Jurgen Habermas was born in 1929 and raised by a father with Nazi sympathies. He was in the Hitler youth and was briefly sent to man the Western defences. The ‘liberation’ occasioned a reassessment. The brutal reality of Auschwitz gradually emerged and in his gymnasium studies Habermas began to read Marx, Engels and Sartre. He attended the universities of Gottingen, Bonn and Zurich and encountered the works of Marcuse before becoming Adorno’s ‘first assistant’ at Frankfurt. Established in philosophy, he turned his attention to European sociology and social theory. He left Frankfurt briefly in 1958 after his politics and interpretation of Marx departed from Horkheimer’s; but he was to return to succeed Horkheimer as professor of philosophy and sociology at Frankfurt in 1964. Although politically active, he warned against ‘student actionism’ and ‘Left Fascism’ during the climactic year of 1968, opposing Marcuse and supporting Adorno when the latter called in the police when students occupied Frankfurt’s sociology department.
After a spell at the Max Planck Institute (1971-82), he returned once more to Frankfurt, delivering lectures on science and politics and defending non-violent civil disobedience. Although retiring in 1994 he has continued to publicly debate German and global events and to proffer distinctive contributions to post-national constitutionality and governance.
Habermas distanced himself from the post-war despondency of his Frankfurt mentors, Adorno and Horkheimer. He rejected their equation between rationality and what Max Weber called Zweckrationalitat, which refers to instrumental rationality, or the kind of rationality that governs means to ends. As we shall see, Habermas was later to characterise this limited form of rationality as system or strategic rationality: it is rationality oriented to outcome. He came to contrast this with lifeworld or communicative rationality, or rationality oriented to common understanding and consensus.
His first major work arose out of his dissertation and was an analysis of the public sphere of information, opinion and debate and its transformation during the Enlightenment of eighteenth-century Europe. It was during this period, he argued, that a literate bourgeois public started to become ‘politicised’, in the process openly debating contemporary events and questioning people in authority. Through the medium of meeting places like clubs and coffee houses independent gentlemen came together on the basis of something like equality to ruminate and disseminate their views in pamphlets and other outlets. Habermas admits (i) that these were privileged white men comprising part of the bourgeoisie, and therefore excluded the less advantaged, women and people from ethnic minorities, and (ii) that the public sphere has long since become dominated by commercial and vested interests via the likes of media barons and think tanks. Nevertheless, the theme of ‘ideal’ rational, informed discussion runs right through his corpus of works. In this sense he wants to reconfigure and breathe fresh life into what he calls a ‘reconstructed’ Enlightenment project.
During the 1960s Habermas picked up on Marx’s distinction between ‘work’ or ‘labour’ and ‘interaction’, seeking to make good his neglect of the latter. One consequence of this neglect of interaction, he argued, was that in Marx’s writings everyday lifeworld or communicative action (oriented to mutual understanding) was reduced to strategic or instrumental action (oriented to outcome). Habermas insisted, contrary to Marx, that there is no ‘automatic developmental relation’ between work or labour and interaction. The analysis of interaction must be given its due and not reduced to or absorbed into an analysis of labour.
This distinction between work or labour and interaction was later complimented by a third dimension, that of ‘domination’. Habermas linked each with specific types of science. With regard to work or labour, what he called the ‘empirical-analytic sciences’ arose out of a prior interest in the behavioural system of instrumental action and have to do with the prediction and control. In relation to interaction, the ‘historical-hermeneutic sciences’ are guided and shaped by a practical interest in human understanding. And with reference to domination, the ‘critical-dialectical sciences’, among which Habermas counted psychoanalysis and the critique of ideology, are geared to emancipation from domination. Knowledge, in short, reflects human interests and can and has continued to take different forms. The later Frankfurt School of Critical Theory that Habermas might be said to represent embraces this patterned diversity of interests-cum-knowledge.
In his examination of crises of legitimacy in late capitalism, Habermas retained a foothold in Marxism while maintaining that late capitalism, unlike liberal capitalism, is susceptible to a multiplicity of possible crises. This was because the state is committed to ‘iron out’ the peaks and troughs of the business cycle and to contain the opposition between wage labour and capital in pursuit of ‘a partial class compromise’. State intervention in the economy renders a crisis of legitimation possible, even likely, because it leaves the state responsible for managing the economy. Habermas argued that an authentic legitimation of late capitalism is impossible because of the continuing existence of its class structure. This is because even in times of growth, when there is no crisis, the fundamental contradiction between the social processes of production and the private appropriation and use of the product remains. The system of late capitalism is geared not to ‘generalisable interests’ but to private goals of profit maximisation. A crisis arises out of a crisis of motivation when there is a discrepancy between the need for motives declared by the state via the educational and occupational systems on the one hand, and the motivation delivered culturally on the other. A motivation crisis occurs most notably when there are failures of mass loyalty associated with parliamentary democracy, or of family and career ambitions associated with status competition.
The two volumes of Theory of Communicative Action embody Habermas’ mature reflections on the changing nature of modern society. He spells out in detail his commitment to a reconstructed version of the Enlightenment. He espoused universal reason. People’s use of language implies a common endeavour to reach consensus in a context in which all participants are free to contribute on equal terms. Language in other words presupposes a commitment to an ‘ideal speech situation’ in which discourse can realise its full potential. This is part and parcel of everyday interaction in the lifeworld. Social life, in Habermas’ words, is based on the ‘counterfactual’ ideal of the ideal speech situation, which is characterised by ‘communicative symmetry’ and a compulsion-free consensus.
So the canons of rationality or the modes of reaching warranted conclusions, are the same everywhere. However, just as Piaget discerns stages of cognitive development in children, so Habermas advances three stages of cultural development or evolution. The first is the ‘mythical’ to be found in early ‘primitive’ societies; the second is the ‘religious-metaphysical’ to be found in traditional societies; and the third is the ‘post-conventional’ to be found in modern societies. The earliest societies dominated by myth were typically ‘closed’ and resistant to change. The institutional arrangements for public engagement were largely absent. Rationality was expanded with the spread of religions like Buddhism, Hinduism, Islam and Christianity, each of which fuelled a rationalisation of culture. Modern capitalism, Habermas insisted, is characterised by post-conventional cognitive domains and forms of organisation. He remained critical of capitalism per se, but he contended that it saw gains in the potential for human enlightenment.
It was in Habermas’ two volume-Theory of Communicative Action that he comprehensively explored the relationship between lifeworld and system. The lifeworld is not easily defined: it is backdrop and resource for our day-to-day encounters. Technically, it is perhaps best seen as the medium or symbolic space within which culture, social integration and personality are nurtured and reproduced. The lifeworld is the natural habitat for communicative reason. The system on the other hand has to do with material rather than cultural reproduction. It has to do with instrumental or strategic action rather than communicative action. Habermas developed the view that social complexity and differentiation during the modern era has led to four increasingly distinct ‘sub-systems’: the economy, the state (comprising the system), and the public sphere and the private sphere (comprising the lifeworld). Further than this, he argues that we have seen an ‘uncoupling’ of system and lifeworld. But the four sub-systems are interdependent. The economy produces money, the state power, the public sphere influence, and the private sphere commitment. As an example of interdependency, the economy relies on the state deploy its power to put in place and underwrite legal institutions like private property and contract, on the public sphere to influence patterns of consumption, and on the private sphere to deliver a committed labour force, and the economy itself sends money into each of the other sub-systems.
But the capacities of the sub-systems are not equal. With enhanced complexity and social differentiation has come not only a separation or de-coupling of lifeworld and system, but the growing domination of the former by the latter. Drawing on Marx and Weber respectively, Habermas maintained that the lifeworld has become commercialised and bureaucratised. It follows that the potential for communicative action has reduced as people’s dealings with each other have become increasingly instrumental or strategic. Using Habermas’ preferred language, ‘system rationalisation’ has outstripped ‘lifeworld rationalisation’: we have witnessed a ‘colonisation’ of the lifeworld by the system. It need not have turned out like this. Habermas does not share the inherent pessimism of either Weber or his Frankfurt mentors Horkheimer and Adorno. The system rationalisation and lifeworld colonisation found in the West was not inevitable and is not irreversible. Lifeworld rationalisation or de-colonisation might yet occur. Writing in Europe in the mid-1980’s he put his faith not in ‘old’ class-based movements but in ‘new’ social movements (especially the women’s movement).
It remains only in this short introduction to mention Habermas’ writings on ‘discourse ethics’. He distinguished between two principles. The first was a ‘principle of universalisation’, which stated any valid norm must fulfil the condition that everyone affected can accept the consequences and side-effects its general observance can be anticipated to have for the satisfaction of everyone’s interests (and these consequences are preferred to known alternative positions). The second was ‘principle of discourse ethics’, which stated that only those norms can claim to be valid that meet, or could meet, with the approval of all affected in their capacity ‘as participants in a practical discourse’. The principle of universalisation has to do with ‘moral’ questions of ‘justice’ and ‘’solidarity’, which permit formal universal resolution; the principle of discourse ethics concerns ‘ethical’ questions of the ‘good life’, which can only be broached in the context of substantive forms of life, cultures or individual projects or aspirations. Just as Habermas’ theory of communicative action summarised above suggests a discourse ethics, so his discourse ethics suggests a concept of ‘deliberative democracy’. Deliberative democracy maintains that the legitimacy of political authority can only be accomplished through public participation in deliberation and decision-making. The public use of reason is key. Habermas critiqued classical liberalism and the formal parliamentary democracies of the West and advocated a transnational form of republicanism rooted in the public use of reason.
Habermas’ theories have a number of advantages for those wishing to draw on them for better appreciating phenomena in the health domain. Principal among these is the extent of their reach: they cover and link system or macro-issues of social order and change and everyday micro-encounters in the lifeworld. Consider the realm of health inequalities and the question of how these are caused or fuelled by known ‘social determinants of health’ like poverty, unemployment or lack of job security, absence of employment rights or work autonomy, and substandard housing or homelessness. It has been argued that many of these social determinants start their lives in the boardrooms of the CEOs of leading global companies, the meetings of major international shareholders and the offices of the world’s major banks and financial institutions. It is decisions taken in these rarefied and privileged global enclaves of the sub-system of the economy, it has been claimed, that prevail on many a national government in the sub-system of the state to introduce policies that further disadvantage the already disadvantaged and hence deepen health inequalities. I have developed the following formula in this context: global economic capital buys national political power to make policy in the overriding interests of its accumulation. I go on to articulate this process in terms of relations of class, deriving from the economy, and command, deriving from the state. His class/command dynamic asserts that material, social and health inequalities are primarily unintended consequences of the maximising of profit on the part of this small hard core of owners and controllers of capital acting worldwide. This transnational ‘ruling class’ and the national political elites it pays to do its bidding has a vested interest in reducing trade union and allied rights. The growing numbers experiencing material hardship and what is now called ‘precarity’ are collateral damage. The class/command dynamic will retain its thrust as long as the state can stave off what Habermas calls a legitimation crisis.
The class/command dynamic picks up on what is left of Marxist theory in the later work of Habermas. Other elements of Habermas’ thinking are relevant to the sociology doctor-patient relationships and interaction. The notion of the system colonisation of the lifeworld clearly has relevance, inviting questions about the interface between the capitalist oligarchy, the expert’s biomedicine with its concept of disease accessed via signs and symptoms, and the layperson’s notion of illness. But it would be a mistake to simply identify the former duo with the system and the latter with the lifeworld. Fortunately, Habermas provides a framework for shedding theoretical light on the intimacies of doctor-patient interaction, an issue I have discussed at length elsewhere.