Biopower and the Liberationist Romance

In the spirit of summer, and especially summer reading, we asked a few well-read writers for an essay on a book or books exploring bioethics issues through story. The result is a compelling look at how we face our fears and hopes about biotechnology and medicine. A reading list appears at the end.

Bioethics lives in the shadow of great structures and practices of power, and yet, it has not been notable for its contributions to an understanding of power.¹ Indeed, the narrative that bioethics has fashioned for itself has been mainly a liberationist romance: a quest narrative in which the individual, seeking autonomy, struggles against limitations, constraints, and inhibitions imposed by forces (rules, roles, institutions, interference by others, customs, traditions) from the outside.

Today this liberationist romance is being challenged, revised, and deepened from at least two angles. One, which might be referred to as “deontological humanism,” refines our comprehension of individual freedom and dignity beyond minimalist notions of self-reliance and freedom from others’ interference.² A second perspective, which offers a critical deconstruction of what it calls “biopolitics” and “biopower,” provides a more overtly political and systemic narrative of ethics in the face of power.³

From the point of view of these emerging critiques, biotechnology’s intervention into the minds and bodies of human beings threatens our rights, dignity, equality, and respect for each other. It also erodes the foundations of personhood, agency, and individual identity upon which these ideals have been built. This is because, although ostensibly designed to benefit human subjects, biotechnology often is an objectifying and reductionistic form of power that erodes self (the “I” as a unique subject). Individuated subjects become fungible parts, edited transcripts, messages written in normal or mistaken codes (i.e., “healthy” people or people with genetic defects). Similarly, biopower and biotechnology alter the liberal, individualist notion of the political and moral community. The state is understood not as a social contract of mutual self-interest and cooperation among free and equal natural persons, but as a structure of protection designed to preserve the life of functional, productive, and efficient bodies, and to exclude dangerous, defective, or aberrant life.

The critique of biopower has been developing for several decades. An early focus, inspired by Foucault’s work and “labeling theory” in sociology, was on psychiatry and psychiatric institutions. In recent years, the biopower critique has broadened as genetic engineering and biotechnology have developed. From this point of view, it is interesting to compare what might be seen as an early novel of biopower with a more contemporary treatment. I know of no better examples for this purpose than Ken Kesey’s One Flew Over the Cuckoo’s Nest and Kazuo Ishiguro’s Never Let Me Go.

One Flew Over the Cuckoo’s Nest calls us to rethink conventional assumptions about normalcy, mental illness, freedom, therapy, and the manifestation of power in institutional culture and in therapeutic discourses of professional expertise. Its setting is a closed psychiatric hospital ward; its focus is the discourse of psychiatry and psychiatric nursing. The narrative voice is that of Chief Bromden, a huge Native American whose paranoia leads him to see himself as small and weak, and whose survival strategy is to become socially invisible by pretending to be deaf and dumb. Bromden sees that the power of the mental health care system is ubiquitously entrapping—just another manifestation of the power system of the broader society, or what the deconstructionists would call the biopolitical state. This power works like a fog; it is both intangible and blinding. If you can see it, you are diagnosable within its categories and may be singled out for special measures of control.

At the center of the struggle against power in Cuckoo’s Nest is Randle P. McMurphy, a charming, rough-hewn ne’er-do-well who lives largely by impulse. He finds rules, schedules, and social structures of all kinds overly confining. He viscerally rejects authority and proceeds to violate, subvert, and outwit those who would confine him and his appetites in any way. By turns irresponsible and well-meaning, selfishly predatory and...