#foucault tag

[caden-archive]

autechres asked: Just saw a tweet claiming Necropolitics as an "annoying little article" that aimed at biopower wrongly (as in, misunderstood it) and consequentially attempted to debunk Foucault from his high status in academia at the time, making the concept even more difficult to parse. Would love to hear your take on it because I have Opinions that are very much in conflict with this premise, but anyway. https://twitter.com/matthiasellis/status/1848801297820225583

mostly disagree with this person as well – for one thing, foucault’s own formulation of biopower / biopolitics was scattershot and incomplete (second perhaps only to heterotopias in this respect) and i have always read mbembe’s work more as developing foucault’s idea than diverging from it. i would also question the idea that foucault ever had uncritically positive reception or that this has meaningfully changed since the aughts – certainly i don’t think either thing is true in academic history, where foucault has always been controversial, has become less so in the past 2 decades, and is still consistently cited despite the open knowledge that he was a bad historian. but this person’s bio says media studies, which is not an academic discipline i have ever paid close attention to, so maybe things are different in those circles.

in any case there are major problems with mbembe’s article, namely the utter lack of class analysis that leads him to make extremely facile remarks on eg the ‘terror’ (not a term most historians of the period even take seriously anymore) and on the use of force in marxist theory-practice to compel the overthrow of a dictatorship of the bourgeoisie (which also mbembe seems to think would be a singular historical moment signifying a total rupture in commodity production and little else.. hm!). similar problems dog his analysis of palestine: he frames the colonial occupation as a clash of two religious narratives, and discusses the actual process of occupation in terms of the infrastructure israel builds and maintains, but with little to say about the material impetus for doing so (i believe there are maybe two or three mentions of the phrase “resource extraction” in the essay, and these are not developed). these are not problems that result from a misreading or misunderstanding of foucault; they are endemic to foucault’s own mode of analysis and have always been one of the major condemnations of his work (in addition to the aforementioned poor historical analysis and lack of basic archival / primary documentation; these are of course overlapping issues, though it is certainly possible to do detailed archival work while still engaging in a fundamentally idealist mode of analysis, and many academic historians do).

where mbembe is most useful imo is in his remarks on sites and practices of 'living death’, which i think are totally consistent with, but an expansion of, foucault’s remarks on biopolitics. i also think it can be useful to analyse things like the form of state power / force, the infrastructure of a colonial occupation, etc – these things matter, it’s not that i find them irrelevant concerns. but what foucault and his ilk, including mbembe, continuously get wrong is that they try to use the forms and appearances (of 'power’, of governance, etc) as explanations of why things happen, even as moral condemnations of them happening – without attending to the class character of such forms. the result is a metaphysics of Power, sans concern for who is wielding it and to what end, and little to no engagement with the historical specificity of each case – thus, for example, the theoretical conflation of jacobin guillotinings, revolutionary proletarian suppression of the bourgeoisie, and israeli occupation of palestine. these are such abstracted writings not because mbembe misunderstands foucault but because he understands him quite well, i think.

[pea-green]

Power, Control and Institutions in Call the Midwife

I combined two of my fave things (ctm and sociological theory) and wrote an essay. 

“Foucault’s theories addressed the relationship between power and knowledge, and how they are used as a form of social control through societal institutions"; this essay discusses how the themes within Foucault’s writing have been drawn upon within recent episodes of Call the Midwife, specifically with Sister Mary Cynthia’s storyline, and more generally about the role of medicine within society.

The first medical framework, identified by Jewson in his work on the development and production of medical knowledge, is what he terms `person-orientated’. He argues that, prior to industrialisation and ‘age of enlightenment’, the physician was required to view the patient as a holistic entity. Medical judgements were made by physicians in terms of the personal attributes of the sick individual rather than a list of symptoms. Foucault argues that, with the industrialisation of both society and medicine, people are attended to by professionals who view them with a ‘clinical gaze’; rational, emotionally detached individuals who hold both knowledge and power over patients, who attend to diagnosed symptoms rather than more general (eg. social) ills. Call the Midwife posits Nonnatus House, centred within the society to which it dispenses medical assistance, as a person-oriented alternative to the more institutionalised hospitals, with strict visitation hours, rigid shift patterns, and little room for personal connections between medical staff and patients.

Foucault himself makes no distinction between the power and knowledge of institutions, and in the most recent episode Sister Mary Cynthia sits at the intersection of the medical authority of the institution and the moral authority of the church (she has been sent to the hospital on the orders of Sister Ursula); she is entirely at the mercy of both. In contrast to the coercive power of a prison, the medical institution asserts authority by identifying and explaining individual problems (illness such as depression) and then providing a solution (treatment in the form of ECT) for them. Call the Midwife has graphically depicted ECT as treatment before, a last-ditch solution unapproved by the nurses of Nonnatus, and more recently underscored the dangers of blind acceptance of the medical industry’s authority by showing the real-world impact over several episodes of the ‘wonder drug’ thalidomide.

As Sister Mary Cynthia herself argues, within this medicalised framework she is not seen as an individual and the promotion of ECT as treatment is more for the benefit of the institution than herself. Drawing upon Foucault’s work, Illich termed this phenomenon ‘iatrogenesis’, which “refers to any effect on a person, resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services as beneficial to health, that does not support a goal of the person affected”; in a societal context it also refers to the way in which medicine is seen to have undermined people’s ability to manage their own health. Within an industrial society, the medical machine ‘contains’ aspects of society such as childbirth, illness, pain, death and dying, shielding them, to a greater or lesser extent, from the rest of society and vice-versa.

Call the Midwife repeatedly questions the need to remove such individuals from society; while men are still not allowed to be present for childbirth, the midwives encourage home births except in exceptional circumstances, and this is often seen as social event, with women from several generations able to immediately celebrate the newest addition to the family, or grieve together in case of tragedy. Sister Monica Joan is shown to have occasionally debilitating health problems, most obviously her failing memory, but the question of sending her to an institution is always immediately shot down, and emphasis put on the responsibility of the nuns and nurses of Nonnatus to care for her in her old age. It is not coincidence that Sister Monica Joan accompanies Fred to visit the institution; SMJ argues that “I find that two opinions are better than one, particularly if one is mine”; she is aware of her own frailty (although the show takes pains to remind viewers of her usefulness and occasional sound memory when she tells Valerie she was there at her birth) and fears institutionalisation more than anyone else at Nonnatus, and it is she who discovers with horror the conditions in which Sister Mary Cynthia has been kept. Like Sister Monica Joan remaining with her sisters, the Reggie’s storyline ends with his joining a collective with others like him where, rather than being cared for by relatives who are well-meaning but hold power/knowledge over him, he has more freedom to control his own existence.

The function of Nonnatus House as an Institution in its own right has been alluded to throughout the series from its beginning; the three vows taken by the Sisters of Nonnatus, as discussed by Sister Evangelia in a previous series are poverty, abstinence and obedience. This parallels the four characteristics of ‘the individuality that discipline constructs’ (controlling the space, activities, reproduction and combination that individual bodies may undertake), which Foucault argues are implemented by institutions for the means of control. The main difference is that for the most part, individuals are imprisoned within the institutions Foucault discusses (prison, the asylum, etc.) against their will, whereas the nuns actively choose to take on the vows to bring themselves closer to God.

The obedience part of the vow for all the nuns at Nonnatus have become bent this series; Sisters Monica Joan and Winifred have each, in their own ways, exhibited disobedience prior to Sister Ursula’s appointment, but where their actions were previously self-serving (breaking Lenten fasts, going to the cinema), the resistance to the new absolute rule are for the direct benefit of patients. Sister Julienne, previously the moral authority at Nonnatus has acted against orders but still in accordance with her own moral code, a freedom not allowed under traditional institutional frameworks.

In his writing about ‘the modern disciplinary institution’, Foucault draws heavily upon Bentham’s ideas of the ultimate realisation of such an institution: the panopticon. This all-seeing tower creates an ‘unequal gaze’; those within the institution could never be sure when they were being watched or not. The nuns at Nonnatus are under constant observation of the eyes of God and this is evidenced as both comfort and burden. Sister Mary Cynthia, in great distress, talks about not knowing what is being asked of her; firstly in Nonnatus, while being comforted by her sisters, unsure of God’s plan, and later in the Institution, when she doesn’t know what behaviours she needs to exhibit in order to be released back to Nonnatus’ care. Sister Julienne mentions that Sister Mary Cynthia “lives to serve others”; she alone has never struggled with the vow of obedience, does not fear the eye of God or the tower seeing immoral actions, instead fearing her observed inaction will lead to judgement and ruin.

During her time at Nonnatus Sister Ursula was committed to efficiency above all else, which fits in with Foucault’s model of the power/knowledge dynamic by the medical institution. The nurses of Nonnatus do not have time to regard the patients and their bodies as individuals, merely as symptoms in need of a cure. The Maternity Home, which provides medical assistance but also social connections for mothers-to-be and enough individual assistance to be old-fashioned, even by the standards of 1962, does not fit in with this model. For the last two series, various characters have made reference to the number of women choosing not to give birth attended by the local midwives at home, preferring instead the facilities of the hospital.

Within this narrative, the midwives of Nonnatus represent the 'person-oriented’ framework of medicine; for example, Trixie volunteers to 'hold the hand’ of a pregnant patient who needs emergency dental work. Dentistry, Trixie points out, is not remotely within her medical training, but she will find time to assist the patient on the basis that it is “best for her and baby”. An episode previously, a mother who gives birth in hospital to a stillborn has the child whisked away before she can see it. Delia expresses distress at denying the mother her wishes to see the baby, but the ward matron insists that this course of action is “best for the patient”. The viewers later see the mother asking Shelagh extremely basic questions about what her baby might have looked like; this emphasises the knowledge/power dynamic discussed by Foucault (the mother had no knowledge of childbirth and therefore no power during it) and the importance of the Nonnatus model of a more person-oriented approach to caring with women during and after pregnancy.

With Sister Ursula gone, Sister Julienne is free to run Nonnatus as the person-oriented health provider she wishes it to be, and appoints a new nurse based partly on those shared values. The challenge for Nonnatus going forward is most immediately the safe return of Sister Mary Cynthia and ensuring her full recovery using the understanding and love that only her sisters can provide, and, more long-term, justifying itself in the face of efficiency drives and patients actively choosing a more detached, economical model of medicine over the more traditional services offered by Nonnatus.

Drawing from Foucault and his contemporaries, the most recent series of Call the Midwife has explicitly condemned the control and unequal power dynamics offered by medical institutions; most obviously the Institution in the most recent episode, but hospitals more generally. It advocates instead for a more holistic, compassionate method of treating illness, mental health, pregnancy and childbirth. This continues the show’s campaign for more community-based politics, and an idealistic liberal ideology which is impractical and unlikely to enact any real change, but still important in a time where the NHS is demonised in the press and in financial turmoil; a show consistently drawing in millions of viewers discussing these issues raises awareness (of these issues and many others) if nothing else.

References: here, here, here

[caden-archive]

yeah foucault’s view of medicalisation was top-down and oversimplified and not really grounded in empirical or material analysis of how diagnosis functions and why. but also every foucault hater who writes about this is a spineless liberal producing doctor apologia and refusing to even engage with the most basic critique of capitalist medical authority so its always like [grits teeth]

foucault’s own analysis focusses on the relationship between medical and juridico-legal authority – which is partly a result of his case studies being essentially limited to 19th century france, a situation in which doctors were consolidating disciplinary prestige & professional privileges, & where physicians by the end of the century were an extremely powerful political bloc (second in number only to lawyers in the national legislature under the third republic, &frequently serving in lower and municipal political roles throughout the century, not to mention extremely influential in the scientific rhetoric & administration of colonial expansion).

however the case study being what it was & combined w/ foucault’s general commitment to a left-libertarian conception of individual freedom means his analyses have little to say of patients’ own responses to things like diagnostic creep. his presumption generally is that processes like medicalisation were impositions from above, either resisted or else tragicomically taken up by those who were made unwitting collaborators in their own subjugation.

what his liberal critics reply with then is almost always some version of their fantasyland where actually, the fact that doctors don’t literally control the entire Government (nb: poor understanding of what a state is) means that this is all fine, actually, and some doctors were/are really nice to their patients, and some patients WANT to be diagnosed anyway, so how can we possibly blame medicalisation on doctors or say it’s a bad thing if we care about patients??

what both foucault and his detractors generally miss then is the extremely basic observation that a diagnosis has multiple functions as a social technology, & one of them is to grant access to specific, limited, rationed accommodations & help. & as long as those resources are gatekept behind the diagnostic code, there will always be people who need the resources but don’t have the chart label. & whether they are fully conscious of the material analysis of diagnostics or not, this is one of thee foremost concerns for patients and patient advocates who fight to broaden diagnostic categories.

but neither foucault nor most of his critics are like, good at being interested in distinctions like this that require you to think about the material outcomes of social processes so instead you just get pages and pages of pablum written as though like. patients trying to expand the autism diagnosis have exactly the same material interests and outcomes as physicians giving pharma company sponsored talks about ‘pre diabetes’. unserious as one says.

[caden-archive]

Anonymous asked: your asks about mental illness/psych and the separation of illness and the person affected kind of reminded me of foucault’s birth of the clinic, so if. u have any thoughts on that work id love to hear them! (sincerely, a philosophy student that enjoys reading ur blog posts)

yeah for as much beef as i have with foucault there are reasons why his fingerprints are still all over history of medicine and science. i think the problems with birth of the clinic are largely the same as the general problems with his historical analyses, namely that he used really limited evidence, mostly british and french written work from physicians and government officials; he was writing very specifically about the 19th century french case, which is fine except he didn’t always seem fully aware of the consequences of working in a specific local case; he sometimes did a poor job of differentiating between the discursive and the political, and presumed the former led 1:1 to the latter; &c. i have written some more on him in my tagged/foucault, i think mostly in regards to the lectures on biopolitics. with birth of the clinic the other really egregious issue imo is, again because of a lack of proper historical context and analysis, he often presents the teaching hospital and its medical epistemology as specifically parisian in a way they simply were not.

however the broad thesis of this text, the idea that the medical practices and epistemic assertions characteristic of the 19th-century teaching hospital were not self-evident or representative of intellectual progress as such, and that they were instead contingent and enforced and contested ideas that ultimately served both physicians as a professional class and state-building endeavours—this is a useful framework and continues to generate or at least encourage a lot of insightful work. i tend to think of madness and civ, birth of the clinic, and the order of things as belonging to their own kind of cycle for this reason and for the most part when i criticise them, my problems are usually more about foucault’s failure to execute his own historical methods than his description or justification of such methods. altho where the biopolitical aspects are more explicitly concerned i also think there’s a lot to be said about his general avoidance of class analysis in favour of a pretty liberal conception of individuality and individual freedom.

[caden-archive]

Anonymous asked: hi! was wondering if you have any recs for some good critiques of Foucault’s historical method (or lack thereof)? I enjoy reading his theory but I know his methodology can be lacking and would love to learn specifically how. ty <3

i don’t have a text off the top of my head that is solely dedicated to making this critique of foucault (usually it’s scattered into various historical literature) but i can just tell you:

foucault the historian has the consistent problem of relying on too few primary sources, almost all of which are french or english, meaning his claims are often only applicable to limited local cases (even the differences between the highly centralised, bureaucratised french state and the british situation tend to get flattened). his sources also tend to be authority figures like doctors and government officials, and he frequently makes the assumption that the powers they claim to have (or claim they SHOULD have) are powers they actually do have, which leads to a ‘top-down’ history that presents authorities and institutions as almost infallible in their efforts to repression, with virtually no attention paid to how people actually received any such mandates, and whether they were actionable, or subverted, or both. he also has a real problem conceiving of liberty in any terms but individual; politics for him is frequently characterised by a group vs individual struggle, which is a problem if what you are trying to understand is, say, the history of class struggle.

as a philosopher foucault articulated some general methodological guiding principles that remain useful in history: genealogical and archaeological methods, the call to historicise (meaning, to problematise; to contextualise) institutions and ideas presented as timeless or transcendent. there are also concepts in his historical narratives that other people have since fleshed out further, nuanced, and grounded in better evidence and 'bottom-up’ histories, like biopolitics. so it’s not unusual to see his name pop up in historical footnotes, especially in an introduction or conclusion where he may form part of a conceptual framework the author is using to interpret their evidence and turn it into a viable argument. but even these usages are certainly subject to critique (eg, the emphasis on individual liberty that suffuses his conceptual work; the extent to which his arguments can apply beyond the specific early modern metropolitan french contexts about which he was writing) and he should pretty much never be cited as a historian because his methodology in that respect was at best lacking.