IDEOLOGY: THE SILENT PARTNER
2. THE CONCEPT OF IDEOLOGY
The introduction of the notion of ideology into the health care debate requires at least an explanation of the word. Its interpretation varies but a working definition is indeed required because without it the concept generates more confusion than clarity. An explanation of the practical role of ideology within the context of health care is also appropriate. A brief etymological overview may be helpful as well.
As used in this book, the working definition of ideology describes it as a tool with which asymmetric relations of power can be established or sustained by the use of regular means of communication. This definition considers ideology to be an ordinary trait in modern society that facilitates the drive for dominance, which is inherently present within current socioeconomic relations. This connotation unveils the reasons that ideology plays such a crucial, albeit underestimated, role in the controversy surrounding health care reform.
The understanding of ideology as a normal trait of a healthy society differs from the more common perception of the term. Ideology is generally associated with fundamental political ideas such as conservatism and liberalism. In its broader sense, it is referred to as a system of thoughts and beliefs that are reflected in social and political actions and in the wording of political platforms and social programs.
Even so, the meaning of the term is rather ambiguous. Ideology is not restricted exclusively to its application to social or political programs. Because of such a nonexclusive connotation, the word developed vague meanings. In fact, in everyday language, ideology has frequently been associated with extreme social or political ideas and practices and, as a result, it has gained a rather negative connotation. This negativity was not embedded at all in the original meaning of the word.
As Thompson (1990) indicated, the French philosopher Antoine Louis Claude Destutt de Tracy (1754–1836) was the first to introduce the term idéologie (ideology) as the name of his philosophy of science. Destutt de Tracy (1970;
translation) argued that humans are incapable of knowing things in and of 63
themselves alone (e.g., an object cannot be anything other than a representation of what our senses perceive it to be). We can gain knowledge of something only through the ideas that our sensations form of them. This systematic analysis of ideas and sensations, of their generation, combination, and consequences, provides us with the basis for all scientific knowledge. In this sense, then, ideology is strictly understood as a theoretical model of epistemology.
The first change in the meaning of ideology occurred when Napoleon de Bonaparte, Emperor of France (1804–1814; 1815), was fighting for political survival. Napoleon first criticized and then later vehemently attacked the philosophy of ideas. He blamed the idea philosophy, which was very influential in the early even further into political territory. Over time, ideology did not identify a philosophy of science at all. Instead, it gained a critical and more negative connotation. Ideology was associated with
Thompson (1990) explained in his book, Ideology and Modern Culture, that from Napoleon’s time on, the word ideology had a negative connotation. However, the term was really converted into a critical tool by the German philosopher Karl Marx (1818–1883). Marx viewed ideology as an essential part of social theory and, as such, the concept acquired new status as a critical tool and an integral component of a new theoretical system. Marx and his associate, Friedrich Engels, made the case in their text, The German Ideology (1970; translation), that the role and value of ideas have been overestimated in history and social life. They postulated that the real chains of mankind are the attribution of independent existence to products of consciousness. Marx and Engels took the position that one cannot oppose ideas with ideas or fight phrases with phrases, because that approach leaves the real world unchanged. Thus, the polemical conception of ideology is of
a theoretical doctrine and activity which erroneously regards ideas as autonomous and efficacious and which fails to grasp the real condition and characteristics of social- historical life. (Thompson 1990, p. 35)
This interpretation assumes that ideology possesses the intrinsic property of both judging and condemning the existing class relations in society. Defining ideology this way proved that those class relations were controversial. This polemical interpretation of ideology allowed Marx to criticize assumptions about labor-related issues and about the study of the social–historical world.
Marx and Engels (1970) also used a different concept of ideology that linked the production and diffusion of ideas to class relations. From their point of view, the class that is the ruling material force of society is also its ruling intellectual force.
Thompson described this new conception as the “epiphenomenal conception,”
because it regards ideology as dependent on, and derived from, the economic conditions and class relations of production.
Ideology, according to the epiphenomenal conception, is a system of ideas which expresses the interests of the dominant class but which represents class relations in an illusory form. (Thompson 1990, p. 37)
1880s, for the failure of his administration. After his abdication, the word slipped
divorced from the practical realities of political life. (Thompson 1990, p. 32) the ideas themselves, to a body of ideas which are alleged to be erroneous and
IDEOLOGY: THE SILENT PARTNER 65 In this context, ideology was understood as a secondary phenomenon caused by and accompanying another phenomenon but having no causal influence of its own.
The ideas of the dominant class, then, express the concerns and ambitions within that social class and, in turn, are used by those in the class to maintain a position of dominance. These ideas represent the nature and the relative position of the dominant class in a way that is consistent with its interests. The illusory form in which class relations are presented refers to the fact that ideology does not validate the legitimacy of the position of a dominant class; it only presents that position as legitimate by claiming that it is founded in empirical truth. On the basis of both definitions, Marx considered ideology to be a symptom of a social illness and not an ordinary trait of a healthy society.
Etymologically, the meaning of ideology continued to change. In the more recent literature, some authors have expressed a preference for dispensing with the concept altogether. They have suggested that its meaning is too controversial and thus too often contested. Others want to limit the connotations of ideology by defining the term as a kind of “social cement” that
succeeds in stabilizing societies by binding their members together and providing them with collectively shared values and norms. (Thompson 1990, pp. 7-8)
Limiting the definition of ideology in such a manner is arguable for two reasons.
First, it is uncertain whether most members of society share the same values and, second, it is questionable whether the stability of a complex industrial society requires and depends on a consensus in regard to particular values and norms (Thompson 1990). Reducing the meaning of ideology to a kind of social cement does not do adequate justice to the concept.
In his book, Ideology and Modern Culture, Thompson (1990) took the position that ideology can effectively be stripped of its negative sense and reinstalled as an appropriate analytical tool for the study of social structures. In his opinion, ideology should be appreciated as a common and unavoidable trait of a healthy society whenever it takes as its exclusive point of focus the cluster of problems about the interrelation of meaning and power. Generally speaking, we communicate with others by using what Thompson referred to as symbolic forms. All our actions and utterances, such as spoken words, texts, and images, that are understood by others as meaningful constructs could be considered symbolic forms. Thompson also described the meaning associated with symbolic forms as being in the service of power; it establishes and sustains relations of power or domination.
are actively involved in creating as well as sustaining the relations between individuals and groups. (Thompson 1990, p. 58)
Symbolic forms are considered ideological only insofar as they serve the purpose of establishing or maintaining asymmetrical relations of power. Within society, power is an important attribute because it functions as a prerequisite for authority. If power is defined as potential influence, then power becomes a necessary condition for authority (e.g., the acquiring of legitimate control).
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Symbolic forms, and the meaning mobilized therein, are constitutive of social reality and
Again, Thompson (1990) considered the presence of ideology in society to be an ordinary trait of society. He stated that the study of ideology itself could show how strategies of symbolic constructs facilitate the production of these relations of dominance. Thompson’s view on ideology is intriguing, because it allows for an exploration of the meaning of words within a particular social context. As a result, it takes the negative sense out of the word ideology.
More importantly, ideology is converted into a useful instrument for the critical analysis of existing asymmetrical relations of power. Simply by studying how and when certain symbolic forms have been used by which groups in society, and how these forms are perceived by others outside those groups, we can identify existing asymmetric relations of power and explain their origins. It is important to note that Thompson (1990) did not restrict the category of classes to an identification of hierarchical levels in society. Class relations and divisions are an important basis of domination and subordination but are not the exclusive constituting factors for dominance and subordination. It can also be applied to distinct groups on the basis of race, sex, and profession or, for instance, on the basis of whether one is perceived as healthy or disabled.
This brief theoretical overview of the meaning of ideology illustrates how the concept can be defined in various ways. Individuals are involved in an ongoing process of constituting and reconstituting meaning by virtue of receiving and interpreting symbolic forms. Thompson (1990) called this process the “symbolic reproduction of social contexts” (p. 153). Thus, the meaning of symbolic forms, as received and understood by recipients, may serve to maintain the structured social relations typical of the contexts within which the symbolic forms were produced or received or both. In this book, ideology is presented as a tool by which meaning serves to establish and sustain asymmetric relations of power and domination, and it is considered an ordinary trait of a healthy society. Studying the ideological aspects of meaning could clarify how and to whose benefit these relations are established or sustained. Key notions such as “health” and “health care,” and the terminology specifically used to legitimize redistribution strategies, can be further investigated for the presence of ideological components that promote, establish, or maintain asymmetrical relations of power or domination.