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International Journal of Drug Policy 19 (2008) 417423

Review

The use of pleasure in harm reduction: Perspectives

from the history of sexuality
Kane Race
Department of Gender and Cultural Studies, University of Sydney, NSW 2006, Australia
Received 23 April 2007; received in revised form 15 August 2007; accepted 17 August 2007

Abstract
The absence of pleasure in harm reduction discourse is more and more frequently noted, but few have considered what, exactly, more
attention to pleasure might do. What is the value of pleasure for harm reduction praxis? Central to such an inquiry is the question of how
pleasure is grasped, conceptually and methodologically. In this paper I use Foucaults History of Sexuality to elaborate a perspective on the use
of pleasure within harm reduction. I argue that Foucaults work suggests a distinction between therapeutic and social-pragmatic approaches to
pleasure, and that such a distinction is important for harm reduction to the extent that it seeks to maintain a critical awareness of the relation
between stigma and care in that the latter model raises the possibility of maintaining de-pathologizing modes of care. An appreciation of
pleasure in terms of its social pragmatics helps to recognize practices of safety, care and risk that might otherwise go unregistered in the
current punitive political environment. It provides a basis for conceiving practical measures that are in touch with given concerns and bodily
practices, and thus have more chance of being taken up. It also enables a more dynamic and responsive approach to the practice of bodies and
pleasures.
2007 Elsevier B.V. All rights reserved.
Keywords: Harm reduction theory; Pleasure; Ethics; Drugs; Self-care; Moralism

Introduction
In this article I use the History of Sexuality to discuss the
use of pleasure within harm reduction (Foucault, 1978, 1986,
1990). I have used this text to structure a graduate course on
harm reduction theory and practice, based at the National
Centre in HIV Social Research, called Bodies, Habits and
Pleasures. The course was designed to encourage students
to reflect critically on the social and political dynamics of
sex, drugs and public health; to develop skills in interdisciplinary practice; and to frame their projects within a broader
field of struggle and intervention. To this end, I combined
Foucaults work with readings on sex and drugs from a range
of disciplines, including empirical social science.
The History of Sexuality provides an excellent basis for
framing social research and education in this field. Although
the text is dense, historical and philosophical not the sort

Tel.: +612 9351 3662; fax: +612 9351 3556.

E-mail address: krace@usyd.edu.au.

0955-3959/$ see front matter 2007 Elsevier B.V. All rights reserved.
doi:10.1016/j.drugpo.2007.08.008

of thing you are likely to hear much of in the mainstream

fields of public health, social policy and medicine it provides one of the most trenchant and far-reaching analyses
of the involvement of the medical and human sciences in
the social maintenance of categories of deviance, normality
and abnormality. It gives us a way of thinking through the
regulative and coercive, as well as valuable and life-saving,
aspects of health and medicine. This is important in the context of infectious diseases such as HIV and Hepatitis C, where
medicine provides important resources, but can also function as a source of oppression (Race, in press). Combined
with concepts from the second and third volumes, such as
the use of pleasure and care of the self, the History of
Sexuality provides a basis for conceiving how subordinated
groups might make use of medicine in ways comparatively
less encumbered by the normalizing effects of psychological
and medical discourses. Enormously influential within HIV
activism around sexuality (Halperin, 1995), the utility of this
text for broader practices of harm reduction and drug policy is yet to be fully realized (Duff, 2004), and takes some

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K. Race / International Journal of Drug Policy 19 (2008) 417423

imagination (Im happy to say that students generally rise to

the challenge). In this article I provide some thoughts on its
import for the field, with a view to formulating a perspective
on the use of the pleasure within harm reduction.

Why sexuality? Why Foucault?

Viewed in terms of its conditions of development at the
onset of the AIDS crisis, harm reduction can be defined as
a mix of programmes, principles and policies that strives
towards a non-moralized approach to care in the context of
drug use. Rather than seeking to eliminate drug use per se,
it aims to reduce the harms associated with drug use through
measures such as needle and syringe exchange, supervised
injecting rooms, drug education for users, and pill testing at
raves. Of course, the categorization of harm inevitably contains moral assessments, and some have rightly queried the
possibility of achieving a value-neutral approach to drug
harm. But while technically speaking, pure value-neutrality
may not be achievable, the prevention of harm in the order
of HIV infection, Hepatitis C transmission and other adverse
events (such as overdose), provides a point of differentiation and mobilisation whereby harm reduction distinguishes
itself from more moralized approaches to care. It is not drug
use per se, but the prevention of these more serious, avoidable, less disputable harms that harm reduction takes as its
object (Keane, 2003). This can be expressed in terms of a
great refusal: the refusal to make public care conditional on
adherence to moralized norms around abstinence.
What characterizes harm reduction, on this reading, is
its commitment to providing practical care, education and
health services irrespective of categories of deviance and
pathology that might otherwise function to exclude certain
groups from public care and responsibility. This is what distinguishes harm reduction from other approaches to drug use,
which it often works alongsidesometimes uneasily. Since
the 1980s, harm reduction has grown into a broad social program and public health movement that provides life-saving
education and care against or despite grander ideological prescriptions about how a moral citizen should behave in relation
to drugs or sex. Broadly speaking, it resists those processes
that pathologize individuals on the basis of their behavior, or
police or neglect them on the basis of their deviance, seeking
instead to provide resources for their care and safety, irrespective of their imputed moral status. It does not engage in
a moral decipherment of individuals, this is not its mode of
operation. Rather, the practices associated with drug use
their potential to give rise to more or less harm and the
conditions in which these emerge or in which access to services and support occurs comprise the target of analysis and
modification. Practices are approached here as sociotechnically mediated by particular environments, inter-relational
dynamics and available equipment rather than merely the
outgrowth of personal resolve. In addition, harm reduction
usually entails a critical perspective on certain regulatory

practices around drugs in terms of their potential to give rise

to barriers to care. Thus, advocates contest dogmatic practices around drug prevention on the basis of the barriers they
create to access to services.
Grasping harm reduction in this sort of specificity, as a
pragmatic social program that maintains a critical awareness
of the relation between stigma and care, indicates the significance of Foucaults work for the field. For among Foucaults
central concerns are the historical construction of the abnormal individual and the material effects of this designation.
Through a series of historical and critical analyses, Foucault
showed how the sciences of the human subject (psychiatry,
psychology, sociology, etc.) are built upon the derogation of
some groups in relation to the social order the mad, the
perverse, the unproductive. Far from being removed from
sociopolitical values, these ostensibly objective sciences are
bound up in the social attribution of deviance. In this respect,
Foucault can be read alongside the work of sociologists of
deviance, who were concerned to show how deviance is
an outcome of processes of social labeling (rather than any
innate deficiency of individuals) (Becker, 1963; MacIntosh,
1968; Young, 1971). But Foucaults work goes much further,
in showing how the medical and human sciences participate
in these processes of social categorization. From this perspective, the sociomedical sciences cannot stand outside the
social field as the impartial corrective of cultural prejudice:
they are intimately involved in the distribution of prejudice
marking out normal and abnormal individuals.
This perspective on medical practice and its relation to
social stigma prompts some reflexivity about the effects of
public health regimes. But while Foucault if often used to
critique the regulatory effects of public health an approach
which includes a number of valuable and important analyses
of harm reduction (Fraser, 2004; Miller, 2001; Moore, 2004;
OMalley, 1999) the History of Sexuality takes aim at more
specific elements of the way pleasure and desire enter into
expert knowledge. This enables a reading that emphasizes
the necessity of ongoing critical work in this area (particularly that which attends to harm reductions regulatory effects
and the privatization of responsibility, health, personhood and
pleasure associated with certain of its discourses and institutions), while at the same time introducing a more dynamic
and affirmative perspective on the social pragmatics of bodies and pleasures. Foucault is concerned in this work to show
how sexuality emerged as an object of scientific knowledge
and a basis for categorizing individuals. But what is original
about his argument is his analysis of the specific mechanisms through which the individual is bound up with power.
As is well known, Foucault rejects the idea of an historical
repression of sex by pointing to the massive proliferation of
expert discourses about sex. These include a general incitement to talk about sex, and a specification of who gets to
make sense of it, and with what effects. It is the putting of
sex into discourses that purport to be able to determine the
truth of individuals that is at the heart of Foucaults critique:
Tell me your desire and I will tell you what you are. His

K. Race / International Journal of Drug Policy 19 (2008) 417423

focus, in other words, is the way sexuality and sexual desire

become available to determine the truth of individuals. What
concerns Foucault is how individual disclosures around sex
and desire are used to categorize and rank individuals to
classify them as normal or pathological. Thus, the insertion
of pleasure and desire into normalizing regimes at the hands
of therapeutic discourses such as psychoanalysis is seen as
centrally problematic.
In order to specify the focus of his critique, Foucault
sketches two different models whereby sex and pleasure are
put to work for the purposes of learning. In the first, the
ars erotica (which Foucault associates with certain ancient
and eastern cultures), the ways of pleasure are passed down
from teacher to novice, for no other reason than initiation and
instruction in certain techniques aimed at maximizing pleasure and attaining bliss. In the second, the scientia sexualis
(which Foucault associates with the modern West) pleasure
and desire become subject to disclosure and decipherment at
the hands of a confessoror, in later times, an expert, who
uses this information to absolve or diagnose the individual
as normal or pathological. It is this latter model which Foucault associates with the modern regime of power, and which
makes sexuality such an effective vehicle for power. For it is
the truth effect of sex its enrollment in expert discourses on
the individual that creates a hold over sexual subjects and
allocates them in moral terms. In relation to the broader argument, the purpose of this distinction is to illustrate the point
that there are different ways of linking pleasure, knowledge
and subjectivity. The scientia sexualis represents a very particular relation between desire, knowledge and power, with
particular subordinating effects.
What is the relevance of this analysis for contemporary
practices of harm reduction? After all sexuality is only one
category through which social subjects are marginalized, and
it is not clear that this category can account for the stigma
and subjection experienced by other drug users. Certainly, the
category of addiction can usefully be subjected to the same
sort of historical and critical analysis that Foucault offers in
respect of sexuality, and indeed much useful and suggestive
work of this sort has been done (Keane, 2004; Levine, 1978;
Sedgwick, 1993; Valverde, 1998). Moreover, there are good
reasons for thinking that this critical orientation is instructive for, if not already implicit in, much work around harm
reduction. As a sociomedical pragmatics at a population
level for example harm reduction is arguably guided by an
aversion to pathologization. Excluding substitution therapy
programs such as methadone, for example, addiction is not
the primary target of harm reduction. The nature of an individuals desire in relation to drugs is not a matter of primary
concern. Rather, the practices surrounding drug use, and the
conditions in which they take place, are the driving target
of intervention: There is little or no concern with the individual as such, in the disciplinary sense of the biographical
individual in need of correctional intervention (OMalley,
1999). In this respect, Foucaults work helps to distinguish
between different practices of health service provision in

419

terms of how they entrench individualizing and typecasting

tendencies.
But another reason for highlighting this work within the
field is the detailed account it provides of how subjective
experience is enfolded into normalizing regimes. It tracks
how subjective experience enters into the machinery of classification and segregation. This makes it germane to any
discussion of the use of pleasure within harm reduction. To
the extent, moreover, that harm reduction wishes to avoid
contributing to processes that individualize and marginalize
users on the basis of their subjective experiences (of pleasure,
for example), Foucaults analysis supplies a cautionary note
about how best, or how not, to proceed. In the next section of
this article, I consider how concepts from the later volumes,
such as ethics of pleasure and care of the self, might in
this respect contribute to the discussion.

The use of pleasure

In the final pages of the first volume of the History of Sexuality, Foucault proposes bodies and pleasures as a potential
rallying point against the regime of sexuality. He contrasts
bodies and pleasures with sex and desire, whose insistent examination, he believes, will only bind us more tightly
within this regime. The remarks are cryptic and underdeveloped and have been the source of much confusion. After all,
Foucault has shown over the course of the first volume how
pleasure, sexual experience and desire are caught up in the
machinery of power and confession. Since Foucault rejects
the idea that power works by a simple repression of personal
desires and sexual pleasure, but rather demands their articulation and examination, it is initially unclear how an assertion
of bodies and pleasures could resist the regime he describes.
The key to understanding Foucaults proposal around
bodies and pleasures relates to the distinction he makes
between pleasure and desire in terms of their relation to
expert knowledge (Davidson, 2001; Halperin, 1995). Unlike
desire, there was no established theory of pleasure, no science linking it to the nature of the human subject. Where
psychoanalysis purported to offer a theory of desire, depicting its structures and proposing it as a universal law that drives
the human subject, pleasure was comparatively untheorised,
and could not be used to diagnose individuals. Pleasure was
less caught up in the whole apparatus that extracts a truth
value from erotic experienceall those therapeutic strategies whose diagnoses presuppose special insight into the
individual on the basis of supposedly universal norms of
desire. In this sense, pleasure could be regarded as much
more open to historical construction, practical variation and
creative experimentation. It provided a way of approaching
the forms of creative experimentation and world-building
which were going on around Foucault in queer communities, with the added advantage of being comparatively
less encumbered by therapeutic or scientific prescription.
It is not meant to invoke some pre-discursive domain of

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K. Race / International Journal of Drug Policy 19 (2008) 417423

experience, as some have worriedpleasure is social and historical material, through and through. Foucaults comments
about bodies and pleasures only indicate a preference for
experimental practice over theory: he was interested in the
cultures that marginalized groups were creating and their
possibilitiesincluding the possibility of creating innovative
cultures of care.
This background helps to explain what is going on in
the second and third volumes of the History of Sexuality
(Foucault, 1986, 1990). Here Foucault turns to ancient Greek
and Roman practices to provide the outline of a response to
the political problematic he sketches in Volume 1. Writing at
the onset of the AIDS crisis, one of Foucaults concerns in
this work was how to adapt and direct the power exercised by
medical and moral experts in the time of the AIDS epidemic
(Foucault, 1993). Central to his project was an attempt to
find models of self-practice that conceived a relation between
pleasure, knowledge and subjectivity different to that dispensed by the scientia sexualis. In this sense, these volumes
can be read as an attempt to furnish his earlier outline of the
ars erotica with some historical detail. Foucault wanted to
find models for existence that might be less enthralled by
psycho-scientific knowledge, affording the subject a greater
degree of freedom in shaping their existence. In framing his
project, Foucault discusses the ancient Greek imperatives to
know thyself and take care of the self (Foucault, 1990).
While historically the principle of care of the self has been
overshadowed by the imperative to know thyself, Foucault
wants to find a basis for ethical decisions (about how to live)
that is less caught up in the sciences of identity. He wonders
what it would be like to give greater prominence to the principle of care of the self (and, by implication, less priority
to categorical self-knowledge). His proposal of an ethics of
pleasure can be understood in these terms: it is crucially concerned with finding frames for shaping ones existence that
are less deferential to the human sciences and their designation of normal and abnormal (Foucault, 1997a, 1997b).
Foucault wanted to conceive forms of care and relation that
need not rely for their validity on expert evaluations of the
self, but are nevertheless able to bring pleasure and form
a basis for enhancing lives. To this end, Foucault explores
different historical relations between the self, pleasure and
knowledge, with the hope of providing models that have some
chance of resisting the prescriptive and demoralizing effects
of official determinations of deviance.
Foucaults work here is highly suggestive for practitioners
who wish to attend to the care needs of stigmatized groups
without contributing to their further pathologization. Indeed,
it suggests the possibility of conceiving de-pathologizing
modes of care, education and service provision. In this work,
Foucault flags the possibility of bringing a certain amount of
care and attention to self-practice that is not automatically disqualified from intelligibility on the basis of its non-adherence
to prescribed norms. He draws attention to the techniques,
practices and aspirations that make up self-hood, and suggest
that these can have a rationale that is relatively independent

of normative categorizations of morality. This does not mean

his aesthetics of existence disregards all moral principles.
Rather, it expands the scope of relations to such principles,
positioning them as a matter of active deliberation, rather than
docile compliance. The model has a specific sociological and
critical value, though this tends to be lost in many contemporary sociological applications. In particular, it takes attention
off the issue of whether an individual subscribes to universal moral codes, and opens up the question of how a body
carries out certain moral aims, and which values or concerns
its practices aim towards. It prioritizes the subjects capacity
to give shape to their existence and asks how this capacity
might be enacted. This optic has great significance for harm
reduction research, as I discuss in the next section. But what
is the significance of pleasure within this frame? And how
does it connect to harm reduction practice?
One answer to this question can be drawn from the work of
Howard Becker in his classic essay Becoming a Marijuana
User (Becker, 1963). Here Becker details the social mechanisms that give rise to the use of marijuana for pleasure.
In some respects, Beckers project complements Foucaults,
in that he seeks to dislodge the primacy of psychological
explanations that attribute some innate deficiency to users.
To this effect, he reverses the normal psychological etiology
of causation, showing how the relevant motivations arise,
like any other taste, as a socially acquired taste, in which
the user gradually learns to enjoy certain aspects of the drug
through processes of social interaction. Beckers approach
was influential for subcultural studies, where the investigation of deviance in its socially situated context helped to
identify the customs and systems of value that shape subterranean experience. But what is particularly innovative about
Beckers essay is how it frames the subject: In order to arrive
at an understanding of marijuana as something that can be
used for pleasure, the user must become proficient in certain
techniques and ways of framing their experience. Pleasure is
a fragile accomplishment. While Beckers project is located
within humanist sociology, a more contemporary reading
would emphasize how these techniques make up the subject
(Gomart & Hennion, 1999).
When thinking about the work of pleasure here, Foucaults
ars erotica easily comes to mind. Pleasure is an event that
draws on certain pedagogical practices and technical arrangements, in which what is learnt is not only how to identify and
experience certain effects, but also the frames for appreciating and moderating these effects: how to conduct the practice
to achieve certain desirable states. Here, pleasure is not an
instinctual urge, waiting for expression and release, but the
medium of a process of learning in which new techniques
and procedures are acquired. It does not stand in opposition to repressive social power a hidden knowledge with
scandalous effects but is a quality of experience that is contingent on certain procedures and skills and the combination
of regularized patterns of activity. Becker breaks the process
down into three distinct stages: learning the technique, learning to perceive the effects and learning to enjoy the effects.

K. Race / International Journal of Drug Policy 19 (2008) 417423

Each technique depends on social interaction, the exchange

of meaning and some evaluation of the experience. One of the
memorable insights of this essay is that drugs have multiple,
contradictory effects, not all of which are obviously enjoyable. Not only does the user learn to identify certain effects as
enjoyable, but also to interpret and prevent other effects. This
depicts an altogether different relation between pleasure and
care than that which is commonly assumed. Pleasure is not
the antithesis of self-regulation and safety, but the medium
through which certain shared protocols of safety take shape.
I will discuss the implications of this observation for harm
reduction methodology in the next section. But by way of contextualizing this point, an analogy from the field of gay mens
HIV prevention might be useful. In the highly moralized climate of the early AIDS crisis, moral authorities condemned
homosexuals, sex-workers and addicts, and dogmatic calls for
abstinence, monogamy and quarantining proliferated. Over
and against these calls, these groups devised strategies that
resisted popular desires for their identification and erasure.
Safe sex was one such strategy: building on the characteristic
pleasures and styles of embodiment found among gay men,
safe sex made promiscuity redundant as a target of hygienic
strategies, promoting instead condoms, alternate sexual activities and explicit community education as effective measures
(Cohen, 1988; Crimp, 1988; Escoffier, 1999; Patton, 1990;
Sendziuk, 2003). In this respect, safe sex can be regarded as
an intervention in the same league as harm reduction. It contested moralized strategies of control by devising measures
for safety grounded in existing embodied practice. Today,
many of the best educational strategies work by contextualizing prevention techniques in terms of the situations within
which people elaborate techniques of pleasure. This approach
encounters political obstaclesand probably will continue to
do so. But in this instance, it is clear that pleasure has functioned, not as the antithesis of safety, but as a crucial element
in its pedagogya sociohistorical resource providing critical
possibilities for survival.

Activating pleasure in harm reduction praxis

Thus far I have used Foucaults History of Sexuality to
distinguish two broad models whereby pleasure is articulated into relations of knowledge and power. I have done
so to counter the presumption that a straightforward voicing
of pleasure, in a context where such voicing is presumptively disallowed, is a progressive achievement in itself. The
absence of pleasure in harm reduction discourse is more
and more frequently noted (Mugford, 1993; OMalley &
Valverde, 2004), but few have considered what, exactly, more
attention to pleasure might dowhat is the value of pleasure
for harm reduction praxis? How might it be put to work? Of
central importance to such an inquiry is the question of how
pleasure is grasped, conceptually and methodologically. A
reading of Foucault gives us one perspective: Pleasure need
not be approached as a repressed thing whose bringing to

421

light will give us special access to the truth (of drugs or

individuals), but rather as a dynamic social material which
is elaborated through embodied interactions. If normalizing
strategies work by extracting individuals (or types of individuals) from pleasure as part of a therapeutic strategy, I
have argued that pleasure might alternatively be grasped as
a socio-technical medium and process of exchange in which
many actors and concerns, including concerns about safety,
are engaged. This is not to suggest that such a framing could
ever be free from relations of power; only that it may be
relatively less susceptible to the processes of pathologization
that Foucault identifies as predominating within biopower. (In
this respect, I find myself oddly in alignment with one anonymous practitioner who, when asked to contribute to this issue,
apparently objected, pleasure has no therapeutic value.)
But if pleasure is entwined with specific techniques, knowledges and practices as part of a pedagogical apparatus that
may complement the project of harm reduction, it is worth
being more specific about how it may be approached within
given apparatuses of knowledge and intervention: What does
a focus on pleasure allow that might otherwise not be appreciated? What alternative does it provide to the processes of
normalization and individualization that mark out deviant
individuals? How might pleasure be put to work so as to
craft better harm reduction praxis? In particular, how does
a framing of pleasure as an affect that is contingent on the
exchange of certain techniques and concerns serve to rework
conventional perspectives on using practice? What are the
methodological implications?
The primary value of this frame, as I see it, is the focus it
musters on practices of safety and care that might otherwise
go unregistered in the current punitive political environment.
As mentioned, it opens up the question of how a body effects
certain transformations, or realizes certain principles or concerns, in place of the usual focus on whether a body abides
by established norms. This approach has been particularly
useful in recent drugs research. Maria Pini has used it to identify the practices of self-care adopted by young women who
take ecstasy, including the specific concerns that inform these
practices, which extend from health to sexual safety (Pini,
2000, 2001). She argues that the social panic around girls
on E obscures these practices and has the likely effect of
generating even riskier ones. Erica Southgate and Max Hopwood document the forms of subjugated knowledge that exist
around drug use in gay community (Southgate & Hopwood,
1999), detailing the contribution they make to controlled
forms of use through the circulation of a folk pharmacology (Southgate & Hopwood, 2001). In the context of sexual
practice, a similar frame has helped to identify the emergence of diverse strategies to reduce HIV risk among gay
men, including strategies that do not conform to the condom
code (Hurley, 2002; Kippax, Crawford, Davis, Rodden, &
Dowsett, 1993; Kippax & Race, 2003; Rosengarten, Race, &
Kippax, 2000). With the successive introduction of new medical and communication technologies, a focus on pleasure
and its social pragmatics has been very helpful in keep-

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K. Race / International Journal of Drug Policy 19 (2008) 417423

ing track of what I have called shifting prevention ethics

(Race, 2003). From this vantage point, subjects of risk may
be seen to subscribe to the general moral principle of preventing HIV infection, but realize this aim in historically
novel ways, by means of changing techniques and strategies.
Where a more conventional epidemiological frame would
approach such practices in terms of noncompliance, the frame
of ethics prompts a focus on how subjects actively combine pleasure, safety and other concerns as they negotiate
new environments and conditions. The significance of this
broad approach is threefold: first, it provides a basis for
conceiving practical measures that are in touch with given
concerns and bodily practices, and thus have more chance
of being taken up. Second, it helps stave off moral panic
around risk and withstand its counterproductive effects (Pini,
2000; Race, 2007). Third and most importantly it is able
to admit of the active participation of affected subjects in
the co-construction of meaningful practices of safety and
care.
These insights around pleasure and safety have generally
relied on qualitative and ethnographic techniques, or what
can be broadly characterized as a symbolic interactionist
approach, which is able to grasp how practice is contextually and meaningfully negotiated. Since Foucault was more
interested in the epistemological construction of reality rather
than the phenomenological experience of it, his contribution
to these studies is conceptual rather than directly methodological. Qualitative methods can nevertheless be regarded
as making an important epistemological intervention (which
a Foucauldian orientation helps us grasp the significance of),
in that they provide a basis for querying the self-evidence of
behavioural measures that tend to dominate the policy field
in public health, and which are typically used to assess the
practices of risk groups. In my experience, a more adequate
understanding of the practices and strategies of those at risk
has been achievable only by means of a robust conversation
between qualitative and quantitative researchers, in which
quantitative measures are actively queried and revised on the
basis of various forms of insider and qualitative knowledge about social pragmatics. (On the often-unacknowledged
role of insider knowledge in harm reduction research see
Measham & Moore, 2006.) To import comments from HIV
prevention made by Peter Davies:
While epidemiological monitoring requires simple, unitary measures of unsafe sex, these cannot be used to clarify
the complex responses of ordinary men who make momentous but increasingly routine decisions about safer sex from
day to day . . . Working on heuristic rules about the world
is a deeply embedded feature of human interaction and
should be encouraged, not condemned. (Davies, 1993, p.
279)
Davies comments refer to the emergence of what would
otherwise have been unrecognized strategies of risk reduction outside the condom code, which were prompting claims

of recidivism among gay men. Davies signals the need

for methods that are capable of bringing embedded practices of risk reduction into perspective. Qualitative insights
(or lack thereof) directly impact the formation of the categories through which risk and safety become intelligible,
and according to which groups and individuals are deemed
compliant or noncompliant.
Embedded work on heuristic rules about the world is
an idea particularly compatible with Foucaults ethics and
indeed harm reduction praxis in that it instantiates a measure of freedom in self-fashioning that is absent from more
normative applications. But this is not the freedom of the
neoliberal subject, the presumption of which generally serves
as a motive for disregard. Nor should care of the self be
confused with the moralistic demands around health and selfcare that are so familiar today, which presume an atomized
self that pre-exists, and is neatly separable from, techniques
and relations of power (Sybylla, 2001). Rather, it refers to
the possibility of adopting an active and reflexive relation
to that field of action we call the selfa possibility that
can be fostered or foreclosed by social programs and policy
(Keane, 2003; Stengers & Ralet, 1997) as well as the conceptual frames we bring to the field. Some appreciation of
pleasure as a social process and interactively crafted medium
may assist in the materialization of freedom and self-care in
this regard.

Conclusion
Harm reduction practitioners are aware that a substantial
part of their work involves efforts to de-dramatize risk so as
to foster the conditions in which people can make practical
choices around care and safety, free from an overblown moral
drama about good and evil, wholesomeness and guilt. The
later work of Foucault helps to navigate the complex terrain
of pleasure and care in such a way that care is not conflated
with the unthinking imposition of norms. A conception of
pleasure as a social pragmatics is useful for harm reduction,
to the extent that it provides an alternative to the normalizing
and pathologizing tendencies implicit in therapeutic morality,
in that it enables the recognition of practices of safety and care
that would otherwise go unregistered in the current punitive
political environment. Such practices are fragile, and prone
to being shamed out of existence. An appreciation of care
as an impulse that may be immanent in pleasure could make
alternative versions of safety intelligible. Among its other
contributions, such an approach would intervene in the ways
in which agency is usually distributed among users, serviceproviders, researchers, drugs and the state by according a
certain freedom to drug-using subjects in their ethical selfrelation. This freedom cannot be taken for granted, nor used
as a rationale for disregarding those in danger. Rather, it
is a capacity that can be fostered or foreclosed anticipated or denied by practices of government, inquiry and
pedagogy.

K. Race / International Journal of Drug Policy 19 (2008) 417423

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