Friday, September 19, 2008

Week 2 Health

Foucault, M. (1978). Right of death and power over life. History of sexuality, vol 1 (pp. 135-159). New York: Vintage.

Crawford, R. (2006). Health as a meaningful social practice. Health, 10, 401-420.

Klawiter, M. (2008). Selections from The biopolitics of breast cancer: Changing cultures of disease and activism. Minneapolis: University of Minnesota Press.

Foucault asserts that the beginning of the seventeenth century was marked by the replacement of the ‘ancient right to take life or let life’ with a power that fosters life or disallows it to the point of death. According to Foucault this power over life evolved in two basic forms: an anatomo-politics of the body and a bio-politics or regulatory controls of the population. The disciplines of the body and the regulation of society are the two poles in which the power over life was now organized. Sex provided an avenue to both the ‘life of the body’ and the ‘life of the population’. The politics of sex revolved around junctures of the ''body'' and the ''population.'' Sex became a crucial target of a power organized around the management of life rather than the threat of death. The main power mechanism of blood lineage was replaced with an ‘analytics of sexuality’. The anatomo-politics and bio-politics are made up of technologies and knowledge of the body that extends power beyond the state to the fields of medicine, education and the state. The mechanisms of power are now addressed to the body and to life instead of its preceding preoccupation with death and sanguinity.

Foucault describes power as being decentralized, that is, power is everywhere and nowhere. With a federal election in both the U.S.A. and Canada I am reminded of the question, “who’s in power”? In other words, what political party is in power? Have we ‘still not cut the head off the king’?

Crawford’s article illustrates the recent emphasis that has been placed on ones life or this life (as opposed to the afterlife). He provides a historical analysis of the health (healthism) movement. One of Crawford’s main points is the multiple meanings and metaphors ‘health’ has come to encompass, namely, health as a symbol of control, health as individual responsibility and health as a stratifying or ‘othering’ mechanism. Linkages between the development of health as a personal responsibility, neo-liberal ideology and middleclassness are discussed. The paradox of individualizing the responsibility of health and the proliferation of health based risks that are beyond the individual such as environmental issues is examined.

What is Crawford saying about health practices in the 21st century? The movement toward contemporary health practices involved neo-liberal ideology and the emergence of the professional middle class. Crawford states a wall has been built based on the symbol of individual control that cannot be breached. Does this mean Crawford thinks there will never be a socialist or democratic perspective on public health?

The biopolitics of breast cancer: Changing cultures of disease and activism is a study of the breast cancer movement that looks beyond the state as the key ‘mobilizer’ of social movements in response to poststructuralist and feminist critiques. Using Foucault’s conceptualization of power and ‘social movements without a sovereign’, Klawiter provides an alternative analysis of the breast cancer movement in the San Francisco Bay area during the 1990s. Klawiter discusses her approach by first discrediting previously popular methods of analyzing social movements for their fixed attention to the role of the state. Klawiter takes her analysis beyond the state and acknowledges the dynamic participation of various social actors and institutions in the Bay area breast cancer movement. Questions of how and why the breast cancer movement occurred are contributed to changes in the anatomo-politics and bio-politics of breast cancer.

How has Klawiter used the concept of a social movement without a sovereign? Is she simply referring to a decentralized and diverse concept of power in the Bay area breast cancer movement?

A common thread of technologies of the body, power and health wove through this week’s readings. However I am not entirely sure how to take them up as a package. It was helpful to see some modern application of Foucault’s concepts clearly in the Klawiter article and somewhat discernable in Crawford’s piece. There was a lot going on in all the articles, I am looking forward to reading your responses.

5 comments:

Nat said...

Reading Foucault, as well as the other authors this week, reminded me of last weeks’ readings on the body. I found that Foucault, while stressing that power now extends beyond the limits of the state, was very much focused on the body and how it was culturally, politically and historically socially constructed and it was interesting to see him develop this idea.
I also liked the idea that one of the functions of “sex” is to give each individual access to their own identities, bodies, and intelligibility – but I sometimes found that to contradict something he would say later, making me question whether I had misinterpreted.
He suggested that “It is the agency of sex that we must break away from, if we aim – through a tactical reversal of the various mechanism of sexuality – to counter the grips of power with the claims of bodies, pleasures, and knowledges, in their multiplicity and their possibility of resistance. The rallying point for the counterattack against the deployment of sexuality ought not to be sex-desire, but bodies and pleasures” (p.157), which I found interesting, especially after he said sex can allow access to ourselves to such an extent that some might say (or might have said) it is worth dying for. But I wonder, is what he meant by the “ficticious point” of sex?

Thinking about Karima’s question “who’s in power?” led me to think of power in the hands of the institutions and regulatory bodies that surround health. I think health is still very much controlled by upper and middle class white men – often in the form of physicians, pharmacologists, and politicians. Notions of the social construction of health only show how this power is on an ever-changing continuum, but still reinforce the notion, for me at least, that even if power has been decentralized from the state, it is not “everywhere and nowhere” as Karima suggested, it’s just being portrayed differently in order to make it look like it has been decentralized. I feel as though the fact that so much of “health” is still being defined, medicalized, and (hetero)normalized shows that there are still very much “men in power”.

But I also liked Crawford’s notion of the “fantasy” of individual control when it comes to (individual) success and health and his suggestion that the SELF is held to be sovereign (p.417). I feel like both are very valid and relevant today. There is this very real heteronormative (white) masculenized power, yet at the same time there is this individual sense of power that makes it possible for (lay?) people to feel that they hold control over their own destinies. I think both are important and need to be addressed side by side when looking at theories of health through a social constructionist lens.

I thought Klawiter used the concept of “social movement without sovereignty” exactly how she said she would: to place the relationship between power and bodies at the center of the analysis (p.21) – although I’m making the answer to simple.
She agreed with Foucault in terms of the limits of state power while still believing that the state shouldn’t be ignored. She saw the constantly increasing “interpenetration” of the state, science, medicine and social movements and her poststructuralist approach to the study of health-based social movements helps to show how these agencies interact rather than keeping them as separate entities as previous models had done. I liked Klawiter’s obvious applications of Foucaults theories as well – they made the link between the two articles pretty self explanatory and made Klawiter a lot of fun to read :)

Marty said...

First off, I liked this week’s readings more than last week’s because I thought as a whole they were clearer and focused more on issues that are interesting to me (social movements, power, capitalism, etc). I like articles that focus on the macro, or the “big picture.”

Karima has a good summary of Foucault’s work, stressing the role of history and how there was a change from a sovereign’s power to take life to an anatomo-politics of the body and a bio-politics of the population. Her question about “who’s in power?” or “what political party is in power?” brings up a good point. I think symbolically we still haven’t “cut off the head of the king” because the language of democracy makes us think that we have the individual power to elect a government(s) and shape our own world. The brilliance of Foucault is that he quite convincingly shows us that the state is only one aspect of the power over life that evolved in the 17th century. I also like how Foucault connects this evolution in the anatomo-politics of the human body and a bio-politics of the population to the emergence and needs of industrial capitalism. Marx isn’t too far away here.

Much like Nat, I made a distinct connection between Karima’s question about “who’s in power” and the regulatory institutions surrounding health that Crawford focuses on. And while I share her view that white men hold the balance of power in the area of health, I would add that white men dominate almost every area of mainstream institutional society. I think this is due to their violent claims over the ownership of capitalism and democracy since the 17th century and how they took the lead in the administration of bodies and the calculated management of life. Did anyone else think of colonization after reading Foucault and Crawford? I think looking at the process of colonization through a Foucauldian lens helps us understand it better; white people stretching their sphere of influence to take charge of as many lives, or bodies, as possible to continuously regulate and correct them for the project of capitalism.

Just to continue briefly with the Crawford article, I felt a little uneasy about his definition of our culture as a “health-valuing” culture. First off, I agree that we have come to define ourselves and judge others in part by how well we succeed or fail in adopting healthy practices. Yet, I don’t think we necessarily associate bad health with bad person, or bad body. A lot of people still think smoking is cool, or risking your life is cool. Isn’t popular culture still filled with unhealthy or unsafe images that are connected to conceptions of power and the pursuit of happiness?

K said...

I am going to start this response with what I feel might seem a simple question about Foucault’s word choice.
“We, on the other hand, are in a society of “sex,” or rather a society “with a sexuality” ” (p. 147)
“It is apparent that the deployment of sexuality, with its different strategies, was what established this notion of “sex” ” (p. 154)
“Sex—that agency which appears to dominate us and that secret which seems to underlie all that we are, that point which enthralls us through the the [sic] power it manifests and the meaning it conceals, and which we ask to real what we are and to free us from what defines us—is doubtless but an ideal point made necessary by the deployment of sexuality and its operation” (p. 155)
“It is through sex—in fact, an imaginary point determined by the deployment of sexuality—that each individual has to pass to in order to have access to his own intelligibility…, to the whole of his body…, to his identity.” (p. 156)
“So we must not refer a history of sexuality to the agency of sex; but rather show how “sex” is historically subordinate to sexuality.” (p. 157)
What I don’t understand is: what are the precise differences between sex and sexuality within this context? And what does Foucault mean by the deployment of sexuality?

Moving on, I really liked Marty’s challenge to us as a health-valued culture. I think that Crawford’s article failed to address a lot of the competing discourses, not all of which are coming from a medical institutions. In many ways it made me think of Bynum’s criticism of the oversimplification of history. I find this most striking given Crawford’s HIV/AIDS example. I completely agree with him that the PLWHA is still an extremely stigmatized body, especially when he makes reference to social space and one’s HIV-positive body being treated as a vector of disease (but in daily human interaction but especially in health literature). And yet, the behaviours that are the potential vectors of transmission for HIV/AIDS are in many ways still glorified: not by the dominant discourse that chastises many sexual activities and drug use, but in other sub-populations. Furthermore the example of the bare breasted activist in Klawiter’s article complicates this in the case of breast cancer where ‘we’ don’t know that much about its etiology, and yet the site of the body’s physical transform as a result of cancer led one person to tears and another to epithets. At risk of falling prey to what Foucault criticizes so intensely, making everything about sex (or sexuality because I can’t tell the difference with him) and thus reinforcing sex as universal, I thought it interesting that both Crawford and Klawiter used exampled of illnesses that are seen to compromise one’s sexual desirability. Are we more afraid of not being desired than we are of death? Would obesity have served as a commensurate example?

It strikes me as a different between what the dominant discourse dictates to be acceptable and the way competing discourses digest that information. I feel like Marty’s comment about the cultural capital in risk taking is a part of an alternative performance of masculinity, one that is in fact countering the capitalistic masculinity, which through consumption, is feminized. Risk taking, such as playing in traffic drunk, smoking, less than safer sex, eating red meat, etc. also takes a certain kind of cultural capital to engage in without social consequence. I am thinking of the way anyone on the street will stop to inform a smoking pregnant woman how out of line she is and that she has crossed over from ruining her own life, to that of the fetus.

This is more of a pleasure question than an ‘on topic’ question, but, Going back to Foucault, I wondered how shaping sex in a discourse of life, as Foucault states that it has been for a long time whether or not we have noticed, should affect sex-education pedagogy that is so often consequence focused? I am referring specifically to his passage on page 147 but have abused the word count to the point where I should just stop here.

Samantha said...

A very interesting discussion once again. Thanks for getting us going, Karima. I think I'll continue in my agenda setting role and make a list of the key questions we might address tomorrow: 1) How is political power with a capital "P" different from a Foucauldian notion of politics and power? Karima and Marty both question whether we have succeeded in cutting the head off the king. I would agree that we haven't, and that we can't, given the context in which we live where sovereign power, biopower and disciplinary power operate simultaneously and with a potency that is highly dependent on context. Nat sees a Foucauldian model of power as something of a ruse. She claims that power may seem dispersed but it is actually still located in particular bodies and attached to particular identities. Let's talk about this: Where do bodies and identities fit into a dispersed mode of power, a power that operates from below? What is the difference between holding power and exercizing it? 2) Karima points to the importance of neoliberalism...but what exactly does this word of the moment mean? How is it different from liberalism? And what is the relationship of health as a social practice to neoliberal ideologies? 3) Kat's provocative list of quotes from the Foucault reading are enough to make my head spin, but they raise a very good question: what is the difference between sex and sexuality for Foucault? And how or why does the difference matter? 4) Both Kat and Marty worry that Crawford erases what Foucault would call "subjugated discourses" about health, risk, and the body. I'd like to interrogate this point and thinking about the relationship between gender identities, class location and risk seems like a good place to start the conversation. 5) Coming full circle, back to politics with a capital P, all three articles are centrally concerned with the state, or to be more precise with with decentering the state. Why? And to what degree to they succeed in that mission?

Andrew Rasta said...

I didn’t get a very positive outlook on the change of power distribution from this week’s articles, as they seem to all work the same way but have evolved through time as different structures.
Foucault’s examples of the father’s power to give and take life coupled with the state’s power to go to war and threaten life were under the auspices of a sovereign power, which eventually evolved into sex/sexual power, controlled in a less violent, not quite as direct way by the men patriarchally, where sex and sexuality imposed the controls and power structures medically onto society. Then lastly health was identified as the overarching power structure that “others” people, imposes controls and fuels the neoliberal fire of individualism and its power represented in Healthism (Crawford).
This all seems to be the same end of power and control, but through a different means, negotiated by the political situation of the day.
Further to the question posed by Karima earlier, wondering if public health could ever have a socialist or democratic perspective considering the symbolic wall that has been built around individual control: I would have to say no. I don’t know how there could ever be a democratic or socialist way of looking positively at a power structure. Public Health is still a control or force imposed regardless of whether an individual is imposing it on his/her self or if a society is democratically imposing a public health regulation.
I think public health could become more social or democratic, but only through who it is serving, not how it serves. It may serve a broader range of people in a more effective manner, but in the end it is still a regulatory body that will impose controls in one way or another. I guess it depends on weather you value positive or negative liberty: freedom to or freedom from.