Dr Anthony Pryce

S/ L Sociology

to provide overview of current trends in sociology of health and illness

to identify central themes in Foucault

to explore the impact of his influence on ways of thinking about Power, medicine and disciplinary knowledge

to consider Postmodernism, health and it’s relevance for practice

The 'Modernist Project' is generally taken to refer 'to the historical period which is supposed to have begun in the west with the 'Age of Enlightenment' towards the end of the eighteenth century, with the secularisation of societies and the rise of scientific and philosophical rationalism' (Fox 1993).

As Foucault (1972) has argued, the drive of the 'modernist project' was through the production of new ways of seeing the world and the construction of modern disciplines of labour, life and languages (economics, biology and philology) and the human 'sciences' which built on them (medicine, sociology, psychology and the study of literature).

Central to this penetration of human ways of seeing the world and its processes, was a philosophical commitment to the notion of 'Truth' as fact, 'Rationality' and rationalisation, 'Progress' together with an ideological belief that scientific analysis is the means by which the world will come to be known, and with Humanism the locus of the human subject as the fountain of knowledge and good.

Challenges the old ‘grand narratives’, stories that were central to religion, science, medicine, literature and architecture.

Where modernity problematises representations of reality, postmodernism problematises reality. Reality is fractured, fragile and numerous realities may co-exist.

A Post-modern sociology of health concerns:

The Body and embodiment

The social construction of meanings attached to health, disease and illness; forms of professional (disciplinary) knowledge(s)

The experience of health and illness

The impact and implications of new technologies

Shilling(1993) has argued that the body is an unfinished biological and social project. The more we know about our bodies, the more we are able to control, intervene and alter them, the more uncertain we become as to what the body actually is. The boundaries between the physical body and society are becoming increasingly blurred.

the self as project:

The self today is for everyone a reflexive project - a more or less continuous interrogation of past, present and future. It is a project carried on amid a profusion of reflexive resources: therapy and self-help manuals of all kinds, television programmes and magazine articles Giddens (1992:30)	

Nettleton suggests (1995:112)

Two key ways in which the Body has been characterised, explained and located:

Naturalistic - Western, biomedical, modernist perspective explains reality of the body and social life are biologically determined e.g. scientific explanations for gender, sexual difference and ‘natural’ superiority of men.

- .suggests on the contrary that social expectations may have a ‘real’ effect on bodily structures and on the development of taboos and symbolic systems

Phenomenological perspectives challenges the man-as -machine Cartesian view to explore the ‘lived experience’ of being embodied.

Feminist reclaiming control of women’s bodies from male-dominated medicine e.g. Our Bodies, Ourselves (Boston Women’s Health Book Collective, 1974)

Developments in reproductive technologies with associated debates on the boundaries between the ‘natural’ and the social body, ethics and rights.

Demographic factors - the greying of populations and the changing nature of human bodies and the ‘ownership’ of bodies e.g. heresy against the state such as euthanasia.

The (youth) cult of the body - fitness and the shift from bodies as the producer of things to the consumer of things

Challenges to medical supremacy and limitations of science e.g. AIDS and the death of young people together with move to take control through complementary therapies

Ethical debates surrounding who controls our bodies, ecological factors the ‘greening’ of the body

Michel Foucault (1926-1984)

Major contributions to the analysis of Power:-

sovereign power < disciplinary power i.e. through regulation of bodies in schools/prisons/hospitals

power/knowledge i.e. observation yielding new knowledge

anatomo-politics of the body through training e.g. dentistry, care of the self

bio-politics of populations are monitored through observation and the deployment of regulatory regimes of power and knowledge e.g. medicine, nursing, education

Power is everywhere: not because it embraces everything, but because it comes from everywhere.... Power is not an institution, nor a structure, nor a possession. It is the name we give to a complex strategic situation in a particular society. &#9;(Foucault, 1979:93)

Hierarchical observation facilitated by architecture of institutions e.g. prisons, schools, hospitals- Jeremy Bentham

The Panopticon serves as a laboratory of humans, with data collected and collated through what Foucault termed ‘the gaze’. This is the basis of disciplinary practices where the individual actors observe their own behaviour. It requires...

Just a gaze. An inspecting gaze which each individual under its weight will end by interiorizing to the point that he is his own overseer, each individual thus exercising this surveillance over, and against, himself. A superb formula: power exercised continuously and for what turns out to be minimal cost. (Foucault 1980:155)

The clinical gaze, he argues, was located in the new types of hospital based medicine, a clinic that was a centre for medical training and characterised by the emphasis on clinical observation, bedside teaching (the ward round) and physical examination and the incitement for the patient to ‘confess’.

The invention of technical assistance in the form of stethoscope in 1819 and the growth of the natural sciences, pathology, and practices such as post-mortems and microscopy, contributed to the development of medical disciplines like surgery, psychiatry, radiology. Disorders became localised to a distinct point within the body, dismembered and separated from the rest.

The clinic became a centre whereby large numbers of non-resistant populations passed under the gaze of a relatively few clinicians and their students who were socialised into the way of seeing and the social order that attended their increasing status.

The systematic observation of bodies and categorising of diseases through the medico-scientific gaze provided the basis of a new ‘anatomical atlas’ that reconstitutes the body. Fox (1993b) summarised this clinical form of panopticism:

&#9;...in the technique of the medical examination, the disseminated power of the gaze permitted the constitution of a knowledgability about disease, observable in symptoms and signs - (these) provide insight into the character of the inscription of the body in this setting. Whereas a symptom ‘is’, a sign ‘says’. &#9;&#9;&#9;(Fox, 1993:29)

The institutionalisation of the clinic, the hospital and its architecture all served to exert power over people and their compliant, ‘docile’ bodies. The construction of this new power relationship between professional and patient dissolves a patient’s claim to ‘authenticity’ in the face of ‘expert’ knowledge that over-rides the experience of embodiment. Kleinmann suggests that:

Clinicians sleuth for pathognomonic signs - the observable, tell-tale clues to secret pathology.... the patient-professional interaction is organised as an interrogation. What is important is not what a patient thinks, but what he or she says. (Kleinmann, 1988:16)

The power of ‘knowing’ the body lies with the ability for expert reading of it, and achieved at the expense of those who are subject of the power of the gaze. Armstrong (1983:2) suggested that the development of this ‘anatomical atlas’ was crucial in the construction of the ‘political anatomy’ or bio-politics of the body:

Armstrong (1983) argued that 20thC. Requires a development of this model of the Panopticon - the Dispensary, or the local clinic which exemplifies a ‘new perceptual structure’ - a new way of seeing illness. This underpins the emergence of what he termed surveillance medicine

Where Panopticism had in effect offered to the observing eye that which was an enclosed space, the school, the hospital or the prison, the Dispensary through its juxtaposition of observation and community replaced enclosed physical space with an open social domain. (Armstrong, 1983:16)

Concerns the gaze which explores localised pathologies and the observation of social networks and relationships

The recruitment of ‘the active patient’ - self-observing actors, monitoring their own body and ‘lifestyle’ for signs of abnormality and deviation from the role of responsible individual citizen and urged into compliance by the medicalisation of everyday life.

Resistances to these networks of power/knowledge

Where is individual emotion or cultural variation?

Does Foucault address gender or race or class?

Foucault uses history to trace the genealogy of ideas e.g. the development of prisons or psychiatry to trace the emergence of disciplinary knowledge and the deployment of regulatory techniques. He challenges traditional notions of hierarchies of power/knowledge and the concept of progress and enlightened. Foucault foregrounds the Body as the arena upon which medicine and other disciplines act and the locus of discourses of regulation and control. Contemporary sociology is not ‘against’ medicine or professional practice, but rather seeks to problematise the taken-for-granted categories or reality within which they operate and deploy power/knowledge.

Observation and the increased surveillance of our bodies by medicine through ourselves as ‘active patients’ is key to this development

Nettleton, S. (1995) Sociology of Health & Illness

Nettleton, S. & Watson, J. (1998) The Body in Everyday Life

Petersen,a. & Bunton, R. (1997) Foucault, Health & Medicine

Scambler, G. & Higgs, P. (1998) Modernity, Medicine & Health

Foucault, M. (1973) The Birth of the Clinic

Foucault, M. (1977) Discipline and Punish

Turner, B.S. (1995 2nd.edition) Medical Power and Social Knowledge

NEW REFERENCE!!: Senior,M. & Viveash,B. (1998) Health & Illness, London: Macmillan.