Application of Medicine as Tool of Power: causes, problems, and tendencies

Anna A. Shibaeva, School of Governance and Politics, MGIMO University

Abstract

Nowadays issues concerning healthcare reforms and statistics are on everyday political agenda. All citizens are directly or indirectly related to these issues: our life begins with vaccines in maternity hospitals and ends with drips on couches. But a rare person considers medicine as a tool of power used in the public interest. However, even today neither scientists nor doctors can define the line where healthcare ends and biopolitics begin. Phenomenon of biopolitics was studied by many Russian and foreign scientists: I. Illich (Illich, 1976), M. Foucault (Foucault, 1973), A. Mbebe (Mbebe, 2003), A. Weheliye (Weheliye, 2014), L. Caldwell (Caldwell, 1964) , A. Somit and S. Peterson (Peterson, 2011), P. Tishchenko (Tishchenko, 2001) . The objective of this research is to follow the changes in biopolitics instruments described by the above-mentioned sociologists and to identify reasons for them. In this work the author will implement the method of institutional political analysis to study medicine as an independent social construction and the historical method in order to monitor the modification of biopolitics as a tool of power.

Keywords: biopolitics, biopower, medicalization.

Main body

Doctors always occupied a special position in society being the only source of information about the secrets of people’s bodies and the only barrier between life and death. The medical profession always provided its representatives with all kinds of benefits from social guarantees to personal integrity. Due to the specifics of their profession supposing direct contact with the sick, doctors were always the first to learn about the weaknesses of society and could not help participating in solving its social problems. Medicine is obvious to be one of the most convenient means of regulating social life in the public interest. But before considering medicine as a tool of power, one should study it as an independent power institution.

First of all, it is necessary to point out the totality of biopower which extends to not only its objects — patients, but also to its subjects — doctors. This phenomenon can be explained by mortality of both the ill and doctors who are equally affected by objective laws of nature. Also people, being afraid of death, voluntarily transfer power to doctors. P. Tishchenko (Tishchenko, 2001) states that doctors can create an «asylum for fear» in illness making it positive and playing the role of death’s «enemy» as long as they can.

Another feature of biopower is singularity of professional knowledge of doctors who have a monopoly on diagnosing diseases. In «The Birth of the Clinic» Michel Foucault states that there are no healthy people in the eyes of medicine, every patient is just «underdiagnosed» (Foucault, 1973). This concept resulted in «medicalization» of the society, which is constantly searching for illnesses inside itself and fancies new ones because it is used to be a «parasite» in its social environment.

Originally doctors had represented the interests of civil society but, over time, medicine was appropriated by governments which made it their tool of power. In order to accomplish this objective state bodies had to eliminate medicine as an independent power institution. It is easily put into practice in authoritarian and totalitarian states like the USSR, where the party machine destroyed Pirogov’s community — a powerful political actor.

However, these measures can be counterproductive for governments, as also happened in the USSR case. «The new» doctors had enough power to decide fates of thousands of people even without resorting to medical procedures. For example, many political and cultural figures were able to leave the USSR by imagining different mental illnesses. «For both citizens and authorities a person in a white coat seemed to be the owner of secret information with virtually unlimited responsibilities and access to people’s homes and bodies (ready to reveal all its darkest secrets). This confusing powerful person seemed demonic. — Natalia Tamruchi wrote in the article «Medicine and power» (Tamruchi, 2013) .

The above-mentioned problem was addressed by means of repressions of some leading doctors («The doctors’ case») and promotion of healthy way of life (slogan «A healthy mind in a healthy body») in the Soviet Union. In that period not treating but preventing diseases was thrusted to the fore in order to deprive doctors of their previous opportunities of impacting the society.

According to a well-known Austrian philosopher Ivan Illich, industrialization was the main factor which contributed to the spread of medicine both as power and as a tool of power. The scientist estimated and described the consequences of industrialization in this way: «Medicine erodes health, schools fool children, transport immobilizes passengers, mass media make people deaf and dumb, information flows destroy meanings, excessive use of natural resources threatens our future, food of industrial era turns into poison» (Illich, 1976). But the most terrible consequence of industrialization is «medicalization» — an excessive role of medicine in society. Too fast industrial growth, mechanization of manufacturing process, urbanization cause disorientation in ongoing processes. Many citizens suffer from hypochondria, more and more often consulting doctors with the symptoms of non-existent diseases. All this makes pharmaceutical industry produce new lines of medicine which do not differ from old ones even by 5 percent and forces doctors to give voluntarist promises concerning these «wonder drugs».

«Swelling of medicine leads to certain consequences and, maybe, performs a special function: an increasing number of people, who consider that every sickness is the result of some changes in their bodies, do not want to admit that their physical state is just their healthy reluctance to adapt to rapidly changing unbearable living conditions. Some doctors prescribe (or used to prescribe) medicine for the „syndrome of a citizen“ or for the ‘‘alarm about workplace environment’’. Medicalization of sickness is both a symptom and the reason of a loss of autonomy: people have neither a need nor a desire to solve their problems. All these conditions facilitate their abandoning social struggles, deprives them of resilience. In our pathogenic society medicine is an alibi.» — states sociologist Jean-Pierre Dupuy (Dupuy, 2003).

Nowadays only doctors are empowered to define the existence of patients’ diseases and to choose who they will help. Usually a state provides free medical care for the social segments it is interested in. For example, in Russia only citizens (who have to pay taxes) can get compulsory medical insurances. These responsibilities and opportunities connect medicine even with economy trough state bodies.

In the 21st century states refuse from medicine as a tool of power, it becomes absolutely unprofitable: state bodies have no financial means to invest in medicine which is exponentially expanding its influence developing drugs for well-studied and new illnesses. Authorities no longer control medicalization and even doctors don’t wish to be liable for it. Modern society creates afflictions faster than upgrades technologies making governments suffer losses. Oddly enough, doctors advocate transfer of biopower to citizens. They fear that medicine has gone too far, it distances people from their nature and victimizes them. Undoubtedly, every doctor who took the Hippocratic oath is responsible for people’s lives but he is not omnipotent. Medicalization means expanding biopower and mastering biotechnologies but these processes do not develop simultaneously and make doctors suffer morally and financially.

It would be logical to assume that the key to solving the issue of medicalization is transforming medicine into an independent social institution, but the challenge is that people are not ready for it. Illness has become a habitual form of social deviancy: everyone can easily shift responsibility for his life to a doctor by getting a prescription.

In the manifest «Hygiene autonomy» Ivan Illich supposed that states should pursue a special healthcare policy, which would sow the following ideas in people’s minds: everyone is destined to die, nobody can avoid sufferings, doctors can not treat all illnesses (Illich, 1978). People should accept death as an inevitable natural process, not as a deviation from symbolic health.

Nevertheless, the issue of the line between productive and counter-productive medicine is still open. Doctors have not detected the state of people’s health in which medical intervention is required due to the indicators of physical, not symbolic health. But both doctors and critics of I. Illich’s theory agree that the power over people’s health can not be entrusted to incompetent patients only.

Conclusion

Means of biopower depend on the objectives of state bodies and on the political regime in a country: the more authoritarian regime is, the more firm and comprehensive measures are used. Nowadays there is no tool of power as effective as medicine due to the resources it manages — unique knowledge about people’s health — the most precious thing everyone has. We can hardly avert the influence of excessive use of medical practices, but state bodies can modify biopower and stop medicalization. A clear distinction between biopolitics and human nature might reduce medical responsibilities to managing only patients’ physical state without the possibility of interfering in their private life. Another way of limiting the importance of medicine as a tool of power in the modern society is to impose on citizens the following opinion: death is a natural process, and illness is not a norm of deviant behavior but just a physical anomaly. Maybe people of this mindset are more resistant to biopower because those who can die live free.

References

1. Caldwell L. (1964) Biopolitics: science, ethics and public policy // Yale Rev. Vol. 54. No. 1. P. 550-567.
2. Dupuy J.-P. (2003) Medicine and Power: A Tribute to Ivan Illich // ComPlexUs: Modelling and Understanding Functional Interactions in Life Sciences and Systems Biology. Vol. 1. No. 4. P. 7-16.
3. Foucault M. (1973) The Birth of the Clinic. New York: Pantheon Books.
4. Illich I. (1976) Limits to Medicine. Medical Nemesis: The Expropriation of Health. London: Boyars.
5. Illich I. (1978) Toward a History of Needs. London: Boyars.
6. Mbembe A. (2003) Necropolitics // Public Culture. Vol. 1. No. 15. P. 11-40.
7. Somit A., Peterson S. (2011) Biology and Political Behavior: The Brain, Genes and Politics — The Cutting Edge // Emerald Group Publishing. P. 229-237.
8. Tamruchi N. (2013) Medicine and Power // UFO. No. 122. P. 11-21. (In Russ.)
9. Tishchenko P. (2001) Biopower in the Era of Biotechnologies // Moscow: IFRAS. (In Russ.)
10. Weheliye A. (2014) Habeas Racializing Assmblages, Biopolitics and Black Feminist Theories of the Human // Duke University Press. P. 48-60.