Regulating The Body :Howson Chapter 5

The body is a "problem of order" for society ( B Turner)

• therefore the body is viewed in terms of the mechanisms and processes societies develop in order to CONTAIN and MANAGE the human body in the interests of social order.
• four R's
• reproduction
• representation
• regulation
• restraint

The REGULATED BODY

• The birth clinic
• (Foucault) the regulation of female sexuality
•  growth of capitalism, urbanization and the population led to increasing concern about the FITNESS of people, their ability to PRODUCE and REPRODUCE and participate in military conflicts
• power emerged in specific INSTITUTIONS (school, prisons, hospitals)
• create examinations, timetables, registers and classification systems
• produce information about populations, but also serve to monitor their movement across time and space
• PUBLIC HEALTH
• systematic surveillance of populations by the state
• created a new body: THE BODY OF SOCIETY, or THE SOCIAL BODY (Scheper-Hughes)

• The Clinical Gaze
• government targets the body as a means to create "good citizens"
• body is rendered as a object amenable to EXPERT SCRUTINY
• based on new sciences of ANATOMY and PATHOLOGY and opens the body through TOUCH, VISUAL OBSERVATION (biomedical monopoly over defining the body
• human body is a MACHINE that can be tinkered with and repaired if necessary
• 3 principles (Foucault) form the basis of the "clinical gaze" and represent a new power that does not use "force", but derives power from their visibility to those in authority (the State):
• continuous surveillance
• specialized knowledge
• corrective measures

• Pre-Modern Medicine
• Foucault claimed that the power of modern medicine does not lie its its discoveries of fact  and the development of new technologies, but in the power of the state to which it is associated.
• before this, medicine was practiced by an array of people who were not coordinated or controlled by the state, most of whom were WOMEN
• diagnosis in premodern medicine
• visit patients homes and listen to their STORIES, which were understood in a wider social and environmental context, or made judgements according to the personal characteristics of the sick person (their constitution or tendencies)
• hospitals were religious orders which served as a last resort for the sick or destitute
• disease=generalized disturbance that must be analyzed in terms of a particular patient

• Continuous Surveillance
• associated with the modern hospital and the growth of modern hospitals
• provided a central place where many living and dead bodies could be observed
• created an examination procedure and a new language to talk about the body
• practitioners (doctors) approached the body ready to listen to "it", touch "it" and observe "it" rather than the person housed by the body, already knowing what they SHOULD hear, feel and see

• Specialized Knowledge
• observations and their results are recorded, creating a classification of conditions and diseases
• accompanied by and dependent on laboratory science and technology
• contributed to the subordination of other forms of knowledge, most particularly the patient's knowledge about their own body
• disease=individualized pathology separate from a particular patient

• Corrective Measures
• hospitals frequently attached to universities which provided them legitimacy and resources for formal education
• limited access to those that had the means to be trained in medicine (socially and financially)

FOUCAULT'S MODEL OF POWER

• Disciplinary Power- sovereign power replaced by the disciplinary power of institutions
• Biopower and Biopolitics-the management of life in three areas, and the regulation of the quality of life of the population in three ways
• regulate sexuality and control disease
• maintain the health of laborers
• maintain a well-disciplined military
•  LED TO NEW DISCIPLINES aimed at surveillance, analysis and regulation, then intervention and correction across time and space (of the population)
• psychology, criminology, sociology
• develop practices and norms in the service of population regulation -biopolitics
• Govermentality-how disciplinary power governs populations -where EXPERT KNOWLEDGE monitors, observes, measures and normalizes individuals and populations through complex bureaucratic mechanisms
• distinct physical spaces provide new points of collection in which people are monitored
• schools, hospitals, prisons
•  disciplinary power is exercised through clinical examination or military inspection
• information collected is held in files or registers or databases which need administration and provide ways of tracking

• information about individuals (cases) is tracked and aggregated to establish NORMS which are used by disciplines as a basis for comparison
• knowledge is shaped to support the development of disciplines (medicine, education, corrections)and help with corrective interventions
• promote health through modes of personal conduct such as self-surveillance, biopower and technologies of self
• works because we believe them to be IN OUR BEST INTEREST
• disease, pregnancy and childbirth

• BIOMEDICALIZATION: increasingly complex multi-sited, multi-directional processes of medicalization that rely on new techno-scientific knowledge and practices.

DISEASE PREVENTION AND SURVELLIANCE

• Disease Prevention
•  state believes that managing and maintaining health is their job and modern medicine is the "police" of social and moral order through public health
• duty to be well: moral control over individuals
• screenings
• "Foucault paradox":  where health is seen as a desirable but LIMITED resource, and where welfare systems make provisions for equity in health, the state will establish a great degree of REGULATION over its citizens
• participation in preventative initiatives (practices of self)
• dietary regimes
• lifestyle choices
• sexuality
• Surveillance Medicine
• expert forms of knowledge serve to regulate our lifestyle and are dispensed through everyday embodied practices of both expert (set up the markers of compliance) and lay people
• encouraged to practice self-surveillance, identifying ourselves for being "at risk" for certain conditions
• rely heavily on ideas about the NORMATIVE BODY
• WHAT IS THE OBESE BODY? How do these reinforce our body consciousness?
• Disease Prevention and Gender
• surveillance and prevention are gendered, and women's bodies are more highly scrutinized and regulated than men's
• women are understood as "mothers" and "guardians" (responsible for the health of others)
• women and their bodies must be contained and protected from both symbolic and actual contamination
• HPV vaccine: Is it a way to prevent cervical cancer or a way to enable promiscuity? why don't we give it to boys as well since they are the carriers of HPV to most women?
• MAMMOGRAMS? How many and when? 
• PAP Smears?
• Disease Prevention and Protective Discourses
• women are subject to the protective discourses more often
• initiatives assume that people and especially women will comply with directives
• parents, especuially mothers are expected to ensure compliance of their children
• vaccinations
• well-check-ups
• flu shots
• health regimens
• Alienated Embodiment/Visualizing the Body
• AIRPORT BODY SCANNING
• technologies which provide VISUAL representations of the previously "unseen" have had more profound implications for women
•  based on biomedicine's unprecedented access to women's bodies 
• has led to a reinforcement of the idea of fragmented, objectified and alienated sense of self (embodiment) by women
• cervical and breast viewing on a screen (through various technologies) disembodied and viewed and manipulated by a host of others-reinforces this disembodiment and makes women feel "vulnerable" rather than empowered and knowledgeable
• images also require "expert interpretation" they are VIEWED rather than EXPERIENCED, and are ABSTRACTED in that they are shown close up and often enhanced or stained through emphasis
• Biometrics: a New Mode of Visualization
• new forms of social identity based on our DNA and other biometric markers (retinal scanners, fingerprint id, etc.)
•  EUGENICS, HUMAN GENOME PROJECT (identify "risk" groups)
• viewed as infallible
• used to discriminate (race, gender, class, disability-certain bodies are untrustworthy, a security threat).
• HOW IS YOUR BODY REDUCED TO ITS PARTS?

EMBODIED EXPERIENCE AND TECHNOSCIENCE

• The Women's Health Movement
• women's expe5rience and knowledge has been disregarded by health practitioners
• reaction against biomedicine: self-knowledge-challenging expert authority
• Our Bodies Ourselves
• Spare Rib
• Embodied Experience and Embodied Health
• women continue to be more incorporated into wider specialized webs of surveillance than men, buttressed by "benign" techniques of visualization and technoscince
• Technoscience and the Normalized Body 
• it is now difficult to THINK about the body without considering technology
• computerized records will give greater access to information and allow for greater "normalization" regimen
• BODY ENHANCEMENTS (sexual or otherwise) allow us to reflect on what the NORMAL BODY is and how bodily normality is shaped by SOCIAL, ECONOMIC and POLITICAL PROCESSES.-what OUGHT to be

OBSTETRIC SURVEILLANCE AND THE LATE-MODERN CLINIC

•  The Transformation of Childbirth
• historically, childbirth was the preserve of women.
• midwives, kin and friends assisted in the birth of a child (all women)
• rise of organized medicine in the 19th century changed all of this (men), located in hospitals instead of in the home.
• allowed for arguing for the use of intervention technologies
• forcepts
• pain killers
• monitors
• Extending the Obstetric Gaze
• radical shift in the location and procedures of childbirth away from the home and more "natural" processes
• routine use of stirrups and recumbance , monitoring, forcepts, artificial induction, shaving, enemas (these have been lightened due to political pressure from women activists)
• increases in C-Sections, especially ELECTIVE c-sections
• Disease Potential, Risk and Genetic Testing
• Testing confirms
• pregnancy
• onset and stages of labor (fetal monitoring)
•  increase chance of c-section and other interventions because physicians are afraid of law suits if the see "abnormalities" in these visualizations
• as fetus becomes visible so laws increase about protecting the fetus from potentially risky maternal conduct-smoking, drinking, body conduct of all sorts (redraws boundaries between medicine and women's bodies)
•  Maternal Conduct
• visualization of fetus establishes a social distinction between mother and the fetus.
• defines all fetuses as potentially at risk for abnormalities and therefore the subject of scrutiny
• screenings for various genetic disorders which can not be treated
• blood, urine, fluids, tissue
• women are required to prescribe to proper conduct for the benefit of the fetus
• diet
• vitamin intake
• proper exercise
• modern pregnancy is a PUBLIC EXPERIENCE (Woman's body is no longer "her own")
• people touch the bump
• people scrutinize a pregnant woman's conduct
• Commodification and Reproduction
•  artificial insemination has led to the commodification of reproduction
• only access to people of means
• people are paid for their reproductive bodies and body parts
• surrogacy (uterus, etc.)
• eggs & sperm (no longer yours once they are donated)
• Regulation, Reproduction and the Male Body
• IVF and masturbation: Semen as a commodity and the necessity of performance
• problems for certain religious orders as well (Muslim men)