19 November 2015

Walk the Walk, Talk the Talk: A Critique of the Medical Model by Michel Foucault

Guest Post by Mathilde Pavis

From the beginning, the InVisible Difference project decided to focus on physical disability in connection to dance and law. Though many factors came into play in deciding to narrow down our investigation to physical disability, the absence of ‘problems’ to fix regarding the practice of artists considered as mentally disabled was not one of them. We do acknowledge that there is much to do in terms of research, support and appreciation of the art made by mentally-disabled individuals. There is also much to learn from the historical evolution of what was once called the 'art of the insane'.[1] The cross-overs between our work with differently-abled dancers and the evolving status of 'mental art' in our society will thus be a theme running through this blog post and future ones.

Modelling Disability

Our research extensively engaged with the literature of disability studies and the distinction between the medical,social and affirmative models drawn by scholars and activists on the perception of disability in our society. To summarise, very briefly, the contention of each model, the medical model places the source of disability on the medical ‘condition’ of the disabled body whereas the social model shifts it onto socially constructed understanding of normality, and in turn, disability.[2] The affirmative model confirms most of the contentions held by its social equivalent but furthers its affirmation by urging a celebration of disability as an empowering trait rather than a shaming limiting one. [3] The medical model is especially criticised for over-medicalising the body and normality for it recommends cures and treatments of conditions it diagnoses as deviating from the norm. If my reading of the social and affirmative models is correct, their claims against the medical model essentially lie in the argument that what the medicalisation of disability achieves is the distancing of the nature of disability from social considerations. It displaces the source of disability from the society and its culture to locate it within the realm of medical biology and science. Re-contextualising disability within socio-cultural parameters would allow us to question the need to treat or eradicate it. If normality and disability becomes relative social constructs, the necessity to cure the different body should disappear or at least could be mitigated more easily.

Socially-driven Medicines

This particular criticism of the medical model as a model pretending to approach disability from an objective and scientific perspective deprived of cultural bias, is where interesting parallels could be drawn between the literature of disability studies and the history of madness explored in other fields. I would suggest that Foucault is critical of similar pretends conveyed in medical narratives in his thesis, Madness and Civilisation: A History of Insanity in the Age of Reason In this book, the philosopher heavily criticises the portrayal of the French physician, Philippe Pinel (1745-1826), and Englishman, William Tuke (1732-1822), as philanthropists and liberators of the mentally-ill; a depiction commonly found in writings on the history of psychiatry and psychopathology. [5] The two men are often associated with the creation of asylums which supposedly marked the beginning of a more humane treatment of mentally disabled patients who were then removed from ordinary prisons and hospitals. [6] Literally removing the chains off mentally-ill inmates and prisoners, Pinel and Tuke are deemed to be the leaders of the 'liberation of the insane' and the fathers of modern psychiatry in the nineteenth century.[7]

Such liberation is supposed to have taken place through a (the first) movement of medicalisation of ‘insanity’, understood very broadly at the time. Although men of medicine were involved, Foucault points out that the work initiated by Pinel and Tuke was mainly based on socially ‘training’ their patients rather than medically treating them in the modern sense of the term. Though very different, both Pinel’s and Tuke’s models were based on the principle that guilt and self-understanding of patients’ own lack of reason were the solutions to curing their insanity. Patients became responsible for their own condition.[8] They were treated via the adoption of what was considered normal social behaviour and settings which were recreated inside the walls of asylums. Patients were required to dress up to attend in-house tea-parties and pursue activities mimicking employment as well as engage with physical exercise.[9] If civilised communication was unattainable, silence was ordered. Methods such as camisoles,isolation or cold showers were used as punishment for failing to conform to the behavioural patterns selected by their physicians, but not as treatments per se.[10] This is why Foucault holds that mentally-ill and disabled inmates were transferred from legal to moral prisons. To him, the medicalisation of the treatment of individuals considered as insane had very little to do with any form of liberation.[11] This medicalised shift was operated on the premise of an unashamed the moralisation of disability and/or madness.

Foucauldian Parallels

The social-construction supporting the science applied to asylum inmates in the nineteenth century was laid out unhidden, and positioned at the crux of medical treatments. The merging of medicalisation and moralisation of mental illness and disability is precisely what Foucault seems to castigate in his writings. Though his theory was criticised for occulting parts of the context in which Pinel and Tuke’s work took place,[12] his position does resonate in a strangely familiar manner with the theories put forwards by the social and affirmative models. Comparing the approach of the current medical model and its nineteenth-century predecessor, the two appear to rely on socially-constructed understandings of disability and mental-illness. Although one might argue that the moralisation of disability softened as decades went by, both medical approaches were and are motivated by culturally or socially driven intentions to normalise difference. Whether it occurs through the mimicking of tea parties and other socially-acceptable behavioural patterns or surgical interventions is irrelevant since the fundamental stand points they support with regard to disability appear to be the same. This suggests that the medical model has a long-standing history in western culture, though not necessarily one which distanced itself from moral judgements.

[1] See on this, MacGregor JM, The Discovery of the Art of the Insane (Princeton University Press 1989). See also, Prinzhorn H, Artistry of the Mentally Ill (1995 edn; Springer-Verlag 1972).
[2] Shakespeare, T and Watson, N., 'The Social Model of Disability: an outdated ideology? In: Exploring Theories and Expanding Methodologies: Where We Are and Where We Need to Go, Research in Social Science and Disability (2) (JAI 2001) 9-28; Brisenden S,‘Independent Living and the Medical Model of Disability’ (1993) 1 Disability,Handicap and Society 173.
[3] Gabel S and Peters S, ‘Presage of a Paradigm Shift? Beyond the Social Model of Disability toward Resistance Theories of Disability’ (2004) 19 Disability & Society 585.
[4] Foucault M, Madness and Civilization: A History of Insanity in the Age of Reason (Richard Howard ed, Pantheon Books 1961); see for its original version: Foucault M, Folie et Déraison : Histoire de La Folie a L’age Classique (Union Générale d’Editions 1961).
[5] Foucault M, Folie et Déraison: Histoire de La Folie a L’age Classique (Union Générale d’Editions 1961) 249-52.
[6] ibid.
[7] ibid.
[8] ibid 283.
[9] ibid 256-7,263-4, 275.
[10] ibid 277-8.
[11] ibid 283, 286-7, 291.
[12] Foucault’s thesis was a warmly praised it was vehemently refuted. See for example, Roudinesco E and others, Penser La Folie, Essais Sur Michel Foucault (Galilée 1992); Still A and Velody I (eds), Rewriting the History of Madness: Studies in Foucault’s Histoire de La Folie (Routledge 1992).

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