Good evening, sickos. I hope Pride month has been treating you well and that everybody is staying relatively safe out there. I am (finally!) firmly into the heave-ho portion of trying to get two big writing projects off the ground; it’s going well, but it eats a lot of time even as it gives me a lot of good ideas for shorter newsletter posts and things like that. As part of this reading, I’ve been deep in Foucault on biopower and population for the fifth or sixth time in my public health career. (Nate wrote an excellent post touching on biopolitics here.) I want to get through the minimum about of theory necessary, as quickly as possible, in order to get to my point.
Basically (and this is very hard to summarize because, as a friend of mine recently put it, Foucault’s “archeological” method means that the history is the argument, which makes it almost impossible to extract terse little nuggets of insight from his texts or lectures) Foucault charts a “dual seizure of power over the body” in the seventeenth and eighteenth centuries. The first movement he traces is what he calls disciplinary power, a power of the individual body. Schools, prisons, barracks, hopsitals… all the classic Foucauldian disciplinary institutions have as their goal the inscription of control in the smallest movement, the most minute gesture. In school, you are being disciplined to sit quietly for long periods of time, to look like you’re paying attention (even if you’re not — I know most people can relate to this). Discipline and Punish, his book-length treatment of this phenomenon, spends as much time on the extreme exactitude of the techniques of French military training as it does on enumerating the exquisitely barbaric medieval tortures corresponding to the right of the sovereign (the monarch) to take life. Foucault eventually (in a series of lectures at the Collège de France in the late 1970s) calls this an “anatomo-politics of the body.”
He also charts another kind of power that emerges a bit later, in the second half of the eighteenth century. This type of power is not disciplinary, it is regularizing. It’s not concerned with disciplining the individual body, optimizing the productive discipline (for education, for industrial work, for martial purposes) that can be wrung from an individual body. This type of power doesn’t care much about the individual body at all; its object is, instead, the population, the mass of individual bodies. This type of power sort of lets the chips fall where they may in terms of what happens at the level of this or that individual body; its explicit concern is the management of the population at the population level — birth rates, endemic illness (Foucault has a really interesting digression on epidemic vs. endemic read through these modes of power in one of his lectures that maybe I will write about one day), death rates, and so on. This is biopower.
Biopower doesn’t replace disciplinary power. Foucault stresses that these two are complementary, they exist at different levels (the individual body vs. the “social body” of the population) without nullifying each other. That much seems clear. The way Foucault describes the relation between the two forms of power is interesting: he describes biopower as “infiltrating” and “permeating” disciplinary power.
These two forms of power sit uneasily together in biomedical discourse generally, and COVID politics more specifically. I do think this uneasy coexistence discloses something about the relationship between these forms of power, at least in this sphere. My starting point is the incommensurability of population-level and individual-level “risk.”
For a long time now, I have felt like the “evidence-based medicine” movement is due for a reckoning because its stated goal is a logical impossibility. The point of evidence-based medicine is to use population health research (aka “evidence”) to guide clinical medicine. That is, this movement seeks to reconcile the irreconcilable: population and individual risk. Population risk is almost always some kind of empirical frequency of disease or death in a given population (the population of an entire country in the case of the huge cancer registries that the Nordic countries maintain, a cohort of administrative data — like Medicare or Medicaid patients — or a study population specifically recruited to study something). But there is a problem: knowing that the population lifetime risk of lung cancer is on the order of 1/16 says absolutely nothing about my risk of developing lung cancer. Statistical adjustment and stratification don’t get us any further: the risk for women is about 1/17, I’m sure for women who smoke weed, it’s higher. The unbridgeable gap from the already-realized population frequencies and my yet-to-be-observed individual outcome remains unbridged.
Of course, it’s not preposterous to imagine that such population-level figures can inform treatment of individual patients. Based on what we know about cardiovascular risk from smoking and from taking hormonal birth control, it is unlikely that if I were a cigarette smoker and went to a primary care doctor seeking birth control options, that that doctor would recommend an estrogen pill for me. That’s a good thing. I think this “informing” is how biopower seeps into disciplinary practices, though.
For example, the Framingham cardiovascular risk calculator is widely known and widely used. The calculator works like this: you input some of your parameters (age, height, weight, and so on) into the calculator, and it spits out your ten-year risk of developing cardiovascular disease. Whoa! How the fuck does it do that? Well, it compares the parameters you input to the risk figures derived from a longitudinal cohort study, the Framingham Heart Study, that has been going on since 1948. This study has observed the participants (residents of Framingham, MA) for decades, recording information about them, their lifestyles, their exposures, and ultimately, their cardiovascular outcomes.
This is crucial. Your “risk score” results from your information being processed and ranked according to the information collected on this cohort. This is one way of bridging the gap between population and individual risk and, indeed, Foucault describes the norm (in this case, I’m using the term in the sense of the abstract population average) as the thing that links individual to population. “Normal” is a relational term, describing where you fall in relation to such an abstract population average. If your risk on the Framingham assessment is particularly high, you’ll probably get lots of disciplinary-sounding medical advice: stop smoking, eat more vegetables, exercise more, etcetera.
Evidence-based medicine read through this Framingham example is an illustration of how biopower “permeates” the disciplinary culture of medicine (I mean, what could be more “anatomo-political” than medicine and the enterprise of “cure”?). Not so much an inversion of biopolitical thinking, but rather a way that biopower and biopolitics present “inside” the disciplinary apparatus of medicine and are instantiated by it.
It’s a very similar case, I feel, with a lot of the risk discourse around COVID, even at this late date. Having to fend for ourselves like good little neoliberal subjects, we’re kind of caught on the horns of this dichotomy between population risk and individual responsibility for mitigating it. Doing your individualized risk assessment based on increasingly abstract (and unavailable) population data, like wastewater data, is an example of biopower permeating disciplinary power. So, too, is masking (and not masking, as the case may be). In fact, I think that this operation of population-oriented biopower within individually-oriented practices of discipline is a really interesting way to make sense of the jumbled politics of masking in this moment. Perhaps for another day when I have time!