Covid crisis and emotional intelligence: the missing link

This text extends the debate on medical and health decision making that was initiated around Evidence-based-medicine (EBM) with the carte blanche entitled :   » the role of physician training and medical epistemology in the Covid 19 crisis » . The discussion continued in a second carte blanche, centered — as its title indicates — on a critique of the precautionary principle: « Precautionary principle or « risk of blame »? ? This was followed by the question of the destructuring of the health care system with regard to the inability to recognize its own resources, a question introduced with a third carte blanche:   » Globality, partnership, autonomy in health. When the emergency sweeps everything away, but reveals the essential! » .

By (1) :

  • Florence PARENT, physician, doctor of public health, coordinator of the thematic group « Ethics of health curricula » of the International Francophone Society of Medical Education (SIFEM).
  • Fabienne GOOSET, Doctor of Letters, certified in ethics of care.
  • Manoé REYNAERTS, philosopher, member of the thematic group « Ethics of health curricula » of the International Francophone Society of Medical Education (SIFEM).
  • Helyett WARDAVOIR, Master of Public Health, member of the thematic group « Ethics of health curricula » of the Société internationale francophone d’éducation médicale (SIFEM).
  • Dr. Isabelle François, physician and psychotherapist, member of the thematic group « Ethics of health curricula » of the Société internationale francophone d’éducation médicale (SIFEM).
  • Dr. Benoit NICOLAY, physician, anesthesiologist, micro-nutritionist.
  • Dr Emmanuelle CARLIER, physician, pediatrician.
  • Dr Véronique BAUDOUX, general practitioner.
  • Jean-Marie DEKETELE, professor emeritus of the UCL and of the UNESCO Chair in Education Sciences (Dakar).

From the evanescence of the soul to the emergence of a robot…

 » I’m interested in the idea that the world has flattened and shrunk in recent years, sucked into virtual worlds. It now seems to be made of thin and fragile layers of facts and materials. « (2)

Could the shrinking of the world like the curled up bodies found, alone, on their beds in the EHPADs in May 2020 be the sign of a more definitive disappearance? That of the soul, which brings Mafalda(3) to so much perplexity:« Perhaps in this world there are more and more people and less and less people. »

Still it seems that the soul manifests itself, suggesting its presence that some even dare to resurrect.…

« We are heading towards a psychological and psychiatric break, very very important. There will be a before and after. People are traumatized. At all levels. In the Ehpad, for example, we know that elderly people have died from slipping and anxiety. Others are traumatized by having to bury a parent in a botched manner. These are just a few examples among a thousand. There is an absolute urgency to take into account the psychological dimension of the current crisis.  » (4)

How did we get here?

By having centered the media, political and, in fine, medical debate on the disease alone, or even on the virus alone and its eradication, we have truncated reality by eliminating the psychological subject (as an object itself). But for what purpose? We can put forward a hypothesis which would have to do with the will to divert reality from (or the incapacity to include) its part of uncertainty (situated on the side of the particular and the singular), while directing it towards its part which seems to us, moderns, the most certain: that of the figure and of the statistical calculations having value of the universal. 

Wouldn’t there be some Descartes in this attitude of rejecting or even denying the diversity of reality and its original movement — yet constitutive of our existences — by turning to the sole (belief in the) rationality of mathematics, in immediate proximity with technosciences?

Our modernity seems to be situated in the middle of the ford of certainty and uncertainty. Could the crisis of democracy that seems to be ours today be, first of all, the symptom of a « mid-life crisis »?(5)A metaphor of the anguish linked to our finitude, suddenly revealed in the middle of an era of transhumanism, by the Covid 19?

The epistemological challenge of a health system and a society: the choice of uncertainty

Epistemological orientation(6) of a society is a « total fact » historically and culturally situated. It affects all of our behaviors because it impregnates our way of seeing reality, of interacting with it, and even of considering it.

This consideration in the sense that Corine Pelluchon understands it(7) is in a way summarized by the sentence taken from Damasio’s book entitled « Descartes’ Error »:  » One of the variants of Descartes’ error is to fail to see that the human mind is embedded in a complex, but unique, finite and fragile biological organism; it therefore prevents us from seeing the tragedy of becoming aware of this fragility, finitude and uniqueness. And when human beings are unable to see the fundamental tragedy of conscious existence, they are less inclined to seek to soften it, and may, as a result, have less respect for the value of life. « (8) Now, as A. Damasio, the consideration for the existence and for the life opens in our self, in the one of our emotions, in the one capable also of history, the autobiographical one, because if :  » Emotions are the zealous executors and servants of the value principle, the most intelligent product to date of biological value. « The self is, as for him  » in each conscious mind (…) the first representative of the mechanisms of vital regulation, the guard and the conservative of the biological value. « (9)

By dint of being in « the world of ideas », we have fallen into the trap that Jocelyn Benoist warns us against(10). This trap is the one where the concept (or what is defined by the theory or the proposition) and the particular (or what is defined by theexperience of the Subject or the lived) would be opposed to each other. Although it is easy and comfortable to fit into this vision marked by antagonism, J. Benoist insists on the radical necessity of not seeing things this way!

But would it be too late?

Indeed, we have ‘made’ ourselves(11)massively, in a too exclusively Cartesian perspective(12)on the only side of the concept in rupture with the particular. That is to say, in a cognitivist epistemology (of pure reason), which is moreover reductive, by its approach of mastery, based on a positivist epistemology (search for certainty and proof by experimental demonstration).

Such an epistemology is rooted in a long-standing Platonism, i .e. in a break with the body and the sensible world. And this, more certainly in our western world, which is particularly affected by this health crisis. In terms of human resource development we could consider Descartes as the greatest manager of all time.

Within this « factory », certain sub-groups are more at risk both for themselves and for the general population because of their decision-making capacity in the city. These include the so-called scientific community, including doctors and certain other categories of caregivers, but also lawyers, economists, etc., as well as, in a way, the university structure through education.

It takes a strong awareness and a long term struggle to emancipate oneself from such a cognitivist drift, without opposing it! Indeed, the question is not so much to reject the Enlightenment as to understand its limits and to free ourselves from it. We agree with Corinne Pelluchon when she says:  » The criticisms addressed to the philosophy of the Enlightenment can help us to complete its unfinished project.(13)

Thus in this crisis of the Covid, facing the confinement of our elders .…

 » A massacre of despair and loneliness also when the whole of a life was concluded, at best, by a few seconds of a video exchange via a smartphone. The son sometimes even crossed France to see his dying father, with certificates from the mayor and the doctor in his pocket: but the gendarme of life forbade him to do so and the son returned, weighed down with a fine of 135 euros. He saw the father neither dying nor dead: the President of the Republic had warned: this war, we would win it « whatever it takes « . « (14)

How can our bodies accept such suffering? Feeling that something is « not right », our intelligence needs other weapons to argue the body’s refusal to continue in such a direction…still we need to feel.

 » At one point, the robot is shot in the arm. The child asks him if he is in pain. The robot answers: « What is pain? The child can only answer him this: to have pain is to have pain, it is to feel a pain, it is to feel having a pain, in other words, to feel is to feel. « (15)

The answer comes from our bodies

 » The future progress of cognitive science seems to imply ever-increasing efforts to anchor our research in the real world of sensation and action. From this anchoring, time, the world and the body emerge as significant actors in the field of cognition. How could we forget them? « (16)

If paradoxically, in the medical world, it is the advance of neurosciences which demonstrates the mesh, the network, the space-time complexity, the beyond of all dualistic antinomies of The Being-in-the-world, this one is impoverished, lost and all powerful at the same time in its techno-scientific world, folded up in its culturo-cartesian and positivist imprints, always as « Master and possessor of the nature ». This is what can make us understand this ambiguous feeling that we have today…

 » Confusingly, we all feel — and this is undoubtedly the origin of the psychological suffering that overwhelms us — that the world that is taking shape and whose advent the virus accelerates is the very opposite of life. For life is fundamentally in the unrestrained, in the carnal presence to the world and to the other. « (17)

However, it is precisely from experience and the particular, the pillars of a reflective judgment (18) from which we are getting further and further away.

In addition,  » Our medicine, although ultra-efficient, too often fails to support patients and their families. Becoming a doctor requires not only learning how the body works and the mechanisms of disease, but also learning about the experience of the sick and the art of healing. « (19)

But can one arrive at such a perspective when the soul is swept away in a few hours of theoretical courses by a vague introduction to psychosomatics in the best of cases?

Mind, psyche or emotion: an unthought of medical curricula?

 » You deplore our great collective « psychic immaturity ». What do you mean by that?  » The population knows very little about the human psyche. It is as if we had put all our engineering into rationalism and logic, forgetting the part of intelligence that structures our psyche. However, it must also be educated and studied… in the same way as mathematics. The major psychological forces are very poorly known by the population. But how can we control what we don’t know? When we see the human psyche as a non-subject, we disarm ourselves. (…) I seriously wonder if we shouldn’t dedicate a course to it in school. There are, in fact, structural psychic laws that deserve to be better known, better understood. We would all benefit from a competent and rigorous entry into these subjects. It would obviously not be a question of interfering in the intimacy of each person, but of teaching the young generations what the great invariants of the human psyche are. Producing different societies also involves this. « (20)

In this way, Cynthia Fleury agrees with what Henri Laborit said in the 1960s in the preface to his book « In Praise of Escape »: « We have to be careful not to overdo it. I regret to have to provide this caricature of central nervous functioning. As this functioning is the basis of all our judgments, of all our actions, it is necessary to recall it. (…) But as long as the progressive knowledge that concerns it and that we have of it will not be part of the fundamental knowledge of all men, in the same way as the language of which it is the source (whereas this one expresses especially our unconscious under the logical speech), we will not be able to do much. Everything will always be drowned in emotional verbalism. « (21)

We join Cynthia Fleury in this urgency, however we consider it under the angle of an epistemology centered on the action(22), in immediate proximity with the experience (of the Subject) and the particular (professional and life contexts), avoiding the historical error denounced by J. Benoist of being exclusively on the side of the concept in rupture with the action. This is how we speak of emotional skills in relation to the field of emotional psychology.

The question of knowing if emotions optimize or hinder our functioning, that is to say if they are adaptive or if, on the contrary, they participate in a psychological disorder, finds an answer, on a pedagogical level, thanks to this notion of emotional competence which reconciles precisely these two points of view (23) .

With this crisis, it seems more important than ever to consider emotions in health training curricula, especially when considering the place of emotions in decision-making.

Indeed, the role of emotions in the ability to decide has been emerging in the scientific literature for several years now, following the pioneering work of Damasio, notably in his book « Descartes’ Error ». He demonstrates the links between decisions, perceptions and emotions, thus promoting, in the field of management, the development of more integrative models of decision-making practices. Their transfer to the care professions and to the medical world in general appears to be more and more a crucial issue for the quality of care and health services. Indeed, health professionals, at different organizational levels, are all concerned by the need to judge the evolution of situations and the duty to decide on a managerial or collective management level with the care team. For each care or management situation at the level of a patient, a family, a community or a nation, the health professional is led, in his practice(24)Whether it is the most daily or the most exceptional, to decide.

We can also report a positive correlation among health professionals between emotional intelligence and job satisfaction; empathy; ability to work collaboratively; organizational commitment; burn-out…(25)

Emotional intelligence, through the introduction of emotional competencies in professional development, would allow toanticipate, prevent andengage more adequately in order to experience favorable outcomes in many health situations where the place of empathy and/or teamwork appears crucial.

It is also from a work on our emotions that it is possible to progressively facilitate a change of attitude in order to avoid discriminatory behaviors carried by our prejudices (always under tended by our values considered, by each, as only truth), so present in the medical world (26) .

When they are not taken into account, it is also these emotions that cancel out any effectiveness in interprofessional training, when we know that the issue at stake is based on power relations whose existence is denied (27) .

Finally, it is these same emotions which, when not identified and judiciously interpreted, can paradoxically plunge us into a dreadful blindness as to our underlying errors of judgment which they have nevertheless come to reveal. The trap of certainty is closing. Cognitive conflict is no longer possible and, as a result, the possibility of learning.

The cognitive conflict being this moment of confrontation with our previous knowledge, in the sense of a doubt, an uncertainty . The real possibility of questioning our knowledge, in order to make it evolve, will depend, on the one hand, on our own emotional capacities to face such cognitive destabilization. On the other hand, emotional security linked to the environment.

This is all the more difficult in contexts where Cartesian, dual thinking is at work, as is most often the case in the Western medical world for which it is the frame of reference. And this is reinforced by the common attitude historically and culturally constructed of the posture of the doctor which is that of the scientist, that is to say the one who knows, a « knowing ». This position is most often shared by the whole of the « nursing profession », which is too exclusively formatted in a single hegemonic paradigm of knowledge, that of science and a positivist epistemology, seeking as the only key to action, the hypothetical assurance of certainty of scientific knowledge and validated protocols alone.

A destabilization of a form of omnipotence can generate very strong emotions and a radical rejection — or an impossibility by incompetence or blindness — of any possibility of doubting and acting in a situation of uncertainty. However, if we systematically lack awareness of our mistakes (blind spots, incompetence), which is a prerequisite for new learning and changes in professional practices, erroneous anchors will build up over time.

Further downstream and from our perspective of action, it is not only a question of considering the psychoaffective dimension but also the sensory and perceptive dimension, which is reflected in numerous advances in neuroscience (hypnotherapy; chronic pain management; neuroplasticity; chronic pathology etc.). (28) .

Thus, the feeling that the child questions to the robot participates in one of the dimensions of our capacity to act, that of touch and perception, to which more and more works testify, notably in the field of education. So why not? Cézanne, by painting the Sainte Victoire mountain nearly 80 times, helps us to open the doors of perception, and, from there, of emotion, allowing an ontological opening of the Being-in-the-world. Thus one could read in his conversations:

 » It is necessary, without losing anything of myself, that I join this instinct (the instinct of the peasants), and that these colors in the scattered fields are significant to me of an idea as for them of a harvest. They feel spontaneously, in front of a yellow, the gesture of the harvest which it is necessary to begin, as I should, me, in front of the same ripening nuance, to know by instinct to pose on my fabric the corresponding tone and which would make undulate a square of corn. From touch to touch the land would come alive again. By ploughing my field, a beautiful landscape would grow there (…). « (29)

In the absence of emotional intelligence, the emotions, those of fear and of our security needs, prevent us from facing our responsibility in decisions where uncertainty is the rule, by enjoining us to always focus on the only determining judgment (30) .

A necessary paradigm shift in medical education

This one would be based on a Reason which does not oppose any more two brains, that of the cognition and the emotion, and two parts, that of the body and the spirit, like a crucifixion which does not say its name.

The affective sciences remind us:  » Born in the 1960s, cognitive sciences first focused on what was called « cold cognition »: reasoning, knowledge acquisition, language, perception. In short, everything that is not related to the self, and therefore without emotional stakes. However, the real objective of cognitive science is to account for everything that happens in the mind. They quickly understood that they were missing a fundamental aspect: the « hot cognition », including the study of consciousness and emotions. This opposition between these two cognitions is simplistic, because there is an intertwining between the two. Nevertheless, it gives a good approximation of the history of cognitive science.(31)

The management, through fear, of fear in the face of uncertainty(32)This is a reminder that it was useless and costly to extirpate emotion from reason, the feminine from the masculine, at the risk of a « return of the repressed » whose abysses we do not control in general! These — feminine-masculine — are not understood as a gender duality but, on the contrary, as a joint presence in each human being.(33)

More fundamentally, such an opening, which participates in an exit from the conceptual dualism emotion — cognition, becomes, according to our perspective developed in a leading article (34) a condition of possibility to a liberation.

This necessarily begins with self-government (35) and is opposed to the « Socratic cure (36) The exit from crucifixion must be total.

Reliance or new frontiers?

Continuing on the path of binarizations, rather than on that of connections and integration, will remain, with the President of the French Republic, to treat death as an enemy and to declare war on it.  » If his assertion can be qualified as extraordinary, it is because, probably for the first time in the history of humanity, a State declared nothing less than a war against death; the President affirmed it, it would not pass through us. « (37)

If we do not manage to reconcile uncertainty with certainty, the chaos of Life with the very question of finitude, the only certainty, we are led to progressively reject it by (re-)erecting new borders between the dead and the living…

Marie de Hennezel, a psychologist specializing in the end of life, says:  » Our scientific experts and our governments have made a mistake. They underestimated the importance of the immemorial rites that connect the living and the dead. They despaired of the dying by stealing their death. They have weakened the living by robbing them of an essential moment of their lives.  » (38)

Notes et références
  1. Ces cartes blanches sont rédigées dans le contexte d’une analyse critique, transdisciplinaire et interprofessionnelle au croisement de regards médicaux, de santé publique, pédagogiques et philosophiques de la crise sanitaire que nous vivons actuellement. Elles ont comme objectif, d’ouvrir à des débats nécessaires (sans les approfondir), en proximité immédiate avec le champ de l’éducation et de la formation médicale.
  2. Van der Auwera E. Exposition Be Modern. Bruxelles : Musées royaux des Beaux-Arts de Belgique, 2021.
  3. Mafalda est un personnage de BD, une petite fille créée en Argentine par Quino dans les années 70, célèbre pour ses réflexions sur le monde et sur les gens. Quino. Mafalda — Intégrale. Grenoble : Editions Glénat, 2018
  4. Schoendorff P. Covid 19. On assiste à une déstabilisation complète de tous les troubles psychiatriques (Entretien avec L. Valdiguié). Le Point, 13 janvier 2021. Disponible sur : https://www.marianne.net/societe/sante/covid-19-on-assiste-a-une-destabilisation-complete-de-tous-les-troubles-psychiatriques
  5. Péruchon M. La crise de la cinquantaine à l’aune du narcissisme. Champ psychosomatique 2008;49:37–56
  6. C’est la façon dont nous construisons nos connaissances.
  7. Pelluchon C. Ethique de la considération. Paris : Seuil, 2018
  8. Damasio AR. L’erreur de Descartes. Paris : Odile Jacob, 2006
  9. Damasio. AR. L’Autre Moi-Même. Les nouvelles cartes du cerveau, de la conscience et des émotions (trad. J‑L. Fidel). Paris : Odile Jacob, 2012
  10. Benoist J. Concepts. Une introduction à la philosophie. Paris : Flammarion — Champs Essais, 2013
  11. Dans le sens où nos connaissances, et nos corps plus globalement, ont subi un formatage en profondeur.
  12. Descartes avait attribué à la nature humaine deux substances : la res cogitans, la substance pensante, et la res extensa, la substance corporelle. Selon ce penseur français, celles-ci sont non seulement séparées mais elles s’excluent, au profit de la prééminence de la conscience. C’est un tel postulat qui est au fondement de la polémique entre le rationalisme cartésien (doctrine de Descartes et de ses successeurs selon laquelle la raison prime sur l’expérience sensible, car elle est la seule faculté capable d’accéder à la connaissance vraie en partant de certaines idées innées) et l’empirisme (courant philosophique qui limite l’origine de la connaissance à l’expérience sensible). Le rationalisme cartésien constitue le socle des logiques scientistes. Nous avons abordé ce débat dans la carte blanche intitulée : « le rôle de la formation des médecins et de l’épistémologie médicale dans la crise de la Covid 19 ».
  13. Pelluchon C. Les critiques adressées à la philosophie des Lumières peuvent nous aider à compléter son projet inachevé (Entretien avec T. Sardier). Libération, 8 janvier 2021. Disponible sur : https://www.liberation.fr/debats/2021/01/08/corine-pelluchon-les-critiques-adressees-a-la-philosophie-des-lumieres-peuvent-nous-aider-a-complete_1810715/
  14. « Certaines personnes connurent des agonies que l’on croyait réservées aux temps de guerre. Pour les vieux, ceux qui précisément n’étaient pas hospitalisés, nulle chambre d’hôtel où être isolé, nul afflux d’infirmières ou de médecins, nul retour provisoire possible chez les enfants quand ceux-ci en faisaient la demande mais des morts de faim, des morts de soif, des morts de douleur, des morts de solitude : soit que l’on redouta de s’approcher sans protection, soit que de médecins, de respirateurs et de morphine, il n’y avait pas. Un virus pourtant pas si létal interdit, au nom de cette séparation entre la mort et la vie, d’étreindre une dernière fois ; la mort en forme d’épouvante justifiant l’abandon pur et simple. La guerre pour la vie, revers de la guerre contre la mort, a un prix. » Hass C. Observations sur la fin de la mort par temps de pandémie. AOC media, 9 septembre 2020. Disponible sur : https://aoc.media/analyse/2020/09/08/observations-sur-la-fin-de-la-mort-par-temps-de-pandemie/
  15. Gély R. La genèse du sentir. Essai sur Merleau-Ponty. Bruxelles : Éditions Ousia, 2000.
  16. Clark A. Moving minds : situating content in the service of real-time success. Philosophical Perspectives 1995;9:89–104
  17. Polony N. Jacques Puisais ou l’art d’être humain. Marianne, 10 décembre 2020. Disponible sur : https://www.marianne.net/agora/les-signatures-de-marianne/jacques-puisais-ou-lart-detre-humain
  18. Concept que nous avons défini dans les cartes blanches précédentes : Le jugement réfléchissant est énoncé sans disposer de catégories universelles contrairement au jugement déterminant. C’est la situation particulière qui fait émerger une loi, ou ce que Cornélius Castoriadis nomme la concrétude particulière. Par exemple, le choix d’hospitaliser ou non un patient avec le risque que cela engage, ou encore celui de confiner une population dans un contexte épidémique ou de mettre une personne en quarantaine. Le jugement déterminant est énoncé en disposant de catégories ou de concepts universels, ayant valeur de certitude. Le jugement déterminant ne tient quasi pas compte du particulier (contexte) ou du singulier (personne). Le degré de subjectivité dans la décision s’avère pour ainsi dire négligeable puisqu’on se fie à des lois générales fondées prioritairement sur des chiffres, des calculs et des statistiques, en proximité avec les principes des mathématiques cartésiennes (analyse de données d’études scientifiques, mais aussi projections sur des modélisations mathématiques, démarche ultime dans l’abstraction).
  19. Lefève C. Devenir médecin. Cinéma, formation et soin, Paris : Presses Universitaires de France, 2012.
  20. Fleury C. Le ressentiment contemporain menace la démocratie (Entretien avec M. Boëton). La Croix, 23 novembre 2020. Disponible sur : https://www.la-croix.com/Debats/Cynthia-Fleury-Le-ressentiment-contemporain-menace-democratie-2020–11-23–1201126115
  21. Laborit H. Eloge de la fuite. Paris : Gallimard –Folio Essais, 1985.
  22. Florence P, De Ketele J‑M, Gooset F, Reynaerts M. Taxonomie de l’approche par compétences intégrée au regard de la complexité. Contribution critique à la santé publique., Tréma 2020 ;54. Disponible sur : https://doi.org/10.4000/trema.5907
  23. Parent F, Jouquan J, Kerkhove L, Jaffrelot M, De Ketele J‑M. Intégration du concept d’intelligence émotionnelle à la logique de l’approche pédagogique par compétences dans les curriculums de formation en santé. Pédagogie Médicale 2012;13:183–201 ; Parent F, Jouquan J. Outiller le futur professionnel de la santé en compétences émotionnelles : une perspective éducationnelle pour prendre en compte la vulnérabilité. In : Collectif. Pouvoir et vulnérabilité, amis ou ennemis? Neufchateau : Weyrich, 2014:61–78 ; Mikolajczak M, Bausseron E. Les compétences émotionnelles chez l’adulte. In : Luminet O. (Dir.). Psychologie des émotions : Nouvelles perspectives pour la cognition, la personnalité et la santé. Bruxelles : De Boeck, 2013:129–174 ; Parent F, Jouquan J. Développement personnel continu : Dictionnaire de responsabilité sociale en santé, Cauli M, Boelen C, Ladner J, Millette B, Pestiaux D (Sous la direction de). Mont-Saint-Aignan Presses Universitaires du Rouen et du Havre, 2019:170–175.
  24. Parent F, Jouquan J. Pratique professionnelle. In : Dictionnaire de responsabilité sociale en santé, Cauli M, Boelen C, Ladner J, Millette B, Pestiaux D (Sous la direction de). Mont-Saint-Aignan Presses Universitaires du Rouen et du Havre, 2019:415–418.
  25. À cet égard nous introduisons une ouverture à la part managériale de cette problématique du burn-out très bien documentée dans l’ouvrage de Pascal Chabot (Global Burn-out). L’auteur nous invite à reprendre la notion de burn-out depuis H. Freudenberger jusqu’à sa généralisation actuelle. À l’origine le terme indiquait l’état d’un toxicomane « vaincu par l’usage trop intense de drogues dures ». H. Freudenberger a étendu ce terme à son propre état, puis aux soignants qui « étaient comme ravagés par des forces qu’il faut bien appeler « toxiques » pour respecter l’analogie inaugurale. C. Maslach, quelques années plus tard, décrira les trois dimensions composant le burn-out : l’épuisement émotionnel, la dépersonnalisation et le sentiment d’inefficacité. Elle insiste également sur la dimension sociale du phénomène, il ne s’agit pas d’une pathologie relevant uniquement de la responsabilité de l’individu car la charge de travail, la pénibilité… interviennent dans l’émergence du burn-out. Cet ouvrage a inspiré le film « Burning out. Dans le ventre de l’hôpital », de Jérôme Le Maire. 2016.
  26. Parent F. Du stéréotype à la discrimination, pourquoi sautons-nous le pas ? Pédagogie médicale. 2020 ;21: 107–9.
  27. Parent F, Jouquan J, Azzi A. L’éclairage des théories du conflit intergroupes pour penser et mettre en oeuvre l’interprofessionnalité en santé. In Parent F & Jouquan J. Penser la formation des professionnels de santé. Une perspective intégrative. Bruxelles : De Boeck, 2013 :169–174 ; Olson RE. How would an egalitarian health care system operate? Power and conflict in interprofessional education. Medical Education 2015;49:353‑354.
  28. Et notamment, celles d’A. Berthoz, associé avec le philosophe et phénoménologue J‑L Petit, lorsque d’une commune voix, ils pensent ce nouveau paradigme de l’agir, qui veut qu’« on attribue à l’environnement naturel des propriétés du corps animé, vivant, parce que en même temps on les perçoit selon un ensemble de régularités propres au corps agissant que nous sommes.» Berthoz A & Petit J‑L. Phénoménologie et physiologie de l’action. Paris : Odile Jacob, 2006.
  29. Doran M (sous la direction de). Conversation avec Cézanne. Paris : Macula, 1978, p. 123.
  30. Cf. définition dans une note de bas de page précédente.
  31. Andler D. Naissance et essor des sciences affectives. La Recherche, avril 2018.
  32. Celle-ci étant attendue, légitime en quelque sorte car notre mode mental automatique dans lequel nous sommes tous par défaut, déteste l’incertitude.
  33. « À partir du déchiffrement symbolique de l’hébreu, on peut entendre ceci : lorsque l’Adam (l’être humain) est créé, il est différencié de son intériorité, que nous appelons aujourd’hui l’inconscient, et cet inconscient est appelé Ishah, en hébreu. Nous avons fait de Ishah la femme biologique d’Adam, qui, lui, serait l’homme biologique. Dans ma lecture, il s’agit du « féminin intérieur » à tout être humain, qui n’a rien à voir avec la femme biologique. Il s’agit de l’être humain qui découvre l’autre côté (et non la côte) de lui-même, sa part inconsciente, qui est un potentiel infini d’énergies appelées « énergies animales ». Elles sont en chacun de nous. » Kempf J (Entretien avec A. de Souzenelle). L’écologie extérieure est inséparable de l’écologie intérieure. Reporterre. Le quotidien de l’écologie, 26 Juillet 2019. Disponible sur : https://reporterre.net/L‑ecologie-exterieure-est-inseparable-de-l-ecologie-interieure
  34. Florence P, De Ketele J‑M, Gooset F, Reynaerts M. , op. cit.
  35. Fleury C. Ci-gît l’amer. Paris : Gallimard, 2020.
  36. La cure socratique est la suppression du monde sensible au profit du monde intelligible, celui de Platon. C’est une forme de castration thérapeutique (pour éviter les déchirements intérieurs) dont l’objectif est de gérer de façon radicale l’anarchie des instincts et des pulsions que représente la pluralité des forces en nous. Ces forces étant de natures opposées elles s’entrechoquent violemment. Il y a d’une part les forces actives, celles de l’artiste, de l’intuition et de notre monde sensible toujours multiple, ce sont des forces qui ont besoin de se déployer dans l’univers sans s’opposer à d’autres forces, elles s’affirment en tant que volonté de Vie. De l’autre, il y a les forces réactives, celles de l’argumentation, de la raison rationnelle et de notre monde intelligible, c’est-à-dire celui du concept et de l’universel ou de l’idéal théorique. C’est à Nietzsche que l’on doit cette notion de « cure socratique » qui a comme conséquence, une fois le monde sensible éliminé, écarté, refoulé, la haine de la terre au profit du ciel, le rejet du corps au profit des idées claires et la possibilité de l’émergence de formes de culpabilisation et de ressentiment propres aux mondes duels. À cet égard, la crise sanitaire de la Covid en 2020 a exemplifié de telles dérives (par exemple) quand les populations adolescentes et jeunes ont été présentées, médias à grande audience à l’appui (spots de santé publique, reportages télévisés, interview…), comme étant les fautives de la transmission à leurs ainés. La perspective étant que face à l’anarchie des sentiments, la seule issue est de se réfugier dans le monde intelligible. Pour Nietzsche, Socrate ou Platon…c’est le prototype du philosophe médecin.
  37. Hass C. Observations … op. cit.
  38. de Hennezel M. L’adieu interdit. Paris : Plon, 2020
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