
systems in France have led the French to question themselves less and less
about the intimate relationship they have in the face of illness and death. When
you were sick, you just had to go see the doctor or go to the hospital to be “taken care of”, while being reimbursed.
As these systems break down and are being privatized, this total “ownership” is
more and more lacking. This means that the most precarious will often have to
face their illnesses alone. Learning to
manage fear will therefore not be superfluous.
The “collective
dimension” of health and disease therefore concerns both the identification of the systemic processes
that induce disease and the development of a new individual and collective culture of responsibility and
autonomy.
• What does this mean concretely?
Any culture is first
based on a common “narrative”. Any
transformation requires a change of
narrative. Any change of story goes through
meetings, to form the new story, then writings, videos, etc... by all means of dissemination. This change
also involves experimenting with the new
narrative and feedback.
The current bases that
the CC can provide to initiate this narrative are questions and reflections
around:
• A social system based
strictly on employment (see previous works) inevitably generates suffering and
disease on a large scale.
• Since it is not
possible for individuals, at their level, to change the system, what can they
change to suffer less and not get sick?
• It is in their
individual power to change what they think and feel, and to share this with
others.
• It is in their power
to explore their individual capacity to stay healthy and to take care of their
minor ailments themselves.
• It is in their
individual power not to harbor the fear of disease and death
• It is in their
individual power to regain self-confidence and not to “need” the disease to
“have the right” to exist socially.
• Etc...
Nous pensons que la mise en commun de ces interrogations et
réflexions pourrait déboucher sur l'organisation
d'un groupe chargé d'animer des rencontres locales vers les publics
chômeurs/RSA/précaires afin de tisser
une culture de la responsabilité et de l'autonomie indispensable en temps
de crise.
Work support
Ken Loach's film
"Me, Daniel Blake" (2016) can serve as a support for opening a
discussion.
https://www.allocine.fr/video/player_gen_cmedia=19564084&cfilm=241697.html
Synopsis: For the first
time in his life, Daniel Blake, a 59-year-old English carpenter, is forced to
call on social assistance following heart problems. However, although his
doctor forbade him to work, he was told by the job center (equivalent to Pôle Emploi)
that he had to look for a job under penalty of punishment. During his regular
appointments at the job center, Daniel will cross paths with Rachel, a single
mother of two children who has been forced to accept a job 450 km from her
home.
Daniel Blake has
completely identified with his paid job, which he has held since his youth: he
“is” this man who earns his living by his own activity.
The serious illness
comes to crash into this identity by
obliging him, since he no longer has
a salary, to ask for social assistance. A situation that will lead him to
confront the representation that
institutions have of unemployed people. He is not treated as a sick person
whose job has been withdrawn, but as a person to be put back on the "right path" of employment. As if he
was a delinquent in rehabilitation. But Daniel Blake is 59 years old, that
is to say that he has passed the
expiration date of employability. However, he will be subjected with
renewed violence to paradoxical
injunctions imposed without mercy by employees of the job center: to look for a
job when his doctor tells him to rest, to find a job when there is no offers
available, etc.
This systemic institutional violence does
not only affect job seekers. It is exercised
in the same way on the employees who work within the institution through
the precepts and methods of new
management in application since the 2000s. The employees only reproduce it
on job seekers. These methods induce the psychic disintegration of the
individuals who undergo them, and the psychic
disintegration always leads to barbarism. As Voltaire wrote, “Those who can make you believe nonsense can
make you commit atrocities. »
All employees within
companies and institutions (and even the “self-employed”) and all recipients of
social minima (unemployment, RSA, etc.) can testify to the trauma experienced and the
paths of resilience in the face of this trauma. On both sides, illness is one of these paths. When the
psychic pressure is intolerable, the body says “stop”, one way or another.
Recognizing
institutional violence as such, learning to identify the phenomena of psychic
disintegration and their consequences, recognizing the trauma experienced,
accepting illness as a way of resilience, are
individual steps that are essential to the recomposition of living collectives.
Physical and mental
health does not only depend on medicine: it also depends on the collective need to rebuild society. It also depends
on the ability of each person to have a sense of continuity and meaning in
their existence, and on the degree of awareness: when the conflict is made
aware, it is less costly psychically for the subject; if, on the other hand, he
remains unconscious, the cost to health can be high.
RSA recipients who are
still alive have, through their experience, knowledge and know-how to overcome
the psychic disintegration that threatens the whole of society.
SAISI
