Biopower Today
Paul Rabinow
Department of Anthropology, University of California, Berkeley, CA 94720, USA
E-mail: Rabinow@SSCL.Berkeley.edu
Nikolas Rose*
Department of Sociology, London School of Economics and Political Science, Houghton Street, London
WC2A 2AE, UK
E-mail: n.rose@lse.ac.uk
Abstract
In this article we undertake some conceptual clarification of the concepts of biopower and biopolitics,
and argue for their utility in contemporary analysis. We consider Foucault’s development of
these concepts, and differentiate his view, which is close to ours, from the philosophical take-up of
the terms by Giorgio Agamben and Antonio Negri. Biopower, we suggest, entails one or more
truth discourses about the ‘vital’ character of living human beings; an array of authorities considered
competent to speak that truth; strategies for intervention upon collective existence in the
name of life and health; and modes of subjectification, in which individuals work on themselves
in the name of individual or collective life or health. We argue that, while exceptional forms of
biopower, especially in conditions of absolutist dictatorship, and when combined with certain
technical resources, can lead to a murderous ‘thanatopolitics’—a politics of death—biopower in
contemporary states takes a different form. It characteristically entails a relation between ‘letting
die’ ( laissez mourir) and making live (faire vivre)—that is to say strategies for the governing of
life. Using examples from our own current research, we consider recent developments in biopower
around three themes: race, population and reproduction, and genomic medicine.
Keywords Biopolitics, Biopower, Genomics, Population, race, reproduction
Paul Rabinow is Professor of Anthropology in the Department of Anthropology at Berkeley. His work focuses on
modernity as a problem, to be understood by means of an anthropology of reason. His current research focuses on
developments in post-genomics and molecular diagnostics. It seeks to invent an analytic framework to understand
the issues of biopolitics and bio-security. A related research interest is the contemporary moral terrain, with special
attention to ‘affect’. His most recent books are Anthropos today: Reflections on modern equipment (Princeton
University Press, 2003) and A machine to make a future: Biotech chronicles, with Talia Dan-Cohen (Princeton
University Press, 2004, 2nd edn, 2006).
Nikolas Rose is Martin White Professor of Sociology and Director of the BIOS Centre for the Study of Bioscience,
Biomedicine, Biotechnology and Society at the London School of Economics and Political Science. His most recent
book is Powers of freedom: Reframing political thought (Cambridge University Press, 1999); his new book The
politics of life itself: Biomedicine, power, and subjectivity in the twenty-first century will be published by Princeton
University Press in November 2006.
*Corresponding author.
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Q: Isn’t it logical, given these concerns, that you should be writing a genealogy of bio-
power?
MF: I have no time for that now, but it could be done. In fact, I have to do it.
(Foucault, 1984: 344).
What is ‘biopower’?1
In a book ostensibly devoted to the history of sexuality, La Volonte´ du
savoir, published in 1976 (English trans. 1978), Michel Foucault included six highly provocative
pages on this theme in a chapter entitled ‘Right of Death and Power over Life’. For a
long time, he argued, one of the privileges of sovereign power was the right to decide life
and death, a right that, by the classical age, had been constrained to occasions when the
sovereign himself was threatened from enemies without and within. This was the juridical
form of sovereign power—the right of a ruler to seize things, time, bodies, ultimately the
life of subjects. It was the model of power that was codified and generalized in classical political
philosophy—a model that remained essentially unaltered when the ‘king’s head’ was
displaced from sovereign to state. But, Foucault argued, since the classical age, deduction
has become merely one element in a range of mechanisms working to generate, incite, reinforce,
control, monitor, optimize and organize the forces under it. While external wars are
bloodier than ever, and regimes visit holocausts upon their own populations, he did not consider
these wars to be waged in the name of the sovereign, but in the name of the existence
of everyone:
. . . entire populations are mobilized for the purpose of the wholesale slaughter in the
name of life necessity.. . . It is as managers of life and survival, of bodies and the race,
that so many regimes have been able to wage so many wars, causing so many men to
be killed. (Foucault, 1978: 137)
Power, Foucault argues, is now situated and exercised at the level of life.
Foucault promised to flesh out his sweeping generalizations in one of the six proposed
volumes of the history of sexuality whose titles appear on the book’s back jacket. That promise
was not fulfilled, although he devoted a number of his 1976 Lectures to this theme. But
he did propose a rather simple and now familiar bipolar diagram of power over life. In this
diagram, one pole of biopower focuses on an anatamo-politics of the human body, seeking
to maximize its forces and integrate it into efficient systems. The second pole is one of regulatory
controls, a biopolitics of the population, focusing on the species body, the body
imbued with the mechanisms of life: birth, morbidity, mortality, longevity. He claims that
this bipolar technology, which begins to be set up in the seventeenth century, seeks ‘to invest
life through and through’ (Foucault, 1978: 139) And, by the nineteenth century, he argues,
these two poles were conjoined within a series of ‘great technologies of power’ of which
sexuality was only one. In so establishing themselves, new kinds of political struggle could
emerge, in which ‘life as a political object’ was turned back against the controls exercised
over it, in the name of claims to a ‘right’ to life, to one’s body, to health, to the satisfaction
of one’s needs.
At its most general, then, the concept of ‘biopower’ serves to bring into view a field comprised
of more or less rationalized attempts to intervene upon the vital characteristics of
1 This paper was first presented at Vital politics: Health, medicine and bioeconomics into the twenty-first century,
London School of Economics and Political Science, 5–7 September 2003.
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human existence. The vital characteristics of human beings, as living creatures who are
born, mature, inhabit a body that can be trained and augmented, and then sicken and die.
And the vital characteristics of collectivities or populations composed of such living beings.
And, while Foucault is somewhat imprecise in his use of the terms, within the field of
biopower, we can use the term ‘biopolitics’ to embrace all the specific strategies and contestations
over problematizations of collective human vitality, morbidity and mortality;
over the forms of knowledge, regimes of authority and practices of intervention that are
desirable, legitimate and efficacious.
More than quarter of a century after the introduction of this concept, at the threshold of
our current ‘biological century’, this contested field of problems and strategies is more
crucial and enigmatic than ever.2
Yet surprisingly little work has been done to develop
Foucault’s own sketchy suggestions into a set of operational tools for critical inquiry. The
term ‘biopower’ is more likely to be taken to refer to the generation of energy from renewable
biological material. The term ‘biopolitics’ has been taken up by advocates of a range
of environmental and ecological causes.3
However, we feel that Foucault’s concepts of
biopower and biopolitics retain considerable analytical utility. As a first step towards
some conceptual clarification, and drawing on our previous work in this area, we propose
that the concept of biopower designates a plane of actuality that must include, at a minimum,
the following elements (Rabinow, 1994, 1996, 1999; Rose, 2001, 2006):
* One or more truth discourses about the ‘vital’ character of living human beings, and an
array of authorities considered competent to speak that truth. These truth discourses
may not themselves be ‘biological’ in the contemporary sense of the discipline, for
instance they may hybridize biological and demographic or even sociological styles of
thought, as in the contemporary relations of genomics and risk, merged in the new language
of susceptibility.
* Strategies for intervention upon collective existence in the name of life and health, initially
addressed to populations that may or may not be territorialized upon the nation,
society or pre-given communities, but may also be specified in terms of emergent biosocial
collectivities, sometimes specified in terms of categories of race, ethnicity, gender or
religion, as in the emerging forms of genetic or biological citizenship.
* Modes of subjectification, through which individuals are brought to work on themselves,
under certain forms of authority, in relation truth discourses, by means of practices of
the self, in the name of their own life or health, that of their family or some other
collectivity, or indeed in the name of the life or health of the population as a whole:
Rabinow has examined the formation of new collectivities in terms of ‘biosociality’,
2 Sydney Brenner is among those who has examined key features of our ‘biological century’: see, for example,
Brenner (2000). Gilles Deleuze, in his Foucault (1988), has a provocative appendix where he talks about the
future of biopower.
3 For example, the Biopolititics International Organization, based in Greece, which focuses on environmental protection,
while in Christian biopolitics: A credo and strategy for the future, by Kenneth Cauthen, seeks to nurture
‘an emerging new consciousness among many potential dreamers and doers in the churches who can help provide
us with the visions and the values we need to promote a movement toward an ecologically optimum world community
full of justice and joy in which the human race can not only survive but embark on exciting new adventures
of physical and spiritual enjoyment. (1971: available online at http://www.religion-online.org/
showchapter.asp?title¼2301C¼2272).
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and Rose has examined the formation of kinds of human subject in terms of ‘somatic
individuality’.
The limits of biopower
We frame our initial specification in these limited terms partly in response to the ways
in which the terms ‘biopower’ and ‘biopolitics’ have been used by two of our leading
contemporary philosophers—Giorgio Agamben and Antonio Negri. Agamben and Negri
have each made these terms central to their critical analyses of the politics of the present.
Their work has had a very significant impact on social and political thought, especially in
the United States. What appears to attract many is the generality of their claims to characterize
the nature and essence of the present epoch. These authors suggest that contemporary
biopower takes the form of a politics that is fundamentally dependent on the domination,
exploitation, expropriation and, in some cases, elimination of the vital existence of some
or all subjects over whom it is exercised. Contemporary biopower, they imply, is a form
of power which ultimately rests on the power of some to threaten the death of others.
Yet we consider the epochal philosophical deployments of the terms to be misleading; it is
relevant to consider them in a little more detail in order to counterpose them to our own
approach.4
Empire
For Hardt and Negri, in Empire, biopower is an encompassing, totalizing term—biopower
serves to secure the dominion of a global form of domination that they term ‘Empire’ (Hardt
and Negri, 2000). Theirs is a neo-Marxist reading: their first premise is that the work of
power should be understood as the extraction of some kind of ‘surplus value’ from human
life upon which Empire depends. This is what they mean when they assert that all contemporary
politics is biopolitics: it is a ‘form of power that regulates social life from its interior’
(2000: 23). Further, they conflate this omnipotent and all pervasive biopower with an idea
loosely derived from a short and speculative essay by the French philosopher Gilles Deleuze,
in which he argues that we have moved from ‘societies of discipline’ to ‘societies of control’
(Deleuze, 1995). Michel Foucault (1977) had characterized ‘disciplinary societies’ as those
in which the management of inclusion and exclusion was accomplished by an archipelago
of disciplinary institutions dotted across the social field—asylums, factories, schools, hospitals,
universities—each seeking to implant a mode of conduct into body and its correlate
soul. Today, argued Deleuze, writing in the closing decades of last century, control was
not confined within such institutions, but was immanent in the flexible, fluid and fluctuating
networks of existence itself. Hardt and Negri take up this idea when they suggest that
biopolitics is a form of power ‘expressed as a control that extends throughout the depths
of the consciousnesses and bodies of the population’ (2000: 24). They claim that this
biopolitical power is exercised in the name of multinational and transnational corporations
4 In France, the reception of Negri has been minimal and that of Agamben has turned more specifically on his
claims about the concentration camps (see Mesnard, 2004).
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which, since the second half of the twentieth century, have chosen ‘to structure global
territories bio-politically’ (2000: 31).
Biopower, here, is enrolled in an attempt to resurrect a revolutionary view of world history,
which ends with a twist of Christianity to inspire resistance to Empire: Hardt and
Negri cite a legend about St Francis of Assisi who ‘refused every instrumental discipline,
and . . . posed a joyous life . . . against the will of power and corruption. Once again in
post modernity we find ourselves in Francis’s situation, posting against the misery of power
the joy of being’ (2000: 413). Now we would certainly agree that it is necessary to extend
the scope of traditional analyses of economic exploitation and geopolitics in order to grasp
the ways in which the living character of human beings, and indeed of other living beings, is
being harnessed by ‘biocapital’.5
But it is difficult to see what analytical work can be done
by such an expanded concept of biopower: in the end, Hardt and Negri merely provide a
superficial description of certain aspects of our present, framed within the kind of grand
narrative of history that other theorists of postmodernity had proclaimed a thing of the
past. But political evaluation of the forms of biopolitics is evaded, submerged under their
simplistic Manichean opposition of a mysterious global Empire to an even more phantom
‘multitude’. This version of the concept of ‘biopower’ is quite antithetical to that proposed
by Foucault: the concept is emptied of its critical force—it can describe everything but analyse
nothing.
It might be useful here to remind ourselves that when Foucault introduced the term in
the last of his Colle`ge de France lectures of 1975–6, Society must be defended (2002), he
is precise about the historical phenomena which he is seeking to grasp. He enumerates
them: issues of the birth rate, and the beginnings of policies to intervene upon it; issues of
morbidity, not so much epidemics but the illnesses that are routinely prevalent in a particular
population and sap its strength, requiring interventions in the name of public hygiene
and new measures to coordinate medical care; the problems of old age and accidents to
be addressed through insurantial mechanisms; the problem of the race and the impact
upon it of geographic, climatic and environmental conditions, notably in the town. The concept
of biopower is proposed after ten years of collective and individual research on the genealogy
of power over life in the eighteenth and nineteenth centuries.6
Foucault himself had
lectured on the politics of health in the eighteenth century in Japan and in Brazil; his seminar
members were producing detailed historical studies of the role of medicine, town planning,
royal shipyards and a host of other sites in which experiments about how to produce and
regulate ways of maximizing the capacities of both the population and the individual as a
target of power are being carried out. The concept of biopower—like that of discipline—
was not trans-historical or metaphoric, but precisely grounded in historical, or genealogical,
analysis.
We should also note that biopower, for Foucault, does not emerge from, or serve to
support, a single power bloc, dominant group or set of interests. While initially linking
biopolitics to the regulatory endeavours of developing States, Foucault recognized
that ‘the great overall regulations that proliferated throughout the nineteenth century . . .
5 On biocapital, see Rose (2006).
6 Note that these lectures were given in the same year that the first volume of History of sexuality was published in
France, and that, aside from a few passing comments, Foucault never returned to the concept of biopower again.
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are also found at the sub-State level, in a whole series of sub-State institutes such as
medical institutions, welfare funds, insurance, and so on’ (2002: 250). This is the point
at which Foucault began to develop his concept of ‘governmentality’, a concept whose
whole rationale was to grasp the birth and characteristics of a whole variety of ways of
problematizing and acting on individual and collective conduct in the name of certain
objectives which do not have the State as their origin or point of reference. As he
develops this line of thought concerning the multiplicity of forms and sources of authority,
Foucault also distanced himself from the view that such power over life is unambiguously
nefarious.7
This is also the turning point that leads Foucault to a fascination with ancient
modes of subjectification and the possibilities of freedom. In this context, it is worth remembering
that medicine is perhaps the oldest site where one can observe the play of truth,
power and ethics in relation to the subject, and to the possibilities of a good, or as the
Greeks would have it, a flourishing, life.
Homo sacer
Giorgio Agamben, in a series of haunting books, identifies the Holocaust as the ultimate
exemplar of biopower, and biopower as the hidden meaning of all forms of power from
the ancient world to the present. In particular he explores the moments that he terms, after
Carl Schmitt, ‘states of exception’, when a sovereign state declares a time or a place where
the rule of law can be suspended in the name of self-defence or national security (Agamben,
1995, 1996, 1998, 2000a, 2000b, 2005). There is much to be learned from these studies of
the profound traumas that mark European histories: we agree that Holocaust is not an
exceptional moment of throwback to a singular barbarianism, but an enduring possibility
intrinsic to the very project of civilization and the law. However, Agamben grounds his analysis
in a particular way that we find problematic. He argues that all power rests ultimately
on the ability of one to take the life of another—it is a power over life grounded in the possibility
of enforcing death. He characterizes this power by reference to the obscure metaphor
of homo sacer—the enigmatic figure in Roman law whose crimes made his sacrifice impossible
but who could be killed with impunity. Like this figure, who is reduced from bios—
crudely, the way of life proper to an individual or group in a polity—to zo¨e—‘bare life’—
he suggests that the birth of biopower in modernity marks the point at which the biological
life of subjects enters politics and belongs entirely to the State. The ultimate grasp of the
Sovereign or the State over the lives of subjects is exemplified, for him, in the concentration
camps, labour camps and death camps of the Nazis: sovereign States depend on their capacity
to create states of exception. Such states may be exceptional, but are nonetheless immanent
in modernity itself—a fourth space added to that of state, nation and land, in which
inhabitants are stripped of everything but their bare life, which is placed without recourse
in the hands of power. Indeed they are the ‘nomos’ of modernity: ‘This is why the camp
is the very paradigm of political space at the point at which politics becomes biopolitics
and homo sacer is virtually confused with the citizen’ (Agamben, 1998: 171).
Agamben takes seriously Adorno’s challenge—how is it possible to think after Auschwitz
(Mesnard and Kahan, 2001)? But, for that very reason, it is to trivialize Auschwitz
7 See, for example, his interview on social security, entitled ‘The risks of security’ (English trans. Foucault, 2000:
365–81).
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to see it as the hidden possibility in every instance where living beings enter the scope of regulation,
control and government. The power to command under threat of death is exercised
by States and their surrogates in multiple instances, in micro forms and in geopolitical relations.
But this does not demonstrate that this form of power—commands backed up by
the ultimate threat of death—is the guarantee or underpinning principle of all forms of
biopower in contemporary liberal societies. Nor is it useful to use this single diagram to analyse
every contemporary instance of thanatopolitics—from Rwanda to the epidemic of Aids
deaths across Africa. Surely the essence of critical thought must be its capacity to make distinctions
that can facilitate judgement and action.8
Holocaust is undoubtedly one configuration that modern biopower can take. Racism
allows power to subdivide a population into subspecies, to designate these in terms of in
terms of a biological substrate, and to initiate and sustain an array of dynamic relations
in which the exclusion, incarceration or death of those who are inferior can be seen as something
that will make life in general healthier and purer. As Foucault put it in 1976, ‘racism
justifies the death-function in the economy of biopower by appealing to the principle that
the death of others makes one biologically stronger insofar as one is a member of a race
or a population’ (2002: 258). It is true that in this lecture he suggests that it is ‘the emergence
of biopower that inscribes [racism] in the mechanisms of the State . . . as the basic
mechanism of power, as it is exercised in modern States’ (2002: 254). But the Nazi regime
was, in his view, exceptional—‘a paroxysmal development’:
We have, then, in Nazi society something that is really quite extraordinary: this is a
society which has generalized biopower in an absolute sense, but which has also generalized
the sovereign right to kill . . . to kill anyone, meaning not only other people
but also its own people . . . a coincidence between a generalized biopower and a dictatorship
that was at once absolute and retransmitted throughout the entire social body.
(2002: 260)
Biopower, in the form it took under National Socialism, was a complex mix of the politics
of life and the politics of death—as Robert Proctor (1999) points out, Nazi doctors and
health activists waged war on tobacco, sought to curb exposure to asbestos, worried about
the over-use of medication and X-rays, stressed the importance of a diet free of petrochemical
dyes and preservatives, campaigned for whole-grain bread and foods high in vitamins
and fibre, and many were vegetarians. But, within this complex, the path to the death camps
was dependent upon a host of other historical, moral, political and technical conditions.
Holocaust is neither exemplary of thanatopolitics, nor the hidden dark truth of biopower.
Sovereignty
Our criticism here is linked to a disagreement about ‘sovereignty’. While Hardt and Negri
differentiate ‘Empire’ from the forms of sovereignty that emerged in the nation state, the
diagram remains more or less unaltered: although ‘imperial sovereignty . . . is organized
not around one central conflict but rather through a flexible network of microconflicts’,
Empire nonetheless gathers unto itself the power relations that traverse all those ‘elusive,
8 This is a point that Agamben himself makes elsewhere.
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proliferating and non-localizable contradictions’ (2000: 201). The monolithic image of
Empire thus tries to condense and unify all those forms and relations into a single Sovereign
Power, to which can only be opposed some force that is radically Other, gestured to in the
name ‘multitude’: the multitude, then, is the contemporary incarnation of the regicide,
who, in eliminating the sovereign, will inaugurate an epoch in which sovereign power is
re-appropriated by subjects themselves. Despite its apparent radicalism, anti-capitalists
would do well to be wary of the religious underpinnings of this fable of resistance as deliverance
to a promised land.
For Agamben, sovereignty also has something of a sacred form—the ancient ritual
declaration of homo sacer remains present today in the capacity of the sovereign State to
establish the state of exception, to commit those stripped of the rights of bios to those zones,
and to torture or kill those reduced to the status of zo¨e—bare life—without legal restraint.
But this sovereign power is no longer confined to those who are explicitly agents of the
State—it apparently extends to all those who have authority over aspects of human vital
existence. Hence Agamben argues that the power over life exercised today by ‘the jurist
. . . the doctor, the scientist, the expert, the priest’ arises from the alliance with the Sovereign
into which they have entered; like those who populated an earlier image of power, Althusser’s
Ideological State Apparatuses, wittingly or unwittingly they do the Sovereign’s will
(Agamben, 1998: 122). Homo sacer, for Agamben, is thus not an historically marginal phenomenon:
it demands our attention as critical thinkers precisely because it is the ordering
principle of contemporary societies. Against such a ‘growing bio-political nightmare’ the
only solution seems equally sacred: no wonder Agamben invokes the figure of a messianic
‘end of time’, taken from Walter Benjamin, as one possible way out.
The interpretation of contemporary biopolitics as the politics of a State modelled on the
figure of the Sovereign, and of all forms of biopolitical authority as agents of that Sovereign,
suits the twentieth-century absolutisms of the Nazis and Stalin. But we need a more nuanced
account of power, and of sovereign power, to analyse contemporary rationalities and technologies
of biopolitics. Sovereignty did, of course, entail the right to take life, but the
essence of pre-modern sovereign power was its sporadic and discontinuous nature—that
indeed was the rationale for its excesses. The totalization of sovereign power as a mode
of ordering daily life at all times and places across a territory would be too costly; indeed,
as many historians have argued, the excessive form in which this power is exercised, for
example in spectacular public executions and the elaborate rituals of the courtroom, seeks
to compensate for its sporadic nature. Sovereignty, in this sense, is precisely a diagram of
a totalized and singular form of power not a description of its implementation. Certainly
some forms of colonial power sought to operationalize it, but, in the face of its economic
and governmental costs, colonial statecraft was largely to take a different form. The two
megalomaniac State forms of the twentieth century—Stalin’s Russia, Hitler’s Germany—
also sought to actualize it, as have some others in their wake: Albania under Hoxha, North
Korea . . . But no historian of pre-modern forms of control could fail to notice the dependence
of sovereign rule on a fine web of customary conventions, reciprocal obligations
and the like—in a word, a moral economy whose complexity and scope far exceeds the
extravagant displays of the sovereign. Sovereign power is at one and the same time an element
in this moral economy and an attempt to master it. A cursory glance at the work of
Jacques Le Goff—whose work Foucault knew well—or Ferdinand Braudel and the whole
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Annales project, or, for English readers, the writings of E.P. Thompson should be sufficient
to dispel such recent misreadings (Hay, 1975; Thompson, 1975; Braudel and Labrousse,
1976; Le Goff, 1980, 1990).
Over the eighteenth and nineteenth centuries, nation states, in addition to their theatres
of power and public display, began to be key mobilizers of the internal forces of their
territories so as to secure their objectives of prosperity and security. But the governmentalized
states of the late nineteenth century took the shape that they did through the prior formation
of ever-growing apparatuses of knowledge collection and problematization that
formed alongside the state apparatus, often in conflict with it, in the emergent terrain of
the ‘social’. From this time on, states can rule only because of the ways in which they manage
to connect themselves up to these apparatuses, which have their own logics and viscosity.
So long as regimes aspire to liberalism, such apparatuses and authorities will exercise
demands and constraints on central powers. Non-state bodies have played a key role in biopolitical
struggles and strategies since the origin of ‘the social’—philanthropic organizations,
social investigators, pressure groups, medics, feminists and assorted reformers have all operated
on the territory of biopower.
Since the end of the Second World War, and taking here only the example of health, a
range of powerful agencies within states and a range of transnational bodies have taken
on a new importance. So have a host of bioethics commissions, regulatory agencies and
professional organizations: a whole ‘bioethical complex’, in which the power of medical
agents to ‘let die’ at the end of life, the start of life or in reproduction, are simultaneously
enhanced by medical technology and regulated by other authorities as never before. Further,
we have seen the rise of new kinds of patients’ groups and individuals, who increasingly
define their citizenship in terms of their rights (and obligations) to life, health and cure.
And, of course, new circuits of bioeconomics have taken shape, a large scale capitalization
of bioscience and mobilization of its elements into new exchange relations: the new molecular
knowledges of life and health are being mapped out, developed and exploited by a range
of commercial enterprises, sometimes in alliance with States, sometimes autonomous from
them, establishing constitutive links between life, truth and value. This is a far from homogeneous
field of agents, tactics, strategies and objectives. Yet, at the same time, States do
retain power to designates zones of exception, even when their legality is dubious –the
camp remains a grim reality from the wars in the Balkans, through Guantanamo Bay to
the ‘detention centres’ springing up across Europe to incarcerate ‘asylum seekers’ and others
who trespass on the spaces of bios but are not admitted. Do these all form part of a
single configuration of biopower? This remains to be demonstrated. And even if they did,
we doubt that such a biopower could be characterized solely, or even principally, in terms
of its propensity for ‘making die’: for while death is part of the picture, it takes the form
of ‘letting die’ as much as of ‘making die’. But also, of course, central to the configuration
of contemporary biopower are all those endeavours that have life, not death, as their
telos—projects for ‘making live’.
We have suggested that the concept of biopower seeks to individuate strategies and configurations
that combine three dimensions or planes—a form of truth discourse about living
beings and an array of authorities considered competent to speak that truth; strategies for
intervention upon collective existence in the name of life and health; and modes of subjectification,
in which individuals can be brought to work on themselves, under certain forms
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of authority, in relation to truth discourses, by means of practices of the self, in the name of
individual or collective life or health. Although we draw these elements from Foucault’s all
too brief interventions on the concept, it is worth remembering that his principal site of
investigation was historical. He studied the emergence of forms of power in the eighteenth
century, their transformation in the nineteenth and, to some limited extent, an examination
of the forms taking shape at the end of the nineteenth century. Rationalities, strategies and
technologies of biopower changed across the twentieth century, as the management of
collective life and health became a key objective of governmentalized states, and novel
configurations of truth, power and subjectivity emerged to underpin the rationalities of
welfare and security as well as those of health and hygiene (Donzelot, 1979; Rose, 1985;
Ewald, 1986; Rabinow, 1989; Rose, 1999). It would certainly be misleading simply to
project Foucault’s analysis forward as a guide to our present and its possibilities. One key
mutation concerns the relations between what one might term, clumsily, the macro and
the micro, or, following Deleuze, the molar and the molecular, poles of this mode of power.
That is to say, on the one hand, the emphases and relations on ways of thinking and acting
at the level of population groups and collectivities, variously defined; and, on the other
hand, the individualization of biopolitical strategies. Undoubtedly, in the era of the social
state—and in those locales where such states still form the organizing principle of political
struggle—it was the molar that was privileged. In the twentieth century, States not
only developed or supported insurantial mechanisms of security, but gathered together,
organized and rationalized the loose threads of medical provision, specified and regulated
standards of housing, engaged in campaigns of health education and the like. Even liberal
States also played their role in the battle against degeneracy, imposing immigration controls,
sometimes legitimating compulsory or quasi-compulsory sterilization, encouraging organizations
giving eugenic guidance on marriage and procreation and so forth. Of course,
each of these was to have its ‘molecular’ counterpart, for example in the transformation
of the home into a machine for health, and the education and solicitation of mothers as
ancillary workers in the health care of their children.
Today, much of this configuration remains, and, indeed, some of it has been translated
to a supranational level in the endeavours of the European Union, the World Bank and
the like. But, with the decline of the domain of the social as a privileged site of national
objectivation and intervention in the ‘advanced liberal’ societies of the West, we observe
new collective formations emergent everywhere (Rabinow, 1996; Rose and Novas, 2005).
At the same time, as we can observe in the politics surrounding the sequencing of the human
genome, we see the birth of new modes of individualization and conceptions of autonomy
with their associated rights to health, life, liberty and the pursuit of a form of happiness
that is increasingly understood in corporeal and vital terms (Rabinow, 1994; Rose, 2001).
Analytics of biopower
To develop this argument further, drawing on our current research, we will focus on three
topics that seem to us to condense some of the biopolitical lines of force active today: race,
reproduction and genomic medicine. Of course, to place all these diverse developments
within the ambit of biopower is not to imply that there is some unity at work here, or
some essence—truth or falsity—that all these forms exemplify or embody. We need to
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recognize dispersion, contingency and virtuality, although not with deconstructionist intent.
Before we can see whether some general political rationality is emerging, the task of analysis
is to articulate some preliminary diagnoses at a smaller scale. Placing the evidence from such
analyses in the framework of biopower, we think we can begin to identify and analyse elements
of such a domain, though it is neither stable nor homogeneous, nor does merely
repeat patterns familiar from history. A modest empiricism, attentive to peculiarities, to
small differences, to the moments when shifts in truth, authority, spatiality or ethics make
a difference for today as compared to yesterday, reveals configurations that do not conform
to the images provided by our philosophers.9
In these configurations, race, health, genealogy,
reproduction and knowledge are intertwined, continually recombining and transforming
one another. By this we mean that knowledge of health transforms the idea of race, that
ideas of genealogy are reframed by new conceptions of reproduction, that changing ideas of
genealogy radically impact upon the politics of race, races and racism. Let us turn to explore
some of these issues in some more detail.
Race
Race, together with health, and in variable relations with it, has been one of the central
poles in the genealogy of biopower.10
Conceptions of race formed a prism not just for the
imagination of the nation, but also for the political management of national health and
vitality, and of international competitiveness, from the so-called ‘war of nations’ in the
eighteenth century (the topic of several lectures by Foucault in Society must be defended),
through the massive biologization of race in the nineteenth century, linked to pre- and
post-Darwinist evolutionary thinking and applied both within states and in their colonial
dominations, to the later nineteenth century obsession with degeneracy and race suicide,
and the strategies of eugenics that spread from the United States to Japan and elsewhere
in the first half of the twentieth century. After the Second World War, official racialist discourses
were discredited: by 1963, for example, the United Nations Declaration on the
Elimination of All Forms of Racial Discrimination took as one of its premises ‘that any
doctrine of racial differentiation or superiority is scientifically false, morally condemnable,
socially unjust and dangerous, and that there is no justification for racial discrimination
either in theory or in practice’ (United Nations General Assembly, 1963: Preamble).11
Of course, racialist practices hardly subsided, but a biological understanding of racial categories
was no longer ‘in the true’ in political or policy discourse. In part due to the persistent
interventions of radical critics, the link between biological understandings of distinctions
among population groups and their socio-political implications seemed broken or at least
de-naturalized. Many biologists still believed they encountered such differences, not least
in examining the prevalence of particular diseases in different regions or the efficacy of medicines
in different national populations, but such arguments tended to remain in the technical
literature. Some individuals and groups persisted in making public claims for politically
9 We have discussed our approach to empiricism elsewhere: see our Introduction to Foucault et al. (2003), and the
Introduction to Rose (1999), especially pp. 11–15.
10 This argument is developed in more detail in The politics of life itself (Rose 2006: ch. 6).
11 To be found on line at http://www.unhchr.ch/html/menu3/b/9.htm
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pertinent correlation between human qualities and racially differentiated biological
capacities in a whole number of controversies from education to criminality, but even those
with scientific credentials, such as William Shockley, largely argued this from outside the
truth discourses of biology. In many countries, not least the United States, race was crucial
as a socio-economic category, a mark of discrimination and a mode of identification that
remained extremely salient socially and politically, from the allocation of federal funds to
the manifestations of identity politics. But, despite the fact that race functioned as a marker
of belonging and the basis of a claim to disadvantage, even when groups or individuals
sought to trace their ‘roots’ they seldom related this genealogy to a biological substrate.
The same is true of the murderous racist wars that spread across Europe in the wake of
the demise of the Soviet empire, from Armenia to the Balkans. Appeals to racial identities
to ground the elimination of other groups needed no justification in the truth discourse of
biology. While, in Rwanda, Hutus referred to Tutsis as ‘cockroaches’, such epithets were
hardly elements in a political rationality drawing on biological understandings of racial
difference.
At the turn of the new century, however, race is once again re-entering the domain of
biological truth, viewed now through a molecular gaze. At a certain moment, when it
became clear that humans shared over 98 percent of their genome with chimpanzees, and
that inter-group variations in DNA sequences were greater than intra-group variations, it
appeared that genomics itself would mark the terminal point of biological racism (perhaps
even species-ism). But this humanitarian dream proved to be short-lived. A new molecular
deployment of race has emerged seemingly almost inevitably out of genomic thinking.
Critics denounced the model of a single genome that underpinned the Human Genome
Project, fearing that it would establish a white male norm. The first move here was cast
as ethical: as the initial proposer of this work, L. Luca Cavalli-Sforza, put it: ‘to explore
the full range of genome diversity within the human family’ and ‘to help combat the widespread
popular fear and ignorance of human genetics and . . . make a significant contribution
to the elimination of racism’ (quoted in M’Charek, 2005: 5–6). Despite criticism, this
effort to ensure the recognition of diversity in the framing of scientific truth as an essential
dimension of genomic knowledge was later adopted by the Human Genome Project
(HUGO), which provided US $1.2 million to set up workshops to develop the technical
and organizational aspects of the project, to consider the social and ethical implications,
and to conduct a pilot study (Reardon, 2001; M’Charek, 2005; Reardon, 2005).
Genome mapping led to the conclusion that, while the DNA sequence of any two
randomly selected individuals will be 99.9 percent identical, the variations at the level of
single DNA base—called Single Nucleotide Polymorphisms or SNPs—are very significant,
notably in relation to susceptibility to disease. On average, it was claimed, one letter in
1,000 differed between two individuals—which made a total of many million variations
between them—estimates of the number ranged from 6 million to 15 million. The National
Institutes of Health (NIH) and the Wellcome Trust have given considerable funds to
research into the establishment of genomic differences at the single nucleotide level. Thus,
in 1999, Wellcome announced a consortium with ten pharmaceutical companies to find
and map 300,000 common DNA sequence variations. Further, it became clear that sets of
nearby SNPs on the same chromosome are inherited in blocks. The pattern of SNPs on a
block is termed a haplotype. While blocks may contain a large number of SNPs, a few
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SNPs—known as tag SNPs—are enough to uniquely identify a haplotype. Haplotype mapping
promised a more economical way of identifying SNPs relevant to disease, and the NIH
and Wellcome, together with labs in Japan and China, are collaborating in an international
HapMap project. Such funding has been justified precisely in biopolitical terms, as leading
towards and ensuring the equal health of the population in all—or some—of its diversity.
For example, to create the HapMap, DNA will be taken from blood samples collected by
researchers in Nigeria, Japan, China and the United States—from US residents with ancestry
from northern and western Europe. While the samples will be anonymous, they will be identified
by the population from which they were collected. The SNP differences that account
for 0.1 percent of the 3 billion base pairs of the human genome seem to provide ample space
for population differentiations as they affect differences that have significance for human
health.
The science itself, and the recognition of the variability of the human genome at the level
of the single nucleotide, thus immediately open up a new way of conceptualizing population
differences—in terms of geography and ancestry—at the molecular level. In addition to the
ethical humanism of the state projects, additional pressure to proceed in this direction came
in some areas from the demands of patient groups for genomic self-knowledge, and in others
from the commercial aspirations of pharmaceutical companies and the biomedical industry
for a genomic strategy for diagnosis, drug development and marketing. By 2003 multiple
projects are under way to map diversity at the level of the SNP. Strikingly, Howard University
in the USA has generated a database of DNA sequences to be used to exploring the
genomic bases of disease among black Americans, and also to trace individuals’ ‘roots’ to
their pre-slavery origins in very specific regions of Africa. This contemporary programme
to identify biological differences is not undertaken in the name of population purity, but
of national economic development, the search for health in biosocial communities, and
the growing sense of many individuals that genetics in some way holds the key to their
‘identity’.
It would be tempting to say that this highly sophisticated genomics has produced new
complexity into the figure of humanity. But, despite the heated debates in the medical literature,
the core racial typology of the nineteenth century—white (Caucasian), black (African),
yellow (Asian), red (Native American)—still provides a dominant mould through which this
new genetic knowledge of human difference is taking shape and entering medical and lay
conceptions of human variation. Medical researchers and gene mappers specify their populations
and their samples in such terms, drug companies seek to target specific pharmaceuticals
to groups designated, for example, as ‘African Americans’, and individuals seek to
trace their ‘African’ roots through matching the patterns of their SNPs with those from villages
pillaged by the slave trade in Niger or Cameroon. It is undoubtedly the case that SNP
mapping will produce typologies of difference between ‘population groups’ and almost
inevitable that these population groups, in the name of health, will be coded in terms of
broad cultural conceptions of race. New challenges for critical thinking are raised by the
contemporary interplay between political and genomic classifications of race, identity politics,
racism, health inequities, and their potential entry into biomedical truth, commercial
logics and the routine practices of health care. We do not think it helpful to assert in
advance that such endeavours are based upon faulty premises, let alone to suggest that
they are implicitly racist and will exacerbate discrimination. Contemporary genomics is
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principally directed at illness conditions rather than gross characteristics such as intelligence
or personality. It understands most of those conditions as arising out of interactions
between multiple coding regions, where gene expression can be activated and inactivated
by many environmental factors at levels ranging from the cellular to the familial, the social
and the environmental. It seeks not to pronounce on destiny per se, but rather to render the
future as probabilistic and to open it to hope and to technical intervention. It would be
unhelpful and misleading to regard this configuration as a replay of the past, or to submerge
it within some imagined global logic of biopower: instead we need to identify the points
where critical judgement, diagnosing new possibilities and dangers, might play a part in
the direction it takes.
Reproduction
For Foucault, sexuality was crucial, in part, because was the hinge that linked an anatamopolitics
of the human body with a biopolitics of the population. But today, perhaps for as
long as the last 50 years, these issues have become decoupled. Sexuality has been disengaged,
to a degree, from the symbolics and practices of reproduction, and reproduction itself
has become the object of a series of forms of knowledge, technologies and political strategies
that have little to do with sexuality. From about the 1970s one can see a triple movement.
The question of reproduction gets problematized, both nationally and supra-nationally,
because of its economic, ecological and political consequences—over-population, limits to
growth, etc. A new politics of abortion emerges, taking different forms in different national
contexts. And, in the West at least, a related issue of ‘reproductive choice’ begins to take
shape, when a small number of couples in the West, in alliance with some doctors, strove
to define infertility as a potentially remediable medical condition and, consequently, the
site of legitimate interventions. All of these sites jointly, yet differently, combined in making
reproduction a problem space, in which an array of connections appear between the individual
and the collective, the technological and the political, the legal and the ethical. This is a
biopolitical space par excellence.
The new reproductive technologies involving the micro-manipulation of eggs and sperm,
and pre-implantation genetic diagnosis and selection, although they have attracted the most
attention in the Anglo-American world, have actually been rather restricted in their impact
on national populations, let alone on global population politics. Though they have been the
site of a discursive explosion, the focus of regulatory attention and political and ethical controversy
in many Western countries, it is hard to discern some unified biopolitical strategy
underlying these developments. The rhetoric of choice clearly resonates with the ethic of
autonomy at the heart of advanced liberal modes of subjectification, and the transformation
of infertility into a treatable illness exemplifies the re-imagining of human capacities as open
to re-engineering and enhancement by medicine. However, we need to recognize the limited
scope of these procedures, and the fact that they are far from routine, and often unsuccessful.
Biopolitically, reproductive choice in the form of embryo selection, far from being in the
service of general racial improvement or even individualized ‘designer babies’, has been
almost entirely limited to the identification of foetuses with major malformations or crippling
and terminal genetic disorders (Franklin, 1997, forthcoming 2006; Throsby, 2004).
Even then, the use of diagnostic techniques has not inevitably led to termination but often
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to providing anticipatory information in the services of the kinds of life planning that have
become intrinsic to forms of life in contemporary liberal societies. Perhaps, as many feminists
have argued, the principal biopolitical achievement here lies on the axis of subjectification:
these strategies exhibit the characteristic formation in which apparent choices entail
new forms of ‘responsibilization’ and impose onerous obligations, especially, in this case,
upon women.
Less attention in the Western academy has been paid to the ‘molar’ pole of the management
of reproduction—the campaigns for population limitation that have spread across the
Indian subcontinent, China and South East Asia and many Latin American countries. These
biopolitical strategies are undoubtedly underpinned by truth claims, although they are those
of demography and economics, not of heredity and eugenics. Take, for example, the publication,
in 1972, of the report from the Club of Rome entitled Limits to growth. Using a
model derived from system dynamics for its analysis, the report concluded that:
If the present growth trends in world population, industrialization, pollution, food
production, and resource depletion continue unchanged, the limits to growth on this
planet will be reached sometime within the next one hundred years. The most probable
result will be a rather sudden and uncontrollable decline in both population
and industrial capacity. (Meadows et al., 1972: http://www.clubofrome.org/docs/
limits.rtf)
Fundamental to their prescription to avert this problem was birth control to stabilize population,
by limiting family size to two children, especially in those countries where it
currently greatly exceeded that, but even this path was no guarantee of success.
We end on a note of urgency. We have repeatedly emphasized the importance of natural
delays in the population-capital system of the world. These delays mean, for
example, that if Mexico’s birth rate gradually declined from its present value to an
exact replacement value by the year 2000, the country’s population would grow
from 50 million to 130 million. We cannot say with certainty how much longer mankind
can postpone initiating deliberate control of its growth before it will have lost the
chance for control. (Meadows et al., 1972: http://www.clubofrome.org/docs/limits.rtf)
These dire warnings resonated with a raft of analogous concerns about the impact of population
growth on economic wealth and the need for governments—especially those of less
developed states—to introduce policies to curtail reproduction—especially among the
poor—as a prerequisite to modernization. These varied from the coercive—China’s One
Child Policy or the sterilization campaigns in India are the two best-known examples—to
those which gradually came to adopt principles of informed consent to what was euphemistically
termed ‘voluntary surgical contraception’—for example, in Mexico. They were based
upon demographic data and algorithms linking population growth to economic
performance developed by geographers and mathematicians, embedded in educational
programmes for development workers and others, proselytized by numerous private pressure
groups and policy advisory bodies, and built into the policies of development agencies
such as the ‘Office of Populations’ of the ‘Bureau for Global Programs’ of the United States
Agency for International Development (USAID). The ‘population time bomb’ became part
of the common sense of public opinion in the West, and a major justification for aid from
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advanced industrial societies to poorer countries was that this would enable them to limit
their population and hence the danger that their population growth posed.
By the end of the 1980s, policies for the limitation of procreation among the poor
stressed the importance of voluntary assent and informed choice, and argued that the aim
was to prevent the misery of maternal deaths and perinatal mortality in the Third World.
Voluntary female sterilization is the most prevalent contraceptive method today, used by
over 138 million married women of reproductive age compared to 95 million in 1984
(Robey et al., 1992). There is particular controversy over the increasing use of the quinacrine
pellet method developed by Dr Jaime Zipper in 1984, distributed to 19 countries
around the world, including Bangladesh, Chile, China, Colombia, Costa Rica, Croatia,
Egypt, India, Indonesia, Iran, Malaysia, Morocco, Pakistan, Philippines, Romania, the United
States, Venezuela and Vietnam, but subject to later banning in some countries. The use
of quinacrine, often surreptitiously, through direct relations between NGOs and individual
doctors, often aimed at particular segments of the population considered problematic or
undesirable, leads critics to conclude that these repeat Nazi non-surgical sterilization
practices, and are contemporary successors to the sterilization and population limitation
campaigns of the 1970s and 1980s, despite their rhetoric of informed choice: they amount
to global eugenics.12
From the perspective of biopower, however repugnant these policies, it is misleading to
make that criticism through a rhetorical association of them with the eugenics of the mid
twentieth century. If we use the term eugenics to apply to any intervention on the reproduction,
morbidity and mortality of the population, it covers everything from contraception
through abortion to public health, and its use becomes merely part of a general critical
rhetoric. Eugenics—the improvement of the biological stock of the population—did indeed
take both negative and positive forms, but in each case, it was directed to maximizing racial
fitness in the service of a biological struggle between nation states. The forms of biological
knowledge that inform our ways of governing others and ourselves are no longer those of
the survival of the fittest. Limiting population in the interests of national economic prosperity
does not operate according to the biopolitical diagram of eugenics, and is not the same as
purification of the race by elimination of degenerates.
This is not to say that there are no forms of eugenics around. One visible form is linked
to public health. In Cyprus, there are systematic programmes of nationwide testing, with the
assent of the population, the church and the state, to identify and eliminate cystic fibrosis—
not by embryo selection but by marriage counselling.13
We can see something of the same
strategy at work in practices for the control of Tay Sachs among Ashkenazi Jews in North
America and in Israel—practices that have been developed by authorities arising from
within those ‘biosocial communities’ themselves.14
By any definition, this is a strategy aimed
at reducing the levels of inherited morbidity and pathology in a population considered as a
whole by acting on the individual reproductive choices of each citizen, through various
forms of authoritative calculation and guidance, sanctioned by a range of religious and secular
authorities, including bioethicists, and approved of by the population. If, as we suggest,
12 For examples of the debate, see http://www.hsph.harvard.edu/Organizations/healthnet/contra/topic05.html#2
13 This is the subject of ongoing research by Stefan Beck.
14 Discussed in the paper by Barbara Prainsack in BioSocieties, 1(1). See also Rose (2006: ch. 6).
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this is a type case of contemporary biopolitics, it would clearly be misleading to diagnose it
as a form of genocide, or the re-awakening of the spectre of the camp. Political violence
between ethnic groups is certainly endemic in the two countries that we have cited, but
that violence turns on a different, non-biopolitical register.
These examples, and others that we could cite, lead us to argue that the economy
of contemporary biopolitics operates according to logics of vitality, not mortality:
while it has its circuits of exclusion, letting die is not making die. With the development
of ever more sophisticated, cheaper and readily available forms of genetic testing, biopolitics
at both poles—the molar and the molecular—might well be changing. As endless
conferences and books have argued, there is all the difference in the world between
using genetic techniques to diagnose and even select against embryos with Down syndrome
or foetal tube syndrome, and seeking to use those techniques to diagnose intelligence
and eliminate the ‘feeble minded’. It is not clear what configurations will take shape
if current research succeeds in identifying genetic markers for susceptibilities to common
complex disorders such as stroke or heart disease, or for risks of depression or schizophrenia.
Our own current research pays close attention to this work, the scientific and
technological techniques directed at these ends. But there is no evidence to suggest
that the forms of biopolitics that are taking shape around these have, as their strategic objectives,
wholesale management of population qualities. Their logic is different, and notably
involves attempts to develop and maximize targets for pharmaceutical markets and other
health care interventions which entail enrolling individuals, patient groups, doctors and
political actors in campaigns of disease awareness and treatment in the name of the maximization
of quality of life. This is capitalism and liberalism, not eugenics, by either the front or
back door, at least insofar as eugenics has acquired an inescapably negative meaning in our
contemporary culture. We still need to develop the conceptual tools for the critical analysis
of the ways in which biopolitics plays out in relation to biocapital and bioeconomics, in
circuits in which health and vitality become key stakes in market relations and shareholder
value.
The possibilities of genomic management of the population—designer babies, engineered
futures, the ‘sorting society’ and the like—have a powerful symbolic presence in contemporary
biopolitics, especially in those polities where twentieth-century eugenics took
its most corrosive form. However large-scale genetic management of the population
has not taken place and, indeed, it is currently technically impossible. More significantly,
with the exception of some minor sects, there are few forces that embrace such a rationality.
Nonetheless, currently feasible practices such as sex selection do seem to be having
molar consequences outside Europe, even though this is the product of individual choices
aimed at personal aspirations and shaped by specific socio-cultural contexts, and is often
explicitly discouraged by official policies. Over and above these alterations in the gross
characteristics of the population, in which genetic technologies merely amplify existing
cultural forms, we think that it is extremely unlikely that the micro-management of
population characteristics through intervention at the point of reproduction will be
scientifically and technically feasible. Even if it is feasible in relation to certain specific
conditions, as we see in relation to sickle cell or Tay Sachs, the forms and extent of such
genomic management will be shaped by the concerns of particular biosocial communities,
rather than by a State commitment to the engineering of population quality for national
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ends. We will neither repeat the past, nor enter the utopias or dystopias of futurology: to
understand and intervene in possible futures we need an analytic which is more modest
and empirical, attuned to all the small mutations where today is becoming different from
yesterday.
Genomic medicine
The first biopolitical strategies, in the eighteenth century, concerned the management of illness
and health. These provided a model for many other problematizations operating in
terms of the division of the normal and the pathological. They have a peculiar saliency in
liberal societies because they establish links between the molecular and the molar, linking
the aspiration of the individual to be cured to the management of the health status of the
population as a whole. The poles of this biopolitical field extend from the management of
collective health by means of pure water, through annual health check-ups, health insurance,
preventive medicine that operates in large domains between collectivities and individuals,
to the field of clinical interventions on the body of the sick person in the name of
health. Despite the contemporary focus on the individuated body, action on the collective
pole has been the main motor of increases in longevity and quality of life. Variations in
the rationalities and technologies directed to this collective pole are the key factors that
have led to the scandalous variations in life expectancy and life chances that we can observe
today around the globe. In the vast majority of these instances, the causes and the remedies
are known, and require no further scientific advance or technological innovation, but only
political will. Even in apparently novel disorders, such as SARS, whose outbreak rapidly
called forth the whole panoply of modern biological medicine including the rapid identification
and sequencing of the pathogen, the preventive modes of intervention required were
archaic. They were basically those of quarantine, first applied to epidemic outbreaks such
as plague, that have been deployed at least since medieval times and have merely been
updated to take account of contemporary mechanisms of mobility and communication.
There strategies proved highly effective without any significant contribution from genomic
medicine.
What then of genomic medicine? It will have become clear that a judgement as to
whether or not a new regime of biopower will take shape—that is to say, will form a qualitative
new configuration of knowledge, power and subjectivity—depends on many factors.
Some of these depend upon the uncertain outcome of genomic research itself, but many
others depend on contingencies external to genomics and biomedicine. As we write, it is still
not clear whether the new forms of molecular and genomic knowledge are actually capable
of generating the kinds of diagnostic and therapeutic tools that its advocates hope for.15
The
stakes here are high, economically, medically and ethically. They lie in the presumed capacity
of genomics to form a new ‘know how’ that will enable medicine to transform its basic
logic from one in based upon restoring the organic normativity lost in illness to one engaged
in the molecular re-engineering of life itself. Genomics promises to identify the key processes
that control the manufacture of proteins and, in doing so, open these to precise intervention
in order to produce therapeutic effect. The political economy of these knowledges is, as
15 This paper was originally written in August 2003.
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Carlos Novas has pointed out, one of hope: the hope of individuals, campaigners, scientists,
health care systems, science policy advisers and the pharmaceutical companies that a new
kind of ‘know how’ of life itself will emerge that will generate cures, along with their
attendant biovalue (Novas and Rose, 2000). For its advocates, the genomic identification
of functional pathology must inevitably open a path towards molecular intervention. But
to the degree that this logic proves impossible to realize, genomics will remain only one
dimension of health care and biological understanding; one that gains its intelligibility
within a wider field of knowledge on the aetiology, prognosis and treatment of disease.
How, then, might we begin to think through the implications of the nascent advances in
molecular and genomic technologies? The belief that something significant is at stake here
mobilizes the strategies and tactics of a whole variety of forces whose characteristics have
been documented in detail in numerous empirical studies. National governments invest in
genomics, set up bio-banks, and fund research into basic and applied genomic medicine.
Pharmaceutical and biotech companies invest billions and employ tens of thousands of
talented scientists and technicians in subtle and elegant experiments and inventions. Patient
groups invest hope, political capital, their own tissue samples and money in the search for
genetic treatments. Pressure groups lobby for and against some or all of these developments
on the basis of their own ethical or biopolitical concerns. So clearly a modified biopolitical
rationality in relation to health is taking shape, in which knowledge, power and subjectivity
are entering into new configurations, some visible, some potential. This formation involves
many elements that have played their part in previous apparatuses, and many that took
more or less their current shape after the Second World War: patient groups are not new,
pharmaceutical companies pre-existed genomics, and governments have invested increasingly
large sums in promoting and regulating basic and applied medical research in the
name of population health, economic development and international competitiveness. But,
alongside these previous configurations, which have by no means disappeared, we believe
that something new is taking shape, something that is beginning to colonize and mutate
the major apparatuses for the management of the health of each and of all, at least in the
industrial democratic world.
Let us take two small examples of these new investments. Rabinow’s research in 2003
was an anthropological investigation of Celera Diagnostics, in Alameda California.16
This
company is an offshoot of Celera Genomics, the company that accelerated the race to
map the human genome (and other non-human genomes as well). With several hundred million
dollars at its disposal, it identified roughly a dozen major disease areas and adopted an
approach that seeks to identify clusters of SNPs (single nucleotide polymorphisms) in functional
areas of the genome. Hence Celera Diagnostics combines massive, expensive machine
capacity, diverse alliances with multiple disease associations and university researchers, and
a strategy that this will enable the diagnostic identification of predispositions to complex
disease involving variations in numerous genes. Their model for polygenetic conditions
moves beyond the search for the ‘gene for’ model of the 1990s, a model that is obviously
inadequate for understanding the most common disorders such as cancer, heart disease
and other complex disorders, and probably also inadequate for understanding the genomics
of most diseases and susceptibilities. The goal is to produce diagnostic tests that would be
16 Since writing this paper, this research has been published as Rabinow and Dan-Cohen (2004, 2006).
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used massively in reference laboratories in a routine fashion, to enable pre-symptomatic
diagnosis and preventive interventions on a previously unimaginable scale within the next
five years.
If this model were to succeed, and to be deployed widely, not only in the developed
but also in the less developed world, the logics of medicine, and the shape of the biopolitical
field, would be altered, and new contestations would emerge over access to such
technologies and the resources necessary to follow through their implications. Further, as
the forms of knowledge generated here are those of probability, new ways of calculating
risk, understanding the self and organizing health care would undoubtedly emerge. It is still
not known if this model will prove operable. If it does, while it is clear that the shape of the
biopolitical field would mutate, there is no technological determinism here: multiple
responses are possible. And if we remember, as we always should, that, even in the world’s
most prosperous nation, millions are still denied access to the basic health technologies and
medical interventions that have been established for half a century, the political and social
implications are evidently shaped more by the political side of the biopolitical than the medical
side. If success is partial and patchy, if hopes are deflated, if venture capital and stock
market investments move elsewhere, this still does not mean that nothing will emerge.
Rather it means simply that, as with so many previous medical advances, the mutations
that will take place in therapeutics will be smaller, more dispersed and their effects harder
to see in the short term, though perhaps evident from the perspective of the future.
In a related but distinct area of the field, Rose’s research in 2003 focused on the development
known as pharmacogenomics, and in particular on its engagement with mental disorders.
The research site here was the take-up, principally in Europe, of the new generation
of anti-depressant medication, in the context of a belief, underscored by the World Health
Organization and accepted by international health management agencies, that by 2020
depression will become the second largest cause of morbidity in both the developed and
less developed world, second only to ischaemic heart disease. There are clearly many factors
that have led to this belief, which cannot be addressed here in any detail. They include the
humanistic belief of doctors and others that much misery is the result of an under-diagnosed
clinical condition for which safe and effective drug treatments are now available, the concern
of national governments about the cost to their budgets of days lost through depression,
the significance of the key indicator of suicide rates in international health
comparisons, and the intensive marketing and ‘disease awareness’ campaigns of the pharmaceutical
companies.
What is the link between this and genomics? First, the new (third) generation of antidepressants
claim to be fabricated at a molecular level to target the precise neuronal
mechanisms that underlie depressive symptoms. Second, because there are over a dozen of
these drugs on the market, there are no clear symptomatic or other markers to enable doctors
to choose between them, and yet the different drugs are variable in their effects, some
having beneficial effects with some individuals, while having no therapeutic effects in others
and generating adverse effects in a third group. Third, some argue that genetic testing may
enable medics to choose the right drug at the right dose for the right individual, thus maximizing
both therapeutic benefit and compliance, minimizing adverse effects, increasing the
efficiency of the targeting of health care resources, and hence acting not just at the individual
level but also upon key financial and population health indicators. If successful, driven
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by the wish of all concerned, including patients, to have effective drugs that have minimal
side effects, genetic testing may migrate from the genetic counsellor’s office to the general
practitioner, and become as routine as blood tests, opening up the population as a whole
to a genetic understanding of their health, illness and predispositions. If only partially successful,
the routinization of genetic testing prior to treatment decisions may be slow, patchy
and limited, but the genetic rewriting of mental illness will nonetheless once more enter the
field of truth, not in the name of population purification and the elimination of degeneracy,
but in the name of quality of life, even happiness. In each case, the potential is there for a
reshaping of the biopolitics of mental health, not only rewriting its epistemology along
biological lines, but also reconfiguring the relations of knowledge, power and expertise
which govern it, perhaps engendering new strategies for minimizing mental disorder at
the individual and collective level, and reshaping the ways in which individuals themselves
think about, judge and act upon themselves in the name of mental health.
Conclusion
One might well imagine what it might have been like in 1800 for an analyst attempting to
grasp the transformative implications of the forerunners of the ‘birth of the clinic’. Today
we may well be in an analogous situation, where the drivers of change can be discerned,
some mutations can already be detected, some consequences predicted, but where the overall
directions remain obscure and their implications still in doubt. Thus it is no surprise that
it is hard to tell whether we are at the early stages of a momentous shift, in the middle of a
process that is well under way towards stabilizing new forms, or in a conjuncture that will
prove to be a dead end or at least marginal to other changes that we cannot envisage today.
But in attempting to make a diagnosis from ‘in the middle’, we think that the concept of
biopower focuses our attention on three key elements that are at stake in any transformation—knowledge
of vital life processes, power relations that take humans as living beings
as their object, and the modes of subjectification through which subjects work on themselves
qua living beings—as well as their multiple combinations.
In the new political economy of vitality, transnational flows of knowledge, cells, tissues
and intellectual property are coupled with local intensifications and regulated by supranational
institutions. Mobilizations of persons, tissues, organs, pathogens and therapeutics
operate at different speeds and encounter local obstacles and incitements. Individualizing
and collectivizing subjectifications are also mobile and transnational: cystic fibrosis groups
cut across national and class barriers as do their care givers; models of patient activism
spread, and are taken up and reinterpreted from Bangladesh to Toronto. Who, in 1955,
could have imagined depressed people as a global category, not only as targets but also as
active subjects in a new biopolitics of mental health? If we are in an emergent moment
of vital politics, celebration or denunciation are insufficient as analytical approaches.
The concept of biopower, used in a precise fashion, related to empirical investigations
and subject to inventive development, would surely take its place as a key part in an
analytical toolkit adequate to the diagnosis of what Gilles Deleuze has termed ‘the near
future’ (1989).
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