Health and empowerment in the 21 st Century: reification and vulnerability in the context of cybertechnologies^*

It was with great joy that I received the invitation to comment on the thought-provoking article of the admired and respected master of Public Health, Prof. Jayme Breilh. Since my first steps into the academic life, I've been learning, with his work, about the challenges of a theoretical practice guided by the critical commitment to human emancipation, and the powerful contribution that epidemiology brought and still could bring to this process. It is therefore with great honor and responsibility that I take the opportunity to participate in this public debate about yet another original and relevant Breilh's contribution to our considerations on epidemiology and health in general.

I received this new work by Breilh at a time, in my career as a public health physician and researcher on primary health care of young people, when I find myself bewildered and uneasy. Certainly not by chance, I find the considerations of Breilh to strongly resonate with questions that I've been asking myself on the challenges of caring for the health of this group, related to the new contexts of inter-subjectivity and public-private relationship in which our personal and collective identities are shaped in this "Internet age." So that is when Breilh, once again enticing us to nonconformity and critical exercise, points us to cybertechnologies and cyberspace as ways to construct a new era of economic and cultural conformation in capitalist societies, pointing out that rethinking the theories on power that guide our understanding of the social determinants of the health-disease-care processes is an inescapable political commitment of the university.

In addition to the physical, cognitive, and emotional impacts that, as the biomedical sciences and epidemiological studies have been showing, can arise from the excessive and unattended use of devices that connect children and youth to the digital world, also cited by Breilh, I am motivated to understand especially the new forms of adolescent sociability in this era of digital interactions. It seems to me that there is an ever-increasing distance between the images and concerns that we, health professionals and managers, have about young people and their health needs and those they actually experience in their daily lives, especially young people who live on the margin (geographical and symbolic) of large cities in industrialized countries. This distancing reduces our chances of dialogue with this population and, consequently, our ability to understand their vulnerabilities and produce convenient and effective responses when faced with their projects for happiness1. What Breilh provides us in his article is a comprehensive/interpretative path that, using the critical tradition of Marxism, invites us to think about these new forms of sociability as structurally determined by the processes of capitalist accumulation, which benefit from the control exercised broadly and specifically by cybertechnologies for various value production strategies, whether by massively (and free of charge), instrumentally appropriating information produced by digital communication networks, or by using these networks to induce consumerism.

Breilh, in his interpretation, makes clear that economic determination should not be construed as a mechanical and unilateral relationship, but as a dialectic, in which digital media are also seen as a possibility for resisting and overcoming this false, individualistic, and commodified sociality, which legitimizes and reproduces relations of domination and exploitation:

Y parece obvio que la respuesta a la subordinación cibernética no es la desconexión, que nos llevaría a prescindir de las ventajas de los herramientas cibernéticas; una alternativa que sería si no imposible al menos claramente desventajosa. Lo que debe generarse es una conciencia colectiva y una movilización desde todos los frentes para mantener el carácter abierto, neutral, democrático, solidario, no mercantil de la propuesta original de la red global, de tal manera de potenciar sus usos para el bien y frenar las tendencias para el monopolio privado y el sometimiento cultural.

What seems especially relevant to me when addressing current health challenges, such as taking care of our teenagers and young people, is the opening to the dialectics of interactions within that cybernetic context, underlying the proposition above. Although inseparable from the dialectics of work, the field of interactions is where seems to be the most fruitful interpretive key to explore the social normativity in advanced capitalism2 and, indissociably, the shaping of health needs and practices in this context. Thus, without ignoring the relationship between power systems and forms of cultural and institutional organization and the forms of material reproduction, it seems clear that, due to the very characteristics of those instances in late-modern societies, communication processes and the production of inter-subjectivities take center stage in building the social order - a fact that seems to be confirmed by the very issue raised by Breilh in his article. From this perspective, in addition to what is the place of cybertechnologies in capitalist production processes, whether in production or consumption, we should therefore ponder on the scope and character of inter-subjective interactions being molded and strengthened by these technologies.

The values to which the normative horizon of Breilh's criticism invite us can be read, in this light, as the search for inter-subjectivity spaces that can be effectively able to build a fair and democratic social order, according to the four "S": To what extent, and under what conditions, can cybernetic technology favor or hinder powerful interactions in the quest for sustainable, sovereign, solidary and safe societies? Furthermore, if we take this issue to the practical plan in which we are specifically interested, we should investigate: What is the actual impact of the global network on how people build a healthy lifestyle in relation to their work, consumption and domestic life, organization and social support, culture and construction of identity and relationship with the environment?

We have historically well-founded reasons to believe that answers to questions like these cannot claim any kind of universality and positivity without a dose of naiveté, leading us, in the least, to arbitrariness and violence. Such responses need to be found counterfactually in relation to experience, from the obstacles that specifically deny the achievement of the values that guide them. One cannot therefore expect epidemiology, or any other branch of knowledge in health, to interfere in any way regarding a way, or ways, of organization and/or use of the global network to ensure successful and productive dialogues toward the four "S." However, and agreeing to Breilh that we indeed need new theories to help us give intelligibility and come up with responses to situations of oppression that hinder the construction of these societies, it seems to me that epidemiology and the humanities and social sciences applied to health can (and should) help to give visibility to situations in which dialogues that are interested in this construction are being hindered, such as in illness or care deprivation.

To be able to move in that direction, I agree with Breilh that we need to revisit the social theories we have used in the field of public health, whether it is Marxism, the Frankfurt School's critical theory or the post-structuralism. Relatively recent contributions in Political Philosophy3 4, which seem very promising in this regard, seek to locate social construction processes in the realm of inter-subjective interactions, as well as to identify the constitutive dynamic of the subjects and the legitimacy of their aspirations and needs in their recognition-seeking processes. The struggle for recognition, according to Honneth, is what leads the several perspectives of the subjects to be constructed toward each other and, therefore, allows us to identify, in the scope of interpersonal relationships, the situations of disrespect that indicate oppression or even seek to suppress each other in the exercise of rights and social esteem. Could such a conceptual construct be used as a reference for the critical developments of epidemiology and human sciences in health to investigate the relationship between cybertechnologies and health-disease-care? Wouldn't it be possible to track, with the help of these experiences with disrespect/lack of recognition, the practical senses specifically taken by cybertechnologies, by evaluating its effects on the normative horizon that supports its various operations and resources, without formalistic moralism? Wouldn't it be possible to interpret the vulnerability to different health problems as the systematic and/or repeated lack of recognition of certain subjects as people, citizens, and/or human beings?

Aside from that instance of inter-subjective construction of social normativity, Honneth also points to a dimension of recognition that precedes that, and which constitutes a precondition for it: the experience of being in the world and in relation to the other as a constitutive moment of our very capacity to objectify the existence - of things, other people and ourselves5. This act of "being affected" by the environment and also of "affecting it" as a possibility of the construction of meaning, with which we objectively (or inter-subjectively) limit our reality, whose description Honneth found in philosophies as diverse as those of Heidegger, Dewey, and Adorno, took him to revisit an author and a concept that seem to dialogue directly with the problems raised by Breilh: the philosopher Georg Lukacs and his concept of reification.

Honneth sees this famous construction of History and Class Consciousness as strongly current, and as a resource for a critical theory of contemporary societies. He disagrees with Lukacs regarding how this author appears to restrict reification - or "objectification" of people and social relationships - when he understands it as exclusively resulting from commercial exchanges, but agrees with the importance of this "second nature" created by reification processes for clarifying the social oppression processes and the wasteful consumption of natural resources that goes with in capitalism. Honneth defines reification as the "forgetfulness of recognition", that is, the interdiction of a critical return to the kind of practical engagement in the world that originates the objective identities we attribute to things, to others, and to ourselves, condemning us to such strict and unilateral identities, "naturalizing them," and crystallizing them, therefore taking from them the possibility of critical reconstruction. Isn't this process of reification especially present in the forms of communication operated on cybertechnologies? In a definition of cybernetics, published online, we literally find the following statement: "Cybernetics is the science that studies men, animals, and machines as a whole, more interested in the similarities than in the differences between these three realms."6 Is there a more expressive example of "forgetfulness of recognition"?

There is no doubt that, in addition to the aspects of domination and exploitation appointed by Breilh, there are potentially criticism and libertarianism within the global network, which is only possible due to the technologies and devices of the era of real-time digital communication, according to the thought-provoking study of Canadian anthropologist Gabriella Coleman7. But still, one has to wonder whether the apparent plasticity and dynamism of the construction of political identities and movements enabled by the network reflect, effectively, an ability to reconnect the sense of practical, affective, and cognitive engagement - in the Heideggerian sense of care or in the practical involvement of Dewey3 - with the objective identity of our representations of the self, of the other and of the world. For example, the Guy Fawkes mask, used worldwide by supporters of the Anonymous strategy7, is only a symbol of the political horizontality advocated by this movement or an indication of a reifying massification? Indeed, it is possible that the subsumption of subjective singularities in "impersonal" identities in the political actions of movements such as Anonymous detach such actions of the practical commitments that, in fact, build subjects/inter-subjectivities - which perhaps explains, on the one hand, the nebulous and ephemeral nature of a significant portion of their recent public demonstrations and, on the other, the crisis in the legitimacy of traditional political representation.

In short, at the end of this first brief reaction to the reflections brought by Breilh in his new study, there is a strong impression that if we do not ponder on the above questions, if we do not seek to identify the ways in which the processes of mutual recognition that underpin contemporary social norms is conducted, as well as the forms of reification/disrespect that hinder access to the existential sense, or practical engagement, of our interpretation of reality, epidemiology, adolescent health, the overall ideals of collective health, will be no more than dystopian discourses, leading us by its inadequacy, at best, to the gradual distancing from the original practical engagement that makes us radically link health and empowerment.

REFERÊNCIAS

• 1. Ayres JRCM. Cuidado: trabalho e interação nas práticas de saúde 11a reimp. Rio de Janeiro: CEPESC, IMS/UERJ, ABRASCO; 2011.
• 2. Habermas J. Trabalho e interação. In: Habermas J. Técnica e ciência como "ideologia". Lisboa: Edições 70; 1987. p. 11-43.
• 3. Ricoeur P.Percurso do reconhecimento. São Paulo: Edições Loyola; 2006.
• 4. Honneth A. Luta por reconhecimento: a gramática moral dos conflitos sociais São Paulo: Ed. 34; 2003.
• 5. Honneth A. Reification: a new look at an old idea. New York: Oxford University Press; 2012.
• 6. Dicionário Informal. Disponível em: Disponível em: http://www.dicionarioinformal.com.br/cibernetica/ (Acessado em 18 de maio de 2015).
  » http://www.dicionarioinformal.com.br/cibernetica/
• 7. Coleman G. Hacker, hoaxer, whistleblower, spy: the many faces of anonymous. New York: Verso; 2014.

• *
  Commentary on the article "Epidemiologia del siglo XXI y ciberespacio: repensar la teoría del poder y la determinación social de la salud", by Jaime Breilh, to Revista Brasileira de Epidemiologia.

Publication Dates

• Publication in this collection
  Out-Dec 2015