Dialogues on Governamentality
Dialogues on Governamentality
0888
interviews
and the psy knowledges:
dialogues with Nikolas Rose (Part 2)*
*
This interview was
done by Sergio Resende
Carvalho during his
studies as a Visitor
Scholar - under the
auspices of CAPES/
Ciências Sem Fronteira
– at the Department
of Social Sciences
Health and Medicine of
the King’s College of
London.
(a)
Departamento
This is the second of three interviews with Nikolas Rose from de Saúde Coletiva,
which we have explored some important aspects of his wide Faculdade de Ciências
Médicas, Universidade
academic production. The first part had, as a central axis, Estadual de Campinas.
questions about the State, Public Policy and Health and their Rua Tessália Vieira de
Camargo, 126, Cidade
relation with the concept of governamentality. In the current Universitária Zeferino
issue we discuss the role of knowledge and practices psi in the Vaz. Campinas, SP, Brasil.
government of conduct and the genealogical research. At the 13083-887. sresende@
fcm.unicamp.br
last interview we will have a opportunity to reflect with Rose (b)
Departamento
about his recent research on Life Sciences, Biomedicine and de Fisioterapia,
Neurosciences. Fonoaudiologia e Terapia
Ocupacional, Faculdade
Medicina, Universidade
de São Paulo. São
Paulo, SP, Brasil.
beth.lima@usp.br
I will open this conversation with some broad question about research and
methodology. In the first part of your interview(c) we had the opportunity
to talk about your dialogue with Foucault’s work. In this context, can
you discuss the criticism that you make of what you call the Foucauldian
commentators and your affirmation, in the book “Powers of Freedom”(d),
that we should take Foucault’s ideas about government as a starting point (c)
Carvalho SR.
for these investigations and not a general “theory or history of government, Governamentalidade,
‘Sociedade Liberal
politics or power latent in Foucault’s writings, which should be extracted Avançada’ e Saúde:
and then applied to other issues”? diálogos com Nikolas
Rose (Parte 1). Interface
(Botucatu) [Internet].
There is, of course, much valuable work to be done on Foucault’s texts. A work 2015 [cited 2015
Nov 10]; 19(54):647-
which comprises commentary and analysis of Foucault’s books, lectures and 58. Available from:
interviews, exploration of the conceptual and philosophical architecture, the http://www.scielo.br/
scielo.php? script=sci_
epistemological infrastructure and the theoretical implications of Foucault’s work; arttext&pid=S1414-
and also the relationship between his work and that of other social scientists, 32832015000300647&
lng=en.http://dx.doi.
other philosophers and other people who have worked on the analytics of org/10.1590/1807-
knowledge and power. That is a perfectly valid task, and there are some excellent 57622015.0216.
commentators or analysts of Foucault’s work along those lines. But I don’t think (d)
Rose N. Powers of
that is all Foucault’s work invites us to do. For a whole range of reasons - personal freedom: reframing
taste, reasons of personal competencies - and because of what I think is most political thought.
Cambridge: Cambridge
socially and, if I dare say, politically important, I’ve chosen to take a different University Press; 1999.
route.
If you want a kind of justification in the texts of Foucault for the routes
that I have taken, you could link this to some of his remarks. First, let me take
his idea of field work in philosophy. Rather than seeking abstract philosophical
justifications for his approach, he is more interested in doing empirical
investigations into the practical and effective forms that philosophy has taken
in making up our world, and in the range of practices that we are engaged in.
One can see that from his most abstract work in The Order of Things or The
Archaeology of Knowledge, through to the specific analyses in Discipline and
Punish. This little phrase field work in philosophy is an incitement to do the kind
of work that I have been attempting.
Second: the question of whether his ideas amount to a general theory. In
many texts, Foucault is critical of attempts to develop a general theory which is
the property of intellectuals who can apply that to any situation. He counterpoises
that idea of the general theory, of the general theoretician, to that of the specific
intellectual working in particular practices and trying to make sense of the
configuration of knowledge, power and subjectivity in those particular practices.
Again, that for me is an invitation to carry on work in that vein.
This does not mean that there are no general lessons to be learnt from the
analysis of a specific practice. It does not mean that everything is tied to its
particular time and place and location. But it does mean that one should be
very cautious about trying to erect these into some sort of general theory, like a
theory of modernisation or detraditionalization or reflexive individualisation or
risk society, or whatever. It would run counter to the ethos of Foucault’s work
turn it into a general theory, which could then be evaluated against others. I don’t
find that a particularly fruitful approach. Maybe it’s a matter of personal taste
or maybe it’s a matter of the kind of work that will have most traction on the
problems that concern me.
You mention yours research’s methodology as a History of the Present, Critical History, Present
interviews
Centred History, and Genealogy of Subjectivation. Are there conceptual differences between
them? Do they intend to respond to different problems? What are the common grounds and the
differences between them and Foucault’s archaeology and genealogy?
I’m not a very systematic thinker or, rather, I’m not terribly interested in systematising the kind of work
that I have done in the different studies that I have undertaken. In different texts I have addressed
myself to different problem spaces, to different literatures, to different sets of concerns and I’ve tried
to articulate the approach that I’ve taken in relation to those specific problems. I’ve used different
phrases at different times to describe this but I would avoid trying to find big theoretical differences
on them. The first three terms that you mention - ‘History of the Present’, ‘Critical History’, ‘Present
centred History’ - all qualify the term history in some way. In doing that I’m trying to indicate the
difference between a genealogical investigation and an historical investigation.
When I teach this to my students, I start by asking what is the most obvious meaning of a
genealogy these days? It is a family tree. What is a family tree?
If we are trying to make your family tree, you are the apex of it in your family tree and we work
back you to mother, father, brother, sister; then their parents, their brothers and sisters and then their
parents, their brothers and sisters - the tree branches out that way. If we were talking about not
you, but your cousin or your friend, their family history would branch out in a completely different
direction.
So, a genealogy starts from a particular current question or problem and tries, like a family tree,
to trace out the dispersed set of relations that have brought that particular present problem into
existence. If we were thinking of a different problem, we would trace a different set of conditions
of possibility, a different set of inter-actions and different dimensions. We would produce different
genealogies, and these wouldn’t all march in step with one another, wouldn’t be organised in the same
temporal sequence, wouldn’t have the same kind of patterns, the same rhythms; let alone would they
relate to the same substrate or the same origin.
That is what I take from Foucault in his argument about not reading through the origin: not
thinking that there is a single origin from which you can trace the characteristics of the present. One
should take the present as the outcome of a set of often very contingent, haphazard, non-necessary
intersections between things that might seem to have very little in common with one another.
If you started from another problem, you would trace that in another way. That is the kind of
approach I try to use in my work and I try to suggest to others who are doing similar kind of work.
There is no necessity in history. There is no necessary coherence between one problem and another,
even though they exist at the same chronological moment.
One of the central themes of your work has been to study the ways in which the contemporary
apparatus for being human has been put together defining “genealogy of subjectivation as a
genealogy of being’s relation to itself and the technical forms that this has assumed”. Therefore,
you propose “an investigation of the intellectual and practical techniques that have comprised
the instruments through which being has historically constituted itself”. Can you tell us about
the importance, the definition and the ways that you use ‘technology’ and ‘techniques’ and how
you relate them to the subjectivation process?
It is difficult to account for the ways that beliefs about the nature of human subjectivity change over
time, but they certainly do. I have argued in my work that different conceptions of individuals emerge,
at least in part, within systems of authoritative knowledge about the human individual - psychology,
psychiatry, the psy disciplines etc. - and that these authoritative knowledges play their part in shaping
a new way of thinking of ourselves. Of course, the psy disciplines are not the only disciplines that have
been involved. It would be too simple to say psychology or the psy disciplines invented the subject of
freedom – that human beings are essentially freedom loving creatures, wanting to act with autonomy
and maximise their potential through acts of choice in the world - but they played their parts in it.
In my books I try to give a more complex answer to that question about how human beings at
a certain historical moment, in certain geographical areas, came to think about themselves in that
way. I’ve argued that the challenge for those who wish to govern legitimately in a free, liberal and
democratic society is always to align their strategies and technologies for governing conduct with
the prevailing images of what human beings are like. This is what I meant by speaking of the need
to invent technologies of subjectivity that worked with, rather than against, the grain of how human
beings were understood at a particular time.
That sounds all rather abstract. But, for instance, if you trace the history of the management of
human individuals in industry – say from Taylorism through to the Human Relations, to the Human
Potential movements that one sees in the 1960’s - you can see very clearly how ways of trying to
govern individual conduct in the workplace were linked to different ideas about what human beings
were and therefore how you could get the best out of them.
As one traces the succession of ways of thinking, one can see that in each case, those who claimed
to know how to manage human beings were always critical of how things had been organised before
because, they said, they did not properly understand what human beings really were. So each version
of management said something like “if you want to get the best out of people, to make them the
most productive, at the same time as most content, you need to align your management practices
with what we now know about how human beings are.” Each appealed to a different way of
understanding the human being, individually and collectively. And one can trace that empirically, which
is what I have tried to do.
In the 1980’s in the UK and in the US, and to a lesser extent across Europe, the idea of the human
being as a subject of freedom, of autonomy, of responsibility, of choice, became inflected in a new
way. It became linked to the idea that human beings were always striving to improve their situation,
to be more successful, not necessarily to get more money, but to improve their lifestyle, to improve the
well-being of their family, to improve the prospects for their children and to improve themselves, to
maximise themselves through the choices they made about their lives.
This idea of the individual who was enterprising - who would run their life as a kind of enterprise,
calculating and thinking about the choices and the risks that they needed to take in order to maximise
their potential - became a very powerful way of thinking across many practices from consumption to
work to insurance and beyond. Those were the kinds of characteristics that I tried to describe in some
empirical work that I did on the emergence of this enterprise culture and the modes of subjectivity and
subjectification that seemed so central to that enterprise culture.
Can you give us some examples of the use of those conceptual tools on your health research?
Strategies around health that took shape in that time partook of a similar idea of the individual who
was personally committed to the maximisation of their health through choices about lifestyle, diet and
so forth.
But of course, the interesting about these ways of thinking is that they purport to be descriptive,
but they are actually normative and interventionist. The idea of the individual seeking to maximise his
or her own health and that of their family becomes a norm, and once it becomes a norm it becomes
also the inspiration for a whole series of interventions to manage the person who does not match up
to that norm: the person who gets obese, who drinks too much, who eats too much saturated fat, or
is it now too much sugar, or is it now too much salt, or is it now too much of whatever else it is that is
too much.
Thus a conception of the human moves from a description to a norm, and the norm becomes
the basis for an intervention. You see this in the self-health movements that arise around maximising
health status. You also see it in the way that those who don’t try to maximise and manage their
health are made problematic. So much public health, certainly in the UK, is underpinned by this idea
in the way it addresses the problem of obesity or the problem of drinking too much
interviews
alcohol or the problem of cardiovascular disease. It works on the premise that what
you need to do is to change attitudes, change individual behaviours and change the
way in which people make their choices in order to align those attitudes, behaviours
and choices with the ways that you want their health status to move.
Such health interventions, first of all, seek to make the person into someone
who wants to be healthy. If only they could be helped to realise that they really
want to be healthy, then they could be given the knowledge and the choices to
make themselves healthy. Much public health in the UK - I can’t really speak for
anywhere else – try to transform the health status of a population by transforming
the health conduct of the individual; by releasing in the individual the desire to be
healthy, maximising the desire to be healthy and training the individual in the ways
in which they might realise that desire to be healthy. The language of enterprise
was rather short lived, but this idea that you will govern conduct best by seeking
to release the desire of the individual to improve themselves, and then training
that desire in a way that will lead to the outcomes that you want – that has lasted
longer. The best way to govern health is to make what the individual wants and
what you want as a health regulator coincide with one another.
Powers of freedom
One of the central aspects of your governmental studies is about the powers
of freedom. Can you comment on the affirmation that the rationality of
government in the capitalism today has as central objective to govern the
person through their liberty, that their autonomy is a necessary and a vital
aspect of government conduct?
That was certainly the central argument of the book “Powers of Freedom” in which
I tried to challenge the unquestioned virtue of the language of freedom. Like most
of my books, it was written, in a particular social, political, historical context. The
work that I did on freedom has to be understood in the context of the rise of a
powerful rhetoric of freedom in the 1980’s. Freedom was certainly a slogan of
resistance, but freedom was also an element within strategies of government.
One emblematic moment for those of us in Europe was the concert in Berlin in
1989 when Leonard Bernstein conducted Beethoven’s 9th symphony, the Ode
to Joy: in that moment, just after the fall of the Berlin Wall, the word ‘joy’ in the
fourth movement, the choral movement, is replaced by the word freedom. At that
moment the work becomes an Ode to Freedom, to freiheit, freedom being the form
taken by the demand of those in the East that led to the collapse of the Wall. It was
a powerful demand, and anyone who heard that concert will recall it as an intensely
moving event(e).
(e)
See: https://
www.youtube.com/
This was also the time the work of Friedrich Hayek became re-discovered with
watch?v=IInG5nY_ his emphasis on freedom, and when the writings of Milton Freedman such as
wrU “Free to Choose” became popular: freedom was on everybody’s lips. I argued that
we needed to distinguish between freedom as a powerful slogan of resistance,
and freedom as a governmental rationality – that is to say, practices that sought
to govern individuals by shaping, modulating, regulating the way in which they
understood and enacted what they took to be their freedom.
You have argued that one of the central achievements of the liberal arts
of government was to govern by ‘making people free’ and that it was
accompanied by the invention of a whole series of attempts to shape and
manage conduct in and through freedom. Can you comment on the way
this is related to the role of health experts in the government of conduct
nowadays?
I think the main strategies for the management of the health of individuals in the
UK at the moment still operate around the re-shaping of individual conduct in the
way that I have just described - this configuration characterises the main form
of public health intervention in the UK today. But perhaps one can also see the
emergence of two other versions that are being experimented today. As I have
said before, government is a congenitally failing operation, but governmentality
is eternally optimistic! So because these attempts to manage obesity, alcoholism,
etc., through individual behaviour change have largely failed, attempts have been
developed to find other strategies to transform individual behaviour.
First: if people themselves will not want to be healthy because can’t be
brought to give value to their own health and that of their family, perhaps one
should give them other incentives to be healthy. So there is some exploration
of the effects of giving people financial incentives to be healthy: paying people
who are obese to go down to the gym or giving them financial incentives to lose
weight or give up smoking, that kind of thing.
Second: “nudge”. Nudge – the term invented by Sunstein and Thaler(f) See: https://
(f)
– works on the basis that while people consciously might wish to be healthy, en.wikipedia.org /wiki/
Nudge_%28book%29
unfortunately, they are mobilised by kinds of passions that are outside their
conscious control. Consciously they would like to take long term views, cut
down their drinking, not eat so much sugar, not buy pizza and so forth. But
unfortunately the human creature is mobilised by short term passions. So when
they see the pizza or the alcohol, they will take the easy option rather than the
long term option. There is a pseudo-neuropsychological underpinning to these
arguments! Since people’s short term goals and short term desires always override
their long term wish to be healthy, what you should do is try to make it easier
interviews
for them to be healthy. You should make the healthy choice be the easier choice.
That is what nudge tries to do. Put a bowl of bananas near the supermarket
checkout at the height of a child’s eyes, and make the sweets and chocolates
harder to see and to reach, and there is at least a chance that your child will
make the right choice and pick up the banana. Make good choice the easier
choice, argue the nudgers’. Because, in their reflective selves, people really want
to make the good choice for the long term, but their evolved automatic selves
are driven to seek the short term reward: I need this sugar and I need it now.
Nudge purports to be an antidote to government, which is construed as a matter
of regulation and direction. It is a kind of liberal paternalism: people are left
free to do what they like, but ‘choice architecture’ makes the good choice – as
defined by those architects – the easiest choice.
But what one seldom sees, at least in coherent public health policy, is the
recognition that individual choice is not sufficient, that people’s choices are
shaped by the environment in which they live, that if you are a poor single
mother in South East London with three hungry children and not very much
money, you can give those children a huge calorie rush and keep them quiet, by
going in to a hamburger joint or a fish and chip shop and buying them a meal
that is largely fat, salt and sugar, very fatty chips and a very calorific drink which
you can probably get for less than a pound. So you’ve got three kids, for three
pounds you can give them something which is going to keep them quiet.
Even though there is a wide recognition that this logic of attitudes,
behaviours and choice is insufficient - and that people’s choices are shaped
by social and political and economic determinants -, there are few attempts in
public health to actually transform the environment in which people are making
their individual choices, or to recognise the need to give people the power – in
particular the money, the time and the incentive – to make better choices.
I am not sure of the best way into this question. Perhaps I can start by returning
to the founding question in my work: what kind of individuals do we think we
are? I don’t think there’s any natural or given way of being a human being.
There is an old cliché: “know yourself”, but there’s no way of knowing yourself
without a language to know yourself, a grid of perception to understand
yourself, a system of judgement to evaluate yourself against various norms, a set
of ideals to measure yourself against and so forth.
So I would rephrase your question “can power relations lead to a libertarian
practices of freedom?” in this way: if we are in a regime which offers us one
set of definitions of who we are, one system of knowledge to understand
ourselves, one regime of judgement, one set of ideals, is it possible to find
a way of radically questioning these? I think it is, but I don’t think that such
radical questioning arises by a conflict between who we really are and who the
practitioners of discipline and subjectification think we are. I don’t think it is a
matter of pitting our authenticity against those who try to suppress it or mould
it. I think it is a question of setting one way of understanding oneself, one way of acting upon oneself,
against another. We don’t live in a totalitarian universe; there are many different ways of thinking
about ourselves – actually even in totalitarian societies which are never so totalitarian in practice.
There is a range of different religious and spiritual beliefs, there are erotic understandings of ourselves,
in most contemporary societies we live in a plural and heterogeneous regime.
Of course, some ways of thinking about the self are dominant and some get deployed in many
different kinds of practices, but there are others that provide the possibility of a certain kind of
resistance. Not resistance by pitting autonomy against domination, but resistance of pitting one way
of thinking about the self, against another way of thinking about the self; one way of judging the self
against another way of judging the self.
In that sense one has to see libertarianism as embodying a particular doctrine of what human
beings are like, particular ideals and aspirations, and indeed particular techniques you would use upon
yourself in order to make yourself free. So, to that extent, power relations, if you want to call them
that, do enable practices of contestation and transformation, and if they didn’t then we wouldn’t see
any change at all.
Our history shows us that at different times, in different practices, human beings have been
thought of as creatures of instinct, as shaped by habits, as driven by unconscious desires, as aspiring
to freedom and self-fulfilment and so on and so forth. We’ve seen the ways in which these multiple
different ways of thinking about and acting upon the human being have come into conflict with one
another, and still are coming into conflict with one another.
So that is the way in which I would answer your question.
You raise the question of life as an affirmation of difference, and that is clearly a different kind of
ethic, perhaps one that is anti-identity, and that sees freedom not as an assertion of one’s true identity,
but as the capacity to change, as the capacity to be something other than you are. I myself would
not want to judge the extent to which this was a fundamentally liberatory way of thinking or acting
upon yourself. Michel Foucault certainly spoke of a particular view of freedom as the capacity to being
something other than what you are, to transform who you are, to remake yourself again and again
and again. That ethical value established a kind of minimal normativity that he used to judge a whole
series of practices that sought the reverse, that sought fixity, that sought identity. That is a powerful
part of the appeal of his work. It doesn’t happen to be an ethic that I share, but that’s a different
question.
Against the idea of a universal, unified and coherent subject and different to those who
criticise this formulation within a certain historical regime (e.g. psychoanalysis) you offer
us a perspective that affirms the subject as a product derived from of multiple relations: a
subject-effect of forces, technologies, practices and relations that seek to transform us and, also,
as a subject which is a result of our work upon ourselves. What are, for you, the consequences
of those three different ways to define the subject for politics and research? Why do you opt to
use the last conceptual formulation in your work? What are the limits and potency of it in your
opinion?
As we have discussed before, I have tried to avoid, “the theory of the subject”. I have tried to avoid
proposing an alternative theory of the subject to add to all the other ones that are already going
around. Rather than trying to have a theory of the subject, I’ve tried to address the question about
how subjects, how human beings come to think about themselves, to act upon themselves as certain
kinds of subjects; to judge themselves and to seek certain ways of living as appropriate ways for
interviews
themselves as certain kinds of subjects.
This is something which for me is open to a more empirical and historical analysis: to chart the
ways, the forms of language, the modes of invention, the types of judgement, the technologies of
reformation within which human beings are caught. That is the sense in which the human being is
enmeshed, perhaps even constituted, by this network of relations and interventions within which it
is brought into being. “One is not born, but one is made a human being”, to misquote Simone De
Beauvoir. So that is first thing.
The second thing is because, I don’t think what we used to, in the old days, call social formations
is coherent. I think there is a multiplicity of different ways human beings are addressed as subjects.
Yes, they bear family relationships at certain times but there is no single way in which a human being is
addressed as a subject. So the human being is enmeshed in multiple and contradictory ways of being;
to be a good parent; to be a good worker, to be a good lover, to be a good member of a particular
church or whatever. These create different modes of subjectification, to use that phrase, which I don’t
really like. As I have said before, when people talk about resistance, what I tend to find are places
where one way of thinking about yourself and being a human being is put into conflict with another
way. You want me to be a disciplined subject of the workforce but I want to realise my true human
potential. These are two different configurations, and they come into conflict with one another, that’s
where you see resistance.
Why do I think about it in this way? There are two reasons. The first is that I don’t see any reason
to believe that my particular theory of the subject would be any better than anyone else’s. Should I
be a Freudian? Should I be a behaviourist? Should I be a Lacanian? Should I adopt the sort of current
fashion for Affect Theory or whatever? There are a variety of different theories and it’s not for me
to adjudicate between them. If I wanted to adjudicate between them, I would be a psychologist,
which I am not. And I don’t want to be a quasi-psychologist, in the same way as in relation to Michel
Foucault, I don’t want to be a quasi-philosopher. Let philosophers do the philosophy, let psychologists
do the psychology and let those of us who are a bit like me do the things that we might be moderately
competent at.
That is the first thing. The second thing is that to approach the question of the subject effect in the
way in which I have just described, opens the possibility of historical and empirical investigation. That
brings it into alignment with the general way I would approach the issues. As I have said before, you
can trace historically and empirically the emergence of these different perceptions of ourselves, of the
ways in which we act upon ourselves etc. etc. That is the potency of this work.
The downside, of course, is that it makes it a little bit more difficult to say: subjects are really like
this and the way in which they are treated in our world misunderstands them and we have to liberate
the reality of the subject. You don’t have that normative underpinning of a liberatory politics if you
take the view that I do. Your choice between different subject forms is more or less like that. It’s an
ethical choice that you have to make because you think this is a better way of living than that way of
living; and then you have to defend that ethically and politically.
But if you take my perspective, you cannot defend it by naturalising it and saying: this is the way
subjects should live because this is what they are like in their nature. No, you can’t do it that way if
you take my kind of view. You have to say: this is the way in which subjects should live because I think
these have better consequences for human beings; but not because it’s in the nature of human beings
and their nature is being oppressed or restricted or whatever by socio-political forces.
You argument in Governing the Soul(g) that psy – as a body of professional Rose N. Governing
(g)
discourses and practices, as an array of techniques and systems of the soul: the shaping of
judgment present in different social fields, and as a component of ethics the private self. London:
Routledge; 1989.
– has a particular significance in relation to contemporary assemblages
of subjectification and that it had “a key role in constructing governable
subjects in ways compatible with the principles of liberalism and
democracy”. Can you reflect about those ideas and about the ways that psy
techniques have been used and incorporated, for example, in management
techniques and medical practice?
I do think that in the second half of the twentieth century, certainly in the regions
that I looked at – the liberal democratic societies of Europe, North America
and, to some extent, Australia - the psy knowledges played a key role in almost
every practice that was to do with the governing of conduct. The social work,
prisons, education, managing people in factories or in work places and indeed
the management of health - became inextricably bound up with psychological
knowledges and psychological conceptions of what human beings were like.
It would take too long to explain how medical practices and related health
management practices took up these psychological ideas, and it would be
necessary to give a lot of examples of. But, to give just one example, consider
how general practitioners have come to think about the patient who comes to
see them, have tried to understand them in terms of not just as patients with
bodily complaints but as persons who were ailing in certain ways. In these
cases what was necessary for the doctor was to try to distinguish the subjective
feelings of ailing from their organic basis; to try to sort out what was anxiety,
what was hope, what was misunderstanding, what were real symptoms of a real
disorder. If you were a general practitioner, you had to treat both of these - you
had to treat the disease, but you also had to find a way of treating the person,
the subject, the patient who was in front of you, not to dismiss their anxieties,
but to act as a kind of therapist on those anxieties. Of course, that was an ideal.
But I have explored many other examples, not just in clinical practice, but also in
questions of public health.
I don’t think one can make any definitive judgement at the moment on whether
or not those psy ways of thinking and acting are becoming less important. First of
all of course, there was never one psy. There were, and still are, multiplicities of
different psy techniques. If you were a medical practitioner, there were a whole
range of different ways of thinking about the human beings that you had in front
of you, different psychological theories, understandings, techniques and so and
so forth. Many of those are still there. Of course, it depends where you look,
which country, which region, which specialism, but I think many of those are still
there and they are working as they did before.
At one point, many believed that biomedicine and, in particular, genetics and genomics would
interviews
come to transform all of those practices where the medical expert confronted the ailing person.
They thought – some hoped, some feared – that the biomedically educated medical gaze would
look beneath the ailing person to see the signs of a genetic condition and a genotype realized in
the phenotype. And they hoped, or feared, that the doctor now, with the aid of various biomedical
technologies - genetic tests, blood tests and other all kinds of tests in the path lab – would read back
to that underlying biomedical condition and would not treat the person but the biology. There are
areas of medicine where you have seen that transformation as in the cancers or in heart diseases, and,
to some extent, in disorders like Crohn’s disease.
But what one sees, I think, is that the attempt to say that the practice of medicine should be based
ultimately on a knowledge of the biomedical pathology that underlies the ailment runs up against
the fact that the experience of the illness is inescapably subjective; that there is no direct relationship
between the biomedical pathology and the symptoms; that symptoms exist without a biomedical
pathology; that the symptoms have multiple biomedical pathologies; that the same gene sequences or
mutations in gene sequence can produce radically different kinds of sets of symptoms depending on a
whole series of other things.
It has not proved easy to make the practice of medicine into an application of biomedical
knowledge. Many doctors have resisted that all along. So there is a genuine tension here. Many
people still argue that the next generation gene sequencing and other technologies would make
genetic knowledge immediately available to the practitioner in the clinics - just take a blood sample,
put it in the machine, identify the underlying pathology and then make your diagnosis and treatment
on the basis of that. There are some who believe that is still going to transform medical practice.
However, most practitioners are quite sceptical of that for a range of reasons that we don’t have time
to go into.
When I started doing my work on neuroscience, the most simple hypothesis that I was exploring
could be put like this “where psy was then, there neuro shall be”. I thought that I would find that the
psychological knowledges would be displaced by knowledges of the neurosciences; that the space of
the mind on which psy worked, the space that opened up in the 19th and 20th centuries between the
organs and behaviour, was closing down, was flattening, and that behaviour would be mapped directly
onto the brain.
It is too early to tell whether that will happen. One can certainly see brain based explanations in a
range of different sorts of practices but what we’ve argued in the book Neuro is that the psychological
knowledges are not being displaced by, but are being underpinned by, supported by, given an
increased objectivity by a reference to the brain. They are not being replaced. Indeed in many ways
the increased objectivity which neurosciences provide is enhancing, rather than diminishing, the
status of some those psy techniques. But, as I say, it’s too early to tell, we are right in the middle of
these transformations and, perhaps, if we begin to analyse them and see the ways in which things are
developing, our interventions, feeble as they are, might help to move things in one direction rather
than the other direction. If there is a practical hope in doing this kind of work, it is that it is not just for
knowing about how things are developing and how they have developed but also to give one some
capacity to shape the way they are going to develop in the future.