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SOVEREIGN AND SOCIAL DEBTS (3/3): The neoliberal re-conceptualisation of life debt as a self-referential debt

par Bruno THERET

The neoliberal re-conceptualisation of life debt as a self-referential debt

Health care, as an essential part of life debt (and health as a major component of life capital) is at the heart of the legitimacy of democratic states where the sovereignty of the people is still the reference. Thus, the current state of decay of public health systems in neoliberal states that has been publicly unveiled by the covid19 crisis can be associated to a crisis of legitimacy of these states. But the financial disengagement of the neoliberal state from the health care system and the devaluation of social debt cannot be understood without taking into account and questioning the profound individualist redefinition of health as a life capital since the 1970s, redefinition that acts as a countertendency to the loss of legitimacy of neoliberal states, notably among the middle and upper classes. The most obvious economic explanations of budget cuts by financial requisits, neoliberal bureaucratization, and competitive pressures of world markets, are relevant but insufficient, since they fail to explain the resilience of neoliberal policies during the last forty years. In order to complement them, we have to take into account the biopolitical specificity of health as life capital, and focus on the individualist neoliberal conception of health and the radical change that has transformed the representation of life debt itself. Indeed, health has been profoundly redefined since the 1970s, and this is a key element in understanding the neoliberal process of devaluing social debt and explaining its over-accumulation. This leads also to considering that the neoliberal re-conceptualization of health has been an important factor of the covid-19 crisis itself; it is a crisis of the neoliberal health care model in which public health has been reduced to an aggregate of individual healths.

Neoliberal individualist re-conceptualisations of health

Individual health is differentiated into two levels that have come to converge, the mental and the biological. Concerning mental health, A. Ehrenberg (1998) and N. Rose (2007) have shown that from the 1970s onwards, mental health has been redefined at the same time as the neoliberal ideal of the autonomous individual, owner and entrepreneur of itself, capable of self-activation and self-control, was taking shape in the real world. Henceforth, “being in good mental health” has gone to mean: being a sovereign individual facing a future that is necessarily “unstable and uncertain”. Thus, a “new morbidity of a behavioral nature” emerged, modelled on depression, itself re-conceptualized as a “pathology of individual emancipation”, a disease of those who are incapable of coping with the injunction of autonomy as a “supreme value”. Along with other “physiological reactions” to the expectations of autonomy, such as anxiety, depression has then constituted “the vast field of mental health”, a field that will extend to the whole of social life, in work, education and the family

As, following Ehrenberg, the ills of autonomy are “a reminder of the existence of a passionate dimension to social life”, a good individual health implies taking care of these “pathologies of the life of relationships”. Hence the need of various forms of “support” to ensure that individuals who want to be their own boss are able to cope individually with the difficulties of life linked to their socialization. Fortunately, in the 1970s also, “the pharmaceutical industry launched a new generation of molecules” that were “safe and comfortable”, making it possible to calm the passions and other anxieties of depressed patients, without dumbing them down, and thus keeping them active and capable of self-discipline. By publishing and regularly updating the Diagnostic and Statistical Manual of Mental Disorders (DSM) which serves as a bible for psychiatrists the world over, the American Psychiatric Association has been extending the scope of these disorders and expanding the market for antidepressants and other anxiolytics, to the point where the boundaries between mental and general health has been becoming blurred.

For his part, N. Rose (2007) has emphasized the bodily dimensions of the new neoliberal norm of mental health and developing a concept of ‘somatic individuality’ that links the question of mental health to that of bodily and biological health. For Rose, being a ‘somatic’ individual means “understanding one’s disorders and desires in terms of the inner ‘organic’ workings of one’s body and seeking to reshape it – usually through pharmacological interventions.” Thus, at the same time as mental health was being redefined, the “somatic individual” was developing as an entrepreneur who, in accordance with an ideal of “perfect health”, invests in his biological capital and optimizes “his biological and bodily potential”. In this way, good health is related only to “life in itself” (“bare life”), and identity and citizenship are redefined through the exclusive use of biology. The ‘somatic individual’ matches with a ‘bio-citizenship’ centered on the emergence of identity claims linked to biomedical issues, and the neoliberal redefinition of mental health in terms of entrepreneurial and self-referential individuality goes with new forms of sociality and identity.

This new conception of health is perfectly in line with neoliberal ideology. The individual is allegedly considered sovereign, and society is the problem, not the solution. Life in society is by its very nature pathogenic; dominated by passions and uncertainty, it hinders the development of the self-regulated ego of the individual entrepreneur. The figure of the autonomous individual is therefore less an immediate reality than an ideal to be brought about by changing institutions. Bringing about this mentally healthy individual requires containing the passionate dimension of social life by facilitating “individual action by multiple means, pharmacological and psychotherapeutic, but also socio-political”. The aim is to depoliticize and dispassionate social life and to reduce the State to a simple Enabling State (Gilbert 2005). So the autonomous individual who wants to be sovereign must not delude itself; (s)he is not “all-powerful or free to do as (s)he pleases”, (s)he must conform permanently to the model of the entrepreneur of itself, or else, in the event of difficulty, unless (s)he is placed on the fringes of sociality, submit to the accompanying bodies whose mission and common rule is to produce an individuality that conforms to the model. Outside the model, there is no salvation. The only choice left to the individual is the dispassionate rational choice, the calculation of interests, a de-subjectivized instrumental rationality.

There is thus a very close relationship between the model of the good mental and general health of the autonomous entrepreneurial individual and the liberal economic model of homo œconomicus rationally maximizing its individual interest. In both models, individuals are supposedly ‘sovereign’, and the healthy behavior of all individuals, i.e. maximizing their individual interest while respecting the rule laid down by the model, leads to the happiness of all. But in both cases, it is in fact the rule that is sovereign, the rule of active, self-regulating individuality, and the rule of the efficient, self-regulating market. Finally, in both cases, the model is intended to become a reality, to be instituted; if this is a source of mental illness or economic crisis, it is not the model, which is of the order of the untouchable, the sacred, that needs to be modified, but the instituted reality, for example by inventing a new drug or creating a new market.

In this ideological framework, as shown by C. Lafontaine (2014), a bioeconomy based on the extension of the capitalist logic of commodification to human ‘life in itself’ has emerged. It is a novel form of capitalism labelled, depending on authors, bio-capitalism, biomedical capitalism or genetic capitalism. As soon as the state of social representations and the techno-scientific development of biology made it possible, “the human body, in its biological vitality” has been considered as a “body-market” (Lafontaine), that is as a mine of biological resources to be transformed into commodities and economic capital.  The human body, “molecularized” (Rose) i.e. “broken down into a series of elements (genes, cells, organs, tissues), has become the object of an immense market whose limits have been “constantly pushed back by the biopharmaceutical industry and the logic of innovation that now governs biomedical research” (Lafontaine 2014)[26]. This emergence of bio-capital invested in human vitality corresponds to a deep change in capitalism that goes beyond the structural transformations brought about by the financialization and digitalization of human activities. In fact, the transformation of medical practices and representations of health affects the very concepts of the individual and life in society.

A self-referential life debt

What has become representations of life and social debt in this evolution of capitalism? Sure, in the neoliberal representation of mental and bodily health, they are invisibilized. But in fact, the life debt is still present under the form of an individualized and self-referential debt, since the entrepreneurial individual owes to himself to maintain his life capital, to invest in his own vitality. The life debt is then a debt owed by the individual to itself, that is to the whole that is “its” Self, and more precisely to that whole which is the organic life of its body; in other words it is a debt of its mind to “its” body. One owes oneself to be a sovereign individual valuing oneself; one owes oneself to mobilize one’s capacity to act and to invest into one’s own vitality.

This individualistic representation of the life debt is a denial of its democratic metamorphosis into social debt, a debt of mutual interdependence calling for redistribution and reciprocity. Such a denial is based on two reductions: first the reduction of society to a collection of self-referential individuals who communicate with each other only through the mediation of a rule that applies to all, that of the competitive market; second the reduction of the individual to a biological body, the mind itself being confused with the brain.

Moreover, any debt of life considered as a debt of collective belonging is conceived now as a source of individual bad health. As for the reduction of human life to the biological dimension of “bare life”, i.e. to a physicochemical process that can be rationalized and manipulated by the market and capital, this is a denial of the values associated with social life, a denial of the fact that human life without passions or beliefs is devoid of meaning. Eventually, in such conceptions of health and medicine, there is no more room for a notion of public health that is not the simple aggregate of individual healths.

But the overall life capital of a sovereign society is not reducible to the addition of individual life-capitals; because it is credited with an infinite lifespan, society has a life-capital of its own, which manifests itself in particular in the event of war when it is necessary to call upon the sacrifice of individual lives to save the life of the social whole, as we have seen above when quoting Macron. The institutionalization and development of these neoliberal conceptions of mental and bodily health, which represent a hijacking of the ideals of democratic citizenship and the ecological bioeconomy (Cooper 2008), are along with financialization and computerization of all activities, key factors in the current state of disrepair of our public health care systems, as highlighted by the covid-19 crisis.

But as noted already above, this libertarian type of individual sovereignty is a lure, since it can only be a behavioral injunction and has nothing to do with a free choice left to people not to conform to the law of the ideal model.  The Individual is in reality in the situation of a debtor of the life debt, and the Market as a whole (with the money which represents it) is the sovereign creditor. Therefore, the true sovereign authority in the neoliberal perspective is not the Individual but the Market which dictates the law. This Market is a naturalized transcendental entity whose laws to be obeyed are based on the creed of its efficiency for the common good and its self-regulative character. This conception is a pure return to a transcendental sovereign authority, of an almost divine order. This is religion, not rationality. Thus, the neoliberal biomedical capitalism, closely intermingled with financial and digital capitalisms, and which for the most part originated in the United States who has renewed its world hegemony thanks to them, is the vector of a new reversal of life and social debt by the conversion of authorized debts into authoritative debt, of releasable contractual debts into unreleasable tutelary debt .

***

To sum up, the privatization of health has taken two forms: one, the most visible and studied, has involved the penetration of capitalist economic logic into the entire health care system; the other, the most concealed, has involved a redefinition of health, both mental and bodily, and its assimilation to a life debt of the sovereign individual towards “itself”. With this second form, and in correlation with the economic imaginary of neoclassical economics, we are confronted with a radical transformation of the imaginary of health and of what good health is. In this process, the notion of public health as a social life capital appears more and more outdated.

It is therefore understandable that with such individualist conceptions of health and medicine, there is very few room for any notion of public health whatsoever. Together with neoliberal financialization and the digitalization of all activities, these conceptions explain the current state of disrepair of our public health research and care systems, which the covid-19 crisis has fully highlighted. We can also understand better the confusion of the ruling classes in the face of the pandemic. Impregnated by radical individualism and committed to the development of financial, digital and biomedical capitalisms, these classes were not and still are not mentally prepared to be confronted with a public health crisis that turns them on their head ideologically; this kind of crisis is in fact a ‘public problem’ that is insoluble within the framework of the neoliberal conception of health. The “perfect health” model, which has gradually taken over from the public health model, is totally inadequate for dealing with an epidemic whose contagiousness is undermining interpersonal and social relationships in all spheres of social life.

Unless the now obsolete monetary and financial regime is changed in its entirety, neoliberal western societies will not be able to address the challenges of future health and climatic crises by the mean of increasing defaults on their social debts. And if the State is no longer able to legitimate itself as the guardian of collective life, the risk is high of its transformation into a pure monopoly of physical force used to keep alive a plutocratic system that benefits only to an extreme minority. It is the State of Law that will be then at risk of exploding. The big issue is to avoid that risk… Returning to a sociologically plural and less purely ideological and dehumanizing conception of debt, e.g. seeing in debts on the one hand ambivalent social links – liberating or enslaving – of credit/debt that cannot be reduced to contractual market relations alone, and on the other hand various types of rights and obligations that are valued and can be honored in money, are not only a way of warning against such a risk, but may also be a tool for designing a new monetary and financial system that will enable us to recover from the social, economic and political crisis of today’s capitalism.

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OpenEdition vous propose de citer ce billet de la manière suivante :
brunotheret (28 mars 2025). SOVEREIGN AND SOCIAL DEBTS (3/3): The neoliberal re-conceptualisation of life debt as a self-referential debt. Sociologie politique de l'économie. Consulté le 7 février 2026 à l’adresse https://doi.org/10.58079/13cwp


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