I found the visualization below to be a very striking illustration of the concept of medicalization:

As you can see, the growth of the DSM perfectly illustrates the range of behaviors that come to be labeled as pathological, and therefore, under the normative purview of the medical profession.

This is also further illustrated by the rise of diagnosing conditions (which is, of course, connected to what is in the DSM):

“The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is on the rise in American children, with an estimated 2 million more kids receiving a diagnosis of ADHD and 1 million more taking medication for ADHD in 2011 than there were in 2003, according to new data released by the U.S. Centers for Disease Control.

In a 2011 national survey of more than 95,000 U.S. households, the CDC found that 11 percent of children between the ages of 4 and 17 — or 6.4 million children nationwide — had received a diagnosis of ADHD, a disorder characterized by hyperactivity, trouble controlling impulsive behaviors and difficulty paying attention.

Among those children who had been diagnosed with ADHD, 83 percent were considered to currently have the disorder, or 8.8 percent of all kids nationwide. And among the children who currently have the disorder, 69 percent are taking medication to treat it — which comes out to 6.1 percent, or 3.5 million kids nationwide, the researchers said in the CDC report released Friday.”

And one can see the correlation between power dynamics and social control:

“Overall, the prevalence of childhood ADHD increased by 42 percent between the years 2003 and 2011, and the frequency of children taking medication for ADHD increased by 28 percent between 2007 and 2011.

“This suggests an increasing burden of ADHD on the U.S. health care system,” the authors of the study wrote. “Efforts to further understand ADHD diagnostic and treatment plans are warranted.”

The researchers did not indicate why ADHD among children has increased, but offered a few potential reasons: significantly, an increase in parental reports of their kids’ ADHD, or “better detection of underlying ADHD, due to increased health education and awareness efforts,” the authors wrote.

The researchers noted that the “prevalence of ADHD medication use also increased despite an overall downward trend in pediatric medication prescriptions,” and that the study’s data suggest that “the impact of ADHD may be increasing.”

The demographic groups most affected by ADA included boys — 15.1 percent of them had ADHD, versus just 6.7 percent of girls. Nearly one in five high school boys and one in 11 high school girls were diagnosed with the disorder.

In addition, children who were white, who lived in the Midwest, and kids whose families lived above 100 percent of the poverty line were more likely to be diagnosed with ADHD.

In terms of regional trends, children living in the West were least likely to receive a diagnosis of ADHD; state-based estimates of ADHD frequency ranged from 4.2 percent of kids in Nevada and 5.9 percent in California to 14.6 percent of children in Arkansas and 14.8 percent in Kentucky.”

It is amazing that there is no questioning whatsoever of the validity of the label for this condition. It is just accepted as an objective medical diagnosis, and therefore, the only question is how to treat it. The fact that the explanation for the increase is roughly limited to greater reporting rather than greater social awareness that a bundle of behavioral markers have been given a medical label and medical treatment options. There is also no real questioning of the demographics: boys, white, non-poor, that is, people who have access to the medical profession. Boys, of course, are more subject to behavior sanctioning in the school system, that is not new. But instead of being given detention, they get a medical diagnosis.

On this topic, the Very Public Sociologist, PhilBC, does a good job of unpacking the social construction of disorders that are currently in fashion:

“Why have Autism and Asperger’s only recently been codified as a social concern? It could part be media curiosity, part the growth and spread of the internet, and part visibility attained by the disabled rights movement. The inescapable trope of the autistic genius might have a role, too.

But I think something deeper could be going on, something to do with structural shifts in the advanced capitalist countries. Short-sightedness and Dyslexia were not social concerns prior to industrial capitalism. The point came when the demands of capital required something more than able bodies to work in its dark, satanic mills – it needed basic education to record and pass on information at all levels. Since then, particularly over the last 30 years, manufacturing has taken a battering. The old industries have fallen back and in its place are what we used to call tertiary industry: the service sector. This sector, from retail to investment banking, from call centres to consultancies, all absolutely depend on social relationships. Of course, thus it ever was. But now is different – the direction of travel clearly is capitalism’s growing dependence on the wealth that can be mined from relationships. Hence the massive values of social media firms who’ve yet to make a single penny of profit. Hence the obligatory ‘person spec’ placed alongside graduate job adverts. Hence the growth of consultancies selling team-building experiences. Hence the concern with Autism and Asperger’s.

For Autistic and Asperger’s people, the economic shift to service finds them singled out as disabled individuals. In front of the new emphasis on relationships, on the complexity of social cues and the (personal and commercial) premiums on networks; they are the newly dis-abled. And this is a very recent shift.”

But PhilBC makes another connection that is also important: what gets considered a crisis and how it is dealt with within the current social arrangements:

“There is an alternative explanation, but again related to changes in political economy. We know Britain is in the midst of a mental health epidemic. One-in-four of us suffer with a mental health problem during the course of a year. Thankfully, the stigma attached to mental health is beginning to lift and it is starting to be talked about. Partly, this is because these problems are so widespread. Why should we be surprised that more insecure and pressured work situations lead to stress, anxiety and illness? That low wages, crushing debts and attacks on social security screw people up? It is reasonable to assume that more job security, more stability would have the effect of decreasing incidences of mental ill-health. But also, with capital’s emphasis on relationship and service, any health problems impacting on its capacity to do business on that basis is bad news. It’s a concern. A social problem. So, is it possible that the relatively recent problematisation of Autism and Asperger’s is a subset of a wider recognition of a crisis around mental health?”

Emphasis mine.

But, of course, whenever something is defined as a problem, the way to deal with said problem has to be framed within the parameters of dominant ideologies and practices. And so, when mental problems are seen to be increasing because of precarious (or liquid, as Bauman would say) social conditions, then, the remedies are not to be found in changing the social conditions. No, under the norms of advanced capitalism, remedies have to be individualized, medicalized, and fit within corporate power.

Hence, this:

Doctors across Europe are warning that the soaring use of antidepressants is down to growing pressure to “medicalise” unhappiness, complaining that a lack of time and meagre availability of other therapies meant that physicians reach for the prescription pad far too often.

In response to a questionnaire devised by the Guardian and five leading European newspapers, the vast majority of almost 100 European doctors and psychiatrists who replied said there was a “prescribing culture” in their country because other help for people with depression was inadequate.

Many of the doctors – from the UK, France, ItalyGermanySpain, Luxembourg, Belgium and the Netherlands – said they believed antidepressants were an effective treatment for cases of severe depression. But dozens expressed frustration that limited time and even more limited resources mean that they often feel pressured to prescribe pills in less-urgent cases.

We are medicalising common situations: conflict, separation and the vicissitudes of life,” said Gladys Mujica Lezcano, a Barcelona-based hospital doctor.

“They are prescribed much too easily,” added Alain Vallée, a psychiatrist from Nantes in France. “If you take an antidepressant and it doesn’t work, you don’t think it’s because you might not be depressed, but that you need to take a stronger one.””

And if the vicissitudes of life widen, as socioeconomic conditions deteriorate, and insecurity increases, then, individually-prescribed medical remedies are the proper solution and recourse.

This is especially interesting when one considers current discourse on health care: rising costs, over use, etc. So, a lot more behaviors have been medicalized, requiring pharmaceutical treatments prescribed individually (something that is often presented as a freedom: patient rights, etc.), but at the same time, then rising costs will demand potential cuts in health benefits (see: Medicare upcoming “crisis”). Double whammy.

A last piece of the overall puzzle has to do with the fact that US physicians tend to make more money than their counterparts in other high-income countries, but are also fewer in number (see the data at this post by Echidne):

Doc pay

Echidne argues this has to do with market controls: access to the profession is guarded by gatekeepers, whether medical schools or physicians’ professional associations. And there may be very good reasons for this (medical services are not like other consumer markets). And such greater control turns into greater social power not just in who can join the club, but regarding what is considered the prerogative of the medical profession. Which gets us back to my initial visualization on the DSM.

Strict controls over access and numbers in the profession + expanded territory = power ← this goes both ways, of course, in mutually reinforcing dynamics. And as more socially-based pathologies occur, they “naturally” come under the purview of the currently powerful group dedicated to dealing with pathology in general (as opposed to priests, 300 years ago in Europe, for instance).

The risk society is a medicalized society.

Needless to say, when two of my favorite contemporary sociologists write a book together, on a topic of high relevance, lately – surveillance – I jumped on it. Liquid Surveillance – A Conversation is actually a dialogue via email between Zygmunt Bauman and David Lyon. The conversation revolves around the two major concepts that have shaped these men’s intellectual career: liquidity for Bauman, and the surveillance society for Lyon. So, it was only natural for their conversation to revolves around joining these two themes.

On that, the book does not disappoint. At the same time, because the conversation assumes at least some familiarity with the works of both men, it might not be as accessible to a non-academic audience as one might hope. It does seem, though, that whoever edited the book wanted to reach a wide audience through a short book, written in a relatively casual style and conversational tone. The book works on those aspects.

Another aspect of the book that makes it easy to follow is that the two sociologists do not seem to disagree on anything. So, each chapter basically revolves around one theme organized through an email exchange, where Lyon sets up the question, and then, Bauman compliments him for hitting the nail right on the head. Things go back and forth a bit until the end of the chapter. And the cycle starts again in the next chapter.

The overall theme of the book then joins two conceptual and theoretical apparatuses that truly seem to belong together: that of the liquidity thesis (the contemporary modern era where individuals have to find individualized solutions for structural and systemic problems in the context of precarization and risk society), and that of the surveillance society as tied not just to the state and governmental surveillance, but also that of consumerist surveillance promoted by large corporations, and the ties between the two types. A big chunk of the discussion questions whether Bentham’s Panopticon image is still relevant, and if not, what has replaced it as the image liquid surveillance. That is what the two sociologists explore.

“Surveillance is a growing feature of daily news, reflecting its rapid rise to prominence in many life spheres. But in fact surveillance has been expanding quietly for many decades and is a basic feature of the modern world. As that world has transformed itself through successive generations, so surveillance takes on an ever changing character. Today, modern societies seem so fluid that it makes sense to think of them being in a ‘liquid’ phase. Always on the move, but often lacking certainty and lasting bonds, today’s citizens, workers, consumers and travellers also find that their movements are monitored, tracked and traced. Surveillance slips into a liquid state.” (Loc. 32)

The way the liquidity thesis and the surveillance society thesis join together goes like this:

“‘Liquid surveillance’ is less a complete way of specifying surveillance and more an orientation, a way of situating surveillance developments in the fluid and unsettling modernity of today.” (Loc. 70)

At the nexus of state, private sector, and surveillance, one encounters the now ubiquitous idea of “security”, whether it is protection against terrorist threats or corporate fears of hackers of all tripes. The whole idea is that the risk society surrounds us and security measures have to be adopted to protect us all from all these risks. It is for our own good and we need to accept it.

“As Didier Bigo points out, such security operates by tracking ‘everything that moves (products, information, capital, humanity)’. So surveillance works at a distance in both space and time, circulating fluidly with, but beyond, nation-states in a globalized realm.” (Loc. 107)

And everything that moves includes, of course, one’s cursor on a computer screen, the clicks on links, the online movements and purchases one makes, the games one plays and the communication one engages in. From this perspective, social media is one giant surveillance apparatus where human beings are turned into little (or big) pile of data that then gets manipulated, repackaged, and sold. Surveillance within social media is pretty much an accepted fact of life. As much as one might get enthusiastic on the use of social media for social movements (as we have seen in the past few years on a global scale), the use of social media is always at the discretion of the corporations that own the platforms and based on state oversight.

A key concept invoked repeatedly by Bauman to define the nature of liquid surveillance is that of adiaphorization in which systems and processes become split off from any consideration of morality.” (Loc. 132). Contemporary technologies of surveillance allows its extension to great distance, creating an almost complete separation between the watchers and the watched (think drone operators and their potential targets and victims).

Adiaphorization also applies to all the different ways in which human being are disembodied and turned into piles of data, whether it is biometric data gathered at the borders, or genetic information collected through medical testing, or consumer profiling through sites like Amazon. These aggregated data are then used as “standing in” for the person who has been in effect disappeared in favor of a substrate that is easier to classify, categorize, select or exclude, through statistical means as run through massive servers. Indeed, one can invoke the fact that “dealing with data” is a morally neutral activity, even though, it obviously is not.

There is a soft power side to surveillance practices in liquid times, its carrot side: the fact that a great deal of information and data comes from us. We voluntarily submit data to a variety of organizations because we get little things in exchange. When Amazon asks us to rate and review our purchases in order to provide us with a more customized experience, we comply and volunteer our free labor as data because we get something in exchange: a more fun Internet and purchasing experience overall. The same goes for Facebook, Google and a lot of other companies. So, we trade a bit of privacy and data in exchange for some reward in a variety of forms.

The end result, though, of all these forms of surveillance, whether public or private or partnership of both, is social sorting: defining classes of individuals as worthy of state or commercial benefits or excluded from those. These benefits though may very well be life chances and opportunities, and results in +and – in terms of social rewards and privileges or their absence.

So, is the old Panopticon dead or have we entered the post-Panoptical era? It is not clear-cut. With the greater presence of ever smaller drones, Google Streetview, etc. we are more than ever subject to surveillance but we never really know when and by whom. That’s the contemporary, ubiquitous Panopticon. On the other hand, social media also hold the promise of constant sociality: you are never alone on Facebook, Twitter and all the other social media platforms. These platforms hold the promise of never being alone, but also of never being invisible, ignored, neglected, etc. They even offer the possibilities of seemingly freely chosen presentation of the self (paging Erving Goffman). Out of the loss of privacy came the pleasures of being noticed and recognized (and how has not checked their Klout scores??). But this means that we also turn ourselves into commodities.

At this point, though, both Bauman and Lyon fall prey to digital dualism while opposing the strong ties of communities and the weak ties of networks, privileging the former over the latter:

“Belonging to a community is a much more secure and reliable condition than having a network – though admittedly with more constraints and obligations. Community watches you closely and leaves you little room for manoeuvre (it may ban you and exile you, but it won’t allow you to opt out of your own will). But a network may care little, or not at all, about your obedience to its norms (if a network has norms to obey, that is, which all too often it doesn’t) and so it gives you much more rope, and above all will not penalize you for quitting.

(…)

All in all, the choice is between security and freedom: you need both, but you cannot have one without sacrificing a part at least of the other; and the more you have of one, the less you’ll have of the other. For security, the old-style communities beat networks hands down. For freedom, it is the other way round (after all, it takes only one press of the ‘delete’ key or a decision to stop answering messages to get free of its interference).” (Loc. 558)

One would hope that this is a dualism that we would have buried once and for all. This opposition is much too simplistic than Bauman and Lyon make it sound. After all, a lot of Facebook users, for instance, use the platform to reinforce their bonding social capital and not exclusively to increase their bridging social capital. I don’t think these oppositions hold empirically.

But this is well in line with a general pessimistic tone that persists throughout the book, and not just on the subject of surveillance but on the larger subject of social networks. In Bauman and Lyon’s discussion, there is little hope for any positive aspect of social networking technologies. It may very well be that one gets different types of relationships through social media than face-to-face (and again, this would need to be demonstrated empirically rather than just asserted), but this whole formation of hierarchy of relationships by medium is getting old and tiresome. There is no reason to assume a priori that face-to-face interactions are more authentic or deeper than digital ones. And yes, one has the freedom to leave a network without constraints. But local communities can be hotbeds of oppression that may impossible to escape, especially for women and girls in highly patriarchal environments. And yes, social networking platforms are as reflective of patriarchy as brick-and-mortar institutions.

Ok rant over on the digital dualism thing. Moving on.

Here is a good question though, and a very relevant one these days:

“If social media are actively used by people for their own purposes, then what happens when those purposes are opposed to the corporations or governments who might be thought of as using them?” (Loc. 625)

In the context of the whole NSA / Snowden fiasco, this is important and we saw how crucial it is when it was revealed that some of the major media players had willingly collaborated with NSA surveillance.

And yes, the jury may still be out on the prospects of social movements that made skillful use of social media over the past few years, here in the US and worldwide, but Bauman and Lyon seem deeply set in their pessimism. But the issue for social movements is not either/or: on the ground or virtual. Analysts like Castells have shown that it is both. There is a two-way street between the virtual and the non-virtual, there is interdependence rather than opposition or hierarchy. As we saw last week with the case of HB5, the anti-abortion bill debated in the Texas legislature, there was ground action, and virtual activism as well. They combined and joined into a powerful demonstration of crowd behavior merging with mass behavior. And in that case, it was the online crowd who watched and monitored as political actors on the ground try to cheat on the final vote on the bill. Without the mass of virtual witnesses, this might have gone without much opposition. The virtual and the on-ground supported and sustained each other. So, again, I think both Bauman and Lyon are lacking imagination and optimism on this.

Back to the Panopticon 2.0:

“The panopticon is alive and well, armed in fact with (electronically enhanced, ‘cyborgized’) muscles so mighty that Bentham or even Foucault could not and would not have imagined them – but it has clearly stopped being the universal pattern or strategy of domination that both those authors believed it was in their times; it is no longer even the principal or most commonly practised pattern or strategy. The panopticon has been shifted and confined to the ‘unmanageable’ parts of society, such as prisons, camps, psychiatric clinics and other ‘total institutions’, in Erving Goffman’s sense. How they work nowadays has been superbly recorded and in my view definitively described by Loïc Wacquant. In other words, panopticon-like practices are limited to sites for humans booked to the debit side, declared useless and fully and truly ‘excluded’ – and where the incapacitation of bodies, rather than their harnessing to useful work, is the sole purpose behind the setting’s logic.” (Loc. 763)

This is a point that is well demonstrated in Eugene Jarecki in his documentary on the War on Drugs, especially as commented by The Wire’s David Simon. US prisons are warehouses for the socially excluded and marginalized.

But Bauman takes this point even further: in the old conceptualization of the Panopticon, there has to be an external watcher. But the Panopticon was a modern construct:

“Having considered bureaucracy as the fullest incarnation of modern rationality, Max Weber proceeded to enumerate the features which any purposeful arrangement of human activities needs to acquire and strive to perfect, in addition to strict hierarchies of command and reporting, in order to come close to bureaucracy’s ideal type and so climb to the peak of rationality. At the top of Weber’s list was the exclusion of all personal loyalties, commitments, beliefs and preferences other than those declared relevant to serving the purpose of the organization; everything ‘personal’, that is not determined by the statute books of the company, needed to be left in the cloakroom at the entry to the building, so to speak, and collected back after the completion of ‘office time’. Today, when the centre of gravity, burden of proof and responsibility for the result has been dropped by managers, as team leaders and unit commanders, on to the shoulders of individual performers, or ‘contracted out’, ‘outsourced’ or ‘hived off’ laterally and judged according to a seller–buyer pattern rather than a boss–subordinate relationship, the aim is to harness the totality of the subaltern personality and their whole waking time to the company’s purposes.” (Loc. 798)

And so, we all become our own watchers:

“Servitude, along with surveillance of performance twenty-four hours a day and seven days a week, is becoming fully and truly a DIY job for the subordinates. The construction, running and servicing of panopticons have been turned from a liability into an asset for the bosses, written into the small print of every contract of employment.

(…)

Just as snails carry their homes, so the employees of the brave new liquid modern world must grow and carry their personal panopticons on their own bodies. Employees and every other variety of the subordinated have been charged with full and unconditional responsibility for keeping them in good repair and assuring their uninterrupted operation (leaving your mobile or iPhone at home when you go for a stroll, and thereby suspending the state of being constantly at a superior’s beck and call, is a case of serious misdemeanour).

(…)

Tempted by the allure of consumer markets and frightened by the new freedom of the bosses to vanish, together with the jobs on offer, subordinates are so groomed to the role of self-watchers as to render redundant the watchtowers in the Bentham/ Foucault scheme.” (Loc. 817)

And so, in the Global North, we carry our own personal Panopticons, and in the Global South, the semi-periphery, factory workers get locked up in unsafe plants to make goods for our consumption, under the brutal watch of old-fashioned floor foremen (think Foxconn or the dead workers in Bangladesh). The Panopticon also applies to the marginalized mass of Manuel Castells’s Fourth World, wherever they are in the world (as welfare recipients have to agree to subject themselves to degrading forms of surveillance through testing if they wish to receive ever more meager benefits).

Here, Lyon borrows an interesting concept from Didier Bigo: “ban-opticon“:

“Bigo proposes ‘ban-opticon’ to indicate how profiling technologies are used to determine who is placed under specific surveillance. But it emerges from a full theoretical analysis of how a new ‘globalized (in)security’ emerges from the increasingly concerted activities of international ‘managers of unease’ such as police, border officials and airline companies. Transnational bureaucracies of surveillance and control, both businesses and politicians, now work at a distance to monitor and control population movement, through surveillance.

(…)

The outcome is not a global panopticon but a ‘ban-opticon’ – combining Jean-Luc Nancy’s idea of the ‘ban’ as developed by Agamben, with Foucault’s ‘opticon’. Its dispositif shows who is welcome or not, creating categories of people excluded not just from a given nation-state but from a rather amorphous and not unified cluster of global powers. And it operates virtually, using networked databases to channel flows of data.” (Loc. 836)

This is a very important point:

“The strategic function of the ban-opticon diagram is to profile a minority as ‘unwelcome’. Its three features are exceptional power within liberal societies (states of emergency that become routine), profiling (excluding some groups, categories of proactively excluded people, because of their potential future behaviour) and the normalizing of non-excluded groups (to a belief in the free movement of goods, capital, information and persons). The ban-opticon operates in globalized spaces beyond the nation-state, so the effects of power and resistance are no longer felt merely between state and society.” (Loc. 846)

Emphases mine. I cannot emphasize enough how important this is. The point of all surveillance (state or commercial) is as much to exclude as to include, and both flow from the same processes. But in some cases, we have created some in-between spaces: the refugee camps, the detention centers for immigrants and asylum seekers, where people are warehoused until a given entity, state or otherwise, makes a decision on inclusion v. exclusion. Snowden is in some such space right now, as countries decide whether to grant him political asylum or not.

In addition to the ban-opticon, Bauman and Lyon borrow another related concept, synopticon:

“Thomas Mathiesen’s neat neologism that contrasts the panopticon’s ‘few watching the many’ with today’s mass media, where as he puts it, ‘the many watch the few’.” (Loc. 936)

How many of you watch The Kardashians? Real Housewives of Wherever? The synoptic is not a contradiction to the panoptic. They work together. Or, as I mentioned above, the 100k+ people “watching” the Texas legislature via Twitter or streaming media.

But in the end, panopticon, synopticon, or ban-opticon all work through databases. And by definition, these databases dehumanize and depersonify (if that is a word), but they do categorize at distance, in absentia.

“Every and any kind and instance of surveillance serves the same purpose: spotting the targets, location of targets and/or focusing on targets.

(…)

Instruments of surveillance installed at the entrances of shops or gated communities are not equipped with an ‘executive arm’ designed to annihilate the spotted and pinpointed targets – but their purpose, all the same, is the targets’ incapacitation and removal ‘beyond bounds’. The same might be said of the surveillance used to pick out the credit-unworthy from among aspiring clients, or of the surveillance tools used to set apart the penniless loiterers from the promising clients among the crowds flooding the shopping malls. Neither of those two varieties of contemporary surveillance has the purpose of causing physical death; and yet what they are after is a sort of death (the death of everything that matters). It is not a corporeal demise, and moreover not finite but (in principle) revocable: it is a social death, leaving open, so to speak, the chance of a social resurrection (rehabilitation, a restoration to rights). Social exclusion, the raison d’être of the ban-opticon, is in its essence analogous to a verdict of social death.” (Loc. 1233)

Which gets us back full circle to adiaphorization, which is a central concept to all this.

While exploring that concept, Bauman takes the opportunity to debunk the trope that technologies are neutral while their uses are not (the high tech version of “guns don’t kill people. People kill people.” All technologies are produced out of socio-political-economic arrangements that are by no means neutral within specific social institutions, marked by social relations of power. Nothing neutral about any of that.

I confess to losing interest towards the end of the book, when Lyon gets all religious-y about all this.

But apart from that, I think this is a very relevant book. As I mentioned above, it helps if readers are already familiar with both sociologists. But they tend to avoid too much jargon (except for the few, highly important, concepts I noted throughout the post).

As I noted above, I have a few disagreements here and there and I do think they are both very pessimistic about future prospects. But otherwise, this book should be read discussed not just in academia but in activist circles as well, especially those groups concerned with surveillance.