Home > biopoliitika, distsipliin, enesehool, meditsiin, Michel Foucault, subjekt, võim > Stuart J. Murray “Care and the self”

Stuart J. Murray “Care and the self”

Murray, Stuart J. 2007. Care and the self: biotechnology, reproduction, and the good life. – Philosophy, Ethics, and Humanities in Medicine 2:6. available: http://www.peh-med.com/content/2/1/6

To “examine” one’s life today is to submit to medical knowledge and techniques, to evaluations, and to normalizing judge-ments. It is to be governed by so-called experts, and to be understood in and through recent genomic and molecular vocabularies of biomedicine.

Medical discourse thus informs one manner in which the self or subject is constituted – and silently comes effec-tively to constitute itself as a subject. In this sense, medi-cine operates as a “technology of the self,” a nexus of social, political, and historical practices and beliefs that provide the very terms of the self and its self-understand-ing.

What Foucault famously called the “clinical gaze” is fast being sup-planted by the “molecular gaze” [4]; biopolitics – a poli-tics concerned with the life of the population – is being supplanted by “molecular politics” [5].

I argue that human identity is fast becoming a mat-ter of genomics, the identity of the self collapsed into its genetic identity.

[…] two sharply contrasting models of “care.” The first I call “self-care,” a model that has dominated public health policy in recent years. “Self-care” relies on a model of selfhood that is drawn from the tradition of lib-eral humanism: the Enlightened, knowing self, the self that is conceived as the source of its own agency, autono-mous, free, and guided by conceptual reason. This is the self that medical ethics typically presumes as founda-tional: rational, autonomous, and freely able to consent. […] In contradistinction, I shall pro-pose a second model of care that I borrow from Foucault’s ethics – “care of the self.” I hope to show how the Foucaultian “care of the self” is incommensurate with the care that we find in the “self-care” paradigm.

[…] while for the Greeks, the question was how to live and live well, for Rome – and for us – life is no longer the “ethical substance” or the fundamental question, but selfhood is that substance.

Today, medicine has become part of the  problem  of the self, and this becomes even more obvious in our genomic era of medi-cine: who or what am I if I am first and foremost a genetic self; what ethico-political responsibilities do I have to myself, to others, and to my offspring within this para-digm; and what subjective agency is left to me if the sov-ereignty of the Kantian “I” is displaced from a rational, autonomous self onto a sovereign genetic code that has the first and last word on who I am, what I am, and on who and what I shall become? These are the new problems of the self in a genocentric age.

Responsibility is conceived in economic or entrepreneurial terms [5,15,19]: I, as a patient, am treated foremost as a client who employs expert-providers in my own health care initiatives, to improve my health, to work on my self as if I were not the subject of my own well-being but an object in need of repair or enhancement. Here, the self-self relation is explicitly technologized, instrumentalized. The self relates to itself as through a knowledge economy – I am respon-sible to “know” my self biomedically, to take decisions and perform “best practice” actions in the project of my own well-being […]

This emphasis on the autonomous individual effec-tively privatizes and depoliticizes what are properly social and political effects, embodied historical effects whose operational power is summarily masked and disavowed by liberalism.

I prefer to imagine the “care of the self” as a self-self relation that is inventive and open, as a self that questions the norms and constraints in and by which that self is said to be a self in the first place.

So to repeat, the spiritual relation the self has to itself will inform epistemological truths and falsities, not the other way around – epistemology is not the founda-tion of the self, as it has been since Descartes. This turns modern Western philosophy and politics upside down.

So we can see that care is a relation that is directed both within and without. It is an ethical relation because it has everything to do with one’s ethos, with the way one lives one’s life and conducts oneself with respect to oneself, to others, and to the world in general. It is about the good life, not the good self.

The self relates to itself non-foundationally, non-substantially, and in this respect, we might be justified to invoke Socra-tes when he speaks of the “soul.” The soul or “psyche” is dynamic and without substance; it is neither body nor mind, as these terms are traditionally understood; it is nei-ther cognitive nor conceptual. Instead, we might call it a rhetorical device for plotting the relation between the self and itself, which includes the relation between the self and the other whose love and wisdom helps to bring that self into a caring proximity with itself.

[…] I fear that increased choice in, say, the genetic marketplace may prove detrimental to truly progressive social and political projects. Ultimately, a proliferation of choices in the genetic marketplace will not unequivocally result in greater social and political diversity, but may instead result in more stringent norms, less diversity, and greater intolerance of all forms of difference, genetic and otherwise.

But by the “care of the self,” Foucault helps us to depart from this normativity. For him, care is a way of being-in-the-world, an attitude, a chiasmatic rela-tion that constitutes the individual and the institution as two separate poles whose positions rely on dynamic power relations and norms that ought to be critiqued. Sev-enhuijsen and Tronto erroneously start by presuming the givenness of individual selves and institutions responsible for our care; this is the model of “self-care” as I have defined it. In contradistinction, Foucault does not pre-sume such a givenness.

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