I’ve been reading a lot of Foucault recently, particularly The History of Sexuality volumes and their surrounding lectures. Guided by the helpful hand of Stuart Elden, I was reading his Foucault’s Last Decade on the train back from Newcastle last night and found myself immediately amused, the next day, to see grumbling about yet another right-wing use of Foucault’s thought for lazy and reductive purposes.
Our good friends over at Sp!ked, recently discussed, have today published an article by Patrick West on why hospitals are like prisons, just not in the way Foucault thought. West writes:
Foucault saw the tendencies to try to control, normalise and rationalise everything as ubiquitous in industrialised society. ‘The judges of normality are present everywhere. We are in the society of the teacher-judge, the doctor-judge, the educator-judge… [E]ach individual, wherever he may find himself, subjects to it his body, his gestures, his behaviour, his aptitudes, his achievements.’ Foucault asked: ‘Is it surprising that prisons resemble factories, schools, barracks, hospitals, which all resemble prisons?’
But is a patient really in the same predicament as a prisoner?
Good question. You’ll likely find the answers you’re looking for in Birth of the Clinic. Discipline and Punish, seemingly the sole focus of West’s understanding of Foucault, focuses explicitly on infrastructures of discipline and punishment, State apparatuses, etc. — that is, the organising processes of power that provide institutions and their representatives with certain kinds of authority. But it is disingenuous to use that to frame Foucault as some critic of judgement in general.
For starters, a major part of Foucault’s project is precisely discerning the different modes of operation of power and how these aren’t always instructive or interventionist. In a psychiatric context, he talks about how many early forms of psychiatry (and still many other forms today) are not necessarily predicated on medical intervention at all. “The observing gaze refrains from intervening: it is silent and gestureless. Observation leaves things as they are; there is nothing hidden to it in what is given”, he writes. The problem is when these observations can be instrumentalised in other contexts, with medical diagnoses, in particular, become juridico-political evidence rather than simply being used to construct a treatment plan. This is how psychiatric diagnoses are sometimes still used today, of course. A psychiatrist observes; it is more likely a judge who decides on prison time or an enforced hospitalisation for someone who has committed a crime but may have diminished responsibility — and never that is a very recent and notably humanising development in Foucault’s genealogy. Nevertheless, in that respect, the line between hospital and prison remains very fine. (Has West not seen One Flew Over the Cuckoo’s Nest?)
It is worth noting that Foucault’s analysis is even more detailed than this, across his whole body of work. Particularly interesting in this context, I think, is his discussion of abnormality and monstrosity when regarding our understanding of sexuality and gender over the last few hundred years. Foucault notes that there is gradually a shift from just executing all intersex or otherwise gender-nonconforming people as satanists and “monstrosities of nature” to later enforcing people to dress one way or another (affirming one particular gender/sexual identity and expressing that within how they dress and who they have sex with — i.e., always the opposite sex) and therefore deeming them to be “monstrosities of behaviour” instead. This is important, because behaviour can be corrected… Nature, we’re led to believe, cannot.
The idea, of course, is that any tendency within society that hopes to change how people act is tyrannical. So TERFs decry the tyranny of pronouns — a “campaign” to change how we speak — whilst failing to acknowledge the centuries of bodily essentialism and “normalisation” they themselves are sorry sycophants for. By turning Foucault on his head, as West later acknowledges he is doing, we end up seeing Foucault deployed as some defender of libertarian infantilism, which reduces biopolitical agency to just doing and saying whatever you, as an individual, want to do. (A common line from Sp!ked, as discussed last time.) This position frames all discipline as tyrannical whilst completely ignoring the ideological discipline they are already exercising, in attempting to replicate the wanton unaccountability of power today.
That these things are complex, however, is ignored at the earliest opportunity. West instead goes on to say that “the power relations in hospitals are ambiguous.”
When a medic administers an injection or tablet, is she exerting her power over me, my space and my body? Or is the medic unwittingly doing my bidding, helping me to recover from an infirmity that was not her fault. Failure to do her duty here will result in her own very real discipline and punishment. As a patient, the medic is my servant. And as a citizen, the NHS worker is my employee.
To turn Foucault on his head, you could easily argue that it is the medical staff who are the slaves, rather than the masters, in the NHS Panopticon. Those in the blue and green uniforms, the masked and overworked, are expected to metaphorically slave all day for the needs and whims of those of us who lie around all day, doing nothing but eating, reading, sleeping or messing around on the internet.
In truth, it’s a power relationship that goes both ways. And it ultimately works to the benefit of both parties. Medics earn a living by making people better and saving lives. They gain a well-deserved feeling of actually doing good. In turn, we as patients hopefully recover and make our way back to normality.
I find this flattening out of Foucault’s argument, making it utterly impotent, very bizarre. Nothing is mentioned here, of course, about how Foucault repeatedly problematised our very idea of “normality” explicitly, showing how it always shifts in line with power more broadly. This leaves West to embrace as “normal” a perspective that is, in fact, completely ideological (in that it is aligned to our prevailing and still-dominant “capitalist realist” ideology.)
To unpack this a bit, I’d argue NHS doctors don’t really work for us at all. Though our taxes may pay their salaries, the NHS remains precariously subject to the whims of a corrupt Tory establishment that wants to privatise everything and siphon off the profits for themselves. This is because, Foucault himself tells us, socialised medicine is only really allowed to exist under some capitalist governments because they realised long ago that its better to actively play a part in maintaining your national workforce than leaving them to their own devices and losing labour and profit to easily remedied ailments (drawing a clear line between hospital and factory).
If there has been a complicating of this tension, it is for good reason. Today we try to actualise informed consent or negotiate the difficult and often violent procedures we endure for the sake of our health without infringing on anyone’s human rights. In fact, there are now many instances where medical practice doesn’t conform to the prejudices of the State and doesn’t simply make their lives easier as owners of the means of production. As such, understanding the doctor-patient relationship as two individuals in some sort of competition is tellingly reductive. The idea that each has something to gain says nothing of real interest or value, other than it places this understanding within the normalised framework of a business transaction, obfuscating the actual relations in play.
And so, once we’ve applied a bit of reason to this argument, contrary to what West thinks, the power relations aren’t ambiguous at all. They are complex, yes, but not ambiguous. Any ambiguity comes from his own willful ignorance.
By way of an analogy, if I’m looking at a picture and it appears blurry or pixelated, it is because it is lacking detail. Some information has been removed or flattened out. Points of intersection and contrast become a potentially misleading gradient. Such is West’s problem. If all appears ambiguous in his framework, it’s because his framework is capitalist — or, more accurately, neoliberal, because the reduction of every relationship of exchange to that of customer and service provider is neoliberalism through and through. It is an approach that has already hollowed out our hospitals, our universities, our government, everything, precisely because it obfuscates the actual power relations in play. No wonder those in power like doing it. Compare West’s suggestion that doctors are the slaves to patient’s whims with those comments made by corrupt MPs currently arguing that they are the hard-done-by slaves to their customer-constituents. They hide their corruption in plain sight by blurring the picture we are presented with and turning those on their heads.
It is embarrassing to witness someone defending this sort of thing, even if only indirectly, because Foucault is explicitly not your friend in this regard. You can’t “easily argue” anything along these lines when you actually consider the driving force of his whole body of work. In fact, this makes West’s usage of Foucault in this context very ironic.
All the finer details aside, what I always find amusing about right-wing appropriations of Foucault is that their sense of discipline (never mind of Foucault more generally) is always the first thing to be reduced and flattened out. Foucault produced a genealogy of societal discipline and power in order to critique it, of course, but he was certainly under no illusion that, in order to do that work, it was necessary he activate those same disciplinary sensibilities in himself. He almost goes beyond discipline, beyond the expectations of society at large, beyond the apparent givens and things it takes for granted, and describes — through discipline — discipline’s own development.
To consider the full breadth of Foucault’s output, then — his books, his case studies, his lectures and seminars, his collaborations, etc. — is to find a great deal of rigorous self-critique and adaptation. And though he may have problematised the “judge”, he did not suspend his own judgement. Rather, he used the disciplinary structure of society against itself. We see no such commitment from the Tory ministers who continue to cite him, denouncing him as the man responsible for our current world order. But perhaps there is actually some truth to that claim. Foucault and others like him have been very successful. I reckon the success of his critique, trickling down into wider socio-cultural contexts, has led those in power to embrace their own incompetence. When they make Foucault out to be this great spectral enemy of truth who actually holds all of the power in our contemporary universities, what they seem to be saying is: We’re not disciplining you, we can’t even discipline ourselves, but you all said discipline was bad anyway, so stop trying to discipline us by being feminazis when we’re actually doing what you Foucauldians wanted. But as if this were a sort of Judo counter-throw, they use the weight of their opponents critique against them, in a carefully orchestrated power move, making the judgement seem excessive against their own lack of any judgement whatsoever. It is cunning but far from clever. All it demonstrates is how few of those with power, with platforms, with soap boxes bother to actually do the work required to use the tools at their disposal.
To read Foucault’s critiques of discipline is nonetheless to see a positive use of discipline in action. He believed firmly in the work and the discipline required to do it right. Those who puppeteer him in our media landscape clearly do not.