This article discusses the nature of work, ideology, and science in Western capitalist societies. It analyzes how capitalist or bourgeois ideology reproduces capitalist dominance in the spheres of production (Section I), politics (Section II), and science and medicine (Section III). Also, this article explains how the working class responds to that capitalist dominance through a continuous process of class struggle. Sections I, II, and II show how class struggle affects bourgeois dominance in the processes of production, politics, and science and medicine, respectively. Special focus in Section III is on the analysis of (a) how bourgeois dominance appears in science and medicine, (b) how bourgeois ideology appears and is reproduced in medical knowledge, and (c) how class struggle determines the nature of scientific and medical knowledge. In this section, an alternative mode of production of scientific and medical knowledge, different from the prevalent bourgeois one, is presented and discussed. In all three sections, medicine and medical knowledge are chosen as the primary points of reference.
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References
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Trilateral Task Force on the Governability of Democracies. The Governability of Democracies. Trilateral Commission, New York, 1975.
2.
By “capitalism,” I mean a mode of production in which a class, the capitalist class, extracts as much labor power from each worker as possible, labor power that is needed to (a) put the means of production (owned, controlled, and possessed by the capitalist class) to work; and (b) produce value, including profit. Labor power is the human energy and competence that the worker provides to enable the means of production to work. It is usually referred to as work.
3.
A most representative view of this position is found in MarcuseH.One Dimensional Man. Beacon Press, Boston, 1975.
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EhrenreichJ.Introduction. In The Cultural Crisis of Modem Medicine, edited by EhrenreichJ., Monthly Review Press, New York, 1979. After having been criticized for his deafening silence about the working class struggles around health and their consequences for the redefinition of medicine, the author added “coal miners' struggle” as a mere perfunctory note to that introduction of his volume, without actually referring to it. As with many other U.S. radicals, Ehrenreich ignores the dramatic and continuous struggles around health-related issues that are being carried out by the U.S. working class.
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See MarshallD.The miners and the UMW: Crisis in the reform process. Socialist Review40/41: 65–115, 1978 for a detailed account of those struggles.
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For an interesting account of the resurgence of class struggles around work, see CroughC.PizzornoA. (eds.). The Resurgence of Class Conflict in Western Europe Since 1968, Volumes I and II. Macmillan, New York, 1978. Also, see BasagliaF., La Salud de Los Trabajadores. Editorial Nueva Imagen, 1978.
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Struggles against the nature of work under capitalism occur not only because of the actual damage imposed on the worker at the workplace, but also because of the harm created to the workers and their dependents in all spheres of their lives.
12.
See BravermanH.Labor and Monopoly Capital: The Degradation of Work in the Twentieth Century. Monthly Review Press, New York, 1974. Also, for an analysis of how the process of class struggle has shaped the form of bourgeois dominance in the process of work, see FriedmanA. L.Industry and Labor: Class Struggle at Work and Monopoly Capitalism, Macmillan, New York, 1977.
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Quoted from DoyeR. J.Management Accounting, 1970.
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Class dominance is a process of continuous endeavor on the part of the capitalist class or bourgeoisie to maintain, regain, strengthen, and extend their interests in all economical, political, ideological, and cultural spheres of society over the ones of the dominated class or working class. In this article, dominance and hegemony are used interchangeably.
17.
Class struggle is the conflict among classes that appears in all economic, political, ideological, and cultural spheres of society and takes place in the pursuit of class interests. Under capitalism, the main conflict is between the capitalist class and the working class.
18.
TaylorM.Creating a health workers' democracy. In Trade Union Register 3, edited by BrownM.CoatesK., Spokesman Books, London, 1973.
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GramsciA.Quaderni del Carcere. Einaudi, Turin. 1978. It is worth stressing that the unions are, of course, very important instruments of struggle by the working class. But the focus of those struggles on economic issues transforms them into limited and limiting instruments for revolutionary change, i.e. change from one to another mode of production.
20.
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By means of production, I mean not only the means that the workers use for their work, but also the infrastructure of production and distribution that enables the produced goods and services to be used and consumed.
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Contrary to bourgeois ideology, which postulates that the state apparatus is neutral and can be used undistinctively by any class or group, I believe that the state's apparatus reflects the power relations of the whole of society and thus comes under the dominant influence of the capitalist class. That dominance explains its composition (the class position of the top echelons of the state personnel), its structure, and its function (i.e. to reproduce the capitalist relations). For a further expansion of this position, see State, power, and medicine: Part III. In NavarroV.Medicine Under Capitalism. Neale Watson, New York, 1978.
29.
Two examples of that perception are HartJ. T.The point, however, is to change it. Medicine in Society4(4), 1979, and FiglioK.Sinister medicine. Radical Science Journal9, 1979. Although different in their political position, both share that vision of the NHS as a socialist island in the capitalist state. Hart reduces socialism to a juridical-political category, i.e. the nationalization of the health sector. Figlio reduces socialism to the absence of market relations and to the mechanism of societal allocations done by the state for the “benefit of society.” In that vision, socialism is defined by the relations of exchange, not by the relations of production. Socialism, however, is a social formation in which the working class and its allies are the dominant class. Thus, socialist control is working class control.
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33.
Representative of this position are Marcuse and most of the theorists of the Frankfurt School. A more recent example of this single society ideology is Kellner, D. Ideology, Marxism, and advanced capitalism. Socialist Review42: 37, 1978. It is worth mentioning that the first major works of Althusser (Pour Marx and Lire le Capital) also carried that position of a single society ideology. Since 1968, however, Althusser has broken with that position. For an excellent and detailed critique of Althusser's position on this subject, see VasquezA.Ciencia y Revolucion. Alianza Editorial, Mexico, 1978.
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TherbornG.What Does the Ruling Class Do When It Rules?New Left Books, London, 1978.
37.
Quoted in Interview con suclovico Geymont. El mito del progreso y de la neutralidad de la ciencia. In El Viejo Topo, No. 24, 1978, p. 13.
38.
BellD., The Post Industrial Society, 1977.
39.
See StalinJ.Dialectical and Historical Materialism. A good critique of the work appears in LecourtD.Proletarian Science: The Case of Lysenko. New Left Books, London, 1976, pp. 110–11.
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Lecourt, op. cit.
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44.
I am not using the categories of “yes” or “no” in an either/or type of relationship. Rather, I am using them in a dialectical way, i.e. that the autonomy of science takes place within a set of class relations that both influence and are influenced by science.
45.
The meaning of “ultimate instance” is that although conflicts may appear between scientific developments and capitalist relations, those capitalist relations tend eventually to impose themselves on those developments.
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KuhnT.The Structure of Scientific Revolutions. University of Chicago Press, Chicago, 1962.
51.
For a critique of the concept of linearity in scientific knowledge, see Kuhn, op. cit. Also, for an alive but not always rigorous discussion on this subject, see FeyerabendP.Science in a Free Society. New Left Books, London, 1978. Neither Kuhn nor Feyerabend touches on the socioeconomic and political determinants of the scientific breakthroughs, a key subject which leaves their positions wanting. A further fault of Feyerabend's work is the key determinant role that he considers scientists have in initiating or stopping changes. For example, in examining the situation of blacks, Chicanos, and American Indians, he writes that “much of the spiritual misery of the remnants of non-western culture in the U.S. is due to this uninformed intellectual facism of most of our leading philosophers, scientists, philosophers of science …” (p. 207). The roots of the problems, however, are much deeper than Feyerabend seems to realize. He does not touch, for example, on the key issues of why those “fascist” ideas are the ruling or leading ideas.
52.
Quoted in Braverman, op. cit.
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Quoted in Breilh, op cit.
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The fact that those assumed causes are only apparent but not the real ones does not make them irrelevant. They may allow for a description, but not for an explanation of reality. The vast array of empirical phenomena immediately observable in social life can only be explained if one analyzes the social reality behind those appearances.
56.
Lecourt, op. cit.
57.
For a critique of similar positivist approaches used in social sciences, see Scientific method in sociology. In ShermanH. J.WoodJ. L.Sociology: Traditional and Radical Perspectives. Harper and Row, New York, 1979, pp. 275–324.
58.
For an analysis of the political and economic forces that determined the Italian experience and for a more detailed account of the process outlined here, see AssennatoNavarro, op. cit.
59.
Hart, op. cit.
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61.
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