Rethinking the relationship between medicine and ideology means investigating the origins of the efficacy of ideological knowledge. Only after this investigation is completed is it possible to advance claims about dominance and hegemony. In order to rethink ideology, it is useful to divide the field into three levels of analysis: the level of ideological knowledge, where manifold and contradictory facts and meanings are produced and come to occupy the consciousness of the individual; the level of ideological discourse, where ideological knowledge is organized into trajectories of dominant facts and meanings; and the level of ideological process, where discourses are given authority and, sometimes, incorporated into ideological hegemonies. However, such an investigation requires that we reject certain preconceptions about “rationality.” In the sovereign sense in which empiricist writers use this term, it has the effect of hiding the origins of ideological knowledge by desocializing its mode of production. Correctly understood, rationality is only one element within a socially determined and embedded rationalization process through which dominant facts and meanings are produced. Only by distinguishing between rationality (an aspect of mind) and rationalization (a social process) is it possible to clarify the relationship between ideology, medicine, and science.
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