The Danger of Being Seen, the Danger of Not Being Seen
Foucault, surveillance, and the case for visibility without degradation
Imagine a woman named Anna applying for disability assistance. Trying to describe her life, in which daily capabilities vary from day to day. She comes to the section about preparing meals. She recalls one day, when she cooked a meal after someone else had done the grocery shopping. She’d had the time to rest beforehand, and nobody had expected her to wash the dishes afterward, or get up in the morning and do it all over again before going to work. She felt good about herself. But in this questionnaire she also wants the reader to understand what a day like that actually involved. How she spent one afternoon doesn’t reflect her capabilities across a work week. To tell her story truthfully, she has to balance the accomplishment with its constraints. But the decision about her qualifications may rest on how well she conveys the constraints. So she second-guesses including the accomplishment at all.
Anna is awarded the assistance. She receives the help she needs and for that, she is grateful her file was convincing enough to make it possible. The problem starts when the part of her file that explains her limitations is later used to discredit her judgment about how she wants to live her life. She then needs to dispute the portion of her assessment that undermines her authority over her own life by treating her need for support as a reason to distrust that authority.
Now imagine Daniel, a man with a similarly variable condition, who receives no decision on his request for assistance. His files are a record of disjoint appointments in which he’s struggled to convey what happened between those meetings. He misses a request for additional information. Now he must account for why he missed the request, as well as provide the requested information, and the deadline looms while the workload associated with his claim continues to mount. The office may have a complete record of every letter it sent and every deadline he missed. But nobody has been asked to establish whether the condition for which Daniel is seeking assistance also made it difficult for him to respond. His file can then explain why the application was closed without explaining why he was left without assistance. He needs someone to assist him in completing a process whose demands have exceeded what he can manage.
Foucault’s account of the examination in Discipline and Punish helps explain what happens when descriptions like these enter an institutional file. The examination combines observation with normalizing judgment, as an examiner compares a person with an accepted standard and records where they differ from it. In the process, the examination “makes each individual a ‘case’” (1995, 191). Once those judgments are recorded, they can be used in later decisions about the person, including decisions made by people who have never met them. The file gives the institution an account it can use in deciding what should happen to the person. Its ability to know them and its authority to act on them develop through the same practice (184–192).
Anna is already trying to anticipate what someone will make of her account. Before anyone has read her application, she is deciding which parts of her experience are safe to include. She wants the assistance and knows she has to explain why she needs it. But she also knows that an accomplishment might be read as evidence that the assistance is unnecessary, while the description of her limitations may later be used to question her judgment. This affects the account she produces. Someone reading it later could assume that it simply reflects how Anna sees herself, without considering how much of what she wrote was shaped by the consequences she expected from being understood a particular way.
I am developing Transordoism to examine how people and their morally relevant realities pass between different systems of knowledge and authority. Within this framework, receivability concerns whether a person’s circumstances can enter an institutional decision and bring about a response. For Daniel, the immediate problem is getting his need for assistance into a process that he can actually complete. The program should be able to hear a claim that its usual forms cannot adequately describe, including a claim from someone whose condition makes completing those forms difficult. Visibility without degradation places a condition on how that happens. Presenting his claim should not require humiliation or exposure of private information the office has no reason to obtain. He should not have to accept that asking for assistance gives the office authority over parts of his life that have nothing to do with the decision.
For someone like Daniel, the application itself can become a considerable amount of work. He may have to contact several offices for records, then follow up when those records fail to arrive. He may have to reconstruct dates and explain apparent contradictions, while managing the condition that led him to apply for assistance. The program decides how that information must be provided. It therefore has some responsibility for helping him when its requirements prevent him from presenting his claim. Someone may need to obtain the missing records with him or help him explain changes that the notes from separate appointments do not capture. That costs money. But when Daniel has to do all of this work himself, the work still has a cost, even if the program never has to pay it. Treating his labor as though it costs nothing overlooks the demands being placed on someone whose condition has already made it difficult to complete the application.
When someone from the office follows up about the missed request, Daniel may be willing to discuss whatever they ask. That could include details about his relationships or his household that have little to do with why he missed the request. He may believe that declining to answer would put his application at risk. His willingness to provide the information does not tell us that he was comfortable sharing it. Before asking for more detail, the employee should be able to explain how it is relevant and consider whether the decision can be made with less. There will be things the office does not get to know about Daniel’s life, even if knowing them would make its work easier.
Anna’s file raises a related problem, even if everything recorded in it is true. Suppose she travelled alone to an appointment, and that fact is used to conclude that she can travel regularly without substantial difficulty. The journey happened. The record may not show how much preparation was required, how she coped when she arrived, or how long she needed to recover afterward. This additional information could change what the journey meant for the assessment without changing whether it occurred. Anna would get nowhere with a correction process that only allows her to challenge inaccurate entries. She needs to challenge the conclusion drawn from an accurate one. If disagreeing with that conclusion is then treated as further evidence that her judgment cannot be trusted, the process has left her no effective way to dispute what the record is being used to say about her.
In “The Subject and Power,” Foucault considers resistance to forms of authority that impose an identity on a person (1982). An appeal can give someone an opportunity to challenge how an official account has been used to judge them. It is still possible for a decision to be justified and for the person affected to disagree with it. But they should be able to see the reasons for the decision and understand how it was reached. They also need practical assistance if they wish to dispute it. If Daniel’s application failed because he could not manage the paperwork, requiring him to manage the same paperwork before anyone will reconsider the outcome gives him little opportunity to be heard.
Someone at the office may understand why Daniel’s application has stalled and still be unable to do anything about it. They may lack permission to reopen the application or arrange another assessment. Daniel then depends on someone finding a way around the ordinary procedure, perhaps by persuading a colleague to take on work that nobody has been assigned to do. A functioning recognition infrastructure would give staff a way to act on what they have understood. That requires someone with the authority to respond, with time to do the work and responsibility for following it through. Without those arrangements, Daniel may explain himself clearly to staff who understand the difficulty and still leave without knowing who is going to do anything about it.
While those conversations and reviews are taking place, Daniel still needs the assistance for which he applied. A correct decision reached months later does not make up for the months in which he went without it. Someone needs to be responsible for finding out what assistance can be provided while the application remains unresolved. Resources may be limited, but deciding to leave him waiting is also a decision about who will carry the consequences of that limitation.
An institution can reach a correct decision under its rules and still leave an important part of the person’s situation unresolved. Someone might fall just outside a benefits threshold while remaining unable to afford the assistance they need. The office may have a defensible explanation for that threshold. It does not follow that the need disappears on the other side of it, or that no one has any further responsibility toward the person. Order-collapse occurs when the institution treats what its own categories establish as an adequate account of the person’s whole reality. In Anna’s case, the evidence may accurately establish that she needs assistance. The problem comes when it is also taken to establish that she cannot make decisions about how she wants to live. We do not have to show that the original assessment was inaccurate to object to that use of it. Adding more information to the file would not necessarily help, because the office could continue making the same unjustified inference from an even more detailed account of her life.
This is why I am cautious about asking institutions to see the whole person. In clinical practice, I want the information needed to understand what is happening and provide appropriate care, including circumstances that a narrow medical description leaves out. That does not mean the patient needs to make every part of their life available for documentation. There may be things they want to keep private that have no bearing on the care they are seeking.
My claim that a person exceeds the account an institution makes of them is a moral claim. The suffering was real before someone learned how to document it, and the need for assistance does not begin when the application is accepted. If a process repeatedly keeps the people it was designed to assist from establishing their needs, the institution has to examine what its own requirements are doing. It cannot keep expecting each applicant to overcome those same difficulties without changing how the process works.
For Daniel, that means someone needs to take up the unfinished application with him. Sending another request for information will do little if the request does not account for why he was unable to answer the previous one. He may need help obtaining the record or putting into words how his condition changes between appointments. His application should be decided after those difficulties have been addressed, so that his ability to complete the paperwork does not take the place of an assessment of his need.
At her next review, Anna should be able to describe the meal she cooked. The assessment needs to account for the assistance and rest that made it possible, along with what she could have managed the following day. She may still need the same assistance. She should be able to say she felt good about cooking that meal, and that she could not have done it again the next morning, without having to decide which part of the truth to leave out.
Author Bio
Josh Sandifer, MSN, APRN, AGPCNP-BC, is an infectious disease nurse practitioner and independent scholar based in Northwest Indiana. His work connects nursing theory, moral philosophy, and institutional ethics. He writes from an autistic standpoint, examining how institutions recognize people and respond to their needs. He publishes The Legibility Project and is developing Transordoism, a framework concerned with how persons and their morally relevant realities cross systems of recognition.
References
Foucault, Michel. 1982. “The Subject and Power.” Critical Inquiry 8 (4), 777–795.
Foucault, Michel. 1995. Discipline and Punish: The Birth of the Prison. Translated by Alan Sheridan. Vintage Books.