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Homelessness, In-Betweenness, and Socio-Medical Interventions in Marseille, France

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Homelessness, In-Betweenness, and Socio-Medical Interventions in Marseille, France Vulnerability in Relation: Homelessness, In-Betweenness, and Socio-Medical Interventions in Marseille, France Mathieu Isabel Department of Anthropology McGill University, Montreal June 2020 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Master of Arts © Mathieu Isabel, 2020 TABLE OF CONTENTS ABSTRACT / RÉSUMÉ ............................................................................................................................................ 4 ACKNOWLEDGEMENTS / REMERCIEMENTS .......................................................................................................... 5 NOTE .................................................................................................................................................................... 6 MAPS ................................................................................................................................................................... 6 INTRODUCTION .................................................................................................................................................... 8 LITERATURE REVIEW ........................................................................................................................................... 16 Vulnerability ............................................................................................................................................................ 16 Multiplicity .......................................................................................................................................................... 16 Poverty, exclusion, precarity and risk ................................................................................................................. 18 In-betweenness and relations ............................................................................................................................ 21 Homelessness .......................................................................................................................................................... 23 Social processes and relations ............................................................................................................................ 25 Health and medicalization .................................................................................................................................. 28 Professionals ............................................................................................................................................................ 31 FIELD SITES : BEYOND PLACES ............................................................................................................................. 32 The City: Marseille ................................................................................................................................................... 33 La Maison Frédéric and L’Oasis ............................................................................................................................... 48 METHODOLOGY .................................................................................................................................................. 54 Ethnography ....................................................................................................................................................... 54 Field: description and immersion ....................................................................................................................... 56 An iterative process ............................................................................................................................................ 60 Research and clinician: on position and identity ................................................................................................ 60 Somewhere between Montreal and Marseille ................................................................................................... 64 I. ON TEMPORALITY: BEING IN TIME ................................................................................................................... 66 PAST ......................................................................................................................................................................... 70 Trauma ................................................................................................................................................................ 71 Mission and History ............................................................................................................................................ 74 PRESENT .................................................................................................................................................................. 78 Emergency .......................................................................................................................................................... 88 FUTURE .................................................................................................................................................................... 92 TRI-TEMPORALITY: A CONSTANT VULNERABILITY IN MULTIPLICITY ....................................................................... 95 II. VULNERABILITY IN RELATION ........................................................................................................................ 101 A CIRCULATING VULNERABILITY ........................................................................................................................... 105 Vulnerability as relational and circulatory ....................................................................................................... 105 VULNERABILITY-BEARING BODIES ........................................................................................................................ 116 2 The body as proof: categories and extensions ................................................................................................ 116 Nonsense and violence .................................................................................................................................... 132 AN ONTOLOGY OF IN-BETWEENNESS ................................................................................................................... 140 CONCLUSION: WHAT IS REALLY HAPPENING HERE? .......................................................................................... 144 REFERENCES ..................................................................................................................................................... 148 3 ABSTRACT / RÉSUMÉ In recent decades, it has become common for medical practitioners and researchers to refer to patients from certain marginalized backgrounds (low socio-economic status, homeless, etc) as ‘vulnerable.’ But what does vulnerability entail in these contexts? In the particular setting of socio-medical interventions with homeless individuals, who is actually vulnerable? The service users? The professionals? Both? Based on three months of ethnographic fieldwork with two different socio-medical organizations offering services to homeless individuals in Marseille (France), this thesis situates vulnerability in-between different theoretical concepts, social relations, and social policies. I first explore how vulnerability suspends professionals (intervenants) and service users (usagers) in a particular form of time -- a constant tri-temporality, in which neither past nor future are open for movement, leaving individuals in an often directionless present. Second, I present how vulnerability is not just a feature of life circumstances external to the socio-medical system, but a form of relation that circulates between, and affects both, intervenants and usagers alike, albeit with different consequences. This thesis is fundamentally an invitation to rethink socio-medical interventions with so-called “vulnerable” individuals through a different ontology of the self – a relational ontology. In this perspective, vulnerability happens in-between; in-between individuals (whether intervenants or usagers) in relation to one another, and in- between individuals and their particular socio-political contexts. In this way, vulnerability extends beyond a simple category of individuals. It stems neither from individual fault nor from fixed social categories: it circulates, rather, within/through a system of vulnerability. Vulnerability is therefore a relational ontological form of existence shared by all of those living and working on the margins of society. Depuis de nombreuses années déjà, les professionnels de la santé et les chercheurs décrivent certains patients issus de différents contextes marginaux (faible statut socio-économique, itinérance, etc.) comme étant "vulnérables". La question se pose toutefois : Qu’implique la notion même de vulnérabilité dans ces contextes précis? Ainsi, lors d’interventions médico-sociales avec des personnes en situation d’itinérance, qui est véritablement « vulnérable »? L'usager? L'intervenant? Les deux? Basé sur une ethnographie d’une durée de trois mois dans deux organismes de Marseille (France) qui offrent des services médico-sociaux à des individus en situation d’itinérance, ce mémoire positionne la vulnérabilité dans un entre-deux; entre différents concepts théoriques et entre de multiples relations individuelles et politiques sociales. Tout d'abord,
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