Earlier this year, The Lancet, a 200-year-old medical journal, carried an editorial entitled, “We must engage in a war of position”. This unashamedly military term derives from the young leader of Italian Communism Antonio Gramsci (1891-1937).
The editorial notes that Gramsci’s “great insight…was to recognise the way in which the dominant group uses culture to exert its controlling influence. If the ruling power can persuade people to share its social, cultural and moral values, the motivation for radical political change will wither”. Those who wish to “advance a more hopeful, compassionate, and liberal vision of the future…must recognise that the culture wars are not peripheral matters.”
The “grounds populists have chosen to protect their power and interests” range, we are told, from “overruling Roe vs Wade to recent legal disputes over access to mifepristone” as well as today’s bitter disputes over “race, sex and gender”. “We”, the editorial informs us, must be prepared to fight these populists in a “war we must not be afraid to engage in”.
Gramsci, whose name The Lancet invokes, spent much of his life in prison under Mussolini. He was concerned to explain how what he saw as an exploitative social order was able to secure the moral consent of those dominated. This ideological domination works through disseminating a description of a value-laden world in such a way that it is internalised by the dominated class.
How was this achieved in Western Europe, which has representative political democracy? For Gramsci, the ruling class achieves hegemony through intellectuals and well-placed “experts in legitimation” who diffuse the ideas of the ruling class downwards throughout society and create a “popular opinion” which prevents the social transformation Marx had predicted. To oppose this domination there is a need for a “counter-hegemony” so as to overthrow the existing structures of power.
Such an analysis, although claiming to be broadly Marxist and materialist, actually turns historical materialist Classical Marxism at a key point on its head. That approach had required that historical developments in the “superstructure” (institutions, laws, religions, culture) be explained in terms of movements in the “economic base” i.e. the means of production and their control. Revolutions occur when the “forces of production” overwhelm the “relations of production”. Gramsci’s theory of hegemony offers an explanation as to why the predicted revolutions failed to happen by ascribing to the “superstructure” the power to limit changes in the base. In today’s terminology, the “culture wars” are far more determinative than the “material forces” allowed for by old-fashioned Marxists and come about as a result of political will as opposed to material processes. By achieving a “counter-hegemony” through a long march through the institutions, revolutionary intellectuals can overcome the prevailing culture enough to allow for a new social order to emerge from the masses which has hitherto been blocked by the hegemony of the ruling class. This combination of intellectuals and the masses must infiltrate all those organs of association the ruling class has hitherto colonised. Marx’s dream of theory becoming a material force grasped by the masses, a “philosophy of praxis”, will be realised.
That there are elites who influence cultures, for good or ill, is not to be denied. But one can recognise this and seek to oppose the evils elites can bring about without adopting a worldview in which classes constantly struggling for hegemony are fundamental to the explanation of reality. That worldview, laden with deep suspicion and seeing power as lurking malevolently everywhere, behind all practices and institutions, is the result of a “philosophy of praxis” that reduces all speculative philosophy to “politics” and views traditional religion as separated from reality. (Gramsci does write of religion as a “need of the spirit” but hoped that a form of Marxist “religion” could ultimately fulfil this spiritual need.)
In his work The Modern Prince, Gramsci tells us that Marx has definitively proved that, “there does not exist an abstract fixed and immutable “human nature (a concept which certainly derives from religious thought and transcendentalism)…human nature is the totality of historically determined social relations…” Elsewhere, in the Prison Notebooks he asserts that, “There exists therefore a struggle for objectivity (to free oneself from partial and fallacious ideologies) and this struggle is the same as the civilisational struggle for the cultural unification of the human race…We know reality only in relation to man, and since man is historical becoming, knowledge and reality are also becoming and so is objectivity.”
In saying this, Gramsci yielded to the perennial temptation for revolutionaries of viewing human nature as a blank slate. What follows is a lack of reverence for what is good in “the given” and an attempt to recreate the world from which a Creator and the essences He created have been banished, along with Original Sin. As Marx had written, the only liberation which is practically possible is “liberation from the point of view of that theory which declares man to be the supreme being for man,” which it is the task of the proletariat to bring about. All that is wrong is the result of social conditions and with the radical alteration of these man achieves his original innocence and goodness.
This view, which has been termed “nihilistic perfectionism”, makes a utopian fantasy, the so-called “man of the future”, the measure of all activity, a fantasy which can never be achieved but justifies a totalising earthly purgation of injustice and of those who would oppose this inevitable new social order. The language of Gramsci and his followers is haunted by the idea of there being a right side of history, with processes by which humans can be moulded to some undefined perfect justice through the action of “the masses”, led by revolutionary intellectuals.
Does the revolutionary self-conscious Lancet seriously believe that the ruling elites of our age are opposed to the anti-Hippocratic practices they so readily fund and which prevail across much of the globe? That venerable journal should be committed to the profoundly practical principles of the Hippocratic Oath which ground the sacred autonomy of medicine: medical care is bounded by respect for and assistance of human bodily functioning, including a prohibition on the destruction of that symbol of peace which is pregnancy. Instead, the journal chooses to adopt revolutionary rhetoric depicting those who disagree about the nature of medicine as influenced by a powerful ruling class which must be removed. By abandoning Hippocrates for revolutionary analysis with a conflictual view of society constantly engaged in a struggle for hegemony, The Lancet has lost the very focus which makes sense of the medical profession, namely the actual embodied human being who exists here and now, in need of healing, not killing or customised mutilation. Little wonder that the rights of medical conscientious objectors are trampled on when leading voices in the medical profession view themselves as involved in an unrelenting Gramsci-inspired revolutionary quest.
It was said by those who cared for him as he died that Gramsci, with a statue of St Thérèse of the Child Jesus by his side, returned at the end to the Catholicism he had once rejected. If there was indeed such a reconciliation with the ultimate immutable nature, it did not come about through the kind of war the Lancet urges upon its readers.
(A graffiti by Italian artist Ozmo depicting Italian writer Antonio Gramsci covers a wall in Rome on March 31, 2014 | ALBERTO PIZZOLI/AFP via Getty Images)
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