1974 Rio Lectures on Social Medicine: Lecture 1

"The Crisis of Medicine or the Crisis of Antimedicine?"

General theme

  - crisis of medicine or a crisis of antimedicine (analogy to crisis of prison and crisis of prison reform; analogy to sexuality and repressive hypothesis) (p.5)

Starting point in present

  - 1942 & Beveridge Plan (p. 5); "the date is very important" because....

     - 1. State takes charge of health

     - 2. Health becomes (part of) a morality of the body; becomes part of “hygiene”

     - 3. Health entered the field of macro-econ

     - 4. Health became the object of intense political struggle

   - “A new politics of the body” (p.7); “a somatrocracy”; but historians have always missed the history of the body

  - Crisis of the present

     - Stemming from “technological-epistemological progress” (e.g., antibiotics) + “economic-political functioning” (e.g., social security) or “social practices” (p. 8) not leading “to the improvement of health that had been hoped for, but rather to a curious stagnation in the benefits” (p. 8)

     - Social practice of medicine, “all medicine is already social” (p. 8)

  - MF reframes the ‘antimedicine’ question: The problem is not individual or social (Illich, to whom MF is here responding in part, argued in his book, for individual medicine or ‘antimedicine’ against social medicine), but whether to question the model of the development of medicine beginning in the 18^th century (p. 8).

     - what was the 18^th c. model?; can that model be corrected?; can it be used today in development economics? (p. 8)

      - these three questions pursued through three themes

1) Scientificity and Efficacy of Medicine (pp.9-12)

-          “mechanisms of bio-history” (p. 18); we are entering into bio-history

-          ways in which medical success results in disease (three examples, p. 10)

2) Undefined Medicalization (pp.12-16)

-          “generalized medicalization” (p. 18):

-          four processes of medicalization’s spread since 18^th c.: social authority, medical intervention distinct from disease, hospital, mechanisms/technologies of medicine (like “data”) (p. 13)

-          “whenever we want to refer to a realm outside medicine we find that it has already been medicalized” (p. 14 three examples ).

3) The Political Economy of Medicine (pp.16-18)

-          “political economy of health” (p. 18)

-          The promised economic gains were not delivered on (p. 17) [though he needs better citations here]

-          “Those who make the biggest profits from health are the major pharmaceutical companies” (p. 18).

Conclusion: (1)-(3) above “have not fundamentally changed since the eighteenth century” (18).

-          MF then rejects a series of alternatives: the individual v. social, medicine v. anticimediine, technology v. pure nature.  These “do not make sense”

-          Rather, for MF the appropriate question is to inquire into the ‘take off’ of medicine in the West since the 18^th c..

o   [A contemporary analogy: anti-vaxxers.  The issue for Foucault is not exemplified by anti-vaxxers who do so in the name of health, i.e. autism anti-vaxxers.  Rather the issue is exemplified by all of us, including autism anti-vaxxers, who buy into health versus those who do not take health to be particularly important or at least of primary importance, namely those who are anti-vaxxers because of their belief in religious predestination.]

o   [The issue is about how health/medicine came to be so important to us.]