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30Revista Iberoamericana de ComunicaciónPUBLICACIÓN DEL DEPARTAMENTO DE COMUNICACIÓNUNIVERSIDAD IBEROAMERICANA

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Sumando esfuerzos: el diálogo entre los estudios CTS y los estudios en comunicaciónSandra González Santos

warning in a social and material worldElizabeth Reddy

Students or experts? Unpacking addiction treatment center operators' mixtos

Joseph Guisti

Lucano Romero Cárcamo

P R I M A V E R A - V E R A N O 2 0 1 6

Revista Iberoamericana de Comunicación

UNIVERSIDAD IBEROAMERICANAMtro. David Fernández Dávalos, S.J.

Rector

Dr. Alejandro Guevara SanginésVicerrector Académico

Dr. Manuel Alejandro Guerrero MartínezDirector del Departamento de Comunicación

REVISTA IBEROAMERICANA DE COMUNICACIÓN, RIC

Dra. Vivian Leticia Romeu AldayaCoordinación editorial

Lic. Jorge Hermosillo GutiérrezAsistente Editorial

COMITÉ EDITORIAL

Dr. Jesús Alberto Cabañas Osorio / Universidad IberoamericanaDr. Fernando Juan García Masip / Universidad Autónoma Metropolitana

Dra. Sandra Patricia González Santos / Universidad IberoamericanaDr. Ozziel Nájera Espinoza / Universidad Autónoma Metropolitana

Dr. Miguel Rábago Dorbecker/ Universidad IberoamericanaDra. Marta Rizo García / Universidad Autónoma de la Ciudad de MéxicoDr. Carlos Manuel Rodríguez Arechavaleta / Universidad Iberoamericana

Dr. Carlos Vidales González / Universidad de GuadalajaraDra. Yennué Zárate Valderrama / Universidad Iberoamericana

COMITÉ DE REDACCIÓN

Mtro. César Alejandro Gabriel FonsecaMtra. Alicia Guzmán Becerril

Mtro. Víctor Manuel Harari BetancourMtra. Olga Rosario Avendaño

CONSEJO ASESOR INTERNACIONAL

Carlos ScolariDepartament de Comunicació, Universitat Pompeu Fabra

Lucila VargasUniversity of North Carolina at Chapel Hill

Rosalía WinocurUniversidad Autónoma Metropolitana

Rosental C. AlvesSchool of Journalism, University of Texas

Víctor Sampedro BlancoUniversidad de Salamanca

PUBLICACIÓN DEL DEPARTAMENTO DE COMUNICACIÓNric / No. 30 / primavera-verano 2016


Universidad Iberoamericana México, 2016

Vivian Romeu AldayaJorge Hermosillo GutiérrezCuidado de la edición

Revista Iberoamericana de Comunicación es una publicación semestral de la Universidad Iberoamericana, a.c., Ciudad de México. Prol. Pa-seo de la Reforma 880, Col. Lomas de Santa Fe. c.p. 01219, Ciudad de México. Tel. 5950-4000 ext 4919 y 7330.

www.ibero.mx; [email protected].

Editor Responsable: Vivian Leticia Romeu Aldaya. Número de Certi-ficado de Reserva al Uso Exclusivo otorgado por el Instituto Nacional del Derecho de Autor: 04-2016-050912455200, issn: 1665-1677. Número de Certificado de Licitud de Título 11831, Número de Certi-ficado de Licitud de Contenido 8434, ambos otorgados por la Comisión Calificadora de Publicaciones y Revistas Ilustradas de la Se-cretaría de Gobernación. Domicilio de la Publicación: Departamento de Comunicación, Universidad Iberoamericana, a.c. Prol. Paseo de la Reforma 880, Col. Lomas de Santa Fe. c.p. 01219, Ciudad de México. Tel. 5950-4000 ext. 4941. Impresión: Diseños e impresos Sandoval. Tizapán 172, Col. Metropolitana 3a sección, Ciudad Nezahualcóyotl, Estado de México, C.P. 57750, Tel. 5793-4152. Distribución: Univer-sidad Iberoamericana, a.c. Prol. Paseo de la Reforma 880, Col. Lomas de Santa Fe, c.p. 01219, Ciudad de México. Tel. 5950-4000 ext. 7600. Todo ar tículo firmado es responsabilidad de su autor. Se prohíbe la reproduc ción de los artículos sin consentimiento del editor. [email protected]

Revista Iberoamericana de Comunicación No. 30, primavera-verano 2016, se terminó de imprimir el mes de septiembre de 2016 con un tiraje de 300 ejemplares.

Índice

Sandra González Santos 7 Presentación. Sumando esfuerzos: el diálogo entre los estudios cts y los estudios en comunicación

Elizabeth Reedy 17 The Production of Earthquake Emergencies: technoscientific earthquake early warning in a social and material world

Joseph Guisti 45 Students or experts? Unpacking addiction treatment center operators’ relationships to scientific knowledge in Mexico City’s mixtos

Lucano Romero Cárcamo 93 Periodismo influido: la cobertura de salud desde la radio en Puebla

Los autores Coordinación editorial 127 Los autores de este número

Mensajes Coordinación editorial 129 Lineamientos y normas generales para la recepción de originales

Elizabeth Reddy

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Revista Iberoamericana de ComunicaciónUniversidad Iberoamericana

[ric no. 30, primavera-verano 2016, pp. 7-15, issn 1665-1677]

Sumando esfuerzos: el diálogo entre los estudios cts y los estudios en comunicación

D urante los últimos 200 años el mundo ha vivido muchos cambios geopolíticos, socioculturales, económicos y ambientales. Se pasó

del transporte en caballo al transporte espacial, de la comunicación epis-tolar a la comunicación cibernética, de entender el cuerpo humano en términos de sistema a entenderlo desde la genética, de la explotación de la naturaleza a la preocupación por la misma; se introdujo la inteligen-cia artificial, la nanotecnología, la manipulación genética y la repro-ducción asistida. Estos eventos nos han afectado a todos y a más de uno lo han llevado a intentar entenderlos, explicarlos y a lo mejor hasta predecirlos y controlarlos. Esta labor intelectual ha demandado una visión compleja y multidisciplinaria de la relación entre ciencia, tec- nología y sociedad. Es en este contexto donde nacen los estudios de Ciencia, Tecnología y Sociedad (cts), una rama de las ciencias so-ciales que estudia a la ciencia y a la tecnología como productos cul-turales desde una perspectiva multifocal y dinámica. Son un área de investi gación interdisciplinaria que tiene por objetivo entender de ma-nera integral (es decir, considerando los aspectos políticos, económicos, legales, simbólicos, epistemológicos y materiales) el origen, la dinámica y las consecuencias de la ciencia y la tecnología (Hackett, Amsterdamska et al., 2008).

Mirar a la ciencia y la tecnología como productos culturales significa partir de la premisa de que son actividades realizadas colectivamente en el seno de comunidades de práctica o epistémicas (Sismondo, 2004). Estas comunidades están ceñidas a normas y estándares de acción, ar gumentación, evaluación y colaboración (piensen en la noción de

Presentación


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paradigma de Thomas Kuhn, 1962). Los integrantes de estas comuni-dades compiten por recursos económicos y simbólicos, y por legitimidad social y política. En estas negociaciones, y por lo tanto en los procesos de generación de conocimiento, se ven involucradas situaciones que ocurren en otros espacios sociales, como por ejemplo iniquidades de género y raza, cabildeos políticos, prejuicios disciplinares y geopolíti-cos, limitantes materiales y económicas, etc. Todo esto constituye la cultura epistémica de una disciplina científica (Knorr-Cetina, 1999), “porque la cultura científica es efectivamente una cultura, no sólo en el sentido intelectual, sino también antropológico” (Snow, 1959).

En este sentido, los estudios cts se enfocan en indagar cómo se es-tablecen las culturas epistémicas y cómo se genera, distribuye y con- sume el conocimiento tecno-científico. Este tipo de estudios ofrece una crítica de la ciencia y la tecnología al emplear una postura post-humanista, relativista y reflexiva. En la siguiente sección ahondaré más en las características e implicaciones de la postura cts, pero antes des-cribiré a la comunidad que realiza estos estudios.

¿Quiénes hacen estudios cts?

Los estudios cts se han conformado por académicos, activistas, artistas y profesionistas provenientes de múltiples áreas disciplinarias. Esto implica que todos aportan métodos de investigación propios de su área. El resultado ha sido un diálogo metodológico enriquecedor. Hablar de me-todología es hablar no sólo de los métodos o herramientas que se em-plean para la generación de datos, sino también de las teorías con las que se analizan dichos datos y el tipo de preguntas y premisas que guían la investigación. Al ser, entonces, una comunidad compuesta por per-sonas con formaciones disciplinares diversas, los estudios cts se alimen-tan de preguntas, teorías y métodos de diversos cortes.

Hay quienes se interesan por analizar y cuestionar las perspectivas tra-dicionales de la filosofía, sociología e historia de la ciencia y la tecnología


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(Bijker, Hughes y Pinch, 1987). Otros se inclinan hacia preguntas so-bre la construcción y representación, en los medios y espacios públicos, de los científicos, de los innovadores, de los usuarios, de los objetos tecnológicos y de los supuestos de verdad (Weingart y Pansegrau, 2003; Wagner, 2007). También hay quienes indagan, de manera empírica, el proceso de generación de aquello que se llama conocimiento científico y tecnológico, analizan cómo se construyen, significan y asimilan las ideas que conforman a la ciencia y la tecnología. En estos casos emplean métodos empíricos como son la observación participante y las entrevis-tas. En esta línea encontramos una gran diversidad de espacios etnográ-ficos que van desde los ya clásicos estudios de Bruno Latour y Steve Woolgar (1979) sobre etnografías de laboratorio, pasando por estudios sobre conferencias (González-Santos y Dimond, 2015), estudios en es-pacios digitales (Horst y Miller, 2012), hasta estudios en espacios de debate político (Callon, Lascoumes y Barthe, 2011). Otros más buscan interrogar a la ciencia y a la tecnología desde el arte y el activismo.

Ante tal diversidad de preguntas y métodos, ¿cómo es que se puede hablar de una comunidad cts? Lo que la une es lo que a continuación describo como la postura cts. Los integrantes de esta comunidad no son uniformes y homogéneos, pero de alguna manera y en grados par-ticulares todos comulgan con todas o algunas de las cinco premisas que conforman esta postura: una visión critica, dinámica, post humanista, relativista y reflexiva del conocimiento y hacer científico y tecnológico.

Una postura cts

Muchos de los investigadores en cts adoptan, como estrategia meto- dológica, una postura crítica respecto a la ciencia y la tecnología. Son críticos en el sentido de que buscan cuestionar los conceptos y procesos que sustentan y dan forma al fenómeno que estudian al seguir la premisa de que “el fenómeno pudo haber sido distinto entonces ¿porqué


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sucedió como sucedió?” Ser críticos también quiere decir que no parten del supuesto de que el método científico, en sí y por sí mismo, ofrece un camino privilegiado hacia el conocimiento absoluto y certero sobre el mundo natural, lo cual tampoco significa que lo desacreditan. Suspen-der el juicio a priori de que la ciencia tiene mayor dominio de la verdad que otras formas o momentos del saber es una estrategia metodológi- ca que permite indagar sobre los elementos y relaciones que dan lugar a un saber y hacer particular, y no apelar a nociones de verdad.

Los estudios cts tienden a enfocarse en, cuando menos, tres momen-tos: cuando el conocimiento se está haciendo (lo que se conoce como ciencia en acción), en las controversias y en los procesos por los que se estabilizan las nociones de verdad. Prestar atención a estos momentos nos permite preguntar por el proceso a través del cual se construye y estabiliza un saber, a veces como verdad mientras que otras veces como mito, pseudociencia, falsedad, error, etc. Dicha postura enfatiza el dinamismo del conocimiento, lo que “se sabe hoy” posiblemente ma-ñana será visto como una creencia resultado de ignorancias, errores y deficiencias tecnológicas.

Otra postura común en los estudios cts es la posthumanista, una mirada que deja de colocar al ser humano como centro y medida de las explicaciones y justificaciones de los haceres científicos y tecnoló- gicos. El propósito de deslocalizar al ser humano es epistemológico y ético. Por un lado, se busca reconocer el papel que juegan los elementos no humanos en la conformación de un saber o una tecnología y por el otro, cuando se conceptualiza la justificación de un objeto, proceso o saber tecno-científico, se intenta considerar y respetar el valor de la vida, y no sólo la vida humana.

Los estudios cts son, por lo general, relativistas, es decir, prestan atención al lugar, tiempo, cultura e historia de aquello que estudian. Esto resulta en una gran afinidad por el estudio de caso y por el recha-zo a generar grandes explicaciones universalistas y atemporales; más bien buscan ofrecer descripciones detalladas y pequeñas explicaciones


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complejas y contextualizadas. Esto mismo conlleva a que se busque una práctica reflexiva respecto a la influencia que tiene el investigador sobre aquello que estudia (Haraway, 1988).

cts en la ric

En este número 30 de la Revista Iberoamericana de Comunicación se presentan tres trabajos de investigación que siguen la perspectiva de cts. Los primeros dos artículos (Reedy y Gusti) fueron presentados en un evento sobre cts que se efectuó en la Universidad Iberoamericana en el otoño del 2015. El objetivo de este evento fue mostrar trabajos de investigación en proceso que se estuvieran llevando a cabo en México y que siguieran una perspectiva cts. Si bien los estudios cts están ya bien establecidos en contextos anglosajones, escandinavos, francófonos, germánicos y hasta en algunos países de Asia como podemos ver por la presencia de revistas y publicaciones sobre el tema, así como por la cantidad de programas de posgrado que allá se imparten, en Latinoa-mérica aún no logran el mismo grado de consolidación (salvo Argentina y Brasil) (Vessuri, 1987; Cerezo y Verdadero, 2003; Kreimer, 2007). Asimismo, la publicación de dichos trabajos en esta revista busca mos-trar lo productivo que puede ser el diálogo entre el área de la comuni-cación y el área de estudios en cts (Baldwin-Philippi, 2011; Wajcman y Jones, 2012). Ambas posturas se interesan por la producción, con-tenido y recepción de los productos mediáticos, pero los estudios en cts aportan un enfoque material a los estudios en comunicación, ya que miran estos procesos desde una interpretación semiótica de las tecnologías, los aparatos y los instrumentos que forman parte de ellos. Una mirada antideterminista que considera que lo material y lo social son inseparables, por ende ambos participan, en conjunto, en el proceso de construcción, distribución y consumo de los medios y sus mensajes. Una mirada que pregunta por el proceso de co-cons-trucción entre “lo social» y “lo material», y que rechaza explicaciones

cts. Los primeros dos artículos (Reddy y Gusti) fueron presentados en

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deterministas, ya sean de orden tecnológico o social. Aunado a esto, los estudios cts se interesan por explorar la historia de las tecnologías y aparatos que participan en la producción, distribución y consumo de mensajes; y en cómo son transformados materialmente y simbólicamen-te en cada instancia en la que se usan.

Los estudios cts en conjunto con elementos teóricos de los estu-dios en comunicación pueden servir para describir procesos de apro- piación y transformación de los medios de comunicación. Porque pueden, por ejemplo, enriquecer la noción de usuario como lo muestran Pinch y Oshdroon en su libro Users Matter (2005), donde plantean que usar una tecnología no siempre tiene que implicar utilizarla de manera activa ni de la manera en la que fue diseñada. Bajo esta perspectiva, es importan-te considerar también a aquellos quienes generan nuevos usos, rechazan o abandonan su uso y a quienes no lo usan por falta de accesibilidad, por postura política o por falta de entendimiento. Los trabajos que se presentan en este dossier son de carácter etnográfico, tanto en su escritura como en el proceso de generación de datos en el que incurrieron sus autores.

El artículo de Elizabeth Reedy, The Production of Earthquake Emergencies: technoscientific earthquake early warning in a social and material world, explora el papel de la alerta sísmica en el proceso de construcción de lo que es una emergencia y lo que es la sismicidad. Hace una explo-ración etnográfica física y digital de las respuestas a la alerta sísmica que se activó el 29 de septiembre del 2015, a la que no le precedió un sismo. De esta indagación y de un trabajo etnográfico y de archivo más extenso, concluye que es importante que la población usuaria y recep-tora de este sistema de alarma tenga un contexto desde el cual pueda hacer sentido de la alerta sísmica. Propone usar los casos en los que se dispara la alerta, así como los casos en que el temblor que la precede es imperceptible a la población, como oportunidades para construir este contexto. Su propuesta es la de entender una situación de emergencia como una relación compleja entre peligro y perturbación, una re-lación que se establece material y socialmente. Aunado a esto, su trabajo

El artículo de Elizabeth Reddy, The Production of Earthquake Emer-

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deterministas, ya sean de orden tecnológico o social. Aunado a esto, los estudios cts se interesan por explorar la historia de las tecnologías y aparatos que participan en la producción, distribución y consumo de mensajes; y en cómo son transformados materialmente y simbólicamen-te en cada instancia en la que se usan.

Los estudios cts en conjunto con elementos teóricos de los estu-dios en comunicación pueden servir para describir procesos de apro- piación y transformación de los medios de comunicación. Porque pueden, por ejemplo, enriquecer la noción de usuario como lo muestran Pinch y Oshdroon en su libro Users Matter (2005), donde plantean que usar una tecnología no siempre tiene que implicar utilizarla de manera activa ni de la manera en la que fue diseñada. Bajo esta perspectiva, es importan-te considerar también a aquellos quienes generan nuevos usos, rechazan o abandonan su uso y a quienes no lo usan por falta de accesibilidad, por postura política o por falta de entendimiento. Los trabajos que se presentan en este dossier son de carácter etnográfico, tanto en su escritura como en el proceso de generación de datos en el que incurrieron sus autores.

El artículo de Elizabeth Reedy, The Production of Earthquake Emergencies: technoscientific earthquake early warning in a social and material world, explora el papel de la alerta sísmica en el proceso de construcción de lo que es una emergencia y lo que es la sismicidad. Hace una explo-ración etnográfica física y digital de las respuestas a la alerta sísmica que se activó el 29 de septiembre del 2015, a la que no le precedió un sismo. De esta indagación y de un trabajo etnográfico y de archivo más extenso, concluye que es importante que la población usuaria y recep-tora de este sistema de alarma tenga un contexto desde el cual pueda hacer sentido de la alerta sísmica. Propone usar los casos en los que se dispara la alerta, así como los casos en que el temblor que la precede es imperceptible a la población, como oportunidades para construir este contexto. Su propuesta es la de entender una situación de emergencia como una relación compleja entre peligro y perturbación, una re-lación que se establece material y socialmente. Aunado a esto, su trabajo


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da cuenta de algunas de las expectativas que los mexicanos tienen de aquello que se encuadra como “ciencia y tecnología».

El trabajo de Joseph Guisti, Students or experts? Unpacking addiction treatement center operators’ relationships to scientific knowledge in Mexico City’s mixtos, es una reflexión etnográfica sobre la construcción de una profesión y su experticia, el rol del consejero en los mixtos, y sobre cómo los actores implicados en los centros de tratamiento de adicciones construyen y se relacionan con “el conocimiento científico” que producen médicos y psiquiatras. Al igual que en el caso de Reedy, su atención está puesta sobre las prácticas de significación y sobre los enre-dos entre seres humanos y materia.

El tercer trabajo que conforma este dossier es escrito por Lucano Romero Cárcamo, Periodismo Influido: la cobertura de salud desde la radio en Puebla, en él nos presenta un estudio sociológico de la pro-ducción de noticias sobre temas de salud en la radio poblana. Es un trabajo cualitativo profundo que visibiliza los distintos elementos, per-sonas, objetos y relaciones involucrados en el proceso de producción de las notas periodísticas en temas de salud. Concluye que, por un lado hace falta mucha profesionalización en la producción de notas especia-lizadas y por el otro, que este proceso de profesionalización es complejo dadas las limitantes económicas y políticas.

Como podemos ver, en este dossier se presentan tres trabajos de corte cualitativo profundo en el que se muestra la importancia que tienen factores políticos, culturales y económicos en el proceso de construc-ción, aceptación, asimilación, divulgación y uso del conocimiento cien-tífico.

Sandra González Santos

Referencias

Baldwin-Philippi, J. (2011). Bringing science and technology studies to bear on communication studies research. Communication Research Trends, 30(2).

producen médicos y psiquiatras. Al igual que en el caso de Reddy, su

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Bijker, W. E.; Hughes, T. P. y Pinch, T. (eds.) (1987). The social construction of technological systems. Cambridge, Massachussets: mit Press.

Callon, M.; Lascoumes, P. y Barthe, Y. (2009). Acting in an uncertain world: an essay on technical democracy. Massachusetts Institute of Technology.

González-Santos, S. P. y Dimond, R. (2015). Medical Conferences as Sites of Sociological Interest: A review of the field. Sociology Compass, 9(3), 235-245.

Hackett, E.; Amsterdamska, O.; Lynch, M. y Wajcman, J. (ed.) (2008). The handbook of science and technology studies. (3rd Ed.). Cambridge: mit Press.

Haraway, D. (1988). Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective. Feminist Studies, 14(3), 575-599.

Horst, H. y Miller, D. (2012). Digital Anthropology. London: Blooms burry.Knorr-Cetina, K. (1999). Epistemic cultures: how the sciences make know

ledge. Cambridge, Mass: Harvard University Press.Kreimer, P. (2007). Social Studies of Science and Technology in Latin

America: A Field in the Process of Consolidation. Science Technology Society, 12(1).

Kuhn, T. S. (1970). The structure of scientific revolutions (2nd ed., onl). Chicago: University of Chicago Press.

Latour, B. (1987). Science in action. Cambridge: Harvard University Press.

Latour, B. y Woolgar, S. (1979). Laboratory life. The construction of scientific facts. New Jersey: Princeton University Press.

López Cerezo, J. A. y Verdadero, C. (2003). Introduction: science, tech-nology and society studies - from the European and American north to the Latin American south. Technology in Society, 25, 153-170.

Oudshoorn, N. y Pinch, T. J. (2005). How Users Matter: The Co construction of Users and Technology. Cambridge: mit Press.

Sismondo, S. (2004). An introduction to science and technology studies. Oxford: Blackwell Publishing.


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Snow, C. P. (1959). The Two Cultures debate controversy, Rede Lecture, disponible en [http://www.age-of-the-sage.org/scientist/snow_two_cultures.html], fecha de consulta: 18 de mayo de 2016.

Vessuri, H. (1987). The Social Study of Science in Latin America. Social Studies of Science, 17, 519.

Wagner, W. (2007). Vernacular science knowledge: its role in everyday life communication. Public Understanding of Science, 16, 7-22.

Wajcman, J. y Jones, P. K. (2012). Border communication: media so-ciology and sts. Media Culture Society, 34, 673.

Weingart, P. y Pansegrau, P. (2003). Introduction: perception and re-presentation of science in literature and fiction film. Public Understanding of Science, 12, 227-228.

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The Production of Earthquake Emergencies: technoscientific earthquake early warning in a social and material world

Elizabeth Reedy

Resumen Con el fin de evitar lesiones y salvar vidas, los sistemas de alerta temprana de terremotos, como el Sistema de Alerta Sísmica Mexicano (sasmex), de-ben empatar ser oportunos y la detección de riesgos con una difusión eficaz para los usuarios vulnerables. La alerta sísmica hace la sismicidad significa-tiva para sus usuarios de nuevas maneras. Este artículo parte del interés de cts por cómo los materiales se vuelven significativos para explorar la manera en que la alerta sola se convierte en un tipo de emergencia sísmica. Al analizar etnográficamente una alerta que no advierte movimientos vio-lentos, y la subsecuente discusión pública de sus efectos, mi argumento se desarrolla en el sentido de tomar la producción social de una emergencia seriamente. Al destacar las respuestas y potenciales efectos de esta emergen-cia sísmica, argumento contra el simple tecno-optimismo para poner de relieve la necesidad de educación para mejorar los alcances de herramientas para salvar vidas como la alerta sísmica. Para convertir las emergencias en oportunidades para los residentes de la Ciudad de México se requiere la introducción de nuevos tipos de estrategias públicas y educación no sólo sobre la alerta, sino sobre las posibilidades y límites de los sistemas tecno-científicos de prevención de desastres.

Palabras clave: sistema de alerta temprana del terremoto, realismo agencial, producción social de emergencia.

Abstract In order to prevent injury and save lives, earthquake early warning sys-tems like Mexico’s public Sistema de Alerta Sísmica Mexicano (sasmex) must pair timely, effective hazard detection with effective alert dissemina-tion to responsive users. The alert makes seismicity meaningful to its users

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in new ways. This article draws on contemporary sts concerns with how mate rials come to be meaningful in order to reckon with how an earth-quake alert comes to be a kind of earthquake emergency. Engaging ethnographically with an alert which did not presage violent shaking, and subsequent public discussion of its effects, I argue for taking the social production of emergency seriously. By highlighting responses to and po-tential effects of this earthquake emergency, I push back against simple techno-optimism to highlight the necessity of public education to sup-port potentially life-saving tools like the Sistema de Alerta Sismica Mexicano. Making emergencies into opportunities for Mexico City residents may require introducing new kinds of public outreach and education about not just the alert, but about the possibilities and limits of techno-scientific disaster prevention.

Keywords: earthquake early warning system, agential realism, social production of emergency.

Fecha de recepción: 29 de febrero de 2016Fecha de aceptación: 26 de abril de 2016

Introducción

W hen loudspeakers warbled their earthquake alarm at 11:44 pm on the evening September 29, 2015, I was in bed but writing

emails. The apartment around me was lit entirely by the streetlights out on Plaza Popocatepetl, and then a siren was sounding.

I was up fast. Enrique, on whose inflatable mattress I was staying, called to me from the bedroom down the hall. Was this scheduled?

No, it couldn’t be, I told him, grabbing shoes and a coat. Mas-sive public drills happen in Mexico City every year, but for all these may catch people by surprise in the moment, they are well-publicized beforehand. These things take a great deal of preparation behind the scenes, too. I had neither read anything about a drill in the paper nor heard anything from the disaster prevention experts whose work I have been studying as an anthropologist since 2010. I was sure that the earthquake was real.


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At the door I met Enrique, and then, a moment later, his wife Beca, holding their two small dogs. We were one broad flight of stairs from the door to the street. The alert stopped, and we paused there.

We waited. The alert should have continued to sound until the quake was over, but the loudspeakers were newly integrated into the public earth quake early warning system and it was possible that they would not follow the same rules that other forms of dissemination did. Re-gardless, the alert could give us, at the absolute most, a bit over a min-ute’s warning before an earthquake could travel from the most distant of the Sistema de Alerta Sísmica Mexicano sensory field stations all the way to La Condesa in the center of Mexico City. The siren had stopped, though, and I still hadn’t felt anything.

I was visiting Mexico City for a series of meetings and events on seismic engineering and earthquake safety clustered around the thirty year anniversary of the tragic 1985 Michoacán earthquake, a deadly seismic event that not only shook buildings but also resonated through politics, regulation, and disaster prevention policy throughout Mexico. In the evening of September 29 and the days that followed, the alert that sounded from the loudspeakers was a topic of some interest among the “seismic community” (that is the community of multidisciplinary experts concerned with public earthquake risk mitigation) and among ordinary people.

There was indeed an earthquake on the evening of the 29th, an event of magnitude 4.6 about 49 kilometers from the city of Ometepec, Guerrero according to a report from the Servicio Sismológico Nacional issued the next day. Measuring earthquakes precisely is not a process that can happen quickly, and though it was small it still triggered the Sistema de Alerta Sísmica Mexicano. It was not quite large enough to be felt on the first floor of a building over La Condesa’s sensitive soil, but it was perceptible in some parts of Mexico City.

In the days which followed, people discussed what this event could mean. The earthquake itself, that is, the material release of energy in Guerrero that resonated through soils and the techno-scientific


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earthquake early warning system was present in these reflections, but so were other kinds of threats mediated by this alert broadcast. Some were stories about immediate concerns, about fright and disturbed sleep. But others were about longer-term consequences of this kind of alert communication, considered in reference to not just one quake, but to Mexico’s ongoing seismicity and the large temblors that were surely coming. Some suggested that this alert could be a kind of drill; produc-tive of future safety. Others, however, made references to “the boy who cried wolf”, the fable about a small boy who warns a village of a wolf when there is none, and who suffers when at last a wolf finally does visit him. I was struck by not just the high stakes of an event in which little, materially, happened, but the proliferation of meaning that the alert of the 29th took on. Although public earthquake early warning is poten-tially life-saving, this technoscientific means of preventing seismic haz-ards from becoming disasters has other effects too.

As an ethnographer of seismicity, I have come to regard knowledge and practice around seismic phenomena in the context of their social production. This, for me, means not just the ways that people build in earthquake zones and are put at new kinds of risk. This kind of social production (sometimes “construction”) has been deployed in policy-making as a goad for thinking through the conditions of possibilities of disaster (Oliver-Smith, 2002; Tierney, 2007). Instead of following this logic, in this article I explore the implications of understanding emergency, often just one moment in the sweep of a disaster, as a com-plex relation of disturbance and danger, the connections between which are constituted materially and socially.

Disaster studies scholar Virginia García Acosta (2002) has described disasters as “social laboratories” (p. 65) in which, through the mixing of metaphorical reagents and crises of heat or pressure, facts of social life can come to be revealed. In this case, it seems appropriate to turn tools that have so illuminated laboratories as spaces of practice on them. If meaning and event are to be linked as in a laboratory, then it is not surprising that analytics borrowed from science and technology studies


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might be productively brought to bear on issues, more properly the disciplinary territory of disaster studies.

By “analytics of science and technology studies”, here, I am thin king particularly of emphasis on and inquiry into the practices of produc-tion of meaning and event. Various approaches to this have been ad-vanced in turns toward the practices of meaning making, each with their own complex empirical implications, but here I am guided by how Karen Barad has articulated an approach to the entanglements of meaning and matter in her work on quantum physics. As Barad (2007) put it: “What is needed is an analysis that enables us to theorize the so-cial and the natural together, to read out best understandings of social and natural phenomena through one another in a way that clarifies the relationship between them” (p. 25).

Indeed, in this context, Barad’s agential realism, her always-already- ethically implicated onto-epistemological framework, is particularly a propos. She not only addresses the social construction of knowledge and what comes to count as fact, but a commitment to realism, “the serious business and related responsibility involved in truth hunting” (2007, p. 43) which in the case I describe here comes to an issue of not just how to make sense of the alert of the 29th, but how real human lives could be put in danger or protected in the context of the Sistema de Alerta Sísmica Mexicano and Mexico City’s potentially life-saving public broad-cast of the alert.

In this article, I consider the various material and social systems which framed the communication of the alert on September 29th and the public arguments which developed around the event, focusing on the various real social effects that it might be understood to have. With reference to Barad’s focus on the practices by which the material world is made meaningful, I suggest that it may be possible to unders-tand the communication of the alert as itself a kind of earthquake emer-gency, even though the earthquake that happened that night barely shook Mexico City. Indeed, I will argue that it is more than possible to do so, that this way of thinking about the alert and the concerns which


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were articulated around it may be a productive strategy for seriously engaging with the urgency that attended the presences and absences of earthquakes the night of the 29th and contextualizing the very different kinds of ways people have described the potential effects of the night’s alert. This offers a conceptual approach to earthquake early warning that runs contrary to a techno-optimistic expectation that social response to the alert can be anticipated and that user´s experiences of mate rial hazards can be controlled for through technology, the multiplicity and unpre-dictability of their needs and vulnerabilities either ignored or designed away. I suggest here that responses to the alert are necessarily complex, and that its meaning should be understood to be produced in practice with technology and in the (often threatening) material world.

If an alert about the occasional earthquake that one doesn’t feel is the price that Mexico City and the other user communities of the Sistema de Alerta Sísmica Mexicano pay for a speedy, public warning of on-coming earthquake, it is relevant to confront the radically different ways that such alerts become meaningful. Unfortunately, public discourse seems to focus largely on the technology of the alert, suggesting that the troubling potentials of such events are either negligible or that they can be entirely designed away with refinements to the alert. In this paper I explore a third option: by highlighting the productive trouble that this event made for many Mexicans, I suggest that disaster prevention should be imagined as a site for more than technoscientific inter-vention. Instead, as a social, material, and technical issue, it should be considered in the context of diverse practice and meaning-making that will always exceed any system designers’ plans. I use the language of emergency to bring attention to these practices and the diverse mean-ing they produce. Debates about the effects of “crying wolf” indicate that emergencies like that of the 29th can have serious implications, but put far too much onus on the earthquake early warning system’s func-tion and the possibilities of technoscientific refinements to transform social relation to material threat, neglecting, for example, public educa-tion and other kinds of actions in the social world of Mexico City.


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This article has three sections. In the first, I situate the complex work of meaning-making which happened around the communication of the alert in the context of emergency, demonstrating the utility of an ethnographic focus on the production of emergency and engaging it with a few of the theoretical and ethical implications of doing so. In the second, I discuss how social as well as material and technical ele-ments work in the context of an earthquake early warning system which both provides new ways of keeping people safe from earthquakes and makes new kinds of emergency possible. In the third, I discuss in detail the ways in which the alert of the 29th might be productively under-stood as an earthquake emergency. Here, I emphasize various discursive works connecting the communicative event of the 29th to potential ma-terial consequences. I take debates about the alert of the 29th to be an essential part of sorting its meaning out. In this case, as in Barad’s, “we are a part of the nature that we seek to understand” (2007, p. 67), or, rather, part of the emergency that many of us in Mexico City both ex-perienced on the 29th and subsequently reflected upon.

While this article only focuses on a single occurrence, it evaluates this case in-depth with attention to details informed by over 17 months of ethnographic and archival research. The event was unique, but the implications that the concerns articulated around it may have for public safety are far from isolated. In such individual experiences and inter-actions around an earthquake emergency, it is possible to interrogate practices and investigate the ways that emergencies can be understood to have effects. I work in the rich tradition of critical field-based ethnogra-phic research developed in cultural anthropology (Gupta, Ferguson and Marcus, 1998), which resonates with certain efforts in science and technology studies to interrogate practice (Pickering, 1992), particu-larly work like that of Barad, which Hannah Knox and Tone Huse (2015) have considered “post-constructivist” in its efforts to “unders-tand the entanglement of ideas, matter, and technology through the study of situated practices” (p. 8). I make use of several auto-ethnogra-phic vignettes (Reed-Danahay, 1997) to illustrate the event of the 29th,


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and my approach to the communicative acts generated around the event is informed by critical discourse analysis. Critical discourse analysis proposes that communicative acts shold be considered as “embedded in more general patterns of human meaningful action”, (Blommaert and Bulcaen, 2000, p. 461), and I give them context in both studies of emergency communication and in research into the nature of emer-gency. Simi larly, the ethnographic vignettes I use describe a lived ex-perience of the event, opening it up for analysis. Using these means, I describe the event itself and responses to it with an analysis which takes communicative acts as social phenomena; any knowledge or reflections regarding which are situated in the social and political world (Haraway, 1988) of emergencies, early warning practices, and research communities which extend through and outside Mexico City. These entangle re sear-chers from around the world and, as earthquake early warning systems proliferate, the wellbeing of publics around the world too.

Though earthquake disaster or even earth motion may not be im-mediately forthcoming, and though communicating alerts of the type that happened on September 29th may simply be part of a speedy, sensi-tive and public earthquake early warning system, their implications can make them, for some, emergencies in their own right. Here, I document how this new public broadcast of the Sistema de Alerta Sísmica Mexicano occasions opportunities to think through the stakes of alerting and the insufficiency of focus on the material world and technoscientific interventions alone to reckon with complex emergencies. I also offer a provocation for further research in both treatments of emergency in science and technology studies and disaster studies.

Emergencies are not disasters

The language of emergency is easy to deploy here but necessary to un-pack in order to attend ethnographically to the ways that the alert of September 29th could be a matter of such different kinds of experience.


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Kathleen Tierney (2007), a sociologist of disaster, breaks the predomi-nant model down simply: “Disasters are characterized as having a be-ginning (the period of onset), a middle (the emergency period), and ultimately an end (when social life returns more or less to normal and when recovery takes place)” (p. 509).

These stages can be mapped on to earthquake action in relatively straightforward ways. When plates or faulting slips, the period of onset has begun. The emergency period may include the moment the quake is felt, as stable ground turns vibratory and structures resonant, and its aftermath, as injured are rescued and treated. The end of a disaster is time for rebuilding, healing (perhaps with preparation for the next disaster) and so forth. An earthquake early alert can be properly con-ceived of as a tool built in a recovery period of use in an emergency period; designed after the 1985 quake to intervene on users in just “one moment”, one moment in a long string of them, each of which allow opportunities for choices that may diminish risk, as Dr. Sergio Puente Aguilar, a researcher and professor at the Centro de Estudios Demográficos, Urbanos y Ambientales at El Colegio de México and the author of a number of works on risk in urban Mexico (Puente Aguilar, 1999, 2013), explained to me in 2014.

The moment at which the earthquake early warning is designed to become really useful to users is sudden. The earthquake early warning itself as encountered by most users is just as much a result of the energy of earth motion through soil as the shaking that people feel seconds af-ter it, that is mediated through a technoscientific system. Its affordances along with issues like users’ locations, their experiences, their capabil-ities and vulnerabilities, and their knowledge about what to do when alerted frame the conditions of possibility for how the sudden noise of loudspeakers on the night of the 29th and the action across the city in the seconds after it can be understood.

Tierney herself highlights the limitations of this three-step process for thinking about recurrent disasters and the conditions, structures and forces that make disasters possible and channel their effects. The way


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that these steps chop up events and foreclose causality is analytically troublesome. Neither complex (Fortun, 2001; Petryna, 2006) events, anticipatory work (Collier and Lakoff, 2008; Anderson and Adey, 2011; Deville, Guggenheim and Hrdlicková, 2014; Choi, 2015) nor the larger-scale logics that frame their fearsomenessand both enable and foreclose possible responses (Massumi, 2005; Davis, 2007; de Goede and Randalls, 2009; Masco, 2014) can be easily accommodated here.

In some ways, though, isolating “emergency” from other stages of event and from the disaster it may be part of, the three-step model has real utility, especially in reference to the alert of the 29th. Emergency is not disaster; though we might understand their relation to be that of a material upset made meaningful. The two co-occur1, and can be chal-lenging to separate conceptually or practically (Guggenheim, 2014; Redfield, 2010) Craig Calhoun (2010) points out that while emergency is “a sudden, unpredictable event emerging against a background of os-tensible normalcy, causing suffering or danger and demanding urgent response” (p. 30), it is also hard to get traction on what else it is and may be. “‘Emergency’ is now the primary term for referring to catas-trophes, conflicts, and settings for human suffering”. Calhoun under-stands it to have “rough cognates such as ‘disaster’ and ‘crisis’”, but he writes: “Use of the word focuses attention on the immediate event, and not on its causes” (ibid).

My effort to consider the complex production of emergency reso-nate with recent work on disaster which has suggested that emergencies and the disasters might be considered sites of emergence in upheaval, of new publics (Tironi, 2015) and new configurations of technical infras tructure (Kane, Medina and Michler, 2015), or “trickster” envi-ronments (Barrios, 2015). Here, through events that disturb normal

1 The threshold at which emergency becomes disaster is, for Adi Ophir (2010), am-biguous for several reasons: “because it is not clear where exactly the line should be drawn… because the line may be crossed at any given moment due to accumulation or acceleration… because it is never certain whether identifying, determining, or declar-ing the threshold is a matter of recognizing a fact or fulfilling a duty” (p. 72).


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arrangements of agents and material conditions, life, techno logies, in - stitutions, and ideas may be transformed. These events and the disasters that they are incorporated into are social, but not purely social.2 While my reading of emergency resonates strongly with their work on com-plex material, technical and social events, I want to point out that the responses to the alert on the evening of the 29th suggest that the distur-bances, upheaval, and danger —the meaningful material danger— that an emergency may present need not be laminated in time, evident and immediate. As I do so, I highlight the affordances (Gibson, 1977) of earthquake early warning technologies for not just new ways of doing earthquake safety, but also in the production of new kinds of earth-quake emergencies as people consider the stakes of new kinds of en-counters with earthquakes through alert communication. That this is not the same as new kinds of earthquake disasters, far from it. The new mode of publicly broadcasting the Sistema de Alerta Sísmica Mexicano can mean new earthquake emergencies, but also offers new opportuni-ties to forestall disasters. Taking advantage of such opportunities will require serious attention to how material, social and technoscientific factors produce emergencies together.

The SiStema de alerta SíSmica mexicano and earthquakes

The Sistema de Alerta Sísmica Mexicano, Mexico’s official earthquake early alert network and, at the time of this writing, the only one recog-nized by the Mexican government, comprises nearly one hundred sen-sory stations stretched along seismically active areas of south and central Mexico, radio repeater stations and central computers in six popula-tion centers (Mexico City, Morelia, Puebla, Chilpancingo, Acapulco and Oaxaca). Sensory stations, equipped with fast-acting algorithms,

2 See Rodriguez-Girault, Tirado and Tironi, 2014, on the topic of how much the social has come to frame the definition of a disaster.


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use changes in movement at the very first part of earthquakes to project the size that those quakes are likely to grow to, semi-integrated into a growing number of dissemination systems. They send signals racing across the expanse of Mexico, reaching vulnerable cities before the quakes can and giving users there seconds of valuable “advantage time”. The system has been astoundingly successful at doing so. The Sistema de Alerta Sísmica Mexicano has experienced only one missed event and one false alert in its long history, both of which happened in the first years it was operational (Espinosa Aranda et al., 2009).

However, parsing seismicity is challenging. The alert signal is not sent out based on a precise measurement, but rather a quick analysis. “It’s not very accurate. We know. Everybody knows!” explained one expert to a room of international peers visiting for a conference in sep-tember 2015, only days before the alert that I began this piece by de-scribing. While it has been demonstrated to function reliably and is constantly refined, the system’s algorithms have not privileged exac titude (Iglesias, Singh, Ordaz, Santoyo and Pacheco, 2007). Making distinc-tions between moderately-sized and small earthquakes, that is, distin-guishing between earthquakes that the Mexico City government has decided to broadcast the alert for and those it has decided not to alert, is challenging.

Earthquakes are complicated events, and the numbers that are at-tached to their magnitude, especially early on, are taken by geophysi-cists as provisional (Lampland, 2010), that is, most likely close to the magnitude at which they will be assessed at, and standing in for them until final calculations can be made. This was indeed the case on the evening of the 29th, as the Servicio Sismológico Nacional made an origi-nal estimate of magnitude 4.8 and later revised it down to 4.6 (as the Excelsior reported on september 30, see Páramo, 2015). The Sistema de Alerta Sísmica Mexicano’s numbers are more provisional still; so much so that, while its alerts are designed around target magnitudes deter-mined by Mexico City (“Preventative alerts” are issued Mexico City for events forecast to be, roughly, between magnitude 5 and 6, and “public


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alerts” are issued for events of around magnitude 6 and up), they are rarely discussed in these numeric terms. The Centro de Instrumentación y Registro Sísmico (cires), a non-profit which has developed and main-tained the Sistema de Alerta Sísmica Mexicano since it began to issue alerts in 1991, instead automatically broadcasts simple warnings to users based on their best algorithmic estimates of whether the earthquake will be moderate or intense. As magnitude is exponential, the difference between a magnitude 4.6 and a magnitude 5 earthquake is much smaller than the difference between a magnitude 5 and magnitude 5.4. More accurate distinctions would take time. When an earth quake is moving at the speed of sound from its epicenter toward a vulnerable population, time is of the essence.

The stakes of alerting are high. Alerts make it possible for people to take action that could include evacuation, taking shelter or pulling over in a car. Though it is difficult to collect data about lives that have not been lost and injuries that have not been suffered, studies of the Northridge and Loma Prieta quakes in California in 1989 and 1993 indicate that more than half of the injuries sustained came from non-structural elements falling (Shoaf et al., 1998; Porter et al., 2006), which are difficult indeed to regulate even with the best norms.

Earthquake injuries do come when buildings collapse, which can take minutes of sustained shaking, but they are also occasioned by much more rapid threats. The system’s utility is, then, a matter of the speed at which the alert can be disseminated, especially given the variety of ac-tivities users may be in the middle of when they are alerted to an on-coming quake and the variety of built environments they may occupy. By evacuating or taking shelter immediately upon hearing the alert, or at least taking steps toward this action before the shaking can do real damage to the built environment, people in earthquake-prone areas can avoid encounters with the materials around them at speeds and angles that they might rather avoid.

Alerting experts often emphasize the advantage of disseminating sub-stantial amounts of information to publics via multiple sources to ad-


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dress their various needs and preferences (Mileti and Sorensen, 1990; Sorensen, 2000), the particularly short timeframe available for earth-quake early warnings can curtail options.3 People hearing the alert of-ten do not know what the best actions to take in the seconds before an earthquake might be, or understand what it is that the Sistema de Alerta Sismica Mexicano does. While significant planning was done in the ear-ly days regarding how to produce a “seismic culture”4, education about the earthquake early alert has only been introduced spottily.

Earthquake early warning systems are remarkable tools, and Mexico’s was the first in the world to issue its alerts to a general public. It was de-veloped in the wake of the disastrous 1985 earthquake, when the possi-bility of a massive seismic event was looming over Mexico.

At first there were twelve stations, arrayed across an area that geo-physicists understood to be not only seismically active but likely to produce the next big one, a portion of the Guerrero coast that included the so-called “Guerrero Gap”, which was overdue for quake. More user populations have been added since, and after tsunami and earthquakes in Chile and Haiti in 2010 and Japan 2011, the network of the system been developed further. It now includes almost one hundred sensory stations, and can detect earth motion in southern and central Me- xico quickly and alert cities aside from Mexico City.

Even as she supported the earthquake early warning system, long-time public safety researcher and advocate Elia Arjonilla Cuenca was critical of the way that the Sistema de Alerta Sismica Mexicano (then called the Sistema de Alerta Sísmica) was deployed by the state with little attention to its use. In the only systematic study of its effective use, she argued that earthquake early warning was a great tool but necessitated

3 In fact, the amount of information that can be communicated by sirens makes this more of an “alert” than a “warning”, the latter can be understood to contain more information (Sutton, Hansard and Hewitt, 2011). I do not parse this difference here, but note it for curious readers.4 This concept was discussed at length in a set of meetings regarding the possible use of the Mexican earthquake early warning system; see Instituto Javier Barros Sierra, 1992.


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“solid planning and preparation on the part of the community”5 (1998, p. 3), suggesting training users about how to act in case of an alert. This requires institutional support and coordination. Community prepara-tion without support runs the risk of simply serving to, as Jesus Maria Macías Medrano (1999) puts it, “transfer the responsibility of the author-ity for the protection of life and property of the society to the disaster threat to the population at risk” (p. 7).

At this writing, the Sistema de Alerta Sísmica Mexicano is designed and maintained by cires to simply broadcast an alert signal based on the specifications of the governments in its user communities. This leaves the question of means of dissemination open. Modes of dissem-ination, and users, have been proliferating over recent years: at this point, there are many ways to receive the alert. tv and radio stations get messages, and many rebroadcast them, and a designated noaa receiver has been made available to many by the city and federal governments on a large scale.

Relatively few had access to earthquake alert receivers until quite recently, in 2010, when funding from the Mexico City and federal gov-ernment allowed the distribution of nearly 90,000 of them throughout the area (Suarez, Novelo and Mansilla, 2009). Now there are not only the several hundred large scale radio receivers that cires techni-cians themselves keep up in schools and government offices, but other official equipment around the city too. There are more of any number of other types for sale directly and second-hand. Even lower-cost radio receivers are in production.6 Cell-phone apps pass along the message or receive information from parallel sensory systems (although not via broadcast, and sometimes with significant lag).

5 “Sólida planeación y preparación por parte de la comunidad”.6 These are sold at ever-more-affordable but still prohibitive costs (as of June 2015, price might range from $1 300 for an new radio and installation to $100 usd for a used off-brand receiver, though a home receiver to be priced at about $25 is currently in the works).


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It was only as of september 19, 2015 that 8,200 loudspeakers across Mexico City were integrated into the alert network, programmed to in-terrupt any other programming to blast a grating warble and a recorded voice through the air telling all of us, even those without our televisions on or specialized receivers, in very simple terms, that an earthquake was on the way.

That they did, ten days later at 11:44 pm. In the context of serious seismic hazard and in the wake of limited public education, a loud siren and digitized voice gave us an “Alerta Sísmica”. It was an earthquake emergency, with seismic causes and a range of potential consequences in our lives.

Earthquake Emergency

The emergency on the night of the 29th was not an earthquake. We were not thrown off balance by the upheaval of what we had thought solid, not knowing when it would stop or in what condition the material of our lives would be when it did. Something happened, however; so-mething made possible by the earthquake early warning system and experienced in different ways.

As we waited at the top of the stairs after the siren stopped, my hosts Enrique and Beca teased each other about their bedtime rituals: about how hard she’d been to rouse from sleep and how he’d been awake, still dressed, still on the internet. Our frantic action had ended abruptly with the sound of the alert from the loudspeakers. The dogs, who liked being carried but perhaps not that much or both at once, squirmed. Eventu-ally, Beca was done. “Take the keys and tell us what you find out”, she said, and, sensibly, went back into her apartment with Enrique and the dogs. They shut the door behind them.

Down on the plaza in front of their house, I found a handful of people talking. They were gathered near the central fountain in little groups, away from buildings and lit greenly by bright streetlights fil-


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tering through the canopy of trees. Against the white of the fountain’s arches, their outlines were visible to me, even blind as I was without my contact lenses.

“I suppose there has been an earthquake”, a young woman in paja-mas told me. “When we came down, the water in the fountain was rip-pling”. Another was more skeptical. “It’s rippling”, she said, adjusting her short blue dress, “from the wind”. Indeed, there was a light breeze, and the water on the surface of the fountain reflected light back.

A magnitude 4.8 earthquake originating in Guerrero might just have made the water in the fountain on top of one of the most sensitive soils in the city ripple. The material truth of earth motion alone, however, was not enough to account for the responses I saw when I returned to my inflatable mattress and laptop. There, I scanned Twitter and Facebook messages for more responses, reading about how people had become bodily caught up in the Sistema de Alerta Sísmica Mexicano.

Communications scholars have documented how social media can function as a platform for resource mobilization within communities. Not only is social media increasingly a means for communication by authorities (Sutton et al., 2014, 2015), they provide a community means of sharing information that could mean the difference between life and death (Starbird and Palen, 2010), and filling gaps in information com-municated by official media (Sutton, Hansard and Hewett, 2011). So-cial media can even support forms of self-care for resilience during and after events (Kaufmann, 2015). Indeed, while no single hash tag sur-faced that evening as a locus for tweets, I found many messages in re-sponse to tweets from official business and ngo accounts affiliated with earthquake early warning, visible to anyone watching the lively feeds and offering commiseration.

Many referenced the scare of the alert. “Fuckin fright!!!”7 one wrote, appending a photo of an adorably horrified-looking child. “I just about

7 “Pinche susto!!!”.


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died of a heart attack in my bb’s arms”8, another wrote. Tweets may have been hyperbolic, but their expressions reflected an understanding of unpleasant physical stress.

Others posted pictures of bloodshot cartoon eyes, of frightened car-toon characters in bed, of bread rolls they would eat (“pa’l susto”). Peo-ple were frightened of seismicity, and understood encounters with this fright to have consequences even without any physical shaking. Accor-ding to the Secretaría de Protección Civil del Distrito Federal (as reported in Páramo, 2015) there were no injuries or damages that could be at-tributed to the quake, but the fright of it was serious to some. Perhaps this response could be related to past experience with earthquakes; if this is the case, the nation and the city in particular have provided residents with many experiences to motivate ongoing trauma. Alert res-ponses, however, can be tricky to parse. While previous experiences can lead to better awareness and preparation, they can also be associated with avoidance or unwarrantedly optimistic assessment of safety (Lan-deros-Mugica, Urbina-Soria and Alcántara-Ayala, 2016).

There was some discussion of preparation and training on Twitter. “Anyway, it can work like a drill”, wrote one person. “Every false alert should be an opportunity to practice a successful evacuation in case an earthquake happens, I don’t know why they just complain!”9. The sen-timent was not uncommon. The alert, here, was made part of a regimen of training for speed and organization in evacuation; an opportunity to rehearse for a more dangerous earthquake, running through the phy-sical steps and the tension of an unexpected experience so that, in the future, one is more likely to know what to do and, moreover, to be able to do it confidently. Drilling, rehearsals or practices of this sort have come to be understood as a way that people can make themselves ready for an otherwise unpredictable emergency, and be ready to avoid the worst of its potential effects (Davis, 2007; Anderson and Adey, 2011).

8 “Pues casi muero de un infarto abrazada a mi bb”.9 “¡Como sea sirvió de simulacro, cada alerta fallida debería ser motivo oportuno para simular una huida exitosa en caso de sismo, no sé por qué sólo se quejan!”


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Taking advantage of alerts in this way has been recommended for years by early warning experts (Mileti and Sorensen, 1990; Goltz and Florez, 1997; Sorensen, 2000).

The issue of the earthquake yet to come came up in other ways too. “They need to recalibrate the system”, Enrique told me over co - ffee in the morning, “or no one will trust the alert”. A post on the Facebook wall of the earthquake early warning mobile phone applica-tion Sky Alert was in agreement. It read: “Me, I left the house when I heard alarm. I think it’s unwise for the government and that company to make panic with a tremor of 3 degrees. I figure the joke, ‘is crying wolf ’, After all this, they’ll lose credibility...”10. An article in the spanish newspaper El País recounted similar concerns (Navarrete, 2015). Their earthquake emergency might have implications in a large quake that has not yet happened, but is very likely to happen sometime soon. The emergency would blossom into disaster when Mexico City experienced a large earthquake and people, expecting another misfire, neglected ear-ly warnings and came to be hurt because of it.

Emergency responses, especially responses to quick-moving hazards like earthquakes, are generally understood to work best when they are trained into the body and come to entail simple and unconfused phy-sical reactions to certain stimuli. This is one of the reasons that drilling and similar exercises have come to be so important in emergency pre-paration. It provides an opportunity to rehearse crisis, to condition em-bodied and mental responses, and to encounter tools and techniques of safety intimately (Davis, 2007; Lakoff, 2008; Anderson and Adey, 2011). In this context, an alert like that of the 29th could interfere with effecti-ve responses to future earthquake early warnings or, just as easily, it could facilitate them.

Public earthquake early warnings use technoscientific means to give users a chance for speedy action in the case of quakes. If people are

10 “Yo sí salí de casa al escuchar la alarma. Creo que es imprudente que el gobierno y esta empresa generen pánico con un temblor de 3 grados. Se me figura al chiste de ‘allí viene el lobo’. Después esto perderá credibilidad...”


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not interested in taking that action, then the value of the “advanta-ge” they provide decreases tremendously. With the loudspeaker broadcast, Mexico City provided a new way for many to make use of the Sistema de Alerta Sísmica Mexicano.

Considering the story of the boy who cried wolf, cires director, Juan Manuel Espinosa Aranda, commented: “That’s an important met-aphor, but it’s the human condition. [Triggering the alert] was war-ranted because we do not control the phenomenon, because we have no certainty that all the structures of the city are safe”11 (Páramo, 2015b). Broadcasting the alert could make a tremendous difference for Mexico City residents in dangerous places. The algorithms of the Sistema de Alerta Sísmica Mexicano have been refined, and in an earthquake of similar magnitude to that of the 29th which happened on march 23rd of 201612, no alert was issued.

However, refinements can only do few to control for many ways that a technoscientific intervention into users’ encounters with seismic Mexico can be experienced. Even the moderately-sized earthquakes that Mexico City has chosen to alert its population of might be felt strongly in the areas of the city with the most sensitive soil, and less strongly in those built on hard rock. Any alert will intervene in the lives of Mexico City residents; this general broadcast is particularly promising because it is available to so many. The ways that it is taken up and related mean-ingfully to the material world, however, is a matter of diverse practice rather than an automatic effect of the technology.

Conclusion

A massive earthquake has not, at the time of this writing, struck Mexico City, and so my final thoughts on earthquake emergency are partial,

11 “Esa es una metáfora importante, pero es una condición humana. Se justifica [el disparo de la alerta] porque el fenómeno no lo controlamos, porque no tenemos la certeza de que todas las estructuras de la ciudad son seguras”.12 A magnitude 4.9 quake which happened at 6:29 pm.


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informed by promises and threats of future seismic events, preparation or loss of trust in the alert, and the frights and unpleasant visions of neighbors in their pajamas that people complained of after the alert of the 29th.

On the 30th of september, at unam’s Engineering Institute, every- one was talking about the evening’s loud interruption and the effects that an alert for an unfelt earthquake on this scale could cause, or had already caused. I had only just left there when loudspeakers sounded again. It was 12:25 in the afternoon, and out of the Metrobus window I watched people file out of government buildings when they were warned of what turned out to be a magnitude 5.5 quake which, though certainly of a size which Mexico City wanted to alert people of, was difficult to feel in many places around the city. “The alert went well”, Carlos Valdes, director of cenapred commented (and was quoted in the digital periodical Animal Político, 2015), though a friend told me privately that the responses that they saw were mixed; that he had seen a coffee shop full of people barely look up.

By suggesting that alerts constitute emergencies produced through social practice in the context of technoscientific tools and material threats, I mean to offer an alternative to techno-optimistic approach-es to seismic disaster prevention which suggest that the technology of the earthquake early warning alone will save lives and can be made to transform users’ experiences of seismicity simply, without causing other kinds of challenges for them.

If any encounter with the alert is understood as an emergency, we can better think about these challenges, including the ongoing threat of violent earthquake, the promise of new opportunities to evacuate or take cover before the danger, the experience of a late-night shock, and the real capabilities and limitations of technoscience in the face of complex, unpredictable, ongoing seismicity. The alert is not simply a communi-cative act, but one part of a complex of meaningful social, technical and material events around seismicity that Mexico City residents experi-ence. Taking encounters with earthquake emergencies in all their forms


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seriously is not only a new way to engage with the technologically- mediated production of meaning. It also points to the necessary messiness of technoscientific interventions into disaster prevention, especially those interventions designed to be accessible to diverse publics, and indicates the need for further research and public education not just about emer-gency procedures and the threats of the material world, but also about all the affordances of this or any technology in the place of simple tech-no-optimism.

Enrique messaged me on WhatsApp soon after the earthquake of the 30th to joke about my anthropological interest in seismicity and my obvious fascination with the events that were unfolding during my visit. “You are now the principle suspect of producing earthquakes! I am sure you are playing with the thingie to see how we, your lab rats, re-act!” García Acosta (2002) suggested that we think about disaster as a social laboratory. If an emergency can be a social laboratory too, then I am, in my encounters with the alert, as much a lab rat —or rather, as much a part of a complex material, technological and social system of practice by which meaning is made— as he.

Acknowledgements

This research was supported by generous funding from a Graduate Stu-dent Fellowship from the Newkirk Center for Science and Society, a National Science Foundation Doctoral Dissertation Research Impro-vement Grant, a Dissertation Research Grant from the University of California Institute for Mexico and the United States, and a Melvin Kranzberg Fellowship from the Society for the History of Technolo-gy; the author would like to thank Sandra P. Gonzáles-Santos, Anaar Desai-Stephens, Ashley Smith, Charis Boke, Hayden Kantor, Armando Cuéllar Martínez and two anonymous reviewers for comments.


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Students or experts? Unpacking addiction treatment center operators’ relationships to scientific knowledge in Mexico City’s mixtos

Joseph Guisti

Resumen En el campo académico que aborda el tratamiento del alcoholismo y la drogadicción en México, muchas investigaciones asumen que educadores avalados por el gobierno están haciendo frente a la brecha de conocimiento científico que afecta a operadores de centros de tratamiento “mixtos”, or-ganizaciones que combinan el trabajo profesional de la salud con plantea-mientos de grupos de ayuda mutua como los establecidos en Alcohólicos Anónimos. En contraste, este artículo argumenta que si bien los opera-dores carecen de conocimientos científicos especializados y acreditados, al mismo tiempo poseen fluidez y un entendimiento propio de conceptos científicos que juegan un papel central para la definición de la ciencia de las adicciones. Adicionalmente, su uso del discurso científico es sólo una de las muchas herramientas empleadas en el servicio de atención a las adiccio-nes y en el reclamo de jurisdicción técnica entre expertos más tradicionales como los profesionales médicos. Para concluir, este artículo argumenta que la manera en que se distribuyen los conocimientos especializados entre ex-pertos acreditados y no acreditados en la actualidad probablemente conti-nuará favoreciendo las explicaciones científicas que sean compatibles con el paradigma planteado por grupos de ayuda mutua.

Palabras claves: drogadicción y alcoholismo, tratamiento de la adicción, alcohólicos anónimos, comprensión pública de la ciencia, normatividad de servicios de salud, estudios sociales de la ciencia y la tecnología, cono-cimientos especializados.

AbstractMany accounts of Mexico’s alcoholism and drug addiction treatment field assume that government sanctioned educators are working to fill a scientific


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knowledge gap among the operators of “mixed” treatment centers, treat-ment organizations that combine the work of health professionals with mutual aid group approaches such as that found in Alcoholics Anonymous. I argue, however, that while operators lack credentialed forms of expertise, they possess their own type of fluency in scientific concepts and play a central role in defining what addiction science is. Furthermore, operators’ use of scientific discourse is one of many tools they apply in service of treating addictions and claiming technical jurisdiction among more tradi-tional types of experts, such as medical professionals. In conclusion I argue that the current way that expertise is distributed between both creden-tialed and non-credentialed experts in the field will likely continue to favor scientific explanations that are compatible with the mutual aid paradigm.

Keywords: addiction and alcoholism; addiction treatment, alcoholics anonymous, public understanding of science, health service regulation, science and technology studies, expertise.

Fecha de recepción: 18 de abril de 2016Fecha de aceptación: 23 de mayo de 2016

Introduction

W hat does it mean to be a drug addict or an alcoholic? Does it mean that one has a genetically inherited inability to metabo-

lize drugs and alcohol? Does the very meaning of “addiction” imply the need for medically supervised treatment? Does it signify a spiritual malady best treated by the sorts of altruistic and confessional projects popularized by Alcoholics Anonymous? Is it possible to talk about ad-diction without talking about neuroscience, medicine, morality, spiri-tuality, criminology or social work?

The drug treatment field, as others have persuasively argued, devel-oped as a series of responses to the above questions, but it cannot be understood solely by a primary focus on any one of the concepts raised by those questions1. In the limited space of this article, however, I will 1 For a general overview on the way these variables have combined historically in pub-lic policy measures directed at “diseases of the will” like alcoholism and addiction, see


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only focus on one element: the ways that people in Mexico’s drug addiction treatment field think and talk about science, specifically neu roscience, psychology and biology. Science is generally defined as something like “the systematic study of the structure and behavior of the physical natural world through observation and experiment”, or “a systematically organized body of knowledge” (apa format Oxford Uni-versity, 2005). Generally, people who work in Mexico’s treatment field share this understanding of the word and assume, as most folks tend to, that science generally entails the pursuit of objective knowledge, prob-ably through some combination of laboratories and carefully recorded data, perhaps involving lab coats. However, when it’s time for them to explain what science does, or who does science, or what is indeed scien-tific about addiction at all, ideas about science necessarily combine with ideas about those other concepts listed above like criminal justice and spirituality. Science then becomes a malleable, contingent thing.

In order to talk about how science is discussed by treatment profes-sionals, however, it is necessary to also mention Alcoholics Anony-mous, which has been extremely influential in the ways that people think about addiction and alcoholism not only in Mexico, but interna-tionally (Anderson, Swan and Lane, 2010; Campbell, 2007; Travis, 2009; Valverde, 1998). In her groundbreaking scholarship on Alcoholics Anonymous (aa) in Mexico, Haydée Rosovsky traced the emergence2

Valverde (1998). For more specific case studies see e.g. Campbell’s work on the way that treatment in the United States fuses the rhetoric of neuroscience with a larger “recovery culture” informed largely by spirituality (Campbell 2007, 2010); Garcia (2010) for a discussion of the ways that treatment in New Mexico is refracted through the experience of Hispano dispossession; or Weinberg (2005) for ethnographic work showing the ways that “considerations of community solidarity and exclusion have consistently figured centrally in assessments of whether, and how, the diagnosis and treatment of of mental illness or addiction should be undertaken”. 2 As its roles and functions are multivalent, throughout this piece I refer to Alco-holics Anonymous alternately as a “society,” “fellowship,” “movement,” and “orga-nization”.


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of the fellowship in Mexico as an increasingly influential form of in-formal social service provision. Arguably the first scholar to evaluate Mexican aa as part of an internationally comparative study, Rosovsky highlighted the ways that Alcoholics Anonymous rapidly proliferated in Mexico, with the number of groups rising from 36 in 1964 to 12 811 in 1990 (Rosovsky, 1998). In this piece, as well as in a later study (Rosovsky, 2009), she suggests that scholars with interests in all sorts of social phenomena, not just alcoholism and addiction, have found aa to be a rich case for thinking about the ways that civil societies produce social networks and forms of identity. As aa is an internation-al movement that tends to reproduce similar ways for its members to talk about power and personhood across very different socioeconomic circumstances around the world, it serves as an interesting case for thinking about how informal, global movements might challenge our assumptions about how individuality and geographic place inform one another (ibid).

I would like to heed Rosovsky’s call to look at aa in Mexico as a case for thinking about social networks and identities, but I would also like to do so in the context of an ethnography of the aa-influenced profes-sional and para-professional drug treatment industry in Mexico City. In this ethnographic account, I situate treatment work within larger national and international projects organized around the management of social problems using scientific knowledge. In the case of addiction treatment, examples of these projects include the National Institute on Drug Abuse (as a producer of scientific knowledge both internationally and in the United States, where it is based), the World Health Organi-zation (as the producer of standards for diagnosis such as the International Statistical Classification of Diseases and Related Health Problems, or icd), the American Psychiatric Association (as producer of the Diagnostic and Statistical Manual of Mental Disorders, or dsm), Mexico’s National Center for Addiction Control and Prevention (cenadic), Na-tional Addiction Commission (conadic) and Mexico City’s Addiction Treatment and Prevention Institute (iapa).


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Almost twenty years ago when Rosovsky was gathering data for her 1998 study, she noted how various fragmentations within aa’s service structure (mainly the cleavage of the movement into “traditional” or “hour and a half ” groups, and the residential or “24 hour” groups) mapped not only onto socioeconomic divisions between middle-class and working-class members, but also onto the ways in which different populations were variously affected by austerity measures that reduced social services for at-risk populations. She also observed a then-nascent referral system in which judicial authorities sent teenagers with drug problems to the more working-class “24 hour” groups (1998). In this article I pick up where Rosovsky left off, so to speak, focusing on the present-day addiction treatment field in Mexico, which is increasingly composed of professionalized versions of “24 hour” groups that are sub-ject to government projects aiming to normalize, regulate, and bureau-cratize them. In these new intersections between aa groups and the government’s attempts to manage drug treatment, we are witnessing another moment of metamorphosis within Alcoholics Anonymous, which has, by Rosovsky’s account, already passed through various pro-cesses of “mexicanization” (ibid). In these processes of mexicanization, it emerged as a highly syncretic way of understanding and managing al-coholism and drug addiction, fusing North American, indigenous, and Mexican-catholic understandings of health, morality, community and identity (Rosovsky, 2009). In the metamorphosis, I trace in this article, aa groups are pulling away from their connections to the ngo like international service structure of Alcoholics Anonymous (as a non-profit organization with global offices in New York City), and aligning more closely with government oversight offices in Mexico. They are, however, maintaining their connections to Alcoholics Anonymous as a philosophy and culture. As aa is historically connected with early attempts to study alcoholism scientifically, these treatment centers are, by extension, already well versed in the popular scientific understand-ings of alcoholism and addiction that aa embraced in the mid-20th century. This article examines the ways that those popular scientific


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conceptions of alcoholism are being fused with the contemporary lan-guage of neuroscience to create a discourse that simultaneously enables and constrains clinical approaches to addiction throughout the field as a whole.

My intervention is essentially Foucaultian in nature, studying the ways that power and knowledge create new forms of knowing and man-aging populations. As mentioned in the introduction to this volume, such a project is integral to the subfield of “science and technology studies”, and the processes I identify extend far beyond the issue of ad-diction treatment, affecting any social problem in which society looks to science to reveal the “truth” about reality. In my case, I discuss how contemporary experts are thinking about addicts in ways that simply don’t move them from a punitive “badness” to a health-focused “sick-ness”, but rather move them from a punitive model to an ostensibly rational medical model which still manages to retain much of its puni-tive character despite claiming to be rooted in morally objective sci-ence. In such a configuration of power/knowledge, scientific “truth” is not the only thing that is created: in addition to “data”, science also produces ways of understanding, regulating, labelling and governing persons and things (Foucault, 1975, 2010; Foucault and Gordon, 1980). If we turn our attention to this element of the scientific process and observe the ways that scientific understandings are reproduced, repeat-ed and interpreted by the publics that they affect, we are better equipped to critically evaluate the claims that science enables, as well as to iden-tify the possibilities for governance, and freedom, that it forecloses.

What is a “mixto” and what does it look like?

In the section above I allude to the hybrid medical/legal/spiritual/psy-chological frameworks that comprise current approaches to addiction, but the best way to discuss the logics that structure the field is to begin with a representative account of the types of interactions I observed


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during my fieldwork. What follows is an edited extract from my field notes, written after I had observed men from a treatment center help-ing to bring a client in for treatment.

On this evening, my respondents asked if I would like to observe a “doceavo”. I had no idea what that term meant in the context of treat-ment, and the following excerpt describes the circumstances in which I came to understand not only what that term means for my interloc-utors, but how it captures the logics of a field built around civil asso-ciations that are not aa groups but which are deeply inspired and structured by the logics of aa, while simultaneously employing and re-lying on the contributions of scientific and medical experts.

I’m in the backseat of a hatchback with three servidores3 from the treatment center and I’m trying to catch whiffs of fresh air from a cracked window as Miguel4, our driver, chain smokes Marlboro reds. We’re speeding down Anillo Periferico at 100 km/hour, flashing our brights as we whip around slower traffic. Miguel and I, along with guys from the center they call ‘Avispas’ and ‘El Ricas’ are headed to a poor neighborhood somewhere in Iztapalapa to apprehend a man and bring him to the center I’ve been observing.

The scene we arrive to is initially far less dramatic than I expect. Four or five people in front of the house hold beers or plates of food as they watch us pull up. A spry looking man around fifty years of age points to a guy in black framed glasses and a black polo shirt slumped

3 All translations are my own. Whenever I feel that meaning would be lost in trans-lation, or when speakers use local terms specific to addiction treatment, I include the original Spanish. In this case, the word servidor is both a local term and something that loses meaning when translated. Servidores are persons who are in treatment at a recovery house and who work in roles that resemble employment, such as greeting vis-itors at the front desk or working in the kitchen. Because this work is considered part of their rehabilitation and is not monetarily compensated, however, they are referred to as servidores, or roughly, “those with a commitment to serve”.4 All names are pseudonyms and I have taken measures to anonymize the non-govern-mental sites I discuss.


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in a recliner in front of a blaring television, eyes closed. A school-age girl looks on as Avispa and El Ricas go into the house, put their arms around the guy we came for, and maneuver him into the backseat of the hatchback so swiftly he barely has time to resist.

El Ricas climbs in next to him and, like an older sibling, puts him in a playful headlock, assuaging him: “don’t trip, papi. Whaddya want? Want a beer? Want a whiskey?”

“Uhhhh, yeah, I do” the guy moans, sounding defeated and bitter.Miguel is outside having our client’s mother and father sign paperwork

on the hood of the car. “Please read this closely. You need to sign this form. And can you sign here…aaand here. Don’t worry, ma’am: it’s a recovery house. There’s no physical mistreatment, they eat regularly, they bathe with warm water. You guys can come see the house and take a look at the living arrangements and you’ll see how it is”.

The mother of the client’s children watches as the client’s parents sign the release forms, then negotiates with the driver until he permits her to get in the car with us so that she can take a look at the treatment center and verify that it isn’t an abusive one like the kind frequently reported in the news.

As we pull onto the highway, dialogue in the car alternates between the client and woman arguing bitterly while the driver advises her to avoid too much conversation while he’s intoxicated, and the woman asking us about the quality of the center.

“It’s a really nice house. I’ll repeat again: there’s no physical mistreatment, they bathe at the proper times, there’s hot water, they get something to eat. My buddies in the backseat there accompanying me, they’re anexa-dos (residents at the center) as well. You can ask them questions to see. Ask them if the treatment there at the house is good treatment that respects the integridad del ser humano (human rights)”.

The woman looks at us to confirm.“To start with, the food is luxurious,” El Ricas offers. This interests her.

“Yeah, there are a few vegetables, but there’s pork chops, longaniza. We eat good. Steak sometimes”.


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“Fish”, Avispa adds. “Yeah?” she asks distractedly, gazing at the father of her children being

restrained by the muscular arms of El Ricas as Avispa lists more menu items. She interrupts him: “because, like, I really don’t know anything about any of this. About the groups, like you guys. Is it a grupo, or a clinic, or, what is it?”

Miguel’s tone is clinical but warm. “It’s a casa de recuperación (recovery house). We work with psychiatrists, psychologists. We work with medical supervision”.

“He has diabetes,” she says.“Whatever medication he takes; you guys bring it. Right now we’re

going to give you a piece of paper that lists all the things you need to bring, clothes, toothpaste, sandals, things like that. At 40 days, a psychiatrist is going to evaluate him. Right now, to start, a general practitioner is going to evaluate him, how he is physically, if he’s sick, if he’s not sick, what he’s suffering from. To make sure he’s in good physical shape, to note that there aren’t any marks of any physical mistreatment. Everything is going to be there on his dossier, and my little colleagues here are going to say what state he was in when he arrived. They’re going to take him to his talks, to his therapy sessions, psychotherapy with a doctor5. The psychiatrist is going to come through at day 40. Why day 40? Because after 40 days we’ve detoxed our brain, now it’s thinking more clearly. So he’s going to be in this same state for a few days until he detoxes. The psychiatrist is going to evaluate him to see if he needs to be prescribed medicine. If he does, we’ll let you know as a family. I repeat: it’s a really good place. I don’t say that for no reason, I was anexado (interned) there just like my colleagues here. In fact, I seem like I still am most of the time, because I’m always around the house”.

To understand this excerpt of field notes, it’s necessary to pause for a mo-ment and explain the 12-step philosophy that these men have adapted

5 The psychologist is not technically a doctor, though she is licensed to practice clinical psychology.


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in the service of the house calls they make. The twelfth step of the pro-gram of Alcoholics Anonymous reads: “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs”. This twelfth step, or “doceavo” as it’s called in spanish speaking aa groups, belies the Pentecostal origins of Alcoholics Anonymous, a mutual aid fellowship-cum social movement that describes itself as “spiritual but not religious”. In the aa’s twelfth step the program diverges from its Christian roots in the sense that members don’t necessarily channel the Pentecostal spirit of evangelizing so much as they enact the core philosophy of aa: alcoholic consumption is symptomatic of profound self-centeredness. Altruisti-cally helping other alcoholics to achieve sobriety, however, is a means by which to turn one’s unique experience as a problem drinker into the core resource that keeps them sober precisely by granting them the authority and the empathy they will use to help others. What I ob-served on this particular “doceavo”, however, was a fusion of aa-inspired altruism with contemporary logics of not-for-profit social work.

As I rode along on the treatment center’s house calls, which they often refer to as the “patrulla enchancladora” (literally “the patrol that puts people in sandals” or the “sandalling patrol”) given that most treat-ment centers require clients to wear sandals6, the men I accompanied referred to both the process of bringing in clients, as well as to the cli-ents themselves, as “doceavos”. As noted above, however, these men were not in an aa group per se. The men I observed do not frame what they do as working aa’s 12th step so much as bringing clients to a semi-professional, government regulated, medically supervised treat-ment center which had once been an aa group and is now considered a mixto, a treatment center that combines both “professional” and “mu-

6 In cramped quarters where sleeping, eating and grooming spaces are often combined, sandals are seen as more hygienic than sneakers. They also serve as a physical reminder that clients are in a sick role, as Talcott Parsons might have put it, in which they must remain subject to therapeutic intervention and surveillance. Some of my respondents also added, only half-jokingly, that sandals are harder to run away in should clients attempt to abscond.


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tual aid” treatment. So-called “doceavos” of the type I observed are the product of an addiction treatment field in present day Mexico that spans the multiple worlds of “mutual aid” centers inspired by Alcohol-ics Anonymous, public health care, neuroscience, social work, criminal justice, religion and new age spirituality.

Like the driver of the patrulla waxing clinical as he described a treat-ment that is not medical but has “medical supervision”, treatment cen-ters are staffed by people who aren’t scientists but mention science in their everyday work, who aren’t therapists but refer to what they do as therapy, and who aren’t medically trained but who speak endlessly of curing sickness and disease. Such contested, hybrid or overlapping boundaries between different forms of expertise are not only a defin-ing characteristic of addiction treatment in Mexico, but central to a growing “expertise” literature within science and technology studies, a discussion I return to below.

Background and methods

This article is part of a larger case study of an emerging profession: the certified addiction treatment counselor in Mexico City. After more than a year of fieldwork, I observed this profession officially come into exis-tence during my last week in Mexico when 43 counselors passed a cer-tification exam provided by the federal government and facilitated by Mexico City’s Instituto para la Atención y Prevención de Adicciones (“Ins-titute for Addiction Prevention and Treatment”), known by its initials as iapa. This exam was the culmination of a five-year professionalization process, also facilitated by iapa, in which a small group of persons who operate mixtos (referred to henceforth as “operators”), and who actively sought governmentally sanctioned legitimacy through colla bo ration with government projects and participation in training sessions, took courses in various topics considered central to addiction treatment. Some of these courses were introductions to basic science concepts such as the neuroscience of addiction or the epidemiology of substance


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abuse, some were more clinical (e.g. “identifying comorbid disorders”, “educating the family”, “mindfulness meditation in the treatment setting”), and some covered the legal and regulatory framework estab-lished by Mexico’s Norma Oficial Mexicana NOM028SSA22009. This five-year professionalization process paralleled a growing sense of professional legitimacy among operators themselves. Even when they weren’t at iapa classes, these same operators made themselves visible in Mexico City’s treatment scene more generally. They collaborated in working groups on treatment regulation, attended conferences on ad-diction treatment hosted by universities in the city and pursued diploma programs in addiction treatment, which frequently employ instructors who currently or previously worked for iapa or for other governmental institutes, such as the National Institute of Psychiatry.

Data collection for this article consisted of attending iapa’s training sessions as well as other workshops and working groups of the kind de-scribed above. I also interviewed 30 operators and spent weeklong stays in two different mixtos: one that is struggling to stay open and another that is flourishing and active in the city’s treatment policy scene.

In contrast to academic and governmental accounts that tend to frame mutual aid treatment centers as problematic organizations that need training in basic addiction science (conadic, cenadic and cicad, 2011; Lozano-Verduzco, Marín-Navarrete, Romero-Mendoza and Tena- Suck, 2015; Marín-Navarrete et al., 2013; Medina-Mora, Real, Villatoro and Natera, 2013; Tavero, 2010), the process I observed was far more dynamic and dialectical. The government educates operators, yes, but they also recognize operators as non-credentialed experts and the gov-ernment’s regulators and educators petition this expertise while simul-taneously attempting to standardize and control it. For their part, mixto operators actively resist the stereotype of the rudo aa traditionalist7 and they tend to seek out and defer to the “science” that the government

7 Persons who have come into contact with Alcoholics Anonymous in Mexico will often mention the rudo stereotype, also referred to as the cavernícola (“caveman”) ster eotype, to connote approaches to aa that employ verbally or physically aggressive tactics in attempts to force persons to take responsibility for their actions or change


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trains them in. However, they also understand aa to be a rational thought system, either compatible with science or itself an extension of scientific thought. For these operators, as well as those who run strict-ly mutual-aid centers, their very status as recovered addicts fulfills three functions related to their understanding of aa as its own ratio nal thought system. Firstly, they see their sobriety as empirical proof of aa’s efficacy. Secondly, they see their sobriety as the outcome of a process through which they have attained mastery of and fluency in the con-cepts and language of aa. Thirdly, they see their experience both in ac-tive substance abuse and in sobriety as conferring upon them a type of expertise that non-addicted and non-recovered persons can never pos-sess. Among those with considerable experience in the program, this expertise is also a “meta-expertise” (Collins and Evans, 2007), enabling them to discern experts from non-experts within aa itself, as well as to determine which outside professionals, if any, might be recognized as valid “contributory” or “interactional” experts within the aa knowledge system (per the typology established by Collins and Evans, 2007).

For their part, many of the “scientifically trained” professionals who teach and regulate operators send an ambivalent message. On one hand, they defer to the expertise of operators and encourage them, as recov-ered addicts who can understand other addicts in ways that non-addicted persons cannot, to take advantage of that privileged tacit knowledge. On the other hand, they position themselves not only as educators who understand addiction in the “correct” way, but as gatekeepers of profes-sional and epistemic authority. Furthermore, there are a great deal of situations for both operators and “professionals” in which the scien-tific state of the art is less important than solving quotidian technical problems and claiming jurisdiction over those problems. These situa-tions add an extra layer of complexity for anyone trying to understand what the relationship is between these actors and scientific knowledge.

their behavior. These stereotypes also imply a lack of education on the part of the rudo themselves, as well as an ignorance or negligence of a person’s human rights.


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On “medicalization”

It is common for sociological writing about addiction science to fall into one of two perspectives: those authors who want to argue that social factors either prevent or enable a benevolent science vs. authors who critique the very assumption that addiction is a valid object for science and medicine, often suggesting that “scientization” or “medica-lization”, understood as the reformulation of complex problems as those that can be entirely understood and treated with the tools of western science or contemporary western biomedicine, are reductive and funnel resources and attention away from more profound social problems such as economic inequality8. This article does not fall into either of those two camps.

Science and evidence-based inquiry indeed have the capacity to produce technological innovations that help people live more com-fortable healthy lives, just as they have the capacity to produce overly reductionist accounts of complex bio-psycho-social problems. I am nei-ther “pro science, anti-mutual-aid”, nor “pro mutual-aid, anti-science”. Rather, I maintain that the rhetoric around both techno-scientific ap-proaches and non-techno-scientific (e.g. spiritual) ones is structured by material realities, and that rhetoric also plays a role in structuring those very realities. Addiction science and mutual aid groups are two im-portant moving parts in treatment projects worldwide, and rather than viewing them as antithetical, I view them as co-constructive and reliant on one another. It is not my goal to argue for any particular policy or approach. My goal, rather, is to analyze the ways that people think and talk about addiction science in Mexico in the context of an increasingly

8 Examples of the first perspective are frequent in public health scholarship on drug addiction and alcoholism, e.g. (Glasner-Edwards & Rawson, 2010; NIH, 2007; Weisner, Mertens, Parthasarathy, Moore, & Lu, 2001). For examples of the second perspective, see e.g. (Conrad, 1992; Fingarette, 1989; Levine, 1978; Roman & Blum, 1991; Schneider, 1978) For a concise discussion of this tension in the literature, see Bryan Turner’s forward to (Weinberg, 2005)


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formalized Mexican drug treatment system, and to discuss how that system both enables and constrains scientific inquiry and application.

This paper is a contribution not only to the applied literature on addiction treatment provision, but a contribution to science studies liter-ature on the nature of technical expertise and the democratization of scientific knowledge. Persons without formal credentials or expertise, such as patient advocacy groups or social movements based around disease categories, are playing an increased role in determining public health policy and research agendas (Collins and Evans, 2007; Epstein, 1995). As scholars have noted, patient groups and health advocacy or-ganizations pose “crucial questions for scholars in the field of Science and Technology Studies, [such as]…” what is the character of the expe-riential knowledge of illness possessed or cultivated by patient groups or health movements? What sorts of challenges do these lay actors pose to the authority of credentialed experts, and what kinds of alliances with professionals do they construct?” (Epstein, 2007). Alcoholics Anony-mous and the 12-step fellowships they have inspired have played a formative role in the development of such social movements (Epstein, 2007; Valverde, 1998). But despite their increasing entrenchment in the world of patient advocacy, mutual-aid inspired groups still merit sociological study into their relationship to formal scientific knowl-edge. As they have aggressively championed the idea that alcoholism and drug addiction are diseases, rather than moral failings, they have played an important role in the “medicalization” of social problems (Conrad, 1992, 2007). However, as other scholars have noted, the hy-brid nature of addictions as psycho-social-medico-legal disruptions have prevented them from being completely medicalized, despite the increasing neurochemical frames used to describe them (Campbell, 2012) and the increasing “biologization” of medicine as a whole (Clarke and Shim, 2011). The role that non-credentialed experts play in the addiction treatment field, then, serves as a sort of limit case for the ex-tent to which social problems might or might not be approached as scientific problems.


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National and transnational histories: a brief sketch

Tracing the genealogy of addiction treatment in Mexico, with its roots in both national and international histories, is a task far too large for this article. It is necessary, though, to provide context for the interac-tions I recount below.

As one might expect, policy makers, academics and the popular press critique “mutual aid” treatment centers for lacking credentials and sci-entific validity. Some of the most notorious centers, which were much more common in Mexico City before the government wrote and began implementing the first version of NOM028 in 1999, literally tortured and starved clients, ostensibly in a brute force attempt to make addicts comprehend that they were powerless over their addictions. Scholars have established the extent to which these centers, often referred to as anexos, have attained enough notoriety that it impedes many families from seeking help at aa-based centers (Carrasco Gómez, Natera Rey, Arenas Monreal, and Pacheco Magaña, 2015). As National Psychiatry Institute researchers Ródrigo Marín-Navarrete et al. describe:

…for years, numerous studies have demonstrated that the emotional and physically abusive procedures that take place [inside some residen-tial mutual aid centers] lack clear evidence of therapeutic value. [Jour-nalists] have amply documented […] the ‘anexos’, highlighting, among other things, overcrowding, unsanitary conditions, physical and verbal aggression, torture, physical restraint, exploitation and slavery (Marín- Navarrete et al., 2013)

While problematic, these centers are also ubiquitous: The Federal Dis-trict alone is home to around 300 of them, and that number doesn’t reflect the thousands of non-residential 12-step groups that make up the metropolis’ larger mutual aid subculture. Compared to the fewer than 100 beds provided by public services in a metropolitan area of over 21 million people, mutual aid inspired centers absorb the vast majority,


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some estimate over 90% (Garcia, 2015), of persons receiving residen-tial care. The sheer number of them combined with the rapid and wide-spread adoption of Alcoholics Anonymous across Mexico means that these centers in many ways are Mexico’s treatment industry. A few pric-ey professional centers exist, as do limited services provide by Mexico’s Centros de Integración Juvenil, but for the vast majority of people work-ing in treatment, “addiction treatment” and “the 12 steps” are one and the same. The following table lists the various treatment options avail-able to persons seeking residential care in Mexico City:

Type of centerNo. of centers

(Federal District)

Organizational features

Residential mutual aid centers registered with local government (“centros [o casas] de recuperación”, “centros de tratamiento”, “centros de ayuda mutua”)

248 Private organizations or non- governmental civil associations, ranging from free to low-cost, may provide govt. subsidized financial aid, majority based in or inspired by Alcoholics Anonymous, few counselors certified by federal govt.

“Mixed” centers that combine mutual aid with “professionals”, registered with local government (“mixtos”)

18 Private organizations or non-governmental civil associations, generally affordable to mid-level fee-for-service, may provide govt. subsidized financial aid, many began as AA groups before attaining “mixto” status, majority initially inspired by Alcoholics Anonymous, majority of operators recently certified as counselors by federal govt.

Professionally staffed private treatment centers (Monte Fenix, Clinicas Claíder)

2 Private, unaffordable for majority of population, treat small percentage of affected population but highly visible and influential in professional treatment community


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Type of centerNo. of centers

(Federal District)

Organizational features

Unregistered or clandes-tine mutual aid centers (“anexos”, “granjas,” “grupos fuera de serie”)

Unknown Private, clandestine/illegal, ranging from free to low cost; inspired government efforts to regulate or eliminate abusive mutual aid groups beginning with the first NOM-028 published in 1999; increasingly rare in Mexico City due to efforts of government regulators, but prolific and notorious in many parts of the Republic, especially rural areas

Centros de Integración Juvenil Iztapalapa “cij” (limited residential services)

1 Para-governmental organization with 30 beds (Iztapalapa location only) for residential treatment

Toxicology centers Xochimilco / Venustiano Carranza (limited acute/emergency care only)

2 Public clinics providing intensive care for patients requiring emergency detoxification

The prevalence of mutual aid centers, especially those engaged in dan-gerous or abusive practices, led federal and municipal government to author the aforementioned NOM028 in 1999 as well as to create or-ganizations like iapa in subsequent years, which help centers to imple-ment the norma9. The official purpose of a norma is to define quality standards for services, which, in the case of NOM-028 are addiction treatment and prevention services. This norma does more than just des-cribe categories of treatment, however; it effectively creates them. The

9 iapa is not a regulatory agency, rather they’re considered a “normative” agency that helps to develop policy, does research and contracts educators to implement the train-ing programs they develop. They also directly refer court-mandated clients to treat-ment services.


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norma divides treatment providers into three groups: “mutual aid”, “professional” and mixto. People who work in the field do not see this delineation as bureaucratic nitpicking, rather these categories mark boun-daries within which people understand their work and their expertise in relation to other people.

It is almost impossible, then, to discuss treatment in Mexico with-out hearing mention of NOM028, as it provides a framework for distinguishing compliant credible centers from noncompliant ones; dis-tinguishing professionals, who possess “scientific understanding” from mutual aid groups who do not; and, very importantly, distinguishing mixto and “professional” centers, which may legally put people in treat-ment against their will, from mutual aid centers, which cannot.

The “doceavo” trips I observed in my field observations of mixtos make sense to people who carry them out on a daily basis because they’ve become a popular accessible resource in a country that, as understood by my informants, not only suffers from a dearth of public options for addiction treatment services but also struggles with other institutional challenges such as widespread corruption, which prevent people from trusting and relying on other social services like law en-forcement and healthcare organizations that might otherwise benefit addicted persons and their families.

This is the context in which I found myself in an unmarked car with men who were having a family sign documents without any judicial validity so that they might have bargaining power against a potentially corrupt patrol car who could otherwise arrest them on (arguably val-id10) kidnapping charges. These men with no medical training invoke the professional authority of doctors and psychologists to a concerned

10 The “sandalling patrol” trips I observed were technically illegal, but they are unof-ficially sanctioned. According to NOM028, compulsory treatment can be provided by mixtos but only when a doctor determines there to be a life threatening emergency. I never observed a doctor provide the mandated written documentation, but I also observed iapa inspectors verify that this center’s adherence to compulsory treatment practices was within the norma without requesting to see any verification of this writ-ten documentation.


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family member who, based on what I observed, got in their car to at-tempt to assess the quality and safety of a service that she did not yet know what to call. Their work is located within larger state and profes-sional projects on the part of treatment industry reformers: they took that client to a center run by a recovered addict-turned-operator who not only complies with government oversight to the best of his ability, but participates in clinical studies managed by the National Institute of Psychiatry as well as pilot programs for service innovations developed by iapa, such as a client nutrition program he was helping to prove during my time in the field. That center operator not only passed the first ever federal examination for certifying addiction treatment coun-selors, he collaborated in the development of its curriculum and in working groups about the official norms for implementing it. In our interviews he passionately maintained that addiction services will not improve until centers everywhere become willing to collaborate with credentialed professionals to provide addicts the holistic treatment nec-essary for, as he explained, “tragically misunderstood biopsychosocial diseases” like drug addiction and alcoholism.

My respondents across the treatment spectrum, from government researchers to people driving around in the “sandalling patrol”, espouse this idea that addiction and alcoholism are all too often misunderstood as badness rather than as sickness, and that this is something that society must change through science. Oftentimes my respondents would as-sume that I, as a researcher from the us, had come to Mexico to imple-ment the wisdom and precision of North American science in Mexico, a place that they often bemoan lacks a “culture” of scientific rigor. Their assumption does not reflect a long history, though, of Mexican reform-ers who claim that addiction is an illness best understood by science. Such discussions go back at least as far as 1939 when Dr. Leopoldo Salazar Viniegra, then head of Mexico’s Campaign Against Alcoholism and Other Toxicomanias, proclaimed that “toxicomanias are illnesses and not crimes, and as such, should be treated with the same humanity that medical science encourages” (Montfort, 1999).


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This odd feature of addiction discourse, in which stakeholders seem to endlessly repeat the putatively new and controversial claim that the stigmatization of addicts prevents society from granting them the dig-nity of a scientific solution, and have been doing so for the better part of a century, is part of a larger international history in which, as sociol-ogist Nancy Campbell argues, “the cultural work of the word ‘addic-tion’ must be situated within the context of a succession of passionate debates conducted by scientific researchers, policy makers, and clini-cians over the need to ‘de-stigmatize’ the field” (Campbell, 2012). The debates that Campbell refers to are often so passionate precisely because stakeholders on both sides are attempting to determine whether society should heal addicts or punish them. What is often missed in these de-bates is the fact that most of society’s addiction treatment efforts tend to do both at the same time. As Julie Netherland writes in the introduc-tion to an edited volume of critical addiction studies, “while the medi-cal and the moral are often pitted against one another rhetorically (e.g. addiction as a public health versus a criminal justice problem), our responses to addiction often contain elements of both. According to May (May, 2001), ‘clinical constructions of addiction still engage a set of moral questions’. These moral questions are often directly built into addiction treatment programs (Whetstone and Gowan, 2011), many of which have explicit crime control functions (Fox, 1999) but rely on medical language to describe addiction” (Netherland, 2012).

Such an arrangement, wherein addiction is described as medical but treated as moral, has its roots in the very history of Alcoholics Anony-mous, which, ironically, ascended to dominant status in the world of alcoholism and addiction treatment partly through advancing the idea that addiction should be understood as an illness rather than as a mor-al failing (Campbell, 2012; Travis, 2009; Valverde, 1998). The fellow-ship and the 12-step program it created were explicitly influenced by a mystical strand of Christianity practiced in a community known as “the Oxford Group”, but early aa also counted agnostics and atheists as members. These non-believers warned their fellows that any perceived


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links to organized religion would scare away potential recovering alco-holics. Simultaneous to discussions of how religious aa should be, found-ing members were also quite interested in the ideas being promoted in the newly developing field of ‘alcohol science’ which, at the time, was starting to suggest that the bodies of alcoholics were most likely differ-ent than the bodies of other people. This emphasis on fundamental bodily difference was seen by the cofounders as a way to emphasize the hopelessness of the alcoholic condition and would help sufferers attain the state of “surrender” that was seen as necessary for adopting the te-nets of a program that is, at its core, spiritual and moral despite lacking any overt religiosity (Travis, 2009). In the same way that it sought to distance itself from any religious controversies, aa members quickly realized that publicly advancing a medicalized definition of alcoholism might be politically unwise and possibly detrimental to the therapeutic program it was trying to establish. Instead of explicitly referring to al-coholism/addiction as a “disease”, then, the fellowship thus “strategical-ly substituted words like ‘malady’ or ‘illness’ to avoid divisive debates with potential medical allies” (Campbell, 2012).

Despite that rhetorical strategy, it is nonetheless the case that “aa popularized a disease concept among lay persons, treatment profession-als, and para-professionals, and the organization bolstered its position by using scientific ideas” (Campbell, 2012). Historians and sociologists note that addiction as a scientific object might be understood in very different ways today if it were not for the formation of the powerful Na-tional Institute on Alcohol Abuse and Alcoholism in the United States, which us Congress agreed to form based on the testimony of experts in the then-nascent treatment field including Bill Wilson, cofounder of Alcoholics Anonymous (Travis, 2009). Indeed, foundational work on the disease concept of alcoholism by E.M Jellinek, widely understood to be something like the “father” of addiction neuroscience, was based on a handful of self-reports from aa members.

Calls for a “scientization” of addiction, then, have come full circle. After rising to prominence by allying with a burgeoning alcohol sci-


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ence and by explicitly avoiding the moralistic overtones of the Wa shin g- tonian and the prohibitionist movements it historically sought to dis-tance itself from, the fellowship of Alcoholics Anonymous (alongside the broa der “recovery movement” it has inspired) now defends itself against those who claim that science, rather than the moral and spiritual in-terventions described by the 12-step program of AA, is what addicts really need.

In Mexico, which is home to the second largest aa service structure in the world (after the combined us/Canada service structure), this same history structures the field, but combines with the gruesome infa-my of abusive anexos to make rallying cries for a more “scientific” treat-ment system all the more pronounced. Mutual aid centers putatively “not directed by health professionals and […] lack[ing] scientific evi-dence and validation” (Marín-Navarrete et al., 2013) which are sites of abuse and torture, then, must be reformed to fit the NOM028’s directive centers that use working methods “based on scientific princi-ples” (NOM-028-SSA2-2009 5.2.1.2) and should receive training that promotes “scientific understandings” (NOM-028-SSA2-2009 13.2.1). In this construction of science vs. non-science, science is not just the opposite of symbolic violence in the form of moral judgment and crim-inalization, it is also the opposite of physical violence.

Mutual aid and science: a co-dependent relationship between two forms of expertise

While science, as I describe above, emerges discursively as the antidote to violence in government projects to reform operators (Conadic et al., 2011), the idea that operators need science is complicated by the fact that operators understand themselves to be informally trained in science due to their experience in aa. This understanding of operators as uncredentialed experts is simultaneously validated and challenged by government regulators. In a iapa class on “mentorship” for operators


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of mixtos, I watch as the instructor breaks from the material regular-ly to stress how important each operator’s uncredentialed expertise is, and to stress to them that they must learn to recognize themselves as a distinct class of experts that can work together to bring about institu-tional change in the field:

…the doctors are actually the ones who need mentoring the most. They have a lot of medical experience and training in school, but they don’t have experience working with addicts. You know, doctors have a carrera of 5 years in school. But what I want to tell you guys is that you have equivalent levels of training! Some groups have been around for up to 40 years! That’s a lot of experience!

Later that afternoon he re-emphasizes this:

In a mixto, what is the biggest component? The mutual aid part. Even though there is a doctor, a psychologist, the counselor is still the most important part. The person who deals with difficult client situations.The counselor. They are the ones that work on the ground, some-times even sleeping in the same space as the clients. They are the ones who realize what’s going on!

But in his depiction of counselors as non-credentialed experts, he sends an ambivalent message. In the following quote, the instructor depicts government resources as stifled by an institutionalized lag in the speed at which the state can produce data that solves technical problems, but he also suggests that it has the power to provide cutting edge infor-mation that operators can petition if they are able to act together as a movement based on their embodied expertise. If they can’t do this, they’ll have to train themselves. Formulated this way, operators have the expertise to decide what the most important knowledge gaps are, but they ultimately rely on the state or on other professionals to fill those gaps:


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Every [national addiction survey] has a two year break between publi-cations, so we have to work with that. You might need to tell the gov-ernment things like “hey, we don’t need to know about marijuana, but we need information about kokodrilo11 and about bath salts”. When I was trained, marijuana was the queen of all this discourse. But what did I see in my toxicology center? Crack. Pure crack. But that had nothing to do with what was on the National Survey 20 years ago. So I had to train myself: what is crack? What is paranoia? People came in with heart attacks and we thought they had hypertension! That wasn’t the issue, so we damaged their health! This is where we need you to help us: las instituciones tienen la politica; no tienen la experiencia (insti-tutions have policies, not experience).

I watched as operators enthusiastically embraced this frame, wasting no time in joining the teacher in his message that they are indeed experts. But at other moments in my fieldwork I saw them admit the high cost of the knowledge deficits they do have. A number of times I watched op-erators slip into a hushed register as they recounted the fatalities that occurred at centers before the government stepped in to regulate. As one operator estimated in a working group I observed, his center saw fatalities as often as once a month. He chuckled ruefully as he recount-ed an arrangement they had with a local mortuary that they allowed to handle all the deaths, provided that the mortuary assuaged bereaved families and painted the center as powerless to have intervened.

In this sense, both educators and operators assume that, while coun-seling is important, medical credentials can mean the difference between life and death. In a different class that met an hour after the one I quote

11 “Kokodrilo”, or “krokodil” as it is dubbed in english language media, is a street drug made from opiate-containing medications like codeine cough syrup. Though there have been few reports of actual krokodil cases outside of a highly publicized story involving two teens in Joliet, Illinois, the drug received sensational news coverage in 2013 (e.g. Luisa Vivas, María. “La droga come-jóvenes llegó a México”. Proceso. Dec 15, 2013, the title translated: “The childeating drug arrived in Mexico”).


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above, operators received basic first aid training from an energetic doc-tor who captured their attention with street slang and dramatic stories of her work in the city’s toxicology center. She gave them explicit in-structions that could save lives: “alcohol stimulates gaba receptors, which is different than cocaine which stimulates dopamine levels”, she explained. “If you receive a client who is showing signs of cocaine- induced psychosis, make sure that they haven’t also been drinking, be-cause if you give them benzodiazepines to calm them down, you risk the disastrous consequences of over-stimulating gaba receptors”. In contrast to other classes I observed in which at least a handful operators played distractedly with their smartphones, I watched the operators in this class hurry to scribble down everything that this teacher said as they snapped photos of her PowerPoint slides.

Ultimately, she stressed that their role as operators was not to play at being paramedics, but to learn the language of medicine enough to effectively communicate with first responders and save lives, in other words, to act as translators. Instead of calling the doctor and being like “we’ve got a guy here and he’s all fucked up”, you need to be able to say “their pulse is doing this, their eyes are doing this, their respiration has these patterns, they’re not responding to such-and-such stimulus”.

As students diligently took notes and asked engaged questions, they seemed to value the idea of translation and to see this class as legitimate and helpful. This contrasted with other interactions I observed wherein operators confessed their frustration with oversight and reform efforts, seeing them as one more example of capricious governmental bureau-cracy.

Translation as goal

While operators seem to have a sense that such translation work is im-portant, it’s not always clear what the goals of that translation are. That confusion partly stems from the fact that there are certain elements of


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the work they do that clearly benefit from scientific knowledge, such as saving lives by communicating with paramedics or avoiding acciden-tal deaths from poorly treated cocaine psychosis. Those situations fall under the category of things that happen as consequences of substance abuse. But when it comes to the work of treating the habitual thought patterns that putatively lead people to relapse, the work of teaching people how to stop engaging in cyclical patterns of harmful behaviors that they themselves cannot seem to stop engaging in, the benefits of translating aa 12-step knowledge to scientific knowledge are less clear12.

I spent a few weeks living at a center called Centro Colonia Iztapalapa and during that time, the operator Ruben and I frequently had discussions about the role of mutual aid in a larger field of addiction expertise. One night I asked him questions about the ways that aa members use certain terminology, particularly as it related to discus-sions of “the disease of addiction”. In retrospect I now see that, in many ways, the questions I asked Ruben were tacitly informed by my own North American (and often quite reductive) tendency to view “health” as the province of biomedicine and to understand it as potentially being ontologically separable and distinguishable from any attendant “spiri-tual, psychological and social factors” (as we might say in North Amer-ica). I thus initially failed to recognize that, for Ruben, a treatment for a “triphasic” condition like addiction, as he describes it below, is

12 This is not to suggest that translation efforts always go in one direction, with “aa knowledge” being translated into knowledge legible to credentialed experts. My larger study shows the extent to which some credentialed experts, particularly gov-ernment educators, have entire projects dedicated to not only translating scientific ideas into forms compatible with 12-step knowledge. Even as they attempt to push 12-step adherents towards more “rational” or “formal” ways of understanding and explaining addiction, the history of 12-step philosophy as a seminal force in mod-ern ideas about addiction, that is sometimes seen, simultaneously, as problematic and “irra tional”, results in ambivalence towards 12-step knowledge on the part of credentialed experts, which results in those experts engaging in equally vigorous, even if not entirely symmetrical, processes of translating scientific knowledge into aa knowledge.


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healthcare whether it is spiritual, psychological or medical in nature. The interaction is nevertheless informative, however, as it shows how Ruben’s understanding of what addiction is informs his claims for the superiority of particular approaches to treatment. In this passage from my field notes, I ask Ruben why aa discourse features such an emphasis on the “disease” concept despite the lack of any explicit injunctions to intervene in biological processes:

Ruben leans forward and begins gesticulating with his hands, waxing pedagogical. “Ok, look, it’s like, well, okay: we, Alcoholics Anonymous don’t say it’s an enfermedad, the World Health Organization (who) says that!” he continues. “And if the who says it, it’s for a reason. So we grab onto what the who says, and we say it’s an enfermedad. Why? Because they do. They’re doctors. They’re scientists”.

I ask him what the difference is between aa and religion, which, as he previously told me, is not effective because religions don’t understand addiction to be an enfermedad.

“Well,” he grants, “they have a very vague idea that it’s an enfermedad. But for them, more than an enfermedad, it’s the absence of God. [...] It’s that the bible says that you need to behave yourself and this, and that. But they never put themselves in the shoes of the addict. Some do, for sure, obviously. Like, there are religious folks who totally comprehend the structure of an alcoholic, although they don’t call [alcoholism] a disease. But the majority [of religious folk]? No. What do they tell you? ‘Pray three Our Fathers and one Holy Mary’ and this, and that. Or, ‘with this blessing, you go behave yourself ’. But [simply behaving yourself ] is impossible. You have to get to the root of the problem”.

I want to know how he sees this as altogether different than the spir-itual surrender and prayers for healing suggested by the Twelve Steps of Alcoholics Anonymous, the same steps that hang on the wall in his group’s main room.


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“And here in the center?” I ask.“We do that”.

Meaning they get to the root of the problem, as he just mentioned. I’m having trouble understanding how recognizing addiction as an enfermedad helps achieve their therapeutic goals if 1) by his account, who states that it’s an enfermedad and aa simply states publicly that they accept that definition, and 2) as he often reminds me, “professionals” are the ones who are supposed to be in charge of treating enfermedades, not aa members.

“What is this center’s relationship to the concept of an enfermedad?” “I’m getting there. The enfermedad that we suffer from, we say that be

cause the who says it, it’s trifásica.Which is to say that it has three, um…”“Components?” I offer. “Components. Exactly. Mental, physical and spiritual, and that’s what

the who says, not us, and that it has fatal consequences if it isn’t treated in time. So: if the who tells me “you know what? Diabetes is a disease”, and I’m not a doctor, but somebody asks me ‘hey, what is diabetes?” I say “it’s a disease”. It’s the same with alcoholism. I say that it’s an enfermedad because they say it’s an enfermedad. They say it, not me!”

I am trying to determine if Ruben sees what he does as health care, but this is hard for me to articulate because of the way he repeatedly dele-gates the definition and treatment of enfermedades to non-aa profes-sionals. Instead of continuing to ask about labels, then, I phrase my question in terms of work objects. I ask:

“Do you believe that this center is an establishment that treats some-thing…health related?”

“Well, at one time we did that. Before this situation where iapa got involved, and I’m not saying they’re bad but I think the focus they had was a little bit bad, we had a doctor, psychologist and psychiatrist. Along with


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that we had the program of Alcoholics Anonymous. Now we can’t sustain that. We can’t pay for that”.

I am confused at this point: by his account, aa works because it under-stands addiction to be an enfermedad. I understand enfermedades in the sense that I understand the world diseases in english: those things best treated by a health professional. Ruben is describing health profession-als as non-aa persons who are scientifically trained, but he is also saying that aa works because it treats enfermedades, which I am understanding to mean “diseases”. How is aa better than church, then, by rec-ognizing something as an ontological entity (“disease”) which it is not equipped to treat?

I try to figure out another way to phrase myself, to get back to the idea of whether or not he understands 12-step work, independently of the fact that health professionals might also treat alcoholics and inde-pendently of what the who says about alcoholism being a disease, to be a form of health care. In the passage that follows, I specifically ask if aa has to do with health. His answer doesn’t satisfy me at the time, but it is highly revealing of the way that aa members understand the intersection of health (we were using the word salud), enfermedades, and scientific/medical expertise. By his account, Ruben does not see aa per se as health care, but aa is increasingly enrolling health care workers. I now understand, however, that while he doesn’t understand himself to be a health care worker, he understands himself as uniquely equipped to treat those elements of the enfermedad that science legitimates (by defining it as an enfermedad in the first place) but cannot treat (because scientists aren’t recovered alcoholics). My position as a native english speaker was keeping me from understanding how health and illness are understood in Mexico: biomedical diseases are enfermedades, but not all parts of all enfermedades are treatable by biomedicine:

“Do you think that aa has to do with health?” “Well, now, in Mexico, they’re starting to do that. They’re starting to

have communication; they’re starting to form enlaces (linkages). And that’s


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good. Because, like I told you, the who says that this is mental, physical and spiritual. So, the physical part, we as alcoholics” he’s speaking in terms of recovered alcoholics who will always be alcoholics, though they’re now providing treatment for other alcoholics, “don’t know how to cure that. We don’t know how. What do we need to cure that? A doctor. And on the spiritual plane, or I should say, on the mental plane, we need psychologists and psychiatrists who understand the level that we are operating on. “Or rather,” he reconsiders, “some of them, because a lot of them don’t understand. Right now we’re seeing training programs for addictionology (adictología) and all of that. So now psychologists and psychiatrists come better prepared to understand the enfermedad of alcoholism and of drug addiction.

So, then, we have the doctor for the physical. We have the psychologists and the psychiatrists, or the therapists, for the part that’s physic, or mental, and aa covers the spiritual part. So we have those three areas covered. And I think that addict turns out better with this arrangement”.

Listening to this account, we also see, hear that Ruben’s understanding of alcoholism and addiction as “triphasic” ultimately produces a con-dition best treated by a mixto. Importantly for debates about whether addiction is “medicalized” or “criminalized,” we should observe that his account is neither a medicalization nor a moralization of addiction. For Ruben, the problem has always existed in humans, and its treatment has always called for both medical and spiritual interventions, like aa’s cathartic compartimientos (sharing at the podium in an aa meeting) or the aa process of moral inventory. What is changing, and should be changing by his account, is professional fluency in addiction treatment.

Which is not to say that he doesn’t strive to improve his understand-ing of “what is scientific about addictions,” as he puts it. Almost a year later when the topic of medical and scientific expertise came up again in one or our many conversations-turned-recorded-interviews, he artic-ulates his understanding of addiction science in a very different way. By his account, he received this education in addiction science years prior


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to us meeting, but for whatever reason, the way he speaks to me about the neuroscience of addiction strikes me as the product of recent studies. Whether he had gone to, as he puts it, “YouTube University” (he’s an avid autodidact) to brush up on his addiction neuroscience since we last broached the subject, or whether he simply feels more comfortable with me in this moment and thus demonstrates more fluency, I’ll never know. But he performs a basic understanding of addiction neurosci-ence that would have earned him the confidence of any government addiction science educator in Mexico City.

He explains to me that when Marcela Lopez Cabrera took the po-sition of iapa director when it first opened, she opened the field up to discussions about science that ultimately gave him the tools to translate his aa knowledge into the language that professionals use. It’s unclear what he would gain from this translation work, clinically speaking. At times he moves away from the clinical frame altogether, such as when he intimates that, as a recovering alcoholic, it will allow him to communicate with doctors in ways that alert them to the stakes of his disease. At other times he frames translation as a hoop that he has to jump through in order to be taken seriously as a health care provider in his own right. Ultimately this explanation of science, despite demonstrating a much higher level of fluency in the vocabulary used by educators, positions the 12-step work he does with clients as the key mechanism for bringing about recovery:

“When Marcela Lopez Cabrera took the reigns at iapa,” he explains, “the first thing that she does is start us on a path of learning everything scientific about addiction. What are amphetamines? How does the body work? What is heroin? thc? Like, all the drugs”.

“Because there was a large gap in your knowledge?” I ask.“Yes,” he answers. “And thanks to Lopez Cabrera we’ve filled those gaps.

Like, Lopez Cabrera was that one that, to be honest, put iapa on the right track. If they would have stuck a bureaucrat in charge of iapa from the beginning, it would be dead right now. But not the case with Lopez Cabrera.


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She started to professionalize all the institutions like ours, and she started to help us out quite a bit”.

I mention that I had heard critiques of the endless drug descrip-tions and that I often wondered why I was attending yet another class on the different classes of mind altering substances. I said that I figured operators already knew all about street drugs.

“No,” he corrects. “They know about their drugs. But they don’t know about, like…“

I interrupt to offer the example I learned in the first aid class about benzodiazepines complicating alcohol withdrawal.“Look, here’s a simple example…”

I expect him to give me another example of the consequences of not knowing about a certain class of drugs, but instead he tells me the stakes of communicating his own alcoholism to a dentist. He explains that the anesthesia won’t be as effective, because his body reacts differently than a non-addicted body.

“I knew anesthesia didn’t work on me, but I didn’t know why! I have to tell doctors when I go for an operation, ‘hey, aguas (look out), I’m an addict! Anesthesia affects me differently than it does a normal person!’ But I didn’t understand that before. Now I do, ever since I started to understand the scientific side of what aa explains to us. How things are”

I asked him to tell me more.

“How things are? Look. We talk about the obsession. And we know that obsession’ refers to an idea that overpowers other ideas, including the force of reason and willpower. But nothing past that. But now at a scientific level, the doctor explained to us that we have neuroreceptors and neurotransmitters”. He’s taken a pedagogical tone, over enunciating those last words for my benefit. “And that these neurotransmitters and receptors have, like, I’ll just say an example number because science doesn’t know exactly


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how many there are, but we have like, let’s say four. Four neurotransmitters. So what the neuron does: when we’re at a resting state, we have, say, two that are working. And they’re sending out their signals. But if there is something that grabs our attention, or something that puts us into a state of alertness, then an additional one turns on, then maybe another, until four are firing. And when you’re in a heightened state of awareness like that, or when you eat food that you really like, all those neurotransmitters open up and they send out all these feelings of pleasure. So addicts, and I also learned this from Lopez Cabrera, we have something that they call neuroplasticity. Our brains can change. So us, because we’ve given ourselves these enormous jolts with drugs, we don’t just have four. Rather, we have another one. And another one. And another one. So we get to the point where we have far more than you normally find in nature. So when you’re just sitting there, like you show up to a bar or whatever, there aren’t just four that turn on, like with normal people. You’ve got, like, say, eight firing. And that is the obsession. Obsessions are things that [the brain] makes you do by force. So when we enter into recovery or we’re in the [aa] group, all those neurotransmitters that our bodies fabricated are still in play. It’s a chemical imbalance”.

He goes on to explain that before he learned this science, he wasn’t able to explain why drug addiction is an enfermedad. He would sim-ply say that the World Health Organization said it was so. He was either making a corrective of our conversation a year earlier when he explained things in just that way, or he had forgotten that conversation entirely. Either way, this was information he had learned years prior, by his account, and it gave him the tools he needed to gain the respect of professionals.

“So now I can explain to someone trained in medicine, or psychiatry or psychology, why this is a disease. Because, through our exposure to substances, we’ve altered our organism and how it should normally function. What substances do is they deteriorate your neurons. They kill some of them. And


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then you have a chemical imbalance. Among those changes is a rupture in the communication between the frontal brain and the mesolimbic area, which is responsible for pleasure”.

At this point he begins to put his neurochemical explanation in service of a treatment policy that his center is uniquely equipped to implement:

“So we need a treatment that forces us to have a period of abstinence so that communication between these parts of the brain can be reestablished. Because the brain is plastic. But we have damage, physical damage, and that’s why we say that we suffer from an enfermedad”.

In the section that follows, I discuss how these discussions, in which operators describe mixtos as the most effective sites for treatment, also serve as moments in which operators use scientific discourse to assert their legitimacy as service providers within the context of this increas-ingly regulated field where government officials have the power to close centers or otherwise threaten their organizational viability.

Science as bargaining power

Because we’d been talking about these things throughout the months, I recognized that Ruben was using his discussion of neurotransmitters to argue for greater autonomy in terms of treating addicts against their will. Per his account, addicts generally require someone or something to force them into treatment until the brain can repair itself. When he spoke earlier of iapa operating poorly, he was critiquing their deci-sion to take away his center’s right to provide compulsory treatment. Due to a series of unfortunate scandals in which Ruben’s center hadto close two of its three houses because of serious employee misconduct, he had been blacklisted by philanthropists, losing grants from several founda-tions and ngoss that were subsidizing the medical doctors and psychi-


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atrists who made up the professional component of his mixto. This reduced the status of Centro Colonia Iztapalapa from mixto to “mutual aid”, meaning the center can no longer use the “sandalling patrol”, like the kind I observed at the mixto I describe above, to bring clients in against their will. Owing to this fact, Centro Colonia Iztapalapa went from a full mixto that treated up to 70 clients at a time to a nearly va-cant “mutual aid center” with only seven clients at the time of this writing. Five of those seven clients have profound mental illness and lived at the center during the entire course of my fieldwork. Given that respondents across my sites repeatedly bemoan the unavailability of mental health services, their families will probably continue to pay for them to be interned at the center indefinitely.

Ruben, then, sees science as validating his claim that centers like his should be allowed to intern clients by force if Mexico City is ever going to see a reduction in its rising rates of drug addiction. Material profit is, of course, a partial motivating factor for Ruben and he admits this in our interview. But he also sees his work as a labor of love: he himself was interned by force seventeen years ago, and if it wasn’t for this act of providence, as he describes it reverently, he would have never found the life he now enjoys. Treating addiction is his source of income to be certain, but by his account, it also keeps his illness in remission.

Ruben’s discussion of neurotransmitters was one of several times that operators I interviewed used science to make claims for organizational autonomy. When I interviewed Porfirio and Fernanda, operators of a mixto called Casa Tlahuac, Porfirio opened the interview with some-thing of a sales pitch for his center. His treatment model, in which clients attend 12-step meetings accompanied by classes on meditation and physical fitness as well as a few visits with the psychiatrist if their case calls for it, is legitimated by neuroscience even if it’s not entirely informed by it.

“Well, I think that our treatment model is very effective because it consists of 18 months here in this center, considering that the addict, or rather,


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the person with problems from consuming substances, should learn a lot of things. Discipline, among others. On the other hand, we should understand that treatment lasts a long time because our central nervous system has been affected over a long period, sometimes years of consuming drugs and alcohol. And if we do a treatment that’s just three months long, during those three months or 90 days, it’s very possible that our neurons won’t be releasing, or rather, the body is not accustomed to the dopamine levels the neurons add in order to be able to maintain the addict without the addictive substance. Therefore, this little bit of dopamine that the body naturally produces is insufficient, and for that reason the person needs more substances to feel okay. But when you’re in treatment for 18 months, we consider that to be a sufficient period for a person to reestablish themselves, for the brain to reestablish itself functioning without substances. With respect to the help that iapa gives us, especially from my personal viewpoint, it’s been really significant because it has opened our eyes with respect to a number of things we’re not super familiar with. I have a lot of experience [in this field], but it was insufficient. Because [I lacked familiarity] for example, with the neuronal component. How it worked. And, like, before, I would suddenly lose hope in people because they didn’t want to quit using. But we weren’t engaged in a type of service that was sustainable. Now that people from iapa have been giving me those courses, I’ve adjusted my criteria (discretion/judgement/criteria/evaluation). But yeah, I strongly believe that someone should receive treatment for 18 months”.

In his pitch, science confers his model with legitimacy. As we discuss later in the interview, 18 months of treatment is not yet authorized by local laws, which only permit up to six months. He is essentially using our interview, then, as a venue to argue for policy reform based on scientific training provided to him by the same policy measures he wishes to reform. I ask later if they have ever been challenged by iapa for exceeding the maximum treatment limit, and he responds by saying that very few clients are willing to stay the full 18 months. This same understanding of neuroscience, then, likely does the double duty of


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legitimizing his model both to the state and to reticent clients and their families.

Porfirio and Fernanda’s position as operators regulated by iapa is sensitive: at any time iapa could refer their case to authorities who would reduce their status from mixto to “mutual aid” and they’re aware of this, which is most likely why they spend time extolling the virtues of iapa. But they also truly grateful for the training that iapa provides, and they tell me later in the interview, convincingly, that iapa has literally chan- ged their lives. Porfirio explains that he initially found sobriety in an anexo where he was abused violently. When he first transitioned from client to operator years ago, he mimicked the treatment he’d received but felt deeply conflicted about this. Because of science, he explains, he now sees why that model isn’t “sustainable,” as he mentions above. In this sense, science replaces violence, and it has helped him carry out his labor of love more sustainably.

Discussion

To be certain, ideas about science are an important element of the treat-ment field in Mexico. It’s clear that the boundaries between mutual aid groups, professionals and “mixed” centers, with their varying perceived levels of scientific rigor, have important consequences, both legally and for the ability of operators to provide, as Porfirio puts it, “sustainable” treatment models. It is also clear, though, that “science” is more than a stable package of skills or knowledge, something that can be imposed on operators as the state works to fill a perceived knowledge gap. It can take that form, as when science-based responses to cocaine psychosis save lives and unscientific ones leave clients dead in treatment centers. But what science cannot explain about addiction is just as important as what it can.

As mentioned above, even when operators reproduce the level of sci-entific literacy that progressive addiction policy is designed to help them


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achieve, they still rely on things like the 12-step model to solve the puz-zling technical problem of how to help people avoid cycles of self-in-jury that they are putatively powerless to control. As Nancy Campbell writes, a persistent lack of a consensus about how to solve that puzzle is endemic to drug treatment projects as a whole, and “symptomatic of the hybrid nature of ‘addiction’ (Dunbar, Kushner and Vrecko, 2010) and its status as a complex social, cultural and biological signifier that has thus far exceeded each and every reductive framework advanced to understand it” (Campbell, 2012).

Given that lack of consensus among even “professionals”, it only makes sense that regardless of how effective education measures are, scientific rhetoric will continue to be the tool that operators use in their daily work.

In discussions that emphasize science as a magic bullet that will render the treatment field functional and effective, discussants often neglect to acknowledge all of the challenges that science is perhaps ill-equipped to solve. In my interview with Dr. Luis Solis, an educator, governmen-tal adviser and addiction professional who has been a part of that dis-cussion for over twenty years, he stressed the extent to which addiction seems to outstrip our attempts to understand it. “It’s extremely painful for families to have an addict in the house”, he explained, “and it’s not pretty, or legal, but the ‘sandalling patrol’ is a practical solution for a lot of people”. Later he remarked that “there is something about human nature that fundamentally cannot understand addiction. This drives a wedge of incomprehensibility between the addict and those who care for them, and ultimately repels every type of service provider besides mutual aid groups”. In this sense, the emotional mediates the technical and the epistemic. Through the course of our interview, Solis agreed when I suggested that, given the lack of consensus among addic-tion “experts”, mutual aid groups and “professionals” are much more similar than they are different. Both groups tend to discuss scientific concepts only insofar as those concepts enable the claim that addiction is a disease. Despite an insistence that the etiology of addiction is (at


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least partly) bio-pathological, there is still little articulation of how un-derstanding that pathology will indicate a given course of treatment. The “best practices” emerging from scholarship on addiction tend to suggest ways that treatment should be configured as to give people the greatest opportunity to recover, and in ways that respect human rights and don’t exacerbate any comorbid conditions. The mechanisms of recovery itself, however, are, for the most part, still a mystery.

I felt the insightfulness of Solis’ comments as I observed fifty people embrace an operator named Julio Jose at a mixto called Casa Texcoco. In our interview a week prior I had asked Julio Jose to define the dis-ease of addiction for me and he responded with a long discussion that essentially framed addiction as a compulsive moral pathology. I asked if he had taken classes on the neuroscience of addiction, and whether he also identified with that understanding of addiction. He told me that he found it interesting, but that he preferred to leave definitions like those to the “professionals”, as they have “nothing to do” with his daily work as an operator. When I asked him to explain why not, he respond-ed in a way that didn’t so much evade my question as reframe his work as emotional labor that carries an emotional cost. He explained that he likes the training that iapa gives, and that any education he receives also benefits the center. But he went on to say that this comes with a high price: he needs to keep a large number of things to himself, as his emotional state and comportment have repercussions for the way the center as a whole functions.

I didn’t follow his logic at that moment and we ended up finishing the interview on a different topic. I understood more, though, when I attended an aa meeting he had invited me to speak at as a special guest. Nothing I had experienced in the field up to that point prepared me for what I observed: after I gave a quick talk about my work in the field, the lights dimmed, a man at the podium went from talking about his ex-perience getting sober to singing christian songs with a guitar, and then the meeting became an impromptu tribute to Julio Jose. I looked on as a room full of recovered addicts made a circle around him, touching his


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face and bringing him to tears. This was a display of love, presented as a partial and humble reimbursement for love given. Here was a room of more than fifty people thanking their leader for loving them; the very fact of their (sober) presence, a testament to the power of his love.

When he explained to me that he finds iapa training to be interesting but unrelated to his work and then transitioned into statements about why he needs to manage his emotions in the workplace, it was likely because he was trying to communicate the idea that, to the extent he un-derstands, neuroscience still lacks an understanding of the mechanisms of addiction in any way that would meaningfully shape the content of his personal treatment model. For Julio Jose, science is an interesting and necessary tool for the “professionals” who work in his mixto, but it is not the primary one that he personally employs to help people get sober.

Conclusion

It is of course difficult for the federal government to regulate something subjective as “love-based treatment”. The government hopes that putati-vely science-based treatment models, such as mixtos, will combine both the rational with the ephemeral and the affective. It should also be noted that despite the general notion that mutual aid work is problematically unscientific, it indeed has its own contingent of scientific support: at an annual conference for the treatment elite held by treatment founda-tion Monte Fenix, for example, Ricardo Nanni, the general addiction policy director at Mexico’s National Center for Addiction Prevention and Control (cenadic), presented a string of slides attesting to the fact that mutual aid programs have proven scientific efficacy. Similarly, in an article on the “disease concept of addiction”, researcher and treatment reformer Jorge Sanchez Mejorada draws a straight line from the work of aa-allied doctors William Silkworth and E.M Jellinek, as well as Al-coholics Anonymous itself, to contemporary scientific understandings of alcoholism and addiction (Fernández, 2007).


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12-step work and the mutual aid model it has inspired are popu-lar, accessible and putatively effective solutions in a context like Mex-ico where public mental health services are chronically underfunded or unavailable. As mutual aid groups in and of themselves become the sites of troubling problems like violence, however, the “culture” (as many of my respondents put it) and practices of these groups are seen by commentators and policy makers as broken and needing re-placement by more modern or scientific approaches. This reaction has produced education programs that both the government and opera-tors see as productive and even, as Porfirio and Fernanda put it, life changing.

Ultimately, though, science isn’t so much a magic bullet as it is a cultural and rhetorical resource that operators and the government will most likely employ alongside other resources. As evinced by the inter-views reproduced above, it can be a tool for establishing credibility for an operator’s claims that the government limits their jurisdiction, or can be seen as a language that can translate what a counselor knows as “real” from their own experience into advocacy that’s legible to creden-tialed experts, as in the case of Ruben. It can also, as in the case of the first aid class I recount, provide life saving information to those instanc-es where clients are still under the influence of substances.

It is true that the field can benefit from “technical innovations with rigorous scientific validity” and equally rigorous research to ensure those innovations “respond to the real needs of the affected population, taking into account the specific sociocultural contexts of treatment provision”, as Marín Navarrete et al. note (Marín-Navarrete et al., 2013). But we should also heed the work of critical addiction scholars who point to the limits of attempting to “innovate” our way to better treatment po-licy. As Nancy Campbell finds, for example, in her ethnographic work on the ways that neuroscience research have been mediated by recovery culture in the United States, “neuroscience cannot abstract itself from the social and political meanings projected onto the figures of ‘addicts’ as a heterogeneous social class” (Campbell, 2013). Writing about the


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ways that popular accounts of addiction such as those on the television show Oprah mediate and translate neuroscientific findings, she comes to the disheartening conclusion that the only “experts” who are able to achieve credibility in the public eye are those who are able to stabilize their framing of science in ways that “accord with the ‘facts’ and ‘values’ prevailing within [the] rhetorical space” of the addiction recovery main-stream. Put more simply, the only science that succeeds is aa-friendly science. Although Campbell’s story takes place in the United States, it bears a striking resemblance to the operators like Ruben, Porfirio and Fernanda I interviewed who tacked between moral and scientific regis-ters as they used neuroscience to bolster their ideas about treatment reform.

Far more serious than the ways that operators and the government might bend understandings of science to fit with their own agendas, though, are the deeper social problems that make services like the “san-dalling patrol” not only possible, but necessary. A deep chasm of income inequality, corruption that potentially affects all levels of government and staggeringly low levels of education need to be addressed for any addiction prevention, harm reduction or treatment policy to be suc-cessful. Neuroscience is producing exciting models of addiction that might lead to pharmaceutical therapies or even, as some scientists at the Ramón de la Fuente Muñiz National Institute of Psychiatry hope, pre-vention tools like vaccines. But addiction is understood to be not only biological, but biopsychosocial. Rather than assuming, as many of my respondents often seemed to, that the “social” in biopsicosocial only ex-tends as far as client’s families or to the edges of their peer network, a truly biopsychosocial response needs to look at the structure of a larger, increasingly global society that systematically produces improvised re-sponses, such as the “sandalling patrol”, to problems that states either cannot, or will not, attend to.


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Periodismo influido: la cobertura de salud desde la radio en Puebla


Resumen El presente trabajo realiza una reflexión acerca del periodismo en salud sobre la base de la reciente evolución política de Puebla y la influencia que ello ejerce sobre la concepción que, periodistas y comunicadores, se han formado de su profesión, para lo cual se realizaron entrevistas a profun-didad a 20 periodistas y comunicadores de 11 radiodifusoras de las tres principales ciudades de este estado, que de acuerdo con datos del Instituto Nacional de Estadística, Geografía e Informática (inegi, 2010) son: Pue-bla (capital), Tehuacán y Teziutlán. El estudio arroja luces en cuanto a que persiste una ideología de fuerte tradición histórica que ha privilegiado la difusión de declaraciones oficiales de orden político, sumado a las relacio-nes comerciales al interior de las radiodifusoras, que limitan el desarrollo del periodismo especializado en salud.

Palabras clave: puebla, salud, radio, política, intereses.

Abstract This paper makes a reflection on the health journalism based on the recent political developments in the state of Puebla and the influence it exerts on the concept that journalists and media have formed their profession for which they were made depth interviews with 20 journalists and com-municators of 11 radio stations in the three major cities in the state of Puebla, which according to data from the National Institute of Statistics, Geography and Informatics (inegi, 2010) are: Puebla (capital), Tehuacan and Teziutlán . The study sheds light as to which an ideology of strong his-torical tradition that has favored the dissemination of official statements of a political nature, in addition to trade relations within broadcasters, limiting the development of health journalism.

Keywords: Puebla, health, radio, politics, interests.

Fecha de recepción: 25 de febrero de 2016Fecha de aceptación: 19 de abril de 2016


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Introducción

L a mayor parte de los estudios sobre periodismo en México se han concentrado en indagar las relaciones entre la clase política y los

medios de comunicación. Sin embargo, el aumento del conocimiento científico y médico, ligado a la proliferación vertiginosa de los medios (visuales, hablados, escritos y ahora digitales) en la segunda mitad del siglo xx, le ha otorgado a las noticias de salud un puesto de cierta im-portancia frente a los informes políticos y económicos (Otero, 1993). Y es que, como afirman Blanco y Paniagua (2007), la información sobre salud a través de los medios interesa cada vez más a las audiencias, de ahí que sea la excusa perfecta para generar noticias. Esa demanda informativa debe aprovecharse en beneficio del público con mensajes bien construidos que eviten riesgos en la salud (Alcalay y Mendoza, 2000). En el caso mexicano, el periodismo en salud ha sido utilizado como un recurso meramente publicitario (De Alba, 2008), exponien- do su fragilidad informativa se expone al competir con temáticas de diverso orden e impacto social (Semir, 1999). Esto, específicamente en regiones mexicanas como las de Puebla, no resulta un fenómeno ajeno. Revisar los antecedentes del periodismo poblano permitirá comprender la forma en la que se ha venido ejerciendo esta profesión con relación a cómo se producen los contenidos informativos en salud.

Los orígenes del periodismo y la comunicación en salud en Puebla no están bien determinados. No obstante, se tiene registro del primer periódico que, con el nombre de La Abeja Poblana, marcó brecha hacia la libertad de prensa. En ese sentido, Del Palacio (2006) apunta que las primeras publicaciones locales no deben ignorarse como algo lejano en el tiempo, pues resultan una fuente privilegiada para entender los mo-mentos fundacionales del periodismo regional, sus vinculaciones con las élites y con la vida social. Lo importante de volver la mirada al pasa-do es visualizar las dinámicas que sigan en la actualidad.

En Latinoamérica, el surgimiento del periodismo en salud tampoco ha estado del todo presente, ni en la formación de los periodistas ni en


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los medios (Massarani et al., 2012), pese a que, desde los años 80, según Waisbord y Coe (2002), la presencia de asuntos relacionados con la salud ha sido cada vez más notable en la escena periodística. Un mo-mento clave es la irrupción del vih/sida como contenido mediático a raíz de la confesión pública realizada por el actor norteamericano Rock Hudson, afectado por esa enfermedad (Huertas y Gutiérrez, 2005). Otro aspecto trascendental, agregan Waisbord y Coe (2002), fue el inicio del movimiento llamado periodismo público o cívico en los Estados Unidos. Esta tendencia nació de la inquietud y críticas de académicos y periodistas hacia el ejercicio de la profesión y su relación con la vida pública. El periodismo público tiene como objetivo identificar proble-mas locales que afecten la vida de las comunidades, como el cuidado y atención a la salud. El debate cobró fuerza a mediados de los 90 respec-to de los fines que deben perseguirse. Por un lado se apunta que, si el periodismo suele legitimar la posición de los poderosos y las fuentes oficiales, la alternativa es un periodismo que permita fortalecer a las audiencias. Por otro, si el periodismo suele concentrarse en las fuentes de poder, la opción es empezar desde los ciudadanos. En la última dé-cada, la discusión en el periodismo sostiene que la prensa debe producir y ofrecer noticias que los lectores necesitan y quieren (Waisbord y Coe, 2002). Dadas estas revisiones, se puede comprender que, al igual que el periodismo público, el periodismo en salud tiene como objetivo estable-cer un puente de unión entre los productores del conocimiento, incluido el médico-sanitario y el público en general, en una labor informativa y formativa, con el propósito de ayudar a los individuos a mejorar y equi-librar su relación con el entorno.

Para entender mejor el alcance de este fenómeno es preciso revisar críticamente qué función ha tenido el periodismo en regiones especí-ficas, como Puebla, donde la presencia continuada de informaciones provenientes de órganos de gobierno y empresas privadas, a través de la radio, permite darse cuenta del poder que han logrado dentro de los procesos de producción de contenidos en salud. Los vínculos que se establecen entre sociedad e individuos con los mensajes de los medios,


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especialmente sus efectos en la conducta, manifiestan que la manera en la que se reportan los temas de salud, particularmente aquellos relacio-nados a enfermedades crónicas, es insuficiente, parcial y confusa (Gon-zález y Hernández, 2013). Por eso, resulta imprescindible documentar la dinámica que se presenta al interior de las salas de redacción noticiosas en relación con la producción de contenidos en salud, particularmente desde la radio. La naturaleza de ese medio, así como su constitución, le hacen ideal para realizar la cobertura y difusión de temas médico- sanitarios, sobre todo en provincias como las de México en donde existe una enorme tradición de escuchar radio (Chávez Fragoso, 2001). Distintos estudios críticos de la comunicación plantean que conocer cómo desde los medios se cubren los temas de salud permite identificar la forma en la que se abordan y qué se puede mejorar de dicha cobertura en beneficio de la audiencia (Alcalay y Mendoza, 2000).

El presente trabajo tiene el objetivo principal de analizar el periodis-mo en salud sobre la base de la reciente evolución política del estado de Puebla y la influencia que ello ejerce sobre la concepción que periodis-tas y comunicadores se han formado y cómo se refleja en sus prácticas informativas a través de la radio, particularmente en las tres principales ciudades de la entidad, que de acuerdo con datos del Instituto Nacional de Estadística, Geografía e Informática (inegi, 2010) son: Puebla (ca-pital), Tehuacán y Teziutlán. ¿Cómo influye el actual contexto político en la divulgación de contenidos periodísticos de salud en la radio en Puebla? El origen de este estudio plantea que periodistas y comunica-dores de la fuente de salud que trabajan en radio elaboran contenidos favoreciendo el acceso a las fuentes institucionales públicas y represen-tantes del sector médico, que resulta de la falta de especialización perio-dística. Para esto se realizaron entrevistas individuales a profundidad entre 20 periodistas y comunicadores de radio, todos de la fuente de salud. El estudio arroja luces en cuanto a que persiste una cultura perio-dística local, en tanto forma de ejercer el periodismo, de fuerte tradi-ción histórica, que ha privilegiado la difusión de declaraciones oficiales de orden político, sumado a las relaciones comerciales al interior de las


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radiodifusoras que también llegan a determinar el tipo de información en salud que se difunde.

El periodismo en Puebla: antecedentes y actualidad

El movimiento independentista de México resultó un fenómeno con-tradictorio en la historia del periodismo (Fernández, 2010). Representó la posibilidad de trascender el periodismo meramente informativo para dar paso a uno politizado; no obstante, con una clara línea propagan-dista. Lograda la emancipación, la prensa gozó de un breve periodo de libertad que le permitió constituirse en la más alta tribuna donde se debatían los arduos problemas nacionales (Ochoa Campos, en Fernán-dez, 2010) y, con ello, incentivar la creación de opinión pública. Esto no impidió que la prensa perdiera su carácter propagandístico, pues los grupos políticos que en principio se peleaban el poder, monárquicos y republicanos, recurrieron a ella para defender sus posturas ideológicas y atacarse entre sí. Esa época también fue propicia para el surgimiento de otro tipo de prensa, que defendía principios políticos fundamentales. De esta forma, de acuerdo con Avilés (2010), el periodismo mexicano nació subyugado al poder del Estado. Un esbozo del panorama que guardó la prensa en Puebla lo confirma.

Puebla fue de los primeros lugares en contar con una imprenta, después de la Ciudad de México; asimismo, fue pionera en producir periódicos fuera de la capital (Del Palacio, 2004). Con la imprenta en tierras novohispanas surgieron las “hojas volantes”, papeles sueltos de carácter informativo (Ruíz y Reed, 1995). Estos impresos recibían in-distintamente los nombres de noticias o sucesos que, a decir de Ruíz y Reed (1995), pueden ser considerados como germen del periodismo. En la segunda mitad del siglo xviii surgieron en Puebla los primeros almanaques que se fueron configurando como documentos de carácter científico, histórico y literario que daban, a los autores e impresores, cierta independencia de expresión en una época donde no existía la


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libertad de imprenta (Fernández, 2010). Esas publicaciones no sólo eran accesibles a las élites, sino también a otros sectores de la población inte-resados en diferentes tópicos de la cultura popular, pues eran de muy bajo costo (Herrera Serna, citado en López Domínguez, 2007).

El primer periódico poblano del que se tiene registro vio la luz el 30 de noviembre de 1820 y se llamó La Abeja Poblana (Ruíz y Reed, 1995), creado por el sacerdote Juan Nepomuceno Troncoso. El tiraje del perió-dico de cuatro páginas fue de 200 ejemplares, cuyo sostenimiento se debió al capital de su fundador (Cordero y Torres, 1947). A decir de Romero Luna (2002), este periódico respondió a la Constitución de Cádiz, por lo que La Abeja Poblana abrió el camino hacia la libertad de prensa en Puebla, que hasta antes de 1820 estuvo prohibida en las colonias americanas y se hizo famosa por haber sido la primera en publi-car el texto íntegro del Plan de Iguala (Ruíz y Reed, 1995), sin importar que para tal fin, Agustín de Iturbide mandase publicar El Mejicano Independiente, documento que también haría las veces de órgano propa-gandístico hasta la consumación de la Independencia. Mientras Iturbide ordenó publicar documentos oficiales y piezas literarias en honor al emperador Agustín I, sus partidarios editaban otros periódicos como El Farol, en Puebla, donde apoyaban la forma de gobierno vigente y a su cabeza (Fernández, 2010). Tras declararse autónomo en sus publicacio-nes, Nepomuceno Troncoso sufrió presiones y persecuciones por parte del gobierno al ser considerado un enemigo peligroso para la sociedad, lo que le costó el destierro. Con 18 ediciones semanarias, La Abeja Poblana llegaría a su fin. De esta manera se puede constatar que la historia de la prensa poblana ha estado vinculada con diversas formas de legiti-mación del poder, revestidas de autoritarismo en la interacción entre periodistas y funcionarios públicos.

Iniciado el siglo xx, el campo periodístico seguía enfocado en el tema gubernamental, ahora desde el movimiento revolucionario y post revolucionario. Sin embargo, también comenzaron a circular publica-ciones de corte cultural a iniciativa de escritores, músicos y pintores (Coudart, 2001). Pero el periodismo poblano no dejó de enfocar sus


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plumas al aspecto político (Sánchez, 2009). Esto puede explicar la razón por la que, históricamente, las organizaciones mediáticas le han brindado más atención al gobierno que a los ciudadanos. De ahí que este análisis se concentre en la persistente influencia del contexto político sobre el periodismo en un asunto de seria relevancia social: la salud pública. Una forma de saber cuáles han sido las prácticas clientelares entre los medios, los altos mandos públicos y empresas privadas en Puebla es revisando otros momentos históricos.

La entidad poblana fue gobernada por el partido oficial, Partido Revolucionario Institucional (pri), desde 1929, y así fue en sus más de 20 gobernadores desde ese año y hasta el 2011 con el gobierno de Mario Marín Torres (Valdiviezo, 2010). Los partidos políticos que han conformado Puebla han estado ligados a dos ex gobernadores que tuvieron gran peso en el gobierno federal; Maximino Ávila Camacho (1937–1941) hermano de quien fuera presidente de México entre 1940 y 1946, y Gustavo Díaz Ordaz, quien fuera gobernador de Puebla de 1942 a 1945 y presidente de México entre 1964 y 1970. Desde la década de los 60 los organismos políticos se diversificaron al no comul-gar con las tesis, tanto revolucionarias y socialistas del Cardenismo, así como con la incorporación de la clase media en la lógica corporativa del régimen (Nateras, 2005). Ello sobrevino en la presencia muy fuerte de otras instituciones como el Partido Acción Nacional (pan). Esta fuerza política ha tenido presencia electoral en el estado desde 1968 (Valdi-viezo, 1998) y ha venido en aumento, pasando del 8.8% en 1980 al 36.0% en 2004 (Valdiviezo, 2010). Durante los 70 años del régimen encabezado por el pri, la comunicación política ha sido históricamente monopolizada por el Estado, el cual ofrecía limitadas oportunidades de acceso a la información y libertad de expresión (González, 2011), lo cual resultaba en coerción hacia los medios y una muy cuestionada pro-fesionalización del periodismo.

En cuanto al desarrollo de la radio en Puebla, este se dio tardío pues inició en 1936. Según Baca (2013), el auge de la radio se dio en los años 30 debido a que no habían entrado otras industrias culturales,


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como la televisión. El autor agrega que, como sucedió en el resto del país, las primeras transmisiones radiofónicas en Puebla fueron auspicia-das tanto por el gobierno como por empresarios, quienes encontraban en este medio el logro de beneficios políticos y comerciales dadas las posibilidades de acercamiento de la radio con el público. Estos datos ayudan a observar cómo la radiodifusión en Puebla tuvo, desde sus ini-cios, la injerencia de entidades político-capitalistas para adueñarse de la entonces nueva tecnología de la comunicación. Lo que llevó a la radio a enfrentar en años sucesivos un sinnúmero de transformaciones técnicas en sus formas de producción, transmisión y recepción para favorecer la obtención de ganancias. Aquí un ejemplo.

En 1987 cobró presencia en Puebla el Proyecto Nacional de la Asocia-ción de Concesionarios Independientes de la Radio (acir) integrándose a Grupo acir Nacional que cubre toda la República mexicana (Anda Gutiérrez, 2004). En 1989 el entonces presidente de la República, Carlos Salinas de Gortari, inauguró las instalaciones de Grupo acir Puebla. El 1 de junio de 2007 desapareció Grupo acir Puebla, propiedad de la Familia Cañedo, y se inició un nuevo corporativo radiofónico llamado Cinco Radio, que se mantiene hasta hoy. El grupo radiofónico Cinco Radio asume el control de siete estaciones en Puebla y algunas ciuda-des del estado, de las cuales cuatro son de frecuencia modulada (fm) y las tres restantes de amplitud modulada (am). Del total, cuatro tienen su sede en Puebla, el resto se ubica y distribuye su programación en San Martín Texmelucan, Atlixco y Tehuacán. Con esto podemos observar cómo la radiodifusión en Puebla tiene, desde sus inicios, la inje-rencia de grupos empresariales para adueñarse de esta plataforma de comunicación.

El 14 de junio de 1996 surgió el llamado Sistema de Comunicación del Gobierno del Estado de Puebla (sicom), considerado en el Plan Es-tatal de Desarrollo impulsado por el entonces gobernador Melquiades Morales Flores. sicom representó un logro del gobierno del estado de Puebla, abanderado por el pri, para que sus habitantes contaran con medios públicos de información y comunicación en todos los rincones


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de la entidad. sicom Radio comenzó con una red integrada por cinco radiodifusoras distribuidas en las regiones más importantes del territo-rio poblano1, las cuales se mantienen hasta hoy con una cobertura de 114 municipios que concentran el 75.8% de la población total del es-tado (Pacheco, 2008). A partir del gobierno panista de Rafael Moreno Valle Rosas, en 2011, sicom pasó sin mayores cambios a ser nombrado Puebla Comunicaciones, que incluye la participación activa de las de-pendencias de gobierno.

A principios del siglo xxi, el contexto político en Puebla estaba in-fluido por el resultado de las elecciones federales de 2000 y 2006, en las que el pan ganó dos veces consecutivas la presidencia del país. La naciente apertura que la transición política suponía resonó en Puebla como resultado del escándalo de las grabaciones, hechas públicas por los medios de comunicación, del gobernador Mario Marín Torres, las cuales le implicaban en una red de trata de personas y en la violación de los derechos humanos de la periodista Lydia Cacho, quien denunció los delitos en los que estaba incurriendo Marín Torres. Ese asunto pudo haber sido el elemento que influyó en las preferencias de los electores poblanos que llevaron al término del régimen del pri al concluir el siglo xx. Esta situación constituye un avance en la transición a la demo-cracia, aunque existen autores que denuncian su fragilidad (Villafuerte, 2005). La creciente demanda por parte de amplios sectores sociales de un nuevo enfoque periodístico y su importancia comercial hicieron que en Puebla emergieran medios de tono independiente del discurso ofi-cial. Pero todavía persiste un sistema informativo acotado por intereses empresariales que ha devaluado el rol de escrutinio y la autonomía pro-fesional de los periodistas.

Con Puebla como recorte empírico de análisis, encontramos que los medios de comunicación y el periodismo han sostenido un fuerte víncu-lo con el gobierno. A través del gasto gubernamental y otros mecanismos,

1 xhcom, 105.9 fm en la ciudad de Puebla; xhngo, 98.9 fm en Huauchinango; xhlib, 95.9 fm en Libres; xhtez, 90.9 fm en Teziutlán y xheuh, 93.1 fm en Te-huacán.


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el Estado ha venido controlando eficazmente la representación mediá-tica de sí mismo (Carreño, 2000). En Puebla persisten añejas rutinas de producción2 que hacen evidentes los vínculos entre la clase política, los periodistas y los medios de comunicación. En un estudio sobre ru-tinas productivas de información en una radiodifusora privada de la ciudad de Teziutlán, Romero (2011) pone de manifiesto que una acti-vidad fundamental que llevan a cabo los periodistas en el proceso de la construcción de noticias es la de relacionarse con las esferas políticas y económicas. González (2011) sostiene que la subordinación de los me-dios al gobierno ha fomentado que, en la práctica, las noticias estén dirigidas, más que para la audiencia, para la clase política. Trejo (1998) asegura que los periodistas y sus fuentes mantienen una fuerte relación donde las reglas del juego mediático están determinadas por el interés mutuo de utilizarse los unos y los otros, al hacerlo, la información que llega a la audiencia está matizada por esa frágil pero compleja dependen-cia que han construido el periodismo y el sistema político. Podemos decir que las actividades desarrolladas por las unidades de prensa de las instancias gubernamentales han sido importantes, también en Puebla, en la mediatización de la información. Para avanzar en la mejor com-prensión de este tema, las siguientes características nos permitirán comprender el escenario.

La importancia de la radio en Puebla

Puebla es un estado donde la industria manufacturera, que incluye la maquila, juega un papel importante; cerca del 60% del valor de la eco-nomía lo genera el sector terciario (Valdiviezo, 2010). Es una entidad que ha venido dejando de lado su papel en la agricultura para desarrollar

2 Las rutinas de producción informativa son prácticas y/o actividades altamente repe-titivas. Las operaciones periodísticas rutinarias se constituyen como prácticas sociales, que están en el eje de la configuración productiva y discursiva de los medios (Salinas & Stange, 2009).


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el sector manufacturero, destacan la industria automotriz y textil, así como el sector de servicios turísticos. En la actualidad, la entidad apa-rece como un emplazamiento de negocios y el gobierno local se ha dado a la tarea de diseñar políticas de atracción a la inversión extranje-ra (Hernández, 2010). Sin embargo, este crecimiento no se ha visto reflejado del todo en el resto de la entidad. De acuerdo con el inegi (2010), el estado de Puebla ocupa la séptima posición en marginación del país:

• 63.9% de la población ocupada no gana más de dos salarios mínimos.

• 31.72% de la población es rural. • 14.61% de la población adulta es analfabeta.

El municipio capital, Puebla, tiene, de acuerdo al último conteo de po-blación, 1.539 mil 819 millones de habitantes. Tehuacán, en segundo lugar, tiene 274 mil 906 habitantes. Mientras que Teziutlán, en la tercera posición, suma 92 mil 246 personas. A la par de su crecimiento pobla-cional, los ciudadanos presentan un considerable consumo de medios de comunicación. Información obtenida por el inegi (2010), del total de viviendas (20 mil 849) que había en el año 2000 en el estado, 18 mil 134 contaban con un radio, es decir, un 87% de la población. El apara-to radiofónico ha sido de gran accesibilidad ya que resulta el más eco-nómico y portátil, lo cual se ha favorecido gracias a la telefonía celular. El inegi (2010) agrega que en el estado operan 44 radiodifusoras, 22 de am (21 de ellas de corte comercial) y 22 de fm (con 14 en el giro de corte privado, ocho de servicio público) así como tres estaciones televi-soras. De acuerdo con el Programa de Medios de Open Society Foundations (2012), las fuentes preferidas de información son la radio, los periódicos y la televisión. En esta última, los noticiarios son el tipo de programas más vistos por encima de las telenovelas, películas mexicanas y extranjeras. En la radio, las noticias ocupan el segundo lugar entre las preferencias de los radioescuchas, después de la música pop.


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La radio continúa siendo una de las herramientas principales para generar estrategias de comunicación, gracias a la importancia que revis-te en las redes de publicidad y propaganda del mercado, sobre todo dentro de la vida cotidiana de ciertas poblaciones. La radio, como en-tidad económica, busca maneras de percibir recursos financieros de empresas del sector privado o, inclusive, subvenciones del gobierno para su manutención, como es el caso de las radios de servicio público. Esto permite colocar a la radio dentro de una cultura de flujo (Bustamante, 2003), por la cantidad de información que proporciona y porque la mayor parte de sus recursos económicos provienen de la publicidad. La cultura de flujo no hace diferencia necesariamente entre la radio co-mercial o pública.

Las grandes empresas, en sus diferentes giros, como el de salud, han visto en la radio, en sus noticieros, programas de entretenimiento, anuncios, entrevistas pagadas, transmisiones especiales, uno de los me-jores modos de acercar sus productos y servicios a las audiencias. En este juego de mercado, como en cualquier situación de compra–venta, la radio está sujeta a las exigencias de sus clientes. Los anunciantes, como parte de la clase dominante, desean mantener y reproducir su posición en el mercado, por lo que llegan a incidir en la producción y control de los mensajes de los medios al pagar por aquellos que ofrecen un amplio rango de audiencias. Así, para Ramonet (2007), la publicidad impone tiempos en los espacios de comunicación: “… y con el discurso pu-blicitario elaborado, el ciudadano se convierte en el blanco de la diana” (p. 69). Pero, las relaciones contradictorias que surgen en ellos son mucho más complejas. No sólo tienen que atender las necesidades de los auspiciantes, sino responder a una lógica de interacción entre las exigencias de estos, las peticiones de su público, las relaciones con el Estado, etcétera.

Por lo antes descrito, se hace necesaria una revisión específica respec-to de cómo se influye el periodismo y/o comunicación en salud desde las relaciones de poder que se tejen entre las radiodifusoras poblanas, las organizaciones políticas y comerciales. Respecto de la aplicación del


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enfoque sociológico y las herramientas metodológicas aquí utilizadas para verificar el fenómeno versa el siguiente apartado.

Metodología

La sociología de la producción de noticias busca identificar cuáles son los procesos y prácticas sociales aplicadas para producir los mensajes informativos por parte de periodistas y comunicadores en los contextos de sus propios ambientes noticiosos (De León, 2004). En la agenda setting, según McCombs y Shaw (citados en Corral, 2008), los medios de comunicación influyen en el público al determinar qué historias po-seen interés informativo y cuánto espacio e importancia se les da. Con base en estos enfoques pudo ser posible comprender el fenómeno de la representación que periodistas y comunicadores se han hecho del perio-dismo en salud y cómo se han dejado influir por las esferas políticas y económicas de sus regiones.

Para este estudio se realizaron entrevistas individuales a profundidad entre 20 periodistas y comunicadores de radio, todos de la fuente de salud, a quienes se ofreció anonimato para su participación. La entrevis-ta a profundidad permitió entrar en diálogo con los sujetos de estudio y analizar sus contrastes en cuanto a lo respondido. Las entrevistas se realizaron entre enero y marzo del 2015 al interior de 11 radiodifuso-ras, privadas y públicas, con sede en las ciudades de Puebla, Tehuacán y Teziutlán.3 Las radiodifusoras pertenecen a diferentes agrupaciones, ta-les como Puebla Comunicaciones, Corporación Mexicana de Radio, Grupo Imagen, Grupo Cinco Radio, Asociación de Con cesionarios Independientes de la Radio (acir) y Grupo Radio Centro. La selección

3 Por expresión ética evitamos citar el nombre de los actores entrevistados y las radiodi-fusoras. Sin embargo, esta situación no es obstáculo para el desarrollo de este estudio, puesto que no importan las identidades sino los actores (como construcción analítica) y las acciones que llevan a cabo en el proceso de producción de contenidos en el contexto de los medios para los que trabajan.


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de las emisoras y la investigación se ubicó considerando las producciones radiofónicas que identifican su eje temático como médicosanitario, se distinguió entre programas informativos y misceláneos o de revista. A los que se nos permitió acceso fueron: 16 programas informativos, dos de revista, uno misceláneo y uno más médico-psicológico, ya que los te-mas que aborda se enfocan en salud mental, psicología y psicoterapia. Estos espacios radiales cuentan con la presencia de dos y hasta tres mé-dicos invitados de manera semanal para proporcionar información en secciones establecidas dentro de los mismos. Se consideraron al menos tres periodistas por radiodifusora, uno de los cuales ocupara un cargo a nivel directivo, con injerencia en la toma de decisiones administrati-vas, editoriales y de producción. Las entrevistas fueron grabadas bajo su propio consentimiento. Nos referimos a los entrevis tados como perio-distas, comunicadores o productores, según el caso. Como parte de la muestra de estudio vale la pena hacer ciertas especi ficaciones que favorez-can una mejor comprensión de los hallazgos de investigación. Dieciséis de los participantes tienen estudios universitarios en comunicación, sin especialidad alguna en periodismo de salud; los otros cuatro cursa-ron hasta el nivel de preparatoria. El rango de edad en el que se encuen-tran es entre los 29 y 40 años. De los 20 entrevistados cuatro ocupan el cargo de editor; sin embargo, al mismo tiempo realizan otra función, dos también son gerentes, uno reportero y otro productor. Del resto, cinco son reporteros de dedicación completa, otros cinco son a la vez conductores de programas de noticias, un reportero más funge como productor de un programa de salud mental ajeno al noticiero para el que reporta. Tres de los participantes tienen el rol único de conductores de programas misceláneos y de revista con secciones de salud y nu-trición. Los dos entrevistados restantes son directores de noticias y re-porteros a la vez. Respecto del tipo de programa en el que ejercen sus funciones y a qué giro de radiodifusora pertenecen es como se estructu-ra la siguiente gráfica:


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Dado el anonimato ofrecido a los participantes, las citas textuales de las entrevistas se identifican con un número según el orden con el que las personas fueron entrevistadas, así como el cargo que ocupan. Lo an-terior permitió identificar la complejidad del fenómeno, el cual resultó en hallazgos que describimos a continuación.

Gráfica 1Tipo de radiodifusora y formato de programa, se

especifica el número de participantes hombres y mujeres que laboran dentro de los mismos

Fuente: elaboración propia

Radio pública

Radio privada

Programa informativo

Programa misceláneo

Programa de revista

Programa médico-psicológico

Mujeres Hombres

0 1 2 3 4 5 6 7 8 9 10 11 12

Catorce hombres y seis mujeres entrevistados en conjunto. La gráfica muestra cómo se distribuye la participación de cada uno de ellos en los programas radiofónicos investigados, se integran las radiodi-fusoras públicas y privadas.


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Hallazgos

Periodismo de salud en radio y sus factores de influencia

Aunque mucho se ha mencionado y discutido en publicaciones médi-cas sobre qué es la salud y la palabra misma se divulga constantemen- te en el contenido de los medios de comunicación, existen factores de diversa índole que influyen en ella. La Organización Mundial de la Sa-lud (oms) la define, de manera concreta, como “un estado de completo bienestar físico, mental y social, y no solamente la ausencia de enfer-medades”4. La Organización Panamericana de la Salud (ops)5 aportó un dato más: la salud también tiene que ver con el medio ambiente que rodea a la persona. En ese sentido, la oms establece una serie de componentes que integran la salud: el estado de adaptación al ambien-te (sociocultural) y la perspectiva social (relaciones familiares, hábitos, estilos de vida). La relación entre estos componentes determina el estado de salud y el incumplimiento o la alteración de uno de ellos puede ge-nerar alguna enfermedad. Situaciones de la vida cotidiana están siendo consideradas padecimientos y, en muchos casos, sometidas a tratamien-to farmacológico, psicológico e incluso quirúrgico. La salud, por tanto, resulta ser también una cuestión meramente subjetiva, por lo menos en lo que al bienestar se refiere. Es un asunto multifactorial en el que no queda exenta la presencia del factor político, mediático y publicita-rio. La concepción de salud, incluso de enfermedad, ha ido respondien-do a las transformaciones en el contexto periodístico, sobre todo en lo que se refiere a cómo los periodistas y comunicadores se relacionan con ello.

En el colectivo de profesionales entrevistados se identificó una cons-tante en cómo conciben a la salud y cómo esos imaginarios influyen en sus prácticas de producción. Resulta ser un término del que, a pesar de

4 Información del sitio web de la oms (www.who.int/es/)5 Consulte el sitio http://www.paho.org/hq/?lang=es


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dedicarse a ello, no poseen claridad ni congruencia que contribuya en sus prácticas profesionales. Las nociones de enfermedad y prevención se presentan constantes para ellos, lo que da pie al privilegio de deter-minadas fuentes informativas. Las opiniones de algunos de los entrevis-tados lo hacen evidente: “El periodismo para la salud es la herramienta esencial para que nosotros podamos comunicar a la gente cuestiones de enfermedades, cuestiones que nos afectan a nosotros como perso-nas” [Conductora, programa de revista, 2]. “Son estrategias que buscan prevenir o buscar una cultura de la salud, todo lo que se emite con la finalidad de prevenir o si ya hay alguna enfermedad, la gente se atien-da” [Directora de noticias, 3]. “El bienestar de la gente, el que tú estés sano, el que tú no portes ninguna enfermedad” [Co–conductor, 18]. “El periodismo para la salud es la divulgación, la difusión de notas, de even-tos, programas que estén relacionados con el bienestar, con el cuidado de la salud de los ciudadanos” [Jefe de noticias, 13].

De los 20 entrevistados, 15 de ellos no puntualizan a qué tipo de problemas se refieren ni cuáles son las condiciones que contribuyen en la conformación de un estado pleno de salud. De esta forma, en la mayo-ría se dibuja un escenario incompleto de su labor al informar. Las no-ticias y temas de salud no se tratan sólo de divulgar aspectos relacionados con enfermedades y avances médico-científicos, sino muy especialmen-te de cómo esos adelantos benefician a la persona, de cómo se pueden evitar padecimientos crónicos o de cómo ciertas pautas de compor-tamiento relacionadas, por ejemplo, con el ejercicio o la alimentación redundan en el bienestar y en la salud. Lo que no está del todo presente en las definiciones que ofrecen los entrevistados en este estudio.

Las entrevistas con el colectivo de periodistas y comunicadores poblanos reveló que los temas sanitarios son tratados desde una pers-pectiva declaracionista, es decir, la información en salud se centra prin-cipalmente en los discursos de las fuentes que consultan de manera frecuente. La tendencia es informar acontecimientos de carácter insti-tucional, no menos sobre métodos diagnósticos que satisfagan las nece-sidades económicas del médico o empresa del ramo, lo que permite


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identificar un alto grado de dependencia informativa, como ellos mismos argumentan: “En este caso sería el sector salud, hospitales regionales, hos-pital de la mujer, porque no hay aquí hospital de especialidades” [Directora de noticias, 3]. “Las fuentes de salud normal, el dif, la Secretaría de Salud, las presidencias municipales para verificar que ellos tuvieran apo-yos para quienes ofrecen este tipo de servicios de salud” [Reportero, 10]. “Las fuentes que principalmente tienen el grueso de la información: la Secretaría de Salud, el imss” [Director de noticias, 14]. Los entrevistados han interiorizado un criterio de noticiabilidad: la institucionalidad, es decir, la importancia de las fuentes oficiales, lo cual en términos em-presariales facilita la producción periodística, puesto que se elimina el tiempo invertido en contrastar, verificar y profundizar.

La relevancia de las fuentes se apareja a que se difunda lo que ella dice (Elías, 2008) sugiere o considera de interés: “Si el director de sa-lud da una noticia es porque tiene que ser algo importante para la gen-te” [Editor, 11]. “Si un médico tiene una campaña de diagnóstico o una institución la promueve, eso es de interés social para que cuiden su salud” [Reportera, 1]. Al final, las fuentes son cada vez menos y más institucionalizadas, pero con más poder, es decir, con mayor acceso al discurso en la radio. Martini (2000) apunta que las fuentes son los ac-tores que el periodista entrevista, que suministran información. Lo que significa que la noticia es una construcción social elaborada a través de relaciones que tienen que ver con procesos de socialización y valoración de las formas de interpretar y presentar la realidad, ponderando víncu-los sociales, políticos y económicos. Las prácticas periodísticas que se han descrito líneas atrás resultan poco favorecedoras dada la subjetivi-dad, es decir, el involucramiento personal del periodista a la hora de categorizar los contenidos en salud; lo cual se hace evidente en la forma en la que se relacionan con las fuentes informativas.

En lo que respecta al factor económico y lo determinante que resulta para entender el periodismo en salud desde Puebla, los entrevistados para este estudio resaltan que la existencia y vigencia de los programas dentro la programación diaria depende del financiamiento que representa la


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contratación de espacios publicitarios, pago por entrevistas, intercam-bios y convenios entre el medio, los médicos, la empresa o institución que lo requiera. Lo que influye en el abordaje, encuadre y emisión de la información. Detrás de las radiodifusoras está el poder económico:

“¿Participan médicos dentro del noticiero?”“Sí, como te decía yo, por temporadas o porque ellos nos adquieran

un paquete de publicidad. Pueden adquirir alguno y ya es como vienen a hablar de cierto tema” [Directora de Noticias, 3].

Esta situación permite discutir que lo que es mera publicidad apare- ce camuflada como información bajo la fórmula de entrevistas o notas informativas. Dentro de las disfunciones del periodismo que recoge Chimeno (2004) están la confusión entre información periodística en salud y contenido publicitario o propagandístico y el encumbramiento de ciertas figuras profesionales, así como el de sus productos y servicios en detrimento del interés de la audiencia. Por lo que las noticias no son el resultado de decisiones individuales, sino de procesos sociales en donde las organizaciones de medios tienen un lugar especial (Hernández, 1992). La opinión de los entrevistados revela la importancia de las rela-ciones económico–informativas dentro de la radio:

… que sepas lidiar con los médicos, que te lleves bien con ellos, es parte importante porque no te puedes pelear y el día de mañana no sabes qué cargo puedan tener, qué información te podrán dar o los espacios que pueda contratar aquí en la radio [Director de noticias, 14].

“¿Por qué los médicos se acercan a los noticieros para anunciarse y difundir sus temas?”

“Lo que pasa es que la gente los escucha más. Incluso se nota hasta en los costos de publicidad, un spot siempre te va a salir más caro en un noticiero que en una programación normal, que en un programa de revista o en un programa musical. Para los médicos es una garantía de éxito” [Productor de noticias, 7].


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La radio en específico, como soporte publicitario, debe atraer el máxi-mo de clientes para publicidad, pues, al igual que las demás empresas privadas, su objetivo es obtener recursos económicos. Lo analizado hasta el momento permite reflexionar que en nada existe un modelo interac-tivo o de participación que, como parte de la información que producen periodistas y comunicadores en sus medios, contemple a los ciudadanos como agentes activos dentro de los asuntos de ciencia y salud, mucho menos con rigor científico y periodístico. El uso general de escasas fuentes parecería condenar a la audiencia a informaciones donde impe-re la falta de pluralidad, análisis e investigación y nos lleva a determinar que existe desde las radiodifusoras una construcción de validez, confia-bilidad y credibilidad. Es decir: el médico se acredita al estar en el pro-grama y el programa por tener al médico, siempre mediando entre ellos el factor económico–publicitario que permita financiar los espacios por los que deben pagar a la radiodifusora una renta mensual que les garan-tice salir al aire.

Tienes la presión, en nuestro caso, que nos cobran una renta por el espacio. Desgraciadamente dependes de la publicidad, dependes de los patrocinios. En nuestro caso, cuando hablamos de un tema de salud es porque a un médico le interesa anunciarse y es entonces cuando hablamos de salud, no tan periódicamente como yo quisiera [Director de noticias, 14].

Estas relaciones económico–profesionales, dentro del proceso de pro-ducción informativa en salud, pesan en la autonomía de los mismos periodistas, la percepción que se han formado de sí mismos, de sus audiencias y de lo que significa la profesionalización en el campo, como lo agrupa la siguiente cita:

Cualquier medio de comunicación que inicia fuerte, con declaraciones fuertes, con el paso del tiempo se suaviza; ¿por qué?, porque ya le lle-garon al precio, porque tal funcionario, tal dependencia ya se anuncia


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ahí y ya tienes que ser hasta cierto punto tolerante con lo que comentes […] El medio que te diga que es independiente está mintiendo, por-que requieres de tus patrocinadores y desgraciadamente tocas intereses [Director de noticias–reportero, 7].

Bajo estas lógicas, la organización del trabajo periodístico se realiza de acuerdo con los ritmos y pautas que devengan de las fuentes cuyas actividades y declaraciones son noticiables en gran medida mediante los siguientes criterios:

a) Político. Actores sociales con determinada legitimidad suelen con-vertirse en fuentes informativas recurrentes: gobiernos de los es-tados, presidencias municipales, oficinas gubernamentales.

b) Comercial. Durante la práctica se observó cómo a los anuncian-tes se les ofrecía cobertura y difusión de ofertas especiales por el pago de la publicidad contratada.

Este sesgo en la información puede generar expectativas irreales que contribuyen, según Orueta et al. (2011) a la medicalización de la vida moderna, entendida como el proceso que pretende resolver, mediante la medicina, situaciones que no son médicas, sino sociales, profesiona-les o de las relaciones interpersonales, es decir, la masificación de las consultas al médico de familia y a los servicios de urgencias. No es re-quisito imprescindible ser científico o médico para ser divulgador de esos temas, sino tener curiosidad e interés, responsabilidad, confianza en sí mismo y, a la hora de producir y divulgar las informaciones, con-trastar los datos con fuentes fiables y buscar más referencias. Pero estos ingredientes profesionales en la actitud de los entrevistados para este estudio parecen estar también en crisis. Herman y Chomsky (2000) refieren que los trabajadores de los medios buscan obtener información de fuentes a las que el público pueda considerar como confiables, el go-bierno y las empresas son ejemplos de estos orígenes de la información.


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Niveles de gobierno como territorios de producción informativa

La organización territorial, en tanto sectores de gobierno, es el principal criterio para desarrollar una estructura que sea la base para la recolec-ción de información. El análisis de las entrevistas permite identificar que la composición orgánica de la entidad, dividida en tres administra-ciones: estatal, municipal y regional, sirve para constituir la producción de contenidos. Las citas concentran el argumento:

“La administración del gobierno es la que tiene una cobertura impor-tante, dependiendo también de qué es lo que se esté haciendo por parte de ellos. A veces la visita del gobernador, o que ya inauguró una obra, etc. La administración local, o sea la que tiene que ver con lo que hace el presidente municipal o sus regidores o los directores de área, por ejemplo, la Dirección de Salud o el dif Municipal. Por ejemplo, luego tenemos los enlaces con otro compañero reportero que nos informa qué está sucediendo en lugares como Tlatlauqui, Zaragoza, dependien-do” [Director de Noticias, 14].

“Se basa principalmente en la actividad del gobierno estatal. La im-portancia informativa que se le da a una nota, por ejemplo, de alguna comunidad u otra región, está en la medida en que genera algún tema relevante como puede ser el desabasto de agua o que sucedió algún accidente. Y la información local o municipal es la más importante por-que a la gente que te escucha le interesa saber qué es lo que está pasando aquí” [Periodista, 9].

En la mayoría de las estaciones de radio investigadas (siete de 11) existe la organización territorial como un primer nivel de estructura informa-tiva interna que marca la pauta en el proceso de construcción de las no-ticias en sus diferentes fuentes, la de salud no es la excepción. Las cuatro estaciones faltantes organizan la información procedente de órganos de gobierno más próximos a ellos, como el ayuntamiento municipal. Pero


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existen los grandes problemas de la población que son muchos, diversos y amplios, pero prácticamente no aparecen del todo en el discurso de los programas sujetos de investigación. Se incluye en el contenido de los programas de radio sólo la parte visible de eso que los sujetos de estudio denominan periodismo en salud (los funcionarios, las instituciones, los médicos y sus servicios).

Siguiendo con la estructura orgánica del Estado como organización informativa territorial, esta depende también de la cobertura geográfica que el espectro radioeléctrico les garantice, pues eso implica que llegue a más lugares y, por tanto, la información que produzcan y difundan pueda ser de interés para los escuchas de esas regiones. Mención espe-cial merece en este apartado que algunas de las estaciones de radio for-man parte de grupos radiofónicos cuyo propósito es cubrir gran parte de la entidad con sus programaciones y contenidos, como lo concentra uno de los entrevistados:

“Nosotros tenemos una amplia cobertura, tenemos mucha gente que nos escucha en varios puntos del estado gracias a que tenemos algunas repetidoras u otras estaciones que son parte de la empresa y eso tam-bién nos da pie a que la información se maneje casi de la misma forma” [Gerente, 12].

Ante esta situación se puede señalar que, en las radiodifusoras, la cons-trucción de la noticia viene determinada por la estructura organizacional de las dependencias que forman parte del gobierno estatal. Investiga-ciones que, aplicando técnicas de observación, se introducen en las salas de redacción para conocer las formas en que trabajan los periodistas, develan influencias presentes en la actividad cotidiana que afectan la producción final de los contenidos. Ahí tenemos el trabajo de Gans (1979), que viene a mostrar cómo las decisiones de los periodistas es-tán condicionadas por infinidad de factores estructurales, tanto internos como externos al medio, que conducen a que los profesionales acaben reflejando las ideas y valores de los poderosos, sin ser muy conscientes


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de ello. Esto supone que los periodistas se interesen más por los asuntos de fuentes institucionales que están concentradas en la capital del Estado, sus regiones y municipios. Así lo señalan los entrevistados:

“Tenemos reporteros dedicados exclusivamente a la información políti-ca del gobierno, del presidente municipal o a veces también cubren las actividades de algunos diputados o, por ejemplo, ahorita que se vienen las elecciones algunos vamos y checamos lo que está pasando con ellos. Hay otros que cubren la información de seguridad pública, la nota po-licíaca o, incluso, se van a cubrir notas de salud a los hospitales” [Editor Periodista, 19]

“Lo que hay es una especie de jefatura con una serie de responsables que cubren información del gobierno, de las escuelas, de las oficinas regionales, gente asignada de forma permanente a fuentes como la de deportes” [Productor–Editor, 11].

Podemos hablar, entonces, de una organización informativa interna en donde la importancia de las instituciones públicas influye en las deci-siones de los responsables de los espacios noticiosos sobre cómo organi-zar el trabajo diario. Si bien diferentes investigaciones han demostrado que el periodismo padece muchas disfunciones, quizá una de las más graves sea la cada vez mayor dependencia de pocas fuentes que, además, están revestidas de autoridad. Estudios como el de Guerrero y Márquez (2014), en donde se aborda el sistema de concentración económica y de propiedad de las concesiones de los medios de comunicación, indi-can que estos se encuentran actualmente capturados, tanto por fuerzas políticas emergentes como por intereses empresariales que muy poco se relacionan con la labor periodística, y que han devaluado el rol informativo y de escrutinio de los medios, al igual que limitado la autonomía profesional de los periodistas. El propio trabajo de las radios comunitarias en países latinoamericanos ha sido capturado por actores económicos y políticos. Como lo muestra Araya (Guerrero y Márquez


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2014), el trabajo de campo de las radios comunitarias en Chile conti-núa reproduciendo modelos verticales de comunicación en donde hay un emisor que ar ticula y unas audiencias pasivas que pudieran “reaccio-nar”. Todo lo antes expuesto favorece que la profesión siga siendo vista por algunos actores sociales como una manera efectiva de intervenir en la producción de contenidos radiofónicos.

Discusión y conclusiones

Al revisar los imaginarios profesionales que tienen periodistas y comu-nicadores sobre la salud, y cómo determinan su cobertura, se puede establecer que resultan cuestionables por varios motivos. En primer lu-gar, se identifica la presencia del mítico modelo del déficit, propuesto por Lewenstein (2003)6, asociado al limitado y sesgado concepto de salud que tienen los aquí entrevistados. El modelo del déficit describe la falta de conocimiento del público que debe ser llenada con la premisa de que, al arreglar dicha deficiencia, la información y el entendimiento de esta será mejor. La postura que asumen los participantes en este estudio manifiesta que su actividad se dirige a suplir esa carencia informativa tratando de acercar el conocimiento sanitario de manera que sea com-prensible para un público no experto. Sin embargo, la principal crítica apunta a que los recursos informativos de los que hacen uso distan de ser considerados fuentes expertas en lo que a salud y ciencia se refiere. Esta situación hace evidente la alta dependencia en las fuentes de in formación “tradicionales” (visita de rutina a los funcionarios–fuentes, recolección de declaraciones, entrevistas pactadas). Los estudios de per-cepción pública de la ciencia han evidenciado que las actitudes hacia

6 Este autor menciona que a pesar del esfuerzo que se da en comunicar la ciencia, la industria de la radio y la televisión no ha obtenido resultados favorables. Lewenstein señala que la falta de contexto es la principal debilidad, y añade que las teorías de la educación señalan que hay un aprendizaje más significativo cuando hechos y teorías tienen un significado en la vida.


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la ciencia y la tecnología no dependen exclusivamente del nivel de co-nocimiento científico (Atienza y Lujan, 1997), sino de un trabajo de investigación más completo por parte de los periodistas. En segundo lugar, las relaciones de dependencia informativa que han establecido los aquí entrevistados arrojan que no consideran dentro de su campo de acción contenidos sobre los usos sociales del conocimiento médico- científico, menos los impactos negativos a futuro en salud. Mayor oferta de información no significa mejores oportunidades de apropiación, mejor oferta formativa no implica mayor volumen de apropiación ciu-dadana, puesto que las actitudes negativas o la desconfianza en las fuentes informativas puede llevar al fracaso en la generación de una cul-tura científica (López, 2005).

Este estudio arroja luz en cuanto a la influencia de las relaciones de poder entre política, economía y radiodifusoras, en las que se maneja desde estas últimas una visión limitada del proceso de divulgación de la salud que desatiende consideraciones de calidad en el proceso de pro-ducción informativa. Por tanto, persiste una forma de ejercer el periodis-mo de fuerte tradición histórica que continúa privilegiando la difusión de declaraciones oficiales de orden político, sumado a las relaciones comer-ciales al interior de las radiodifusoras que determinan el tipo de infor-mación en salud que se difunde. Se trata de una cultura periodística y de co municación que construye un modelo descendente de difusión, no de los mínimos asuntos médico-sanitarios que abordan, sino de los de orden político y comercial en salud. Es, como se grafica en el esque-ma siguiente (Figura 1), un proceso de traslación de información pro-ducto de la cobertura recurrente a determinados agentes, utilizando como criterio de calidad la presencia obligada de las declaraciones de las fuentes informativas impuestas por la jerarquía institucional. En este circuito in formativo, periodistas y comunicadores fungen como reco-lectores y emisarios de discursos que, con el mínimo esfuerzo de inter-pretación, difunden a través de la radio para consumo de la audiencia.


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El desafío resulta en cómo evitar que este modelo vertical de infor-mación y la cultura de producción lineal del quehacer periodístico en salud desde Puebla sigan vigentes, lo cual afecta no sólo la función de divulgación a través de la radio, sino el proceso de participación y apro-piación del conocimiento sanitario por parte de las audiencias. La per-tinencia de estudiar la radio es un tema vigente, sobre todo porque ha jugado un papel determinante en la consolidación de la ideología que transmiten las instituciones dominantes.

Los profesionales de los medios interesados en informar sobre sa-lud deben fijar sus objetivos más allá del acto de dar a conocer algo: ahondar en el papel formativo. Es necesario que se muestre aquello que de otro modo las audiencias no sabrían, contribuyendo a formar una población con más conocimiento sobre diferentes aspectos de la salud, sin limitarse a aquello que los periodistas piensen que las audiencias deben saber (Waisbord y Coe, 2002). En buena parte las deficiencias se han atribuido, como se concluye en este estudio, a la precaria forma-ción especializada de los periodistas.

Figura 1 Modelo descendente de difusión

Fuente: elaboración propia

Periodistas Comunicadores

Fuentes institucionales y privadas

Audiencias

Información


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Una cultura periodística de calidad debe ser crítica y responsable y, en el caso de la ciencia, la tecnología y la salud, con conocimiento de sus riesgos, de las posibilidades de transformación en contextos espe-cíficos y de los dilemas éticos que conllevan. Esta especialización debe insistir en hacer conciencia acerca de la necesidad de información cien-tíficamente validada, equilibrada y experta para disponer de mejores elementos de juicio. Con las informaciones que el periodista recolecte, procese y difunda debe procurar que las audiencias hagan uso de ellas tomando decisiones de consumo, diagnóstico y exposición a productos tecnológicos, médicos, alimenticios, etc. Estos rasgos de comporta-miento deberían ser considerados a la hora de prefigurar los asuntos a tratar en cualquier pieza informativa dentro de las radiodifusoras, aten-diendo al valor personal y riqueza de esta y no sólo a la cantidad de información recogida (Welsh y Wynne, 2013).

El asunto aquí tratado permite reflexionar que el periodismo y la comunicación deben ser herramientas que ayuden a reorientar los es-fuerzos en materia de salud hacia lo que la sociedad está demandando: mejores servicios, accesibilidad, atención, cuidados, etc., y no sólo la emisión de discursos institucionales e información sesgada. Es ahí donde en contramos una de las principales razones por las que en el periodismo, cualquiera que sea su campo de interés, se hace énfasis en la importan-cia de la especialización, en la producción de contenidos procedentes de fuentes diversas y capaces de mostrar la mayor cantidad posible de án-gulos de la realidad que se intenta reflejar (Sanmartí, 2003). Los perio-distas que dediquen su trabajo a los asuntos de salud pública deben ser lo suficientemente aptos para producir contenidos incluyentes, con-centrándose en necesidades y problemáticas de poblaciones específicas (Aumente, 2005) adecuados a las prácticas de salud, los valores, las creencias, la cultura y las características socioeconómicas de esas audien-cias. No sólo hay que intentar informar a la audiencia, debe procurarse que esa información sea científicamente correcta y ese debe ser un asun-to prioritario: tener plena seguridad de que lo que se dice es científica-mente correcto y válido.


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Welsh, I. y Wynne, B. (2013). Science, Scientism and Imaginaries of Publics in the uk: Passive Objects, Incipient Threats. En Science as Culture. (22), 4, 540-566. Recuperado de: [http://www.lan caster.ac.uk/people-profiles/Brian-Wynne#publications].

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Los autores de este número

Elizabeth ReedyElizabeth Reedy holds a ma from the University of Chicago and a PhD from the University of California at Irvine. She studies expertise, risk, and expertise about risk. Her current research is on Mexican seismi-city and she teaches at Bucknell University. http://elizabethreddy.info/

Joseph GustiJoseph Guisti is a doctoral candidate in the department of sociology at Northwestern University, Chicago, Illinois, us. He received his ma in sociology from Northwestern University in 2012 and his ba in socio-logy with a minor in “society and genetics” from the University of Ca-lifornia, Los Angeles, us. He is also a doctoral fellow in Northwestern’s Science in Human Culture program. [email protected]

Lucano Romero CárcamoMaestro en Comunicación por la Universidad Iberoamericana, Ciu-dad de México. Productor, periodista y locutor de radio con más de 15 años de experiencia, varias de sus series y producciones radiofónicas han sido premiadas en diferentes ocasiones a nivel nacional e inter-nacional; destacan el Premio Internacional de Periodismo Colombine 2015, el Premio Nacional de Periodismo “Rostros de la Discrimina-ción” (del cual ha sido ganador tres veces), el Premio de Reportaje de la Bienal Internacional de Radio 2010; el Premio Nacional de Docu-

Elizabeth ReddyElizabeth Reddy holds a ma from the University of Chicago and a PhD

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mental Radiofónico 2008, entre otros. Ha participado en proyectos de investigación, par ticularmente en Worlds of Journalism Proyect, lidera-do por la uia y la Universidad de Miami, y en el Journalistic Role Performance Around the Globe Project. Sus inquietudes dentro del campo académico se han concentrado en el fenómeno de la producción infor-mativa radial sobre contenido de salud. En su labor como periodista, en 2009 fue nombrado Embajador por la No Discriminación en Medios de Comunicación por el Consejo Nacional para Prevenir la Discrimi-nación (conapred). Ha impartido cursos, talleres, conferencias y cla-ses a nivel licenciatura en algunas universidades de México en las áreas que competen al periodismo y la producción radiofónica. [email protected]

Sandra González SantosEstudió psicología en la Universidad Iberoamericana (Ciudad de Méxi-co), una Maestría en Comunicación de la Cultura Científica en la Uni-versidad de Bath (Reino Unido) y realizó un Doctorado en Sociología en la Universidad de Sussex (Reino Unido). Su enfoque metodológico y analítico son los Estudios Sociales de Ciencia y Tecnología (Science and Technology Studies, sts), específicamente referente a la bioética. Es profesora de asignatura en el Departamento de Comunicación de la Universidad Iberoamericana en licenciatura, maestría y doctorado, par-ticipa en el Programa Universitario de Bioética (pub) de la unam y es coordinadora de proyectos interdisciplinarios en el Centro Nacional de las Artes. [email protected]

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Lineamientos y normas generales para la recepción de originales

• Todas las colaboraciones serán recibidas exclusivamente en el correo electrónico [email protected] y por ese medio se ofrecerá retroali-mentación a los colaboradores.

• Todas las contribuciones deberán ser originales y cumplir con las nor-mas editoriales aquí expresadas para poder ser sometidas al proceso de dictaminación correspondiente.

• El artículo o reseña que se postule para ric no deberá ser postulado para ninguna otra publicación o revista de forma simultánea.

• El envío de cualquier colaboración implica la aceptación de todo lo que se establezca en las presentes normas editoriales, así como la autorización para que el trabajo sea publicado en los diversos medios en los que se difunde ric.

• Todas las colaboraciones aceptadas para publicar deberán ser some-tidas a un proceso de corrección de estilo y su publicación estará su-jeta a la disponibilidad de espacio en cada número.

• Para la presentación de un dossier, el proponente debe indicar en no más de una cuartilla el tema u objeto de estudio a tratar, la impor-tancia o relevancia del mismo para el campo académico de la comu-nicación y los posibles autores de los textos que lo compondrían. Es deseable, en lo posible, incorporar también los títulos tentativos de dichos textos.

• El formato de presentación y recepción de los textos será word (.doc o .docx), tamaño carta, con tipografía Times New Roman a 12 pts; 1.5 de interlineado y márgenes iguales de 2.5 cm por lado.


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• Los títulos de películas y textos se presentarán en cursivas y, de pre-ferencia, en español; se indicará también su nombre en el idioma original.

• Las imágenes sólo serán aceptadas en formato .jpg en blanco y negro con una profundidad de 300 dpi. Estas deberán ir en una carpeta separada del texto pero que indique el lugar exacto de su ubicación, tanto en el artículo como en las imágenes.

• Cada texto deberá estar acompañado por un resumen de no más de 200 palabras y su traducción al inglés. Asimismo se agregarán 5 térmi-nos clave sobre el tema del escrito en cada idioma. En el texto también se debe señalar la sección para la que se propone dicho original.

• El nombre del documento deberá indicar el primer apellido del autor, sus iniciales y el nombre abreviado del artículo.

• Todos los originales deberán tener un documento anexo que contenga todos los datos de localización del autor, su adscripción actual y una reseña curricular breve de no más de 150 palabras.

• La extensión máxima para los artículos no deberá exceder las 35 cuar-tillas, incluida la bibliografía.

• Los textos para las secciones Entrevistas y Reseñas no deben exceder las 30 y 10 cuartillas, respectivamente; y deben seguir el formato in-dicado en las Normas para la presentación de reseñas críticas.

• De acuerdo a la cantidad de artículos recibidos, pedimos a los autores considerar un mínimo de seis meses a partir de la recepción del ar-tículo para recibir una notificación final del resultado.

Normas para la presentación de reseñas críticas: • Las reseñas deben de tener la naturaleza de comentario crítico refe-rido al contexto académico en el que se inscribe la obra.

• Deben ofrecer una presentación breve del contenido de la obra rese-ñada.

• Debe destacar la relevancia de la obra para el campo académico y su pertinencia dentro de uno de sus nichos de investigación.


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• Es deseable que contenga un análisis de la discusión académica en la que se inserta la temática de la obra reseñada y destacar las aportacio-nes del texto en su área de conocimiento.

Normas para la presentación de entrevistas: • Debe ir acompañada de una breve introducción del tema u objeto de la entrevista y reseña académica del entrevistado.

Normas para proponer traducciones: • Debe ir acompañada de los datos del traductor, así como de las referen-cias bibliográficas del texto traducido.

• No hay límite de páginas para las traducciones.

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Visita nuestras revistas electrónicas

www.ibero.mx/publicaciones

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Para mayor información comunicarse a la Universidad Iberoamericana. Prol. Paseo de la Reforma 880, Col. Lomas de Santa Fe, C. P. 01219, Ciudad de México, Tel. 5950 4000 / 9177 4400, exts. 4919, 7600 y 7330, [email protected], www.ibero.mxpublicaciones


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Sumando esfuerzos: el diálogo entre los estudios CTS y los estudios en comunicaciónSandra González Santos

warning in a social and material worldBeth Reddy

Students or experts? Unpacking addiction treatment center operators' mixtos

Joseph Guisti


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