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Healthy citizenship beyond autonomy and discipline: Tactical engagements with genetic testing

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Abstract

In recent decades a model of healthy citizenship has emerged, which construes citizens as autonomous, responsible and active participants in the management of their health. While proponents view this as an empowering discourse, critics claim that it creates new forms of discipline and social control. This article argues that there is a need for a shift in the conceptual framework surrounding this discussion – beyond autonomy versus discipline understood as heteronomy – because it obscures the many ways in which individuals engage with healthy citizenship discourse that are not governed by principles of autonomous choice and that do not corroborate fears of normalization and discipline. Michel de Certeau’s theory of the creative tactics of everyday life is offered as a useful alternative framework, insofar as it is concerned less with individual autonomy than with the rendering ‘habitable’ of a given space. Drawing on existing empirical research on people’s engagements with genetic risk information, four tactics are identified that escape both healthy citizenship discourse and its critique: translation; selective mobilization; non-disclosure; and a refusal to engage. Thinking in terms of tactics and habitability, it is argued, provides a vocabulary with which to articulate other modes of reasoning, action and moral conduct that are at work.

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Notes

  1. De Certeau’s work has had a broad influence (see, for example, the numerous journal issues – Diacritics 22(2) (1992), Social Semiotics 6(1) (1996) and South Atlantic Quarterly 100(2) (2001) – and intellectual biographies – Ahearne (1995), Buchanan (2000), Highmore (2006) – devoted to his work). In particular, his ethnography of everyday practices has been useful as a framework that allows individuals a space of agency and plurality of practice within otherwise constraining orders, such as biomedical discourses (Arris, 1997) or the Internet (Franklin, 2004).

  2. This type of governmentality-inspired scholarship can be seen as resonating with some of the critical voices that have been recently raised against the ‘biosociality’ and ‘biological citizenship’ literature (Kerr, 2004; Plows and Boddington, 2006; Braun, 2007; Raman and Tutton, 2010). These critiques have argued, in different ways, that the claims to novelty attributed to ‘molecularization’ and ‘ethopolitics’ should be nuanced in light of the persistence of traditional forms of ‘state’ biopolitics.

  3. Foucault himself did not attribute the same attention to the concept of resistance as he did to his analysis of modern forms of power. And while his theory of power is closely linked to concrete empirical studies, his concept of resistance is articulated mostly in theoretical terms. This may be a source of ambiguity that makes it easier to interpret strategies of resistance as ‘functional’ to the imperatives of disciplinary power. See, for example, critiques by Jürgen Habermas (1990) and Nancy Fraser (1989).

  4. Indeed, de Certeau positioned himself as seeking to nuance Foucault’s exposition of disciplinary society, of bringing to light what he called an “anti-discipline” (1984, p. xiv).

  5. Though, his work has often been misinterpreted precisely in terms of the rigid, polar model that he contested. See, for example, Frow (1991, pp. 57–58).

  6. Furthermore, where susceptibility genes for complex and common diseases have been identified using genome-wide association studies (GWAS), they have been found to count for only a small percentage of the known genetic variation in disease risk (Hall et al, 2010; Makowsky et al, 2011).

  7. I thank an anonymous reviewer for calling this distinction to my attention.

  8. For women who receive a positive prenatal diagnosis, selective abortion is the most frequently reported option (Mutton et al, 1998; Mansfield et al, 1999).

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Acknowledgements

This article has benefited from the generous comments of Jens Lachmund, Ine Van Hoyweghen, Barbara Prainsack, Tsjalling Swierstra and the participants of Maastricht University’s STS “Summer Harvest” in September 2012, as well as those of three anonymous reviewers. This research was conducted within the framework of a project on “Healthy Creativity: The Implicit Normativity of Healthy Citizenship” funded by the Netherlands Organization for Scientific Research (NWO).

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    Tamar Sharon

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Sharon, T. Healthy citizenship beyond autonomy and discipline: Tactical engagements with genetic testing. BioSocieties 10, 295–316 (2015). https://doi.org/10.1057/biosoc.2014.29

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