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“How can I be healthy, when I’m already dead?” Confronting the dominance of the medical model within social services, with an oppression-informed analysis

[What follows is the transcript of the material I tried to present at a conference called Streetlevel.  It’s a conference for people working in social services that are rooted in the Christian faith.  As you will see in what follows, I see this as an highly problematical endeavour.  However, given the audience and given my own background in textual criticism, especially in relation to the New Testament, I found it useful to use language, stories, and characters familiar to the audience in order to try and make some of my points.]
“How can I be healthy, when I’m already dead?”  Confronting the dominance of the medical model within social services, with an oppression-informed analysis
Opening
I will begin by recognizing that I am speaking while occupying land that Creator has gifted to the keeping of the Anishinaabe and shared with the Haudenosaunee and Lenape.  I lift my hands to these caretakers of the land and thank them for allowing people like me to live, work, play, and settle in their territories beside the Askunessippi and all across Turtle Island.  As a Settler, I benefit from the ongoing project of Settler colonialism as it plays out in the occupied territories named “Canada” on the maps we learned in school (maps that no longer show European colonies like Rhodesia, the Belgian Congo or Spanish Guinea, but which continue to show Canada).  In these territories, more than six hundred Indigenous nations have been the target of genocidal practices and policies from before independence up until the present day.  In all of this, the government of Canada, the Christian churches, the charities, and all the settlers and citizens of the nation, have been implicated.  Indeed, it is necessary to acknowledge from the beginning that as a white male settler of Christian European descent, I am a beneficiary of the genocidal process of colonization that has secured for me legal rights, access to wealth and education, and political and social status.  So, it is with a sense of my own liability and responsibility that I express my thanksgiving and lift my hands to the caretakers of the land I occupy. Chi-miigwetch.
In light of this history of genocide, so tightly woven together with the history of Christianity, it is often difficult to think or speak of God, and just as difficult to think about prayer.  However, I want to open with a prayer I learned from an elder in Vancouver’s downtown eastside.  After sharing some of his story of surviving in a Christian-run residential school, a student in a class I was helping to lead asked this elder what he now thought of God.  The student was doing what I have seen lots of Christians do – she was struggling to really hear this story of abuse, to see how it was intimately linked to Christianity, and to then respond in a manner that genuinely sought to enter into communion with the man sharing.  It seemed as though she was more upset by the idea that a person may have drifted away from the Christian God because of this experience (because she was convinced that Jesus Christ was not represented but misrepresented in residential schools and that the people who did such horrible things were not really Christians, even though they called themselves Christians). She was wanted to highlight the importance of maintaining a sense of one’s relationship with the Christian God.  She was, in other words, trying to be both sensitive and missional (these two characteristics will come up a lot in what follows).  In response to this line of questioning, the elder was very gracious.  He did not say too much but he did say that there was a prayer that he learned from one of his elders.  This was a prayer he could still pray.  It is one I can still pray, too, and I will pray it now:
Creator, may this day be good.

Introduction: “I see people; they look like trees walking around.” Why Ideology Matters
In this workshop, I want us to think about how we see things.  I want us to think about why some things appear good to us, while other things appear to be bad.  I want us to think about why some things appear obvious to us, while other things appear to be more ambiguous.  Why do some things appear to us as natural, while other things appear to be unnatural, perverse, artificial, or contrived?
As we think about how we see what we see, it is important to remember that seeing is something we are taught to do.  For example, what do you see in this picture?
Smooth Sumac
[Here, in response, people say that they see a tree.  We discuss how we know this is a tree.  I then point out that this is not, in fact, a tree but is actually a shrub.[1]   We have now been taught a new way to see the central item in the picture.  Some people also identify this item as a plant, regardless of if it is a tree or shrub.  Conversation ensues demonstrating that we also call some things plants because we are taught to call those things plants.]
So, we see what we see because we have been taught to see those things.  To pick another example, let’s say I see a married couple sharing a kiss in the park while the sun sets.  Does that look like a good thing to me?  What if the married couple is composed of two men?  Does that look like a bad thing to me? We have to learn to see things, and this learning is something always passed on to us from others.
We are taught the names for things from the time we are born, and these names include not only names like “tree” and “bench” and “sunset” but also names like “good” and “bad,” “natural,” and “perverse.”  However, there are often different, competing, contradicting, and overlapping ways of seeing the same thing.  Where we come from, what voices and perspectives dominant our environment, and what voices we consider to be authoritative, are able to influence us so much that certain ways of seeing appear more obvious, plain, or natural to us than others.  This is why Slavoj Žižek says that nature is nothing but ideology operating at its finest (ideology, after all, is just a fancy word people use to talk about ways of seeing).  What Žižek  means by this is that we are taught to see some things as natural and other things as things that are made by people, but this very distinction between nature and not-nature, is one that is made by people.  So nature, itself, is ideology, and whatever feels natural or appears natural to us, reveals the ideology that has must successfully shaped the way in which we see the world.
In other words, from the day we are born until the day we die, we are all given glasses to wear.  These glasses are the words we are taught to use in relationship to the world.  The prescription of your glasses depends upon the context in which you are born and grow up and live.  We often misunderstand and talk past each other because looking at the world through another person’s glasses can make everything look fuzzy and blurry, and can result in feelings of nausea and dizziness.  Consequently, we try to join together with others who have the same prescription we have in order to reassure ourselves that we see things the right way.
So, seeing is something we are taught to do, and what we see is always contested.  However, at any given historical moment, a specific way of seeing may come to dominate a particular field.  Dominance comes about through a process of struggle, negotiation, and conquest.  Orthodox Christianity is a good example of this.  There has never been a single Christianity.  There have ever only been competing, contesting, overlapping, and contradicting Christianities.  We see that already in the letters of Paul in the New Testament – whether he’s arguing against Cephas and the faction of leaders from Jerusalem when writing to Galatians, or whether he’s arguing against so-called “Super Apostles” in Corinth, what we see is that there is a lot of conflict and disagreement regarding what is or is not a critical belief, action, or way of seeing, for people who claim to be members of this group.  Whatever form of Christianity comes to dominate the others, usually has a lot to do with who is connected to people with money, wealth, power, and more advanced military technology.  Augustine, for example, helped to shape what is now considered orthodox Christianity because he was connected with the imperial court so he was able to both silence and kill his enemies.  Although, of course, first he taught people to see his enemies as “heretics” or “enemies of Christ” or “public security threats” which made killing them, and erasing their version of events from history, that much easier.  So it goes with the history of orthodox Christianity.
But there are many kinds of orthodoxies, not just those that are explicitly related to religious creeds, and the orthodoxy we are going to explore today is the one that dominates how we view poverty and homelessness.  A medical perspective has come to dominate social services that are engaging with people experiencing poverty and homelessness.  People now see poverty and homelessness as community or public health concerns.  For example, when you look at the following pictures, do you think you see a contrast between a wicked person who has become good, or between a person a sick person who has gotten healthy?

What do you see?

What do you see?


A formerly bad person who has become a good person?

A formerly bad person who has become a good person?


A formerly sick person (mentally ill? physically ill? both?) who has become a healthy person?

A formerly sick person (mentally ill? physically ill? both?) who has become a healthy person?


Bad to good? Sick to healhty?

Bad to good? Sick to healhty?


Seeing these people as sick people, perhaps mentally ill, perhaps physically ill, perhaps both, who have now recovered or are in recovery, is probably a common reaction in this room.  However, I want us to stop and think why we are being taught to see things in this way.  In fact, as will become obvious, I think it is a very troubling and problematical to view poverty and homelessness as community or public health issues.  However, I also don’t want to return to a traditional Christian social service perspective on these matters.  I think that approach is also problematical and actually follows the same trajectories and goals as the medical model.  For example, let’s look at the pictures we just saw, think about all the makeovers we have celebrated in our work, and include some pictures from other makeovers.
What do you see now?

What do you see now?


Bad to good?

Bad to good?


Sick to healthy?

Sick to healthy?


Savage to civilized?

Savage to civilized?


It is remarkable how much these residential school makeover pictures resemble the before and after pictures we celebrate of people who experience homelessness and come out the other side.  They look identical.  Isn’t this disconcerting?
Here, I am reminded of the words of Mary Douglas: “Though we laud charity as a Christian virtue we know that it wounds.”[2]  And I think it wounds, in part, because it does not see well.  In many ways, we are like the blind man from Bethsaida Jesus heals in Mark 8.  When the blind man asks Jesus to heal him, Jesus spits in his eyes and asks him what he sees, “I see people as trees walking,” is the man’s reply.  It is only after a second touch that the man sees more clearly.  I think Christian social services are mostly at the trees walking stage of seeing.  I want to propose another (better) way of seeing – a way informed by an analysis that takes oppression very seriously as a core component of poverty and homelessness.  This way of seeing then opens the door to another way of acting and of being in relationships with others.  Because how we see impacts what we do.  For example, if I look down an alleyway at night and see an evil man, I will act one way.

If I look down that same alleyway and see an abandoned child, I will act another way.

And if I look again down that alley at night and see somebody who has been shot, and realize I am holding a smoking gun, I will act in a third way.

All of these ways of seeing, are ways in which people see those who experience poverty and homelessness.
Consequently, in this workshop, we will begin by looking at the medical perspective as it relates to social services engaging with poverty and homelessness – how it rose to dominance, what it entails, and what it neglects – before drawing on Jesus’ manifesto in Luke 4 to explore an oppression-informed perspective.  I will then conclude with some reflections on what that might mean for us in the work that we do.  And here, it is worth considering, one more set of before and after pictures.
Jesus before...

Jesus before…


Jesus after.

Jesus after.


This is quite a different kind of makeover, isn’t it?
Part 1: “Stop resisting, we’re doing this for your own good!” Maintaining the Right to Other Peoples’ Bodies
(1A) A Crisis in Justified Enforcement: From Religion to Health Care
When considering the rise of the medical model and the spread of the language of community or public health, the first thing to realize is that this is a relatively recent phenomenon.  Medicine used to be practiced very differently, health and sickness used to be understood and prioritized very differently, and those concerned with such things used to have a much lower and much less influential place within society.  So, what happened?  How did the discursive practices of health care come to dominate all others?
What happened was this: from the Renaissance onward, there were dramatic shifts within Western societies.  Science, empiricism, and rationalism, confronted the worldview provided by the dominant forms of Christianity.  This confrontation created a crisis in authority for those who were able to legitimately wield force over others within society.
For example, during the Inquisition, deviant or threatening groups or individuals could be classified as witches and as heretics and then force could be legitimately brought to bear upon their bodies – they could be tortured or killed or both – and this right of some people to act in violent and dominating manner towards other people, was justified by the Roman Catholic way of seeing that was widespread at that time.  Similarly, on the Protestant side of things, people like Martin Luther could urge the German princes to mercilessly slaughter any peasants who dared to challenge the authority of those princes, because, according to the Lutheran way of seeing, the  authority of the princes was aligned with the authority of God.  To speak or act out against them, was to speak or act out against God and was a crime that merited death.  Consequently, what was essentially a popular uprising of an oppressed and exploited people was crushed with divine blessing and plenty of reference to Romans 13, as Luther urged the princes to “stab, smite, slay whoever you can.”[3]
The dawning of the age of scientific reason, created a crisis for those who had used religious discourses to justify the use of force against others.  If deviant people are not witches, heretics, and sinners, by what right can those in centralized places of power use force in order to ensure that the trajectory of the status quo continues to be structured around meeting their needs and further entrenching their access to power, wealth, status, influence, land and property?  Force can always be used by people with the means to act forcefully – anyone with a knife or gun or cage can use it to harm the body of another person – but how can the use of force be justified and be made to appear to the rest of society as right, appropriate, and acceptable?  With the decline of religion and the rise of reason, something of a vacuum of legitimacy appears.
Over time, one of the consequences of this move away from a religious or Christian worldview, is a shift in the group of people who are at the hub of centralized power within society.  Ultimately, the decline of religion leads to a decline in the legitimacy to rule claimed by monarchs, nobles, and aristocrats.  This creates the space for another group to make a move to rule.  The group that rises to power is the capitalist class – the elite members of the bourgeoisie.  Technological advances, both in the production and transportation of goods, allowed this group to gain and hoard vast amounts of wealth.  Wealth, paired with the collapse of the belief that hierarchies on earth mirrored hierarchies in heaven, allowed the capitalists to take charge of or create new central institutions of power.  Hence, Christendom is replaced by the nation state, the aristocracy is replaced by the capitalists, and blood is conquered by money.
However, a vacuum related to justifying the use of force over others also appears here.  The propertied classes are keen to hold onto all the money, goods, and land they accumulate thanks to their ability to exploit the labour and lives of others.  People who are exploited, however, tend to feel differently about things.  Force becomes necessary in order to maintain this arrangement.  However, saying, “I have the most money so I am justified in using the most force” is not a justification that gets a lot of widespread credibility. Something different is needed in order to fill the vacuum created by the decline of religion and the rise of capitalism.  It is this vacuum that is filled by the rise of medicine and the discourse of public health.
In order to understand how this works, it’s useful to provide a brief history of the notion of mental illness.  In this section, I will briefly summarize Michel Foucault’s History of Madness, while simultaneously drawing on Deviance and Medicalization: From Badness to Sickness by Peter Conrad and Joseph W. Schneider.  As we survey this history, it is critical that we reflect upon our own experience within social services.  How much to our institutions mirror the values, trajectories, and structures, of the institutions that we discover here?
Western society is unique in understanding “madness” to be “mental illness.”[4]  How did this come about and what are the implications of this?  Foucault argues that with the rise of reason during the Renaissance, cultural values shifted away from Christian virtues, and behaviour that was previously classified as sinful came to be seen as “folly” or a “great unreason.”[5]  Here, as continues to be the case over the years, we see behaviours that were already classified as deviant being reclassified as sickness – illness, in other words, follows after a predetermined badness and negative evaluations of behaviour precede any explanations of that behaviour.[6]
With sin reclassified as folly, institutions of confinement are built by the mid-1600s to house any who are considered mad or fools.  These institutions would grow so large that in Paris, for example, 1 out of 100 people ended up being confined at some point.  Niether hospitals nor prisons, these houses of confinement threw together the unemployed, criminals, people experiencing poverty, libertines, beggars, idlers, and people considered mad.[7]  However, the primary markers of madness were poverty, unemployment, and idleness.
It was important to the emergent capitalist class that the focus be on associating madness with these characteristics.  Because their rise to power required an easily exploitable and docile base of workers (the proletariat), it was necessary to ensure that work remained both possible and necessary for those who could not live without it.[8]  Beggars, idlers, paupers and the abjectly poor (the lumpenproletariat) were seen as embodying a threatening alternative to this.  Previously, cities had tried to address this threat by using force to expel beggars, idlers, and the unemployed but this approach led to violent, popular uprisings.  A more effective approach was needed. Reclassifying those who could not or would not work as mad was more conducive to the exercise of force over deviants.  People were reclassified as mad, and so they were housed and fed – since their madness turned them, by definition, into dependents who couldn’t care for themselves – but they were also deprived of freedom and the institutions that housed them, also forced them to work.[9]  Consequently, those who demonstrated an adequate work ethic while staying in these institutions, were considered sane and permitted to return to society.
Here, the mad person is not yet considered sick.  He or she is considered more like an animal, controlled by passions.  However, fear began to spread that such people were contagious.  People were afraid to live close to the institutions housing the mad lest they also become infected. A reorganization took place to address those fears – those who could work were sent to workhouses or back to society, those who were criminals were sent to prisons, and those who were mad were sent to the insane asylum and placed under the control of doctors.  They were isolated, not for their own well-being, but because it was feared that their madness would spread to the working poor and to the criminals.  This reorganization came along with the realization that poor people – paupers – were actually beneficial to the wealth of nations and of capitalists as they allowed a rotating labour pool and could be used to keep workers in line – if workers threatened a strike, or asked for a greater share in the profits of their labour, they could be replaced from a standing reserve of people experiencing poverty who wanted to work but could not.  Consequently, people experiencing poverty were reintegrated into society as people experiencing poverty and were then maintained by charity in order to function as an ongoing threat to any kind of organized labour.[10]  The abjectly poor, in other words, become a useful tool for disciplining the working poor.
Within the insane asylum itself, the cure for madness continued to be seen as having patients accept the morals, values, and priorities of bourgeois society.  The focus remains on teaching patients to accept obedience, work, and the value of property.  Sanity comes with learning to judge things in the same way as everyone else, and developing the same habits as everyone else.[11]
Much of this trajectory continues until the 20th-century when major developments in psychotropic medications increase compliance in deviant groups without, simultaneously, severely limiting the functionality of members of those groups.[13]  The (no longer mad or insane but) mentally ill, then, no longer need to be isolated but can continue to fit within the trajectory and values of the status quo and can fulfill their role within it, as long as they continue to take their medication.  However, class interests continue to prevail.  Members of lower classes are more likely to be diagnosed and described as “psychotic” and confined, whereas members of the upper classes are more likely to be diagnosed as “neurotic” and receive psychotherapy.[14]  Furthermore, the more members of a higher class exhibit problematical behaviours, to more likely that cluster of behaviours are to be identified as symptoms of an illness.  The more members of lower classes engage in behavoiurs that are not mirrored by higher classes, the more likely those clusters of behaviours are to be identified as criminal activity or badness.  On average, people experiencing poverty who are diagnosed as mentally ill, tend to be seen as a threat to others, people experiencing wealth who are diagnosed as mentally ill, tend to be seen as nonthreatening, and simply working through a process of self-discovery which, itself, speaks to their more enlightened state of being.
However, this shift in the location of those who are mentally ill – from institutions to the community – has led to a massive expansion in community based mental health programs, which now play a critical role in the maintenance of the social order.  As Conrad and Schneider observe: “Virtually any human problem [can] be addressed by community psychiatry and… through the lens of the medical model.”[15]  A remarkable shift in the definition of “health” has been a critical component of this expansion.  Previously, health was defined as “the absence of disease” but now health is understood as relating to a comprehensive list of biopsychosocial determinants.  The World Health Organization is clear about this: “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” and health includes “healthy or unhealthy behaviours.”[16]  Essentially anything can be considered a health determinant.  The medical model is now distributed through all areas of life – it has successfully replaced religion as the moral compass of society and the tool by which force can be brought to bear on the lives and bodies of the general population at anytime, anywhere.[18]
This infusion of the medical model into all areas of society is also very profitable for a good many of the elite members of the upper classes.  “Medicalization increases directly with its economic profitability.”[19]  Tracing the development of the Diagnostic and Statistical Manual (the DSM, commonly referred to as the Bible of psychiatry) illustrates this.  In 1952, when the DSM was first published,106 disorders were identified. In the current version of the  DSM, the DSM-5, over 300 disorders are mentioned.  Nearly 70% of the professionals who prepared the DSM-5 have significant financial ties to pharmaceutical companies (up from the 57% who revised the DSM-IV).[20]  The Chair of the DSM-5 task force, had previously worked as a consultant for Novartis, Pfizer, Eli Lilly, Johnson & Johnson and a host of other pharmaceutical related companies and organizations.[21]  Hence, Allen Frances, the former chairperson of the DSM-IV task force, stated that the DSM-V would be a “bonanza for the pharmaceutical industry.”[22]  (Additionally, updating the DSM is a profitable exercise and it is estimated that the American Psychiatric Assocation made $100,000,000 from sales of the DSM-IV, given that it is a required text for many counselors, schools, lawyers, and others.)
So we now live in the highly profitable world of health care.  What does one discover here?  Well, according to the Canadian Mental Health Association, we discover that 20% of Canadians will suffer from a mental illness at some point in their lives, and that 100% of Canadians will be impacted in some way due to mental illness in society.[23]  However, class and distributions of money, land, and power, continue to matter a great deal.  The closer one is to the central hubs of power – the richer, better educated, more connected, and privileged one is – the more likely one is to be healthy.  As one Canadian report emphasises: “Being poor is in itself a health hazard; worse, however, is being urban and poor.”[24]  Hence, civil authorities now speak about “curing homelessness” and treating poverty as a community or public health concern.
However, we must remember that what is often being medicalized and treated is deviance – i.e. “behavior that is negatively defined or condemned in our society.”[27]  Previously, immoral, sinful, or criminal behaviour, has been reclassified as sickness.  Deviance has been redefined in this way because the people and institutions at the centre of power and wealth have shifted, but what has not shifted is the way in which these people are able to impose their categories of condemnation and negative judgement onto others and onto the whole of society. The medicalization of deviance, leads to the use of medicine, treatment, or health care, as a form of social control.[29]  It is a handy tool because the medical model claims to be rooted in the objectivity of science, reason, and evidence-based studies, and so the fact that moral decisions, judgments and violent or coercive actions are being made and taken is often masked by the discourse.[30]
Not only that, but the morality associated with health care is one that is deeply committed to the maintenance of the trajectory of the status quo and current distributions of power, wealth, land, and property.  Illness is considered deviance because it threatens the stability of the social system, especially because of the manner in which it impacts a person’s ability to perform the role assigned to him or her within that system.[31]  Conrad and Joseph do a great job of showing how this unfolds in relation to things like things like alcoholism, drug use, and homosexuality.  In light of their studies, they conclude that: “Criminals are punished with the goal of altering their behavior in the direction of conventionality; sick people are treated with the goal of altering the conditions that prevent their conventionality.”[32]  Hence, health-based interventions aim at “returning sick individuals to compliance with health norms and to their conventional social roles, adjusting them to new (e.g. impaired) roles.”[33]  One of the consequences of this focus on conventionality and understanding one’s proper place within the status quo is that there are now right and wrong ways to be sick.  If a person is sick the right way – i.e. if one recognizes that one is sick, if one takes responsibility for getting well, if one sees that being sick is undesirable and tries to recover, if one agrees to seek out and cooperate with a treatment or recovery plan assigned by the officially recognized authority  – then that person is exempted from normal responsibilities and expectations for a set period of time.[34]  However, if a person is sick in the wrong way, if he or she does not see it as a priority to spend most of his or her waking hours working a bullshit job in order to give money to a landlord to rent a shithole apartment in a house he or she will never afford to own, and if the sick person does not cooperate with the parties assigned to help him or her attain these goals – refusing to express remorse for his or sickness, refusing to take responsibility for his or her situation, and refusing to express gratitude to the parties who line up to get him or her back on track – then the sick person can expect to be punished – dropped by social workers, discharged from shelters, targeted by police officers in public spaces and by security guards in corporate spaces, and likely institutionalized in jails or psychiatric wards.
(1B) Health Care: Surveillance, Discipline, Compliance
So far we have traced how health care and the discourse of community or public health has replaced religion as the primary socially acceptable tool employed by centrally located institutions and individuals to exert force over the bodies and living situations of others.  I have also asserted that this discourse it brought to bear especially heavily upon populations that are judged to be deviant – amongst whom, people experiencing poverty, unemployment, and homelessness are especially prominent.  In this section, I want to talk about the importance of surveillance to this model and within our workplaces.  As we shall see, surveillance is an excellent tool for disciplining deviance and for producing compliance.  To normalize a certain way of seeing – let’s call this way of seeing “the medical gaze” – helps to make it invisible and ubiquitous.  This works to provide the medical gaze with access to everything, and produces people who view themselves through the lenses of this gaze.  In order to discuss this gaze and the rise of surveillance, I want to outline two more texts by Foucault: The Birth of the Clinic: An Archaeology of Medical Perception and Discipline and Punish: The Birth of the Prison.  We will then engage in a group exercise that explores the all-encompassing surveillance that is taken for granted within social services.
In The Birth of the Clinic, Foucault talks about how the appearance of medical clinics, from the French Revolution onward, changed the ways in which medicine was practiced and the ways in which people chose to view themselves and others.  With the birth of the clinic, a medical gaze emerges that views people as individual and unique collections of symptoms – the individual becomes, in Foucault’s words, “the portrait of the disease… the disease itself.”[35]  Hence, managing disease, especially epidemics, was as much about managing people and social spaces as it was about treating illness.[36]  From the beginning, the role of the clinical doctor was always a political role and in its initial stages in Europe, there was a dream of replacing all the clergy with doctors in order to cure society.  This is a political task because, to be cured, people must be liberated.[37]  To be liberated, certain (unhealthy) ways of life must be condemned and certain other standards of living must be normalized.[38]  Consequently, it is the medical gaze that establishes these standards and the truths which are used to justify them.
One of the first outworkings of this was that doctors in France were put in charge of aiding people experiencing poverty and it was the medical gaze that judged who deserved assistance and who did not.[39]  At the same time, doctors in Germany proposed the creation of a medical police who would supervise the health and hygiene of the general population and pay special attention to deviant activities like sex work.[40]  Furthermore, in order to advance the knowledge associated with this gaze, public hospitals – which at that time were largely only frequented by people experiencing poverty – were used as areas of research and experimentation.  Because the people treated there were too poor to pay for treatment, they were expected to accept such experimentation, observation and objectification with gratitude.[41]  The rich who funded these hospitals were told that the knowledge gained by testing things out on the poor would be used to their own benefit, and could possibly produce the cures they would need at some point in life.[42]
Hence, the medical gaze both discovers and destroys – it is a “purified purifying gaze.[43]  It determines what is essential, it illuminates what is obscure, and through saying what it sees, it engages in a “seizure of being.”[44]  It lays claim to all that we are, and disease goes from being viewed as something inserted into the body to being the body itself.[45]  As a part of who we are, disease is hooked onto life itself, feeding on it, and sharing in it – life has become pathological life.[46]  Hence, we all appear as individual patients and the unique seat of the disease that are a part of us.
A few things are worth emphasizing here: First, health care is dominated by a gaze that transforms a person into an individualized and objectified seat of disease.  Second, although disease is largely depoliticized and removed from socioeconomic and political contexts, this gaze itself is highly political and has always had a strong interest in exploiting and controlling people experiencing poverty to meet the interests of people experiencing wealth. Third, because the individual is the seat of the disease – because the individual is the disease itself – it is the diseased individual who becomes the threat to the status quo.  Consequently, the medical gaze is focused heavily upon the diseased person, who is deviant precisely because he or she is labeled as diseased.  Everything about that person must be brought into the light, seen, examined, and purified.  Surveillance becomes an essential component of health care.
In Discipline and Punish, Foucault focuses much more on surveillance and how it is an excellent tool for controlling deviance.  He engages in this study by examining the rise of prisons.  Prior to the rise of prisons, the public spectacle of torture (cutting off hands or heads or other acts of torture performed in the public square) was used to reveal the tru