Depersonalisation in banking and medicine: Revisiting the Modern Gnosticism thesis (part ii)
One of the most, if not the most, pernicious aspects of modern mechanisation, standardisation and centralisation is the loss of the personal dimension of human life, or depersonalisation. This was again one of the central concerns of Max Weber; in fact, in a path-breaking contribution this was identified by Wilhelm Hennis (1988)[1] as the main concern of Weber’s entire life-work, as according to Hennis its central theme was the relationship between personality and the life orders.
In this article, I will focus on the use of algorithms and the connected, indiscriminate use of statistical data – indiscriminate in one sense, as in another sense, very discriminating – in two areas: banking and medicine. In both areas by today such practice is generally established, according to the logic of “international best practice” – which I call the worse possible practice, as it ignores as a matter of “principle” everything concrete and contextual; even though, most evidently,[2] these are exactly areas where personal contacts, and personal judgments, are and should be vitally important. They are therefore crucial illustration of Voegelin’s modern Gnosticism thesis at its core: how the mindless search for more data and facts, mere knowledge, quantifiable, “objective”, becomes not just applied to ever more intimate aspects of our lives, but is used to make decisions about us, over our heads, ignoring our personalities.
Banking
Let me start with a personal anecdote.[3] In late 1982, when I started to work on my PhD in economics at the University of Texas, Austin, I met the father of one of my teachers, who worked as a banker in Gatesville, Texas all his life, and by then was near or beyond 80 (thus, an exact coeval of Voegelin). Knowing that I was from Hungary, he no doubt tried to instruct me concerning the wonders of the free market, and told me how they did, and do (he assumed) banking in Texas, in contrast to Soviet-type systems. Well, the central issue was that decisions were not made by people sitting in offices in central organisations in the capital as – he supposed, and quite rightly – was done in the Soviet Union and satellite countries, but by people who concretely and personally knew the individuals who applied for a loan. Thus, he said (with more or less the same words), if Bill applied for a loan, he knew that he had 2,000 good cattle out there on the fields, so it was not a problem, they even gave him the double that he asked for, as they knew that he was only too cautious, but if Matt asked for a loan for half that some, then they again knew that in spite of the fact that he had a lot of property he would only waste the money and hardly could give it back. The conclusion was that everything in good banking depends on close personal contact and familiarity.
I conveyed this anecdote to a few persons inside banking, both in Ireland and Italy, when I got a chance, in recent years, but of course they were only laughing, though with some unease – well, this is obviously not done in this way anymore. Certainly not, but why obviously? Was the elderly banker plain wrong? Or just old-fashioned? But why and how? Would somebody please stand up, in case, and explain to that person why and how he was wrong? That is clearly out of the question. So, let’s see a bit what is going on now, and why this is wrong.
Again, I bring in my own personal experiences.[4] In 1998 I was appointed as Professor of Sociology in Ireland, at a time and place when and where this was still an important status. In fact, such appointments then were so important that I did not even receive a contract – it was not necessary, as my job was secured by a statute (I must admit I never fully understood what this exactly meant). Such status, as one can still know it again from Max Weber, was something very closely personal – I was appointed as a Statutory Professor, was treated in a special way given my status, but at the same time such status also became part of my – Irish – personality, and so everyone treated me as a concrete person, and not just as representative of such status. At any rate, elements of such a culture and tradition were still vaguely accessible to me in Hungary, where my grandfather was a district judge, and even though he was thrown out of his job by the communists in 1948, locals in the 1960s and 1970s still treated him as “Sir Judge”, or something like that. That culture was highly personal and concrete, knew its values and kept it as long as it was not destroyed (by Communism, in the name of democratic egalitarianism), and I consider it as way superior to modern democratic egalitarianism.
At any rate, and returning to matters of banking, having just arrived in Ireland, I needed a mortgage for buying a house, and this was of course no problem. This did not mean, even then, that I could apply for any amount – this was fixed in terms of percentages of actual salary and the like, and in fact I was not happy about the mortgage limit they gave me, as that took as its basis my initial salary, which was supposed to rise for years, but this was ignored according to the – clearly nonsensical – rule; but there was no question of giving the mortgage, or a personal loan which I asked for a few years later. I was Professor, thus having a status; but then, they also knew me personally – as a Professor, because I was a Professor, but then immediately also personally, this again is the “game” played in such status-societies, in contrast to egalitarian societies (where, of course, everything depends on money, which produces a world of infinite substitutability way worse than the one based on status); and so there was no question of not giving me a mortgage or a loan.
All this changed by about 2005 or so. Its first sign for me became visible through my application for a Ryanair credit card. At that time, I had to travel a lot, much through Ryanair, and they charged an atrocious fee for credit card purchases – and of course you had no other way of buying a ticket. Given the low prices they started to have, it happened that I had to pay more for the use of the credit card than for the ticket itself. Thus, learning about the existence of a Ryanair credit card, I applied for it, and it did not even occur to me that I might not get it. It was an Irish company, I was a Professor in Ireland, and of course had a decent salary, case closed.
Except that it wasn’t – and you can imagine, kind reader, how great was my surprise when I received a letter that my application was refused. I could not believe my eyes, so wrote them back, asking for an explanation and a reconsideration, and they even replied, but they gave no reason, just restated that they do not give me the card, full stop. I did not have a clue and still do not know what could have been the reason, but I was not simply upset that an amenity – a potentially cheaper credit card use – was denied to me, but I was hurt and injured, even shamed, somewhere at the core of my self-esteem: it was a kind of personal rejection that was all but without precedent in my life. It was as if someone had questioned my honesty and personal integrity. Not a minor issue.
I did not know then, but know now, that no human being refused the credit card to me, but an algorithm. Actually, at one level, it does not matter, because it is the same act of refusal, and even being refused by an algorithm does hurt, almost the same way. But what the example also shows is that the algorithm was of course stupid, as it rejected a customer and thus caused a lost business even to the company. Had I received the credit card, I would have used it amply, and I suppose Ryanair was offering credit cards to make money, and not as an act of charity. Of course, all algorithms are stupid, and the cleverer they seem to be, the more stupid they are, because they always ignore concrete persons, and go by some general rule (not principle, in the proper sense of “principle”, connected to Greek arkhé). In my case, the reason might have been that in its infinite wisdom, the algorithm realised that my name starts with “Sz”, and perhaps too many persons whose names started with these letters came to work at that moment in Ireland, and perhaps not all of them paid their credit card bills. This of course is just a guess, but as good a guess as any, as given my status and salary there was no reason to deny me a credit card – and the example is also perfect to illustrate how computer smartness indicates profound absurdity, as computers indeed can recognise all kind of patterns – but such patterns can be completely meaningless, and so basing judgments on them is simply absurd.
My second encounter with the changed practice of banking goes back to about 2010. Again, I was asking a certain reorganisation of a personal loan – nothing even near declaring me insolvent, just a kind of readjustment of the conditions in a particular situation which I asked before and was met without a question; but now received an answer that was actually simply personally rude – I was so shocked that could not even respond properly. I was later told by local banking people that that person was not part of the branch, just sent there centrally, in order to “sort out” matters there.
Making some investigations, and thinking, I managed to realise what was going on. Before the 2008 crash, as it is of course well known, banks made all kinds of bad loans during the boom years, in Ireland as elsewhere. As the story then went, if you asked a bank 200,000 euros, they threw a million after you, as part of the overall excess. Needless to say, these were not the “local” banks, based on their “personal” knowledge and connections, that started and kept spinning this practice, but this was the mood everywhere, instigated from the centre, and span further by the various media outletsand corridor talks – don’t let the opportunity pass, make as much money as possible, you cannot go wrong. But then, when the inevitable collapse came, these same centres, and spin-doctors, used the opportunity to clamp down on local offices, inaugurating a new regime where all decision-making was taken from local offices into the centre, and even there entrusted increasingly to algorithms that were programmed, again, according to the logic of “international best practice” – or worse practice possible. And, of course, beyond such intra-banking changes, it went together with blaming us, simple people taking out loans, of being irresponsible – in spite of the fact that of course I never missed any of my loan or mortgage payments. But I was no longer a Professor, or a concrete person with a given status, just one of “them” – a customer, a loan-taker, a debtor: an idiot. Sovietisation or Byzantinisation (two phenomena that are so much connected) was already under way, way before the current lockdown.[5]
Step by step I learned the lesson, had to learn it, that even in Ireland the human person no longer counts, was just a medieval survival; one must learn the rules of the game, and this is to gain knowledge about how the algorithm works. This is not an easy matter, as of course nobody tells this to you – as such algorithms are only efficient if they are secret. We, all of us, today, in the so-called liberal democracies, are controlled up to the minute details of our daily lives by algorithms which observe us, collect information on us, even make vital decisions about us, and we neither know about their existence nor do know how they actually work – and supposedly this is all right, even very “liberal” and “democratic”! At least, under Communist countries we knew that the secret police existed, and even knew, more or less exactly, what they were interested in and why. What this means is that you just do things you think are right – making credit card purchases that you repay as you need; making changes in your loan or credit card use as you think best; use the overdraft you were granted as you think proper; but then the time comes when you apply for a loan, or a change in your credit terms, and the algorithm will say: no, as you did not behave “properly” – though you had no clue about such “misbehaving”. Again, not that you made obvious mistakes, not making a payment or meeting a monthly installation; just that your “spending behaviour” was adjudicated by the algorithm as not simply improper but as “risky” – as compared to “others” (a very democratic word!), by a “proxy” variable: a crucial term in mathematical statistics, or survey analysis, by which not a concrete person or practice is analysed, but the “data” are adjudicated by their similarity to others, in terms of “risks”, and their “prevention”. And you cannot do anything, as you did not supposedly break any law or clear rule, where you can defend yourself saying that you did not do so, just were judged solely by “algorithms”, taking into consideration the “others”, through probability calculations.
With such practice, only one thing can be done: fully in line with European or Western culture, and its constitutional laws, they should be rendered unconstitutional as inhuman. Before it is too late – though perhaps, it already is. So, to repeat and make it crystal clear – I call for a systematic and unconditional ban on any algorithms that are used to make automated decisions or judgments over any person or any human practice. Full stop.
That this is a genuine issue of life and death, we can see by turning to the use of algorithms in medicine, or in judging matters of health. Again, only the surface will be scratched, by personal experiences – but these make enough things visible.
Medicine
Depersonalisation in matters of health through the using of algorithms and statistical data goes back way before the current COVID related measures and – not getting involved in distant origins here – are central to what is usually called as neoliberal managerialism (I call it as equivalent to Brussels-style Europeanisation or Asiatic Sovietisation). One central aspect of such developments was the closing of local hospitals. Here again I am relying on personal experiences, both in Cork and in Florence, where the closing of local hospitals goes back at least to the 1990s. Thus, in Cork, around 2000 we several times – no joke! – had to carry pregnant women into Cork University hospital from West Cork, interrupting our weekend or holiday trips, as local hospitals or emergency rooms were closed down, while public transport was similarly non-accessible or inexistent. In Italy, our fifth son was supposed to be born near our then home in 1996, in the hospital of Fiesole that was within walking distance, except that a few months before it had similarly been closed down – so we had to use the “nearest” hospital that was a good half an hour car ride, except that it was also near to one of the busiest traffic junctures in the city, beyond the exit of the main interregional highway. The reason for such changes were of course monetary or budgetary, supposedly in our best interests, as the most advanced technologies cost a fortune, and could not be afforded by small local hospitals. However, such technologies are only required in most exceptional cases, while the closing of local hospitals affects routinely everyone living in the area – and at any rate such matters cannot be dealt with through probability calculus on human lives. We can easily imagine the harm that was done to those pregnant women in Ireland who were forced to chase cars alongside the road to carry them into the local centre (a car ride near or over an hour), so that they would not have to give birth alongside the road. But even in our much less serious case, instead of walking into the hospital in Fiesole, or taking a short ride, we repeatedly had to cross the greatest possible traffic in Florence, with my wife due at any minute. And the threat to such hospitals is by no means over: when my wife broke a wrist in the Apennines in 2018, she was healed in a local hospital, in Pavullo, in an at once most personal and efficient way, in a small hospital in a small town that is not missing anything, at least in the 99,9% of the cases, and was friendly and personal in a way that in Florence (not to mention Milan or London) is unimaginable, but recently we have heard that the hospital is again on the brink of being closed down.
The central issue is very simple: if there is a hospital somewhere, that is part of local services and local culture, with competent doctors, nurses, decent services, etc., then to close it down solely due to financial reasons is simply a criminal act. If a private firm would build a hospital somewhere, and then would close down the nearest hospitals as threatening competitors, that would be rightly prosecuted as placing private gain in front of public interests. But the state, as a state, can get away with it? Evidently so. And this is a very serious issue.
Moving further alongside the same theme, one of the contemporary buzzwords is “evidence-based medicine”. The nonsensicality of such an expression is evident, as this makes it sound as if previously, or in any “normal” time and place the curing of the sick were not based on some “evidence”. Of course, what it really means is that this slogan is part of an effort to eliminate and destroy the personal and experiential content and context of health and medicine – knowledge which is based on the concrete knowledge accumulated by concrete doctors about their patients, and to replace this by excessive statistical generalisations and universalisations where all matters of context are systematically eliminated.
Here again, I can convey the points through some personal experiences. The first concerns the birth of our third son – of all places, in London, in 1990. Encountering the NHS in the last year under Margaret Thatcher’s rule was an unforgettable experience in many senses, which I cannot treat here in any detail. Only one instance will be mentioned, related to the first check-up visit at the local NHS clinic after our son was born.
When the doctor called out our name, I was alone in the waiting room, as the waiting time – as usual – was too long, and the baby – as it is only natural – was crying too much, so my wife went out with him for a walk. I ran to the doctor (who happened to be a relatively young woman, maybe around 40) and told her that I go immediately to fetch the baby, but she reassured me that it is not necessary: all the analyses were done, the data are there, it is completely irrelevant for her to see the child. I could hardly believe my ears, as this was my first encounter with the would-be “evidence-based medicine”; but you should have seen my wife when she returned and learned that the doctor did not want to see our child: what kind of doctor is that does not even want to see a baby?
The second story goes back to about a decade earlier and was told to me by my Indian friend who was on the same economics PhD programme in Austin, Texas. A friend of his broke his left shoulder and was flown to Atlanta, GA, in order to have it operated. He found it most peculiar, and when there asked the doctor, ironically, whether to have operated on the right shoulder he would have been sent to another hospital in Atlanta. The doctor responded, without any sense of humour: no, he would have to fly to Seattle (or something like that). His friend conveyed that at that point he completely lost any faith in Western Civilisation. That reaction might have been exaggerated, but it still uneasily recalls a quip by Mahatma Gandhi:
Question to Gandhi: What do you think of Western Civilisation?
Answer by Gandhi: I think that would be a very good idea.
The corollary is just as clear, unreserved and self-asserting as in the case of banking algorithms: evidence-based medicine is wrong and dehumanising. One might object that, not being a medic, I have no business, even right, to make such a claim; however, evidence-based medicine is not based on medical but statistical knowledge, and I have my credentials in mathematical statistics. I was trained as an econometrician and mathematical economist, having graduated from the high school in Hungary with the highest reputation in mathematics teaching (year by year our school prided itself in winning numerous medals in the high-school mathematical Olympic games), eventually gaining a PhD at the University of Texas at Austin, until I gave up this profession as found it unacceptable and dehumanising, and contributing to further dehumanisation. Furthermore, I was member of the research group at the Institute of Sociology, Hungarian Academy of Sciences that pursued as its vocation to bring the most advanced statistical and other methods of Western survey research into Hungary – until I found it also unacceptable and dehumanising. I came to recognise, and later obtained further support from etymology and semantics, that statistics, as its name says, is indeed a science of the “state”, even more directly of “reason of state”, and does nothing else – as Michel Foucault and Giorgio Agamben argue so powerfully, and so close to Voegelin’s concerns with modern Gnosticism – than, as instrument of a “bio-politics”, reducing everything that is the most specific and dear to us to measurable and quantifiable, meaningless and quality-less cases alongside general variables.[6] It might, within certain limits, keep us alive longer, but deprives us of the very conditions of possibility of a meaningful, good life.
As it was argued by Agnes Horvath in his 13 October 2021 article in VoegelinView, the “mind-building potentates” of our world aim not at a good life, only a life spent in pursuit of sensuals that can be amplified through technologically produced copy-images: phantasms of the imagination which can be extended and recycled up to infinity; an artificially maintained substitute living. A clear sign of this is the sky-rocketing obesity rates all around the “Western” world, but especially the US: one of many revealing symptoms of a world obsessed by eliminating “risks” to health and well-being, but forgetting completely what it means to live well. What this indicates is that, tragically, our rulers are pursuing a technologized dystopia in which a concern with real beings are replaced by making decisions on the basis of statistical numbers which only deal with faceless generalities and anyway are often manipulated.
It is very important to spell out, as clearly as possible, what is wrong with something like “evidence-based medicine”, as it is meant and practiced today, by politicians, policy makers, experts, and all sort of decision-makers. The central issue that health is a crucial and intimate matter for the concrete human person, belonging to or having to do with the core of the personality, and this simply cannot be reduced, perceived and assessed from an external perspective. Health, as its etymology shows, is about wholeness, whether in English (health = “wholeth”), Latin (sano, “intact”, see “sanity”), or Hungarian (egészség, egész = whole), and not the sum total of various sundry indicators. In this sense, it is all but identical to happiness: whether a person is happy or not cannot be seen from the outside, often the person himself does not explicitly “know” this, as just as health is – in a memorable definition taken up by Georges Canguilhem – the “silence of the organs”, happiness is the absence of those troublesome worries that are the sign of unhappiness. Sociological surveys, consequently, since forever and hopelessly try to measure “objectively” the happiness of various “populations”, but only come up with nonsensical reproductions of stereotypes in which people (mis)represent themselves, thus showing that Nordic people, especially Danes, are way happier than Southerners like Italians – at least, according to what they reveal to the conductors of surveys. It is of capital importance that the entire utilitarian philosophy, symptom and cause at the same time of what is wrong with modernity today, back to Bentham, is based on the ludicrous idea of promoting the “greatest happiness of the greatest numbers, or “making people happy”, the reason why utopias and dystopias are so close mirrors of each other, just as the current “biopolitical” regimes are based on the similarly ludicrous idea of “making everybody healthy”; a concern that, as Foucault has shown in the article I mentioned in note 6, returns to the 18th century, and well before the French Revolution and Bentham.
Health as an intimate personal matter is different from privacy, which is just a legal concern, and thus can be dealt with through legalistic tinkering, as it is done today by forcing a meaningless agreement with whatever the search engines of various sites are doing. Health, in contrast, is profoundly personal – this is the meaning of the position of Georges Canguilhem (1978), one of the most important historians and philosophers of the life sciences, according to whom health is simply a matter of a concrete organism and cannot be assessed by externally imposed norms. Statistics offer important tools for diagnosis, to be sure, nobody questions that, but to reduce the concrete person to a simple case within the realm of a totality of measures is, first, an offense against the concreteness of that person, thus by extension a crime against humanity; and second, is bound not to work: it imposes the law of large numbers at the very heart of the personality, its “wholeness”, or health, and each of us in some of other measure will always be outside the norm as defined by statistical average, and thus our wholeness, and personality, will be slowly but steadily eroded, diminished, clipped away. Today it is for me, tomorrow it is for you, and eventually for all of us: we’ll all be streamlined, reduced, forced into a numerical average, deprived of our essence, our essential humanity. The salami tactics, first experimented with by Mao Zedong, by our days, with “evidence-based medicine” and the like, is becoming the standard stock of modern Western liberal democratic politics and policy making. Such externalisation is an error and even a crime, as it is an attempt to do away with integrity, wholeness, and presence, which is a main problem with modern politics in general, as it is argued in her recent monograph by Franziska Hoppen (2021), who was a student of Stefan Rossbach, and as it is also emphasised by Evan Boyle (2021) in his review.
But there is a second, even more pernicious level, of “evidence-based medicine”, where the concrete person oneself is encouraged to assess his or her own health through such externalised measures, and actually does so. What this means is an interference with the most internal, self-evident and natural processes of the human body and the soul, as a result of which that person indeed loses his wholeness, the ability of his body and soul to make the right decisions, becoming permanently at the mercy of doctors or other advisors of bodily, mental or spiritual health. Thus, the body of any normal person, in any culture, knows what he or she needs to eat. But the moment one tries to follow the medical prescription of eating, say, 2500 calories per day, and so carefully measures every bit of food taken in, making a record of it, and keeping “methodically” to it, fully following the logic of “evidence-based medicine”, that person will certainly not only be forever dependent on continuous medical advice, but will regularly fall ill. The reason for such measures, of course, is that commercials and other tricks of the modern propaganda machines interfered so much with the will and reason of individuals that they have lost their capacity to care for and govern properly themselves. The circle is thus closed by doctors and medics being accomplices to the systematic abuses proliferated by the economy and the public arena.
Far from to be praised as a key achievement of civilisation, another victory of modern science, evidence-based medicine should also be discarded.
References
Boyle, Evan (2021) ‘Franziska Hoppen, Liminality and the Philosophy of Presence: A Book Review, International Political Anthropology 14, 2: 3-24.
Canguilhem, Georges (1978) On the Normal and the Pathological, Dordrecht: Reidel.
Foucault, Michel (1980) Power/ Knowledge: Selected interviews and Other Writings by Michel Foucault, 1972–1977, ed. Colin Gordon, Sussex: Harvester.
____ (1981) ‘Omnes et Singulatim: Towards a criticism of “political reason” ‘, in S.M. McMurrin (ed.), The Tanner Lectures on Human Values, Salt Lake City: The University of Utah Press.
____ (1994) Dits et écrits 1954-1988, 4 vol-s, Paris: Gallimard.
Hennis, Wilhelm (1988) Max Weber: Essays in Reconstruction, London: Allen & Unwin.
Hoppen, Franziska (2021) Liminality and the Philosophy of Presence: A new direction in political theory, London: Routledge.
Szakolczai, Arpad (2000) Reflexive Historical Sociology, London: Routledge.
Szakolczai, Arpad (2021) ‘Eric Voegelin’s Readings of Max Weber: Struggling with the Grip of Scientistic Rationalism’, in Bernat Torres Morales & Josep Monserrat (eds) Eric Voegelin’s Political Readings, London: Routledge.
[1] Wilhelm Hennis was the first German student who visited Voegelin in the US after WWII, around 1950. Unfortunately, this was just the moment when, influenced by Leo Strauss (for further details, see Szakolczai 2000: 58-9), Voegelin developed a rather negative position on Weber, so Hennis (1988: 198-9) would consider Voegelin only as one of the main persons who ‘withdrew’ from Weber.
[2] It is by no means accidental that the two worst COVID medical police regimes in Europe, Italy and France, are both led by former bankers.
[3] Anecdotes, to repeat myself (see Szakolczai 2021: 85) are crucial tools in the sociology of knowledge and political sociology, with their own methodological importance. My colleague and friend, and pioneer of the political sociology of Ireland, Paddy O’Carroll (1937-2015) used to teach his course on political sociology much through anecdotes. While there were dissenters, indoctrinated by ruling ideas about ‘rigorous’ political ‘theory’ and ‘empirical’ sociology, most students hardly could wait for a week to hear again his lectures or seminars, and profited immensely. Coincidentally for VoegelinView, Paddy O’Carroll did his PhD at Louisiana State University, under Gottfried von Haberler, a Weberian sociologist, the same person who invited Voegelin in 1941 at LSU.
[4] This article, to repeat again, is based, and can only be based, on personal experiences. It would certainly be important to conduct research on current banking practices, demonstrating plainly why and how they are wrong. I hope somebody reading this article indeed would take up such a task. The aim of the articles I’m writing for VoegelinView is to make people realise what is currently going on, unquestioned and unrealised, in the name of ‘technological progress’ and the like, and to help promote thinking and research in that direction. More I cannot do.
[5] Giorgio Agamben, in a 7 October 2021 intervention before Commission on Constitutional Affairs of the Italian Senate on the “Green Pass” argued that the current Italian (and by implication other similar) legislations on “Green Pass” place citizens in a condition that is without parallel even as compared to the Soviet Union. See https://www.nicolaporro.it/agamben-al-senato-green-pass-peggio-dellunione-sovietica/, accessed on 30 October 2021. A partial Italian translation is published in the Introduction to the November 2021 issue of International Political Anthropology.
[6] See Foucault’s 1979 article on “The Politics of Health in the Eighteenth Century”. This article was first published in 1976, in a collective volume with the stunning title “Les Machines à guérir” (Healing Machines), and translated into English in the Power/Knowledge collection edited by Colin Gordon. However, for the 1979 Belgian edition of the collective volume Foucault substantially re-drafted his article, which contains, among others, the following crucial passages: beyond curing the sick or taking care of the poor, the new objective of the hospitals was to prevent illness; for this reason the interventions were concerned with the ‘conditions and modes of living’; and most importantly, it implied ‘an at least partial integration of medical practice to economic and political management, aiming at the rationalisation of society [qui vise à rationaliser la société]’ (Foucault 1994, III: 727). Or, as Foucault also added later in the same article, specific reactions to illnesses were integrated ‘to a control of the forms of existence and co-existence’, implying a certain administrative medicalisation which was explicitly aimed at the well-being and health of a population (III: 731), or a kind of secular salvationism. This analysis opens directly towards Foucault’s most important 1979 Stanford lectures on police and reason of state, published first in 1981, where this secular salvationism would be defined as a ‘pastoral power’, and which Paul Caringella attended at Voegelin’s request, who could not be present as being indisposed.
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