Abstract

Introduction

Assuming the health field as a research setting, it is possible to recognize a fertile territory with many possibilities for methodological designs, given its intense and complex network of social, educational, political, epidemiological, clinical, economic, management, and care issues, among others. In the health area, different objects with potential to be researched circulate, and it is up to those interested to identify the best path to follow for the construction of the investigation.

The way we develop research in the health field can be presented as studies that employ numerical variables, which result in quantitative-based investigations, and studies whose main question is related to what is produced in the encounter between people, to the singular, to the life that is also in the numbers or, alternatively, where numbers cannot access. However, qualitative research is still considered by some to be a superficial approach with empirical weakness and doubtful neutrality¹1 Taquette SR, Minayo MCS. Ensino-aprendizagem da metodologia de pesquisa qualitativa em medicina. Rev Bras Educ Med. 2015; 39(1):60-7.. In this case, when understood in this way, they fail to consider or realize that they are studies committed to understanding the lived reality with all its impertinences, incongruities, and irregularities, typical of the movement of life.

Qualitative studies consider the uniqueness of the individual, because his subjectivity is a manifestation of total living²2 Minayo MCS. Análise qualitativa: teoria, passos e fidedignidade. Cienc Saude Colet. 2012; 17(3):621-6. (p. 623). If the largest amount of research operates in the construction and correspondence of neutrality between subject and object, this should not and does not invalidate the fact that other relationships, such as the subject-subject relationship, can coexist in the territories of research fields. There are other ways of expanding contact indeed, which collaborate and facilitate the production of knowledge. A movement that places us before different conjunctures that produce deviations and build new territories for the research setting.

The research that advances towards the construction of a field of investigation in real circumstances, with real subjects, - which, in face of the various ways of life, launches us as researchers to unexpected situations - has, many times, these situations not considered as a source for the construction of knowledge. These are circumstances that produce facts, events that throw differences in the construction of hegemonic knowledge and that escape the design previously established for the research that we will call repetition.

If etymologically the word method means metaphor ‘behind, then, through’ and hodos ‘way’; should we consider that there is only one way to build paths? Or can we elaborate ways of doing from observation, from the demand of what we study? If we elaborate a path that reflects what the researched field asks for, it is important to incorporate those singular paths can produce deviations and, thus, place the researcher in new and different territories of existence.

We wage our bets on the construction of research that advances in the radicality of the manifestation of intense living and that starts to reflect on the researchers’ posture in the field, that is, an investigation in which the new territories can be incorporated as elements of the research, producing changes in the researcher, in the participants, and in the context, while launching the investigation to different forms of knowledge. A research formulation in which the participants integrate the research scenario and produce themselves as subjects, in the same act of knowledge production, in a double construction: subject and knowledge³3 Abrahão AL, Merhy EE, Gomes MPC, Tallemberg C, Chagas MS, Rocha M, et al. O pesquisador IN-MUNDO e o processo de produção de outras formas de investigação em saúde. In: Gomes MPC, Merhy EE, organizadores. Pesquisadores IN-MUNDO: um estudo da produção do acesso e barreira em saúde mental. Porto Alegre: Rede Unida; 2014.. A dynamic of total living that is built from the problem to be investigated, in territories capable of producing change on the lived reality, incorporating the event, that which provokes changes in the research design, in the increment of the study.

In this essay, we aim to proceed with the idea of event as central to the production of research, aiming to present the reflection of a group of researchers, highlighting the debate from the concept constructed by Deleuze and Foucault associated with the dynamics of the subjects involved. A theoretical reflection that originates from a multicenter investigation, in the period from 2013 to 2016, in Family Health Units, in the city of Rio de Janeiro.

Prescribing a qualitative research model is not our intention, for we understand that each research is unique and singular. What we intend is to provoke the debate about the various forms of knowledge production based on the singularity of the subject and, therefore, on the subjectivity of living. It is, then, about making available to the academic community our experience, and theoretical reflection, about the production of research in the health field.

Reflecting on qualitative research from the concept of event, following Foucault and Deleuze

Where the reflection comes from

The presented essay explores the concept of event as a central element for the production of the research, and started from a multicenter investigation called “National Observatory of Care Production in different modalities in the light of the process of implementation of thematic health care networks in the Brazilian National Health System (SUS): evaluates who asks, who does and who uses”, in the period from 2013 to 2016. The research, which aimed to evaluate the production of care in several areas of the SUS, involving managers, workers, and users through a Shared Care Network (RAC), was approved by the Research Ethics Committee of the Federal University of Rio de Janeiro, opinion CEP nº 876.385.

The purpose of the research was to enter the health care networks and evaluate them based on who asks for, who does, and who uses the production of care in SUS; that is, the users, managers, and professionals. A shared evaluation under the eyes of these actors, seeking to produce knowledge in the manifestation of total living. “This is because the knowledge to be produced cannot do without what occurs in the act of caring, since only those involved in this place can bring certain information to the research scene, even in a fragmentary way”⁴4 Feuerwerker LCM, Merhy EE, Silva E. Como temos armado e efetivado nossos estudos, que fundamentalmente investigam políticas e práticas sociais de gestão e de saúde? A pesquisa sobre acesso e barreira na saúde mental. In: Feuerwerker LCM, Bertussi DC, Merhy EE, organizadores. Avaliação compartilhada do cuidado em saúde: surpreendendo o instituído nas redes - Livro 2. Rio de Janeiro: Hexis; 2016. (p. 13).

The proposal of the study differs from traditional research, because it builds a territory of investigation architected in the encounter between the actors who were part of the research. A methodology focused on the singularity of the production of health care and the movement of care networks instituted by the Ministry of Health, as a policy for the SUS. This is a movement that summons the dynamics and disputes that inhabit the field of production of health care and knowledge.

As a multicentric study, there were different RAC research fronts distributed throughout the country, precisely 12 states participated in the study with distinct insertions and strategies in the care networks, centered on the need to construct encounters of the subjects in the health networks.

The encounters, held in the different fields, occurred from what we call in-worldization.³3 Abrahão AL, Merhy EE, Gomes MPC, Tallemberg C, Chagas MS, Rocha M, et al. O pesquisador IN-MUNDO e o processo de produção de outras formas de investigação em saúde. In: Gomes MPC, Merhy EE, organizadores. Pesquisadores IN-MUNDO: um estudo da produção do acesso e barreira em saúde mental. Porto Alegre: Rede Unida; 2014., between the various subjects involved with the objectives of the RAC. To experience being an “in-world” researcher is to break with the subject-object structure. “Other forms of knowledge production do not operate within the subject-object paradigmatic split of the so-called hard sciences; on the contrary, they operate from the perspective of the constitution of the research subject in the world, in-world, with the object”³3 Abrahão AL, Merhy EE, Gomes MPC, Tallemberg C, Chagas MS, Rocha M, et al. O pesquisador IN-MUNDO e o processo de produção de outras formas de investigação em saúde. In: Gomes MPC, Merhy EE, organizadores. Pesquisadores IN-MUNDO: um estudo da produção do acesso e barreira em saúde mental. Porto Alegre: Rede Unida; 2014. (p. 156).

Based on the encounter, monitoring the movement of care networks in the field of qualitative research, we began a debate on the various forms of knowledge production based on the uniqueness of the subject and, therefore, the subjectivity of living. By following the movement of managers, users, health professionals, and the movement of each researcher himself, we identified a process of knowledge that was being built during the course of the study.

The concept and the tool event

The proposal of the RAC, which guided the study, implied the production of encounters, in collective acts capable of producing knowledge about caring. The encounter provokes and produces double movements of escape lines, reveals debates, disputes, accommodations, and gains concreteness by inaugurating new ways of verbalizing the event, and the production of knowledge among the actors involved in the research⁵5 Deleuze G. Lógica do sentido. São Paulo: Perspectiva; 2007..

Thus, we take, in this essay, the concept of event⁵5 Deleuze G. Lógica do sentido. São Paulo: Perspectiva; 2007.:

In this way, we discard the idea of event as a succession of facts, as a daily routine or as something inherent to culture, or something detached from the collective or transcendent to the encounter. We look at what could be considered a banal fact through repetition and give it the singular look; we extract there in the repetition, the difference, what is. What unites the notion of event with history is the novelty of the Foucauldian theory of practices⁶6 Deleuze G. Foucault. Paris: Les Éditions de Minuit; 1986.. The book Order of Discourse⁷7 Foucault M. A ordem do discurso: aula inaugural no Collège de France. São Paulo: Loyola; 2009., when addressing event, makes a distinction between the present and the actual, between today and now, considering the interrogation of actuality as a way to problematize it as an event, a permanent reactivation of an attitude⁸8 Foucault M. Nietzsche, Freud e Marx e o Theatrum Philosoficum. Porto: Publicações Anagrama; 1980.. Since truth is inseparable from the singularity of the event⁹9 Foucault M. Histoire de la folie à l’âge classique. Paris: Gallimard; 1972.. What is considered as true is not established in the act, it is produced as an event, with particular space and time. A non-universal truth, which is produced in the event¹⁰10 Candiotto C. Verdade e diferença no pensamento de Michel Foucault. Kriterion Rev Filos. 2007; 48(115):203-17. Doi: https://doi.org/10.1590/S0100-512X2007000100012.
https://doi.org/10.1590/S0100-512X200700... . Therefore, a truth that deserves to be questioned and problematized in the time and space of the event, allowing us to know and get in touch with the truths that circulate in the field, in the territory of what is lived.

We incorporate event as what it is in the act, in essence, a permanent reactivation and in becoming, a minority force of a process of comings and goings whose goal is transformation, the becoming, in the encounter. They are singularities that present themselves at that moment and that can de-territorialize us, momentarily taking us out of context, irremediably impelling us to reflection. It holds within itself a creative power, the very power necessary for the reorientation of the logic of services (as, for example, the reorganization of a work process or the offer of services) and for the construction of subjects.

Event, as a force in research, is the result of this reflection, its meaning, that which provokes us to produce a horizontalized reflection on the process of knowledge production. It is a reconstruction of the territory in which the subject-object relationship is established. And a territory of research in another perspective.

In this case, we are not referring to the classical perspective, but to the construction in which

The research, when it incorporates the event, provokes an exercise in which the methodological design is produced in the contact with the field, to the extent that the subject is activated by the view of the point allowing the multiple possibilities of the experiment to require this or that research technique (here the researcher can avail him/herself of different qualitative research techniques), with room for the construction of methodological innovations during the study. In this sense, the researcher is “lightly” prepared for the field, since he/she uses the methodological arsenal, his/her theoretical-methodological toolbox, but with plasticity for the incorporation of the event, of the demands that the field triggers with the encounters between the study participants.

The lightly prepared researcher is sensitive and available for the various types of triggers that the field provokes, being able to use techniques, concept-tools, and research methods according to the call made by the encounters built in the research scenario, that is, to be lightly prepared is to have a creative and Amerindian toolbox.

Happening, as reflection in the act of investigating, leads us to reflect on the encounter:

The event as a research tool operates in the plasticity of being in front of the other, to what he/she brings with him/her as truth, as well as to what we carry with us. In these encounters, we get in touch with the different regimes of truths that we operate in our daily lives. This mechanism requires analysis of the logics and rationalities present in the act of encounter. A delicate movement of construction is essential in the development of a research that focuses on the singularity of the subject, the subjectivity in the manifestation of total living, incorporating the event as what it is, pure in the act.

The type of research that proposes to incorporate the event and that places the encounter as something fundamental and singular does not present facilities for the researcher because it deconstructs the construct that there would be a conductor in this process, once it horizontalizes the relationship researched-researcher by redoing the subject-object relationship and starts working the notion of subject-subject. This way of operating is different from most research and carries in itself the need for a researcher who allows himself to be in the encounter with the other and not seek total control of the next step, who learns to experience the event, who is the protagonist of the research as much as the other, who, in principle, would be the “object” of study.

In the horizontal relationship, the encounters directly affect our potency to exist and to act, provoking, respectively, increases or decreases. These encounters are produced together, there is no separation; however, there is variability. Everything that can arise from them, including possible concrete actions, will effectively depend on the movement of what is affected¹³13 Abrahão AL, Gomes MPC, Chagas MS, Costa MA, Santos NLP, Freire MAM, et al. O pesquisador, o objeto e a experimentação: a produção do conhecimento IN-MUNDO. In: Feuerwerker LCM, Bertussi DC, Merhy EE, organizadores. Avaliação compartilhada do cuidado em saúde: surpreendendo o instituído nas redes - Livro 2. Rio de Janeiro: Hexis; 2016.. However, more than the result, or whether it was a powerful encounter or not, it is important to perceive and reflect about the impulse produced in the encounters that cross us.

The event as becoming includes looking at and welcoming bad encounters as well, even if we encounter resistance from them that discourages us, both in research and in the work we develop in the health system. However, as they are part of everyday life, they cannot be ignored; and, if revisited, they can become a very powerful source of analysis¹⁴14 Gomes MPC, Merhy EE, Silva E, Abrahão AL, Viana L, Rocha MC. Uma pesquisa e seus encontros: a fabricação de intercessores e o conhecimento como produção. In: Gomes MPC, Merhy EE, organizadores. Pesquisadores IN-MUNDO: um estudo da produção do acesso e barreira em saúde mental. Porto Alegre: Rede Unida; 2014..

On the other hand, good encounters, because they increase our potency to exist, are much easier to take in. Reflecting about the impulse of the encounters is difficult, because they are related to the singularity of the affected bodies. Sometimes we simply have the satisfaction of an accomplished duty, other times of finding the thread, instigating the professional to action; other times we are invaded by discouragement and let ourselves be involved by the absence of power.

For the researcher, the persistence of not giving up, of trying once more to live with the obvious, as a novelty - which, most of the time, has always been present uncritically at our disposal - is always a challenge. It is part of the craft, becoming ingrained in us. Thus, a certain plasticity is needed, to welcome the unexpected and be willing to re-edit oneself as a professional and as a person, to recognize that the other is different from us and that this should not prevent experimentation from the perspective of the event.

Final notes for reflection

The form of knowledge production that is based on the singularity of the subject and, therefore, the subjectivity of living, with the presentation of a theoretical reflection about the field in research, guided the production of this essay. Observations allow us to take the concept of event in health research as the construction of an investigation permeable to what emerges in the encounters, as it seeks to avoid a priori thoughts and positions and has a commitment to the transformation of the subjects (researchers, health professionals, and users), and should not be detached from daily life.

When we place the experience as a key element to know and produce knowledge, we are referring to the idea of being available to the crossings, affections and strangeness that come from the care processes in the health field. Qualitative research techniques are incorporated into this process, establishing a research field in real circumstances, with real subjects.

We can identify as newness, in the exercise of knowledge production, what can be or be in what is considered already known, but that can gain new looks on the daily doing that is capable of being provoked to review from the questioning of an outsider, or the subject itself decides to review its own acting and doing. These “provocations”, invitations to reflect on what one does, occur as the research goes on, and the doing together appears and must be problematized.

The “doing with” recognizes that all subjects involved in the research are researchers, co-participants in the investigation process and, therefore, holders of different knowledge, which, by mixing together, are capable of producing something new or even of producing a different way of saying something about something that was already established. By provoking reflection on the ways of doing that occur horizontally, the saying of these arrangements that are placed in the research field, gain another format. It is not about producing novelties, but revealing another perspective, on the same point, stimulating the subject to be activated by the point of view.

To reflect on qualitative research, including the becoming event, is to recognize the present powers and offers of existing knowledge in the health field in order to avoid dichotomies, thus advancing in the production of ways of knowing that are closer to the reality experienced.

References

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