The Ill-health assemblage Deleuze, Guattari and the sociology of health and illness Nick J Fox University of Sheffield

To understand the body, let us ask: what can it do?

Introduction The Deleuzian ontology of bodies. Ill-health and biomedical assemblages. Health assemblages. D/G and the sociology of health and illness. Gilles Deleuze (top), and Felix Guattari

Deleuze and Guattari Gilles Deleuze ( ) – philosopher. Felix Guattari ( ) – psychotherapist and activist. Together they wrote:  Anti-Oedipus (1984)  A Thousand Plateaus (1988)  What is Philosophy? (1992)

The Deleuzian Ontology Relations Assemblages Affect Productive desire Territorialisation

In a nutshell... The relations between bodies, things and ideas form assemblages. Relations are affected by, or affect others in the assemblage. These flows of affect territorialise a body’s capacities to desire: what a body can do.

Relations Bodies, objects, ideas, etc. come into being only in relation to others. Relations can be: Physical (e.g. medicines, technologies). Psychological (e.g. memories, attitudes, subjectivity). Social-cultural (e.g. beliefs, social institutions). Philosophical and abstract (e.g. science, Marxism, humanism).

Assemblages are... ‘a kind of chaotic network of habitual and non- habitual connections, always in flux, always reassembling in different ways’ (Potts 2004: 19). Image: ‘The bride stripped bare by her bachelors, even’. Marcel Duchamp,1923.

Life is lived through assemblages

Affect The capacity to affect or be affected.... is a becoming (DG 1988: 256) that changes the state of a body or entity. Flows of affect in assemblages produce bodies, identity, social life, history, social institutions. Flows of affect, not human ‘agency’.

Desire Pygmalion: the heart desires, by Edward Burne -Jones

Territorialisation Flows of affect in assemblages territorialise body capabilities and desires. The body can be territorialised by events, cultural factors, habituation, learning etc. New relations/affects can de-territorialise the body, making resistance and a line of flight possible.

Anti-humanism and sociology Assemblages of relations not single bodies and individuals. Flows of affect not agency. Territorialisations not social structures. What bodies can do, not what they are.

Bodies are... neither fixed nor given, but … particular historical configurations of the material and immaterial, captured and articulated through various assemblages which to some extent determine them as particular bodies, but never manage entirely to exclude the movement of differing and the possibility of becoming otherwise (Currier 2003: 332).

The Ill-health Assemblage The relations and affects that surround bodies during illness. The ill-health assemblage produces a sick body’s capacities to act and to feel. It territorialises embodiment and identity (in illness and in health).

The Biomedical Assemblage patient – disease – doctor – biomedicine – health technology – care system – economy – capitalism In this assemblage the micro-level of illness and its treatment are linked to the macro- level of economics and politics.

The Biomedical Assemblage Affective flow in this assemblage produces the ‘patient’, ‘doctor’, ‘disease’ and ‘body’ (body-with-organs).

Alternatives While the biomedical assemblage is wide- spread, other ill-health assemblages are possible: Expert patient (Fox et al 2005) Resisting consumer (Fox and Ward 2006) Cf. Szasz and Hollender; active/passive; guidance/co-operation; negotiated.

Resisting consumer The ill-health assemblage of members of a pro-anorexia group (Fox and Ward 2006) body shape – daily troubles – pro-ana – thinspiration – sanctuary – weight loss drugs – community

A Different Perspective Ill-health does not act on a prior body. The body is the product of an ill-health assemblage that includes many different relations and affective forces. ‘Disease’, ‘illness’, ‘health’ are produced by these assemblages.

The Health Assemblage Not just the opposite of ill-health assemblage or the ‘absence’ of illness relations. Health is a flow of affect that de-territorialises and opens up possibilities for acting, feeling and desiring. Health is resistance to territorialisation. Health = the capacity to form relations.

Deleuze and Guattari ask: Given a certain effect, what machine [assemblage] is capable of producing it? And given a certain machine, what can it be used for? (Deleuze and Guattari 1984: 3) These questions form the basis for an empirical anti-humanist sociology

Young men’s health identities Under-researched topic. Secondary analysis of interviews with 31 young men. Young Men, Masculinities and Health 2003– 2004 study (de Visser and Smith 2006), distributed via the UK Data Archive, University of Essex (UKDA 5371).

Methodology Fox and Ward (2008a): 1.Hermeneutic reading of interviews to identify the relations and affects in the assemblage. 2.Hypothesise assemblages. 3.Explore flows of affect in assemblage. 4.Ask: what (else) can the body do?

Findings Reading the interview transcripts: The relations in the assemblages were many and varied, including: sports; fitness; injuries; alcohol use; drug use; smoking; relaxation; yoga; sexual conduct; future; masculinity; risk; peer pressure. Focus on three participants.

Andrew university - team sport – fitness – body size – health professionals - biomedicine – alcohol - stress –medicine – food allergies – fear – home Affective forces produce denial and avoidance of his illness and health care.

Rahul sport – fitness – masculinity – control of body – risk – alcohol – religion/culture – peer group – (lack of) money - gender stereotypes Gender stereotypes and culture/religion contribute an affective flow between ‘health’, sport, masculinity and activity.

Marco Key relations: body – energy – holism - health – well-being - yoga - balance – drugs – alcohol Complex assemblage that incorporates discipline and balance derived from yoga and meditation, and use of drugs and alcohol to relax.

Study summary A focus on relations and affects uncovers many different assemblages. They are a mix of culture, institutions, background and idiosyncratic relations. Health policy needs to recognise this variety when engaging with this group.

What can D/G offer to SHI? a)Anti-humanist and methodological re- focusing on assemblages and affects. b)Re-thinking key conceptualisations in sociology of health, illness and bodies. c)Politics of biomedicine and resistance to territorialisation.

Anti-humanist sociology Not what a body is, but what are its capacities, and how are these produced? Flows of affect between relations, not human agency Territorialisation and de-territorialisation produce bodies, identities, social life; and capacity for resistance. Beyond micro- and macro-levels of analysis.

Re-thinking concepts Health = capacity to form relations (Bio)medicalisation = territorialisation into body-with-organs Resistance = de-territorialisation Social stratification = assemblages Inequalities = inequalities

The politics of medicine and care Critique of the biomedical/scientific/ industrial and economic assemblage. Care, health policy, public health are territorialisations of bodies, but can also be de-territorialisation that enhances capacities. Resistance and refusal always possible (makes all care political).

Further Reading Fox, N.J. (2012) The Body. Cambridge: Polity. Fox N J. (2011) The ill-health assemblage: beyond the body-with-organs. Health Sociology Review, 20 (4): Fox, N.J. and Ward, K.J. (2008) What are health identities and how may we study them? Sociology of Health and Illness, 30 (7),

In the Fox-assemblage Deleuze and Guattari Ansell Pearson Buchanan De Landa Potts Braidotti

The Ill-health assemblage Nick J Fox University of Sheffield