Abstract
That medicine is political, and that governments shape healthcare, are familiar claims. This article advances a stronger one: the political organization of a society helps determine what medicine can understand health to be, what it recognizes as a medical problem, and what kinds of intervention can count as healing. Michel Foucault came close to this argument in his 1974 lecture on the birth of social medicine, where he linked German state medicine, French urban medicine, and English labour-force medicine to differences in state formation, urban authority, and private property. He historicized medical power without theorizing the political variability of medical ontology, and the scholarship that applies his work to modern medicine has mostly used biopower to reveal medicalization, the extension of medical power into new realms of life. This article starts from a different premise: life has been comprehensively medicalized for centuries, and what varies is the political shape of medical recognition and restraint. Distinguishing medical ontology, medical jurisdiction, and medical practice, and analysing regimes through jurisdiction, capacity, legitimacy, and accountability, the article compares eighteenth-century medical police, Virchow’s social medicine, Myanmar under military rule, Mao-era schistosomiasis campaigns, and contemporary liberal medicine. Myanmar is the decisive case: the same regime represented drug elimination as the reorganization of agriculture, infrastructure, and livelihoods while suppressing the recognition of depression, which implicated the state. Political authority selectively expands and contracts medical recognition according to what particular diagnoses mean for that authority, and a theory that looks only for the expansion of medicine cannot register either the suppression of a diagnosis or the explicit self-limitation of liberal medicine, which the biopsychosocial model articulates. Living Value Theory provides a way to ask which forms of healing a political order can recognize, pursue, sustain, or obstruct, and why healing cannot be commanded.
I. Introduction: Does Political Power Determine What Healing Can Mean?
The Drug Elimination Museum in Yangon occupies more than fourteen thousand square metres on the northern edge of the city. Visitors pass planes once used to bomb opium fields, life-sized dioramas of addiction and rehabilitation, and a button that incinerates seized drugs. Glass cases labelled “psychotropic drugs” display packets of amitriptyline, alprazolam, diazepam, fluoxetine, and sertraline, as if antidepressants belonged with heroin. Yet the exhibition’s account of how drugs are to be eliminated reaches far beyond seizure and treatment. It presents pig farms for alternative income in Shan State, mushroom cultivation as a substitute crop, roads into the hills, industrial development, and the reintegration of farmers and users into national life (Ecks 2025). Drug elimination appears as the reorganization of how people grow food, keep animals, travel, earn, and live together.
The case is unsettling. A military dictatorship, which one might expect to treat patients purely as objects of coercion, articulates an unusually expansive understanding of the conditions involved in removing a health problem, and leaves none of its supposed causes outside the field of intervention. Liberal-democratic medical institutions, meanwhile, increasingly acknowledge the social determinants of health, yet the physicians who invoke them rarely have authority to alter housing, employment, land tenure, infrastructure, or the distribution of income. The contrast raises a question: could the boundaries of what medicine recognizes as health and healing be shaped by the boundaries of politically permissible intervention?
The comparison must be qualified at once. The museum represents a state’s official programme and legitimating narrative, and it proves nothing about what the programme achieved. Myanmar’s military has been deeply implicated in the narcotics economy it claims to eliminate, and the museum can be dismissed as propaganda. Its understanding of what must change may be extensive even where its interventions were coercive, unsuccessful, or harmful. The question concerns what the state could present as belonging together in a single project of healing, and why.
Three distinctions govern the argument. Medical ontology is what health, illness, and healing are understood to consist of. Medical jurisdiction is which parts of living conditions medicine and its associated authorities may legitimately intervene in. Medical practice is what interventions actually take place and what they accomplish. The three are analytically distinct and historically intertwined.
These distinctions set the argument apart from the way Foucault is usually brought to bear on medicine. From Irving Zola’s account of medicine as an institution of social control and Ivan Illich’s medicalization of life to Peter Conrad’s studies of medicalization, David Armstrong’s surveillance medicine, and Nikolas Rose’s analyses of the psy disciplines and advanced liberal government, critical scholarship has largely set out to reveal what medicine actually does beneath what it says it does, and what it has revealed is expansion: medicine absorbing domains of life that once lay outside it (Zola 1972; Illich 1976; Conrad 2007; Armstrong 1995; Rose 1996, 1999). This article starts elsewhere. Medical intervention into life has always been there, and life has been massively medicalized for centuries. Eighteenth-century medical police regulated marriage, childbirth, food, schools, and housing; urban medicine demolished houses and removed cemeteries; Poor Law medicine compelled the poor to be inspected and vaccinated. The question is therefore less whether medicine expands than how political orders shape what medicine may recognize and what it may change, including the cases in which recognition contracts. And medical models can be understood without being unmasked, since they are explicit articulations of what medicine is and may do, institutionally stabilized and taught, and their claims about the scope of medicine can be read directly. The hypothesis of this article is that political organization helps constitute medical ontology, partly through its effects on jurisdiction and practice. The argument proceeds through Foucault’s account of biopower, through a proposed mechanism linking political arrangements to medical concepts, and through a series of comparisons: eighteenth-century medical police, Rudolf Virchow’s social medicine, Myanmar under military rule, Mao-era public health campaigns, and the biopsychosocial and social-determinants models of contemporary liberal medicine.
II. Foucault’s Biopower: What the History of Medicalization Explains and What It Does Not
A. From sovereignty to biopolitics
Foucault identified a transformation in the political significance of life. For a long time, he wrote, the characteristic privilege of sovereign power had been the right to decide life and death, which was in reality “the right to take life or let live” (Foucault 1978, 136). From the seventeenth century this right was overlaid by a power “that exerts a positive influence on life, that endeavors to administer, optimize, and multiply it, subjecting it to precise controls and comprehensive regulations” (137). “One might say that the ancient right to take life or let live was replaced by a power to foster life or disallow it to the point of death” (138). The new power developed around two poles: the disciplines of the individual body, “an anatomo-politics of the human body”, and the regulation of the species body, its births, mortality, level of health, and longevity, through “an entire series of interventions and regulatory controls: a bio-politics of the population” (139). The result was “nothing less than the entry of life into history”, and a threshold of modernity at which “modern man is an animal whose politics places his existence as a living being in question” (141–43).
In Society Must Be Defended, Foucault distinguished disciplinary techniques directed at individual bodies from regulatory mechanisms directed at populations, and described the new right as the power “to make live and to let die” (Foucault 2003, 241). In Security, Territory, Population he set sovereignty, discipline, and security side by side, and insisted that they are not successive ages in which each new form abolishes the last; the mechanisms combine and are reorganized over time (Foucault 2007, 8). In The Birth of Biopolitics he turned to liberal and neoliberal governmental rationalities, which complicates any claim that he ignored differences among political orders (Foucault 2008). The criticism developed here therefore cannot be that Foucault offered a simple chronology, or that he overlooked politics. It concerns what his categories allow him to distinguish and what they leave undifferentiated.
B. The overlooked significance of “The Birth of Social Medicine”
The lecture Foucault gave in Rio de Janeiro in October 1974 comes closest to the argument of this article, and it deserves to be taken seriously. Foucault rejected the view that modern medicine became individualistic with capitalism: “Modern medicine is a social medicine whose basis is a certain technology of the social body” (Foucault 2000, 136). For capitalist society, “the body is a biopolitical reality; medicine is a biopolitical strategy” (137). He then reconstructed three historically distinct forms.
German state medicine developed in the eighteenth century in a fragmented territory of small states, in which a science of the state and an administrative class formed before either political power or economic development. Medical police, Medizinischepolizei, implied much more than a census of births and deaths: a system of observing sickness, the standardization of medical education and practice, a central administrative office supervising physicians, and medical officers appointed for districts of six to ten thousand inhabitants. “The doctor was the first standardized individual in Germany”, and the doctor “appeared as a health administrator”. This medicine was directed less at workers’ bodies than at “the bodies of individuals insofar as they combined to constitute the state” (140–41).
French urban medicine arose instead from the need to unify the fragmented jurisdictions of the eighteenth-century city, where seigneurial authorities, the Church, religious communities, guilds, and royal officials held overlapping powers. It took the plague quarantine as its model and set itself three objectives: to analyse the zones of accumulation and danger in the city, removing cemeteries and slaughterhouses to the periphery; to control the circulation of water and air; and to organize the distribution of fountains, sewers, pumps, and washhouses. Urban medicine, he wrote, “is not really a medicine of man, the body, and the organism but a medicine of things”, of air, water, decompositions, and fermentations; “it is a medicine of the living conditions of the existential milieu” (150). Its key concept, salubrity, “did not mean the same thing as health; rather, it referred to the state of the environment and those factors of it which made the improvement of health possible” (150). And its authority was bounded. Until the end of the eighteenth century, the state claimed ownership of the subsoil but not of the surface; public spaces could be controlled, private houses could not. “The problem of private property, a sacred principle, kept this medicine from being endowed with a strong authority” (151).
English labour-force medicine came last. Under the Poor Law, the poor received medical assistance and were subjected to medical control, establishing “an officially sanctioned sanitary cordon between the rich and the poor” (153). From 1875 the health offices of John Simon’s system controlled vaccination, recorded epidemics, and located and destroyed unhealthy places. These controls provoked resistance. Foucault noted the small-scale antimedical insurrections against compulsory vaccination in late nineteenth-century England, and the dissident religious groups that asserted “the right to life, the right to get sick, to care for oneself and to die in the manner one wished”; he read the mass pilgrimages to Lourdes as a muddled resistance to the obligatory medicalization of poor people’s bodies (154–55). The result, Foucault argued, was three superimposed medical systems, welfare medicine for the poor, administrative medicine for general problems, and private medicine for those who could pay, which the Beveridge Plan and the health systems of wealthy countries continued to combine (155–56).
This is a comparative history of medicine organized by political structure. Foucault linked each form of medicine to state formation, urban jurisdiction, industrialization, and property rights, and he explicitly connected the content of medicine to the authority available to it. The distinction between salubrity and health is itself a jurisdictional boundary drawn inside medical ontology. And the resistance he describes shows that accountability, in the form of refusal, protest, and flight, also shaped what each system could do.
C. The analytic limitation
Three limits nonetheless remain. First, Foucault’s guiding question is how medicine becomes a technique of government. He asks how the state, the city, and the poor became objects of medicalization, rather than how different political arrangements shape competing conceptions of what health and healing are. His own observation that urban medicine was “a medicine of things” invites a further question that he does not pursue: what happens to the concept of health when medicine’s jurisdiction stops at the threshold of a private house?
Second, sovereignty, discipline, and security are mechanisms of power, and they do not amount to a classification of actually existing regimes. Constitutional democracy, absolute monarchy, military dictatorship, and the socialist party-state each combine these mechanisms, and none can be read off them.
Third, the category of biopower does not separate interventions that suppress or control life from interventions that sustain, restore, or expand living possibilities. An intervention into housing may normalize conduct, prevent infection, dominate a population, improve everyday life materially, or do several of these at once. Foucault’s own lecture supplies an example. He reports that eighteenth-century calculations credited the demolition of three houses on the Pont-Neuf, which were thought to block the circulation of air, with saving four hundred lives a year (148). The demolition was an exercise of power over property and over the people who lived in those houses, and it was also, on its own terms, a measure to preserve life. Whether it improved anyone’s living conditions depends on what happened to the people displaced, to the air, and to the deaths it was supposed to prevent. The category of biopower establishes that power has taken life as its object; whether a given exercise of that power made anyone’s life go better is a question it leaves open.
D. The proposed extension
Foucault showed that medicine and power are historically intertwined. The next analytical task is to explain how different political arrangements make different conceptions and practices of healing possible, legitimate, impossible, or dangerous. This requires comparing regimes and their concrete interventions, rather than treating medicalization as a single historical process.
It also requires leaving behind an assumption that the literature applying Foucault to modern medicine has inherited without examination. To describe a doctor’s questions about a patient’s family, work, or housing as an intrusion of medicine into private life presupposes a private sphere that is naturally outside medicine. That sphere is a historical achievement of liberal sovereignty, secured by the same doctrines of property, privacy, and individual right that, as Foucault noticed, kept French urban medicine at the threshold of the house. The medicalization critique measures medicine against a boundary that liberalism drew, and then reads every crossing of that boundary as an expansion of power. It thereby takes as its baseline the political order whose effects on medical ontology need explaining.
A theory that looks only for the expansion of medical power cannot see its contraction. Political power can produce demedicalization as readily as medicalization, and the absence of a diagnosis may be as politically produced as its proliferation. The Myanmar case examined below provides direct evidence of this. So does the self-limitation of liberal medicine itself, which the biopsychosocial model states openly and which a search for hidden expansion is bound to misread.
III. How Political Regimes Condition Medical Ontology: The Mechanism
A. The scope of political intervention
Political orders distribute authority over land, labour, families, movement, infrastructure, religious practice, economic organization, and the environment in different ways, and medicine develops within those arrangements. Where authorities can reorganize agriculture, relocate settlements, direct labour, or mandate changes to households, such transformations may enter the imaginable repertoire of health intervention. Where equivalent decisions belong to separate institutions, private owners, autonomous professions, courts, or citizens exercising protected liberties, medicine faces a different set of possibilities. No regime has unlimited capacity and none has none. What matters is the particular distribution of authority.
B. From practical possibility to medical concept
The proposed mechanism runs in five steps. A political order allocates powers of intervention across institutions. These arrangements establish which changes medical and public health actors can realistically pursue. Repeated practices then establish recognizable categories of intervention and success. Professional theories and institutions stabilize distinctions between medical, social, economic, and political problems. And these categories in turn shape what clinicians, researchers, governments, and patients recognize as legitimate healing.
The process is recursive. Medical knowledge can challenge political boundaries, creating demands for legislation, redistribution, or public investment, as Virchow’s case will show. The fourth step produces explicit medical models, which are ideologies in a precise sense: institutionally stabilized articulations of what medicine is and may do, written into curricula, guidelines, and definitions of competence. They require no unmasking, because their claims about the scope of medicine are part of what they say. The central theoretical claim is that the boundaries between medical and non-medical intervention are political achievements. They do not mark natural divisions within life. In the terms of Living Value Theory, they are classifications stabilized at the fourth level of recursivity, the level at which distinctions become institutional, and like all such classifications they can be reopened when the coordination they organize comes under strain.
C. Four political dimensions
A simple continuum from authoritarian to democratic cannot make the hypothesis testable. Four dimensions are needed. Jurisdiction concerns who may order changes to living conditions. Capacity concerns which changes can actually be implemented. Legitimacy concerns which interventions can be publicly justified as health measures. Accountability concerns who may challenge a diagnosis, an intervention, or a claim of success. A regime may possess extensive formal jurisdiction and little effective capacity. Another may possess excellent infrastructure and face constitutional constraints. A third may intervene without meaningful accountability, producing apparent achievements that no one can independently verify. Each combination conditions medical ontology differently.
D. The difference between understanding and doing
A physician may understand perfectly well that poverty contributes to tuberculosis while lacking any authority to address poverty. A state may intervene extensively in living conditions while holding an impoverished understanding of the problems it claims to solve. Ontological recognition and practical jurisdiction must therefore be kept apart. The hypothesis is that they shape each other over time, and identity between them is no part of it. Keeping them apart prevents the argument from collapsing into political determinism: medical ontology is conditioned by jurisdiction, and it also exceeds jurisdiction, which is precisely what allows medicine to become a demand for political change.
IV. Historical Comparisons: Medical Police, Liberal Limits, and Social Medicine
A. Medical police in eighteenth-century central Europe
Monarchy and feudalism must not be treated as interchangeable. A feudal order of overlapping jurisdictions, estates, ecclesiastical authorities, and local obligations differs fundamentally from a centralized administrative monarchy, and an absolute ruler might claim sweeping authority without the administrative means to implement a population-wide medical programme. The question is which kinds of political authority enabled which forms of medicine.
Johann Peter Frank’s System einer vollständigen medicinischen Polizey, whose first volume appeared in 1779, articulated the most expansive programme of the tradition (Frank 1779). Over its successive volumes it extended medical administration to marriage and procreation, pregnancy and childbirth, the rearing of children, schools, food and drink, clothing, housing, the cleanliness of streets, the prevention of accidents, and the burial of the dead. George Rosen showed how this conception of medical police grew out of cameralism, the science of administration in the German states, in which a large, healthy, and productive population was the foundation of the prince’s revenue and military strength (Rosen 1953). Health here was a responsibility of territorial administration that extended into the ordering of collective life, and its ontology was correspondingly broad: illness had causes in marriage customs, diets, and dwellings because the administration claimed authority over all of them.
The distinction between prescription and implementation is essential. Frank’s comprehensive programme does not show that any state implemented what he advocated, and Foucault himself noted that the German states were small, unstable, and economically weak. Medical police combined extensive claimed jurisdiction with limited capacity, and its expansive ontology owed as much to the cameralist imagination of government as to any administrative reality. Its significance lies in how it framed the remit of medicine: the broad conditions of life fell within the normative responsibilities of medical administration. Two centuries later the biopsychosocial model would represent the same conditions as dimensions that medicine must acknowledge within clinical understanding. One ideology tends towards encompassing intervention, the other towards encompassing recognition. The contrast is not one between authoritarianism and democracy. Patrick Carroll has shown that medical police was neither confined to continental absolutism nor absent from British public health, whose reformers knew and drew on its terms and practices (Carroll 2002), and Foucault himself observed that Chadwick drew on German methods (Foucault 2000, 153). The comparison is between doctrines of medical sovereignty, not sealed political civilizations.
B. Liberal political economy and the limits of intervention
The emerging liberal order changed the conditions of intervention. Private property, individual rights, markets, and limits on administrative discretion relocated authority over many conditions of health away from the state. The shift was never simply from social to individual medicine. Liberal states continued to build sewers, enforce vaccination, regulate housing, and clear slums, often compulsorily. What changed was how intervention had to be justified and where authority lay. Foucault’s observation that French urban medicine stopped at the surface of private property marks the point exactly. Medicine could act on the street, the cemetery, the river, and the air; within the house it could advise. The distinction between salubrity and health, between the conditions that make health possible and health itself, followed the line of jurisdiction.
The English sanitary movement shows how such limits can shape aetiology itself. Before Edwin Chadwick’s sanitary report of 1842, physicians such as William Pulteney Alison in Edinburgh argued that fever followed destitution, and that its remedy lay in adequate relief and wages. Chadwick, the architect of the New Poor Law, located the cause of fever in filth, decaying refuse, and foul air, and its remedy in drains, sewers, and piped water. Christopher Hamlin has shown how this narrowing turned public health away from questions of poverty and wages, which would have implicated the Poor Law and the labour market, towards engineering works that a liberal state could undertake without redistribution (Hamlin 1998). The sanitary idea saved many lives. It also defined the causes of disease in a way that matched what the state was prepared to change. Here the five steps of the mechanism can be followed in a single case: the political order allocated authority over sewers to local boards and kept wages outside public health; sanitary engineering became the recognized form of intervention; filth became the recognized cause; and a generation of physicians and officials learned to see fever as a problem of drainage.
C. Virchow as a complication
In 1848 the Prussian government sent the young pathologist Rudolf Virchow to investigate an epidemic of typhus in Upper Silesia, a region of impoverished Polish-speaking peasants. His report went far beyond medical treatment. Virchow concluded that the epidemic arose from poverty, hunger, ignorance, and political neglect, and his remedies were education, freedom, and prosperity, self-government, the separation of church and state, the use of the Polish language in schools and administration, agricultural reform, and what he called full and unlimited democracy (Virchow 1848; Taylor and Rieger 1985). In the journal he founded that year he wrote that medicine is a social science, and politics nothing but medicine on a large scale.
Virchow complicates any thesis that an expansive medical ontology belongs naturally to authoritarian systems. His report emerged under a Prussian monarchy, and he demanded democratic transformation rather than stronger paternalism. His case shows something more illuminating. Medicine can identify conditions of illness that exceed the interventions a political order permits, and it can thereby become a demand to transform that order. Virchow’s ontology outran his jurisdiction, and the gap became a political programme. The comparative hypothesis that emerges from these cases is that medical ontologies develop in encounters between existing political authority, material capacity, and efforts to expand or resist the jurisdiction of healing.
V. Myanmar: The Authoritarian Expansion and Suppression of Healing
A. The Drug Elimination Museum as a representation of total remediation
Myanmar provides the decisive test because a single political system contains both directions of the process. The museum presents drug use and production as embedded in agricultural livelihoods, in movement between upland and lowland regions, in infrastructure, in economic organization, in relations among ethnic groups, and in personal conduct. Its displays declare that drug use “threatens the entire Myanmar race”, attribute opium to British colonizers and the expansion of production to exiled Chinese and American actors, and set treatment and rehabilitation alongside pig farms, mushroom cultivation, transport roads, and industrial development (Ecks 2025). The medical problem is constructed as one that requires reorganization across living conditions: across human relations with plants and animals, across roads and markets, across the reintegration of growers and users.
In the terms of Living Value Theory, the museum represents a multimediation. It addresses multisensorial embodiment through treatment, multispecies being-with through the replacement of opium poppies by mushrooms and pigs, multimateriality through roads and industry, and multisymbolization through the narrative of national unity it tells. The regime presents health as irreducible to the dyad of prescriber and patient or of army and opium grower (Ecks 2025). Why should this set of transformations appear as a single project of eliminating drugs? The answer proposed here is that the regime’s claim to comprehensive authority over territory, livelihoods, and movement provides a setting in which agricultural reform, infrastructure, social reintegration, and treatment can be brought together as elements of one intervention. Its jurisdiction, as claimed, was total, and its ontology of drug use was correspondingly broad. None of this shows that the interventions were carried out, or that those carried out improved lives.
B. The suppression of depression
Within the same political system, psychiatric recognition moved in the opposite direction. The Ministry of Health’s report for 2014 to 2016 listed six people with depression per hundred thousand, a rate of 0.006 per cent against a global estimate of more than three per cent, without describing its method. A study of three community clinics in Yangon recorded roughly ten diagnoses of psychosis for every diagnosis of depression. Yangon had trained psychiatrists and affordable antidepressants, so neither a shortage of clinicians nor a lack of drugs explains the gap (Ecks 2025).
The psychiatrists interviewed during fieldwork before 2020 offered another explanation. One of them, here called Dr Htin, argued that psychosis and schizophrenia were treated as biological and therefore politically safe, while mood disorders were read as signs of political distress: “Schizophrenia is not ‘their fault’, but trauma, anxiety and depression are.” “The government psychiatrists are very afraid to talk about trauma, anxiety, and depression.” When he found depression among a fifth of four hundred medical staff in two Yangon clinics, a professor shouted, “That is not Myanmar result!”, and his application for research funding was rejected: “If you want to study depression, they will resist you.” Of the profession’s relationship to the regime he said: “So, the Myanmar psychiatrists are their army” (Ecks 2025). Another psychiatrist, Dr Zaw, said simply: “I have never seen anyone with severe depression.”
Here the state constricts a medical category instead of expanding it. Where a health problem could be assigned causes that served the regime’s claims, those causes could extend into agriculture and the economy. Where a diagnosis could expose state responsibility, the boundaries of recognized illness were drawn tightly. The two directions even meet in the same building. By displaying antidepressants and anxiolytics under the heading of “psychotropic drugs” alongside narcotics, the museum that represents drug elimination as the remaking of whole livelihoods also places the treatment of depression among the substances the nation must be protected from. Spatial arrangements tell a similar story. In 2000 the old mental hospital in Yangon was closed and a new one opened about thirty kilometres outside the city, a site that its psychiatrists described as letting patients enjoy the peace of the countryside and that staff could reach only by long daily journeys (Ecks 2025). Multimateriality, in the form of roads, buildings, and distances, can amplify one kind of healing and mute another. Whether either attribution is medically correct is a separate question. The political stakes helped determine which forms of medical explanation became institutionally permissible. The inversion of the familiar Western critique is striking: where critics of psychiatry in liberal societies warned that dissent could be pathologized, in Myanmar a pathology was refused recognition because it could be read as dissent.
C. One regime, two directions of medicalization
The juxtaposition is the article’s central empirical finding. The same regime represented drug elimination as requiring comprehensive social transformation while discouraging recognition of forms of suffering that implicated the state itself. Political regime type therefore does not produce a single expansive or restrictive medical ontology. Political organization provides opportunities and constraints that differ according to whether particular forms of medical recognition serve or threaten existing claims to authority.
This suggests a sharper generalization. The political constitution of healing involves the selective expansion and contraction of medical recognition and jurisdiction, according to the consequences of particular diagnoses and interventions for political authority. Drug use could be attributed to colonialism, foreign enemies, and underdevelopment, all of which the regime claimed to be overcoming, so its causes could be acknowledged as broadly as possible. Depression pointed to fear, violence, and poverty under military rule, so it had to be recognized as narrowly as possible, ideally not at all. That formulation is considerably more precise than the claim that authoritarian medicine is more holistic. It also shows why the medicalization paradigm is insufficient. A theory that reads the history of medicine as the progressive extension of medical power into life has no place for a regime that refuses a diagnosis because the diagnosis points back at the regime.
D. What would verify or refute the argument?
Evidence must be distinguished from representation. The museum documents official claims. The clinical interviews provide evidence about professional recognition and the reported political constraints on diagnosis, from an urban, educated, English-speaking group of respondents in Yangon. The official statistics are weak, and the claim of deliberate suppression rests largely on interviews and on documented research restrictions; how common depression actually is in Myanmar nobody knows (Ecks 2025). Demonstrating an institutionally enforced relationship between medical models and political intervention would require examining medical curricula, administrative orders, diagnostic practices, records of research censorship, public health programmes, and changes across political periods, from the quasi-civilian decade to the coup of 2021. The existing research supports an unusually strong hypothesis, and it does not yet amount to a demonstrated causal account of every link.
VI. Socialist Public Health: Healing as the Remaking of a Countryside
A. The campaigns against schistosomiasis
Mao-era China offers a second, contrasting case of a state bringing collective living arrangements within the remit of public health. The Patriotic Health Campaigns began in 1952, during the Korean War, when the government mobilized the population against flies, rats, and other carriers of disease in response to its accusations of American germ warfare, so that public health was framed from the outset as national defence and mass mobilization. Schistosomiasis, transmitted through freshwater snails in the rice-growing regions of the Yangtze basin, became the object of a mass campaign from the mid-1950s, folded into the Patriotic Health Campaigns and into the collectivization of rural life. The campaign joined treatment and health education to the burial of snails, the filling and reshaping of irrigation ditches, the management of water and night soil, and the reorganization of agricultural labour. Mao’s poem “Farewell to the God of Plague”, written in 1958 when one county was declared free of the disease, made the campaign a symbol of the revolutionary remaking of the countryside. Disease elimination was represented, and in part practised, as the transformation of an environment and of the collective that worked it.
B. Scope is not healing
The history of the campaign also shows how far political scope can diverge from effective healing. Miriam Gross’s archival study argues that the received account of the campaign’s success is mistaken (Gross 2016). Villagers and local cadres frequently did not support it; cadres whose pay depended on agricultural output saw snail control as a diversion of labour, and peasants sent to bury snails regarded the work as pointless without permanent control. The mass campaign collapsed when Mao’s cycles of mobilization waned, as after the Great Leap Forward, and the disease rebounded. Lasting results came later, during the Cultural Revolution, from the less celebrated treatment arm: fully subsidized treatment, delivered by barefoot doctors trained in what Gross calls grassroots science, working alongside urban physicians. Infections fell from more than ten million around 1949 to well below one million by the late 1970s.
Political capacity to intervene broadly is therefore distinct from effective healing. Centralized mobilization can produce recursive blockage: institutional imperatives to meet declared targets override reports that an intervention is failing, that harms are occurring, or that other arrangements are needed. A state that can order a countryside dug up can also prevent anyone from saying that the digging is not working. Accountability, the fourth political dimension, determines whether failure can enter the record.
C. Comparison with Myanmar
The two cases should not be merged into a single category of authoritarian medicine. China’s campaigns were embedded in collective agriculture and a socialist project of rural reconstruction, and they mobilized millions of people as participants, however reluctant. Myanmar’s museum represents a military state’s programme of narcotics control and national integration, presented to visitors rather than enacted through mass participation. They share the possibility of presenting health intervention as the restructuring of collective conditions. Their forms of organization, purposes, and practical effects differ, and that difference supports a comparative approach centred on concrete political arrangements rather than on regime labels.
VII. The Political Boundaries of Liberal Medicine
A. Engel’s biopsychosocial model as an articulation of limits
In 1977 George Engel argued that “the dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioral dimensions of illness”, and he proposed a biopsychosocial model to change medical research, education, and practice (Engel 1977). The significance of the intervention is beyond doubt. In practice the model came to organize multidisciplinary teams, psychosocial assessments, and referral pathways, through which clinicians record the psychological and social dimensions of a patient’s illness and pass them to other professionals. The Foucauldian literature has usually read it as an extension of the medical gaze into emotions, families, and ways of life. Measured against medical police or Poor Law medicine, the model shows the opposite tendency: an expansion of medical recognition combined with a contraction of medical jurisdiction.
Engel’s 1980 paper on the clinical application of the model makes this visible. It presents a hierarchy of natural systems running from subatomic particles, molecules, cells, tissues, organs, and the nervous system through the person, the two-person relationship, the family, the community, culture and subculture, and society and nation, up to the biosphere (Engel 1980). Engel was explicit that a patient’s illness could originate anywhere in the hierarchy and that the physician must understand the levels above the person in order to understand the patient. The physician’s action, however, is located at one level, the person, approached through the relationship between doctor and patient. Information travels up and down the diagram; authority does not. The diagram depicts a medicine whose ontology extends across nature and society and whose jurisdiction occupies a single node.
The model also expanded medicine’s claims in a particular direction. Engel feared that if psychiatry narrowed itself to brain disease, the problems of living that patients brought to doctors would pass to psychologists, social workers, and counsellors. Andrew Abbott has shown that professions define themselves through claims to jurisdiction over particular problems, won against neighbouring professions (Abbott 1988). The biopsychosocial model was in part a claim of this kind, enlarging medicine’s professional jurisdiction within the clinic. Professional jurisdiction in Abbott’s sense is distinct from political jurisdiction over the conditions of life, and the model left the latter untouched. It enlarged the problems medicine could claim to understand and manage, entirely on the side of the patient.
The three domains of the model trace the edges of medical jurisdiction under liberal institutions. Physicians possess clear authority over bodies and clinical treatment, while authority over employment, housing, schooling, transport, and economic organization lies elsewhere, and the social enters clinical medicine chiefly as something to be recognized, assessed, recorded, referred, or negotiated. The model is the explicit articulation of a biomedicine restricted by private property, individual rights, markets, and the separation of jurisdictions. This is a claim about the historical formation and institutional uses of the model, and it makes none about Engel’s personal motivations.
B. Social determinants without medical jurisdiction
The World Health Organization’s Commission on Social Determinants of Health makes the point more sharply. Its 2008 report, Closing the Gap in a Generation, declared that social injustice is killing people on a grand scale, and called for improving daily living conditions and for tackling the inequitable distribution of power, money, and resources (CSDH 2008). It would be wrong to accuse this literature of ignoring political and economic transformation. The more interesting question is why these conditions are conceived as determinants of health.
The formulation identifies conditions that affect health without bringing their transformation within medical authority. Responding to them depends on housing authorities, employers, finance ministries, schools, and political coalitions. Recognizing that housing matters for health is different from making the construction, allocation, and tenure of housing part of medical practice. Recognizing that insecure employment damages health is different from having authority to transform employment relations. The concept of a determinant may thus encode a particular division of responsibilities, in which medicine recognizes connections whose transformation belongs to other jurisdictions. Social prescribing in the English National Health Service illustrates the arrangement in miniature. A general practitioner who recognizes that a patient’s distress is bound up with isolation, debt, or poor housing can refer the patient to a link worker, who connects them to a walking group, a debt advice service, or a community garden. The recognition is medical; the remedy is a referral across the boundary of medical jurisdiction into voluntary and municipal services whose capacity medicine does not control. Health in All Policies, adopted under the Finnish presidency of the European Union in 2006 and promoted by the World Health Organization’s Helsinki Statement of 2013, extends the same arrangement to government as a whole: every ministry is asked to consider the health consequences of its decisions, while authority over housing, transport, labour, and finance stays with the ministries that already held it (WHO 2014). This may be part of why the social-determinants framework has become the dominant way of articulating the breadth of health under contemporary liberal governance: it lets medicine know everything that matters while doing only what it is authorized to do.
C. Liberal democracy is not an absence of expansive intervention
The obvious objection must be met directly. Liberal democracies have undertaken extensive reforms with profound consequences for health: public sanitation, social housing, workplace regulation, universal healthcare, vaccination, pollution control, and social insurance. Many of these were compulsory, and many involved large-scale alteration of material conditions. The difference cannot therefore be that democratic states are incapable of restructuring the conditions of health. It lies in the pathways through which restructuring becomes possible. Under constitutional democracy, interventions require legislation, budgets, administrative coordination, public justification, judicial scrutiny, and electoral accountability. These requirements constrain intervention, and they also enable public contestation, the correction of mistakes, the recognition of previously excluded suffering, and more durable commitments. Liberal-democratic institutions condition how comprehensive healing is conceptualized, divided among authorities, authorized, and practised. They do not prevent it.
D. The paradox
Contemporary liberal medicine may combine an exceptionally expansive understanding of the causes of illness with a comparatively restricted conception of its own legitimate jurisdiction. The result is a recurring tension between knowing what sustains health and being authorized to transform it. The biopsychosocial model and the social-determinants framework can be read as responses to that tension, as much as progressively more complete descriptions of a pre-existing reality. Myanmar suppressed a diagnosis that implicated the state; liberal medicine acknowledges determinants that implicate the state and assigns their transformation elsewhere. Both are political constitutions of healing, and neither is a neutral discovery. The medicalization critique and the biopsychosocial model, finally, share a premise from opposite sides. The critique treats the liberal division between medical and private life as the baseline against which medicine’s expansion is measured; the model crosses that division in knowledge and respects it in action. Neither asks how the division itself constitutes what medicine can profess health to be.
VIII. Living Value Theory: From Medicalized Life to the Political Possibilities of Healing
A. Healing as the restoration and transformation of living coordination
Living Value Theory treats life as recursive coordination mediated through five irreducible mediations: multisensorial embodiment, multispecies being-with, multiversal dwelling, multimateriality, and multisymbolization. Health and healing cannot be located exclusively in any one of them. Healing may involve bodily recovery, the restoration of shared activities, changes in the material environment, adjustments to seasons and landscapes, or transformations in symbolic recognition and institutional arrangements. The analytical point is not that every medical intervention must address all five. An adequate investigation cannot assume in advance that the relevant conditions of healing will fall inside the jurisdiction conventionally assigned to medicine. Foucault’s urban medicine was, in these terms, a medicine of multimateriality and dwelling: of drains, cemeteries, rivers, and air. Its jurisdictional limit at the private house was a limit on the mediations it could reach.
B. Medical models as mesocosmic formations
A diagnosis, treatment model, or public health programme is a historically situated way of coordinating interventions. It depends on medical professionals, legislation, material infrastructure, institutions, administrative categories, public expectations, and the actions of those seeking healing. Political regimes participate in these processes by enabling certain forms of coordination, stabilizing others, and obstructing still others. Medicine is therefore neither an autonomous science that subsequently enters politics nor an instrument imposed on passive populations. Its ontologies develop within concrete political and institutional arrangements that medical actors can also challenge, as Virchow did, and as the young researchers presenting studies of depression at a Yangon psychiatric congress in 2018 did in a quieter way (Ecks 2025).
C. Why healing cannot be commanded
Living Value Theory also distinguishes extensive intervention from effective healing. A regime can build roads, relocate populations, impose treatment, and compel agricultural change. These actions may substantially reorganize multimateriality and the use of land without improving the living coordination of those affected. People may resist, withdraw, conceal information, adapt in unintended ways, or suffer new forms of disruption. Healing involves nonrecursive, selfrecursive, and interrecursive counterparts at once. Commands, plans, and targets can reach the nonrecursive aspects of a situation: a ditch can be filled, a road paved, a crop replaced. The recursive aspects, the body’s own repair, the trust between patients and healers, the adjustments of households and villages, answer back to how they are engaged, and they cannot be ordered into existence. Whether a failed command can even be registered depends on accountability: where reports of failure are punished, failures leave no trace, and the record shows only the targets met. The Chinese campaign succeeded where it worked with these recursive aspects, through treatment, trained local health workers, and subsidized care, and faltered where it relied on command alone.
The limits of liberal medicine are therefore more than a defect. The right to refuse treatment, the privacy of the household, and the patient’s control over what a doctor may know restrict medical authority, and they also protect the recursive coordination on which healing depends. Foucault’s nineteenth-century dissidents, claiming the right to get sick and to care for themselves, defended exactly this. A medicine with unlimited sovereignty would be no guarantee of more healing. This is where Living Value Theory offers an alternative to treating every intervention into life primarily as an instance of biopower. An inquiry must ask what is being coordinated, which vital stakes are involved, whether coordination improves, whose lives are affected, and how the intervention changes the possibilities of future living.
D. The new comparative question
Instead of asking only how political power medicalizes populations, the comparative question becomes: which forms of healing can be recognized, pursued, sustained, contested, or obstructed under particular political arrangements? This makes differences among political systems empirically investigable without assuming that any one of them possesses a superior understanding of health.
IX. Conclusion: The Political Constitution of the Possible in Medicine
The Drug Elimination Museum in Yangon represents the elimination of drugs as the transformation of many conditions of life at once: crops, animals, roads, livelihoods, and the relations between growers, users, and the nation. The same political order constrained the recognition of psychiatric suffering that pointed back to itself, so that official statistics could report six cases of depression per hundred thousand people and a psychiatrist who found far more could be told that his result was not Myanmar’s. These two processes show why an account of medicine as a general technology of biopower, and of its history as one of ever-expanding medicalization, is insufficient on its own. Medicine has intervened in life for centuries. What needs explaining is the political shape of its recognition and its restraint. Political authority does more than produce more or less medicalization: it selectively enlarges or restricts the scope of medical recognition, reorganizes the jurisdiction of intervention, and determines which forms of suffering are politically acknowledgeable.
Eighteenth-century medical police, Virchow’s social medicine, Mao-era campaigns against schistosomiasis, the biopsychosocial model, and the social-determinants framework can all be reconsidered in this light. Each reflects a particular configuration of jurisdiction, capacity, legitimacy, and accountability, and each shaped what its medicine could understand health to be. The biopsychosocial model is the clearest articulation of the liberal configuration: a medicine that has learned to recognize nearly everything and to change very little beyond the patient. Two assumptions should be set aside: that medical science discovers its objects independently of political organization, and that political intervention into health is adequately understood as the exercise of domination. The first ignores how jurisdiction shapes ontology. The second cannot distinguish an intervention that improves living coordination from one that damages it.
The comparison also changes how liberal medicine looks. Its broad aetiologies and narrow jurisdiction are as much a political constitution of healing as the museum in Yangon, the medical police of the German states, or the campaigns along the Yangtze. Chadwick’s drains, Engel’s three domains, and the Commission’s determinants each drew the boundary of medicine where the authority available to medicine ended. The question that remains is the one Living Value Theory places at the centre of comparison: what forms of living coordination can a political order recognize as worth sustaining, and what forms of intervention can it permit in their name?
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