Speech-Language Pathology in Colombia 1966–2025: A Critical Discourse Analysis of Biopower and Therapy Devices

Therapy as a form of governance

Although it is usually considered a practice of aid and care, the therapy field can also be analyzed as a powerful means for social control. Hurvitz (1973) warned us that psychotherapy, even with benevolent intentions, often works to adjust individuals to dominant social norms, thereby defining deviation as a personal problem rather than a social matter. Similarly, from a Foucauldian perspective, Rose (2007) analyzes the mechanisms through which therapy exercises this power. It is not a power that suppresses but one that governs—that is, it seeks to guide people’s behaviors. According to him, therapy has become a ‘technology for governance of souls’ (104). Therapy provides the language and techniques through which people learn to examine and work on themselves, becoming autonomous and responsible subjects. Hurvitz and Rose pose a crucial question: What types of political and social work does SLP therapy develop beyond its declared communicative functionality? To answer this question, we turn to Foucault (2010) and Rose’s concepts.

Critical tools: biopolitics, governance, and ‘device’

Biopolitics refers to the way in which the modern state governs people by centering on the health and wellness of a collective national body. Historically, this entailed public health measures, such as sanitation and disease control. Rose (2007) refined this concept by addressing governance, showing how this power operates through individuals’ freedom. Power is not imposed, but it encourages us to freely choose to be ‘healthy subjects’, to optimize our wellness, and to govern ourselves according to the impositions of expert knowledge. It is a shift from national body management to individual subject governance.

A device (dispositif) is the mechanism through which this type of governance operates. In Foucauldian terms (2010), it is a network of heterogeneous elements (discourses, institutions, policies, scientific statements, and even architectural shapes) that work together to achieve a strategic goal. Our goal is that SLP therapy will function as a therapeutic device that serves the biopolitical objective of managing the body and communication, that is, as a complex assemblage of discursive elements that includes professional knowledge, diagnostic criteria, intervention techniques, materials, time management, interpersonal relations, and institutional practices. This therapeutic device operates with a purpose that goes beyond functionality, since its ultimate goal is to govern life by teaching and producing individuals as a specific type of communicative subject.

The critical disability theory (CDT) lens

To analyse the specific effects of the therapy devices, we use the CDT lens to understand how the devices participate in the construction of the ‘communicatively disabled body’ and in the devaluation of body forms (embodiment) that do not conform to a normalized ideal (Shildrick 2012). CDT emphasizes the analysis of disability as a social and political issue that involves not only bonds of oppression for people with disabilities but also their devaluation in relation to the mechanisms involved in the production of the normalized body (Minich 2016).

In summary, poststructuralist and critical approaches allow us to see how SLP devices have participated in the configuration of discourses around the normal communicative subject versus the deficient communicative subject and in the world in which they meet.

Global critical and poststructuralist studies

According to Preciado (2013a), between 1830 and 1850, the modern meanings of deficiency and disability arose as linked to mechanisms of the clinic’s truth production. Deficiency and disability represent a challenge in this verification apparatus because they defy the binary logic of normal and pathological in that they are not diseases to be cured but conditions. In fact, in critical diversity studies, Tremain (2018) proposes that disability be understood as a recent power relationship device. Drawing on Foucault’s work, she approaches disability as a historically and culturally relative concept, and as a device that governs ableist power relations.

Several studies (Johnson 2014; Salisbury and Code 2016; Eagle 2014) have contributed to the emergence of a critical approach to stuttering. They critique the assumptions made about people who stutter and who are stigmatized as weak or nervous. These studies have sought to destabilize rigid notions of speech fluency in the literature that are grounded in standards of race, class, ability, gender, and sexual orientation. St. Pierre and St. Pierre (2018) refer to how arbitrary cultural standards of efficiency, rhythm, and self-control judge stuttering. They argue that the SLP serves to control disability—which is considered a threat to the productive individual ideal—as well as a promise to achieve normalcy. As a device, communicative disability is represented as a not-quite-human or nonhuman status, since it is constructed as a deficiency in relation to both standard and official communicative forms. Hoegaerts (2015) describes how, in the modern history of speech disability, there have been privileged medical discourses and, only recently, social and cultural approaches. She shows how stuttering was made visible in the 19th century for a lucrative market of objects and curative practices that aligned with modern consumer identity.

Horton (2021) has gone further to argue in favor of a critical history of SLP, given that the discipline has had little discussion of what social justice approaches would be. She states that SLP does not consider in depth how ideological orientations, practices, educational policies, and training models in the discipline reproduce and deepen people’s marginalization. She concludes with a call to inquire how SLP has incorporated issues related to social positioning and stratification, such as racism, classism, linguism, ableism, homophobia, and transphobia, which create particular ecological contexts that reproduce inequity for groups already on the margins. Nair, Brea-Spahn and Yu (2024) discuss the decolonial and critical theories that support a shift in the SLP field and propose five foundational notions of what a critical-oriented SLP theory, teaching, and practice should consider: reframing the idea of disorder and pathologization, centering the insider, focusing on intersectionality, integrating positionality, and enacting indigenous knowledge as an alternative epistemology.

Local Colombian critical and poststructuralist studies

In Colombia, we conducted critical and poststructuralist research on children and adults with disabilities. Gómez-Victoria and Pava-Ripoll (2021) questioned the oppression experienced by children with disabilities and their families. They stated that dominant ableist assumptions that lead to the consideration of verbal oral language (VOL) as an essential characteristic of the full-human-being status restrict the configuration and expression of the different ways of being, living, and interacting of children without VOL. They highlight the necessity of changing SLP’s professional practices through ontological reflections on the meanings we carry about being human, the relationships we build, and the worlds we create through different semiotic repertoires. Likewise, Guerrero-Arias, Acosta-Calle and Vásquez-Narváez (2022) stated that theoretical frameworks beyond structuralism are required to understand communication and the role of therapy in people with aphasia (PwA). This is because PwA’s communication is explained in comparison with the structuralist communicative standard. They call attention to the importance of poststructuralist stances that explain nontraditional communicative repertoires and the challenges this poses for professional practices in SLP. Méndez (2022) analyzed how rehabilitation with hearing devices in Colombia is framed within the deficit, mercantile, and ableist dynamics that the national health policy has strengthened. He explained that the global and local hearing rehabilitation market, which he called the medical-industrial-financial complex, accumulates large amounts of money despite the questions that implantable and nonimplantable prostheses raise about the invisibility of the linguistic community of deaf people.

More recently, Gómez-Victoria et al. (2025) questioned the use of traditional linguistic-structuralist approaches to understanding Ela’s communication, a child with autism and no VOL. By appealing to other theoretical frames, such as relational ontology, semiotic repertoires, translanguaging, and multisensory ecology, they explain her communication as dynamic assemblages. This approach allows for a more ethical and mutually constructed view of communication while also leading to a nonpathologizing and pluriverse-welcoming stance towards people with communication disability.

The studies reviewed here show how critical and poststructuralist approaches have emerged to question the field as natural, neutral, and apolitical. Thus, this study’s goal is to critically analyze the discursive history of SLP in Colombia and unravel the biopower discourses embedded in professional practice. This unraveling contributes to reflecting on the profession’s history as biopolitically funded and device-networked while inviting new ways of doing SLP.

Eugenic-therapeutic device (E-TD)

Eugenics is a movement that reflects the scientific belief in improving human species through biological means (Pedraza 2009). In Colombia, this movement grew during the first half of the 20th century. The prevailing discourse of modernity at that time legitimized pedagogical, psychological, biological, and medical knowledge and practices (Sáenz-Obregón, Saldarriaga and Ospina 1997), opening the country’s gateway to a new productive era. In Colombia, this translated into a hygienist perspective from which public policies intended to manage citizens’ lives.

Within this framework of events, debate on race degeneration became possible by means of a knowledge/power network that mobilized the administrative decisions of a country in which ‘blackness, indigenism, miscegenation and poverty were equated with inferiority, and consequently with moral degeneration’ (Tovar 2016, 17). The public policies mandated at the time focused on seeking ‘a productive individual, lover of work and the economy, practical, useful, healthy and with individual initiative; a man thought of in the image and likeness of the Anglo-Saxon worldview, the main bearers of these values’ (Sáenz-Obregón, Saldarriaga and Ospina 1997, 46), which became a type of national identity. The following quote illustrates these interests of the time:

It is not possible to understand why pedagogues try to teach a worker not what he needs for life but what he will not need. The poor child does not need literature, but physical exercises that harden his muscles, that give him health and joy, so that he can be aggressive and effective in life struggles; they need to learn arts and crafts, to become expert workers […] Healthy men, strong men are what the country needs. (Camacho, 1917, 288)

Similarly, Congress sought to implement measures of social hygiene and race whitening, as shown by some sections of Immigration Law 114 of December 30, 1922:

Article 1. To foster the economic and intellectual development of the country and the improvement of its ethnic conditions, both physical and moral, the executive power will encourage the immigration of individuals and families who, owing to their personal and racial conditions, cannot or should not be grounds for precautions regarding the social order or the purpose that has just been indicated […]

Article 11 […] It is prohibited to allow entry of elements into the country that, owing to their ethnic, organic, or social conditions, are inconvenient for the nationality and for racial improvement and development. (Law 114 of 1922)

These immigration regulations contributed to the adoption of biopolitical measures to manage the body and the norm in Colombia, since anything else would be considered abnormal. Therefore, bodies considered inferior and deficient should be sanitized and disciplined to reach the normal standard as quickly as possible. In the Colombian educational context, as elsewhere (Noguera-Ramírez and Rubio 2019), health records were used to classify students, as seen in a scientific article published by the doctor Suárez (1940), who shows the results of a study carried out with 12,000 children from schools in Bogotá, Colombia, to whom a health record was applied to identify and separate those who presented ‘some language anomalies’. The record card identified the causes of the language disturbance; thus, the procedure involved the use of data from parents, teachers, and physicians to establish a clinical-medical-pedagogical diagnosis. The text shows that a total of 387 (3.3%) children were affected by language deficiencies, also considering that ‘probably a more rigorous and perhaps more scientific selection of the examined files, the total number of language deficient children would have been greater’ (652), which ‘justifies more than enough the creation of ortho-phonetic schools’ (654). Professionals’ training was biopolitically required to discipline children’s bodies with language pathologies to reach the norm and to avoid degeneration.

The demand for these new professionals was consistent with the consolidation of the industrialized economy in the country during the first half of the 20th century (Hernández 2002). Thus, the eugenic-therapeutic device (E-TD) stage in Colombia had already occurred even before the emergence of SLP as a profession in the country in 1966. Therefore, the profession arose under ‘the shelter of a unique epistemic regime of diagnoses/treatments/programs that has dealt with the deficit’s objectification’ (Munévar, Guevara and Rodríguez 2022, 3). This device articulates discourses and strategies of what was ‘desirable, legitimate, and indeed necessary to secure the future welfare of the nation’ (Rose 2007, 54). It includes the control of hereditary biological characteristics to eliminate the weaknesses of the population (negative eugenics), as well as the impulse of incoming European migration to promote those most apt to reproduce (positive eugenics).

The SLP profession became part of an E-TD that sought, through evaluation and intervention, to eliminate as much as possible the consequences of genetic or acquired problems that threatened the formation of a healthy national body capable of communicating, being cognitively intelligent, being able to study and work, and being docile to indoctrinate. This device articulated statements that portray communicative disability as a problem to be addressed by the SLP’s disciplinary knowledge, as shown in the following newspaper article:

The child whose parents are going to divorce, one who is not accepted by his classmates and who does not get to have friends, one who is poorly dressed, or one with red hair or a different skin colour […] may have problems paying attention in class. These children are obviously dyslexic. (El Espectador newspaper 1970)

This excerpt shows not only the implementation of harmful eugenic mechanisms but also a step towards the biomedicalization of childhood as an essential pathway to wellness and health. Nevertheless, biomedicalization internalizes society’s constant surveillance of the risks of pathology (Iriart and Iglesias 2012). By pathologizing situations such as parental divorce or physical traits such as skin color under the label ‘dyslexia’, the diagnosis expands beyond the clinical setting and recruits parents, teachers, and society at large into a permanent surveillance of childhood. In this way, social problems and human differences are transformed into individual medical issues, justifying therapeutic intervention as the necessary solution, thus consolidating the power of the device.

Children with hearing impairments can learn to speak as normally as any other child. In addition, what is most surprising, not through that manual language to which we have all become acquainted but with a new technique: lip reading. (El País newspaper 1978)

This quote illustrates the E-TD’s definition of deafness as an impairment to be addressed through a new body-management technique that sought to avoid the threat posed by sign language to the formation of a communicatively homogeneous national body. The E-TD is a discourse that denies difference while highlighting an ideal communicative human being. Moreover, it undermines other semiotic repertoires that do not correspond with the hegemonic and privileged forms of communication. This device not only acts upon those we intervene with but also produces us as professionals. It has molded us with a specific gaze to detect deviation, endowed us with a voice of authority to name and classify, and trained us in a set of disciplinary practices to guide others towards expected standards. Consequently, our professional actions are deeply governed, since the very lens through which we see, believe, and think about society has been shaped by these norms. This recognition compels us to denaturalize our professional practices, questioning not only what we do but also the kind of professional subject we have become.

Mercantile-therapeutic device (M-TD)

In the 1990s, a critical chronological threshold was set in Colombia because of political changes that consolidated the neoliberal ideal that had been woven in Latin America and that responded to international guidelines for industrialization, capitalization, and privatization of health. These new economic frameworks generated particular logics for understanding subjects and how human lives should be conducted. Governments formulate policies and promote initiatives to regulate citizens’ behavior and to act on their capacities (Miller and Rose 1990, 1). Government regulation and the scientific apparatus consolidated the market as another means of verification. Thus, the neoliberal economic model served as an SLP framework to deploy the logic of the commodification and marketing of health services in the E-TD. This commodification logic established what we call the mercantile-therapeutic device (M-TD), which establishes ‘new contractual relations between agencies and service providers, and between professionals and clients’ (Rose 1996, 327).

The market’s logic has always required the population to become a consumer of health services and technologies (Miller and Rose 1990). This purpose is served by studies that seek to characterize populations with expert knowledge. For instance, the basic model for the management of information in rehabilitation at the national level (Cuervo, Trujillo and Escobar 1993), which, in a neoliberal context, explicitly articulates specialized knowledge to organize practices that contribute to the quality of life of people with disabilities. The model was justified in the absence of an information system that would make it possible to identify the rehabilitation response needs, as the following quote shows:

In the country it is unknown: the number of disabled people, type and degree of disability […]; accreditation status and physical conditions of rehabilitation services in the national territory; […] the cost of the rehabilitation process per person; the benefit to society on the basis of the recovery of the productive capacity […] the incidence of the nonrehabilitated population in the gross national product. (132)

This model does not escape the bias of a perspective focused on people’s productivity and on the economic revenue of a health system regulated by the market, which is evident, on the one hand, in the use of dividing practices that maintain a classification system that mediates differences in people with disabilities and that groups them according to type and severity. On the other hand, neoliberal mechanisms incorporate factors such as the accreditation status of institutions and the costs associated with the nonproductivity of people with disabilities. In this M-TD, transformations brought by the market and industrial production became visible, turning the body into the ‘business of the millennium’ (Preciado 2013b, 36), a change that urged patients to become active consumers of medical services and products (Rose 2007). In the SLP field, this is illustrated in a magazine article as follows:

The child had to start a process to ‘untwist the tongue’. However, this was not the only therapy he was prescribed. Shortly after, Samuel began a second one to learn to smear substances such as paint on his body and to overcome his fear of exploring different textures. Both activities entail time and economic effort and raise questions about Samuel’s development. (Semana 2016, 88)

Therapeutic consumerism, illustrated in the quotation, is based on the promise of children’s normalization (Gómez-Victoria and Pava-Ripoll 2021). In this mercantile logic, the family ends up being governed and assuming social and economic responsibilities to achieve their child’s benchmarks. Faced with parents’ expectations regarding access to rehabilitation services that implicitly promise their children with disabilities’ normalization, they have even appealed to the courts.

For example, the Constitutional Court’s decision T-563/19 (2019) contains arguments used by parents in tutela legal actions to obtain benefits that guarantee children’s well-being through access to therapies such as ‘equine, dog-assisted, music, myofunctional, Halliwick, ABA behavioral, sensorimotor integration, or physical, occupational and SLP therapies based on neurodevelopment or neurorehabilitation’ (4). That is, M-TD intertwines in a complex relationship with both children’s normalization expectations and opportunities to expand the market for services. This multiplicity of intervention technologies is what Rose (2007) calls the therapeutic machine.

In Colombia, the tutela legal action became a massive and systematic mechanism ‘to obtain specialized therapies for children with disabilities, almost completely displacing the ordinary provisions contemplated in the health policy…’ (Court’s Decision T-563/19 2019, 68). Thus, in 2006, 134 tutela actions were filed for this purpose, and in 2014, they amounted to 31,000, demonstrating how more and more therapies are requested. In economic terms, these therapies’ revenues ranged from $240,836,824 COP in 2006 to $62,863,172,792 COP in 2014 (Ibid., 69). Unfortunately, these economic relations have led to confusion about what should serve as the guarantee of the right to health amid commercialization practices. This financial impact underscores that, in the marketing of these therapeutic services, families are immersed in dynamics that mask what should truly be a right and a service for people’s well-being.

In conclusion, capitalist, commercial, and neoliberal ideologies, along with the right to normalization, govern this M-TD. SLP practices in relation to this device are not those that seek well-being from difference but those that seek to govern life through the marketing of solutions to normalcy expectations. In other words, people’s desire is exploited to sell therapeutic technologies that inaugurate various ways of inhabiting territories of normalcy and pathology, thus governing life in pursuit of autonomy and productivity. We do not propose here to dispute the benefits that the various technologies can bring to buen vivir but rather the exploitation and commercial use made of them. We question whether the investment of large sums of money in therapies that seek bodies’ normalization continues to be privileged when they resist being normalized, which generates processes that undervalue and oppress difference/disability lives. Moreover, funding for actions that contribute to the materialization of environments that enable living with dignity from the experience of difference/disability is disregarded.

Body customization-therapeutic device (BC-TD)

This device is part of an individualistic culture in a world in which interventions are developed to expand people’s choices over their lives and bodies. That is, the two previous devices are no longer enough. These devices coexist with others that seek to modify the body at ease. Body customization-therapeutic device (BC-TD) goes beyond recovering deficient bodies’ functionality to center the pursuit of bodily and mental integrity with an imposed aesthetic ideal. The rationale is that bodies are considered capable of being strengthened and expanded to intensify joy and pleasure. BC-TD responds to desires for a new ‘freedom’ in which developments in the biotechnology market expand the limits of human corporality. Similarly, Rose (2007, 15) defines this as ‘technologies of optimization’ that do not operate with eugenic practices but with self-government practices imposed by the obligations of choice, the desire for fulfillment, and people’s yearning. In fact, in the last 50 years, pathologies, deficiencies, or suboptimal capacities have become sources of biovalue managed by states and corporations: ‘we should conceptualize the economy of contemporary biopolitics as operating according to logics of vitality, not those of mortality… it is a matter of governing life’ (70).

SLP has not been immune to the opportunities of conceptualizing deficiencies as sources of biovalue. The profession has been positioning itself in the market for practical services that fulfill desires generated through the neoliberal expectation of exercising choice. For instance, technological advances in hearing science have led to the development of aids and procedures that promise hearing restoration. To reach consumers, there are frequent promises that are not always fulfilled, such as significant improvements in sound clarity, better speech understanding, more employment opportunities, greater security, and a fuller social life.² The forms that represent or closely resemble the expected body in an ableist ontology circulate in social networks and contribute to positioning a single idea of the body and of humanness—in this case, the hearing body is the only way to be human as an unquestionable idea. In this context, deaf communities view the implant as part of a biopower that seeks to silence deafness and delegitimize deaf identities built on sign language (Cooper 2019; Méndez 2022).

Cochlear implants are offered on the market to cure deafness by transforming the human body with a technological device that replaces the organ of hearing (MedlinePlus 2023). The implant is part of the profound transformations that technologies have undergone in contemporary societies, which, according to Preciado (2013b), produce new subjectivities. It is about ‘a third system of knowledge-power that is neither sovereign nor disciplinary, neither premodern nor modern’ (77), a regime that considers the impact of the new technologies of the body in the construction of subjectivity. The implants that are promoted as a new way of hearing are part of this device because they announce a body improvement that goes beyond the ear’s functionality, as promoted by the Austrian multinational company, MED-EL (2023): ‘Receiving a cochlear implant is a big decision, but it can be life changing. Why? Because the benefits go beyond simply hearing better’. In Colombia, the rise of cochlear implants is evident in a report published on social media titled, ‘The cochlear implant revolutionized the way of listening for people with hearing loss.’ The authors reported that between 400 and 500 devices are currently implanted per year in Colombia. That implantation is a process that must be accompanied by rehabilitation therapy to be successful:

Experts in this field assert that the cochlear implant is the only medical device capable of replacing hearing. Specialists noted that cochlear implantation in Colombia began in September 1992, with thousands of successful cases, and added that its market entry has enabled more patients with hearing disabilities to participate in social and working life effectively. (Cabrera 2021)

SLP is part of the BC-TD to the extent that professionals participate in teams that advise or provide implantation programs. Their role consists of applying biopower mechanisms through the evaluation of possible candidates and oral language rehabilitation, since VOL does not appear spontaneously. In addition, VOL is considered the instrument that allows thinking, learning, and understanding.

For its part, the analysis of texts in the speech domain shows two emergent discourses: the first, driven by artificial intelligence (AI) in augmentative and alternative communication (AAC), and the second, the application of orofacial myofunctional therapy (OMT) in aesthetics. The first narrative is associated with life optimization promises offered by technological advances. The AI’s capacity is advertised for learning unique speech patterns, integrated into smartphones that are easy to use and customize. These technologies aim to reduce frustration, enhance social interaction, and, in some cases, increase speech production. Nevertheless, these solutions are focused on the individual level and do not imply social change in terms of relating to each other or vindicating the inherently human interdependent nature.³

The second narrative shows how OMT has positioned itself at the intersection of function, health, and aesthetics. While its traditional focus has been on correcting orofacial patterns to improve vital functions (breathing, swallowing, and speech), a growing body of evidence demonstrates its potential for facial rejuvenation. Publications such as those by Levrini et al. (2024), Ribeiro (2022), and Pavez and Silva (2015) affirm that OMT can improve muscle tone and facial harmonization, opening a new frontier for SLP practice.

Both discourses offer promises of communication optimized by technology and of a face rejuvenated by therapy. They also risk being captured by market logics and bodily perfectibility. Therefore, the SLP challenge is not to reject these practices but to redefine them. The goal should focus on promoting the agency and well-being of individuals, helping them inhabit their bodies with greater comfort and functionality on their own terms, rather than simply conforming to a communicative or aesthetic standard imposed from outside.

These practices are part of a social organization whose currency is a somato-political context of the body, seemingly dominated by new technologies that infiltrate and penetrate daily life. A characteristic of these new technologies is that they can be incorporated into the body, unlike disciplinary technologies that control it from the outside (Preciado 2013b). Body customization measures are framed in ableist ontologies as part of knowledge-power mechanisms that combine scientific knowledge, institutional practices, economic interests, and people’s search for perfectibility. This scenario raises questions about human nature, how we exercise freedom, and when our desires are territorialized and colonized (Rose 2007). The debate is no longer merely about whether biotechnology can erase difference but about recognizing how our participation in it entangles us SLPs more intimately in the biopolitics of life itself. The biotechnology illustrated here no longer seeks merely to restore function; instead, it pursues goals of bodily improvement and optimization.

Conclusions and recommendations

We state that SLP practices are integrated over time in therapeutic devices that intertwine hegemonic knowledge with power mechanisms that discipline bodies and subjectivities from difference/disability. Understanding these devices reveals the discipline’s underlying knowledge/power relations in Colombia and exposes the colonization processes to which it has been subjected. Such a revelation guides us to a more situated SLP practice that responds to individuals’ and groups’ singularities. We value the communication practices that are configured in daily experiences with difference/disability, and we question the profession’s self-image as a purely technical, apolitical field.

Future research in SLP using critical and poststructuralist approaches can address the following: the design of alternative ways of producing knowledge; the resignification of SLP in the country; the questioning of its colonial heritage and its logics of the market and consumption; and students’ and professionals’ reflections on the ontological, epistemological, and axiological positions underlying SLP practices. The aim is to critically discuss how uncritical positioning contributes to maintaining market and consumption, human beings’ customization, and greater social exclusion.

This study’s dataset is not available online and cannot be found publicly. Only the corpus cited is available online and in newspaper archives since all those documents come from public sources.