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January 23, 2005
This is a lecture on social medicine given by Foucault in Brazil in 1974. I'm having a look at it because it refers to the crisis in medicine with a reference to Ivan Illich (ed.). Medical Nemesis: the Expropriation of Health. The lecture is now 30 years old and it is part of Foucault's key argument that modern medicine is social medicine, and therefore a social practice that has been developing in capitalist society since the end of the 18th century and the beginning of the 19th century.
Does it have any insights for us with respect to social medicine? We are currently caught up in a debate about federalism, the governance of health (hospitals) and they way that political power can be, and is, used to direct our conduct. How then does Foucault's lecture help is out?
In this lecture Foucault provides a social history of medicine and he goes back to the English Beveridge Plan of the 1940s to explore the way in which the state took charge of the health of a population for the benefit of individuals.
Foucault says that the Beveridge Plan is significant as it meant that:
"...the concept of a healthy individual in the service of the State was replaced by that of the State in the service of the healthy individual. It is not only a question of a reversal of rights, but also of what might be called a morality of the body ... It was no longer a question of an obligation to practise cleanliness and hygiene in order to enjoy good health, but of the right to be sick as one wishes and as is necessary."
Health began to enter the calculations of the macro-economy. The Beveridge Plan gave rise to a new series of rights, a new morality, a new economics, a new politics of the body. Since then the body of the individual has become one of the chief objectives of State intervention, one of the major objects of which the State must take charge.
Foucault then connects this governmentality (concerned with economics and power) with the technological advance of biological medicine through the discovery of antibiotics. This enabled the medical institution to effectively fight infectious diseases in the human boddy for the first time.
Thus we have a new form of social medicine. What then is the crisis of social medicine that Foucault alludes to? Foucault addresses this in terms of several characteristics of modern scientific medicine.
The first characteristic is that scientific medicine kills. Not because of ignorance, errors of diagnosis, but because of the very effects of medication as a therapeutic intervention. The bugs and germs have adapted to our anti-biotics. So the positive effects of an enlightened scientific medicne are now accompanied by negative and harmfu effects.
Medicine has historically functioned on the basis of its own failures and the risks that it has taken. Medical risk becomes greater when medicine shifts to modifying genetic cell structure as every aspect of life now becomes subject to medical intervention.
The second characteristic of modern scientific medicine is undefined 'medicalization" whereby medicine functions outside its traditional field as defined the patient's needs, pain, symptons and malaise. Medicine has shifted from being clinical to being social as it has gone beyond being concerned with diseases to being involved in screening populations, sexuality, health promotion and delinquency.
The third characteristic of modern scientific medicine is its political economy. Medicine and health are now presented as an economic problem. This is more where is the money going to come from, as it involves the health of the body as a consumer object, produced by drug companies and doctors and consumed by patients. Health as a product is marked by inequality, profit making, doctors becoming functionaries of drug companies, self-regulating subjects etc.
How does this medical sociology address the current crisis in medicine? Foucault says that a historical account of the rise, or takeoff, of social medicine indicates that the talk about 'the crisis in medicine'is a false one.
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