Expanded answers to bureaucratic questions: Negotiating access to public healthcare

Abstract

This article analyzes expanded responses to statistical-epidemiological questions at a mental health outpatient service at a public hospital in Buenos Aires, Argentina. Bureaucratic questioning is a highly routine activity which supplies information to the biopolitical apparatus of the modern State. We understand that expanded answers are meaningful actions which not only serve individual, local tactics (such as raising personal concerns), but also index higher contextual levels. In this sense, resisting the constraints of a question may also imply resisting State-defined policies of biopolitical classification and exclusion. We examine, from a discursive interactional point of view, 41 admission interviews held at the outpatient mental health care service. We observe four types of expanded answers which: (a) display competence in bureaucratic discourse; (b) move from the sphere of the public to the private; (c) deal with potential facethreats; and (d) pre-empt rejection. Although the former is actually an optimized way of collaboration with the biopolitical order, the latter three types can be seen as actions of resistance to classification, not only symbolically but also in material terms: resisting statistical criteria of exclusion allows clients to negotiate access to mental healthcare.

en este art ıculo analizamos respuestas expandidas a preguntas estad ıstico epidemiologicas en un hospital publico de buenos aires, argentina. los cuestionarios burocraticos son una actividad rutinaria que alimenta el aparato biopol ıtico del estado moderno. consideramos que este tipo de respuesta es una accion significativa que no solo responde a tacticas locales individuales (como presentar preocupaciones personales), sino que tambi en indexicaliza niveles contextuales mas altos. en ese sentido, responder resistiendo los condicionamientos impuestos por una pregunta puede tambi en suponer una resistencia a las pol ıticas estatales de clasificacion y exclusion. examinamos, desde una perspectiva discursiva interaccional, 41 entrevistas de admision a los consultorios externos de salud mental. observamos cuatro tipos de expansion, las cuales: muestran competencia en el discurso burocratico; se desplazan de la esfera publica a la privada; enfrentan amenazas potenciales a la autoimagen; buscan anticiparse al rechazo. aunque el primero pueda verse como una forma optima de colaboracion, los otros tres tipos pueden verse como forma de resistencia a la clasificacion, no solo en t erminos simbolicos, sino tambi en materiales: resistirse a los criterios estad ısticos de exclusion le permite a los pacientes negociar el acceso a la salud mental.