Cermes3 stands for Centre de recherche médecine, sciences, santé, santé mentale, société, or Center for research in medicine, science, health, mental health, and society. It is a multidisciplinary laboratory dedicated to social analyses of the contemporary transformations of the worlds of science, medicine, and health, and their relationships to society.It is, in Europe, one of the most important research centers in this field.The center's researchers and university professors, while putting their expertise to work on a diversity of problems (health professions, end of life, mental disease, disability, aging, drugs, patenting of living organisms, addiction, genetics, etc.), all share the same ambition, which is to focus their investigations simultaneously on knowledge, practices, and health policies.
The Cermes3 laboratory is affiliated with the CNRS (UMR 8211), Inserm (U 988), the EHESS, and Paris Descartes University.It is also part of two excellence laboratories (LabEx):SITES and TEPSIS (see below).
Cermes3 is the result of a 2010 merger between Cermes—a research unit supported by the CNRS, Inserm, and the EHESS founded in 1985 by Claudine Herzlich and chaired from 1998 to 2009 by Martine Bungener—and Cesames—a research unit supported by the CNRS, Inserm, and Paris Descartes University established in 2004, whose director was Alain Ehrenberg.
A CNRS, Inserm, and EHESS mixed research unit, Cermes (Centre de Recherche Médecine, Sciences, Santé et Société, or Medicine, Science, Health, and Society Research Center) explored, since its institution in 1986, the relationships between the knowledge, health practices, care, and organization of the health system characteristic of the postwar era. Its scientific project was particularly attached to understanding the factors that led to the progressive exhaustion of society’s delegation to biomedicine and science after the end of the war. The issues investigated included:
- the transformations of scientific and technological knowledge, and more generally of knowledge of disease, which have contributed in particular to defining a new area for public health;
- the changes that occurred in the dominant epidemiological landscape of Western societies, soaring chronic pathologies, and health-care problems induced in particular by demographic evolutions and population aging;
- the increasingly growing role played by actors who had previously had little involvement in the organization of the health system and in medical decisions, particularly patients and their families but also the pharmaceutical industry and biotechnology;
- the more general reconfigurations of economic regulations and of welfare policies, which gradually did away with the exceptional status of health expenditure and legitimized the idea of cost containment and the need of a hierarchy of needs and interventions.
In 2009, when it merged with Cesames, Cermes was headed by Martine Bungener and comprised 42 members from a broad spectrum of disciplines:sociology, economics, history, epidemiology, anthropology, and political science.
A CNRS, Inserm, and Paris Descartes University mixed research unit, Cesames (Centre de recherches psychotropes, santé mentale, société, or Psychotropic drugs, mental health, and society research center) continued the research work begun in 1990 under the Association Descartes then in the framework a CNRS human and social sciences department research group (GDR 1106, Psychotropic Drugs, Politics, Society).
Cesames studied from a social sciences perspective the emergence and transformations of “mental health.”The concept, which has acquired major visibility over the past thirty years, signals a paradigm change in the social-medical-moral production of contemporary individuals,from simply treating mental diseases to optimizing “normal” human beings and their performances, thus inducing an overall reconfiguration of the borders between normality and pathology.In this new paradigm, favoring the “normal” mind means working to develop one’s capacities from the very moment of conception, to increase one’s quality of life through a well-managed psychological life, and to regulate one’s performances and their fulfillment in “personal development” and “self-esteem.”The idea is now to treat individuals by integrating the whole of their behavior, therefore of their sociality, in consideration of the vulnerabilities that expose them to malaise, risk behavior, and, ultimately, but only in its most extreme forms, to traditional psychiatric illness.The shift from mental disease to mental health therefore affects not only standards and action procedures, and the role of the various categories of actors, but also the way patients’ needs are expressed and taken into consideration.
Founded by Alain Ehrenberg, who was its director until 2009, Cesames comprised researchers from a number of different disciplines:sociology, history, anthropology, philosophy, and demography.
The Cermes3 scientific project today
The scientific project is organized around three general issues:
Knowledge, tools, and practices
Innovation is an essential component of the biomedical model of care.Considered as a potential source of progress in diagnoses and especially in therapies, it is also the target of considerable questioning—as much by those directly involved in innovation as by social scientists—regarding: the forms knowledge it involves; the complexity of the links between research and care practices; the risks and side-effects of interventions; access to innovations and health inequalities; and the diversification of represented actors (inclusion and participation of patients and families).
Knowledge, tools, and practices
The originality of the work conducted at Cermes3 on innovation issues lies not only in the choice of subjects on which our research is focused (medicine, genetic testing, reproductive medicine, etc.) but also in our approach, which features two unique characteristics.
The first is consideration of the different forms of knowledge contributing to the constitution of medicine and health categories beyond biological disciplines and laboratory sciences.These different forms of knowledge are not easily combined and undergo tensions, falling within hierarchies determined as much by their position in society as by their epistemic heterogeneity and the modes of expertise on which they rely.Consequently, our work pays particular attention to the processes that objectify categories and to the role of tools.Objectivity is not an attribute derived from compliance with formal rules or methodological precepts. It is an emerging social property intimately linked to the deployment of measuring techniques, indicators, classifications, and protocols, the use of which is historically and socially situated.
Analyzing categories, their boundaries, and their performative effects therefore requires in-depth analysis of the tools intended for their circulation and of the actors who use them or dispute them—whether they are experts, professionals, patients, industrialists or nonprofit organizations.
The originality of the research on innovation conducted at Cermes3 lies, in addition, in our focus on the trajectories of innovations, from their initial stages of invention through to their implementation in routine, looking at what happens beyond the relatively controlled spaces of experimentation, at the dynamics of circulation and usage, at the unexpected effects of innovative practices, and at the conflicts that can be triggered by diffusion and generalization.Accordingly, our investigations do not separate scientific and technological innovation from organizational, social, legal, and ethical innovation.For instance, we approach the issue of the relationship between an invention and its economic appreciation by studying how its markets are built socially and following the ways in which the different stakeholders—researchers, enterprises, health professionals, legal practitioners, regulation authorities, patients, and consumers—negotiate (with or without authorization) its forms of appropriation, its placement on the market, and its standards of usage and access.
Health policies, treatment interventions, and care procedures
The rise, in the field of health, of performance and evaluation requirements has brought the primacy of professional regulations into question, while in the area of treatment, especially out-of-hospital care, new forms of articulations between medical and social practices are emerging. Parallel to this, the management of inequalities and vulnerabilities is increasingly calling on procedures aimed at “targeting” populations or subgroups, and advancing policies of risk “reduction.”
Health policies, treatment interventions, and care procedures
Following up on Cermes3 long-term commitments to analyzing the transformations that have occurred in medicine, medical work, and care practices, we examine health policies not only from the standpoint of their development—whether through expertise processes, stakeholder logics, or the definition of priorities and procedures—but also from the standpoint of their implementation.We thus take particular interest in local practices, be they medical, care-related, or in providing assistance and social services. We also look at the consequences of these practices on people's life trajectories, as well as at the institutionalization or reconfiguration effects that these practices can induce.Finally, we give particular importance to the issue of regulation understood in its broader sense, such as the specific combinations of representations, actors, tools, and procedures that define the targets, the means, and the limits of interventions.
In this perspective, the responsibility of individuals in health matters appears as a crucial issue to be analyzed. The injunction of autonomy, capacity of choice, consent, and active participation is an essential dimension of the new policies on disability, aging, mental health, or chronic diseases.It is an integral part of the forms of organization, categories, and procedures at work on many different levels:that of expertise and the identification of target populations; that of the bodies in charge of organizing assistance, services, and benefits; and that of specific care-taking arrangements. The autonomy injunction also contributes to redefining how medical and social interventions are associated or not.More generally, it relies on a system of standards and values characteristic of an individualized vision of society and of new configurations of Western individualism, which largely remain to be analyzed.
The globalization of health
Acutely visible today, the reconfiguration of international public health around “the global” intersects with changes connected to the new phase of economic globalization, notably those touching upon the status of knowledge (local or traditional), the nature of the stakeholders (emerging countries, the World Bank, public-private partnerships, etc.), the definition of diseases (neglected, emerging), and the nature of intervention tools (eradication by therapy).
The globalization of health
The processes leading to the globalization of health have a history going back to more than 30 years:contemporary globalization is no more than the most recent of the many waves of the internationalization of health to have come to pass since the mid-nineteenth century.Understanding the specificities of this latest wave requires approaching it in relation to the emergence of the intergovernmental organizations set up after World War II to take charge of health issues at the international level, the development policies implemented by UN agencies and post-decolonization states, as well as the expansion of markets since the 1980s.
Our approach to globalization processes places emphasis on two dimensions.First, globalization is a change in scale of the circulation, not only of goods but also of persons, knowledge, and standards.Moreover, we are not simply dealing with transfers but with transformation processes of what is being circulated. Second, increasing numbers of arrangements such as public-private partnerships or global “alliances” have often led to viewing the globalization of health as overriding the authority of states. The new roles played by states like India or Brazil suggest that more than overriding state authority, what we are experiencing is a shift in the functions of the state, a renewal the latter’s mode of action, and the advent of new regulations. Our research is therefore particularly focused on the ways in which the policies of so-called emerging countries transform the knowledge, markets, and agenda of international public health.
Research operations are organized under four lines of work:
Line 1 – Transformation of mental health:objectification of psychiatric knowledge and the production of individuals
In this line of research, mental health is approached as an analyzer of some of the key transformations of our contemporary societies, thus contributing to the renewal of issues in sociology, anthropology, and the history of psychiatry with a focus on the dynamics of production, circulation, and localization of knowledge.
Line 2 – Disability, chronic diseases, and aging:policies and social reclassifications
The work included in this line of research is first organized to analyze the categories and schemes associated with the new ways of classifying disability and dependence. The second issue being addressed is that of how these reclassification operations affect the lives of individuals from the practical, cognitive, and moral points of view, focusing on the development of policies and services.
Line 3 –Drug consumption, risks, and addictions
Taking note of the increasing individualization of risk objectification and policies, in parallel with the fact that this individualization is a source of tensions, this line of research questions the forms of knowledge, the practices, and the policies related to the management of drug consumption and addictions, as well as the standards and values presiding over their construction in a context of increasing empowerment of individuals in the social area.
Line 4 – Innovations and the globalization of health
The projects gathered under this line of research combine analysis of the construction of global markets for pharmaceuticals and health practices—globalization through firms and the market, so to speak—and studies in the international government of health, focusing on issues of circulation, standardization, and usage of biomedical innovations by a variety of actors (from local practitioners to international organizations).
Partnerships and collaborations
The research contracts and international collaborations forged by Cermes3 researchers testify to the academic prestige of their work. The researchers also widely circulate their expertise to public health authorities through their participation in health advisory bodies or in the scientific committees of health agencies.The supervision or involvement of the laboratory's members in the coordination of several Master programs is also a reflection of their investment in education and research training.
Cermes3 is a founding member of two excellence laboratories (LabEx) working on highly complementary topics
SITES – Science, Innovation and TEchnology in Society
Supported by the Paris-Est University research and higher education hub (ESIEE, École des Ponts ParisTech, UPEM), the PRES HESAM (EHESS, CNAM), the CNRS, the INRA, the IRD, and Paris 13 University, it brings together more than 150 researchers belonging to 7 research groups working on science and technology, their production dynamics, and their relationships to the economy and policy making.
TEPSIS – State transformation, politization of society, institutionalization of social issues
Supported by the EHESS research and higher education hub, it brings together researchers and teams belonging to 13 mixed research units associated with the CNRS and the ENA research center. Its aim is to study the diversity of forms of political intervention in community life and the social sphere.
Dissemination of knowledge
Cermes3 has developed a strong commitment to graduate and postgraduate education. The center is currently involved in coordinating five Master programs:
- at the EHESS: Master of Social Science specializations in Health, Population, and Social Policies, and in History of Science, Technology, and Societies
- at Paris Descartes University: Master in Sociology specialization in Survey Sociology; Professional Master in Risk Management; and Science of Education Master in Education and Health Professional Training.
In addition to their work with their thesis supervisor, PhD students at Cermes3 (there are currently more than 40, all of them financially backed) have the benefit of outstanding pluridisciplinary scientific support: thesis committees, PhD seminars, workshops, and PhD days.
This policy is extended to post-doctoral students, along with support for their career plan (teaching, research, or other).