This development has garnered considerable attention from researchers in many disciplines, including medical sociology and biomedical ethics. Although several scholars have established links between Foucault and medicalization from a number of different disciplines, including anthropology Frykman and Lofgren, , history, Mort, , philosophy Lupton, , and sociology Conrad , , , ; Turner ; Clarke et al.
Conrad, , As a result, Conrad argues that more and more spheres of life have become medicalized, such that an ever-expanding range of medical treatments is applied to human conditions. Medicalization is now a common part of professional, consumer, and market cultures Conrad, , The constant development of new drugs, technologies, and treatments sparks consumer demand in both mediated and private markets.
In mediated markets, there is an indirect relationship between consumers and producers, with a third-party intervention typically private or public insurance deciding what is medically necessary and paying only for those services deemed necessary.
In private markets, the relationship between consumer and provider is direct, where a consumer can obtain any health service or product they desire, as long as they have the resources to pay Conrad, , DTCA, through various techniques and strategies, has helped to expand both mediated and private markets, while simultaneously expanding the medicalization of human problems.
Although advertisements often appear to clarify and educate, they purposefully confuse, causing people to redefine normal aspects of their lives in medical terms, which in turn creates greater demand for a medical product Conrad and Leiter, , ; Conrad, , Thus, the field remains undertheorized in terms of the ways that DTCA relates to medicalized subjectivities.
This provides solid ground to explore Foucaultian concepts, as medicalization does not simply redefine human problems; rather, it redefines human beings themselves as problematic. Theorizing medical subjectivity along these lines shows us how there are multiple social forces at play.
We can see that medicine and medical practitioners are not the only mechanisms for the over-medicalization of society. This highlights the ways patients are responsible as they freely participate and become complicit in the processes of medicalization. This geographic metaphor provides a more fruitful approach to conceptualize medicalized subjectivity illuminating the multiple points from which the power of medical knowledge and expertise are exercised.
These forms of power are also internalized in the process of the constitution of the self, as well as circulating throughout the social landscape.
In the context of medicalizing deviance, Conrad distinguished three types of medical social control: medical ideology, collaboration, and technology. Conrad argued that:. To these categories, we can add a fourth—medical surveillance. In The Birth of the Clinic , Foucault chronicles the rise of the medical industry in the eighteenth and nineteenth centuries, linking its growth directly to the expansion of medical knowledge.
This economic—political nexus led to the expansion and dominance of the medical field over the next few centuries. This detachment or dehumanization of the body into an object of analysis, to be isolated, probed, analyzed, examined, and classified, became the basis on which medical knowledge was developed. The gaze is just as constitutive of the object as it is of the observer; the gaze defines both the object of knowledge and the subject knowing that object Foucault, , For Foucault, modern medicine emerged with the rejection of medieval superstitions.
However, this did not mean that modern conceptualizations were without their own unquestioned mythologies. Although the authority of the physician was not new, the theoretical underpinnings and justifications for that authority in modernity were, as they shifted from abstract to practical knowledge and examination, based in the wisdom of the doctor Foucault, , 54— For Foucault, the gaze is defined as follows:.
The observing gaze refrains from intervening: it is silent and gestureless. Observation leaves things as they are; there is nothing hidden to it in what is given. The correlative of observation is never the invisible, but always the immediately visible, once one has removed the obstacles erected to reason by theories and to the senses by the imagination.
For Foucault, the gaze is not an abstraction seeking hidden essences, but rather is practical and a concrete examining of the object before it. The gaze, through which knowledge is produced, is able to penetrate the body, ascertain its true meanings, master its secrets, diagnose, and prescribe treatment. The invention of the medical gaze brought about a shift in understanding: what was once concealed became revealed through the illuminating power of the gaze and, in so doing, medical knowledge was considered free from distortion as it brought unprejudiced truth to light Foucault, , —5.
It was while I was studying the origins of clinical medicine. I had been planning a study of hospital architecture in the second half of the eighteenth century, when the great movement for the reform of medical institutions was getting under way.
I wanted to find out how the medical gaze was institutionalized, how it was effectively inscribed in social space, how the new form of the hospital was at once the effect and the support of a new type of gaze.
Foucault, a , These analyses document how the gaze is constitutive of our subjectivity, as we become self-diagnosing, self-scrutinizing, and self-analyzing subjects. This article now turns to consider one of the ways in which the gaze—and by extension medicalization—operates as a socializing force which inscribes itself simultaneously in both viewer and viewed. In doing so, however, as Lupton has argued in her now foundational essay on Foucault and medicalization, one of the major tendencies with Foucault and with other scholars who have drawn on his work is to:.
It is here that a Foucauldian perspective has had little to offer hitherto. Lupton, , 94—5. As a result, there has been little scholarship undertaken on the ways that power is mediated through social categories such as race, gender, class, or by occupational or institutional constraints Nye, , By failing to do so, her analysis ends up reaffirming the monolithic, dominating effects of advertising on the agentless bodies that absorb and abide by this propaganda.
These include: pharmaceutical companies, medical regulators, drug regulators, advocacy groups, advertising agencies, media companies, biotech firms, etc.
Finally, understanding how DTCA illustrates the ways in which larger systems of power, including not only medical power, exert effects at both the individual and collective levels of society necessitates further engagement with the work of Foucault.
In order to understand that move, this section begins with panopticism to show how the individual internalizes the medical gaze in the process of the constitution of the self, through which norms and regulations are deployed against individuals.
In moving from the medical gaze to the carceral archipelago, a brief overview of the ways Foucault theorized relations of power is needed. Foucault drew on the metaphor of the panopticon, a prison proposed by Jeremy Bentham, the utilitarian philosopher, as an image of modern society.
In the panopticon, the prisoners are locked in individual cells, arranged in tiers of a circular structure, which is observed from a central vantage point. The prisoners can be seen at all times by the guards and the knowledge of their visibility eventually induces them to monitor and regulate their own actions.
As the gaze of surveillance is turned upon oneself, self-scrutiny becomes the most pervasive and effective form of social control. Foucault conceptualized the panopticon as a template for all forms of social control in modern society; for Foucault, society was increasingly becoming a carceral system. Modern social life is a world in which surveillance, self-surveillance, and social regulation are diffused throughout all institutions of society.
These forces are deployed to control, modify, torture, mark, and train bodies to perform, carry out tasks, and behave in particular ways without the need for overt coercive measures Foucault, , 25—6. For Foucault, power is pervasive and polyvalent throughout society:.
It is a type of location of bodies in space, of distribution of individuals in relation to one another, of hierarchical organization, of disposition of centres and channels of power, of definition of the instruments and modes of intervention of power, which can be implemented in hospitals, workshops, schools, prisons. Whenever one is dealing with a multiplicity of individuals on whom a task or a particular form of behaviour must be imposed, the panoptic schema may be used.
Foucault, , Panopticism provides a framework to theorize the ways that a constant surveillance over all areas of life by which all individuals are made visible, their conduct shaped, and their behavior determined.
Through panopticism, society is spatially organized and temporally ordered; social groups and individuals are categorized and classified and understood. For Foucault, the surveilling gaze of society is internalized into individuals and constitutes them through power relations. As Foucault argues:. We are much less Greeks than we believe. We are neither in the amphitheater, nor on the stage, but in the panoptic machine, invested by its effects of power, which we bring to ourselves since we are part of its mechanism.
The workings of power are articulated on and through bodies—inscribed on them—where dispositions, attitudes, orientations, and understandings of the world are variously cultivated. Foucault writes:. He who is subjected to a field of visibility, and who knows it, assumes responsibility for the constraints of power; he makes them play spontaneously upon himself; he inscribes in himself the power relation in which he simultaneously plays both roles; he becomes the principle of his own subjection.
Foucault, , —3. The effect of power relations is the way in which norms, rules, laws, and regulations are deployed against people. People are constantly being critiqued and evaluated in all aspects of life. The judges of normality are present everywhere. The carceral network, in its compact or disseminated forms, with its system of insertion, distribution, surveillance, observation, has been the greatest support, in modern society, of the normalizing power.
Power operates on the body as a form of social regulation. Although power may be coercive in terms of discipline and punishment, it is more often than not regulatory and order maintaining in terms of norms, codes, and rules through which the social organization is produced and reproduced. Highlighting the metaphor here provides a concrete example to theorize how power is constantly circulating, not as an all-seeing eye or unified field of vision imposing itself, but through a multiplicity of sites and conduits in the constantly changing field of forces of social life cultural, social, political, economic.
These forces are simultaneously individualizing and totalizing in the production of both a medicalized population and individuated medicalized subjectivity. By moving past the gaze to the archipelago, we can develop our theoretical apparatus as fluid and mobile and, therefore, better understand how medicalization is embedded in and constitutive of contemporary social relations.
In an interview, while discussing the relationship between geography and power, Foucault emphasized a particular geographical point:. There is only one notion here that is truly geographical, that of an archipelago. Foucault, b , Geography acted as the support, the condition of possibility for the passage between a series of factors I tried to relate. Where geography itself was concerned, I either left the question hanging or established a series of arbitrary connections. The longer I continue, the more it seems to me that the formation of discourses and the genealogy of knowledge need to be analyzed, not in terms of types of consciousness, modes of perception and forms of ideology, but in terms of tactics and strategies of power.
Tactics and strategies deployed through implantations, distributions, demarcations, control of territories and organizations of domains which could well make up a sort of geopolitics where my preoccupations would link up with your methods. For Foucault, power is not reducible to the State, nor any one authority, set of laws, or centralized institution. Power is not restricted to political institutions nor is it reducible to them, where one class can dominate over another, or where power is simply the reproduction of the relations of production.
Therefore, power cannot be understood as a false-consciousness produced by ideology or propaganda; rather, power is constitutive of all social relations, norms, and practices, working on the dominant as well as the dominated. Like an archipelago, power operates through a plurality of positions, from the top—down, in both institutions and authorities, as well as from the bottom—up and laterally, because individuals themselves serve as vehicles for the transmission of power.
By viewing power as multi-dimensional, power is not something one has or wields over others, as if power were a position or an object, because those who exercise power are just as much as those over whom power is exercised and, therefore, power circulates in a web of relations in which we are all enmeshed Foucault, a , Finally, in focusing on the cartographic aspect of the archipelago, we can understand what Foucault means when he differentiates power from a uniform or totalizing process such as rationalization:.
It may be wise not to take as a whole the rationalization of society or of culture but to analyze such a process in several fields, each with reference to a fundamental experience: madness, illness, death, crime, sexuality, and so forth. What we have to do is analyze specific rationalities rather than always invoke the progress of rationalization in general. Foucault, , — The archipelago of power provides a way of mapping out the diverse and intersecting dynamics of socialization, which form their own internal logic of organization.
The archipelago functions as a field of forces circulating through the state, the law, and other hegemonies, forming an interrelated system of relations in which all discourses, practices, and institutions crystallize. As a result, we can view DTCA not as a monolithic social formation that imposes itself uniformly on consumers in terms of the gaze, but can conceptualize the ways in which DTCA forms a plurality of points of view and perspectives that overlap and reinforce each other.
Theorizing DTCA through the medical gaze, as Smirnova did for beauty ideals, simply reifies medicalization, rather than drawing out the dynamics through which medicalization circulates. Medical knowledge is no longer only dispensed by physicians, but is disseminated through a myriad of mediums: magazines, TV, internet, billboards, popular culture, as well as through social relations of family, friends, co-workers, and others.
The medical gaze is no longer appropriate for understanding our medical culture today because it ignores the way that we experience medical knowledge in our consumer-oriented, technology-driven society.
Rather than assuming that all people are shaped the same way through the imposition of the medical gaze, we must focus on the individual as an active discerning subject who finds different types of utility in DTCA and the different behaviors that the practice encourages.
No longer relying on the medical gaze, we must turn to an alternative model, extending the carceral archipelago metaphor to a medical archipelago, in order to conceptualize the dynamism of medicalization in society today.
Through the medical archipelago, we can theorize DTCA as a series of nodes and conduits, both as points where medicalization is crystalized and as vehicles through which medicalization flows, as it socializes us into the way in which we understand ourselves and the world around us.
The medical archipelago provides an analytical framework to analyze multiple spheres both micro and macro applications of medicalization simultaneously. DTCA in isolation is just one island among others. We can analyze an individual caught in a series of advertisements. In addition, we can consider an individual within the nexus of institutions and media outlets that promote DTCA, or physicians, medical practitioners, and clinics and hospitals that would constitute another archipelago.
Just as individuals are socialized through institutions and other individuals, they are also socialized through forms of media such as DTCA. Although DTCA is but one segment of this saturation of the social landscape, it has become the primary way individuals receive medical information Frosch et al. By conceptualizing the crisscrossing field of advertisements as constitutive of a medical archipelago, whereby bodies become complicit in this social order as fully functioning participants in the normative order of everyday life, we can further our understanding of how medicalization is embedded in and constitutive of social relations.
Medicalization—that is, the fact that starting in the eighteenth century human existence, human behavior, and the human body were brought into an increasingly dense and important network of medicalization that allowed fewer and fewer things to escape.
Although distinct in their contextual emergence, these developments converged in different ways to form modern social medicine Foucault, , However, as Foucault is careful to point out, these developments in the areas of health and medicine were tethered to considerations of disease as a political and economic problem for social collectivities.
First, Foucault emphasizes the emergence of markets for medical services, the innovation of new medical technologies, the professionalization of medical experts, and the intertwined notion of the development of medicine with political and economic considerations. By taking these foundations of medical development as being multi-faceted, as having multiple origins and orientations, and coming from a multitude of sites—as multiple, dispersed, and having no center—Foucault theorizes an archipelago of power relations.
In linking this conceptualization of multiple nodes of power to a noso-politics of medical classifications and treatments, DTCA can be understood as a natural extension of creating and responding to new medical markets. Scholars such as Davis have criticized the medicalization thesis as having become analytically empty by encompassing everything:. The concept of medicalization has become a complete muddle.
It once referred to a specific social process—the expansion of the jurisdiction of the medical profession that followed from the successful redefinition of forms of deviance, natural life processes, and problems of living as illnesses requiring medical intervention.
Medicalization by this definition was similar to other terms about institutional categories and jurisdiction, such as criminalization. But, theorists decoupled medicalization from the institution of medicine some years ago in an effort, apparently, to give the concept greater generalizability.
This medicalization without medicine is wrongheaded and untenable. Davis, , For example, recent critiques of the overselling of prescription medications conceived as increased medicalization under the broad definition focus on the aggressive advertising of the pharmaceutical companies.
What they miss or badly underemphasize is that none of this overselling would be possible without physician support and acquiescence. The action or inaction of the profession, including its collusion with industry, needs to be the target of critical analysis. Otherwise, we end up, as in this case, with a vacuous criticism of Big Pharma for marketing its products so cleverly and, implicitly, an elitist criticism of people for being such nitwits to fall for it. The argument that none of this would occur without physicians is clear.
Sociologists such as Conrad document how the expansion of medicalization has come through social forces both inside and outside of medicine. As a result, Conrad concludes that:. In a culture in which health has become a high-value asset, it should not be surprising that life problems have become medical pathologies. One of the ironies of our culture is that no matter how much health is improved as evidenced by decreased mortality rates, increased life expectancy, and improved health care , the reporting of health problems continues to rise.
By bringing back in the notions of the social and cultural into his overall analysis of medicalization, medical sociologists such as Conrad appropriately raise, but do not fully develop, their own positions.
Actually, one must not think that medicine up until now has remained an individual or contractual type of activity that takes place between patient and doctor, and which has only recently taken social tasks on board.
On the contrary, I shall try to demonstrate that medicine has been a social activity since the eighteenth century. Medicine has always been a social practice. What does not exist is non-social medicine, clinical individualizing medicine, medicine of the singular relation.
All this is a myth that defended and justified a certain form of social practice of medicine: private professional practice. Thus, if in reality medicine is social, at least since its great rise in the eighteenth century, the present crisis is not really new, and its historical roots must be sought in the social practice of medicine.
Foucault, , 8. To conceptualize it as individualistic or in terms of doctor—patient relationships misses the crucial social contexts within which the field of medicine exists.
Power for Foucault is what makes us what we are, operating on a quite different level from other theories:. And it induces regular effects of power. Foucault is one of the few writers on power who recognise that power is not just a negative, coercive or repressive thing that forces us to do things against our wishes, but can also be a necessary, productive and positive force in society Gaventa 2 :.
In fact power produces; it produces reality; it produces domains of objects and rituals of truth. Power is also a major source of social discipline and conformity. Their systems of surveillance and assessment no longer required force or violence, as people learned to discipline themselves and behave in expected ways. Foucault was fascinated by the mechanisms of prison surveillance, school discipline, systems for the administration and control of populations, and the promotion of norms about bodily conduct, including sex.
So Foucault himself expressly refused to develop an overarching theory of power. Interviewers would sometimes press him to give them a unified theory, but he always demurred. Such a theory, he said, was simply not the goal of his work.
Yet he did not himself offer a philosophy of power. How could this be possible? His is a philosophical approach to power characterised by innovative, painstaking, sometimes frustrating, and often dazzling attempts to politicise power itself.
He wanted to free philosophy to track the movements of power, the heat and the fury of it working to define the order of things. Before Foucault, political philosophers had presumed that power had an essence: be it sovereignty, or mastery, or unified control. Thomas Hobbes , the English philosopher and original theorist of state power, saw the essence of power as state sovereignty.
Hobbes thought that at its best and purest power would be exercised from the singular position of sovereignty. Foucault never denied the reality of state power in the Hobbesian sense. But his political philosophy emanates from his skepticism about the assumption and it was a mere assumption until Foucault called it into question that the only real power is sovereign power. Foucault accepted that there were real forces of violence in the world, and not only state violence.
There is also corporate violence due to enormous condensations of capital, gender violence in the form of patriarchy, and the violences both overt and subtle of white supremacy in such forms as chattel slavery, real-estate redlining, and now mass incarceration.
What he doubted was the assumption that we could extrapolate from this easy observation the more complex thought that power only ever appears in Leviathan-like form. Power is all the more cunning because its basic forms can change in response to our efforts to free ourselves from its grip.
In seeing through the imaginary singularity of power, Foucault was able to also envision it set against itself. He was able to hypothesise, and therefore to study, the possibility that power does not always assume just one form and that, in virtue of this, a given form of power can coexist alongside, or even come into conflict with, other forms of power.
Such coexistences and conflicts, of course, are not mere speculative conundrums, but are the sort of stuff that one would need to empirically analyse in order to understand.
What these studies reveal is that power, which easily frightens us, turns out to be all the more cunning because its basic forms of operation can change in response to our ongoing efforts to free ourselves from its grip.
To take just one example, Foucault wrote about the way in which a classically sovereign space such as the judicial court came to accept into its proceedings the testimony of medical and psychiatric experts whose authority and power were exercised without recourse to sovereign violence.
Foucault showed how the sovereign power of Leviathan think crowns, congresses and capital has over the past years come to confront two new forms of power: disciplinary power which he also called anatomo-politics because of its detailed attention to training the human body and bio-politics.
More than any other book, it is Discipline and Punish in which Foucault constructs his signature, meticulous style of enquiry into the actual mechanisms of power. While Foucault worked on this book, he was deeply engaged in its material, leading research seminars and giving huge public lectures that are now being published under such titles as The Punitive Society and Psychiatric Power.
When he eventually organised his archival materials into a book, the result was the consolidated and efficient argumentation of Discipline and Punish. It is power in the form of correct training. Discipline does not strike down the subject at whom it is directed, in the way that sovereignty does. Discipline works more subtly, with an exquisite care even, in order to produce obedient people. The exemplary manifestation of disciplinary power is the prison.
For Foucault, the important thing about this institution, the most ubiquitous site of punishment in the modern world but practically non-existent as a form of punishment before the 18th century , is not the way in which it locks up the criminal by force. This is the sovereign element that persists in modern prisons, and is fundamentally no different from the most archaic forms of sovereign power that exert violent force over the criminal, the exile, the slave and the captive.
Foucault looked beyond this most obvious element in order to see more deeply into the elaborate institution of the prison. Why had the relatively inexpensive techniques of torture and death gradually given way over the course of modernity to the costly complex of the prison?
Was it just, as we are wont to believe, because we all started to become more humanitarian in the 18th century?
Foucault thought that such an explanation would be sure to miss the fundamental way in which power changes when spectacles of torture give way to labyrinthine prisons. The purpose of constant surveillance is to compel prisoners to regard themselves as subject to correction. Foucault argued that if you look at the way in which prisons operate, that is, at their mechanics, it becomes evident that they are designed not so much to lock away criminals as to submit them to training rendering them docile.
Prisons are first and foremost not houses of confinement but departments of correction. The crucial part of this institution is not the cage of the prison cell, but the routine of the timetables that govern the daily lives of prisoners.
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