Español  
English  
Français  

Avignon - Journées Nationales 2002

Intimacy and money

Precisely beyond the clinical richness of relations existing between the intimate and the money, these latter forge paradoxical links in our practice.

Psychiatrists base their act on the inter-subjective meeting with their patients. The consultation, concealed from public view and social pressure — which are not ignored though — creates an intimate space-time that invites to a confiding confidence. Then the suffering can be told as a complaint, the designated, or offered, “victim” may move to a demand for help and understanding, beyond the claim for reparation. Ethics demands that the individual be not reduced to the fate of a genetic manufacture, to the automatic process of an evolving illness, nor even to a social image, nor to his/her professional or family characteristics. When facing the adaptive pressures of the social standard, the psychiatrist defends the individual’s dignity and catalyses the involvement of the patient as the subject of his/her own words, the place of the unconscious, the actor of the change and not a passive, care-receiving object.

The psychiatrist’s competence is often differentiated as the knowledge and scientific expertise necessary to treat a designated illness and to relieve psychic suffering. As a doctor, he/she gives access to social security benefits and to supporting networks.

The French social security system combines patients’ free choice of a doctor and financial coverage of expenses. Though health is priceless, it definitely generates costs that cannot be ignored virtuously. However, is the best care always delivered at the best cost ? Is the search for health costs reduction not likely to result in a protocolizing rigidity of formatted “therapeutical products”? Is care delivery for all, a “public health” goal, not likely to drift dangerously from an individual and personalized intervention towards the automatism of controlled prescriptions ? Or else, is the concern about costs reduction not leading us to a generalized delegation of competences atomizing the complexity of situations into “targeted” interventions ? When health insurance hides from patients a debt that they can no longer free themselves from, does it not deeply modify their relationship with care delivered ? The psychic saving is such that it is difficult to — reasonably— enjoy care, as a freeing donation, and in the long run, it rather raises the question of something due, of a dependence and even a reparation. Is medical care a “consumer product” like many others ? As a social transaction standard, as an object of a polyvalent exchange, does money not play a part, however, in a singular way, through its symbolic significations where there is a transfer (donation, symbolic debt, independence, illusion of mastering, gift and influence, access to the intimate etc.) ?