Risk, Governmentality and Biology

Risk, governmentality and biology act as fundamental elements in todays restructured neo-liberal sense of governance, which dominates contemporary culture. Specifically, this week’s readings explore many issues and consequences arising due to innovations in biomedicine, the predominance of mood-altering drugs, genetic developments, the collusion of insurance and risk, and preventive medical strategies. All of these factors act as catalysts, in the transformation of traditional social and moral norms historically attribute to life itself.

An Emergent Form of Life?
Nikolas Rose argues that developments in medical biotechnology create a myriad of theoretical questions. Rose explains that, “many social theorists, bioethicists, and philosophers worry that biomedical knowledge is effacing the distinction between the natural and the artificial and, in doing so, is raising fundamental questions about human nature, free will, human dignity, and crucial moral values” (Rose, 77). Here in the crux of the neo-liberal governmental rationality, the very essence of what it is to be human becomes blurred. Rose introduces, Leon Kass and colleagues, who reported the President’s Council on Bioethics in 2003. These authors note a dramatic shift in medicine over the last two centuries. Kass and his team identify four particular capacities in which medical biotechnology is now moving beyond therapy to pursue goals of augmentation or transformation of life; including:

I. Better children- prenatal diagnosis, embryo selection, genetic engineering of embryos, and behavior modification with drugs especially in relation to ADHD
II. Superior performance in sport
III. Ageless bodies—the whole range of technologies designed to increase the healthy human lifespan
IV. Happy souls—memory alteration and, in particular, mood improvement through the SSRI family of drugs

Additionally, Rose explores The Future of Human Nature, by Jürgen Habermas.Habermas shares similar concerns as Kass and his contemporaries regarding contemporary biomedicine. Explicitly, Habermas focuses on the issue of reproductive genetics. Reproduction acts as a biological function that is rapidly changing, as critical moral decisions transcend into a new politicization of life itself. One form of reproductive genetics is the emergence of the prepersonal life. Rose defines the prepersonal life as that “of the child to come constraining the ethical freedom of the genetically modified person by undermining their capacity to see themselves as the undivided author of their own life” (Rose, 78). This represents the ideology of optimization as it defines contemporary biopolitics, relating optimization of life itself to two related issues: susceptibility and enhancement. Now, individuals can actively manage the human body according to susceptibility and enhancement.

Susceptibility, according to Rose, “indexes the multitude of biomedical projects that try to identify and treat persons currently without symptoms, in the name of preventing diseases of pathologies that might manifest themselves in the future” (Rose, 82). That is, the individual becomes a pre-patient in terms of susceptibility. “Protodiseases” also emerge. Rose defines a protodisease as “a pathology revealed by diagnostic tools revealing the previously invisible” (Rose, 84). Enhancement, “refers to the attempts to optimize or enhance almost any capacity of the human body or soul—strength, endurance, longevity, attention, intelligence—to open it to artifice and include its management within the remit of biomedicine from bench to clinic and marketplace” (Rose, 82).
Similarly, the individual now possesses the capability to enhance or reshape his or her body through pharmaceuticals and other measures seeking to optimize the body. Rose identifies enhancement as possessing an element of restoration. Through intervention, the individual feels as though he or she can restore the body to a natural or favorable state. A new molecular scale emerged alongside contemporary biology. This focus is the basis on which life is visualized and acted upon. Numerous processes arose as the molecular gaze of the human body widened including; reverse engineering of life, its transformation into intelligible sequences of processes that can be modeled, reconstructed in vitro, tinkered with and reoriented by the molecular interventions to eliminate undesirable anomalies and enhance desirable outcomes” (Rose, 83). In other words, the individual becomes malleable, subject to intervention so that he or she may have a healthy future or outcome. Due to advances in biomedicine, Rose further argues that “any element of a living organism—any element of life—can be isolated, its properties identified, mobilized, manipulated, and recombined with anything else” (Rose, 83)..

Rose notes that Hans-Jorg Rheinberger furthers his own exploration of recent innovations in contemporary biopolitics. Rheinberger suggests that the human race has shifted from an “age concerned with representing organisms and their processes—an age concerned with discovery—into a technological age, one concerned with intervention, whose telos is that of rewriting and transforming life” (Rose, 83). Although Rose does not agree with Rheinberger’s argument fully, he finds the central argument to be accurate. Rose proposes that life forms and forms-of-life that persons inhabit resulted in the merging of bios and zoë. In contemporary neo-liberal governance, the bios merged with the animal nature of zoë as medicine and the optimization of health has become a highly politicized in contemporary society.

As the human body is no longer a natural given, Rose argues that a new ontology of the individual now dominates biomedicine. He furthers, “ The multiple transactions between expertise and subjectivity, and the multiple injunctions and managed desires to reform and remake ourselves through calculated intervention in the name of our authenticity, self-realization, and freedom, have been central to the government of self in advanced liberal democracies” (Rose,105). That is, through optimization interventions of the human body; individuals provide an economic opportunity where individuals become consumers in an economic marketplace where an emergent form of life if quite possible.


At Genetic Risk
In, At Genetic Risk, Rose explores the notion of risk and its application to genetics. Specifically, Rose examines the consequence of being ‘at genetic risk’ as ‘mutations in personhood.’
Persons become obligated in the present to act in relation to potential futures now observable. It is in this capacity that discourses and practices in genetics now relate to risk. Rose introduces a new variation of genetic risk stating, “Various forms of risk thinking, the availability of predictive genetic testing introduces a qualitative new dimension into genetic risk, creating new categories of individuals and according genetic risk a new calculability” (Rose, 107). Essentially, Rose treats these phenomena as the surveillance or treatment ‘in the name of prevention. Additionally, genetics also closely mirror what Rose terms, ‘contemporary practices of identity.’ In this sense, life becomes a strategic initiative obligating the individual to maximize his or her life and the subsequent lives of decedents to come. Rose explains, “As life has become a strategic enterprise, “the categories of health and illness have become vehicles for the self-production and exercise of subjectivities endowed with the faculties of choice and will” (Rose, 107-108). The individual body, now the subject of ‘molecular gaze’, has in turn, labeled susceptibility of disease as a molecularized concept as genetic risk is now largely a molecular matter rather than that of the soma or of the flesh.

Somatic individuality, according to numerous theorists, represents a ‘whole-scale geneticization of identity’ (Rose, 109). However, Rose argues that this geneticization argument is deceiving. First, Rose argues that contemporary medicine does not subject an individual; suppressing and relinquishing the individual’s freedom. Instead, genetic identity acts as a creator, producing subjects out of the human individuality. Once patients, individuals emerged in contemporary medical practice as active subjects and consumers of treatments and cures. This ideology is future-oriented. That is, genetics act not only to trace historical and ancestral genetic links but also to prevent future illness and. Asymptomatic patients now emerge as ill individuals but it is also crucial to note that illnesses have become much a ‘family matter.’ Rose identifies these pre-patients as belonging to a genetic network. He further explains, “The subject genetically at risk may re-think his or her relation to current family, lovers, potential and actual spouses, children, grandchildren, and so forth—in terms of the issues of risk and inheritance” (Rose, 112). This often results in a reshaped lifestyle, where the pre-patient individual acts in order to prevent illness. Additionally, Rose notes that identity practices lie in a complex web in which the geneticization of identity becomes entangled.

Next, Rose, using Novas’ three distinct periods in which he finds mark the shifts that have taken place in the field of genetic advising. Novas identifies the first ‘eugenic period’ as running thought the 1930s and 1940s. This period stressed the reshaping of ‘voluntary’ individual reproductive decisions using contemporary eugenic considerations. Later in the period, film and propaganda acted to reshape individual’s choices regarding reproduction. Particularly, the first eugenic age represented the idealized assessment of good genes and bad genes, which experts used to advise reproduction based on hereditary genetic risks. Second, the 1950s through the 1970s marked the second ‘eugenic period.’ In an attempt to distance eugenics as used by the Nazis in Germany, experts in this era urged that preventing genetic disease should be a ‘voluntary measures.’ Optimization of health became the standard, specifically through prevalent discourse urging the prevention of birth defects. As Rose notes, “Novas argues that during this period genetic counseling was redefined as a form of guidance to help relieve anxieties, fears and inner tensions of being provided with genetic risk information” (Rose, 115). Third, the period lasting from the 1970s to contemporary times exemplifies a eugenic period, which Novas urges notes the emergence of a new form of ‘psychological counseling,’ which became dominant then and remains so today. Rose explains that in this model the, “identification of genetic risks has become bound up with a concern to maximize life chances and improve quality of life; in order to do this, genetic counseling was no longer to be exclusively concerned with the prevention of genetic disease, but must be involved in the communication of genetic risk” (Rose, 115). Psychosocial genetic counseling, today, stresses the modification of an individual’s lifestyle. This assumes individual autonomy and prudent action for their individual future but also for future decedents. As persons ‘at risk’ emerged, governance ostracized and marginalized genetically risky persons based solely on their individual genetic makeup. This especially applied to ‘populations at risk’ as governances sought to alleviate bad genes leading to genetic discrimination.

Genetic discrimination represents the use of individual genetic information discriminatorily based only on the individual’s genetic makeup in comparison to the “normal genotype” (Rose, 117). Rose notes that the “a new underclass based on genetic discrimination” was threatening to researchers in the early 1990s (Rose, 117). Additionally, by insurance policies further genetic discrimination through monetary schemes based on an individual’s level of risk. Increases in genetic information resulted in a general shift by insurance companies to practice risk segmentation. Rose explains, “ While insurance can acts so as to socialize risk, the current tendency has been to utilize knowledge about populations and information about individuals to ‘unpool’ risks and to allocate individuals to tightly defined risk categories” (Rose, 123). Now, individuals become calculable units within a network of risk and prudent behavior is required in order to promote further health by acting ‘genetically responsible.’

Individuals act responsibly using genetic information as neo-liberal governances construct the human life as a project , “framed in terms of the values of autonomy, self-actualization, prudence, responsibility and choice” (Rose, 125). Here, Novas identifies four distinct precepts of technologies of the self:, which are created through individuality of contemporary medicine. These include:
I. The location of a molecular- genetic identity:
II. A domain of ethical problemization:
III. A new relation to expertise:
IV. Formation of life strategies :
All of the above characteristics of technologies of the self are future-oriented while acting in the present. One must be genetically responsible so not to plague future generations with illness or abnormality. Individuals now adopt a genetic personhood . Summarily, Rose argues that genetic risk is evolving into a governmental practice politicizing individual human lives.



Insurance and Risk
The term, insurance, possesses multiple meanings and different forms of practice. Francois Ewald identifies the term insurance as an institution, an abstract technology, the insurance as form and as a technology of risk. First, insurance as an institution refers to the various companies managing a wide range of insurance liabilities. Insurance institutions apply to both persons and property, which creates distinct institutions. These organizations serve different purposes as well as attract different patrons. Second, insurance acts as an abstract technology. This view assumes that insurance technology is ‘an art of combination’ (Ewald, 197). Ewald elaborates this idea stating, “Considered a technology, insurance is an art of combining various elements of economic and social reality according to a set of specific rules” (Ewald, 197). Using utility-effect strategies, insurers use insurance as a technology based on the technology of risk. Third, the idea of insurance as a form refers to the numerous ways various insurance institutions are shaped. Fourth, insurance becomes a technology of risk in contemporary society.
Risk as it applies to insurance holds three significant characteristics Ewald states that, risk is ‘calculable, collective, and it is a capital.’ The calculability of risk essentially assumes that it is possible to evaluate probability. That is, the idea of insurance centers on both a ‘statistical table which establishes the regularity of certain events’ and ‘the calculus of probabilities applied to that statistic.’ In other words, this formulaic model results in the actual chances of an event occurring. Making risk a specific function in predicting action regardless of intent or will among the individuals evaluated. Second, risk is collective as events often affect a population or groups. Individual risk is moot in this scenario as risk is only calculable as it encompasses a population. Through selection and division of risks, insurers act to socialize risks making each individual a part of the collective body. According to Ewald, “insurance provides a form of association which combines a maximum of socialization with a maximum of individualization” (Ewald, 204). Ewald deems this form as reconciling society-socialization and the issue of individual liberty, allowing insurance to succeed politically. In sum, Ewald addresses the notion of risk in todays society as it drives individuals to act in the present to secure an illusory future good



From Dangerousness to Risk
In From Dangerousness to Risk, Castel explores preventive strategies used especially in the United States and France, which transform traditional mental medicine and social work. The subject dissolves, as he was once a concrete individual. Now the individual enters a realm in a ‘combinatory of factors’. Particularly, one enters ‘the factors of risk.’ Risk begins to establish itself as it channels flows of population through the establishment of numerous factors that act as liabilities in the future production of risk. According to Castel, the principal shift in social work and medicine that has taken place over the past century as the, “transition from a clinic of the subject to an epidemiological clinic, a system of multifarious but exactly localized expertise which supplants the old-doctor-patient relation” (Castel, 282). That is, there is no longer a direct relation between the patient and the doctor/ technician as individuals become statistical information channeled through numerous networks comprised of experts and administrators. It is in this period that dangerousness ceased to dominate medicine as preventive strategies replaced former notions of patient care to an ideology based on risk. It is through prescribed preventive measures that one actively seeks to prevent future abnormalities. Interventionist techniques act to guide and assign individuals according to abnormalities.

The transformation from dangerousness to risk over the past century occurred largely due to the heightened postulation by experts of future events. Individuals now act in the present in order to secure a favorable future. This future-oriented ideology sought to control unpredictabilities and liabilities of future actions. Classic psychiatry began using two notable forms of preventive strategies; confinement and sterilization. Confining an individual sought to prevent and neutralize an individual who may act dangerously at some point in time. Sterilization, on the other hand, is capable of wholly eradicating future risks. Once sterilized, the individual cannot pass on his or her abnormality to future generations. Eugenics also finds reason in risks rather than danger. Intervention then occurs based on “preservation of the race” to protect descendants much like sterilization. http://youtu.be/qaQQHuwqg6A

Castel introduces a new mode of surveillance, which he terms, systematic predetection. Systematic predetection seeks to influence individuals to anticipate and prevent a future pathology or abnormality using preventive practices. In the process, the subject ceases to exist, as individuals become “factors and statistical correlations of heterogeneous elements” (Castel, 288).
Castel identifies two consequences of the shift in medicine and social work over the past century.

I. The separation of diagnosis and treatment, and the transformation of caring function into an activity of expertise
II. The total subornation of technicians to administrators

As new forms of control materialize in today’s neo-liberal society, an ‘unified apparatus linked to the machinery of the state’ materialize as maximizing returns while treating populations. However, this apparatus marginalizes lower class individuals, as these persons do not create profit. Consequently Castel explains, “ The profiling flows of populations from a combination of characteristics whose collection depends on an epidemiological method suggests a rather different image of the social; that of a homogenized space composed of circuits laid out in advance, which individuals are invited or encouraged to tackle, depending on their abilities” (Castel, 295). Therefore, the marginalization of certain populations becomes an organized force within the social realm directing lower class populations who have no opportunity to insure against liability as the wealthy may This results in a dualistic situation whereby the wealthy benefit while the poor are continually marginalized and controlled by the notion of risk using preventive strategies.

Discussion Questions:

I. According to Rose, genetic discrimination is growing, making individuals into statistical data. How might one solve the marginalization of lower-class individuals especially in light of drastic measures such as sterilization?

II. Following the idea of insurance and risk proposed by Ewald, how much is the human body actually worth? In other words, how would you price yourself or your family? This poses an interesting theoretical debate as loss ensued are never wholly reparable.