The work of Michel Foucault is central to the medicalisation and biomedicalisation theses and the sociology of the body more generally. Lupton (1997: 94) notes that whilst Foucault and his followers have not necessarily subscribed to the visions of power and dominance presented within the medicalisation critique or mobilised the term ‘medicalisation’ specifically, they nonetheless represent a ‘vision of a world in which individuals’ lives are profoundly experienced and understood through the discourses and practices of medicine’. In The Birth of the Clinic (1975), Foucault argues that medical paradigms have developed over time and have provided frameworks through which bodies have been defined, understood and experienced. According to Foucault, then, medical expertise and power is the framework through which bodily pathologies are identified and dealt with in various epochs of history12.
A point of departure between Foucauldian perspectives and those forwarded by proponents of the medicalisation critique is the existence of an ‘authentic’ human body. Whilst the medicalisation critique understands the body as being an essential object, albeit a socially and politically constituted one, Foucauldian analyses understand the body and its component parts as being constituted only through
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Tentative links can perhaps be made here between Foucault’s ideas and those found within Pickstone’s (2000) way of knowing presented in Chapter Two
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discourses and practices through the ‘clinical gaze’ which is exerted by medical practitioners. This clinical gaze is used by Foucault to describe the ways in which medical practitioners from the eighteenth century onwards became increasingly focused on the observation of patient bodies as a series of symptoms and signs to be managed through discourse and practice (Armstrong, 1997). Unlike in the medicalisation critique, medical power is not imagined in Foucauldian terms to be consciously cultivated and reproduced by medical practitioners but is, instead, regarded as a form of disciplinary power within which medical practitioners mobilise their clinical gaze to observe individuals and compare them against the ‘norm’ in order to arrive at a diagnosis.
Foucault’s notion of the clinical gaze is pervasive within sociological analyses of the body and a full representation of the span of its employment would be impossible here. However, the notion of a practitioner gaze has previously been empirically employed where the characterisation of a ‘nursing gaze’ has been developed (see Gastaldo and Holmes, 1999; Henderson, 1994; May, 1992). As an example, May (1992) highlights the ways in which the nursing gaze is employed as a way to ‘know’ patients, their bodies and their clinical needs. He suggests that nurses develop foreground and background knowledge of patients, the former of which establishes a clinical definition of the body and the nursing work which it necessitates whilst the background knowledge constructs patients as private idiosyncratic subjects upon which appropriate nursing work is carried out. The structures of nursing work (for example, being based on wards, having more time than doctors to talk with patients and building more personal relationships with patients) and their relatively subordinate position within hospital divisions of labour are posited in May’s (1992) paper as facilitating the development and employment of this specific nursing gaze. In the case of pharmacy, Ryan et al. (2004) argue that a Foucauldian analysis of pharmacy could be employed in a number of ways such as an examination of discursive construction of pharmacy in different countries, the power relations within healthcare teams and the position of the body in pharmacy vis-a-vis medications adherence practices.
Barber (2005) argues that pharmacists employ a ‘pharmaceutical gaze’ in their everyday practice given their ability to ‘see’ the properties of medicines and
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their potential effects. Despite employing a Foucauldian framework to analyse pharmacy, however, he suggests that pharmacy practice ‘is not based on parts of the body…manipulating, cutting or caring for the body’. It is argued below, and demonstrated throughout the later empirical chapters, however, that in fact the body is central to pharmacy practice as Ryan et al. (2004) suggest. Nonetheless, Barber’s (2005) tentative employment of the Foucauldian gaze perspective highlights its widespread applicability.
Despite this widespread application of Foucauldian perspectives, his understanding of the body as ‘totally imprinted by discourse’ (Butler, 1990: 130) and having no ‘essential’ physical qualities (see Nettleton, 1992) has provided the basis for critiques of his construction of ‘docile bodies’ subject to, but unable to challenge, the clinical gaze. As such, in Foucauldian terms, to attribute agency to a body would be to provide it with some essential qualities which is in opposition to Foucault’s idea of body being wholly constituted through discursive practices. Bodies, then, must lack agency on account of their wholly discursive constitution. To proponents of the medicalisation perspective such an understanding of the body is problematic as this limits the capability of the patient body to exert agency and resist medical power. This construction of docile bodies also presents a paradox within Foucault’s own terms where he purports that ‘power, after investing itself in the body, finds itself exposed to a counter-attack in the same body’ (Foucault, 1980: 56), suggesting that power itself generates resistances. The contradiction, then, comes from the inability of docile, discursively constructed bodies to exert resistance to power. Within this Foucauldian understanding of the body it becomes ‘futile’ (Armstrong, 1997: 21) to speculate on any essential features that the body might have. This understanding of the body, it is argued, is challenging for sociologists to effectively engage with as sociological analyses are more often premised on a body which represents an interface between elements such as the biological and the social; the collective and the individual (Fox, 1997: 41)
Foucault’s influence on the work examining the sociology of the body is empirically wide and theoretically deep and only its very surface can be scratched here. Nonetheless, the overlaps between increased (bio)medicalisation and Foucault’s clinical gaze are important here as new technologies redefine bodies
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through altered practitioner gazes. This is reflected on in more detail in the case of PGx in the later empirical analysis.