Philosophy Hammer
Philosophy, Economics, Politics & Psychology Tested with a Hammer

89: Michel Foucault XI:
The Politics of Health in the Eighteenth Century & we 'Other Victorians'

Summary by: Jeff McLaren

In the “Politics of Health in the Eighteenth Century,” Foucault deals with the development of a medical market in the 18th century that went side by side with the organization of a politics of health which Foucault defines as “the consideration of disease as a political and economic problem for social collectivities which they must seek to resolve as matter of overall policy.” Or as he called it noso-politics.

There were several institutions that took up a noso-politics: the state, religious groups (for example the Quakers), a new wave of secular charitable organizations, the new learned societies (like the Royal Society). Where previously medical service was just one component of the broad category of assistance in the 18th century it became divorced from assistance thought of as charity (that is the provision of food, clothing, shelter, education, work etc.) organized by religious groups.

The methods used to divorce medical assistance from assistance in general and create a market for medical services involved: 1) an economic investigation into the use of charitable funds, 2) the ranking of types of “poor” people (idle poor, sick poor, etc.) so as to address the problem of the poor by getting them to work and minimizing the cost to society of the “incapable of working poor”

“The new noso-politics inscribes the specific question of the sickness of the poor within the general problem of the health of populations, and makes the shift from the narrow context of charitable aid to the more general form of a ‘medical police,’ imposing its constraints and dispensing its services.”

Among the reasons for the development of noso-politics was the improvement in the health and capabilities of the workforce and the accumulation of men. Similar to the accumulation of wealth, the accumulation of men me referred to the desire for large armies of soldiers, workers and researchers thought to make a country great.

There were two great tactics of power that made the accumulation of men possible the first was the privileging of the child and medicalization of the family. No longer was it important to get as many children as possible; now with the advent of “childhood” the problem became how to get the optimal number of children, keep them alive and healthy to fill the ranks of soldiers, workers and or scientists. The tool used was the medicalization of the family to which its function of establishing lines of decent was added the purpose of raising (that is disciplining – as making docile and useful) children. Child care becomes a central aspect of family life: a new discipline through campaigns of pediatrics, inoculation and vaccination, new institutions of orphanages, foundling hospitals, and foster parenting.

The second great tactic of power that made the accumulation of men possible was the privileging of hygiene and the function of medicine as the instance of social control. Good hygiene was found to be a critical factor in eliminating epidemics, reductions in death rates and the extension of life spans to such a degree that the state could justify authoritarian medical interventions and controls. First intervention justifications in city hygiene came through urbanism and zoning control of disease causing building and practices (such as the development of sewage systems and the placement of abattoirs and charnel houses etc.) Secondly as doctors discovered the health promotion properties of hygiene they became invested with even more social power to teach and force ever more behavioural changes in the population for their own and society’s good. Suddenly the doctor is found in all institutions and often as head of each. “it is the doctor’s function as hygienist, rather than his prestige as a therapist, that assures him this politically privileged position in the eighteenth century, prior to his accumulation of economic and social privileges in the nineteenth century.” In the 18th century the doctor is as much in demand for his hygienist services (that is political services) as for his medical services.

Interestingly the hospital came under attack at this time for causing more illness and death than benefit to the population. That the hospital as an institution survived the attacks on its viability from the medicalization of the family and hygiene as social control is a testament to the political power of the medical corps. “the disappearance of the hospital was never more than the vanishing point of a utopian perspective. The real work lay in the effort to elaborate a complex system of functions in which the hospital comes to have a specialized role relative to the family,…to the extensive and continuous network of medical personnel, and to the administrative control of the population.”

In Foucault’s essay “We ‘Other Victorians’” he sets out his project with regards to his history of sexuality. “I would like to disengage my analysis form the privileges generally accorded the economy of scarcity and the principles of rarefaction [Foucault is talking against the repressive hypothesis], to search instead for instances of discursive production…of the production of power, of the propagation of knowledge.”

The prevailing discourse goes like this: While there was an extreme silencing and intolerance of the speech and practice of sex prior to and culminating in the Victorian era there was a tolerance in the brothel and in the mental hospital, “everywhere else modern puritanism imposed its triple edict of taboo, nonexistence, and silence.” But we are all so much freer and better now.

“The question I would like to pose is not: Why are we repressed? But rather: why do we say, with so much passion and so much resentment against our most recent past, against our present, and against ourselves, that we are repressed?”

The repressive hypothesis is not fact exactly it is a discourse and Foucault’s aim is to “put it back in a general economy of discourse….to discover who does the speaking, the positions and viewpoints from which they speak, the institutions which prompt people to speak about it….to bring about the ‘will to knowledge’ that serves as both their support and their instrument.”

© 2008 - 2018, James Jeff McLaren