The Politics of Life Itself and Biomedicalization

Nikolas Rose’s “The Politics of Life Itself” opens by identifying our entrance into a “biotech century, an age of marvelous yet troubling new medical possibilities” (1). Careful to emphasize the co-existence of both fears and hopes about these possibilities, Rose locates various controversies and debates surrounding increasing biomedical options. Above all, the question at the forefront of discussion is: what biomedical practices should be permitted, regulated, and off-limits entirely? (2). And, most importantly, how do we, and to what extent can we, distinguish between and among those practices which do not merely “seek to cure organic damage or disease, nor to enhance health, as in dietary and fitness regiments, but [rather] change what it is to be a biological organism…? (17).

Rose’s aim is to focus on vital politics. While vital politics of the past (18th and 19th century) was a “politics of health” (“delimited by the poles of illness and health” and “eliminating pathology to protect the destiny of the nation”) vital politics of the present “is concerned with our growing capacities to control, manage, engineer, reshape, and modulate the very vital capacities of human beings as living creatures” through the employment of various “rationalities and technologies of government” (3). For this shift to take place, the state and its various apparatuses have reorganized themselves, taken on responsibilities of management and regulation, and overseen the creation of commissions, organizations, political initiatives, and larger industries to accomplish these goals (3).

The key outcome of these “modifications in rationalities and technologies of government” have entailed “an increasing emphasis on the responsibility of individuals to manage their own affairs, to secure their own security with a prudential eye on the future” (4). A multifaceted combination of “marketization, autonomization, and responsibilities gives a particular character to the contemporary politics of life in advanced liberal democracies” (4). Thus, it is Rose’s task to uncover and analyze how it is that the “vital existence” of humans (“as biological selves”) becomes:

• a focus of government;
• the target of novel forms of authority and expertise;
• a highly cathected field for knowledge;
• an expanding territory for bioeconomic exploitation;
• an organizing principle of ethics;
• and the stake in a molecular vital politics (4).

On pages 5 – 6, Rose introduces to us five pathways which help to explain the formation of the contemporary biopolitical space:

1. Molecularization: envisioning life at the molecular level; “molecular entities can be identified, isolated, manipulated, mobilized, and recombined.”

As a means to trace and understand the shifts from emphases on the “molar body” (i.e. limbs, organs, tissues, etc.) to emphases on the “molecular body” (i.e. molecules, genes, proteins, DNA, membrane, etc.), Rose refers to Ludwik Fleck’s “style of thought”: “a particular way of thinking, seeing, and practicing [which] involves formulating statements that are only possible and intelligible within that way of thinking” (12). A style of thought discursively “shapes and establishes the very object of explanation, the set of problems, issues, phenomena that an explanation is attempting to account for” (12).

2. Optimization: conceiving of life beyond terms of health and illness to instead focus on achieving the optimal life through various technologies. Technologies (“technologies of life”) refers not necessarily to “equipment or techniques,” per se, but rather to “any assembly structured by rationality governed by a more or less conscious goal…hybrid assemblages of knowledges, instruments, persons, systems of judgment, building and spaces, underpinned at the programmatic level by presuppositions and assumptions about human beings” (17). Technologies are geared toward susceptibility and enhancement. Susceptibility “indexes the problems raised by attempts to identify and treat persons in the present in relation to ills that they are predicted to suffer in the future” (18), while enhancement refers to “improvement by technological intervention” (20).

3. Subjectification: the duties, rights, and expectations of human beings are reorganized from terms of health and illness into new relations based on “biological citizenship.” Citizens are not merely passive recipients of treatments, but rather become active consumers concerned with “maximizing and enhancing their own vitality” (23). Some biological citizenship projects come from above (i.e. government incentives) and some come from below (i.e. feminists pushing for birth control) (24).

Rose also proposes ethopolitics as “the self-techniques by which human beings should judge and act upon themselves to make themselves better than they are” (27). Combined with biopolitics, ethopolitics becomes biological ethopolitics: “the politics of how we should conduct ourselves appropriately in relation to ourselves and in our responsibilities for the future” (27).

4. Somatic Expertise: “new ways of governing human conduct” along with the emergence of means to govern that conduct via experts, specialists, clinics, therapists, centers, etc. These can include, but are not limited to, nurses, midwives, health visitors, psychological therapists, speech therapists, occupational therapists, art therapists, physiotherapists, nutritionists, dieticians, health promotion experts, remedial gymnasts, counselors, educators, etc. (28). Citing Ludwik Fleck again, Rose shows us that somatic expertise surpasses mere application of conduct-guiding practices: it is a “thought collective” comprised of its own discourses, meaning-making apparatuses, performers, histories, myths, and ethics (29). Far from being solely external, somatic expertise is highly internalized.

5. Economies of Vitality: the emergence of a bioeconomy, along with a “new form of capital,” comprised of a complicated relationship between science and markets, between citizenship and expertise, between truth and capitalism.

Biopolitics is both lucrative and expensive. Biovalue is “the plethora of ways in which vitality itself has become a potential source of value: biovalue as the value to be extracted from the vital properties of living processes” (32). Importantly, biocapital is both a “mode of production” and “a way of thinking and acting” (33-34).

Essentially, “the circuits traced out by these contemporary economies of vitality are thus conceptual, commercial, ethical, and spatial. These spaces range from the atomic, the molecular, the cellular, the organic, the spaces of practices [laboratories, clinics, consulting rooms, factories] of cities and their economies, of nations and their regulatory frameworks and economic strategies, and of the virtual spaces of the Internet that ensure the immediate availability at any point in the world of the totality of data on the genome” (38).

Clarke, et. al. describe bioeconomy (along with biocapital) in more detail, identifying both as “the imbrications of capital with the biological sciences and technologies, biomedicine, megacorporate pharmaceutical and biotechnological industries, (bio)-nanotechnologies, and so on” (7). In other words, these biological practices, etc. have become infused with capitalistic implications. And, there are of course ethical implications to fusing biology and capital, for “biocapital” can also refer to the capacities of certain things – such as organs and tissues – to produce surplus value,” or rather, to become commodities (8-9).

Key Concepts:

Some of the concepts Rose employs may be unfamiliar to us, so here is a brief guide to additional terms and definitions.

Genomes - according to the Genome News Network, a genome is “all of a living thing's genetic material. It is the entire set of hereditary instructions for building, running, and maintaining an organism, and passing life on to the next generation.”

Psychopharmaceuticals - according to Medical Dictionary Online, psychopharmaceuticals are “a loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents).” Concerns about the future of psychopharmaceuticals can be found in articles like “The Pharmacy of the Future and You,” where David Owens warns that “the more we learn about ourselves, the less free we will be” (Bailey).

Transhumanists – according to the World Transhumanist Association, transhumanism is characterized by this belief: The human species can, if it wishes, transcend itself —not just sporadically, an individual here in one way, an individual there in another way, but in its entirety, as humanity. We need a name for this new belief. Perhaps transhumanism will serve: man remaining man, but trans¬cending himself, by realizing new possibilities of and for his human nature (Huxley).

Biomedicalization – “Introduction”

Five key interactive processes comprise biomedicalization:

1. A new biopolitical economy of medicine, health, illness, living, and dying which forms an increasingly dense and elaborate arena in which biomedical knowledges, technologies, services, and capital are ever more co-constituted.

2. A new and intensifying focus on health (in addition to illness, disease, injury), on optimization and enhancement by technoscientific means, and on the elaboration of risk and surveillance at individual, niche group, and population levels.

3. The technoscientization of biomedical practices where interventions for treatment and enhancement are progressively more reliant on sciences and technologies, are conceived in those very terms, and are ever more promptly applied.

4. Transformations of biomedical knowledge production, information management, distribution, and consumption.

5. Transformation of bodies and the production of new individual, collective, and population (and niche group) level technoscientific identities (1-2).

Whereas medicalization is emphasis on “exercising control over medical phenomena – diseases, illnesses, injuries, bodily malfunctions,” biomedicalization emphasizes “transformation of such medical phenomena and of bodies, largely through sooner-rather-than-later technoscientific interventions not only for treatment but also increasingly for enhancement” (2).

Biopower arose during the 18th and 19th centuries and “is a ‘michrophysics of power,’ taking particular forms of knowledge coupled with technologies to exert diffuse yet constant forces of surveillance and control over living bodies and their behaviors, sensations, physiological processes, and pleasures – individually and in terms of groupings and populations through governmentality” (5). Biopower is “embodied through social practices and norms rather than invested in particular individuals or institutions” (5).

Individuals, groups, and entire populations engage in biomedical practices, while at the same time other individuals, groups, and populations resist biomedical practices: all done under the umbrella of “biological citizenship,” which promotes “the rights of citizens to the protection and promotion of their health and well-being” (12). First Lady Michelle Obama’s “Let’s Move” campaign is a good example of the complications of certain biomedical practices and programs.

Unsurprisingly, biomedicalization has gendered implications as well. Early work on gender and biomedicalization (pre-2000) focused primarily on “women and/or how the concepts of sex/gender are produced, maintained, and negotiated in health, illness and biomedicine;” that is, how gendered biomedical practices can be…”an effect of power” (27). Of course, there is not only a multitude of examples geared toward women, but it is important to also highlight masculinity and biomedicalization. Not dissimilarly, race and class are also grossly underrepresented in explicit studies about biomedicalization. Clarke et. al. propose that this is because race and class are realms of undermedicalization: “unequal access to medicine due to class- and race-related factors” (29). One remedy to undermedicalization is the work of Clarke et. al. through stratified biomedicalization: emphasis on “the selectivity and strategic nature of biomedicalization, its unequal (and sometimes unintended) effects across populations, and how these may exacerbate rather than ameliorate social inequalities along many different dimensions” (29). Another remedy is intersectionality theory, proposed by Patricia Hill Collins and concerned with simultaneously taking multiple categories ( gender, class, race, etc.) into account (30).

Discussion Questions:

1. In the article I posted about psychopharmaceuticals, the author writes that: “…the better we understand how human beings work, the freer we shall be. But The Pharmacy of the Future suggests that the more we learn about ourselves, the less free we will be. A scientific understanding of man is a threat to our freedom because it undermines our capacity to govern our own lives by making decisions. If man is just a bag of chemicals, once we know what these chemicals are, we can re-mix them at will. And by re-mixing them at will, we can give ourselves whatever character we like. But if we can choose a character at random, our current needs and interests lose their authority as grounds for making any decision. And what other grounds for making decisions are there?" Can you provide any concrete examples for discussion that either support or challenge this view? How do we define “freedom” in this framework?

2. Clarke et. al. quote Singh and Rose (2006, 97) with the following question: “Can individuals resist/access the pharmaceutically powered drive toward perfection; is their personal agency sufficient to resist/access enhancing drugs, especially if they are very young, or poor, an ethnic minority, a convicted felon – or, for that matter, if they are students at elite competitive universities?” (12). How would you answer this question, and with what evidence?