The body is at once elusive and substantial, ensuring that it can never be pinned down to everyone’s satisfaction. This irresolvable dilemma is usually attributed to the human condition itself and is commonly expressed by saying that individuals both have and are bodies. The struggle to resolve this dilemma has preoccupied philosophers and religious scholars from classical times, but in recent years interest in the body has taken on renewed vigor. The dualisms that have characterized thinking about the body for centuries are under attack, but they linger on in our thinking and continue to reveal the limitations in our understanding of human embodiment. In this paper I will look at the split between the contingent, postmodern body and the universal, biological body; the biological determinist vs. social constructionist understandings of embodiment; and the ways that new biotechnologies trouble but do not resolve these persistent dualisms.
Beyond Biological Universals and Postmodern Contingencies
The acerbic literary critic Terry Eagleton, writing about the contentious interest currently shown in the body by academics, suggests “there will soon be more bodies in contemporary criticism than on the fields of Waterloo. Mangled members, tormented torsos, bodies emblazoned or incarcerated, disciplined or desirous...” Eagleton, concerned that a move is afoot to dispense with the idea of subjectivity entirely, notes the existence of “a glamorous kind of materialism about body talk, which compensates for certain more classical strains of materialism now in dire trouble.”11xTerry Eagleton, “It is not quite true that I have a body, and not quite true that I am one either,” London Review of Books (27 May 1993): 7. As Eagleton’s choice of adjectives indicates, the meretricious body to which he is referring is a body of style and form, a body of surfaces in which many of the differences we recognized as crucial to embodiment during the course of the twentieth century— notably gender, ethnicity, class, and age—are marginalized or even erased. These chic new bodies exist, Eagleton suggests, in critical theory at least, to decenter the “unhoused intellect” favored by philosophers and others for whom mind is still “a sexy notion.” Talking and writing about bodies, that is, body surfaces—about “exteriority without depth”—is a last ditch effort to dispose of the “ghost in the machine,” an effort that, in Eagleton’s opinion, risks settling for subjectivity itself as no more than a humanist myth. Meaning simply becomes the material.
Although they appear strikingly new in their brashness and violence, these cultish bodies sprinkled through literary criticism and cultural studies pursue a familiar course, though with some notable exceptions. The philosopher Russell Keat noted some time ago that “a good deal of time [is spent] discussing the distinctiveness of human beings, at the same time holding an assumption about the nondistinctiveness of the human body.”22xRussell Keat, “The Human Body in Social Theory: Reich, Foucault, and the Repressive Hypothesis,” Radical Philosophy 42 (1986): 24. Discourse about body surfaces, body sculpting, sexual preference, cosmetics, piercing, tattooing, anorexia, and so on, inform us, often brilliantly and provocatively, about the normalization in popular culture of dominant ideologies for social life and about resistances to them, resistances that at times transcend anomie, and move towards a creative body politics. The interiority of the body for the most part, however, remains all the while “black boxed” (in the idiom of the sociologists of science), a tedious universal, and therefore consigned to the biological sciences. Discourse about activities of the mind (but not the brain) including reasoning, meaning-making, and the exercise of will, remain largely in the hands of philosophers. Irreconcilable dualisms of objectivity and subjectivity, body and mind, nature and culture created by this division of labor have long been entrenched as the legitimate ways to understand embodiment.
But the materiality of the body cannot be fully and satisfactorily represented either by the biological sciences or by the decontextualized, fragmented bodies of postmodern theory, and neither can it be consciously experienced in a void, without representation. In an effort to convey the intransigence of the problem, Eagleton plays on a popular adage with the title of his essay, “It is not quite true that I have a body, and not quite true that I am one either.” Objectivity and subjectivity, representation and experience, outward form and interiority, cannot be dissolved into or reduced to each other. But acknowledgement of these essential tensions is only part of the difficulty. The task remains to figure out how to move beyond the dualisms to a richer, more nuanced, and contextualized understanding of the body.
Medical anthropology and research into the history of the body has shown how representations of the body differ through time and space.33xCaroline Walker Bynum, Fragmentation and Redemption: Essays on Gender and the Human Body in Medieval Religion (New York: Zone, 1991); Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge, MA: Harvard University Press, 1990); Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (New York: Zone, 1999); Margaret Lock, Encounters with Aging: Mythologies of Menopause in Japan and North America (Berkeley: University of California Press, 1993); Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton: Princeton University Press, 1995).
Recent research has shifted the emphasis away from the body as passively constructed and transformed it from object into agent, or at least partial agent.44xMargaret Lock and Patricia Kaufert, Pragmatic Women and Body Politics (Cambridge: Cambridge University Press, 1998); Angela Zito and Tani E. Barlow, Body, Subject and Power in China (Chicago: The University of Chicago Press, 1994). As a result of this shift, renewed attention is being paid to the material and our understanding of it. Judith Butler has argued, for example, that the concept of nature has a history, and the “figuring of nature as the blank and lifeless page, as that which is, as it were, always already dead, is decidedly modern, linked perhaps to the emergence of technological means of domination.”55xJudith Butler, Bodies that Matter: On the Discursive Limits of Sex (New York: Routledge, 1993), 4. Bruno Latour reminds us that, prior to the Enlightenment, nature was understood in Europe as an animated moral force. With the establishment of the biological sciences, however, nature was made into an object for scientific experimentation, and it then became pragmatically expedient to dismember and decontextualize the human body in order to facilitate its manipulation. Matter was thus made essentially independent of the moral order.66xBruno Latour, We Have Never Been Modern (Cambridge: Harvard University Press, 1993).
It has become clear to many commentators, including many scientists, that nature is not, after all, immutable—the bedrock upon which the culture games are played. Nature must inevitably be represented making use of culturally produced categories. It is also called upon to do cultural “work,” that is, it is used to create commentary on social life— some behaviors and actions are “natural,” while others are not. Moreover, nature forces itself selectively into our consciousness in the form of pain, distress, happiness, and so on. Above all we create technologies—cultural products—to transform the world of nature. Nature/culture boundaries are contested by putting into practice new technologies that permit us to tinker with “the body,” “life,” and “death.” Many people are today deeply cynical of all forms of Utopian rhetoric, especially when it is associated with advances in technoscience; nevertheless the artifice of culture continues to work its way ever deeper into the labyrinth of molecular biology. The transformations currently taking place in connection with animal and human reproduction and with genetic materials, some of which may alleviate a considerable amount of physical pain and suffering, require a radical reformulation of modernist ideas about the separate domains of the material, technology, and culture, and with it our thoughts about embodiment.
The embodied experience of physical sensations, including those of well being, health, illness, and so on, is informed in part by the material body, itself contingent upon evolutionary, environmental, and other factors. Embodiment is also inevitably constituted by the way in which self and others represent the body, drawing upon local categories of knowledge and experience. If the experience of embodiment is to be articulated and made social, then history, politics, language, and local knowledge, including scientific knowledge to the extent that it is available, are implicated. In practice this means that knowledge about the body is informed by the social, and the social is in turn informed by the reality of the material. In other words, the biological and the social are co-produced and reproduced, and the primary site where this engagement takes place is the subjectively experienced, socialized body. The material body cannot stand as a black-boxed entity, assumed to be universal, with so much social, cultural, and political flotsam layered over it. The material and the social are both contingent—both local.77xLock, Encounters with Aging, 373.
Embodiment of the co-production of local biologies and culture is, by definition, internalized and individualized. Humans are unique in terms of their genetics and their lived experience, and to this extent embodiment is personal. At another level of abstraction, most embodied experiences are, up to a point, shared by us all—pain, immunological responses to infection, the biological changes of aging, hormone secretions (although these last two are inevitably modified by sex), and so on. But even these most basic of biological events are contingent.88xMary-Jo Delvecchio Good, Paul E. Brodwin, Byron J. Good, and Arthur Kleinman, Pain as Human Experience: An Anthropological Perspective (Berkeley: University of California Press, 1992); Carol Worthman, “Hormones, Sex, and Gender,” Annual Review of Anthropology 24 (1995): 593–616. This contingency is due in part to individual biology and in part to language and social, environmental, and political contexts in which individuals live. Even so, some types of embodied experience are relatively common across groups of people due in part to the fact that they share common environments, histories, languages, behaviors, and values. Other factors implicated in a shared embodied experience are biological attributes common to individuals whose ancestors have at some time lived in close proximity to one another and who have, therefore, a reasonably close, partially shared biological ancestry.
Biological Determinism vs. Social Constructionism: The Example of Menopause
One example of this complex co-production of biology and culture must suffice. When considering comparative research findings from Japan and North America in connection with menopause, I felt compelled to create a concept of local biologies in order to interpret the data.99xSee Lock, Encounters with Aging.By drawing on this concept, my hope was to prevent the Japanese findings from being treated as so much exotica, and at the same time to challenge the hegemony of the disease-like medical model of the end of menstruation that is dominant in North America and Europe.
Medical knowledge about menopause has been created in large part out of the symptom reporting and experiences of small samples of women in clinical situations, almost all of them living in Europe or North America. Most of these women have gone to visit doctors because of their physical and emotional distress. In addition, many of them have had hysterectomies. These patients are not representative of the population at large, and until very recently virtually no research had been done in connection with the subjective experiences of middle-aged women as a whole as they pass through mid-life. A great deal of medical knowledge about menopause is produced and circulated, therefore, without reference to the lived experience of the majority of women, and as such is biased, in particular with respect to the frequency and type of symptoms reported.
Despite these shortcomings, the professional organizations of gynecologists in the United States, Canada, Australia, most European countries, and elsewhere, have made blanket recommendations to the effect that virtually all women once past menopause should take powerful hormone replacement therapy (HRT) until the day they die. These recommendations, that in effect make the bodies of 30 year-olds the norm for all women, are designed to counter what are believed to be the long term consequences of “estrogen-starved bodies,” including being at an increased risk for heart disease, osteoporosis, and Alzheimer’s Disease. But these recommendations ride roughshod over the considerable variation in the incidence of these diseases across populations and social and economic groupings of women, and also ignore the side effects that many women experience when taking the medication. They also rarely acknowledge that the epidemiological studies on which the recommendations are based are hotly contested in terms of both methodology and significance of findings. There is by no means a consensus that HRT will reduce the risk of heart disease or Alzheimer’s, and there is considerable concern that its long-term use will increase the risk of breast and ovarian cancer. Some experts are belatedly suggesting modifications to this regimen in part perhaps because “compliance” is so low (approximately 15% of all women past menopause in North America take HRT on a regular basis).
In order to counter received medical wisdom on this subject, survey research was carried out in the mid-1980s with over 1,300 women in Canada, nearly 8,000 in the United States, and over 1,300 women in Japan, aged between 45 and 55 inclusively, all drawn from the general population. This research strongly indicates that the menopausal transition is not a difficult time for the majority.1010xNancy Avis and Sonja McKinlay, “A Longitudinal Analysis of Women’s Attitudes Towards the Menopause: Results from the Massachusetts Women’s Health Study,” Maturitas 13 (1991): 65–79. Of more significance for the present argument is that in Japan women going through kônenki (the term usually glossed as menopause) report very few of the “classical” symptoms of menopause—hot flashes and night sweats. Through extensive open-ended interviews with over 100 women, I concluded that this difference has little to do with a lack of willingness to cooperate with the researcher. Nor has it to do with shyness on the part of women about reporting symptoms (as is often assumed to be the case by medical audiences). The fact that no clear and unambiguous signifier exists in Japanese that refers exclusively to hot flashes in female middle age does not appear to be a major stumbling block either. Those relatively few women in the study (12.5%) who had experienced hot flashes talked about them unambiguously, suggesting that the difference between Japan and North America is quantitative, not qualitative, but nevertheless statistically significant.
Japanese doctors deal every day with middle-aged patients whose symptoms and experiences differ quite markedly from that which medical texts written in Europe or North America tell them is “normal” for menopause. When I carried out this research, virtually no doctors listed the hot flash as a “typical” symptom. After exposure to conferences and reading the proceedings of International Menopause Society meetings and other sources, a few of these doctors have come to believe that the problem lies with Japanese women themselves who simply do not pay “proper” attention to their bodies. However, the majority prefer to hypothesize that a biological difference sufficiently marked—due perhaps to environment, diet, or genetics—results in a subjective experience at the end of menstruation for many Japanese women that is different from that commonly experienced by women in North America. I argue that these embodied experiences, when verbalized, produce an effect on (but do not determine) the production of medical and popular discourse in Japan.
Japanese accounts about the end of menstruation sound bizarre to most North Americans and Europeans because emphasis is usually given to stiff shoulders, dizziness, and other non-specific symptoms. It is tempting to Orientalize this discourse and dismiss it as anomalous. The danger, of course, is that the Euro/American body remains as the gold standard and the medical model of a universal menopause survives intact. Research conducted in Hong Kong, Singapore, Taiwan, China, Korea, the Philippines, Thailand, Malaysia, and Indonesia, all reveal low reporting of hot flashes and night sweats. Some of this research is not strong methodologically, but the relative consistency of the results is nevertheless suggestive. A comprehensive study in the Yucatan found no reporting of these symptoms among Mayan women.
In all, these data strongly suggest that it is not appropriate to conceptualize the end of menstruation as an invariant biological transformation modified by culture and language alone. Similarly it should not be assumed that post-menopausal women are equally at increased risk for heart disease, osteoporosis, and other late onset chronic diseases. The co-production of biology and culture is implicated in embodied experience and its expression, and this effect has a tendency to be manifested in similar ways in individuals where culture and shared biological attributes are reasonably congruent.
Biological and genetic determinisms must be rejected outright, but it is also necessary to reject those equally deterministic arguments for the social and cultural construction of the body and related medical practices, in which the material body is universalized. Recognition of the embodiment of an historicized biology and the way it is made social through language, culture, and politics is one way to partially combat obdurate dualisms, the heritage of modernity. But embodied experience should not be understood as causal, rather it is a powerful point of entry into this complex engagement that can never be put to rest.
Biomedical Technologies and Persistent Dualisms
Biomedical technologies have permitted us to create new entities, mixtures of self and other, of life and death. Donna Haraway coined the term “cyborgs”—warning devices of our own creation—to characterize these new entities. Cyborgs are shape-shifters, neither wholly technological nor wholly material. They are constructed by means of discourse, communication networks, and other complex technological processes associated with biotechnology, but the material body never disappears entirely from sight.1111xDonna Haraway, “A Manifesto for Cyborgs: Science, Technology and Socialist Feminism in the 1980s,” Feminism/Postmodernism, ed. Linda J. Nicholson (New York: Routledge, 1990) 190–233. The technology of organ transplants, the condition of patients who are irreversibly unconscious and diagnosed as brain dead, and disputes in connection with other biomedical technologies are illustrative of these hybrid conditions.
Mixed metaphors associated with human organs encourage confusion about their worth. On the one hand, the language of medicine insists that human body parts are material entities, devoid entirely of identity, whether located in donors or recipients. But in order to promote donation, organs are animated with a life force that can be gifted, and donor families are not discouraged from interpreting their acts of altruism as permitting their relatives to “live on” in the bodies of recipients. Organ donation is very often understood as creating meaning out of an accidental and horrifying death—a technological path to transcendence, although the enforced anonymity of the donor family ensures that no earthly ties of solidarity between donors and recipients can be formed, except on rare occasions.
Despite the enforced cloak of anonymity, it has been shown on many occasions that large numbers of recipients experience a frustrated sense of obligation about the need to repay the family of the donor for the extraordinary act of benevolence that has brought them back from the brink of death. The “tyranny of the gift” has been well documented in the transplant world,1212xRenée Fox and Judith P. Swazey, The Courage to Fail: A Social View of Organ Transplants and Dialysis (Chicago: The University of Chicago Press, 1978). but when people experience a need to know more about the donor, it is not merely a desire to try to settle accounts.
It is abundantly clear that donated organs very often represent much more than mere biological organs; the life with which they are animated is experienced by recipients as personified, an agency that manifests itself in some surprising ways.
A conversation I had recently with a heart transplant surgeon was most revealing in this respect. This surgeon was responding to stories that have been circulating for some time now as to whether prisoners on death row should have the option of donating their organs for transplant before they are put to death. He was uncomfortable about the idea of organ donations made by death row prisoners, not so much because he was concerned about the highly questionable ethics (can one make an “informed choice” in such circumstances?), but about receiving a heart that had been taken out of the body of a murderer. He said to me, with some embarrassment, “I wouldn’t like to have a murderer’s heart put into my body.”1313xSee Margaret Lock, Twice Dead: Organ Transplants and the Reinvention of Death (Berkeley: University of California Press, 2001).
A good number of organ recipients worry about the gender, ethnicity, skin color, personality, and the social status of their donors, and many believe that their mode of being-in-the-world is radically changed after a transplant, thanks to the power and vitality diffusing from the organ they have received. That certain of their surgeons also think this way is surprising, but lends support to the presence of a mystical fetishism of the kind described by Marcel Mauss: body parts remain infused with life and even personality, and cannot be stripped casually of their human attributes. Even so, once an organ is procured and transplanted, the recipient is severely reprimanded, even thought of as exhibiting pathology (Frankenstein’s Syndrome), if she attributes this “life-saving” organ with animistic qualities.1414xLeslie Sharp, “Organ Transplantation as a Transformative Experience: Anthropological Insights into the Restructuring of Self,” Medical Anthropology Quarterly 9 (1995): 357- 89. Human organs are both objectified as things-in-themselves, and at the same time diffused with a life force and agency that is manifestly social.
Most human organs are procured from brain-dead donors. This new death located in the brain was legally recognized in North America two decades ago. In Japan, brain death was recognized as the end of human life only three years ago, and then under very specific, circumscribed conditions. Brain-dead patients who do not wish to donate organs retain full human rights and are treated as though living in Japan. Recognition of the brain dead as embodied patients has, of course, severely curtailed the organ transplant enterprise in Japan. Although essentially the same technologies, basic scientific knowledge, and clinical expertise are present in North America and Japan, transition from an embodied living patient to a living cadaver with only the rights of the dead, from which organs can be procured, is remarkably different in these two locations.1515xSee Lock, Twice Dead, for a full explication of this point.
There is unanimous agreement among I.C.U. intensivists in both Japan and North America that the clinical criteria for whole brain death are infallible if the tests are performed correctly. It is also agreed that whole brain death, properly diagnosed, is an irreversible state, from which no one has ever recovered. At the same time a unanimous sentiment exists that the organs and cells of the body remain alive, thanks to the artificial brain stem supplied by the ventilator. Indeed, if organs are to be transplanted, then they must be kept alive and functioning as close to “normal” as is possible. Intensivists are aware that infants have been delivered from brain-dead bodies. It is not possible to disregard the fact that the brain dead are warm and usually retain a good color; that digestion, metabolism, and excretion continue; and that the hair and nails continue to grow. Further, clusters of cells in the brain often remain active after brain death has been declared, and endocrine and other types of physiological activity continue for some time. For by far the majority of North American intensivists, although biological death has clearly not occurred, a diagnosis of brain death indicates that the patient has entered into a second irreversible state, in that the “person” and/or “spirit” is no longer present in the body. The body has assumed a hybrid status—that of a dead-person-in-a-living-body.
Despite the routinization of organ procurement from brain-dead bodies, rendering these entities as cadaver-like and as non-persons has never been without dispute. Use of the concept of brain death is currently being subjected to a new round of debate, and several influential dissenters have emerged in North America who insist that a massive public lie has been perpetrated by making brain death equivalent to the end of human life.
In Japan, where the debate about brain death has been continuous for 30 years, a total of only ten procurements have been made from braindead bodies, since the condition was legally recognized as the end of life. It has proved very difficult to overcome the profound hesitation that so many Japanese feel about cutting up entities that they believe are not quite dead. Embodiment and disembodiment have their own histories, and medical technologies make them yet more complex.
Other new biomedical technologies create ambiguities similar to those noted about brain-dead bodies. Cloning, clinical use of fetal tissue, the introduction of animal genes into humans, and germline engineering are just a few of the technologies that pose a threat in the minds of some people because they permit a radical break with our “natural” evolved selves and with our very “humanness.” In order to counter this kind of charge, French Anderson, a well-known gene therapist, divides all humans into two unequal component parts: those characteristics and features that are measurable, and that part which “all of our quantitative measurements will fail to define: perhaps it could be called a soul.”1616xFrench Anderson, “Genetic Engineering and Our Humanness,” Human Gene Therapy 5 (1994): 755–60. A soul cannot be examined under a microscope, nor can it be assigned a quantity, declares Anderson. He believes that this is the subjective, non-measurable, spiritual aspect of a human being, and it is that which makes the whole greater than the sum of the parts. Anderson insists:
if what is uniquely important about humanness (not about individual humans but about humankind as a whole) is not defined by the physical hardware of our body, and since we can only alter the physical hardware, it follows that we cannot alter that which is uniquely human by genetic engineering.1717xAnderson, 758.
He takes comfort from this conclusion and believes that he should be free to go ahead with genetic manipulations of all kinds. Gilbert Ryle’s ghost in the machine lives on; our souls will emerge unscathed, even as our genomes will be suitably enhanced in the coming years.
One intransigent continuity survives intact, at least in some quarters it seems, in this age of technologically manipulated bodies: the idea of an unambiguous dichotomy between, on the one hand, a stable, internalized, authentic, embodied subjectivity—a subjectivity located in the mind, that constitutes our uniquely human heritage—and, on the other, our material bodies. According to this dichotomy, our bodies, along with the rest of the animal world, are constituted entirely from nature and therefore we are at liberty to tinker endlessly with them. But is this dichotomous view our best understanding of what it means to be human?