The body as a machine: The medicalisation of the workforce in Chile

By Nicolás Fuster Sanchez

The book "The body as a machine" explores the historical process of medicalisation in Chilean society, mainly focusing on the labour force. It highlights the transformation of medicine from a private sphere concerned with individual care to a social phenomenon encompassing various collective dimensions. The book argues that the rise of the liberal oligarchic state, rural-urban migration, and the emergence of a professional medical elite contributed to the socialisation of medicine in Chile. This process involved the standardisation and regulation of the population through medical interventions and establishing a comprehensive healthcare system.

• Language: English
• Publisher: Ediciones metales pesados
• Release date: Aug 3, 2023
• ISBN: 9789566203476

Book preview

Frente.png

Intellectual Property Registration Nº 2023-A-8095

ISBN: 978-956-6203-47-6

Cover: I.W.W. Hoja Sanitaria, mayo 1926, Chile.

Cover design and digital layout: Paula Lobiano

Translated: Rocío Pozo Peña

First published 2013, El cuerpo como máquina. La medicalización de la fuerza de trabajo en Chile, Ceibo Ediciones, Santiago de Chile.

De esta edición:

© Nicolás Fuster Sánchez

© Ediciones Metales Pesados

E mail: [e-mail]

www.metalespesados.cl

Madrid 1998 - Santiago Centro

Teléfono: (56-2) 26328926

Santiago de Chile, julio de 2023

Index

Prologue. Towards a workers’ morality: the medicalisation of the workforce in Chile and its lines of flight

Diego Rivera López

Introduction

Chapter I.

Medicine and Power: Some intelligibility guidelines. From Foucault to Rosen

18th-century healthcare administration in the European city: from the welfare model to the medical police model

Medicine and the city in the 19th century: from medical statisation to the medicalisation of the workforce

Chapter II.

Science at the Fatherland’s Health Service: Medical Device Development in Republican Chile

New physicians, new knowledge, new objectives

State and University: a strategic alliance for the legitimisation of medical science

Scientific medicine and healthcare institutions: the battle to monopolise medical knowledge and practice

Chapter III.

Development of Urban Medicine in Chile: the Medicalisation of the Popular Space of Santiago During the 19th and Early 20th Centuries

Santiago’s demographic expansion in the 19th century and the growth of the city panic

Public Hygiene and the social significance of the medical dispositif system

Medicalising Santiago’s Urban Space: Public Hygiene as a Standardisation Technology

The medicalisation of popular housing: public hygiene to modernise the workforce

Chapter IV.

Medicine for the Workforce: Medicalisation for the Enlightenment of Chile’s Proletariat

Colonial Welfare and Social Discipline: Political and Economic Precedents

The Popular World’s Proletarianisation Process: Political-Economic Background to an Enlightenment Notion of Labour

Association, medicine and enlightened working-class culture

From mutualist organisation to self-management of healthcare: the medicalisation of the workforce and the objectification of enlightened workerism. 1850-1927

People’s Organisation for mutual aid: Developing a comprehensive medicine for working people and their communities

Enlightened workerism and self-governed healthcare: The Polyclinic and the I.W.W. Sanitary Bulletin 1922-1927

Overview and Synthesis

Prologue

Towards a workers’ morality: the medicalisation of the workforce in Chile and its lines of flight

Diego Rivera López

Introduction

Be consistent with your ideas and show solidarity with us in this modest work.

It is not a reproach, comrade; it is a call we make to you.

Juan Gandulfo, Hoja Sanitaria, I. W. W.

Translating this book into English implies updating some discussions to a framework that does not need it. One of the most exciting things about The body as a machine is operating as a document with its articulation. However, after a health crisis embodied during the pandemic, how we conduct our research methods requires some elements which must be shown.

Years after this book, Bruno Latour¹ with an ironic gesture stated that now (during COVID-19 emergency), we cannot avoid that non-humans as microbes can be their own actors and are capable of building social relations. Or, in a similar frame, bodies have multiple ontologies enacting in different spaces², opening research questions and reminding us that the relationship between politics, health, biology, and what we understand as life is now open.

The intention in bringing back a discussion of the medicalisation of the workforce in Chile goes beyond getting a book on a foreign language or recovering a sociohistorical approach. It is possible to think of the situated character³, as more than a synonym of local in the way of composition of phenomena that we call social. The possibility to relate the different strata interacting into shaping, and regulating a problem is still open, especially in times of neoliberal intensification.

The reception in the field

This book has had a special reception in the humanities, social and medical sciences. We divided the lectures of the book into epistemological approaches and problems.

In terms of historical theory, this book has been received as a document of a background of health and medicine in Chile. Fuster’s archive work lets research in several frames. It rebuilds the set of relations that shape national nutrition⁴, the place of the body in the medical view⁵, and the ways of institutionalisation of medical knowledge⁶ meanwhile perform public⁷ or pharmaceutical discourses⁸ ⁹ ¹⁰.

In another way, in the modernisation and formation of the Chilean State, we found special attention to the sort of conflictive relations that shape what we understand for condition and its implications for power exercises¹¹. Fuster’s work is part of the political need to build a national project with a workforce and better ways of capital accumulation using a human engine¹². It is one of the approaches that insert him into the Latin American studies of social medicine.

Particular attention has the functional classification dimension, objectivations¹³ and modular behaviours¹⁴, and its effects on the society normalisation, even its contradictions¹⁵, which the post-structuralist research approach of Fuster explains it. Therefore, the methodological contribution is highlighted¹⁶.

Also, the legitimation of medicine in the intellectual field got attention in terms of an area and its effect as a hygienist device¹⁷ of capitalist development¹⁸. In that sense, its place as a field of knowledge lets medicine and medicals take place as legitim power.

Opening the discussion to contemporary problems, the adoption of neoliberal nomenclature, especially in individual management of social issues, we found studies highlighting the work's centrality. Although, we must consider that the results that reference Fuster do not adopt this approach from Marxism and hold its critical apparatus. Particularly, relational and critical research¹⁹ from the notion of experience, transgressions of personal limits and its practices²⁰, performing its production of subject ²¹.

Unfortunately, the final statement of the book and the possibility of thinking the power beyond the state had lower attention and just considered strategies of an organisation or nomenclature²². Nevertheless, resistance is viewed in the working-class press²³ as part of a repertory of self-psychologisation and medicalisation of its claims.

The body as a machine, ten years after

One of the most exciting things about this research is the impossibility of locating this work in sociology, medical anthropology, philosophy, or history. It is, in a Foucauldian way, porous.

Furthermore, this impossibility has something which made this book particular; its lack of a traditional theoretical frame at the beginning. Classic social sciences books often start with a state of discussing a topic, but this book has not. The body as a machine uses a critical apparatus, presenting the reader with an articulation of epistemological approaches which structure the text.

In the beginning, we saw how medicalisation had intervened in body and individual behaviour, its space, and every social relation reminding us of biomedicine’s meddling. This process lets the author precisely explain some of their hypothesis—first, his attention to demographic expansion and its imbrication with modes of accumulation. As a Foucauldian assumption, Fuster’s attention to the effects forces the reader to review how emerged normalisation tools are directly proportional to technological advances and specialisation. For example, the apparition of populational statistics, mortality and birth rates or urban disinfection programmes.

Using these analytical tools, Fuster presents how Chile emerges as a study case. His focus is on how the first social organisations collected their discomfort to build what we know today as collective medicine beyond the State.

In that sense, we could divide the book among its research objectives. Unfortunately, the temptation of this text is paying attention to the object that articulates the theoretical connection: the development of a worker’s morality.

This lecture holds in Fuster’s hypothesis. To study workers’ medicalisation in Chile between 1842 and 1925, specifically during the formation of the modern Chilean State, he presents some ideas which let the reader understand how, when, and why biomedicine colonises spaces that are, apparently, only social. First, we highlight how the Chilean Oligarchic State and its transforming of the productive and political system were accompanied by a hygienist inspiration. It is precisely the process that lets medicine turns to the collective, installing epistemological and institutional bases for its socialisation. Second, its effect on cities development, occupational and productive twist inaugurating a constant medicalisation process in Chilean society. Lastly, an institution directly affected by this process is the workers’ families. State’s intervention with a hygienist approach changes social dynamics and how they understand us—in Fuster’s words, producing an objectivation of a workerism²⁴ in accordance with a civilisational illustrated discourse.

We are employing the book’s main contributions to the academic field. As the text shows, classic approaches to social science and health establish causality from something that we could name history of totalities²⁵, which considers a teleological narrative of knowledge and medical practices, avoiding power relations which made medicine a science with the field, object, epistemology, and space of deployment.

Workers’ morality and the IWW: some lines of flight

Consequently, the critical apparatus needs a key concept that articulates the theoretical truss. Fuster uses the concept device in the translation, but we will use dispositif²⁶. Notably, it emerges as a network that interweaves heterogeneous elements, which operate as a game with different discourses, changing positions and making possible some practices. In the case of the text, Chilean modern medical dispositif found in the workforce is based on its development and legitimacy. The foundation of a lack of the lecture is one of the main contributions of The body as a machine. Identifying the medicalisation process as a power space capable of objectifying modern workerism lets the reader understand its political potential. A text as a document to re-think class contradictions, self-organisation, and workers’ mutuals in a neoliberal context with problematic sublimation of the social and the self with health as articulators.

This ambivalent dimension should be noted if we want to bring this discussion to the present. For instance, Clara Han²⁷ considers Chilean contradiction from the precarity concept. The author focuses on the historical condition of the lumpenproletariat, the State’s neglect, and victims of informal work dynamics from a material perspective.  Likewise, it proposes it as a common condition of humanity that could acquire substance through attention and singularity. Furthermore, in this perspective that considers anthropologic, political, philosophical, and sociological frames, precarity implies a political condition in which subjects are precarious, like embodied vulnerability. Thus, social structure performs a precarity’s emergence that, in an insecure²⁸ environment, encourages joint problems managed as individual problems. 

In that sense, the conditions of economic exploitation and their modes of subjectivation are not static and correspond to a socio-historic construction that lets us cartograph their dynamics. An activity orchestrated by and as a matrix of power reminds us of what philosophy is and its place.  

It is possible to think not only about the conditions of accumulation and their effects but also about the centrality of the problem of power in precariousness: the body. Considering that Foucault gave us a body²⁹ to problematise, some points must be identified to keep developing precarity production.  

The body is moved by rules, a culture, a time, a set of strains and disputes that finish in its incorporation. The winners of history and its ways of subjection – the medicalisation, for example- the science, objectivity, and its right discourse-the medicine, among others-the procedures or mechanisms configurators of subjectivity- the disease or the health-are part of the body: field of battle, and spoils of war ³⁰.

As Fuster said, the body is a non-orthodox archive, trapped in a series of regimens that model it. Remembering from Foucault that the body is broken by work, rest, and life as an extension; it is forged by resistance.  Considering these processes as part of governmentality, we should apply our analysis to technics influencing behaviour and political possibilities. Governmentality is a set of institutions, proceeds, research, and strategies to exercise power. Nevertheless, considering the population as a political-economic tool and a security dispositif. In Foucault, if we apply government techniques with any objective, it is equally essential to disentangle the object of those decisions. Mainly: the constitution of the public is a political problem. 

The public, which is a crucial notion in the eighteenth century, is the population seen under the aspect of its opinions, ways of doing things, forms of behaviour, customs, fears, prejudices, and requirements; it is what one gets a hold on through education, campaigns, and convictions. Therefore, the population is everything that extends from biological rootedness through the species up to the surface that gives one a hold provided by the public³¹. 

Considering that, the population mobilises the reorganisation of power mechanisms and articulates disciplinaries means, promoting new ways of subjectivation and subjectivity production. From this approach, we can affirm that governmentality exists to produce and let behaviours on subjects under possibilities established by the power mechanisms. Linking this to the Foucauldian notion of government, we would consider power as a double sense exercise: to himself and the others. It is attractive because it implies that social relations have a normative character. We understand that a behaviour government tries to establish the belief of the free, volunteer, and individually scaled of a set of institutional imposed rules. In that sense, they constitute tools to objectify individuals and characterise them, putting knowledge mechanisms at service, like statistics, of population objectivation. 

In that sense, understanding a worker’s morality from its etymological perspective would let us think of it as a dwelling. Precisely, a way to self-production relations with the space and in relations with other institutions such as family or workers’ societies. Indeed, mutual benefit movements, in the case of the book, let us problematise how it became an integral assistance and an opportunity to produce their archives to develop grounded and situated sanitarian strategies. Is it more than that, and therefore the point of view of this research is necessary. If we review the literature, we can see how the Marxist hypothesis focuses³² ³³ ³⁴ the field. A post-structural approach like this one contributes to the discontinuities, becoming subject processes, highlighting the class potential, not in a linear historical version and bringing the reader a toolbox to understand its presence from emergencies, accidents, and the chance of being and staying.

Finally, as the Chilean I.W. W’s pamphlet³⁵ said:

With most explicit intentions, we have received pecuniary [financial] help from the State; but we have not accepted it; we despise our precarious economic situation because we do not want to fall into claudication or inconsistencies with our principle of every State is a useless parasitic organism.

We pretend to keep doing - even if it is embryonic - the practice of postulates of real ethic or moral: mutual benefit, help, justice, and magnanimity (sacrifice spirit), to realise living in a society where words solidarity and liberty are not valid.

References

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Callewaert, Staf. 2017. Foucault’s concept of dispositif. Grunde: Nordisk tidsskrift for kulturoch samfundsvidenskab (1-2): 29-52.

Calquín, Claudia. 2017. Maternidad y gobierno de los hombres: el caso de la invención de la maternidad científica. Rumbos TS. Un espacio crític para la reflexión en ciencias socailes 16: 11-34.

Devés, Eduardo. 1990. La cultura obrera ilustrada chilena y algunas ideas en torno al sentido de nuestro quehacer historiográfico. Mapocho. Revista de humanidades y ciencias sociales (30): 127-136.

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Foucault, Michel. 1988. The Foucault Reader. New York: Pantheon Books.

Foucault, Michel. 2014. Seguridad, territorio y población. Curso en el Collège de France: 1977-1978. Buenos Aires: Siglo XXI.

Fuster, Nicolás, and Pedro Moscoso. 2015. La hoja sanitaria. Archivo del policlínico obrero de la I. W. W Chile 1924-1927. Santiago: Ceibo Editores.

Fuster, Nicolás. 2013. El cuerpo como máquina. La medicalización