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Society
128
Health Promotion,
Governmentality and
the Challenges of
Theorizing Pleasure
and Desire
Kaspar Villadsen
Copenhagen Business School
Abstract
The relationship between pleasure and asceticism has been at the core of debates
on western subjectivity at least since Nietzsche. Addressing this theme, this article
explores the emergence of non-authoritarian health campaigns, which do not
propagate abstention from harmful substances but intend to foster a well-balanced
subject straddling pleasure and asceticism. The article seeks to develop the Foucauldian analytical framework by foregrounding a strategy of subjectivation that
integrates desire, pleasure and enjoyment into health promotion. The point of
departure is the overwhelming emphasis in the governmentality literature on
prudence, self-responsibility or risk calculation, such that pleasure and desire
remain largely absent from the framework. Some insights from Zizeks work are
introduced to help us obtain a firmer grasp on the problematic of the wellbalanced subject. The article argues that, in order to analyse the transformation
of interpellation in recent health promotion, we must recognize the mechanism of
self-distance or dis-identification as an integral part of the procedure of
subjectification.
Keywords
asceticism, Foucault, governmentality, health promotion, pleasure, subjectification,
Zizek
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acknowledge that you as a subject are already well aware of what you
want and what is best for you.
That apparently trivial examples can serve in analysing and estranging a theory is well explained by Pfaller (2007: 44): The commercial is not just there in order to be analysed by elaborated theoretical
means; on the contrary, it may very well be used to analyse a given
theory, as its object. By this move, the example shifts status from
being the object we look at and becomes the lens through which
we look at something else. The ambiguity manifest in the example
places the exemplified (for instance a concept) in a new light that
undermines its self-evidence and unambiguousness. Using examples
in this way makes the question of the variety of their specific qualities less urgent, since the main concern is to articulate the example so
that it radically sharpens our view of something else (Pfaller, 2007:
45; see also McGowan, 2014: 69).
The thesis of this article is threefold. First, as exemplified above,
we suggest that something new is happening in the field of health
promotion; a new form of interpellation is emerging which involves
an element of self-distance, and a new subject-figure, a subject balancing between abstention and pleasure. We substantiate this suggestion through a survey of critical research on health promotion
in the first part of the article. The focus of this discussion becomes
more specific when we situate our thesis in relation to existing studies of subjectivation in medicine and health promotion that draw
upon Foucaults concept of governmentality. On this basis we
argue, and this is the second part of our thesis, that although these
studies have offered many critical insights, the new subject of
health promotion calls for a sharper focus on issues of desire and
pleasure. This includes the connection between libidinal investments and subjectivation, which remains underdeveloped in governmentality studies (Butler, 1999; Dean, 2012).2 Arguing this
point involves a critical examination of the status of the subjectfigure in Foucauldian studies of health promotion, which leads us
to introduce some insights in Zizeks work that allow us to get a firmer grip on the problematic of the well-balanced subject. The third
part of our thesis is that to analyse the transformation of interpellation in recent health promotion, we need to take into account the
idea of self-distance or dis-identification as an integral part of the
procedure of subjectification. This last step in our argument will
draw inspiration from Zizeks reformulation of the analysis of ideological interpellation.
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factors into account by modifying appeals with regard to such factors. An example are appeals addressed to young men, who are
assumed to carry a particular masculine culture characterized by
disregard for their own health, and risk-taking or outright healthdamaging behaviour (Petersen and Lupton, 2002: 25). Nonauthoritarian health recognizes the need to negotiate or reconcile
itself, at least partially, with cultures of risk-taking or selfdestructive masculinity. Similarly, campaigns may be designed from
the premise that cautioning against the imminent danger of harmful
substances might have adverse effects on consumers for whom precisely risk holds a certain attraction (Bunton and Burrows, 1995:
213). In such cases the rational, authorized goals of health promotion must be balanced with the irrational values and dispositions of
the target group. It is not a matter of eradicating cultures and identities detrimental to health, but rather of keeping their effects within
acceptable levels. Hence, recent diversified health promotion seeks
to contextualize goals and prevention techniques in terms of the
situations within which people entertain practices of consumption
and pleasure.
Strategies of harm reduction and risk reduction emerged in the
mid-1980s, but have roots in the 1960s and 1970s critiques of legal
persecution of drug users as voiced by activists and professionals.
Eventually, harm reduction became less a platform for broader social
change and more a medical strategy for mitigating the harm inflicted
upon individual substance users (Roe, 2005: 243). It has gained
acceptance across areas like alcohol treatment, psychotherapy, sexual education and gambling. As a general approach to health promotion, harm reduction displays a series of characteristics pertinent to
our present discussion: It takes a non-moralized approach which
replaces pathologization with a pragmatic calculus of individual
costs and social consequences. It refuses to make addiction and
abstinence the primary target of harm reduction, or to accept that
public care is conditional on abstinence (Race, 2008: 418). Finally,
pleasure and taste are accepted as key factors in harm reduction, insofar as the conventional psychological and sociological aetiology of
causation is supplanted by the assumption that the relevant motivations are principally generated as a socially acquired taste.
In harm reduction, pleasure is not the antithesis of self-regulation
and safety, but rather a potential medium through which certain
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shared protocols of safety may be practised (Race, 2008). The pragmatics of harm reduction seem to resonate in the design of nonauthoritarian health campaigning. The assumption seems to be that
the subject targeted by campaigning is fundamentally split between
two dispositions: on the one hand, it is amenable to appeals for prudent and rational health behaviour, and, on the other hand, there is
desire and pleasure, an irrational side resistant to such appeals. Here,
the objective of health promotion is not a conversion of the individual into a fanatically committed disciple of healthiness, but rather the
fostering of a well-balanced subject.
Our argument is not that this subject-figure is pervading the entire
domain of health provision and health campaigning. The Danish policy context is, like that of other countries, still marked by disagreements between different convictions with regard to the use of
harmful substances, including the ongoing and often bitter tensions
between harm reduction and demands for abstinence. The campaign
films presented above should be viewed as part of a multi-pronged
strategy of health promotion which encompasses conventional medical treatment, long-standing legal measures and economic incentives. Although the campaign ads are certainly not hegemonic,
they are highly interesting, we contend, in the fundamental ways that
they depart from previous health promotion centred on warnings,
self-control and rationality.
The Rational Health Subject of Governmentality Studies
The governmentality literature that has focused on health issues has
paid much attention to strategies for inculcating prudence, selfresponsibility or risk calculation. Early scholars of critical health
invoked Foucault mainly in order to emphasize rational regulation
of populations and to critically interrogate the dominance of modern
medicine. Particularly, but not exclusively, early followers of Foucault described health services as part of a social strategy to make
individuals conform to entrenched morals of modern medicine. For
instance, Bryan Turner introduced governmentality as a perspective
on medicine by defining it as a regime which links self-subjection
with societal regulation (Turner, 1997: xv). Petersen and Lupton
similarly invoked Foucault to assert that medical institutions were
part of an expanding apparatus of control, discipline and regulation
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answers to the question of how the subject can be viewed as other than
a product of textual, material, institutional and historical factors
(Blackman et al., 2008: 8; see also Butler, 1997; Hook, 2007).
Common to these contributions is that they seek to theorize the
conditions under which subjectivity is possible. We do not oppose
such a theoretical project, but have a different emphasis here. Our
objective is smaller in scale and guided by the diagnostic concern for
better understanding a novel form of health campaign that foregrounds mechanisms of identification/dis-identification rather than
internalization. The psychoanalytical vocabulary becomes pertinent
to a health promotion which addresses its target audience as subjects
who dis-identify and never are at one with discursive positions.
The Well-balanced Subject between Asceticism
and Hedonism
Zizek presents at various places a narrative of a recent mutation in the
structure of subjectivity in western capitalist societies (from Oedipal
to post-Oedipal, from hysteric to perverse), which he sees as closely
connected to a general postmodern decline of paternal authority and a
related scepticism towards symbolic mandates in these permissive
societies. Interestingly, Zizek (1999b) thematizes this mutation
through the well-known Nietzschean figure of the Last Man, a
post-metaphysical subject that enters the historical scene after the
death of God. According to Nietzsche (1999), the Last Man lives
without any illusions of a beyond, without transcendent, absolute
or eternal values, but also without any desires to transcend himself.
Emblematic of western passive nihilism, the Last Man is no longer
marked by a tension between what he is and what he might become;
he is wholly satisfied by continuing to be what he is. The Last Man is
the subject that corresponds to what Zizek (2001: 10) terms our postideological era, or the end of history, echoing the title of Francis
Fukuyamas influential book, an era in which the liberal, capitalist
consumer society has been entirely naturalized, and radical political projects are immediately deemed morally suspect or potentially
totalitarian.
Nietzsches figure of the Last Man is invoked by Zizek in a manner that relates explicitly to our problematic. Zizek connects the Last
Man to contemporary concerns about health care and politics. Given
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that the Last Man is not willing to take any real chances, seeking
merely comfort, small pleasures and security, he is, on Zizeks
account, a figure who prefers politics without politics, revolutions
without revolution, love without commitment, but also on a smaller
scale beer without alcohol, chocolate without fat and (electrical)
cigarettes without tobacco. In short, he wants enjoyment without
paying the price for it. However, this permissive attitude of the Last
Man is paradoxically accompanied by an endless number of prohibitions to secure a comfortable life for oneself and ones neighbours
(Zizek, 2000a: 173). This is also why the real consequence of the
death of God is not that everything is permitted as allegedly
claimed by Dostoevsky, but that everything is prohibited as suggested by Lacan: God is dead, says Zizek, and we live in a permissive universe, you should strive for pleasures and happiness but, in
order to have a life full of happiness and pleasures, you should avoid
dangerous excesses, so everything is prohibited if it is not deprived of
its substance (Zizek, 2003: 96).
Accordingly, Zizek (2003: 957, 2008b: 76) describes the survivalist behaviour of the Last Man as hedonistic asceticism, precisely
because it combines pleasure and constraint in a reactionary equilibrium the only goal of which is not to die, or to die as comfortably
as possible. This hedonistic asceticism of the Last Man, combining
pleasure and constraint, can be further elucidated by invoking a
Lacanian understanding of the superego which espouses an obscene,
permanent imperative to enjoy: The concept of the superego designates precisely the interzone in which these two opposites overlap: in
which the command to enjoy doing your duty overlaps with the duty
to enjoy yourself (Zizek, 2000a: 135, emphasis in original). The Last
Man is thus a subject not only characterized by having to enjoy doing
his duty, but also by having the duty to enjoy. Thus, the allusion to
the figure of the Last Man conveys to our discussion not just the
theme of nihilism but, more importantly, the issue of the possible
inseparability of enjoyment and obligation, pleasure and prevention.
Zizek (2003: 95) connects the subject-figure of the Last Man to the
notion of biopolitics. Biopolitics, argues Zizek (2008b: 34), is precisely post-ideological insofar as biopolitics designates the regulation of the security and welfare of human lives as its primary goal
(Zizek, 2008b: 34). Hence, it must abandon the biologically risky and
costly ideological struggles inherent to passionate political projects.
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Foucault and Zizek offer compatible observations regarding the permissive and balance-seeking rationality of the health campaigns, and
the form of subjectivation involved.
It should be noted, however, that Zizek would undoubtedly insert
the postmodern, culturist-consumerist traits in the campaign films
within a more explicit and encompassing critique of globalized capitalism than Foucaults localized, analytical critique permits. In fact,
Zizek often argues that post-structuralists, including Foucauldians,
adhere to a politics of difference that has become too timely in its privileging of multiplicity, differentiation and creative self-formation.
Instead of unveiling the antagonisms of contemporary capitalism,
they produce a form of knowledge that constitutes no fundamental
challenge but is in fact productive within a system which itself operates through differences and multiplicities. If we accept Zizeks critical diagnosis of the compatibility between contemporary capitalism
and the post-structuralist politics of difference, we are afforded an
additional argument for why we need to develop the conventional
concept of subjectification.
Conclusion
The article started from the observation that the subject in recent
health campaigns is increasingly characterized by a newly discovered pragmatism, irony, self-subversion, inversion of traditional
authority, anticipation of viewers dissociation and noncompliance, and attempts at alignment with the cultural identifiers
of the target groups. We then discussed to which extent the framework developed by governmentality analytics can make intelligible
this new subject-figure.
The key project of governmentality analysis has been to interrogate technologies and concepts that align what is presumed to be
healthy at the level of the individual, desirable at the social level, and
normal at the statistical level (Rose, 1988: 196). Responsibilization,
psychosomatic knowledge, risk calculation and lifestyle choices
are among such registers at the intersection of population regulation
and the disciplining of the body. However, recent non-authoritarian
health campaigns complicate the conceptual framework of governmentality analysis in terms of its rendering of health, risk, responsibility, subjectivation and healthy balance. The emerging campaigns
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all we ever do is (or should be) concerned with leading a healthy life;
indeed such a lifestyle might in fact be quite unhealthy.
Perhaps, this intertwining of pleasures and vital functions is not
something completely new but rather a readjustment of the deeprooted tension in western culture between the technical, biological
and psychological body and the political body (Agamben, 1998).
This readjustment directly impacts on what is understood by prudent
lifestyle choices and, more specifically, the formation of the categories through which risk and safety become intelligible, and according to which groups and individuals are deemed compliant or
noncompliant. Undertaking analytical reconstruction will hopefully open up further interrogation into how libidinal investments are
intertwined with the exercise of power and, specifically, with strategies of subjectivation. This article has merely begun expanding our
analytical possibilities in the light of the present context and its hopes
for pleasures within the limits of reason.
Notes
1. However, as part of what has been termed the affective turn there
seems to be an incipient interest in these issues in governmentality studies as well (Bjerg and Stauns, 2011; DAoust, 2014; Lupton, 2013).
2. Throughout this article we use concepts such as desire, pleasure
and enjoyment. We are aware of the multiple and diverse meanings
of these heavily loaded concepts, and of the important theoretical discussions concerning these concepts in the literature that we draw on
Foucault studies as well as psychoanalysis. However, it is beyond the
scope of this article to engage in these discussions. In the following we
use the terms desire and pleasure in a broad, or common, sense,
not confined to either a specific Foucauldian or psychoanalytical
definition.
3. In several of his books Zizek refers to this idea of a crisis of symbolic
investiture which he derives from Eric L. Santners reading of Schrebers Memoirs in his book My Own Private Germany: Daniel Paul
Schrebers Secret History of Modernity. According to Santner (1996:
xixii, 2011: xii), a general crisis of investiture exemplified in Schreber
occurs in the late 19th century in terms of the failure of subjects to
assume and perform the mandate of symbolic authority that they are
given. In Schrebers case, this crisis occurred when he, as Zizek
(1997: 73) puts it:
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4. Agamben and Sinnerbrink argue, like Dean, that pleasure was largely
overlooked by Foucault as a factor functional to biopolitics (Agamben,
1998: 187; Sinnerbrink, 2005: 249). Similarly, to our knowledge, the
potential for examining instances of biopolitics which explicitly invoke
pleasure and desire remains underdeveloped in the vast literature on biopolitics, medicine and health promotion.
5. It should be mentioned that Foucault viewed pleasure as a possible mode
of de-subjectivation (rather than merely subjection), and hence as harbouring a potential for resistance against the biopolitical regime of
sex-desire (Foucault, 1990: 157). This idea has subsequently come to
play an important role in feminist theory and queer studies (Butler,
1999; Grosz, 2013; McNay, 1992; McWhorter, 1999). The notion of
pleasure as developed by Foucault might serve as a fruitful starting point
for a dialogue with Zizeks psychoanalytical position, while a reconciliation of the two approaches would still involve serious challenges (see
Dean, 2012).
6. We do not imply that Foucault offers no resources for addressing questions of desire, excess, risk, or the balance between hedonism and pleasure. In History of Sexuality, vols 2 and 3, Foucault excavates principles
for the regulation of self and others which are not prohibition centred but
rather seek for a balanced cultivation and use of pleasures. Similarly,
Foucaults (2000) comments on transgression and limit experiences,
through which the subject escapes himself, hold potential for discussing
the subject of present health campaigns.
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Kaspar Villadsen is Professor at the Department of Management, Politics
and Philosophy, Copenhagen Business School. He is the author of the
books Power and Welfare: Citizens Encounters with State Welfare (coauthored with Nanna Mik-Meyer, Routledge, 2013) and Statephobia and
Civil Society: The Political Legacy of Michel Foucault (co-authored with
Mitchell Dean, Stanford University Press, forthcoming). He has published
on Foucault, organizations, biopolitics and welfare policy in Economy and
Society, Theory, Culture & Society, Organization, Constellations, Social
Theory and Health and more. His current research is on governmental technologies, health promotion, and the problem of state and civil society.
Mads Peter Karlsen is Assistant Professor at the Department of Management, Politics and Philosophy, Copenhagen Business School. He did his
PhD thesis on Alain Badiou and Slavoj Zizek. He is the author of the book
Pastoralmagt: Om velfrdssamfundets kristne arv (2008) and the editor
(with Lars Sandbeck) of the books Religionskritik efter Guds dd (2009)
and Kristendom og engagement: Peter Kemps teologi til debat (2014).
He has published on Foucault, Badiou and Zizek in New Political Science,
Journal for Critical Research on Religion and the International Journal of
Zizek Studies. His current research is on the interrelationship between theology and psychoanalysis.
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