COVID 20
The Categorical Imperative: RELIANCE
A plea for an epistemological renewal of medical studies
Online book written & coordinated by
Florence PARENT and Fabienne GOOSET
THE CRUCIFIXION Ethel Coppieters
With the participation ofManoé REYNAERTS, Helyett WARDARVOIR, Isabelle FRANCOIS,Benoit NICOLAY, Emmanuelle CARLIER, Véronique BAUDOUX, Jean-Marie DE KETELE
KAIROSPRESSE edition. 2022
Henry Joly affirmed: « That Socrates was thethe last of the shamans and the first of the philosophersis now part of the truthsanthropologically accepted ». To addimmediately: « but this truth, which throws astrange light on the very appearance of thephilosophy, is not clear for all that, neither for thephilosophy, nor for epistemology.
Roustang, F, Le secret de Socrate pour changer la vie, Paris: OdileJacob, 2011.
Table of Contents
Authors
Co-signatories
Acknowledgements
Preface
Introduction
Reading, terminology clarifications and index
White Cards: On the epistemic thread of this crisis of the Covid 19
WHITE CARD 1: The Role of
of Physician Education and Medical Epistemology in the Covid Crisis 19
WHITE CARD 2: Covid 19: Precautionary Principle or « Risk of Blame »?WHITE CARD 3: Globality, partnership, autonomy in health. When the emergency sweeps everything away, but reveals the essential!WHITE CARD 4: Covid Crisis and Emotional Intelligence: The Missing LinkWHITE CARD 5: Of the vegetative soul in Covid weatherCARTE BLANCHE 6 : Dancing with the CovidWHITE CARD 7: Spirituality, individuation and medicine: the covidian Kairos
Discussion
Conclusion
Notes and bibliography
Authors
Author, Florence
I probably started writing this text at the beginning of the first confinement. Its movement was certainly initiated by my need to express artistically what was playing out, according to my emotional feeling, shared on an artist page on FB, throughout each of these days of blue sky solidarity and sunshine. The pen, through my keyboard, imposed itself on me, without my knowing it, in early December in the middle of the second confinement, it was colder and greyer. I was busy writing, with friends and writing colleagues, a practical guide on integrating emotional competencies into physician training, when a detour occurred to question the issue of uncertainty and emotions in medical decision-making. From writing a two-page column, this one grew into an article and finally, at some point, I had to stop writing and say: this text is in memory of those who made me cry and who led me to write, and I thank you for it, because from your departures more understanding appeared to me, which I have now shared. For it is urgent today, even more than yesterday, to get out of what I will call a « pedagogy of crucifixion »…
Florence Parent is a physician, a doctor of public health and author of books on pedagogy and engineering of professionalization in health organizations. Founding member of the ASBL « Are@Santé » (Association for the reinforcement of teaching and learning in health) and long time teacher at the School of Public Health (ULB) and international consultant, she is currently an independent expert and coordinator of a research group on the ethics of health curricula. As a lecturer at the Université libre de Bruxelles, she continues her teaching and research activities by maintaining as a founding principle, beyond all antinomies, a systemic perspective centered on connection. Also an artist, she maintains an essential relationship between art, aesthetics and ethics, which she sees above all as a complex process of individuation, empowerment, creativity and freedom.
Co-author, Fabienne
The first wave of the pandemic highlighted the sick bodies, anonymized by the prone position, connected to the machine to breathe, feed, live. Physical pain but also moral suffering. It is this last one that has challenged me the most because of its multiple faces: terror of contamination, cruelty of the absence of social relations, stopping artistic impulses, professional projects, cruel isolation of our elders in their retirement home, patients in services other than those dedicated to Covid.… Desperately long list which, by dint of repeating itself daily, has touched me in the deepest part until it erodes my life thread… Urgency to reassemble it, to restore what the management of this virus is eating away, in an endless loop like Penelope weaving her veil… Evidence of reflection and writing to tend to it, this book carries the trace…
Fabienne Gooset has a doctorate in literature and holds an inter-university certificate in the ethics of care. Through her thesis, she analyzed the relationship between literature and medicine as well as the more singular relationships between patient and caregiver. This approach has led her to different fields of research, including narrative medicine. She is the author of articles whose common denominator is the highlighting of the word of the suffering body.
Co-signatories
The experience and expertise of the author and the co-author have been extended to the different views and rereadings of a philosopher, a doctor, a psychologist, a physiotherapist, an expert in education and public health, allowing, in addition to specific contributions clarifying or opening, a multidisciplinary validation of a singular text, because unusual or ‘inactual’, against the direction of modernity, use in reference to Nietzsche.
Between the journalistic and medical investigation, the scientific and demonstrative article, the philosophical argument or the poetic, artistic and literary connection, there is no possibility for whoever wants to classify this original text, representative of a categorical mesh proper to a complex and emancipated thought. It is to be taken as it is given.
Co-signer, Isabelle
Sometimes the paths cross unexpectedly and they immediately meet almost without saying a word. It is then proposed simply to go on a journey together. A common and almost inescapable desire to reflect, to position oneself beyond heavy dichotomies, to better understand the chaos, to find a thread of Ariadne. To let ourselves be quenched by other views and expertise, to try to approach the complexity of the moment. I thank the authors for being this referral that brings people together. I remain amazed by their insatiable curiosity, their talent for connections, their ever-changing erudition, and their skill at reflective judgment that they embody before promoting it. This incredible opportunity that they offer us, through this essay, to be able to feed ourselves with their analysis and their vision. The cobblestones are thrown, sometimes almost ferociously because the pools are so deep. Of course, doubt is allowed (even prescribed when it opens rather than closes), debate is ardently desired. This is precisely what is important to preserve in the end. The challenge is to bring it to the right level, not to get lost in content rhetoric but to question the container, the very foundations of our usual frames of reference. And it is there, exactly there, that Florence and Fabienne lead us. Our exchanges allowed me to put into words this blurred sensation of a dysfunctional medical world, trapped in multiple issues that go beyond it. I agree with their aim to open the eyes of us caregivers, cared for, companions, individuals, society and their invitation to fundamentally question ourselves (i.e. to the epistemological and ontological foundations of our relationship to the world, to illness, to health). I join their motivation to exchange, share, write. Shaking up our certainties in this way is, in my opinion, an ethical act, a responsibility that falls to us all, individually and collectively. Because we are also the actors of what shapes us.
Isabelle François is a psychotherapist. She has been practicing in Brussels for the past ten years after having led another life in the four corners of the world, in humanitarian work and public health research. She is a member of the thematic group « Ethics of health curricula » of the Société internationale francophone d’éducation médicale (SIFEM) and works on the development of emotional competencies in the curricula of health professions (with Florence Parent, Helyett Wardarvoir and Fabienne Gooset).
Co-signer, Helyett
Poppies are blooming!
In homage to all those fallen in battle, often isolated from their loved ones, perhaps soothed by the hand of the caregiver and fading in the depth of his or her gaze. To care, to accompany is above all an encounter, a relationship that is established. It passes through touch, the look, the experience of otherness, an experience in 3D. To let oneself be seized or unseized by the other, to accept to be moved, lost, to look for a way to move forward and arrive where life leads us. The development of emotional competencies in health professionals did not come to me from the covid19 crisis but already long before, because the signs of a medicine that is dehumanizing and weakening caregivers is not new and the issue of managing the covid19 crisis is only the revelation of the need for a paradigm shift in health curricula. What health professionals are we training through the screen at a time when all decisions in the management of the covid19 crisis are not made by health professionals. What happens to clinical diagnosis, such as palpatory observation?
What motivated me is the radical upheaval of society by the development of a life in confinement which is inscribed in our realities and our memories by interposed screens: a life in 2D. On March 12, announcement of the confinement for Friday, March 13, 2020, I teach a course in performing arts. We are upset, what will become of our co-presence, our breathing, our intertwining of bodies? As if for fear of forgetting, we dance much longer than expected, we say goodbye. Blossom the poppies that will keep our soul in motion.
What collateral damage, since in the middle of a play rehearsal with a young director, everything freezes up at .… When? Then comes the moment of incomprehension : why it’s ok to be on top of each other in a not really ventilated subway, and why it’s not ok to be 6 in a rehearsal room bigger than a half car ! What does containment mean? The cultural and artistic mediations with the young people in institutions stop for state reasons: confinement! Why do the psychosocial dimensions of health have so little prominence today? How could a humanistic model of health be so radically swept away? And what a sweep of the approach through art, yet a form of knowledge and experience of oneself, of others and of a world at a time when humans are in « survival » mode?
I went through these white cards as one would board a raft in a storm. I found there a space for reflection, expression, enunciation, as an artistic workshop could do, with its own language. Animated by the will that the human cannot be reduced to life behind a glass, that it cannot be buried under the layers of a reifying thought. That the approach to complexity by a collective reflexivity animated by a diversity of people having all for heart of reflection: the human. Convinced that poppies always bloom more beautiful and more numerous despite their fragility and the aridity of the earth.
Helyett Wardavoir, originally trained in physical therapy and contemporary dance, has a Master’s degree in Public Health and a Master’s degree in Performing Arts. Combining « Art, Health and Society », she designs public health programs using the art approach and conducts artistic projects mainly with young people in difficulty. She is a member of the thematic group « Ethics of health curricula » of the Société internationale francophone d’éducation médicale (SIFEM) and works on the development of emotional competencies in the curricula of the health professions (with Florence Parent, Isabelle François and Fabienne Gooset)
Co-signer, Benoit
« Why did it come to this? ? « This question sums up my incomprehension, my anger, my sadness, my need for humanity that many have been deprived of in the management of this crisis. Should-do we forget the basics of what we learned many years ago?
The pillars of our profession, ethics and deontology, have been badly damaged… « Those who know » have imposed their rules with a narrow vision of their field of competence. Is this public health? Is this the intended definition of health?
I could not do otherwise than to support the fewbut to support the few professors and other courageous academics who have been able to keep their freedom of expression and their honesty by constantly demanding scientific debate.
The authors of these white cards gave me the opportunity to reflect deeply on their philosophical experiences and thoughts. Not everything can be taken or left, but as a thinking person, here is some food for thought. And everyone understood that covid had played the role of revealing the dysfunctions of our societies.
What kind of medicine do we want? By which caregivers and physicians do we want to be cared for? The authors and their team have been asking themselves these questions for years and have been trying to draw attention to the deviations of the choices made. This crisis has shown us the limits of a scientistic, reductionist approach and the need for a more global, open and integrative approach. This is what the authors of this work propose. Thank you.
Benoit Nicolay is a physician, Anaesthesiologist-Resuscitator. Trained in micronutrition and hospital management. Former department head and operating room manager. Member of the ethics committee of the hospital where he practices since early 2021. A field physician well aware of the underfunding and technical and digital evolution of health care to the detriment of the humanity needed by patients and caregivers.
Co-signer, Emmanuelle
Since the beginning of this crisis, fear, essentially, has been the leitmotiv of communication for the whole of humanity.
After a few days, I had the feeling that it was not justified and since then I have been asking myselfnt to me endless questions, shaking my deepest convictions. And this has become a driving force to re-act.
When faced with something new, you have to adapt and move forward based on experience.
In this crisis, the only engine proposed was that of fear, paralyzing and toxic.
This scourge, more worrying than the virus itself-itself, has plunged the entire world into a dysfunction that has caused and will cause significant collateral damage.
Faced with this perplexity, taking a step back, reflecting and sharing my questions allowed me to find some reference points and a semblance of serenity.
Emmanuelle Carlier is a pediatrician in Brussels.
Co-signer, Véronique
Véronique Baudoux is a general practitioner in Nivelles.
Co-signatory and co-author of the preface, Jean-Marie
Jean-Marie De Ketele is Professor Emeritus of the Catholic University of Louvain and UNESCO Chair in Educational Sciences at the Cheikh Anta Diop University in Dakar, which awarded him the title of Doctor Honoris Causa. The latter was also conferred upon him by the Catholic Institute of Paris where he is a visiting professor and thesis director. He is currently editor of the International Education Review of Sèvres.
Co-signatory and author of the preface, Manoé
Manoé Reynaerts is a philosopher.
Thanks to Kairospresse
The astonishment of meeting, at a given moment, like a lifeline in extremis, other people who, like oneself, wonder, perceive that « something is not right », put into action a look that listens, feels, wants to understand and gives the word even if it is unusual, or inactual: such was the meeting with Kairospresse and Alexandre Penasse, unpublished and almost solitary representative, during the first year of this crisis, of a press which, moreover in Belgium, will have to be reborn from its ashes if the aim of emancipation of the human being is always of topicality for our humanity.
Preface
We need Antigone!
In the 5th century B.C., the poet Sophocles expressed a unique figure, still present today, embodied in the features of Antigone:
« In ancient times, a terrible civil war ravaged the city of Thebes. When it was finished, King Creon ordered to leave the body of a warrior, Polynices, unburied, because he had taken up arms against his country. But Antigone, his sister, defied this ban and was arrested when she was burying Polynices. So she was taken to King Creon who asked if she knew about the law against burial and if she knew that she was facing death.
- I knew it, » replied Antigone. But it was only a human law. There are more important laws, those that are deep in our hearts. All my thoughts and my love commanded me to bury my brother’s body. In the face of these laws, human law weighed little…just as it weighs little that I must die. I would rather perish for that, than be forever in despair that I had left my brother’s body unburied. »[note]
The centuries passed, but the figure of Antigone persevered through them: in the humanist Renaissance, the man of law, Robert Garnier, inspired by the plays of Sophocles, Euripides and Seneca, made Antigone the incarnation of family devotion and the justice of the just. In the 17th century, Jean Rotrou, continuing his predecessor, sees in Antigone the defender of the natural laws of fraternity in the face of the tyrannical laws of Creon. In Racine, it is a loving Antigone who, in the face of death, chooses to live for love, while at the dawn of the French Revolution, in Vittorio Alfieri’s Italy, Antigone sets herself up as the heroine of a desperate freedom in the face of tyranny and the Reason of State. As for the heirs of the French Revolution, they saw in it their own liberal aspirations and those of a defense of human rights; it represented then for Nerval « the eternal fight of the moral duty against the human law, of the conscience or of the passion against the obedience due to the princes {…} »[note]. In Hölderlin’s romantic Germany, it embodies an ontological potential*, the announcement of a new form of being, of a becoming in realization, it covers a teleological power. At the time of the First World War, Romain Rolland launched in London in 1915, a call to the « eternal Antigone »; in 1917 in Leipzig, Walter Hasenclever prefigured an anti-militarist and pacifist Antigone; Jean Cocteau presented her as an anarchist, a social and cultural anti-conformist; Brecht put her at the service of a criticism of the capitalist and contemporary society. In 1972, Liliana Cavani, through a young protagonist named Antigone, denounced police terror, while in 1973, the director Claude Vermorel exported it to West Africa, perhaps illustrating the universality of the figure.
What is Antigone’s name? To what reality and depth does it refer us, so that through the centuries, in our souls, as a dictable hope, it lodges itself? And today even more, what face covers it, how does it invite us to dance with it, so that at its meeting we rejoice in a possible horizon? Surely then, today too: we need Antigone!
For, if it is indeed the announcement that allows itself to be shaped to the needs of our highest and most intimate aspirations, it is certainly that in it, in the figurehead that it is for us, is played out the opportunity for human beings, for the societies that they inhabit and erect, and for the world that thus unfolds, to toreflect otherwise than in the only reference to what is and to what is determined, but also in the horizon of what could be, and in what could be reflected by us, for us and according to us. As such, the figure of Antigone is akin to a focal point, within which our relationships to worlds, to those desired, to our values, those of our intimate and shared, private and public, individual and collective lives, are seen to be combined and presented as a possible reality, not as a dream that fades in the light of day, but as a utopia, certainly « not yet realized », but sensed as achievable. The content of Antigone is thus at the same time political, social, individual, committed, existential, contextual, universal and singular, it is global and animated by an aim, it is, so to speak, teleological, and the judgment to which it invites us is certainly just as much: the reflective judgment*.
Such is the stake of the reflective judgment, which it proposes to reach: the various dimensions of our existence, but also their deployment, the recollection of those forgotten or the emergence of new possibilities. It could not be only a reflection on an action or on a way of being in particular, because it is rather an action and a being. It cannot therefore only be conceived, because it must also be lived. Its ambition exceeds, perhaps, the possibility of being satisfied. But it is in the horizon of its possibility, rather than in that of its impossibility, that the authors of the white cards preferred to place their hopes.
Thus, the texts compiled here in the form of white cards begin as so many reflective possibilities, as so many points that question the singularity of practices, care situations, values and epistemologies* of care in relation to the visions of humanity that they offer or do not offer. Also, the reader will never find in these texts only an analysis, but always the occasion to measure the stake in play in the ways in which our actions and our modes of existence are summoned or could be in these contexts. The hope nourished by the exercise of reflective judgment has led the authors to orchestrate, in a vast interdisciplinary opening and according to a progressive logic, the conjugated meeting of dimensions of existence, of places and functions of society, of pedagogical and ethical approaches in the curricula of medicine, of cultural and emotional expressions, or of anthropological considerations. And it is thus in the singularity of these connections, that the globality and the complexity of our humanity were taken into account.
It is consequently that the reflective judgment, animating all the white cards, will recover the quality of an ethical judgment. Indeed, when it is a condition of a way ofbeing-in-the-world, ipso facto of a singular and chosen re-appropriation of experience and of the way of doing it, the reflective judgment then truly announces itself also as an ethical judgment. It is announced thereafter like an action in the strong sense of the term, an action on our being and our desired manners of being in becoming. Certainly, the context of the Covid seriously questions this possibility, and the capacity that we may have to seize it. It is in this sense that the time of Kairos is questioned in the carte blanche 7: spirituality, individuation and medicine: the covidian kairos — (kairospress.be).
The reflective judgement is therefore also an ethical judgement, because it tries to reinstate in us the possibility, not only, to grasp what is singular in our contemporary experience, but also, and even more so, to produce it where it would seem to be absent, where perhaps our power of individuation would seem to be no more or in the process of being no more. Thus, the reflective judgment is the expression of a way ofbeing-in-the-world, of a way of making the world, whatever the form of adversity, as in Antigone. Even today, by her example, she encourages us in the hope of such a possibility, because we are gifted beings and capable of acts of existence. This reflective and ethical action is then the opportunity to « persevere in one’s being ».[note]To be able to persevere in our capacity to be and to emerge from being.
The white cards compiled here open with a reflection on the dominant epistemology in the curricula of future caregivers and its impact on decision making. These white cards mark the beginning by observing that this epistemology is not very capable of reflective judgment, but it does produce decisive judgment*. That is to say, a judgment capable of categorization, identification, and conceptualization, but not very apt to reflect on the way it categorizes, generalizes, identifies or conceptualizes. It is even less able to consider the global consequences on the anthropological, existential, social and political reductions of humanity when it is applied in the form of a protocol of care intervention or management. As such, the first white card mobilizing EBM (Evidence Based Medicine), » The role of physician education and medical epistemology in the Covid crisis 19 — Kairos (kairospresse.be) », highlights the ethical stakes of an epistemological* and methodological reflection on the way of constituting knowledge, on our relation to it, and on the possible uses which depend on it. On these ways of knowing and practicing depend in fact the possibility of visions of the world and of humanity. A vision that first interests the body: since, as we know, it is important to be able to distinguish the « Leib » and the « Körper ». The first one, often forgotten in medical epistemology, is the living body, the one that life animates — « leben » meaning « to live » in German -, the one in which we experience ourselves in the quality of living, existing, desiring, intimate and social being, in projection and animated by intention, subjectivity again. The second refers to the objectifiable and objectified body, the one that is measured, the one that must therefore be established first as measurable. Foucault has very well identified how, already since the 17th century, medical epistemology made the body a prisoner of the representations that the soul affixed to it, an object to be reduced in order to be measured and manipulated. But on the other hand, Foucault has also wonderfully accounted for the powers of the lived body, when for example referring to the plurality of the dancer’s bodies, he proposes that :
« The body in its materiality, in its flesh, would be like the product of its own fantasies […] the body of the dancer is dilated according to a whole space which is interior and external at the same time « .
The « Leib » is thus this lived body, the proper body, the one that is singular to me, the one in which I feel joy and pain as to myself, the one that could not be the simple subjective corollary of the objective, objectivable and objectified body, because the proper body is the original point, from which my opening to the world and, consequently, my being-in-the-world opens up and begins at first. It is what Martin Heidegger called the « there » of being, the one from which the meaning and the significance granted to life were possible. It is the body within which and from which utopia becomes possible, this utopian body that does not make the soul a prisoner of the body, but the body a potential prisoner of the reductive representations that the soul would project on it (the « medical body » on which a biopower* is exercised). Mr. Foucault reminds us, while: « The human body is the main actor of all utopias », that :
« My body […] is always elsewhere, it is linked to all the other places in the world, and to tell the truth it is elsewhere than in the world […] the body is the zero point of the world, where the paths and the spaces come to cross, the body is nowhere: it is at the heart of the world this small utopian nucleus from which I dream, I speak, I advance, I imagine […] My body has no place, but it is from it that all possible places real or utopian come out and radiate. »
The reader will find, in the succession of the white cards 4, 5, 6 and 7, a set of testimonies, poetic expressions, analyses and reflections taking « in hand » this theme. He will find in it the expression of a non-dualistic vision of the body, of an integrated, unified and global vision, of a vision concerned with finding and exploring the fields of the body’s being, and the possible songs of its being. Thus, the dimensions of emotions and their intelligence (white card 4), those of our vegetative soul (white card 5), of our spirituality (white card 7) and of our vital energy, which, in these times of covidian kairos, feels dancing (white card 6) will be explored.
It is thus, through reflective judgment and respect for the totality of our being, that the various white cards first initiated their progression from this observation, that epistemology also depends on ethics, that medical epistemology, more particularly, depends on the possibility for ways of being to be realized or, conversely, to be excluded from the start. Indeed, from one epistemology to another, the possibility of persevering as a practitioner of one’s practice, as a constitutive actor of one’s practice, and not only as a practitioner of a generalized, generalizable, standardized and standardizable practice, will depend. This individualized relationship to one’s practice must therefore be individuating: it can do so if subjectivity, the subjectivities and intersubjectivities in presence are stakeholders and constituents of the practice, and not relegated to the level of independent variables. However, the interest of the current crisis also lies in the fact that it encounters the medicalized relation to the body, as well as all the other fields of existence of humanity and society. Also it is in the measure of this globality and this complexity that the sciences today must impose themselves the interdisciplinarity and the transdisciplinarity as, not only an epistemological requirement, but also ethical, because of the possibilities that will depend on the cancellation of diverse forms of reductionism of the human being, and consequently, perhaps will open emancipating aims.
In this respect, it is good to remind the reader that such projects were born in our societies and still animate them. This is certainly a hope not to be lost sight of and it is in this line that, modestly but certainly, the white cards are part of. Thus, in a perfectly emblematic way, the « ever famous Frankfurt School (whose fame Horkheimer and Habermas participated in) supports the importance and the idea that, never only science or a science, but always the sciences must be able to associate, in order to open to humanity its social, anthropological, philosophical, psychological and cultural dimensions. It is not a question there simply of wanting a strict better knowledge of its being, but also of supporting an emancipating and autonomizing movement for this humanity in front of the whole of the contrary, dominant and opposite forces which tries to or calls to reduce it.
Manoé Reynaerts and Jean-Marie Deketele
Introduction: The Covid health crisis[note] as revealing our epistemological ambiguities
This essay aims at a form of investigation at the heart of medical and health decision during this period of Covid 19. Our research was primarily conducted from December 2020 to May 2021. The many references that nourished us were added as we wrote. Some of them — and we are thinking in particular of electronic references — are likely to have disappeared by the time the reader gets to know our work.
We will consider how the choices made, by their somewhat obscure modalities, for the protagonists themselves but also for those who are confronted with them, build a breeding ground, like the opportunity that makes the thief, for logics of health dictatorships.
Our writing takes into consideration the deep fracture of the medical world on an epistemological level, and this, often without conscience, because reductionism has a long history. Thus, in 2021, the conflation of storming the Capitol with resistance through non-compliance with health regulations led to both situations being considered equally criminal[note] by a good number of doctors themselves, leading to a confusion in which the medical world participates amply and whose consequences we can no longer accept! It is all the more essential that the value of life is promoted, often in a closer way, by those on whom one is going to put, for their lack of measures, protocols and norms, a peremptory judgment, the one of the only determining judgment.
However, it is precisely (and without excluding the decisive judgment) of reflective judgment that we need today more than ever. This essay helps to understand, to situate oneself in relation to what is exposed, and this, in all fields. Reflective judgment and decisive judgment do not only apply to the medical field, they extend to all our actions, so to speak. This is where this writing takes on its full meaning and value by revealing what is behind what we want to be shown but also what we want to see, by going to the roots of actions, to find what presides over them and what, very often, we are not even aware of: our epistemic choices.
In order to make it easier for everyone to understand, we have written a glossary explaining some terms and their flexions in the meaning we have chosen. These words are preceded by an asterisk on their first occurrence.
This work of reflection proposes to offer a grid of reading on the types of decisions or judgments (and their underlying epistemologies) which prevail in the various contexts and their degree of emancipation compared to the emotions when these alienate rather than make the situations more intelligible (fear, guilt…).
Of course, it is a question of uncertainty and emotion, but probably, above all, of competence, capacity and professionalism.
This paper is also a critical contribution to a public health system in which the Covid crisis shows multiple flaws and deep failures inaction and in the consideration of globality. Globality of a medical decision, globality of a health system, globality of a person, soul and body. Globality of a World in which we, caregivers and physicians, wish to participate by emancipating it and not by dominating or reducing it. And this involuntarily, determined as we are by an epistemology of which we are not aware and which works by the hand, not of God, but paradoxically, of man!
Our references come from a wide range of backgrounds. We have made the deliberate choice to mix authorized voices with those that are less authorized or that engage in controversy in order to explore the subject as broadly as possible and to orchestrate polyphony around this topical theme. Thus, we will also find testimonies of future health professionals resulting from students’ group work within the framework of a teaching device for a course of social medicine[note].
By restoring, through the reflective judgment, fully its place to the patient and to the caregiver ‑Subjects of Act‑, it is to the universal of the Particular rather than to the universal of Knowledge that we attribute, first — in the sense of first (underlining the non-opposition) — the role of Reason, allowing, with Henry Joly quoted by François Roustang previously, to humbly question ourselves:
Are we mistaken about the universal?
Peter Fischli & David Weiss.
In their work, there is a close relationship between chaos and order.
Through their diverse and protean works, the two artists question the contrasts, the fragility of the vital balance, the tight link between chaos and order while deliberately neglecting the classical borders between popular and founded art.
Reading, audiences, terminology clarifications & index
This essay presents texts in the form of white cards that were published regularly between February and May 2021.
Each of the seven white cards has a particular significance in relation to our hypothesis. Indeed, a thread links them, that of the decision relative to our epistemological or epistemic choices from which emerges progressively, and in an increasingly open way, a radical questioning — commensurate with this health crisis — on our knowledge in medicine. For it is indeed, for us, a « crisis of knowledge », and above all a crisis that questions the very mode of elaboration, of construction, of our knowledge. Thatis to say, a crisis that offers us the opportunity to question the epistemology that is at the base of our knowledge, behaviors, capacities, aptitudes, but also and especially, postures, attitudes and values.
Thus, insofar as it offers an analytical and critical perspective ‑in the sense of the Frankfurt School[note]- of the crisis of the Covid 19, this text participates in a better understanding of the determinants that drive the medical and public health sector.
In contrast to a society that seems to move forward with its head down, straight ahead without looking back, without digging, without trying to understand what drives and moves it, we have opted for a look, certainly introductory, but deep into the abyss of our behaviors or « actions. The interest of these white cards is to propose a necessary and salutary pause, but which interests perhaps only a minority, the others being in the train…or, in the action. Action that refers to the « man of action » that Nietzsche criticizes, the one who must always « do », and this, whatever the ideology at work, even if it is humanitarian like the (humanitarian) emergency to which the management of this crisis is in every way similar[note].
We also recognize, of course, a primary urgency when entering a health crisis, as well as the need to act against the liberticidal measures that are being put in place on the back of this crisis. However, whatever the outcome, only an in-depth look, such as that of psychoanalysis, will play on the repetitive occurrences.
As such, this text may be of interest to the health sector, philosophy, and the education sector in the broadest sense. However, in view of the opening of the debates through the networks and media on the decision-making stakes of this health crisis, and which fell very directly on the population, this text can answer, at least in part, many questions, ultimately very general:
What is knowledge?What is knowledge?What is science?What is a health decision?How was my doctor trained?Why do some physicians think very differently from their colleagues? Why do doctors attack each other so much?Why was the WHO definition of health not respected in the management of this crisis?Etc.
An introductory text precedes each carte blanche. Similarly, a discussion focusing on the social psychological processes at work closes this essay, opening up some issues that go beyond the health and medical crisis as such. Indeed, this step back seemed to us indispensable in order to satisfy the more global need to contextualize this societal and democratic crisis.
From the form…
I go with Nancy Huston when I[note] speaks about the singular writing of these texts. This essay — epistemological argument — because it was written without any a priori forms, allowed me to » to find the « invisible attribute », forgotten when organizing my previous collections, and I felt like resurrecting it too. These texts are milestones on my path as an author and expatriate, as a mother and intellectual, as a dreamer and realist, as a soul and body. They will speak for you, or not, depending on whether your path follows mine, crosses it or diverges from it; some of them may be useful to you, others will leave you cold or throw you into the fire of anger, and that’s what’s needed; they are to be taken or left, taken and left, in complete freedom, as always.[note] »
Indeed, these white cards, more formal and fussy at the beginning, will open up to the global connection* that we particularly need today. They are not in the claim but in the « autopsy[note] The project is based on a « reflective » approach to a health crisis, using philosophical tools among others, but also with the spontaneity of artistic and literary work. They are intended to be both a dialogue with the reader’s senses and a tool for reflection.
Guidance
In order to guide the less experienced reader through this thought process, the figure below and its explanation, as well as the definitions and the proposed index, can accompany the reading at certain moments considered more complex. It is probably a good idea to return to these elements of guidance regularly throughout the reading of the various white cards. These are also independent of this preliminary text.
This figure is adapted from an original article[note] positions the perspective of epistemological renewal that is, globally, proposed through these texts. It is the one that is based on the recognition of the mode of elaboration of the knowledge, techniques and products of our culture, considering as much » the hand that makes » as » the result that is « . This point of view — a true perspective in the Nietzschean sense of the term[note]- meets the epistemological thought of Richard Sennett developed in his book entitled « What the hand knows[note] ».
Figure 1: The Decision and Acting Appropriately in Health [note]
Specifically in this figure, we observe:
- a pole at the bottom right entitled « Determining Judgment », centered on stabilized, universal or generalizable knowledge. This knowledge or product is associated with the results of any form of research as a field of production (technique, culture, knowledge, concept, theories, standards, protocols, guidelines…). The results of the fake Lancet study (see white card 1), for example, are exclusively in this location. We specify this in order to draw attention to the scientific drifts mentioned in the white card 1 when one refers, without critical thinking, to Evidence-based-medicine or EBM. This pole may or may not be open to knowledge other than that mobilized by EBM alone, in reference to the notion of « plural sciences ».[note].
- a pole at the bottom left entitled « Reflective Judgment », centered on the lived experience or practice ‑the Living- referring to the field of professions as fields of activity (action, acts and know-how) of the professionals concerned (nurse, doctor, psychologist, osteopath and any other caregiver, but also sociologist, anthropologist, political scientist, teacher, economist, and the patient who has the experience of living with the illness.…). This pole refers to the theories of action in Education[note].
- an upper pole centered on the intentionality of human action, which makes it possible to question the meaning or value of the decision or of the action in health with regard to the other two poles. It questions the validity of the determining judgment as much as of the reflective judgment. She is perhaps there the figure of Antigone: she knows the human law, that of the determining judgment, she is also the reflecting subject of an experience and she will decide to act « with knowledge of the facts, with lucidity ».
Note that a theory of judgment can encompass both determinative judgment (a deductive process that relies on scholarly knowledge) and reflective judgment (an inductive process that relies on experience), as signified by the arrow on the figure
[note]
.
It is the consideration of these three poles at the same moment ‑for a time T- that allows a look, or even an ethical debate, on the decision.
By explicitlyidentifying knowledge (or even by modelling it in terms of training engineering by means of this figure in particular) on the one hand to: an « act-singular » (process — interiority: bottom left-hand pole) and, on the other hand, to an « object-in-itself » that we could call « shared object » (result — exteriority: bottom right-hand pole)[note]In the course of these white cards, we put our finger on the epistemological knot that needs to be untangled in order to retrain our actions with greater lucidity.
By this decentering (which is not separation!) of the object « Knowledge », of our action, we can already consider a radical assumption of responsibility of the relativity to give to the concept of science and proof. We can emphasize this by paradoxically using the framework proposed by Éric Chevet [note] But let us distinguish between enlightening science and active science. If there is no question of wanting to limit the first and « opt for the dreams of non-knowledge », would it not be possible, given certain risks linked to the consequences of our own practices, to want to limit the second? The problem is therefore to ask ourselves whether we should give up certain technical applications born of science, whether it is necessary to reduce this « progress fever » which is taking us away and which, however, seems incurable « . At this point, it is important to understand what we are talking about in the above excerpt and to clear up any confusion about the term » action science « . It is a question of « science for science’s sake », which acts in order to act with a positivist, directive aim, without worrying too much about the consequences, the result. Also, by positioning, on this figure, science on the side of the object and not on the side of the action we give back the full power (and responsibility) to the hand that constructs this science (socio-constructivist perspective) and let us get out of a good-natured fetishism, recognizing at the same time science as enlightening. Indeed, would the obscurantism of modern man be a manifesto of his lack of self-confidence, camouflaged in a Cartesian, positivist epistemology, giving the illusion of full control?
The complementary hypothesis in the continuity of a Möbius knot would be that of a humanity that has trapped its own « action » in the necessity of proof, the legal one of the defense of a medical act progressively leaving the place to the only determining judgment.
For our part, following the thinking of Eric Chevet, we opt for an enlightening and non-acting science, leaving this responsibility radically to the hand of man, thus joining our definition (Folscheid[note]) »
medicine is […] neither a science nor a technique, but [bien] a personalized care practice, accompanied by science and instrumented by technical means
« . (Bold type is our own).
However and that is the main thingAs we can see in our figure, no frontier (opposition) is erected between these three poles ensuring a connection between action and knowledge or between practice and theory (loss of the usual binarization), without any form of sublimation of the latter to the detriment of the former.
The central question is to reconsider the interactions between these elements in order to redistribute power, and perhaps even the power to act.
Further upstream, we assert that only (and this is the hypothesis developed in the main article)[note] from which this figure 1 comes) a paradigmatic* (i.e. radical) epistemological break in medical training would make it possible to become aware of the techno-scientific drifts of our modernity and to slowly reverse the trend, culturally and historically. We see the epistemological but also ontological problematic in the medical world as » indispensable stones of thought of tomorrow in the tumultuous world of today « . [note]
Indeed, the critical issue lies in the critical mass of its actors, or actants as Benasayag calls them[note]. It is primarily that of medical students, but also that of caregivers more generally, both of which are currently (and probably more than ever) formatted according to a positivist and reductive epistemology, i.e., too exclusively based on the sole determining judgment, which is moreover not, or not very open to a plural science. This, while our knowledge (and paradoxically those concerning our own actions) has never been so numerous [note]. Determining a health system by such ‘training’ participates in the decadence of our societies by widening the gap between our capacities — our developmental faculties inherent to the human species — to act, with our (transdisciplinary) knowledge.
In view of the successive losses in the different dimensions of diversity, it is urgent for the modern man wishing the Enlightenment to happen to give back their place to formal and final causes and not only to material and efficient causes[note]. Indeed, they are the ones who are at stake in the movement of life and thus in theaction, allowing (condition of possibility to) the diversity of form and reason to occur. Borrowing from Corine Pelluchon the title of her latest book[note]We can say that « enlightenment in the age of the living » is conditioned by an epistemic project.
Terminology clarifications
We have chosen to define here certain terms or concepts whose nuance it is important to understand. An asterisk on the first occurrence of a term identifies it and invites the reader to consult the glossary below.
Biopower : Term taken in the sense of the philosopher Foucault who « calls « biopower » the specific techniques of the power exerted on the individual bodies and the populations » [note]
Epistemology Epistemology is a young discipline which, for a century, as its etymology gives us the meaning, has made its object or its project the discourses (logos) on knowledge (epistèmê). Jean Piaget defined epistemology « as the study of the constitution of valid knowledge », allowing us to include in such a broad definition the three great questions that everyone encounters as soon as they wonder about the legitimacy of the knowledge they use to elaborate their cognitive and social behaviors (from the multiplication tables to the declarations of Human Rights): What is knowledge (knowledge of knowledge); how is it constituted or generated (method); how can we appreciate its value or its validity (ethics)? Note of clarification on the concept of epistemology (inspired by Jean-Louis Le Moigne’s book. Les épistémologies constructivistes. Paris : Presses Universitaires de France, 2007).[note]
Randomized trial: A randomized trial is an experimental study in which a treatment (or intervention) is compared to another treatment, no treatment, or a placebo. Participants are randomly assigned to a group receiving the tested treatment or to a group receiving the other treatment or no treatment. Participants do not know whether they are receiving treatment or not [note].
Categorical imperative: this imperative posits an action as necessary and unconditional, regardless of the goal to be achieved. The set of categorical imperatives gives laws whatever the inclination of the subject[note].
Determining judgment: this type of judgment is at work when the medical and health decision is based on the measurement and the norm defined a priori of reality
[note]
.
Reflective judgment: this type of judgment is exercised when the medical and health decision is inserted into praxis as a conscious action
[note]
.
Ontology: science of the being as being independently of its particular determinations
[note]
ontology determines our relationship to the World, to the Whole, to the Oneness and founds our deepest or most hidden values.
Paradigm : it represents a theoretical framework, a set of ideas that form a model. The paradigm is therefore a common reference for scientists. It facilitates their communication within the scientific community[note].
Prevalence: the ratio of the number of cases of a disease to the total population, without distinction between new and old cases, at a given time or during a given period
[note]
.
Reliance: this is a notion that has been explained by E. Morin and that could be translated as the need to link what has been fragmented, disunited
[note]
.
White Cards: On the epistemic thread of this crisis of the Covid 19
WHITE CARD 1: The Role of Physician Education and Medical Epistemology in the Covid Crisis 19
Introductory text
Throughout these white cards, we propose to analyze the Covid health crisis by trying to better understand the relationship between certainty and uncertainty in the various decision-making processes. We will attempt to document some of the issues and consequences of these in this particular context. Indeed, it shows more than ever the epistemological ambiguities underlying medical, but also political and sanitary decisions, revealing some of the foundations of the dysfunctions of our health systems, reflections of our societies. As such, this is a moment to be seized. It is still necessary to be able to decode them in order to learn from them or, at least, to acquire a form of lucidity.
Such an analysis must necessarily begin, in our opinion, with a fundamental clarification, which consists in correctly positioning the very notion of EBM (Evidence-based-medicine). For the reader interested in the concept of Evidence Based Medicine, we suggest the article by Jean Jouquan and Florence Parent « Pour un examen critique du statut de la preuve en médecine[note] « . This work was published in the wake of this first carte blanche dedicated to the explicitation of EBM. It immediately makes us aware of what is at stake in this entire health crisis, that of of the risk of certainty, reminding us of an element of Descartes’ thought that we will recognize as essential (while his dualistic thought will be deeply fought): it is about critical thinking and this, for a doctor and a scientist, starts with a look at critical of the very use of EBM.
Car.…
» Most scientific studies are wrong, and they are wrong because scientists are interested in funding and their careers rather than the truth. » Richard Smith, Editor-in-Chief, British Medical Journal, 2013.
» It is simply no longer possible to believe much of the clinical research that is published, nor to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I have slowly and reluctantly come to in my two decades as an editor. « Marcia Angeli, Editor-in-Chief, New England Journal of Medicine, 2009
» The medical profession is bought by the pharmaceutical industry, not only in terms of medical practice, but also in terms of teaching and research. Academic institutions in this country allow themselves to be paid agents of the pharmaceutical industry. I think it’s a shame. « Arnold Relman, Editor-in-Chief, New England Journal of Medicine, 2002
» Certain practices have corrupted medical research, the production of medical knowledge, the practice of medicine, drug safety, and the oversight of pharmaceutical marketing by the Food and Drug Administration. As a result, practitioners may think they are using reliable information to engage in sound medical practice while actually relying on misleading information and thus prescribing drugs that are unnecessary or harmful to patients, or more expensive than equivalent drugs. At the same time, patients and the public may believe that patient advocacy organizations are effectively representing their interests when in fact these organizations are neglecting their interests. » Institutional Corruption and the Pharmaceutical Policy, Edmond J. Saffra Center fr Ethics, Harvard University & Suffolk University, Law School Research Paper No. 13–25, 2014 (revised)
In addition…
In addition to such corruptive issues, the use of EBM must necessarily take into account the contextual dimension of the decision. It is also this capacity that is part of a critical mind. Indeed, the results of randomized controlled studies* are always situated. That is to say, directly related to the prevalence* of the phenomenon in the population studied (the Likelihood ratio, or probability test, is calculated from the prevalence in a given population of the phenomenon studied. Data are rarely available for all the highly variable situations in terms of prevalence of the same phenomenon, except (potentially) through meta-analyses which require even more research time). For the populations involved in the studies themselves, this may concern gender bias for example, and thus be a source of discrimination[note]. Or again, as it is recalled in the context of vaccine research, in particular for Covid 19, questioning the extension of a vaccine coverage with regard to the benefits/risks depending on the populations from which the efficacy was initially studied…
This is also true for the clinic, in relation to the decision-making level where one is (first line of health care or hospital referral for example), the prevalence of a phenomenon being directly dependent on the referral level in the health organization, the results of a test or of any protocolized decisions will be influenced.
Thus, like the title of the movie « Harry, a Friend Who Wants to Help You », EBM can be a ‘false friend’ if we take it as it is presented under the guise of science or in the absence of a necessary contextualization of its results. Consideration that the original EBM authors advocated for the understanding of the findings, on the other hand.
A return to figure 1 (introduction & guidance) reminds us that the data of science belong, as objects, to the determining judgment, but do not exempt the scientist and practitioner from his reflective judgment. Indeed, any data is always produced in a context that has its own issues. Thus, developing « a well-made head rather than a full head[note]« This is an ethical necessity and a social responsibility of medical schools.
As these students point out, once they are immersed in real life, » We need to warm up this cold, statistical medical knowledge of EBM that does not speak to the mind that is not immersed in it. This is also pointed out by Sebastian Rushworth in his online analysis entitled: How well do physicians understand the likelihood[note]? the following excerpt summarizes its substance: » Medical schools should think long and hard about the implications of this study. What it tells me is that medical education needs a massive overhaul on par with what happened a hundred years ago after the Flexner Report. We don’t send pilots into the air without making sure they have a complete understanding of the tools they are using. Yet, this is clearly what we do in medicine. »
Moreover, not only is it a question of mastering the use of EBM with its probabilistic logic, but it is also a question, as already underlined, of not making it the sole principle of decision, but rather a tool to help in the decision. This is what is underlined by this testimony of a doctor (anonymized), gleaned on the web of this covidian era:
» Where all this seems totally crazy is that we prefer to do nothing rather than try a combination of early treatments that NEVER constitutes a loss of chance for a patient. The proven loss of opportunity is to send him home and tell him to take paracetamol and wait for his case to get worse. This is what history will judge…and perhaps Justice. This is what most frightens all those who have been campaigning against all forms of early treatment of Covid since the beginning. The situation is bound to change in favor of early treatment, not only existing but also in the future. These treatments will concern not only the antiviral aspect but the whole of this disease characterized by its inflammatory and thrombogenic syndrome which evolves independently of the viral load. (…) Gargling with empty words and over-interpreting the notion of EBM does not make science. Thank you also to those who love science for limiting their prescriptions to treatments validated by randomized double-blind studies. For your information, resuscitators (of which I am one) have successfully introduced in the treatment of serious conditions due to Covid-19: antibiotics; anticoagulants; corticoids. And this without reference to RCT (randomized controlled trials) but from their knowledge and observations… »
It is the role of these medical training institutions in this health crisis that is addressed, in an introductory way, in our first carte blanche. Between knowledge and skills, it is high time to balance the balance for those who want training to participate in professional development and stimulate what is called in ethics: professionalism.
Let’s continue with our first online carte blanche:
The role of physician training and medical epistemology in the Covid 19 crisis — Kairos (kairospresse.be)
WHITE CARD 2: Covid 19: Precautionary Principle or « Risk of Blame »?
Introductory text
The importance of context
The precautionary principle mobilized in health decisions and public health strategies must be differentiated, as we develop in this white paper, from the use of EBM on the one hand and the cost-benefit-risk criterion on the other. Moreover, its use requires an anchor: the real situation!
This requires a particular context, properly documented. As the popular saying goes, and the statistics should agree: « You can’t compare apples and pears ». India is not Belgium and the T0 time of a pandemic is not the T1, T2 or T3 time of this same pandemic situation. Hence the importance of taking into account the context (space and time) and, above all, of knowing it on a democratic and shared basis (patient-partner, community or national relationship)
« Indeed, if the containment was decided by fear of an accelerated saturation of the resuscitation services, it also aimed at protecting the elderly, the most fatally vulnerable to the virus. It was for this purpose that the nursing homes were closed, which, already contaminated and often deprived of everything — protection, screening tests, nurses, doctors — became, in many places, an incubator for the virus and a gas pedal of death; confinement proved to be the surest way for many residents to die. With the political and health spotlight on hospital emergencies, the closure of nursing homes went hand in hand with the secrecy of death; no one was able to put their nose in to find out what was going on or simply to help. The question is: to confine or to protect?
« The importance of context » also means knowing your communities, their living environments and their vulnerability factors. This is part of complex thinking, avoiding the simplistic drift offered by generalization strategies.
In the absence of attention to the context and, above all, of a real intention to consider it, we have seen an immoderate use of ad hominem arguments throughout this crisis. What is it about?
Ad hominem argumentation refers to a rhetorical argument that consists in confusing an opponent by opposing his own words or actions. Its frequent use by the media in the health crisis has put politicians, scientists, practitioners and field actors at fault, thus contributing greatly to the general confusion.
This rhetorical exercise has been deployed with regard to mask wearing, Covid treatment, vaccination, etc. It has thus led the population to expect from each of the protagonists a binary point of view, for or against (like a vote in politics), and which, above all, must remain constant over time (otherwise one would lose the esteem of the audience), as a guarantee of the good faith of its author.
However, such argumentation favored the slide towards an ad personam attack or an argumentum ad personam (unfair maneuver aiming at directly discrediting one’s opponent as a person). Moreover, carried out on such a large scale in the media, it has not allowed (or at least has strongly slowed down) the emergence of a critical, systematic reflection about the importance of a situated or contextual judgment (as much scientific, political, as health).
Each decision is anchored in a specific context that should give rise to a series of questions to judge its relevance (populations, prevalence, effectiveness, risks involved, multiple resources, alternative strategies, new data, issues, etc.). This approach is in line with a criterion (rather a ratio) to which we return in this white paper, that of cost-benefit or risk. It also converges with the reflection on the use of the precautionary principle.
Developing one’s capacity for reflective judgment also means developing the ability to turn around and change one’s point of view when the context changes (adaptive capacity) or if it has not been properly considered or if new data appear. Such a way of acting can only be done in total political transparency underpinned by a relationship of trust with the population (or with its patient in the case of the health care relationship), as has been the case at certain moments of this crisis in cultural contexts such as Sweden. This awareness can be achieved through active listening[note] other points of view, from different perspectives, which open up the context and the problematic. As such, reflective judgment requires the development of emotional skills in order to facilitate cognitive conflict, i.e. the ability to question oneself, to challenge one’s beliefs and to share one’s doubts and errors out loud. This is one of the topics we are developing in White Card 4, which focuses on the role of emotions in decision making.
By doing so, we do not put the situation into perspective, but rather our own views!
Such an attitude is essential in order to avoid the loss of efficiency and effectiveness of measures and to have responsible public health strategies, unless we consider that incompetence is maintained, or that other issues than the health of the populations guide the decisions. The following testimony, gleaned from a network, completes this introduction to our second carte blanche:
» To base a common health care policy on the entire population makes no sense in medicine, which has always endeavored to develop a health care policy adapted to each individual or group of individuals.
Colonoscopies are not performed on the entire population in the name of generational solidarity, but on people over 50 years of age and on people with a genetic predisposition (even though colon cancer diagnoses are also made on patients who do not fall into this target population because they are statistically infrequent). Medicine, in order to set up procedures, is based on the benefit-risk-cost and on the proportionality of the measures to be taken in relation to the cause. Obviously, these notions are totally foreign to our politicians and their advisors who prefer the precautionary principle or the so-called umbrella technique.
The population at risk has been known since June, prevention should have focused only on this population by allowing them to have professional quality masks, as well as dedicated information in order to explain how to avoid dangerous situations while waiting for the vaccine which only concerns this population at risk. The others should have been able to live their lives normally. A targeted strategy based on benevolence, empathy and pedagogy is more likely to work than a strategy imposed on all, based on authoritarianism, violence, denunciation and fear. »
Let’s continue this reflection with our second online carte blanche:
Covid 19: Precautionary principle or « risk of blame »? — Kairos (kairospresse.be)
WHITE CARD 3: Globality, partnership, autonomy in health. When the emergency sweeps everything away, but reveals the essential!
Introductory text
» Hi, I live in Spain, I had Covid in January and as always I was told to go home and wait taking ibuprofen.
After a week I had to be hospitalized and there I was given Dexamethasone. After 3 days I was feeling better and after 1 week I was able to go home a little weakened but that’s it.
Why don’t we treat the patients directly? This would prevent hospital overcrowding!
It’s incomprehensible!!! »
This testimony gleaned from a network will remain, indeed, with others, of the order of the incomprehensible, except for a critical and lucid analysis of what is at stake, unconsciously or not, in this health crisis.
Indeed, how can we rationally understand such a lack of front-line care in relation to theories on the organization of health systems in public health? Beyond even the early treatments on which we come back in this white paper, it is a structural reinforcement of the base, with an improved ambulatory care line that we could have expected (such as the addition of oxygen saturation monitoring; the implementation of protocols including anticoagulants and corticoids…)
The following testimony, proposed as an introduction to this third carte blanche, reinforces the problems encountered by the health system when its front line is thus prevented from working properly.
When reflective judgment is prohibited
» Yesterday I had to stop by to see a patient that I had to place in a nursing home. I adapted the treatment for my patient and, before leaving, the nurse gave me a sheet of paper to indicate whether my patient should take the « Covid vaccine » or not. […].
Only, underneath, there was only one box to fill out: a box to say, in a general way, that I agreed to the SARS-CoV‑2 vaccination of my patients. I felt like I was in a choice offered under a totalitarian regime, where there was only one way to vote. […].
It is especially this last sentence that caused discussion and concern among the nurses who had seen the message, because in this Home of Rest and Care we vaccinated people who had had the Coronavirus as much as those who had not. There is in fact very little experimental evidence to say whether or not patients who had previously had Covid-19 were at greater risk of developing side effects: what can reasonably be said is that the benefit/risk ratio is much less in favor of vaccinating these people (because they already have natural immunity), and that there is a greater risk of creating a painful state of iatrogenic inflammation in people who have recently had the disease « [note]
In these testimonies, we observe the crushing of the reflective judgment by the only determining judgment, and the exacerbation of a fetishism of the discourse, only centered on the result (the expectation of the proof of the effectiveness), allowing to deny the process actually lived by the persons (patients & sick) concerned. This attitude ignores the temporality of reality, jumping from time T0 to time T1 as in a video game where only the virtual counts; the real, the lived temporality, seems quite obsolete.
In the same way that the particular situation, the spatiality proper to the patient, that is to say his own space, in which he moves and lives, also seems to be obsolete, the hic et nunc belonging to the Subject is evanescent…and is lost under the sands.
Hence the interest in regularly returning to the reflective judgment, by confronting it with the decisive judgment, because by being based on the here and now, it has value in itself. It takes into account the immediacy of reality, it does not make it disappear, and this against all formalism and imposed rules, as long as this capacity for reflective judgment is sufficiently integrated, anchored in its practice.
The reflective judgment can be related, as Kant had envisaged it, to phronesis (in Greek) or prudencia (in Latin).
The foundations of the Primum non nocere principle of medicine according to Hippocrates are based on phronesis. The faculty of judgment in Kant’s « Critique of Practical Reason » is essentially based on reflective judgment.
No practice can escape the reflective judgment, except to radically deny its global, contextual and situated dimension. This would amount to a denial of reality.
This is what has been imposed during this Covid 19 crisis on a large number of caregivers, as we develop in this next carte blanche.
But before we get there, we recall, through these students’ words, that a structuring of our « actions » is always elaborated in a long time, that of our school, academic and institutional formatting: » The last reflection concerns the individuality of specialists. We find it crucial in our profession to dare to ask for the opinion of our peers. It is unfortunate that some colleagues find it very difficult to seek advice from other more specialized providers on a case/pathology basis. This may be due to the fear of some practitioners of devaluing themselves in the eyes of their colleagues. General practitioners, for example, are accustomed to referring their patients to specialists for overall care and follow-up. However, it is common to see a lack of feedback from the latter. This is an impediment to the multidisciplinarity necessary in a optimal follow-up. We can imagine that, from the specialists’ point of view, as the years of work and the less close follow-up of each patient progress, the social reflexes are lost. »
Some chapters of the following books on medical training, on the one hand « Penser la formation des professionnels de la santé. Une perspective intégrative », and « Comment élaborer et analyser un référentiel de compétences en santé », address very explicitly the issues of professionalization linked to the capacity to work in a network and in interdisciplinarity:
Intergroup conflict theories for thinking about and implementing interprofessionality in health
[note]
;Developing organizational learning dynamics within health organizations
[note]
;The patient-partner perspective: a necessity for the future in health sciences education
[note]
;Organize the coherence of the pedagogical transposition with regard to project engineering (process and interactions of the actors)
[note]
.
Let’s look at how the Covid crisis came to meet a health system lacking in its capacity for collective intelligence, by extending our thinking with our third online carte blanche:
Globality, partnership, autonomy in health. When the emergency sweeps everything away, but reveals the essential! — Kairos (kairospresse.be)
WHITE CARD 4: Covid Crisis and Emotional Intelligence: The Missing Link
Introductory text
Anonymized testimony from a general practitioner:
» À the final stage of the disease, that of the possibility of death, it is even more striking to note that, for patients over 70 years of age, the instructions issued by the scientific authorities (SSMG: Scientific Society of General Medicine) make it possible to coexist:
- On the one hand, the precautionary principle of not using Hydroxychloroquine and Azithromycin on the grounds of their presumed non-effectiveness and their possible side effects;
- On the other hand, the possibility of circumventing the law governing euthanasia, as soon as a single sign of severity appears, by means of a protocol pudimentarily called on the SSMG website: « Palliative management of respiratory distress: therapeutic protocol ». This protocol consists of the use of Morphine, Valium, Scopolamine and Primperan. Each of these molecules has the well-known side effect of depressing the nerve center of respiration.
While it may seem understandable to have recourse to this compassionate approach when a patient is at the end of life without any therapeutic possibility, it is an immense paradox to advise against a possible treatment (in use for other pathologies) because of its potential side effects while recommending rather dangerous molecules with the (unconfessed) intention of accelerating the death of patients who end up in respiratory distress without any treatment having been attempted.
Each doctor obviously acts according to his or her own conscience, depending on the end-of-life project previously established by the elderly person or his or her family, but it seems legitimate to ask how many doctors have not perceived this paradox and have accepted the impotence recommended/imposed on them by their scientific authorities.[note] »
The risk of being literally swallowed up, consciously or unconsciously, by such prerogatives plays out on two levels. One, personal, regarding the conflict of loyalty, such as any manipulative process can embark us. The other, professional, in order to respect the commitment of the patients we care for. Only a well-made rather than a well-filled soul will avoid this double pitfall.
This is where Montaigne’s thought: » I prefer to forge my soul than to furnish it » becomes inescapable…and that such forging abilities cannot be exempted from emotional skills[note]. This is all the more true given the prevalence of multiple mental health issues that the physician will be called upon to manage[note].
As well as intuition.
Such as the one that is noted through an enigmatic character, in Krzysztof Kieślowski’s 1988 film, « The Decalogue 1: One God Thou Shalt Worship. » The director shows the complexity and the sometimes paradoxical aspect of the relationship to the law, here to that of mathematics, in situations drawn from reality. Thus the fate of this child, skating on a frozen lake whose ice breaks, throwing him into the cold and deadly water while statistics and his father, a university professor, whom he admired, had predicted with certainty the absolute absence of risk.
It is to such a reflection that this next carte blanche invites us.
And we are, moreover, enthusiastic to discover that the journal Pratiques, whose number 93 concomitant with this essay, entitled « Can we care without touching or being touched?[note]He is also involved in radio with the program « Les voies de la médecine utopique ». It is, indeed, in some respects, to a form of Utopia that we invite you from now on and in the continuation of these white cards…
Indeed, and again, as the medical students remind us, we are talking about utopia because we are talking about profound changes that are desired. Changes that have an impact not only on the object in front of you, but on yourself: » It would also be interesting to work on the ever-present taboo around mental health: someone suffering from stress or depression, for example, is often ashamed of it and fears being perceived as weak. The idea that you have to be crazy to consult a psychiatrist or even a psychologist is still very common. This is acommon problem, which hinders patients in their proper management and recovery. « …and this taboo is already present within the medical world itself, with the consequences that go with such a denial of reality. Let’s examine this with the Covid crisis, expanding our considerations with our fourth online white card:
Covid crisis and emotional intelligence: the missing link — Kairos (kairospresse.be)
WHITE CARD 5: Of the vegetative soul in Covid weather
Introductory text
« As Richard Horton, editor of the British medical journal The Lancet, reminds us , Covid-19 is not just an infectious pandemic. It is above all a syndromic disease, where the interactions between infectious disease, non-communicable pathologies and age are potentiated, aggravating the symptoms and the prognosis of the infection. The prevalence and severity of the Covid-19 pandemic is thus amplified by pre-existing epidemics of chronic diseases, which are themselves socially distributed. Indeed, these non-communicable diseases are distributed in the population according to a social gradient: their prevalence increases as the economic and social capital of individuals decreases. This social gradient also illustrates the notion of syndromes: economically fragile populations with multiple co-morbidities have paid the highest price for Covid-19 and its management. [note]« The article « When the global response to the COVID-19 pandemic goes without health promotion.[note] « This notion of the union being absent from the overall strategic vision of public health, when it is part of the principles of health promotion, is also emphasized.
Thus, some physicians in the field, who are used to focusing their practice on ways to preserve the health of patients as much as on ways to cure them, are approaching the arrival of this virus with thoughts aimed at prevention and health promotion. They can draw on their reflexes and knowledge rooted in their practice to try to improve patients’ abilities — or resources — to respond effectively to any disease or virus.
« The exclusively materialistic approach to life leads us insidiously to the weakening of the vital potential of all forms of life on the planet, or even their pure and simple disappearance, by the collapse of the immune systems, in humans, animals or plants.[note]
This is true for physicians who have developed a more global practice of their medicine. This is far from being an easy path, as what encourages openness to such potentialities is not favored, as attested by this (anonymous) testimony of a medical student: » During my internship in general medicine, one of the doctors had submitted her application to become a training supervisor and it was blocked because she was training in nutrition. In the end, this was accepted on the condition that what was learned in training would not be taught to the students during the internships… « . And a trainer of emotional skills for practicum teachers added (anonymized testimony): » Yes, I know. I’ve had plenty of other similar stories when I’ve been involved in training practicum teachers. This is absolutely true. « .
Such an observation is all the more decadent (in the sense of an indecent gap between knowledge and action) as the progress of science shows and demonstrates new knowledge about the importance of adequate nutrition, information sometimes relayed by the general public press as shown by this excerpt from a program on RTBF, the Belgian public channel, on the issue of microbiota[note] : » The microbiota has a very broad and general role. Simply because it is closely related to our immune system, which is largely located there (70% of immune cells are at the intestinal). And of course, our immunity is our great guarantor of health. It must not be too active because otherwise it causes chronic diseases, it must be sufficiently active otherwise we get sick all the time, and it must work properly so that it does not turn against our own cells, which is an autoimmune disease. So in any case, it is important. Metabolic diseases such as diabetes or obesity, cancers, neurodegenerative diseases, chronic inflammatory bowel diseases, autoimmune diseases, depression, and even things like osteoporosis…
All diseases are in some way related to the microbiota.
To break excessively with our own resources in favor of a chemical, physical and technical whole appears, to say the least, as a lack of anchoring to reality, to the body and to the present.
What a downstream site again!
Being intrinsically linked to the living, just like this virus we are trying to fight, we should rather try to listen to what it teaches us…
And it is perhaps precisely this role of prevention and health promotion that would be the most fundamental learning from this crisis in terms of global medicine (taking into account all the social and health dimensions of the human being and the corresponding social and health services), or even holistic medicine (integrating a deeper connection between the person and between the person and Nature), leading to a break in the paradigm* of medical education, which is too exclusively centered on the curative field. And this so that the definition of health of the WHO can, one day, be operationalized concretely… and not remain a vain speech, or, in fine, a tool of confusion.
It is to such a reflective perspective on our Covid 19 crisis that we invite you with this fifth online carte blanche:
Of the vegetative soul in Covid times — Kairos (kairospresse.be)
CARTE BLANCHE 6 : Dancing with the Covid
Introductory text
Art is knowledge, to take up here an idea of Nietzsche. Art is not something that would be added to the world as we know it by our intelligence and that would be a form of decoration of this world, an adjuvant, a way to embellish our world. It is also an experience, a knowledge of the world which implements our intuition and thus from that point of view, we have this other faculty by which we know the real, this other faculty by which we give ourselves another experience. And our whole human endeavor is to become complete humans who walk on our two legs, that is, who have the intelligent experience of the world and also the intuitive experience of reality. And there we put an end to the drama or tragedy and we become the complete humans that it is our task to make happen.
Souleymane Bachir Diagne
« There are those who want to die on a rainy dayAnd others in full sunThere are those who want to die alone in a bedQuiet in their sleep
I want to die on stageIn the spotlightYes, I want to die on stageThe open heart in full colorTo die without any painAt the last meetingI want to die on stageSinging to the end[note] »
» The « poetics », more than all the other knowledge, it was necessary to uproot it once for all « . This sentence taken from Nancy Huston in her book « Souls and bodies [note]This « intuitive, emotional, connecting intelligence », whose scope is reduced by the explanation of how and why, is reflected in the work.
And nevertheless it is indeed knowledge as she specifies it. In our perspective, this knowledge refers to personal resources ‑capacities, faculties, aptitudes- allowing this opening to the imaginary, to the symbolic, to narration, to creative expression. And all the more, or all the better that this last will emancipate itself from the conventions and the standards, within which the artistic environment, caught up by the academism, just like the scientific environment, can lock itself up or even reduce itself, enclosing the knot of Möbius in a loop always narrower in the direction of a becoming which impoverishes itself rather than opening itself.
Because, it is necessary to specify it, a person can have made 10 years of studies without having neither good sense, nor critical spirit, nor intellectual curiosity. It is a reminder that instruction should not be confused with intelligence. And intelligence is above all global, full, of all our resources, both cognitive and emotional.
Let’s expand our perspective by reading our following white card, which calls on our imaginative and creative capacities to better deal with the next health crisis.
Or else. By fostering the ability to observe and interact, as can be learned in some acting classes. Our rush to judge what is right and what is wrong confuses our observations. Yet few things are more important, more inspiring (and more overlooked) than observation. Knowing how to observe, and especially observe oneself, can be learned. It is even one of the highest forms of intelligence. In the same way that interacting means starting by making the three brains interact: head, heart and guts!
And, as no health certificate is necessary to cross the borders of the imagination together, let’s proceed with our new online carte blanche :
Dancing with the Covid — Kairos (kairospresse.be)
WHITE CARD 7: Spirituality, individuation and medicine: the covidian Kairos
Introductory text
« But is it the lake, is it the eye that best contemplates? The lake, the pond, the still water stops us towards its edge. He says to the will: you will not go any further; you are made to look at the distant things, from beyond! While you were running, something here was already watching. The lake is a big quiet eye. The lake takes all the light and makes it a world. Through him, the world is already contemplated, the world is represented. He too can say: the world is my representation.[note] »
It is to a radical reversal of perspective that we invite our reader throughout these texts. This last carte blanche suggests more particularly to leave the world of our only representation in order to enlarge it to a reality to which our own senses can give us access. Such an approach is all the more crucial today, as it is a question of « learning to pray in the age of technology », quoting the beautiful book by Gonçalo M. Tavares, professor of epistemology and an important figure in contemporary Portuguese literature. It is that the urgency is palpable and not only that of the operating room as seems to say this extract of the back cover of his book:
« The surgeon Lenz Buchmann is not a good man. In his world, disease is cellular anarchy, the scalpel a weapon. Compassion is a superfluous feeling. Eager for power and combat, he abandons medicine for politics. His credo: never lose control, refuse the irrational. Stay strong no matter what it takes. Fear is illegal. »
The urgency would be here to get rid of the « mirage of the certainty », quoting, in echo to the book of Tavares, that of Siri Hudsvedt
[note]
already mobilized in our white card 5.
The only possible way, a path of individuation ‑of subjectivation- always uncertain and which passes by the « to understand its action to understand what one is » allowing to give again « the lightness of the gravity to the man without gravity », as this next white card engages us there in order to avoid the impasse of Oedipus…
« The episode of the Sphinx possesses a singular depth which makes it perhaps the center, the node of the whole story. For Oedipus knows nothing about himself, neither his origin, nor even his name (Oedipus is a nickname). All men know how to answer the easiest of questions : who am I ? What is my name? Who are my parents? Oedipus, him, does not know it… But no man before him had been able to solve the enigma of the Sphinx, whose answer is precisely, man. So, where everyone knows his singularity (who I am, me), but not the concept (the man), for Oedipus, it is the opposite: absolute blindness on the singularity of his self, but unique clairvoyance on the generic concept. Way also to mean that this knowledge by concept gives nothing if the immediate knowledge of oneself is not present. »
This last text concludes our 7 white cards. Among the infinite number of meanings given to the number 7, we choose a meaning which is however charged with a certain anxiety because it indicates the passage from the known to the unknown: a cycle has been completed, what will be the next one[note]?
If each of these white cards represented, in its own way, a time of investigation, a true Chronos, in a duration necessary to understand , to commit is another time.
It is the time of Kairos!
The one to leave the only representation of the world and learn to Live.
» The stars, we do not desire them; we can only rejoice in their splendor. »
Goethe
Let’s continue this opening with our latest online carte blanche:
Spirituality, individuation and medicine: the covidian Kairos — Kairos (kairospresse.be)
ISHAH
[note]
Florence Parent
Discussion[note]
» Yes, but, » — as many people still argue — « without measures, the disaster would have been even greater! » If it is useless to want to convince, that is an intellectual challenge, it is now clear that the epistemology in which we will have built ourselves and the degree of openness to knowledge that we will have offered ourselves in life will, both, fundamentally determine our way of feeling, managing, reacting, understanding, or acting in this crisis.
Conversely, the observation — at the time of writing — of a whole year of trying to deal with uncertainty through numbers and witnessing the overall worsening of this same uncertainty could be unanimous.
The chaos is at its height, allowing, in the confusion that accompanies it, the mechanics of the Karpman triangle
[note]
of the Karpman triangle, by the immoderate use of it by the most accomplished, or skilful, « experts », media or politicians in the field.
Indeed, the first studies emerging at the beginning of 2021 have confirmed on the one hand, the psychological suffering[note],[note] as well as many other « collateral damages » on various levels[note]. On the other hand, they have established the uselessness or very low effectiveness of containment measures[note]. At the same time, letters and white cards [note] more and more open to officials, illustrating very critical opinions on governance itself have appeared in so-called « mainstream » newspapers and no longer only through alternative media[note],[note]. Faced with these observations, denial is most frequently encountered, sometimes manifesting itself paradoxically in a ‘benevolent’ or ‘listening’ attitude among the most dogmatic of these ‘experts’ or politicians who have promoted these same logics of confinement, and this in cognitive dissonance[note] the most total. In other words, they display an « air of nothing » or a direction « with the turning wind » passing from T0 to T1 without consideration of their fallen soldiers, in various forms (also psychic, economic, social…) on the battlefield. Would we be so easily « replaceable »?[note] ?
Among the soldiers who fell on this front, we note the unprecedented proximity between distant generations, that of grandparents and young people, as testified by the father of a teenage girl who committed suicide at the dawn of her 18th birthday[note]A young soldier, mouth open, head naked, And the nape of his neck bathed in the fresh blue watercress, Sleeps; he lies in the grass, under the naked sky, Pale in his green bed where the light rains.[note]
To the aforementioned cognitive dissonance, if not outright denial[note]confirmation bias and cognitive bias[note] quite common from « immature » authorities[note]In addition to the above, a number of other social psychological mechanisms have been added that are clearly more tendentious in terms of democracy (and contradictory debates) on a social and societal level. In addition to a rather infantilizing communication around a « behavior-reward » type of containment management close to a « stimulus-response » type of behaviorist logic (which we document a little more in a footnote, including the role of certain academic circles, including social psychology[note]), we have already alluded to media censorship.
However, by a kind of amplification, perhaps specific to our modernity so much mediatized, digitized and networked, a phenomenon of discrimination has invaded all the layers of the population[note]. The media-political logic of « pro-or-contrary » has allowed the most informed people, those who have tried to understand the more global stakes of the situation through complex and analytical thinking, to be systematically labelled as « conspiracy theorists » or other stigmatized terms[note].
» There is the stigma of infamy, such as the fleur de lys engraved with red iron on the shoulder of the galley slaves. There are the sacred stigmata that strike the mystics. There is the stigma of illness or accident. There is the stigma of alcoholism and the stigma of drug use. There is the skin of the Black, the star of the Jew, the ways of the homosexual. Finally, there is the activist’s police record and, more generally, what you know about someone who has done or been something, and « these people, you know.… « .
What does all this have in common? To mark a difference and assign a place (…).
» With a 50-year career as a biologist and virologist, Bernard Rentier, now retired, scans the Covid-19 figures and scrutinizes scientific articles. The former rector of the University of Liege says he is tired of hearing the anxiety-inducing speeches of some health experts. Hurt by being called a « reassurer » and even a « merchant of denial » during the second wave, the septuagenarian maintains that another approach to the epidemic is possible « [note].
The « social harm » process.
« According to sociologist and professor at Rennes 2, Stéphane Héas, co-author of the book « Les porteurs de stigmates », « this phenomenon constitutes an element of the process called ‘social prejudice’ that leads to violence to people ‑up to and including murder, intimidation, insults. »
The process has been known for decades, he assures us, whether « in history, in sociology, in psychology ». And it is cumulative. « People who undergo this process will often be burdened with other reproaches, more or less logical, sometimes completely irrational, but with very concrete effects of exclusion and avoidance. These people may then be considered as not very careful, or even ‘dirty’ because they are in contact with people who are supposedly dirty or infected. Therefore, to be avoided, or even for the most violent cases to be removed or destroyed[note]. » « .
In the face of the vaccine propaganda
[note]
In the face of the vaccine propaganda that is in full swing at the time of writing, the very heart of the intervention troops, i.e. the « medical profession », is very particularly subject to the mechanisms of social psychology, notably through the normative authority represented by the Order of Physicians.
» (…) It is clear that a strong physician recommendation is the only way to contribute to adequate prevention, protection and promotion of health, as prescribed in Article 5 of the Code of Medical Ethics (CDM 2018). The College of Physicians will ensure that physicians fulfill their ethical duty by taking a pioneering role through the recommendation and promotion of vaccination. »[note]
The guilt mechanism, easily anchored in our Judeo-Christian past and which is also reflected in our epistemological choices (cf. white cards on this subject), is at work with a potential for reinforcement in the exclusion of some to the benefit of others, the logic of groups (identity and belonging or « the herd instinct » as Nietzsche would say!) and the zizanie that can operate according to the often known relationships between medical peers on the question of vaccination. The latter is emblematic of a certain relationship to the world (the most anchored convictions because they determine our ontological choices, in proximity with the spiritual dimension of our beings) and participates in deep values and, therefore, emotions. Such a radical imposition was made in the absence of an open debate on the issue of preventive, protective and promotional medicine as we have outlined throughout this essay.
Why play with emotions downstream rather than having developed emotional, relational and ethical skills upstream, which are conducive to debate and controversy in the medical and health world? And why radicalize the option of vaccination alone when a fundamental debate on the multiple and critical stakes of vaccination has never taken place in our medical studies, that it emerges perhaps in a salutary way (but also too late) with this crisis…
We thus see the emergence or reinforcement of the most deleterious mechanisms of social psychology, reminiscent, in some respects, of the worst hours of history[note] …Because it is a question of understanding, with the help of the fields of social psychology[note]. If Arendt developed her theory of the « banality of evil » during the Eichmann trial[note]A hypothesis remains. It is that of having missed the final explanation, that of « doing good by doing evil », having left the trial too soon, while Eichmann affirmed his action not by reason of authority but because he was doing Good[note]In opposition to a group that does good,building a group that does evilWhether it is represented by armed terrorists entering the Bataclan, or people discussing the risk-benefit of Covid vaccination, the outcome is the same: these representatives will be connoted as « anti-vax-anti-modern-anti-society-anti-well … » extremists, or anti-5G, but also associated with one political extreme or another. This is the risk of totalitarianism in the face of the instrument of social binarization[note].
How did we get here
[note]
?
The current binarization of society, inherited from the epistemological foundations that built us, is based, more than ever, on sterile oppositions. In this respect, it is not in vain to say that the health crisis becomes one of the major contemporary levers of this duality, setting up a form of binarization that it globalizes. The latter engulfs, or makes others dissipate. It is that of a constant need for reassurance through figures in order to manage the uncertainty of reality. The duality of « security-formal-order-institution » versus » insecurity-informal-disorder » is confirmed in the relationship to rules, protocols, norms and measures that is splitting up all our spaces of encounter and construction of the Self through the Other[note].
This mechanism of binarization, or opposition, obviously does not favor the much-needed dialogue, which, like it or not, is the only way out. This is what this testimony tells us, gleaned among many others on the web; this one having the merit of its lucidity…
Smoking
» Let’s go beyond smoke and mirrors to find a way out!
This week, a young girl committed suicide. Her father describes his daughter’s distress, his own distress at not having been able to help her. This week, young people have dared to speak out and ask for access to life.
In the media and on social networks, the positions are polarized because they all start from the assumption that one should choose between preserving the lives of the young or the old.
And that’s the real smoke and mirrors: while we allow ourselves to be pitted against each other, we don’t stand up for the ideas that would benefit the most people. »
Establishment of a dogma allowing dual thinking
Dogma of a deadly pandemic where the only possible narrative is that of the health authorities and dogma of The solution which is that of vaccination.
In this interview
[note]
of which we propose an extract below, we clearly perceive the presence of a dogmatic thought and we detect how democracy is reduced to such a logic: to chatter!
Indeed, to the question » what role do social networks play in this crisis? « , this social psychologist and university professor answers: » The main role they play is to allow people who are similar to each other to find each other, to create a link, to develop a collective identity and a vision of the world. That’s pretty positive. On the other hand, some world views are not always very conducive to fighting a pandemic. Often this vision will be built in opposition to the authorities’ discourse. This polarizes society and sometimes makes democratic debate difficult. »
The use that is made by some doctors in the press[note] of the concept of discrimination is another manifestation of this religious, dogmatic logic at work. Thus, for some of them, the accessibility of the vaccine to all is sufficient to make it non-discriminatory. However, the choice of people not to be vaccinated allows them to be discriminated against at the entrance to festive events, for example. To put it another way and quoting Caroline Vandermeeren, writing on a social network about this same article: » In short, his understanding of the principle of discrimination: if one has had the choice to refuse a vaccine that is not compulsory, one has the right to discriminate against access to events on the basis of the choice of the people… It’s funny, because it seemed to me that in the principle — for example — of non-discrimination on the basis of religious choice, precisely the principle consists of not discriminating against people in relation to a choice that is left free and that — therefore — cannot lead to discrimination in fact. »
This dogma concerning the vaccine is also well known and criticized by certain doctors who have ventured into a form of public « revelation », an exercise that is similar to social violence in terms of confrontation with the norm. As a testimonial, the one made by a resuscitation physician, gleaned in May 2021 from a network: » It is important to know that most physicians are spiritual sons of Pasteur, Koch and Jenner, by culture and training, me first. For some this goes as far as making « THE » vaccination an ideology based on almost uncreated revealed truths and not a means among others to fight against infectious diseases … with suras that are recited without having the slightest permission to discuss them and even less to criticize them. For them it is a sin not to take the whole vaccine pack, it is a kind of apostasy. The Ordre des Médecins is the guardian of this vaccine faith that even a world-renowned virologist cannot be allowed to question, even if only occasionally. (See Raoult’s book on Vaccinations)[note]. NO vaccination can be criticized insofar as vaccination is a revealed and uncreated truth… A kind of Koran. It is as useless to try to criticize ONE vaccination to a « provax » as it is to bring a proof of utility of ONE vaccination to an « antivax »..
This is a psychiatric phenomenon that is known and studied in connection with sectarian movements.
Like the belief in THE mask and the blind confinements and other grotesque curfews, vaccination has long since left the field of science.
There is no evidence to dampen the fervor of believers. »
It is not surprising that, starting from the medical discourse, a line of demarcation is deeply established in society, reinforcing in a masterly way in this crisis the simplistic logic of the organization in two rival groups, those of the pro and those of the against… like a soccer match for which it is always a question of taking sides if one wants to favour a hot atmosphere… or the zizanie in a way!
This duality, contrary to Morin’s « complex thought », removes from our view the perfect but nevertheless paradoxical meeting of the Cartesian, positivist, and here scientistic logic, which prevails in the medical field, and the neoliberal, technical, and cold logic of numbers, based on the sole logic of the market and of profit. This conjunction is the open door to all the corrupt drifts in a form of global alienation.
Many of the protagonists of these two worlds meet through what we would call « a paradoxical reversal of empathic necessity ». Namely, in some countries (are they the most Cartesian countries?), a mechanism of guilt, playing on the feeling of empathy, of populations, groups of actors and individuals, is observed. However, we would expect the opposite, as the reflective judgment built from a comprehensive logic reminds us. This is true both in terms of care and health policy. The whole understood in a democratic partnership approach, that is to say based on a collective intelligence, inclusive, also allying the patient, in coherence with the most beautiful speeches on health, since the definition of this one given by the WHO, to the Charter in promotion of health of Ottawa[note].
Discourses widely conveyed by all schools and institutions of public health in our countries, but not operationalized in the concrete of medical training and therefore not integrated into the practice — praxis — of caregivers, as we have demonstrated throughout these white cards.
However, and in contradiction with such a democratic perspective, our humanity, constitutively vulnerable, as defined above, is currently deprived of its power to act. The latter is restrained by the domination of the other, by the authority represented by governments and experts. To the figure of injury (illness and « collateral » damage) and dependence (technical, technological, economic and pharmaceutical), is added that of self-impropriation (dominance), in reference to the three figures of vulnerability developed by the philosopher, Estelle Ferrarese[note].
There would be here a form of plot without actors, where, even armed, we would not know whom to shoot. The Russian doll is renewed endlessly, while our souls are in perdition and our bodies in pain. Philosophers argue that the political system that is being set up in many countries as a result of the health crisis is a « digital totalitarianism », while the pundits of the World Economic Forum in Davos speak of a « Great Reset ».
Some, like the lawyer Régis de Castelnau, maintain that if, on the one hand, our governments[note] did not come to power through tyranny and that, on the other hand, the concept of totalitarianism popularized by the philosopher Hannah Arendt[note] cannot be applied to the functioning of these same political organizations, on the other hand the term dictatorship could in a certain way be invoked. In fact, according to this same lawyer, the way in which power is exercised poses serious problems. To speak of a form of dictatorship is not completely absurd.
Some people invoke, in front of the progressive control of our bodies, rather than the notion of dictatorship which should remain a temporary measure, a plutocracy responsible for a totalitarian drift. History will help stabilize the discourse on what we are experiencing…
Still others go radically further. A witness to the Holocaust and a survivor of the Nazi regime, Vera Sherav warns us of the dangers of what we are experiencing now with the waves of totalitarian tyranny, medical, political, economic and social absurdity that have descended on people around the world.
» What distinguishes the Holocaust from all other mass genocides is the central role played by the medical system. The entire system at each stage of the killing process has been approved by academic and professional medicine. Prestigious doctors, institutions and medical societies have helped legitimize the mass murder of civilians[note]. »
Such a statement is in line with Sylvie Simon, when in 2009, in her book entitled « Vaccines, lies and propaganda[note] « she warned us: » According to Plato, Socrates was sentenced to death because he did not believe in the gods recognized by the state. Later, the Inquisition burned anything that went beyond its understanding or could jeopardize the hegemony of the Catholic Church, which taught us to accept dogmas without trying to understand them. Today, as George Bernard Shaw once said, « We have not lost faith, we have merely transferred it to the medical professions. Faith in this new religion has now become a veritable fanaticism and the gods have been replaced by mandarins and experts. We no longer think, we « believe ».[note]. »
In any case, the surprise is great for us Westerners, but it is undoubtedly in line with the idea of an « evil of banality » as developed by Ece Temelkuran, who urges us to always remain vigilant to avoid falling out of democracy[note]. A form of acceptance of these liberticidal measures, and even more so of their scientific incongruities as we have developed throughout this essay, is cause for concern.
Between interiority and exteriority: a middle way to be drawn…
While we do not advocate any kind of backward step, we do seek through these white cards to initiate a debate within the medical world and more particularly at the level of its training institutions. This, in order to know which path we want to favor between two extremes, summarized (in a caricatured way) as follows: on the one hand, Klaus Schwab’s Great reset, connected objects, 5G, transhumanism, the headlong rush towards a future where we would progressively lose our humanity. We would then be at the service of an all-powerful technocracy where control and security would be the leitmotivs. On the other hand, a humanity in proximity with a philosophy of Life and Living such as the one deployed today with, as an example, the perspective of permaculture, or the one defended by Corine Pelluchon, in proximity with animal philosophy and animal ethics in order to complete the project of the Enlightenment developed in her last book « Enlightenment in the age of the Living ».[note].
Where are our Western societies headed? As an additional argument, the only sectarian aberrations denounced by « the interministerial mission of vigilance and combat against sectarian aberrations » are[note] concern the alternatives, as much of health as of education (anthroposophy for example), favorable to the emergence of the particular (singularization; individuation; emancipation). The scientistic drift, based on a positivism and a reductive, but universal materialism, does not participate of the tendentious imagination.
We could still believe exaggerated the transhumanist horizon, even post humanist, but with this crisis that hits us full force, the reality of a form of more or less conscious puzzle has taken shape and the dangers of drifts have become totally credible.
And we, doctors and caregivers, are in trouble because technocracy has decided to use the most beautiful art of all, that of healing, as a Trojan horse to accomplish its goal. What Foucault would have called: biopower.
This makes us even more responsible being in the field of care and, therefore, aware of a clear drift at the medical level.
On an epistemic and ethical level, with regard to the social responsibility of medical schools in this crisis, the shift to reflective judgment is the categorical imperative! Moreover, this is the only way out of a « pedagogy of the crucifixion » and the way of the cross that it imposes…
Bruno Edan, Crucified, 1981, reproduced with permission of the publisher, Delphine Durand. Bruno Edan, the urgency to paint (Photographs by Pierre-Marie Villereal). 2020: p. 59
At dawn…
Our conclusion will be like a dawn.
If our investigation on the field of medicine has led us to question the subsoil of human mechanisms at the basis of medical and sanitary decisions, through the epistemological choices that our societies make, in the techno-scientific habitus that freezes them in place, a wider world nevertheless exists.
On the condition of an awakening that the perspective of the robot can only offer us in mechanical form
…of a morning awakening.
Because lost we are and so let’s give the floor to Jacques Bouveresse, whose editorial note of his book « The modern myth of progress » is[note] presents a form of synthesis to this analysis of the Covid crisis and to this plea for a renewal of the epistemology of medical studies.
» Among other remarkable aspects of this analysis of the « modern myth of progress » is the fact that most of the authors on whom Jacques Bouveresse relies have seen « the fanaticism of progress » as « the characteristic feature of our time » — even though their time seems to us, by comparison, to be quite spared. Without mentioning the authors of the 19th century mentioned in the introduction, neither Karl Kraus (1874–1936), nor Robert Musil (1880–1942), nor Ludwig Wittgenstein (1889–1951) have known the glorious destiny of the work of the British mathematician Alan Turing (1912–1954), the originator of the computer. It would therefore not be necessary to have benefited from the promises of the Internet and the nuclear industry, nor to expect in the benefits of biotechnologies but only to have attended the beginnings of the industrialization of the scientific research to see that the religion of the progress, which replaced all the others, including like « opium of the people », does not hide any more only a report of political, social and economic domination but truncated the survival of humanity against the improvement without limit of the material conditions of life of some.
One may wonder whether the possibility of going further back in time to find the wrong fork in the road of knowledge accumulation is more reassuring or, on the contrary, more worrying. For the American historian Lewis Mumford, the danger that threatens us « does not come from scientific discoveries, nor from particular electronic inventions. The constraints to which man is subjected and which dominate contemporary authoritarian technology go back to a time before the invention of the wheel.
But once the disease of progress has been diagnosed and the myths of reason have been disemboweled, Jacques Bouveresse specifies, we still have to avoid re-establishing, « in one form or another, an ancient authority », of the kind whose « assertions do not need proofs nor commandments of justifications »: for then we would have replaced « the progress recognized as more or less mythical by a very real regression ».. »
For our imaginations need myths and rites, those that allow for connections that our ancestral and reptilian dominance and submission do not seem to have integrated yet. The challenge remains in our ability to « reflect » to the depths of our intentionalities…
About intentionality…
Is it romantic to think of rites as the fox of the little prince (carte blanche 6) when we know that they also participate in the construction of group identity, and, potentially, in a logic of violence such as that developed by René Girard[note] or recalled by Erwin Goffman in this same carte blanche 6 [note] And this, in proximity with the violence analyzed in the field of research in social psychology (theories of intergroup relations), conducive to the construction of rivalry, conflict and war.
However, not having rites anymore is also problematic as we object, with Edgar Morin, in our carte blanche 6 focused on the ability to develop our imagination and emotional skills.
Thus, from this short argument around this notion of « rite » (rites to develop our imaginative capacity and to open up or rites to reinforce our group identity and conformism, etc.), what we want to raise, or what matters above all, is the need to develop a awareness of our actions. That is to say, the ability to analyze — to understand — what determines our action, even unconsciously (influence of our environment), what guides it and for what purpose our action is mobilized. This is what we would call intention. We will not enter, here, in the theories and researches in philosophy around the concept of intentionality so much the field is vast, however it is well there that a way of emancipation is found…
… The « Dreamtime ». The mythical moment of the creation of the world by the ancients.
In Australia, in the context of a revival of Aboriginal identity, in the Papunya Tula community, elders have translated their cultural practices and symbolic knowledge into paintings. These works reflect a new field of dialogue from Gaia our common earth[note].
The Toraja
[note]
is a people who live in a mountainous region of the island of Sulawesi, it is predominantly Christian, and it has a very particular funeral rite: the burial of the deceased occurs only long after death.
For this indigenous people, death is not perceived as an end, but as a state of prolonged sleep. The cadavers are mummified with a solution based on water and formaldehyde which stops the putrefaction process.
This particular ritual allows people to cohabit for some time, weeks or even months, with the deceased, as if they were still alive. During this period, he symbolically receives prayers and food four times a day. He is dressed, his hair is done, and his family is having conversations with him as if he were still alive.
The love they have for their ancestors is such that they find it normal to share their existence with the remains of their loved ones. The dead do not frighten them. Sometimes, some families organize a kind of « second funeral ». Called « ma’nene », the ceremony consists of removing the deceased from his tomb to clean his body and put on new clothes.
This essay was written in memory of our ancestors, for us, Westerners, who no longer know.
And the man of tomorrow, on a path lost for humanity, in a too exclusively externalized balance, clinging to the only determining judgment, dropping more and more his capacity to reflective judgment, seems to delegate all his fears rather than to appropriate them. Here is the drift of the « theoretical man », as Nietzsche might call him.
For as Clément Rosset reminds us in this extract from an interview with Alexandre Lacroix
[note]
:
CR: « Every life is going to end and there are no exceptions to this rule. We are faced with the most undesirable reality. I think that the finitude of the human condition, the intolerable prospect of aging and death are enough to explain the so constant, so widespread obstinacy of men to turn away from reality.
AL: Is there a connection between this denial of the real, because of death anxiety, and Freudian repression?
CR: No, I don’t think so. Sigmund Freud is interested in the mechanisms of repression in neurotic individuals, whereas the elimination of the real by what I call in my philosophy the double is the procedure used by normal people. And normal people are much harder to cure than sick people, believe me! « .
Notes and bibliography
