In the middle of last year I travelled through Norway just before Anders Breivik was sentenced. At the time, the big question in the trial in the minds of Norwegians was whether Breivik was going to be committed to gaol, or to a psychiatric ward. Many Norwegians took the view that a commitment to a psych ward would have been the preferential result. That would have put him away for the rest of his life, whilst a gaol term could have seen him released in a few decades time (Breivik was eventually sentenced to gaol).
It seemed quite puzzling. Why would a medical determination result in a longer sentence, and why would we allow that? If we want people to be punished for serious crimes, shouldn’t we just punish them, rather than use the medical system as a way to do so?
The Breivik case was part of an interesting phenomenon that I’ve been thinking a lot about recently; one of the power of medicine. It seems to me that medicine has become a tool of many power systems, often being used as a worse form punishment than regular punitive justice.
We can see examples of this all over the place.
For example, in what he called the “Hippocratic Paradox”, Jonathan Groner, has investigated the use of medical practitioners in executions. Jonathan explains:
“…lethal injection uses medical technology and medical expertise for the purpose of killing. Even without physician participation, the lethal injection process so closely mimics medical practice that the entire medical community is tied to the death chamber.”
We can also look at the area of sexuality, where medicine has often been treated as a way to punish those who acted out of the norm. A perfect example is that of chemical castration, or the use of chemicals to destroy people’s sex drive, which has regularly been discussed as a method for punishing sex-offenders.
In fact, as Michel Foucault explains, medical practices have have often been used to ‘treat’ a range of ‘sexual disorders’. In describing his ‘scientia sexualis’, or the scientification of sexuality, Foucault explains that a growing legal permissiveness around sexuality has been replaced with medical interventions:
“There was permissiveness, if one bears in mind that the severity of codes relating to sexual offences diminished considerably in the nineteenth century and that law itself often deferred to medicine.” (p. 40)
“sexuality was defined as being “by nature”: a domain susceptible to pathological processes, and hence one calling for therapeutic or normalising interventions…” (p. 68)
What this points to is a powerful use of medicine. On top of its place as a healer, medicine has also become a ‘punisher’. This has occurred through two fundamental means.
First, as described in the Breivik case, medicine has been used as a punitive measure in criminal cases. Whilst we often hear about those who ‘plead insanity’ as a way to avoid gaol sentences, the reality is, that it is used often also used as a method to punish.
As in the Breivik case, medicine can be used as a way to say that someone is ‘incurable’ – therefore committing them to a life in a psych ward, when a criminal sentence would allow for some release. Let’s think about it this way. You can argue that our justice system has two main goals; first to punish people for their crimes, and second to ‘rehabilitate someone’ so they can be members of our society again. Note that when we talk about rehabilitation in these terms, we are discussing a ‘social rehabilitation’ – effectively teaching someone the rules of society. Medical fixes however allow us to skip over the rehabilitation part of our system. It gives someone a disease that is often considered incurable, hence meaning eternal punishment.
The second area is in the way it creates medical reasons for those who act out of social standards. For example, it is common practice for people to assume that those who act out in public; people who walk through the streets nude, shout at the top of their lungs, or just act ‘socially weird’, have some form of mental health issue. They are medically unwell.
In creating this medical problem for people, rather than in looking at whether they are knowingly and purposefully breaking social norms, our society not only takes away their agency in their actions, but we also take away any potential rationality behind actions. We place people in a box where they are no longer mentally able to act in society, entrenching social standards through the use of medicine.
So how has science and medicine ended up doing this? Medicine is really thought of as something that is there to help people; not as a way to punish people. Foucault, once again provides an answer. Of course, here he is talking about sexuality, but we could add in any number of topics into this sentence and it would prove to be true:
“One must not suppose that there exists a certain sphere of sexuality that would be the legitimate concern of a free and disinterested scientific inquiry were it not the object of mechanisms of prohibition brought to bear by the economic or ideological requirements of power.”
Now, of course not all science, and certainly not all medicine, has been used to entrench modern power systems. But look around a lot of scientific and you can see that Foucault’s statement rings true. This points to a use of science that many wilfully ignore; its use to entrench societal power systems.
The problem is, that for most scientists in particular, this is extremely problematic. Again, looking at executions, Jonathan Groner explains that there are major ethical issues with the use of medicine in this way:
“This Author has previously called lethal injection “a stain on the face of medicine” because with its intravenous lines, electrocardiograph monitors, and anesthetic drugs, it creates an aura of medical respectability that has a “deeply corrupting influence on medicine as a whole.”
“Not only does lethal injection induce physicians to perform unethical activities, but lethal injection also “medicalizes” executions, meaning that its veneer of medical respectability allows the imagery of healing to be used to justify killing.(p.907)”
I’m not saying that there is some evil scientific cult out there looking at the best ways to punish people using medicine, but the economic and social realities of the discipline mean that we have to think about how scientific practice is often directed into those areas that entrench social power structures. Medicine is a great example of this, and one that’s worth thinking about. Do we really want to use medicine in this way, or should we go back to some more basic principles of our justice system?