A Faustian Pact – transforming patient subjectivities

 

With thanks to, and  inspired by, a seminar on ‘Metamorphoses of the Brain’ by Jan de Vos, and on ‘Religion and Psychoanalysis in India’ by Sabah Siddiqui hosted by Ian Parker and Erica Burman of the Manchester Discourse Unit on the 16th May 2016. This is about the production of ‘faith’ as a surplus value that, after Marx,  requires both circulation, and not-in circulation, time

So, the inspirations were to do with ‘the brain’ as ‘thinking matter’ interacting with ‘test results’ as manifestations of spirit-ghost-signifiers in the form of ‘extended matter’ (in diachronic production-linear time), transforming subjectivities in the shrine of the medical market place (in synchronic circulation time) to create a trance-like state of enhanced faith and a transformed subjectivity.

This is a Marxist economic analysis of the patient and the pro-diagnostic test. For those not familiar, a pro-diagnostic test is one like Oncotype DX, a genetic signature that ‘tells’ you how likely it is that your breast cancer will recur so that you can make better decisions about whether to have further chemotherapy. In general terms this analysis applies to all medical and predictive and screening tests.

This analysis describes a sequence of Medical transformations of patient subjectivities: from ‘potential patient’ to ‘patient’ to ‘compliant patient’ to ‘treated patient’. You might see parallels with Foucault’s process of subjectification or subjectivisation.

I did wonder, in my last blog, if the ‘number’ of the ‘risk’ provided by pro-diagnostic tests: (x% chance of event ‘y’ in ‘z’ time) was a form of labour-power (see previous blog[1]) . I now see it more as a combined ‘number-patient’ labour-power, where the number is a material ‘given’, a written or spoken object with use-value as a kind of raw material that interacts with the thinking matter of the ‘patient’ to create anxious-hope, an enhanced need for reassurance and an enhanced faith that the result will mean ‘longer’ healthy life, and, therefore, enhanced compliance. So, here, the ‘number-patient’ acts as labour and works to produce something of use-value to the medical industry: the labour-power of ‘a compliant patient-customer’ willing to pay to be provided with and subject to, with the help of the physician-merchant middle man, medical ‘treatment’.

Lets take the person whose early breast cancer has been treated. The putative asymptomatic customer/patient is ‘offered’ the opportunity to enhance their life chances. Tempting that must be. In a Faustian pact the patient sells his soul and signs his name in blood – hands over his genome to the devil. He/she has entered a world of perpetual indentured debt – life from now on will absolutely depend upon perpetual and repetitive self-objectivisation, handing over of bodily knowledges, and consumption of medical technology.

Here the patient willingly offers his/her labour-power and provides the raw material for the product (‘risk’), that he/she will use, later, to labour on, to transform him/herself into a profitable customer. The patient pays for this product (the test result ‘risk’), that industry ‘makes’ in the lab, (with the lab’s labour-power generating the first phase of surplus economic value for industry).

When the patient receives the result, he/she subsequently labours on the ‘risk’ and this completes the production process and generates the commodity of use-value to industry: ‘the compliant patient’, willing to pay for him/herself to be provided with, and subject to, the treatment ‘ordered’ by the ‘risk’ in the test result. The patient objectifies him/herself as a commodity object, and is then subjugated by industry and turned into a ‘treated patient’ subjectivity.

Put slightly differently, the test result is the product of labour carried out on the genome, already provided by the patient, as bodily raw material. It was at that point that the patient tacitly agreed to receiving a result, (and to ‘labour’ on the result), and to comply with its outcome. This is the meeting of the capitalist with the labourer free to sell his labour in the market place – the slight extension here is that the labourer first provides some bodily ‘knowledge’ that will be transformed into ‘risk’, ‘risk’ that will then be given back to the ‘patient’, to labour on, and to transform him/herself into an anxiously-hopeful ‘compliant patient’ and customer/consumer, able to generate more surplus economic value for industry by becoming a ‘treated patient’.

The fatal flaw in all this is the mythology and superstitious belief in the power of the test. The scenario above is the acting out of a kind of worship in the temple of the consultation, using the body in a sacrifice that has been sanctioned already by the quasi-religious authorities. The other interesting question therefore is how the religious authorities decide which sacrifices to authorize. For our purposes this is asking the National institute for Clinical Excellence how it decides to authorize tests like Oncotype-DX to be an official ‘spirit’. It has already been clearly shown that tests like Oncotype DX are under-regulated, over–valued in terms of their clinical utility, over valued economically, and unaffordable for publicly funded healthcare systems.

 

[1] https://myownprivatemedicine.com

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