Commentary and Reflections: On Stratification and Complexity
All three of the “new engagements” comprising this section share two assumptions common to much “old” feminist scholarship: namely, that (a) oppression exists and (b) oppression should be challenged. Those assumptions often help to concentrate research in potent ways, Janet Shim and her colleagues point out, by placing and keeping “power and relations of domination and subordination at the center of the analysis” (Shim et al. 2015:73, Chapter 3, this volume). Yet while feminism’s emancipatory goals offer researchers compelling motivation and focus, they also present persistent conundrums for analyses of contemporary biomedicine. For within biomedicine, the chapters in Part I take pains to emphasize, relations of power are “messy” enough that hierarchies of domination and subordination are not always clear (Bell and Figert 2015:19, Chapter 1, this volume). Indeed, biomedical processes may be best conceived not in terms of hierarchical ladders but “in terms of networks, spirals, and complexity” (Bell and Figert 2015:26). These diffuse networks are “everywhere tempered and complicated by” pluralisms, partialisms and contingencies (Annandale and Hammarström 2015:42, Chapter 2, this volume, citing Clarke 2010:389). Even the most hegemonic formations are “immanent with and animated by” counter-formations, their own “‘modes of undoing’” (Shim et al. 2015:63, citing Murphy 2012:183, n. 3). Far from readily captured and pinned “at the center of analysis,” then, power in biomedicine flows and fluxes, forming the very subjects it regulates. Thus, for those of us, like Shim and colleagues, trying to challenge “‘relationships of exploitation of subordinate groups by dominant groups’” (Shim et al. 2015:73, citing Weber 2010:91), contemporary biomedicine presents some serious challenges. Who (or what) might accurately be characterized as “‘oppressed groups struggl[ing] to gain rights, opportunities, and resources,’” and who instead as “‘dominant groups … seek[ing] to maintain their position of control’” (Shim et al. 2015:73, citing Weber 2010:91)? What might “emancipation” even look like, given that biomedicine constitutes the very bodies and subjects that seek deliverance?
This brief comment cannot address those questions in their broadest strokes, of course.1 I will not even purport to address them in a more limited, context-specific way. I intend merely to draw attention to the tensions generated by the juxtaposition of “feminist” opposition to exploitative, hierarchical relations of power with analyses of biomedicine’s multidirectional, multi-sited, life-altering churn. While it might be argued that the analyst’s role is to cut through that frothy churn to grasp the relatively fixed structural mechanisms within, my suggestion here, based on the three chapters in Part I, is that the conceptual tensions produced by feminist analyses of biomedicine cannot be so easily wiped away. Drawing on elements of the three chapters, I try to show that such tensions, far from suggesting the irrelevance of feminist approaches to biomedicine, instead highlight their ongoing generativity.
In contrast, more recent scholarship shifts the “analytic gaze” from medical professionals to other “key drivers” of social change (Bell and Figert 2015:23; Annandale and Hammarström 2015:41). The proliferation of pharmaceuticals, commercial genetics and new surgeries and devices is said to distribute processes of legitimation and decision-making once concentrated with doctors. Now patients (“consumers”) are actively responsible for their individual health and bodily “enhancement.” This ceaseless, increasingly commercialized pursuit suggests phenomena unfolding “from below” as much as through the imposition of narrow professional interests (Annandale and Hammarström 2015:42, citing Conrad 2013; Furedi 2006). As Bell and Figert aptly note, contemporary dynamics “do not easily fit into a conceptual frame of … governmental or medical professional control” (2015:25). For the affluent, at least, “life itself” has been transformed into an object of ongoing, personalized intervention (Franklin 2000; Rose 2007).
For feminists in particular, engagement with these developments is often framed by the concept of “biomedicalization,” first elaborated by Adele Clarke and her colleagues in a 2003 essay cited in some version by all three chapters in Part I. Worth stressing here is that Clarke and her colleagues employ biomedicalization not merely as a theoretical concept, but as a referent to an actual “historical shift” – a dramatic set of material changes in the organization and practice of contemporary medicine. “Power” and “control” in this new historical context are far from simple. As they describe it, biomedicine today is being reorganized “not only from the top down or the bottom up but from the inside out” (Clarke et al. 2003:162; emphasis in original). Causality in this context is equally complex: a “fundamental premise” of biomedicalization is that new technical capabilities, new institutional organizations, new political economies, new bodily identities and new social forms are all mutually and reciprocally constituted (2003:163). Attendant to those tangled co-productions are “new forms of agency, empowerment, confusion, resistance, docility, subjugation, citizenship, subjectivity, and morality” (2003:185).
Enter the three chapters that comprise Part I
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