On the Theme: «Environmental Approach in the Social and Medico-Social Sector»
Editor : Meddy Escuriet
Meddy Escuriet : Foreword
Louis Bertrand
«Granting Social Rights: Medical and Medico-Social Approaches in French Disability Policies. A study of the Evaluation of Applications in Two Maisons Départementales des Personnes Handicapées» (p. 15-22)
Abstract : The debates around a biomedical or social definition of disability find an echo in the assessment of disability by the French Maisons Départementales des Personnes Handicapées. The constraints they face lead them to favor an assessment that is either medical or multidisciplinary and environmental, as shown by the analysis of the applications for recognition as a disabled worker.
This assessment work is characterized by the tension between a principle of individualization of care and a principle of equivalence of treatment. Two types of resolution of this tension can be distinguished: a biomedical resolution, stressing on the diagnosis, and a medicosocial resolution, based on the work of multidisciplinary teams. Conflicts between these two approaches may arise when determining an official “disability rate”. These differences in approach may overlap with professional and generational differences (between doctors and social workers, between agents who worked in the former bodies / recently recruited agents).
Keywords: disability assessment; social magistracy; medical approaches; environmental approaches
Cyril Desjeux
«The Administrative Production Process of Human Aids» (p. 57-96)
Abstract: This article shows the difficulties that the human aid from the Disability Compensation Benefit (DCB) has raised and may still raise in order to guarantee the effectiveness of this right. This analysis is based on work carried out since 2015 on human aid, on departmental houses of disabled persons (DHDP) and on disabilities due to alterations of mental, psychological and/or cognitive functions. Based on the elaboration and implementation process of the human aid plan, the aim of this article is to describe obstacles and factors facilitating the consideration of the environment from the person’s disability situation perspective. Thus, we will see that taking environmental factors into account is part of a chain of responses characterized by a density of important constraints.
Keywords: compensation; human aid; disability compensation benefit (DCB); departmental houses of disabled persons (DHDP); disability; autonomy
Meddy Escuriet
«To Propose a Medico-Social Accompaniment by the Geography: Identify, Analyze and Stimulate the Relations between Person and Environment» (p. 97 138)
Abstract: This article aims to present a methodological device deployed in France within the framework of a thesis work in geography carried out in immersion in an association which accompanies people having undergone brain injuries (LADAPT Puy-de-Dôme in Clermont-Ferrand). The consequences of a brain injury can be physical, sensory, psycho-
behavioral or cognitive, and are multiple and different depending on the individual. Affecting the capacity of people to construct mental images of space, they often result in feelings of stress and anxiety that they experience in environments that they do not master well. Built from an environmental and situational approach to disability, the methodological device deployed in this thesis is based on two main tools: interviews and cartographic workshops. While the cartographic interviews made it possible to understand the relationship that the persons accompanied have with their daily spaces, the cartographic workshops were built with the aim of stimulating their perception of the environment. The latter, set up following the association’s move to new premises located in another district of Clermont-Ferrand, took the form of several activities. Based on the hypothesis that the new district where the association was established would be the object of a poorly defined mental image in the people accompanied by the association and would be a generator of ill-being, the aim of this approach was to propose cartographic and spatial exercises in order to reinforce their spatial mastery of the sector.
Keywords: disability; perception of space; cartography; medical and social support
Sophie Arborio and Géraldine Letz
«Towards an Ethics of the Communication Relationship with People with Angelman Syndrome» (p. 139-171)
Abstract: As part of anthropological research within several medico-social establishments, the ecosystem of the communication relationship with people with Angelman syndrome (AS) was analyzed, a genetic particularity generating in particular a delay in physical and mental development, as well as a profound impairment of the faculty of oral language. Through a corpus of twenty-six semi-structured interviews carried out in eight French medico-social establishments, as well as four days of participant observation and starting from the point of view of daily support professionals, we were able to analyze from an anthropological point of view, the challenges of the interaction linked to communication. In this context, the use of enhanced alternative communication (EAC) tools is an integral part of co-learning between professional and user. “Alternative” communication sets up alternative means when natural communication is not sufficiently developed to be operational. Besides this substitutive aspect, “enhanced” communication supports or augments oral language when it is insufficient to establish a communicative relationship (Élisabeth Cataix-Nègre, « Polyhandicap, communication et aides à la communication. Communiquer autrement », 2017). For example, sign language, facial expressions and/or body position are part of AAC as well as pictograms (images, drawings or photos expressing words or ideas).
This respective development is part of a diachrony and is based on mutual understanding, itself linked to the initiatives of professionals who must grasp the specificities of their experience with each AS. Support cannot be provided without pooling the knowledge and experience of professionals, taking into account the subjective dimension of their relations with a person with AS. More specifically, these relationships are established in the long term and they must be personalized, repeated and ritualized according to the fluctuations of the patient’s resources. Thanks to their appropriate use, EAC tools facilitate mutual understanding taking into account the singularities of each and the relational and environmental context of individuals within the framework of an individualized project.
Analyzed from an anthropological point of view, the use of AAC covers not only specific techniques to be applied but also an intersubjective situation which leads to a better understanding of the representations of professionals with regard to this handicap, the processes of observation, interpretation, and adaptation to the other. These different levels of analysis allow, ultimately, the highlighting of an ethical posture at the center of the care of these users. In doing so, we will question the role of communication with a person with AS: is it intended to better “decode” their needs or does it ultimately correspond to the search for mutual understanding which, however imperfect it may be, requires respect for the integrity of another? This leads more broadly to rethinking the notion of autonomy, the main objective of the support and development of EAC, through the prism of pleasure and well-being, and no longer, exclusively, from the angle of the basic needs of people with AS.
Keywords: Angelman syndrome; alternative communication tools; relational ethical; care; France.
Martine Dutoit et Marie-Claude Saint-Pé
«Investigating the Relationship of Interaction with One’s Environment: An Approach of People Positioning Themselves as Mental Health Peers» (p. 173-196)
Abstract: This article retraces the sensitive and intellectual journey of users of the mental health system in France, who have become pairadvocates, in support of access to rights and recourse alongside other users. This process consists in elaborating, through experience and as it progresses, their principles of action in pairadvocacy and user representation practices. Three of them are given here: From the problem-person to the problem-situation; Interactions to be questioned and challenged; Being the address of the other to understand and act. The article addresses the anthropological, sociological, societal, and political context in which this practice of pairadvocacy evolves. This context and this approach, according to pairadvocacy practices, are exemplary of an appropriation of their environment by people who have many reasons to think of themselves as excluded, as strangers. A first step towards inclusive thinking, perhaps.
Keywords: pairadvocacy; environment; ownership; experience
Eugénie Terrier
«Environmental Approach in Understanding and Supporting Farmers in Difficulty» (p. 197-237)
Abstract: This analysis is based on a research about partnership and local experiment helping farmers in difficulty towards a professional retraining in the West of France. Based on a qualitative survey by observations and interviews with a variety of stakeholders (farmers, elected officials, executives, social workers), this research aims to analyze the social situations of these farmers with the ecosystemic model, and to question the representations and practices of the different stakeholders involved in their support. The results show that the vulnerable situations of farmers are located at the intersection of the influences of a set of socio-cultural and spatial environments and individual trajectories punctuated by biographical events that are more or less weakening depending on the context. Faced with these situations and even if the stakeholders are aware of the influence of the environments, the institutional organisations and the social norms remain focused on the individual responsibilities.
Keywords: farmers; vulnerabilities; social support; ecosystem model; effect of the place
Open Topic
Mélanie Girard, Simon Laflamme et Émilie Tremblay
«Gender Pay Equity in Canada from 1971 to 2016: An Empirical Analysis» (p. 241 275)
Abstract: This article examines the theme of gender pay equity in Canada. As a first step, using public-use microdata from the 2016 census, it compares the wages of men and women globally and then using the intermediate variables of age, industry sector, education and work status depending on whether it is full-time or part-time. It thus discovers an inequality of pay according to sex although as well, paradoxically, a small variance in wages explained by gender. In a second step, it presents this comparison in the light of those made since 1971, all of which are based on census microdata. It observes a general trend towards reducing the gender gap in wages, but also towards reducing the variance explained in wages by gender; it also observes some stagnation in the reduction of the gap between 2011 and 2016. In a third step, it examines the difference in wages between genders, but according to salary brackets, revealing a clear variation in this difference according to the salary bracket that is taken into account. Fourthly, it lays out some legislative considerations.
Keywords: pay equity; gender inequality; Canada; legislation, wage ratio; explained variance; standard deviation
Ines Bouguerra
«For a Relational Analysis of Religious Conversion» (p. 277-304)
Abstract: Religious conversion is a complex research subject that has aroused the interest of several disciplines. This monodisciplinary knowledge obscured its conception in its complex reality. It has also reinforced the power of categories reminiscent of holistic or individualistic approaches (power, reproduction, intention, rationality). The interractionist approach has contributed to the understanding of religious conversion, on the one hand. It has, on the other hand, reduced the temporality to a linearity which suggests that a possible religious conversion could occur punctually, in a “before-after” framework. The objective of this contribution is to think outside the box by observing the relationship of the psyche to religion through relational theory.
Keywords: religious conversion; relational theory; causal relation; rationality; psyche; methodological individualism; methodological holism; socialization; Pierpaolo Donati; Simon Laflamme