WORLD WORLDWIDE FRANCE News Journal Update - (en) France, OCL CA #333 - Health: the challenge of autonomy. (ca, de, fr, it, pt, tr)[machine translation]

 

The feminist movement maintains a difficult contradiction in the face of
the medical institution. We can no longer count the denunciations of
"abuse" of power on the part of doctors while at the same time there are
increasing numbers of forums calling for better care, cutting-edge
research and treatments for some of the diseases we are dealing with.
let us suffer. We reject medical ideology, but are dependent on its
techniques: the medical institution mistreats us but the research and
certain treatments it produces also help us. So what to do? Break away
from it and "do it ourselves"? The self-help movement has charted an
exciting path: it gives us a glimpse of what medical care could be in a
system in which our needs are not met at the cost of our dignity. But it
is reserved for a few, those who have the time to learn this knowledge
and share it... At the same time, in France and elsewhere, millions of
women are fighting to benefit from basic care. Therein lies the
stumbling block: we all want to have access to quality care, when we
deem it necessary, but we want to have access to it on our own terms,
without being at the mercy of medical power based on mastery. care
skills by just a few people. This side route is perhaps impractical, but
I will still try to clear the path a little by summarizing here ideas
developed at length elsewhere (1) in an attempt to offer a critique of
medical power which contributes to undermining its ideological and
material foundations, making them conscious.

Medical power

The definition of power used here is as follows: it is the possibility,
on the part of a person or a group in pursuit of its own interests, to
restrict other people or groups in the choice of their conduct. Power
strips individuals and groups of their ability to decide for themselves:
whether conscious or not, it involves a destruction of individual autonomy.

Medical power is the prerogative of an elite who have a legal monopoly
on the practice of medicine. It is based on a class relationship (in
view of the social extraction of doctors, there is most of the time a
large socio-cultural gap with those being treated), and on the retention
of medical knowledge for the benefit of those initiated only. Like
religious power in its time, medical power fears seeing a competing
authority rise against it: it can only exercise itself fully by making
its priests the holders of knowledge inaccessible to lay people. Any
transfer of knowledge to society would generate debates and discussions
which would undoubtedly turn into criticism of skills, which doctors
cannot accept, they who justify their position and their privileges
precisely by their competence (combination of knowledge and knowledge do).

Medical power is based on the myth of the omnipotence of scientific
knowledge... of which the doctor is the custodian: he is therefore
commonly perceived as being the only person who can free the patient
from suffering, or even death. But this power is often overrated,
because medicine manages the consequences of illnesses (the symptoms)
more than it treats their causes, whether these are organic,
psychological or social.

Finally, the medical system is a service industry, caught in a market.
Care is a commodity, patients are its consumers. Doctors play the
essential role in this distribution: they accelerate consumption and
help to divert the enormous budget whose use they control to private
interests. As the main authorizers of health expenditure, they therefore
have economic power.

Doctors

Among all the institutions that standardize industrial society and oil
the wheels of capitalism, medical power holds a good place: the medical
system is in fact the only authority to determine who is in good health,
who is sick, who is adapted and who is not. is not.

Occupational medicine does not play the role of protecting workers that
they would be entitled to expect from it and, tied hand and foot to the
company (its direct employer, or its payer), its recommendations are
rarely taken into account. taken into account if it decides to request
the adaptation of a workstation. Even outside the workplace, and even
though people's health needs require a global overhaul of production
methods, the only response from the medical profession is to participate
in the development of the consumption of care and medicines... Every
year in France, there are 17 million prescriptions for anxiolytics: this
is the response provided, through a doctor, to the discomfort of
individuals in relation to social life, that is to say to human
concerns, problems of daily life, in and out of work, which degrade health.

In exchange for economic and social privileges and a particular status,
the medical profession as a whole turns a blind eye, probably
unconsciously, to its role: the reinjection of workers into the
production system after treatment. He poses as being able to classify,
understand and deal individually with the failures of society, without
the slightest attempt to question it: this testifies to his
collaboration/collusion with the ruling class, and a need to maintain
his domination as is. It therefore endorses the ambient order and
establishes social norms in the same way as other constituted bodies
(judges, teachers, priests in their time): at the level of the
community, it results that doctors, who only make up a small group of
people can impose on the majority discourses, patterns of ideas and
models of behavior, not only in the field of health, but also in all
areas of social life. The medical institution is a powerful instrument
of social control which affects all individuals.

The conference

Medical power is exercised directly over individuals during the doctor's
appointment, the "singular conference" defined as the "meeting between
trust and conscience"... But is it really just an encounter? between two
people? Far from it, the singular conference is also (above all!) a
class relationship. The language used, often jargonous and
incomprehensible to the layman, conveys symbolic domination. The doctor
provides few explanations, but readily recalls the sanctions that will
fall on the patient in the event of disobedience to his orders (the
prescription): "you will give him his vitamins every day without fail,
otherwise he will have the fragile legs"; "I would only prescribe this
test if you are taking this medication", etc. The doctor thus poses as
the sole repository of the words and the healing technique. It is
accepted that he is the only one who can intervene in order to relieve
the patient's body, and through his particular language, he imposes
silence and prevents the patient from taking charge of his illness or
naming it.

When the

During the decades that brought hope for emancipation, the 1960s and
1970s, criticism of the healthcare system and medical power was made in
actions and words. In Illich, in Medical Nemesis (1975), we find a
radical critique of the very purpose of the medical institution: the
thesis defended in his essay is that far from improving health, it
compromises it by developing general morbidity through different
intertwined processes that he calls "iatrogenesis", borrowing from
medical vocabulary this word covering the illnesses caused by medicine.
His theory still seems fruitful to me for understanding why we are
unable to get better despite (because of?) the increasing medicalization
of our lives.

He suggests that our modern medicine makes us sick on several levels:

firstly through clinical iatrogenesis: it systematically criticizes the
very competence and merits of the activities of the medical profession,
due to the morbidity associated with a number of highly technical,
dangerous and expensive acts, not always necessary, sometimes worse than
evil;

then by a social iatrogenesis, understood as a development for
individuals of dependence on medical procedures, and the loss of the
capacity to adapt to our environment and to refuse intolerable
environments through personal actions;

finally, by a structural iatrogenesis, by maintaining the idea according
to which the elimination of pain, disability and the indefinite delay of
death are desirable and achievable objectives, scourges which can be
combatted by purely technical means, thanks to progress of the medical
system. This developing idea compromises people's autonomous ability to
cope with pain, disability and death by giving them meaning.

These last two causes of discomfort are only two parts of the same
reality: modern medicine, due to its technical nature, transforms the
person into an object that is manipulated, into a patient who suffers
and abandons himself to others. taking care of your body, and possibly
your mind. It denies him the freedom to choose, to decide, that is to
say, to be an autonomous person. Pain becomes something external to
oneself, which must be gotten rid of, and in front of it, is the
liberation which one thinks will be granted by the medical institution
that one seeks: through this process, people lose their ability to adapt
to their environment, to possess health conceived as "the capacity to
actively cope with the environment and the vagaries of life".

Epidemiology

Start to criticize the merits of a particular diagnosis, of a particular
treatment... or as Illich did, medicine as such, and you will see the
medical community rise up as one man by defending the victories almost
"miraculous" results that it obtains (heroic operations most often, but
also eradication of certain pathogenic strains). However, if we agree
that we must not deny the successes of medicine, we must be able to
question their significance on a collective scale: the effects of these
spectacular advances are very limited in comparison to all the
collective problems to which the majority of the medical profession is
blind - or to which it is powerless. With rare exceptions, doctors
ignore public health and epidemiology problems. And for good reason,
they are trained to treat an abstract and undifferentiated being,
reduced to a biological category, ignoring the collective dimension: the
patient's social class, their activities, their lifestyle are never
taken into account. and his individuality.

And yet it is our social roles and therefore the environment in which we
live and work, hygiene, and not our biology, or medical factors, which
determine in advance our level of health. But without statistical tools
to understand them, without epidemiological studies, medicine presents
our state of health to us as the expression of a biological
inevitability caused by our sex, our age... or a genetic cause, as is
fashionable these days. moment.

Sexism

If we can affirm with Illich that "all ages are medicalized, just like
sex, intelligence quotient or skin color", there is one group which is
systematically: that of women. We are perceived by the medical
profession as naturally sick beings and all stages of our life are now
medicalized, making us patients for life: from our first periods which
come too early or too late (hop! first appointment at the gynecologist),
at menopause, necessarily disabling if we are still old enough to work,
going through the periods...

Medical ideology conveys sexism that is deeply rooted in society,
without creating it. Male domination did not wait for its advent to
exist (2), which has always doubled the very material domination of
myths (3) to justify its existence. Medicine here appears as a modern
myth: it only reformulates sexism in its terms, those of biology and
evolution, and in this way it is one of the current links of male
domination. Recent medical ideology has in turn presented us as
hysterical to be treated, fragile little things to be treated (wealthy
bourgeois clients) or contagious and carriers of venereal diseases
(working-class women, their "necessary treatment" causing the rise of
public health in the 19th century). Over the past centuries, we have
gone from being sickly beings who must be pampered and contained at
home, to working women who develop fewer illnesses than men, but are
stupid and self-indulgent patients. So when doctors are concerned about
identifying an organic cause, they frequently refer us to psychosomatic
reasons, which leads to irrational approaches and ineffective
treatments. We arrive at the doctor's office sick, and leave the office
feeling crazy... The tendency of doctors to determine that our ailments
are of psychosomatic origin shows that the medical perception of women
has not gone from "sick" to "well". health", she went from "physically
ill" to "psychologically ill". The ideological straitjacket in which
modern medicine has been constructed is particularly detrimental to the
health of women in particular, so we have a particular interest in
empowering ourselves with regard to our health.

Be in

It is now clear that the medical institution discussed throughout this
article prevents individuals from being autonomous regarding their
health. It strips them of the medical knowledge that would allow them to
deal with the most common ailments, it teaches them to see salvation
only in the search for external relief, within the medical institution,
in scientific research. It helps create a certain passivity and goes
well with a society in which people are trained to obtain things rather
than do them. It annihilates the reflex of avoiding situations that make
us sick, the possibilities of questioning them and radically modifying
them (understand: a good strike at the very least, at best a good
revolution) as it places health on the individual level. .

Contrary to a conception of health as a service produced (relief
external to oneself) by doctors and consumed by patients, we can follow
Illich in his proposal to consider that health would be the ability to
cope in an active and to be independent from the vagaries of life. This
active conception of health allows me to return, after a long detour
through the foundations of medical power, to the tension initially
exposed between "doing it yourself" and the fight for improvement in the
way in which care is carried out in our system.

As things currently stand, the basic question is still the same: who
decides what perspectives are offered to us? Who controls the social
environment? (see Box on menstrual leave). Demanding an improvement in
medical care in current conditions makes me wince, as the state of
"health" of people is linked to other structures that must be modified
all together to be able to change the lives of all. . We do not decide
on anything, in this context, and everything that we put forward as an
argument to modify things will be systematically turned against us to
serve the interests of the bosses: concerning the particular case which
concerns us, say that women often have periods painful, and without
trying to understand why, and if this is particular to certain living
environments more than others, we will be discriminated against when
hiring. Say we're as strong as men, and we'll be on the job full time.
The issue here is always the same: who proposes, who decides, who
applies? The only perspective of demanding a better healthcare system is
to wish for a significant dilution of the skills devolved to doctors
alone, whether towards other paramedical professions (midwives, nurses,
physiotherapists, etc. more numerous than doctors, but also of different
social classes) or within society. It seems important in this context to
participate in the true popularization of medical knowledge, a
popularization that allows for a critique of skills to strip doctors of
their status.

As for individual empowerment, it is such a limited operation that it
makes one wonder about its capacity to modify anything on a societal
scale. However, it is by becoming alert to the conditions that are
degrading our health that we can, collectively, question them and rise
up in the face of the urgent need to change them. It is by training
ourselves, by desacralizing medical knowledge, that we will be able to
realize when protocols are abusive, not adapted, to require a real
examination - for example, when a doctor attributes an organic illness
to psychological disturbance. . Knowledge and know-how, becoming
competent in health in general, are the necessary guarantees to defend
our dignity. It is on this principle of autonomy that the most
significant challenge to the medical system that ever took place in the
1970s was based, with the creation of self-managed care centers by users
(such as the Women's Dispensary, created in Switzerland in 1978) or by
the practice of clandestine abortion (with the Movement for the
Liberation of Contraception and Abortion). I dare to conclude by betting
that if there were less medicine in our lives, there would be more
revolutions, as by putting people back to work and individualizing
health problems it seems to participate in the conservation of the
current structure Of our society.

Eloise

Notes

(1) In the following works:

Medical Power, François and Nicole Robin (1976), coll. Stock 2, ed. Stock

Medical nemesis, The expropriation of health, Ivan Illich (1981), coll.
Techno-criticism, ed. Threshold

A modern-day witch, Self-help and the women and health movement, Rina
Nissim (2014), ed. Mammamelis

Fragile and contagious, Medical power and the body of women, Barbara
Ehreinreich, Deirdre English (original text 1973), ed. Cambourakis (2016)

(2) Past, prehistoric societies are not a reflection of a lost Eden,
free from male domination, division of labor, and violence. Human
societies have had cultural traces of male domination for at least
70,000 years, the age around which Homo sapiens emerged from Africa. See
on this subject Primitive communism is no longer what it was, Christophe
Darmangeat (2012), Smolny...and the following note.

(3) One of the myths justifying patriarchy is the myth of primitive
matriarchy, justification for a given society of a system of male
domination by the reversal of a hypothetical opposite situation (female
domination) previously. It has been present for at least 70,000 years,
cf. Cosmogonies, Julien d'Huy (2020), La Découverte.

Menstrual leave

Menstrual leave, which has hit the headlines since the two legislative
proposals (ecological and socialist) made in parliament four months ago,
is yet another example of a partial concession, which, not being decided
(or even requested ) by the workers, will not properly meet our
expectations.

Issued by doctors, it will still subject us to their good will to
recognize "incapacitating" pain and will serve to mask diagnostic
defects in the case of diseases such as endometriosis. No normal
physiological condition causes incapacitating period pain. Periods are
not something that hurts when the body is otherwise fine.

 From an economic and political point of view, its financing is a means
of helping companies wishing to adorn themselves with a "feminist"
label, relieving them of the responsibility for this leave and it does
not participate in the simple elimination of waiting days currently
supposed to "empower" workers in their use of medicine.

We have no collective control over the implementation of this leave, no
prospect that it will change life overall: it is, again, an adaptation
in order to see ourselves more effective at work... all we have to do is
judge on the evidence: the socialist proposal includes the possibility
that this "vacation" day could be converted into a teleworking day! This
is really making fun of us.

So we persist and we sign: it is not an extra day of monthly leave that
we need, but to stop working and to control our conditions of activity
and existence.

http://oclibertaire.lautre.net/spip.php?article3964
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