versão impressa ISSN 1414-3283
Interface (Botucatu) v.4 n.se Botucatu 2008
Biopolitics, healthcare production and another humanism
Biopolítica, produção de saúde e um outro humanismo
Biopolítica, producción de salud y otro humanismo
Claudia Abbês Baêta NevesI; Altair MassaroII
IDepartamento de Psicologia, Universidade Federal Fluminense, Campus do Gragoatá, bloco O, 2º andar, Gragatá - Niterói, RJ, Brasil, 24.210-350 <email@example.com>
IIÁrea de Planejamento e Gestão, Secretaria de Saúde de Campinas
Translated by Maria Aparecida Gazotti Vallim
Translation from Interface - Comunicação, Saúde, Educação, Botucatu, v.13, supl. 1, p. 615 - 626, 2009.
The aim of this text was to reflect on the production of a humanization policy for the Brazilian Unified Health System (SUS) and its influences on healthcare management and production practices. For this, we have developed discussions on the concept of humanism, the ways in which capital power strategies function biopolitically and the present-day challenges of constructing public healthcare policies that have the aim of affirming the processes of autonomy, thereby registering another way to produce humanization of care and its management.
Keywords: Humanization of assistance. Biopolitics. Public healthcare policies.
O objetivo deste texto é pensar a produção de uma política de humanização do Sistema Único de Saúde (SUS) em suas interferências nas práticas de gestão e produção de saúde. Para tanto desenvolvemos uma discussão sobre o conceito de humanismo, os modos de funcionamento biopolítico das estratégias de poder do capital e os desafios da construção de uma política pública de saúde no contemporâneo que tenha como objetivo a afirmação dos processos de autonomia, inscrevendo outro modo de se produzir humanização do cuidado e da gestão.
Palavras-chave: Humanização da assistência. Biopolítica. Políticas públicas de saúde.
El objetivo de este texto es el de pensar la producción de una política de humanización del Sistema Único de Salud brasileño en sus interferencias en las prácticas de gestión y producción de salud. Para ello desarrollamos una discusión sobre el concepto de humanismo, los modos de funcionamiento biopolítico de las estrategias de poder del capital y los desafíos de la construcción de una política pública de salud contemporánea que tenga como objetivo la afirmación de los procesos de autonomía, inscribiendo otro modo de producir la humanización del cuidado y de la gestión.
Palabras clave: Humanización de la atención. Biopolítica. Políticas públicas de salud.
Inspired by the airs of Espirito Santo, in the so called land of the botucudo indians, impregnated by the intense memory of the native Indian battles, slave fights, and the fights of the Landless Movement, we were lovingly invited to discuss a Humanization Policy (NHP) for the Brazilian Unified Health System (SUS)]1. Such invitation included, as main offer to the guests, the experimenting of an anthropophagic exercise of devouring and swallowing of what intends to decolonize life.
Anthropophagy, here thought of as a movement with its disruptive strength in the production of the unbearable. Production, as such, of other perceptive, sensory, ethical enrolment, which 'shouts the problems', engendering possible openings and widenings of the hegemonic ways of living and dealing with life, with work, with alterity, with the everyday practices of the production of health. We speak about an anthropophagic exercise inspired by the Oswaldiano manifest, 1928 (Andrade 1990), whose proposal is to devour what is difference from us, to evaluate what, in this difference, gives power to the body, deviating from all the catechism. Invitation launched, invitation accepted!
For the discussion of Biopolitics, Healthcare Production and another Humanism, we draw, as a problem field, what is, for us, a recurring problem: how to think, contemporarily, interference in the social production of existence among the intrinsic intertwining of the workings of capital and desire? In the health field we can modulate this problem in the following questions: how to produce interference in the practice of health production that potentializes the living amidst the steel rolling of biopolitics in the way of taking care and managing life?
These questions are born from the experiments of institutional support and processes of formation in health, which we have been performing together with the SUS health services and at the university. And they acquire strength, primarily when we find ourselves involved, since 2003, in the paradoxical building of a National Humanization Policy for the Brazilian Unified Health System (SUS), as a public dimension of the health policies, in the State and government machines.
What brings us to understand this construction as paradoxical? We believe that a healthcare policy conquers its public dimension (res-public) for all and any when connected to collective processes, when it is porously built to the social multiplicities in its movements of tension and twisting in the making/thinking.
The collective processes state the indissolubility between thought and life, between desire and politics. For, making politics implies experimenting, as a problematic field, the ways in which, in their forms and intensities the integrality of human life happens. In this case, how to keep this tension/twisting, which would be its component, in a strict relationship between the State and the government machines? Hybrid machine, absolute producer of "centripetals" which, in connection with other power dispositions, slips, stops the flow and modulates the movements in their programs, bureaucracies and transcendent (de)regulations.
However, we ask ourselves: can we dispense with the relationship with the State/government in relation to the building of social politics, amongst them, a universal health policy for all and for one?
In Brazil, where we cannot even experience the State of social welfare, the relationship between public and State politics, in their regulatory role cannot be trivialized. Our recent history shows the importance of the sanitary movement, in its articulations with other social movements in the 1960, 1970 and 1980, in the induction to the reconfiguration of the Brazilian state intervention standard of health and on human rights area.
The struggle in favor of the construction of a universally reaching social politics, guided in socialization of attention and in a new thought for health, in open dispute with ideas and the liberal privatizing model (Campos, 2007), ended up in the building of the Brazilian Unified Health System (SUS), and its publication in the Brazilian Constitution of 1988. The Brazilian Unified Health System (SUS), and its publication in the Brazilian Constitution of 1988. The Brazilian Unified Health System (SUS), as a universal health system, guaranteed by the government, constituted itself as citizenship value, different from the concession by "working merit".
However, its constitution and implementation in times when the neoliberalism grows worldwide and, in Brazil, we lived a crisis in the developing model and of the military regime, with all its administrative, financial and social consequences. Added to this we had the election of a new president, Fernando Collor de Mello (1990/92), who takes charge with a guiding program clearly neoliberal.
We can say that the process of execution of the Brazilian Unified Heath System (SUS) as a State Policy was, and still is to this day, built "anticlockwise" (Benjamin, 1996, p.225).
In the twenty years of SUS we could notice important advances in the guarantee of access and full attention, but also many challenges to be faced for the concrete execution of its principles on the everyday practices of attention and management.
We constantly see the production, by the media power, of a permanent public health crisis. These, serving the neoliberal command of a "Minimum State" to the social issues, in favor of a "Maximum State" fruition of the global financial capital, has decreed the inefficiency of the Brazilian Unified Health System (SUS), and the Brazilian State in the management of a health policy for one and for all, making invisible concrete experiences of a "SUS that works".
We believe that, possibly, one of the most important and difficult tension to problematize is: what, in the workings of the SUS, hybridizes itself with a "liberal-private order which manifests itself as a permanent resistance to SUS, being inside SUS and, at the same time, inside the dominant model of this in these times of globalization of capitalism" (Campos, 2007, p.1870). One of the dangers of this non-facing is the enunciation of the SUS configuration, as a health policy "for the poor", with low-solving capacity, whose function would be to manage survival.
Merhy (2002) calls attention to the proposals by Managed Attention (AG), which incorporating/steel rolling the critics to the practices of medicalcentric attention plugs in work processes through propositions that move the "clinical microdecision throught the administrative, imposing a new technological way of constituting the very act of care and way to operate its management." (Maerhy, 2002, p.34). It demonstrates how AG has being "looked after with care) by local governments, specially in Latin America, and the international organizations which have enough influence to create themes for the projects for health reform.
In Brazil this model gains strength amongst the health service providers linked to private health care, and is being broadcast as a solution for the health crisis, its ineffectiveness, and the high cost to the Brazilian State. Added to this, at the present, is the Brazilian government courtship with proposals of transformation of public hospitals into Social Equipments, which would search for financial supplement in the individual and/or collective consumers market available.
In health, the privileged field for the logic of productive restructuring, viewpoint expressed in the cumulative financial capital, has been the processes of care and their management. That is, the territory of the light and light-hard technologies, field which is , paradoxically, the anti-hegemonic project of those who fight for the health as public well-being, and are committed to a vitalist logic and dignity of care.
The practice of poor medical assistance, negligence and neglect with life, be it of users or health workers urgently need to be guided and faced so that SUS win the "hearts and brains" (Campos, 2007, p.1873) of the Brazilian population and re-enchant those who have being militating for it for some decades.
In this field of tension, as a bet of activation of the public dimension, SUS constituint, that a National Politics of Humanization (NPH) is created. But how to produce the collective in the State Machine, being in it? How to build actions in health implicated with another humanism, one engaged with the singular experience of any man, who imposes himself in an ethical autonomy in which life conquers its own experience conditions?
Within this article, we will discuss this field of tension, making use of a method of thinking which, causes problems to the lines which weave the contemporary, to allow us the possibility of a debate about the challenges of a of a policy of humanization of SUS in times of merchandising and regulating life, from its biological to genetic and affective aspects, by biopower.
A method of thinking: from the time of Anchieta's devir with the Tamoio people
Lancetti, in his text-propositon "Notes about Humanization and Biopower"2, provoques pointing to the paradoxa character of this meeting, when he refers to the Seminar for a discussion of a Humanization Politics of SUS, based in a land where the forefather of biopolitics in Brasil, the Jesuist Jose de Anchieta3, created his humanitarian School of "domesticating bodies".
Welcoming the provocation, and with it operating an inflection, it is worth remembering that, in this land, where the priest Jose de Anchieta went by together with, his paranoid capturing machine4, segregation and homogenization of what differs from "my equal"5 there lived other lifestyles. "Tamoios" lifestyles, who invented themselves as War Machines6 to resist the colonization of their lives in the "peacemaking and docile-making" humanism of the white man.
The "Tamoios"(Dannemann, 2008; Alves Jr., 2006) were the native Indians who, at the time of the French invasion, which occurred still at the first phase of the brazilian colonial period, organized a coalition of tribes known as the Tamoios Confederation, making an alliance with the French and offering strong resistance to the Portuguese. This native indian name comes from the tupi language "tamuya" which means "the old, elderly, old ones", and according to historians, was commonly used as reference to the alliance formed, in 1560, by three experienced "tupinambas caciques" (chief) and some villages of different ethnicity (goitacazes, guaianazes and aimorés , aiming to fight the "perós", name they used to call the Portuguese and the tribes which supported them.
Even though the visible effects of this meeting were, as registered in the brasilian colonial history, the extermination and the almost massive attempt to make them docile, of the Indians and their way of living, it is necessary to question about the interferences, the estrangement and tension which were produced in this not so passive meeting. What disorders the different style of living, the Indian naked bodies could operate? If Anchieta escaped being eaten by the cannibal "tamoios", in 1563, when they kept him captive, we may think that, in him, some sort of anthropophagic devouring might have happened. Did Anchieta really escape from being eaten by the Indian style of living? In historian accounts allusion are made to the masses performed by him, stuffed with indigenous rituals and strange songs, which caused other Jesuits strangeness, who passed by. Could we affirm that these mixtures were only the effect, since its conception, of the strategy of dominance?
This brief historical digression aims to bring, to our problem field, the idea that our interference in the production, comprehension and reinvention of reality imply a methodological twisting which forces, in our thoughts, the opening to porosity of practices and feelings which (re)produce reality for beyond the homogeneous configurations and interpretations in which it presents itself and is presented. At the appendix about Foucault, Paul Veyne (1978, pag. 181) says something that helps us in that direction. It is not a case of explaining the practices from one only cause, but from all the neighboring practices, to which they are anchored. This pictorial method produces strange pictures, where the relationships substitute the objects."
The concept of Recurrence, as formulated by Nietzsche (1998) in thinking the theme of Truth and History, and, from that, by Foucault (1979) when he draws his genealogical7 method, and is also a good intercessor, as it allows us to think reality as a historical contingence. An entanglement of different recurrence-movements, which can express the shock between forces in which the phenomenon and things receive as much meaning/value as the forces that they appropriate.
The events, as experiments anchored in reality, bring the vibration of the chaotic multiplicity that is life forking in the same event. These present themselves double faced: as visible formalizations and as effect without a body immersed in the maze of becoming,of the unexpected and the unforeseeable. In their visible movements we have the stratification of the process of living in the state of things, steel rolling in totalities, objections and subjections. In their intensive effects, the event is a track of line e ways which cross "diverse structures and specific groups", operating cracks between knowledge disposition, power and objectivity, amongst which history and world are produced. It does not happen following a first intention or as a result of something. Far from it, it puts in play "the forces at play that emerge at random in the struggle"(Foucault, 1979, p.28). We can only speak about it from the negotiations and the connections produced as forces which take it over.
The historical event, previously discussed, we may think that, at the meeting between "state Jesuit machine" and "Tamoio, the war machine", it was produced, amongst other things, the catechism and the extermination, as visible effects of the formalization of reality, immanent from the production of "infamous" forces (Foucault, 1992) of history. That is, active resistance operating strangeness and rearrangements in which wants to colonize the living in its nomade potency of invention others.
This way of thinking history and what, in it, constitutes as "reality in us" requires a critical exercise of the present, and implies "destabilization and displacements of the places of knowledge and power which we found and instituted us, questioning "what we are" and, more specifically, what we are not anymore, and are on the verge of becoming" (Neves, 2002, p.19).
The reality, thus thought-out, moves away from the superiority of conservation and affirms itself, also, as the principle of differentiation, as it happens in the moviments amongst which there is production of life as strength in fight which, among other things, creates man itself. Be these reactive forces (a desirable investiment in an obedient life), be these forces active (freedom, creation and potent life), what they put to play is life as a better possible way of effecting the power; life flowing in its expanding movements and experimentation in the performances of becoming. Performances which affirm the production of difference and allow the production of difference and allows history in its productive unfinished quality.
In this direction, it is necessary to make use of another method of analysis which invests "in the cracks more than in the uniform configurations with which reality presents itself" (Barros, 2007, p.199). For that purpose, it is necessary to try the chemistry of the world, and, in it/with it, follows its games, its traces of circulation, map it out.
Mapping is a method of study-intervention of the socius, proposed by Deleuze and Guattari, which calls for an problematizing experiment in following the process of composing and decomposing a reality or matter, learning it in its immaterial indexes and connective movements in the production of the socius and the forms of subjugation. In this sense, it implies not so much the apprehension of reality as a subject of unveiling or cognition, but the affirmation of reality in its power of opening of the senses and invention. Because it is in the meeting, at strength level, in the power of the propagation of experience that we affect and are affected by the limitation of knowledge, by the constrains of matter, by the emerging of other perceptions and by the unexpected quality that are expressed by the heterogenesis of the process in question and its potency for the invention of new subjectivities and new worlds.
Map making requires the learning of listening and attention to the force of the present that brings the new in its disruptive character, and allows us to question: what life species this and/or that agencing of desire does it promote?
It is in this summoning, at creating other ways of being at the verbs of life, that resides the ethical-political forces of this method. A twisting in the doing/thinking, stated in the inseparability between thought and life, between desire and politics.
With these political-methodological principles we want to follow in our task of thinking the challenges which we face in the creation and consolidation of a humanization policy for the Brazilian Unified Health System (SUS).
We point out two 'compass-challenges' which are: the PNH construction in its tense relationship with the State/government machine, and its consolidation in a contemporary context characterized by a new relationship between power and life.
In this manner, it becomes necessary to think in which grounds we move ourselves, that is, what delineates our contemporary from the point of view of the biopolitics strategies of the functioning of capitalism at present. This thinking exercise, dissociated from the production practices of itself and the worlds, summon us to plunge into the working strategies of power in our present: the sciences, the State, the media, in their hybridities and flexibilizations in contemporary capitalism.
Contemporary capitalism and biopolitics
There was a time when we used to believe in the possibilities of being outside a determined capitalistic production system and, opposed to it, we built fighting strategies against exploitation, against subjection of expression and the creation of means of existence. Basing our fighting strategies in a certain "revolutionary" Marxism, we seek, in it, ideologies which could guarantee external opposing interference to the capital functioning way. We found ourselves, however, taken by it from the point of view of production subjectivity. In the so called real socialism, what we saw was the mechanical reproduction of the same means "of itself" production which happens in the capitalist mode of production.
The May 1968 interferences, the fall of the Berlin Wall, the metamorphosis of the Cold War, the so-called "just wars" against terror, amongst others, indicated the need for a change in the way of fighting, specially, in us. These interference, in its different modes of expression, produced neighboring relationships between mutiple becomings which, in their resonance, state the coexistence of macro and micropolitics, showing that the desirable production and the social production are one only flowing economy. In other words, desire and politics are made in the same plan, a plan of immanent variation, built on the encounter where life, in its constitutive wandering digs exits amid the proliferation of umberables. On this account, we judge the umberables as intensity that makes scream the problematic field and may serve as an indicator of our interference. In this sense he would not be "dominantly in what they do not let us be, but in the procedures that make us what we are" (Rodrigues, 1998, p.43).
How does this poductions interlacing happen? Mapping the comtemporary, we see that we are living a such entanglemente of codes, situations, experiences and existences, which the interference/resistence become more difficult to visualize or say, but above all, to "inhabit". It is as if we were resisting a certain movement of the straitening of the socius and, in the same resisting movement, we saw ourselves in the middle of it. We realize, then, that the question is in another place, or better still, in a "on-place", which is the plan of immanent variation of desire where life and its interferences engender themselves as signs of movements.
We also have a glimpse of the paradoxal functioning of the strategy of capitalist production, which, in its hybrid and globalizing forms of biopolitical dominance, convert the nations and their inhabitants, and more specifically their lives, hostages of the vicissitudes of the speculative bubble of financial capital. "This production strategy works like operational modulation, which, winding through releases and controls, is immanent in the process amongst those in which these combinations take place" (Neves, 2003, p. 138).
Foulcaut (1999) draw attention the emerging, since XIX century, of a new technology of power which works taking possession of life from the organic to the biological. He calls it biopolitics and shows that it is exercised by taking the population as target of regulation, of care. It is, here, a power exercise, which is not done outside the processes, but in the midst of them.
We can notice these workings through observing the media speech delivered by the anti-smoking actions and their witch-hunting effects against tobacco, and, more directly against the smokers. Biopower which gains legitimacy not only from the technocratic efficient speech which doubles in health programs and actions (after all statistics point to a greater number of cancer and heart attack in smokers), but of the public in general, who sees, in tobacco, the devil that contaminates their lungs (even the French have been persecuted in their traditional cafes).
In principle, everything is very consistent, but there is an invisible operation, which, if it does not invalidate the anti-smoking actions (after all it is a fact the ills produced by tobacco), at least, summon us to map other lines that weave and incite this witch-hunt. One of them is updated in the migration of capital investments from the tobacco industries (smoking production) to the pharmaceutical industries (production of transdermal nicotine and ansiolitics which minimize the effects of tobacco and help to endure the abstening period). As well as for the security and health plans (decrease in spending with treatment of ills caused by cigarette, and with payouts to parents of fatal addiction victims), who see, in smoking quitting, an exceptional source of savings. Therefore, to whom it concerns, in fact, a sanitarian policy of tobacco control? If there is damage to smoker's health, what is the relationship health professionals may have with the users in the sense of analyzing those questions without their lives being taken by submission (biopower)?
Biopower incites, conjugates, modulates equilibrium and mediums aiming at optmizing states of life to which it submits. It does not take the body to individualize, subjugate and discipline, but it takes it to operate an individuality that replaces the bodies in the "biological processes of the collective" (Foucault, 1999, p.297), as collective phenomenon which only gains importance at mass level. In spite of functioning in reverse to ancient technologies of sovereignty power, - expressed in the wish and right of the sovereign of "kill or let live" (Foucault, 1999, p. 287),- and the discipline, -which governs the multiplicity of men to transform them into individualities for being controlled, trained and watched, biopower does not erase them. It combines, penetrates them, identifying and modifying them, in its exercise of "fostering live and letting die" (Foucault, 1999, p.287), it takes men's lives as a living being, as a species.
Negri and Hardt (2001), prolonging the Foucault intuition on biopower, show that power now is not more restrictive, punitive and it is not exercised vertically, but in the form of a horizontal network spread, interwoven to the social fabric and to its heterogeneity, articulating ethnical, religious, minorities singularities, and requiring, with that, new forms of control. Its monitoring mechanisms are, now, more difuse, ondulating, immanent and focus on the minds, lacking in institutional intermediation. They function by means of communication systems, information networks, framing activities and, also, mechanisms for internalizing, which are reactivated by the subjects themselves.
What the capital makes work is an axiomatic machine, combining the most different social flows, desirable, cultural, affective, in favor of its accumulation and expansion. Its working is markedly inclusive, all its hybridizations have a place: 'come eat a Big-Mac with Coke at the Mac Donald's fight cancer week the more you eat, the more you will be helping the Ronald Mac Donald house to fight infant cancer'.
The capital invests, in special, in the process of life production, in its variations, showing itself as its ontological entrepreneur. This, as value which values itself, needs these variations to expunge its internal limits of accumulation. Also, urges and maintains even, as pointed out by Rolnik (2002, p. 310), ways of singular subjectivation, but to be reproduced and reified as merchandise of mass consumption and "prêt-à-porter identities" (Rolnik, 2002, p.311), separated from the life intensive extract. The capitalism perversion lies in disconnecting the singularity of the process, in dissociating the force of creation of the intensive substract, that is, separate it from what the intensive body is asking for. This way, it makes the distance between production and consumption disappear, in which "the consumer himself becomes the raw material and the product of its own plot." (Rolnik, 2002, p.310).
However, if it is a fact that the desire, as commensurate to the social, it ensnares with the capital, it is also a fact, on the other hand, that the capital does not recover all the uncontrolable desiring power connected to life.
The flow of knowledge, affection, desire and communication are unbreakable and unpredictable in their connections. These flows, at the same time in which they became fixed capital or the basis for productive links indispensable to the accumulation of capital, are potentially dangerous to this accumulation, as they carry the vigorous power of the escape lines of resistance, whose multiplicity states itself in a constant self-revolutionizing. In removing all limits to real and total subsumption of the capitalist society, the capital, at the same time, uncovered life synergies and the collective strength of desire.
We may affirm with Pélbart (2007, p.1) that "to the power over life answers the potency of life, to biopower answers biopotency, but this "answer" does not signify a reaction, as what is being noticed is that such potency of life was already there from the start".
This brief mapping of the contemporary enables us to understand that the social production of existence happens in an intricate relationship between capital and desire. We are immersed in this complex involvement between the snake capital and the snake desire, in this two-faced uncontrollable, pointing out that we are not necessarily before two opposites, from which we would choose the best way out according to our way of living, but immanent to these snakes, amidst the more varied combinations between these uncontrable ones. We do not find, in this sense, a good way in or a better way out; what is presented, in this interweaving, is an indication of always punctual multiple displacement, multiple ways out and multiple ways in.
In this direction, our managing practices and production of care in health are made amidst this paradoxical working of the contemporary biopolitics, immanent to the workings of the biopower which wishes to colonize and abstract life, and at the same time, immersed in the constituent power of the living , in his biopower, as production of freedom, re-existence and autonomy.
The analysis of these workings allows us to question, among other things, the process of restructuring in the work in the health sector, which has, today, as territory in dispute "the action field of live work in act" (Merhy, 2002, p. 31), in its capacity to print new technological arrangements and directions for productive health acts.
Immersed in this workings, how to think interference in the production of existence which make an alliance to other ways of being in the verbs of life? How to interfere in the production of a life worth living? How to state another humanism in the practice of health production?
The production of a public policy of humanization for the Brazilian Unified Health System (SUS) at the razor's edge
Benevides and Passos (2005b, p.391), in discussing the process of building of the National Policy for Humanization at the Health Ministry, in 2003, signaled that "[ ] of the government policy to the public policy there is no easy and guaranteed passage. To built public policies for the State machine demands a connection work with the force of collective, with the social movements, with the concrete practices in the everyday rountine of health Services.
We have been experimenting, in the construction and consolidation of these policies, a field of tensions which updated themselves in the coexistence between practices which state the construction of managing and care ways allied to the process of collective democratization and, at the same time, singular, in which the fight for health writes itself as "value of use" (Campos, 2000, p.228 and production of autonomy, and the production of practice in health which reaffirm a working of the biopower. Functioning in which processes of nationalization and privatization are hybridized which (de)regulate, modulate and control the ways of life and living, from their biological aspects to the production of subjectivity.
Our interference is made amongst processes which may expand life extensively by means: of biotechnologies, of genetic engineering, of anti-smoking policies, of new drugs and modalities of intervention in the territory and along the population (PSF), and, at the same time, may serve to regulate it and constrain it. These processes are expressed: in the "inclusion-exclusive" on the access to therapeutic and innovating technologies, in the medicalization of social questions, in the register and control of the population lifestyle in the direction of a new modality of medical policy.
The objects (technologies, the practice (programs, proposals) and the intentions (speeches, laws) are neither "good or bad" out of relations and the problematic field which engender themselves and may produce. That is, it is necessary to accompany them in their exercises, production of senses and connections; ethic-politically evaluating their level of openness to social multiplicity, in what that promote and update as the production of reality.
On this understanding, we may state that what moves us in the construction of policy of humanization of SUS is what goes in between. At a meeting with health works and users/social networking, amongst the health workers and their work partners, immersed in everyday life tensions and paradoxes of the practices of management and care.
An 'in-between' stated as the constant engendering plan of life, of the collective, in all the bonds, and not as poles of a relationship, or, even, specialities and temporalities enrolled in opposite dualities, juxtaposed or matching.
Life is not formed by biology, physiology, nature and subjectivity as fields which are related maintaining their delimitations, but in a proliferation plan, of a relationship of strength. These, in their creations and recreations, trace, in the molecularization of forms, functions and organizations other compositions which may reinforce these forms and organizations, or recreate them.
It is in the encounter, in the midst of proliferation, that the bodies express their power of affecting and be affected. It is in it that the desire flows and creates worlds, managing means of expression and life's connectivity in its multiple experimentations. Because the ties which we establish with ourselves, with others, that is, with social multiplicities, which update themselves and affect us, they are catalysts of events, conditions of meetings and the production of reality.
Thus, we see ourselves distant and few summoned to compose with reductionist analysis which asks from us an identification in poles or units already constituted, a pragmatic humanization 'a la Anchieta' versus a humanizing policy "a la tamoios'. We bet, instead, in a policy of humanization which is made with Anchieta becoming Tamoios.
However, alert to the history of the practices that constitute as humanization of health for them and with them deviate.
This understanding implies, at least two primordial inflections, namely: in the senses instituted of humanism referred to an idealization of human and correlate to this, in the verticalized and prescribed ways of making public politics.
When the public dimension of a policy affirms its opening power
The loved one Marx reminded us, are not autonomous entity, and are all immersed in intricate web relations with nature, with other men, and with their inventions. In other words, men do not directly produce his own existence, be it material or immaterial, it produces itself and reproduce itself in a moving texture of multiple connections, in which and with which they weave themselves in the production of material life.
This affirmation by Marx is, for all of us, precious because it allows us to think about the social production of existence, human, its fundamental affirmations; they are: the non-essentialization of human existence and the creative power of human activity.
In rejecting human essence, this philosopher showed that there is not a separation between social production and human production. He takes him in the dimension of otherness, because a being objectifies himself, exteriorize, in the relations that confirm him "a being whose nature is not outside himself, is not a natural being" (Marx, 1984, p.15). This understanding marks the inseparability of nature production generic life as processes of production and reproduction which weave themselves, and, in the middle of what, all beings in their texture.
We talk about, then of a human sense as production, a complexity which engenders as open work. A humanity constructed in experimentation, that is, a materiality of the human forms and the immateriality of the inhuman affections which form and update themselves in practices and ways of being in the verbs of life (live, love, work, produce health).
This understanding decentra what was configured as common sense in the senses instituted of Humanism and Humanity, as follows: the ideal-man (metro-standard). Men, abstract and universal, who would serve as moral standard from which point we could refute and classify the practices and behaviour as good or bad, right or wrong.
This decentering enroll the production of the practice of humanization in health on the field of relations and, these, are confirmed in the indissolubility among our ways of production of subjects and the ways of work. We have, then another challenge, the alteration in the ways of doing, working and constructing processes of management in health.
In the field of health we may notice, still today, that humanization, although reinvidicated by the users and by many workers, still keeps a sense of abstract, charitable and religious; little involved in processes of production of networks and changes to attention and management. This is expressed in the affirmation o what humanizing is: be good, smile, be polite, give more of yourself, respect the paciente, create/have a group of humanization at work. These senses, in their different connections and resonances, have produced humanization practices in health markedly individualized, tutelary and "devotional" (Fuganti, 2008, p.84).
These practices, produce a moral and/or prescriptive care which, to the taste of biopower, desconsider the nomade qualities of life.
These health production practices, either directed to the users, or directed to workers/administrators, degrade and weaken the inventive character of work in its production power of autonomy and role in everyday life with the constitutive variability of life and living processes. When we make coincide the senses of work to jobs and reduce their managerial processes of administrative procedures, verticalized and regulating, we play our strength in the processes of exploration, submission and violence in which, in capitalism, work has being reduced.
Canguilhem (1990) indicated to us that life affirms itself by its power of criating norms, normativeness, and not by subjection to rules. Considering health as experience of creation of itself and ways of living, is to take in its movement of production of norms, and not subjegation to them.
The humanization of SUS in which we believe is built in the affirmation that the iinseparability between management and attention and inciting to autonomy production and the "production of new existencial territories" (Benevides, Passos, 2005a, p. 570). This believe is effective in the middle of everyday health production, in its envolviment e tensioning with specialisms, verticalities and privatization traps, by which we are also "in health, always under the risk of seen ourselves being captured" (Benevides, Passos, 2005b, p. 393).
It is, then, a policy of humanization which claims, in its making, the acting of our power of normativity. The norms diversity, constituint of the living, in the middle of which we try, in the collect moviments, the creation of our humanity.
The authors worked together in all production stages of the manuscript.
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1 We refer here to "Seminar Humanization of the SUS in Debate", which took place in Vila Velha, ES (June 2008), in which we discussed issues from this article, more specifically during the discussions on Axis 4 of this seminar: Biopolitics, production of health an another humanism. Promoted by MS/SAS/PNH in partnership with UFES. The struggles in favor of the construction of a universal social policy, guided in the socialization of attention and a new thought for health, in a clear dispute with the ideologies and the emerging liberal-private model (Campos, 2007) culminate with the construction of SUS, and in its promotion in the 1988 constitution. SUS, as a universal health system, guaranteed by the State, constituted itself as citizenship value, different from granting by "labor merit".
2 The text by Lancetti (2009) to which we refer, was written for the debate of Axis 4: Biopolitics, production of health and another humanism, which had Antonio Lancetti and Luis Fuganti as having proposed it, and, Claudia Abbês debating, at the Seminar "The Humanization of SUS in Debate"
3 Jesuist priest who came to Brasil in 1553, with the first Jesuists from the Companhia de Jesus, who came to Brasil with the aim of catechesing the native Indians.
4 The concept of machine is a central concept in the works of Deleuze and Guattari (1976), and is utilized for thinking the workings of socius, its production character and immanent engendering from an ontological model. It is used by Guattari, already in 1969, to differentiate idea from structure.
5 Expression used to designate what is reference and model for the 1500: white European, rational and catholic.
6 War Machines, concept created by Deleuze and Guattari (1996), who refers to the movement of resistance to the imprisonment of wished production in established form and senses. Nomad working, considered as outside the State Machine.
7 Geneology will use history to desmitify the divine, aseptic, rational and/or transcendental origem of knowledge, speeches, objects and practices, to expose the coping of forces of which they are only its effects. For Nitzsche, in the words of Foucault (1979, p.35) "History, genealogically directed, does not aim to refind the roots of our identity, on the contrary, it persists in dissipating it; it does not intend to delimit the territory where we came from, the first country to which the metafisics promise we will return to; it intends to make appear all discontinuity that we come across.