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Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

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Journal of Genetic Counseling

Abstract

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.

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References

  • Barker, J. R., & Cheney, G. (1994). The concept and the practices of discipline in contemporary organizational life. Communication Monographs, 61, 19–43.

    Google Scholar 

  • Bates, B. R. (2005). Public culture and public understanding of genetics: A focus group study. Public Understand Sci, 14, 47–65.

    Article  Google Scholar 

  • Bates, B. R., Poirot, K., Harris, T. M., Condit, C. M., & Achter, P. J. (2004). Evaluating direct-to-consumer marketing of race-based pharmacogenomics: A focus group study of public understandings of applied genomic medication. J Health Commun, 9, 541–59.

    Article  PubMed  Google Scholar 

  • Bauer, M. W. (2002). Controversial medical and agri-food biotechnology: A cultivation analysis. Public Understand Sci, 11, 93–111.

    Article  Google Scholar 

  • Beers, M. H., & Berkow, R. (1999). Merck manual of diagnosis and therapy, 17th ed. Hoboken, NJ: Wiley.

  • Brookey, R. A. (2001). Bio-rhetoric, background beliefs and the biology of homosexuality. Argumentation and Advocacy, 37, 171–83.

    Google Scholar 

  • Brown, M. (2004). Taking care of business: Self-help and sleep medicine in American corporate culture. J Med Humanities, 25, 173–87.

    Google Scholar 

  • Buckholtz, A. (2004, Nov. 16). Tracing your health roots: plant a health family tree now, and it could bear fruit for generations. Washington Post, HE1.

  • Burke, K. (1969). Grammar of motives. Berkeley: University of California Press.

    Google Scholar 

  • Butler, J. (1997). The psychic life of power: Theories in subjection. Stanford, CA: Stanford University Press.

    Google Scholar 

  • Carmona, R. (2004, Nov. 8). Press conference to launch “U.S. Surgeon General's Family History Initiative.” Remarks as prepared, Department of Health and Human Services, National Press Club, Washington, DC.

  • Ceci, C. (2003). Midnight reckonings: On a question of knowledge and nursing. Nurs Philos, 4, 61–76.

    PubMed  Google Scholar 

  • Cheek, J., & Rudge, T. (1994). The panopticon revisited?: An exploration of the social and political dimensions of contemporary health care and nursing practice. Int J Nurs Stud, 31, 583–91.

    Article  CAS  PubMed  Google Scholar 

  • Clegg, S. R. (1989). Frameworks of power. London: SAGE.

    Google Scholar 

  • Condit, C. M. (1999a). How the public understands genetics: non-deterministic and non-discriminatory interpretations of the “blueprint” metaphor. Public Understand Sci, 8, 169–180.

    Article  Google Scholar 

  • Condit, C. M. (1999b). The meanings of the gene. Madison: University of Wisconsin Press.

    Google Scholar 

  • Conn, M. (2004, Nov. 24). Doctors: Learn family's medical history. Marshfield (WI) News-Herald.

  • Conrad, P. (1999). Uses of expertise: sources, quotes, and voice in the reporting of genetics in the news. Public Understand Sci, 8, 285–302.

    Article  Google Scholar 

  • Conrad, P. (2001). Genetic optimism: framing genes and mental illness in the news. Cult Med Psychiatry, 25, 225–47.

    Article  CAS  PubMed  Google Scholar 

  • Conrad, P., & Markens, S. (2001). Constructing the “gay gene” in the news: optimism and skepticism in the US and British press. Health, 5, 373–400.

    Google Scholar 

  • Craig, D. A. (2000). Ethical language and themes in news coverage of genetic testing. Journalism and Mass Communication Quarterly, 77, 160–74.

    Google Scholar 

  • Ellis, C. (2003). Foucault, feminism, and informed choice. J Med Humanities, 24, 213–28.

    Google Scholar 

  • Elwyn, G. (2004). Arriving at the postmodern medical consultation. Eur J Gen Pract, 10, 93–7.

    PubMed  Google Scholar 

  • Fahy, K. (2002). Reflecting on practice to theorise empowerment for women: Using Foucault's concepts. Aust J Midwifery, 15, 5–13.

    PubMed  Google Scholar 

  • Finkler, K. (2000). Experiencing the new genetics: Family and kinship on the medical frontier. Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  • Foucault, M. (1980). Prison talk. In C. Gordon (ed.), Power/Knowledge. New York: Pantheon.

    Google Scholar 

  • Foucault, M. (1983). Afterword: The subject of power. In H.L. Dreyfus & P. Rabinow (Eds.), Michel Foucault: Beyond structuralism and hermeneutics. Chicago: University of Chicago Press.

    Google Scholar 

  • Foucault, M. (1986). History of Sexuality, Volume 3: Care of the Self. New York: Vintage.

    Google Scholar 

  • Foucault, M. (1997). The ethics of the concern for self as a practice of freedom. In P. Rabinow (Ed.), Ethics: Subjectivity and truth. New York: New Press.

    Google Scholar 

  • Frank, A. W. & Jones, T. (2003). Bioethics and the later Foucault. J Med Humanities, 24, 179–86.

    Google Scholar 

  • Geller, G., Tambor, E. S., Bernhardt, B. A., Rodgers, J., & Holtzman, N. A. (2003). Houseofficers' reactions to media coverage about the sequencing of the human genome. Soc Sci Med, 56, 2211–2220.

    Article  PubMed  Google Scholar 

  • Genetic information nondiscrimination act of 2003: Report. (2003). 108th Cong., 1st Sess. Rep. 108–122.

  • Georges, J. M. (2003). An emerging discourse: Toward epistemic diversity in nursing. Adv Nurs Sci, 26, 44–52.

    Google Scholar 

  • Gibson, D. (2004). The gaps in the gaze in South African hospitals. Soc Sci Med, 59, 2013–24.

    Article  PubMed  Google Scholar 

  • Gilbert, T. (2003). Exploring the dynamics of power: A Foucauldian analysis of care planning in learning disabilities services. Nurs Inq, 10, 37–46.

    Article  PubMed  Google Scholar 

  • Goldstein, D. M. (2003). Reproductive technologies of the self: Michel Foucault and meta-narrative-ethics. J Med Humanities, 24, 229–40.

    Google Scholar 

  • Gollust, S. E., Hull, S. C., & Wilfond, B. S. (2002). Limitations of direct-to-consumer advertising for clinical genetic testing. JAMA, 288, 1762–1767.

    Article  PubMed  Google Scholar 

  • Gostin, L. O., & Hodge, J. G. (1999).Genetic privacy and the law: An end to genetics exceptionalism. Jurimetrics, 40, 21–58.

    Google Scholar 

  • Harley, D. (1994). Political post-mortems and morbid anatomy in seventeenth-century England. Soc Hist Med, 7, 1–28.

    CAS  PubMed  Google Scholar 

  • Henderson, L., & Kitzinger, J. (1999). The human drama of genetics: “hard” and “soft” media representations of inherited breast cancer. Sociol Health and Illn, 21, 560–578.

    Google Scholar 

  • HHS launches new family health history initiative. (2004, Nov. 8). States News Service.

  • Hick, C. (1999). The art of perception: From the life world to the medical gaze and back again. Med Health Care Philos, 2, 129–40.

    Article  CAS  PubMed  Google Scholar 

  • Holmes, D. & Gastaldo, D. (2002). Nursing as a means of governmentality. J Adv Nurs, 38, 557–565.

    Article  PubMed  Google Scholar 

  • Holmes, D. (2001). From iron gaze to nursing care: Mental health nursing in the era of panopticism. J Psychiatr Ment Health Nurs, 8, 7–15.

    CAS  PubMed  Google Scholar 

  • Hubbard, R., & Wald, E. (1999). Exploding the gene myth, 3rd ed. Boston: Beacon Press.

    Google Scholar 

  • Hustead, J. L., & Goldman, J. (2002). Genetics and privacy. Am J Law Med, 28, 285–307.

    PubMed  Google Scholar 

  • Jaret, P. (2001). 10 Ways to improve patient compliance. Hippocrates, 15(2).

  • Kellogg, S. (2004, Nov. 26). When family gathers, talk about health. Newhouse News Service.

  • Kinsman, G. (1996). “Responsibility” as a strategy of governance: Regulating people living with AIDS and lesbians and gay men in Ontario. Economy and Society, 25, 393–409.

    Google Scholar 

  • Krumm, J. (2002). Genetic discrimination: Why Congress must ban genetic testing in the workplace. J Legal Med, 23, 491–521.

    Google Scholar 

  • Learmonth, M. (1998). Kindly technicians: Hospital administrators immediately before the NHS. J Manag Med, 12, 323–330.

    Article  CAS  PubMed  Google Scholar 

  • Lynch, J. (2004). Foucault on targets. J Health Organiz Manag, 18, 128–135.

    Google Scholar 

  • MacDonald, C., & Williams-Jones, B. (2002). Ethics and genetics: Susceptibility testing in the workplace. J Business Ethics, 35, 235–241.

    Google Scholar 

  • Manias, E. & Street, A. (2000). Possibilities for critical social theory and Foucault's work: A toolbox approach. Nurs Inq, 7, 50–60.

    Article  CAS  PubMed  Google Scholar 

  • Mayeaux, E. J., Murphy, P. W., Arnold, C., Davis, T. C., Jackson, R. H., & Sentell, T. (1996). Improving patient education for patients with low literacy skills. Am Fam Physician, 53, 205–11.

    PubMed  Google Scholar 

  • National Family History Day declared by surgeon general. (2004, Nov. 25). Early Show 7:00 AM EST CBS.

  • Nelkin, D., & Lindee, M. S. (1995). The DNA mystique. New York: W.H. Freeman.

    Google Scholar 

  • Nordgren, A. (2003). Metaphors in behavioral genetics. Theoret Med, 24, 59–77.

    CAS  Google Scholar 

  • Nye, R. A. (2003). The evolution of the concept of medicalization in the late twentieth century. J Hist Behav Sci, 39, 115–29.

    Article  PubMed  Google Scholar 

  • O'Malley, P. (1998). Consuming risks: Harm minimisation and the government of drug users. In R. Smandych (Ed.). Governable places. Brookfield, VT: Ashgate.

    Google Scholar 

  • Ong, A. (1995). Making the biopolitical subject: Cambodian immigrants, refugee medicine and cultural citizenship in California. Soc Sci Med, 40, 1243–57.

    CAS  PubMed  Google Scholar 

  • Peckover, S. (2002). Supporting and policing mothers: An analysis of the disciplinary practices of health visiting. J Adv Nursing, 38, 369–377.

    Article  Google Scholar 

  • Peerson, A. (1995). Foucault and modern medicine. Nurs Inq, 2, 106–114.

    CAS  PubMed  Google Scholar 

  • Petersen, A. (1999). The portrayal of research in genetic-based differences of sex and sexual orientation: a study of ‘popular' science journals, 1980–1997. J Commun Inq, 23, 163–182.

    Google Scholar 

  • Petersen, A. (2003). Governmentality, critical scholarship, and the medical humanities. J Med Humanities, 24, 187–201.

    Google Scholar 

  • Pollock, A. (2003). Complicating power in high-tech reproduction: Narratives of anonymous paid egg donors. J Med Humanities, 25, 241–263.

    Google Scholar 

  • Prado, C. G. (2003). Foucauldian ethics and elective death. J Med Humanities, 24, 203–211.

    Google Scholar 

  • Priest, S. H. (1995). Information equity, public understanding of science, and the biotechnology debate. J Commun, 45, 39–54.

    Google Scholar 

  • Public awareness and attitudes about reproductive genetic technology. (2002, Dec. 9). Genetics and public policy research center, Johns Hopkins University.

  • Rapp, R. (1999). Testing women, testing the fetus: The social impact of amniocentesis in America. New York: Routledge.

    Google Scholar 

  • Rawlinson, M. C. (1987). Foucault's strategy: Knowledge, power, and the specificity of truth. J Med Philos, 12, 371–95.

    CAS  PubMed  Google Scholar 

  • Rendell, J. (2004). A testimony to Muzil: Herve Guibert, Foucault, and the medical gaze. J Med Humanities, 25, 33–45.

    Google Scholar 

  • Ritter, J. (2004, Nov. 25). U.S. encourages knowing family medical histories. Chicago (IL) Sun-Times.

  • Rock, M. (2003). Death, taxes, public opinion, and the Midas touch of Mary Tyler Moore: Accounting for promises by politicians to help avert and control diabetes. Med Anthropol Q, 17, 200–232.

    Article  PubMed  Google Scholar 

  • Rose, N., & Novas, C. (2005). Biological citizenship. In A. Ong & S.J. Collier (Eds.), Global assemblages: Technology, politics, and ethics as anthropological problems. Malden, MA: Blackwell.

    Google Scholar 

  • Rothenberg, K. H., & Terry, S. F. (2002). Before it's too late—addressing fear of genetic information. Science, 297, 196–197.

    Article  CAS  PubMed  Google Scholar 

  • Rothman, B. K. (Norton, 1998). Genetic maps and human imaginations: The limits of science in understanding who we are. New York: W.W.

  • Ryan, J. (1991). Observing and normalizing: Foucault, discipline and inequalities in schooling. J Educ Thought, 25, 104–119.

    Google Scholar 

  • Schatz, G. S. (2002). Health records privacy and confidentiality: pending questions. J Contemp Health Law Policy, 18, 685–689.

    PubMed  Google Scholar 

  • Schillo, K. K., & Thompson, P. B. (2003). Postmodernism for animal scientists. J Animal Sci, 81, 2989–2994.

    CAS  Google Scholar 

  • Scott, C. E. (1987). The power of medicine, the power of ethics. J Med Philos, 12, 335–50.

    CAS  PubMed  Google Scholar 

  • Senay, E. (2004, Nov. 25). Thanksgiving: Family history day. Early Show 7:00 AM EST CBS.

  • Singer, E., Corning, A. D., Antonucci, T. (1999). Attitudes toward genetic testing and fetal diagnosis, 1990–1996. J Health Soc Behav, 40, 429–445.

    CAS  PubMed  Google Scholar 

  • Smith, A. (2004, Nov. 22). Family history is important for your health. Post-Standard (Syracuse, NY), D1.

  • Steiner, J. F., & Earnest, M. A. (2000). The language of medication-taking. Ann Intern Med, 132, 926–30.

    CAS  PubMed  Google Scholar 

  • Swerdloff, D. (2004, Nov. 10). Sharing family health information at Thanksgiving. Voice of America News.

  • Taussig, K.-S., Rapp, R., & Heath, D. (2003). Flexible eugenics: Technologies of the self in the age of genetics. In A.H. Goodman, D. Heath, & M.S. Lindee (Eds.), Genetic nature/culture: Anthropology and science beyond the two-culture divide. University of California Press: Berkeley.

    Google Scholar 

  • Thomas, K. H. (2004, Nov. 21). Holidays are a good time to focus on health history. Atlanta (GA) Journal-Constitution, 8MS.

  • Toast family's health on Thanksgiving Day. (2004, Nov. 15).The (Springfield, MA) Republican.

  • Turkey, football and ... family genetic history? (2004, Nov. 23). Thanksgiving gatherings are perfect opportunities to discuss family health histories, says Karmanos Cancer Institute. PR Newswire US,.

  • U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. 2nd ed. Washington, DC: U.S. Government Printing Office.

  • United States Surgeon General. (2004). My family health portrait: The Surgeon General's family history initiative. http://www.hhs.gov/familyhistory/downloads/MyFamilyHealthPortrait-English.pdf.

  • Weir, L. (1996). Recent developments in the government of pregnancy. Economy and Society, 25, 372–92.

    Google Scholar 

  • Werner, D. (2004, Dec. 5) Climb into your family tree. Vail (CO) Daily, 4.

  • Willems, D. (2000). Managing one's body using self-management techniques: Practicing autonomy. Theor Med Bioeth, 21, 23–38.

    Article  CAS  PubMed  Google Scholar 

  • Zimmerman, B. K. (1999). The use of genetic information and public accountability. Public Understand Sci, 8, 223–40.

    Article  Google Scholar 

  • Zoller, H. M. (2003). Working out: Managerialism in workplace health promotion. Management Communication Quarterly, 17, 171–205.

    Article  Google Scholar 

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  1. School of Communication Studies, Ohio University, Lasher Hall, Athens, OH, 45701, USA

    Benjamin R. Bates

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Bates, B.R. Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program. J Genet Counsel 14, 423–434 (2005). https://doi.org/10.1007/s10897-005-4845-5

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