Day 27: Foucault at the Doctor’s Office
I just got back from the doctor. Every time I go to the doctor I am amazed at how right Foucault is about the disciplinary power of the medical establishment. Foucault explains that a number of institutions are put to work beginning in the 17th and 18th centuries to take control over–to discipline–bodies. Sovereign power forms in order to protect life, and this protection of life, and this right to take it, becomes integral to the work of the sovereign. In the 17th and 18th centuries, Foucault argues in the last lecture of Society Must be Defended, “techniques of power”… “were essentially centered on the body, on the individual body.” These techniques organized, arranged and surveilled bodies in an effort to increase their (re)productivity. Foucault writes:
They were also techniques for rationalizing and strictly economizing on a power that had to be used in the least costly way possible, thanks to a whole system of surveillance, hierarchies, inspections, bookkeeping, and reports–all the technology that can be described as the disciplinary technology of labor.
This is how going to the doctor feels to me. Tests are done, questions are asked, personal histories are taken. I have had this same conversation with my doctor about my personal history over and over again. But she still asks the same things. Apparently nonjudgmental questions that are loaded with judgment are asked: questions about your sex life, your alcohol consumption, drug use, cigarette use, whatever. It doesn’t matter if you are doing something wrong or not, you feel like you are. In fact, the being in the doctor’s office, like being stopped by a police officer, creates the feeling that you are somehow in violation, you need to be better disciplined. They don’t even have to say it. You feel it.
Foucault argues that the subject is produced as the subject in and through this disciplinary process — at the crossroads of the various institutions that produce this sense of being better disciplined: the doctor, the police officer, the school, even work (probably the place most people feel surveilled these days).
What struck me today is the notion that knowing all of this did not in any way enable me to transcend the force of the discipline. I left feeling overweight and guilty.
(For real, people, she commented that I had gained some pounds and then said, it’s probably the winter clothes, I’m not worried, as if she should have been worried that had I gained three pounds, three pounds which I see move in either direction every other time I get on the scale. Our imaginary weight problem, indeed. I need to stop stepping on that damned scale–damn you “whole system of surveillance, hierarchies, inspections, bookkeeping and reports”!)
But the point is, the knowledge did not increase my power to resist. I’ve blogged some (here and here) about one view among philosophers that we do what we know to be good, so if you want to change how you act, you need to change your view of what is good. But what about when the knowledge that you have is not about what you should do but about what is being done to you? Knowledge of patriarchy and misogyny and racism, for example, does not make you immune to patriarchy and misogyny and racism. If anything, it makes you more aware of it, unable to write off whatever offensive remarks or behavior to something else. I know this, but in my philosophical pride I somehow think that knowing makes me immune. It does not. I’m not even sure that it empowers you to resist. Maybe it does. Maybe being able to name the thing–this is the disciplinary process of the medical field producing me as a certain kind of subject–makes it easier to say, I am not guilty. But to be honest, that disciplinary process is intense. I do feel like I need to worry about those three pounds and start counting the number of units of alcohol I have a week to make sure it’s not over the acceptable level.
There is something empowering about the knowledge, but to suppose that the knowledge undoes the disciplinary force would seem to suggest the process is individual. Foucault explains that the tricky thing about disciplinary power is that it does not come from above, it is deployed from all around — we are both the regulated and the regulators, the subjectified (made into subjects) and the subjectivating. We deploy power in small ways in relation to one another that produce us all collectively as particular kinds of subjects. Resistance in Foucault has always been a difficult thing to think, but it surely is not just in supposing that you can cease to be subjectivated or cease to subjectivate because you know what’s really going on. In “The Subject and Power,” Foucault describes the disciplinary process as “subjection” in the two senses of the term–the process of becoming an agent and the process of being subjected to some power. Resistance to becoming subjected to some power must then be coupled with resistance to becoming the particular kind of agent you have become. In this sense, knowledge on its own does not release you from the process of subjection, but knowledge can motivate strategies for resisting it. That seems to me to be what the knowledge at work in critical theory is all about.
Someone let me know when you figure out how to resist in the doctor’s office.
Sometimes it is easier to resist and ask the probing questions when doing it for someone else. There’s also alternative health care.
I’ve struggled with this–it’s all the more striking because at this point, all my doctors and caretakers are so nice. Yet the discipline is always there. I have ONE amazing doctor who radiates love and kindness–but he is a maverick who studies kabbalah and has a genuinely collective view of the planet. I earn a living collaborating on books with functional medicine MDs, so I spend many hours a week writing about what’s wrong with conventional medicine. You are 100% right that “knowing” isn’t nothing–but it’s not nearly enough.
My strategy for resistance–only partially successful–is to try to engage the doctor in my own theories of health. E.g., when my oncologist told me repeatedly that the s/fx of a med was “depression, slowing down, aching joints, gaining weight–but that happens as you get older anyway,” I finally asked her to make a deal with me that, with me at least, she would not speak of aging in that way. I stressed my respect for her, and assured her I wasn’t bargaining with her–I would follow her medical advice regardless. But I explained my vision of age, and I asked her to at least respect it. She still thinks I’m wacky, but I think she sees me as a human in a way that before, nice as she was, she saw me as a patient. That helps.
LOVED this piece, in case that wasn’t clear! You have SO validated the awful press of dehumanizing treatment EVEN in a humane center with genuinely caring staff. When I was getting radiation, I would talk with the West Indian staff about the theme of Jamaican slavery in my novel, and I would talk about gluten & its effects, with one of the nurses who had just gone gluten-free. But as soon as I lay down on the table, I was no longer a person but a patient–and therefore a thing. Inconsistent and in some ways dispiriting resistance, but probably better than not?