The Lancet’s Editor-in-Chief: “We will be transformed into biopolitical citizens” (2021)

by Federico Soldani – 3rd Aug 2021

Topics that readers of PsyPolitics might already be familiar with such as the concepts of power, for instance as discussed by Michel Foucault, the transformation “from citizens to patients”formulated for the first time in 2019 – or the psychologization and medicalization of the global political discourse are present in the latest book by Richard Horton, a long time Editor-in-Chief of the medical journal ‘The Lancet’.

‘The Lancet’, besides being one of the oldest and most prominent medical journals, has been traditionally the most cited British medical journal and the second most cited peer-reviewed journal in medicine worldwide, according for instance to the bibliographic metric called “impact factor”.

Published initially in June 2020 and seven months later as an “expanded and updated” version, as per the book cover (the publisher’s website also adds “completely revised”) Horton‘s book second edition was published at the end of January 2021: “The COVID-19 Catastrophe. What’s Gone Wrong and How To Stop It Happening Again” (Polity Press).


The second edition includes an Introduction and an Epilogue in addition to the seven chapters already present in the first one as well as topics previously largely or entirely absent such as an emphasis on mental health and psychiatry – see among other examples Horton mentioning of Levy’s “The virus in the age of madness” (2020) – and a final emphasis on “technocracy” a topic previously completely absent that now takes the last four pages of the book and grand finale.

The new Introduction, ends with the quotation of a 1960 lecture delivered in London by French sociologist Raymond Aron entitled “The Dawn of Universal History” and a stance that clarifies Horton’s ideological framework:

“He argued” – Horton writes – “that countries were converging towards one and the same history – a history in which all humankind had access to the same tools. The spread of this industrial society meant, Aron claimed, that the world was moving from a time characterised by division to one defined by unification – ‘the beginning of a united mankind engaged in the only worthwhile struggle, the one for mastery over nature and the wellbeing of all humanity.’ His optimism was premature. The past sixty years have seen neither the diminution of conflict nor the erasure of ideology. But perhaps COVID-19, an acute global phenomenon, will usher in a single universal history. Not the end of history, but the beginning of a new history – one in which humanity will join and act together for the interests of all in the name of all. A dreamy and quixotic imagining? No, I think necessary and inevitable.”

The global nature of the phenomenon under examination is clear since chapter one “From Wuhan to the World”. The next three chapters are about how the 2020 coronavirus pandemic could have happened: “Why Were We Not Prepared?”, then “Science: The Paradox of Success and Failure”, and “First Lines of Defence”.

In the fifth chapter entitled “The Politics of COVID-19” the topic of politics is explicitly introduced. Chapter six “The Risk Society Revisited” is entitled after an expression initially used during the 80s and 90s including by sociologist Ulrich Beck in his “Risk Society: Towards a New Modernity” (a title similar to Aldous Huxley’s “Brave New World Revisited”, an essay in which Huxley re-examined his 1932 dystopia, some thirty years later). The term ‘risk society’ is usually also associated with Anthony Giddens of the London School of Economics who was also a co-founder of Polity Press, the publisher of Horton’s book.

A relevant concept not discussed by Horton but present in Beck’s work was that of “cognitive sovereignty”, which is that in a complex interconnected world the ordinary citizen would have to rely more and more on the knowledge of experts instead of his or her own more directly appraised knowledge. A concept that in my view could possibly be better expressed not by resorting to the idea of ‘cognition’ but to that of ‘knowledge’.

Finally Horton warns us about a future that in his book sounds certain in the seventh chapter “Towards the Next Pandemic”.

If he is pointing in the right direction here – as other well connected people appear to reiterate recently – are we then going to be governed not via democratic politics anymore but via medicine and “public health” broadly speaking, including via epidemiology and psychology?

In the first, June 2020, edition there was no Epilogue which instead is present in the January 2021 second edition: in this update the topics of mental health and psychology as well as of technocracy become prominent.


In the second edition of the book Horton also quotes from his own article, a sort of editorial, from an issue of the Lancet in October 2020 entitled “Covid-19: a crisis of power” (in pdf version here) which included a photo of Michel Foucault and an emphasis on Foucault’s series of lectures at the College de France during the 70s and early 80s.

Criticism of Horton’s article was published in PsyPolitics at the beginning of November 2020 in an article – about a 2019 London talk of mine on the rise of medical and psychological global power – largely centred on technocracy: “the (anti)political, technocratic and revolutionary globalist agenda was clearly and unambiguously presented as the one that would have benefitted from phenomena and discourses of mass global psychiatrization. The prospects of ‘technocracytechno-fascismscientific dictatorship or totalitarianism‘ were prefigured as the possible outcomes.”

Horton, by writing about Foucault, indirectly highlights the fact that in the Anglophone world Foucault is completely ignored in medical circles.  In my experience, for instance, when I sent to some colleagues in academic medicine in Boston the aforementioned 2019 London talk, although the content was largely appreciated, the choice of a Foucauldian approach was criticized as “post modern.”  This is in my view a label usually employed, especially in the U.S., to disqualify Foucault’s work as if he did not believe in a distinction between true vs. false facts, seen as basic in modern science in the Anglo-American medical world.


From my perspective, about the knowledge of Foucault’s oeuvre in the Anglo-American medical world, it took me twenty years in the medical and scientific fields, including doctoral studies in Boston and work at the FDA in the Washington, D.C. area as a medical reviewer and epidemiologist, to properly encounter Foucault’s work and to appreciate its relevance to modern medicine and politics. Previously I only heard occasionally about his debate with Chomsky or about his ‘History of Madness’, however usually presented as boring or invalid.  I found this hard to believe, especially when I came to know that Foucault is one of the most cited – if not, depending on the metric, the most cited – authors of the 20th century overall.  Similar metrics, more recently in 2019, revealed a similar trend.

My encounter with Foucault’s work was fortuitous: when I started working in London, arriving from the U.S., as I described how psychiatry worked in the clinic to someone who was in media studies,  a recommendation was given to me to read some of Foucault’s work.  The genealogical approach and also discourse analysis are two of the Foucauldian tools I have since found extraordinarily helpful.  Indeed, Foucault did not attempt to develop a coherent methodology but by studying specific historical instances he aimed, in his own words, at providing “tools” for understanding. 

Nowadays, during the past year and half, authors with no previous familiarity with Foucault’s work and ideas started talking – because of the coronavirus pandemic and especially because of the media, policy and governmental responses to it – about biopolitics. A concept that was mentioned by authors before Foucault but that he developed in his lectures series, such as “Society must be defended” and later “The birth of biopolitics.”

It is important to highlight – and this is remarkable in my view – that initially Foucault began to work on psychology and psychiatry. Indeed his very first publications were Maladie mentale et Personnalité (1954) and later his Folie et Déraison: histoire de la folie à l’âge classique (1961).  

When I read his lectures on “Psychiatric Power” (1973-1974), published only in 2003 (and, by the way, its 2006 English translation included to my knowledge the very first English translation of Pinel openly talking about King George III of England – the “mad king” – after more than 200 years from the original in French, an observation that I am making here for the very first time) I found Foucault’s genealogical method quite helpful.  He analyzed the texts of the first French psychiatrists – which is, practically speaking, of some of the most prominent very first psychiatrist tout court – showing how the discipline developed and how it could be seen primarily as a disciplinary technique which developed precisely at the opposite pole of surgery and pathological anatomy (eg, Bichat).  Surgery started in his view as an effective body of knowledge, while psychiatry started out with the figure of the doctor and essentially without a medical body of knowledge. 

Applying some of the concepts and tools derived from Foucault’s work to medicine of course would require a multidisciplinary approach.  So probably no single expert or scholar might have all of the required historical and technical knowledge for Foucauldian studies to be better known, applied and appreciated in the larger medical anglophone community. 


Horton’s book is not only about medicine or public health. It has a political dimension and is situated in an ideological context in which, for instance, Horton informs the reader about how “at the Lancet, a COVID-19 Commission” was “led by the economist Jeff Sachs.

Among other things, such as being a prominent economic adviser to several countries of the former Soviet Union or more recently to the Vatican, Jeffrey Sachs – an intellectual clearly informed by a globalist ideology – wrote in 2019 about politics and psychiatry in the second edition of the book “The Dangerous Case of Donald Trump”:

“Those who pretend that we are in the realm of politics when we are really in the realm of psychopathology make the situation even more dangerous, because they will not be prepared while the future of the planet and the human race are at stake.”


About twenty years ago, I can recall how refreshing was to read Dr. Horton’s critiques of conflicts of interest in medicine and medical journals and publications. However, judging from his current book, there appears to be no trace of such issue when clearly huge interests are at stake. Would now the discovery of an author such as Michel Foucault, promoted by Dr. Horton on the Lancet as well as in his latest book here reviewed, be a genuine change in perspective, or would it be more similar to what Guy Debord – author of ‘The Society of Spectacle’ and co-founder of the Situationist International – called recuperation?

Recuperation somehow means “the process by which politically radical ideas and images are twisted, co-opted, absorbed, defused, incorporated, annexed or commodified within media culture and bourgeois society, and thus become interpreted through a neutralized, innocuous or more socially conventional perspective.  More broadly, it may refer to the cultural appropriation of any subversive symbols or ideas by mainstream culture.”

Horton ends its second 2021 edition of the book, as mentioned above, with a topic previously absent from the first edition, that of technocracy with a much stronger emphasis on topics related to mental health, madness, and psychiatry. Foucault not only started out his career publishing work about psychology, personality and madness, but he was also characterized by a political figure such as Brzezinsky in his 1969-1970 essay “Between Two Ages. America’s role in the technetronic era” in the following manner in relation to the concept of technocracy:

Foucault‘s views, associated with a school of thought called “structuralism,” have been characterized by a critic as the ideology of contemporary technocracy, for Foucault sees man as the object of a process which deprives him of any autonomy and rules him impersonally, according to a structural dynamic.”

As already highlighted elsewhere in PsyPolitics, for Brzezinski, Foucault’s views could be used to understand at some level contemporary technocratic views.

So, Horton, while clearly and unmistakably espousing a globalist and technocratic view, at the same time introduces themes from an author such as Foucault – who worked largely on topics related to psychology and psychiatry – and even appears to criticize the dangers of technocracy at the end of his book. The risk of recuperation – of Foucauldian themes and tools radically challenging the rising ‘biomedical’ as well as ‘psy’ global power – into mainstream globalist and technocratic discourse is definitely present, in my view, in Horton’s latest book.

(1 – first of a series of articles)

[In the photo at the top, a cover of ‘The Lancet’ Vol. I, 1823]

Cite this article as: Federico Soldani, "The Lancet’s Editor-in-Chief: “We will be transformed into biopolitical citizens” (2021)," in PsyPolitics, August 3, 2021,

Last Updated on August 16, 2021 by Federico Soldani

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