Paris-based translator and writer Ryoko Sekiguchi offers an introduction to French philosopher and psychoanalyst Cynthia Fleury’s message for society about care.

Every night at eight o’clock, bursts of applause rang out here and there across town. It feels like something from the distant past now, but this observance arose spontaneously during the lockdown period, when people’s movements were restricted to slow the growth of COVID-19 cases in France. It was a symbolic act expressing gratitude to nurses, doctors, carers, and others whose work it was to protect our health and lives, and it was practiced for as long as the lockdown remained in place. At the appointed hour, everyone opened their front door or balcony window, sent half a minute of applause skyward, and then exchanged neighbourly pleasantries, balcony to balcony. This period, I suspect, was when the populace became conscious of the vital importance of work like garbage collection and street cleaning. Those whose professions are often forgotten by society despite being essential to society’s function were thrust into the spotlight all at once.

　Even before COVID-19, the harsh working conditions faced by medical personnel in France were hotly debated. National hospitals rendered dysfunctional by government budget cuts, nurses and doctors working overtime due to inadequate staffing, and high rates of burnout and even suicide had been known issues for years, and medical personnel held regular strikes and demonstrations in protest. The government paid no heed to these calls for reform, and as a result the rise of COVID-19 immediately caused hospital bed shortages and other problems. Hospital budgets had been cut to the bone in an overzealous quest for efficiency, and the bill had finally come due. The government subsequently promised to make medicine a priority.

　It was amid this earlier wave of hospital strikes and demonstrations in the year before the COVID-19 pandemic began that French philosopher and psychoanalyst Cynthia Flurry aroused debate with a 48-page manifesto entitled Le Soin est un Humanism (Care is a humanism). Fleury has published dozens of books in fields ranging from governance and society to psychoanalysis, and is a frequent contributor to newspapers and magazines. Over the past few years in particular, her work has offered much insight into the problems of dignity and care in particular.

　But timeliness was not the only reason Fleury’s works attracted attention that year. She has spent decades not only writing but also taking concrete action to centre the problem of care in society.
After teaching political philosophy at many research institutions, Fleury is currently Professor and Chair of Humanities and Health at the Conservatoire National des Arts et Métiers. In 2016, in collaboration with the GHU-Paris, Psychiatry & Neurosciences, she established a research chair in philosophy at the Centre Hospitalier Sainte-Anne, with a focus on humanities and health.

　Establishing the “Research Chair in Philosophy at the Hospital,” as the initiative is known, was a groundbreaking move deriving directly from Fleury’s conceptualization of care as something far broader than medical treatment alone; education and dialogue, she argues, are forms of care as well. The chair’s courses are open not only to students, but also to medical professionals, patients, and the general public. Seminars are freely available online, and a range of research findings are published under Creative Commons licensing. These seminars are about architecture, care, and resilience, raising themes such as philosophical perspectives on mental health and the design of care.

　The Research Chair in Philosophy at the Hospital aroused animated discussion, and currently has nearly 4,000 registered members, with similar experiments underway in multiple other cities.

　“In the sense that it gives a person the potential for capabilities they did not have before, education, too, is care,” said Fleury in a dialogue with philosopher Alexandra Midal. “Today, education has become a tool for fitting people into the framework of social regulations, and is losing this element of care. Of course, regulations are essential for a community, but they are a means, not an end. Ultimately, we should be aiming to bring out the best of each individual and their inherent properties.”

　Caring professions have always existed to meet the needs of groups such as children, the elderly, people with illnesses, and people with disabilities. However, Western society has rendered these professions invisible and failed to recognise their value. These roles have largely been played by women and immigrants, who have been viewed as “naturally” suited to caring for others, making it unnecessary to involve money in the matter. The task before us now is to de-feminise care, make it visible, and impart social value to the work it involves. Taking this idea even further, Fleury expanding the definition of “care” from a single class of professions to include work relating to regional social activities and education more broadly. Mutual dependence (caring for one another) is not a weakness but the source of a society’s strength, making creative innovation within that society possible.

　Fleury also argues for a reconsideration of our definition of vulnerability. “Care” is often understood as something received by those who are relatively powerless in society, but we all find ourselves physically or psychologically weakened at some point in our lives. Vulnerability as such is an ever-present fact of society. It cannot be eliminated simply by diving society into those who are vulnerable and those who are not and wilfully ignoring the former. If anything, pushing the problem out of sight only magnifies it.

　This is not a sentimental argument about suffering as an inevitability for humans. The existence of vulnerability in society is an incontrovertible fact, Fleury argues, but when we are equipped with knowledge about this fact, weakness becomes an opportunity to create new states of affairs. We become capable of accepting the existence of a problem and creating new modes of being in response.

　For example, some instances of vulnerability are, ironically enough, the result of medical progress turning critical illnesses into chronic conditions. Some forms of cancer now result in conditions that could be termed chronic illnesses. Live-saving hospitalization, treatment, and surgery can leave patients unemployed and families destroyed, bringing about a kind of social death. Devising new ways of life to address this issue is another problem of care.

　Even the definition of “treatment” is debatable. If we take it to refer only to a return to the status quo before the illness in question, then for many patients no “treatment” is possible. Accordingly, Fleury proposes a reconsideration of our existing definitions of treatment. Here, too, she does not argue sentimentally for giving up and accepting one’s fate. Suppose that someone is incapable of a full physical recovery and must, therefore, coexist with vulnerability: if that person’s hope is kept alive and the number of things they must give up kept to a minimum, Fleur asks, could we not call this “treatment”?

　Treatment thus means not simply eliminating illness but caring for an individual with an illness by understanding their psychology and physiology along with the surrounding environment. This does not mean abandoning medicine, of course. “Humans have an essential love of science, and technology has the goal of freeing humans . . . however, for technology to be something that imparts humanity to humans” is essential. In medicine as elsewhere, technology cannot be an end in itself.

　When care is made central to society, hospitals become what Fleury calls “pillars of the city.” They are not simply places to avoid, where the weak are warehoused until they are deemed socially healthy again, but spaces for thinking about how life could be better and taking action accordingly. Hospitals can be venues for sharing knowledge, as Fleury showed by establishing the Research Chair in Philosophy at the Hospital. Beyond patients’ right to know about their own conditions, they also exist as human beings considering the problems of life from a standpoint that differs from that of medical professionals. This means hope for the creation of a space of solidarity.

　Venues for learning also give medical personnel the opportunity to receive care. After all, those who provide care also require care themselves. As noted earlier, medical personnel face working conditions that are far from ideal. When we think about what care for medical personnel might entail, it goes without saying that concrete improvement in working conditions are essential, as are respect and dignity for those in caring professions. Beyond this, however, we must overcome our tendency to view medical professionals solely as subjects in relation to care, replacing this with a shared understanding that, in relation to care, everyone is both subject and object.

　The Research Chair in Philosophy at the Hospital also publishes books. One example is Quand le récit faits soin (When narrative becomes care), a book about burnout among medical professionals that began as a creative workshop for medical professionals. When performing the work of care, it is particularly important to give meaning to and make time for words and dialogue. Prioritization of efficiency in medicine often leads to staffing cuts and less time spent in dialogue with patients and colleagues. This not only makes patients feel as if they are being treated as objects but also makes medical personnel feel as if they have become machines. When doctors and nurses do not feel that their complaints about deteriorating working conditions are heard by the government, and have no time for collegial dialogue, how can they themselves hear what patients have to say?

　Philosophy is a venue for considering life and the world through language. In that sense, choosing to publish Le Soin est un Humanism in 2019, when medical personnel in France were striking and demonstrating to gain understanding from outsiders about their working conditions, was a political act by Fleury as a philosopher who aims to make care central to society. The dialogue and discussion about this book gave voices to people involved with care, and many words were spent creating the understanding that care is everyone’s problem.

　The word “humanism” is sometimes translated into Japanese as ningen chushin shugi, roughly meaning “human-centricity.” But care is by no means a problem for humans alone. Fleury maintains that we should care not only for others but also for ourselves, and not only for humans but also for nature. Viewed in these terms, care can be an excellent ecological theme. When Fleury speaks of humanism, she is referring to the relationships humans can form precisely because they are human and a state in which our humanity is respected.

　There is much we can learn from Fleury’s philosophy, but two insights particularly important for those of us in Japan are her conceptualization of care as a keyword for the formation of free and equal relationships between humans, and her definition of care as a pillar that actually supports social innovation.

　In this essay I have focused chiefly on Fleury’s activities at the Research Chair in Philosophy at the Hospital. However, care is not merely an issue for the medical world. It lies in the very act of refusing to treat people as interchangeable objects across a range of fields. Care is, in that sense, essential for the formation of the self.

　Thus, when Fleury declares that society cannot exist without care, this is backed by the realistic and concrete goal of constructing a society with care at its centre. This point cannot be emphasized enough. For care to be taken up as a theme for discussion is certainly desirable—but so long as this is not accompanied by drastic social reforms, the risk exists that the word “care” will be used across so many fields, with its meaning so diluted that it becomes a mere buzzword, that questions of care will be subsumed into the Japanese concept of “consideration” (kizukai) on the part of the individual. Care cannot be reduced to a characteristic of individuals; it must be shared as an ethic by society as a whole.

　It is only when we consider things in this light that the gravity of Fleury’s position can truly be understood. Care is an act that makes our world a place where we can live with humanity, and defending care is both a political and ethical stance and an unending battle—because to defend care is to believe in the ceaseless activity of life.

Ryoko Sekiguchi

Ryoko Sekiguchi is a translator and writer based in Paris. She has translated works by Michel Houellebecq, as wll as Japanese literature and manga. In 2022, she received a Special Mention at the 42nd France-Lebanon Literary Prize and SGDL Grand Prize for Non-Fiction for 961heures à Beyrouth (et 321 plats qui les accompagnent), a work she also translated into Japanese.