The Operation Succeeded, but the Patient Died
:Biopower and the Nightmare of a Totally Managed Society
What connects the laboratory where medical studies are conducted, the holding cell where arrestees are confined, and the cancer ward where patients are treated? The following essay explores the phenomenon that Michel Foucault termed biopower, in which the same structures that sustain our lives also constrain them.
For more on this subject, consult “One Way or Another, One Day We’ll All Wear Masks”. An earlier version of this text appeared in issue 12 of our “anarchist journal of dangerous living,” Rolling Thunder; the art is by Nick Baxter. We also strongly recommend Achille Mbembe’s related essay, “Necropolitics.”
“Never before did regimes visit such holocausts on their own populations. But this formidable power of death now presents itself as the counterpart of a power that exerts a positive influence on life, that endeavors to administer, optimize, and multiply it, subjecting it to precise controls and comprehensive relations.”
-Michel Foucault, The History of Sexuality
I didn’t really get what Michel Foucault meant by biopower until the night I went straight from the city jail to the hospital.
Foucault’s idea is that at some point in the emergence of capitalism, fostering life became a more efficient strategy for accumulating power than dealing death. While the sovereigns of old left people well enough alone except when it was necessary to threaten them into obedience, the new power structures are explicitly concerned with refining and organizing the means by which to sustain populations.
What’s wrong with that? Today, as we approach the conclusion of the era of biopower, we take it for granted that the point of power structures is to sustain us. When we protest against them, we do so on the grounds that they are harming rather than nourishing us. Demonstrating against global warming and police brutality, we call for governments that will halt climate change, police who will protect rather than shoot or choke us. But Foucault’s point is that as long as they hold the power to make us live, they will also have the power to let us die. And what’s more—both our lives and our deaths will assume the forms designated by the authorities.
Don’t take his word for it, though. Look at your own day-to-day experiences and see if the theory resonates. Here are some of mine.
cdn.crimethinc.com/assets/articles/2020/02/10/3.jpg
It’s December 2013 and I’m contributing to the advancement of medical science. In return for a few hundred dollars, I’m leasing my body to a private pharmaceutical testing corporation so they can try out a new blood-coagulating agent on me. I’ve signed forms releasing the company from any liability should I experience lightheadedness, shortness of breath, nausea, vomiting, unconsciousness, or a host of other symptoms including death.
The intake procedures at the opening of the study illustrate the administrative dimension of biopower clearly enough. For the experiment to yield universally applicable data, it’s necessary to maintain strict control over us.
“Have you had anything to eat since midnight last night?” inquires the nurse in a well-lit antechamber to the facilities.
“As stipulated in the study requirements, no, I have not.”
“Have you engaged in any form of exercise in the past 48 hours?”
“No.”
“Have you ever been diagnosed with arthritis? Gingivitis? Abnormal bleeding or blood clotting?” She asked me these questions when I first applied for the study, but she has to ask me again every time I come in.
“No.”
“Do you have asthma? Have you ever experienced an allergic reaction to any medication? Do you currently have a medical condition of any kind?”
“No, I’ve never had an allergic reaction to anything. I’m perfectly healthy.”
“Have you ever experienced faintness while giving blood?”
“No.” Though I can’t say I’m thrilled about having my blood drawn two dozen times over the next four days.
“Are you currently taking any medications or herbal supplements?”
“No,” I lie. In fact, I applied for this study because I desperately need money to pay for a root canal—but if I let on, they’ll turn me back out on the street. I’m holding the pain at bay with the clove oil I’ve duct-taped to the inside of my thigh. You motherfuckers think I’m here just to selflessly advance the cause of medical science?
The nurses searched my bag upon entry, but they didn’t find the clove oil—just a plastic fork, which they threw away so I wouldn’t use it as a weapon or to consume food surreptitiously. Later, I learn that my fellow lab rats have smuggled in coffee, food, and medications of their own.
Capitalism isn’t even good for pure science: the same conditions that compel us to sell our bodies to the industry strip us of any incentive to be honest with the researchers. This is a far cry from Jonas Salk experimenting on himself to develop the polio vaccine.
Two days pass. I’m locked in a windowless annex, my movements circumscribed to a hospital bed and the “confinement lounge.” A battery of machines ceaselessly monitors my blood pressure, heart rate, and breathing; nurses regularly take my temperature and collect my blood and urine to be tested and evaluated. This is 21st century proletarian labor: my employer is not purchasing my labor power, but my very biology—not to produce material goods, but patented information. Salk didn’t patent the polio vaccine.
When it’s time to dose us, they wake us up at 5 am to strap pouches full of coagulant to our forearms, with IVs steadily releasing the drug into our bloodstreams. That familiar pulse of pain is beginning to pound in my jaw again. I go to the restroom, clove oil concealed in my sock, and turn out the light to apply it to my gumline—for all I know, there could be surveillance cameras concealed even here in the bathroom. Only in the darkness does the hospital disappear, leaving me alone with my clove oil and my pain.
I return to bed. I can see my neighbor’s body laid out beside mine, though the plastic curtain conceals his head. His breathing surfaces and submerges within the rhythmless whir of the ventilation system. My own body is becoming habituated to this environment: when I lay down, I feel the rubber tourniquet around my bicep even when it isn’t there, the ghost of the blood pressure pump tightening around my other arm.
At 7 am, the blood draws begin. The nurses call them “labs.” A digital clock counts the seconds; at first, we’ll have blood draws at five-minute intervals, then every ten minutes, then every thirty. Rather than using another IV, the nurses have to stick us with a new needle every time they draw. The blood draws are my least favorite part—the sensation of the needle punching through my skin always makes my stomach clench.
The first blood draw goes fine. I look away as the nurse pushes the needle into my vein. The doctor supervising the trial has come in early to oversee this part of the procedure in person. He receives the vials of our blood at the door and holds them up to the light, peering at them without acknowledging me or the other patients.
Five minutes later, the nurse pushes the needle into my arm again, next to the previous entry point and all the bruised entry points of the past two days, itching as they heal. This time, she has to wiggle the needle around for a while to strike blood. Finally, she fills a vial of it, and turns it over to the doctor.
He returns a few seconds later, shaking his head. “It’s unusable,” he instructs her. “Draw another.”
I look away from the nurse as she plunges the needle once more into my arm. All the other patients in the room are black men. The nurses in their blue smocks are all Latina women or white women with rural accents. Between the patients, the nurses, and the white doctor in his white coat, it’s easy to make out the continuum between black flesh and white brains that still characterizes the racial distribution of the US workforce. The doctor is scowling at the latest vial of my blood. “This one is ruined, too,” he says. “I need another draw.”
The nurse explains that my blood is clotting before she can get a clean sample. She’s sorry, but she needs to try a third time. You motherfuckers, you knew you were testing a fucking blood coagulant on me, and now you’re confused that my blood is coagulating? Fuck, is this my fault because of the clove oil?
The draw succeeds—but only a minute passes before it is time for them to draw again. This time, the nurse has to work the needle around in my arm for several seconds to enter a vein, and then the blood stops flowing before she gets a full sample. She pulls the needle out and breaks my skin again. She’s already made five holes, and this is the sixth—a tiny crimson Pleiades in the crook of my elbow.
I’m trying to disassociate from the pain in my arm. One stick every five minutes sounded bad enough; now that I don’t know how many sticks are ahead, I’m starting to panic. My head is a jumble of rage and recriminations. If only I’d made smarter decisions about how to market myself—if only I could maintain a positive attitude—if only I could put a scalpel to that fucking doctor’s throat and make them give me that paycheck up front! Pump that blood back into my arm, you fucking vampires, and throw in a dentist too if you don’t want to leave here in a biohazard bag!
Under the fluorescent lights, I can see my blood in the capsule beside me on the bed, resting on a gauze square like a tiny corpse—organic matter reduced to scientific evidence, or maybe just medical garbage. My body is contained in this facility the way my blood is contained in that vial: it is measured by it, but also shaped by it. I realize that I’m about to black out.
“Are you OK?” All the nurses in the room are flocking around me. “You look pale.” One of them puts her hands on my shoulder and bicep, massaging me, trying to get my blood to flow. It’s a gesture of care, and I appreciate it, even if its purpose here is just to get the machinery running again: like my blood in that vial, her empathy is shaped by the imperatives of this space, serving to advance that agenda. The nurse with the needle is still digging around inside my arm, chasing the vein across the muscles and tendons, breaking my skin again and again. Even if I lose consciousness, they can’t afford to fall behind schedule.
Another nurse rushes in. “We’re not getting anything from his EKG.” They all look at me with mounting concern. “If your EKG doesn’t work, we can’t do the study.” My heart, connected through my circulatory system to the needle and, beyond it, the whole medical-industrial complex, leaps in my rebel chest: What I wouldn’t give to leave this fucking study, to walk out right now! May every EKG fail and all the sick perish, if only my healthy body might be spared, if only I could walk out of this hospital into a world without dental bills!
But I have to force myself to stay here, the doctor in my head coercing the subject of my body to serve the economy. If I don’t, I can’t get the root canal.
What better argument is there for our civilization than the wonders of modern medical science? Yet, at this moment, that apparently universal good is inflicting personal injury on me. I’ve spent much of my life doing studies like this to pay the bills; it strikes me that, were I to tally everything up, I might find that modern medicine has done me more harm than good. The Environmental Protection Agency has locked me in chambers filled with pollutants. The pharmaceutical industry has pumped poisons into my bloodstream. The doctors whose oath is “First, do no harm” have overseen all this, indifferently entering data into spreadsheets.
As the nurse forces yet another needle into my arm, I no longer identify with the abstract humanity that is to benefit from all this research. I identify with the inmates of Stateville prison hospital who were infected with malaria to test investigational drugs. I identify with the teenagers of the Ohio Soldiers and Sailors Orphanage upon whom toxic vaccines were tested. I identify with the black sharecroppers in whom the US Public Health Service allowed syphilis to progress untreated, observing its effects as they sickened and died without ever informing them of their condition. I identify with the billions of animals tortured by vivisection, the vast foundation of carcasses on which the pyramid of the medical industry rests. I’m still not sure exactly what biopower is, but I feel in my gut that I’m against it.
cdn.crimethinc.com/assets/articles/2020/02/10/2.jpg
A few days later, I’m back out on the streets, surrounded by hundreds of people chanting and beating drums. Another young man of color has died at the hands of the city police—the fourth in this city in five months. This time it’s a Latino teenager, Jesus Huerta, “Chuy” to his friends. One night, when he left home, his mother was afraid that he was running away. She called the police to go find him and bring him back—tragically taking their motto “to serve and protect” at face value. He arrived at the police station in handcuffs, dead of a gunshot wound.
The police maintain that he smuggled a gun with him into the back of the police car and, with his hands still cuffed behind his back, shot himself in the head. In response to public outcry and disbelief, they’ve announced that in fact, this is a popular way to commit suicide—though based on the examples they cite, it chiefly seems to occur in Texas. One police department has even released a helpful instructional video showing how to shoot yourself in the head while handcuffed, provided the handcuffs are as loose as they are in the video.
Those same police are lining our demonstration now, hundreds of bike cops flanking us, riot cops in full armor, lieutenants filming us, motorcycle cops gunning their motors in the intersections. When we stop at the place Chuy passed away so his family can set out candles and say a prayer, the police issue a dispersal order through a megaphone and prepare to attack us. It’s a tense moment: the officers pulling down their gas masks and readying their weapons, the tearful faces of the family in prayer, some of us in black sweatshirts steeling ourselves to defend them with our fragile banners and bodies.
Just before the final order is given to charge us, we resume marching. Now the police are jostling their bikes into us, screaming orders at us. They are the antibodies of the political system, surrounding the contagion of social unrest—intent on isolating it from the rest of the social body and neutralizing it by any means necessary. They aren’t simply concerned with preserving our biological existence, but with enforcing their biological metaphor of health: the smooth functioning of the existing system. That explains the line of police separating us from the good citizens spending their hard-earned money in the restaurants, just as I spent my paycheck at the dentist.
All this infrastructure that is supposed to serve life, to protect life, serves to protect and enforce a certain kind of life—and no other. You are supposed to accept that the police are taking the right lives—the lives of the black, brown, and expendable—lest you become a target, too.
We reach the destination of the march. It’s a relief. We will exchange farewells and condolences and phone numbers, and return to our lives as presumably law-abiding good citizens—at least, those of us who are not always on the receiving end of the sort of violence that took Chuy from us. But suddenly, without warning, the police are charging, shooting volleys of tear gas into the crowd. Choking parents stumble back blindly, trying to drag their children to safety. A wall of riot police with batons rams into us: “MOVE! BACK! MOVE! BACK!” they chant in unison, like testosterone-powered robots. I interpose myself between the threshing line and the other protesters, hoping to buy my comrades enough time to get their children to safety. The officers are striking us, methodically, but they will not meet our eyes. Then everything goes white and the world dissolves in a stinging fog.
Surely, that tear gas closing my throat and flattening my lungs was tested in a medical facility like the one I just worked in. Doctors administered tests and recorded results; scientists refined their theories, confident that they were contributing to the advancement of humanity. The more total the understanding of the human body and its functions, the more precisely it can be controlled—whether that means extending life, ending life, or imposing a form upon it and correcting deviations. Some contrary part of me wishes I had done more to cheat the scientists than just smuggling in clove oil.
The next morning, there’s some fallout in the press. Youtube videos show law-abiding citizens opening the windows of their downtown apartments to see what is happening, only to choke on the tear gas wafting in. Shouldn’t the police be more restrained, more targeted, more precise? But the critical editorials in the newspaper offer me little reassurance. The more targeted the police are, the more restrained they appear to all the good citizens going about their ordinary business, the less their actions will provoke outrage—and the easier it will be for them to kill young men of color with impunity. If the police were able to identify those who were committing specific violations of the law and utilize precise biological weapons that only affected them, these concerned journalists would have no grounds for their complaints. The smooth functioning of the police itself is the problem—it is not just that it kills some people, or that it represses others, but that it fosters a society in which no one can imagine or enact any other form of social relations.
I’m starting to understand what biopower means.
cdn.crimethinc.com/assets/articles/2020/02/10/1.jpg
Fast-forward a year to December 2014. The police have killed another—no, two—no, hundreds more young men of color. We’re back out downtown, more of us now, a great angry crowd chanting and beating drums and shooting flares into the night sky. This time, we’re blocking the freeway. Illuminated only by the headlights behind us, we are slowly marching from one exit to the next, leaving graffiti on the pillars of overpasses as police helicopters circle overhead. We are shutting down the circulatory system of the body politic, interrupting the smooth functioning of the order that sustains us. It seems like the only way to get any leverage on it.
I almost didn’t come tonight. My partner is in the hospital with cancer; she’s had an operation and still can’t keep down fluids. I’ve been staying there with her all week, sleeping with my face pressed into the sticky patent leather of the chair at her bedside, emphasizing my presence and care as she fights against nausea, against the relentless stabbing pain in her abdomen, against despair.
Supporting someone with cancer is a little like taking on white supremacy. There is nothing you can possibly do that would suffice to solve the problem. You have to give everything you have, humbly and without expectation, knowing it will never be enough. I reach across the machinery of the automated bed to hold her hand as she struggles to breathe, summoning warmth and optimism to sustain her through my own mounting fatigue. She’s angry with me for all the ways I am failing her, just as my friends who are poorer and darker-skinned than I am are angry with me for not doing more to challenge the system that benefits me at their expense. They’re right to be angry. It’s unjust.
She had an uncomfortable feeling in her stomach for a year. It took us that long to navigate the bureaucracy of the health care system. The government just overhauled the way insurance coverage works in the US, but in the end it didn’t help us at all—people in her income bracket are supposed to be covered by Medicaid, which doesn’t apply in our state. And all that time, the cancer was growing inside her, drawing in resources, spreading from one organ to the next like a bureaucracy extending its reach.
The worst part of being ill in this society is not just the fear of death, but the shame of being a broken thing—an object that can no longer produce, no longer pay its way. She can’t stop thinking about the inconvenience to everyone else, how she can’t go to the bank or take care of the water bill or even get to the bathroom without someone to roll the IV drip alongside her. In the hospital, you feel the stark line of demarcation between the healthy and the sick, between doctors and patients, machinery and flesh, clean and unclean, sacred and profane.
I never feel that sort of shame with my herbalist friends. Their tinctures don’t always work, that clove oil did precious little to soothe my dying tooth, but their care emphasizes that I am precious to them, that I have nothing to be ashamed of—that I don’t have to be productive or integrated into a bureaucracy for my life to count.
When we get off the highway and make our way onto quieter streets, the police charge. They’ve had a year to refine their procedures, to become more precise, more targeted, more surgical. Ordinarily, they arrest black and brown youth at the edge of demonstrations, but tonight they wait until our numbers have dwindled, and then they sprint directly for the ones they think hold the most social power. The first person they grab is the medic—I see him three steps behind me, plaintively mouthing “Help me!” as three of them swing him to the pavement, tearing off the equipment with which he would turn medical care against the establishment it ordinarily serves. Another officer tackles me from behind at full gallop, slamming me to the ground so we roll over each other until his colleagues secure a zip-tie around my wrists.
On the bus, my hands contorted behind me against the seat, the zip-tie cuts into my skin. At least it beats an IV needle—or a bullet.
The intake procedures at the station are monotonous and familiar. My arresting officer copies down my biometrics: height, weight, date of birth, distinguishing features. Do I have any former arrests in this county? Do I have any tattoos or distinctive markings? They scan my fingerprints and palms. I lie to them, saying I have no tattoos, and refuse to answer their questions. The officer is trying to make small talk with me. I keep my mouth shut: anything I say can and will be used against me in a court of law. Just as the compassion of the nurses greased the wheels of the medical study, his conversational banter has been integrated into the intelligence-gathering apparatus of the state.
Sitting in the cell, the internal recriminations resume. I told my partner I would be back at eleven, and now who knows when I’ll get out of here. Here I am, irresponsible again, failing to come through for the person I love when her life is on the line. Instead of standing up for the lives—no, for the deaths—of people I never knew, I should have kept my head down, looking out for myself and my family, individual solutions for individual problems. I should be grateful, right? Grateful that my lover can be the beneficiary of such an advanced civilization, with all its medical technology.
No, actually, fuck that. Fuck the nurses, fuck the doctors, fuck the dentists, fuck the journalists, fuck the police, fuck all the good citizens behind the windows of the restaurants and automobiles, and fuck integrating myself into their logic of how power should be distributed, who deserves to survive. Trapped here while my partner waits in the hospital, it suddenly strikes me that cancer and police are parallel manifestations of the same thing. They both impose limits on how we can realize our potential, circumscribing what our lives can be. They both appear inevitable—death and taxes. But at least one of them is a needless tragedy, unnecessary and ridiculous. We’re bound to die, one way or another, but we don’t have to live like this.
Some people say we’re stupid to blockade highways, to disobey orders, to get in the way of how things work. They can’t imagine things working any differently, they can’t even pose the question of what another world might look like—and therein lies the ultimate triumph of the police. When such people picture social change, they can only imagine the existing apparatus of power functioning more efficiently, more effectively. They propose to abolish white supremacy by means of the institutions created to enforce it; they propose to do the same for climate change and authoritarian power itself.
Entering the hospital straight from the jail, I am struck by how similar they are. My body reacts to the dry aseptic air, to the sterile walls of the hospital foyer hung with motivational posters and grade-school art, the same way it did to the windowless corridors of the police station. I feel clenched up, hunted, hyper-alert. Both of these environments are designed to minimize your agency, rendering you a spectator of your own fate, managed and directed by specialists. Both of them conceal the objects of their operations—disobedience and death, respectively—in order to set you at a distance from everything within you that cannot be integrated into the regime of biopower. Both of them are supposedly here to help us. Together, they force a biological metaphor onto social life, and vice versa—defining and excising the broken, the dependent, the destructive, the criminal.
I sneak past the security guard who would ask for my pass if he noticed me arriving at this late hour—I have no pass and it’s too late to get one. I take the elevator to the sixth floor and make my way around the night nurse at the desk. I slip the door open quietly and creep through the darkness to take my partner’s hand. She is semiconscious in the dim glow of digital displays, beautiful even at the precipice of death, in defiance of the cancers within and around her and the machines into which her body is integrated as if it were itself just a defective machine. Fighting the urge to weep, I apologize for being late. Blurrily, she asks me how the demonstration went, whether everyone is OK. Yes, I tell her, Everything went fine. Everyone is OK.
Afterwards, the police claim that in blocking the highway, we delayed an ambulance on its way to the hospital. I joke that it’s smart of them to keep an ambulance on hand alongside their fleet of personnel carriers and tactical vehicles just so they can be sure we’ll always be blocking one—but there’s a bigger issue at the bottom of this. They take life—and the system is ordered in such a way that we endanger life when we try to discourage them from doing so. It is life that is at stake here, for certain, on their side and ours—the question is whose lives, and what kind of living. When we fill the highway with our unruly flesh, slowing the traffic that is pumping pollution into the atmosphere and hastening climate catastrophe, they can convincingly argue that we are the ones endangering life, because it is their system that nourishes it, even as they take it away. Every other way of surviving has been closed off by that same system.
And now, finally, I’m clear on what biopower is. Biopower is a network of interlinking institutions in which the things that sustain us become inextricable from the things that control and kill us. That’s why it is so insidious: because we can’t resist it without opting, like Mohamed Bouazizi, for some kind of self-destruction. Biopower coordinates all life in a single vast apparatus, maximizing productivity, ceaselessly compelling us to mobilize ourselves according to its logic. From its perspective, the freedom we seek is indistinguishable from catastrophe. From our vantage point, the same is true of the ruling order.
I’m not proposing a grand alternative. I don’t have a universal system to argue for, or a new blueprint according to which to reorganize society. Maybe universals are part of the problem. All I have to go on is an inkling that, speaking from my immediate personal experience, it seems like no system of management can foster the lives we deserve. Disentangling our means of survival from all the institutions of management has never been more difficult, nor more pressing.
And yeah, it’s terrifying.
