Saturday, January 3, 2015

Reproductive health, HIV/AIDS, and Foucault's "History of Sexuality"

by Gideon Lasco MD

The medicalization of our lives cannot be discussed without juxtaposing it with the commercialization and politicization of the medical. By transitivity, the medicalization of our natural processes is the commercialization and politicization of such, and in this way, medicine becomes a route, among others, by which our bodies are subjugated by politico-economic regimes. Following this premise, behavior, even sexual behavior, can be produced by these regimes, by way of and as seen in discourse, or how things are discussed as distinguished from what people actually do. This, I think, sums up what Foucault depicts in the first volume of his "History of Sexuality"; the juxtaposition that I described is what he terms as "biopower" and the discourse on sex is what he ascribes to as the author of “sexuality”.

In History of Sexuality, Foucault rejects the notion that sexuality was repressed; in fact, there was, in fact, an “incitation to discourse” (p. 33); a “need to talk” about sexuality, traceable to the Christian tradition of confession. He builds the case for this “need” for sexuality across different cultures, citing the ars erotica of the Japanese and the Indians and, within Western culture, the divergent but in some ways analogous concept of scientia sexualis. But instead of simply concluding that the a priori need to articulate sex is a cultural universal, he deftly connects it with his central theme: the production and use of power. In fact, it is this very “biopower” that has produced sexuality as we know it (p. 105).

It is not difficult to apprehend the implication of Foucault's book on the overarching themes of reproductive health, sexuality, and HIV/AIDS.  If sexuality is "produced", then reproductive health, too, is a product, and it can be "reverse engineered" to yield the secrets of its construction. Likewise, the intimate relationship between sexuality and AIDS becomes situated in the "embeddedness" of sex in relation to power.

Which begs the question: by what method? Herein lies the significance of Foucault: he lays down the theoretical foundation of anthropology and sociology as methods for the understanding of sexuality (and by extension, its intimacies). Indeed, by emancipating sexuality from sex (and thus, from the realm of the biological, the inevitable), Foucault makes it a valid focus of social science research. we can then think of heterosexuality, homosexuality, bisexuality, and other “genders” as “imagined sexualities” [1].

In approaching HIV/AIDS, thus, we too must look for the “repressive hypothesis” to debunk, we must look at the discourse, and at the practice. A spectrum of approaches then emerges: from micro, in-depth observational studies on what is actually practiced (a paean to ethnography) to macro, ecological, critical observation that looks at “biopower” (i.e. critical medical anthropology). Among the firstfruits of this approach include the use of concepts like “structural violence” that actually elaborate the relationship between power structures and HIV/AIDS in more discrete terms [2].

Foucault’s paradigm not only shapes and legitimates methodologies, it also influences interventions. For instance, the categorization of people as “men having sex with men” instead of “gay” or “homosexual” is in a way an application of the social constructionism that Foucault espoused.

Perhaps a useful thought experiment on reproductive health would be to imagine a future when (in)fertility can be perfectly controlled by biomedicine – a total schism between recreation and procreation. Or perhaps we can imagine a world where sexually-transmitted diseases have been completely eradicated. Via Foucault, we can navigate through these imagined worlds by discussing it in terms of biopower, the deployment of alliances (p. 115), which itself can lead us to reject the very possibility of these worlds’ coming into being. In these imagined words, there is at least a Foucaultian trajectory by which we can commence our speculations. I can begin by suggesting that only a complete liberation from any form of pathology can liberate us from the regimes of biopower.

Ultimately, by inextricably linking medicine and our bodies with politics and economy, i.e. the "power without the king" (p.91), Foucault's book lays down the premise that upholds the importance of context. As we continue to confront HIV/AIDS and reproductive health issues, embedded as they are in a myriad of issues, the centrality of Foucault‘s message cannot (and should not) be lost. Indeed, the voice of anthropology is essential in HIV/AIDS studies if we are to put an end to the epidemic. Foucault may yet help kill the illness that claimed his own life.

Brussels, Belgium
January 28-29, 2012

NOTES

1. The allusion on Benedict Anderson’s “Imagined Communities” is intentional. Anderson’s assertion that the concepts of nations, too, are constructed, is as revolutionary as Foucault’s notion of sexualities as constructs.

2. Here I am thinking of Paul Farmer’s Pathologies of Power and also some of Vinh-Kim Nguyen’s works.

3. As a final thought on History of Sexuality, it can be suggested that Foucault’s work is itself part of “discourse” (or, anti-discourse) that legitimates criticism of “biopower” (anti-power).

SELECTED BIBLIOGRAPHY

Foucault, M. (1978) The History of Sexuality Volume I: An Introduction, translated by R. Hurley. London: Penguin Books

Anderson, Benedict R. O'G. (1991). Imagined communities: reflections on the origin and spread of nationalism (Revised and extended. ed.). London: Verso.

Farmer P (2003). Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, Cal.: University of California Press

Young R, Meyer I (2004). The Trouble With “MSM” and “WSW”: Erasure of the Sexual-Minority Person in Public Health Discourse. Am J Public Health. 2005 July; 95(7): 1144–1149.

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