from being entrepreneur of the self to the medicalization of performance: reflections upon labour market flexibilization

This critical-reflective essay seeks to discuss the medicalization of performance based on reflections on flexibility in the world of work and the phenomenon of self-entrepreneurship. In a context of economy financialization, productive restructuring and State’s weakening as guarantor of social rights, precarization and informality are increasingly prevailing, where the promotion of labour flexibilization occurs in line with politi-cal-ideological strategies of neoliberal inspiration. There emerge ways of individualization tied to the construction of a multifunctional worker, availa-ble to develop multiple abilities, which becomes a potential enterprise and has as a principle the same market dynamics as this enterprise. The entrepreneur of the self needs to invest in itself to keep being valuable and having great functioning conditions, in order to avoid, to the fullest, its own decapitalization. Therefore, in order to enable conditions to sustain the image of success and of author of its own story, the usage of medicines, stimulants and multivitamins has been used as a strategy in search of high performance. To reflect on “the entrepreneur of the self”, the new ways of subjectivity and the suffering derived from those, as well as the apparatus that produces them, is necessary and consists in a challenge for community health.


Introduction
This critical-reflexive essay aims to discuss the medicalization of performance from reflections upon flexibilization in the labor world and on the phenomenon of the entrepreneurial self.To do so, we will initially approach the structural crisis of capitalism, according to Istvan Mészaros, following with reflections on the precarization of work in times of crisis and the social construction of the "entrepreneur of the self " until we get to the medicalization of performance in post-modernity.
Phrases like: "Entrepreneurship, 7 steps to success", "Unemployment: how to turn bad times into opportunities", "Work while they sleep, learn while they party, live like they dream...", or even "Your success depends on you" are becoming increasingly common.Phrases like these convey the message that people, by their own effort and determination, will achieve success, especially in the labor and financial fields.Moreover, this media bombardment of catchphrases and stories of overcoming creates a smokescreen to cover up the growing rates of job precarization and the alarming increase in unemployment in Brazil, which have been strongly associated with the health crisis and the economic instability experienced in the country.In this scenario, the "entrepreneurial" way out emerges as a promise of solution, in which people start to see in individual effort the main, if not the only, opportunity to survive the crisis 1 .

the structural crisis of capitalism
From the analysis of the current situation, it is clear that this crisis scenario, more specifically the crisis of capitalism, is not just another momentary crisis of capital, a consequence of a temporary bad performance of the economy, but a deep, lasting, and structural crisis.A situation in which the dominant class seeks, as a possible way out of this situation, to reduce the remuneration of the working class and increase its exploitation 1 .
According to Istvan Mészaros 2 , the structural crisis of capitalism began in 1973, with the oil crisis, and has a continuous deepening trajectory, despite periods of slowdown.According to the author, the crisis leads to the realization that cap-ital has no limits to its expansion, which leads to a process that is uncontrollable, destructive and unconcerned with people.The crisis addressed by Mészaros 2 is based on the unsustainability of capitalism with its decreasing profit rate and unstoppable increase in social and economic inequalities, leading to a mismatch between overproduction and consumption.
In this sense, the current contemporary State, driven by the crisis context, has intensified the forms of labor exploitation through the withdrawal of labor rights.Then there is outsourcing, flexibilization, the zero-hours contract (a contract that guarantees only the worker's availability, but does not ensure income), uberization (outsourced work, with only digital links with the company that has Uber as its major employer, but there are many others, Uber is just one example), "independent-contractor-only hiring policy" phenomenon (now workers in many sectors need to register a company, a legal entity, in order to provide services, thus eliminating labor charges), working from home (remote activity on a seasonal, sporadic and occasional basis, in which the work performed at home must be equal to that performed in the company with identical working hours), telecommuting (a modality in which the company cannot control the working hours, nor make additional remuneration, only being able to pay reimbursement for additional expenses such as internet), and the end of any form of social protection.Besides, the new information and communications technologies (ICT), through a sophisticated instrument of management and control of the workforce that determines who can work, how, in what way, and in how much time the work should be done, how much money will be received for the accomplishment of a task, among others, end up coercively pressuring the workers to be assiduous, not to deny demanded services, and to be available, based on the threat of blocking and the possibility of dismissal at any time and without the need for justification or prior notice.Ultimately, they aim to increase "exponentially the ways of obtaining profits and even of extracting the maximum value", helping to deepen and strengthen the modalities of precarization of work.For this, large companies and digital platforms use a discourse in which they propose to mediate activities between final consumers and workers who offer services autonomously, thus converting the workforce into clients, eliminating their subordination, and claiming that they enjoy freedom to work when, where, and how they wish 3,4 (p.33).
Thus, the working class is unprotected as regards health, education, housing, minimum income, food safety.As if the absence of social protection were not enough, the entrepreneurial discourse blames individuals for their individual failure, which is usually the rule 3,5 .The term "working class" refers to the immense collective that depends on its own work to survive, because the entrepreneurial discourse, appendix of neoliberalism, affects an entire class, its rights, and the concrete condition of life, whether they are young or old, more or less poor, everyone will suffer, with differences and in different ways, the consequences of the social unprotection that comes from the State.
This ideology materializes through changes in the Brazilian constitution, such as the Labor Reform 6 and the Social Security Reform 7 .The Labor Reform -Law No. 13.429/2017 6 -makes way for labor relations where the exploitation of workers and the suppression of their rights take center stage, through new forms of hiring, flexible working hours, reduced pay and social protection.The 2017 Labor Reform expands the freedom of employers to determine the terms of employment, the use of the workforce, and the workers' remuneration.Employers now define the rules of the employment relationship to companies in a way that restricts the participation of workers' organizations and the State, bringing insecurity and loss of workers' rights, as well as the reduction of social protection 8 .In this context, with lower salaries, longer working hours, high rates of work accidents and insecurity resulting from the circumvention of social and labor protection legislation, outsourcing has an increasingly important role in the destruction of labor and its rights 9,10 .As a consequence, we have the configuration of new proletarian figures (such as freelancers), produced by the transformations of wage relations in times of flexible production 11 .
The Social Security Reform 7 , on the other hand, has led to significant setbacks for social protection, since the toughening of the rules for the concession of benefits does not take into account the living conditions of most Brazilians.With this reform, the guarantee of the right to basic conditions of life was compromised.A large number of workers who have committed their working time will suffer drastic losses at the most vulnerable time of their lives, at retirement.In Brazil, Social Security, which used to be an instrument for human dignity and the eradication of poverty, has moved away from these purposes and may lead to more social inequalities with the Social Security Reform 12 .
In the Brazilian context, a heterogeneity of types of employment emerges in the working class.All of them characterized by the various modalities of atypical labor contracts, for an indefinite period of time, configured by the logic of productive flexibility.Some examples are temporary work contracts, part-time work, outsourcing (subcontracting), apprenticeships (interns), and informal work itself 11 .Thus, the working class today is broader, more heterogeneous, complex and fragmented than the industrial proletariat of the 19th and 20th century 10 .
Among the measures in question is the labor reform, which, in the form of Law No. 13.467/2017, altered 201 points in the labor legislation, liberalized outsourcing and expanded the temporary contract.
In this context, the promotion of flexibilization strategies in the labor world occurs in consonance with the political-ideological strategies of neoliberal inspiration that see in the redirection of the State's functions a condition for the good functioning of the market 11 .The complex articulation between financialization of the economy, neoliberalism, productive restructuring, and the mutations in the microcosmic space of work and companies, has deeply affected the working class.The neoliberal logic is explicit in placing the State at the service of companies to the detriment of basic rights such as health, education, and sanitation.In short, current capitalism presents a multiform process in which informality, precarization and insecurity have become vital mechanisms for the capital 10,13 .

the precarization of work in times of crisis
In times of crisis, especially of health and economic crisis, similar to the one we are experiencing in Brazil and in the world due to the coronavirus, the precarization of labor relations and labor rights is considered a "[...] domination strategy that affects all workers, even if in a differentiated and hierarchical way, as part of the development dynamics of flexible capitalism in the context of globalization and neoliberal hegemony" 9 (p.16).
Therefore, in a social scenario in which the logic of precarious rights is installed as a constitutive element of the new configuration of the labor world, workers are forced to learn to deal with risk situations arising from the transitoriness of new forms of occupation and the demobilizing effect they produce on the collective of workers 11

(p.123).
As a consequence of this new morphology of work, which is at the service of capitalism with the aim of recovering the economic, political and ideological forms of class domination, we have, besides the elimination of labor rights, social security and the intensification of the workday, the increase of isolated work, provided with a precarious sociability and distorted by the competitive standard, without class union representation.Thus, to live in a world of instability and uncertainties produced by the weakening of the rights linked to the protection network connected to salaried work is the fundamental characteristic of the precarious worker condition, a situation of fragility and difficulties of resistance 3,10,11 .
According to Standing 14 the precariat is a class in the making.Its work is of a fragile and unstable nature, associated with casualization, informalization, employment agencies, and parttime work, among others.For the author, the precariat depends almost exclusively on nominal wages, is usually subject to fluctuations, has no secure income, is exposed to chronic uncertainty and to a life of unknowns, and has fewer rights than all other salaried workers.
Thus, in a social context of growing impoverishment and social exclusion, produced by the weakening of the State as a public sphere that guarantees social rights, there is an increasing prevalence of precariousness, informality, and underemployment, with more intermittent workers, more job elimination, and fewer workers with their rights preserved.Then, strategies of individualization emerge, linked to the creation of a type of polyvalent worker, always willing to develop the skills and obtain the qualifications considered adequate to the changing interests of capital.It uses as a subterfuge, as a way to soften the gravity of this reality, the narrative of the individuals as the entrepreneurs of themselves, in a kind of employers and wage-earners of themselves, where individuals begin to perceive themselves as disconnected from any collective project 10,11 .Under this perspective, questioning and analysis of social problems are redirected to individual levels of resolution, thus transferring the responsibility of the State for social ills to the individuals themselves 15 .

the social construct of the "entrepreneur of the self "
With the strong presence of the neoliberal model of government, it is possible to observe the valorization of the autonomous individual who, unassisted by the State, would be able to manage himself and to survive the oscillations of the mar-ket.Unprotected by labor laws and social security, each worker becomes his own salesperson and/or employer, becoming a potential enterprise 1 .
As an individual enterprise, the entrepreneur starts to ´dance to the tune` of the prevailing economic model.In an optimistic discourse in which the solution to the problems generated by the crisis and unemployment depends only on individual effort to adapt to the neoliberal rationality that demands autonomous subjectivities, predisposed to risk and competition, flexible and in constant movement 1

(p.605).
It points to the political direction of competitiveness and unbridled meritocracy that blames the individual for their underachievement, or "failure" 16,17 .
The widespread belief that the individual characteristics and efforts are what defines the ascension in the social hierarchy places the individual category (individualization) in a central place in the neoliberal discourse, seeking to keep the people productive and docile, and with this, the good functioning of the capitalist machine 18,19 .This is what Monteiro et al. 17 call a global society of control, where everything and everyone is included in the capitalist logic, deeply marked by the individual mode of subjectivation, which considers consumption and social ascension as prerequisites for humanity.
In addition, there also seems to be a new market "morality", a form of regulation that pushes individuals to abandon some of the moral principles socially prevailing in pre-globalization periods, and to follow patterns and ways of feeling, thinking and acting under the aegis of the high competitiveness that marks the work environment and the individualistic search for satisfaction in postmodernity 20 .
Postmodernity is characterized as an era marked by the supremacy of commodities, the transformation of culture, the advent of neoliberal societies and, consequently, the dismantling of the State 21,22 , where the norms that previously (in modernity) governed daily and community life were then replaced by the "anything goes" logic of the market 23 .
From the desiring production imposed by the contemporary capitalism model, the desires, aspirations and beliefs of the individual are not exclusively his, but produced in the encounters that occur in the social field, which consequently end up building certain types of subjectivity 24,25 .
According to Romanini and Detoni 19 , the concept of subjectivity implies an incessant production, which occurs from the encounters expe-rienced with the other, be it the social other, nature, events, people -that which affects the ways of living -not being able to be totalized or centered in the individual, but being essentially manufactured and modeled in the social register 26 .
In this way, with the rise of neoliberalism and the entrepreneurial spirit in various spheres, each subject became an enterprise, and began to have as a principle the same marketing dynamic of the latter.That is, there is the need to invest in oneself to keep oneself valorized, with a high quotation and with "good working conditions", besides being apt to the volatility of the social and market demands, in order to "avoid, to the last consequences, one's own decapitalization" 27 (p.5).Thus, "the neoliberal purpose is to make the worker [...] an entrepreneur of the enterprise-unit personified in and by itself, being at the same time his own capital, producer and source of income" 28 (p.175).
Meanwhile, the protagonist of contemporaneity always seems to be one step behind in relation to the novelties of consumption, as well as to the new competencies and demands of the market.Devoid of a sense of satisfaction, he finds himself caught up in the unrestricted flow of information that circulates through the networks, in the imposition of continuous and unlimited training, and in the high performance that is demanded of him (and almost never achieved) in the various social roles he plays 27 .
In the same perspective, Goffman, in his work The Presentation of Self in Everyday Life 29 , states that individuals play different characters and act as "everyday actors", making a metaphor of social life as a theatrical stage.For that theorist, people cooperate among themselves in order to ensure the continuity of the show, being concerned with the performance of particular characters or versions of themselves before the audiences they encounter, since the success of each performance depends on the perception/approval of the audience.On stage, the chosen character is played, and backstage the actors relax from playing that role.In other words, in what Goffman called the "dramaturgical perspective", actors create impressions of themselves and perform for audiences, at the same time serving as an audience for other actors 30 , raising to the ultimate power, in the current society of the spectacle 31 , the Hollywood maxim that the "show must go on".
The concept of the "Society of the Spectacle", developed by Guy Debord, in synthesis, refers to a universe where you are only what you see and how you let yourself be seen.In this context, which seems to crystallize in all spheres of daily life, someone only really exists if they make their performance visible, and preferably envied by others, thus being necessary to permanently fight to stand out in an increasingly competitive market of appearances 31,32 .
In this way, according to Ehrenberg 16 , contemporary society has been under the aegis of the cult of performance, where a heroic nature is increasingly valued, whose established model is of an individual who does not depend on anyone and who takes responsibility for their actions.In other words, the model desired, as well as less and less subtly demanded, is that of the entrepreneur individual.
This process of objectification, of reification or transformation of people into merchandise was theorized by Karl Marx, in The Economic and Philosophic Manuscripts of 1844 33 .Marx, based on the centrality of labor, addresses the category of alienation.For Marx, alienation can be analyzed under four aspects: the alienation of man in relation to nature, when the worker ceases to provide his food, his housing, his clothing and begins to look at the natural environment with strangeness; the alienation of the worker in relation to his own work, because his work is no longer for himself, or to meet his own needs, but to serve others in exchange for a wage; alienation of the worker in relation to the human species, when the worker no longer perceives himself as belonging to the community, individualization alienates workers in relation to belonging, to affection, to the bonds proper to humans; and finally, Marx suggests alienation at its deepest and most complex level, self-alienation, when the worker is disconnected from himself and no longer perceives himself in his actions, in his desires and in his capacity as an agent in the historical evolution.
It must be considered, therefore, that this process of human reification is not something unprecedented in human history.It is necessary to contextualize this process and realize its dramatic intensification in the current stage of development of the productive forces, where the accumulation and production of social inequalities has taken a destructive pace.

the medicalization of performance in postmodernity
To achieve contemporary performance ideals, permeated by the obsession with winning, being someone, and ultimately, being recognized and valued, the mass consumption of pharmacological substances, especially psychotropic drugs, has become an attempt to extend one's own limits, aiming to meet the expectations of the entrepreneurial spirit and the new dynamics that drive postmodern society 27,34 .
Furthermore, in postmodernity, more than just being successful, the discourse on well-being and healthy lifestyle, as well as the relentless pursuit of happiness, have become primary goals to be achieved."From a democratic right, happiness has become an imperative" 22 (p.176), in which the pharmaceutical technology of licit drugs is a path built by formulas, prescriptions and package inserts, for the achievement of this happiness, as well as a means to make the individual more efficient and able to respond to the demands of a permanent (optimal) performance.
In this regard, Binkley 35 argues that the imperative of being happy is aligned with the task of becoming an autonomous, independent, self-centered, controlled, and entrepreneurial social actor.For him, happiness is a "technology" of neoliberal government, in which its optimized management and intervention techniques in suffering, and (increasingly) in performance, have become instruments of governmentality.Governmentality is a concept developed by Foucault that has an eminently political meaning.It has had various conceptualizations, but in this essay we understand it as the encounter between the techniques of domination exercised over others and the techniques of domination exercised over the self 36 .
Therefore, in order to block any manifestation and emergence of affections undesirable to the market, such as dissatisfaction, laziness, insecurity, fear, sadness, among others, considered negative "by the entrepreneur of the self ", self-control becomes a demand of the subject, who seeks to silence his insistent subjectivity.For this, one of the aids in the search for entrepreneurial performance is the use of medications, stimulants and multivitamins, which goes beyond therapeutic use and becomes daily and generalized in order to give conditions for the subject to sustain the image of success and of being the author of his own story 37 .
Without cultural matrix or knowledge that would provide another way out, the new workers, now entrepreneurs, accept their condition of vulnerability and insufficiency before the market as God and submit themselves to medical treatments or self-medication.This creates a cyclical and vicious process in which the individual learns to see himself as a consumer of weight-loss pills, stimulants, tranquilizers, anxiolytics, sleeping pills, and many other promises of a better life.On the other hand, and consistently, "entrepreneurial performance" comes to be seen as an obligation, in terms of behaviors prescribed for success.It becomes an obsession of the postmodern individual transformed into merchandise and consumer under the health discourse, leading people to a process of loss of autonomy.According to Illich 38 , this process of social medicalization of life generally leads to a decrease in good health: the ability to maintain, intervene in, and transform in an autonomous and socially shared manner, one's own life and the environment in which one lives, with a view to preserving and/or increasing the degree of "lived freedom".
The same medicalization denounced by Illich 38 , in Medical Nemesis, which deals with this medicalization process in the doctor-patient relationship is observed nowadays in the relationship between the "entrepreneur of the self " and the market, where the worker, now deprived of his union, of his identity, and even of a formal employment bond, can be related to the category of alienation, by the Marxian matrix.
The effects of the medicalization of life are closely related to alienation, since both act to destroy certain cultural and psychological conditions that make possible the autonomous production of use values.People have become alienated from themselves, so they have become alienated from their historical becoming as a class, as a subject, and as a community.The workers who are docile, well-judged, "entrepreneurs of the self " find themselves removed from criticism regarding their living situation, they struggle only to fit in.
Permeated by the entrepreneurial discourse, where what counts, what is desired, are the results, performance is medicalized, once again transferring to the subject the responsibility for their own success, in a true cult of meritocracy.The individual, isolated -with poor socialization and no collective projects, disconnected from society, under constant pressure, permanent dispute, no guarantees, and complete uncertainty -begins to seek subterfuge (medicalization) to stay alive, productive in the market, and socially accepted.He tries, at all costs, to play the entrepreneur character, which, disguised as an individual conscious choice, was deliberately built to keep the gears of capitalism's domination and exploitation turning in postmodernity.
This process of reification of people generates suffering, since it stimulates and somehow prom-ises success and recognition to the best, but has frustrated a huge group of people.These people, the vast majority of workers, consider themselves failures, because even though they dedicate a lot of effort and time to reach certain goals, they do not succeed.That is, the reward does not come.In addition, the cycle of the individual entrepreneur often requires geographical dislocation, readaptation, which can generate disrespect to one's own culture, to one's own time, guilt and self-blame.Thus, the most perverse form that the process of alienation could produce was built: the entrepreneur of the self, victim and tormentor of the capitalist production mode, which already coexists with its environmental, economic, and social limits.

final considerations
This discussion should bring important consequences for those who care about human sociability, because the "entrepreneurs of the self " as well as the apparatus that produces them need to be reversed, or minimum values of social coexistence, fraternity, and solidarity may be lost even more.The production of identities and belonging in their common character, of use values focused on the good life and the quality of life are urgent, a matter of health and survival for humanity.It is about questioning the capitalist assumptions and building other relationships based on life.
Issues related to the austerity measures implemented, the lack of access to various rights and social security, the precarization of work, the new forms of subjectivation and the suffering resulting from these have important impacts and constitute challenges for community health, public health, and the Brazilian health system.Mental health problems and psychological suffering are a growing demand in health services and have been aggravated by the precarious living and working conditions of the population.Sooner or later, it will be necessary to address this issue and develop strategies to deal with it.Problematizing the social, political, economic, and historical context and proposing ways to understand this reality is perhaps the first step.

Collaborations
The authors participated equally in the discussion, planning, writing and final review of the article.