Foucault

MARY C.
RAWLINSON
FOUCAULT'S STRATEGY: KNOWLEDGE, POWER, AND THE SPECIFICITY OF TRUTH*
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ABSTRACT. This paper investigates the exemplarity of medicine in Foucault's analyses of knowledge generally. By tracing the development of his concept of power and its relation to knowledge, it offers an account of Foucault's unconventional philosophical project. Finally, it specifies Foucault's strategy for undermining processes of normalisation. Key Words: medicine, knowledge, power, truth.
Insofar as Foucault is "still a philosopher"1 he might be expected to approach medicine as if he were to cure its ills, as if he brought with him just the right conceptual treatments for its ethical dilemmas and ontological or epistemological confusions. He might be expected to conceive of philosophy as a "science of knowledge in general" and to assume that it is his task as a philosopher to lay down the general conditions of knowledge, the rules and limits that govern any science (Hegel, 1979 [1807], p. 41). Thus, he might be expected to treat medicine as one more regional, empirical inquiry, subject like any other to the general laws that philosophy reveals. Instead, in Foucault's analyses medicine is elevated to the status of a privileged exemplar. At the end of The Birth of the Clinic, having analysed the epistemological and institutional mutations that give rise at the end of the eighteenth century to the development of the anatomico-pathological method in medicine and the identification of disease as a morbid process lodged in the body of the patient, Foucault provocatively posits the concomitant emergence of a new relation between philosophy and medicine:
. . . health replaces salvation . . . because medicine offers modern man the
Mary C Rawlinson, Ph.D., Associate Professor, Department of Philosophy, State University of New York at Stonybrook, Stonybrook, New York 11 794, U.S.A. The Journal of Medicine and Philosophy 12 (1987) 3 7 1 - 3 9 5 . 1987 by D. Reidel Publishing Company.
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obstinate yet reassuring face of his finitude; in it, death is endlessly repeated, but it is also exorcised; and although it ceaselessly reminds man of the limit that he bears within him, it also speaks to him of that technical world that is the armed, positive, full form of his finitude. [At the end of the eighteenth century] medical gestures, words, gazes took on a philosophical density that had formerly belonged only to mathematical thought. The importance of Bichat, Jackson, and Freud in European culture does not prove that they were philosophers as well as doctors, but, that, in this culture, medical thought is fully engaged in the philosophical status of man (1975, p. 1980).
Whereas in the Classical Age finitude was only a negative reality, the inverse of the infinite, in the modern period it is precisely at the point of the finitude of man that knowledge and power are gathered. The representing power that produced the "table and picture" of the Classical Age was itself always elusive, hidden, not subjected to dissection and the gaze.2 When the human being himself ceases to be a priveleged moment of nature and is subjected to the same procedures and technologies of investigation, classification, and calculation as the stars or the botanical kingdom, the shape of knowledge changes and medicine becomes exemplary in three ways. First, clinical medicine exemplifies the epistemological norms and structures that determine the human sciences, the system of truth that dominates thought in the modern period.3 Moreover, medicine embodies more clearly than any other human science the intertwining of knowledge and power that is the general figure of them all: on the one hand, the positivity of the finite in extremis disease, aging, death, poverty, handicap, sexual frustration, the self in its misery; on the other, the mass of skilled and certified personnel and the arsenal of material technologies that comprise modern health care. An account of the specific conditions of its formation opens up an inquiry into the whole array of scientific discourses that analyse the human subject and make his body available to vast technologies of correction, regulation, and development. Secondly, this analysis of the forms and conditions of knowledge in the human sciences generates a countermovement to the motion of an old system of truth that finds in Hegel both a summation and a new point of dispersion. The specification of the procedures and conditions for the production of knowledge in medicine both opens up the possibility of repeating (the form
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of) the analysis elsewhere, and raises the disturbing idea that all truth is produced according to determinable conditions, that all truth is historically specific and intertwined with contingencies of force and power. Foucault disturbs and puts into question classical philosophical conceptions of the universality of truth, of the necessity of regular procedures that dehistoricize and disindividuate the scientific knower; of the essential separability of the faculty of knowledge and the faculty of the will; of the conception of knowledge itself in terms of forms of representation and self-representation. A genealogical analysis of modern scientific medicine reveals that the epistemological and the political, knowledge and power, are ineluctably intertwined, so that truth is not so much discovered as if it lay ready-made in an objective reality patiently awaiting the articulate voice of science as produced according to regular and identifiable procedures that determine in any given historical situation what it is possible to say, who is authorized to speak, what can become an object of scientific inquiry, and how knowledge is to be tested, accumulated, and dispersed. Thirdly, the election of medicine as an exemplar has a political and strategic value.
I tried first to do a geneaology of psychiatry because I had had a certain amount of practical experience in psychiatric hospitals and was aware of the combats, the lines of force, tensions and points of collision which existed there. My historical work was undertaken only as a function of those conflicts. The problem and the stake there was the possibility of a historical truth which could have a political effect (1980 [1976], p. 64).
Beyond disrupting the conventional operation of the concepts of metaphysics, Foucault's writing aims to be effective in disrupting the normalising practices of the human sciences. This intertwining of knowledge of the finite with the power and technology to supplement its limits defines the critical disciplines of the modern period, those sciences that set norms and standards, make measurements and diagnoses, impose regulations on the basis of statistical generalisations or projections, and establish mechanisms for dividing the normal and abnormal, the self-realized and the unfulfilled, in the domain of human being. Through the production of a subversive writing by planting questions just where these practices are exercised, questions, for example, regarding the way in which these procedures and interventions
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are justified, or questions about how the general images by which these sciences measure the particular are established and administered in their truth Foucault aims to interrupt our participation in the bureaucracy of normalcy, and to divert our force elsewhere. Herein, then, lies the crucial importance of Foucault's analysis: it calls into question classical notions of the universality of truth by establishing the historicity of all knowledge; it undermines any pose of scientific neutrality or disinterestedness by exposing the ineluctable intertwining of systems for the production of knowledge with systems for the deployment of power and force; and, it educes a reexamination of what is happening when actual human subjects are formed by institutionalized procedures of education, testing, certification, evaluation, regulation, and treatment. What is being done when actual human subjects take up as their own the sanctioned problems and methods of formalized disciplines and professions, and deploy upon others the practices and procedures authorized by them? If the scientist does not merely represent clearly and distinctly the given reality of a preconstituted objective world, then what does happen when we participate in learning and the production of knowledge? If the physician or the teacher do not merely restore in their subjects the natural order by correcting a distortion or supplying a lack, then what are we doing when we engage in the actual practice of our scientific disciplines? My own analysis has three parts. The first outlines Foucault's method for objectifying discourses and the analytic procedures to which he subjects them. It focuses in particular on his dissection of the discourse of clinical medicine and explicates at greater length its exemplarity. The second develops an account of the evolution of Foucault's concept of power from its initial formulation in Madness and Civilization (1973 [1961]), as a merely repressive force of negation, exclusion, and prohibition, through its mutation after The Archaeology of Knowledge (1982 [19691) into a positive and productive force that engenders both knowledge and pleasure. This mutation in the concept of power occurs correlative to and concomitantly with a mutation in the concept of truth. When "apparatus" is substituted for "episteme" as the name or concept for the general figure of a discourse, both the hope (that undermines Madness and Civilization) of releasing by severing the link between knowledge and power a reality not already marked by discourse and the struggle over the possibility of a general or scientific language have been left behind. The pos-
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sibility of a purely formal and discursive truth, which haunts The Archaeology of Knowledge, gives way before an analysis of the historical embodiments of specificiable systems of truth and the discovery that any discourse is intertwined at every point with the technologies and the practices of the disciplines and professions in which it is spoken. The third part of my paper investigates this idea of a "regime of truth", and it outlines Foucault's strategy a strategy that is literary and political, as well as historical. "We are now at a point," Foucault remarks, "where the function of the specific intellectual needs to be reconsidered" (1980 [1977], pp. 130133). And, through his complex strategy Foucault means to effect a mutation in the "specific intellectual" the professor, the physician, the laboratory scientist, his reader. In language both more familiar and less appropriate, the third part of my paper explicates Foucault's 'moral challenge' to the professional. 1. THE SCIENCE OF MAN To the ordinary scientist the discourse of his discipline is nothing less than the field of his activity, wherein problems emerge, methods are proposed and tested, new objectivities come to light, and solutions are discovered. It is the horizon of his thought. Foucault develops a method by which this silent horizon is itself objectified and made to offer its anatomy for dissection. The identifying features of a scientific discourse the concepts, rules, and authorities that determine it can only be revealed by an historical operation wherein its difference and distinction from other competing discourses is marked out. Only by specifying the historical conditions of the period of transmutation when one way of seeing and thinking and speaking about a region of human being is substituted for another is it possible for either discourse to appear as a positivity. Thus, Foucault's method is historical because it is necessarily comparative. The very identity of a scientific discourse is revealed only at the site of its competition with others. The purpose, for example, of marking the difference between the discourse of classical medicine, on the one hand, and the modern scientific medicine of the clinic and the anatomico-pathological method, on the other, is neither to reveal a history of progress according to which some general form, the 'science of medicine', inexorably reveals itself ("We are ever making progress in the war on disease."), nor to lament the deterioration and decay
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of some original truth ("Medicine used to be more human and personal."). Even less is the purpose of Foucault's analysis to say what disease or health is, naturally, in-itself, before all knowledge. On the contrary, under the "archaeological" aspect of Foucault's method all commitments on truth and falsity with respect to specific objectivities are suspended in favor of an analysis of the system of concepts, rules for the formation of meaningful statements, and procedures for determining truth and falsity in the discourse for which those objectivities are constituted as real. The scientist, concerned to make true statements about some objectivity, does not focus usually on the governing logic and historical conditions of his own discourse; however, Foucault's analysis marks out just that moment of transmutation and site of substitution at which one system of truth replaces another. Thus, in marking the difference between classical and modern scientific medicine, Foucault details the theoretical, institutional, and material conditions necessary to the substitution of the "morbid process" and the evidence of the autopsy for the conception of disease in terms of the coherence and completeness of the nosological table. By showing that disease was not always conceived as a morbid process lodged in the human body, that the individual has only recently become the site of disease, that for classical thought the reality of disease was to be found in the nosological table and not in the individual where it was always "denatured", and that clinical pathology had to be established against the nosological project of the classical period Foucault reveals the historical specificity and conditionality of that horizon of thought and truth in which modern medicine operates. For this conceptual shift to take place, as Foucault demonstrates, it was necessary for the clinic with its ordered spaces to be established, for medical education to shift from the theory of disease to the specificity of the case, for new regulations to be instituted governing the certification of medical authority, and for new ideologies to be developed legitimating radical intervention into the lives of actual human subjects. In short, modern medicine, like any scientific discourse, emerges in concrete historical conditions which are specifiable: it can be determined how people came to think and talk and act in this way. And, by marking its historical limit Foucault reveals not only the conceptual commitments, but also the institutionalised forces, systems of justification, and concrete material realities upon which it de-
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pends. If under the "archaeological" aspect of Foucault's method the question of the truth of disease is suspended in favor of an analysis of the logic of the discourse in which the question is asked and answered; nevertheless, under the "geneaological" aspect of Foucault's method, health and disease are taken as real, as legitimating concepts, articulated not only in a language of description and explanation, but also deployed through a highly organized and carefully regulated system of concrete practices upon the living bodies of particular humans and upon the "body politic" as well. The first effect, then, of Foucault's methodological operations is the objectification of some specific discourse, and its positive reality is elaborated along three axes. (A) The Axis of Knowledge Its system of concepts and rules for the formation of statements; its rules for determining the difference between true and false; the specific subjective operations that for this discourse are valorized under the heading of "method" and accorded the power to produce truth; and the objectivities with respect to which the science defines itself that which can be spoken about, that which can engender evidence, that which is real for the science. Between the concepts and rules in which the reality of an object is elaborated and the being of the object Foucault discovers an irreducible reciprocity. There can be no truths or falsehoods about quarks or schizophrenia outside of the sciences that posit them. The very discourse that is supposed to discover the reality of the thing's being, the truth of disease itself or of physical space and time in themselves, has always already actively contributed to the constitution of the object. This is the closure of the system of truth. (B) The Axis of Authority Systems of certification that determine who has the right to speak in a given scientific discourse; systems for the preservation, transmission, and general dissemination of the science; systems for establishing the relative authority of the science vis-a-vis other operative discourses; and systems of education and association for the reproduction and advancement of actual scientists. This might be denominated the bureaucratic dimension of discourse the historical formation of the authority of the science, how
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it came to enjoy the right to pronounce truth in some region of experience, and the contingent institutions and organisations through which this authority is preserved, exercised, and reproduced. It was, of course, not always the case that the right to deliver, as well as the responsibility for, health care were concentrated uniquely in the hands of the university-trained, statecertified physician. Moreover, it is impossible for scientific authority to refer to something outside itself for its foundation. Only physicians can determine what medical education ought to include or what ought to count as standard care, just as one is generally required to hold a Ph.D. in a field in order to serve on the committees of its doctoral candidates. Only the already certified can certify: thus, a self-establishing authority. This is the closure of the system of power.
(C) The Axis of Value or Justification
Systems of regulation, organisation, normalisation, and punishment, vast and highly elaborated technologies of power, whose deployment upon living human beings is justified by the scientific discourse. On the one hand, the science that has the authority to speak the truth about some region of experience, merely describes that reality; on the other hand, it generalises its object, producing out of its observations a second positivity an ideal or standard, the regular or normal. And, in the name of this second positivity, the science makes prescriptions and executes practices in order to supply the lack or correct the abnormality revealed in its object by this second positivity itself. Scientific discourse always exercises a certain "policing" function: professors of English and philosophy correct and shape the very language in which the student expresses his ideas and experience; physicians operate upon our bodies and minds to keep them in line with a certain range of normal functioning; economists promulgate not only theories, but also rules and regulations that will determine the kind of work individuals do and the kind of compensation received for their labor. The problem revealed by Foucault's analysis is not that science is in itself morally neutral or pure (knowledge, after all, is said to be good in itself), yet contingently suffers some politicization from the "outside". Foucault's disturbing thought is that a necessary effect of the operation of scientific discourse, an inevitable field of its elaboration, is the development of mechanisms through which the being-in-truth of its object language, the
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human body, or work and the circulation of money, e.g. is controlled. In the name of the object that it has itself constituted, every scientific discourse deploys its authority upon the body of the material world, and, paradigmatically for Foucault, upon the bodies of living human beings. This the closure of the system of value. The first effect of Foucault's strategy, then, is to make the horizon of our thought appear before us as an object: to expose its rules of knowledge, specific lines of authority, and mechanisms of effect. Each of Foucault's sites of analysis medicine, the science of sexuality, psychiatry, economics, philology, biology, penology has been chosen for its strategic value. What is to be generally exposed here across all these examples is the line of division that marks the respective profiles of the Classical age and modernity. And, modernity itself is precisely marked by the development of the "sciences of man". In place of a uniform power over life and death that always descended, there is substituted a bureaucratized power, governed by the idea of the "universal individual" and deployed laterally in a levelling operation and a mastery of the self more pervasively constraining than the erratic threat of the lord's physical might. (See, e.g., Foucault's discussion of the emergence of "biopower", 1978 [1976], pp. 142-145; also, "The Carceral", 1978 [1975]) The universal individual, the normal man the self that can be developed, educated, considered a "human resource", whose vote can be predicted, even as his labor and welfare can be projected and regulated is constituted, Foucault argues, in a specific history of discourse that begins in the late eighteenth century with the substitution of the self-dispensing authority of the state for a power organised around the idea of the family and the exercise of a personal will. At the same time, a certain heterogeneity and non-systematicity of language, modes of thought, and loci of power is reduced to the universal system of science: the standardisation of the university and its curricula, forms of licensing and certification, the concentration of physical force in the hands of the state's army and police, the regularised treatment of children by educational and medical institutions, the organisation and supervision of the labor of either the "worker" or the "consumer", all derive their justification form a generalisation of the human individual under the idea of the Same. (See, 1980 [1977], pp. 131-133) The privilege of medicine and psychiatry in Foucault's analysis
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derives from their unique embodiment of this concept of the normal man and their unique deployment in nearly every arena of human life of powerful and highly differentiated technologies of control and regularisation. It is in the science of medicine, first and foremost, that man is constituted as an object of knowledge and concomitantly measured against generalised standards of function. Eighteenth century medicine, Foucault argues, was oriented by the concept of health and those positive qualities of strength or vigor that were threatened by illness.
Nineteenth century medicine, on the other hand, was regulated more in accordance with normality than health; it formed its concepts and prescribed its interventions in relation to a standard of functioning and organic structure, and physiological knowledge once marginal and purely theoretical knowledge for the doctor was to become established (Claude Bernard bears witness to this) at the very centre of all medical reflection. Furthermore, the prestige of the science of life in the nineteenth century, their role as model . . . is linked originally . . . with the fact that these concepts were arranged in a space whose profound structure responded to the healthy/morbid opposition. When one spoke of the life of groups and societies, of the life of the race, or even of 'psychological life', one did not think first of the internal structure of the organized being, but of the medical bipolarity of the normal and the pathological . . . If the science of man appeared as an extension of the science of life, it is because it as medically . . . based . . . the very subjects that it devoted itself to (man, his behaviour, his individual and social realizations) therefore opened up a field that was divided up according to the principles of the normal and the pathological (1975 [1963], pp. 3536).
Thus, on the one hand, medical science provides the crucial conceptual polarity that will determine the sciences of man generally. On the other hand, it displays in an undeniable way the indissoluble link between this conceptual figure and the highly differentiated forms of practice that define, develop, and normalise that creature of nineteenth century discourse, man or the self. By objectifying this discourse-by exposing the self-enclosed systems of knowledge, power, and justification that determine it Foucault offers an emblem of the structure of knowledge and power that determines modernity itself, that period from which, as Foucault often remarks, we are "just emerging", and in terms of which we still think and live. We may speak, then, of a Foucaultian circle: on the one hand, discursive formations constitute specific objects as real, as with the formation of the anatomico-pathological method a variety of
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differentiated objects fevers, possession by demons, malingering, sin, humoral imbalance, monsters, moral failings, hunger came to find the law of their truth in the conceptualization of disease as an abnormal and pathological process in the human body. On the other hand, a scientific discourse undertakes to articulate the natural or given being of its object and finds on the basis of this description material procedures of intervention and regulation. With the revelation of the truth of disease in the concept of the morbid process came the institutionalisation of medical authority, the standardisation of medical education, and the entry of this authority into every nook and cranny of human life the love-making of individuals, the workplace, personal hygiene, the family, the political and legal systems, even the relation of the individual to himself. If the first effect of Foucault's strategy is to objectify those discourses in which we operate, thereby exposing what is ordinarily the horizon of our thought, then the second effect of his strategy is to disrupt the nearly irresistible workings of this circle of power and knowledge governed by the idea of the universal individual and the project of normalisation. It is through a refinement of the concept of power that Foucault opens up this project of disruption. The next section of my paper traces this development, from a conception of power as a purely negative and repressive force to a conception of power as a force that produces objects, induces pleasures, and generates knowledge. 2. FOUCAULT'S CONCEPT OF POWER: FROM REPRESSION TO POWER/KNOWLEDGE Foucault's early misconception of power under the paradigm of repression is initially demonstrated in Madness and Civilization (1973 [1961]). This work constitutes a study of the division between madness and reason and it offers an analysis of the historical course by which madness, divested of its pretensions to divine inspiration or demonic possession, became constituted as an object to be treated and regulated by medical science. Despite Foucault's later criticisms of this work, it introduces themes that will recur throughout his writing: the formulation of concepts of normalcy and concrete procedures of normalisation that divide and regulate populations, the institution and justification of confinement, the constitution of scientific objects by forces and
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powers not strictly internal to the science, and the repetition across apparently distinct sciences of unrecognised, inarticulate, but nonetheless operative, forms and principles of knowledge. Here, too, is deployed for the first time that remarkable and original gesture that will be repeated again and again: the inversion of the heroic. French psychiatry has produced no greater hero than Pinel who bravely struck the chains from the inmates at Bicetre and led them into the airy daylight of freedom. He stands this day, monumentalised, before the Salpetriere, the inmates still huddled in grateful adoration at his feet. This image, as we shall see, provides a key to Foucault's early misconception of power, and his correlative failure to duly appreciate its role in the determination of the destiny of knowledge and truth. Foucault conceives his project in Madness and Civilisation as the "archaeology of a silence". Once, so his story goes, the positive content of madness enjoyed a free voice. Conceived as an excess of passion, as a "liberty raging in the monstrous forms of animality", madness was not divided off from the rest of human experience, but accepted as its extreme horizon. Moreover, madness served as a source of revelation; it was in fact"... the lower limit of human truth."
As death is the limit of human life in the realm of time, madness is its limit in the realm of animality . . . the scandal of madness showed men how close to animality their Fall could bring them; and at the same time how far divine mercy could extend when it consented to save man . . . [it] disclosed that underlying realm of unreason which threatens man and envelops at a tremendous distance all the forms of his natural existence (1973 [1961], pp. 81-83).
And, so Foucault argues, it was precisely because madness had this positive content, this excess of passion and liberated animality, that it was necessary to chain the madman up like the wild beast that in truth he had become. The very practice that Pinel condemns as "inhumane" turns out to have been a recognition of the genuine reality of madness. By the end of the Classical period, however, madness was deprived of its positive truth and concomitantly subjected to a different form of treatment. No longer did madness contribute to truth by marking the extreme limit of a certain dimension of human possibility; rather, it disappeared into a pure privation:
. . . madness in the classical period ceased to be the sign of another world, and
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. . . became the paradoxical manifestation of non-being . . . confinement was not the exorcism of a danger . . . Confinement is the practice that corresponds most exactly to madness experienced as unreason, that is, as the empty negativity of reason; by confinement madness is acknowledged to be nothing . . . whence those options for death so often to be found in the registers of confinement, written by the attendants, and which are not the sign of confinement's savagery, its inhumanity or perversion, but the strict expression of its meaning: an operation to annihilate nothingness (p. 116).
On the basis of this nullity, Foucault continues, it was possible to reconstitute the figure of madness (see p. 158). What had once been excess of passion or animality, an extremism of human experience, became reduced to an individual moral fault: ". . . the problematics of madness shifts to an interrogation of the subject responsible (pp. 182183). Thus, Foucault demonstrates how Pinel, the great liberator, instituted a "surveillance and judgment" to which madness had never before been subject and deployed upon the mad a regulative moralism as intractably confining as the chains it replaced. "How necessary it is," writes Pinel, "in order to forestall hypochondria, melancholia, or mania to follow the immutable laws of morality" (p. 197). Treatment took the dual form of punishment and rehabilitation, or as Pinel himself expressed it, "repression" and "benevolence". On the one hand, it was necessary to force the madman to relinquish the selfindulgent theatrics of his madness:
Do not employ consolations, they are useless; have no recourse to reasoning, it does not persuade; . . . What is required is great sang-froid, and when necessary, severity. Let your reason be their rule of conduct. A single string still vibrates in them, that of pain; have courage enough to pluck it (p. 182)4.
On the other hand, insofar as madness is essentially a moral failing or the result of an individual weakness, treatment must be directed toward returning the madman to his proper contributory role vis-a-vis others and society in general; in short, the madman must be made to work. Thus, in 1801 in the Traite medicophilosophique sur Valienation mentale Pinel writes, "The most con-
stant experience has indicated . . . that [physical labor] is the surest and most efficacious way to restore man to reason." (quoted in Foucault, 1973 [1961], p. 196) Only through his regulated labor can the madman both learn to satisfy his own needs and repair the injustice that his madness inflicts on others.
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Let your reason be their rule of conduct Thus, according to Foucault was a scientific discourse about madness substituted for the authentic and positive voice of madness. And, in a history that can only be termed ironic, the elaboration of an ever more precise language about madness in both physiological medicine and psychoanalysis effectively silences the dim echoes of that voice by transforming what was once a uniquely disclosive human experience into a disease like any other. In concluding Madness and Civilization Foucault exhibits a romanticism that in the context of his thought is almost shocking:
Since the end of the eighteenth century, the life of unreason no longer manifests itself except in the lightning-flash of works such as those of Holderlin, of Nerval, of Nietzsche, or of Artaud forever irreducible to those alienations that can be cured, resisting by their own strength that gigantic moral imprisonment which we are in the habit of calling, doubtless by antiphrasis, the liberation of the insane by Tuke and Pinel (p. 278).
In language as fierce and defiant as the "lightning flash of Nature" of which it speaks Foucault unfolds the spectacle of the world judging itself by art and precisely that art that is linked to madness.
After Sade and Goya, and since them, unreason has belonged to whatever is decisive, for the modern world, in any work of art . . . the world that thought to measure and justify madness through psychology must justify itself before madness, since in its struggles and agonies it measures itself by the excess of works like those of Nietzsche, of Van Gogh, of Artaud. And nothing in itself, especially not what it can know of madness, assures the world that it is justified by such works of madness (p. 285289).
It is as if the positive voice of madness, so thoroughly silenced by the carefully elaborated diagnostic categories and treatments of psychiatry, erupted through the power of genius to once more remind the rational man that it is neither other, nor alien, but only the extreme threshold of his own experience. Genuine madness, in spite of the efforts of psychiatry to substitute for it its own nosological entities, returns to exercise its liminal truth. The reader is assisted in driving the concepts of knowledge and power that operate in this analysis to a more critical stage not least by Foucault himself.5 First, the concept of power. Foucault will never reject the
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concept of power that is articulated here in relation to knowledge about madness. He continues to see in the formation of medical psychiatry and the elaboration of its concepts an instance of the production of knowledge as an effect of repressive power. What will have been his error is the generalisation of this concept of power, the assumption that repression is the essence of power, rather than a type. And, this error will be found linked, in the second place, to one far more egregious:
The notion of repression is a[n] . . . insidious one, or at all events I myself have had much more trouble freeing myself of it, in so far as it does indeed appear to correspond so well with a whole range of phenomena which belong among the effects of power. When I wrote Madness and Civilzation, I made at least implicit use of this notion of repression I think indeed that I was positing the existence of a sort of living, voluble and anxious 'madness which the mechanisms of power and psychiatry were supposed to have come to repress and reduce to silence (Foucault, 1980 [1977], pp. 118119, my emphasis).
At the same time that he inflates the model of repressive power into a general concept of power, Foucault posits behind those objectivities constituted in the elaboration of the scientific discourse of medical psychiatry, the pristine, natural, living truth of madness. Not only does he assume the existence of a positive objectivity not itself produced by discursive practices, but also he writes as if he were releasing the truth by severing the link between knowledge and power. Nowhere else in Foucault's writing will the reader find this positivism:6 hereafter, any objectivity disease, the normal man, crime, Garbo's smile7 is analysed into the complex of forces that constitute and regulate its reality. Neverthless, the inflation of the concept of repression from type to essence persists, and with it an overvaluation of the abstract and formal registers of discourse. Foucault himself marks the moment of transition in Discipline and Punish, it was there that he substituted as the essence or general form of power a concept of technique and strategy for one of repression. At the same time the general figure with respect to which any discourse is determined is no longer the "episteme", but the "apparatus" (1980 [1977b], pp. 196-197). The "episteme" will have taken him too far in the direction of "systematicity, theoretical form, or something like a paradigm" (1980 [19771, pp. 112113). Again,
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it will have been an error of overgeneralisation: the episteme turns out to be a particular type of apparatus.
. . . the episteme is the strategic 'apparatus' which permits of separating out from among all the statements which are possible those that will be acceptable within . . . a field of scientificity, and which it is possible to say are true and false. The episteme is the 'apparatus' which makes possible the separation, not of the true from the false, but of what may from what may not be characterised as scientific (1980 [1977b], p. 197).
It is the complex of concepts and rules for the production of statements by which a given discourse is identified. The episteme, however, is a purely discursive reality. Foucault has always insisted on the intertwining of theory and practice, language and bodies, knowledge and power, and specified it in a wide empirical field; nevertheless, the concept of the episteme, inflated in the direction of the abstract analysis of a field of statements in terms of concepts and rules of logic, undervalues the effective role of strategies of power in producing, maintaining, and dispensing any type of knowledge and in appropriating that knowledge as a selfjustification. The idea of the apparatus, conversely, complicates discursive and non-discursive realities, so that the distinction as such becomes "uninteresting" (1980 [19771, p. 198). (See also, 1977 [1971], pp. 200201, where Foucault discusses the impossibility of disentangling a discourse from the practices that sustain it.) After Discipline and Punish, it will be clear that Foucault's writing articulates a form of knowledge (the general system of a given discourse) only in pinning it down thereby countering any hasty flights of generalisation to the historical conditions of its emergence and, specifically, to the actual forces that establish, maintain, and amplify its authority.
The apparatus is essentially of a strategic nature, . . . it is a matter of a certain manipulation of relations of forces, either developing them in a particular direction, blocking them, stabilising them, utilising them, etc. The apparatus is always inscribed in a play of power, but it is also always linked to certain coordinates of knowledge which issue from it but, to an equal degree, condition it. That is what the apparatus consists in: strategies of relations of forces supporting, and supported by, types of knowledge (1980 [1977b], p. 196).
Foucault's object, then, is neither power, nor knowledge in its
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general form, but power/knowledge, the chiasmatic binding in determinable procedures, practices, regulations, and principles in every region of reality and register of discourse of the one and the other.
We should admit . . . that power produces knowledge . . . that power and knowledge directly imply one another; that there is no power relation without the correlative constitution of a field of knowledge, nor any knowledge that does not presuppose and constitute at the same time power relations . . . it is not the activity of a subject of knowledge that produces a corpus of knowledge, useful or resistant to power, but power-knowledge, the processes and struggles that traverse it and of which it is made up, that determines the possible forms of knowledge (1979 [1975], pp. 2728).
Far from being a merely repressive and negative force, power is fundamentally productive; and, it proliferates, amplifies, and justifies itself through the generation of knowledge. This web of transactions comprising power, right, and truth, and binding them inextricably is the body that is subjected to dissection by Foucault's archaeological-genealogical method. (See also, Foucault's discussion of truth and power (1980) [1976], pp. 9394.) In analysing the anatomy of forms of power/knowledge, Foucault's writing reveals commitments on truth its concept and value that challenge classical metaphysical notions of universality, systematicity, and objectivity. The subersive movement that he joins is inaugurated by Nietzsche and it is directed against the system of the One Truth as it appears in the modern age under the name Hegel. In 1807, Hegel will argue that the particular human being is only an instance of the general form of the human, more or less adequate to its own normative ideal, and that history, unfolding so as to realized the latter, often requires the sacrifice of the former (see, e.g., paragraphs 7780 of the "Introduction" to Hegel's Phenomenology of Spirit). Like Kant before him, Hegel specifies in his writing the educational practices and processes through which the universal individual is produced, at the same time that he enjoys the widest access to the lines of authority and mechanisms of disbursement provided by his contemporary educational institutions. The figure that determines his thought, as it determines the whole of modernity, is that of the universal science. The problem for all science is to reproduce in its material language through the concepts, methods, tools, and pro-
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cedures that it provides the truth of its object. Not only language, taken generally as an image or concept of the thing at issue, must be made adequate to object. Human existence itself history, society, the particular individual must be measured by and brought into line with its truth or essence. And, when universality has "gathered such strength",
. . . the individual must all the more forget himself, as the nature of Science implies and requires. Of course, he must make of himself and achieve what he can; but less must be demanded of him as he in turn can expect less of himself, and may demand less for himself (Hegel, 1979 (1807), p. 45).
Plato's One, having disseminated itself through all the registers of reality the Same, the State, the citizen, the worker, the consumer, the universal individual, the normal man accomplishes a project of mastery through generalisation. It is this figure of power/knowledge, in its nearly irresistable and ubiquitous forces that Nietzsche undertakes to subvert, counter, and displace in his attacks on the concepts of truth and "the one true world", as well as in his critical geneaology of morality, its analysis in terms of mastery and slavery and in terms of the "anti-natural" or "anti-life." After Discipline and Punish (1979 [19751), Foucault never again attempts to gather his concepts into the unity of a system; rather, concepts are determined by and limited by their strategic value in his overall project. Any concept is subject to substitution should the analytic situation require it. (The concept of repression continues to have a special strategic value in a discussion of the discourse of medical psychiatry, despite its demotion from the controlling position of the general concept, just as the episteme continues to be priveleged with respect to the discourse of philosophy.) For a specific concept of power and a specific epistemological theory, Foucault substitutes the controlling concept of power/knowledge, and he invites the analysis of the body of mechanisms and transactions that is their intertwining. Especially, he invites a dissection of the controlling generalities of modernity science, the universal individual, the normal man, the model worker, and the average voter or consumer through which the system of truth produces over and over again the Same.
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Within the horizon of any given discourse it will always be possible for the skilled practitioner to deploy his conceptual forces on the object at issue, determine truth and falsity, and act on the object so as to bring it into line with its concept. Foucault does not dispute this; rather, he objectifies the whole apparatus for producing truth the discourse and all its related institutions, bodies, and practices. Like Nietzsche, Foucault considers truth to be a "fiction", that is, a fabrication, a materially embodied object produced according to specifiable procedures. (See, e.g., Nietzsche, 1966 [1886], sections, 1-6, 36, 211, also, 1968 [1888], sections 583b-586; see, e.g., Foucault, 1979, p. 75) Furthermore, Foucault follows Nietzsche in relating this mechanism of production to need and the exigencies of a play of heterogenous forces, psychological, social, economic, institutional, and so on. The operation of the regime of truth is set in motion by some contingent material urgency in the play of forces that is power/knowledge as in the body of medical science, we have, on the one hand, the face of death, and on the other, the technology that is the "armed, positive, full form of... finitude," almost unique in its detail and diffusion. What strikes Foucault about the modern period is the Veritable technological take-off in the productivity of power" (1980 [1977], p. 119). As technologies for investigating the body and mind of the human individual, as well as the body and mind of the body politic, multiply, so do strategies of control, regulation, and appropriation. The discourse that justifies this investigation and manipulation of actual human beings is, of course, the science of man and in particular the powerful image of the normal and that vessel of universal truth, the concept of the Same. For both Nietzsche and Foucault ". . . truth isn't the reward of free spirits, the child of protracted solitude, nor the privelege of those who have succeed in liberating themselves," rather, the productions of any system of truth the concepts, rules, foundations, or justifications that it supplies are almost destined to become conventionalised, repeated, circulated, and disseminated. Thus, Nietzsche and Foucault work assiduously to develop literary and conceptual strategies that throw each reader back on his own resources, that leave him with a question, instead of an
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answer. Both Nietzsche and Foucault understand the search for truth a commitment that can only be made in a specific discourse as only one possible enterprise for the philosopher,
and it is not theirs.
Their project is to produce a language that effectively resists both the natural tendency of concepts and systems of truth toward universalisation and generalisation, and the correlative production via multiple material technologies of the "they-self" or the 'normal man'. What gets written, what gets published and circulated, what gets conserved, preserved, and studied, what comes to provide the language of justification and prescription in concrete material realms in our time is determined at once by an almost ineluctable tendency toward centralisation, unification, normalisation, etc, and the elaboration of a dense field of operative technologies for the manipulation of the human being under the idea of the Same. The much-abused "yuppie" offers an exemplary, if ironic, image: his narcissism has been studied, documented, and converted into a general truth; the televised images and group experiences (e.g., the classroom, sports, rock concerts, shopping malls, etc.) that have formed him have bound him to himself by an ideology of individualism repeated millions of times; and, this very ideology urgently requires extensive technologies for the care and development of the self to prepare it for its competition in the world of labor and consumption where it will become a "human resource" and a "target population". Medicine offers, according to Foucault, the paradigm of this system. Through the proliferation of a "loquacious gaze", a look that reports what it sees, objectivities are constituted and explained, and, behind the raw facticity of the immediate, there appears, what Merleau-Ponty calls, a "second positivity", viz., the 'normal human body', against which any particular body can be measured (1968 [19631, p. 149). To the degree that the scientist is committed to the universality of his discourse, to the pure generality and absolute transposability of it i.e., to the belief that it applies to anyone he must reduce his object under the logic of the Same to its kind or essence, purged of individual, empirical determinations. The patient is a case of coronary artery disease or an alchoholic, etc. The scientist is an agent of a system of disindividuation. Foucault's strategy is to disrupt the discourse of explanation and justification that licenses the development of procedures of
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normalisation upon the living bodies of actual human beings. By specifying the rules for truth that determine the science of clinical medicine and the particular history of its authority; Foucault would render its system of claims and practices only one example among others in an open-ended historical field of possible options, and thereby, undermine its nearly inexorable power over our immediate empirical condition. By "creating a blank space from which to speak" by writing Foucault does not so much yield a general theory of discourse, as consolidate a language and a set of methodological procedures that oppose both conceptual and practical processes of universalisation. In characterising a group of struggles, of which his own in the domain of language is an exemplar, Foucault remarks
[tjhey arc struggles which question the status of the individual; on the one hand, they assert the right to be different and they underline everthing which makes individuals truly individual. On the other hand, they attack everything which separates the individual, breaks his links with others, splits up community life, forces the individual back on himself and ties him to his own identity in a constraining way. These struggles are not exactly for or against the 'individual', but rather they are struggles against the "government of individualisation". (1983, pp. 211-212)
What all these struggles attack is a form of power/knowledge, rather than a particular institution, class, or political authority. What Foucault's writing struggles against is that system of truth wherein the human individual is constituted as a subject. This subjection has two aspects: on the one hand, the human being is subjected to the ideology of the universal individual and, thereby, subjects and is subjected by others to the technology of normalcy. On the other, he is subjected to the ideology of the self "tied to his own identity by it" and, thereby, subjected to multiple technologies for its care and development, including techniques of self-knowledge, conscience, and confession. The self that is constituted as an object in the sciences of man is at the same time subjected to a destiny of development and regulation. Moreover, its generally prescribed care and development its normalisation results in an alienation of particularity, of the particular human being from his body, his individuality, and his actual powers of production. In advancing after Nietzsche a countermovement to the opera-
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tion of concepts of universality, generality, the universal individual, or normal man, Foucault joins a "battle around truth" (1980 [1977], p. 132). His strategy is not to "emancipate truth from every system of power', an impossible project, but to "detach the power of truth from the forms of hegemony social, economic, and cultural, within which it operates at the present time" (1980 [1977], p. 133). The political effect of his literary strategy would take place indirectly, through the reader, as his language circulates, interrupting and detouring the logic of the Same. Foucault challenges the specific intellectual- the physician, the professor, the laboratory scientist-not only to confront the specificity and historicity of his* science, but also to subvert in his own discourse forces of standardisation and normalisation. Truth is a thing made, fabricated, performed, no less than a building, a machine, or a surgical operation. Over against the truth of the Same, of which we have so lamentable an example in our bureaucracies, armies, educational institutions, and houses of correction, where the violence of the rules and regulations is so often immediately felt, Foucault advances, on the one hand, an exposure of the historical conditions of emergence of systems of truth, a series of demonstrations revealing their specificity and limitation by other optional discursive formations. On the other, he produces the positive materiality of a new language, which instead of constantly returning us to forms that are familiar, conventional, authorized, constantly confounds our expectations and opens up a new way of thinking about truth and practice. Not only does he refuse to supply a general theory, but also he plants in the mind of his reader the "specific intellectual" strategically selected points of worry. What his writing risks is that it pulls at just those conceptual threads that will unravel the fabric of practices and processes in which the system of the Same is embodied. It interrupts the thought of the philosopher by calling into question the very idea of a universal science or universal truth. It undermines any comfortable pose of scientific neutrality or disinterestedness on the part of the laboratory scientist, by exposing the indissoluble link between knowledge and power. And, it disturbs the professor's confident execution of the business of research and teaching, by educing a reexamination of the production of knowledge and the manipulation of the particular individual through our educational institutions. Were such a language to begin to be effective in the formations
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of power that operate on the human body, the physician might begin to be suspicious of diagnoses and prescriptions that reek more of standard nomenclature or standard practice than the particular named being before him. The physician might reevaluate certain conventional commitments of medical science that life is always better than death; that normality is always better than abnormality; that above all else, one must do something. And, particular human beings might begin to look elsewhere and in a variety of different places, for the resources with which to meet and the language with which to understand the irreducibly specific and various reality of human suffering. NOTES
In 1986 Professor Alphonso Lingis of Pennsylvania State University invited me to participate in a conference honoring Michel Foucault. In the end I was unable to attend; however, Professor Lingis' invitation set off the train of thought that became this paper, and for that I thank him. The paper's final form owes a considerable debt to Mr. Brian Seitz, with whom I have frequently discussed Foucault's thought since we taught together The Birth of the Clinic in 1982. 1 "... for all that I may like to say I'm not a philosopher, nonetheless, if my concern is with truth then I'm still a philosopher" (Foucault, 1980 [1976], p. 66}. As we shall see, Foucault is not engaged in a "search for truth" in the usual sense; rather, he undertakes an anatomy of truth, a dissection of the powers and conditions that establish, sustain, and advance specific discourses. For another formulation of Foucault's unconventional philosophical task, see, Foucault, 1985 [1984], pp. 8 - 9 . 2 The Classical Age (roughly 16001789) undertook to represent the order of reality in the classificatory table and the essential description, on the assumption that this representing power left no remainder. What disrupts the project of the mathesis universalis and the "exhaustive ordering of the world" what is not laid out upon the table and not yet exposed in its finite limits is the representing power itself. "From Kant onward, the problem is quite different. ..." (Foucault, 1973 [1966] pp. 7 4 - 7 5 , 246-248). 3 For a discussion of the hegemony of science over knowledge and truth in the modern period, see, e.g., Foucault (1980 [1977], p. 131 ff.) The human sciences are, paradigmatically, those that study the labor, life, and language of actual human beings economics, biology, medicine, psychiatry, the science of sexuality, as well as linguistics. 4 The quote, of course, is not from Pinel, but from EsquiroPs student Francois Leuret, Fragments psychologiques sur la folie, Paris, 1834, pp. 308321. It gives some indication of the lengths to which Pinel's moralism was disseminated.
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See, e.g., the discussion of Leuret in Les Pionniers de la Psychiatrie Francaise avant et apres Pinel, tome 1, pp. 214225. 3 See especially, "Two Lectures" (1976) and "Truth and Power" (1977) in Power/Knowledge (1980) where Foucault comments upon the itinerary of his concept of power. 6 In the Discourse on Language (1982 [1977]), Foucault characterizes the "genealogical mood" as one of "felicitous positivism". This refers to Foucault's method of taking concepts and discursive regularities generally as objective realities, materially embodied in a mutiplicity of inscriptions and materially effective exerting a traceable power in a variety of practices and institutions. 7 I include this example only to indicate what cannot be investigated here, viz., the link between Roland Barthes' analysis of cultural images and Foucault's archaeological/geneaological method. See, e.g., Barthes (1978 [1957]). 8 See, e.g., Nietzsche (1968 [1889], pp. 485-592).
BIBLIOGRAPHY Barthes, Roland: 1978 [1857], Mythologies, Annette Lavers, trans., Hill and Wang, New York. (Mythologies, Editions du Seuil, Paris.) Foucault, M.: 1973 [1961], Madness and Civilization: a History of Insanity in the Age of Reason, Richard Howard (trans.), Vintage Books, New York. [Histoire de la Folie a Vage classique, Librairie Plon, Paris.) Foucault, M.: 1975 [1963], The Birth of the Clinic, A. M. Sheridan Smith (trans.), Vintage Books, New York. (Naissance de la clinique: une archeologie du regard medical, Presses Universitaires de France, Paris.) Foucault, M.: 1973 [1966], The Order of Things, Vintage Books, New York. (Les Mots et les choses, Editions Gallimard, Paris.) Foucault, M.: 1982 [1969], The Archaeology of Knowledge, Pantheon, New York. (L Archeologie du Savoir, Editions Gallimard, Paris. Foucault, ML: 1982 [1971], 'Discourse on language', in The Archaeology of Knowledge. (L'ordre du discours, Editions Gallimard, Paris.) Foucault, M.: 1977 [1971], 'History of systems of thought', in Donald F. Bouchard (ed.), Language, Counter-memory, Practice, Cornell University Press, Ithaca, New York. Summary of Foucault's course at College de France, 1970-71. Foucault, M.: 1979, 'Interview with Lucette Finas', in M. Morris and P. Patton (eds.), Michel Foucault: Power, Truth, Strategy, Feral Publications, Sydney. Foucault, M.: 1979 [1975], Discipline and Punish, Alan Sheridan (trans.) Vintage Books, New York. (Surveiller et Punir; Naissance de la prison, Editions Gallimard, Paris.) Foucault, M.: 1978 [1976], The History of Sexuality, Fobert Hurley (trans.), Pantheon, New York. (La Volonte de savoir, Editions Gallimard, Paris.)
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Foucault, M: 1980 [1976], 'Questions on geography', in Colin Gordon (ed.), Power/Knowledge, Pantheon, New York. ("Questions a Michel Foucault sur la geographic", Herodote 1.) Foucault, ML: 1980 [1977], Truth and power', in Colin Gordon (ed.), Power/ Knowledge, Pantheon, New York. ("Verite et Pouvoir", in L'Arc 70.) Foucault, M.: 1980 [1977b], 'The confession of the flesh', in Power/Knowledge, Colin Gordon (ed.), Pantheon, New York. ("Le jeu de Michel Foucault", Ornicarl) Foucault, M.: 1983, 'Afterword: the subject and power', in Michel Foucault, Hubert Dreyfus and Paul Rabinowitz, University of Chicago Press, Chicago. Foucault, M.: 1985 [1984], The Use of Pleasure, Robert Hurley (trans.), Pantheon, New York. (L'usage desplaisirs, Editions Gallimard, Paris.) Hegel, G. W. F.: 1979 [1807], The Phenomenology of Spirit, A. V. Miller (trans.), Oxford University Press, New York. Merleau-Ponty, M.: 1968 [1963], The Visible and the Invisible, Alphonso Lingis (trans.), Northwestern University Press, Evanston. Nietzsche, F.: 1966 [1866], Beyond Good and Evil, Walter Kaufman (trans.), Vintage Books, New York. Nietzsche, F.: 1968 [1889], Twilight of the Idols, Walter Kaufman (trans.), Viking Press, New York. Nietzsche, F.: 1968 [1887-88], The Will to Power, Walter Kaufman (trans.), Vintage Books, New York.

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MARY C.

FOUCAULT'S STRATEGY: KNOWLEDGE, POWER, AND THE SPECIFICITY OF TRUTH*

Foucault's object, then, is neither power, nor knowledge in its

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