Julian Assange
618 weeks of deprivation of liberty for telling the truth
618 weeks of deprivation of liberty for telling the truth
This text extends the debate on medical and health care decision making that was initiated around Evidence-based-medicine (EBM) with the white paper 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! « . Still on our epistemological thread, we then turned to the issue of emotions in medical education: » Covid crisis and emotional intelligence: the missing link ». The fifth carte blanche entitled : » Of the vegetative soul in times of Covid allowed to anchor this psychological dimension in our bodies, breaking with all forms of idealism.
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).
» I will dance .
Because I’m angry and desperate, to no end. I’m going to dance because this whole mess is leading me to economic death, because I’m afraid for my freedoms and because it’s the only way I have not to die in the face of the absurd. I’m going to dance for French excellence, which won’t happen by itself. I will dance so that people can see me, hear me, the unrecognized child that I am.
Katia Benbelkacem(2)
It is undoubtedly from a loss, « on the way to modernity », of our sensitive ( White card 4 ) and vegetative souls ( White card 5 ) from which we suffer the most today, decision-makers, doctors, actors and populations, in this historic health crisis.
And this is because they are our capacities sensory and emotional abilitieswhich nourish the capacity — or faculty — to imagine, allowing this creative imagination, in movement, which it is a question with Isabelle Stengers(3) to differentiate from the » The « lack of imagination » of our governments, doctors and experts whose decisions are based on a static and univocal imagination: » Because you have to make a difference. The idealism of our leaders and of so many others is an imaginary one. This is their horizon, this is their reality. The imaginary which makes reality. Imagination is being able to foresee difficulties, to anticipate, to know that what is normal today could suddenly change…, and to think it seriously, …could suddenly not be normal tomorrow. So the imagination is an anesthesia of the imagination and that’s what we suffer from. »
The problem is not the imaginary in itself, but the impossibility of setting oneself in motion and imagining other possible worlds, other imaginaries. Thinking one’s own world as the real world, without understanding that it is an imaginary one — that is to say, a subjective interpretation of it — does not allow for adaptation to the context, which is what the concept of imagination refers to above, more closely related to the verb of action — « to imagine » — thus manifesting the movement of thought.
We join the point of view of this scientist and philosopher of sciences who calls such decision-makers « idealists ». Isabelle Stengers specifies that, in the face of threat and panic, these show a collapse of the state’s thinking through an attitude of paralysis, which we interpret as a symptom of a lack of emotion. It is important to remember the Latin etymology « movere » which means precisely to shake, to set in motion. Now: » We don’t know what to do anymore, we stop everything « . This also implies forgetting all the most vulnerable groups, the elderly, workers in all contact occupations, catering, art, hospitalized people deprived of visits, people who have to be operated on and whose intervention is postponed sine die etc., but also the black market worker who, even if he objects that the State cannot help him, exists ! Except to create a totalitarian imaginary, which excludes it from reality.
» Over the past year, while containment is by definition a temporary measure, it has become one of the main policies to flatten the curves. On this subject, Jean-Loup Bonnamy, interviewed by Eddy Caekelberghs, criticizes an overly emotional management and wonders how such developed societies come to use this medieval method. « (4) This « too emotional » refers in fact to an emotional dysfunction — or emotional immaturity — due to a lack of emotional intelligence or emotional incompetence (we have developed this dimension of knowledge in the carte blanche 4 as well as the drift in the use of the precautionary principle, notably with the containment, in the carte blanche 2 ).
Faced with the absence of imagination, the formal, the norm and the rule impose themselves on the « destitute man ».
» On what we can’t talk about, we must remain silent ».(5) and the silence was made in a masterly way, abyssal, like a chasm of solitude in which the borders erected and inherited in the folds and folds of our mnemonic traces and our cerebral convolutions maintain our identities safe from the chaos, inherited belief, culturally anchored.
And yet chaos is particularly acute in the medical world, as the certainty forged over decades of a positivist epistemological meta paradigm ( carte blanche 1 ) has favored the closure of — or at least dried up the doors — of creativity, of other imaginaries, of the doubt necessary to numerous forms of ethics and thus of praxis.
Let’s get out of the silence and dare to open the Pandora’s box! This is all the more true since the progress of neurosciences comes, paradoxically, to support us in such an effort.
Once again, it is a question of epistemology(6). Indeed, it is not only essential to understand the « positivist imaginary » as one of the possible imaginaries, but it is also important, more fundamentally, to question the fact that: The imaginary part of the human being is undoubtedly too much hidden or, at least, not valued as a learning and development objective in the training programs, even though the whole of our societies and our human relationships are based on such individual and collective capacities, often unconscious. For example, all religions are part of a network of symbolic images, organized in myths and rituals. According to Edgar Morin, » the imaginary cannot be dissociated from the « human nature » — from the material man. It is an integral and vital part of it. It contributes to his practical training. It constitutes a real scaffolding of projections-identifications, from which, at the same time as he masks himself, the man knows himself and builds himself. Man does not exist totally, but this half-existence is his existence. The imaginary man and the practical man (homo faber), are the two faces of the same « being of need » according to the expression of Dionys Mascolo. « Neuroscience now also places great emphasis on the role of the imagination in learning, suggesting that imagination is a process of making images in connection with an object of thought. « (7)
« The next day the little prince returned.
— It would have been better to come back at the same time, said the fox. If you come, for example, at four o’clock in the afternoon, from three o’clock I will start to be happy. The more the hour advances, the happier I will feel. At four o’clock, I will already be restless and worried; I will discover the price of happiness! But if you come at any time, I will never know what time to dress my heart… We need rituals.
— What is a rite? said the little prince.
— It’s also something that’s been forgotten, » said the fox. This is what makes a day different from other days, an hour from other hours. There is a ritual, for example, among my hunters. They dance on Thursdays with the village girls. So Thursday is a wonderful day! I’m going to walk to the vineyard. If the hunters danced any time, the days would all be the same, and I would have no vacation.
Thus the little prince tamed the fox. »(8)
Why and how should we encourage, in the field of health, for patients as well as for professionals, the ability to create images, to listen to one’s dreams, to develop times conducive to escape and creation.
For the risk is great, as Stendhal reminds us: « Any feeling that one no longer experiences is a feeling whose existence one does not admit. « (9) Is it indeed a matter of a health professional, as has long been said of emotions, » leaving his imagination and beliefs at the door of the hospital « , on the grounds that these dimensions, prejudged as very personal, would not have a place there? That they should be considered only as counter-productive dysfunctions, or at least useless in medical practice and decision making, is contradicted by the most current research in the fields of emotional psychology and neuroscience. Art therapy, for example, tells us about it(10).
» We are abandoned∙es. It’s hard because we feel like less than nothing, like we artists are not important∙es. « (11)
» It was a cry from the heart, a real call for help that 180 actor∙ices, dancer∙ses, singer∙ses and circus∙nes launched on Saturday afternoon. These Montpellier∙es artists have come together∙es in a collective with an evocative name: Les Essentiels. Their essentiality is what they have been denied since the beginning of the health crisis. Gathered∙es on the Charles-de Gaulle esplanade, they protest against the postponement of the opening of cultural venues, although announced on December 15. They will have to wait, at best, until early January. And what better way to protest than to do what they do best? What better way than to do what containment and health guidelines have prevented them from doing for several weeks? On their black clothes, only one element stands out. A red clown nose, symbol of the image they seem to have in the eyes of the government. Or the one they have of the Minister of Culture. « (12)
Gauguin’s painting, »The Self-Portrait with the Yellow Christ » (1889), testifies through a crucifixion and a mask close to an image of muscularity, to this profound incomprehension of the experience of the artist, always singular, which such [l’expérience de] Romeo and Juliet, should live forever « the solitude of the excess of the particular », rejected far from what makes the norm wanting to be structure, Institution, based first, and more and more exclusively with this crisis, on theuniversal as opposed to the particular.
Can the « deprived man » see that it is precisely there, with the particular, his Salvation!
As John Dewey, philosopher and pedagogue, points out in his book « Art as Experience »: » It is the aesthetic experience that allows the philosopher to understand what experience is. « . The philosopher being seen here as the rational man, which includes the scientist.
It is from such a consideration than a leading article, to which we invite the curious reader to refer(13)develops a renewed epistemological perspective of medical studies, focused primarily on (particular) experience, — and not (universal) knowledge — and on an aesthetic, artistic, emotional and sensitive opening of this same experience.
Indeed, as we have already pointed out in various ways in our previous white cards, medical practice is first and foremost a singular conversation between a doctor and his patient in a specific context, by recognizing the particularity of the experience. That’s kind of what manifest (in the real sense of Toshow a divergent opinion, even dissident in the context of the crisis which concerns us) some initiatives such as the collective initiated by Violaine Guérin, endocrinologist and gynecologist, founder of the movement » Let the doctors prescribe » (analysis developed in the card white card 3 ).
This practice is based on the state of science and technology at a given time. However, technoscience cannot take the place of praxis, of the caregiving experience or of living with illness, at the risk of a relationship that is inverted and can become hegemonic. It is that of knowledge and technologies on practice (the anchored, bodily and situated experience of the encounter between two people, a practitioner and a patient), annihilating the very notion of person (the Other and the caregiver self) and/or reifying it (them) into « technical knowledge ». The reification will be, on the one hand, for the doctor or any caregiver, the positioning as « knowing », merging with the only knowledge, or even with the technology in the sense of a purely technical logo (protocol, algorithm, proof and probability). On the other hand, it will appear, for the patient, under the features of a diagnostic identity, a disease, a nosographic category, a new procedure, a new vaccine, tipping everything, in an unbalanced way, towards a single place: the universal of technoscience.
Normativity (norms) and formalism (formal logic) easily follow this qualitative step towards a quantitative and categorical shift, without even being aware of the process of elimination of the qualitative and appreciative dimensions at work, as revealed by Roland Gori (15). This is all the more real as the medical world evolves in a culture of results and productivist performance, whose competitive logic ‑of rivalry- begins as early as the « first year », to quote Thomas Lilti’s very accurate film(16), or even in the preparatory class(17). With Albert Jacquard (18) we can worry, in relation to our current problematic, that of the crisis management of the Covid, about the capacities to move the lines when the actors of such an environment are on the side of the repetition, stake of the science, rather than of the diversity — and the particular — stake of the person. Speaking of his experience as a student in polytechnic and as a first-year medical teacher, the French scientist and essayist wonders: » What does it mean to be the best? it is an act of submission, it is proof of conformity and currently the principle of the grandes écoles only selects the most conformist. However, we are entering a world that is going to renew itself and the more conformist we are, the more dangerous we are. Therefore, we are selecting the most dangerous people, those who are not capable of imagination « .(19)
It is necessary to note with Erwin Goffman that » Social life is a theater, but a particularly dangerous one. By not showing the deference required by his role, by behaving badly, by detaching himself too much from the other actors, the actor, here, runs great risks. First of all, the risk of losing face and perhaps even freedom: psychiatric hospitals are there to receive those who deviate from the text. It happens that the play takes on the appearance of a drama full of fatality and action, where the actor-acrobat — sportsman, flamboyant or criminal - must and we owe it to ourselves to work without a net. And the spectators applaud, then return to their daily comedies, satisfied to have seen embodied for a moment, resplendent in its rarity, the moral always saved which supports them. « (20)
It appears today a form of urgency to encourage other spatio-temporal appointments of connection between our ‘old’ worlds, sensitive and intelligible, and to plunge into the complexity of our actions, or of the potential of our actions, with arms or with a heart lost. Because in front of the fear of the robot, it is especially of the fear of the human capacity to mimic the robot — capacity of mimesis — of which it would be necessary, on a metaphysical or ontological level, to account.
From there, the necessity of the aesthetics and the poetics(21) to break the dualisms and better open, with an enlarged circularity, the borders of our thoughts and our capacities to think. And this, in order to help us to break our psycho-cultural conditioning and to lead us towards a new shore, all dazed and witnesses of a renewed poiësis(22), since also :
» What most expressively characterizes the man whose training is already developed is the intelligence of the gaze, and the mouth that depicts the most intimate impulses of the heart. »
Johann Gottlieb Fichte
Because, if the aesthetics contains the ethical word it does not guarantee this one without the installation of forms of reflexivity and subjectivation. To work these links between aesthetics and ethics by the means of the connections to imagine and create, between poetics and poiësis, between aesthetics and creation, in the « To make » of the everyday life can be source of utopia. This utopia is to be sought in our most daily professional practices, those that the city asks us to « do »: « do-care »; « do-right »; « do-housing »; « do-eating »; « do-education »; « do-citizen »; etc.
However, this sentence « And all the rest is literature », which concluded a poem of Verlaine, used as a synonym of « the rest has only little importance ».(23)This is particularly important in the training of « service professions », such as nurses, lawyers, architects, engineers and, more specifically, doctors.
To link our Action (in health), our praxis, ‑daily professional practice‑, specific to our professions beyond the functionalities that a reductive scientific materialism will propose to us, isn’t that the proper role of Art and Aesthetics, allowing all Action to become a reflection of a poiësis, of a « Global Doing », of a singular creation continuously renewed, the only guarantee of an ethical perspective necessarily situated, contextual and, always particular. In this sensethe universal is reached.
However, if fear is much more contagious than Covid as underlined by Marie- Estelle Dupont (24), is that the challenge of the crisis that concerns us is to face, with competence, the overflow of uncertainty and the emotions that crash into it. And only the integration of the particular, a condition of « individuation » (cf. carte blanche 7)(25), will allow an emancipating exit from the crisis and not a reduction to our individualities, atomized and universalized.
If » the decadence of a society begins when man asks himself ‘what will happen’ instead of asking himself ‘what can I do’ « (26), we opt, radically through these white cards, to put ourselves in motion on the side of « doing ». But not just any one, the one (re)linking our « beings-of-nature » as much as our « beings-of-culture », allowing us to understand the nuances to be specified in this sentence by Xavier de Lignerolles: » If we take away from our children the possibility to get closer to art, poetry, beauty, in one word to culture, we are destined to a future of superficial and dangerous people. « (27)
Because the culture, also, needs as much of our vegetative, sensitive, emotional, intelligible souls(28) to avoid to Bach to resound again in the camps of confinement. We know that the Art can become the supreme tool of propaganda of a totalitarian regime, we also know how much are complex and deleterious, in the artistic environment, the epistemological fractures between the Artist, the Craftsman and the Art historian. Nevertheless, we understand the importance of what Xavier de Lignerolles is showing while museums, cinemas, workshops, theaters, operas are closed.
We conclude by giving the floor to a painter, Bruno Edan :
» This sums up what drives me to paint fear and anxiety are the impulses that drive me to paint, and by painting, to escape because there is no other place for me in our society. Blacks were great musicians because they were denied the honorable places reserved for whites, they lived in a world so much more frustrating that their blues were full of disenchantment. My painting is full of bitterness, and reflects a great disenchantment because like the blacks I was very humiliated until they made me feel that it would be better to hide until they made me feel that in relation to a norm I am not in the loop of behavior and spirit, I always felt too much elsewhere than in my painting, the fact of being excluded from many things pushes you to flee like a wandering Jew from your own environment, especially if it is the reflection of what life lets augur of very pale and superficial, to have the impression to exist it is necessary to have sometimes the courage to flee from one’s own, to not depend on them any more like a beautiful animal because they do not try to understand you, they only want to reassure their conscience » (Diary 1978–1979).(29)
But you still have to want to understand… and for that you have tobe connected to your emotions and therefore, as every cinema ticket invites you to do(30), you have to » cultivate your emotions « , but the theaters are closed…(31)
And Nietzsche then resumes: » Descartes was superficial(32) » while Beatrice Commengé gives us the opportunity to conclude, really this time, by opening to « Nietzsche’s dance ».
» Yes, he said it, it is the foot that must react to the music and not the mind. Let us flee the « languid complaints » of Parsifal, its « penitential fury »; let us flee The Master Singers, this music which « has no beauty, no South, nothing of the subtle clarity of the southern sky, no grace, no dance ». The ancients understood it well: music must be « useful », it alone can bring us closer to the invisible universe of the gods and « unload the soul of its overflow » (whether it was fear, mania, pity, thirst for revenge). Didn’t Plato himself notice that mothers who want to put their babies to sleep sing them a lullaby (« melodian ») while rocking them in their arms? He even specifies: « They enchant their babies as one would enchant frenetic bacchants, by the combined movement of dance and music. » Rhythm imbues the body with a movement that, through its repetition, draws the soul out of itself. It is also the rhythm that the verse must obey if it wants to touch the heart of the man. Poem, dance, music: a magical triad from which tragedy has emerged, whose purpose is not to tell us the adventures of the heroes, but to « prepare us for the emotion « . « (33)
