“Ein Wunderkind” is what the Germans might call a child-prodigy. At under forty years of age, Jacques Attali is all at once an economist with an international reputation, a teacher, a well-regarded Socialist Party political advisor, and a versatile writer, author of not only theoretical works in his discipline, but of noted essays in domains more varied than politics: music, and, recently, medicine. The work that he published in the autumn of 1979, “The Cannibal Order, or Power and the Decline of Medicine“1 has relaunched the debate in France, not only on the validity of therapeutic act, but on all existential problems, from birth to death, which underpin the organisation of the system of care and treatment in the West.
What makes Mr. Attali tick?
For those who are his friends, so much energy deployed in so many directions at the same time bewilders them. For those who are his enemies—and he has many of them, least of all because of his friendly, and endearing personality, than his political choices—this prodigy is suspect. Rooted in the ground of reason, of measurement, of the “middle ground”,—the middle of what exactly?—, the French Establishment has always distrusted intellectuals who trample its ‘French’ gardens.
Jacques Attali without a doubt disturbs, with his excess, his outrages, his permanent and feverish questioning. But in these times of crisis, do we not have a need to be more “worried” than reassured?…
Michel Salomon—Why does an economist take interest in medicine and health with so much passion?
Jacques Attali.—I noticed in studying the general economic problems of western society that the costs of health are one of the essential factors of the economic crisis. The production of consumers and their support costs a lot, even more than the production of goods themselves. Men are products through the services they render to one another, in particular within the domain of health, of which the economic productivity does not increase very quickly. “The production of the production of machines” grows more rapidly than productivity relative to the production of consumers. This contradiction will be removed by a transformation of the system of health and education towards their commodification and industrialisation. Whoever analyses economic history realises that our society moves away more and more from artisanal activities to industrial activities and that a number growing of services produced by men for other men are more and more becoming objects which are produced in machines.
The meeting of these two questions leads to oneself to ask: is it possible that medicine can also be produced by machines which could come to replace the activity of medicine?
M. S.—This question appears a little academic, a little theoretical…
J. A.—Certainly, but it gives an account of the current crisis. If medicine must, like education, be mass-produced, the economic crisis would be quickly resolved. It is a bit like the point of the view of the astronomer who would say: “If my reasoning is good, a star is there…” If this reasoning is accurate and if our society is coherent, the logic leads to this: as other functions were eaten, in the previous phases of the crisis, by the industrial apparatus, medicine becomes a mass-produced activity, which leads to the metaphor.
The latter means that medicine is largely replaced through protheses which have a role of recuperating the functioning of the body, of restoring or substituting it. If the prothesis attempts to make the same thing, it performs it as the organs of the body performed, it therefore becomes a copy of the organs of the body or of the functions of the body. Such objects would therefore be prostheses to consume. In economic language the metaphor is clear: it is that of cannibalism. One consumes the body. So, to leave the metaphor (and I have always thought that it was a source of knowledge) I asked myself two questions:
Is cannibalism close to being a therapy?
Does it exist as a kind of invariant in different social structures, which would make it an axiomatised form of cannibalism, in the mathematical sense, would it rediscover itself in the therapeutic procedure?
Firstly, cannibalism seems to be explained largely as a foundational therapeutic strategy. Secondly, it seems that all these strategies of healing, in relation to sickness, contain a series of operations made by the body itself, but made also through cannibalism, and we find in all these strategies: select indicators that we are going to observe, we monitor them to see if they are going well or not, we report upon what is going to break the order of these indicators, that we call Disease; to negotiate with Disease, to separate Disease. All these systems of healing have thus employed these same operations: selection of indicators, denunciation of sickness, surveillance, negotiation, separation. These different operations raise also a political strategy: to select some indicators to observe, to monitor to see if all goes well, to denounce sickness, the scapegoat, the enemy, and expelling it. There is a very deep relationship between the strategy with regard to individual Disease, and the strategy with respect to social Disease. It is what has led me to think, at foundation, that the distinction between social Disease and individual Disease was not a very clear distinction. These diverse fundamental operations applied themselves to some different historic periods, different conceptions, that one was able to have a sickness of evil, of power, of death, life, and therefore one which must fulfil the function of the designation of evil, separation. In other words, there are the same operations, the same roles, but is not the same actors who play the roles, and the play isn’t performed at the same time.
M. S.—From there to found a theory on historical or mythic cannibalism… Your essay has shaken and shocked not only doctors but also the potential patients that we all are, in brief, public opinion…
J. A.—This essay is a triple effort:
Firstly, it is an attempt to recount the economic history of disease, the history of our relationships with sickness.
Secondly, to show, that there is in some way, four dominant periods, and consequently three great crises between which are structured systemic shifts, and that each shift does not affect only the healer, but also the conception even of life, of death, and of sickness.
Thirdly, and finally, to show that these switches concern the signs and not the strategy, which remains that of cannibalism, and that in fact, we leave cannibalism in order to return there later. In sum, we can interpret all industrial history as a machine to translate the foundational cannibalism, first relative to evil, where men eat men, in an industrial form of cannibalism, where men become the commodities which eat commodities. Industrial society would function like a dictionary with different steps in translation: there are some intermediary languages of some kind, four great languages. There is the fundamental order, the cannibal order. It is there the first gods which appear are cannibals and in the following myths, historically, the cannibal gods eat each other, then it becomes terrible for the gods to be cannibals.
In all the myths that I have studied in different civilisations, the religion serves in some manner to destroy cannibalism. For cannibalism, the souls of the dead are evil. If I want to separate the soul of the dead from the dead, one must eat the body. Because the best method to separate the dead from their souls, is to eat their corpse. Therefore what is fundamental in cannibal consumption is separation. It is there where I wanted come from: consumption is separation. Cannibalism is a formidable therapeutic force of power. So why does cannibalism no longer work? Well, because from the time (we saw it in the myths,—and I give an interpretation of much of Girard’s work on violence, also that of Freud on “Totem and Taboo”, in which he saw the totem and the totemic meal as foundational, and the totemic meal disappears in sexuality) where I said “eating the dead” allows me to live, so… I go to find something to eat. Thus cannibalism is healing, but it is, at the same time, a producer of violence, and it is like that I try to interpret the passage to sexual prohibitions, the same with cannibal prohibitions. Because it is evident that if I kill my father, or my mother, or my children, I am going to impede the reproduction of the group, and yet they are are the most easy to kill given that they live near me. Sexual prohibitions are secondary prohibitions through relation to prohibitions on nourishment. Then, we ritualise, we stage cannibalism in a religious fashion. In some way, we delegate, we represent, we stage. Religious civilisation is a staging of cannibalism. The signs that we observe are those of gods. Disease is possession by the gods. The only sicknesses that we can observe and heal are those of possession. The healing, finally, is the expulsion of evil, and evil which, in the case there, is Malice, that is to say the gods. The principal healer, that is the priest. There are always two permanent healers. There is the denunciator of evil and the separator, that we will find later under the names doctor and surgeon. The denunciator of evil, that’s the priest, and the separator is the practitioner.
I have tried to demonstrate, in one part, that Christian ritualisation is fundamentally cannibalistic. For instance, the passages from Luke on “the bread and the wine” which are “the Body and the Blood of the Christ”, and which if we eat them give us life, are cannibalistic texts, and obviously therapeutic; from these books, we get a medical lecture, which is at the same time cannibalistic, which is striking.
I try to sketch, subsequently, the history of the relationship of the Church to the healer, and see little by little, without a doubt around the 12th or 13th century, that a new system of signs appear. We observe no longer only sickness coming from gods, but also sickness coming from the bodies of men. Why? Because the economy starts to become organised. We exit from slavery. The dominant sicknesses are epidemics which start to circulate like men and commodities. The bodies of poor men bear sickness and there is a total unity between poverty (which did not exist before because nearly everyone was either slave or master) and sickness. To be poor or ill signified the same thing from the 13th to the 19th century. Therefore the strategy with regard to the poor in politics and with regard to the ill, are not different. When we are poor, we fall ill, when we are ill, we become poor. Sickness and poverty do not exist yet. What exists is to be poor and ill, and, the poor or ill being designated, the best strategy consists in separating it, containing it, not to heal it, but to destroy it: we called it, in the French texts, à l’infirmer (to lock-up/enclose)—incarceration in theses of Foucault. We lock up in multiple fashions: quarantine, the lazaretto, the hospital, and in England workhouses. The law regarding the poor and charity is not a way of helping people, but of designating them as such, and containing them. Charity is none other than a form of denunciation.
M. S.—The police become the therapist in place of the priest.
J. A.—That is it. Religion removes itself and takes its power elsewhere, yet it cannot assume any longer the power of the healer. There are, already, doctors but those here do not play a role of consolation, and this is evidenced by, the political power, very astutely, not recognising yet certifications of medicine. Political power considers that its principal therapist is the policeman and never the doctor. Elsewhere in Europe, at the time, they only had one doctor for 100,000 inhabitants.
But I come to the third period where it is no longer possible to enclose the poor because they are too numerous. They must, to the contrary, be supported because they have become workers. They cease to be bodies in order to become machines. Sickness, the evil, constitutes a (mechanical) breakdown. Clinical language isolates, objectifies a little more the evil. We designate evil, we separate and we expel it.
During all of the 19th Century, with the surveillance that is hygiene, the new remedy, and the new separation of the doctor-surgeon, we saw the policeman and the priest conceal themselves behind the doctor.
M. S.—And today, it is the turn of the doctor to fall into the trap…
J. A.—Today, the crisis is triple. In one part, as in the prior period, the system can no longer ensure to him his role alone. Today, in a certain fashion, medicine is largely incapable of helping all sicknesses because the costs become to high.
In another part, we observe a loss of respect for the doctor. We have much more confidence in quantified data than in the doctor.
Finally illnesses or forms of behaviour emerge which are no longer indebted to classical medicine. These three characteristics lead to a kind of natural continuum which runs from clinical medicine to prosthesis, and I have tried to distinguish three phases which interpenetrate this transformation.
In the first phase, the system attempts to survive by monitoring its financial costs. But this will culminate in the necessity of the surveilling behaviours, and therefore defining the norms of health, of activity, to which the individual must submit themselves. Thus appears the notion of the economic life profile and health expenses.
Then, we pass to the second phase which is that of self-denunciation of evil thanks to behavioural self-control tools. The individual can therefore conform himself to the standard profile of life, and become autonomous in relation to their sickness.
The principal criterion of behaviour was, in the first order, to give meaning to death, in the second order, to contain death, in the third order, to increase life expectancy, in the fourth, the one in which we live, it is the search for an economic profile of life in expenses of health.
The third phase is constituted by the appearance of prostheses which allows for the designation of disease in an industrial fashion. Thus, by example, electronic medications such as the pill coupled with a micro-computer allowing the release in the body, at regular intervals, of substances, which are elements of regulation.
M. S.—In sum, health, with the appearance of these electronic prostheses, will be the new industrial motor of expansion…
J. A.—Yes, in conclusion, all the traditional concepts disappear: production, consumption both disappear, life and death disappear because the prosthesis renders death a blurred moment…
I believe that the important thing of life will no longer be to work, but instead to be a consumer, to be a consumer amongst other machines of consumption. The dominant social science up to the present has been the science of machines. Marx is a clinician since he designated the disease, i.e. the capitalist class, and he would eliminate it. He held, in one sense, the same discourse as Pasteur. The great dominant social science will be the science of codes, informatic, then genetic. This book is then also a book on codes because I try to demonstrate that there are successive codes: the religious code, the police code, the thermodynamic code, and today the informational code and one calls that socio-biology.
This theoretic discourse is only useful if the future does not occur: we only avoid being a cannibal by stopping becoming one. I believe that the essential thing, in order that a theory might be false, is not that it might be refutable but refuted. The truth is not the refutable, but the refuted.
M. S.—Does your thesis lead up to a concrete reflection on medicine, even eventually; is it the first signs of a concrete reflection of political man, and of the economist on the organisation of medicine?
J. A.—I don’t know. For the moment, I do not want to ask myself this question. I believe the first thing that I wanted to show, uniquely, is that healing is a process in full transformation towards a model of organisation which has nothing to do with the current one, and that the choice is between three types of attitudes: either to conserve current medicine like before, or to accept the evolution and make it the best it could be, with greater equality of access to prostheses, which would be a third evolution, in which the expulsion of disease is thought of in a new fashion, which is neither of the past, nor that of the future cannibal system; it would be an attitude near to the acceptance of death, a way to render people more conscious that the urgency is neither forgotten, nor delayed, nor awaiting death, but to the contrary, wishing that life would be the most free possible. Therefore, I think that, little by little, we will polarise ourselves around these three types of solutions and I want to show that, in my sense the latter is truly humane.
M. S. —It is social utopia; it is sometimes dangerous to be utopian…
J. A.—Utopia can have two different characteristics, we speak of utopia as a complete dream, then the dream is a dream of eternity, or we refer to etymology of the word, that is to say, to what has never taken place (i.e. οὐ τόπος or no place—Ed.) and we attempt then to see which type of utopia is probable. Or I believe that if we want to understand the problem of health, one must take account of the fact that there are some probable utopias. The future is necessarily an utopia, and it is very important to understand that it is not dangerous, since to speak of utopia signifies to accept the idea that the future has nothing to do with prolongations of current tendencies.
I will say however that all futures are possible except one which would be the prolongation of the current situation.
M. S.—The future, is there a particular prosthesis from these all medications of the future—and of the present—which help man to better support his condition…?
J. A.—I find frightening this fascination for medications against anxiety, also all things that might even eliminate anxiety, but as a commodity, and not as a mode of life.
We try to provide the means to make anxiety tolerable, and not to create the means by which we are no longer anxious.
Subsequently, all doctors of the future who are linked to the control of behaviour could have a greater political impact.
It could be possible in effect to reconcile parliamentary democracy with totalitarianism, because it could suffice to maintain all the formal rules of parliamentary democracy, but at the same time to generalise the use of these products so that totalitarianism could be normalised.
M. S. — Does an Orwellian “1984” based on a pharmacology of behaviour, seem to be conceivable…
J. A. — I don’t believe in Orwellianism, because it is a form of technical totalitarianism with a “Big Brother” that is visible and centralised. I believe rather in an implicit totalitarianism with a “Big Brother” that is invisible and decentralised. The machines for surveilling our health, that we might be able to acquire for our well-being, will enslave us for our well-being. Sort of subjecting us to a soft and permanent form of conditioning…
M. S. — How do you see the man of the twenty-first century?
J. A. — I believe that one must distinguish between two kinds of man in the twenty-first century, that is to say: the man of the twenty-first century from the rich countries, and the man of the twenty-first century from the poor countries. The first will certainly be a man much more anxious than today, but who will find his response to unhappiness in a passive escape, in anti-pain and anti-anxiety machines, in drugs, and he will attempt at all costs to live some kind of commercial form of convivality.
But, next to that, I am convinced that the considerable majority, who will have understanding of these machines, and the mode of life of the rich, but who will not have access to them, will be extraordinary aggressive and violent. It is from this imbalance that will be born the great chaos which could occur either by racial war, conquests, or by the immigration into our countries of millions of persons who will want to take part in our way of life.
M. S. — Do you believe that genetic engineering might be one of the keys to our future?
J. A. — I believe that genetic engineering will come to be in twenty years a commonplace technique, also well-known and present in daily life like the combustion engine is today. Moreover, we can establish a similar kind of parallel.
With the combustion engine we were able to make two choices: either to privilege the communal transport network and facilitate people’s life, or to produce automobiles, tools of aggression, of consumption, of individualisation, of solitude, of storage, of desire, of rivalry… We have chosen the second solution. I believe that with genetic engineering we have the same type of choice, and I believe that we will also choose, alas, the second solution. In other terms, with genetic engineering we could, little by little, create the conditions of a humanity freely taking responsibility for itself, but collectively, or to create the conditions of a new commodity, this time genetic, which would be comprised of copies of men sold to men, of chimeras or hybrids used as slaves, as robots, or as working tools (resources)…
M. S. — Is it possible and desirable to live 120 years…?
J. A. — Medically, I do not know. We were always told that it was possible. Is it desirable? I will answer in several stages. First I believe that by the same logic of the industrial system in which we find ourselves, extending the length of life is no longer a desired objective by the logic of power. Why? Because as long as it was about the extension of life expectancy for the purposes of reaching the maximum threshold of profitability of the human machine, in terms of work, it was perfect.
But as soon as one passes 60/65 years, man lives longer than he produces and he therefore costs more to society.
Hence I believe that in the same logic of industrial society, the objective is no longer going to be the elongation of life expectancy, but to make sure that within a determined length of life, man lives the best life possible, but of such a kind, that health expenses will be the most reduced as possible in terms of the costs for the collectivity. Therefore giving rise to a new criteria for life expectancy: that of the value of a health system, focussed not on the elongation of life expectancy, but on the number of years without illness, and particularly without hospitalisation. In fact, from the point of view of society, it is more preferable that the human machine stops itself brutally rather than it deteriorating gradually.
It is perfectly clear, if we recall that two thirds of health expenses are concentrated on the last months of life. Also, cynicism aside, health expenses would not reach a third of the current level (175 billion Francs in 1979) if all these individuals would die brutally in car accidents. We need to recognise that the logic no longer resides in the increase of life expectancy, but in length of life without illness. I think however that increase of the length of life rests on a phantasm which corresponds two objectives: the first is that of men and power. Societies more and more prescriptive and totalitarian in which we find ourselves, tend to be led by “old” men, i.e. they become gerontocracies. The second reason resides in the ability of capitalist society to make old age economically profitable, simply in making the old financially solvent. It is currently a market, but it is not solvent.
That is fine in the eyes of the man today, it is no longer important to be like a worker, but rather like a consumer (because the worker is replaced by machines at work). Therefore, we could accept the idea of increasing life expectancy with the condition of rendering the old financially solvent and creating a market. We have seen very well how the current big pharmaceutical companies behave themselves, in countries that are relatively egalitarian, where at least the method of financing retirement is adequate: they privilege geriatrics, to the detriment of other domains of research like tropical sicknesses.
It is therefore a problem of retirement technology which determines the acceptability of the length of life.
I am, for my part, as a socialist, objectively against the lengthening of life, because it is a trap, a false problem. I believe that to pose this type of problem allows for the avoidance of more essential questions, like that of the freeing time actually lived in one’s present life. What purpose does it serve to live until 100 years old, if we end up with 20 years of dictatorship?
M. S. — The world to come, “liberal” or “socialist”, will need a morality of “biology”, in order to create itself an ethics of cloning or euthanasia for example.
J. A. — Euthanasia will be one of the essential instruments of our future societies in all cases. To start from a socialist logic, the problem poses itself as the following: the socialist logic is that suicide is a liberty, and a fundamental liberty; consequently, the right to direct or indirect suicide is thus an absolute value in this type of society. In a capitalist society, killing machines, and prostheses that will permit the elimination of life when it becomes too unbearable or economically too costly, will see the light of day and will become common practice. I think that euthanasia, might be a value of liberty or of commodity, will be one of the principles of future society.
M. S. — The men of tomorrow, will they not be conditioned by psychotropic drugs, and be subjected to manipulations of the psyche? How do you protect yourself from this?
J. A. — The only precautions that one might be able to take are linked to knowledge and understanding. It is essential, today, to forbid a very great number of drugs, to stop the proliferation of drugs conditionally; but maybe the border is already crossed…
Is television, for its part, not an excessive drug?
Is it not that alcohol has always been an excessive drug?
The worst of drugs is the absence of culture. Individuals want drugs because they have no culture. Why might they search for alienation through drugs? Because they have grasped a consciousness of their inability to live, and this inability translates itself concretely through a complete rejection of life.
An optimistic bet on man would be to say that if man had culture, in the sense of tools of thought, he could escape with solutions to his impotency. Thus, getting to the root, it gives to men a formidable instrument of subversion and of creativity.
I do not believe prohibiting drugs would be sufficient, because if one does not attack the problem by its root, we will fall inevitably into the gears of the police, and that is worse.
M. S. — How are we going to face mental illness in the future?
J. A. — The problem in the evolution of the psychiatric medicine will be done in two stages. In the first stage, there will be yet even more drugs, psychotropics, which correspond to a true progress, for 30 years of psychiatric medicine.
It seems to me that, in the second stage, for economic reasons, a certain number of electronic methods will be put in place, that will be either methods of control for pain (bio-feedback, etc.), or an informatic system of psychoanalytic dialogues.
This evolution will have a consequence of leading to what I call the explication of the normal; that is to say, electronic methods will allow us to define with precision the normal and to quantify social behaviour. The latter will become economically consumable since the methods and criteria of conformity to norms will exist. In the long term, when sickness will be vanquished, temptation points to a conformity with the “biologically normal” which conditions the functioning of a single absolute social organisation.
Medicine reveals the evolution of a society which orients itself tomorrow towards decentralised totalitarianism. We perceive already a certain conscious or unconscious desire of conforming oneself in the most possible way to social norms.
M. S.—This forced normalisation, do you think that it will govern all the domains of life, including sexuality, as the science today allows the near complete dissociation with sexuality and conception?
J. A.—From an economic point of view, there are two reasons which allow me to think that it will go very far.
The first concerns the fact of the production of men is not yet a market like other domains. In following the logic of my general reasoning, we do not see why procreation would not become a commercial form of production like others.
We can perfectly imagine that the family or the wife would only be a method of production of a particular object, i.e. the infant.
We can, in some way, imagine “matrices of rental” which are already technically possible right now. This idea corresponds entirely to an economic evolution in the sense that the wife, or the couple, will fit into the division of labour and into general production. Consequently, it will be possible to buy children like one buys “peanuts” or a television set.
A second important reason, and linked to the first, could explain this novel familial order. If in the economic plan the child is a commodity like any other, society would consider it equally so, but for social reasons. In effect, the survival of collectives depend on a sufficient demography to survive. If for economic reasons, the family does not wish to have more than two children, this attitude clearly opposes itself to the interest of the collective! Appearing thus a complete contradiction between the interest of the family, and that of society. The only method of resolving this contradiction is to imagine that society might be able to buy children from a family who would be paid in return. I’m not thinking of family allowances, which are weak incentives. A family would agree to have a number of children if the state guaranteed them one part towards substantial progressive allowances, and another part taking total care of the material life of each child. In this schema, the child will become a sort of currency in the relationship between the individual and the collective.
What I say here is not from my side a kind of complacency in front of what appears inevitable. It is a warning. I believe that this world in preparation will be so frightening that it will signify the death of man. We must therefore prepare to resist, and today it seems to me that the better way of doing it, it is to understand, to accept the fight, in order to avoid the worst. It is for that I push my reasoning to the end…
M. S.—To resist what, since you said there would be an inevitability to prostheses?
J. A.—The protheses that I see coming are not mechanical but are methods of striking against chronic diseases linked to the phenomenon of tissue degeneration. Cellular engineering, genetic engineering, and cloning prepares the way for these prostheses which will be regenerated organs replacing failing organs.
M. S.—The increasing penetration of informatics into society invites an ethical reflection. Is it not an underlying threat to the liberty of man?
J. A.—It is clear that the discourse on prevention, the economy of health, good medical practice, will bring about the necessity for each individual to possess a medical dossier which will be placed on magnetic tape. For epidemiological reasons, these files will be centralised together in a computer to which doctors will have access. The question is posed: will the police be able to have access to these files? I notice in all honesty that Sweden possesses today this kind of sophisticated system, and is not a dictatorship. I will add that certain countries do not have files but are dictatorships. With some new threats we might figure out how to create a bulwark of novel procedures. Democracy has the duty to adapt to the technical evolution. The old constitutions confronted with new technologies can lead to totalitarian systems.
M. S.—One of the most common projections on the future, predicts that man will be able to apply biological control on his own body, and between each other, thanks to microprocessors…
J. A.—This control already exists for the heart via “pacemakers”, and the same for the pancreas. It should extend to other domains like pain. We predict the focus of little implants in the organism capable of releasing hormones and active substances in the target-organs. If it aims to prolong life, its progress is inevitable.
M. S.—It seems that we left the era of physics to enter into an era of biology, closer to a ‘pan-biology’. Is that your opinion?
J. A.—I believe that we are exiting a world controlled by energy, in order to enter into a world of information. If matter is energy, life is information. It is why the major manufacturer in the society of tomorrow will be of living matter. Thanks in particular to genetic engineering, it will be the producer of new therapeutic weapons, foods and energy.
M. S.—What is the future of medicine and medical power?
J. A.—Somewhat brutal, I would say that along with washerwomen being faded behind the advertising images of washing machines, integrated doctors in the industrial system might become a subordinate, a foil, to biological prothesis. The doctor that we know will disappear in order to give up its place to a new living social category of industry and prosthesis. Like for washing machines, there will exist creators, vendors, fitters, and repairmen of prostheses. My comments can surprise, but do you know that the principle enterprises who are thinking about protheses are the big automobile companies such as Renault, General Motors, and Ford…
M. S.—In other terms, we will no longer have need of therapeutic medicines yet “normalisation” will be made through a kind of preventive medicine, self-managed or not, but in all cases “controlled”. Will it not be necessarily coercive?
J. A.—The appearance on the market of individualised items of self-surveillance and of self-control will create a preventive spirit. People will adapt themselves in a fashion to conform to the criteria of normality; prevention will no longer be coercive, but desired by people. We should not lose the sight that the most important thing is not technological progress, but the most elevated form of commerce between men that represents the culture. The form of society that the future prepares us for rests on the ability to master technical progress. It will dominate us or will we be dominated by it? There is the question.
1Published in English as Cannibalism and Civilization: Life and Death in the History of Medicine, Bloomsbury Academic USA, 1984.