The_Cambridge_Foucault_Lexicon

294 / Bill Martin

Suggested Reading

Afary, Janet, and Kevin B. Anderson. 2005. Foucault and the Iranian Revolution: Gender and the Seductions of Islamism. Chicago: University of Chicago Press.

Badiou, Alain. 2009. Pocket Pantheon, trans. David Macey. London: Verso.

Burchell, Graham, Colin Gordon, and Peter Miller, eds. 1991. The Foucault Effect: Studies in Governmentality. Chicago: University of Chicago Press.

Jameson, Fredric. 2009. Valences of the Dialectic. London: Verso.

May, Todd. 1994. The Political Theory of Poststructuralist Anarchism. University Park:

Pennsylvania State University Press.

Nealon, Jeffrey T. 2007. Foucault beyond Foucault: Power and Its Intensii cations since 1984.

Stanford, CA: Stanford University Press.

Poster, Mark. 1984. Foucault, Marxism, and History: Mode of Production versus Mode of Information. Cambridge: Polity Press.

Smart, Barry. 1983. Foucault, Marxism, and Critique. London: Routledge.

50

MEDICINE

Medicine played a central role in Foucault’s work from early essays on the history of psychology to his works on the history of sexuality. In an important essay here, “Crisis of Medicine or Crisis of Anti-medicine?”

Foucault inds that medicine “is not a pure science, but part of an economic system and of a system of power” (ECM, 19). While highlighting its role in technologies of power and its place in a political economy, Foucault does not neglect its scientiic aspect. Rather, this aspect of medicine has made it central to the development of modern society since its truths are the realities on which modern economic and power systems work, enabling the exportation of medical practices to other domains, known as medicalization. Medical practice has determined the ontology of the human being and made knowledge itself into a most dangerous enterprise insofar as it now operates at the species level in an effective yet unpredictable manner. Moreover, it is medical practice that grasps man in his historicity. Modernity, therefore, is tied up with medical practice, making it central to Foucault’s project of a historical ontology and the correlative discussions of the modiications that can be pursued on its basis.

Foucault identiies two contemporary myths about medicine: one a naive rationalism, the other a naive antirationalism. The former inds that modern European medicine is thoroughly clinical; that is, deined by the agreement between doctor and patient to listen attentively and speak the truth. According to Sournia, out of this intimate clinical union arises a universal medical science, a rationality that knows no national borders (Sournia 1961). Yet this approach, which looks to a founding contract, is based on an acephalic phenomenology because it treats experience as something unstructured by concepts, as a brute reality accessible to an attentive clinical gaze (EBC, xv). Moreover, Sournia’s approach normalizes medical practice by erecting a universal standard against which all particular forms of medicine are implicitly measured and judged. Against this myth, Foucault argues that modern medicine is a social medicine that deploys a scientiic leveling of the distinction between normal

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and pathological in order to treat individual illnesses. Illich’s critique of modern medicine in the name of a return to premodern conceptions and practices (Illich 1976) exempliies the other contemporary myth (ECM, 8), since this antimedicine has already been shaped by modern medical activity. This critique gets caught in the labyrinth of modern medicine because it does not realize that its own dream of collective health and hygiene is historically conditioned by it. For Foucault, the dream of a return to a space of spontaneous, collective health outside medicine is the dream of a medicalized consciousness. Although it might give voice to a collective disturbance about the social role of medicine today, such an antimedicine does little to help relect on possible actions.

Against these two myths, Foucault recognizes the pervasiveness of medicine in modern society and, instead of encouraging a revolt, responds with a historical examination in order to better grasp what might be done now. In this, he draws on the work of Georges Canguilhem, who reveals processes of normalization in social life brought about by a medicine with scientiic pretensions. Positivist medicine brings a methodological presupposition to bear on any illness – namely, that illness is merely a pathological modiication of normal functions, of norms that medical science can identify in the healthy being and deploy as standards for diagnosis and therapy in practice (Canguilhem 1991). For Canguilhem, the supposed norms of health are actually the fruits of scientiic intervention and thus are norms established by a social practice of experimentation (Canguilhem 2008, 3–22). From the standpoint of the sick individual, by contrast, sickness itself is a normal state of being, since sickness is the state from which health is sought. Scientiic medicine therefore normalizes, since it subjects individuals to foreign social norms and judges them according to these norms, not the vital norms and normativity of the living individual.

Foucault investigates medicine not by following Canguilhem’s theory of the normativity of the individual but by elaborating his account of normalization by investigating the historical rationality of scientiic medicine as this has been embedded in the normalizing projects of medicalization. Medicine has furthered such projects in two ways: (1) through authoritarian imposition on individuals and populations, and (2) by turning attention away from disease as a medical object to health as a social concern (ECM, 13). Combined, these have allowed for authoritarian medical treatment of the abnormal as pathological in an effort to keep society healthy. Modern medicine therefore has supported an open-ended process of medicalization; that is, the production of novel forms of life on the basis of the distinction between the normal and the abnormal. Abnormal explains how medical concepts are brought to bear in the fashioning of new juridical categories of abnormality as substitutes for the old category of the criminal. In this, the medical concepts of normality and abnormality allow a transformation in the courts such that the state is now able to seek to correct the behavior of individuals who, though not criminals, are socially abnormal (ECF-AB, 309). This last example is helpful, since it makes clear that this

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is not the result of a purely medical enterprise but a contested enterprise that takes its sense and meaning from the struggle in which it is engaged. It would therefore be a mistake to think that Foucault simply rejects medicine as merely normalizing or ignores it as irrelevant when founded on scientiic truths. Rather, medical activity and processes of medicalization continue to deine modern man and the conditions of action.

Advances made in contemporary research led Foucault to proclaim the importance of molecular biology and the coming genetic medicine for medical risk, awareness of which “dates from the moment when the positive effects of medicine were accompanied by various negative and harmful consequences” (ECM, 10). Although the eighteenth century saw the coming of a medicine that socialized disease, thereby transforming it, medical risk remained essentially conined to a very limited group until the twentieth century. But with the advent of molecular biology appear radically novel possibilities for intervention, since genetic modiication affects all descendants of an individual. Life, in all its elements and facets, is opened to medical intervention, leaving us anxious about our ability to modify the very future and history of life itself (ECM, 11). Charles Darwin’s work inserted history into life, which could no longer be understood apart from it, yet life and the living remained essentially external to questions of the human being. The new genetics, however, shows that human history now has an impact on life itself, and this makes medical sciences and practices dangerous in a way not before known. And among those who know, this provokes serious anxiety about the status of knowledge, since medical science might now produce effects that modify how life comes about. The new possibilities for medicine have direct effects on biohistory, deined as “the pressures through which the movements of life and the processes of history interfere with one another” (EHS1, 143). Unlike Weber, Foucault thinks that capitalism and modernity appear with the realization that species-life, human or otherwise, has entered the domain of knowledge and power (EHS1, 141–142). And scientiic medicine is an integral part of a history in which Western societies have had to learn the meaning of this new status and the power over life implied therein.

Foucault’s attention to the history of medicine should be read in connection with this, since it is modern medicine that inaugurates biohistorical understanding and reveals best who we are today and the questions that face us. In the medieval period, according to Foucault, medicine was properly clinical; that is, medical activity was undertaken in response to the demands of the individual, yet this period never saw any great advances in medical powers to heal the individual or produce knowledge of the illness experienced. Between 1720 and 1750, however, a series of changes in medical activity removed obstacles to effective practice and scientiic knowledge. Four processes transformed the conditions within which medical therapy and knowledge were pursued: (1) the appearance of medical authorities;

(2) the appearance of medical ields of intervention distinct from disease, such as

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hygiene and environment; (3) the introduction of the hospital as the site of collective medicalization; and (4) the introduction of mechanisms of medical administration, such as recordkeeping (ECM, 13). In the late eighteenth-century birth of the clinic, therefore, medicine moves from a properly clinical to a social model within the context of the nation, abandoning its focus on the individual, who constituted an obstacle to its very development as a science (EBC, 64–85). By looking at ill populations, as gathered together in the hospital, and examining the anatomy of those who died within a changed epistemological context, it became possible for medicine to increase its powers (EBC, 105). Thus hospitals became healing machines, to a certain extent, and ceased to be only places where one would go to die. All of this involved a medicalization that inserted the human body into the economy and made health an object of national concern, casting scientiic medicine as an element in the life of the nation. As populations blossomed, medicine worked not only to heal the injured but to propose standards of hygiene in order to sustain and shape the laboring population through criteria of normality and abnormality. Since then, medicalization has continued unfettered, such that every domain of human life is amenable to medical techniques, making medicine diabolical since it cannot be escaped (ECM, 14).

The initial insertion of the living body into a social medicine was doubled in the twentieth century with a reinvestment of the body in normalizing systems of health as a commodity. Foucault writes, “Health becomes a consumer object, which can be produced by pharmaceutical laboratories, doctors, etc., and consumed by both potential and actual patients. As such, it has acquired economic and market value” (ECM, 16). An increase in health consumption, however, has led to neither an increase in health standards nor an equalization in the social consumption of medicine. What was envisioned as a plan to redistribute and equalize health care has not succeeded, even though based on an appeal to rights, since the equal right to health is caught in a mechanism that preserves inequality. Foucault links the pharmaceutical industry to this mechanism, arguing that it “is supported by the collective inancing of health and illness through social security payments from funds paid by people required to insure their health” (ECM, 18). Doctors, by contrast, are in the awkward position of seeing their profession converted into a mechanism for pharmaceutical distribution from which knowledgeable patients choose. Such enlightened consumerism, even if supported by social inancing, has prohibited an equalization of health care, since wealthier members of society alone seek the beneits of socially inanced medicine, the poorer consigning themselves to working to support it. And even though the political economy of medicine is to blame for the failure to equalize health consumption or increase health, this is not a state of crisis but rather a state of affairs that has subsisted since the late eighteenth century. If the discourse of rights is incapable of overcoming the biopolitical problems of medicalization, contemporary medicine and antimedicine are also incapable of helping, because of their normalizing or normalized approach. Rather, thinks Foucault, “an examination of the history

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of medicine has a certain utility. It is a matter of acquiring a better knowledge ... of the model for the historical development of medicine since the eighteenth century with a view to seeing how it is possible to change it” (ECM, 19). Knowledge of medicine’s history will foster a critical approach to the sciences, practices, and technologies deining our actuality that begins to modify them through this very historical knowledge. Moreover, these histories are important for developing nations insofar as they may be able to avoid the problems the European nations experienced when becoming modern.

Samuel Talcott

See Also

Abnormal

Biohistory

Knowledge

Life

Man

Georges Canguilhem

Suggested Reading

Artières, Philippe, and Emmanuel da Silva, eds. 2001. Michel Foucault et la médecine: Lectures et usages. Paris: Éditions Kimé.

Canguilhem, Georges. 1991. The Normal and the Pathological. New York: Zone Books. 1994. A Vital Rationalist. New York: Zone Books.

2008. Knowledge of Life. New York: Fordham University Press.

Illich, Ivan. 1976. Medical Nemesis: The Expropriation of Health. New York: Pantheon. Mol, Annemarie. 2008. The Logic of Care. New York: Routledge.

Sournia, Jean-Charles. 1961. Logique et morale du diagnostic. Paris: Gallimard.

51

MONSTER

Foucault’s hypothesis concerning the emergence of abnormality is certainly indebted to the views of his mentor, Georges Canguilhem, who once said, quoting Gabriel Tarde, “the normal type is the degree zero of the monstrosity” (Canguilhem 2008, 126). Foucault’s analysis relects Canguilhem’s assertion that during the nineteenth century a whole system of knowledge (a sort of normative project [ECF-AB, 50]) structured around the polemical/political concept of norm (ibid.; Canguilhem 1991, 146) made possible the incorporation of deviant individuals. But more importantly, Foucault claims that the constitution of such a domain of analysis made possible a speciic apparatus of intervention and transformation of abnormal individuals that was driven by a new form of power, “the power of normal-

ization” (ECF-AB, 26, 42).

Three igures – the human monster, the individual to be corrected, and the onanist – “come together in the nineteenth century to give rise to the domain of abnormality” (ECF-AB, 55). Among those three igures, the monster is the most problematic one,“the fundamental igure around which bodies of power and domains of knowledge are disturbed and reorganized” (ECF-AB, 63). What are the bodies of knowledge that constitute this notion?

The monster is a legal notion that appears in the “juridico-biological domain” (ECF-AB, 56). It represents a double violation, “a breach of the law” both at the level of nature and at the level of society. First, the monster does not merely represent a deformity or a dysfunction of some living organism. Each period, says Foucault, from the Middle Ages to the eighteenth century, has privileged a form of monster. Although for the Middle Ages the monster was a mixture of two species (the bestial man), for the Renaissance it was a mixture of two individuals in one body (Siamese twins), and for the classical age a mixture of two sexes (hermaphrodites). Although the monster was seen as a transgression of natural limits (FDE1a, 659), it nonetheless carried within itself the ambiguity of a “natural form of the unnatural” (ECF-AB, 63,

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56). Ultimately, as Foucault points out, “there is monstrosity only when confusion [in nature] comes up against ... canon or religious law” (ECF-AB, 63). How is this possible?

Since the monster is a blurring of the limits, it cannot be classiied. The confusion in nature introduces a second confusion into the canonical law. For example, should a monster be baptized? Canonical law cannot solve this problem, and thus the monster is a juridical enigma. The monster stands outside of the legal framework; it represents a moment of contradiction of the law, a failure of legal classiication, and so it leaves the law with nothing to say (ECF-AB, 56). The monster symbolizes the undecidability of the law (ECF-AB, 64). For these reasons, “the monster is the limit, both the point at which law is overturned and the exception that is found only in extreme cases” (ECF-AB, 56). Thus, the human monster is a double transgression since it combines the impossible and the forbidden.

The nineteenth century, however, brings a new understanding of the monster, and for Foucault this fundamental shift can be observed in the treatment of two igures: the cannibal and the incestuous. They were previously the sign of a mixture of species (ECF-AB, 97) or sexes, and as such they were subject to the criminal law. However, these forms of monstrosity as mixture, these “forbidden consumptions” (ECF-AB, 98) or “alimentary and sexual prohibitions” (ECF-AB, 102), either slowly disappear (hermaphrodites: ECF-AB, 72) or crystallize into a new problem in criminal psychology (criminal monstrosity: ECF-AB, 111). This change resulted from a double shift. First, there was a shift in the type of explanation from pathological anatomy to penal psychiatry (outward vs. inward). Second was a shift in the economy of power to punish (ECF-AB, 75) from an immeasurable system of punishment intended to restore the sovereignty of power to a new measurable punitive structure where a crime was to be punished “at the level of interest that underpinned it” (ECF-AB, 114).

Instead of being condemned for the anatomical structure of their body, for their somatic abnormality, hermaphrodites would be charged for their “perverse sexual tastes” (e.g., the case of Herculine Barbin: FDE2a, 935). Thus emerges “the attribution of a monstrosity that is not juridico-natural but juridico-moral; a monstrosity of conduct rather than a monstrosity of nature” (ECF-AB, 73; Davidson 1991, 57–58). Monstrosity shifts from the domain of nature itself to the domain of conduct while continuing to be seen as a breach of the legal system, so it penetrates every small deviation (ECF-AB, 55) and renders them criminal. In this sense, the monster plays the role of a “magnifying model” since it becomes the very principle of intelligibility, the form of every small deviation or irregularity (ECF-AB, 56).

On the other hand, cases of criminal monstrosity (e.g., the case of Henriette Cornier: ECF-AB, 112) brought to light the fact that motiveless crimes created a blockage in the penal system. Since the penal system operated on a system of motives (raisons), in such cases the system could no longer judge and thus was obliged “to come to a halt and put questions to psychiatry” (ECF-AB, 117). The application of

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the law required two superposable systems of reasons. Not only should the motives for committing the criminal action be established (intelligibility of the act) but also the subject’s rational motivation, since according to Article 64, if the criminal was in a state of dementia, no punishment could be applied (ECF-AB, 115).

As a consequence of two simultaneous codiications, psychiatry was institutionalized as a form of “hygiene of the social body” (ECF-AB, 118). First, madness was codiied as illness, and as an effect of this codiication, all sorts of disorders, errors, and small failures of conduct were captured within a system of the normal and the pathological. From this, public hygiene emerges as a speciic form of medical knowledge. Second, madness, along with all sorts of deviations, was perceived as dangerous. For that reason, psychiatry became not simply a system of knowledge of mental illness but more importantly “an absolutely necessary form of social precaution” against a certain number of dangers related to psychiatric disorders. So, the monster, the one present in the smallest deviations of conduct, comes to permeate the social body. At the same time, it is detected and codiied as a social danger that has to be normalized (ECF-AB, 119–120).

Certainly, if “monstrosity is systematically suspected to be behind all criminality,” a new economy of power (procedures, analyses) is required. Its task is to “enable the effects of power to be increased, the cost of its exercise to be reduced, and its exercise integrated into the mechanism of production” (ECF-AB, 87). As a condition for this power of normalization “to be exercised without gaps and penetrate the social body in its totality,” an entire medical process inscribes the slightest irregularity into a system of correction and control of crimes.

For Foucault, the modern monster would take two main forms. The irst is the political monster, the criminal who breaks the social contract, who “prefers his own interest to the laws governing the society” (ECF-AB, 92) and reverts to a state of nature. The second is the juridical monster, who abuses his own power; for example, a despot, a king, or a prince. These two igures are the two forms of the monster: “the monster from below” and “the monster from above” (ECF-AB, 101). On the one hand, the small thief, the brigand, represents a return to nature, to a state of nature where one’s interest prevails over the common good. On the other hand, the despot represents the abuse of power. Foucault states: “In their very twinship, these two igures will haunt the problematic of abnormal individuality” (ibid.).

In short, the category of monster plays a key role in Foucault’s genealogy of normality and abnormality. Foucault does not simply show how this category has evolved from a juridico-natural to a juridico-moral concept, but more signiicantly how this notion, along with the application of a certain norm of conduct, has permeated all behavior to such an extent that all individuals, in some degree, are deviants. We are all monsters; hence, des anormaux.

Nicolae Morar

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See Also

Abnormal

Life

Madness

Nature

Suggested Reading

Canguilhem, Georges. 2008. Knowledge of Life, trans. Stefanos Geroulanos and Daniela

Ginsburg. New York: Fordham University Press.

Davidson, Arnold. 1991. “The Horror of Monsters,” in The Boundaries of Humanity, ed. James

Sheehan and Morton Sosna. Berkeley: University of California Press, pp. 36–68. Elden, Stuart. 2001. “The Constitution of the Normal: Monsters and Masturbation at the

Collège de France,” Boundary 2, 28, no. 1:91–105.

Foucault, Michel, et al. 1976. Généalogie des équipements de normalisation. Fontenay sous-Bois:

CERFI.

Rai, Amit S. 2004. “Of Monsters – Biopower, Terrorism, and Excess in Genealogies of Monstrosity,” Cultural Studies 18, no. 4:538–570.

Sharpe, Andrew. 2007. “Foucault’s Monsters, the Abnormal Individual and the Challenge of English Law,” Journal of Historical Sociology 20, no. 3:384–403.

2010. Foucault’s Monsters and the Challenge of Law. New York: Routledge.