Table Of ContentREBIRTH OF THE CLINIC
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REBIRTH OF THE CLINIC
Places and Agents in Contemporary Health Care
CINDY PATTON, EDITOR
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Sponsored by the Quadrant Health and Society Group (advisory board Susan Craddock, Jennifer Gunn,
Alex Rothman, and Karen-Sue Taussig) and by the Center for Bioethics
Quadrant is generously funded by the Andrew W Mellon Foundation
An earlier version of chapter 4 was published in Suzanne Fraser and kylie val-
entine, Substance and Substitution: Methadone Subjects in Liberal Societies
(New York: Palgrave Macmillan, 2008); portions reprinted with permission of
Palgrave Macmillan. An earlier version of chapter 5 was published as Anne-
marie Mol, "Customer or Patient?" in The Logic of Care: Health and the Problem
of Patient Choice (New York: Routledge, 2008), 14-28; reprinted with permis-
sion of Routledge.
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Library of Congress Cataloging-in-Publication Data
Rebirth of the clinic : places and agents in contemporary health care /
Cindy Patton, editor,
p. cm.
A Quadrant Book.
Includes bibliographical references and index.
ISBN 978-0-8166-7018-5 (he : alk. paper) — ISBN 978-0-8166-7019-2
(pb : alk. paper)
1. Clinics. 2. Medical anthropology. 3. Social medicine. 4. Foucault,
Michel, 1926-1984. Naissance de la clinique. I. Patton, Cindy, 1956- .
IL University of Minnesota. Institute for Advanced Study.
RA966.R43 2010
362.1 —dc22 2010033908
Printed in the United States of America on acid-free paper
The University of Minnesota is an equal-opportunity educator and employer.
16 15 14 13 12 11 10 10 9 8 7 6 5 4 3 2 1
CONTENTS
Preface and Acknowledgments vu
Introduction Foucault after Neolifaeralism; or. The Clinic Here and Now ¡x
Cindy Patton
1 Clinic or Spa? Facial Surgery in the Context of AIDS-Related
Facial Wasting i
John Liesch and Cindy Patton
2 Implications of an Epistemological Vision Knowing What to Do in
Home Health Care 17
Christine Ceci and Mary Ellen Purkis
3 Where Is Community Health? Racism, the Clinic, and the Biopolitical
State 39
Jenna Loyd
4 Repetition and Rupture The Gender of Agency in Methodone Maintenance
Treatment 69
Suzanne Fraser
5 Freedom or Socks Market Promises versus Supportive Care in Diabetes
Treatment 99
Annemarie Mol
6 Clinic without the Clinic 121
Cindy Patton
7 Practices of Doctoring Enacting Medical Experience 143
Lisa Diedrich
Contributors 169
Index 171
PREFACE AND ACKNOWLEDGMENTS
This volume treats clinical treatment. As members of this project we are
deeply concerned with what happens to the people, both patients and
providers, who enter into clinical transaction/interaction. As feminists
and activist researchers, we have all wondered how we got to this place
and where we might go from here; how, in this case, "the clinic" might be
treated—both in the sense of intelligently describe and of cure.
This project was born when several of us participated in an applied
anthropology conference. Although originally we had not thought to cre-
ate a book based on this event, we soon found ourselves increasingly frus-
tratedby research that used narrow definitions of "clinic" (and allied terms
such as "care") to explore the web of relationships between the sick, the
caregivers, and the institutions through which they meet—namely, the
clinic as perceived in Michel Foucault's broader sense. Although many
researchers invoke Foucault through terms such as biopowerand respon-
sibilization, the fundamental insights of Foucault's most sustained work
on the clinic seem to have drifted from view.
Our work in developing this volume grew more geographically diverse
as we explored the side channels carved by avant-garde researchers in
the humanities and social sciences who plied their crafts at the margins
of medicine. In particular, the research assistant and collaborator Helen
Loshny spent considerable time attending conferences and tracking
down new work in the intellectually aligned areas of history, the theory
of clinical practice, and the representation of shifting styles of health and
healthcare. We are especially indebted to Loshny's efforts in convinc-
ing authors to let us review their work for this volume. We are equally
indebted to Marguerite Pigeon, the staff editor at the Health Research
and Methods Training Facility at Simon Fraser University, for managing
vii
the contributed pieces from submission through completion. I thank Lisa
Weeks, also of the Health Research and Methods Training Facility, who
shepherded the project through its final stages before turning it over
to the publisher. Finally, we are indebted to Richard Morrison, editorial
director of the University of Minnesota Press, who has a keen eye for a
worthy project, and to his former editorial assistant, Adam Brunner, who
smoothed the process through every phase.
viii • PREFACE AND ACKNOWLEDGMENTS
INTRODUCTION
Foucault after Neoliberal/sen; or, The Clinic Here and Now
CINDY PATTON
THE ENLIGHTENMENT is OVER. Still, the inherited question of how to
mediate the macrostructural (society, now market) and the individual
(citizen, now consumer) lingers in the way of a really bad relationship:
we know it's over—there is no solution, likely it's the wrong question—
but we can't quite find an "exit strategy." We engage in deferral tactics. We
devote our time to requiems for our enlightenment lost. The broad space
of discourse and practice that Michel Foucault called la clinique lies in
tatters, while nations grapple with how to produce "health for all."1 It is
no surprise that I want to return to Foucault, the most rigorous chron-
icler of modernity's constitution. Followers of Foucault have developed a
set of terms to describe the "present" of la clinique, or rather they have
to some extent turned away from the broadest articulation of his idea
by intensifying their focus on a later set of his concepts: biopower and
governmentality, along with techne of the self and responsibilizing (the
latter as developed in genealogical works, which, Foucault [1971 (1970)]
insisted, complement but do not replace the "critical" or archaeological
works).2 Rather than "forget Foucault," as Jean Baudrillard (1987 [1977])
suggests, I want to remember his earlier work, which may contain a set of
utilities—possibly an exit strategy—obscured by the blindingly obvious
fit of the later terms with neoliberalism.
There. I've said the word. I'm now obliged to discuss its meaning in
order to forestall a misreading of the ensuing essays, which provide rich
descriptions of clinical contexts that exceed the concept.
Economic neoliberalism has a long history; indeed, the concept might
just slightly predate the global dominance of political liberalism. In its nar-
rowest sense in the contemporary era, the term refers to a set of policies—
sometimes called the "Washington Consensus"—that formed the basis
ix
