2.2.2 Calidad en la atención primaria
2.2.2.7 Cartera de servicios de atención primaria
All human beings, according to Lonergan, are subject to bias, which is “a block or distortion of intellectual development.”556 Of interest in this study is the threefold bias that infects the commonsense intelligence of the practical subject: individual bias, group bias, and general bias.557 Although these biases are distinct from one another, they share at least one feature in common: they are all “aberrations of human understanding which exclude and repress insights, along with their further relevant questions they would have engendered.”558 Characteristic of the biased subject is a partial, though incomplete, development of intelligence that leads to an exclusion of correct understanding.559
The three biases, to the extent that they are operative in oneself, hinder one from being able to act intelligently. If one cannot act intelligently, one cannot be expected to act reasonably. And if one cannot act reasonably, one cannot be expected to act
554 Ibid.
555 Bernard Lonergan, “The Human Good,” 346. 556 Method in Theology, 231.
557 Insight, 651.
558 Matthew L. Lamb, “Lonergan: Social and Political Dimensions,” The Desires of the Human Heart, Ed. Vernon Gregson (Mahwah: Paulist Press, 1988), 260.
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responsibly.560 Insofar as people fail to be attentive, intelligent, reasonable, and responsible, a breakdown ensues “in the individual case, the group case, and the general case.”561 The irrational and irresponsible behavior that follows from this breakdown “creates a non-intelligible, absurd situation, where everything is out of place.”562 The three biases and the resultant absurd situation will now be discussed.563
The root of the first bias, individual bias, is found in the tension between personal or animal spontaneity564 on the one hand, and spontaneous intersubjectivity - along with the unrestricted, detached, disinterested intelligence that is characteristic of the pure desire to know - on the other.565 The egoist, who is afflicted with individual bias, is not altogether “devoid of the disinterestedness and detachment of intelligent inquiry.”566 When it comes to intellectually engaging and striving to satisfy the appetites afforded by his personal, perhaps culturally-refined spontaneities, the egoist exceeds many others in his ability to “face issues squarely and to think them through.”567 If the egoist is concerned about something, he permits “the immanent norms of intelligent inquiry [to]
560 The purpose of discussing the three biases is not to eventually isolate and excoriate particular individuals who were part of the subprime mortgage crisis. Inevitably, as I examine the different parties involved in the crisis, certain names are mentioned. Institutions are composed of human beings, and the decisions that the various institutions elected to make were, of course, made by individuals. However, I will argue that the damage caused by group and general bias was more pervasive and both created conditions for instances of individual bias to flourish.
561 Early Works on Theological Method I, 604. 562 Ibid.
563 In chapter six of Insight, Lonergan discusses his notion of dramatic bias. This fourth bias is
characterized by the way in which elementary passions can distort “understanding in practical and personal matters.” Please see: Insight, 214. Lonergan argues that dramatic bias is a refusal to understand that engenders several important, deleterious consequences. For Lonergan’s detailed discussion of dramatic bias, please see: Insight, 214-227.
564 Insight, 244. 565 Ibid., 245-246. 566 Ibid.
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overrule any interference from desire or fear.”568 Within his own “restricted terms of reference,” the egoist permits the free play of intelligent inquiry.569
The egoist’s horizon of concern or interest is too restricted. As Lonergan writes, “With remarkable acumen one solves one’s own problems. With startling modesty one does not venture to raise the relevant further questions, Can one’s solution be generalized? It is compatible with the social order that exists?”570 Thus, the egoist’s area of interest “is confined to the insights that would enable him to exploit each new situation to his own personal advantage,” often at the expense of others.571 Questions arising from “the demands of intersubjective spontaneities and springing from the love of others” are summarily blocked.572
Human beings not only naturally and spontaneously seek to satisfy their own appetites, they are also naturally and spontaneously predisposed to “help others in the attainment of their satisfactions.”573 This latter form of spontaneity, which Lonergan calls intersubjective spontaneity, means that “human persons spontaneously take care of one another.”574 Similar to how “one spontaneously raises one’s arm to ward off a blow to one’s head, so with the same spontaneity one reaches out to save another from falling.”575
This intersubjective spontaneity is so primordial that it prompts Lonergan to declare, “It is as if ‘we’ were members of one another prior to our distinctions of each from the
568 Ibid. 569 Ibid. 570 Ibid.
571 Bernard Lonergan, “Healing and Creating in History,” A Third Collection, Ed. Frederick E. Crowe (Mahwah: Paulist Press, 1985), 105.
572 Paul Hoyt-O’Connor, “Bernard Lonergan’s Macroeconomic Dynamics,” Mellen Studies in Economics, Vol. 24 (Lampeter: Edwin Mellen Press, 2004), 99.
573 Insight, 244.
574 Bernard Lonergan, “The World Mediated by Meaning,” Philosophical and Theological Papers 1965- 1980, Collected Works of Bernard Lonergan, Vol. 17, Ed. Robert C. Croken, and Robert M. Doran (Toronto, University of Toronto, 2004), 110.
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others.”576 There is, then, an earlier, prior “we” that precedes the more familiar “we,” the one which results “from the mutual love of an ‘I’ and a ‘thou’.”577 An elemental feeling of belonging together makes manifest this primordial “we.”578 Lonergan warns that the efficacy of this primordial “we” diminishes rapidly with distance in place or time.579
The egoist consciously orients himself in such a way that “he devotes his energies to sizing up the social order, ferreting out its weak points and its loopholes, and discovering devices that give access to its rewards while evading its demands for proportionate contributions.”580 Above all, what the egoist attempts to do is delegitimize and make unnecessary the well-being of others and employ his intelligence for the sake of his own aggrandizement. It is in this sense that individual bias is an incomplete development of intelligence.581 Individual bias is the interference that disallows the “complete free play” of intelligent inquiry. Those afflicted by individual bias give free rein to the unrestricted desire to know, but only with respect to the whims of his or her own personal spontaneities. In short, the successful egoist is one who overcomes “both the drive of intelligence to raise the relevant further questions that upset egoistic solutions and, as well, the spontaneous demands of intersubjectivity.”582
Lonergan provocatively argues that the egoist is not “totally unaware of his self- deception.”583 Amidst all of the egoist’s rationalizations and reassurances that his intelligent selfishness is justified, he cannot completely quell “the dynamic criterion of
576 Ibid. 577 Ibid.
578 Bernard Lonergan, “The Role of a Catholic University in the Modern World,” Collection, The Collected Works of Bernard Lonergan, Vol. 4, Ed. Frederick E. Crowe and Robert M. Doran (Toronto: University of Toronto, 1988), 109. 579 Insight, 245. 580 Ibid., 246. 581 Ibid., 245. 582 Ibid., 246. 583 Ibid.
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the further question [that is] immanent in intelligence itself.”584 The egoist is marked by a peculiar disingenuousness, for he knows the value of the unrestricted, detached, disinterested desire to know through the pursuit of his own narrowly-conceived interests, yet he simultaneously elects to cut the reach of the desire short.585
Group bias, the second bias, is blinder, more secure, and more powerful than individual bias.586 Lonergan observes that “individual bias is, of course, something that is always disapproved of by all the groups. But when you have group bias, well, everyone in the group is all for it.”587 Whereas individual bias was characterized by an effort to overcome the natural and spontaneous intersubjective fellow-feeling, group bias finds itself supported by such feelings.588 To get a clearer grasp of group bias, it will be helpful to examine Lonergan’s discussion of social progress.
Social progress is a “cyclic and cumulative process that results when situations give rise to insights revealing new possibilities.”589 These new possibilities, when grasped and implemented, lead to new courses of action. The new courses of action, in turn, produce new situations, and those new situations give rise to further insights that reveal additional possibilities.590
This cyclical and cumulative process “admits of an indefinite unfolding.”591 As long as a community of individuals possesses a self-transcending orientation, the mistakes of the past will be illuminated and, to some extent, eliminated. More worthwhile
584 Ibid., 247. 585 Ibid.
586 Method in Theology, 231; Bernard Lonergan, “Mission and the Spirit,” A Third Collection, Ed. Frederick E. Crowe (Mahwah: Paulist Press, 1985), 31.
587 Early Works on Theological Method I, 507. 588 Insight, 247.
589 Bernard Lonergan, “The Human Good,” 344. 590 Ibid.
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courses of action will be grasped in response to existing problems. Human intelligence will be able to effectively guide the unfolding of the historical process so that it is marked by cumulative progress. Lonergan declares that such progress would potentially be inevitable if all of these responses were made by pure intelligences.592 Human progress in this fashion is a fact, but only a first approximation to fact, for it is stymied and marred by bias.593
In theory, the course of social change could consist of “a succession of insights, courses of action, changed situations, and fresh insights.”594 Under such circumstances, the key distinction would be between “fresh insights that are mere bright ideas of no practical moment and, on the other hand, the fresh insights that squarely meet the demands of the concrete situation.”595 A community would embrace and participate in a collaborative laboratory that welcomed insights and rigorously tested them for their efficacy and accuracy. But individuals can freely decide to develop a self-regarding orientation, which results in the promotion of a special type of intelligence, one in which the particular interests of a group or groups are promoted, encouraged, and even imposed on others.596
Under these conditions, an interference in the development of practical common sense emerges, which Lonergan calls group bias. When this bias is functioning, groups are not completely content with the criteria of an insight squarely meeting the demands of the concrete situation. Instead, biased groups are predisposed to sort through pools of practical insights in an effort to determine which serve their interests and which do not.
592 Insight, 248.
593 Bernard Lonergan, “Mission and the Spirit,” 31. 594 Insight, 249.
595 Ibid.
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Consequently, truly practical insights “have to be divided into operative and inoperative; both satisfy the criteria of practical intelligence; but the operative insights alone go into effect for they alone either meet with no group resistance or else find favor with groups powerful enough to overcome what resistance there is.”597
At stake here is that group bias prevents practical intelligence from being truly practical. As Doran declares, “[Group bias] is responsible for the neglect or rejection of those practical insights that could genuinely meet social problems, but that call for the renunciation of narrow group or class interests, or the subordination of these interests to some larger viewpoint embracing the whole community.”598 It is not enough to simply have a good idea, even if that idea is precisely what is needed at the time. Under the conditions created by group bias, the timely idea cannot “simply emerge from the man on the spot, diffuse, give rise to new potentialities in a chain reaction.”599 Instead, it “has to combine with power, with wealth, with popular notion, before it can be realized.”600
The historical process, when plagued by group bias, becomes grotesquely distorted. The social situation that results “does not correspond to any coherently developed set of practical ideas.”601 Instead, it merely reflects “the fraction of practical
ideas that were made operative by their conjunction with power, the mutilated remnants of once excellent schemes that issued from the mill of compromise, the otiose structures that equip groups for their offensive and defensive activities.”602 Groups can offensively strike down practical plans of action that serve the common good, or defensively protect
597 Insight, 249.
598 Robert M. Doran, Theology and the Dialectics of History (Toronto: University of Toronto, 1990), 370. 599 Topics in Education, 60.
600 Ibid. 601 Insight, 249. 602 Ibid.
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the status quo in the face of practical insights that “reveal [the group’s] well-being to be excessive or its usefulness at an end.”603 Group bias is particularly potent when it comes to changes in economic and political institutions.604
Over time, the historical process, burdened by group bias, unfolds in such a way that some groups are favored and others are neglected. The longer group bias functions, “the smaller the group it favors and the larger the group it neglects.”605 This can result in what Arnold Toynbee calls “the schism in the body social.”606 Yet, Lonergan argues that this distorted development “creates the principles for its own reversal”607 because eventually the social situation will deteriorate to the point where “there is no need to call upon experts and specialists to discover whether anything has gone wrong, nor even to hit upon a roughly accurate account of what can be done.”608 In other words, it will become blatantly obvious that things have gone awry. The neglected groups will come to discover and later champion the practical insights and ideas that were neglected by the favored groups. Lonergan calls this deterioration the shorter cycle of decline.609
More intractable and grave than group bias is the third bias, which Lonergan calls general bias. At its core, general bias stems largely from “a failure on the part of practical knowers to accept the fact that common sense knowing is a limited, specialized form of knowing.”610 The extraordinary success and productivity of common sense, which “engenders and maintains enormous structures of technology, economics, politics, and
603 Ibid., 248. 604 Ibid., 251.
605 Bernard Lonergan, “The Human Good,” 343-344.
606 Ibid., 345. Arnold J. Toynbee, A Study of History: The Disintegrations of Civilizations, Vol. 5 (London: Oxford University Press, 1962), 35-376.
607 Insight, 249. 608 Ibid., 250. 609 Ibid., 252.
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culture,”611 is glaringly vulnerable to cherishing the illusion that it is omnicompetent.612 The fact that common sense works, it gets things done, incites people to relegate the value of theoretical knowing. Lonergan notes that common sense is “easily led to rationalize its limitations by engendering a conviction that other forms of human knowledge are useless or doubtfully valid.”613 If a current pattern of behavior is leading to the generation of satisfactory results, common sense pats itself on the back and then rises to meet the next immediate challenge. While this is an integral part of human living, common sense “is very, very weak at paying attention to long-term results and consequences.”614 As Lonergan affirms, “The general bias of common sense prevents it from being effective in realizing ideas, however, appropriate and reasonable, that suppose a long view or that set up higher integrations or that involve the solution of intricate and disputed issues.”615
To use an analogy of vision, common sense is far-sighted. Up close, it sees the present concrete situation with utmost acuity. However, with regard to issues that are far away, the long-term issues, common sense is profoundly blind. Common sense needs the corrective lens of theoretical knowing to enable human beings to consummately function
intelligently.616 Lonergan uses the analogy of a court of law to accentuate this point when he writes, “One can entrust common sense with the task of a juror; one cannot ask it formulate the laws of a country, to argue cases in its courts, to decide on issues of procedure, and to pass sentence on criminals.”617 Theory anchors the latter four activities,
611 Insight, 232.
612 Bernard Lonergan, “Healing and Creating in History,” 105. 613 Insight, 251.
614 Early Works on Theological Method I, 508. 615 Insight, 253.
616 Ibid. 617 Ibid., 445.
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while common sense, with its predilection for the immediate, practical, and concrete is well-equipped to handle the task of the juror.
Portraying general bias as a certain kind of blindness is only part of the story, however. In addition to what Lonergan calls “sins of omission,” general bias involves “sins of refusal” as well.618 Lonergan points out that general bias involves not only the dismissal of theoretical ideas that could be potentially profitable in the future, it also involves actively and willingly refusing to entertain and having disdain for those same ideas. Common sense’s “complacent practicality” banishes ideas that fail to address the satisfaction of immediate desires or the alleviation of present fears.619 Lonergan provides a snapshot of this pernicious attitude in Insight:
To advance common sense is to restrain the omnivorous drive of inquiring intelligence and to brush aside as irrelevant, if not silly, any question whose answer would not make an immediately palpable difference… [T]he man of common sense (and nothing else) is ever on his guard against all theory, ever blandly asking the proponent of ideas what difference they would make, and if the answer is less vivid and less rapid than an advertisement, then solely concerned with thinking up an excuse for getting rid of the fellow. After all, men of common sense are busy. They have the world’s work to do.620
As one can imagine, this additional refusal on the part of common sense makes the illness of the general bias all the more severe. It is not just a matter of common sense knowers being immoderately caught up in the fruits of their specialized intelligence. It also consists of common sense knowers pretending “to be omniscient knowers who tend to spurn and depreciate theoretical knowers as impractical idealists lost in their abstractions.”621 Lonergan expresses concern over the general bias of common sense by
618 Ibid., 253. 619 Ibid.
620 Ibid., 201-202.
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wondering how the world’s work could ever be done efficiently and effectively if men of exclusive common sense never bother themselves with the contributions of theory.622
Devoid of the guidance of theoretical intelligence, the human social situation, rather than progressing intelligently, deteriorates cumulatively.623 This is what Lonergan calls the longer cycle of decline. Whereas the shorter cycle of decline consists of dominant biased groups selectively making inoperable ideas that may detract from their well-being, but nevertheless have potential for serving the common good in some capacity, the more pervasive longer cycle of decline consists of a general “neglect of ideas to which all groups are rendered indifferent.”624 Regardless of whether one is part
of a dominant or depressed group, insofar as one is afflicted with general bias, one will exhibit a certain apathy, if not hostility, towards those theoretical ideas that suppose a long view. What is “unnecessary and disastrous” is not practical knowing itself, but the