Of Shepherds, Sheep and Sheepdogs? Governing the Adherent Self through Complementary and Competing ‘Pastorates’

Abstract

Foucault’s concept of ‘pastoral power’ describes an important technique for constituting obedient subjects. Derived from his analysis of the Christian pastorate, he saw pastoral power as a prelude to contemporary technologies of governing ‘beyond the State’, where ‘experts’ shepherd self-governing subjects. However, the specific practices of modern pastorate have been little developed. This article examines the relational practices of pastoral power associated with the government of medicine use within the English healthcare system. The study shows how multiple pastors align their complementary and variegated practices to conduct behaviours, but also how pastors compete for legitimacy, and face resistance through the mobilisation of alternative discourses and the strategic exploitation of pastoral competition. The article offers a dynamic view of the modern pastorate within the contemporary assemblages of power.

Pastoral power and the promotion of self‐care

“…Waring and Latif's () study highlights how the variegation of the discursive field makes governmentality fragile. In my study, alternative subjectivities and ontologies of care were available to both staff and patients through socialisation into professional roles and enduring patterns of consultation.…”

“…Efforts to re-culture patients may also face resistance from patients themselves, as found by Waring and Latif (2017), or they may compete with alternative foundations for action, such as family roles or cultural heritage. An independent evaluation of the Expert Patient Programme found no effect on levels of service use (Gately et al 2007).…”

“…Self-care may bring benefits to both patients and professionals, but as a dimension of social policy it is utopian in the belief that re-culturing the public will significantly reduce demand on statutory services, and that organisations in local health and social care markets will respond to a reduction in demand by reducing supply and closing facilities so as to produce 'significant cost savings' (rather than, say, lowering access thresholds). Waring and Latif's (2017) study highlights how the variegation of the discursive field makes governmentality fragile. In my study, alternative subjectivities and ontologies of care were available to both staff and patients through socialisation into professional roles and enduring patterns of consultation.…”

“…Waring and Latif infer a considerable degree of strategic agency on the part of patients, for example, patients were seemingly aware of the difference in status between the GP and the pharmacist, and the competition between the two, and used this to enact their own influence. Both GPs and pharmacists appreciated the limits of their influence on patient behaviours, recognising that, as one respondent put it, ‘you can talk to them for half an hour, they'll do exactly what they want when they get back home’ (Waring and Latif : 17).…”

“… Abstract In many countries government policy is becoming increasingly reliant on citizens taking greater responsibility for their health and wellbeing and limiting their consumption of public services. In this paper I develop Foucauldian perspectives on the work required to create and maintain responsibilised subjects, focusing on the role of ‘pastors’ – specialists, experts and therapists who promote desirable subjectivities (Waring and Latif ). Drawing from ethnographic research, I consider how government policies for the promotion of self‐care within the English healthcare system not only place increased emphasis on patients taking responsibility for their own health and wellbeing, but also seek to constitute new pastoral subjectivities as responsible for conducting the conduct of patients.…”