health promotion,governmentality and the challenges of theorizing pleasure and desire

8/15/2019 Health Promotion,Governmentality and the Challenges of Theorizing Pleasure and Desire

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Consider three examples of recent campaigns for prudent health behaviour. In a short film produced by the Danish Psychiatry Foun-dation, a mental health advocacy group, we are shown a lively partyscene in which young people are dancing and making out to thesound of trendy rock music with the subversive, and in this context,ambiguous lyrics (‘we don’t need ropes to climb the walls you build’). On a sofa, two teenagers are trying to sniff cocaine. A hip-looking young man with a hat and fashionable beard suddenly inter-rupts, ‘Hey ! What the hell are you doing? !’ There is a tense momentwhere one awaits the much anticipated warning to not use drugs. Thesuspense is cancelled when the young man walks over to the noviceusers and says ‘You’re doing it all wrong !’ He then quickly mixes thedrug correctly and passes it to the astonished teenagers: ‘Here yougo!’ The short film is followed by the message: ‘Be sure about drugsand their effects. Check out our homepage’ (Danish Psychiatry Foun-dation, 2013). The film is in every detail similar to commercials for beer, alcohol, music or clothes that target youth culture. It was pro-duced by the advertising agency AdPeople and released in 2013.

Another short campaign film bears the title Remember the Seat-belt, Goose! A girl who appears to be about ten years of age gets intoa car and sits on the front seat next to her mother. The mother asks,‘Did you have a nice day, sweetheart?’ The daughter looks disap- provingly at her mother and says with a deep sigh, as if it were arecurring incident: ‘You’ve been driving without the seatbelt !’ After admitting this fact, the mother asserts: ‘This is something that I decide. I find the seatbelt annoying. Apart from that, I’m an ‘‘elitedriver’’, twenty years with no accidents.’ Rolling her eyes, thedaughter shouts out: ‘I’m not going to drive you around in somefucking wheelchair !’ The mother ridicules her daughter by makingthe sound of a duck: ‘Quack, quack, quack !’ She then starts the car while the daughter turns her eyes to the roof in despair. The clip isfollowed by the text: ‘There was only one silly goose in this film.’The film was produced by the Danish Council for Greater TrafficSafety (2007a). In another film, issued in the same campaign for seat-

belt use, a handicapped young man has a similar conversation withhis self-confident driver, who refuses to wear his seatbelt for just ashort ride. That film is followed by the message ‘There was only onefool in the car’ (Danish Council for Greater Traffic Safety, 2007b).

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A campaign film produced by the Danish Cancer Society follows arelated model: an ordinary-looking young man dressed in jeans and ared sweatshirt with a hood walks down a street on a grey autumn dayand enters a solarium. In the background, rap music by the humoristicDanish rap group KNA Connected can be heard. Behind the desk wesee a young, good-looking, if somewhat tawdry, blonde woman. ‘Hi,I would like some skin cancer’, the young man says with a smile.‘That’ll be 20 kroner’ (approx. US$3), the attendant replies in anindifferent tone of voice. ‘Nice !’ says the young man. ‘If you payan extra 15 kroner, you get melanoma cancer included’, the attendantinforms him. ‘That’s cool !’, the young man exclaims, putting themoney on the desk. ‘Cabin four is free’, the attendant says, while themusic gets louder and the lyrics say ‘I’m brown, I’m delicious. Solong until I die; let it burn now; let it burn now.’ The short film endswith the voice-over: ‘Turn off the solarium; it can cost you your life.’It was produced on the basis of a competition for campaign filmsagainst skin cancer and used in a nation-wide campaign in 2008sponsored by the Danish Cancer Society and the philanthropicallyengaged Tryg Foundation.

Compared to more conventional health campaigns, these threefilms are noteworthy for several reasons. First, they exhibit a totallack of any objective data, legal regulations or statistical predictions. Nor do we encounter any medical or legal authorities warning usabout our behaviour. The films seem to recognize the limits of bio-medical approaches to addiction and instead show how drinking and the use of drugs are socially and culturally shaped. Second, in con-trast to conventional public service advertising, with their typicalwarnings and prohibitive edicts, the campaigns display ‘postmodern’stylistic traits such as relativism, irony, surrealism, auto-referentialityand the creative mixing of genres. It seems that conventional (medical)authority can only be positively expressed insofar as it is immediatelyundermined through irony, ridicule, surrealism, etc. Third, there is aninversion of authority in the films: the conventionally subordinated subjects (the drug user, the child, the handicapped person) here act as

‘truth tellers’ and informed instructors. Fourth, a barefaced pragma-tism is evident, especially in the first film, where the goal is not tocompel the target audience to abstain from using illicit drugs butto encourage them to use them in a more informed way. ‘Sensible’consumption seems to replace prohibition and abstention.

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The campaign films, we contend, are hardly arbitrary incidencescompletely unique to the Danish context, since ironic and humoroushealth campaigning can be found in other countries as well. Never-theless, Danish public campaigns are probably particularly receptiveto the use of anti-authoritarian genres such as irony, relativism, and sur-realism, due to a culture in which scepticism towards conventionalauthorities is pronounced, not least due to the lasting impact of the1968 youth revolt. The Danish context is the home of anti-hierarchicallearning and management methods like ‘roundtable pedagogy’ and ‘dia-logue-based’ management (Karlsen and Villadsen, 2008).

Notably, these health campaigns implicitly show respect for thetargeted subject as a subject with certain desires – for pleasure, for personal freedom, for beauty – even though such desires do notalways accord with official norms for good health. It is indirectlycommunicated in these campaigns that the authorities propagatingthem are attentive to the fact that the addressee of the message is her-self aware of this discrepancy between the official norm and theactual message. Hence, as in other contemporary health campaigns,the aim is not to impose an absolute prohibition in a paternalist way,nor to enlighten a supposedly ignorant audience, but to encourage amoderated or controlled consumption of harmful substances. This iscombined with the goal of fostering a more reflexive attitude in rela-tion to health-risk behaviours, encouraging a balancing of these risksagainst the pleasures, meaningfulness or beauty that they afford.Thus, a ‘desirable health promotion’ must take as its starting pointthe acknowledgement not only of our personal freedom and informed state of mind, but also our conflicting desires.

This is reflected in the form of ‘hailing’ in operation in these healthcampaigns, which has undergone a noteworthy transformation. Incontrast to hailing in its traditional form, analysed by Louis Althusser (1971) in his classical text on ideological interpellation, the mechan-ism of hailing or interpellation characterizing the three examplesabove leaves open a space for critical distance for the targeted subject(Karlsen and Villadsen, 2015). This form of interpellation not only

anticipates but actually utilizes the potential resistance of the subject.The indirect message in all three of these examples seems to be:

Although we [the health authorities] are telling you [the citizen] whatserves your health the best, we do it in a way in which we fully

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That apparently trivial examples can serve in analysing and ‘estran-ging’ a theory is well explained by Pfaller (2007: 44): ‘The commer-cial is not just there in order to be analysed by elaborated theoreticalmeans; on the contrary, it may very well be used to analyse a giventheory, as its object.’ By this move, the example shifts status from being the object we look at and becomes the lens through whichwe look at something else. The ambiguity manifest in the example places the exemplified (for instance a concept) in a new light thatundermines its self-evidence and unambiguousness. Using examplesin this way makes the question of the variety of their specific quali-ties less urgent, since the main concern is to articulate the example sothat 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 involvesan element of self-distance, and a new subject-figure, a subject bal-ancing between abstention and pleasure. We substantiate this sug-gestion through a survey of critical research on health promotionin the first part of the article. The focus of this discussion becomesmore specific when we situate our thesis in relation to existing stud-ies of subjectivation in medicine and health promotion that drawupon Foucault’s concept of governmentality. On this basis weargue, and this is the second part of our thesis, that although thesestudies 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 invest-ments and subjectivation, which remains underdeveloped in gov-ernmentality studies (Butler, 1999; Dean, 2012). 2 Arguing this point involves a critical examination of the status of the subject-figure in Foucauldian studies of health promotion, which leads usto introduce some insights in Zˇ ižek’s work that allow us to get a fir-mer grip on the problematic of the well-balanced subject. The third part of our thesis is that to analyse the transformation of interpella-

tion in recent health promotion, we need to take into account theidea of self-distance or dis-identification as an integral part of the procedure of subjectification. This last step in our argument willdraw inspiration from Zˇ ižek’s reformulation of the analysis of ideo-logical interpellation.

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Non-authoritarian Health PromotionThe campaign films described illustrate the recent emergence of anovel ‘genre’ in health promotion, which replaces prohibition, cau-tioning and moralistic appeals with humour, irony and an explicitlynon-authoritarian attitude. This is particularly noticeable in campaigns for alcohol awareness, traffic safety and safer drug use. Theemergence of non-authoritarian campaigns can be situated in thecontext of a broader transformation within health provision desig-nated ‘the new public health’ (Petersen and Lupton, 2002) or ‘latemodern medicine’ (Bunton and Burrows, 1995). These terms encap-

sulate a number of broad changes, including the prominence of asocial concept of health that extends beyond the purely medical or microbiological view; the use of interdisciplinary and ‘decentred’activities moving beyond hospital-centred medicine; the emphasison risks and the environment of illnesses, including people’s every-day life; the idea of health as achieved through calculation of con-sumption choices as inputs to a healthy lifestyle; the view of the patient as active and self-responsible; the differentiation of health

provision with regard to communities, groups and subcultures; and the proliferation of harm- or risk-reduction approaches. This new public health regime is typically said to emerge from the early1970s across the western world (Greco, 2009: 14; Petersen and Lup-ton, 2002: 15).

Differentiation of health provision in relation to target groups has been indicated as a key characteristic of contemporary public health.Today, official health programmes often propagate health as an arena

of dialogue, and express the need to incorporate multiple voices intoinstitutions and campaigns (O’Brian, 1995: 192). This strategy reso-nates with social marketing, insofar as health campaigns take accountof factors such as age-group, social class, gender, ethnicity and con-sumption patterns. The injunction to diversification also reflects thecritical health literature, which contests the expert knowledge mono- poly and entrenched moralism of established medicine. This empha-sis on diversified cultures also implies an extension of health

calculations to encompass the multiple dimensions of everyday life,including habits, desires and pleasure – factors increasingly consid-ered essential for how individual lifestyles are shaped. In some cases,health promotion seeks to take cultural, ethnic, gender- or age-related





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factors into account by modifying appeals with regard to such fac-tors. An example are appeals addressed to young men, who areassumed to carry a particular masculine culture characterized bydisregard for their own health, and risk-taking or outright health-damaging behaviour (Petersen and Lupton, 2002: 25). Non-authoritarian health recognizes the need to negotiate or reconcileitself, at least partially, with cultures of risk-taking or self-destructive masculinity. Similarly, campaigns may be designed fromthe premise that cautioning against the imminent danger of harmfulsubstances might have adverse effects on consumers for whom pre-cisely risk holds a certain attraction (Bunton and Burrows, 1995:213). In such cases the ‘rational’, authorized goals of health promo-tion must be balanced with the ‘irrational’ values and dispositions of the target group. It is not a matter of eradicating cultures and identi-ties detrimental to health, but rather of keeping their effects withinacceptable levels. Hence, recent ‘diversified’ health promotion seeksto contextualize goals and prevention techniques in terms of thesituations within which people entertain practices of consumptionand pleasure.

Strategies of ‘harm reduction’ and ‘risk reduction’ emerged in themid-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 socialchange 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, sex-ual education and gambling. As a general approach to health promo-tion, harm reduction displays a series of characteristics pertinent toour present discussion: It takes a non-moralized approach whichreplaces pathologization with a pragmatic calculus of individualcosts 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, inso-

far as the conventional psychological and sociological aetiology of causation is supplanted by the assumption that the relevant motiva-tions are principally generated as a socially acquired taste.

In harm reduction, pleasure is not the antithesis of self-regulationand safety, but rather a potential medium through which certain

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shared protocols of safety may be practised (Race, 2008). The prag-matics of harm reduction seem to resonate in the design of non-authoritarian health campaigning. The assumption seems to be thatthe subject targeted by campaigning is fundamentally split betweentwo dispositions: on the one hand, it is amenable to appeals for pru-dent and rational health behaviour, and, on the other hand, there isdesire and pleasure, an irrational side resistant to such appeals. Here,the objective of health promotion is not a ‘conversion’ of the individ-ual into a fanatically committed disciple of healthiness, but rather thefostering of a well-balanced subject.

Our argument is not that this subject-figure is pervading the entiredomain of health provision and health campaigning. The Danish pol-icy context is, like that of other countries, still marked by disagree-ments 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 campaignfilms presented above should be viewed as part of a multi-pronged strategy of health promotion which encompasses conventional med-ical treatment, long-standing legal measures and economic incen-tives. Although the campaign ads are certainly not hegemonic,they are highly interesting, we contend, in the fundamental ways thatthey 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’, ‘self-responsibility’ or ‘risk calculation’. Early scholars of critical healthinvoked Foucault mainly in order to emphasize rational regulationof populations and to critically interrogate the dominance of modernmedicine. Particularly, but not exclusively, early followers of Fou-cault described health services as part of a social strategy to makeindividuals conform to entrenched morals of modern medicine. For

instance, Bryan Turner introduced governmentality as a perspectiveon medicine by defining it as ‘a regime which links self-subjectionwith societal regulation’ (Turner, 1997: xv). Petersen and Luptonsimilarly invoked Foucault to assert that medical institutions ‘were part of an expanding apparatus of control, discipline and regulation





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that involved micropolitical processes whereby individuals wereencouraged to conform to the morals of society’ (Petersen and Lup-ton, 2002: 14). Robert Castel’s (1991) influential study demonstrated that the increased availability of scientific risk calculation wasaccompanied by demands for risk-minimizing conduct by theaffected individuals. In Mitchell Dean’s (1999: 166–8) diagnosis of ‘the new prudentialism’ in contemporary welfare policy, groups thatmanifest high risk are targeted by technologies that aim to make themactive citizens capable of managing their own risk. Seminal work onthis theme was published by Marianna Valverde and Monica Greco.Valverde’s (1996, 1997) early work addressed the problems of alco-holism, free will and morality, while Greco (1993) focused on the psychosomatic subject and the modalities of knowledge defining it.

In discussing the liberal conception of the rational subject, Val-verde (1996) begins with the discourse on alcoholism and then sug-gests, more broadly, that liberal government often implies illiberalmodes of moral governance in its core. Valverde observes that withinliberal regimes, the division of subjects into different groups and dif-ferential treatment of these groups are often carried out with refer-ence to the elusive faculty of ‘rational willpower’ or the lack hereof. Coercive interventions into poor, youth, degenerate and indi-genous populations are justified by reference to a binary opposition between passion and reason, and the general idea of a rational willthat must dominate irrational impulses (Valverde, 1996: 362). Read-ing influential liberal philosophers, Valverde finds that they all work with some concept of ‘the reasonable man’, who is master of his pas-sions, desires and tendencies towards excesses. This figure is emble-matic for liberal thought, and in the case of Habermas’s ‘ideal speechsituations’, it turns out that free men can only undertake reasoned debate about values ‘once they have despotically suppressed their own desire for the not unconnected pleasures of rhetorical persuasionand erotic interchange’ (Valverde, 1996: 364). The key problem isnot lack of intellect but a defective will in the ‘unreasonable’ subjects. In Valverde’s analysis, the distinction between reasonable and

unreasonable individuals reflects an alleged internal division insidethe liberal subject:

The distinction between the self that controls and the (immature,lower) self that is controlled presupposed by the term ‘self-control’

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is in some ways a naturalized distinction between two things, between passion and reason, but could also be regarded as a spatial division between two psychic spaces. (Valverde, 1996: 369)

Monica Greco (1993, 2009) has offered a supplementary analysisto that of Valverde. Greco begins with the problem of how it has become possible to envisage health as a domain of ‘individual appro- priation through rational choice’ (Greco, 1993: 357). Her key obser-vation is that within contemporary strategies of health promotion,health is viewed as contingent upon the will of individuals (Greco,1993: 369). However, Greco arrives at this conclusion by focusing

on psychosomatic knowledge as having major significance in defin-ing health and illness.

In the prism of psychosomatics, the riskiness of a givenenvironment or social circumstance is not objectively given but isco-produced by the individual’s dispositions and the way he or sherelates to the environment: ‘The pathogenic value of a given environ-ment is only ever a function of an individual’s interpretation of it’(Greco, 1993: 360). Greco suggests that psychosomatics entails themoralistic idea that each individual can (and should) acquire a per-sonal preventive capacity that includes greater self-knowledge, bodilyawareness and self-regulation of lifestyle. A failure to exercise pru-dence constitutes irrationality, a kind of disease antecedent to symp-toms, manifested in particular behavioural, psychological and cognitive patterns (Greco, 1993: 361). ‘For the neoliberal individual’,Greco (2009: 19) asserts, ‘health has thus come to represent an objec-tive witness to his or her ability to function (and to be addressed) as afree, rational and moral agent’. Health becomes something ‘chosen’, asign of strength of rational will, underpinned by good moral attitudes.

Their differences aside, Valverde and Greco diagnose the emer-gence of a concept of health that is dependent upon the wilful choiceof persons rather than health as received by heritage, social condi-tions or the medical system. Across a broad range of medical and phi-losophical literature, they identify the idea of a conflict-ridden, splitsubject who should become the bearer of a single, rational willpower.Both Valverde and Greco offer valuable perspectives for renderingcontemporary health promotion intelligible. However, their analysishas certain limitations as a framework for analysing non-authoritarian health campaigns. First, they both observe that liberal





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governance conceptualizes illnesses as partly or entirely due to moraldefects, and that cure accordingly involves inculcating an ‘ethicaldespotism’ in the subject. The non-moralizing approach of currentanti-authoritarian health campaigns challenges these assumptions.These campaigns display no illusions of eradicating ‘corrupt moral-ity’ or ‘the savage within’. Rather, they seek only to negotiate ‘it’, toestablish a balance between desire and rationality. Second, rather than the inculcation of inner guilt as the driver for abandoningunhealthy behaviour, it is through exercising practices and acquiringnew tastes that a healthy lifestyle change will take place. Third,whereas Valverde’s and Greco’s analyses foreground ‘Victorian’values of rational control, suppression and asceticism, they ignore thefact that recent health campaigns express more hedonistic values of enjoyment, self-fulfilment and pleasure. Their emphasis on controland asceticism as solutions to health problems conflicts with the con-temporary identity projects which focus on leisure, experimentationand self-actualization (Bunton and Burrows, 1995: 208).

In the following sections, we turn to Z ˇ ižek in order to further elabo-rate the connections between libidinal investments and subjectivationand, in particular, the emergence of the new health subject balancing between hedonistic pleasure-seeking and rational abstinence. Follow-ing Žižek, this subject-figure can be linked to a general anti-authoritarian tendency, which involves a new form of subjectivation.We are, of course, not the first to draw on Lacanian concepts to sup- plement a Foucauldian framework and to challenge ideas of a subjectcharacterized first of all by rationality. The authors of the book Chang-ing the Subject (Henriques et al., 1984) seek to establish a framework that transgresses the dual model of society and the unitary subject.From Foucault they take the view that the subject is positioned indiverse discursive practices that are culturally and historically spe-cific. They combine this with Lacan’s theorization of subjectivity asnon-unitary and fundamentally contradictory. The result is, in brief,an approach to subjectivity as shaped by practices that ‘are alwaysalready locked in power-knowledge relations, and the production of

desire is inextricably intertwined in them’ (Henriques et al., 1984:226). The editorial group behind the journal Subjectivity pursues asimilar project insofar as they criticize Foucauldian approaches for viewing the subject as a mere epi-phenomenon of operations of power-knowledge. Here, psychoanalysis is also enlisted among the

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answers to the question of how the subject can be viewed as other thana 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 theconditions under which subjectivity is possible. We do not opposesuch 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 fore-grounds mechanisms of identification/dis-identification rather thaninternalization. The psychoanalytical vocabulary becomes pertinentto a health promotion which addresses its target audience as subjectswho dis-identify and never are at one with discursive positions.

The Well-balanced Subject between Asceticismand HedonismŽižek presents at various places a narrative of a recent mutation in thestructure of subjectivity in western capitalist societies (from Oedipalto post-Oedipal, from hysteric to perverse), which he sees as closelyconnected to a general postmodern decline of paternal authority and arelated scepticism towards symbolic mandates in these ‘permissive’societies. Interestingly, Zˇ ižek (1999b) thematizes this mutationthrough the well-known Nietzschean figure of the ‘Last Man’, a post-metaphysical subject that enters the historical scene after thedeath of God. According to Nietzsche (1999), the Last Man liveswithout 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 isthe subject that corresponds to what Z ˇ ižek (2001: 10) terms our post-ideological era, or the ‘end of history’, echoing the title of FrancisFukuyama’s influential book, an era in which the liberal, capitalistconsumer society has been entirely ‘naturalized’, and radical politi-

cal projects are immediately deemed morally suspect or potentiallytotalitarian. Nietzsche’s figure of the Last Man is invoked by Z ˇ ižek in a man-

ner that relates explicitly to our problematic. Z ˇ ižek connects the LastMan 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, seekingmerely comfort, ‘small pleasures’ and security, he is, on Z ˇ ižek’saccount, a figure who prefers politics without politics, revolutionswithout 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 LastMan is paradoxically accompanied by an endless number of prohibi-tions to secure a comfortable life for oneself and one’s neighbours(Žižek, 2000a: 173). This is also why the real consequence of thedeath of God is not that ‘everything is permitted’ as allegedlyclaimed by Dostoevsky, but that ‘everything is prohibited’ as sug-gested by Lacan: ‘God is dead,’ says Z ˇ ižek, and ‘we live in a permis-sive universe, you should strive for pleasures and happiness – but, inorder 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’ (Ž ižek, 2003: 96).

Accordingly, Zˇ ižek (2003: 95–7, 2008b: 76) describes the surviv-alist behaviour of the Last Man as ‘hedonistic asceticism’, precisely because it combines pleasure and constraint in a reactionary equili- brium the only goal of which is not to die, or to die as comfortablyas possible. This hedonistic asceticism of the Last Man, combining pleasure and constraint, can be further elucidated by invoking aLacanian understanding of the superego which espouses an obscene, permanent imperative to enjoy: ‘The concept of the superego desig-nates precisely the interzone in which these two opposites overlap: inwhich the command to enjoy doing your duty overlaps with the dutyto enjoy yourself ’ (Žižek, 2000a: 135, emphasis in original). The LastMan is thus a subject not only characterized by having to enjoy doinghis duty, but also by having the duty to enjoy. Thus, the allusion tothe figure of the Last Man conveys to our discussion not just thetheme of nihilism but, more importantly, the issue of the possibleinseparability of enjoyment and obligation, pleasure and prevention.

Žižek (2003: 95) connects the subject-figure of the Last Man to the

notion of biopolitics. Biopolitics, argues Zˇižek (2008b: 34), is pre-cisely post-ideological insofar as biopolitics ‘designates the regula-

tion of the security and welfare of human lives as its primary goal’(Žižek, 2008b: 34). Hence, it must abandon the biologically risky and costly ideological struggles inherent to passionate political projects.

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However, another important insight follows from Z ˇ ižek’s discussionof the figure of the Last Man and biopolitics, namely that ‘the expertrule of ‘‘biopolitics’’ is grounded in and conditioned by the crisis of investiture; this crisis generated the ‘‘postmetaphysical’’ survivaliststance of the Last Man’ (Zˇ ižek, 2004a: 505). 3 As a consequence, theLast Man is a subject for whom it is no longer possible to fullyassume his received symbolic mandates and who thus needs to con-stantly express an ironic-reflexive distance with regard to the social-symbolic roles he performs (Zˇ ižek, 2002: 70).

The implication for contemporary analysis of power is that effec-tive technologies of power must take their point of departure in this‘crisis of investiture’ and integrate the self-reflexive distance thatcharacterizes the Last Man. Accordingly, contemporary biopoliticalstrategies of subjectivation, for instance in health promotion, will bedirected towards individuals who cannot be expected to fully identifywith the positions to which they are subjected. This means that biopolitics must invoke a form of authority which is inherently anti-authoritarian (Ž ižek, 2006: 92–3). The difference between the tradi-tional authoritarian form of authority and this anti-authoritarian formof authority parallels the difference between the ways that symboliclaw functions and the way the superego functions. While the symboliclaw tells you to just do your duty, the superego says: ‘Don’t just takeorders, do what you have to do, because you think you should do it’;that is: do your duty because you enjoy doing it (Ž ižek, 2000a: 134). Notably, this ambiguous reflexivity undermines the commonplacenotion of the postmodern subject free to choose and reshape his iden-tity (Ž ižek, 1999a). Ž ižek’s point is that we need to recognize this self-reflexive dimension of the superego, and more broadly the libidinalinvestment involved in the exercise of power, when studying power relations.

Linking biopolitics with the figure of the Last Man and introdu-cing the Lacanian notion of the obscene superego, Z ˇ ižek connects pleasure and enjoyment to the theme of biopolitics. Following TimDean (2012), we consider this move to hold a significant potential for

the development of the analytics and notion of biopolitics.4

Zˇižek’sreflections on biopolitics help render intelligible the advent of health

activities that do not rest upon eternal (health) values and temper their aspirations to simply reducing harm and prolonging life. Theyare also pertinent to technologies and programmes of health





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promotion which, in their form of ‘hailing’ depart from compliance,abstention and rationality and signal elements of dis-identification, pleasure and irrationality.

The Pleasure of Power and Self-distancing SubjectificationWe now wish to elaborate on this matter of dis-identification and therelated issues of pleasure and desire by paying attention to Z ˇ ižek’scritical engagement with Foucault’s analytics of power. It hasalready been noted that the analysis of the construction of subjectiv-ity may be enriched by supplementing Foucault with psychoanalyticconceptions, insofar as psychoanalysis can extend the Foucauldianapproach with notions of desire and pleasure. In turn, Foucault’sview of power in historically specific formations can counter psycho-analysis’ premise of a universal, albeit contradictory, subject who isnot situated historically (Henriques et al., 1984: 217). Our ambitionof combining the two traditions is not to extend Foucault’s discursiveconstruction of subject positions with extra-discursive, psychoanaly-tical dimensions. For present purposes, we find a more restricted point of congruence in the psychoanalytical notion of dis-identification, particularly as articulated by Z ˇ ižek, and Foucault’sconcept of subjectivation as ‘the conduct of conduct’.

For Ž ižek, Foucault’s analytics of power ‘leaves out of consider-ation . . . the process by means of which the power mechanism itself becomes eroticized’ (Zˇ ižek, 1999b: 254). To illustrate his point,Žižek deploys the example of the Christian ascetic subject. What

Foucault’s analytics of power neglects, according to Zˇižek, is ‘howthe ascetic who flagellates himself in order to resist temptation finds

sexual pleasure in this very act of inflicting wounds on himself’(Žižek, 1999b: 254). In other words, the Christian subject is notmerely subjected to the ascetic arrangements of pastoral power butis in this very process also involved in some kind of pleasure-seeking or hedonism. Zˇ ižek’s critical point is that there is alwaysan element of pleasure involved in the exercise of power; not only

in regard to the one who exercises power over someone else, but alsoin regard to the one over whom power is exercised: ‘When we aresubjected to a power mechanism, this subjection is always and bydefinition sustained by some libidinal investment: the subjectionitself generates a surplus-enjoyment of its own’ (Z ˇ ižek, 2004b:

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253). In short, Ž ižek criticizes Foucault’s analytics of power for notconsidering this ‘libidinal investment’ or ‘surplus-enjoyment’ innateto the exercise of power, a critique similar to Z ˇ ižek’s objection toAlthusser’s theory of interpellation (Z ˇ ižek, 1989: 124).

On the one hand, Ž ižek’s critique of Foucault is completely unfair.For one thing, in History of Sexuality , vol. 1, Foucault (1990: 81–90)embarks upon a detailed analysis of the intimate relationship between a certain form of power and the concept of desire, demon-strating how theories of desire, from Christianity to psychoanalysis,served as a precondition for strategies of power. 5 On the other hand,Žižek nevertheless has a point, as evidenced by Dean’s (2012)detailed discussion of the role of pleasure in Foucault’s work. HereDean observes how pleasure figures principally as an object of theo-retical reflections (mostly in interviews) and not as an operative ana-lytical concept in specific analyses, contrasting with Foucault’sanalyses of self-practice in which pleasure was a key analyticalnotion. 6

Žižek also raises this critique of Foucault’s analytics of power in aslightly different vocabulary, focusing on the concept of the subjectrather than the issue of enjoyment and pleasure. More precisely, hecriticizes Foucault for neglecting the Lacanian (libidinal) ‘subjectof the unconscious’, which is simultaneously that which ties the indi-vidual to the subjection to power and that which escapes it. This subject is the ‘excess’ which resists or remains after the process of subjectivation. Or, as Zˇ ižek says:

Production . . . does not stand for the result of the discursive opera-tion, but rather for its ‘indivisible remainder’, for the excess thatresists being included in the discursive network – that is, for what thediscourse itself produces as the foreign body in its very heart. (Z ˇ ižek,2004a: 506)

As a corollary to this, Ž ižek claims that the Foucauldian analysisof power overlooks the fact that the process of subjection involvesnot only a moment of identification, but also always involves a

moment of dis-identification, of not being fully subjected (Z ˇ ižek,2000b: 218). Another word for the Lacanian subject – this particular excess which is produced in and resists the process of subjection – isvery appropriately ‘surplus-enjoyment’.





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Žižek’s critique requires some modification, however. One reasonis that Foucault’s concept of subjectification actually resemblesŽižek’s notion of ideological interpellation in one significant aspectwhich, to our knowledge, remains unnoticed in the commentaries. Asis well known, Foucault’s rendering of modern government as ‘con-duct of conduct’ implies that the governed subject must always begranted a fundamental, inviolable freedom (Foucault, 1982). Z ˇ ižek’smoment of dis-identification is comparable to the problem of govern-ing subjects who are assumed to exercise ‘ethical self-practice’, inso-far as they autonomously, perhaps critically, relate to thegovernmental objectives in their self-conduct. In this reading, Fou-cault’s dictum about freedom as a fundamental condition of govern-ment could imply that the subject must be able to maintain theassumption that it enjoys a space of freedom in relation to power and acts on his own. Supplementing governmentality analytics withŽižek’s concept of dis-identification can thus help us to specify con-temporary strategies of subjectivation, including appeals for ‘sensible’ or ‘responsible’ consumption of harmful substances. In this perspective, health promotion rarely aspires to a one-to-one adoptionof health values by those targeted, but assumes that individuals willtake on (ideological) identities only when an explicit space for man-oeuvre is communicated in relation to the official mandates. We sug-gest, then, that Ž ižek’s concept of dis-identification (unintentionally)can enrich and extend the analytical framework for understandingwhat it means to ‘govern through freedom’. This includes, as a keycomponent, appeals to maintain a distance from the governmentalobjectives.

The parallel observation in Zˇ ižek and Foucault that modern power operates through the freedom of the subjects can be applied to issuesof contemporary consumerism and neoliberalism. We noted at the beginning of the article that the campaign films address their audi-ence by using formats similar to commercials for young people, inso-far as they invoke markers from youth culture. The choice of music,clothes, language and postures would certainly seem to take account

of the identities of the targeted age-group and the values that areassumed to inform their lifestyle choices. In this regard, the films arecomparable to social marketing, since they differentiate and shapetheir messages according to the lifestyles of their audience, includingtheir habits, desires and pleasures. They reflect a kind of health

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promotion which seeks to integrate goals and preventive calculationsin the subcultures and situations within which people exercise their lifestyle choices.

It would be possible to consider how this kind of health campaign-ing resonates with the discourses and techniques of neoliberalismthat Foucault (2008) analysed in his lectures on biopolitics. There,Foucault describes neoliberal forms of governing that operate not pri-marily by eliminating otherness but rather by fabricating othernessand proliferating differences. Biopolitics, on his account, does notwork principally by excluding and correcting individuals with refer-ence to rock-hard norms like discipline. It rather produces a multipli-city of distinct ‘types’, which become objects of (economic)calculation and intervention. In a concluding remark, Foucault(2008: 260) says that neoliberalism entails the idea ‘of a society inwhich there is an optimization of systems of difference, in which thefield is left open to fluctuating processes, in which minority individ-uals and practices are tolerated’. This observation would seem highly pertinent to forms of power that allow space for singularities and dif-ference by avoiding sovereign commands and disciplinarity. It would be possible to insert within this analysis of neoliberalism forms of health promotion that substitute legal regulation and demands for abstention with more permissive messages. In non-authoritarianhealth promotion, it is not a matter of eradicating cultures and iden-tities detrimental to health, but rather of keeping their effects withinacceptable levels. The ‘well-balanced subject’ would be the subjec-tification that corresponds to a diversified, non-authoritarian and pleasure-permitting health promotion.

It would also be possible to examine the health campaign’s atten-tion to diversified cultures, individual choices and tolerance by draw-ing on Ž ižek’s analysis of contemporary capitalism. In particular, thisanalysis highlights the antagonistic position of the ‘self-managing’subject who is expected to perform a series of practices that are at thesame time jouissif , or fun-filled, and socially conformist. On thisview, current health promotion is less a matter of correcting and nor-

malizing behaviours (as in Foucauldian discipline) than of encoura-ging practices of consumption and pleasure that remain withincertain sensible limits, by being neither too puritan or fanatic, nor sliding into what is considered to be outright health-damaging beha-viour. We notice, then, that despite their different epistemologies,





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Foucault and Ž ižek offer compatible observations regarding the per-missive and balance-seeking rationality of the health campaigns, and the form of subjectivation involved.

It should be noted, however, that Z ˇ ižek would undoubtedly insertthe ‘postmodern’, culturist-consumerist traits in the campaign filmswithin a more explicit and encompassing critique of globalized capit-alism than Foucault’s localized, analytical critique permits. In fact,Žižek often argues that post-structuralists, including Foucauldians,adhere to a politics of difference that has become too timely in its pri-vileging of multiplicity, differentiation and creative self-formation.Instead of unveiling the antagonisms of contemporary capitalism,they produce a form of knowledge that constitutes no fundamentalchallenge but is in fact productive within a system which itself oper-ates through differences and multiplicities. If we accept Z ˇ ižek’s crit-ical diagnosis of the compatibility between contemporary capitalismand the post-structuralist politics of difference, we are afforded anadditional argument for why we need to develop the conventionalconcept of subjectification.

ConclusionThe article started from the observation that the subject in recenthealth campaigns is increasingly characterized by a newly discov-ered pragmatism, irony, self-subversion, inversion of traditionalauthority, anticipation of viewers’ dissociation and non-compliance, and attempts at alignment with the cultural identifiers

of the target groups. We then discussed to which extent the frame-work developed by governmentality analytics can make intelligiblethis new subject-figure.

The key project of governmentality analysis has been to interro-gate technologies and concepts that align what is presumed to behealthy 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 regulationand the disciplining of the body. However, recent non-authoritarianhealth campaigns complicate the conceptual framework of govern-mentality analysis in terms of its rendering of health, risk, responsibility, subjectivation and ‘healthy balance’. The emerging campaigns

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are much more tempered and pragmatic in their attempt to influenceindividual behaviour towards desirable social ends. This is evident inthe explicitly communicated discontinuity and discordance betweenofficial (conventional) health values and the choices of the targetaudiences. The campaigns do not act, then, like the technologies of power discovered by Foucault and governmentality scholars, emble-matically represented by the technology of sexuality, a ‘formidabletool of control and power’.

Another challenge arises in terms of the function that rationality isascribed in the government of health subjects. Governmentality writ-ers have demonstrated how interventions of illiberal character can be justified with reference to the existence of a defective will in the subjects. On this account, passions, desires and erotic pleasure need to be‘despotically suppressed’ in order for subjects to become responsible protectors of health. The entrenched moralism involved in this strat-egy implies that to become an ill person who is not deemed morallydefective requires responsible and compliant behaviour. However,the analytical emphasis on the role of pleasure or enjoyment intoday’s health campaigns challenges interpretations that univocallyemphasize demands for rational risk calculation, calls for abstentionand suppression of irrational pleasures. In fact, contemporary health promotion seems to have incorporated certain incitements to enjoy-ment or even transgression. In Zˇ ižek’s (1999b: 345) terminology,we could say that health campaigning reminds us not so much of an authoritarian father figure who forbids you to enjoy but of ananti-authoritarian, obscene father figure who enjoins you to enjoyyour pleasure. In today’s health campaigns, these two father figuresseem to merge in the imperative to enjoy ourselves, but to do so in ahealthy and responsible way.

This antagonistic subject-figure is paralleled in the format of thecampaign films that articulate the antagonistic message of ‘ascetichedonism’. Notably, the films do not employ rational argument buttake the form of jokes, surprise and surrealism. They constitute‘examples’ in the sense discussed at the beginning of the article. Con-

trary to the argument – in our case, for instance, ‘you have to realizethat if you go to the solarium three times per week, you’ll increaseyour statistical risk of skin cancer by 25 per cent’ – the example hasthe advantage that it is capable of containing an excess of significa-tion. Furthermore, the example is capable of bringing forth inherent





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contradictions and impossibilities, something that the argument isrestricted from doing. The problem is the difficulty of putting antag-onisms into argumentative form. As soon as one attempts to articu-late an antagonism in propositional language, one ends upconcealing the antagonism under the cover of assertions (McGowan,2014: 68). The superiority of the example over argumentation lies inthe fact that the latter cannot formulate its own antagonistic premisesand structure. By contrast, the example can articulate its own failureand inherent contradictions: ‘It has the capacity to successfully indi-cate that which it fails to state directly’ (McGowan, 2014: 70). Whatthe example can indicate is the antagonism which lies underneath anargument, for instance the dual appeal for irrational fulfilment of desire and rational moderation of desire. The choice of examples(in Žižek’s sense) answers to the health campaigns’ assumptionsabout their addressee – that he/she is a fundamentally antagonisticsubject, stretched out between the contradictory rationalities of asce-ticism and hedonism.

The argument here is not that this exercise of power, a power thatrevolves around the rationality and self-responsibility of the subject,has ceased to exist, nor is it that demands for compliance with med-ical authority are completely abandoned. Nonetheless, today’s health promotion witnesses the emergence of a reconfigured objective thatdoes not involve a ‘conversion’ of the individual into a whole-hearted disciple of healthiness. The problem mutates from being oneof lack of self-mastery to being what we term a problem of balancingself-control and desire, rationality and pleasure. This figure, whichwe attempted to capture by drawing on Z ˇ ižek’s term ‘ascetic hedon-ism’, represents a subjectivation that integrates desire, pleasure and enjoyment. The well-balanced subject that today’s health promotionseeks to produce is someone who certainly may – indeed is enjoined to – enjoy, but within reasonable limits, that is, in a controlled man-ner, so as not to damage her own or others’ well-being too much.Both too much pleasure and too little might threaten to ruin our phy-siological as well as our psychological health. In this perspective,

intense exercise training or extreme dieting is considered indisputa- bly unhealthy. This is also evident in regard to lifestyle more broadly.It is now considered unhealthy to completely give up all unhealthyelements of one’s lifestyle: by doing that, one risks becoming a‘health fanatic’. Thus, having a healthy lifestyle does not mean that

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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 notsomething completely new but rather a readjustment of the deep-rooted tension in western culture between the technical, biologicaland psychological body and the political body (Agamben, 1998).This readjustment directly impacts on what is understood by ‘prudentlifestyle choices’ and, more specifically, the formation of the cate-gories through which risk and safety become intelligible, and accord-ing to which groups and individuals are deemed ‘compliant’ or ‘noncompliant’. Undertaking analytical reconstruction will hope-fully open up further interrogation into how libidinal investments areintertwined with the exercise of power and, specifically, with strate-gies of subjectivation. This article has merely begun expanding our analytical possibilities in the light of the present context and its hopesfor pleasures within the limits of reason.

Notes1. However, as part of what has been termed the ‘affective turn’ there

seems to be an incipient interest in these issues in governmentality stud-ies as well (Bjerg and Staunæs, 2011; D’Aoust, 2014; Lupton, 2013).

2. Throughout this article we use concepts such as ‘desire’, ‘pleasure’and ‘enjoyment’. We are aware of the multiple and diverse meaningsof these heavily loaded concepts, and of the important theoretical dis-cussions concerning these concepts in the literature that we draw on – Foucault studies as well as psychoanalysis. However, it is beyond thescope of this article to engage in these discussions. In the following weuse the terms ‘desire’ and ‘pleasure’ in a broad, or common, sense,not confined to either a specific Foucauldian or psychoanalyticaldefinition.

3. In several of his books Ž ižek refers to this idea of a ‘crisis of symbolicinvestiture’ which he derives from Eric L. Santner’s reading of Schre- ber’s Memoirs in his book My Own Private Germany: Daniel Paul Schreber’s Secret History of Modernity . According to Santner (1996:

xi–xii, 2011: xii), a general crisis of investiture exemplified in Schreber occurs in the late 19th century in terms of the failure of subjects toassume and perform the mandate of symbolic authority that they aregiven. In Schreber’s case, this crisis occurred when he, as Z ˇ ižek (1997: 73) puts it:





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was unable to come to terms with the stain of obscenity which formed anintegral part of the functioning of symbolic authority: the ‘crisis of investiture’ breaks out when the enjoying underside of the paternal

authority . . . traumatically affects the subject.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 har- bouring 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 pointfor a dialogue with Ž ižek’s psychoanalytical position, while a reconci-liation of the two approaches would still involve serious challenges (seeDean, 2012).

6. We do not imply that Foucault offers no resources for addressing ques-tions of desire, excess, risk, or the balance between hedonism and plea-sure. In History of Sexuality , vols 2 and 3, Foucault excavates principlesfor the regulation of self and others which are not prohibition centred butrather seek for a balanced cultivation and use of pleasures. Similarly,Foucault’s (2000) comments on transgression and ‘limit experiences’,through which the subject escapes himself, hold potential for discussingthe subject of present health campaigns.

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Kaspar Villadsen is Professor at the Department of Management, Politicsand Philosophy, Copenhagen Business School. He is the author of the books Power and Welfare: Citizens’ Encounters with State Welfare (co-authored with Nanna Mik-Meyer, Routledge, 2013) and Statephobia and Civil Society: The Political Legacy of Michel Foucault (co-authored withMitchell 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 tech-nologies, health promotion, and the problem of state and civil society.

Mads Peter Karlsen is Assistant Professor at the Department of Manage-ment, Politics and Philosophy, Copenhagen Business School. He did hisPhD thesis on Alain Badiou and Slavoj Z ˇ ižek. He is the author of the book Pastoralmagt: Om velfærdssamfundets kristne arv (2008) and the editor (with Lars Sandbeck) of the books Religionskritik efter Guds død (2009)and Kristendom og engagement: Peter Kemps teologi til debat (2014).He has published on Foucault, Badiou and Z ˇ ižek in New Political Science , Journal for Critical Research on Religion and the International Journal of Z ̌ ižek Studies . His current research is on the interrelationship between theol-ogy and psychoanalysis.

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health promotion,governmentality and the challenges of theorizing pleasure and desire

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