Governing the Health of the Hybrid Self: Integrative Medicine, Neoliberalism, and the Shifting Biopolitics of Subjectivity
Fries, Christopher J., Health Sociology Review
'What should be the treatment of quackery? It should be that of abomination, loathing and hate. It should be considered the unclean thing - foul to the touch, wicked and treacherous to the soul - as a deadly miasm to every generous and benevolent emotion - as the death of every upright principle ... how can we endure their base betrayal and prostitution of our noble profession?' (Transactions of the New Hampshire Medical Society, 1856, cited in Coulter 1992:157).
The problems of governmentality and the techniques of government have become the only political issue, the only real space for political struggle and contestation (Michel Foucault, 'Governmentality' in Burchell et al 1991:103).
Much of the current discourse within the biomedical community concerning complementary/alternative medicine has shifted towards developing an 'integrative medicine' by which such practices are incorporated within a biomedical regime (e.g. Bell et al 2002; Snyderman and Weil 2002). From a sociological perspective, 'integrative medicine' is a term as politically charged as it is culturally loaded (Tovey et al 2004). This paper employs a Foucauldian perspective on the shifting spacialisation of medical knowledge to explore the manner in which integrative medicine is discursively represented by its biomedical architects so as to ensure good cultural fit with neoliberal strategies of governance in which the focus is on enabling citizens to accept personal responsibility for their health. This refiguration of medical knowledge seeks to carve a niche for integrative medicine alongside emerging biotechnological and genomic medical technologies. Such a fundamental reworking of medicine represents a transformation from biopolitics to an 'ethopolitics' (Rose 2001) of human existence and as such is the most recent movement in the spacialisation of medicine documented first by Foucault (1973), elaborated by Armstrong (1983), and later refined by Rose (2001). It is argued that integrative medicine represents an expansion of medical rationality into all domains of human life: biological, psychological, sociological, and spiritual. This proposed expansion of medical influence rests not upon domination but rather, through enabling the autonomous individual at the centrepiece of neoliberal governance.
I proceed by first reviewing the Foucauldian perspective on the shifting spacialisation of medical knowledge, arguing that with the development of global cultural flows, human subjectivity has itself hybridised, provoking a reconfiguration of medical knowledge in which the twin discourses of 'medical consumerism' (Henderson and Petersen 2002) and the 'marketing of ethnicity' (Halter 2001) have an unexpected effect of becoming discursive mechanisms through which the governance of health proceeds within a globalised, neoliberal context. Then I examine integrative medical discourse to trace its emergence and contestations within the wider field of the politics of health, interrogating points of convergence between integrative medicine and neoliberalism. I conclude by remarking on how this way of framing the development of integrative medicine is a step towards a new health sociology.
Foucault and the shifting spacialisation of medicine
Foucauldian insights have made it possible to understand biomedical discourse as constituting health as an object of knowledge, including and excluding a wide variety of phenomena within the definition of 'health', delegating the role of subjects implicated in the pursuit of health such as physicians and patients, producing concepts of the normal and the pathological, and subsequently prescribing acceptable social practices for the pursuit of health (cf: Jones and Porter 1994; Petersen and Bunton 1997). In the first volume of The History of Sexuality, Foucault details (1978: 143-144) 'the proliferation of political technologies that ensued, investing the body, health, modes of subsistence and habitation, living conditions, the whole space of existence' to explain biopower in terms of a shifting spacialisation of medicine. …