Foucault, Health and Medicine

The reception of Michel Foucault's work in the social sciences and

humanities has been phenomenal. Foucault's concepts and methodol-
ogy have encouraged new approaches to old problems and have opened
up new lines of enquiry. The study of health and medicine is no
exception and his influence is so profound here that few topics in the
field are discussed without some reliance on his work. Foucault, Health
and Medicine assesses the contribution of Foucault's work in this area.
The foreword offers some reflections on Foucault's contribution to
medical sociology as a whole. Part I problematises Foucault's work,
examining the different 'readings' to which it lends itself. Part II deals
with his concept of 'discourse' and explores some of its applications:
the study of personality disorder and the problem of the 'dangerous
individual', the study of the problem of child mental health, and the
critique of the 'medicalisation' thesis. Part III turns to the analysis of
the body and the self, major themes in Foucault's work. The
implications of Foucault's concepts for feminist research on embodi-
ment and gendered subjectivities are explored, and the notion of 'bio-
power' is considered in the context of health education. Finally, Part IV
explores the application of Foucault's concept of governmentality to the
analysis of health policy, health promotion and the consumption of
health. Common themes in these chapters include the emergence of risk
culture, the concept of the enterprising self and the role of expertise in
liberal technologies of government.

Alan Petersen is Senior Lecturer in Sociology at Murdoch University,

Western Australia. Robin Bunton is Senior Lecturer in Social Policy at
the University of Teesside, Middlesbrough.
This page intentionally left blank
Foucault, Health and
Medicine

Edited by Alan Petersen and

Robin Bunton
Foreword by Bryan S. Turner

London and New York

First published 1997
by Routledge
2 P a r k S q u a re , M i lt o n P ark , A b in g d o n , O x o n , 0 X 1 4 4 R N

Simultaneously published in the USA and Canada

by Routledge
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Reprinted 1998

T r a n s f e r r e d to D ig ita l P rin tin g 2 0 0 6

© 1997 Alan Petersen and Robin Bunton, selection and

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All rights reserved. N o part of this book may be reprinted

or reproduced or utilised in any form or by any electronic,
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P u b lish er’s N o te
T h e p u b li s h e r h a s g o n e to g re a t le n g th s to e n s u r e
th e q u a lity o f this re p r in t bu t p o in ts o u t th a t so m e
im p e r f e c tio n s in the o rig in a l m a y be a p p a r e n t
Contents

List of contributors vii

Foreword: From govemmentality to risk, some reflections on
Foucault's contribution to medical sociology ix
Bryan S. Turner
Acknowledgements XX111

Introduction: Foucault's medicine 1

Robin Bunton and Alan Petersen

Part I Fabricating Foucault

1 Foucault and the sociology of health and illness: a prismatic
reading 15
David Armstrong
2 Is there life after Foucault? Texts, frames and differends 31
NickJ Fox

Part II Discourses of health and medicine

3 Mental health, criminality and the human sciences 53

David McCallum
4 At risk of maladjustment: the problem of child mental health 74
Deborah Tyler
5 Foucault and the medicalisation critique 94
Deborah Lupton
vi Contents

Part III The body, the self

6 Is health education good for you? Re-thinking health
education through the concept of bio-power 113
Denise Gastaldo
7 Bodies at risk: sex, surveillance and hormone replacement
therapy 134
Jennifer Harding
8 Foucault, embodiment and gendered subjectivities: the case
of voluntary self-starvation 151
Liz Eckermann

Part IV Governmentality
9 Of health and statecraft 173
Thomas Osborne
10 Risk, governance and the new public health 189
Alan Petersen
11 Governing the risky self: how to become healthy, wealthy
and wise 207
Sarah Nettleton
12 Popular health, advanced liberalism and Good Housekeeping
magazIne 223
Robin Bunton
Index 249
Contributors

David Armstrong is Reader in Sociology as Applied to Medicine,

Department of General Practice, at the United Medical and Dental
Schools of Guy's and St Thomas's Hospitals (UMDS).
Robin Bunton is Principal Lecturer in Social Policy in the School of
Human Studies at the University of Teesside and works as a member of
the Centre for the Study of Adult Life (C-SAL) at the University.
Liz Eckermann is Senior Lecturer in Sociology of Health and Illness,
and Director of the Centre for the Body and Society, at Deakin University,
Geelong, Victoria, Australia. Recent publications include 'Self-starvation
and binge-purging: embodied selfboodlsainthood', Australian Cultural
History (Special Issue on Bodies), 13, 1994, pp. 82-99, and 'Beyond
Giddens: differentiating bodies', Annual Review ofHealth Social Sciences
(Special Issue on Embodiment), 4, 1994, pp. 92-103.
Nick J. Fox is Senior Lecturer in Sociology at the University of
Sheffield. He is author of The Social Meaning of Surgery (Open
University Press, 1992) and Postmodernism, Sociology and Health
(Open University Press and University of Minnesota Press, 1993).
Denise Gastaldo is a postdoctoral fellow at the Faculte des Sciences
Infirmieres, Universite de Montreal, Canada. She is editor of the book
Paulo Freire at the Institute (Institute of Education, University of
London, 1995).
Jennifer Harding is Senior Lecturer in Communications at London
Guildhall University. Her main areas of research interest/activity and
publication are/have been: theories of the body, feminist theory and
critiques of medicine, sexuality, cultural history and ethnography. Her
recent publications examine 'the sexed body' and 'the honnonal body'.
viii Contributors

Deborah Lupton is Associate Professor in Cultural Studies and

Cultural Policy at Charles Sturt University, Bathurst, Australia. Her
latest publications include The Imperative ofHealth: Public Health and
the Regulated Body (Sage, 1995) and Food, the Body and the Self
(Sage, 1996).
David McCallum teaches Sociology and Social Policy at Victoria
University of Technology, Melbourne, Australia. His publications include
The Social Production of Merit (Falmer Press, 1990). He is currently
writing another book on personality disorder and dangerousness.
Sarah Nettleton is Lecturer in Social Policy in the Department of
Social Policy and Social Work at the University of York. She is the
author of The Sociology ofHealth and Illness (Polity Press, 1995) and
Power, Pain and Dentistry (Open University Press, 1992) and a co-
editor of The Sociology of Health Promotion: Critical Analyses of
Consumption, Lifestyle and Risk (Routledge, 1995).
Thomas Osborne is a Lecturer in Sociology at the University of
Bristol.
Alan Petersen is Senior Lecturer in Sociology at Murdoch University,
Western Australia.
Bryan S. Turner is a Professor in Sociology, Dean of Arts and founder
of the Centre for the Body and Society at Deakin University, Geelong,
Victoria, Australia. His current research interests are in two areas: the
sociology of ageing and generations, and the sociology of citizenship
(with special reference to voluntary associations, the welfare state and
globalisation). He is the editor of The Blackwell Companion to Social
Theory (1996). With Mike Featherstone, he is the founding editor of the
journal Body and Society.
Deborah Tyler teaches Sociology and Social Policy at the Footscray
campus of Victoria University of Technology, Footscray, Victoria,
Australia. She is the co-editor, with Denise Meredyth, of Child and
Citizen: Genealogies of Schooling and Subjectivity (Institute for
Cultural Policy Studies, Griffith University, 1993).
Foreword

From governmentality to risk

Some reflections on Foucault's
contribution to medical sociology
Bryan S. Turner

INTRODUCTION
During much of the post-war period, medical sociology lacked any
significant theoretical direction or focus; it was an applied area of
sociology, the aim of which was to assist general and community
medicine in achieving greater patient compliance. This introductory
observation on the recent history of medical sociology should, however,
be qualified by noting two important and interrelated intellectual
developments. The first is the general impact of Michel Foucault's
analysis of power/knowledge which has come to influence a range of
research topics and perspectives in the study of mental health and
sickness since the publication in English of Madness and Civilization
(Foucault 1965). The second crucial development, which is closely
related to an interest in Foucault's social philosophy, is the tentative
emergence of the sociology of the body as an analytical underpinning
for medical sociology.
These two developments - the impact of Foucault on social science
generally and the rise of the sociology of the body - pushed the
discipline away from medical sociology towards the sociology of health
and illness, that is towards a critical epistemology of disease categories
as elements of the moral control of individuals and populations. This
movement was based on an implicit slogan, namely that the body is
historical. In this Foreword I want to comment on these contemporary
developments in sociology as a framework for evaluating Foucault and
as a perspective for the continuing growth of sociology. In particular,
this Foreword attempts a comparison between Foucault's analysis of
powerlknowledge/discipline (namely 'governmentality') and Ulrich
Beck's notion of 'risk society' (1992). These two frameworks are
analysed as paradigms for understanding the new epidemiology of
x Bryan S. Turner

disease in late modem or postmodem society, but the philosophical

choice between these two paradigms also indicates real tensions in
contemporary society between the deregulation of the macro-global
level (so-called 'risk society') and the micro-local requirement for a
continuing micro-politics of surveillance and control (so-called
'carceral society').

SITUATING FOUCAULT: THE THEORY OF POWER

Foucault's academic reception within the English-speaking world was
initially based upon his work on the history of psychiatry and the
problem of madness in Western civilisation. Because Foucault was
clearly associated politically with the interests of minority groups such
as the mentally ill, prisoners and homosexuals, his contribution to
sociology was seen in over-simple terms as a contribution to the study
of social control. Foucault's critical work of psychiatry appeared in the
context of the anti-psychiatry movement. Shortly after the English
publication of Madness and Civilization, Thomas Szasz (1971)
published The Manufacture ofMadness. R.D. Laing's important Sanity,
Madness and the Family had been published in 1964. In sociology
(especially in North America) the dominant paradigm of deviance and
mental illness was labelling theory which depended heavily on the work
ofH. Becker in Outsiders (1963). The intellectual and political context
within which Foucault's work was launched guaranteed that his original
philosophical and historical studies 'Yere interpreted as a contribution to
social control theory, within which the mentally ill were a socially
deviant group who challenged the basic norms and values of society,
and who, as a consequence of being labelled deviant, were forced into
careers of secondary deviance. In this context, Foucault's studies of
normalisation through medical discourse had some relationship to
Talcott Parsons's concept of 'the sick role' which interpreted sickness
as the legitimisation of social deviance in which not being at work
meant being deviant. The sick role normalised this absence from work
and other functionally important roles (Holton and Turner 1986).
This interpretation of Foucault was reinforced by the appearance in
English translations of The Birth of the Clinic (1973) and Discipline
and Punish (1977). The complexity of Foucault's interest in
'technologies of the self' (Martin et al. 1988) only became apparent
with the publication of the six-volume study of sexuality in the 1980s.
Indeed the subtle interrelationships between Foucault's notion of the
self and discipline were not adequately recognised until the importance
 From govemmentality to risk xi

of his treatment of 'governmentality' (Foucault 1991) was embraced

within the secondary literature. Foucault was of course interested in the
issue of social control, but this interest has to be situated within his
theory of power, where governmentality can be seen as the bridge
between the early historical interest in regimes of discipline and the
later work on the production of the self, which began with his
investigations into the ancient world and early Christianity. This
intellectual interpretation is now fully supported by the biographical
studies of Foucault's life and work by Didier Eribon (1992) and David
Macey (1993). In retrospect, the single most important thread or theme
in Foucault's diverse and complex work is the study of power (Simons
1995).
It is now clear that Foucault made three major contributions to
contemporary social science, namely an analysis of power/knowledge, a
contribution to the understanding of the emergence of the modern self
through disciplinary technologies, and an analysis of govemmentality,
which integrated these dimensions into a single theory of power. Partly
for the sake of economy of presentation and interpretation, I shall leave
to one side Foucault's work on the philosophy of social science and
methodology (Foucault 1970), recognising that in a more elaborate
presentation of his work it would in fact be difficult to separate these
dimensions of his research.
Foucault's analysis of power has been particularly useful in
understanding the functions of the medical profession and the related
spheres of psychiatry. Foucault has been important in locating, for
example, the historical functions of the clinic as a site of bio-power
(Foucault 1973). Foucault's theory of power can be seen as a critical
reaction against both French Marxism and the existentialism of Sartre.
Recent biographies (Eribon 1992) of Foucault have shown that his
preoccupation with his own sexuality, his critique of Marxism and his
involvement in the politics of the French academy did much to shape
his theory of power. Foucault attempted to challenge the Marxist
conceptualisation of power as a macro-structure such as the state which
functioned to support industrial capitalism and which was displayed
through major public institutions such as the police, the law and the
church. Such a view of power was central to the work of Louis
Althusser who was the dominant Marxist theoretician of the state and
the ideological state apparatus in the 1960s.
By contrast, Foucault saw power as a relationship which was
localised, dispersed, diffused and typically disguised through the social
system, operating at a micro, local and covert level through sets of
xii Bryan S. Turner

specific practices. Power is embodied in the day-to-day practices of the

medical profession within the clinic, through the activities of social
workers, through the mundane decision-making of legal officers, and
through the religious practices of the church as they operate through
such rituals as the confessional. This approach to politics had a
particular message for radical Marxism, namely that the attempt to
seize the state through political action would not destroy power,
because power is rather like a colour dye diffused through the entire
social structure and is embedded in daily practices. This view of power
is very closely associated with Foucault's fascination with discipline,
namely that power exists through the disciplinary practices which
produce particular individuals, institutions and cultural arrangements.
The disciplinary management of society results in a carceral society,
that is a form of society in which the principles of Bentham's
Panopticon are institutionalised through everyday routines and
mundane arrangements.
Foucault's originality as a theorist and historian was to see how the
ethical systems of ancient civilisations and early Christianity produced
the self through practices of self-subjection. These ethical systems
involved the identification of an ethical substance (such as desire)
which is to be shaped through moral activity. Second, it requires
subjection in which moral obligation is recognised (to subject oneself to
God, for example). This subjection leads to the objectification of moral
obligations into codes or discourses of ethics, such as the discourses of
sexuality which Foucault studied under the notions of the 'care of the
self' (Foucault 1986) and the 'use of pleasure' (Foucault 1985). These
discourses of subjectivity then produce identities or roles such as the
hysterical woman or the masturbatory child, and it is these identities
which then become the object and focus of medicalisation and
normalisation. In the modem period, the medicalisation of the
menopausal woman in North America and the export of those
discourses and identities to other societies such as Japan are clear
illustrations of these processes (Lock 1993). These practices of
subjection and self-formation also involve the emergence of complex
pedagogies of self-transformation and education. The medieval
confessional has now been elaborated and refined by modern forms
of 'talking therapy' in psychoanalysis and, at another level of society,
manuals of self-help (Giddens 1992). Finally, subjection requires the
production of a moral order and an ethical ethos which becomes the
organising principle of practices of the self; a moral code evolves by
which moral identities are shaped and guided. In contemporary society,
 From governmentality to risk xiii

these goals typically include not only the ideology of self-fulfilment

through self-knowledge, but a range of preventive health policies and
measures which can be seen as an extension of these self-regulatory
activities.
These ideas about power were further elaborated through Foucault's
interest in 'governmentality', a system of power which articulated the
triangular relationship between sovereignty, discipline and government.
Governmentality (Foucault 1991), which emerged in the eighteenth
century, is a mechanism for regulating and controlling populations
through an apparatus of security. This governmental apparatus required
a whole series of specific savoirs and was the foundation for the rise of
the administrative state (Gutting 1989). A further important feature of
Foucault's work was the analysis of the relationship between power and
knowledge. Whereas liberal theory tended to separate power and
knowledge on the grounds that truth is always corrupted by the exercise
of power, Foucault saw that power and knowledge were always
inevitably and inextricably interconnected so that any extension of
power involved an increase in knowledge and every elaboration of
knowledge involved an increase in power. Foucault approached this
question typically through a consideration of populations and bodies.
For example, the growth of penology and criminology was closely
associated with the development of panoptic principles of surveillance
and control. In a similar fashion the whole development of psychology
and psychiatry was seen in tenns of fonns of knowledge, related to an
extension of power over the subordinate populations of urban Europe.
Foucault normally spoke about knowledge in the plural (savoirs) in
order to illustrate the notion that specific fonns of power required
highly specific and detailed formations of knowledge.
This conceptual apparatus, which Foucault built up around the study
of the history of ideas, the analysis of power and the explication of
forms of discipline, proved enormously useful and important for
medical sociologists in their attempt to understand the fonns of power
assumed by medical practices. Foucault's work permitted sociologists
to think about the medicalisation of society within a new framework,
where the exercise of medical power was seen in terms of local diffuse
practices. The influence of Foucault is particularly significant in such
publications as Political Anatomy of the Body (Annstrong 1983)
Medical Power and Social Knowledge (Turner 1995), and The
Imperative of Health (Lupton 1995). The medical sociology which
was inspired by Foucault is typically understood to have made a
distinctive break with the past. It was heavily infonned by theoretical
xiv Bryan S. Turner

and philosophical analysis; it was highly critical of established

medicine, seeking to provide alternative ways of examining mental
illness and disease; it placed power and knowledge at the centre of the
sociological understanding of medical institutions; and it showed how
medical ideas of the moral character of disease operated at an everyday
level.
As Foucault's work evolved and as more of Foucault's studies were
translated into English, such as The Use of Pleasure (Foucault 1985)
and The Care of the Self (Foucault 1986), it also became clear that for
Foucault the study of medicine was part of a larger programme which
examined the evolution of sexuality in European societies from
classical Greece and how that evolution was intimately bound up with
the transformation of medicine. In his final publications Foucault
appeared to turn more and more to an analysis of the self in the context
of medical history and the development of sexuality. His interest in how
the self in Western societies was an effect of discourse of the self
became increasingly obvious in his studies of 'technologies of the self'
(Martin et al. 1988). Medical sociology and the sociology of health and
illness were now seen to be both far broader in their terms of reference
and also more central to the mainstream concerns of sociology as a
whole.
Foucault provided a description of what one might call 'the
institutions of normative coercion', such as the law, religion and
medicine (Turner 1992). These institutions are coercive in the sense that
they discipline individuals and exercise forms of surveillance over
everyday life in such a way that actions are both produced and
constrained by them. However, such institutions as the medical clinic
are not coercive in the violent or authoritarian sense because they are
readily accepted as legitimate and normative at the everyday level.
These institutions of normative coercion exercise a moral authority over
the individual by explaining individual 'problems' and providing
solutions for them. In this sense we could say that medicine and religion
exercise a hegemonic authority because their coercive character is often
disguised and masked by their normative involvement in the troubles
and problems of individuals. They are coercive, normative and also
voluntary.

FOUCAULT AND THE SOCIOLOGY pF THE BODY

Although there was significant change in the intellectual evolution of
Foucault's social philosophy, it is also clear that the body and
 From governmentality to risk xv

populations played a continuous role in the analytic structure of his

work. The body was the focus of military discipline, but it was also
subject to the monastic regulation of medieval Catholicism. The body is
the target of the medical gaze and govemmentality. Generally speaking,
health is a form of policing which is specifically concerned with the
quality of the labour force. This view was clearly expressed by Foucault
(1980a) in an article on 'The politics of health in the eighteenth
century', where he suggested that the transformation of population:
arguably concerns the economic-political effects of the accumula-
tion of men. The great eighteenth-century demographic upswing in
Western Europe, the necessity for co-ordinating and integrating it
into the apparatus of production and the urgency of controlling it
with finer and more adequate power mechanisms caused 'popula-
tion', with its numerical variables of space and chronology,
longevity and health, to emerge not only as a problem but as an
object of surveillance, analysis, intervention, modification, etc.
(Foucault 1980a: 171)
The nexus of knowledge/power was thus initially an effect of
demographic changes, particularly the pressure of populations on
systems of government and regulation from the eighteenth century. I
have taken this demographic transformation to be, in fact, the major
societal context for the emergence of modem forms of management,
discipline and government (Turner 1987, 1992). It is the principal
context for governmentality, as a regime which links self-subjection
with societal regulation.
The body was clearly of major significance in Discipline and Punish
but it also continued to playa crucial role in the larger project of The
History of Sexuality, where Foucault was concerned with the body in
relation to medicine and the body in relation to the development of the
self within a Christian paradigm. Briefly, Foucault was interested in the
production of bodies, the regulation of bodies and the representation of
bodies within a context of disciplinary surveillance (Turner 1984). The
integration of legal and medical controls over the body and identity was
a theme in the study of hermaphrodites in Herculine Barbin (Foucault
1980b). Foucault's work on the production of sexual identity played a
major part subsequently in the historical analysis of gender and
sexuality (Laqueur 1990) and in the relationship between women and
medicine (Martin 1987). In subsequent years the sociology of the body
emerged as a major theme in medical sociology because it provided a
powerful perspective on the socially constructed nature of disease
xvi Bryan S. Turner

categories and the role of medicine in regulating individuals through

regulating their bodies, and contributed also to new perspectives on the
question of sexuality and medicine. Having been neglected as a
theoretical topic for many decades the question of the human body has
recently become a critical issue in the social sciences. There have been
a number of major publications in this area resulting eventually in a
new sub-field of sociology (Featherstone et al. 1991; Leder 1990;
O'Neill 1989; Shilling 1993; Synnott 1993).
The causes and nature of this interest in the cultural aspects of the
human body are both divergent and complex. However this new interest
in the body is clearly related to the growing problems of human identity
brought about by legal and social changes which in tum are a
consequence of technical transformations in medicine, specifically in
the area of huinan reproduction. There is also widespread public
anxiety about the nature of contemporary epidemics such as HIV and
AIDS which have drawn attention to the complexities of sexuality in
modem society. These medical changes are also related to various
social movements in modem society which seek to change social
attitudes towards the body, particularly the gay and feminist move-
ments. These anxieties about the body are also part of a broader
concern about the demographic revolution of the last century, the
process of ageing and the ecological deterioration of the environment.
Within the context of capitalism, the body has also emerged as a
significant feature in consumption advertising and consumer culture
(Falk 1994). Cultural postmodernisation has also underlined the idea
that the human body is simply a fabric or social product which has no
ontological fixity. These postmodem questions about the body have
brought a number of writers to speculate about the interaction between
information systems, computer technology and the body.
Through these studies of the self, discipline and the body, medical
sociology evolved more fully and effectively into the sociology of
health and illness. At the same time, it became part of the mainstream
interest of sociology, because the sociological study of health was
perceived more openly as a sophisticated contribution to the study of
power, where micro-practices of power were interpreted from
Foucault's perspective of governmentality. These changes in the
intellectual climate of the social sciences were direct consequences of
the adoption of Foucault's perspective on bio-politics.
 From governmentality to risk xvii

RISK SOCIETY AND CONTEMPORARY POLITICS:

EVALUATING FOUCAULT
I have argued that to see Foucault's work as a contribution to the
sociology of social control and deviance is, if not mistaken, at least a
distorting over-simplification. Nevertheless, Foucault's focus on
discipline, power and governmentality does have an intellectual
proximity to Max Weber's study of instrumental rationality and
bureaucracy, and to Theodor Adorno's contributions to the notion of an
administered society. It also suggests a parallel to Erving Goffman's
notion of the total institution. The carceral society indicates a regime of
micro-regulations and disciplines which operate through a complex
web of self-sUbjection. In short, we can see Foucault as part of a
sociological tradition which emphasises the importance of regulation
and administration as key features of 'modern society'. Like Weber,
Foucault provided a profound insight into the bureaucratic mentality of
a society dominated by the logic of instrumental rationality. How
relevant then is Foucault to a social environment which is seen to be
postmodem, deregulated and risky?
Throughout the 1980s there were major changes in the structure of
the economy and government, which in retrospect we can see as part of
the Thatcherite revolution in the marketisation of social relations,
including the marketisation of the provision of social services.
Managerialism, privatisation and deregulation were dimensions of a
profound globalisation of the world economy the effects of which were
particularly visible in the areas of the service industries, tourism,
consumerism and labour markets. We can see the current enthusiasm
for the concept of 'risk society' as a response to this general sense that
the modem world has become more uncertain, contingent, flexible and
risky. It appears to be in structure and ethos very far removed from the
carceral society with its dependable and recognisable processes and
procedures.
In the health field these changes have been profound. The traditions
of centralised mechanisms for the provision of social security and
welfare have been replaced by a logic of internal markets, competitive
tendering and devolved budgets. The very notion of 'security' sits oddly
with the contemporary enthusiasm for a discourse of entrepreneurish,
just-in-time management systems and 'the culture of risk. These
changes in bureaucratic structures have occurred alongside major
epidemiological changes which in a sinister fashion appear to mimic
the contingency of the market place; namely the spread of AIDs and
xviii Bryan S. Turner

other infectious diseases, the deterioration of the food supply, the

danger of inter-species disease such as 'mad cow disease' and the
associated risks of Creuzfeldt Jacob's disease. These changes are not
easily encapsulated within Foucault's language of discipline and
control. It is true that Foucault was aware of changes in the provision
of welfare (Foucault 1988) and it is also the case that his notion of
govemmentality can be extended to analyse some aspects of a risk
environment. However, there is a profound tension between the
metaphors which lie behind risk society and governmentality (Turner
1995: 218-27).
How might we, at least in theoretical terms, resolve some of these
tensions? There are a number of possibilities (Turner 1994: 167-82). To
some extent we might argue that financial deregulation in the 1980s
produced a global environment of political and economic uncertainty
between nation states but within each industrial society the need for
micro-surveillance and discipline continued with greater intensity;
indeed the importance of a carceral society has increased with the
growth of extemalised macro-risk. As the global economy develops
into a culture of risk, the nation state is forced to invest more and more
in internal systems of governmentality. Second, a risk society, based on
deregulation and devolution, often requires more subtle and systematic
forms of control. For example, the state is forced to create regulatory
systems of quality control where public utilities have been privatised.
Third, financial deregulation increases the scale of economic risk.
Where major companies and public institutions fall into debt and
bankruptcy, governments typically intervene, despite their ideological
commitment to privatisation and deregulation, to save such institutions.
Fourth, we can in fact argue that modern societies are structured by two
apparently contradictory processes: the growth of risk cultures and the
McDonaldisation of society (Ritzer 1993). McDonaldisation is the
application of Fordist production methods and rational managerialism
to the fast-food industry which is then extended to all sectors of society.
McDonaldisation reduces uncertainty and unpredictability; it is, in
short, a response to risk and uncertainty. McDonaldisation removes
surprises from everyday life by an extension of instrumental rationality
to production, distribution and consumption. After the McDonaldisa-
tion of the fast-food industry, these principles have also been applied to
universities and medicine. McDentists and McDoctors extend the
principles of cheapness, standardisation and reliability to the health
industry. The welfare and health system is now a complex mixture of
risk culture and McDonaldisation of services. Finally, the notion of
 From governmentality to risk xix

generalised risk in the environment may lead to greater surveillance and

control through the promotion of preventive medicine (Lupton 1995).
The AIDs 'epidemic' creates a political climate within which
intervention and control are seen to be both necessary and benign.
Individuals need, especially in the area of sexual etiquette, to become
self-regulating and self-fonning.
If Foucault's theories of sexuality and govemmentality are to
continue to inspire and to shape the future development of the
sociology of health and illness, followers of Foucault will be compelled
to address the new environment of risk cultures, political contingencies
and deregulated welfare systems. The burden of dependency, with the
ageing of Western societies, is being answered increasingly with the
privatisation of medicine and a doctrine of obligation. The traditional
notions of citizen rights (to health and social welfare) are being
questioned by a liberal ideology of individual obligation (to save and to
create personal bases of security). The problem of mental health in
society is being resolved, not with greater surveillance, but with de-
institutionalisation. In America, the number of residents in state mental
hospitals fell from 513,000 in 1950 to 111,000 in 1986 as a
consequence of a policy of de-institutionalisation. The economic cost
of state intervention in health care has in most advanced societies
resulted in new policies of privatisation, 'out-sourcing', 'down-sizing',
internal markets, managerialism and de-institutionalisation. Such
economic and social processes are not easily described or explained
within Foucault's paradigm of the disciplinary society, panopticism and
governmentality. The intellectual challenge is to comprehend the
structures and institutions of postmodern society within the conceptual
apparatus of Foucault's understanding of governmentality.

REFERENCES
Armstrong, D. (1983) Political Anatomy of the Body. Medical Knowledge in
Britain in the Twentieth Century, Cambridge: Cambridge University Press.
Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage.
Becker, H.S. (1963) Outsiders. Studies in the Sociology ofDeviance, New York:
Free Press.
Eribon, D. (1992) Michel Foucault, London: Faber and Faber.
Falk, ~ (1994) The Consuming Body, London: Sage.
Featherstone, M., Hepworth, M. and Turner, B.S. (eds) (1991) The Body. Social
Process and Cultural Theory, London: Sage.
Foucault, M. (1965) Madness and Civilization. The History of Insanity in the
Age of Reason, New York: Random House.
xx Bryan S. Turner

Foucault, M. (1970) The Order of Things, London: Tavistock.

Foucault, M. (1973) The Birth of the Clinic. An Archaeology of Medical
Perception, London: Tavistock.
Foucault, M. (1977) Discipline and Punish. The Birth of the Prison, London:
Allen Lane.
Foucault, M. (1980a) 'The politics of health in the eighteenth century', in C.
Gordon (ed.) Power/Knowledge. Selected Interviews and Other Writings,
1972-1977, Brighton: The Harvester Press, pp. 166-82.
Foucault, M. (1980b) Herculine Barbin. Being the Recently Discovered
Memoirs of a Nineteenth-Century French Hermaphrodite, Brighton: The
Harvester Press.
Foucault, M. (1985) The History of Sexuality, Volume 2: The Use ofPleasure,
New York: Random House.
Foucault, M. (1986) The History of Sexuality, Volume 3: The Care of the Self,
New York: Random House.
Foucault, M. (1988) 'Social security', in L.D. Kritzman (ed.) Michel Foucault.
Politics Philosophy Culture, Interviews and Other Writings, 1977-1984,
New York and London: Routledge, pp. 159-77.
Foucault, M. (1991) 'Governmentality', in G. Burchell, C. Gordon and P. Miller
(eds) The Foucault Effect, Brighton: Harvester Wheatsheaf, pp. 87-194.
Giddens, A. (1992) The Transformation of Intimacy. Sexuality, Love and
Eroticism in Modern Societies, Cambridge: Polity Press.
Gutting, G. (1989) Michel Foucault's Archaeology of Scientific Reason,
Cambridge: Cambridge University Press.
Holton, R.J. and Turner, B.S. (1986) Talcott Parsons on Economy and Society,
London and New York: Routledge and Kegan Paul.
Laing, R.D. (1964) Sanity, Madness and the Family, Volume 1: Families of
Schizophrenics, London: Tavistock.
Laqueur, T. (1990) Making Sex. Body and Gender from the Greeks to Freud,
Cambridge, Massachusetts: Harvard University Press.
Leder, D. (1990) The Absent Body, Chicago and London: Chicago University
Press.
Lock, M. (1993) Encounters with Aging. Mythologies of Menopause in Japan
and North America, Berkeley and Los Angeles: University of California
Press.
Lupton, D. (1995) The Imperative of Health. Public Health and the Regulated
Body, London: Sage.
Macey, D. (1993) The Lives of Michel Foucault, London: Hutchinson.
Martin, E. (1987) The Woman in the Body: A Cultural Analysis ofReproduction,
Milton Keynes: Open University Press.
Martin, L.H., Gutman, H. and Hutton, ~H. (eds) (1988) Technologies of the
Self. A Seminar with Michel Foucault, London: Tavistock.
O'Neill, 1. (1989) The Communicative Body. Studies in Communicative
Philosophy, Politics and Sociology, Evanston, Illinois: Northwestern
University Press.
Ritzer, G. (1993) The McDonaldization ofSociety, Thousand Oaks, California:
Pine Forge Press.
Shilling, C. (1993) The Body and Social Theory, London: Sage.
Simons, 1. (1995) Foucault and the Political, London: Routledge.
 From governmentality to risk xxi

Synnott, A. (1993) The Body Social. Symbolism, Self and Society, London and
New York: Routledge.
Szasz, T.S. (1971) The Manufacture of Madness. A Comparative Study of the
Inquisition and the Mental Health Movement, London: Routledge and Kegan
Paul.
Turner, B.S. (1984) The Body and Society. Explorations in Social Theory,
Oxford: Blackwell.
Turner, B.S. (1987) 'The rationalisation of the body. Reflections on modernity
and discipline', in S. Lash and S. Whimster (eds) Max Weber. Rationality and
Modernity, London: Allen and Unwin, pp. 222--41.
Turner, B.S. (1992) Regulating Bodies. Essays in Medical Sociology, London
and New York: Routledge.
Turner, B.S. (1994) Orientalism, Postmodernism and Globalism, London:
Routledge.
Turner, B.S. (1995) Medical Power and Social Knowledge, revised edition,
London: Sage.
This page intentionally left blank
Acknowledgements

The editors would like to thank all the contributors for agreeing to be
part of this project, and for their enthusiasm. They would also like to
thank Heather Gibson and Fiona Bailey from Routledge for their
support and editorial assistance. Alan Petersen is grateful to Murdoch
University, which granted him a period of study leave in 1995 and paid
for his travel to the UK which allowed him to make contact with a
number of the contributors, and to his colleagues in the Sociology
Program for providing intellectual stimulation. He would also like to
thank Ros Porter, who has accompanied him on his travels and
sustained his work in innumerable ways. Robin Bunton would like to
thank colleagues and friends in the School of Human Studies,
University of Teesside, especially Mike Featherstone, Barbara Cox
and Roy Boyne. Special thanks to Lesley Jones for supporting the
project and for reading through early parts of the text. Thanks also to
Sue Jackson.
This page intentionally left blank
Introduction

Foucault's medicine
Robin Bunton and Alan Petersen

The reception of Foucault's work in the social sciences and humanities

has been truly phenomenal. It is difficult to overestimate his influence
over the last decade or so. Few subject areas remain untouched by his
analyses of discourse, power and governance. A burgeoning 'Foucault
industry' has produced books and articles exploring the implications of
these concepts for social and political theory as whole, and for studies
of government, body regulation and sexuality and gender. The study of
health and medicine is no exception and his influence is so profound
here that we cannot think of a great many topics without some reliance
on his work. Foucault's approach has opened up new lines of enquiry,
crossed disciplinary boundaries and made links between areas that have
hitherto been treated as discrete, such as the merging of pathological
anatomy and health policy, and sexuality and bio-medical practice.
Foucault deserves our attention if no other reason than that health and
medicine were major themes in his enquiries and were used to illustrate
his broader theories about the relationship between power and
knowledge (see Foucault 1965, 1975, 1980, 1991). It would be wrong,
however, to see Foucault's contribution to the study of health and
medicine as limited to his own substantive enquiries. Foucault's legacy
is best assessed in the light of the influence of his work on subsequent
thinking and research. There has been a noticeable 'Foucault effect' in
the study of health and medicine as elsewhere (Burchell et ale 1991). In
planning this book, we sought to convey something of the breadth of
recent Foucauldian scholarship in the area of health and medicine,
while recognising that we could never do justice to the broad range of
work that is being undertaken.
Most of the authors of the following chapters are known for their
research in the sociology of health and medicine, though their interests
clearly extend beyond the discipline of sociology. This work illustrates
2 Robin Bunton and Alan Petersen

how researchers are currently engaging with Foucault's work and the
problematisations of health he developed. In turn, their work
problematises and critiques Foucault's work itself. There is a necessary
reflexivity in this exercise. Foucault, as Kate Soper (1995) observes,
makes those who problematise his thought acutely conscious of the
pieties they bring to it. We are well aware, since his death, of the
packaging of Foucault's thought and the dangers in providing too
limited a reading of it and that at times it is difficult to distinguish
between what Foucault wrote and what has been represented as his
ideas. We are also aware that with Foucault, as with Marx and
Nietzsche, the point is not simply to interpret his work but 'to use it'
(Rajchman 1995). This collection attempts to bring together some of
those who are currently using Foucault to study health and medicine.
They necessarily draw upon and give different readings of Foucault's
work but, with a similar exploratory line of enquiry, they attempt to
produce varying problematisations of contemporary health and
medicine. Foucault's work encourages new approaches to old problems
and, as David McCallum (in chapter 3) so eloquently puts it, 'rather
than providing "schemas" and closures, the implied intellectual
invitation is to take up his methods of enquiry as a way of charting
new territories and formulating questions in different sorts of ways' .
These papers focus upon some familiar health topics such as
madness, child---nealth, health policy and health education, though the
approach taken is distinct from that of, say, the sociology of health and
illness. The collection also addresses newer sites of health care,
including eating disorders, hormone replacement, risk management,
self-care and consumption. These areas are representative of a changing
world of health. As Bryan Turner notes above, if Foucault's theories are
to continue to inspire, then analysts will be compelled to address new
environments of risk cultures, political contingencies and deregulated
health and welfare systems. These papers illustrate how Foucauldian
studies of health and medicine are exploring recent changes in health
and health care. Some familiar Foucauldian topics emerge throughout
the chapters, in particular the discourses of health and disease, the body
and the self, and governmentality. These topics broadly correspond to
some of the changing focuses of Foucault's work throughout his life
(McHoul and Grace 1993). We use them here for heuristic purposes
where they serve to roughly divide up the contributions into three of the
four parts of this volume. For the moment, these categories are pivotal
in Foucauldian studies of health. They are far from being definitive and
we would expect them, in tum, to be re-problematised.
 Foucault's medicine 3

In Part I, concerned with the problematisation of Foucault's work

itself, David Annstrong's and Nick Fox's chapters implicitly question
this scheme. By drawing attention to the range of topics and the
different readings (or 'differends ') of Foucault, both authors remind us
of our continuing fabrication of Foucauldian method. These critical
pieces serve to introduce the collection as a whole, as a set of
treatments of Foucault and health and medicine. In chapter 1, David
Armstrong alerts us to Foucault's problematisation of the author and
identifies some of the 'Foucaults' that have been evident in the
sociology of health and illness. Armstrong's chapter outlines the
influence of four of Foucault's books which have had, and continue to
have, an effect: Madness and Civilization, Birth of the Clinic,
Discipline and Punish and The History of Sexuality, Volume 1. By
reading the different readings of Foucault, Annstrong usefully charts
Foucault's influence on writers and areas of study. In chapter 2, Nick
Fox argues that Foucault's ontology is ambiguous and contradictory and
proposes alternative sources for exploring, theorising and researching
discourse, the body and the self. He suggests that the use of texts and
framing derived from the writing of Barthes, Derrida and Lyotard offers
useful points of departure. Lyotard's notion of the differend is used to
illustrate how we may more sucessfully account for intertextuality and
the play of difference and resistance. Both the above chapters are useful
starting points, reminding us of the ways in which this volume engages
with Foucault's incomplete ontology.
Part II deals with one of the significant legacies of Foucault's work -
the concept of discourse - which was employed extensively in his
analysis of the subject. For Foucault, the subject is constituted through
discourse rather than having a prediscursive existence. As he himself
indicated towards the end of his life, his objective in his work had been
to 'create a history of the different modes by which, in our culture,
human beings are made subjects' (1982: 208). In his later writings on
the history of sexuality he began to focus on those practices through
which human beings turned themselves into subjects (Foucault 1985,
1986). Foucault's corpus concentrated on the modem period and he
sought to challenge the modernist assumption of historical progression,
continuity and unilinear development - a narrative which serves to
confirm rather than challenge the beliefs and practices of the present.
His method of genealogy or 'history of the present' directs attention to
discontinuities and ruptures in thought and involves recognition of
multiple detenninations and the role of chance. It is a method that has
an explicit theoretical and political goal: to disrupt the taken-for-
4 Robin Bunton and Alan Petersen

grantedness of the present and to show how things could be different.

As Deborah Tyler notes below, it is not an attempt to understand the
past from the point of view of the present, but rather to disturb the self-
evident present with the past. This method has proved a powerful tool
of deconstruction, as is evident from a long line of studies in the social
sciences. Foucault's genealogical approach to sexuality has, for
example, helped stimulate the development of a rich field of historical
enquiry into the social construction of sex and sexuality (Hausman
1995; Katz 1995; Laqueur 1990; Weeks 1985). Historical research such
as this, by pointing to shifts in discursive practices, indicates the
inherent instability of the present, and allows us to imagine things being
otherwise.
In different ways David McCallum's and Deborah Tyler's chapters
demonstrate the emergence of certain subjectivities in the discourses on
mental health and criminality, and on child development, respectively.
In chapter 3, McCallum disturbs the certainties and truths of the
categories of personality and personality disorder by providing a
genealogical analysis of the conceptual terrain of the problem of the
'dangerous individual'. Rather than accepting accounts of an ahistorical
problem individual, the categories of the present can be understood as
the combination of a number of elements. On the one hand there
developed an increased individualisation of the population in the late
nineteenth century, accomplished through a range of statistical
procedures, administrative reforms and social hygiene strategies. These
developments were coupled with a twentieth-century growth in the
'psy-disciplines' which sought to understand the internal workings of
the individual, and increasing attempts to regulate citizens through the
advancement of norms of personal life. Knowledge of the person is
made possible by means of a complexity of interrelations between law,
psychiatry and the institutional spaces in which they operate.
In chapter 4, Tyler examines and disturbs a similar scientific
'discovery' - the propensity of boys to display 'bad habits' more than
girls. She examines the conditions of possibility that allowed boys' and
girls' behaviours to become 'recognised' as 'at risk' or 'maladjusted' at
all. She accounts for the techniques of governing the child and the
strategies for modifying the behaviour in the kindergarten and other
educational milieux. The contemporary Australian Temperament
Project casts boys as an 'at risk population'. This is due not to
'discoveries' of the inner working of the human mind but to the
techniques of governing child populations developed throughout the
early part of this century. For this discourse it would appear that what is
 Foucault's medicine 5

known about the soul of the child is less important than what is known
about what can be done to deal with it.
The issue of discursive domination is examined critically by
Deborah Lupton in chapter 5. Lupton compares the similarities and
differences between the orthodox medicalisation critique and Foucaul-
dian commentaries on bio-medicine. She notes that whereas supporters
of the 'medicalisation' critique see power as being primarily repressive,
Foucauldian commentators acknowledge the productive aspects of
disciplinary power in the 'clinical gaze'. However, as Lupton points
out, both orthodox sociological accounts of medical knowledge and
Foucauldian accounts tend to ignore a number of features of the
medical encounter - such as the unconscious and the emotions - which
are in need of further exploration.
Part III turns to the analysis of the body and of the self, and of their
relationship. As Turner indicates above, the body was of major
significance in Foucault's work, and his unique perspective on the body
as a focus for disciplinary power has undoubtedly helped to recast
thinking about the nature of the body and about the operations of power
in modem societies. The analysis of 'bio-power' gives us two axes
through which power works in relation to the human body: one working
on the individual body, the so called 'anatomo-politics of the body', the
other as a 'bio-politics of population' working through population.
Such an approach to the body was to have a significant reordering effect
on the sociology of health and illness (Petersen 1993; Turner 1995).
Foucault .conceives the body not as natural or neutral but as reproduced
in specific sets of practices and discourse. His approach draws attention
to the techniques used for managing populations or the social body, and
particularly the 'apparatus of normalisation' (Armstrong 1983: 51). In
The Birth ofthe Clinic (1975), for instance, he showed how, during the
nineteenth century, there emerged a unique discourse of 'the body'
which shaped the way it was seen, described and acted upon.
Increasingly the body was objectified and subject to new techniques
of power - disciplinary power. Medicine played a key role in the new
perception of 'the body' through its focus on pathological anatomy
where disease was located in the body of the patient. This discourse
differed from that which had prevailed up until the end of the
eighteenth century, when medicine related much more to health than to
normality (1975: 35).
In chapter 6, Denise Gastaldo argues that health education has come
to play an increasingly important role in the exercise of 'bio-power'
through its association with illness prevention and health promotion.
6 Robin Bunton and Alan Petersen

Drawing on data from her study of health education policies and

practices in the Brazilian national health system, Gastaldo describes
how discourses on health education have contributed to the manage-
ment of social and individual bodies by introducing new knowledge,
surveillance and disciplinary techniques into everyday life. By inviting
subjects to make decisions about their health and become actively
involved in the care of themselves and their communities, health
"education invokes self-autonomy and self-governance. Like a number
of other contributors to this collection, Gastaldo seeks to emphasise the
complexity of modern relations of power which depend not upon the
direct control of subjects through coercive means but rather upon
creating a sphere for their regulated autonomy.
Foucault has been criticised for his inattention to gender in his own
analyses of the body and the self (see e.g. Barrett 1991: 151-2; Flax
1990: 212). But his concepts have nevertheless been highly influential
in feminism, both in terms of explorations of the utility of his concepts
for feminist theory and practice and for the analysis of such areas as
eating disorders, reproductive technologies, and the regulation of
women through medical discourse and in health care settings (see e.g.
Diamond and Quinby 1988; Hausman 1995; McNay 1992; Oudshoom
1994; Ramazanoglu 1993; Robertson 1992; Sawicki 1991). Foucault's
work offers feminism a sophisticated perspective on the power relations
of health and of medicine, and draws attention to the productive
potential of medical knowledges and practices, and the opportunities
this creates for resistance. For example, new reproductive medical
technologies create such categories of individual as the infertile,
surrogate and genetically impaired mothers, mothers whose bodies are
not fit for pregnancy (either biologically or socially), mothers who are
psychologically unfit for fertility treatments, mothers whose wombs are
hostile environments to foetuses and so Oll. At the same time, the
possibility of new sites of resistance is created, such as the case of
single and lesbian women who challenge these norms by demanding
access to infertility treatments (Sawicki 1991: 84). Foucault's work
challenges those feminist perspectives which posit women as victims of
a violent and repressive patriarchy. In the area of medical technologies,
for example, it leads one to question why many women see new
medical technologies as enabling and have at times been among the
strongest proponents of their development and use. More fundamen-
tally, however, Foucault's work problematises what has come to be
taken as the stable object of most feminist analyses: the sexed body.
In her analysis of hormone replacement therapy (HRT), in chapter 7,
 Foucault's medicine 7

Jennifer Harding argues that feminist and medical discourses converge

in their reference to an already sexed body. She compares medical and
feminist discourse on HRT and their subject and audience - the post-
menopausal woman - and examines how they both participate in the
sexing of bodies. Feminist women's health discourse, like medical
discourse, presupposes the existence of 'sex' as a fixed category and
precondition for defining menopause and designating individuals as
either requiring or not requiring treatment. The feminist critique fails to
appreciate the extent to which bio-medicine provides the language
through which bodies become culturally intelligible. Through their
deployment of the construct of 'risk', both medical and feminist health
discourses call upon women to make themselves objects of self-
surveillance. One outcome of this is that ageing women's desires are
circumscribed by a responsibility to resist their own 'decrepitude'. This
chapter explores not just dominant techniques of the body and the self
but also 'unofficial' or subjugated knowledges, though in this case both
produce similar technologies of the self, thus underlining, as Foucault
was so fond of doing, the ironies of the power effects of 'new social
movement' politics.
In chapter 8, Liz Eckermann examines the relevance of Foucault's
ideas to feminism through an analysis of embodiment and gendered
subjectivities, with particular reference to self-starvation. As Eck-
ermann points out, both in his early work on the body and in his later
work on the self - as articulated in the last two volumes of The History
ofSexuality - Foucault offers useful conceptual tools for sociologically
understanding the body and those factors shaping the modern
'epidemic' of self-starvation. His concepts of surveillance and
confession, for example, prove useful in the analysis of behavioural
modification techniques used in treatment and of the self-disciplinary
strategies brought into play in the attempt to achieve the ideal body
appearance (e.g. weight reduction). As Eckermann concludes,
Foucault's work is invaluable in developing a feminist political
practice, for generating new research questions, and in providing
suggestions for therapeutic intervention.
In Part I~ the chapters explore the application of Foucault's notion
of govemmentality to the analysis of health policy, health promotion
and the consumption of health. Governmentality is an overarching
~concem that runs throughout all parts of the book, reflecting Foucault's
rather broad notion of the concept, which he described as the contact
point between technologies of domination (including discourse) and
technologies of the self (Foucault 1988: 19). In chapter 9, Thomas
8 Robin Bunton and Alan Petersen

Osborne draws upon Foucault's (and Canguilhem's) work to break out

of what he terms 'reactive' accounts of the relation between health and
policy. Such accounts, he argues, tend to see health policy as a reaction
to objective health needs, on the one hand, and state of health as the
result of the effectiveness of health policy, on the other. The concept of
govemmentality directs attention to the problematisations of govern-
ment, and to policy as a creative rather than as a reactive endeavour.
Health is seen not as an absolute or determinate concept, but rather as a
relative and indeterminate one - a by-product of governmental
intervention. The discourses of health policy are examined from the
point of view of liberal and neo-liberal rationalities of government, a
theme that is taken up in the final three chapters.
Alan Petersen, Sarah Nettleton and Robin Bunton focus on the
particular techniques of governance associated with the discourses of
health promotion and 'care of the self' in these remaining chapters.
Common themes explored are the salience of risk culture, the central
role of expertise in liberal technologies of government, and the
emergence of the concept of the enterprising self. Techniques for
empowerment and participation are analysed as double-edged:
extending the 'clinical gaze' whilst constructively managing the
population. The reliance of neo- or advanced liberal societies on an
enterprising, self-caring subject is a theme developed by Foucault in the
latter part of his career. Although Foucault's historical approach is tied
to a critique of the autonomous, rational, self-reflexive subject of
Western liberal humanism, his later work acknowledges a self that is
autonomous and able to extricate itself from normalising judgements
and disciplinary practices. He left us with, as Schrift puts it:
The task of thinking a notion of a subject that is both autonomous
and disciplined, both actively self-forming and passively self-
constructed, as he left us to think about the emergence of a modern
state whose exercising of pastoral power both totalizes and
individualizes.
(1995: 34)
The final chapters take up these problematics in different ways.
Alan Petersen, in chapter 10, identifies the central technology of
newer approaches to health characteristic of health promotion and the
new public health, that of risk management. The analysis of risk and
health has been given renewed force in sociology of late through the
work of Ulrich Beck (1992, 1995) and Anthony Giddens (1991).
Petersen develops the implications of the analysis of risk for
 Foucault's medicine 9

governance and the management of populations, drawing upon the work

of Castel, who identified the shift in focus in contemporary health and
social care from 'dangerousness' to 'risk'. This shift has had a profound
influence on relationships between experts and subjects and requires
more diverse intervention strategies. Risk appears here as a technology
by which the freedom of the neo-liberal subject is generated. The
rationality of neo-liberalism produces an entrepreneurial self, endowed
with the ability to manage its own risks and risk behaviour. Health
promotion is a strategy that engenders risk minimisation by attention to
lifestyle and the privatisation of risk. 'Healthism' and 'bodyism' are
integral processes.
This theme is also taken up by Sarah Nettleton in chapter lIon
governing the risky self. Referring to contemporary health policy and
health promotion practice in the UK, she examines how current styles
of governance produce autonomous, enterprising reflexive selves and
communities who manage risks. This is not a one-way relationship of
domination relying on certainties but the outcome of reciprocity
between aggregate and individual actions. Power is exercised because
subjects are able to react to expert knowledge. Like a number of other
contributors (e.g. Lupton in chapter 5 and Gastaldo in chapter 6), she
recognises the productive aspects of disciplinary power at work; in this
case in health promotion discourse. Challenge to expert knowledge, she
notes, is integral to this style of governance. Drawing upon Rose's
(1992) analysis of governmentality in liberal democracies, this chapter
points out that subjects are not simply subjected to policies and
programmes but are required to participate.
In the final chapter, Robin Bunton analyses the technologies of
governance associated with advanced liberalism through a study of
changing representations of health and self-care in the Good House-
keeping magazine since 1959. Bunton notes a growth during this period
in 'health-related' goods and services in line with the increasingly
market-oriented approach to health and the emergence of the more
discerning, health-conscious subject. Products have become increas-
ingly marketed with an eye to their expressive as well as instrumental
function; for what they signify about the identity of the consumer. This
can be seen with the marketing of new 'soft' toilet tissue products,
which represented a shift from a focus on the purely hygienic aspects of
the product towards an emphasis on the luxuriousness of the product.
At the same time, new, preventive, 'risk-oriented' knowledge was
becoming more apparent while challenges to medical authority were
becoming routine. It can be seen how also, during this period, 'psy'
10 Robin Bunton and Alan Petersen

expertise was employed in governing acts of consumption: in

establishing the psychological significance of products, and in their
design and marketing. As this analysis illustrates, the health consumer
of advanced liberalism is positioned not as a passive, cultural dope but
as an active, enterprising and self-caring subject capable of selectively
consuming health products and selectively reading his or her own
health messages.
In collecting the chapters in this volume we are acutely aware of
gaps and omissions, both in topics and in authors. We have not
attempted to produce a collection representative of a field of study in
this sense. Nor is it an attempt to identify or assess the gaps and missing
topics in post-Foucauldian scholarship (such as phenomenological
study, 'race' or a post-colonial focus). Rather we have brought together
some critically appreciative papers illustrating the possibilities that
Foucault's work continues to bring to the study of health and medicine.
It shows how some researchers are drawing on Foucault's work to use
and 'diagnose' the health and medicine of our times. In different ways
these authors have sought to open up and problematise areas of study
and have produced different readings of Foucault. They have drawn
upon the 'toolbox' of Foucault's work and hopefully, in so doing, have
made these tools more available to others.

REFERENCES
Annstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in
Britain in the Twentieth Century, Cambridge: Cambridge University Press.
Barrett, M. (1991) The Politics of Truth: From Marx to Foucault, Cambridge:
Polity Press.
Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage.
Beck, U. (1995) Ecological Politics in an Age ofRisk, Cambridge: Polity Press.
Burchell, G., Gordon, C. and Miller, ~ (eds) (1991) The Foucault Effect:
Studies in Governmentality, Hemel Hempstead: Harvester Wheatsheaf.
Diamond, I. and Quinby, L. (eds) (1988) Feminism and Foucault: Reflections on
Resistance, Boston: Northeastern University Press.
Flax, J. (1990) Thinking Fragments: Psychoanalysis, Feminism and Post-
modernism in the Contemporary West, Berkeley: University of California
Press.
Foucault, M. (1965) Madness and Civilization, trans. R. Howard, New York:
Vintage.
Foucault, M. (1975) The Birth of the Clinic: An Archaeology of Medical
Perception, New York: Vintage Books.
Foucault, M. (1980) The History of Sexuality, Volume 1: An Introduction, New
York: Vintage Books.
Foucault, M. (1982) 'The subject and power' (Afterword), in H.L. Dreyfus and
 Foucault's medicine 11

P. Rabinow, Michel Foucault: Beyond Structuralism and Hermeneutics,

Hemel Hempstead: Harvester Wheatsheaf.
Foucault, M. (1985) The Use of Pleasure, The History of Sexuality, Volume 2,
London: Penguin.
Foucault, M. (1986) The Care of the Self, The History of Sexuality, Volume 3,
London: Penguin.
Foucault, M. (1988) 'Technologies of the self', in L.H. Martin, H. Gutman and
P. Hutton (eds) Technologies of the Self: A Seminar with Michel Foucault,
London: Tavistock Publications.
Foucault, M. (1991) 'The politics of health in the eighteenth century', in P.
Rabinow (ed.) The Foucault Reader, London: Penguin.
Giddens, A. (1991) Modernity and Self-Identity: Self and Society in the Late
Modern Age, Cambridge: Polity Press.
Hausman, B. (1995) Changing Sex: Transsexualism, Technology, and the Idea
of Gender, Durham, North Carolina: Duke University Press.
Katz, 1. (1995) The Invention of Heterosexuality, New York: Penguin.
Laqueur, T. (1990) Making Sex: Body and Gender from the Greeks to Freud,
Cambridge, Massachusetts: Harvard University Press.
MeHoul, A. and Grace, W. (1993) A Foucault Primer: Discourse, Power and the
Subject, London: University College London Press.
McNay, L. (1992) Foucault and Feminism: Power, Gender and the Self,
Cambridge: Polity Press.
Oudshoorn, N. (1994) Beyond the Natural Body: An Archaeology of Sex
Hormones, London: Routledge.
Petersen, A.R. (1993) 'Re-defining the subject? The influence of Foucault on
the sociology of health and illness', in B.S. Turner, L. Eckermann, D.
Colquhoun and ~ Crotty (eds) Annual Review of Health Social Science,
Volume 3, Geelong: Centre for the Study of the Body and Society, Deakin
University.
Rajchman, 1. (1995) 'Foucault ten years after', New Formations, 25: 214-20.
Ramazanoglu, C. (ed.) (1993) Up Against Foucault: Explorations of Some
Tensions Between Foucault and Feminism, London: Routledge.
Robertson, M. (1992) Starving in the Silences: An Exploration of Anorexia
Nervosa, Sydney: Allen and Unwin.
Rose, N. (1992) 'Governing the enterprising self', in P. Heelas and ~ Morris
(eds) The Values of the Enterprise Culture, London: Routledge.
Sawicki, 1. (1991) Disciplining Foucault: Feminism, Power and the Body, New
York: Routledge.
Schrift, A.D. (1995) 'Reconfiguring the subject as a process of self: following
Foucault's Nietzschean trajectory to Butler, Laclau/Mouffe, and beyond',
New Formations, 25: 28-39.
Soper, D. (1995) 'Forget Foucault?', New Formations, 25: 21-7.
Turner, B.S. (1995) Medical Power and Social Knowledge, 2nd edn, London:
Sage.
Weeks, 1. (1985) Sexuality and its Discontents: Meanings, Myths and Modern
Sexualities, London: Routledge and Kegan Paul.
This page intentionally left blank
Part I

Fabricating Foucault
This page intentionally left blank
Chapter 1

Foucault and the sociology of health

and illness
A prismatic reading
David Armstrong

INTRODUCTION
Who is Foucault? I do not know, and I do not really care. I confess that I
have not read any of the biographies that have been written about him
and I have no interest in his personal life. Indeed, if, as in some
Shakespearean authorship mystery, I was told that he never really
existed and that the books bearing his name were written by a number
of different people it would not bother me. How then can I write about
an author who mayor may not have existed?
In his essay 'What is an author?', Foucault identified a shift in the
'author function' over the centuries. In medieval times the truth of the
text was to be discovered in the truth of the author - a saint, being who
he was, only spoke the truth while heretics were known to write
untruths. But in modem times, that relationship has been reversed; the
truth of the author is to be found in the truth of the text as we scan the
author's words to find out who he or she really was. In other words, the
answer to the question 'Who is Foucault?' is given by whoever we infer
from the texts bearing his name. But of course there are many different
readings/inferences despite attempts to find the 'real Foucault' behind
them (and then in some medieval hegemonic gesture claim to grasp
what Foucault really did mean).
Many different readings and many different Foucaults. Mine can
only be one such reading: if others got it 'wrong' then that reflects no
more than my personal reading. This means that in the following review
of the influence of Foucault on the sociology of health and illness my
task is not to describe the links between the man and the sociological
researcher but to explore the connections between some texts that bear
his imprimatur and the reader.
Foucault was a prolific writer. Besides a number of books there were
16 David Armstrong

many essays and interviews. Trying to determine the supposed

'influence' of this corpus would be a massive task, even if it was a
legitimate one. A more focused goal for this chapter is to identify some
'influences' of four main texts as evidenced by explicit acknowl-
edgements (in the fonn of discussion or reference) in my own writings
and those of others. This will involve reconstructing that engagement
between text and reader as Foucault's words have been subjected to
different interpretations at different times.

MADNESS
Foucault's first major book (after a somewhat obscure work based on
his doctoral thesis) was Madness and Civilization (from now
abbreviated to Madness), first published in French in 1961 followed
by an abridged shortened version in English in 1965. The book made its
appearance just as questions were being posed about the nature of
psychiatry and psychiatric incarceration in Western societies (Goff-
man's Asylums was published in 1961) but it reached Anglophone
countries when 'anti-psychiatry' was a growing movement and was
rapidly recruited to the anti-psychiatry side. The passage in the book
that was seized upon by the anti-psychiatrists was the apparently radical
re-interpretation of Pinel's famous act of removing the chains from the
mad in Bicetre: removing the chains might have been an act of
'liberation' but only in that it separated the mad from the criminal;
more importantly it identified the insane as a new problem and
proceeded to subject them to an even more intensive imprisonment. As
Sedgewick, an important writer in the field of anti-psychiatry, was later
to express it, Foucault's was an 'anti-history of psychiatry'; the new
regime was to 'replace the fetters and bars of the old madhouse by the
closed, sealed order of an asylum system founded on a gigantic moral
imprisonment, that of the medical superintendency of insanity' (1982:
133). In effect, Foucault's accoun~ of the history of insanity was seen to
undermine the conventional 'progressive' histories of psychiatry, a
perspective that was seized upon by those opposed to modem
psychiatric incarceration to berate psychiatry's own pretensions to be
a progressive and humane discipline. And the example of Pinel
provided a model of how to enact another revolution in the care of the
mentally ill, only this time patients truly would be liberated from the
psychiatric regime that imprisoned them (Ingleby 1980).
The other reading of Madness produced by anti-psychiatry was the
idea that psychiatric illnesses were 'socially constructed'. There were
 Foucault and the sociology of health 17

two facets to this process, both intertwined and never really separated in
the sociological literature of the period. On the one hand, mental illness
was constructed in the sense of being caused or produced by social
activities and conflicts (see, for example, Brown and Harris 1978; Scull
1977); on the other hand, mental illness arose through the definitional
processes of psychiatry that labelled some behaviours as normal and
others as abnormal (see, for example, Scheff 1966; Szasz 1961). The
early formulation of social constructionism that occurred in these
debates about psychiatric illness prefigured later applications of this
thesis to so-called 'organic' illness but in many ways mental illness was
an easier target on which to practise. Whereas physical illnesses could
claim a 'real' underpinning in terms of a biological referent, it was
clear that psychiatric illness depended very much on the consensual
diagnostic practices of psychiatrists that certain illnesses did exist
(famously illustrated by the American Psychiatric Association's vote to
re-categorise homosexuality as a normal variation rather than a
disease).
Not all those in favour of psychiatric reform found Madness to their
liking. It was either omitted from their analysis of the state of
psychiatry or read as a polemical tract by an extremist author (of the
Left). Jones, for example, in her original history of the mental health
services (published in 1972) makes no mention of Foucault. But by the
time of her revised history (1993) published some twenty-one years
later, she claimed that Madness had exerted a 'massive influence' on
sociological thought but only through what she judged as 'an analysis
deliberately based on emotive images rather than on logical argument'
(1993: 170). Further, she located Foucault on the extreme political left
and claimed that he, like Marx, believed that 'capitalism is the sole
cause of oppression' (1993: 2). In contrast, Busfield, in her own account
of the historical development of madness, found little in Madness
concerned with asylums and psychiatric practice (others read the hook
as being precisely about these issues) and thought that Foucault's work
could be usefully contrasted with Marxist thought: 'Foucault's lack of
direct interest in the extent and nature of the institutions and practices
that have arisen to deal with the insane is, therefore, matched by his
lack of interest in attempting to link ideas to specific social and
economic conditions' (1986: 130). In fact, for Busfield, Foucault's
Madness was essentially based on the symbolism of insanity producing
what she discerned as 'an idealist not a materialistic conception of
history' (1986: 130). Yet reading the same text Brown could claim that
Foucault showed that 'the creation of the European asylum in the
18 David Armstrong

seventeenth and eighteenth centuries [was] a response to the economic

dislocation of early industrialism and the political unrest associated
with that process' (1985: 13).
In many ways the legacy of Madness for sociologists was created in
its reading during the anti-psychiatry movement and seems rooted in
this period. Reference to the text in most writing in the sociology of
health and illness has all but disappeared - though this might also
reflect on the relatively low profile of psychiatric disorder in the
discipline's literature in the closing years of the century. Other than in
explicitly historical accounts of insanity Madness is largely ignored.
For example, Miles's (1981) book on mental illness in contemporary
society makes no reference to Foucault; nor does Prior (1993) in his
book on the social organisation of mental illness.
But some of the wider implications of Madness that so excited the
anti-psychiatrists have been developed by others. Pilgrim and Rogers
(1993), for example, in their sociology of mental health and illness,
offer a summary of sociological perspectives on psychiatric illness
distinguishing between the social causal, the societal reaction and the
social constructivist. The last, they charge, has been most strongly
influenced by Foucault: 'reality is not self-evident, stable and waiting to
be discovered' (1993: 19). And whereas, they suggested, Foucault's
early work (in the form of Madness) concentrated on the days of
'segregation and "coercive" power', they point to the greater interest of
his followers in what they call 'voluntary relationships'.
In my view it is these 'voluntary relationships' that underpin the
relevance of Madness for the late twentieth (and, no doubt, twenty-first)
centuries. In many ways, as I have already argued (Armstrong 1979b),
the problem of madness has disappeared just as simply and quickly as it
was created by Pinel's liberating gesture. With the post-war policy of
de-institutionalisation and legislative changes (including the formal
abolition of the term 'insanity') the problem of 'unreason' is also
removed from the psychiatric agenda. But this newly vacated
psychiatric space did not remain empty for long: a new set of mental
health problems have begun to crystallise in the fonn of the neuroses,
the psychological problems of coping with living, the anxieties and
depressions of everyday life. This new focus for psychiatric practice -
and indeed the wider counselling movement - began to emerge early in
the twentieth century and now completely overshadows the old
problems of the renamed psychoses. The importance of this shift has
been explored in France by Castel (1989) and in Britain notably by
Rose (1985, 1990) - though neither of them is identifiable as a
 Foucault and the sociology of health 19

sociologist of health and illness. In the main, however, sociologists have

largely chosen to concentrate on the social causes of these novel
problems and on their distribution in the population/community, rather
than explore their 'Foucauldian' origins.
In contrast, medical historians continue to be bemused and
exasperated by Madness. Arguably, no historical account of psychiatry
or of mental illness can ignore a major thesis taken from Madness: that
not all might be progress in 'improvements' in the management of
mental illness. And then there are the historical details of Madness that
can still provoke historians to arms (Still and Velody 1992). Is Madness
riven with historical errors? Or is the answer to historians' questions on
accuracy contained in the chapters omitted from the English version
(Gordon 1992)? Take the noteworthy debate surrounding Foucault's
claim that a 'ship of fools' once sailed European waterways. No
contemporary evidence, claim some historians, historical reference to
such a phenomenon was simply a metaphor for something else, or
myths, or distorted readings of texts and so on. But, claim others, this is
precisely the point: a 'ship of fools' was a 'reality' but not according to
the simplistic notions of historical fact as laid down by professional
historians. A problem of language or of translation? (Though even the
French historians have to confess the writing in the original is
ambiguous.) Whatever its historical 'inaccuracies' this is clearly not a
text that historians can ignore. 1
In summary, the influence of Madness is probably greater in history
than in sociology. Certainly it has had its adherents who recruited it to
the anti-psychiatry movement but with the passing of the asylum and
the lower profile given psychoses in recent sociological writing, the
effect of Madness seems to have waned. However, as in history, some of
its broad framework has passed into the sociology of health and illness.
Arguably theories of social control and medicalisation have been
influenced by the reading that the intervention of the medical profession
in areas of human suffering has not always been beneficial; and also its
perceived anti-progressivist framework has fed into later 'postmodem'
tendencies in the field. Perhaps the ultimate fate of Madness is likely to
be an ironic one: itself an important reference in a future historiography
of unreason.

BIRTH
The Birth a/the Clinic (Birth) followed Madness, published in French
in 1963 but having to wait until 1972 for its English translation. Its
20 David Armstrong

appearance elicited less excitement than Madness and its use by

sociologists of health and illness has been much more low key despite
the apparent centrality of its subject matter to their concerns. (And if it
provokes little interest in health and illness it predictably excites less
interest elsewhere. Even Sheridan's [1980] otherwise comprehensive
account of the Foucauldian oeuvre is curiously brief in describing the
contents of Birth.)
Inasmuch as Birth claims to be a history of the beginnings of the
'Clinic', that is the cradle of Western hospital or pathological medicine,
then it has received a genuflection from those sociologists who wish to
argue that such a form of clinical practice is historically and culturally
located. Herzlich, for example, in her book on lay representations of
health, makes a brief reference to Birth as an outstanding example of a
text that links together the development of medical science with 'the
social conditions from which it emerged' (1973: 6). However the first
extended treatment of Birth is probably in Illich's Medical Nemesis of
1975. In his chapter entitled 'The invention and elimination of disease'
Illich states that he draws 'freely from documents gathered in the
masterly study [The Birth of the Clinic]'. Thereafter, the specific
influence of Foucault on Illich '8 polemic is more difficult to determine;
perhaps his reference to the contemporary documentation that Foucault
had gathered together in Birth reflects an indebtedness to sources rather
than the interpretation of that material.
During the 19808 and 1990s Birth has been used in two ways within
the sociology of health and illness. First, it seems to have a useful and
relatively uncontroversial role as an easy reference to quote to cover the
sweep of the early history of Western or hospital medicine (and
performs a similar function for historians who have been less critical of
its historical 'accuracy' than they were of Madness). Mention Western
medicine, biD-medicine, the clinic, pathological medicine, or some
other synonym and a citation of Birth perfonns a useful support
function (the first time I referenced Birth in my own work was in this
abbreviated way, see Annstrong 1979a). Such a reference is a safe one
to make: it indicates that Western medicine is both historically and
culturally located (not much to disagree about there), but beyond that
requires no commitment or involvement in any other aspect of
Foucauldian disputation.
Second, and less ritualistic, is the use of the 'medical gaze' that
frequently emerges as a central theme of Foucault's text. The ground
has been well covered: the original French 'Ie regard' was translated as
'perception' for the sub-title and as 'the gaze' in the main body of the
 Foucault and the sociology of health 21

text. Neither translation on its own fully captures the subtlety of 'Ie
regard', at once a perception but also an active mode of seeing. The
gaze has been identified by a number of different writers as
representing the process through which specific social objects, namely
disease categories, come into existence and how more recent shifts can
be seen as changes in the gaze (Armstrong 1983; Nettleton 1992;
Thornquist 1995). A particular example of the genre is Atkinson's
(1981) study of medical student socialisation in which he describes the
processes through which the artistry of the gaze is communicated to
neophytes. One result of these analyses has been 'social construction-
ism' or 'constructivism'. Here, even more than in Madness, it can be
argued that Foucault's work has been a major influence on the
constructionist heresy in sociology of health and illness (whilst
recognising that social constructionism has other roots and appears
independently of Foucault in cognate disciplines such as in the
sociology of science and in psychology). Indeed it is not uncommon to
write about the social construction of the body with no reference to
Foucault (Nicholson and McLaughlin 1987) or only a passing one
(Freund and McGuire 1995).
But, as is well recognised, social constructionism is a broad church
and even those drawing inspiration from Foucault's original arrive at
different conclusions. For example, Prior observes in his study of death
in Belfast that it was Foucault who made the fundamental point that the
body was historically and culturally located; this meant that 'The body,
therefore, does not and cannot yield its essential features to naked
observation unmediated by forms of knowledge' (1989: 13). Yet he
implies that there are 'essential features' of the body, independent of
the 'gaze'. Others, such as myself and Nettleton (1992), have been
more relativistic on this point: if the body can only be known through a
descriptive language (the 'gaze' for the last two centuries) then it is
futile to speculate on 'essential features' that could never be described.
While Birth provided an important conceptual framework for some
writers in terms of a 'way of seeing' for understanding how Western
medicine was able to identify diseases deep in the body, it has probably
proved most fruitful when this insight has been combined with themes
of surveillance and power that are described in Foucault's later work.
However, the rest of Birth, to my mind, has been little exploited. It is
dense and, as it is focused on a few decades two centuries ago, it can
appear more suited to the interests of historians. But it displays a
glittering prose style that begs for recitation. I am afraid that a lecture
or seminar that includes Birth can rapidly degenerate into a sermon as
22 David Armstrong

the master's words are read out loud. And besides the poetry I also find
the book full of nuggets that can be easily mined. For example, 1 have
found an analytic tool in the use of spaces for exploring the
distributions of illness in geriatric medicine (Annstrong 1981 a), or in
the identification of spaces - conceptual, social, geographic, temporal -
in modem British general practice (Armstrong 1993, 1985). Indeed,
Foucault's opening differentiation of primary, secondary and tertiary
spatialisation of illness (a sort of cognitive, corporal and geographic
map) provides an excellent device for explaining more recent changes
in the nature of illness (Annstrong 1993, 1995).
I have also found value in reading about the meaning of death. 'Man
does not die because he falls ill; he falls ill because he might die' allows
death itself to be seen as a social construction interwoven with
particular models of illness. Thus, as I read it, Foucault suggested that
death was a natural phenomenon in the eighteenth century (only the
coroner's court determining 'unnatural' causes such as murder or
misfortune) but became a pathological event in the nineteenth (and
twentieth) century with the concomitant rise of hospital medicine and
the post-mortem to establish the pathological cause of death. (I still
tease medical students with the question: is death normal or abnormal?)
This analysis gave me the framework to explore the construction of
infant deaths during the final decades of the nineteenth and twentieth
centuries (Annstrong 1986). It also, together with ideas from a later
text, allowed me to explore a mid-twentieth-century change in the
nature of death (Armstrong 1987).
But perhaps the most profound lesson I take from Birth is the sub-
text on the emergence of the individual. The patient appears at various
points as a repository for this new model of a pathology-based disease.
The patient in this sense is no more than a container for the lesion; but
it seems that this undistinguished container is one form in which
individual identity begins to make its appearance on the Western stage.
The very idea of separate identity, albeit in prototype and anatomical
form, begins to emerge for me from these pages: sometimes there
seems explicit reference, as in Foucault's discussion of the relationship
between the individual and death, but it is in the brief concluding
chapter that he suggests out loud, so to speak, that the deployment of
the clinical gaze forms an integral part of our individual experience and
identity. This belief that medicine has an important role in fabricating
individual experience and identity has been an important one for me
and has underpinned many of my writings. For example, it was hardly a
major step to move from my reading of Foucault on this point to an
 Foucault and the sociology of health 23

exploration of the further development of the individual through the

advice on interrogating/interviewing patients contained in clinical
manuals published during the twentieth century (Armstrong 1984).

DISCIPLINE
While I found that Birth had a tendency to ovenvhelm by its detail, the
strength of Discipline and Punish (Discipline) was the simplicity and
clarity of its main thesis. Published in French in 1975 and in English in
1977 it seemed instantly accessible; for me, working on a thesis on
medical knowledge and the medical division of labour (198Ib), later
published as Political Anatomy of the Body (1983), it was a godsend. I
read it as contextualising his previous books: here he described a shift
from sovereign to disciplinary power that seemed to fit with key
historical shifts identified in his earlier works. And in the idea of
surveillance as the underlying mechanism of disciplinary power,
Foucault seemed to strike a chord for many other readers.
Three types of research have subsequently been published in the
sociology of health and illness that have utilised notions of surveillance
and power. First, there are those 'historical' studies that have in
common the use of the idea of historical shifts in surveillance/power, as
in Discipline, as the main explanation for the emergence of new
medical phenomena. Thus, Arney (1982) and Arney and Bergen (1984)
found it of value in understanding the post-war explosion in obstetric
technology and in recent trends in clinical practice respectively;
Nettleton used it as the basis for explaining the emergence of teeth and
the mouth over the last century (1992); and I have used it a number of
times as the basic map that guides my own explorations of some of
these issues. (Though when Osborne [1994] revisited some of the topics
that I had found of interest with his own reading of Foucault he judged
my work to be too pessimistic and overly determined.)
The second group of studies, increasing in number, are qualitative
investigations into aspects of interaction in medical settings. While
these have often relied on apparently inductive approaches, they have
begun to see surveillance - and its effects - as a recurrent theme. For
example, Silverman (1987) used ideas of surveillance to understand
the broader context in which clinics function; Daly (1989) found the
idea of surveillance, and resistance to surveillance, significant in her
study of echocardiography; similarly Bloor and McIntosh (1990) found
the tension between surveillance and concealment a valuable frame-
work for explaining interactions in the community between profes-
24 David Armstrong

sionals and their clients. Less surprisingly perhaps, the Foucauldian

notion of surveillance also has more immediate resonances in those
parts of medicine that are, by their own admission, concerned with
surveillance; for example, in dental check-ups (Nettleton 1988), in
cervical screening (McKie 1995) and in health promotion (Bunton
1992; Petersen 1996).
The third type of output to include the theme of surveillance/power
is that which attempts to state or develop a more theoretical argument
for the sociology of health and illness than the more empirically based
studies described above. These run from the undergraduate textbooks
that try and locate the Foucauldian perspective (often under the
constructionist label) as one of several theoretical perspectives in the
sociology of health and illness (for example, Morgan et ale 1985).
Others have tried more ambitiously to develop and extend Foucault;
however, these have all read Foucault in different ways and therefore
achieve different outcomes. Gerhardt (1989), in an ambitious
intellectual history of medical sociology, places Foucault, along with
the Marxists, in a 'conflict-theory paradigm'. In contrast, Fox (1993a)
locates Foucault as a postmodem author but still subsumes him to other
better recognised figures from that arena. But perhaps the best-known
exposition of the Foucault influence on the sociology of health and
illness is the work of Turner.
Besides a number of papers (and books on other subjects) Turner has
engaged with Foucault in three main texts, namely The Body and
Society (1984), Medical Power and Social Knowledge (1987) and
Regulating Bodies (1992). Turner's main argument is that the body has
been essentially 'absent' from social theory and his aim is to make it a
central feature. In part this has involved the 'application of the
philosophy of Michel Foucault' to the problem of the body, but he has
also brought to bear the work of other theorists. As Turner himself
explained, this has meant that he has 'often been criticised for
eclecticism, and for a lack of theoretical integration' (1992: 4) - though
he felt that this view was partly the product of the diversity of projects
that he had pursued. The result of this eclecticism in The Body and
Society, by Turner's own admission, was a predominantly Marxist
framework - and Foucault was 'integrated' into this. For example,
Turner felt that 'Foucault's project can be seen to bear a relationship to
a view of historical materialism presented by Engels' (1984: 35). This
Marxist framework continued into the 1987 text: for example, Turner
placed great emphasis on the importance of Foucault's radical notion of
power but proceeded to suggest that 'The clinical gaze enabled medical
 Foucault and the sociology of health 25

men to assume considerable social power in defining reality and hence

in identifying deviance and social disorder' (1987: 11).
By the time of his 1992 text, again apparently strongly influenced by
Foucault, he acknowledged that 'a Marxist problematic was relatively
dominant in The Body and Society and that a decade later these
arguments look somewhat dated' (1992: 6). Indeed, in retrospect, he
felt that The Body and Society had 'brought to a conclusion a period in
my own intellectual development, which had been heavily influenced
by the sociologies of Karl Marx and Max Weber' (1992: 5). The stage
was thus set for are-interpretation of Foucault: 'Now that the full scope
and scale of his work [following his death] can be more adequately
appreciated and understood, my original use of his approach appears in
retrospect to be inadequate' (1992: 7). However, the new look was not
Marx but Weber. Foucauldian ideas on power and surveillance were 'to
my mind parallel to Weberian categories of rationalisation and
disenchantment' (1992: 10), claimed Turner. Indeed, he now pointed
out that in The Body and Society he had made similar claims, arguing
that his own previous work denied the originality of Foucault's thesis by
bringing out certain continuities between Weber's notion of 'rationa-
lisation' and Foucault's discussion of 'disciplines' (1984: 2).
Clearly Turner has himself made a number of readings of Foucault,
particularly in terms of the theoretical tradition in which he locates him.
Yet there are some common features of these readings that are at odds
with the work of others, in particular my own work. To my mind the
gaze of the clinic and the surveillance machinery of the Panopticon
fabricated bodies and the diseases that were contained within them. But
Turner would see limits to this argument. Again his eclecticism allows
him to bring in sociobiology as part of his explanatory framework
(surely itself demanding explanation?): 'While human society has
change [sic] fundamentally over the last 2000 years, sociobiology
would suggest that the human body has remained, in all important
respects, physiologically static' (1984: 35). His biological reductionism
comes through more fully when he tackles directly the social
construction of disease: 'It appears bizarre to argue that there are no
organic foundations to human activity' (1992: 16); he goes on: 'For
example, it is unlikely that a human being will ever outrun a horse over
a mile in fair conditions; if the front legs of the horse are not tied
together!' (1992: 16). These statements might seem to fit uneasily with
Turner's oft-repeated assertion that 'the body is socially constructed',
but for Turner 'some things ("hysteria") may be more socially
constructed than others ("gout"), (1992: 26). Given the stated
26 David Armstrong

importance of Foucault's writings for Turner it might be assumed that

claims such as the above (that seem to privilege knowledge provided by
the biological sciences) are somehow rooted in a biological reductionist
reading of Foucault, though they might equally represent yet another
facet of his eclecticism.
The shifting nature of Turner's position as well as his view of
Foucault as a neo-Marxist or a neo-Weberian illustrates the different
readings of Foucault that are possible. Certainly many writers have tried
to fuse him to a Marxist position or locate him within a 'great tradition'
of sociological theorists (my [1985] contribution to this search for
origins managed to discover great affinities to Durkheim!); others have
taken his texts as more of a radical break with the past.

HISTORY
The History ofSexuality, Volume 1 (History) was published in 1976 and
translated into English in 1978. Like Madness, its instant appeal
seemed to lie in its overturning of conventional assumptions. The
nineteenth century had not been a period of repression but one of
incitement to talk about and discuss sexuality. In this sense, like disease
in Birth, sexuality was a product of discourse or, more correctly,
discursive practices. This thesis has proved a powerful one, especially
in an era of AIDS, but its impact on the sociology of health and illness
has been relatively slight. Turner tried to link the sociology of the body
with the sociology of sex and claimed that the failure to engage with the
latter was one good reason for 'taking Foucault seriously' (1984: 9). Yet
his appeal has not been taken up with enthusiasm, perhaps because
sociologists of health and illness per se have been less concerned with
researching sexuality.
Nevertheless, I think that there are other themes to be quarried from
this slim book, in particular a more extensive description of what is
meant by power within a disciplinary regime. It still might be less than
totally transparent but to my mind the dozen pages following Foucault's
claim that 'we have yet to cut off the head ofthe king' offer a provocative
and novel way of looking at power. This has underpinned some of my
own work: for example, the shift in regimes of public health that I
identified seems to tie in well with underlying mechanisms of power,
from the role of sovereignty in maintaining the traditional cordon
sanitaire to the disciplinary power implied by the new public health and
its message of individualised risk and ecological purity. Even so this
reading is by no means common and many writers, such as Turner, take
 Foucault and the sociology of health 27

Foucault to be describing new mechanisms for operating more traditional

power as possessed by individuals or interests. For example, Anderson et
al. see the power to normalise conferring new powers on those who hold
that power: 'Foucault would have us see power diffused throughout
society, and the oppressors not as a faceless "ruling class", but
psychiatrists, physicians, managers and the like' (1989: 274).
While the overt linking of power/resistance with sexuality might
have seemed more relevant for the literature on the latter topic, there is
another theme that had been read in Foucault's earlier work but was
now placed in a seemingly wider theoretical perspective, and this was
subjectivity. The fabrication of bodies in Birth and Discipline could so
easily be linked to the wider problems of identity; but here in History
the linkage seemed more explicit. Studies of power/resistance in
clinical settings might sometimes reference 'earlier' Foucault but seem
to depend on the 'clarifications' offered in History. A good example is
the work of Lupton, particularly in her analysis of public health (1995),
also Fox (1993b) on the emergence of subjectivity, and May (1992) on
the problem of subjectivity in nursing, as well as many of the studies
mentioned above.
On a more personal note, I was also impressed by the way in which
Foucault handled the 'undercurrent' of sexual discourse that was incited
by the Victorians yet has continued to our own day, in particular his
claim that 'silence' was not the opposite of discourse but another facet
of it. It made me recall Aries's claim that discourse on death had been
silenced for a hundred years between the mid-nineteenth and mid-
twentieth centuries. Could this be given the Foucault treatment too?
Rather than repression about death, an incitement to discourse? And
rather than late twentieth-century liberation the imposition of a new
regime of truth? Yes, the new and massive discourse on death within
medicine fitted almost exactly into the period of so-called silence. And
the new requirement from the 1960s that the dying should mourn their
own deaths fitted the point of so-called liberation (Armstrong 1987).

CONCLUSION
This has been a personal reading at many levels. It is a personal
reading, or perhaps re-reading, of some of my own work; indulgent
perhaps, but only to pay homage. Foucault's texts have been a constant
source of inspiration and, as I have tried to make clear, a cornucopia of
ideas and frameworks that I have unashamedly stolen: it is reassuring to
think that he might not have existed and therefore cannot take umbrage
28 David Armstrong

at these thefts acknowledged only casually by the conventional

superscript and bibliographic reference.
The essay is also a personal reading of the work of others. And as in
the debate over the ship of fools, others have read sentences and
concepts differently. Sometimes I have liked their reading, other times I
think they have missed the pearls. Nevertheless Foucault does seem to
have been an important influence, perhaps more cited over the last
decade than any other theoretical source.
Finally, this essay is a personal reading of Foucault. Like everyone
else, I have been reading Foucault and reading readers of Foucault
through a prism in which text and reader are simultaneously refracted
and reflected. The exact source of the light is therefore unclear, but this
is not a problem that should seriously concern us.

NOTE
See David McCallum's chapter (chapter 3) for further discussion of
'Foucault the historian', with particular reference to Madness.

REFERENCES
Anderson, J.M., EIfert, H. and Lai, M. (1989) 'Ideology in the clinical context:
chronic illness, ethnicity and the discourse on normalisation', Sociology of
Health & Illness, 11: 253-78.
Armstrong, D. (1979a) 'The emancipation of biographical medicine', Social
Science and Medicine, 13: 1-8.
Annstrong, D. (1979b) 'Madness and coping', Sociology ofHealth & Illness, 2:
293-316.
Annstrong, D. (1981a) 'Pathological life and death', Social Science and
Medicine, 15: 253-7.
Annstrong, D. (1981 b) 'Developments in medical thought and practice in the
twentieth century', Unpublished PhD thesis, London University.
Armstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in
Britain in the Twentieth Century, Cambridge: Cambridge University Press.
Annstrong, D. (1984) 'The patient's view', Social Science and Medicine, 18:
737--44.
Armstrong, D. (1985) 'Space and time in British general practice', Social
Science and Medicine, 20: 659-66.
Armstrong, D. (1986) 'The invention of infant mortality', Sociology of Health
& Illness, 8: 211-32.
Annstrong, D. (1987) 'Silence and truth in death and dying', Social Science and
Medicine, 24: 651-7.
Annstrong, D. (1993) 'Public health spaces and the fabrication of identity',
Sociology, 27: 393--410.
Annstrong, D. (1995) 'The rise of surveillance medicine', Sociology of Health
& Illness, 17: 393--404.
 Foucault and the sociology of health 29

Arney, W.R. (1982) Power and the Profession of Obstetrics, Chicago:

University of Chicago Press.
Arney, W.R. and Bergen, B.J. (1984) Medicine and the Management of Living,
Chicago: University of Chicago Press.
Atkinson, P. (1981) The Clinical Experience: The Construction and
Reconstruction of Medical Student Reality, Farnborough: Gower.
Bloor, M. and McIntosh, 1. (1990) 'Surveillance and concealment: a
comparison of techniques of client resistance in therapeutic communities
and health visiting', in S. Cunningham-Burley and N. McKeganey (eds)
Readings in Medical Sociology, London: Tavistock.
Brown, G.W and Harris, T. (1978) Social Origins of Depression, London:
Tavistock.
Brown, ~ (1985) The Transfer of Care: Psychiatric De-institutionalisation and
its Aftermath, London: Routledge.
Bunton, R. (1992) 'More than a woolly jumper: health promotion as social
regulation', Critical Public Health, 3, 2: 4-11.
Busfield, 1. (1986) Managing Madness: Changing Ideas and Practice, London:
Hutchinson.
Castel, R. (1989) The Psychiatric Order, Cambridge: Polity Press.
Daly, 1. (1989) 'Innocent murmurs: echocardiography and the diagnosis of
cardiac normality', Sociology of Health & Illness, 11: 99-116.
Foucault, M. (1965) Madness and Civilization, New York: Random House.
Foucault, M. (1973) The Birth of the Clinic: An Archaeology of Medical
Perception, London: Tavistock.
Foucault, M. (1977) Discipline and Punish: The Birth of the Prison, London:
Allen Lane.
Foucault, M. (1979) The History of Sexuality, Volume 1: An Introduction,
London: Allen Lane.
Fox, N.J. (1993a) Post-modernism, Sociology and Health, Buckingham: Open
University Press.
Fox, N.1. (1993b) 'Discourse, organisation and the surgical ward round',
Sociology of Health & Illness, 15: 16-42.
Freund, P.S. and McGuire, M.B. (1995) Health, Illness and the Social Body,
Englewood Cliffs, NJ: Prentice Hall.
Gerhardt, U. (1989) Ideas about Illness, London: Macmillan.
Goffman, E. (1961) Asylums, London: Allen Lane.
Gordon, C. (1992) 'Histoire de la folie: an unknown book by Michel Foucault',
in A. Still and I. Velody (eds) Rewriting the History of Madness, London:
Routledge.
Herzlich, C. (1973) Health and Illness: A Social Psychological Analysis,
London: Academic Press.
Illich, I. (1975) Medical Nemesis, London: Calder and Boyars.
Ingleby, D. (1980) Critical Psychiatry: The Politics of Mental Health, New
York: Pantheon.
Jones, K. (1972) A History of the Mental Health Services, London: Routledge.
Jones, K. (1993) Asylums and After: A Revised History of the Mental Health
Services: From the Early Eighteenth Century to the 1990s, London: Athlone.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated
Body, London: Sage.
30 David Armstrong

May, C. (1992) 'Nursing work, nurses' knowledge, and the subjectification of

the patient', Sociology of Health & Illness, 14: 472-87.
McKie, L. (1995) 'The art of surveillance or reasonable prevention? The case of
cervical screening', Sociology of Health & Illness, 17: 441-57.
Miles, A. (1981) The Mentally III in Contemporary Society, Oxford: Martin
Robertson.
Morgan, M., Calnan, M. and Manning, N. (1985) Sociological Approaches to
Health and Medicine, London: Croom Helm.
Nettleton, S. (1988) 'Protecting a vulnerable margin: towards an analysis of
how the mouth came to be separated from the body', Sociology ofHealth &
Illness, 10: 156-69.
Nettleton, S. (1992) Power, Pain and Dentistry, Buckingham: Open University
Press.
Nicholson, M. and McLaughlin, C. (1987) 'Social constructionism and medical
sociology: a reply to M.R. Bury', Sociology of Health & Illness, 9: 107-26.
Osborne, T. (1994) 'Power and persons: on ethical stylisation and person-
centred medicine', Sociology of Health & Illness, 16: 515-35.
Petersen, A.R. (1996) 'Risk and the regulated self: the discourse of health
promotion as politics of uncertainty' , Australian & New Zealand Journal of
Sociology, 32, 1: 44-57.
Pilgrim, D. and Rogers, A. (1993) A Sociology of Mental Health and Illness,
Buckingham: Open University Press.
Prior, L. (1989) The Social Organisation of Death: Medical Discourse and
Social Practices in Belfast, London: Macmillan.
Prior, L. (1993) The Social Organisation of Mental Illness, London: Sage.
Rose, N. (1985) The Psychological Complex, London: Routledge and Kegan
Paul.
Rose, N. (1990) Governing the Soul: The Shaping of the Private Self, London:
Routledge.
Scheff, T. (1966) Being Mentally Ill: A Sociological Theory, Chicago: Aldine.
Scull, A.T. (1977) Decarceration, Englewood Cliffs, NJ: Prentice Hall.
Sedgewick, ~ (1982) Psychopolitics, London: Pluto Press.
Sheridan, A. (1980) Michel Foucault: The Will to Truth, London: Tavistock.
Silvennan, D. (1987) Communication and Medical Practice, London: Sage.
Still, A. and Velody, I. (1992) Rewriting the History of Madness, London:
Routledge. -
Szasz, T. (1961) The Myth of Mental Illness: Foundations of a Theory of
Personal Conduct, New York: Hoeber-Harper.
Thornquist, E. (1995) 'Musculoskeletal suffering: a diagnosis and a variant
view', Sociology of Health & Illness, 17: 166-92.
Turner, B.S. (1984) The Body and Society: Explorations in Social Theory,
Oxford: Blackwell.
Turner, B.S. (1987) Medical Power and Social Knowledge, London: Sage.
Turner, B.S. (1992) Regulating Bodies: Essays in Medical Sociology, London:
Routledge.
Foucault and the sociology of health and illness
Anderson, J.M. , Elfert, H. and Lai, M. (1989) ‘Ideology in the clinical context: chronic illness, ethnicity and the discourse on normalisation’,
Sociology of Health & Illness, 11: 253–278.
Armstrong, D. (1979 a) ‘The emancipation of biographical medicine’, Social Science and Medicine, 13: 1–8.
Armstrong, D. (1979 b) ‘Madness and coping’, Sociology of Health & Illness, 2: 293–316.
Armstrong, D. (1981 a) ‘Pathological life and death’, Social Science and Medicine, 15: 253–257.
Armstrong, D. (1981 b) ‘Developments in medical thought and practice in the twentieth century’, Unpublished PhD thesis, London
University.
Armstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century, Cambridge: Cambridge
University Press.
Armstrong, D. (1984) ‘The patient’s view’, Social Science and Medicine, 18: 737–744.
Armstrong, D. (1985) ‘Space and time in British general practice’, Social Science and Medicine, 20: 659–666.
Armstrong, D. (1986) ‘The invention of infant mortality’, Sociology of Health & Illness, 8: 211–232.
Armstrong, D. (1987) ‘Silence and truth in death and dying’, Social Science and Medicine, 24: 651–657.
Armstrong, D. (1993) ‘Public health spaces and the fabrication of identity’, Sociology, 27: 393–410.
Armstrong, D. (1995) ‘The rise of surveillance medicine’, Sociology of Health & Illness, 17: 393–404.
Arney, W.R. (1982) Power and the Profession of Obstetrics, Chicago: University of Chicago Press.
Arney, W.R. and Bergen, B.J. (1984) Medicine and the Management of Living, Chicago: University of Chicago Press.
Atkinson, P. (1981) The Clinical Experience: The Construction and Reconstruction of Medical Student Reality, Farnborough: Gower.
Bloor, M. and McIntosh, J. (1990) ‘Surveillance and concealment: a comparison of techniques of client resistance in therapeutic
communities and health visiting’, in S. Cunningham-Burley and N. McKeganey (eds) Readings in Medical Sociology, London: Tavistock.
Brown, G.W. and Harris, T. (1978) Social Origins of Depression, London: Tavistock.
Brown, P. (1985) The Transfer of Care: Psychiatric De-institutionalisation and its Aftermath, London: Routledge.
Bunton, R. (1992) ‘More than a woolly jumper: health promotion as social regulation’, Critical Public Health, 3, 2: 4–11.
Busfield, J. (1986) Managing Madness: Changing Ideas and Practice, London: Hutchinson.
Castel, R. (1989) The Psychiatric Order, Cambridge: Polity Press.
Daly, J. (1989) ‘Innocent murmurs: echocardiography and the diagnosis of cardiac normality’, Sociology of Health & Illness, 11: 99–116.
Foucault, M. (1965) Madness and Civilization, New York: Random House.
Foucault, M. (1973) The Birth of the Clinic: An Archaeology of Medical Perception, London: Tavistock.
Foucault, M. (1977) Discipline and Punish: The Birth of the Prison, London: Allen Lane.
Foucault, M. (1979) The History of Sexuality, Volume 1: An Introduction, London: Allen Lane.
Fox, N.J. (1993 a) Post-modernism, Sociology and Healthy, Buckingham: Open University Press.
Fox, N.J. (1993 b) ‘Discourse, organisation and the surgical ward round’, Sociology of Health & Illness, 15: 16–42.
Freund, P.S. and McGuire, M.B. (1995) Health, Illness and the Social Body, Englewood Cliffs, NJ: Prentice Hall.
Gerhardt, U. (1989) Ideas about Illness, London: Macmillan.
Goffman, E. (1961) Asylums, London: Allen Lane.
Gordon, C. (1992) ‘ Histoire de la folie: an unknown book by Michel Foucault’, in A. Still and I. Velody (eds) Rewriting the History of
Madness, London: Routledge.
Herzlich, C. (1973) Health and Illness: A Social Psychological Analysis, London: Academic Press.
Illich, I. (1975) Medical Nemesis, London: Calder and Boyars.
Ingleby, D. (1980) Critical Psychiatry: The Politics of Mental Health, New York: Pantheon.
Jones, K. (1972) A History of the Mental Health Services, London: Routledge.
Jones, K. (1993) Asylums and After: A Revised History of the Mental Health Services: From the Early Eighteenth Century to the 1990s,
London: Athlone.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body, London: Sage.
May, C. (1992) ‘Nursing work, nurses’ knowledge, and the subjectification of the patient’, Sociology of Health & Illness, 14: 472–487.
McKie, L. (1995) ‘The art of surveillance or reasonable prevention? The case of cervical screening’, Sociology of Health & Illness, 17:
441–457.
Miles, A. (1981) The Mentally Ill in Contemporary Society, Oxford: Martin Robertson.
Morgan, M. , Calnan, M. and Manning, N. (1985) Sociological Approaches to Health and Medicine, London: Croom Helm.
Nettleton, S. (1988) ‘Protecting a vulnerable margin: towards an analysis of how the mouth came to be separated from the body’,
Sociology of Health & Illness, 10: 156–169.
Nettleton, S. (1992) Power, Pain and Dentistry, Buckingham: Open University Press.
Nicholson, M. and McLaughlin, C. (1987) ‘Social constructionism and medical sociology: a reply to M.R. Bury’, Sociology of Health &
Illness, 9: 107–126.
Osborne, T. (1994) ‘Power and persons: on ethical stylisation and person-centred medicine’, Sociology of Health & Illness, 16: 515–535.
Petersen, A.R. (1996) ‘Risk and the regulated self: the discourse of health promotion as politics of uncertainty’, Australian & New Zealand
Journal of Sociology, 32, 1: 44–57.
Pilgrim, D. and Rogers, A. (1993) A Sociology of Mental Health and Illness, Buckingham: Open University Press.
Prior, L. (1989) The Social Organisation of Death: Medical Discourse and Social Practices in Belfast, London: Macmillan.
Prior, L. (1993) The Social Organisation of Mental Illness, London: Sage.
Rose, N. (1985) The Psychological Complex, London: Routledge and Kegan Paul.
Rose, N. (1990) Governing the Soul: The Shaping of the Private Self, London: Routledge.
Scheff, T. (1966) Being Mentally Ill: A Sociological Theory, Chicago: Aldine.
Scull, A.T. (1977) Decarceration, Englewood Cliffs, NJ: Prentice Hall.
Sedgewick, P. (1982) Psychopolitics, London: Pluto Press.
Sheridan, A. (1980) Michel Foucault: The Will to Truth, London: Tavistock.
Silverman, D. (1987) Communication and Medical Practice, London: Sage.
Still, A. and Velody, I. (1992) Rewriting the History of Madness, London: Routledge.
Szasz, T. (1961) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, New York: Hoeber-Harper.
Thornquist, E. (1995) ‘Musculoskeletal suffering: a diagnosis and a variant view’, Sociology of Health & Illness, 17: 166–192.
Turner, B.S. (1984) The Body and Society: Explorations in Social Theory, Oxford: Blackwell.
Turner, B.S. (1987) Medical Power and Social Knowledge, London: Sage.
Turner, B.S. (1992) Regulating Bodies: Essays in Medical Sociology, London: Routledge.

Is there life after Foucault?

Armstrong, D. (1983) The Political Anatomy of the Body, Cambridge: Cambridge University Press.
Barthes, R. (1977) Image-Music-Text, Glasgow: Collins Fontana.
Bertholet, J.M. (1991) ‘Sociological discourse and the body’, in M. Featherstone , M. Hepworth and B. Turner (eds) The Body: Social
Process and Cultural Theory, London: Sage.
Brown, B. and Cousins, M. (1986) ‘The linguistic fault: the case of Foucault’s archaeology’, in M. Gane (ed.) Towards a Critique of
Foucault, London: Routledge and Kegan Paul.
Butler, J. (1990) Gender Trouble: Feminism and the Subversion of Identity, London: Routledge.
Cixous, H. (1990) ‘The laugh of the Medusa’, in R. Walder (ed.) Literature in the Modern World: Critical Essays and Documents, Oxford:
Oxford University Press.
Collins, H. (1994) ‘Dissecting surgery: forms of life depersonalized’, Social Studies of Science, 24, 2: 311–334.
Deleuze, G. and Guattari, F. (1984) Anti-Oedipus: Capitalism and Schizophrenia, London: Athlone.
Deleuze, G. and Guattari, F. (1988) A Thousand Plateaus, London: Athlone.
Derrida, J. (1987) The Truth in Painting, Chicago: University of Chicago Press.
Donnelly, M. (1986) ‘Foucault’s genealogy of the human sciences’, in M. Gane (ed.) Towards a Critique of Foucault, London: Routledge
and Kegan Paul.
Dreyfus, H.L. and Rabinow, P. (1982) Michel Foucault: Beyond Structuralism and Hermeneutics, Chicago: University of Chicago Press.
Foucault, M. (1974) The Archaeology of Knowledge, London: Tavistock.
Foucault, M. (1976) Birth of the Clinic. An Archaeology of Medical Perception, London: Tavistock.
Foucault, M. (1977 a) ‘What is an author?’, in D.F. Bouchard (ed.) Language, Counter-Memory, Practice, Oxford: Blackwell.
Foucault, M. (1977 b) ‘History of systems of thought’, in D.F. Bouchard (ed.) Language, Counter-Memory, Practice, Oxford: Blackwell.
Foucault, M. (1977 c) ‘Theatrum Philosophicum’, in D.F. Bouchard (ed.) Language, Counter-Memory, Practice, Oxford: Blackwell.
Foucault, M. (1979) Discipline and Punish: The Birth of the Prison, Harmondsworth: Peregrine.
Foucault, M. (1980 a) ‘The eye of power’, in C. Gordon (ed.) Power/Knowledge, Brighton: Harvester Press.
Foucault, M. (1980 b) ‘Truth and power’, in C. Gordon (ed.) Power/Knowledge, Brighton: Harvester Press.
Foucault, M. (1980 c) ‘Two lectures’, in C. Gordon (ed.) Power/Knowledge, Brighton: Harvester Press.
Foucault, M. (1980 d) ‘The confession of the flesh’, in C. Gordon (ed.) Power/Knowledge, Brighton: Harvester Press.
Foucault, M. (1981) The History of Sexuality, Vol. 1: An Introduction, Harmondsworth: Penguin.
Foucault, M. (1985) The Use of Pleasure (Vol. 2 of the History of Sexuality), New York: Pantheon.
Foucault, M. (1986) The Care of the Self (Vol. 3 of the History of Sexuality), New York: Pantheon.
Foucault, M. (1988) ‘Technologies of the self’, in L.H. Martin , H. Gutman and P.H. Hutton (eds) Technologies of the Self: A Seminar with
Michel Foucault, London: Tavistock.
Fox, N.J. (1992) The Social Meaning of Surgery, Buckingham: Open University Press.
Fox, N.J. (1993) Postmodernism, Sociology and Health, Buckingham: Open University Press.
Fox, N.J. (1995) ‘Intertextuality and the writing of social research’, Electronic Journal of Sociology 1, 3: no page numbers.
Freundlieb, D. (1994) ‘Foucault’s theory of discourse and human agency’, in C. Jones and R. Porter (eds) Reassessing Foucault: Power,
Medicine and the Body, London: Routledge.
Game, A. (1991) Undoing the Social: Towards a Deconstructive Sociology, Buckingham: Open University Press.
Haber, H. (1994) Beyond Postmodern Politics: Lyotard, Rorty, Foucault, London: Routledge.
Hacking, I. (1986) ‘The archaeology of Foucault’, in D.C. Hoy (ed.) Foucault: A Critical Reader, Oxford: Blackwell.
Hoy, D.C. (1986) ‘Introduction’, in D.C. Hoy (ed.) Foucault: A Critical Reader, Oxford: Blackwell.
Lash, S. (1991), ‘Genealogy and the body: Foucault/Deleuze/Nietzsche’, in M. Featherstone , M. Hepworth and B.S. Turner (eds) The
Body: Social Process and Cultural Theory, London: Sage.
Lupton, D. (1994) Medicine as Culture: Illness, Disease and the Body in Western Societies, London: Sage.
Lyotard, J. (1988) The Differend: Phrases in Dispute, Minneapolis: University of Minnesota Press.
McNay, L. (1992) Foucault and Feminism: Power, Gender and the Self Oxford: Polity.
Martin, R. (1988) ‘Truth, power, self: an interview with Michel Foucault’, in L.H. Martin , H. Gutman and P.H. Hutton (eds) Technologies of
the Self: A Seminar with Michel Foucault, London: Tavistock.
Nettleton, S. (1992) Power, Pain and Dentistry, Buckingham: Open University Press.
Nettleton, S. (1995) The Sociology of Health and Illness, Cambridge: Polity.
Pizzorno, A. (1992) ‘Foucault and the liberal view of the individual’, in T.J. Armstrong (ed.) Michel Foucault, Philosopher, New York:
Harvester Wheatsheaf.
Poster, M. (1986) ‘Foucault and the tyranny of Greece’, in D.C. Hoy (ed.) Foucault: A Critical Reader, Oxford: Blackwell.
Rorty, R. (1992) ‘Moral identity and private autonomy’, in T.J. Armstrong (ed.) Michel Foucault, Philosopher, New York: Harvester
Wheatsheaf.
Silverman, D. (1985) Qualitative Methodology and Sociology, Aldershot: Gower.
Smart, B. (1985) Michel Foucault, London: Tavistock.
Turner, B. (1984) The Body and Society: Explorations in Social Theory, Oxford: Blackwell.
Turner, B. (1992) Regulating Bodies: Essays in Medical Sociology, London: Routledge.
Valverde, M. (1991) ‘As if subjects exist; analysing social discourses’, Canadian Review of Anthropology and Sociology, 28, 2: 173–187.
Wickham, G. (1986) ‘Power and power analysis: beyond Foucault?’, in M. Gane (ed.) Towards a Critique of Foucault, London: Routledge.

Mental health, criminality and the human sciences

American Psychiatric Association (1982) Diagnostic and Statistical Manual of Mental Disorders (3rd edition revised), Washington DC:
American Psychiatric Association.
Armstrong, D. (1993) ‘Public health spaces and the fabrication of identity’, Sociology, 27, 3: 393–410.
Bartholomew, A. and Milte, K. (1976) ‘The reliability and validity of psychiatric diagnoses in courts of law’, The Australian Law Journal, 50:
450–458.
Berry, R.J.A. (1924) ‘The correlation of recent advances in cerebral structure and function with feeble-mindedness and its diagnostic
applicability’, Medical Journal of Australia, 7 June: 393ff.
Binet, A. and Simon, T. (1905) ‘New methods for the diagnosis of the intellectual level of sub-normals’, in The Development of Intelligence
in Children, New Jersey: Vineland Training School.
Blackstone, W. (1972) Commentaries on the Laws of England, 1765–9, Oxford: Oxford University Press.
Bleechmore, J.F. (1975) ‘Towards a rational theory of criminal responsibility: the psychopathic offender’, Melbourne University Law
Review, 10, 1: 19–46.
Bostock, J. (1968) The Dawn of Australian Psychiatry, Sydney: Medical Publishing Company.
Burchell, G. (1993) ‘Liberal government and techniques of the self’, Economy and Society, 22, 3: 267–282.
Campbell, L.G. (1988) Mental Disorder and Criminal Law in Australia and New Zealand, Sydney: Butterworths.
Cleckley, H. (1941) The Mask of Sanity: An Attempt to Clarify Some Issues about the So-called Psychopathic Personality, St Louis: C.V
Mosby and Co.
Cocozza, J. and Steadman, H , (1976) ‘The failure of psychiatric predictions of dangerousness: clear and convincing evidence’, Rutgers
Law Review, 30: 1084–1101.
Coppe, L. (1986) ‘Insane or greatly injured? The Captain Hyndman case’, in 1838 volume, Collective of Australian Bicentennial History,
The Push from the Bush, 23: 55–57.
Cummins, C.J. (1967) The Administration of Lunacy and Idiocy in New South Wales 1788–1855, Sydney: NSW Department of Public
Health.
Danziger, K. (1990) Constructing the Subject. Historical Origins of Psychological Research, New York: Cambridge University Press.
Dax, E. Cunningham (1981) ‘Crimes, follies and misfortunes in the history of Australasian psychiatry’, Australian and New Zealand Journal
of Psychiatry, 15: 257–263.
Deleuze, G. (1993) Foucault, Minnesota: University of Minnesota Press.
Ellard, J. (1989) Some Rules for Killing People, Sydney: Angus and Robertson.
Ellis, A. S. (1983) Eloquent Testimony: The Story of the Mental Health Services in Western Australia, Nedlands: University of Western
Australia Press.
Ernest Jones, W. (1929) Report of Mental Deficiency in the Commonwealth of Australia, Canberra: H.J. Green Government Printer.
Fairall, P. (1993) ‘Violent offenders and community protection in Victoria – the Gary David experience’, Criminal Law Journal, 17: 40–54.
Floud, J. and Young, W. (1981) Dangerousness and Criminal Justice, Heinemann: London.
Foucault, M. (1965) Madness and Civilization, trans. R. Howard , New York: Vintage.
Foucault, M. (1980) ‘Body/power’, in C. Gordon (ed.) Power/Knowledge: Selected Interviews and Other Writings by Michel Foucault,
1972–1977, New York: Pantheon.
Foucault, M. (1988) ‘The dangerous individual’, in L.D. Kritzman (ed.) Michel Foucault: Politics, Philosophy, Culture, New York: Routledge.
Foucault, M. (1991) ‘Questions of method’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in Governmentality,
London: Harvester Wheatsheaf.
Garton, S. (1982) ‘“Bad or mad”. Developments in incarceration in NSW’, in Sydney Labour History Group What Rough Beast? The State
and Social Order in Australian History, Sydney: Allen and Unwin.
Glaser, W. (1990) ‘Morality and medicine’, Legal Service Bulletin, 15, 3: 114–116.
Glaser, W. (1994) ‘Commentary: Gary David, psychiatry, and the discourse of dangerousness’, Australian and New Zealand Journal of
Criminology, 27: 46–49.
Gordon, C. (1990) ‘ Histoire de la folie: an unknown book by Michel Foucault’, History of the Human Sciences, 3, 1: 3–26.
Gutting, G. (1994) ‘Foucault and the history of madness’, in G. Gutting (ed.) The Cambridge Companion to Foucault, Cambridge:
Cambridge University Press.
Hacking, I. (1986) ‘Making up people’, in T. Heller , S. Morton and D. Wellber (eds) Reconstructing Individualism: Autonomy, Individuality
and the Self in Western Thought, Stanford: Stanford University Press.
Hacking, I. (1990) The Taming of Chance, Cambridge: Cambridge University Press.
Historical Records of Australia (1914) Series 1, Governors’ Despatches to and from England, vol. 1, 1788–1796, The Library Committee of
the Commonwealth Parliament, 2–8.
Kissane, K. (1990) ‘Are they mad or bad? Lawyers and psychiatrists differ on how to protect society from violent psychopaths’, Time
Australia, 135, 5 (June): 42–43.
Law Reform Commission of Victoria (1990) The Concept of Mental Illness in the ‘Mental Health Act’ 1980, No. 31, Melbourne: Government
Printer.
McCallum, D. (1990) The Social Production of Merit Education, Psychology and Politics in Australia, 1900–1950, London: Falmer.
Mercier, C. (1911) Crime and Insanity, London: Williams and Norgate.
Midelfort, H.C. Eric (1980) ‘Madness and civilisation in early modem Europe: a reappraisal of Michel Foucault’, in B. Malament (ed.) After
the Reformation: Essays in Honor of J.H Hexter, Philadelphia: University of Philadelphia Press.
Miller, P. and Rose, N. (1988) ‘The Tavistock Program: the government of subjectivity and social life’, Sociology, 22, 2: 171–192.
Miller, P. and Rose, N. (1990) ‘Governing economic life’, Economy and Society, 19, 1: 1–31.
Minson, J. (1985) Genealogies of Morals. Nietzsche, Foucault, Donzelot and the Eccentricity of Ethics, New York: St Martin’s Press.
New South Wales Mental Hygiene Authority , Annual Reports, 1934–1950, Sydney: Government Printer.
O’Brien, P. (1989) ‘Michel Foucault’s history of culture’, in Lynn Hunt (ed.) The New Cultural History, Berkeley: University of California
Press.
O’Sullivan, J. (1981) Mental Health and the Law, Sydney: The Law Book Company.
Parker, N. (1991) ‘The Gary David case’, Australian and New Zealand Journal of Psychiatry, 25: 371–374.
Reid, W. (1985) ‘Psychopathy and dangerousness’, in M. Roth and R. Blugrass (eds) Psychiatry, Human Rights and the Law, Cambridge:
Cambridge University Press.
Report of the Royal Commission on the Care and Control of the Feeble-minded (1908) London: HMSO.
Rose, N. (1985) The Psychological Complex: Psychology, Politics and Society in England, 1869–1939, London: Routledge and Kegan
Paul.
Rose, N. (1988) ‘Calculable minds and manageable individuals’, History of the Human Sciences, 1: 179–200.
Rose, N. (1990) Governing the Soul: The Shaping of the Private Self London: Routledge.
Victoria, Inspector-General of Insane , Annual Reports, 1905–1933.
Weeks, J. (1982) ‘Foucault for historians’, History Workshop, 14: 106–119.
Williams, C. R. (1990) ‘Psychopathy, mental illness and preventive detention: issues arising from the David case’, Monash University Law
Review, 16, 2: 161–183.

At risk of maladjustment The problem of child mental health

Campbell, A.W. (1935) ‘Psychoses of adolescence’, Medical Journal of Australia, 12 October: 479.
Castel, R. (1991) ‘From dangerousness to risk’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect, Studies in
Governmentality, Hemel Hempstead: Harvester Wheatsheaf.
Cunningham, K.S. (1932) ‘Problem children in Melbourne schools’, Australian Education Studies (First Series), Melbourne: Melbourne
University Press.
Dawson, W.S. (1935) ‘Psychoses of adolescence’, Medical Journal of Australia, 12 October: 478–479.
Farran-Ridge, C. (1935) ‘Psychoses of adolescence’, Medical Journal of Australia, 12 October: 479.
Foucault, M. (1976) ‘On governmentality’, Ideology & Consciousness, 6: 5–21.
Foucault, M. (1977) ‘Nietzsche, genealogy, history’, in D. Bouchard (ed.), Language, Counter-Memory, Practice, Ithaca: Cornell University
Press.
Foucault, M. (1981) ‘Questions of method: an interview with Michel Foucault’, Ideology & Consciousness, 8: 4–14.
Foucault, M. (1988) ‘Technologies of the self’, in L.H. Martin , H. Gutman and P.H. Hutton (eds) Technologies of the Self A Seminar with
Michel Foucault, Cambridge, Massachusetts: University of Massachusetts Press.
Gutteridge, M.V. (1932) ‘The story of an Australian nursery school’, Australian Education Studies (First Series), Melbourne: Melbourne
University Press.
Gutteridge, M.V. (1935) The Duration of Attention in Young Children, no. 41, Melbourne: Melbourne University Press.
Heath, S. (1995) ‘Easygoing children find life easier’, The Age, 6 December: 4.
Legge, K. (1995) ‘Boy have we got trouble’, Australian Magazine, 11–12 March: 26–31.
Lush, M. (1926) Progressive Kindergarten Methods, Melbourne: Lothian Press.
Prior, M. (1989) ‘The Australian Temperament Project’, in G.A. Kohnstamm , J.E. Bates and M.K. Rothbart (eds) Temperament in
Childhood, Chichester: John Wiley and Sons.
Prior, M. (1992) ‘Development of temperament’, in P.C. Heaven (ed.) Life-span Development, Marrickville: Harcourt Brace Jovanovich.
Riley, D. (1988) ‘Am I That Name?’ Feminism and the Category of Women in History, London: Macmillan.
Rose, N. (1985) The Psychological Complex: Psychology, Politics and Society in England 1869–1939, London: Routledge and Kegan
Paul.
Rose, N. (1988) ‘Calculable minds and manageable individuals’, History of the Human Sciences, 1, 2: 179–200.
Rose, N. (1989) Governing the Soul. The Shaping of the Private Self, London: Routledge.
Sanson, A. , Prior, M. and Kyrios, M. (1990) ‘Contamination of measures in temperament research’, Merrill-Palmer Quarterly, 36, 2:
179–192.
Sanson, A. , Prior, M. , Smart, D. and Oberklaid, F. (1993) ‘Gender differences in aggression in childhood: implications for a peaceful
world’, Australian Psychologist, 28, 2: 86–92.
Sweet, M. (1995) ‘Boys: sadder and badder than girls’, Sydney Morning Herald, 5 April: 1.
Tyler, D. (1993) ‘Making better children’, in D. Meredyth and D. Tyler (eds) Child and Citizen, Genealogies of Schooling and Subjectivity,
Brisbane: Institute of Cultural Policy Studies.
Walkerdine, V (1985) ‘On the regulation of speaking and silence: subjectivity, class and gender in contemporary schooling’, in C.
Steedman , C. Urwin and V Walkerdine (eds) govemmentality Childhood, London: Routledge and Kegan Paul.
Williams, J.F. (1932) ‘Child guidance work in a public hospital’, Medical Journal of Australia, 3 September: 294–299.
Williams, J.F. (1935) ‘Psychoses of adolescence’, Medical Journal of Australia, 12 October: 480.
Williams, J.F. (1938) ‘Mental hygiene of the pre-school child’, Medical Journal of Australia, 30 July: 145–148.
Foucault and the medicalisation critique
Armstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century, Cambridge: Cambridge
University Press.
Armstrong, D. (1984) ‘The patient’s view’, Social Science and Medicine, 18, 9: 737–744.
Armstrong, D. (1987) ‘Bodies of knowledge: Foucault and the problem of human anatomy’, in G. Scambler (ed.) Sociological Theory and
Medical Sociology, London: Tavistock.
Armstrong, D. (1994) ‘Bodies of knowledge/knowledge of bodies’, in C. Jones and R. Porter (eds) Reassessing Foucault: Power, Medicine
and the Body, London: Routledge.
Atkinson, P. (1995) Medical Talk and Medical Work, London: Sage.
Bloor, M. and McIntosh, J. (1990) ‘Surveillance and concealment: a comparison of techniques of client resistance in therapeutic
communities and health visiting’, in S. Cunningham-Burley and N. McKeganey (eds) Readings in Medical Sociology, London: Routledge.
de Swaan, A. (1990) The Management of Normality: Critical Essays in Health and Welfare, London: Routledge.
Ehrenreich, B. and English, D. (1974) Complaints and Disorders: The Sexual Politics of Sickness, London: Compendium.
Foucault, M. (1967) Madness and Civilization: A History of Insanity in the Age of Reason, London: Tavistock.
Foucault, M. (1975) The Birth of the Clinic: An Archaeology of Medical Perception, New York: Vintage Books.
Foucault, M. (1977) Discipline and Punish: The Birth of the Prison, London: Allen Lane.
Foucault, M. (1980) ‘Body/power’, in C. Gordon (ed.) Power/Knowledge: Selected Interviews and Other Writings, 1972–1977, New York:
Pantheon.
Foucault, M. (1984 a) ‘Truth and power’, in P. Rabinow (ed.) The Foucault Reader, New York: Pantheon.
Foucault, M. (1984 b) ‘Space, knowledge, and power’, in P. Rabinow (ed.) The Foucault Reader, New York: Pantheon.
Foucault, M. (1986) The Care of the Self Volume 3 of the History of Sexuality, New York: Pantheon.
Foucault, M. (1988) ‘The political technology of individuals’, in L.H. Martin , H. Gutman and P.H. Hutton (eds) Technologies of the Self: A
Seminar with Michel Foucault, London: Tavistock.
Fox, N. (1995) ‘Postmodern perspectives on care: the vigil and the gift’, Critical Social Policy, 15, 44/5: 107–125.
Freidson, E. (1970) Professional Dominance: The Social Structure of Medical Care, Chicago: Aldine.
Gerhardt, U. (1989) Ideas about Illness: An Intellectual and Political History of Medical Sociology, New York: New York University Press.
Henriques, J. , Hollway, W. , Urwin, C. , Venn, C. and Walkerdine, V. (1984) ‘Theorizing subjectivity’, in J. Henriques , W. Hollway , C.
Urwin , C. Venn and V. Walkerdine , Changing the Subject: Psychology, Social Regulation and Subjectivity, London: Methuen.
Illich, I. (1975) Medical Nemesis, London: Calder and Boyars.
Lupton, D. (forthcoming) “‘Your life in their hands”: trust in the medical encounter’, in V James and J. Gabe (eds) Health and the Sociology
of Emotion, Oxford: Blackwell Publishers.
May, C. (1992) ‘Nursing work, nurses’ knowledge, and the subjectification of the patient’, Sociology of Health & Illness, 14, 4: 472–487.
Osborne, T. (1994) ‘On anti-medicine and clinical reason’, in C. Jones and R. Porter (eds) Reassessing Foucault: Power, Medicine and the
Body, London: Routledge.
Porter, S. (1996) ‘Contra-Foucault: soldiers, nurses and power’, Sociology, 30, 1: 59–78.
Rose, N. (1994) ‘Medicine, history and the present’, in C. Jones and R. Porter (eds) Reassessing Foucault: Power, Medicine and the Body,
London: Routledge.
Shilling, C. (1991) ‘Educating the body: physical capital and the production of social inequalities’, Sociology, 25, 4: 653–672.
Stein, H. (1985) The Psychodynamics of Medical Practice: Unconscious Factors in Patient Care, Berkeley, CA: University of California
Press.
Waitzkin, H. (1984) ‘The micropolitics of medicine: a contextual analysis’, International Journal of Health Services, 14, 3: 339–378.
Zola, I. (1972) ‘Medicine as an institution of social control’, Sociological Review, 20: 487–503.

Is health education good for you?

Armstrong, D. (1995) ‘The rise of surveillance medicine’, Sociology of Health & Illness, 17, 3: 393–404.
Barret-Kriegel, B. (1992) ‘Michel Foucault and the police state’, in T.J. Armstrong (ed. and trans.) Michel Foucault, Philosopher:
International Conference, London: Routledge.
Beattie, A. (1991) ‘Knowledge and control in health promotion: a test case for social policy and social theory’, in J. Gabe , M. Calnan and
M. Bury (eds) The Sociology of the Health Service, London: Routledge.
Brasil, Ministério da Saúde (1980) Educação em Saúde nas unidades federadas [Health education in the federation unities], Brasília:
Ministério da Saúde.
Brasil, Ministério da Saúde (1981) Ação educativa nos serviços básicos de Saúde [Educative action in the basic health services], Brasília:
Ministério da Saúde.
Brasil, Ministério da Saúde (1982 a) Ação participativa: metodologia [Participatory action: methodology], Brasília: Ministério da Saúde.
Brasil, Ministério da Saúde (1982 b) Ação participativa: avaliação de experiências [Participatory action: evaluating experiences], Brasília:
Ministério da Saúde.
Brasil, Ministério da Saúde (1982 c) Ação participativa: capacitagão de pessoal [Participatory action: human resources education],
Brasília: Ministério da Saúde.
Brasil, Ministério da Saúde (1983) Ação participativa: produção de materials instrucionais [Participatory action: production of educational
materials], Brasília: Ministério da Saúde.
Brasil, Ministério da Saúde (1984) Ação participativa: perspectivas de atuação dos educadores de Saúde pública [Participatory action:
perspectives on health education practice], Brasília: Ministério da Saúde.
Brasil, Ministério da Saúde (1989) Educação em Saúde – diretrizes [Health education – guidelines], Brasília: Ministério da Saúde.
Brasil, Ministério da Saúde (1992) Educação para a participação em Saúde [Education for participation in health], Brasília: Ministério da
Saúde.
Bunton, R. (1992) ‘Health promotion as social policy’, in R. Bunton and G. Macdonald Health Promotion – Disciplines and Diversity,
London: Routledge.
Canguilhem, G. (1989) The Normal and Pathological, New York: Zone Books.
Caplan, R. and Holland, R. (1990) ‘Rethinking health education theory’, Health Education Journal, 49, 1: 10–12.
Catford, J. and Nutbeam, D. (1984) ‘Towards the definition of health education and health promotion’, Health Education Journal, 43, 2–3:
38.
Codd, J. (1988) ‘The construction and deconstruction of educational policy documents’, Journal of Education Policy, 3, 3: 235–247.
Cowen, M.F. and Gastaldo, D. (1995) Paulo Freire at the Institute, London: Institute of Education.
Crawford, R. (1980) ‘Healthism and the medicalisation of everyday life’, International Journal of Health Services, 10, 3: 365–388.
Dean, M. (1992) ‘A genealogy of the government of poverty’, Economy and Society, 21, 3: 215–251.
Donnelly, M. (1992) ‘On Foucault’s uses of the notion “biopower’”, in T.J. Armstrong (ed. and trans.) Michel Foucault, Philosopher:
International Conference, London: Routledge.
Dreyfus, H. and Rabinow, R (1982) Michel Foucault – Beyond Structuralism and Hermeneutics, Brighton: Harvester Press.
Ewald, F. (1992) ‘A power without exterior’, in T.J. Armstrong (ed. and trans.) Michel Foucault Philosopher: International Conference,
London: Routledge.
Foucault, M. (1970) The Order of Things – An Archaeology of the Human Sciences, New York: Random House.
Foucault, M. (1976) ‘Governmentality’, Ideology and Consciousness, 6: 5–21.
Foucault, M. (1990) The History of Sexuality, Volume I: An Introduction, London: Penguin.
Foucault, M. (1991) Discipline and Punish – The Birth of the Prison, London: Penguin.
Gastaldo, D. (1996) ‘Is health education good for you? The social construction of health education in the Brazilian national health system’,
PhD thesis, University of London.
Gordon, C. (1991) ‘Governmental rationality: an introduction’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in
Governmental Rationality, Hemel Hempstead: Harvester Wheatsheaf.
Griffiths, J. and Adams, L. (1991) ‘The new health promotion’, in P. Draper (ed.) Health through Public Policy, London: Grenn Print.
Hakosalo, H. (1991) Bio-power and Pathology, Oulu: University of Oulu Press.
Ham, C. (1992) Health Policy in Britain, 3rd edn, London: Macmillan.
Hewitt, M. (1991) ‘Bio-politics and social policy: Foucault’s account of welfare’, in M. Featherstone , M. Hepworth and B. Turner (eds) The
Body – Social Process and Cultural Theory, London: Sage.
Lupton, D. (1995) The Imperative of Health – Public Health and the Regulated Body, London: Sage.
Milio, N. (1990) ‘Healthy cities: the new public health and supportive research’, Health Promotion International, 5, 4: 291–297.
Pederson, A. , Edwards, R. , Marshall, V , Allison, K. and Keiner, M. (1989) Coordinating Healthy Public Policy – An Analytic Literature
Review and Bibliography, Toronto: Minister of National Health and Welfare.
Petersen, A. (1996) ‘Risk and the regulated self: the discourse of health promotion as politics of uncertainty’, Australian & New Zealand
Journal of Sociology, 32, 1: 44–57.
Rodmell, S. and Watt, A. (eds) (1986) The Politics of Health Education, London: Routledge.
Seedhouse, D. (1986) Health – The Foundations for Achievement, Chichester: John Wiley and Sons.
Seymour, H. (1984) ‘Health education versus health promotion – a practitioner’s view’, Health Education Journal, 43, 2–3: 37–38.
Taylor, V. (1990) ‘Health education – a theoretical mapping’, Health Education Journal, 49, 1: 13–14.
Tones, K. (1990) ‘Why theorise? Ideology in health education’, Health Education Journal, 49, 1: 2–6.
Weare, K. (1992) ‘The contribution of education to health promotion’, in R. Bunton and G. Macdonald (eds) Health Promotion – Disciplines
and Diversity, London: Routledge.

Bodies at risk
Butler, J. (1990 a) Gender Trouble. Feminism and the Subversion of Identity, New York and London: Routledge.
Butler, J. (1990 b) ‘Gender trouble, feminist theory, and psychoanalytic discourse’, in L. Nicholson (ed.) Feminism/Postmodernism, New
York and London: Routledge.
Butler, J. (1992) ‘Contingent foundations: feminism and the question of “postmodernism”‘, in J. Butler and J. Scott (eds) Feminists Theorize
the Political, New York and London: Routledge.
Coney, S. (1991) The Menopause Industry: A Guide to Medicine’s ‘Discovery’ of the Mid-life Woman, Auckland: Penguin Books.
Finkelstein, J. (1990) ‘Bio-medicine and technocratic power’, Hastings Center Report, 20, 4: 13–16.
Foucault, M. (1979) Discipline and Punish: The Birth of the Prison, New York: Vintage Books.
Foucault, M. (1981) The History of Sexuality, Volume I: An Introduction, Harmondsworth, Middlesex: Penguin Books.
Foucault, M. (1986) The Archaeology of Knowledge, London: Tavistock.
Goldman, L. and Tosteson, A. (1991) ‘Uncertainty about postmenopausal estrogen’, editorial, The New England Journal of Medicine, 235,
11: 800–802.
Gorman, T. and Whitehead, M. (1989) The Amarant Book of Hormone Replacement Therapy, London: Pan Books.
Greer, G. (1991) The Change: Women, Ageing and the Menopause, London: Hamish Hamilton.
Harding, J. (1993) ‘Regulating sex: constructions of the postmenopausal woman in discourses on hormone replacement therapy’,
unpublished PhD thesis, University of Technology, Sydney.
Harding, J. (1996) ‘Sex and control: the hormonal body’, Body and Society, 2 (1): 99–111.
Haug, F. (ed.) (1987) Female Sexualization: A Collective Work of Memory, London: Verso.
Illich, I. (1977) Limits to Medicine. Medical Nemesis: The Exploration of Health, Harmondsworth, Middlesex: Pelican Books.
Klein, R. (1992) ‘The unethics of hormone replacement therapy’, Bioethics News, 11, 3: 24–37.
Laclau, E. and Mouffe, C. (1985) Hegemony and Socialist Strategy: Towards a Radical Democratic Politics, London: Verso.
The Lancet (1991) ‘More than hot flushes’, editorial, The Lancet, 338: 917–918.
Law, M. , Wald, N. and Meade, T. (1991) ‘Strategies for prevention of osteoporosis and hip fracture’, British Medical Journal, 303:
453–459.
Lewis, J. (1993) ‘Feminism, the menopause and hormone replacement therapy’, Feminist Review, 43: 38–56.
Long Hall, D. (1973) ‘Biology, sex hormones and sexism in the 1920s’, Philosophical Forum, 5, 1–2: 81–96.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body, London: Sage Publications.
MacLennan, A. (1991) ‘Hormone replacement therapy and the menopause’, Medical Journal of Australia, 155: 43–44.
MacLennan, A. (1992) ‘Menopause and preventive medicine’, editorial, Australian Family Physician, 21, 3: 205.
Marsh, M. and Whitehead, M. (1992) ‘Management of the menopause’, British Medical Bulletin, 48, 2: 426–457.
Martin, E. (1989) The Woman in the Body: A Cultural Analysis of Reproduction, Milton Keynes: Open University Press.
Moon, T. (1991) ‘Estrogens and disease prevention’, editorial, Archives of Internal Medicine, 151: 17–18.
National Women’s Health Network (1989) Taking Hormones and Women’s Health: Choices, Risks and Benefits, Washington: National
Women’s Health Network.
Oudshoorn, N. (1994) Beyond the Natural Body. An Archaeology of Sex Hormones, London and New York: Routledge.
Riley, D. (1988) Am I that Name? ‘Feminism and the Category of Women’ in History, London: Macmillan Press.
Stampfer, M. , Colditz, G. , Willett, W. et al. (1991) ‘Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up
from the Nurses’ Health Study’, New England Journal of Medicine, 325, 11: 756–762.
Treichler, P. (1987) ‘AIDS, homophobia and bio-medical discourse: an epidemic of signification’, Cultural Studies, 1, 3, pp. 263–305.
Vines, G. (1993) Raging Hormones: Do They Rule Our Lives?, London: Virago.
Wilson, R. (1966) Feminine Forever, New York: M. Evans.
Worcester, N. and Whately, M. (1992) ‘The selling of HRT: playing on the fear factor’, Feminist Review, 41: 1–26.
Wren, B. (1992) ‘HRT and the cardiovascular system’, Australian Family Physician, 21, 3: 226–229.
Zita, J. (1988) ‘The pre-menstrual syndrome: “dis-easing” the female cycle’, Hypatia, 3, 1: 157–168.

Foucault, embodiment and gendered subjectivities

APA (American Psychiatric Association) (1985) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III), Washington DC:
APA.
APA (American Psychiatric Association) (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV), Washington DC:
APA.
Armstrong, D. (1983), Political Anatomy of the Body, Cambridge: Cambridge University Press.
Ben Tovim, D. and Morton, J. (1989) The Anorexia Nervosa and Bulimia Study Project, .
Bordo, S. (1988) ‘Anorexia nervosa – psychopathology as the crystallization of culture’, in I. Diamond and L. Quinby (eds) Feminism and
Foucault; Reflections on Resistance, Boston: Northeastern University Press.
Celermajer, D. (1987) ‘Submission and rebellion: anorexia and a feminism of the body’, Australian Feminist Studies, 5.
Cleo Magazine (1988) ‘Fat is beautiful: but could advertising agencies make us believe it?’, Cleo, August: 87–120.
Colquhoun, D. (1989) ‘Healthism, the sociology of school knowledge and the curriculum’, TASA Conference , Melbourne, December.
Connell, R.W. (1987) ‘Scheherezade’s children: critical reflections on Michel Foucault’s History of Sexuality, Vol. 1’, Arena, 78: 139–145.
Dreyfus, H.L. (1987) ‘Foucault’s critique of psychiatric medicine’, The Journal of Medicine and Philosophy, 12, 4: 311–333.
Eckermann, E. (1994) ‘Self-starvation and binge-purging: embodied selfhood/sainthood’, Australian Cultural History (Special Issue on
Bodies), 13: 82–99.
Festinger, L. (1957) A Theory of Cognitive Dissonance, London: Tavistock.
Foucault, M. (1965) Madness and Civilization: A History of Insanity in the Age of Reason, London: Tavistock.
Foucault, M. (1973) The Birth of the Clinic: An Archaeology of Medical Perception, New York: Pantheon Books.
Foucault, M. (1979), Discipline and Punish: The Birth of the Prison, Harmondsworth: Penguin.
Foucault, M. (1980) Power/Knowledge, edited by C. Gordon , London: Harvester.
Foucault, M. (1981) The History of Sexuality: An Introduction, London: Penguin.
Foucault, M. (1983) M. Foucault: Beyond Structuralism and Hermeneutics, 2nd edn, edited by H. Dreyfus and P. Rabinow , Chicago:
University of Chicago Press.
Foucault, M. (1986) The Foucault Reader, edited by P. Rabinow , Harmondsworth: Penguin.
Foucault, M. (1987) The History of Sexuality, Vol. 2: The Use of Pleasure, London: Penguin.
Foucault, M. (1988), The History of Sexuality, Vol. 3: The Care of the Self London: Penguin.
Giddens, A. (1991) Modernity and Self Identity: Self and Society in the Late Modern Age, Stanford: Stanford University Press.
Giddens, A. (1992) Transformation of Intimacy, Cambridge: Polity Press.
Kalucy, R.S. (1987) ‘The “new” nutrition’, The Medical Journal of Australia, 147: 529–530.
Laing, R.D. (1988) ‘Interview with R.D. Laing’, Anthony Liversidge, OMNI Magazine, 10, 7: 56–63.
McNay, L. (1992) Foucault and Feminism, Cambridge: Polity Press.
Parsons, T. (1951) The Social System, Glencoe, IL: Glencoe Free Press.
Patton, P. (1989) ‘Taylor and Foucault on power and freedom’, Political Studies, 37: 260–276.
Place, F. (1989) Cardboard, Sydney: Local Consumption Pubs.
Probyn, E. (1988) ‘The anorexic body’, in A. Kroker and M. Kroker (eds) Body Invaders: Sexuality and the Postmodern Condition, London:
Macmillan.
Robertson, M. (1992) Starving in the Silences: An Exploration of Anorexia Nervosa, Sydney: Allen and Unwin.
Rorty, R. (1986) ‘Foucault and epistemology’, in D.C. Hoy (ed.) Foucault: A Critical Reader, Oxford: Basil Blackwell.
Silverman, D. (1985) Qualitative Methodology and Sociology, Aldershot: Gower.
Spitzack, C. (1987) ‘Confessions and signification: the systematic inscription of body consciousness’, The Journal of Medicine and
Philosophy, 12, 4: 357–369.
Taylor, C. (1986) ‘Foucault on freedom and truth’, in D.C. Hoy (ed.) Foucault: A Critical Reader, Oxford: Basil Blackwell.
Turner, B.S. (1984) The Body and Society, Oxford: Basil Blackwell
Turner, B.S. (1987) Medical Power and Social Knowledge, London: Sage.
Turner, B.S. (1990) ‘The talking disease: Hilda Bruch and anorexia nervosa’, Australian & New Zealand Journal of Sociology, 26, 2:
157–169.
Turner, B.S. (1992) Regulating Bodies: Essays in Medical Sociology, London: Routledge.
Ussher, J. (1991) Women’s Madness: Misogyny or Mental Illness, New York: Harvester Wheatsheaf.
Weedon, C. (1987) Feminist Practice and Post-structuralist Theory, Oxford: Basil Blackwell.
White, M. (1988) ‘Language and anorexia’, paper presented to the Anorexia Bulima Nervosa Association, Eastern Community Health
Centre, Adelaide, South Australia.
White, M. and Epston, D. (1989) Literate Means to Therapeutic Ends, Adelaide: Dulwich Centre Publishing.

Of health and statecraft

Armstrong, D. (1983) Political Anatomy of the Body, Cambridge: Cambridge University Press.
Barry, A. , Osborne, T. and Rose, N. (eds) (1996) Foucault and Political Reason, London: University College London Press.
Burchell, G. (1996) ‘Liberal government and techniques of the self’, in A. Barry , T. Osborne and N. Rose (eds) Foucault and Political
Reason, London: University College London Press.
Burchell, G. , Gordon, C. and Miller, P. (1991) The Foucault Effect, Hemel Hempstead: Harvester-Wheatsheaf.
Canguilhem, G. (1989) The Normal and the Pathological, trans. C. Fawcett, Dordrecht: Reidel.
Cousins, M. and Hussain, A. (1984) Michel Foucault, London: Macmillan.
Davey Smith, G. , Bartley, M. and Blane, D. (1990) ‘The Black Report on socioeconomic inequalities in health ten years on’, British Medical
Journal, 301, 18–25 August: 373–377.
Foucault, M. (1973) The Birth of the Clinic, trans. A. Sheridan-Smith, London: Tavistock.
Foucault, M. (1984) ‘What is Enlightenment?’, in P. Rabinow (ed.) The Foucault Reader, Harmondsworth: Pelican.
Foucault, M. ( M. Florence ) (1988 a) ‘(Auto-)biography’, History of the Present, 4 (Spring): 13–15.
Foucault, M. (1988 b) ‘On problematization’, History of the Present, 4 (Spring): 16–17.
Foucault, M. (1988 c) ‘Social security’, in L. Kritzman (ed.) Michel Foucault: Politics, Philosophy, Culture, London: Routledge.
Foucault, M. (1989) Resume des cours, Paris: Juillard.
Foucault, M. (1994) ‘Crise de la medicine ou crise de l’antimedicine’, in Dits et Ecrits, volume III, pp. 40–58, Paris: Gallimard.
Gordon, C. (1991) ‘Governmentality – an introduction’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect, Hemel
Hempstead: Harvester-Wheatsheaf.
Hirschman, A. (1977) The Passions and the Interests, Princeton: Princeton University Press.
Hirschman, A. (1982) Shifting Involvements, Princeton: Princeton University Press.
Jacob, J. (1988) Doctors and Rules, London: Routledge.
Kant, I. (1979) The Conflict of the Faculties, trans. M.J. Gregor , Lincoln, Nebraska: University of Nebraska Press.
la Berge, A. (1992) Mission and Method, Cambridge: Cambridge University Press.
Macleod, R. (1968) ‘The anatomy of state medicine: concept and application’, in F.N.L. Poynter (ed.) Medicine and Science in the 1860s,
London: Wellcome Institute.
Meinecke, F. (1962) Machiavellism: The Doctrine of Reason of State and its Place in Modern History, trans. D. Scott , London: Routledge
and Kegan Paul.
Osborne, T. (1993) ‘On liberalism, neo-liberalism and the “liberal profession” of medicine’, Economy and Society, 22, 3: 345–356.
Osborne, T. (1996) ‘Security and vitality: drains, liberalism and power in the nineteenth century’, in A. Barry , T. Osborne and N. Rose
(eds) Foucault and Political Reason, London: University College London Press.
Rosen, G. (1953) ‘Cameralism and the concept of medical police’, Bulletin of Historical Medicine, 27: 21–42.
Rosen, G. (1958) A History of Public Health, Cambridge, Massachusetts: Harvard University Press.
Webster, C. (1988) The Health Services Since the War, volume 1, London: HMSO.
Weiner, D. (1993) The Citizen-Patient in Revolutionary and Imperial Paris, Baltimore: Johns Hopkins University Press.

Risk, governance and the new public health

Ashton, J. (ed.) (1992) Healthy Cities, Buckingham: Open University Press.
Ashton, J. and Seymour, H. (1988) The New Public Health: The Liverpool Experience, Milton Keynes: Open University Press.
Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage.
Beck, U. (1995) Ecological Politics in an Age of Risk, Cambridge: Polity Press.
Beck, U. , Giddens, A. and Lash, S. (1994) Reflexive Modernization: Politics, Tradition and Aesthetics in the Modern Social Order,
Cambridge: Polity Press.
Bita, N. (1993) ‘Bid for fitness bonus under private cover’, The Australian, 30 April: 2.
Bunton, R. (1992) ‘More than a woolly jumper: health promotion as social regulation’, Critical Public Health, 3, 2: 4–11.
Bunton, R. , Nettleton, S. and Burrows, R. (1995) The Sociology of Health Promotion: Critical Analyses of Consumption, Lifestyle and Risk,
London: Routledge.
Burchell, G. (1993) ‘Liberal government and techniques of the self’, Economy and Society, 22, 3: 267–282.
Castel, R. (1991) ‘From dangerousness to risk’, in G. Burchell , C. Gordon and P. Miller (eds), The Foucault Effect: Studies in
Governmentality, Hemel Hempstead: Harvester Wheatsheaf.
Commonwealth of Australia (1993) Goals and Targets for Australia’s Health in the Year 2000 and Beyond, , Canberra: AGPS.
Commonwealth of Australia (1994) Better Health Outcomes for Australians: National Goals, Targets and Strategies for Better Health
Outcomes into the Next Century, Canberra: AGPS.
Crawford, R. (1994) ‘The boundaries of the self and the unhealthy other: reflections on health, culture and AIDS’, Social Science and
Medicine, 38, 10: 1347–1365.
Cruikshank, B. (1993) ‘Revolutions within: self-government and self-esteem’, Economy and Society, 22, 3: 327–344.
Davies, J.K. and Kelly, M. (1993) Healthy Cities: Research and Practice, London: Routledge.
Douglas, M. (1990) ‘Risk as a forensic resource’, Daedalus, 119, 4: 1–16.
Douglas, M. (1992) Risk and Blame: Essays in Cultural Theory, London: Routledge.
Douglas, M. and Wildavsky, A. (1982) Risk and Culture, Oxford: Basil Blackwell.
Dutton, K.R. (1995) The Perfectible Body: The Western Ideal of Physical Development, London: Cassell.
Ewald, F. (1991) ‘Insurance and risk’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in Governmentality,
London: Harvester Wheatsheaf.
Finkelstein, J. (1991) The Fashioned Self, Cambridge: Polity Press.
Foucault, M. (1991) ‘Governmentality’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in Governmentality,
London: Harvester Wheatsheaf.
Freeman, R. (1991) ‘The idea of prevention: a critical review’, in S. Scott , G. Williams , S. Platt and H. Thomas (eds) Private Risks and
Public Dangers, Aldershot: Avebury.
Fujimura, J.H. and Chou, D.Y. (1994) ‘Dissent in science: styles of scientific practice and the controversy over the cause of AIDS’, Social
Science and Medicine, 38, 8: 1017–1035.
Giddens, A. (1991) Modernity and Self-Identity: Self and Society in the Late Modern Age, Stanford: Stanford University Press.
Glassner, B. (1989) ‘Fitness and the postmodern self’, Journal of Health and Social Behaviour, 30, 2: 180–191.
Gordon, C. (1991) ‘Governmental rationality: an introduction’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in
Governmentality, Hemel Hempstead: Harvester Wheatsheaf.
Greco, M. (1993) ‘Psychosomatic subjects and the “duty to be well”: personal agency within medical rationality’, Economy and Society, 22,
3: 357–372.
Kawachi, I. and Pearce, N. (1991) ‘Aluminium in the drinking water – is it safe?’, Australian Journal of Public Health, 15, 2: 84–87.
Koval, R. (1986) Eating Your Heart Out: Food, Shape and the Body Industry, Ringwood: Penguin.
Labonte, R. (1990) ‘Empowerment: notes on professional and community, dimensions’, Canadian Review of Social Policy, 26: 64–75.
Lash, S. (1994) ‘Reflexivity and its doubles: structure, aesthetics, community’, in U. Beck , A. Giddens and S. Lash Reflexive
Modernization: Politics, Tradition and Aesthetics in the Modern Social Order, Cambridge: Polity Press.
Lash, S. and Urry, J. (1994) Economies of Signs and Space, London: Sage.
Legge, K. (1993) ‘High octane handicap’, The Weekend Australian, 24–5 July: 23.
Luhmann, N. (1993) Risk: A Sociological Theory, New York: Walter de Gruyter.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body, London: Sage.
Malpas, J. and Wickham, G. (1995) ‘Governance and failure: on the limits of sociology’, Australian & New Zealand Journal of Sociology,
31, 3: 37–50.
McMichael, A.J. and Slade, G.D. (1991) ‘An element of dental health? Fluoride and dental disease in contemporary Australia’, Australian
Journal of Public Health, 15, 2: 80–83.
Petersen, A.R. (1996) ‘The “healthy” city, expertise, and the regulation of space’, Health and Place: An International Journal, 2, 3:
157–165.
Petersen, A.R. and Lupton, D. (1996) The New Public Health: Health and Self in the Age of Risk, Sydney: Allen and Unwin, and London:
Sage.
Roche, M. (1992) Rethinking Citizenship: Welfare, Ideology and Change in Modern Society, Cambridge: Polity Press.
Rose, N. (1993) ‘Government, authority and expertise in advanced liberalism’, Economy and Society, 22, 3: 283–299.
Rose, N. and Miller, P. (1992) ‘Political power beyond the state: problematics of government’, British Journal of Sociology, 43, 2: 173–205.
Scott, S. and Williams, G. (1991) ‘Introduction’, in S. Scott , G. Williams , S. Platt and H. Thomas (eds) Private Risks and Public Dangers,
Aldershot: Avebury.
Wallerstein, N. (1993) ‘Empowerment and health: the theory and practice of community change’, Community Development Journal, 28, 3:
218–227.
Yeo, M. (1993) ‘Toward an ethic of empowerment for health promotion’, Health Promotion International, 8, 3: 225–235.

Governing the risky self How to become healthy, wealthy and wise
Arney, W.R. and Bergen, B. (1984) Medicine and the Management of Living: Taming the Last Great Beast, London: University of Chicago
Press.
Calnan, M. and Williams, S. (1996) ‘Lay evaluation of scientific medicine and medical care’, in S. Williams and M. Calnan (eds) Modern
Medicine: Lay Perspectives and Experiences, London: University College London Press.
Castel, R. (1991) ‘From dangerousness to risk’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in
Governmentality, London: Harvester Wheatsheaf.
Davison, C. , Macintyre, S. and Davey Smith, G. (1994) ‘The potential social impact of predictive genetic testing for susceptibility to
common chronic diseases: a review and proposed research agenda’, Sociology of Health & Illness, 16, 3: 340–371.
Department of Health (1991) The Health of the Nation: A Consultation Document, London: Department of Health.
Donzelot, J. (1991) ‘The mobilisation of society’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in
Governmentality, London: Harvester Wheatsheaf.
Ewald, F. (1991) ‘Insurance and risk’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in Governmentality,
London: Harvester Wheatsheaf.
Foucault, M. (1977) Discipline and Punish. The Birth of the Prison, London: Allen Lane.
Foucault, M. (1979) ‘Governmentality’, Ideology and Consciousness, 6: 5–22.
Foucault, M. (1982) ‘The subject and power’, Critical Inquiry, 8: 777–795.
Foucault, M. (1988) ‘The ethic of care for the self as a practice of freedom’, in J. Brenauer and D. Rasmussen (eds) The Final Foucault,
Cambridge, Mass.: MIT Press.
Giddens, A. (1992) The Transformation of Intimacy, Cambridge: Polity Press.
Greco, M. (1993) ‘Psychosomatic subjects and the “duty to be well”: personal agency within medical rationality’, Economy and Society, 22,
3: 357–372.
Hewitt, M. (1991) ‘Bio-politics and social policy: Foucault’s account of welfare’, in M. Featherstone , M. Hepworth and B.S. Turner (eds)
The Body: Social Process and Cultural Theory, London: Sage.
Illman, J. (1996) ‘Fat fees and MOTs’, Guardian 2, Tuesday 20 February: 11.
Kelleher, D. (1994) ‘Self-help groups and their relationship to medicine’, in J. Gabe , D. Kelleher and G. Williams (eds) Challenging
Medicine, London: Routledge.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body, London: Sage.
Lupton, D. and Chapman, S. (1995) ‘A healthy lifestyle might be the death of you: discourses on diet, cholesterol control and heart disease
in the press among lay people’, Sociology of Health & Illness, 17, 4: 477–494.
Nettleton, S. (1989) ‘Power and pain: the location of pain and fear in dentistry and the creation of the dental subject’, Social Science and
Medicine, 29, 10: 1183–1190.
NHSME (National Health Service Management Executive) (1992) Local Voices, London: NHSME.
Ogden, J. (1995) ‘Psychosocial theory and the creation of the risky self’, Social Science and Medicine, 40, 3: 409–415.
Rose, N. (1990) Governing the Soul: The Shaping of the Private Self London: Routledge.
Rose, N. (1992) ‘Governing the enterprising self’, in P. Heelas and P. Morris (eds) The Values of the Enterprise Culture, London:
Routledge.
Squires, P. (1990) Anti-Social Policy: Welfare, Ideology and the Disciplinary State, London: Routledge.
Skolbekken, J. (1995) ‘The risk epidemic in medical journals’, Social Science and Medicine, 40, 3: 291–305.
Williams, G. and Popay, J. (1994) ‘Researching the people’s health: dilemmas and opportunities for social scientists’, in J. Popay and G.
Williams (eds) Researching the People’s Health, London: Routledge.
Witherow, J. (1996) Change Your Life: A Six-Part Guide to Health and Diet, London: The Sunday Times and PPP Healthcare, 7 January.

Popular health, advanced liberalism and Good Housekeeping magazine

Armstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century, Cambridge: Cambridge
University Press.
Baudrillard, J. (1988) ‘The system of objects’, in M. Poster (ed.) Jean Baudrillard: Selected Writings, Cambridge: Polity Press.
Baum, F. (1993) ‘Healthy cities and change: social movement or bureaucratic tool?’, Health Promotion International, 8, 1: 31–40.
Bauman, Z. (1988) ‘Is there a postmodern sociology?’, Theory, Culture & Society, 5: 217–237.
Beetham, M. (1996) A Magazine of Her Own? Domesticity and Desire in the Women’s Magazine, 1800–1914, London: Routledge.
Black, M.E.A. (1995) ‘What did popular women’s magazines from 1929 to 1949 say about breast cancer?’, Cancer Nursing, 18, 4:
270–277.
Bonney, B. and Wilson, H. (1990) ‘Advertising and the manufacture of difference’, in M. Alvarado and J.O. Thompson The Media Reader,
London: British Film Institute.
Bourdieu, P. (1984) Distinction: A Social Critique of the Judgement of Taste, London: Routledge.
Bunton, R. (1990) ‘Regulating our favourite drug’, in P. Abbott and G. Payne (eds) New Directions in the Sociology of Health, London:
Falmer.
Bunton, R. (1992) ‘More than a woolly jumper: health promotion as social regulation’, Critical Public Health, 3, 2: 4–11.
Bunton, R. and Burrows, R. (1995) ‘Consumption and health in the “epidemiological” clinic of late modern medicine’, in R. Bunton , S.
Nettleton and R. Burrows (eds) The Sociology of Health Promotion, London: Routledge.
Bunton, R. , Murphey, S. and Bennett, P. (1991) ‘Theories of behavioural change and their use in health promotion’, Health Education
Research: Theory and Practice, 6, 2: 153–162.
Burchell, G. (1993) ‘Liberal government and techniques of the self’, Economy and Society, 22, 3: 267–344.
Butland, G. (1993) ‘Commissioning for quality’, British Medical Journal, 306: 251–252.
Calnan, M. (1987) Health and Illness: The Lay Perspective, London: Tavistock.
Castel, R. (1991) ‘From dangerousness to risk’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in
Governmentality, London: Harvester Wheatsheaf.
Cox, D. (1991) ‘Health service management – a sociological view: Griffiths and the non-negotiated order of the hospital’, in J. Gabe , M.
Calnan and M. Bury (eds) The Sociology of the Health Service, London: Routledge.
Crawford, R. (1980) ‘Healthism and the medicalization of everyday life’, International Journal of Health Services, 10, 3: 365–388.
Davies, J. and Kelly, M. (eds) (1993) Healthy Cities: Research and Practice, London: Routledge.
Davison, C. , Davey-Smith, G. and Frankel, S. (1991) ‘Lay epidemiology and the prevention paradox: the implications of coronary
candidacy for health education’, Sociology of Health & Illness, 13, 1: 1–19.
DH (Department of Health) (1991) The Patient’s Charter, London: HMSO.
DH (Department of Health) (1992 a) The Health of the Nation: A Strategy for Health in England, London: HMSO.
DH (Department of Health) (1992 b) The Health of the Nation: Key Area Handbook; Coronary Heart Disease and Stroke, London: HMSO.
DHSS (Department of Health and Social Security) (1976) Prevention and Health: Everybody’s Business, London: HMSO.
DHSS (Department of Health and Social Security) (1983) NHS Management Enquiry (Griffiths Report), London: HMSO.
Donzelot, J. (1979) The Policing of Families, London: Hutchinson.
Douglas, M. and Calvas, M. (1990) ‘The self as risk-taker: a cultural theory of contagion in relation to AIDS’, Sociological Review, 38, 3:
445–464.
Douglas, M. and Wildavsky, A. (1982) Risk and Culture, Oxford: Basil Blackwell.
Dutton, K.R. (1995) The Perfectible Body: The Western Ideal of Physical Development, London: Cassell.
Elliot, J.B. (1994) ‘A content analysis of the health information provided in women’s magazines’, Health Libraries Review, 11: 96–103.
Ewald, F. (1991) ‘Insurance and risk’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in Governmentality,
London: Harvester Wheatsheaf.
Farrant, W. and Russell, J. (1986) The Politics of Health Information, London: Health Education Council.
Featherstone, M. (1991) Consumer Culture and Postmodernism, London: Sage.
Figlio, C. (1989) ‘Unconscious aspects of health and the public sphere’, in B. Richards (ed.) Crisis of the Self: Further Essays on
Psychoanalysis and Politics, London: Free Association Books.
Fleck, L. (1979) Genesis and Development of a Scientific Fact, Chicago and London: University of Chicago Press.
Foucault, M. (1985) The History of Sexuality, Vol. 2: The Use of Pleasure, New York: Random House.
Foucault, M. (1988) ‘The dangerous individual’, in L. Kritzman (ed.) Michel Foucault: Politics, Philosophy, Culture; Interviews and Other
Writings, London: Routledge.
Foucault, M. (1991) ‘Governmentality’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect, Brighton: Harvester Wheatsheaf.
Fox, N.J. (1991) ‘Postmodernism, rationality and the evaluation of health care’, Sociological Review, 39, 4: 709–744.
Fuss, D. (1989) Essentially Speaking: Feminism, Nature and Difference, New York: Routledge.
Gabe, J. , Kelleher, D. and Williams, G. (eds) (1994) Challenging Medicine, London: Routledge.
Giddens, A. (1991) Modernity and Self-Identity: Self and Society in the Late Modern Age, Cambridge: Polity Press.
Giddens, A. (1992) The Transformation of Intimacy, Cambridge: Polity Press.
Gillick, M.R. (1984) ‘Health promotion, jogging, and the pursuit of the moral life’, Journal of Health, Politics, Policy and Law, 9, 3: 369–384.
Glassner, B. (1989) ‘Fitness and the postmodern self’, Journal of Health and Social Behaviour, 30: 180–191.
Glassner, B. (1992) Bodies: The Tyranny of Perfection, Los Angeles: Lowell House.
Glassner, B. (1995) ‘In the name of health’, in R. Bunton , S. Nettleton and R. Burrows (eds) The Sociology of Health Promotion, London:
Routledge.
Gordon, C. (1991) ‘Governmental rationality: an introduction’, in G. Burchell , C. Gordon and P. Miller (eds) The Foucault Effect: Studies in
Governmentality, London: Harvester Wheatsheaf.
Greco, M. (1993) ‘Psychosomatic subjects and the “duty to be well”: personal agency within medical rationality’, Economy and Society, 22,
3: 357–372.
Green, J. (1995) ‘Accidents and the risk society: some problems with prevention’, in R. Bunton , S. Nettleton and R. Burrows (eds) The
Sociology of Health Promotion, New York: Routledge.
Harrison, S. , Hunter, D. and Pollitt, C. (1990) The Dynamics of British Health Policy, London: Unwin Hyman.
Hermes, J. (1995) Reading Women’s Magazines: An analysis of everyday media use, Cambridge: Polity Press.
Hunter, D. (1991) ‘Managing medicine: a response to “the crisis’”, Social Science and Medicine, 32: 441–449.
Irwin, H. (1989) ‘Health communication: the research agenda’, Media Information Australia, 54: 32–40.
Jewson, N. (1976) ‘The disappearance of the sick man from medical cosmology, 1770–1870’, Sociology, 10: 225–244.
Kelleher, D. , Gabe, J. and Williams, G. (1994) ‘Understanding medical dominance in the modern world’, in J. Gabe , D. Kelleher and G.
Williams (eds) Challenging Medicine, London: Routledge.
Kelly, M. and Charlton, B. (1995) ‘The modern and the postmodern in health promotion’, in R. Bunton , S. Nettleton and R. Burrows (eds)
The Sociology of Health Promotion, London: Routledge.
Kickbusch, I. (1989) ‘Self-care in health promotion’, Social Science and Medicine, 29: 125–130.
Kohn, M. (1992) Dope Girls: The Birth of the British Drug Underground, London: Lawrence and Wishart.
Lalonde, M. (1974) A New Perspective on the Health of Canadians, Ottawa: Information Canada.
Leiss, W. (1983) ‘The icons of the marketplace’, Theory, Culture & Society, 1, 3: 24–35.
Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body, London: Sage.
Lyotard, J.F. (1984) The Post-Modern Condition: A Report on Knowledge, trans. G. Bennington and B. Mascum , Manchester: Manchester
University Press.
McCracken, E. (1993) Decoding Women’s Magazines, Basingstoke: Macmillan.
Manning, K. and Cullum-Swan, B. (1994) ‘Narrative, content, and semiotic analysis’, in N.K. Denzin and Y.S. Lincoln (eds) Handbook of
Qualitative Research, London: Sage.
Miller, P. and Rose, N. (1996) ‘Mobilizing the consumer: assembling the subject of consumption’, Theory, Culture & Society, 14, 1.
Mills, S. (ed.) (1994) Gendering the Reader, Hemel Hempstead: Harvester Wheatsheaf.
Nettleton, S. (1991) ‘Wisdom, diligence and teeth: discursive practices and the creation of mothers’, Sociology of Health & Illness, 13, 1:
98–111.
Nettleton, S. and Bunton, R. (1995) ‘Sociological critiques of health promotion’, in R. Bunton , S. Nettleton and R. Burrows (eds) The
Sociology of Health Promotion, New York: Routledge.
O’Brian, M. (1995) ‘Health and lifestyle: a critical mess? Notes on the dedifferentiation of health’, in R. Bunton , S. Nettleton and R.
Burrows (eds) The Sociology of Health Promotion, New York: Routledge.
O’Malley, P. (1992) ‘Risk, power and crime prevention’, Economy and Society, 21, 3: 252–275.
Osborne, T. (1993) ‘On liberalism, neo-liberalism and the “liberal profession” of medicine’, Economy and Society, 22, 3: 345–356.
Parsons, T. (1951) The Social System, Glencoe, Illinois: Free Press.
Petersen, A.R. (1994) ‘Governing images: media constructions of the “normal”, “healthy” subject’, Media Information Australia, 72: 32–40.
Petersen, A.R. (1996) ‘Risk and the regulated self: the discourse of health promotion as politics of uncertainty’, Australian & New Zealand
Journal of Sociology, 32, 1: 44–57.
Petersen, A.R. and Lupton, D. (1996) The New Public Health: Health and self in the age of risk, London: Sage.
Prior, L. (1995) ‘Chance and modernity: accidents as a public health problem’, in R. Bunton , S. Nettleton and R. Burrows (eds) The
Sociology of Health Promotion, New York: Routledge.
Reaves, J.L. and Campbell, R. (1994) Cracked Coverage: Television News, the Anti-Cocaine Crusade, and the Reagan Legacy, London:
Duke University Press.
Rose, N. (1989) Governing the Soul: The Shaping of the Private Self London: Routledge.
Rose, N. (1993) ‘Government, authority and expertise in advanced liberalism’, Economy and Society, 22, 3: 283–298.
Savage, M. , Barlow, J. , Dickens, P. and Fielding, T. (1992) Property, Bureaucracy and Culture: Middle Class Formation in Contemporary
Britain, London: Routledge.
Schrift, A.D. (1995) ‘Reconfiguring the subject as a process of self: following Foucault’s Nietzschean trajectory to Butler, Laclau/Mouffe,
and beyond’, New Formations, 25: 28–39.
Starr, P. (1982) The Social Transformation of American Medicine, New York: Basic Books.
Stevenson, H.M. and Burke, M. (1991) ‘Bureaucratic logic in new social movement clothing: the limits of health promotion research’, Health
Promotion International, 6: 281–296.
TIHR (Tavistock Institute of Human Relations) (1956) ‘Some psychological and sociological aspects of toilet tissues – final report’, No. 419
(July), London: Tavistock Institute of Human Relations.
Turner, B.S. (1992) ‘The interdisciplinary curriculum: from social medicine to postmodernism’, in M.B.S. Turner Regulating Bodies: Essays
in Medical Sociology, London: Routledge.
Turner, B.S. (1995) Medical Power and Social Knowledge, 2nd edition, London: Sage.
Valverde, M. (1996) ‘Governing out of habit: from “habitual inebriates” to “addictive personalities’”, paper presented to the History of the
Present Group, London School of Economics, 22 May.
WHO (World Health Organisation) (1986) Ottawa Charter for Health Promotion, Canada: WHO. (Reproduced in Health Promotion, 1:1.)
WHO (World Health Organisation) (1991) Introducing the Lifestyles and Health Department, Copenhagen: Regional Office for Europe.
Williams, G. and Popay, J. (1994) ‘Lay knowledge and the privilege of experience’, in J. Gabe , D. Kelleher and G. Williams (eds)
Challenging Medicine, London: Routledge.