Governmentality: Plugging the Contextual Gap?

3.1. Risk Society versus Governmentality; Realism versus

Constructivism.

The idea of ‘governmentality’ is based on the critical theories of Michel Foucault, who argued that the principal objective of those who wield sovereign power in the modern era is government as an end in itself. Foucault believed that the government’s role was analogous

to that of the head of a household: both seek the ‘correct manner of managing individuals, goods and wealth’ in order to make their fortunes prosper.141 To achieve this, Foucault posited that governments had to have a continuing interest in maintaining ‘the welfare of the population, the improvement of its condition, the increase of its wealth, longevity [and] health’.142 Consequently, the management and control of the population is ‘the ultimate end of government’.143 Power is therefore exercised according to the priorities of ‘biopolitics’, which seeks to integrate people ‘into systems of efficient and economic controls’ by supervising the population to maintain its regularities (and therefore its utility) and discipline those that deviate from them.144 The term ‘governmentality’ describes ‘a situation in which the state becomes increasingly concerned with the government of population as an end in itself rather than the consolidation of state power’.145

141

M. Foucault, ‘Governmentality’ in G. Burchell et al (eds.) The Foucault Effect: Studies in Governmentality’ Chicago: University of Chicago Press, 1991, at p92.

142

Ibid, at p100.

143 _Ibid. 144

M. Foucault, The Will to Knowledge: The History of Sexuality – Volume 1, London: Penguin Books, 1998, at pp136, 139.

145

87 As in Beck’s scholarship, risk is a key component of governmentality, although the concept is interpreted differently. Whereas the Risk Society’s ‘realism’ states that risks ‘exist in a hard, material way’, governmentality adopts a ‘constructivist’ approach, which regards risks as social and cultural phenomena to be determined through complex processes of selection and definition.146 While Risk Society interprets risk according to the principles of natural science, governmentality prefers a social scientific methodology. It offers a particular way of ‘representing events in a certain form so they might be made governable in particular ways, with particular techniques and for particular goals’.147 Owing to this flexibility, Dean believes that risk may have either a quantitative or qualitative character according to the governmentality model. For example, ‘epidemiological’ risk is concerned with the rates of morbidity and mortality among populations.148 It has an essentially quantitative character and acts as a calculus of health outcomes. By contrast, ‘case management’ risk ‘concerns the qualitative assessment of individuals… as falling within “at- risk” categories’.149 This is common in clinical practice wherein certain symptoms will point to the presence (or absence) of disease.150 Governmentality therefore does not assume a fixed definition of ‘risk’; instead, it examines the role that social structures play in

146

K. Rasborg, ‘“(World) Risk Society” or “New Rationalities of Risk”? A Critical Discussion of Ulrich Beck’s Theory of Reflexive Modernity’ (2012) 108(1) Thesis Eleven 3, at pp11-12.

147

M. Dean, Governmentality: Power and Rule in Modern Society, 2nd ed., London: SAGE Publications Ltd, 2010, at p206. 148 Ibid, at p218. 149 Ibid. 150 Ibid.

88 influencing ‘subjective’ knowledge about risk.151 Here, then, interpretations of risk are much more fluid that those implied by the Risk Society model.

The idea that the concept of risk functions as a technical calculus stems from the discovery of statistical regularities amongst the population. Hacking argues that a key feature of modern societies is their ‘fundamentally quantitative feel for nature, how it is and how it ought to be’.152 Today, we live in a numerical world in which it is possible to calculate the likelihood and magnitude of adverse incidents. This stemmed from the fact that ‘an avalanche of numbers’ fuelled the development of the modern industrial state.153 Hacking points to the collection of medical statistics during the 19th Century, which revealed that the spread of epidemics like cholera was not random but instead conformed to a pattern.154 This data revealed much about the aetiology of diseases and, as a result, epidemiologists found they could predict with reasonable accuracy their likely impact on the population. In Hacking’s view, modern society is no longer shaped by notions of ‘determinism’ but is rather governed by ‘chance’, thereby requiring all decision-makers to function probabilistically.155 The discovery that populations have their own ‘regularities’ and ‘aggregate effects’, e.g., rates of death and disease, cycles of scarcity, and levels of mortality,156 transformed the priorities of the wielders of sovereign power. Indeed, Foucault believed that it was the

151

Mythen, supra n.4, at p303.

152

I. Hacking, The Taming of Chance, Cambridge: University of Cambridge Press, 1990, at p5.

153

I. Hacking, ‘How Should We Do the History of Statistics?’ in G. Buchell (eds.) The Foucault Effect: Studies in Governmentality’, Chicago: University of Chicago Press, 1991, at pp183, 189.

154 Ibid, at p189. 155 Hacking, supra n.152, at p5. 156 Foucault, supra n.144142, at p99.

89 discovery through statistical data of the population’s regularities which provided the rationale for the ensemble of institutions and procedures which we would today recognise as government.157 By analysing trends in the population, governments can redirect their efforts to maintain the optimum conditions through which they could extract maximum productivity. More significantly, they can also identify those people who, by deviating from the statistical norm, are ‘at risk’ and therefore present a hazard to the population and, by extension, the government’s authority. In this way, imputations of risk are a condition- precedent for the exercise of the supervisory or disciplinary power of government. From the governmentality perspective, risk is an instrument of power which justifies the continuing surveillance and control of a population by the state.

When viewed in this way, it is easy to see how the concept of risk acquires a moral dimension. This is especially true when we consider also that assessments of risk may entail a qualitative analysis. If a member of a population does not comply with the construction of

regularity, he thereby frustrates the purposes of the governing elite and thus warrants discipline. Consequently, when a person is considered to be ‘at risk’, this connotes that he has failed to conform in some way. This represents a moral judgement, meaning that considerations of risk have been ‘interwoven with ideas of responsibility’.158 Lupton argues that the concept of risk is now widely used to explain deviations from the norms of

157

Foucault, supra n.141, at pp102-103. Foucault argued that governmentality is characterised by three things: (i) a framework which enables the exercise of a complex form of power which is directed towards the control and management of the population, (ii) that power must achieve pre- eminence over all others, and (iii) an ‘administrative’ state equipped to complete the objectives of that power.

158

J.O. Zinn and P. Taylor-Gooby ‘The Challenge of (Managing) New Risks’ in P. Taylor-Gooby and J.O. Zinn (eds.) Risk in Social Science, Oxford: OUP, 2006, at p58.

90 contemporary Western societies.159 She contends that imputations of risk are levelled against those people that are culturally positioned on the margins of society.160 Governmentality values the ‘civilised body’, i.e., that which is aligned with the white, able- bodied, bourgeois, heterosexual and masculine majority, over ‘The Other’, which includes women, the working class, non-whites, the disabled, and gays and lesbians.161 Lupton argues that ‘The Other’ comprises those people who are deemed to be ‘prone to emotionality, excessive desire, violence or disarray’.162 She uses the example of homeless people, who are reconceptualised in modern society as ‘dirt’ and ‘matter out of place that requires removal so as to regain order and purity’.163 Such people are socially inferior to the ‘civilised body’ and considered as morally and physically contaminating.164 For that reason, they are constructed as ‘“grotesque bodies”… needful of control surveillance and discipline’.165 A social system underpinned by governmentality therefore uses risk to demarcate the interests of the ‘elite’ and to discriminate against those deemed capable of undermining its hegemony. One example of this dynamic is the ‘War on Terror’, which followed the terrorist attacks of 11th September 2001. Mythen argues that the attacks re- scripted the discourse so as to sanction a variety of measures directed against a section of the population perceived as a risk to national security, e.g., detention without charge or trial

159

D. Lupton, Risk, London: Routledge, 1999, at p3.

160 Ibid, at p49. 161 Ibid, at p130. 162 Ibid. 163 _{Ibid, at p136.} 164

M. Douglas and A. Wildavsky, Risk and Culture: An Essay on the Selection of Technological and Environmental Dangers, Berkley and Los Angeles: University of California Press, 1982, at p47.

165

91 and intense forms of surveillance.166 That risk was inferred from the religious beliefs and ethnic backgrounds of the members of that section of the population, which were deemed to threaten the security of the ‘civilised’ majority. Here, we can see the influence that public discourse has on interpretations of risk. More importantly, we see how risk becomes deeply bound with notions of morality and ‘Otherness’ when viewed through the prism of governmentality.

In spite of the emphasis on surveillance and control in the Foucauldian model of risk, there is a degree of overlap with Beck and Giddens’ theories. Both schools of thought believe that risk has become a more prominent feature of the modern era. For that reason, Beck and Foucault would presumably agree that modernisation has transformed humanity’s understanding of, and interaction with, the world around it. However, whereas Beck argues that society’s pre-occupation with risk stems from the increasingly catastrophic hazards which are a by-product of progress, Foucauldian thinkers believe that the concept is an important coefficient which with governments can identify deviance from the norm in a given population. Notwithstanding these distinct theoretical interpretations of the concept, it may be that from a more practical standpoint the consequences of both positions are very similar: both appear to engender a pre-occupation in society with avoiding future hazards, both reshape institutional geography and reorient social policy to adapt to risks, and both seem to prefer a regulatory administrative framework. The key difference is that while Risk Society coheres ostensibly to an objectively-justifiable scientific method of defining risks, governmentality relies on the more subjective influence of prevailing social and political

166

92 mores. To what extent can it be said that the construction of a mentally disordered person’s risks to himself or others finds its theoretical roots in the ideas of the Foucauldian School?

3.2. Plugging the Gap? Applying Governmentality to the 2007 Act

When one considers the emphasis that policy-makers placed on the risks to patients and the public when they set about reforming the MHA, it is difficult to deny that governmentality offers a convincing prism through which to analyse the 2007 Act. It is arguable that a process similar to that which Mythen identifies in the War on Terror took place in mental health policy: policy-makers successfully re-scripted the discourse in order to justify legislative reforms which have since made it easier to admit people with mental disorder to hospital on a compulsory basis. The discourse of New Medicalism therefore values control of people with mental illness by practitioners who refer to factors which are deemed liable to increase their risks. What these factors may be is unclear but reasoning by analogy from Mythen’s example would suggest that they may have little causal potency in practice. According to Castel, this transformation of psychiatric practice is consistent with the broader trends exhibited by medicine in general. He argues that medical practice has shifted ‘towards the point where the multiplications of systems of health checks [have made] the individualised interview between practitioner and client almost dispensable’.167 Clinical judgment is now less important where an expanding knowledge base allows decision-makers to select from a range of abstract factors those which are liable to produce risk.168 This actuarial approach has become a common feature of psychiatric practice of late.

167

R. Castel, ‘From Dangerousness to Risk’ in G. Burchell et al (eds.), The Foucault Effect: Studies in Governmentality, London: Sage, 1996, at pp281-282.

168

93 Here, risk assessment focuses on those factors shown to be ‘statistically associated with increased risk in large samples of people’, resulting in an overall score which serves as an indicator of presumed risk over a specific time period.169 As a result, medical practices are predominantly administrative processes in which doctors plan out trajectories and ensure

that human profiles match up to them.170 This ‘de-personalisation’ of clinical practice has been particularly evident in psychiatry. The upshot, according to Castel, is that it is no longer necessary for patients to manifest symptoms of dangerousness; instead, it is enough for them to display whatever characteristics have been reinterpreted as risk factors.171 In this way, psychiatrists and allied professionals can complete the objectives of governmentality. It is easy to see why Foucault believed that the ultimate purpose of psychiatry was the ‘supervision of normality’.172 How far does the 2007 Act continue in this tradition?

Denney argues that as a result of the risk agenda, ‘increased surveillance and attempts to predict dangerous and violent behaviour in the mentally ill’ are now essential requirements of the mental health system.173 Yet, why this should be the case is not clear. We know that the risks of people with mental disorders harming either themselves or others are low. Indeed, they have remained consistent over the course of time, suggesting that there is no causal relationship between social progress and an increase in these risks. For that reason, we must assume that there is another explanation for the keen emphasis that policy-makers placed on these narrower risks when drafting the 2007 Act. The answer,

169

Best Practice Guide, supra n.103, at p18.

170

Castel, supra n.167, at p295.

171

Ibid.

172

M. Foucault, Discipline and Punish: the Birth of the Prison, Penguin Books, 1991, at p296.

173

94 plainly, is that they were subject to what we might call a Foucauldian impulse to assert control over a section of the population that they had recast as ‘deviant’. Policy-makers were adamant that considerations of risk should always take precedence in mental health decision-making. They identified an ineluctable relationship between mental illness and suicide and violence, believing that it warranted coercive oversight notwithstanding

evidence which suggested that the link in fact rarely materialised. Consequently, people with mental disorders were implicitly seen as a challenge to the ‘civilised body’. They are therefore a category extension of Lupton’s notion of ‘Otherness’; a group that policy-makers considered needful of control and discipline.

Mindful of this, it is perhaps unsurprising that the reforms of the MHA took the shape that they did. We already know that the 2007 Act, inter alia, simplified the definition of

‘mental disorder’,174 thereby removing the 1983 Act’s rigid legalistic categorisations; abolished the ‘treatability test’,175 requiring only that treatment for mental disorders be ‘appropriate’; and broadened the range of professionals who could engage the compulsory powers,176 removing the separation of powers that existed between representatives of the clinical and social models. The central theme of the 2007 Act made it easier to exert control over risky patients with mental disorders using the compulsory powers. What might amount to a risk is a matter for decision-makers; there is no definition of the concept in the MHA, suggesting that doctors and allied professionals can take their cue from the discourse in which the legislation was enveloped. Indeed, this is a particular necessity when one

174 2007 Act, s.1(2). 175 2007 Act, s.4. 176 2007 Act, ss.9-21.

95 considers that the judgment of riskiness is only partially conducted in medical terms; according to Rose, matters such as employment, family, alcohol consumption, coping skills, and the patient’s ability to cook, shop and manage money have become absorbed within the mental health practitioner’s discretionary competence.177 In this way, decision-makers have been co-opted into completing the objectives of policy-makers by facilitating greater control over patients with mental disorders. It is on this theoretical basis that the narrower concept of risk to self or others must be understood in the context of the 2007 Act.

4.

Conclusions

It is difficult to deny that risk was instrumental in shaping the policy behind the 2007 Act. The question is: why? Was the ‘rise of risk’ in mental health policy simply part of a broader pre-occupation with risk in modern society? Or did risk gain prominence because it offers a handy device with which to exert control over a ‘deviant’ section of the population? This chapter has shown that to some extent it was both.

First, Beck and Giddens’ Risk Society theories posit that society manufactures potentially catastrophic hazards as a by-product of its progress. As a result, the priorities of its social policy are transformed to prevent adverse incidents occurring in the future. It is true that modernity has had particular consequences for health: around a quarter of the population of the United Kingdom is now at risk of developing some form of mental disorder, which has further implications for public spending and service provision. Policy- and decision-makers have also recognised that timely interventions can reduce the risk of mental illness by

177

N. Rose, ‘Governing Risky Individuals: the Role of Psychiatry in New Regimes of Control’ (1999) 5(2) Psychiatry, Psychology and Law 177, at p185.

96 tackling the social and environmental factors that render people susceptible to mental illness. Here we see both a decline in traditional or natural interpretations of adverse events and a growing faith in the capabilities of human intervention. This explains why mental health policy has placed greater emphasis on preventive strategies in recent years. It also provides a context for the growth of regulatory oversight and professional responsibility (and defensiveness) since the 1983 Act.

Yet, Risk Society does not entirely account for the amplification in public discourse of anxieties about mentally disordered patients’ risks to themselves or others. In order for the Risk Society thesis to apply, there would have to be evidence of an increase in the risk of