Spirituality, individuation and medicine: the covidian Kairos

« Why must the fierce lion become a child? », asks Zarathustra. The answer is not long in coming: « The child is innocence and oblivion, a new beginning and a game, a wheel that rolls over itself, a first movement, a sacred ‘yes.’  » Nietzsche.

This text extends the debate on medical and health decision making that was initiated around Evidence-based-medicine (EBM) with the white card entitled: »  the role of physician training and medical epistemology in the crisis of Covid 19 « . The discussion continued in a second carte blanche, centered — as its title indicates — on a critique of the precautionary principle:  » Precautionary principle or « risk of blame »? « This was followed by the question of the destructuring of the health system with regard to the inability to recognize its own resources, a question introduced with a third carte blanche:  » Globality, partnership, autonomy in health. When the emergency sweeps everything away, but reveals the essential! « . Still on our epistemological thread, we then turned to the issue of emotions in medical education: »  Covid crisis and emotional intelligence: the missing link « . The fifth carte blanche entitled: »  Of the vegetative soul in Covid weather  » allowed us to anchor this psychological dimension in our bodies, breaking with all forms of idealism. A sixth carte blanche: »  Dancing with the Covid  » introduced us to the realm of imaginative and creative abilities, a possible path to individuation in a mechanistic and increasingly robotic medical world.

This seventh and final carte blanche concludes this reflection on the thread linking epistemology, medicine and the crisis of Covid 19.

By(1):

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

She did not say fear

 » My grandmother, standing before my grandfather, put a big bowl of coffee with bits of bread in front of me and asked me if I had slept well. If I told her about some bad dream born of my grandfather’s stories, she always reassured me: « don’t worry, in dreams there is nothing real. » I was thinking that my grandmother, even if she was very learned, was no match for my grandfather, who, lying under the fig tree, with his grandson José by his side, was able to set the universe in motion with just two words. It wasn’t until many years later, when my grandfather had already left this earth and I had become a man, that I finally understood that my grandmother also believed in dreams after all. This was certainly the meaning of the fact that one evening, as she sat outside the door of her humble home, where she now lived all alone, looking up at the stars, big and small, she spoke these words: « The world is so beautiful, and it pains me to die. » She did not say fear, she said sorrow to die, as if the life of hard and continuous work she had had received, at this almost ultimate moment, the grace of a supreme and last farewell, the consolation of the revealed beauty. She was sitting in front of the door of a house as I don’t think there was any other in the world, because there had lived people capable of sleeping with the pigs as if they were their own children, people to whom it was painful to leave life just because the world was beautiful, people like my grandfather Jeronimo, pig farmer and storyteller, who, feeling that death was coming for him, went to say goodbye to the trees in his garden, one by one, hugging them and crying because he knew he would never see them again.(2)  »

You talk about spirituality, but I thought you were an atheist…

In relation to the crisis that hits us, we consider the existence, and, therequirement of a Kairos.

 » The kairos is the time of the appropriate moment. It qualifies an interval, or a precise, important, even decisive duration. In common parlance, this would be called a tipping point. The kairos is therefore « the « T » moment of opportunity: before is too soon, and after is too late.(3)  »

This is the one that we introduce, in an obviously daring and at the same time reasoned way, through André Comte-Sponville(4).

« But spirituality can also spring from a discovery, a joy, an ecstasy. André Comte-Sponville prefers to speak of « enstasis » to describe the experience he had one day in the forest. He was walking with friends, when suddenly his consciousness expanded to the whole universe. Everything became simple, clear and beautiful, without separation or ego. Later on, he used the expression of the writer Romain Rolland: « oceanic feeling ». But at the time, there were no more concepts or words. His mind dissolved to make way for a jubilant presence. André Comte-Sponville speaks of it as a « spiritual experience that not everyone has the chance to live ». After a conference, a gentleman interrupts him:« You talk about spirituality, but I thought you were an atheist… ». The philosopher raises an eyebrow: « I have a spirituality because I cultivate my inner life. I am an atheist because I do not believe in a divine transcendence — even if I feel close, for example, to the ethics of the Gospels » « .

I have a spirituality because I cultivate my inner life

This introduction with this Spinozist philosopher allows us to target this necessary « interiority — exteriority » connection, proper to spirituality.

But such a connection is, in the end, not so far from us. It joins the taking into account and the conscience of our « multiple souls », those which with Aristotle we took again: the « vegetative soul » ( carte blanche 5 ), the « sensitive soul » ( carte blanche 4 & carte blanche 6 ) and the « intelligible soul » ( carte blanche 1 & carte blanche 2 ).

It’s about ‘nothing else’ than an enlargement of our own faculties, allowing (to paraphrase Fabienne Berthaud’s film with Cécile de France) « A bigger world ».

 » The Totality, the Whole, the World and the Real is at hand, but at the distance of what we can call capacity, ability, faculty. The Whole is right there, in front of you, behind you, in you. So close and so far away, at a distance from our senses like the spirit of the Centaur’s body. In the look at the patient, in the look at the caregiver, in the technicality of the touch and the sensitivity of the voice, a relationship is impregnated in the body.(5)  »

The Centaur refers here to « The Metaphysics of the Centaur », a metaphor used by the philosopher Eugen Fink(6) to capture an understanding of man, in the Judeo-Christian tradition, as being constitutively torn between opposing aspirations. That is to say that the man would occupy an intermediate position between the divine (Pure — Idea — rationality) and the bestial (animality — instincts — desire — corporality — irrationality). Such a perspective is in immediate proximity to the Platonism(7) in which the dualistic thought of Descartes, and of our modernity, was structured.

Returning to the definition of a « Kairos », we specify:  » He [Kairos]) is the condition of successful action and he teaches us that, paradoxically, success is almost nothing. If this one is so difficult to define, it also comes from the fact that it comes from « almost nothing ». « .

Could this « almost nothing » be, today, the expansion of our consciousness ? An « almost nothing » because it cannot be measured, quantified, objectified — and therefore despised? Only’ the invisible of a process of integration of all our Aristotelian souls, as a way of managing future crises: such would be the learning of the Covid, our Grandmother to all. And she added:  » I say ‘all’ because I am speaking in the masculine first(8) who does not hear the feminine ‑the subtle- in him « .

Thus, this XXIst century, if some think it is religious because of the extremes with which it is provided, others think it is spiritual, joining in this the famous debate of which philosophers and specialists of religions discuss endlessly, namely, the exactitude of the sentence pronounced by Malraux.

« I have been made to say,« The twenty-first century will be religious. » I never said that, of course, because I don’t know. What I am saying is more uncertain: I do not exclude the possibility of a spiritual event on a planetary scale.(9)  »

Open our mind to all our resources

According to our investigation throughout these white cards that punctuated a period of this health crisis, a way review(10)constructive and learning, directly dependent on the educational lever, would be the one that proposes to recognize the inherent complexity of life and to to use all our resources as conscious capacities. It is obvious that this is a long-term perspective whose utopia is proportional to the superficiality of our politicians, experts, doctors and managers of this crisis, whose people, paradoxically voters, are today, emblematically ‘hostages’.

Hostage to superficiality!

In this we join Nietzsche’s concern for the 21st century when he says, as we have already underlined in the previous carte blanche ( carte blanche 6 ):  » Descartes was superficial « .

Getting out of the Cartesian coordinates

There is, indeed, a need to go further upstream in a debate that is at the heart of cognitive sciences in order to give back the lightness of gravity to, as Charles Melman calls it(11)The « man without gravity », the one whose rejection of the « real » in favor of the « virtual » has made him lose his anchorage in the very sense of a loss of gravitation. However, the challenge of achieving such an understanding, and subsequently implementing it, requires precisely an interdisciplinary approach. This is to allow the scientific questioning to join the philosophical questioning(12) so urgently necessary in front of the observation of shrinking, like a skin of chagrin, of the loop « body-mind-world ».

How can we do this when our physicians — the very ones we have built and trained in our In addition, many of our own universities and faculties are not trained to perceive the limits of their knowledge and to be open to other ways of thinking, to cooperate and to work in networks, in interdisciplinarity and interprofessionality, in order to go beyond the disciplinary organization in silos of our faculties, knowledge and mental structures.

Let’s expand, let’s expand!

It is necessarily to recognize the importance of the whole of the action in the name of all the verbs of actions — to love as to prescribe — of which this action can account for.

To achieve a « transdisciplinary action » ‑condition of a collective intelligence- and, moreover, by integrating the partnership perspective of care ( carte blanche 3 ), is directly dependent on our « action » — on the way we set ourselves in motion — and on the way we act. to embody the verb of action(13) — of which we are in a way perpetually prisoners.

No knowledge will deliver us from this without going through or going back through the experience and an attentive reflexivity work, strongly conscious of the stakes of confinement, in all humility.

On the essentiality of conscious experience

Hannah Arendt says exactly that, but in a different way, when she talks about the Eichmann trial… She had noted that he refused to talk about his experience, to remember it… because it implied togive meaning to it, to make it something else… to get out of the (protective) process of « banality of evil » which would then set the conditions of empathy… and would have seized the totalitarian machine…

However, in an increasingly narrow Möbius knot, Descartes’ deaf voices are rumbling to the emotional nourishment our Reason needs (as we argued in our  carte blanche 4 ) :  » I have tried throughout my life to put all affects aside in my professional life.(14) « A doctor and professor of medicine, and a faculty educator, recently said. Guardian of a temple!

The categorical imperative(15): the exit of crucifixion and the epistemology of reliance 

« By making this choice, one postulates a certain relationship to reality that is particularly integrative and complex. This one presupposes the absence of ontological dualism (the problem of the separation« body-mind » in philosophy of the spirit). Indeed, it integrates, to the cognitive domain, a sensory, bodily domain, as well as the absence of conceptual dualism (separation« emotion-reason »). […] A form ofhorizontalism of « action » appears (« seeing » is valued as much as « analyzing », « reasoning », « touching », « feeling », « meditating », « creating », « diagnosing », « applying » etc.) without any hierarchy of value between the different activities. Any activity originating from the real defined as a sensitive and moving world has the same value.(16)  »

With Mauriac, it is to consider that:  » Nothing is in our intelligence that was not first in our senses « .

« Being scared to death »

Definition: to feel an oppressive fear, a great fright.

Origin of the expression: This expression was born during the 19th century and is based on the observation of some anthropologists, the latter having found corpses of humans apparently dead of fear. These deaths were part of societies with a belief in the curse.

Exchange on the health crisis (between navigators), gleaned from a network. April 2021.

  • « There is no need to be afraid(17). Especially now. Fear of what? Fear of whom? The state, with the help of the media, hits us directly on a sensitive part of our person. Don’t let it happen to you. Stay in control of yourself.
  • No, they won’t get to us. There is no need to be afraid to be careful. On the contrary, we all know from the example of our navigations that fear makes us lose our means and prevents us from having behaviors adapted to the reality. We also know that only our senses bring us the information we need.

What if, to paraphrase Immanuel Kant,  » we measure[ait] the intelligence of an individual by the quantity of uncertainties he is able to bear « ? It is undeniable that fear paralyses thought and that it is urgent to recognize that intelligence is indeed multiple, made of emotional and sensory capacities as much as of intelligibility ( carte blanche 4 ), allowing this first opening to the palpable World as much as impalpable and invisible.

An « epistemology of reliance », inclusive of positivist epistemology ( carte blanche 1 ), but not reduced to it, is the categorical imperative that should be urgently assigned, with this health crisis, to the faculties of medicine, in the name of a social responsibility that is incumbent upon them(18).

It is also, and only, such an aim that protects us from a century’s evil, that of a modern thought, which, by producing new knowledge, becomes in some respects, more ignorant. Indeed, as Maryvonne Charmillot points out in an article devoted to this subject(19), by excluding the lived experience (that proper to the reflective judgment)  » The fact that researchers are searching for the truth reproduces hegemonic knowledge and prevents social actors from thinking for themselves. This questioning is worked through the examination of the production of ignorance. It is a question of grasping how the dominant scientific conventional framework participates in the fabrication of ignorance. As a counterpoint to the criticisms formulated towards Western epistemological hegemonism, the article presents alternatives that embody a way of producing knowledge from social interactions, groups of belonging or institutional anchorings: « social epistemology », « epistemology of resistance », « liberating epistemologies », « epistemologies of the South », « epistemology of the link » « .

A constructive revolution to come

Imagination and creativity, at the same time ways out for individualisms and other mechanisms of rivalries constitutive of our democracies and conditions of emergence of a global process of individuation, are the paving stones of the constructive revolution to come.

This notion ofindividuation, which finds an original expression in the writings of Nietzsche, is fundamental. It joins the fact that we are « irreplaceable » beings, to paraphrase the title of Cynthia Fleury’s book(20). The individuation is the stake of the emergence of the Subject in its plenitude ‑which will differentiate it from the individual‑, thus meeting this radical criticism of the myth of Narcissus by Fabrice Midal from which we propose an extract of his work:

 » Everything that is said about Narcissus is false. Narcissus is not selfish. He is not in love with himself. He is an example of what it means to be responsible. An adult being. An acquiescence to life. To reject Narcissus is to reject a force we need. […]. True narcissism is not turning towards an image but towards oneself. Narcissus does not understand that he is the cause of the image that he sees and that fascinates him. He is unaware that the reflection he is contemplating is his reflection. He doesn’t know enough about who he is. We often make this mistake. We often identify ourselves with the image we are given of ourselves, whether it is flattering or on the contrary depreciating. For Plotinus, being narcissistic does not mean being self-obsessed, navel-gazing, indifferent to others, or manipulative. Narcissism is not seen as a psychological flaw, but as a misunderstanding of our own nature. It refers to the attitude of misguidance about who we are in the most fundamental sense. Narcissus is therefore by no means the symbol of egotistical perversion, but he symbolizes the being too ingenuous. Narcissus is a naive person, and this naivety, we do not have to condemn it, but to deliver ourselves from it. And this is the role of philosophy.(21)  »

Le Gai savoir(22)

Because of Erving Goffman(23), to James Ensor(24), while passing by  » the masked man of 2020(25) « , we remain unknown to ourselves and our action remains to be revealed unceasingly, in order to approach the being-in-us, and to manage to understand its destructive and constructive creativity.

Thus, in our perspective of a pedagogy by competences(26), the definition of this one takes back, in its foundations, this masked vision of our beings, in order to better regulate its action, by trying to understand its (own) action.

Indeed, a competence does not exist a priori, as universal, generalizable or predefined. It belongs to each individual empirical Subject, is elaborated in context and should make it possible to account for the transactional process at work, explained by the use of the metaphor of the « Möbius knot. Thus, to evaluate or judge a person or a situation (problem) is to understand, first of all, the context and the interactions of (powers over) the action. We are far from the perspective of an autonomous, self-engendered and autarkic Subject as some definitions (or uses) of competence may suggest. The openness given to situations, including their normative and technical dimensions, but also to the different forms of action, brings us closer to the definition of the notion of enabling capacity developed for example in critical philosophy by Ferrarese(27).

 » Even within the medical profession, there are contradictory views. Physicians do not agree with each other. And for good reason: two schools offer a different methodology. There are those who believe that medicine should be an exact science based on « evidence », Evidence Based Medicine (EBM)(28). Others defend observational medicine, based on clinical competence, experience and the sharing of empirical results among physicians.(29)  »

This excerpt above and the one that follows, by returning to the first movement on EBM ( Carte blanche 1 ) that they offer us as we close this set of white cards, allow us to realize how far we have come and that  » it’s not as simple, because there’s a huge difference between clinical trials that involve cohorts of patients and offer statistical data, and the real life of medicine, where you’re treating not a cohort of patients, but someone.  »

And this difference is the one that exists between a decisive judgment and a reflective judgment, a subtle difference — ESSENTIAL — developed at the heart of these white cards.

But be careful… !

… this same article states  » EBM is a way of teaching medicine, not practicing it « , and this is where we think the problem lies.

Also…

a culprit of this sanitary disaster seems to be found!

It is in the fine understanding of the pedagogical and learning stakes, of the formatting of our bodies and minds. It is also, more upstream, in a critical reflection on the epistemological and ontological foundations of our choices of society, joining in this as well known names as Freinet, Montessori, Freire, Illich, Whitehead, Dewey.…

Depending on the type of teaching and, above all, as we have seen, depending on the epistemology implemented, we will end up with two situations. On the one hand, a neuronal and corporal shrinkage of our beings-in-the-world progressively locking themselves into the only determining judgment, based, moreover, on a positivist logic of proof (EBM) and securing themselves by the standard and the protocol. The competition with the robot then becomes tough for the human. On the other hand, a contrario, the neuronal and corporal enlargement of our beings-in-the-world of which only the « Gai savoir » of Nietzsche will be able to specify the limits. It is indeed two different worlds which are built.

Certainly, we take up the clarification developed by Folscheid, according to which:  » medicine is […] neither a science nor a technique, but [bien] a personalized care practice, accompanied by science and instrumented by technical means (30) », i.e. a praxis.

She did not say fear, she said  pain to die

Only such an integrative perspective will allow the necessary opening to the pain of the world and not to its fear, in reference to the text of José Saramago in the introduction to this carte blanche. Only then will it be possible to assume what many white cards and calls for: a multidisciplinarity in the use of science.

 » Finally, in view of the uncomfortable situation in which the person who has to base his decisions on something as fragmented as the current state of knowledge about this virus finds himself, it would be incomprehensible to deprive oneself of the multidisciplinarity that science offers us in order to contextualize each of these decisions according to its global impact on society, and no longer only its supposed influence on the propagation of the virus.(31)  »

To connect, or at least to open up to all of our resources, including our reflective and critical capacities, is to realize, or at least understand, this connection, this « body-mind-world » continuum. Only the latter will allow us to stop the hegemonic discourse of the « change of the planet », to start thinking about the « mutation of our minds » and therefore of our Actions, joining in this, also, the transition necessary to the management of the ecological crisis. Indeed, how can we mutate in favor of Gaia — our Mother Earth, without first changing our personal relationship with Nature, of which we are a part? But we are trapped in our own mental constructions, like the camel in its desert(32).

« First of all, as it is suggested, reflexivity starts off with preconceived assumptions of binaries rather than investigating how boundaries or binaries are produced through the methodology itself (33).

On an epistemological level, it is a question of starting from scratch, rather than aiming for zero risk.

We see to what extent the issue of this crisis is, above all, epistemic(34). And this regardless of the economic and political opportunisms that have been added to the initial soil represented by our fragmented and fragmented medical world. In ontological rupture.

This hypothesis is the one that confronts the Covid crisis with the epistemological ambiguities of decision making in the medical and health world. Indeed, if the causes are complex and diverse, it seems that a common and critical denominator emerges from our modernity, splitting the « human group » deeply. This break comes from the idea that we, as human beings, through science and technology, can put nature in our hands. Yes, always « as masters and owners of nature… ».

« Progress, faith in progress, the fanaticism of progress, this is the trait that characterizes our era, that makes it so magnificent and so poor, so great and so miserable, so wonderful and so boring. Progress and cholera, cholera and progress, two plagues unknown to the ancients.

Progress is that wind which, from all points at once, blows over the plain, agitates the tall trees, bends the reeds, tires the grasses, makes the sands swirl, whistles in the caves and desolates the traveler even on the bed where he expected to find rest(35) »

This is where the problem lies, at least for those who aspire to emancipation rather than reductionism. Singing the robot, this technical and technological whole, reduces us in a tighter and tighter loop, far from the enlargement necessary for a more spiritual life.

We leave it to Nietzsche to make the synthesis.

Drom the individual to individuation

« But what the psychology of the will to power shows is that the destiny of the impulses is not reduced to this alternative: to dominate in a tyrannical way, or to be annihilated. Nietzschean psychology still detects the possibility of a third mode of existence and manifestation for the instincts (…): the « spiritualization ». (36)  »

In proximity with Buddhism, Nietzschean spirituality differs, however, by the choice of « tragic wisdom » rather than Pyrrhonian apathy and anesthesia(37) Men have believed, for thousands of years, that their lives had a definite meaning, that coming into the world, they came in the sense. They discover that this is not the case. Hence the anguish and nihilistic dereliction: if God is dead « do we not wander as through an infinite nothingness? » But, correlatively to this nothingness of meaning, the « heroic man » discovers the immensity of his freedom. He discovers himself as a creator, a giver of meaning; he marvels. To create what has value, even if that is assured to perish, not even for the pleasure, because deep perhaps the pain of the creator, or lasts the sorrow, but for the beauty of the thing itself, here is what seems a challenge to its measure, worthy of its new courage. »

Become what you are!

« What does your conscience say? — « You must become who you are. » No one has made Pindar’s precept more his own than Nietzsche, who quoted it often throughout his life, even to the point of making it the subtitle of his autobiography, Ecce Homo: « How one becomes what one is ». Inactual, Nietzsche crosses stubbornly the modernity backwards to go to seek from pre-Socratic Greece or from the Italian Renaissance the aristocratic exaltation of the strong individualities and the powers of the becoming. This gesture responds to a real concern about civilization, to a « distress of the present »…(38) « .

It is that of the loss of the potential of individuation, of diversity and of the particular when the ideology of meaning, which is that of the technoscience proper to our modern civilization, will have definitively equalized and secured everything, in a dull monadism!

The distress of the present

Could it be summarized by this last testimony on this health crisis?

 » What shocked me enormously was that, faced with the fact that there was no real treatment — because paracetamol is a symptomatic medication that does not treat the cause — we did not know or did not want to listen to recognized experts who, in their sphere of activity, were expressing the fact that there could be good results with hydroxy chloroquine (in combination with Azithromycin). I did not understand why this well-known, inexpensive drug was not widely prescribed at the beginning of the disease. At worst, we would have found it to be ineffective.(39)  »

Sanitary crisis that we choose to name rather human catastrophe and manifestation of a biopower that Foucault, disciple of Nietzsche had anticipated and perfectly theorized.

Because, to come back to this testimony, neither the EBM ( carte blanche 1 ) nor the precautionary principle ( carte blanche 2 ) are not sustainable in the face of such absurdity.

The only logic that seems to operate is the cold, neo-liberal, market logic in which programmed obsolescence bursts out a step further in front of the whole planet, without embarrassment, almost with cynicism. Indeed, the Kafkaesque bureaucracy, which has been revealed a little more, still allows the explanation — the defense — by the standard(40), testifying today, as some denounce it, to a form of programmed obsolescence of the drugs themselves(41).

Thus, unless we consider that we are « replaceable » contrary to the philosophical and anthropological perspective developed by Cynthia Fleury previously cited, and that it would not matter what the losses between T0 (March 2020) and T1 (March 2021) are, such a choice, that of early treatment, would have seemed reasonable.

But have we lost our minds?

Because it is not only early treatment that is at stake, but all decisions that have had little basis in fact.

If the perspective to come goes beyond people and nations, and if serious hypotheses are emerging about the path of loss of emancipation that our humanity is taking, at least in the West, this work of reflection (through this series of 7 white cards) has focused on the medical world. How does it become, in the true sense of becoming, this fertile ground for totalitarian drifts, taking flight on the crushed, scorned body of our patients?(42)

There is a way…

However, the path is made of uprooting, what Nietzsche’s book, « Thus Spoke Zarathustra », well accounts for, which sees his balancing on the wire of life, falling, but to this metaphor of the fall we prefer the one, targeting the stake of « transvaluation » (creation of new values) — thus of individuation - of the three transformations: that of the camel, the lion and the child, thus manifesting our commitment to change. This is, moreover, the very role of education, understood as a lever for emancipation. As such, pedagogy assumes its political role.

If we organize a well-directed life for you
Where you will soon forget yourself
If we make you dance to soulless music
Like a love that we leave
If you realize that life is not there
That you get up in the morning
Without knowing where you are going

Resists(43)

Notes et références
  1. Ces cartes blanches sont rédigées dans le contexte d’une analyse critique, transdisciplinaire et interprofessionnelle au croisement de regards médicaux, de santé publique, pédagogiques et philosophiques de la crise sanitaire que nous vivons actuellement. Elles ont comme objectif, d’ouvrir à des débats nécessaires, en proximité immédiate avec le champ de l’éducation et de la formation médicale.
  2. Saramago J. Comment le personnage fut le maître et l’auteur son apprenti. Paris : Mille et une nuits, 1999.
  3. Collectif. Kairos. Wikipédia [On-line] Disponible sur : https://fr.wikipedia.org/wiki/Kairos
  4. Extrait de la revue : « La spiritualité n’est pas une religion ». Magazine de société / CLES. Février-Mars 2016. Patrice van Eersel (page 38). Référence introuvable sur le Web. Le magazine « Clés » a cessé de paraitre en 2016.
  5. Parent F. Extrait « Le tout est à portée de main », 2017.
  6. Fink E. Le Jeu comme symbole du monde (trad. H. Hildenbrand et A. Lindenberg). Paris : Editions de Minuit, 1966
  7. À différencier de Platon
  8. Ceux-ci – féminin-masculin- n’étant pas entendus en tant que dualité de genre mais, au contraire, comme présence conjointe en chaque être humain (cf. note Carte blanche 4).
  9. Anonyme. « Le XXIe siècle sera religieux ou ne sera pas » ? Malraux a‑t-il dit la célèbre phrase ? 2016 [On-line] Disponible sur : https://www.lesoir.be/art/1136269/article/soirmag/soirmag-histoire/2016–02-29/xxie-siecle-sera-religieux-ou-ne-sera-pas
  10. Dans le sens de l’École de Francfort (L’École de Francfort a appliqué les réflexions multidisciplinaires de ses membres, chercheurs et intellectuels (économistes, psychanalystes, philosophes…) afin d’interroger de manière critique la société capitaliste dès le début du XXe. Nous proposons ici la même démarche en la transposant dans le cadre pandémique de 2020–2021.). L’édification critique d’une pluralité des sciences, ayant pour objet l’humanité et la société, fut l’une des conditions instaurant les sciences humaines en qualité de sciences émancipatrices de la société et de l’humanité. Ainsi : « Conformément au thème central de l’école de Francfort, la spécificité des sciences humaines continue donc à se concentrer dans des savoirs dont le sujet est l’émancipation humaine. » in Haber. S, « Science, Histoire et Société. L’école de Francfort : la question du savoir émancipateur. » in Wagner. P. (dir.), Les philosophes et la science, Gallimard, Paris, 2002, p. 914. Par ailleurs nous rappelons pour le lecteur curieux, cette émission : https://www.franceculture.fr/emissions/les-chemins-de-la-philosophie/lecole-de-francfort-14-la-theorie-critique-une-nouvelle-philosophie
  11. Melman C. L’Homme sans gravité. Jouir à tout prix. (Entretiens avec J‑P Lebrun). Paris : Gallimard (Folio Essais), 2005.
  12. Les deux types de questionnements font référence à l’œuvre de Schopenhauer, la perspective étant de maintenir la nécessité de la volonté de vérité scientifique (Monde de la Représentation) avec le questionnement plus macro, voire métaphysique (Monde du Vouloir) que la science ne peut aborder étant dans l’impasse de la logique même de la causalité (régression à l’infini), à savoir, une approche selon le principe de raison suffisante et une autre, complémentaire, mais essentiellement distincte, selon la contemplation esthétique, ainsi que selon l’antériorité de l’être.
  13. Parent F, De Ketele J‑M, Gooset F, Reynaerts M. Taxonomie de l’approche par compétences intégrée au regard de la complexité. Contribution critique à la santé publique, Tréma 2020;54. Disponible sur : https://doi.org/10.4000/trema.5907
  14. Anonyme (Source privée), 2021
  15. Un impératif catégorique est ce qui doit être fait nécessairement et inconditionnellement, indépendamment du but à atteindre. Il s’impose sans justification.
  16. Parent F, De Ketele J‑M, Gooset F, Reynaerts M. Taxonomie de l’approche par compétences intégrée au regard de la complexité. Contribution critique à la santé publique., Tréma 2020;54. Disponible sur : https://doi.org/10.4000/trema.5907
  17. Nous attirons l’attention du lecteur sur le fait que nous ne voulons pas induire une perception réductrice de la peur dans ces paragraphes. En effet, la peur est bien quelque chose d’utile à priori. C’est un indicateur très important sur la façon dont nous interprétons le monde autour de nous. Un réel travail de la part de la personne concernée est donc nécessaire afin de la gérer de façon intelligente. La sensation de peur, celle dont on parle ici (peur de l’incertitude, de la mort, de la maladie, du jugement d’autrui, de désobéir …) est un programme purement génétique de l’ordre de l’instinct et par essence, incontrôlable par la volonté. (On ne peut pas décider sur un coup de tête de ne plus avoir peur par exemple !). Cependant, ce qui l’a déclenchée est là où nous pouvons agir. Le stress est généré lorsque nous appréhendons le stresseur (ou encore l’agent déclencheur) avec un mode mental peu adaptatif (nous manquons de nuance, de recul, nous refusons, …). En cela, la peur est une information clé. Elle peut justement nous faire prendre conscience de notre paire de lunettes réductrice sur le nez (nos biais, nos intolérances, nos préjugés…) et inviter par là-même à un travail de bascule préfrontale (mobiliser notre intelligence adaptative). La peur est, avec les autres, une des émotions à accueillir, écouter, comprendre, réguler, utiliser, rejoignant le dernier commentaire « seules nos sens(ations) nous apportent les infos dont nous avons besoin ». Nous faisons référence à la question des émotions dans notre carte blanche intitulée : Crise de la Covid et intelligence émotionnelle : le maillon manquant — Kairos (kairospresse.be) et, pour le lecteur souhaitant appréhender sur un plan pédagogique une taxonomie en éducation spécifiquement centrée sur les compétences émotionnelles, nous le référons à l’article : Parent F, Jouquan J, Kerkhove L, Jaffrelot M, De Ketele J‑M. Intégration du concept d’intelligence émotionnelle à la logique de l’approche pédagogique par compétences dans les curriculums de formation en santé. Pédagogie Médicale 2012;13:183–201
  18. Nous faisons référence ici à la notion de responsabilité sociale des facultés de médecine, véritable stratégie éducative centrée sur les soins de santé primaires, la santé publique et la promotion de la santé. Cette perspective est explicitée, notamment, dans un chapitre de l’ouvrage (page 89) « Penser la formation des professionnels de la santé. Une perspective intégrative », Ed. De Boeck, 2013.
  19. Charmillot M. Le rapport à la vérité dans une perspective transactionnelle participative : l’expérience contre la production de l’ignorance. In : Heimberg C, Maulini O, Mole F (Éds.) Le rapport à la vérité dans l’éducation. Raisons éducatives. Genève : Université de Genève, 2020 : 31–54
  20. Fleury C. Les irremplaçables. Paris : Gallimard, 2015
  21. Midal F. Narcisse n’est pas égoïste. Paris : Coédition Flammarion / Versilio, 2019
  22. Titre emprunté à l’ouvrage de Friedrich Nietzsche, publié en 1882.
  23. Goffman E. La Présentation de soi. La Mise en scène de la vie quotidienne (Trad. A. Accardo). Paris : Editions de Minuit, 1973
  24. Legrand F‑C. James Ensor 1860–1949. Exposition, Bruxelles, musées royaux des Beaux-Arts 23 septembre, 1999–28 février 2000.Paris : La Renaissance du livre, 1999
  25. Et de 2021…
  26. Parent F, De Ketele J‑M, Gooset F, Reynaerts M. Taxonomie de l’approche par compétences intégrée au regard de la complexité. Contribution critique à la santé publique, Tréma 2020;54. Disponible sur : https://doi.org/10.4000/trema.5907
  27. Ferrarese E. (Vivre à la merci. Le care et les trois figures de la vulnérabilité dans les théories politiques contemporaines. Multitudes 2009;2(37–38):132–41
  28. L’EBM, ici, est considérée dans sa forme réductrice, celle qui est le plus habituellement véhiculée autant dans les médias que dans le milieu médical. Nous avons corrigé une telle vision dans la carte blanche 1 centrée sur l’EBM et l’enjeu des traitements précoces dans la crise qui nous concerne. Pour plus de clarté nous reprenons ci-après un extrait de cette première carte blanche : « Le problème est que le projet princeps de l’EBM s’est radicalement rétréci à l’issue d’une dérive technoscientifique et normative aussi insidieuse qu’implacable, sur une conception positiviste de la démonstration et de la preuve. »
  29. Debey A. L’invraisemblable désaveu des traitements précoces. 2021 L’impertinent 2021 [On-line] Disponible sur : https://www.limpertinentmedia.com/post/l‑invraisemblable‑d%C3%A9saveu-des-traitements-pr%C3%A9coces
  30. Folscheid D. La médecine comme praxis : un impératif éthique fondamental. Laval Théologique et Philosophique 1996;52:499–509
  31. Buysse M, Debaille V, Dechamps M, Dupont C, Ernst D, Jungers R et al. Au nom de la science? Le Vif. 2021 [On-line] Disponible sur : https://www.levif.be/actualite/belgique/au-nom-de-la-science-carte-blanche/article-opinion-1387855.html
  32. En référence aux trois métamorphoses de l’esprit de Nietzsche que nous reprenons en conclusion de cette carte blanche, et dont nous en rappelons la signification par le biais de Gilles Deleuze dans son ouvrage « Nietzsche par Gilles Deleuze », Ed. Philosophes PUF, 1965 (page 5) « Le premier livre de Zarathoustra commence par le récit de trois métamorphoses : « Comment l’esprit devient chameau, comment le chameau devient lion, et comment enfin le lion devient enfant. » Le chameau est l’animal qui porte : il porte le poids des valeurs établies, les fardeaux de l’éducation, de la morale et de la culture. Il les porte dans le désert, et, là, se transforme en lion : le lion casse les statues, piétine les fardeaux, mène la critique de toutes les valeurs établies. Enfin il appartient au lion de devenir enfant, c’est-à-dire Jeu et nouveau commencement, créateur de nouvelles valeurs et de nouveaux principes d’évaluation ».
  33. Bozalek V & Zembylas M. Diffraction or reflection? Sketching the contours of two methodologies in educational research. International Journal of Qualitative Studies in Education 2017;30(2):111–27.
  34. Synonyme de « Epistémologie »
  35. Rodolphe Töpffer : « Du Progrès dans ses rapports avec le petit bourgeois et les maitres d’école ». 1835. La suite de ce texte est proposée en totalité et malgré sa longueur, en note de bas de page : « (…) Le progrès, plus qu’une figure ardente, c’est cette fièvre inquiète, ce continuel transport qui travaille la société tout entière, qui ne laisse ni trêve, ni repos, ni bonheur. Quel traitement il faut à ce mal, on l’ignore. D’ailleurs les médecins ne sont pas d’accord : les uns disent que c’est l’état normal, les autres que c’est l’état morbide ; les uns que c’est contagieux, les autres que ce n’est pas contagieux. En attendant le choléra, le progrès, veux-je dire, va son train. Pour moi, je m’imagine qu’ici de la chose est né l’abus, me fondant sur ce que l’abus naît ordinairement de la chose. Or, que la chose soit, qui le nierait ? Le progrès social a été aussi subit qu’immense ; il se révèle à chaque instant, sous mille formes, en toutes choses. Rien ne se fait ainsi qu’il y a trente ans, vingt ans, dix ans ; tout se fait mieux, plus vite, au profit d’un plus grand nombre. Voilà la chose. Mais devant ces merveilles, Joseph Homo, qui n’a pas la tête forte, demeure ébloui, il bat la campagne. Il voit du progrès partout, dans le soleil et dans la lune, dans les sandwichs et dans les toupets, dans l’Amérique et dans les choux gras. Ce n’est rien que cela, il en veut partout et sur l’heure, dans la religion et dans les capsules, dans la morale et dans les faux cols, dans la politique et dans les binocles. C’est là l’abus. Il y a, dit-il, progrès en ceci ; donc il y a progrès en tout. Tout progrès, dit-il, est une innovation ; donc toute innovation est un progrès. C’est ainsi qu’il raisonne, passant du relatif à l’absolu, du vrai au préjugé, et du préjugé à mille sottises, selon la méthode qui lui est propre. Mais la sottise fondamentale, la sottise mère, la sottise modèle, c’est la manière dont Joseph considère le progrès, non pas comme un moyen seulement, mais comme le but, comme l’unique but du bonheur. De cette façon, il poursuit sans atteindre, car derrière un progrès s’en trouve toujours un autre ; de cette façon, il ne jouit pas, la jouissance étant indéfiniment ajournée ; de cette façon, il méprise le passé qui est quelque chose, il dédaigne le présent qui est beaucoup, il attend l’avenir qui est toujours devant lui ; de cette façon, tout en étant mieux, il se trouve plus mal. C’est ce que nous voyons. Partout malaise au milieu du perfectionnement. Partout la chose corrompt à l’avance la chose d’aujourd’hui ; le mieux qui n’arrive pas gâte le bien qui est sous la main. Point d’assiette, point de sécurité, point de calme ; impossible de se poser, de s’arrêter nulle part. Le progrès est là, avec son grand fouet, qui frappe le troupeau : Marche ! – Quoi ! toujours marcher ! jamais faire halte ! – Marche ! — Cet ombrage me plait, cet asile m’attire…- Il y en a un préférable ; marche. – Nous y voici. – Marche encore. Vous diriez ce vilain petit vieux cramponné aux épaules de Sindbad le marin, le poussant de-ci, de-là, de gauche, à droite ».
  36. Wotling P. La pensée du sous-sol. Paris : Allia, 2016 : 33.
  37. Conche M. Nietzsche et le bouddhisme. Paris : Encre Marine, 1997:55
  38. Astor D. « Deviens ce que tu es »: Pour une vie philosophique. Paris : Autrement, 2016
  39. Saegesser P (Entreien avec A Debey). Notre gouvernement n’est plus défenseur des valeurs fondamentales de notre société. L’impertinent 2020 [On-line] Disponible sur : https://www.limpertinentmedia.com/post/notre-gouvernement-n-est-plus‑d%C3%A9fenseur-des-valeurs-fondamentales-de-notre-soci%C3%A9t%C3%A9
  40. Nous pouvons, ici, faire référence au totalitarisme de la norme tel que l’argumente Roland Gori, mais également au concept de « densification normative » développé par Catherine Thibierge « La densification normative : Découverte d’un processus », Mare et Martin, 2014.
  41. IHU Méditerranée- infection Contre l’obsolescence programmée des médicaments — YouTube
  42. Delmas-Marty M. Le rêve de perfection transforme nos Etats de droit en Etats policiers. Le Monde. 2021 [On-line] Disponible sur : https://www.lemonde.fr/idees/article/2021/03/01/mireille-delmas-marty-le-reve-de-perfection-transforme-nos-etats-de-droit-en-etats-policiers_6071518_3232.html
  43. Berger M. Résiste. Universal Music Publishing. 1981 [On-line] Disponible sur : https://www.paroles.net/michel-berger/paroles-resiste
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