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
