Disposition and determinism – genetic
diagnostics in risk society
Thomas Lemke
Abstract
This article investigates the relationship between genetic determinism and the discourse
of risk by making use of an elaboration of the concept of governmentality
developed by Michel Foucault. After a short outline of the theoretical profile of the
employed risk analysis, the main part of the text distinguishes three core level of
analysis. With a view to illustrating several aspects of a ‘genetic governmentality’
the increasing social impact of genetic information is examined from the angle of
truth programs, power strategies and technologies of the self.
The decoding of the human genome makes available an ever growing body
of increasingly accurate knowledge on the structure and function of human
genetic material and provides more sophisticated genetic testing methods.1
It
is already evident that the application and evaluation of this new information
on the genome will have far-reaching effects which go well beyond the original
goals of developing forms of medical diagnosis, prevention, and therapy.
The availability and use of genome analysis and genetic testing will alter the
way individuals experience pregnancy and birth as much as it will change
social institutions (such as the health system, the legal and insurance systems)
and influence the way we collectively treat disability, illness and death.
However, in contrast to the longstanding scientific interest and the
advanced technical work related to human genetic research, the discussions
on the possible social consequences and ethical implications of such interest
have only just begun. Many critics fear that the real significance of the human
genome project is not so much the advancement of biological knowledge or
medical therapies, but rather the resurgence of genetic determinism which
already in the past served as a heuristic for all kinds of social and individual
divergence. Generally speaking, the socio-political impact of genome analysis
project is seen ‘in the replacement of social solutions by genetic engineering
solutions’ (Beck, 1988: 43) and in a ‘geneticization’ of society (Lippman,
1991: 19). Criticism focuses primarily on the ‘illusion’ (Procter, 1992: 82) that
biological, psychological and social differences between individuals can be
explained by differences in their DNA, and warns against a ‘genetic fatalism’
© The Editorial Board of The Sociological Review 2004. Published by Blackwell Publishing Ltd.,
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(Assheuer, 2000) that replaces the principle of self-determination and
autonomy by the fate of the genes and derives individual and collective
phenomena from the genotype.
I would like, by contrast, to adopt a somewhat different evaluation. In my
view the ‘social power of genetic information’ (Nelkin, 1992) lies less in the
resurrection of genetic determinism and more in the construction of genetic
risks. The analytical methods and procedures employed in genetic diagnostics
are not so much designed to generate clear causal chains or to reduce all possible
information to the genome, but rather seek to highlight probabilities,
possibilities and expectations, referring less to a model of determination than
to the mode of dispositions. In place of the guarantee of certainty and assurance
what can now be observed is a dominance of risk semantics and ‘apparatuses
of insecurity’. My thesis is that it is this recourse to ‘risks’ which makes
it possible to call for autonomy and self-regulation in bioethical and human
genetic discourses. Rather than being viewed in terms of objective fate, genes
today are increasingly seen to represent subjective potential: they refer to the
supremacy of the consumer, who aims at profitable optimization of individual
human capital and personal quality of life.
In the following, I wish to investigate the relationship between genetic
determinism and the discourse of dispositions and risks. Prior to this, it is
necessary to outline the theoretical profile of the risk analysis employed here;
on the one hand, parallels are drawn to the problematics surrounding the
theme of governmentality developed by Michel Foucault (1991; see Lemke,
1997) while the differences to realist and relativist concepts of risk are
expounded on the other. The main part of this article distinguishes three core
levels of analysis, with a view to illustrating several aspects of ‘genetic gov-
ernmentality’2
by examining the ‘geneticization’ of society from the angle of
truth programs, power strategies and technologies of the self. I shall conclude
by examining the Foucauldian account of bio-power in the light of the current
practices in human genetics.
1. The government of genetic risks
The ‘government of genetic risks’ I intend to outline entails two particular
theoretical features. First, it differs from the notion of risk society that underlies
the work of Ulrich Beck. Although Beck stresses that risks are to a certain
extent ‘open to social definition and construction’ (1992: 23), this refers solely
to the appraisal and perception of risks, not to the risks themselves.As a result,
in Beck’s account risks primarily appear as technical threats which are socially
relevant only to the extent that they are linked to a social impact (Beck, 1988;
1992).3
Instead of this realist notion of risk I have opted for a nominalist concept:
risks do not correspond to or depict natural facts, they are rather instruments
and effects of a more complex social-material reality. In this respect, ‘genetic
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© The Editorial Board of The Sociological Review 2004 551
risks’ are not found but invented; their ‘reality index’ rests not on their existing
as scientific data beyond all social definitions and assessments.4
Genetic
risks are, in other words, not biological-empirical matters of fact, but the result
of a ‘problematization’ (Foucault, 1985: 115).5
They represent a specific
knowledge, a way of thinking about occurrences and are to this extent not
arbitrary. On the contrary: predictive genetic tests are part of a broader movement
toward management of probabilities and risks – they appear in an existing
landscape of social and cultural trends that indicate a switch from a
reactive to an active orientation toward uncertainty and are to be observed
in a multiplicity of areas of society. Put differently, the nominalist approach
allows us to focus rather on technologies of power than on the power of technologies
(Pearce and Tombs, 1996; O’Malley, 1996; Ericson and Haggerty,
1997).
Secondly, the concept of risk cannot be reduced to insurance risks. Genetic
risks differ from insurance risks by dint of the fact that they obey less a logic
of compensation and capitalization and more an imperative of prevention and
prevision. Lorna Weir (1996) has rightly pointed out that clinical risks constitute
a risk type of their own. While, on the one hand, they require statistic
and epidemiological knowledge on the spread of cases in a population,
unlike insurance risks they do enable the risk to be diagnosed directly in the
body of the individuals. Unlike the system of insurance risks, which does
not for example attempt to identify later victims of car crashes and prevent
these, genetic risks can be localized, predicted, and (if possible) avoided.
Instead of deciphering genetic risks as the expression of instrumental reason,
they should be considered as the instrument of a political rationality, which
undertakes the recoding of power relationships and entails the individualization
and privatization of social risks (see also Ogden, 1995; Kavanagh/Broom,
1998).
In order to operationalize this distinctive concept of genetic risk I propose
to distinguish between three analytical dimensions: truth programs, power
strategies, and technologies of the self. These all draw on the concept of
governmentality which articulates Foucault’s working hypothesis of the reciprocal
constitution of forms of knowledge, power techniques, and subjectivation
processes. Let me explain what I mean by each of them.
2. The construction of a consensus genome and discourses
of deficiency
The attempt to link complex behavioral patterns and social phenomena back
to a genetic basis has repeatedly been criticized as genetic ‘reductionism’.6
A
series of objections have been raised, focusing above all on the ‘unscientific’
and ‘ideological’ character of such arguments. The debate has hinged on
geneticization as a process which rests on a ‘false’, ‘distorted’ or ‘one-sided’
form of scientific knowledge. Scholars from the humanities and social scienThomas
Lemke
552 © The Editorial Board of The Sociological Review 2004
tists have contradicted the ‘gene myth’ (Hubbard/Wald, 1997) and pointed to
the significance of social regularities, psychological factors and historical
knowledge (Nelkin/Lindee, 1995; Duden, 2002). Indeed, even within the biosciences
the ‘molecular dogma’ has by no means gone undisputed. Above all,
insights from the biology of evolution have been presented as an opposing
paradigm, but even within genome research itself there are increasing
references to the complexity, and multi-causality of genetic activity
(Strohman, 1994; Williams, 1997; Keller, 2000; Lewontin, 2000).
This form of critique of genetic reductionism is indispensable. It bears
pointing out that human (and non-human) life is more than the sum or interplay
of genes and that individual and social phenomena cannot be grasped
solely by resorting to explanatory approaches, or possible solutions based on
genetic reasoning. At the same time it does not suffice to rebuke molecular
genetic research for being one-sided, ill informed, or geared only to specific
interests. The purpose cannot be solely to assert its reductionism or to illustrate
the complexity of the problems addressed. Rather, the issue is also how
this reductionism functions in practical terms and what social consequences
it will have beyond all scientific debate. In this respect it is important not only
to study whether genetic reductionism is true or false, but also to explain
how it produces truth. Theoretical attention must be focused on ‘spaces of
representation’ or ‘regimes of signification’ (Rheinberger, 1997 resp. Kay,
2000: 18) that organize an epistemo-political field of the visible and the
expressible, which controls the diverse forms of signification, and defines the
conditions for truth and falsehood. What is involved is a representation of
reality which guides practical interventions and structures the terrain for possible
action. In other words, instead of juxtaposing reality and reductionism,
we should study the reality of reductionism as a ‘truth program’. I shall concentrate
in this regard only on two elements which I shall now briefly present,
namely the construction of a consensus genome and the discourse on
deficiency.
If each deviation from the norm can be attributed to genetic causes, what
then is the norm? What serves within genomics as the genetic norm, when we
likewise know that the actual genomes of two randomly chosen individuals
differ in terms of at least three million base pairs? In view of this constitutive
‘deviation’, the genome project is aimed at nothing less than the construction
of a consensus genome (Flower and Heath, 1993: 28, see also Lloyd, 1998), ie
a uniform genetic standard which can be derived from the DNA sequences of
various individuals without therefore being identical with the DNA of a single
natural person. ‘The human being’ in the human genome project is, in other
words, a canonical sequence compiled from many individuals (Schmidtke,
1997: 153). This certainly does not mean that in the case of this artificial human
we are dealing with was a ‘democratic’ representation of individuals or a
general statistical median of the population. Instead, the human in the ‘human
genome’ is a very special person ‘who will possess both an x and a y chromosome.
It will therefore be a man. This ‘he’ will be an average collection in
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© The Editorial Board of The Sociological Review 2004 553
terms of his chromosomes, of sequences (ie the chemical structures found in
his genome) which occur in men and women of different nations, the United
States, Europe, and Japan. In other words, he will be an average male from
the industrialized nations, who together are internationally researching the
genome’ (Feyerabend, 1997: 38).
When constructing this norm genome, the object is not to ensure that idea
and reality concur, for reality itself becomes an ideal that must be permanently
perfected. Genetic research corresponds to a discourse of deficiency
(Gottweis, 1997: 65) which analyzes life by means of concepts such as
‘absences’, ‘faults’ and ‘defects’: bacteria, animals, plants, and humans require
supplementation, assistance, and correction by means of genetic interventions,
and in this respect the code always provides incomplete information in need
of improvement. For this reason, the advances in deciphering the genome
engender an ever growing number of genetic risks, susceptibilities and dispositions
of illness.7
We can also observe that not only is the concept of genetic
disease extended from ‘mono-genetic’ (eg, Huntington) through more
complex diseases (eg, cancer, Alzheimer); indeed, we are seeing a radical
break with the old concept of disease and its transformation. Edward Yoxen
has shown that over the last decades the meaning of this concept has shifted,
with a re-definition occurring that has led to diseases increasingly being identified
as deviations from the genetic norm. The emergence and expansion of
the notion of ‘genetic diseases’ prepared the ground for the growing social
and medical significance of molecular genetics (Yoxen, 1984; Koch, 1993;
Kerr, 2000; Temple et al., 2001). The concept of genetic disease has now turned
into ‘an extremely large category, encompassing not only genetic disorders
that are thought of as diseases but also genetic abnormalities associated with
no known disorder as well as disorders that may be neither genetic nor
diseases’ (Keller, 1992: 292, and 291–3; Smith, 2001; Lemke, 2003). A productive
circle has been established which derived illnesses from genetic anomalies
and attributes illnesses to genetic anomalies, which construes illnesses as
risk and risks as illnesses. In this perspective, disease does no longer refer to
an exceptional or limited state but becomes a normal handicap and a constitutive
deficit: No body is perfect (Rabinov, 1996).
However, it does not suffice to decipher genetic reductionism as a
truth program. Moreover, it is important to address the problem of the
‘tactical polyvalence’ (Foucault, 1979: 100) of knowledge on molecular
genetics. In principle any number of goals can be pursued by recourse to the
genes and there is thus no unambiguous political program to be derived from
it.8
Molecular genetics may provide the basis for traditional forms of racist
and sexist discrimination, but also of new rights (eg for animals) and it may
even contribute to call into question the patriarchic/anthropocentric perspective
itself (Haraway, 1991). Put differently: the question arises of how this
truth program functions in the framework of power strategies and political
rationalities.
Thomas Lemke
554 © The Editorial Board of The Sociological Review 2004
3. Spaces of visibility, promises of certainty and regimes
of (in)equality
The emergence and popularization of the genetic paradigm is not at all the
necessary consequence of scientific and technological progress. The massive
financial support and public acceptance of human genetic research in western
liberal societies are part of a comprehensive transformation that is increasingly
individualizing and privatizing the responsibility for social risks. Since
the 1970s, the security systems offered by the welfare state are being supplemented
and replaced by mechanisms of uncertainty and ‘strategies of precarisation’
(Bourdieu, 1998: 99). The individual is expected to show explicit
willingness to take risks and to conduct a forward-oriented risk management.
In the domain of health care, the retreat of the state goes hand in hand with
an appeal to personal responsibility and self-care, as well as the establishment
of self-regulatory competencies among individual and collective subjects
(Knowles, 1977; for a critical account see Crawford, 1977; Bell, 1996; Minkler,
1999).
In this changed social context, genetic explanations for individual
behaviour and personal health acquire a greater significance. Genome analysis
and genetic diagnostics not only provide a specific form of representation
for individual and society, they also articulate a controlling knowledge which
simultaneously accesses a whole terrain for action and intervention. In this
way, the ‘geneticization’ of society can be construed as a power strategy which
couples a knowledge of molecular genetics with forms of social regulation and
individual self-control.
In the framework of this ‘government of risks’ genetic diagnosis might be
important both in political and economic respect. Prediction and prevention
together with individual self-management could replace the dangers of
explicit state prescriptions and proscriptions. Genetic diagnostics presumably
avoids general and anonymous control mechanisms and creates the possibility
of compiling individual risk profiles with a concrete list of susceptibilities
and dispositions to disease.9
At the same time the use of genetic
information helps to transform human existence into some kind of ‘risk
capital’, open to the logic of investment and the imaginary of possible losses
and desired profits. While the body is on the one hand conceived as a disposable
resource and exploitable material, it is also the source of a new and richer
identity and the object of interventions that aim at improving the value of life
by diminishing diseases or optimizing performances. By localizing and identifying
genetic risks it is possible to construct an ‘ideal’ style of life for each
and every individual – and in this way genetic diagnostics provides a political
technology defined by specific constellations of visibility/invisibility, certainty/uncertainty
and equality/inequality.
First, genetic diagnostics is located in the tradition of enlightenment insofar
as it creates spaces of visibility. It inaugurates a new, prognostic view which
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not only offers information on the future health status of individual persons,
but in addition makes available a new, trans-generational transparency of the
body, which may affect the individual tested and/or his/her descendants
depending on the type of inheritance and illness concerned (Uhlemann, 1999:
4; Scholz, 1995: 40–1). Admittedly, in order to see we depend on visual aids.
There is no visibility without (enlightenment) experts who explain to us what
there is to see. Predictive genetic tests will show us that, although we are
ostensibly healthy now, we probably will become ill in the future and are
therefore in fact already ill. Unlike the ‘invisible’ social and economic risks,
genetic risks can be verified by testing devices. However, genetic diagnostics
contributes to ensuring the social and economic risks remain ‘in the dark’, by
re-coding these as biological risks and presenting them as a matter for the
individual. Thus, the recourse to the molecular text blots out the social
context.
The translation of social into genetic risks not only sheds light on individual
risk profiles, it might also allow this visibility to become profitable in both
political and economic terms. One example for this strategy is the use of
genetic testing in the workplace. Instead of simply forbidding potentially
harmful products or putting pressure on enterprises to change hazardous production
procedures (eg those known to cause cancer), it might prove more
‘economic’ or politically suitable to develop and use expensive genetic tests
for the diagnosis of these diseases inside the human body. In this respect,
genetic governmentality favors more a reactive than a preventive strategy:
While the change of the conditions that cause illnesses might be more
appropriate, scientific research and social interest concentrate on the ‘genes
for diseases’. Thus, the hope of a ‘victory’ on cancer, Alzheimer etc. coincides
with the prospective knowledge of their molecular structures and the promise
of a ‘genetic medicine’ (Hubbard/Wald, 1997: 90–2; Draper, 1991; Childs,
1999).
It is worth noting that already in the present the genetic diagnostic procedures
have contributed to producing a new category of individual, people who
in the framework of genetic examinations and tests have been diagnosed as
running the risk of certain illnesses which they may or may not possibly contract
in the future: they are known as ‘asymptomatic ill’ or ‘the healthy sick’
(Nelkin, 1992; Scholz, 1995: 48). As surveys in the United States and other
countries have shown, these ‘risk individuals’ are confronted with real forms
of genetic discrimination in the present. For example, married couples are prohibited
from adopting children if one of them has the disposition for a genetic
disease. In other cases, the ‘handicap’ can manifest itself simply in the form
of qualifications for a certain job ceasing to apply in the case of genetic risk
and the person thus being dismissed. It also happens that health or life insurance
companies terminate contracts or refuse to conclude them if their
(potential) clients have been shown by genetic tests to have the disposition to
contract an illness (Billings et al., 1992; Low et al., 1998; Thébaud Mondy, 1999;
Geller et al., 2002).
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556 © The Editorial Board of The Sociological Review 2004
Second, genetic tests constitute a specific promise of certainty: they appear
to be objective and convey an impression of accuracy and of lack of arbitrariness.
Genetic diagnostics promises control over what was hitherto uncontrollable
and seems to offer certainty in planning and unequivocality in an age
of general uncertainty. For example, in the legal domain ‘genetic fingerprints’
are now considered an especially accurate form of proof. Ever more frequently,
courts base their decisions on insights offered by human genetics. Not
only in criminal law, but also in claims for damages, in inheritance and family
law, people are resorting to genetic diagnostic instruments and examinations
of human genetics, while expert opinions in other areas of science (above
all of a psychological or psychiatric nature) are more and more losing their
validity and are being downgraded (Nelkin and Tancredi, 1994: 133–58;
Hubbard and Wald, 1997: 145–57; Cole, 2001: 287–311; Petrila, 2001).
The promise of certainty is in turn based on the uncertainty which genetic
diagnostics has strongly helped to create. It is the linking of genomic knowledge
with risk forecasts, the redefinition and delimitation of disease, and the
evaluation of genetic variabilities which enables to visualize and diagnose
genetic risks. Moreover, prognostic certainty cannot necessarily be translated
into greater personal freedom of choice. Under contemporary social conditions
and a political climate that favors further reductions in collective security
systems the possibility that in the future individuals will fall ill with an incurable
sickness or give birth to a handicapped child spawns new fears and biographical
uncertainty. The knowledge of genetic risks itself engenders risks: it
generates ethical, social, and psychological risks which would not exist without
such knowledge (Lupton, 1993; Rapp, 1995; Hallowell, 1999).
Third, genetic diagnostics establishes a specific regime of equality. It not
only represents social and biological risks in like manner as genetically caused,
but also affirms that all these risks are in principle similar. Rich and poor,
black and white, young and old – they are all subjected to the dictate of the
genes. In this view, our social position has less to do with power strategies or
exploitation structures and more with biological differences. The recourse to
the power of the genes renders the question of social power relationships
irrelevant. Yet even if all people are fundamentally exposed to the same
genetic risks, they are all empirically unequal: apart from identical twins there
are no two identical genomes. Genetic diagnostics thus couples the hypothesis
of our fundamental equality as regards risks with proof of the actual
inequality of individuals, thus suggesting a natural basis for inequality. Collective
uncertainty as regards individual risks is replaced by recognizable
inequality, which is transformed from a social problem into a natural fact,
indeed a fact which at the very latest becomes socially relevant when deviations
from the norm are detected in an individual’s genetic profile and this
triggers preventative measures and discrimination mechanisms.
Genetic governmentality transforms different opportunities in life into
variations of the same DNA and paves the way for a biomedical view of the
world in which differences as regards material and immaterial resources such
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as education, income, and working and living conditions fade into the background.
It implements a revolutionary program which is no longer geared to
the transformation of the social conditions of inequality responsible for social
and personal suffering but instead ensures the dynamic ‘adaptation’ and profitable
‘optimization’ of individuals to these conditions. The vision of social
progress is replaced by a therapeutic regime of self-improvement which rests
on specific forms of subjectification.
4. Risk individuals and rational subjects
It does not suffice to analyze ‘geneticization’ in terms of truth programs and
power strategies – it also depends on the development of ‘technologies of the
self’ (Foucault, 1988). What is relevant is not only the question how genetic
information is generated and produced, how it is circulated and used, but also
how it is appropriated and ‘consumed’: What consequences do genome analysis
and genetic diagnostics have for the personal and social identity of subjects
and the way they lead their lives? How does the genetic code inscribe
itself as bio-graphics in the life of subjects?
Indeed, the government of genetic risks does not abolish the bourgeois
individual, but it seeks to produce, if seemingly paradoxically, a new form of
autonomous subjectivity. He or she is conceived not as a passive recipient of
medical advice, but as an active seeker of information and consumer of genetic
testing devices and health care services (Petersen/Bunton, 2002).The social
significance of genome analysis and genetic diagnostics lies less in that they
offer a factual deterministic relationship and more in that they generate a
‘reflexive’ relationship between individual risk profile and social requirements.
The reference to personal responsibility and self-determination in
the biosciences only makes sense if the individual is more than a victim or
prisoner of her or his genetic material. If there is indeed a direct relationship
between genotype and phenotype in the sense of genetic determinism, then
it would be far harder to uphold the appeal to individual autonomy. By contrast,
the construction of individuals, couples, pregnancies ‘at risk’ makes it
easier to moralize on deviant behavior and to assign guilt and responsibility
(Douglas, 1990). The construction of risk spaces enables therapies and forms
of prevention to come to bear in a non-medical and a supra-individual sense
and raise predictive genetic diagnostics to the status of a social medicine
(Rose, 2001).
My assumption is that the concept of information is crucial in this context.
In the molecular genetic perspective, information at the same time serves
as the ‘code of life’ and as the ‘key to freedom’. If the body is nothing other
than a genetic program, then disease points to a communication problem.
However, this means that the emergence of an illness indicates a functional
disturbance which can in principle be avoided to the extent that sufficient
information and risk management is undertaken and the life style led adeThomas
Lemke
558 © The Editorial Board of The Sociological Review 2004
quate. Genetic enlightenment (as the deciphering of the ‘dark’ code) therefore
also entails a precise notion of ‘Mündigkeit’ (maturity), which is linked
to possessing adequate medical information and to the knowledge of one’s
own code. What we observe today is not the reduction of individual responsibility
by reference to genetic dispositions and inborn traits. The affirmation
of genetic factors does not result in a position that negates or forecloses the
responsibility of the subject; quite on the contrary, we can observe the contours
of a new discourse on ‘genetic responsibility’ (Hallowell, 1999; Novas
and Rose, 2000: 21–7). The new genetic knowledge is the central point of
reference to expand moral duties, it engenders new modes and fields of
responsible action.
Here, more is involved than the constitution of a ‘rational’ health-aware
citizen; the autonomy of the morally responsible subject should be brought
into line with the freedom of the autonomous market participant. Health is a
type of knowledge, but this knowledge has a price tag. Health becomes a commodity,
objectified, measured and evaluated in cost/benefit analyses like any
other commodity. Being mature thus means assessing supply and demand, and
selecting the suitable item for yourself or deciding how much health you can
buy for what price. The old authority of the welfare state, which attempted to
compensate for health risks, is replaced by the mature patient as active
demander and sovereign consumer. In this way, rationing of medical services
can even be presented as rationalization: the ‘client as king’ always
knows best which medical services can be ‘dispensed with’ – without state
parochialism, taking the cue only from the laws of market (Bertrand et al.,
1995: 141–7).
While advances in genomic research and genetic testing may contribute to
the individualization and privatization of health risks, they also give rise to
new forms of social identity and political activism. Self help movements and
support groups have actively lobbied for research to map genes and find
treatments, discovering cures for particular genetic disorders. As more and
more people identify themselves as being ‘at risk’ of a genetic disease, we find
collective experiences of ‘biosociality’ (Rabinow, 1996) and the appearance
of ‘new genetic citizens’ that participate in political struggles to eliminate
discrimination and stigmatization and to promote recognition of (genetic)
difference (Petersen/Bunton, 2002: 180–207; Rabeharisoa/Callon, 1999;
Lemke, 2004). Indeed, by referring to the notion of genetic governmentality
I do not intend to suggest that subjects just ‘incorporate’ or ‘adapt’ to the proposed
genetic (risk) information. Rather than analysing the actual impact of
genetic diagnosis, I am concentrating in this paper on more or less coherent
programs, strategies and technologies. The use of genetic diagnosis in institutional
settings as well as in everyday life is still a very contested terrain; in fact
it is not at all clear that provision of genetic information about individual risk
profiles or susceptibilities will result in changing health related behaviour and
what direction this change will take (see Davison, 1996; Marteau/Lerman,
2001).
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5. Bio-power and the molecular politics of genetic risks
Let me summarize the main points of the argument before I conclude with
some remarks regarding the concept of bio-power.An account of genetic diagnosis
and genome analysis in terms of truth programs, power strategies and
technologies of the self provides useful insights that might inform political critique
and scientific inquiry in several respects. It shifts the focus of analysis
away from the preoccupation with problems of reduction, reproduction and
repression, allowing for a better understanding of the relationship between
changing forms of knowledge, power and subjectivities.
(1) It is not sufficient to blame the ‘falseness’ of the theoretical presumptions
of molecular genetics by juxtaposing them to ‘reality’, ie the
natural laws of biochemistry. Indeed, such an approach must itself
prove reductionist insofar as it does not take into account the effects
of this reductionist programme, since it ignores how this ‘ideology’ can
seize hold of reality. Instead of exposing the phantasmic substance or
the reductionist character of molecular genetics (although this is an
important and necessary task), we should conceive of the genetic paradigm
as a ‘truth program’ which enables a specific representation of
individual and society, nature and technology. Regarding DNA as a
program of the organism from which all possible characteristics and
features can then be read must itself be analyzed as a program, as a
machinery for producing truth (cf. Kay, 2000; Van Dijk, 1998).
(2) The representations of nature, society and the individual provided by
this truth program help to form new social relations and alter existing
ones. Thus, we are confronted with the question: What social consequences
does the ‘geneticization of society’ have, even if genome analysis
and genetic diagnostics cannot redeem the high expectations we
have of them? At this level, the object is to analyze the coupling of a
scientific-technological and a socio-political development – both are
not independent variables and yet cannot be reduced to each other.
The notion of power strategy allows us to construe the relationship
between technology and society other than in narrow terms of cause
and effect. Instead of pointing to the inherent social and political implications
(Nelkin/Tancredi, 1994: xxiii) of genetic diagnostics or assuming
that social solutions are simply replaced with those generated by
genetic technology (Beck, 1988: 43), it would be more precise to investigate
a power strategy that aims less at abolishing the social than at
re-coding it, as a space where the instruments of genetic diagnostics
and genome analysis could both have an important role.
(3) A fundamental aspect of this social transformation is that it entails the
increasing individualization and privatization of risks. The success of
this strategy assumes a change in the technologies of the self, aiming
at ‘responsible’ subjects with ‘due foresight’ who (wish to) use genetic
Thomas Lemke
560 © The Editorial Board of The Sociological Review 2004
diagnostics. Predictive medicine might contribute then to constituting
a ‘homo geneticus’ (Gaudillière, 1995: 35) who submits to practices of
self-control and personal management of the body – which comprises
an embodiment of risk technologies that goes well beyond processes
of exclusion or mechanisms of repression. Eugenic programs decreed
by the state which make use primarily of repressive means and are
geared to achieving ‘racial hygiene’, are replaced by the government
of genetic risks geared to optimization of human capital in the
name of self-determination, personal preventative provisions, and
freedom of choice. While this ‘genetic responsibility’ individualizes and
establishes a new body politic, which calls on us to be as economic as
possible with our own body, health or ‘quality of life’, it is also possible
to discern new forms of social identity and political participation.
Genetic support groups and individuals that are at risk for genetic diseases
claim civil and human rights, call for respect for difference and
demand resources for biomedical research.
What follows from this theoretical perspective for the understanding of
contemporary bio-power? Foucault understood the term to ‘designate what
brought life and its mechanisms into the realm of explicit calculations and
made knowledge-power an agent of transformation of human life’ (Foucault,
1979: 143). He distinguished historically and analytically between two dimensions
of this ‘power to life’, namely between the disciplining of the individual
body, on the one hand, and the social regulation of the body of the population,
on the other. While anatomo-politics focuses on the production of
‘normal’ individuals, the bio-politics of the population is geared to a ‘technology
which is aimed not at individual disciplinary training, but at something
like homeostasis through something like a global balance, ie at the security of
the whole against its inner dangers’ (Foucault, 1997: 222).
This perspective of bio-power probably needs to be supplemented and corrected
(see also Haraway, 1991; Rabinow, 1996). Philosophers and social
scientists claim that individual disciplining and social regulation are today recoded
in a ‘post-disciplinary’ and ‘post-social’ rationality (Deleuze, 1990;
Rose, 1996). Here, dangers are essentially replaced by the recourse to risks,
and the link between ‘apparatuses of security’ (Foucault, 1991: 102) and a
reference to the body of the population is increasingly severed as it comes to
be replaced by the management of uncertainty of (individual and collective)
subjects. The focus of the new bio-power might be more on preventive guidance
of ‘risk factors’ than on direct therapeutic or disciplinary interventions
on individuals and populations (Castel, 1991).
In the framework of this social transformation, genome analysis and
genetic diagnostics could play an important role. They create a new level of
intervention in addition to the traditional poles of bio-power – individual disciplining
and social regulation – establishing a control matrix with different
forms of visibility and new types of intervention (see Flower/Heath, 1993;
Disposition and determinism
© The Editorial Board of The Sociological Review 2004 561
Rabinow, 1996; Gottweis, 1997). Genetic diagnostics allows for a ‘sub-cellular
panoptism’ and a surveillance regime which is aimed neither at individuals
nor at the population, but covers ‘dividuals’ (Deleuze) as risk carriers. These
are classified by genetic characteristics and selected or aggregated to form
genetic pools and risk populations. Alongside anatomo-politics and bio-politics
we thus have a ‘molecular politics of (genetic) risk’. This is a politics that
goes beyond disciplining or discrimination, aiming at design: instead of resocializing
individuals or excluding collectives, the future focus might concentrate
by means of genome analysis on the deliberate configuration of ‘healthy’
human existence.
University of Frankfurt/Main Received 7 October 2003
Finally accepted 11 August 2004
Notes
1 Previous versions of this paper were presented at the Ethos of Welfare – Metamorphoses and
Variations of Governmentality Conference in Helsinki in September 2000 and Goldsmiths
College/University of London in May 2001. Thanks to participants of those occasions, Monica
Greco, Nikolas Rose, Carlos Novas, Lene Koch, Ilpo Helen and anonymous reviewers for their
comments and criticism.
2 The notion ‘genetic governmentality’ was first introduced by Michel J. Flower and
Deborah Heath (1993: 31), but they did not use it as a conceptual tool as proposed in this
paper.
3 For a more comprehensive analysis see Dean, 1998; Lupton, 1999: 58–83; for a critical examination
of theories of reflexive modernity with respect to the new human genetics see Kerr/
Cunningham-Burley, 2000.
4 Likewise, they are not the result of ideological strategies which can be/are instrumentalized by
‘interest groups’ for their own ends. Elisabeth Beck-Gernsheim focuses in her study of the
social construction of genetic risks on the example of prenatal diagnostics in particular on the
rhetorical means brought to bear by representatives of science, medicine, politics, and the business
world in order to promote the application of genome analysis. Now, while it is important
to explore the contours of the rhetoric of acceptance, threats, and salvation and the interests
articulated therein, the analysis of the construction of genetic risks cannot be reduced to this
approach of ideology critique (see Beck-Gernsheim, 1996).
5 Thomas Osborne distinguishes problematisations from constructivist approaches: ‘Problematisations
are not modes of constructing problems but active ways of positing and experiencing
them’ (1997: 174; cf. Kay, 2000: xvii–xix).
6 In the following paragraphs I make use of material already published elsewhere (see Lemke,
2000).
7 The number of medical articles that deal with the term ‘genetic risk(s)’ in the title/or
abstract of the MEDLINE database increased rapidly from the end of the 1960s to the
beginning of the new millennium. While only four articles are listed for the period from
1967 to 1971, ten years later 67 ‘genetic risk’ articles were published (1977–1981); another ten
years later the count is 211 (1987–1991), while it goes up to 1082 for the period from 1997 to
2001.
8 The same is true for the history of eugenics. Eugenic goals were pursued by socialists, conservatives,
liberals, fascists and feminists (Kevles, 1985).
Thomas Lemke
562 © The Editorial Board of The Sociological Review 2004
9 See eg Collins, 1999: 34–5 for an illustration. For a popular description see the internet publication
‘Your Genes, Your Choices’ by the American Association for the Advancement of Science
that emphasizes the importance of ‘genetic literacy’ (http://www.ornl.gov/TechResources/
Human_Genome/publicat/genechoice/contents.html, 3rd July 2003).
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