Leprosy, Plague, and Smallpox. Three Paradigms of Modern Governmental Techniques
Michel Foucault’s »Discipline and Punish« and the »Lectures on Governmentality« revisited
By Markus Arnold
There are key points in Michel Foucault’s oeuvre concerning a typology of modern governmental techniques, where he repeatedly refers back to epidemics. Already in Madness & Civilization (Fr. orig. 1961), he described the measures for the sequestration of lepers from medieval society as a model for later social and institutional practices of exclusion (Chapter 1. Stultifera Navis [= »Ship of Fools«], 7f.). And later on, he analyzed how combating epidemics, such as the plague or smallpox, led to the evolution and implementation of new modern governmental techniques.
For example, in the likely most-cited section of Discipline and Punish, the chapter about panopticism, Foucault surprisingly does not begin his analysis of Bentham’s Panopticon with Bentham, but with an account of how the plague was contained in the seventeenth century. He presents the measures taken by the government against the plague and those against leprosy as two exemplary paradigms: on the one hand, »exclusion«, banning the complete group of people from the community and declaring them »lepers«; on the other, in the case of the plague, »confinement«, which facilitates an individualizing disciplinary control over space and the people. For the plague is »the trial in the course of which one may define ideally the exercise of disciplinary power«. (Foucault 1995, 198) The two models of leprosy and the plague, which differ at the core, are however not irreconcilable, as Foucault stresses, quite the contrary:
It is the peculiarity of the nineteenth century that it applied to the space of exclusion of which the leper was the symbolic inhabitant (beggars, vagabonds, madmen and the disorderly formed the real population) the technique of power proper to disciplinary partitioning. (Foucault 1995, 199)
In this way, Foucault traces Bentham’s Panopticon as well as the general surveillance principle of panopticism back to the political-administrative techniques developed to combat leprosy and the plague:
The constant division between the normal and the abnormal, to which every individual is subjected, brings us back to our own time, by applying the binary branding and exile of the leper to quite different objects; the existence of a whole set of techniques and institutions for measuring, supervising and correcting the abnormal brings into play the disciplinary mechanisms to which the fear of the plague gave rise. All the mechanisms of power which, even today, are disposed around the abnormal individual, to brand him and to alter him, are composed of those two forms from which they distantly derive. Bentham’s Panopticon is the architectural figure of this composition. (Foucault 1995, 199–200)
But these are not Foucault’s last words on the role of epidemics. In his later »Lectures on Governmentality« (1977–78) he identifies vaccination—in particular, the early inoculation practices for smallpox—as a third paradigm underlying modern governmental techniques. Here, at the beginning of his lectures, he returns to the measures exercised against leprosy and the plague to then address the medical practice of inoculation against smallpox in the eighteenth century. In his eyes, smallpox inoculation is a paradigmatic example of what he calls the »security dispositif«, the so-called »biopolitics« intrinsic to »liberal« governmentality. It is an example of a governmental technique grounded in »security« and (statistical) »normalization«, which presents itself as an alternative to the disciplinary techniques outlined in Discipline and Punish.
In contrast to the »plague regulations formulated at the end of the Middle Ages, in the sixteenth and still in the seventeenth century«, the problem with smallpox and the vaccination practices since the eighteenth century is posed quite differently: The primary objective of governments has changed; their problem is no longer
[…] the imposition of discipline, although discipline may be called on to help, so much as the problem of knowing how many people are infected with smallpox, at what age, with what effects, with what mortality rate, lesions or after-effects, the risks of inoculation, the probability of an individual dying or being infected by smallpox despite inoculation, and the statistical effects on the population in general. In short, it will no longer be the problem of exclusion, as with leprosy, or of quarantine, as with the plague, but of epidemics and the medical campaigns that try to halt epidemic or endemic phenomena. (Foucault 2007, 10)
With the invention of smallpox inoculation and the evolving concept of the »security dispositif«, it is no longer predominantly about exercising sovereignty over a »territory« and the discipline of obedient subjects, rather about the »population« and their »regulation«. Whereby »population« refers to the notion of humans as a statistically constructed species, just as »life«—which biopolitics aims to regulate as the subject of its political interventions—refers to the life of the population, as it appears to the government in the statistics.
Central to this governmental technique is the urban model of the »open city«: for it is especially modern port and trade cities where the movement of people and goods is to be regulated, but not prohibited. Trade cities as nodes in global trade networks thrive off of people and goods being able to flow in and out. Their open economy is defined by the »natural« laws of the market, by supply and demand, which indeed should be regulated by the government at points, but must not be impeded by too many rules—a governmental technique that liberal economists praise to this day. But in the event of an epidemic, sustaining an »open city« is only possible when the government possesses an appropriate vaccine to immunize the population.
Foucault sees parallels between the medical model of inoculation and liberal market regulation in an »open« trade city. Inoculation builds upon existing biological processes, like that of the human immune system, in order to contain the spread of the disease (cf. Foucault 2007, 58). Liberal market governance uses existing economic processes, such as supply and demand, in order to control them through selective regulating interventions. Similar to how the government acknowledges the market’s laws as »natural« and only intervenes selectively, inoculation postulates that diseases and the reactions of the human immune system are something quite »natural« and follow their course in regular, statistically quantifiable patterns. This course of an epidemic can be altered with inoculations, but only stopped in the rarest of cases.
This third paradigm of modern governmental techniques (besides exclusion from the community and quarantine as disciplinary surveillance) also forced Foucault to rethink his earlier statements on »normalization«: In Discipline and Punish Foucault still used »normalization« when speaking about disciplinary techniques that aim to subject the behavior of people to a fixed behavioral norm through clear behavioral rules. (Foucault 1995, 177f.; Foucault 1978, 144f.) But in order to integrate this third model into his analysis of power in his »Lectures on Governmentality«, he chose for a terminological name change: He now called the disciplinary methods of behavioral rules described in Discipline and Punish »normation« and reserved the term »normalization« for the statistics-based, regulating interventions into the population, which are intrinsic to the security dispositif and biopolitics:
Discipline fixes the processes of progressive training (dressage) and permanent control, and finally, on the basis of this, it establishes the division between those considered unsuitable or incapable and the others. […] Disciplinary normalization consists first of all in positing a model, an optimal model that is constructed in terms of a certain result, and the operation of disciplinary normalization consists in trying to get people, movements, and actions to conform to this model, the normal being precisely that which can conform to this norm, and the abnormal that which is incapable of conforming to the norm. In other words, it is not the normal and the abnormal that is fundamental and primary in disciplinary normalization, it is the norm. […] Due to the primacy of the norm in relation to the normal, to the fact that disciplinary normalization goes from the norm to the final division between the normal and the abnormal, I would rather say that what is involved in disciplinary techniques is a normation (normation) rather than normalization. (Foucault 2007, 57)
The main difference between disciplinary »normation« and the »normalization« of the security dispositif is that disciplining assumes a norm that defines normal and abnormal, whereas the security dispositif, first and foremost, empirically ascertains the statistically normal and abnormal within a population as a basis to construct a statistical mean as a norm (e.g. the normal mortality rate, by which deviations can be identified). Hence, Foucault reserves the term »normalization« for those governmental techniques, whose measures are either oriented upon a (flexible) statistical average (where one attempts e.g. to sink the normal mortality rate in a population with inoculation, or increase the average »economic growth« of a country) or with which one tries to improve the own statistical values in comparison to the values of other actors (e.g. in national rankings, to be »better than the European average«).
Foucault analyzes this new form of »normalization«, for instance, on the basis of smallpox inoculation. He emphasizes that inoculation as a medical practice was something completely new; so new that in the beginning it could not be brought in line with existing medical theories. In doing so, he identifies four characteristics of inoculation, which initially set it apart from existing, theoretically founded medical treatment techniques:
From 1720, with what is called inoculation or variolization, and then from 1800 with vaccination, techniques were available with the fourfold characteristic, which was absolutely out of the ordinary in the medical practices of the time, of first, being absolutely preventative, second, having almost total certainty of success, third, being in principle able to be extended to the whole population without major material or economic difficulties, and fourth, and above all, variolization first of all, but still vaccination at the start of the nineteenth century, had the considerable advantage of being completely foreign to any medical theory. The practice of variolization and vaccination, the success of variolization and vaccination were unthinkable in the terms of medical rationality of this time. It was a pure matter of fact, of the most naked empiricism, and this remained the case until the middle of the nineteenth century, roughly with Pasteur, when medicine was able to provide a rational understanding of the phenomenon. (Foucault 2007, 58)
Only because of these new, initially not even imaginable aspects could smallpox inoculation—along with the liberal market theories of economists—fundamentally change existing governmental techniques. However, this posed the question of how inoculation, this medical practice without medical theory, was ultimately integrated into medical theory and how it has transformed healthcare policies to this day. Foucault identifies two factors:
What happened and what were the effects of these purely empirical techniques in the domain of what could be called medical police? I think that variolization first of all, and then vaccination, benefited from two supports […] First, of course, thanks to the statistical instruments available, the certain and generally applicable character of vaccination and variolization made it possible to think of the phenomena in terms of the calculus of probabilities. To that extent, we can say that variolization and vaccination benefited from a mathematical support that was at the same time a sort of agent of their integration within the currently acceptable and accepted fields of rationality. Second, […] was the fact that variolization and vaccination were integrated, at least analogically and through a series of important resemblances, within the other mechanisms of security […]. Now, I think that through this typical practice of security we see a number of elements emerging that are absolutely important for the later extension of apparatuses of security. (Foucault 2007, 58f.)
This second factor, with these similarities to the other security dispositifs, manifests in four new terms: the case, the risk, the danger, and the crisis:
First, what do we see in all the processes of the practice of inoculation: in the supervision of those inoculated, in the set of calculations made in the attempt to determine whether or not it really is worth inoculating people, whether one risks dying from the inoculation, or dying from the smallpox itself? […] When quantitative analyses are made of smallpox in terms of success and failure, defeats and successful outcomes, when the different possibilities of death or contamination are calculated, the result is that the disease […] [appears] as a distribution of cases in a population circumscribed in time or space. Consequently, the notion of case appears, which is not the individual case, but a way of individualizing the collective phenomenon of the disease, or of collectivizing the phenomena, integrating individual phenomena within a collective field, but in the form of quantification of both the rational and identifiable. (Foucault 2007, 60f.; translation modified)
The (modern) statistical conception of the case leads directly to the second concept: the risk.
If the disease is accessible in this way at the level of the group and at the level of each individual, in this notion, this analysis of the distribution of cases, then with regard to each individual or group we will be able to identify the risk for each of [catching] smallpox, of dying from it or being cured. For each individual, given his age and where he lives, and for each age group, town, or profession, we will be able to determine the risk of morbidity and the risk of mortality. (Foucault 2007, 60–61)
The calculation of the risk facilitates—thirdly—the calculation of the danger:
This calculation of risk shows straightaway that risks are not the same for all individuals, all ages, or in every condition, place or milieu. There are therefore differential risks that reveal, as it were, zones of higher risk and, on the other hand, zones of less or lower risk. This means that one can thus identify what is dangerous. [With regard to] the risk of smallpox, it is dangerous to be less than three years old. It is more dangerous to live in the town than in the country. So, after the notions of case and risk, there is the third important notion of danger. (Foucault 2007, 61)
The risk of becoming sick is now statistically quantifiable. Which also makes the governmental measures, that should lower the risk of becoming sick, accessible to an empirical-quantitative evaluation by experts. Because risk is not something static, rather it is subject to dynamic changes over time at different places, which can be influenced by interventions and represented through statistical curves in their temporal development. In order to be able to capture the natural dynamic of the temporal development, one resorts—fourthly—to the concept of crisis. Because now
phenomena of sudden worsening, acceleration, and increase of the disease can be identified that do not fall within the general category of epidemic, but are such that its spread at a particular time and place carries the risk, through contagion obviously, of multiplying cases that multiply other cases in an unstoppable tendency or gradient […] This phenomenon of sudden bolting, which regularly occurs and is also regularly nullified, can be called, roughly—not exactly in medical terminology, since the word was already used to designate something else—the crisis. The crisis is this phenomenon of sudden, circular bolting that can only be checked either by a higher, natural mechanism [e.g. the human immune system], or by an artificial mechanism [e.g. the vaccine (author’s notes)]. (Foucault 2007, 61)
These four characteristics connect the medical practice of inoculation and vaccination with the other political technologies of the security dispositif.
But what is the difference between smallpox inoculation as a governmental technique and combating the plague, between the biopolitical security dispositif and the panopticism of the disciplinary power? Which economies of power form around these governmental practices of disciplinary normation and biopolitical normalization? Foucault on the biopolitical mechanisms of the security dispositif:
Finally—and here I think we come to the central point of all this—all these mechanisms, unlike those of law or of discipline, do not tend to convey the exercise of a will over others in the most homogeneous, continuous, and exhaustive way possible. It is a matter rather of revealing a level of the necessary and sufficient action of those who govern. This pertinent level of government action is not the actual totality of the subjects in every single detail, but the population with its specific phenomena and processes. The idea of the panopticon […] basically involves putting someone in the center—an eye, a gaze, a principle of surveillance—who will be able to make its sovereignty function over all the individuals [placed] within this machine of power. […] None of my subjects can escape and none of their actions is unknown to me. The central point of the panopticon still functions, as it were, as a perfect sovereign. On the other hand, what we now see is [not] the idea of a power that takes the form of an exhaustive surveillance of individuals so that they are all constantly under the eyes of the sovereign in everything they do, but the set of mechanisms that, for the government and those who govern, attach pertinence to quite specific phenomena that are not exactly individual phenomena […]. The relation between the individual and the collective, between the totality of the social body and its elementary fragments, is made to function in a completely different way; it will function differently in what we call population. The government of populations is, I think, completely different from the exercise of sovereignty over the fine grain of individual behaviors. It seems to me that we have two completely different systems of power. (Foucault 2007, 66)
This distinction is decisive to understand Foucauldian government typologies: because the »life«, which Foucault speaks about in his theory of »biopower«, means the characteristics of the »population« represented in the statistics as biological-physical beings (birth and death rate, sickness and health conditions, nutritional status, working and living conditions, etc.). Hence, Giorgo Agamben’s much discussed thesis—that the camp is apparently the biopolitical paradigm of the modern, and biopolitics has to do, above all, with totalitarian rule (Agamben 1998, 166f.)—has, contrary to his own claims, nothing to do with Foucault’s concept of biopolitics.
One must study liberalism, not totalitarian regimes, as »the general framework of biopolitics«: because »only when we know what this governmental regime called liberalism was, will we be able to grasp what biopolitics is.« (Foucault 2008, 22) When Foucault speaks of biopolitics, his focus is thus on liberal governmental techniques, which strive for a »limitation of government« and thereby leave relatively ample leeway for a great majority of people to realize their personal desires and goals. These techniques only intervene selectively, for in this conception the »population« is ruled by »natural« processes, which must remain in their own dynamic and only be regulated with minimal interventions in order to adapt them to the government’s goals. The paramount example of these types of governmental techniques (besides the medical vaccination) is the so-called »free market«—with its aid, the »natural« dynamic of supply and demand can be employed for governmental ends (such as economic growth). The government only intervenes here in exceptional cases, solely to sustain »free competition«; similar to how the government tries to make use of the natural biological processes between pathogens and physical defense mechanisms for its own purposes, with only selective regulating interventions in the form of vaccinations.
Disciplinary techniques, for example, which are there to influence the sexual behavior of children and their parents, can equally play a role in a »liberal« biopolitical security dispositif, just as eugenics and racist laws, but also social state legislation, when it is deployed as regulating interventions in natural processes, analogous to market regulation and medical vaccinations. In short: For Foucault, biopolitics has little connection with concentration camps and »totalitarian rule«—for him, it is primarily a concept for the analysis of the governmental techniques of classical liberalism and postmodern neoliberalism (this must be stressed, above all, in light of the numerous misunderstandings in Philipp Sarasin’s text »Understanding the Coronavirus Pandemic with Foucault?«).
What one can learn today by rereading Foucauldian texts is thus how Foucault, already in the late 1970s, analyzed the three techniques available to the government—(1.) »exclusion«, (2.) »discipline«, and (3.) the »security dispositif«—which have been discussed in the media in the corona crisis of 2020 under the catchwords (1.) »separation of risk groups« and (2.) disciplinary »quarantine« and »surveillance« (police state mentality), but above all, were and are present in (3.) the statistical concepts of »normal mortality« or »overmortality«, »herd immunity«, and »flattening the curve«. However, as long as there is no appropriate vaccination available (to the great surprise of the media and the population), governments once again have to resort, at least provisionally, to the classical disciplinary techniques of quarantine—despite always legitimizing the necessity and effectiveness of their measures from the standpoint of a statistics-based security dispositif.
I would like to thank Insa Haertel and Nicola Condoleo for their valuable suggestions and inspirations.
Link: Michel Foucault, »Panopticism,« in Discipline and Punish. The Birth of the Prison (New York: Vintage Books, 1995), 195–228.
Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life, trans. Daniel Heller-Roazen (Stanford, CA: Stanford University Press, 1998).
Michel Foucault, Discipline and Punish. The Birth of the Prison, trans. Alan Sheridan (New York: Vintage Books, 1995).
Michel Foucault, The Will to Knowledge: The History of Sexuality I, trans. Robert Hurley (New York: Pantheon Books, 1978).
Michel Foucault, Security, Territory, Population (Lectures at the Collège de France 1977–1978), trans. Graham Burchell (New York: Palgrave Macmillan, 2007).
Michel Foucault, Birth of Biopolitics (Lectures at the Collège de France 1978–1979), trans. Graham Burchell (New York: Palgrave Macmillan, 2008).