No More Learning

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Weighty subjects
Thus Foucault argues that new subj ectivities have become available to us that are both ways to be an individual - to be distinctive - and to be sub- ject to the control of a range of extra-legal mechanisms. For some schol- ars, Foucault's example of homosexuality has been implausible : this may be for historical reasons (some critics argue that in fact the idea of "the homosexual" pre-dates Foucault's account) or scientific reasons (some think that biological explanations for homosexuality can be adduced). But for many less opinionated readers the suggestion that homosexuality is historically specific just does not feel convincing: even if Foucault were right, so much time has passed since the emergence of the homosexual "species", and the practices that consolidate the contemporary identity of "being" a homosexual have so much of a grip, that we cannot imagine things being otherwise. By contrast, the idea that one's weight might define a subject-position is, I have argued, much more recent, and still in the process of being sedimented in a variety of institutions and prac- tices. Let me conclude with this example, then, to show how Foucault's account of assujettissement might play out in practice. Any process of assujettissement happens at two levels: the management of the social body, and the disciplinary forces acting on the individual's body. At the level of population, obesity is now decried as a marker of corruption in the body politic (Herndon 2005) and a public health catastrophe. The strident, compulsive nature of public anti-obesity discourse is enabled by seemingly infinite statistical parsing and public policy strategizing about the population's "obesity epidemic". The very ability to construct such statistical and policy information of course depends on a range of disciplinary institutions and practices, from public health nurses who record the weight of schoolchildren to actuaries who analyse death rates. Of particular historical significance, the standard height/weight tables that were produced in the 195Os (based on actuarial rather than strictly medical evidence) provide a technique for analysing the population (how many more people are now "overweight" or "obese"? ) as well as a way for individuals to define their body mass index and weight status (Heyes 2007: 67-7 1 ; Gaesser 2002).
Thus at the level of the individual, weight is turned from an inciden- tal feature of a person into an identity. Being "overweight" becomes a numerically defined status as well as a marker of individual failure to regulate the body appropriately. This is made possible not just by the "disciplines" of public health and medicine, but also by endless confes- sional narratives detailing the consumption pattern, weight, fat distribu- tion, cholesterol level, caloric expenditure, exercise habits, and so forth,
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of each person. Some dieting internet discussion boards feature profiles introducing each person through opaque abbreviations that actually identify starting weight, current weight and goal weight; dieters discuss the minutiae of calorie-counting, carbohydrates and exercise options with reference to the weight deviations stipulated on the screen, invok- ing norms such as body mass index. The web is littered with video blogs of "my weight loss journey", in which ordinary people make of their biography an object worthy of representation, while also confessing the truth of their weighty selves, often dwelling on parts of their lives that might seem only tangentially related to dieting. Increasingly the identity "dieter" becomes as real as "homosexual". This consolidation of a subject-position requires that everything about a person be dragged within the remit of weight loss; the subject-position "dieter" becomes the lens through which personal identity is revealed (Heyes 2007). True to Foucault's predictions, the practice of dieting is not simply repressive (if it were, it would not be so popular) but is also enabling: people feel better about themselves (if only for a short time) , learn new information (about nutrition, for example) and develop new skills (such as how to describe and manage their personal "weaknesses"), at the same time as they are drawn ever deeper into a disciplinary system that can then exercise its control and management.
In this brief discussion I hope to have shown why Foucault believes that the modern individual is not just a fact of our humanity but is rather a historical product of disciplinary power in its overall form as well as in the specifics of the subject-positions we have inherited. My own analysis of discourses of weight has struggled with the two objections I identified: what kinds of value-judgements are justified by a genealogi- cal reading of dieting, and how can oppressed dieters fight back? In the end, I adopt both of the strategies I mentioned. I engage largely in practices of critique, showing how the intensification of power relations and the consolidation of subjectivity accompany a discourse that most of us assume simply aspires to increase our autonomy and liberate us from the demon fat. But I also show that our "cares and commitments" are in some ways at odds with the kind of subjectivity that dieting pro- motes, and that this gap between the kinds of people we aspire to be and those that our practices sediment can be exploited to ethical and political purpose.
Notes
1. "11 faut rappeler que le pouvoir n'estpas un ensemble de mecanismes de negation, de refus, d'exclusion. Mais il produit effectivement. Il produit vraisemblable-
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ment jusqu'aux individus eux"? memes. L'individualite, l'identite individuelle sont des produits du pouvoir . . . " (Michel Foucault, "Je suis un artificier" ["I am an artisan"], 1975 interview with Roger-Pol Droit, available online in French at http://foucault. info/documents/foucault. entretien1975. fr. html [accessedAugust 2010]).
2. Foucault admits the specificity of his history to the French penal system (see 1979: 309 n. 3). His translator Alan Sheridan also notes the distinctiveness of "supplice" - "the public torture and execution of criminals that provided one of the most popular spectacles of eighteenth-century France" (ibid. : "Translator's Note").
3. A third example is Foucault's reading of the memoir of Herculine Barbin, "a nineteenth century French hermaphrodite" (Foucault 1980b).
4. Feminist critics have suggested that in his haste to see Jouy as exemplary of a historical moment Foucault is too quick to characterize the power relations in which he participates as benign. See Alcoff (1996).
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? TWELVE
Practices of th ? self
Dianna Taylor
Previous chapters have illustrated that for Foucault subjectivity is not a state we occupy but rather an activity we perform. Moreover, it is an activity that always takes place within a context of constraint. We constitute ourselves as subjects (we are enabled) by way of vari- ous "practices of the self", which include activities like writing, diet, exercise and truth-telling. At the same time, we are constituted (we are constrained) in so far as the way in which we undertake these practices is shaped by institutions such as schools, courts of law, hospitals and the state security apparatus, as well as by the more general prevailing norms and values of the society in which we live.
Put differently, subjectivity is not distinct from but is rather formed in and through relations of power. There are not emancipatory institutions and norms that enable us, on the one hand, and oppressive or normal- izing institutions and norms that constrain us, on the other; rather, we are simultaneously enabled and constrained by the same institutions and norms. We therefore find ourselves confronted with the task of figuring out when and how we are enabled and when and how we are constrained, of determining ways in which existing practices have the potential to loosen constraints and thus resist normalization, and of employing those practices not only for that purpose, but also in order to develop new and different practices - new and different ways of relating to ourselves and others. We need, in other words, to be able to reflect critically on the very process of becoming a subject.
This critically reflective activity comprises a specific set of practices, which Foucault collectively refers to as "critique". In this chapter I provide an overview of Foucault's account of the origins of modern
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Western subjectivity in early Christian practices of the self. These prac- tices reflect an interconnection of power and truth, in the sense that one comes to know the truth about oneself and also gains access to the truth more broadly by way of a process of self-abnegation: subjectivity is achieved only by way of a sacrifice of self. According to Foucault, this element of self-sacrifice is retained within the modern hermeneutics of the subject, where it comes to characterize techniques of governmental- ity. In the second part of the chapter, we will see how the practice of critique functions as a Foucauldian response to the problem of the self- sacrificing modern subject. As he conceives of it, critique may loosen the relationship between truth and power that characterizes modern subjectivation (the process of becoming a subject) and in doing so facili- tate the development of new, emancipatory forms of subjectivity.
Subjectivity and self-sacrifice
Early Christian practices of the self were carried out within a relation- ship through which persons were guided toward salvation by another or others to whom they subordinated themselves (Foucault 1997b). Within a "salvation-oriented" relationship, the subordinate individual must submit to certain externally generated truths, such as religious doctrines and codes. But this acceptance is not merely passive; the subordinate individual also participates in various kinds of practices, "general rules, particular knowledge, precepts, methods of examina- tion, confessions, [and] interviews" in order to access and reveal the truth about her or himself (ibid. : 26). Through taking up these prac- tices, then, the individual also constitutes him or herself as a subject. Practices of the self thus possess a two-fold character: on the one hand they are manifestations of the norms and values of the society in which an individual lives and thus establish a relationship between the indi- vidual and others; on the other, in so far as the individual takes them up and incorporates them into the construction of his or her own subjectivity, these practices establish a relationship of the individual to her or himself.
Foucault shows that early Christian practices of the self, like their ancient and Hellenistic counterparts, entail a process of "conversion". To o b t a i n t h e r i g h t t o a c c e s s t h e t r u t h a b o u t o n e s e l f a n d t h e w o r l d , t h e subject must "be changed, transformed, shifted, and become, to some extent and up to a certain point, other than himself" (2005a: 15). In ancient and Hellenistic contexts, conversion takes the form of a "turn- ing" within the self: a kind of self-reflective taking stock of oneself
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through which one gains (a different) perspective. By contrast, early Christian conversion, metanoia, entails not a turning of but instead a break within the self; it is less a process and more an "upheaval", a single, sudden transition from one form of existence to another: "death to life", "mortality to immortality", "darkness to light", "the reign of the devil to that of God" (ibid. : 211).
The break that occurs i n metanoia i s thus a kind o f renunciation or sacrifice of the self, of one's "old" self, in the name of truth and salvation (ibid. : 250). A process characterized by self-practices comes into play, therefore, primarily after conversion has taken place. Post-conversion, practices of the self function to "decipher" the self in order to ensure that its thoughts are pure and properly focused on the truth and the light. This deciphering therefore involves practices that are intended to demonstrate that the old self has been renounced; it in fact involves a repeated and public sacrifice of the old self. Foucault identifies two prac- tices as being fundamental to this process of renunciation and sacrifice : confession and self-examination. In early Christianity, these practices look quite different from the modern sacraments of penance and the confession of sins (Foucault 1980h). Penitence is not a "determined act" but a status that involves the execution of a number of different practices which allow a person who has sinned to become reintegrated into the religious community (ibid. ). It is a public demonstration on the body through, for example, wearing a hair shirt, covering the head in ashes, and fasting, of the authenticity or truth of one's repentance (ibid. ). Hence the reference ofthe entire reintegration process as "exo- mologesis" or "manifesting the truth" (ibid. ).
Confession functions a s a similar manifestation. As i s the case with penitence, in order to be authentic, to reveal and thereby provide access to the truth, confession must be expressed to another. It performs a kind of check on self-examination in the sense that through confess- ing, one's thoughts and the condition of one's soul are expressed to another person who possesses the authority to interpret them. Unlike penitence, however, to which there is an identifiable end, Foucault argues that confession, with its requirement that one perpetually put the contents of one's soul into words ? that one ceaselessly verbalize - establishes a permanent relation of obedience to authority. But verbali- zation does not merely subjugate the speaker to the listener. According to Foucault, these particular acts of verbalization are simultaneously acts of self-sacrifice:
Verbalization is a way for . . . conversion, for the rupture of the self. It is a way for the conversion to develop itself and take effect.
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Since under the reign of Satan the human being was attached to himself, the verbalization as a movement towards God is a renunciation of Satan. It is for the same reason a renunciation of oneself. (Ibid. )
Thus, Foucault argues that both penitence and confession entail a "self-revelation which is at the same time a self-destruction" (ibid. ). One comes to know and tell the truth within a power relation i n which "[n]o truth about the self is without the sacrifice of the self" (ibid. ). In illustrating his point, Foucault tells the story of a young monk who, when he became gravely ill, was forbidden by his master to die (1980h). The monk "lived a few weeks more", at which time, commanded by his master to die, he did so (ibid. ). "Even when the monk is old," Foucault writes, "even when he is, at his turn, the master, he has to keep the spirit of obedience as a permanent sacrifice of his own will" (ibid. , emphasis added).
Self-sacrifice and governmentality
From Foucault's perspective, this same type of power relation - one in which access to truth is linked to the sacrifice of self - characterizes modern Western subjectivity. With the rise of modernity, practices that had once possessed solely religious applicability were adopted within secular contexts and thereby came to characterize modern societies more broadly. This generalization occurred in part as a result of the inadequacy of sovereign power in the face of the increasing complexi- ties of modern life. Given the social, political and economic restruc- turing that resulted from the "state centralization" and "dispersion and religious dissidence" (specifically, the Reformation and Counter- Reformation) of the fifteenth and sixteenth centuries (Foucault 1 9 9 1 c : 88), Foucault asserts that "[f]ar too many things were escaping the old mechanism of the power of sovereignty, both at the top and at the bottom, both at the level of detail and at the mass level" (2003 : 249). Hence the concern within early modern societies with what Foucault refers to as the problem of "government". For Foucault, government includes but is not limited to the administration of a state and its peo- ple by a ruler. It also exists as a more general concern about how to direct the conduct of oneself and others. Government as a "general problem" pertains to "the government of oneself . . . the problem of personal conduct, the government of souls and lives" as well as to "the government of children" (1991c: 87), "beggars and the poor",
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"families" and "armies" (1997b: 27). Foucault argues that at this time one can observe a preoccupation with questions about "[h]ow to gov- ern oneself, how to be governed, how to govern others, by whom the people will accept being governed, [and] how to become the best pos- sible governor" (ibid. ).
It is not difficult to see how the two types of modern power Foucault identifies could emerge within a context characterized by a concern with government and, therefore, how early Christian practices of the self develop into modern governmentalizing techniques. Foucault's descriptions of prisons, army training and schools in Discipline and Punish, for example, illustrate how governmentalizing techniques func- tion in the service of disciplinary power. Within each of these contexts, particular types of efficient yet limited subjectivity (the delinquent, the soldier, the pupil) emerge. With respect to biopower, governmentalizing techniques take the form of, for example, analysis by state agencies of rates of transmission of infectious disease. Such analysis produces norms of normality (health) and abnormality (illness) and, hence, "normal" and "abnormal" subjects. A certain number of annual deaths from influ- enza, especially among certain segments of the population (the elderly, infants, persons with compromised immune systems), are expected and therefore considered normal; intervention into the population by health officials is intended less to prevent these deaths than to protect the "normal" or healthy segment of the population and, therefore, "defend" society as a whole (Foucault 2003 ) .
A whole host of societal institutions reproduce these subject catego- ries: prisons, schools, courts of law, hospitals, government agencies (i. e. the Centers for Disease Control and Prevention), social services agencies, and state and private mental health agencies and treatment centres. To the extent that individuals participate within or are subject to scrutiny by these institutions (and all of us, to greater and lesser extents, do and are), we also constitute ourselves in and through these same subject categories; in doing so we implicate ourselves more deeply in modern relations of disciplinary power and biopower. To be clear, even if we have not been diagnosed with, for example, some form of physical or mental illness, our constitution of ourselves as "healthy" takes place in and through broad categories of normality and abnor- mality that prevail within our culture. It is no coincidence that the techniques and practices we employ in such constitution include some of the same practices that characterized the Christian pastoral: physical exercise, self-reflection, self-writing and confession (whether to a priest, a therapist or a police officer).
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? Self-sacrifice and the Western philosophical tradition
Even though these modern practices of self-constitution are no longer linked specifically to a religious context, given their origins and the fact that they were for the most part uncritically adopted within secu- lar contexts as modes of individual and collective conduct, Foucault argues that they retain their self-sacrificing character. This modern interconnection between subjectivation and self-sacrifice has presented Western cultures with the problem of how to " [save] the hermeneutics of the self and [get] rid of the necessity of sacrifice of self which [is] linked to this hermeneutics" (1980h). Hence the concerted and sus- tained efforts within Western philosophy to construct and substitute a positive notion of subjectivity (i. e. the autonomous subject) for the self-sacrificing subject (ibid. ). Foucault has in common with the rest of the Western philosophical tradition the desire to break with the cycle of "unconditional obedience, uninterrupted examination and exhaustive confession" which underpins modern subjectivity (1999a: 157). Yet, unlike the tradition, Foucault wishes to move away from self-sacrifice not because it violates the subject's independence and autonomy, but rather because it cultivates a destructive and therefore harmful rela- tionship of the self to itself (ibid. ). For him, critique provides ways of negotiating modern relations of power that loosen the interconnection between truth and power that characterizes modern power relations and, hence, opens up possibilities for being constituted and constituting ourselves as subjects in ways that do not simply reproduce an abnegat? ing self-relation.
Critique
Critique, Foucault argues, emerges in response and is inextricably linked to the spread of governmentalizing techniques: it reflects a concern with the question of "how not to be governed" (1997b: 28). Rather than presenting itself as a simple opposition to the art of gov- erning, this question reflects a concern with how to navigate a con- text characterized by governmentality in ways that expand the field of possible courses of action and modes of thought. This response does not (nor does it aim to) avoid or release persons from governance. As Foucault makes clear, given the nature of modern power relations our aim is not to get outside of power, but rather to navigate those rela- tions differently. Critique can be conceptualized as a different kind of "art", which Foucault refers to as the "art of not being governed quite
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so much" (ibid. : 29). It is an art, he explains, "[of not being governed] like that, by that, in the name of those principles, with such and such an objective in mind and by means of such procedures, not like that, not for that, not by them" (ibid. : 2 8 ) . If governmentality is the "move- ment through which individuals are subjugated in the reality of a social practice through mechanisms of power that adhere to a truth", critique functions as the "movement by which the subject gives himself the right to question truth on its effects of power and question power on its discourses of truth" (ibid. : 32). As a response to governmentality, then, critique might be understood as an "art of navigating power relations". As one of those techniques and practices that challenge and thereby loosen the link between truth and power, critique character- izes and in turn promotes modes of subjectivity that likewise challenge self-sacrifice. It retains a critically (self-)reflective character and there- fore possesses emancipatory potential.
Let us be clear about how this kind of negotiation of power rela- tions is possible; that is, let us be clear that although we cannot com- pletely extricate ourselves from relations of power, we are not simply determined by them: we are not doomed to uncritically reproduce the prevailing norms and values of our society. If we were determined in this way I would, for example, accept and reproduce prevailing views about what it means to be a woman in US society. I would subordinate myself to men; I would behave in a passive and accommodating man- ner; and I would accept primary if not sole responsibility for caring for my (male) spouse, children and home. But I do not in fact do any of these things: I assert my equal standing with men; I am not passive and accommodating but instead argue, for example, that I ought to be paid the same wage for doing the same work; I am involved in a heterosexual marriage but I do not have children, I have a career, and my husband and I both work at making our relationship as egalitarian as possible. 1 Moreover, I even go a step further: rather than settling for equal status within the existing gendered order of things, I call into question the fact that we as a society adhere to a system of gender at all, and contend that there are other ways of organizing our lives that do not entail dominance and subordination. I am able to adopt a criti- cal perspective precisely because I am not merely constituted, but also constitute myself. I identify as a woman but, owing to my experiences constituting myself and being constituted in this way, I also identify myself as a feminist and constitute myself in ways that challenge prevail- ing gender norms: in so far as I am the one who takes up the norms and values of my society, I have the capacity to take them up differently, or not to take them up at all. As Foucault puts it:
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It may be that the problem about the self does not have to do with discovering what it is, but maybe has to do with discovering that the self is nothing more than the correlate of technology built into our history. Then . . . [m] aybe the problem now is to change those technologies, or maybe to get rid of those technologies, and then, to get rid of the sacrifice which is linked to those technolo- gies. (1980h)
Here Foucault reiterates the point made at the outset ofthis chapter, that part of what constituting ourselves as modern subjects must entail is critical analysis of precisely how we do this constituting. But for such critical analysis to be possible, we have to recognize that we actively participate in our self-constitution and thus possess the capacity to engage in such analysis. Subjectivity is not a matter of uncovering our "true self", a process which requires us to adhere to some pre-given, external definition of who and what we are; rather, it is a matter of calling into question such an understanding of what it means to be a subject, of investigating the effects that such a notion has on our relationship to ourselves and others, and of exploring possible ways of thinking and acting differently.
Critique as an emancipatory practice
Bearing these points in mind, we are in a position to better understand Foucault's assertion that subjects "give themselves the right" to cri- tique, a right that is, at the same time, always constrained and that is exercised within a context of constraint. Judith Butler articulates this point clearly and succinctly when she argues, "it is not the case that a subject is formed and then turns around and begins suddenly to form itself . . . the subject is both crafted and crafting, and the line between how it is formed, and how it becomes a kind of forming, is not easily if ever drawn" (Butler 2002: 225). Even more to the point: "The self delimits itself and decides on the material for its self-making, but the delimitation that the self performs takes place through norms which are, indisputably, already in place" (ibid. ). This conceptualization of critique is also consistent with Foucault's view of power and freedom as mutually constitutive. He conceives of freedom as the ability to navigate power relations in ways that mediate against and attempt to minimize constraints (such as direction and management) while maxi- mizing capacities, rather than as the ability to extricate oneself from relations of power. My constitution of myself as a feminist does not
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require that I extricate myself from the context that defines me as subordinate because I am a woman: just as critique emerges within a context of governmentality, so feminism emerged within a context of sexism. The fact that subjects are simultaneously enabled and con- strained by the same norms and practices may complicate but does not destroy possibilities for either freedom or subjectivity.
Now that we have a sense of how critique can facilitate the negotia- tion of power relations, let us explore in a little more detail precisely what it means to put critique into practice, as well as how its practice counters the self-sacrificing character of modern subjectivity and facili- tates new forms of self-constitution. We have seen that critique emerges from and responds to our present context, a context within which pre- vailing conditions present themselves as necessary conditions (gender is viewed not as a contingent sociopolitical system but as a description of women's and men's inherent natures), where our relationships to ourselves and others, as well as to knowledge and truth, are relation- ships of obedience to authority and, as such, are relations of power. Foucault refers to our stance relative to our present generally as an "attitude". For him, an attitude encompasses "thinking, speaking and acting", our relationships to "what exists, to what one knows, to what one does" - in other words, our relationship to ourselves - as well as "to society, to culture, and . . . to others" (1997b: 24). Critique, or a "critical attitude", thus comprises a particular way of responding to the present; specifically, a critical attitude entails thought, speech, acts and modes of relating that reflect "insubordination" against prevailing conditions, which reveal those conditions as contingent, and thus do not simply reproduce the same relationship between truth and power which leaves persons in a self-sacrificing relationship of obedience to the authority of prevailing norms (ibid. ) .
Taking into account these characteristics - critique is a practice that encompasses how we think, speak and act; critique establishes a way of relating to oneself and others within the context of one's present conditions; critique does not merely affirm and rearticulate those conditions - it is clear that Foucault, himself a cultivator of a critical attitude, is not simply going to tell us what a critical attitude looks like and how we need to go about practising it: to do this would be to undermine critique's insubordinate character and, therefore, its emancipatory potential. Nevertheless, Foucault does provide his read- ers with some clues or "tools" that we can utilize in ways that, given the challenges of our own present (which are not necessarily the same challenges of Foucault's), facilitate our insubordinate constitution of ourselves.
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? In a late interview, Foucault described himself as a "moralist", but he also made clear that he meant something very specific by this term. "In a sense, I am a moralist", Foucault explains:
insofar as I believe that one of the meanings of human existence - the source of human freedom - is never to accept anything as definitive, untouchable, obvious, or immobile. No aspect of real- ity should be allowed to become a definitive and inhuman law for us. (Foucault 1980g)
What Foucault describes here bears a strong resemblance to the "insubordinate" character of critique, and his articulation of the spe- cific "moral values" that underpin - and which he in turn seeks to articulate and practise through -- his work gives us an idea of how he thought a critical attitude could be cultivated. The first value Foucault identifies is refusal - specifically, refusing "to accept as self-evident the things that are proposed to us" (ibid. ). The second value is curi- osity, which Foucault describes as "the need to analyze and to know, since we can accomplish nothing without reflection and knowledge" (ibid. ). The third value is innovation: "to seek out in our reflection those things that have never been thought or imagined" (ibid. ). While Foucault initially refers to refusal, curiosity and innovation as val- ues, in the same interview he also refers to them as principles. Given their relevance to critique, and also taking into consideration that Foucault states that he both engages in and endeavours to promote them through his philosophical work, I think it is consistent with a Foucauldian perspective also to think of refusal, curiosity and innova- tion as techniques or practices.
Cultivating a critical attitude/countering self-sacrifice
The practices of refusal, curiosity and innovation illustrate that critique or a critical attitude opposes the self-sacrificing character of modern subjectivity. Self-sacrifice characterizes a mode of subjectivation that requires individuals to subjugate themselves to authority in order to gain access to truth. The first thing we notice about critique is that gaining such access is not central. Cultivating a critical attitude entails an oppositional or at least ambivalent stance relative to what is pre- sented to us as true, as given, as necessary. It emphasizes reflection and knowledge, as opposed to truth, with the result that self-constitution is an ongoing and continually evolving process, not a linear development
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toward a pre-established goal. The non-linear nature o f critique as a mode of self-constitution is further supported by the practice of innova- tion: critique functions in such a way as to develop new, different and unexpected modes of thought and existence; it does not move toward a pre-determined, identifiable end.
Considering a specific example from my own experience may help to illustrate how engaging in refusal, curiosity and innovation facilitates new modes of self-constitution - specifically, modes that do not entail self-sacrifice. A few years ago I began to experience physical pain that was unrelated to injury or, as far as I could tell, to illness. At an appoint- ment with my primary care physician I described what I was experienc- ing. He made a diagnosis and prescribed medication. After a few days I was still in pain, and so went to the emergency room that weekend. The ER doctor said that the specific way in which I described the pain was puzzling to him, but given the area of the body in which the pain was present, he agreed with my primary care physician's diagnosis. He wrote me a new prescription and referred me to a specialist.
Two doctors had now suggested that my pain was stemming from a certain condition, despite the fact that the way in which I was describing the pain did not exactly coincide with the way in which that condition usually manifested itself. At this point, I began to doubt my own experi- ence. Was I describing the pain incorrectly? Or did the pain in fact feel more like what the literature on this particular condition said it was supposed to ? When I met with the specialist a few days later I could tell by the expression on his face that what I was describing was unfamiliar to him. I stopped mid-sentence and asked, "Haven't you ever heard things described in this way before by other patients? " He replied that he had not, and that he ought to examine me to see what was going on. I agreed to the examination and subsequently to a procedure he said would provide me with relief.
For the purposes of our discussion here, what matters about my experience is not the success of the procedure or the competence of my physicians. What requires our attention is rather how I constitute myself and am in turn constituted as a subject. Within the context of the health care system I constitute myself as a subject in order to gain access to the truth about myself by way of a set of practices that subordinate me to authority (not only that of physicians, but also of system and hospital administrators, insurance companies and the like). Within this system, in other words, I both constitute myself and am in turn constituted as a "patient" (and also as a "consumer"). Through this constitution, I sacrifice a part of myself, specifically, the insubordinate part, the part that "gives itself the right to question truth on its effects of power and
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question power on its discourses of truth" (Foucault 1997b: 32). Such sacrifice, in so far as it curtails my critical capacities, results in the reinscription of my own subordination. Sitting in physicians' offices and the emergency room, I questioned myself instead on what it was about my situation that was making me question myself. I agreed to treatment (medication and a procedure) even though I was uncertain about whether I was being properly diagnosed. I was inhibited from asking questions of my physician and taking a more active role in my own physical health and well-being.
As noted earlier, it is not the case that "good" doctors do not subor- dinate their patients and therefore promote self-sacrifice while "bad" doctors do: there are not beneficial norms I can utilize and harmful norms that I can avoid. As "the patient", I constitute myself (and am constituted) through norms and practices that subordinate me. Given the relationship I have illustrated between self-sacrifice and being a patient, we might be tempted at this point to fall back upon a sovereign notion of power, and say that doctors possess power which they then wield against their patients, thereby subjugating them. But we need to remember from earlier chapters Foucault's analysis of how modern power relations function; doing so, we see that doctors are also impli- cated in relations of power through which they are constituted and also constitute themselves in ways that promote self-sacrifice and inhibit critique. While it is true that "the doctor" is constituted as an authority figure who possesses knowledge that "the patient" does not, the doctor gains and maintains access to that knowledge only through adhering to accepted norms and practices within the health care system. She must, for example, conduct herself in a professional manner and treat patients in accordance with prevailing medical standards and protocols (as well as within the parameters set by insurance companies). This is not to say that doctors ought to adopt a casual attitude toward their patients' health, become overly friendly with them, or treat them with unap- proved medical interventions. It is rather to encourage critical analysis of ways in which the (self-)constitution of "the doctor" both enables and constrains physicians' ability to effectively care for and promote the physical and mental health of their patients (and themselves, for that matter).
How might a critical attitude, characterized by the practices of refusal, curiosity and innovation, facilitate a new mode of self-constitution that does not entail such sacrifice on my part? My discussion in the previ- ous paragraph, I think, constitutes refusal as Foucault conceives of it. In order to refuse particular norms that are presented to us as self- evident, we have to be able to see that prevailing modes of thought and
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PRACTICES O F THE SEL F
existence are not necessary modes; without such realization, refusal of particular norms and practices is not even conceivable, for how can I see as refusable what is simply inevitable? Once I see that I am in fact constituted as a patient within the health care system I can begin to take issue with particular aspects of how I am constituted and in doing so, begin to constitute myself differently. That is, having refused to accept that prevailing conditions are necessary conditions, I can become curi- ous about my current situation. Recognizing that I constitute myself as obedient to authority within the context of the health care system in order to gain access to truth, I can begin to analyse what it is about the health care system that encourages me to behave in this manner, and analyse the effects of my current attitude. I can also begin to think about how I might act differently. For example, if I determine that part of the reason I defer to the authority of my doctor is because I do not want to appear disrespectful, I might consider why, within this particular context, I seem to be confusing respect with deference. Am I concerned with appearing respectful or with actually treating the physician with respect? I can then do some innovating by marking clear distinctions between respect and deference, beginning to experiment with conduct- ing myself in a manner that is both respectful and assertive, and making sure that the physicians and others with whom I am dealing within the health care system are in fact worthy of my respect. If they are, I should treat them accordingly; if they are not, I shouldn't be concerned with appearances at all.
It is important to recognize that cultivating a critical attitude through the practices of refusal, curiosity and innovation does not get me outside of prevailing power relations. Even if I wanted to I could not become a medical doctor and treat myself to avoid being "the patient". I must rely up physicians for care, and I still have to navigate the system's bureaucracy: within the health care system I will be constituted as "the patient" or "the consumer", and my treatment within the system will be based on prevailing notions of what a patient or consumer is. But as Foucault makes clear, even though all self-constitution takes place within a context of constraint, I am not merely determined by those pre- vailing notions; I possess the capacity to constitute myself and I can do so differently by way of taking up existing norms and practices in new ways or rejecting them completely. While neither strategy is without its risks (my doctor may find me annoying if I ask too many questions or seek a second opinion) even negative consequences (being thought annoying) may open onto other possibilities: I can find a new doctor, engage in holistic practices like yoga that problematize the traditional Western separation of body and mind, explore alternative methods
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MICHEL FOU CAULT: KEY CONCEPTS
of alleviating pain (acupuncture, for example). Foucault's work thus provides us with the crucial insight that in so far as I constitute myself, I can constitute myself differently. Equipped with this insight, I am able to take up practices that facilitate my negotiation of existing power relations in ways that maximize my critical and creative capacities, thereby minimizing and working towards the eradication of subjectivity characterized by self-sacrifice.
Notes
1. In describing my own situation I am suggesting neither that marriage is unprob- lematic nor that feminists should not have children. Indeed, I believe that mar- riage as an institution is oppressive to women; I mention the fact that I do not have children simply in order to draw attention to the prevailing expectation that married women reproduce. From my perspective, my relationship to my own marriage is one way in which I endeavour to constitute myself differently.
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Chro ology
? ? 15 October 1926 1936-40 1940-45 Autumn 1945
Autumn 1946 August 1951
Autumn 195 1- Summer 1952 June1951
1952-55 1955-5 8
1958
1959 1960-66 1 9 6 1 1963 1966-68
Paul-Michel Foucault is born in Poitiers, France
Attends Lycee Henri-1\-: Poitiers
Attends College Saint-Stanislaus, Poitiers
Enters Lycee Henri-IV, Paris (to study for khd? ne - a year of special preparatory training for entry into the Ecole Normale Superieure) ; meets Jean Hyppolite
Enters Ecole Normale Superieure, Paris; meets Louis Althusser Achieves Agregation de Philosophie; examined by Georges Canguilhem
Fondation Thiers, Centre de recherches humanistes, Paris
Earns a Diploma in Psychopathology from the Paris Institute of Psychology
Assistant Lecturer at University of Lille
Cultural Delegate to the University of Uppsala, Sweden; meets Georges Dumezil in March 1956
Director of Center for French Civilization, Warsaw, Poland; teaches in the Romance Languages Institute at the University of Warsaw
Director of French Cultural Institute, Hamburg, Germany; teaches in the Department of Romance Languages at the Uni- versity of Hamburg
Member of the Faculty of Letters and Human Sciences, University of Clermont-Ferrand; becomes a tenured professor in 1962 after successfully defending his thesis
Publication of Folie et deraison. Histoire de ! a folie a l'dge Clas- sique (Madness and Civilization: A History of Insanity in the Age ofReason)
Publication of Naissance de ! a Clinique. Une archeology du regard medical (The Birth ofthe Clinic: An Archaeology ofMedi- cal Perception)
Visiting Professor of Philosophy, University of Tunis, Tunisia
187
December 1970
Delivers inaugural lecture at the College de France, 'TOrdre
Autumn 1982 Autumn 1983
delivers the Howison Lectures in October
Spends eight weeks at the University of Vermont
Visiting Professor at the University of California, Berkeley
2 June 1984 25 June 1984
MICHEL FOUCAULT: KEY CON CEPTS
1966 Publication of Les Mots et les choses. Une acheologie des sciences humaines (The Order ofThings: An Archaeology of the Human Sciences)
1968-69 Tenured Professor of Philosophy, University of Paris VIII, Vincennes
1969 Elected to the College de France; Publication of I! Archeologie du savoir (The Archaeology ofKnowledge)
du discours" (The Discourse on Language)
1971 Founds Groupe d'Information sur les Prisons (GIP)
1975 Publication of Surveiller et punir. Naissance de Ia prison (Disci-
pline and Punish: The Birth of the Prison)
1976 Publication of La Volante de Savoir: Volume I of Histoire de Ia
sexualite (Volume I of The History of Sexuality)
1980 Visiting Professor at the University of California, Berkeley;
1984 Publication of I! Usage des plaisirs: Volume II of Histoire de Ia sexualite (The Use ofPleasure: Volume II of The History of Sexuality)
1984 Publication of Le Souci de soi: Volume III of Histoire de Ia sexualite (The Care of the Self: Volume III of The History of Sexuality)
Foucault collapses in his apartment; he is admitted to the Hopi- tal Salpetriere on 9 June
Foucault dies in the Hopital Salpetriere, Paris All information comes from Eribon (1991).
? ? 188
Bibliography
? Works by Michel Foucault
Foucault, M. 1 972. The Archaeology ofKnowledge and the Discourse on Language, A. M. Sheridan Smith (trans. ). New York: Pantheon. Originally published as I. ;Archeologie du savoir (Paris: Gallimard, 1969).
Foucault, M. 1973. The OrderofThings. NewYork: Vintage. Originally published as Les Mots et les chases: Une acheologie des sciences humaines (Paris: Gallimard, 1966).
Foucault,M. 1975. TheBirthoftheClinic:AnArchaeologyofMedicalPerception,A. M. Sheridan Smith (trans. ). NewYork: Vintage. Originally published as Naissance de Ia Clinique: Une archeology du regard medical (Paris: PUF, 1963).
Foucault, M. 1976. Histoire de la sexualite val. 1: La volonte de savoir. Paris: Gallimard.
Foucault, M. 1977. "Nietzsche, Genealogy, History". In Language, Counter- Memory, and Practice: Selected Essays and Interviews, D. F. Bouchard (ed. ),
139-64. Ithaca, NY: Cornell University Press.
Foucault,M. 1979. DisciplineandPunish:TheBirtho{thePrison,AlanSheridan
(trans. ). New York: Vintage. Originally published as Surveiller et punir: Naissance
de la prison (Paris: Gallimard, 1975).
Foucault, M. (ed. ) 1980a. Herculine Barbin, Being the Recently Discovered Mem-
oirs o{a Nineteenth-Century French Hermaphrodite, Richard McDougall (trans. ).
Brighton: Harvester.
Foucault, M. 1980b. Introduction to Herculine Barbin: Being the Recently Dis-
covered Memoirs o{ a Nineteenth-Century French Hermaphrodite. New York:
Pantheon.
Foucault, M. 1980c. "Body/Power". In Power! I<nowledge: Selected Interviews and
OtherWritings 1972-1977, C. Gordon (ed. ), C. Gordon, L. Marshall,].