Read this article published on the Cercle Psy website.

While France’s cities are full of psychologists, the countryside has few. And yet, in rural areas, isolation, poor access to care and precariousness tend to exacerbate the psychological difficulties encountered.

In urban areas, there are far more psychologists than green spaces. In rural areas, the opposite is true. These professionals rarely set up practice there, despite a growing need for consultations, an increasing number of graduates, and a saturated urban job market. Rural areas are definitely not to everyone’s taste. There are many reasons for this: fear of isolation, of moving away from loved ones, of working part-time in the four corners of a sparsely populated region, of coming up against preconceived ideas about the profession…

A farmer on the couch

For other shrinks, working in rural areas is a choice, a desire to discover another rhythm, with other issues.  » I graduated in July 2011. I’ve always lived in the countryside, I did all my internships in the countryside in hospitals and EHPAD, and my professional project was therefore to work in the countryside. It’s not always easy to find a job in a rural area, » says Marion Delarce, a gerontopsychologist based in La Ferrière-aux-Étangs and Saint-Georges-des-Groseilliers, two villages in the Orne region of Lower Normandy. In some cases, working in a rural environment can even be a strategy. For, given the perilous professional integration that awaits them once they graduate, some immediately seek out positions far from any psychology university, where competition would be virtually non-existent.

However, practicing in rural areas is not easy. The lack of human and material resources often comes up in the testimonies of these field therapists:  » There is a much greater shortage of professionals than in urban areas. For example, it’s hard to find child psychiatrists, speech therapists or psychomotor therapists who want to come and practice here… This makes treatment much more complex… « A young psychologist working with young children and aging disabled people in the Aisne region of Picardy, France, anonymously testifies.Public health care services are sometimes non-existent on the spot, there are not always any associations or colleagues to refer people to, » explains Virgile Allemand, who practises psychotherapy in villages in the Alpes de Haute-Provence region of France. And it’s not always easy to adapt to this population so that a bond of trust can be established.

On the other hand, it has to be said that the image of a farmer on the couch makes many a city-dweller smile. Many of them, whether psychologists or not, have a stereotypical view:  » The idea that farmers, for example, also have a psyche is not obvious to everyone. Psychoanalysis, at its most caricatured, is something for posh city dwellers, once reserved for the upper middle classes. In fact, Freud was a Viennese grand bourgeois who had never lived in the country. And the first psychoanalysts practiced in their luxurious Parisian apartments. It’s only since the 1960s that psychoanalysis has been used in a pragmatic, more realistic way, in CMPP-type institutions. notes Jean-Charles Héraut, a doctor of psychology, psychoanalyst and trainer-consultant in Anglet, a town in the Aquitaine region. In addition, we know that psychoanalysis requires the spoken word. However, peasants have the reputation of being silent, their motto would be rather « Suffer and die in silence ». « .

I’ll always remember, » confides Marion Delarce, of my training supervisor’s response to my question: « How would you describe the population you’re dealing with here? » – « Well, it’s a lot of rural people all the same, » she replied, looking apologetic. I was expecting her to give me an age range and tell me directly about their way of life.  »

On the patient side

Let’s take a look through the other side of the mirror: that of rural dwellers, peasants and farmers. Are the bucolic landscapes of our postcards as placid as they seem? No. If the psychological difficulties encountered in rural areas are similar to those in urban areas, isolation, lack of access to healthcare, lack of recognition and precariousness tend to exacerbate them.Basically, » observes Jean-Charles Héraut, city dwellers and rural dwellers suffer in the same way. However, I have observed configurations that are specific to the rural environment: the greater importance of the family and the gaze of others, the intertwining of farm management with family operations, the question of inheritance, the importance of the land, of animals… all interfere with psychological problems.  »

Even though mores are evolving and psychology is becoming increasingly democratized, many people are still reluctant to consult a therapist because, for many, shrinks are « for lunatics or big-city nerds ».« I’m constantly having to explain and justify my work, and break down clichés about shrinks, sometimes even with doctors, » exclaims Virgile Allemand.

According to Emeline Grolleau and Marion Haza, clinical psychologists and authors of the article « Un dispositif expérimental de consultation pour adolescents en milieu rural » (« An experimental consultation system for adolescents in rural areas ») (1), this representation of the shrink’s role is particularly prevalent in rural areas, making access to care all the more complex for outlying villages.  » You can’t ask someone to drive six hours round-trip a week to see a shrink in town. It would take half a day a week for a one-hour interview, not to mention the additional costs involved, the gradual loss of motivation and the incompatibilities with certain pathologies such as alcohol dependence. « says Virgile Allemand.

Awkward promiscuity

What’s more, it’s not uncommon for some small communities to be marked by a high degree of promiscuity among their inhabitants. Everything is known and said. So it’s not always easy to push open the door of a counseling center and consult a psychologist discreetly.  » All the more so as our premises are located in the heart of local communities, in town halls for example. So anonymity is not as guaranteed in rural as in urban areas. « say Marion Haza and Emeline Grolleau in their article.

This promiscuity is compounded by the financial and social insecurity that afflicts some rural areas. For the few communes farthest from urban areas, and with no public transport network to speak of, isolation can be rampant. Such a context tends to increase the psychological difficulties of adolescents, suggest Marion Haza and Emeline Grolleau in their article:  » Promiscuity with the parents and the difficulty of distancing oneself from the family do not make it any easier to gain psychological independence, which is made all the more difficult by the fact that travel requires the availability and agreement of the parents (…) We have observed that many situations reveal a family incestuous climate, which can sometimes go as far as acting out. » In such a context, where it’s difficult for potential patients to go for a consultation and stereotypes about shrinks persist, it’s easy to see just how perilous private practice in rural areas can be.  » I’ve always worked as a salaried employee, mainly as a trainer-consultant, alongside my private practice, and I also have a lot of urban patients. In a rural environment alone, I wouldn’t have had enough patients. admits Jean-Charles Héraut. In a rural environment, my clientele is largely built up through « word of mouth ». My website also plays a role, as it displays my interest in the countryside and farmers.  » (2).

Suffering in silence

Among rural people, farmers are particularly affected by disorders such as depression and other psychological suffering. So much so that, on average, one farmer in France takes his or her own life every day. According to the French Institut national de veille sanitaire (INVS), farmers are three times more likely to commit suicide than managers. The reason for this? A combination of unfavorable factors, such as isolation, lack of recognition of their profession, accumulating debts… ». As soon as there’s a suicide in the workplace, as has been the case at France Télécom on several occasions, the media are quick to relay the information, and TV news presenters talk about them with compassionate cocker spaniel eyes… Meanwhile, dozens of farmers commit suicide. And nobody talks about it. « regrets Jean-Charles Héraut. Why this lack of interest in rural people on the part of city dwellers and the media?  » In my opinion, there are two reasons for this: on the one hand, we have a false image of the campaign according to which « Happiness is in the meadow », « Fresh air makes us happy ». Which, of course, is absolutely false! On the other hand, I’ve observed a kind of condescension on the part of city dwellers towards farmers; the countryside doesn’t get much buzz, so why bother? « . Added to this is the fact that the institutions themselves, such as the Chambers of Agriculture, do not wish to publicize these problems to avoid damaging their image, which Jean-Charles Héraut describes as « a form of denial and repression ».

However, in the face of this shortage of psychologists in less populated areas, a few projects are emerging. For example, the Mutualité Sociale Agricole (MSA) health insurance funds have set up multidisciplinary units made up of psychologists, doctors and social workers to prevent suicide in rural areas, or to support people in distress. Psychologists play a significant role in these institutional arrangements:« As a psychologist, I have often led group sessions for farmers, farm workers, young people and families, and mediated in rural areas for organizations such as the MSA, the Chamber of Agriculture and, of course, the General Council, » explains Jean-Charles Héraut. At the same time, multidisciplinary outreach teams, telephone support centers and networks of discussion groups are being set up to support the most vulnerable. A start… –

(1) Marion Haza and Emeline Grolleau, « Un dispositif expérimental de consultation pour adolescents en milieu rural », Le Journal des psychologues, no. 254, February 2008.
(2) See www.jean-charles-heraut.fr.