Foucault, Health and Medicine

Robin Bunton, Alan Petersen, Robin Bunton, Alan Petersen

• Publisher: Routledge
• Year: 2002
• Print ISBN:
  9780415151788
• eBook ISBN:
  9781134745463
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

The reception of Michel Foucault's work in the social sciences and humanities has been phenomenal. Foucault's concepts and methodology have encouraged new approaches to old problems and opened up new lines of enquiry. This book assesses the contribution of Foucault's work to research and thinking in the area of health and medicine, and shows how key researchers in the sociology of health and illness are currently engaging with his ideas.
Foucault, Health and Medicine explores such important issues as: Foucault's concept of 'discourse', the critique of the 'medicalization' thesis, the analysis of the body and the self, Foucault's concept of 'bio-power' in the analysis of health education, the implications of Foucault's ideas for feminist research on embodiment and gendered subjectivities, the application of Foucault's notion of governmentality to the analysis of health policy, health promotion, and the consumption of health.
Foucault, Health and Medicine offers a `state of the art' overview of Foucaldian scholarship in the area of health and medicine. It will provide a key reference for both students and researchers working in the areas of medical sociology, health policy, health promotion and feminist studies.

Part I Fabricating Foucault

Chapter 1 Foucault and the sociology of health and illness

A prismatic reading

David Armstrong

DOI: 10.4324/9780203005347-2

Introduction

Who is Foucault? I do not know, and I do not really care. I confess that I have not read any of the biographies that have been written about him and I have no interest in his personal life. Indeed, if, as in some Shakespearean authorship mystery, I was told that he never really existed and that the books bearing his name were written by a number of different people it would not bother me. How then can I write about an author who may or may not have existed?

In his essay ‘What is an author?’, Foucault identified a shift in the ‘author function’ over the centuries. In medieval times the truth of the text was to be discovered in the truth of the author – a saint, being who he was, only spoke the truth while heretics were known to write untruths. But in modern times, that relationship has been reversed; the truth of the author is to be found in the truth of the text as we scan the author’s words to find out who he or she really was. In other words, the answer to the question ‘Who is Foucault?’ is given by whoever we infer from the texts bearing his name. But of course there are many different readings/inferences despite attempts to find the ‘real Foucault’ behind them (and then in some medieval hegemonic gesture claim to grasp what Foucault really did mean).

Many different readings and many different Foucaults. Mine can only be one such reading: if others got it ‘wrong’ then that reflects no more than my personal reading. This means that in the following review of the influence of Foucault on the sociology of health and illness my task is not to describe the links between the man and the sociological researcher but to explore the connections between some texts that bear his imprimatur and the reader.

Foucault was a prolific writer. Besides a number of books there were many essays and interviews. Trying to determine the supposed ‘influence’ of this corpus would be a massive task, even if it was a legitimate one. A more focused goal for this chapter is to identify some ‘influences’ of four main texts as evidenced by explicit acknowledgements (in the form of discussion or reference) in my own writings and those of others. This will involve reconstructing that engagement between text and reader as Foucault’s words have been subjected to different interpretations at different times.

Madness

Foucault’s first major book (after a somewhat obscure work based on his doctoral thesis) was Madness and Civilization (from now abbreviated to Madness), first published in French in 1961 followed by an abridged shortened version in English in 1965. The book made its appearance just as questions were being posed about the nature of psychiatry and psychiatric incarceration in Western societies (Goffman’s Asylums was published in 1961) but it reached Anglophone countries when ‘anti-psychiatry’ was a growing movement and was rapidly recruited to the anti-psychiatry side. The passage in the book that was seized upon by the anti-psychiatrists was the apparently radical re-interpretation of Pinel’s famous act of removing the chains from the mad in Bicetre: removing the chains might have been an act of ‘liberation’ but only in that it separated the mad from the criminal; more importantly it identified the insane as a new problem and proceeded to subject them to an even more intensive imprisonment. As Sedgewick, an important writer in the field of anti-psychiatry, was later to express it, Foucault’s was an ‘anti-history of psychiatry’; the new regime was to ‘replace the fetters and bars of the old madhouse by the closed, sealed order of an asylum system founded on a gigantic moral imprisonment, that of the medical superintendency of insanity’ (1982: 133). In effect, Foucault’s account of the history of insanity was seen to undermine the conventional ‘progressive’ histories of psychiatry, a perspective that was seized upon by those opposed to modern psychiatric incarceration to berate psychiatry’s own pretensions to be a progressive and humane discipline. And the example of Pinel provided a model of how to enact another revolution in the care of the mentally ill, only this time patients truly would be liberated from the psychiatric regime that imprisoned them (Ingleby 1980).

The other reading of Madness produced by anti-psychiatry was the idea that psychiatric illnesses were ‘socially constructed’. There were two facets to this process, both intertwined and never really separated in the sociological literature of the period. On the one hand, mental illness was constructed in the sense of being caused or produced by social activities and conflicts (see, for example, Brown and Harris 1978; Scull 1977); on the other hand, mental illness arose through the definitional processes of psychiatry that labelled some behaviours as normal and others as abnormal (see, for example, Scheff 1966; Szasz 1961). The early formulation of social constructionism that occurred in these debates about psychiatric illness prefigured later applications of this thesis to so-called ‘organic’ illness but in many ways mental illness was an easier target on which to practise. Whereas physical illnesses could claim a ‘real’ underpinning in terms of a biological referent, it was clear that psychiatric illness depended very much on the consensual diagnostic practices of psychiatrists that certain illnesses did exist (famously illustrated by the American Psychiatric Association’s vote to re-categorise homosexuality as a normal variation rather than a disease).

Not all those in favour of psychiatric reform found Madness to their liking. It was either omitted from their analysis of the state of psychiatry or read as a polemical tract by an extremist author (of the Left). Jones, for example, in her original history of the mental health services (published in 1972) makes no mention of Foucault. But by the time of her revised history (1993) published some twenty-one years later, she claimed that Madness had exerted a ‘massive influence’ on sociological thought but only through what she judged as ‘an analysis deliberately based on emotive images rather than on logical argument’ (1993: 170). Further, she located Foucault on the extreme political left and claimed that he, like Marx, believed that ‘capitalism is the sole cause of oppression’ (1993: 2). In contrast, Busfield, in her own account of the historical development of madness, found little in Madness concerned with asylums and psychiatric practice (others read the book as being precisely about these issues) and thought that Foucault’s work could be usefully contrasted with Marxist thought: ‘Foucault’s lack of direct interest in the extent and nature of the institutions and practices that have arisen to deal with the insane is, therefore, matched by his lack of interest in attempting to link ideas to specific social and economic conditions’ (1986: 130). In fact, for Busfield, Foucault’s Madness was essentially based on the symbolism of insanity producing what she discerned as ‘an idealist not a materialistic conception of history’ (1986: 130). Yet reading the same text Brown could claim that Foucault showed that ‘the creation of the European asylum in the seventeenth and eighteenth centuries [was] a response to the economic dislocation of early industrialism and the political unrest associated with that process’ (1985: 13).

In many ways the legacy of Madness for sociologists was created in its reading during the anti-psychiatry movement and seems rooted in this period. Reference to the text in most writing in the sociology of health and illness has all but disappeared – though this might also reflect on the relatively low profile of psychiatric disorder in the discipline’s literature in the closing years of the century. Other than in explicitly historical accounts of insanity Madness is largely ignored. For example, Miles’s (1981) book on mental illness in contemporary society makes no reference to Foucault; nor does Prior (1993) in his book on the social organisation of mental illness.

But some of the wider implications of Madness that so excited the anti-psychiatrists have been developed by others. Pilgrim and Rogers (1993), for example, in their sociology of mental health and illness, offer a summary of sociological perspectives on psychiatric illness distinguishing between the social causal, the societal reaction and the social constructivist. The last, they charge, has been most strongly influenced by Foucault: ‘reality is not self-evident, stable and waiting to be discovered’ (1993: 19). And whereas, they suggested, Foucault’s early work (in the form of Madness) concentrated on the days of ‘segregation and “coercive” power’, they point to the greater interest of his followers in what they call ‘voluntary relationships’.

In my view it is these ‘voluntary relationships’ that underpin the relevance of Madness for the late twentieth (and, no doubt, twenty-first) centuries. In many ways, as I have already argued (Armstrong 1979b), the problem of madness has disappeared just as simply and quickly as it was created by Pinel’s liberating gesture. With the post-war policy of de-institutionalisation and legislative changes (including the formal abolition of the term ‘insanity’) the problem of ‘unreason’ is also removed from the psychiatric agenda. But this newly vacated psychiatric space did not remain empty for long: a new set of mental health problems have begun to crystallise in the form of the neuroses, the psychological problems of coping with living, the anxieties and depressions of everyday life. This new focus for psychiatric practice – and indeed the wider counselling movement – began to emerge early in the twentieth century and now completely overshadows the old problems of the renamed psychoses. The importance of this shift has been explored in France by Castel (1989) and in Britain notably by Rose (1985, 1990) – though neither of them is identifiable as a sociologist of health and illness. In the main, however, sociologists have largely chosen to concentrate on the social causes of these novel problems and on their distribution in the population/community, rather than explore their ‘Foucauldian’ origins.

In contrast, medical historians continue to be bemused and exasperated by Madness. Arguably, no historical account of psychiatry or of mental illness can ignore a major thesis taken from Madness: that not all might be progress in ‘improvements’ in the management of mental illness. And then there are the historical details of Madness that can still provoke historians to arms (Still and Velody 1992). Is Madness riven with historical errors? Or is the answer to historians’ questions on accuracy contained in the chapters omitted from the English version (Gordon 1992)? Take the noteworthy debate surrounding Foucault’s claim that a ‘ship of fools’ once sailed European waterways. No contemporary evidence, claim some historians, historical reference to such a phenomenon was simply a metaphor for something else, or myths, or distorted readings of texts and so on. But, claim others, this is precisely the point: a ‘ship of fools’ was a ‘reality’ but not according to the simplistic notions of historical fact as laid down by professional historians. A problem of language or of translation? (Though even the French historians have to confess the writing in the original is ambiguous.) Whatever its historical ‘inaccuracies’ this is clearly not a text that historians can ignore. ¹

In summary, the influence of Madness is probably greater in history than in sociology. Certainly it has had its adherents who recruited it to the anti-psychiatry movement but with the passing of the asylum and the lower profile given psychoses in recent sociological writing, the effect of Madness seems to have waned. However, as in history, some of its broad framework has passed into the sociology of health and illness. Arguably theories of social control and medi...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• List of contributors
• Foreword: From govemmentality to risk, some reflections on Foucault's contribution to medical sociology
• Acknowledgements
• Introduction: Foucault's medicine
• Part I Fabricating Foucault
• Part II Discourses of health and medicine
• Part III The body, the self
• Part IV Govemmentality
• Index