Is It Possible for Critical Social Sciences to Trespass the Biomedical Sciences Bunker in a Neoliberal Era?

Is It Possible for a Critical Progressive Social Science to Impact the Medical Field?

I found a woman leaping downstairs with great effort.

—“What is wrong with your legs?” I asked.

—“My knees” She answered.

—“Have you been at the Social Security health care service?”

—“Yes, they say that I need a surgery, but won’t give it to me because I am too old.”

—“How old are you?”

—“I’ll be 60 in a few months.”

—“But you have the right to health care!”

—“Well, yes. But they don’t give me any appointment with orthopedic services anymore. They told me I was old, and that’s it.”

Different kinds of medicines are one of the most precious humanizing technologic, arts, meanings, and knowledge developments of human kind. All along history, medicines embed language, meanings, and practices of the historic moment and the social groups. We can tell who people are, what they cherish, how they organize, what are their hopes and sorrows by reading medicines, their rituals, their Cosmo visions, and the relationships they establish with suffering people. A beautiful, good, just medicine tells the story of beautiful, good, and just people. What story does current “scientific” biomedical and neoliberal medicine tell?

At the public health services in México and many other countries, it seems as if there was a hidden agenda where old people, the poor, and other “non productive” people were stripped from their right to health care. For at least the last three decades, public health services in different countries became bureaucratic, undersupplied, and inefficient, among other signals of abandonment and burglary, while private services—from highly sophisticated to cheap—flourish here and there (Leal, 2010). Political discourses show in numbers the chaotic state of health services, what much technology is needed to conjure their favorite menaces of disease, and how services’ privatization is the route to provide better disease care that includes more expense in more and more sophisticated preventive, diagnostic, and curing services (see, for example, the discourse of Frenk, 2002). Once convinced of the low quality of public health services, people do not show effective organized resistance to defend their services, searching healing in flourishing “religions,” medical quackery, private services, or other. In the meanwhile, come and go governments and international agencies selling maladies and health care privatization (Laurell, 2010), dismantling social security structures, and giving way to financing formulas to capture money out of citizens’ pockets (Arredondo, 2010). Despite the official recognition of the social determinants of disease by the medical institution (Commission on Social Determinants of Health, 2008), social sciences are still far away from being taken seriously in this field. A single positivist medical discourse convenient to social order and market goods realization has long been oblivious of alternative paradigms, feeding publicity about the importance to endure more biological years, about how each of us is going to develop the most painful and disabling diseases that can only be conjured by expending in preventive drugs, food, activities, sport devices, check-ups and so on, or by accessing high curing technology. This discourse and publicity blame individual people for social and historically produced maladies, hiding the social murder resulting from the way society is organized, its inequality, and injustice (Engels, 1844) and also denying the failure of medical sciences to achieve knowledge and comprehension of the human beings and their sufferings beyond the biological machine. Particularly, in the last four decades, the disease and suffering effect of neoliberal action shows across and within social classes. Besides the disease effect, the symbolic effect is pervasive, for example, in the concepts of the Self, the Other, body, community, sense of living, and life, or in the devaluation of the health knowledge historically produced within particular cultural contexts. To all social classes, the right to good and timely dead has been replaced by an offer of longevity and cure through expensive therapies or “life style.” To talk about dead when confronting a terminal disease is taboo, meaning defeat, pessimism, bad behavior, feelings, and soul. To refuse invasive therapies such as chemo is often socially condemned. This state of current medicine tells the story of current neoliberal society.

A medical reviewer of these statements immediately will ask for scientific sources; day-to-day confrontation with people and literature from my professional health-promotion qualitative research practice is my source, and this is not the place to unload thousands of voices telling so. I will then answer to such a reviewer: “Beyond the medical-statistical paradise walls—The Matrix?—there is reality, including the Social Science.” Cultural Studies–Cultural Methodologies is asking whether it is possible for a critical progressive social science to make a difference in the second decade of the 21st century. In the health field, the question needs to be a bit humbler or, probably, aged: Is it possible for social science to trespass the biomedical sciences bunker? The incursion of social science has probably penetrated “soft” health areas such as demography, social medicine, public health, health promotion, or epidemiology, but has not penetrated clinical or basic medical sciences, which dominate the health field. Furthermore, social sciences’ paradigm tolerated in the medical field is positivistic, conforming to the positivistic thinking of the field as a whole. Clinical and basic sciences focus in disease and not in health; their positivist thinking endure looking for biological answers and “hard” evidence to embodied social problems. For current medical sciences, the gene, the molecule, its components, and how they change during a “non-healthy” life (vis-à-vis a life in the power socio-historical context) explain, or will eventually explain, human suffering due to disease. Every “discovery” will become a product to sell in the market considering the rich—diagnostic and therapies—and the poor—health promotion—target clients, disregarding transcendental human projects. I get trapped with the marvelous and amazing medical discoveries; however, the products of medical scientific research do not illuminate the social production of disease, do not explore other paradigms, are not accessible to the socially excluded, create symbolic dependence to medical market products, and, above all, again and again realize Foucaults’ social order control (Foucault, 1973). The balance of the social resources invested in medical scientific research, vis-a-vis social research, hardly shows political will to make effective the right to health for all (World Health Organization [WHO], 1978) or the will to disclose the power contents of hegemonic medical knowledge.

It is not only the medical positivistic thinking that prevents a progressive critical social science to illuminate health problems and eventual solutions. As in the 20th century, in the first decade of the 21st century, the medical field has proven handy to a capitalist and neoliberal project in different ways, some of them described particularly by Foucault (2008): social order, social control; and in a world ruled by the market, an unlimited source to produce and sell merchandise. A different panorama is difficult to imagine for the second decade of the 21st century. Progressive critical social science has shown outside the medical field, many aspects of the now-a-days absurd of thinking health from a single positivistic medical paradigm; nevertheless, once in front of a disease event or disease event-to-be, even many of the same progressive critical thinkers become dominant medicine consumers. The medical paradigm of how, why, and where to live and die has become hegemonic, cutting across cultures, social classes, gender, age groups, or other. In this situation and at present time, it does not seem possible for a progressive critical social science to effectively penetrate the medical field. This is not to say that progressive critical social sciences have no chance at all to penetrate the health culture.

Are We on the Edge of a New Politics of Possibility in the Health Field?

Biomedical sciences’ tyranny in the health field is only possible because we, as public, permit it. As social scientists and critical qualitative health researchers, we know long ago the fragile situation of tyrannies in front of knowledgeable citizens acting together (Freire, 1972). What are second 21st century decade strengths to confront biomedical tyranny? Current socio-historic context of violence, misery, and injustice is attesting more and more disenchantment with biomedical responses to suffering. Despite biomedical research, infectious as well as noncommunicable diseases—including injuries—are rising without effective medical control (WHO, 2013b). For people dying because of hunger or violence, the prospect of a long life cared by medicine is out of bounds. With the same disease, the poor can die faster with little medical care while the rich may lengthen agony, consuming technology and medical insurance. At the end, neither one nor the other can be satisfied by the medical market offer. Medical care is unaccessible for a vast number of the population (WHO, 2013a), and medical services tend to be authoritarian, bureaucratic, careless, and inefficient. International agencies discourse claims for the inclusion of Health in All Policies (HiAP Task Force, 2013). New forms of communication and the information at hand for people with Internet access facilitate the public to corroborate what doctors say, to become illustrated about the problems of their concern from different paradigms and other person’s experiences, about what can be done, and the real costs and effects of particular therapies at the time of knowing who is behind policies and market products. I consider the H1N1 epidemic a landmark for open public suspicion on biomedical sciences and their relation with politicians and business. People with access to the Internet got to know that this “devastating epidemic” wielded scientific support to sell vaccines, Tamiflu, alcohol gel, and other merchandise, producing international panic, selective exclusion in airports, and even paralyzing countries’ economy, as is the case of Mexico. In this way, the same neoliberal health project is suffocating itself. In the neoliberal project, health is in a hidden state, but not in the hermeneutic Gadamerian sense (Gadamer, 2001), but in the sense that health has been blurred by hegemonic medicine. Within an unsustainable neoliberal project, peoples’ disenchantment with medicine opens a chasm in the medical bunker for critical social science.

On the other hand, a robust critical transdisciplinary social science addressing health is flourishing away from biomedical and market control, for example in the understanding of the body, gender, inequity, the meaning of life and dead, being diseased, becoming a patient, being poor and sick, health care, or other. From outside medicine, social science can illuminate many aspects of such situation and disperse knowledge to the public. Three out of those aspects can be the antiautonomy medical culture and the fact that the body became body-territory (Chapela & Consejo, 2010) invaded by medical meanings, knowledge, and practice; the potential of a culture of citizenship to confront the medical tyranny and impulse new ways to understand health; the role of medical training and research in the maintenance of the medical paradigm (Chapela, 2007).

Where We Stand as a Community of Health Scholars?

Neoliberalism does not construct but destroy. We need to face the wreckage neoliberalism has left within our critical communities. Our forces are dispersed but alive and looking for reconstitution. From a Latin American health community perspective, we have critical scholars—some dispersed, some constructing community—potential newcomers disenchanted with current neoliberal medicine, and new ones wishing to find and collaborate to build up paradigms of hope. Our context and circumstance are different from the Anglo community, at the time we are building from scrap, developing what we have, and rebuilding from wreckage with scarce resources of all kinds. The relationships with overall critical social science and qualitative inquiry communities are growing at a very slow pace.

This is a moment for parresía (to say and do what we think disregarding consequences but in need of truthfulness: Foucault, 2002, 1983); this a moment to enhance our collective ethos, to look for common good and beauty, to understand in the boundaries, to search for the unthought-of, for the invisible in front of our eyes, to close our ears to sirens chanting neoliberal success, excellence, comfort, and amusement, or, if necessary, to pass on the torch of hope. As community of scholars, we need to build up community to diminish solitary efforts and achieve change in the present state of suffering and injustice. We may be already in the “sheep of fools,” ready to be dumped somewhere in open sea, however, insofar we are alive; hence, with hope, we can always, if in community, become mutineers on behalf of a better story of a renewed medicine and health where we can also find a renewed social organization and life.

What to Put in a Common Agenda?

One main health scholar critical “community” problem is its dispersion; how can something dispersed become a “community?” To keep the mutiny struggle, it is important, among other things, to look first for the Others, to as loud as we can call for each other, to see who responds, who they are, where are they, what are their quests, questions, and practices, to develop dialogue and reflection, to heal old wounds, to join or support their initiatives and enhance each other’s and common strengths. This comes along with the recognition of multiple inequities existing within our own health critical scholar communities. Divides can be found, for example, in awareness, training, quality perception, and standards, access to information resources, advice, publishing, meaningful voice, conferencing, collective backing, networking capacity, or other. In the way to diminish inequities, we need to construct alliances. Once a critical health scholar community has been achieved—with the agreement about the main objective of social justice through looking at health in the biosocial boundaries, by becoming communities of meaning—we need support from each other to produce meaningful research and teaching to conform to strong social and qualitative “evidence” about the need of changes in health understanding. Then, we will be in a position to look for common practical targets and strategies to reach local, regional, national, and international public forums from where we can disperse questions and alternatives to contaminate health research, health people’s meanings, public health policies, and health teaching programs with progressive critical social science knowledge. This agenda is not for today nor for this decade, it points to Utopia, it is an inheritable agenda for dreamers, those of yesterday, today, and tomorrow, a common dream that is a humanized health understanding that can at the time understand and do something for people’s collective action toward world’s suffering relief.