Series Editors: Sheila Payne and Sandra Horn
Series Editors: Sheila Payne and Sandra Horn
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w Embodiment
Health Psychology
Series editors:
Sheila Payne and Sandra Horn
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1 Body plasticity if
The idea of embodiment Z
Being-in-the-world 2
The mirror phase 6
The gaze ii
An embodied brain? 7
Embodied language 9
Body images il
Brain plasticity 11
Psychological images Ves
Body cosmesis 16
The body as a message 17
The body as a cultural icon 21
Chapter summary 25
Discussion points 24
Key reading 24
2 Sensing self 23
Embodied language 25
Disembodied language 26
Distancing the body 28
Searching for selfin chronic pain one)
Living with an unwanted self 30
A body separate from the self 6
vill Contents
Somatic complaints
Stress
Heart ache
Immunology
Health economics
Somatoforms
Somatization
Somatized depression
Functional syndromes
Hysteria
Mass hysteria
Hystories 65
Neuropsychiatric disorders 66
Misidentification
On being in-valid
Self-division
Stigma
Reclaiming the body
Body history and abuse
Moving bodies on
Chapter summary
Discussion points
Key reading
Body sculpturing
Physiognomy
Phrenology
Somatotypes 86
Tweenagers
Svelte as a gazelle
Regenesis
Fat land
Contents ix
Enabling technologies
The body as a machine
Technology for people
Technology, disability and constructing meaning
Ways of being with technology
Levels of technological engagement
Monitoring the production line
Nesting babies
Hello Dolly!
x Contents
References 182
Index 201
Series editors’ foreword
accounts are set alongside findings from research studies, philosophical writ-
ings, discourses on the use of language, cultural considerations — so that
several perspectives and types of knowledge are brought to bear on a wide
range of topics, including cosmetic surgery, pain, prostheses, eating dis-
orders. This approach invites new insights into processes such as ‘adaptation’
and ‘accommodation’ to variations in health and bodily states, by broadening
and enriching our understanding of embodiment.
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Body plasticity
But O alas, so long, so far
Our bodies why do they forbear?
They’re ours, though they are not we, we are
The intelligencies, they the sphere
(john Donne, Songs and Sonnets, in The Ecstasy)
The world experienced (otherwise called the ‘field of
consciousness’) comes at all times with our body as its
center, center of vision, center of action, center of interest.
Where the body is, is ‘here’; when the body acts is ‘now’;
what the body touches is ‘this’; all other things are ‘there’
and ‘then’ and ‘that’. These words of emphasized position
imply a systematisation of things with reference to a focus
of action and interest which lies in the body ... The body
is the storm centre, the origin of coordinates, the constant
place of stress in all that experience-train. Everything
circles round it, and is felt from its point of view. The
word ‘I’, then, is primarily a noun of position, just like
‘this’ and ‘here’.
(William James 1890, cited in Thayer 1970: 154-5)
Our increasing interest in the human body 1s surely linked to our increasing
anxieties about what it is. If we assume that there remains some fundamental
truth in the basic ‘plan’ oflife — you are born, you live and you die — then we
must also recognize that the means ofour creation, how long and with what
sort of permutations we can live and even the finality of our death, are
becoming increasingly uncertain punctuation marks in the stories of our
lives. While for many centuries people could expect that the world they
would leave behind them was broadly similar to that which they were born
into, in the past hundred years we have had no idea of what that world we
leave behind will be like, or even if we might leave it clutching a high-tech
biological ‘return ticket’ — you again!
Technical transformation in medicine, especially in the reproductive area;
the epidemic of AIDS, highlighting the sexual complexities of contempor-
ary societies; the gay and feminist movements; the changing demography of
many Western societies, especially as regards the process of ageing; the adop-
tion of the body by consumption advertising and the consumer culture; all
of these and many other aspects of modern living effectively question the
stability of the human body (Turner 1997).
2 Embodiment
Yet I do not think that this should be seen as an age of the ‘body
under siege’. Instead, the loosening up in thinking about the body, at least in
some quarters, offers new opportunities for some people to be re-enabled,
often when historically they have been disabled. While recently there has
been much excitement in the humanities about just how to conceptualize
‘the body’, much of this has not been grounded in a way that makes it
relevant to people in health-related settings. I wish to apply the concept of
embodiment to the increasing variety of ways in which we can understand
the experience of those suffering from bodily distress and its indivisible
psychological expressions.
Furthermore, in parallel to the excitement that the concept of ‘brain
plasticity’ has recently generated in the neurosciences, I seek to develop its
overlooked cousin — body plasticity. It has been overlooked because, par-
ticularly in the health sciences, we have largely failed to recognize, but
certainly to take on board, the essence of embodiment. One reason for this is
that within Anglophone Western science there has been a construction of
people as ‘split’ between their mental life and their physical body, and
their problems have been largely segregated into systems of dealing with
these two domains. Outside the largely English-speaking world of ‘logical
positivist science’ there have been parallel, but quite different, advances in
how we understand such issues. In the next section of this introductory
chapter we explore how the concept of ‘embodiment’ can constitute a
middle ground between clinic and culture. Out of this consideration a
more flexible idea of ‘the body’ arises and we consider how body images
are influenced by neurological, psychological and socio-cultural factors.
In the next few pages I review some relevant philosophical ideas on
embodiment, and as in the old cavalry adage try and ‘travel light over
rough ground’.
Being-in-the-world
The ‘blame’ for splitting the mind and the body is usually attributed to Plato
and Descartes. Plato (fifth century Bc) believed that ‘truth’ only existed in
Body plasticity 3
pure forms; that is, it wasn’t embodied in physical objects. As such the
physical world, and the bodies that lived in it, were at an inferior level to
this higher reality. Similarly, René Descartes argued in the seventeenth
century that ‘pure knowledge’ could only be achieved through disregard
of the senses. In searching for the certainty of his own existence, Descartes
came up with the Cartesian, cognito ergo sum: ‘I think, therefore I am’,
Because, Descates argued, he was aware of his own thinking, he could
therefore be sure that he existed. As such, he separated mental life from
physical life. The mind and the body parted. While today this may seem
to have been a retrograde step, the dissociation between mental (and
spiritual) life on the one hand and mere physical existence on the other
hand allowed for science to proceed to work on the body — objectify-
ing it — safe from the suspicion that God’s work was being messed
with. Christianity has long had a poor impression of the body, seeing
it as imperfect, impure and transitory — something to be transcended
(Cavallaro and Vago 1997).
Wilde (1999: 26) summarizes the implicit contemporary assumption that
still prevails in many quarters thus: ‘people often think that the human (self)
owns the body, and that the body is separate from the self. Whether
Descartes’s cogito ergo sum was inspired by political astuteness or whole-
hearted conviction, it has endured and underpinned many of the assump-
tions that our understanding of human health and welfare is based on, even
to the extreme of us having one sort of hospital for ‘mental’ problems and
another sort for ‘physical’ problems. In striving to study ourselves scientific-
ally — and there is nothing wrong with that — we have sought to be as
objective as possible and to play down our opinions in favour of repro-
ducible facts. This detached scientific viewpoint has been described by
Nagel (1986) as ‘the view from nowhere’.
While many have noted the abstractness and emptiness of the Cartesian
cogito (Lechte 1994) it is the philosophy of Maurice Merleau-Ponty that
perhaps offers the most compelling alternative in respect of the concept of
embodiment. Merleau-Ponty argued against a philosophy of psychology
that opposes the mental and the physical and sees them as external to each
other, and therefore only associated in some sort of cause-and-effect rela-
tionship (Mathews 2002). Merleau-Ponty ties mind and body inexorably,
not in seeing them as two sides of the one coin, but perhaps more in denying
the possibility of the shape of the coin existing without the metal that
constitutes it.
He believes that ‘to be a body is to be tied to a certain [sort of] world’ and
that our study of that world should start from how we actually perceive it,
rather than from theories of how it must be. By way of analogy, a car
manufacturing plant is ‘set up’ to manufacture automobiles, it is configured
to facilitate the most efficient assembly of these vehicles. At a stretch this
production line could be modified to, say, produce motorcycles or perhaps
even cranes. However, it is never going to be a suitable framework for the
4 Embodiment
133-4). It is important to realize that the images of the body from ‘outside’
and ‘inside’ are never simply superimposed over one another in a neat fit.
There is no one-to-one correspondence in these two images. You will rarely
see the back of your head, the bottom ofyour heel or the end of your spine,
yet you do have an inner experience of these.
The gaze
Michel Foucault, another Frenchman, was interested in the production, regu-
lation and representation of bodies within a context of disciplinary surveil-
lance (Turner 1984). One aspect ofthis is what he refers to as ‘the gaze’, and
Foucault (1979) uses Bentham’s Panopticon to illustrate it. The Panopticon is
a circular prison designed such that the cells of the prisoners are all around the
outside and the wardens sit in the middle. The cells are always illuminated so
that the wardens can see into them, but the central area is always in darkness.
Consequently the inmates never know when they are being watched and, in
effect, ‘watch themselves’ all the time. This sort of‘disciplinary surveillance’ is
not, however, restricted to prisons, Foucault argues: the ‘warder’ can easily be
replaced by the doctor, nurse, teacher, foreman or whatever authority figures
presides over whatever institution (Foucault 1990). In the case of healthcare,
the scientific gaze now penetrates the skin, aiming to regulate our inner
functioning. As we will see later, this ‘gaze’ — the sense that we are being
looked at all the time — may make us feel ashamed and guilty if we fail to
conform to our ‘invisible observer's’ expectations of the shapes and forms
that our bodies ‘ought’ to adopt.
While Descartes and others saw the ‘body as the prison of the soul’,
Foucault turns this around: ‘the soul is the prison of the body’, in the
sense that the body is worked on in order that it conforms to abstract prin-
ciples of propriety, these principles being the ‘soul’ into which our cultures
socialize us. Another influential idea of Foucault, relevant to embodi-
ment, is his suggestion that while we might think that abnormality 1s
defined as a deviation from normality, in fact things work the other way
round. We search for signs of abnormality in order to know what 1s
normal. If we did not have abnormal, or ‘improper’, bodies, then we could
not identify normal ones. While the definitions of abnormality may
change over time and across cultures, its social function, he argues, remains
the same.
An embodied brain?
Embodied language
and gestures (where they convey related but distinct information, e.g. point-
ing to a cup and saying ‘mummy’ meaning, it is mummy’s cup), predicts the
onset of two-word speech (see Goldin-Meadow and Butcher 2003).
Having examined evolutionary and developmental arguments, Kelly et al.
(2002) also consider the ‘moment-to-moment’ production of language.
They argue that the original lesion studies of Brocca and Wernicke that
were interpreted as localizing language centres must now be reviewed in the
light of evidence that language involves additional areas, including subneo-
cortical areas (for instance, the cerebellum, thalamus and basal ganglia), neo-
cortical areas (for instance, the temporo-parieto-occipital junction and
occipital lobe) and motor areas in the cortex; even the right hemisphere,
long considered as ‘inferior’, at least with regard to language function, seems
to have an important role in language. Thus language does not seem to
reside in one or two places, but seems to be an ‘emergent’ skill, based on
interacting modalities.
Gesture and speech constitute an integrated communication system
(McNeill 1992). So fundamental is this association that even congenitally
blind speakers interacting with other blind speakers still use gesture (Iverson
and Goldin-Meadow 1998). Kelly et al. (2002: 343) conclude:
gestures appear to be linked to adult speech on multiple levels of analy-
sis — from neural, to cognitive to social. The fact that this link is in place
well into adulthood suggests that gestures are not merely a vestige of
our evolutionary and developmental past, but are something that is
fundamental to how fully formed humans continue to communicate in
the present.
Gesture is embodied thought. The Oxford English Dictionary defines meta-
phor as ‘something considered as representing or symbolising another (usu-
ally abstract) thing’. Thus gesture, in as much as it can both represent and
symbolize other things, may be thought of as metaphorical. Language can
obviously be metaphorical, but it can also be metaphorical in a literal sense.
Recent research has found that semantic processing of action words activates
sensory motor areas in the brain (Etard et al. 2000). Pulvermuller ef al.
(2001) reported that while processing action words, the areas most strongly
activated in the motor cortex were those associated with the body part used
to perform the action described by the words. Thus cortical activity
involved in thinking about an action overlaps with that involved in perform-
ing the action. It may well be that using our hands to gesture the idea of
trying to achieve balance is a very effective metaphor because it creates the
experience of balance in those who perceive such a gesture (Church et al.
2002).
Body plasticity 11
Body images
Brain plasticity
Within hours or even minutes of delivery newborn babies can imitate
orofacial and head movements performed in front of them (Meltzoff 1990).
This ability to identify specific bodily movements and then produce the
same action with the corresponding part of their own body suggests that
neonates have some sense of their own body. Such an idea would tie in
well with Melzack’s (1990) neuromatrix theory, which suggests that we
innately inherit a sort of ‘neuronal signature’ of our bodies. This ‘matrix’,
or network, is comprised of somatosensory cortex, posterior parietal lobe
and insular cortex, and together they produce an implicit sense of the
body.
These ideas are of course supported by the earlier work of Wilder
Penfield. Penfield, a Canadian neurosurgeon working in the 1940s and
1950s, opportunistically stimulated specific regions of the brain that were
exposed during operations. These patients were conscious because only
local anaesthesia was used and since there are no pain receptors in the brain
such stimulation is painless. He simiply touched an area with an electrode
and asked people what they felt. Elicited sensations ranged from images and
memories to physical sensations (Penfield and Rasmussen 1950). By tracing
sensations experienced down one strip of the brain Penfield ‘mapped’ out
where different parts of the body are represented (Figure 1.1).
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Genitals ’
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Figure 1.1. Sensory-motor areas as ‘mapped-out’ on one side of the brain,
representing the opposite side of the body (Penfield and Rasmussen 1950)
12 Embodiment
This strip, now known as the somatosensory cortex (or sensory “homun-
culus’, meaning ‘little man’), reconfigures the body and allots greater space
on the cortex to those body parts that are more sensitive (there is a similar
pattern in the motor cortex, the strip of cerbral cortex that runs parallel to
the somatosensory area, located on the other side of the central fissure of the
cortex). So in both of these, the area given over to the hands, for instance, is
much larger than that given over to the back or the trunk. Figure 1.2 depicts
the proportional representation of the body in the brain. The good news is
that most of us don’t look like that! In effect, the somatosensory cortex is a
map of how we sense the world, but not how we make sense out ofit.
Of great importance is research indicating that how we sense the world
shapes the neuronal structure of our brains. A dramatic example of this comes
from the treatment of ‘webbed finger syndrome’ (or syndactyly), in which
people are born with fingers webbed together with the result that they don’t
move independently of each other. Rather than the fingers having — as they
usually do — their own distinct area on the somatosensory cortex, the somato-
sensory representation for people with ‘webbed finger syndrome’ clumps all
the fingers together as a “whole hand’. For example, the distance between the
sites of representation of the thumb and little finger is significantly smaller
than normal. However, when fingers are surgically separated from each other
so that they can move independently, within a month of this happening the
somatosensory representation of the fingers has changed so that they each
have their own ‘patch’ on the cortex and the distance between representation
of the thumb and little finger has increased (Mogilner et al. 1993).
It would seem that a genetically inherited condition that webs the fingers
together and has associated morphology in the brain is treatable not only in
Eyes. ie Lee
Figure 1.2 This ‘homunculu s’ shows how the body is represented in the cortex.
The biggest features, such as the hands, have the most neurons
Body plasticity 13
the sense of separating the fingers, but also in the sense of changing brain
structure. This is just one example of what is referred to as brain, or neural,
plasticity. Robertson (1999) describes the underlying principle of neural
plasticity as ‘cells that fire together, wire together’. It is in this sense that he
talks about ‘sculpturing the brain’, where people’s experience of their world
is inscribed upon their brain. Intriguingly, then, our social and cultural con-
structions of the world, our subjectivity, our intuitions, are neurologically
‘underwritten’ by the creation of Hebbian neural circuits that reverberate to
our lived experience of the world. Our experience of the world is not only
through being-in-the-world by virtue of our physical body but also through
the world we construct being-created-within-us, by virtue of our physical
body. More will be said about neural plasticity in Chapter 5, but the essential
point being made here is that our neurology is dynamic, reactive and often
adaptive and it reflects our subjectivity.
While the homunculi in your brain offer a representation of your body,
they are very clearly not the only ones, the ones you are consciously aware
of, or the ones responsible for our drive to sculpt our bodies beautiful. The
fact that these neurological homunculi are so strange and foreign to us
testifies to the fact that they (usually) play a limited role — if one at all — in
our sense of the physical self. A range of psychological factors are involved.
Psychological images
It was not until the work of Paul Schilder that the role of non-neurological
factors was incorporated into the understanding of body image. Schilder
(1935) considered the broader psychological and social context in which
our experience ofthe body occurs. He defined body image as:
the picture of our own body which we form in our mind, that is to say
the way in which the body appears to ourselves . . . we are not dealing
with a mere sensation or imagination. There is a self-appearance ofthe
body ... although it has come through the senses, it 1s not a mere
perception. There are mental pictures and representations involved in it,
but it is not mere representation.
(Sehilder 1935: 11)
He was also interested in what he called the ‘elasticity’ of the body image:
how its properties of size and heaviness and its influence on interactions
with others could fluctuate. Schilder (1935: 283) noted with disdain that
‘in the voluminous books by Wundt and Tichener there is no mention of
the body as an entity and as a unit’. This same situation still pertains in
most psychology books, even those dealing with perception.
Schilder’s term ‘body image’ has subsequently been used to refer to
attractiveness, size, distorted body perceptions, perceptions of body boun-
daries and perception ofinternal body states. These are all legitimate aspects
of bodily experience, and can perhaps be included within Grogan's (299151)
14. Embodiment
use of the term ‘body image’: ‘a person’s perceptions, thoughts and feelings
about his or her body’. However, it may be useful to recognize a division
between purely perceptual aspects of the body and evaluative aspects, while
acknowledging that these may interact.
The complexity of the relationship between perceptual and evaluative
images of the body is illustrated in a study by Cash (1989) which found that
evaluation of individual elements of the body does not add proportionately
to produce an overall impression of the body. Cash reported that for men
the following were found most important (in descending order) in statistic-
ally predicting overall appearance satisfaction: weight, upper torso, face, mid
torso, lower torso and muscle tone. Height was not a significant factor.
For women the order was: weight, upper torso, mid torso, lower torso and
face evaluation. Neither height nor muscle tone were significant factors for
predicting ratings of overall appearance satisfaction in women.
While these results are interesting they are also doubtless ‘culturally
encapsulated’. That is, different cultural values will influence people’s evalu-
ation of their body. Even within the same societies we are now well familiar
with changing attitudes regarding thinness. Grogan (1999) traces a change in
the ‘ideal body’ of women, from the voluptuous form of the Middle Ages
continuing right into the twentieth century, to the recent (1920s) idealiza-
tion of slimness, propagated by the fashion industry. Until recently, to be
plump was to be fashionable and erotic. This ‘reproductive figure’ was often
portrayed with rounded hips and fullness of the stomach and breasts, 1n
order to symbolize fertility (for example, Rembrant van Rijin’s Bathsheba,
1654). As Grogan (1999: 12) points out, ‘The ample and curvaceous
woman’s body was idealised as the antithesis to the taut male body
portrayed by neo-classicists such as Jacques-Louis David.’
It has been argued that the pursuit of thinness arose from the fashion
industries’ need to mould bodies to the ‘right’ shape to ‘show off their
garments. Thus fashion in the 1920s required women to have a boy-like
flat-chested figure in order to display to greatest effect the ‘Flapper’ fashion
of straight low-waisted dresses (Grogan 1999). In the 1930s and 1940s
clothes that emphasized breasts again became fashionable — ‘sweater girls’. In
the 1950s it was big breasts, tiny waists and slim legs — hello Marilyn! How-
ever, the sensuality of the 36-23-36 buxom figure of the 1950s had to
compete with the slimmer likes of Grace Kelly and Audrey Hepburn, who
symbolized sophistication, and this thinner body became associated with
‘upper classness’. By the 1960s Twiggy (all 96 pounds of her), boyish and
flat-chested, had become the new role model, embraced by all social classes
and seen as unconventional, free, youthful and part of the ‘Jet Set’ (Grogan
1999). The ‘waif’ models of the early 1990s, appearing painfully thin to
many people, gave way to the ‘heroin chic’ models of the late 1990s, who
not only appeared painfully thin, but, with black eye make-up, blue lips and
matted hair, looked to many like heroin addicts.
There have also been changes in the idealized male body, though, at least
Body plasticity 15
until recently, the social pressures on male bodies have been less extreme
than those on female bodies. In cultures beset with poor socio-economic
conditions being thin often signifies negative attributes of malnutrition,
poverty and infectious disease, while in cultures in wealthier socio-
economic conditions, being thin signifies wealth, health and prosperity
(Grogan 1999). In poorer contexts obesity signifies wealth because plump
people are able to afford to eat to excess, while in wealthier contexts obesity
may be viewed much more negatively as excessive indulgence and lack of
self-control. That these ‘cultural’ interpretations of body image can change
when socio-economic (and cultural) circumstances change was illustrated in
a study by Furnham and Alibhai (1983), which compared Asian woman
living in Kenya and Asian women who had emigrated to Britain
from Kenya. Heavier women were more positively rated by the Kenyan as
compared to the British residents. Helman (2001: 12) suggests:
The culture in which we grow up teaches us how to perceive and
interpret the many changes that occur over time in our own bodies and
in the bodies of other people. We learn how to differentiate a young
body from an aged one, a sick body from a healthy one, a fit body from
a disabled one; how to define a fever or a pain, a feeling of clumsiness or
of anxiety; how to perceive some parts of the body as public, and others
as private; and how to view some bodily functions as socially acceptable
and others as morally unclean.
Cultural aspects of body weight and body perception are further discussed
in Chapter 4.
Cultural factors can have a strong effect on body sculpturing, even to the
extent that the overlap between artificially changing the body by accentuat-
ing characteristics of beauty on the one hand and distorting the body
through mutilation on the other hand becomes quite ambiguous. Polhemus
(1978) has catalogued some extreme forms of body alterations that have
been used (and in some cases still are). These include artificial deformation
of infants’ skulls, filing and carving of teeth, scarification of the chest and
limbs, binding of women’s feet, artificial fattening of girls, tattooing, inser-
tion of large ornaments into the lips and earlobes and the wearing of nose
and ear rings. Helman (2001) suggests that the most widespread form of
bodily mutilation is male circumcision (about one-sixth of the world’s
population), while the most controversial is female circumcision. Although
the amount of tissue that is removed during female circumcision varies
across cultural groups, it can include removal of all of the external genitalia.
The practice is opposed by many on the grounds of human rights, but in
some cultures many women continue to advocate this ‘right’ for their
daughters (see MacLachlan 1997).
16 Embodiment
Body cosmesis
If in some traditional societies female circumcision is seen as a way of
avoiding stigmatization and becoming an eligible marriage partner (because
one has adhered to the cultural rites of passage), then in the highly indus-
trialized Western societies, cosmetic interventions can be seen as conferring
eligibility in others ways. In 1999, Newsweek magazine ran a cover feature on
‘The new age of cosmetic surgery: younger patients, more choices, greater
risks’. The article by Kalp (1999) led off by recounting the ‘improvements’
of Holly Laganante, a 35-year-old from Chicago. She had had an eyelid lift,
liposuction on her thighs, varicose vein removal and a forehead peel. And
we were told that she was saving up for a forehead lift, or perhaps liposuction
to fix her saggy knees. She said, ‘It’s been tough on me financially, but
it’s worth every penny . . . It’s life-changing.’ She is not alone. According to
the American Society of Plastic and Reconstructive Surgeons, there was a
153 per cent increase between 1992 and 1999 in such operations , more
with
than one million in the last year. Gerald Imber, a New York plastic surgeon,
recommends to his patients that they begin ‘maintenance’ procedures —
removing fat in the neck, eliminating worry lines — somewhere between the
ages of 35 and 45. He says, ‘The idea of waiting until one day you need a
heroic transformation is silly ... you’ve wasted 20 great years of life and
you've allowed things to get out of hand’ (Kalp 1999: 38). California leads
America in ‘augs’ (augmentations), where it is apparently not uncommon
for 16-year-old high school girls to get breast enlargements — long before
they may have finished physically maturing.
McGrath and Mukerji (2000) reported that the eight operations most
commonly done on teenagers of 18 or less were (in descending order):
rhinoplasty (‘nose jobs’), ear surgery, reduction mammoplasty (breast reduc-
tion), surgery for asymmetric breasts, excision of gynecomastia (male breast
reduction), augmentation mammoplasty (breast enlargement), chin aug-
mentation and suction assisted lipoplasty (removal of fat under the skin).
While these procedures may be necessary and appropriate in many cases, the
difficulty is where to draw the line between cosmetic therapy and cosmetic
recreation, and perhaps even a culturally sanctioned ‘cosmetic mutilation’.
McGrath and Mukerji (2000: 105) state:
In the final analysis, the purpose ofplastic surgery is to change the patient’s
psyche in a positive way. By making what the patient sees as an
Improvement in appearance, his or her self-perception of the body is
changed, and this has an impact on the well-being and conduct ofhis or
her life (italics added).
This raises the question as to whether plastic surgery may be the most
appropriate intervention ‘to change the psyche’. While the possibility of
psychological disorder motivating a desire for plastic surgery certainly exists,
Body plasticity 17
area of
Figure 1.3 Portrait of Ngaiti Kahungunu, a Moira chiefin the Hawkes Bay
n of the New
Aotearoa/New Zealand, painted in 1877 (reproduced by permussio
Zealand National Gallery)
20 Embodiment
specific areas of the face (for example, above the eyes, below the chin, on the
cheek) convey distinct types of information.
Contrast this traditional, highly specific and stylized method of conveying
a message on the ‘body canvas’ with more contemporary art that seeks
to convey ambiguities and anxieties concerning body identities. Recently
Thad the good fortune to visit the Bodyscape exhibition at the Rodin Gallery
in Seoul, South Korea. The word ‘bodyscape’ has been used by American
art historian Nicholas Mirzoeff to refer to scenery produced by representa-
tion ofthe body in visual cultures. The exhibition showed representations of
the body produced by nine Korean artists. In introducing the works, Joon
(2002: 12) suggests that they are ways of challenging the ‘inherent limita-
tions of the Cartesian logocentric thinking and the restrictive binary of
body—mind’. While exposure of the naked body 1s still largely taboo in
Korean society, many ofthe artists chose to work with the naked body, as if
this is somehow more authentic. Briefly I will discuss the work ofjust three
artists.
Kim ll-Yong takes plaster casts of body parts to produce astonishingly
realistic ‘life-casting’ assemblages (see Figure 1.4). The female bodies he
renders into plaster are presented deindividualized, without faces. His ‘Being
without being, 1999” images are comprised of shell-like skin. The diminu-
tive and fragile body presented challenges us to define the space inside
the container and to wish for a face to put on it. A face would at once
‘complete’ the image and remove our awareness of its hollowness. In view-
ing this in three dimensions I felt an uncomfortable mix of voyeurism and
nihilism.
Park Sung-Tae used very thin and fragile wire netting shaped into various
body postures and suspended in mid-air. Cleverly lit, it is their reflections
that take on form and substance, only hinted at in the wire mesh. For me,
these striking images reflect the ambiguity between what we (biologically)
are made of and the image we (psychologically) cast. These images often
seem more real and life-like than their substrate. Here, however, there is both
the empowering aspect of your biology — that it allows us to be more than it
is — and its undermining aspect, in that whatever we do can be reduced to a
simple substructure. Presumably the light that casts the shadows is the life we
breath.
Finally, I also found the video works of Yun Aiyoung quite startling. The
‘Abyss’ series presents video images on horizontal screens immersed in the
space of open-topped empty oil drums. One therefore looks down on these
images, viewed though glasses that ‘stabilize’ the otherwise flickering foot-
age, and this produces a distancing and ‘Godlike’ perspective on the video
pieces. One ofthe pieces is of about 15 naked men and women standing in a
close ‘blob’ of bodies, wailing and weaving in an interconnectedness that
defies their own individuality and indeed their own nakedness — the indi-
vidual becoming a ‘dividual’, a division of amany legged and armed organ-
ism. For me, the point ofthese and other artistic representations of the body
is that they help us to question the representations that we are accustomed
to. In so doing they highlight how we socially construct meanings out of our
bodies. Art, no less than science, is a ‘truth seeking’ pursuit.
Chapter summary
Discussion points
1 What assumptions does your own discipline make about the body and
how open are these to the idea that the body affords the ‘point of view’
for your impression of the world?
2 Cana body ever reconcile its inner and outer experiences?
3 Is there such a thing as ‘cosmetic mutilation’, and how would you know
when it happens?
Key reading
Cash, T. Rand Pruzinsky, T. (eds) (2002) Body Images: AHandbook of Theory, Research,
and Clinical Practice. New York: Guilford Press.
Kelly, S. D., Iverson,J.M., Terranova,J.,Niego,J.,Hopkins, M. and Goldsmith, L.
(2002) Putting language back in the body: speech and gesture in three
timeframes, Developmental Neuropsychology, 22: 323-49.
Mathews, E. (2002) The Philosophy of Merleau-Ponty. Chesham: Acumen.
wy Sensing self
The body is a symbol. Its appearance and actions point
beyond itself to an inner world, but also beyond itself to a
total life situation. The body expresses a state of being.
(Kenny 1985: 72)
One day, for example, | can find it amusing, in my forty-
fifth year, to be cleaned up and turned over, to have my
bottom wiped and swaddled like a newborn’s. | even
derive a guilty pleasure from this total lapse into infancy.
But the next day, the same procedure seems unbearably
sad, and a tear rolls down through the lather a nurse’s aid
spreads over my cheeks.
(Bauby 1998: 24)
Embodied language
When people talk, their heart rate increases. When they talk about
themselves, it increases even more. When they talk about themselves in
situations where their personal integrity is in some way challenged, their
heart rate goes up further again — maintaining a psychological sense of self
involves active physiology. Our language, how we talk and refer to ourselves,
like a spanner, can ratchet up — ‘put the squeeze on’ — our hearts. However,
psychology, in particular, has treated people's conversations as though there
were only a linguistic enterprise in a social domain. Now it 1s becoming
26 Embodiment
clear that our talk, the conversations we engage in and the discourses we
develop, are fully embodied activities. They require not just psychological
work but also physical work and so we should not be surprised to learn that
the work of se/f-construction has both psychological and physiological correl-
ates. Focusing in particular on cardiovascular reactivity (CVR), Lyons and
colleagues (Lyons et al. 2000; Lyons and Farquhar 2002) have presented a
framework to explain much of the work in this area. They suggested that
elevations that occur in CVR during talk, or indeed any form of communi-
cation (including sign language), are a correlate of self-construction
processes: ‘speakers become more engaged and show increased CVR
depending on how salient their sense of self or subjectivity is during talk’
(Lyons and Farquhar 2002: 2044). Physiological and psychological processes
are seen not as having a causal relationship but as being correlates, in fact as
being simultaneous processes.
Lyons and Farquhar also note research indicating other psychological
variables that influence CVA during talk: CVR is higher when a person 1s
in an unfamiliar context. It is lowest when with a family member, higher
when with a friend and highest when with a stranger. People show lower
CVR when they are in the presence of another supportive person, as com-
pared to when they are alone or when they are in the presence of someone
who is not supportive of them. It is, however, important to note that the
results of the above research, and indeed the results of Lyons and colleagues’
own research, is not entirely consistent with their suggested explanatory
framework. This may be because not everybody reacts physiologically in
the same way to ‘talk’ and ‘self-work’. Perhaps a broader range of physio-
logical ‘correlates’ (i.e. other than CVR) should be taken into account.
However, for our present purposes, it can be concluded that their main
point stands: ‘that a sense of self occurs through social interaction and
relatedness and that this process ... [has] physiological correlates’ (Lyons
and Farquhar 2002: 2044). Importantly, these ‘correlates’ are not ‘side
issues’ or ‘physiological noise’, they are part and parcel of the process of
continually reconstructing and of renewing the person’s sense of self
though conversing with others.
Disembodied language
Talk about the self may reveal significant insights especially when con-
sidered in relation to aspects of the physical body that cause pain or distress.
If modern North-Western medicine objectifies disease, do individuals do
likewise? Cassell (1976) described how a woman who had a mass in her
breast discussed ‘my breast’ and ‘my nipple’, but referred to the tumour in
her breast as an ‘it’. She didn’t say to the doctor ‘Make my breast well’ or
‘Make me better’, what she did say was ‘Make it go away’. As Cassell (1976:
144) notes: “The very naturalness of the patients’ words — indeed, the dif.
Sensing self 27
ficulty of even hearing the word, “it”, or the word, “the”, in this context,
unless it is pointed out, suggests how common such speech patterns are.’
Perhaps tumours that appear on the skin, with their definitive boundary, are
easily spoken of as discrete objects, but Cassell argues that disease itself is
objectified. He does note, however, that hypertension and diabetes tend not
to be referred to impersonally but to be identified with the self: ‘my dia-
betes’, ‘my hypertension’. Interestingly, Cassell suggests that the heart, when
treated as a site of emotion, is personified (‘he broke my heart’), but objecti-
fied when it is the site of dysfunction (the example he gives is ‘when I had
the mumps, they told me it affected the heart’). Finally, Cassell argues that
some healthy aspects of the body are personified while others are not: cer-
tain organs ‘hidden’ from view are often referred to as objects (the lungs,
kidneys, liver, ovaries), while external anatomy attracts the use of personal
pronouns (my eyes, ears, skin, arms, legs). Of course these ‘data’ may be quite
culturally specific (Cassell’s sample was drawn from New York) and may also
be epoch-bound (his study was conducted some 30 years ago) and so we do
not know if these linguistic constructions reflect a basic human propensity
or are another aspect of North-Western cultural constructions. It is, how-
ever, important to consider what function such constructions might have.
Objectifying a disease may help to distance that disease and the distress it
causes from the person who is experiencing it. This can be seen as being a
self-protective ploy because it disengages the self from the thing that is
damaging the ‘self’. Of course we are familiar with many health professions
objectifying a disease. The tumour or the cancer can be attacked by my
doctor by using chemotherapy, even when, in fact, the assault is on the
whole body. This linguistic construction allows my doctor to be on my side
even when she is killing me (or parts of me, to be more objective). It 1s also
good for the doctor to know that she is fighting an if and not a you. Such
constructions continue to reflect clinicians’ and patients’ (note that patients
are objectified people) basic philosophical understanding of what they are
about. I, for instance, prefer to talk of someone suffering through depression
or cancer, or whatever, rather than with depression or cancer, or from depres-
sion or cancer (which I think is more objectifying— the depression or cancer
is attacking the self, but not a part of the self). However, I recall a very
eminent psychiatrist who lectured me during my clinical training, talking
about someone who was depressed ‘having a nasty dose ofthe illness’.
We have recently seen the mapping of the human genome, but what
Cassell alludes to is a sort of ‘mapping of the body and its diseases as they are
portrayed in the language ofaperson’ (Cassell 1976: 145). To paraphrase and
update Cassell’s conclusion, “we know much about the function of our
genes, but remarkably little about the function of our words’. If, as I have
argued above, we are continually constructing ourselves in conversation, and
if objectification is a form ofdistancing the self from the dis-ease, then what
happens over time as people recover from disease? How do their linguistic
self-referents change?
28 Embodiment
truth in the assertion that ‘doctor knows best’, there is also probably a desire
not to be responsible for dismembering oneself.
Morse and Mitcham explored a number of conjectures regarding the
function of detached speech, and considered its use in people who had
experienced different sorts of health problems. None of the spinal cord
injury group they reported displayed ‘disembodying language’, although
like the burns group they had experienced sudden, unanticipated injury that
threatened their survival. Furthermore, their lengthy exposure to ‘doctor
talk’ did not lead them to assume a more distanced rhetoric. The lack of
disembodying language in this group would suggest that its function is
therefore not to maintain a sense of self when an individual loses control or
sensation of a body part, nor is it learned from the clinical environment.
People with myocardial infarction also showed no evidence of dis-
embodied language, and so the threat of death which often accompanies
such life threatening traumatic events does not seem to be a spur to
linguistic detachment either. Finally, there was only ‘scant evidence’ of dis-
embodying language in the transplant group — who had lost body parts —
and this tended to refer to internal organs (liver or heart). Morse and
Mitcham argue that while each of these conditions may have some aspect of
pain, the pain of severe burns patients is quite simply incomparable to the
much lesser degree of pain in the others. Burn patients are often quite
literally ‘lost for words’ to describe the sort of pain they suffer:
I remember having pain. I remember how great the pain was. I'd had
four children and every one of them a hard delivery. I remember with
this pain, thinking that a baby — that labour pains — didn’t even hold a
candle to this pain. This pain is even too great to even try to describe.
It’s just solid pain. I’ve never felt anything that comes close to it, since
or before. It’s the greatest pain I’ve ever had.
(Morse and Mitcham 1998: 669)
Since disembodying language was a much stronger feature of severe burns
patients than the other groups, Morse and Mitcham (1998: 676) argued that
the function of disembodying language is as an attempt to retain the integ-
rity of self during prolonged agonizing experiences: ‘Disembodiment is a
strategy used to remove the body part, hence to remove the pain when the agony ts
overwhelming (original italics). Schilder (1935: 104) also suggests, although
without giving a mechanism, that we respond to pain by isolating it and try
‘pushing it out of the body image. When the whole body is filled with
pain, we try and get rid of the whole body. We take a stand outside our body
and watch ourselves.’
Searching
for selfin chronic pain
Morse and Mircham (1998) emphasize how the language of disembodiment
that accompanies episodes of severe pain reverts to an embodied language
30 Embodiment
with successful rehabilitation — ‘claiming back the body’. Osborn (2002) has
explored what happens to concepts of self when pain endures, when, albeit
less severe, pain becomes a part of life. Osborn reports on interviews he
conducted in England with six people, all of whom were from white
working-class backgrounds and no longer in paid employment due to
their chronic pain. Using interpretive phenomenological analysis (IPA; see
Smith et al. 1999) Osborn found that their accounts of living with pain
clustered around four broad themes: living with an unwanted self, the social
aspect of the self among others, a self that cannot be understood or con-
trolled and living with a body separate from the self. Here I wish to focus
particularly on the first and last of these clusters and will quote from
Osborn’s illuminating interviews to illustrate these themes (see also Osborn
and Smith 1998).
I dunno, that’s the pain bit, Iknow your gonna say it’s all me, but I can’t
help it even though I don’t like it. It’s the mean me, my mean head all
sour and horrible, I can’t cope with that bit, I cope with the pain better.
Interviewer: How do you cope with it?
Get out the way, [tearful] sit in my room, just get away, look do you
mind if we stop now,I didn’t think it would be like this, Idon’t want to
talk any more.
(Osborn 2002: 198)
Sensing self 31
There is a sense here of Kevin feeling that it is imperative for the interviewer
to understanding (‘what you need to understand’) that the pain is not him,
because unless he understands this (as Kevin himself does) he may get the
wrong idea of who Kevin is. Later, Kevin is asked what is the hardest thing
to manage in terms of how he sees himself and his pain:
the bits that aren’t me, I can’t be me, the hardest part is the pain
obviously, but the fact that I’m like this monster, I get mean, I do things
and think things which are mean, things which I’d never tell anyone
and ll not tell you so don’t ask, I get so and I can’t stop myself and I
hate it and I know it’s wrong but I can’t do much about it except to say
sorry afterwards or just keep it to myself, the family understand I know
but that’s the hardest part now you ask. Its not me to think like that, I’ve
had enough now . . let’s stop now.
(Osborne 2002: 205)
Confronting himself, not thinking like himself, seems to be too much for
Kevin, as if to continue the interview would be to contradict the very
understanding he has made of himself— that ‘it’s not me’. The second phrase
of this quote (‘I can’t be me’) possibly conveys, in almost Shakespearean
complexity, at once the impossibility of ‘being himself? (as in ‘just be your-
self’ and relax etc.) and at the same time the impossibility of the pain that
‘comes from’ and is experienced through his body, ‘being me’ — this can’t be
me, I will not let it be me.
I have noted, and it would seem to be supported in Osborn’s work,
another striking aspect of how people in chronic pain describe their
behaviour. The pain makes them do things they do not wish to do, and to
present an aspect of themselves (that if previously present at all) they would
prefer to remain hidden. Pain is almost experienced as an authoritarian
figure that compels them to act against their better judgement, for which
32 Embodiment
they feel great guilt afterwards. This ‘authoritarian aspect’ of pain has simi-
larities to Milgram’s (1963) now infamous ‘obedience’ experiments, which
subsequently, and rightly, provoked such ethical furore. Using US college
students as subjects, Milgram sought to explore the extent to which people
would follow inhuman orders, in this case to apply potentially fatal electric
shocks to an apparently innocent victim. To his surprise they complied a
great deal: even when they could hear their apparent victim screaming they
continued to administer electric shocks when instructed (by the experi-
menter) to do so. While I am not suggesting that chronic pain ‘tells’ people
to ‘act out’ their distress on others (in thought or deed), I am suggesting
that it can result in the expression of aspects of self that the person in
chronic pain was previously unaware of, or perhaps which previously didn’t
exist. In that sense at least, these aspects may authentically be experienced as
‘not me’.
Osborn’s second theme, concerning the social aspect of the self, conveys
how people in chronic pain are left with am impression oftheir inferiority to
others. The third theme, that ofa self that cannot be understood or controlled,
highlights the sense of uncertainly that people in chronic pain live with. Not
being able to anticipate their pain or their own actions in the future, they had
become unreliable and unpredictable, and might indeed worsen.
I suppose it’s made me think about it, before I thought about what it
looked like, whether I was putting on weight or what make-up to wear,
but never about what was going on inside, never gave it a thought,I still
don’t about the bits that don’t hurt, but I know I’ve got a back now and
a bum and left leg, because it hurts and you can feel it like a solid thing
like something that’s gone wrong.
together in Lynette’s speech. Yet both are of her body and juxtaposition
that body. The hurt does not, however, seem to be of her ‘self’ (she carries it
around) and is distanced by use of the second and third person (a. backerna
bum and left leg’, ‘you carry’, ‘giving you hassle’). Lynette went on to
describe her body in two parts: ‘an old bit and the pain bit, which has gone
wrong . . .it won’t obey me’ (Osborn 2002: 223). It seems to me that there
is a profound paradox here: when you are aware of your body, it is not
‘you’, it is only ‘you’ when you are not aware ofit. Taking this further we
might suggest that ‘you’ are only embodied in what you can’t sense,
because only then does that body offer a clear channel for being-in-the-world,
Just as when taking a picture we don’t want to see the lens, as this detracts
from the reality of the image, nor do we want to sense the body when
trying to be-in-the-world.
Williams (2000, cited in Osborn 2002) also makes a clever distinction
between the ‘disappearance’ of the body in the absence of pain and its
‘dysappearance’ in the presence of pain. Again Williams is emphasizing that
only in the event of bodily dysfunction does its presence enter conscious-
ness. In this circumstance there is a consciousness of ‘its’ being, but not
necessarily a consciousness of ‘it being me’. It is perhaps ironic that the
dualism that the concept of embodiment seeks to erase seems to find expres-
sion in the sufferer’s distinction between themselves and their body: the
identification of a ‘me’ (without the body) and an ‘it’ in pain (within the
body) (see also Bendelow and Williams 1995)
My quotations from Osborn’s excellent interviews, and indeed his own
study, are of course very selective and cannot hope to be representative of
the breadth of people suffering with chronic pain. Furthermore, it 1s
important to stress that many people suffering from a chronic illness manage
their lives quite successfully, maintaining high self-esteem and being pro-
ductive in their own eyes. At this stage we now broaden our consideration
of how language is used in relation to embodiment.
Throughout my work with her (over a period of about four months) she
repeatedly used the phrase ‘I don’t know where I stand’. Now, on the one
hand, it could be quite misleading to make too much ofa phrase that might
simply be a frequently used term from her personal lexicon, and as such, has
no great significance. It might be that one of her ‘favourite’ phrases just
happened to coincide with her particular type of physical difficulty, and that
she might just as easily have said ‘I feel disorientated’, ‘I can’t contemplate
the future’ or ‘I’m not sure what’s happening to me’. On the other hand, her
choice of words might also have conveyed something about her ‘symptoms’,
and, indeed, her symptoms may have conveyed something about her broader
life situation. Here, I think, is the crux of the difficulty with accepting the
notion of embodiment within many clinical contexts: physical distress
undoubtedly exists and can be shown to be underpinned by clear biological
processes; so to what extent can one seriously think of organic pathology
‘embodying’ concerns of the self, when, in fact, the physical problem would
exist without those concerns?
I believe that it is not as much a matter of the soma expressing the self
here (in some sort of psychosomatic formulation) as of the self looking for a
form of expression through the soma, as it is. As such, ‘self-concerns’, anxiety
and dysphoria may paint themselves on the canvas that allows for the great-
est degree of expression. Our hint that this may be happening comes from
the metaphorical use of language that highlights the person’s current pre-
dicament as a signifier for additional concerns. Such a process would be
‘innocent’ and banal were it not for the possibility that the body itself
becomes a metaphor. For Mary, her anxiety about walking and ‘going for-
ward’ magnifies the very real (organic) difficulty she has in doing just that
(due to muscle wastage, gait difficulties and pain) and this in turn becomes a
vehicle for her to express her concerns both physically and by routing her
distress into a lexicon salient to her experiencing of the world. Thus, when
Mary says ‘I don’t know where I stand’, she means it, both literally and
metaphorically.
Falling ill
I have summarized the different factors involved here in Figure 2.1, which
also illustrates how the above process may mediate the embodiment of
Mary’s distress in her difficulties in walking. Having recounted an example
of my own understanding of how aspects of the self may become
embodied through physical illness, | now wish to turn to accounts ven-
tured by others. Kidel (1988) suggests that many of us experience the onset
of illness as an external blow, almost like being tripped up (‘falling ill’) and
being ‘unmasked’, as illness reveals our vulnerability and dependency.
Indeed, Kidel goes as far as to argue that our ‘New Age’ focus on perfect
health is one that seeks to place us on a God-like pedestal, freed of negativ-
ity and limitations, beyond the bounds of merely being human, aged and
36
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Sensing self 37
Somatic symbolism
Seeing illness as more than a mechanical malfunction for which we have no
responsibility challenges us to understand what its role is in our personal life
‘story’, and ultimately, if it can in some way be considered as a meaningful
‘role’. McCormack (1988: 37) addresses the personalized nature of a
frequently objectified organ: the heart.
And why have we forgotten what was taken for granted before the
existence of the new branch of medicine called cardiology, that the
heart is constantly affected by what we feel and think, the way we live,
what we ask of it, that it is subordinate to the brain, that it has a
language of its own and that it has for centuries carried the symbol of
the centre, the spirit, the place from which love flows like the flow of
blood itself, that it is the four-chambered beat and continuum of life
itself.
Our hearts beat rapidly when enthused or hurt by those we love, ‘bursts’
with excitement, ‘leaps into our mouth’ when afraid, ‘flutters’ with pleasure,
‘spills’ with ecstasy, ‘soars’ with happiness and ‘sinks’ when we lose some-
thing dear to us. What may be reflected in our hearts, then, is a biological
correlate of our need for human relationships (see also Chapter 3).
38 Embodiment
Somatic fixation
somatic fixation, where the real (psychological) reason for their distress is
not explored. Biderman et al. (2003: 1137), cautioning about somatic fix-
ation, warn that ‘Once put into motion, it leads to certain expectations of
how the doctor will react to complaints and problems and can enmesh the
patient in the system, preventing him or her from relating to the emotions as
a potential source of bodily discomfort.’ Thus, Biderman et al. (2003) seem
to be describing a socially contrived situation (almost a folie a deux, in psy-
chiatric terms) where people share a delusional belief based on somatic
preoccupation.
The propensity towards ‘somatic fixation’ is perhaps one aspect of the
medicalization of everyday life. For instance, the rate of Caesarian sections
has dramatically increased in recent years, although to different extents in
different countries. In the UK one-fifth of births are by Caesarian section,
compared to about one in ten in Scandinavian countries (Struthers 2002).
Although it may be argued that women labour better in a private familiar
setting, moving about freely and keeping upright, clinical ‘risk management’
has them very much more publicly connected up to a monitor, and usually
on a bed in an unfamiliar and often ‘harsh’ clinical environment. The clin-
ical context ‘tells’ women that their body needs medical and midwifery
expertise to deliver their baby, when often this is not the case (see also
Chapter 6). One response to the harshness of medical environments and the
objectification of‘patients’ has been demonstrated in the, perhaps unlikely,
context of neurological disorders.
Romantic science
This sense of no longer ‘living in’ the leg is strongly conveyed by his loss
of both the feeling of and his feeling for the leg. He was not embodied
in the leg either through action or emotionally, and this points
to two essential elements of the embodied experience. Sacks was fortunate
to have correspondence with A. R. Luria, the famous Russian neuro-
psychologist, whom he quotes as writing: ‘The body is a unity of actions,
and if part of the body is split off from action, it becomes “alien” and not
felt as part of the body’ (cited in Sacks 1984: 115). But as Sacks (1984:
164) emphasizes:
If a hand is ‘alien’, it is alien to you, if something is done, it is you
who are doing it. But the ‘you’ or the ‘I which is everywhere
implicit is formally, explicitly, denied or disallowed. Hence the pecu-
liar double-think of . . neuropsychology . . . It is precisely the sub-
ject, the living ‘I’, which is being excluded. Neuropsychology is
admirable, but it excludes the psyche — it excludes the experiencing,
active, living ‘T’.
Sensing self 41
It would seem that even Luria felt it necessary to write two sorts of books:
‘systematic’ books dealing with complex neurological systems (for example,
Higher Cortical Functions in Man, 1966) and ‘neurological biographies’
addressing the experiencing ‘I’ (for example, The Man with a Shattered World,
1972). In the latter work Luria goes beyond what he described as the ‘veter-
inary’ approach; or what might, in more contemporary parlance, be referred
to as ‘meat-with-a-beat psychology’.
One ofthe themes Sacks develops in his writings is the importance of the
use of body parts and how such use is necessary in order to have a sense of
‘being’ in them. He also describes peripheral neuropathies that (often as a
result of diabetes) had resulted in sensory and sometimes motor loss in the
arms or legs. The result was that those so afflicted felt that their hands or feet
were ‘alien objects stuck on to arm and leg stumps’ (Sacks 1984: 158). He
also mentions patients with broken necks feeling that they consist of only a
head and shoulders. In 1991, Sacks, after another accident, received a spinal
anaesthetic and, losing all sensation of his legs, felt himselfto be ‘terminated’
in the middle. But he emphasizes that his legs didn’t feel ‘missing’, he felt a
sort of ‘seamless completeness’, as though he never had had a lower half— ‘a
sense of wholeness ending above the legs’ (Sacks 2002). Sacks’s sense of
being embodied would therefore seem to require some form of feedback
from those parts of the body.
Luria defined a romantic science as one that would ‘preserve the wealth
ofliving reality’ and contrasted this to a classical analytical science reducing
‘living reality with all its richness of detail to abstract schemas’ (quoted in
Wasserstein 1988). In Sacks’s attempt to achieve the former he, for instance,
considers the role of art, music, religion and personal relationships and
explores them as tools to living and rehabilitation that reach beyond ration-
ality. Such insight is once again based in his own experience ofinability to
move his leg with his own volition by ‘rationally’ trying to through deep
concentration. He contrasts this with the ease ofits (effortless) movement in
response to music he enjoys. While Sacks humanizes neurological and other
physical disorder by allowing the reader to identify with the person’s lived
experience, he also often refers to such disorder as an ‘it’, against which the
person’s ‘I’ must struggle to integrate itself amidst perceptual, motor and
other types of ‘gaps’. The way in which people do this (with, for instance,
defences, compensations and social relationships) is understood by Sacks to
tell us something about the person. As I have also argued earlier in this
chapter in the context of Parkinson’s disease, so Wasserstein (1988: 444)
summates: ‘The symptom is not accidental to the person, it expresses the
person; disease symptoms have unexpected significance’ (italics added).
The expression of disorder/illness through particular symptoms should
not be taken as a random and accidental selection of the disorder, but as the
‘fall-out’ of the person’s struggles to combat the disorder through their own
particular means. It is also in this sense that a person’s symptoms, their
expression ofdistress, may be said to embody at least an aspect oftheir self. It
42 Embodiment
Organic moorings
I want to end our review ofSacks’s fascinating work by mentioning the case
he refers to as ‘The Disembodied Lady’ (1985). Following abdominal pain
Christina was found to have gallstones and was admitted to hospital for
removal of her gallbladder. Before her surgery she dreamt of feeling very
unsteady, being unable to feel things with her hands and dropping things she
picked up. Later the same day, she actually developed these symptoms and,
worsening, said ‘I can’t feel my body. I feel weird — disembodied.’ On being
reminded of a psychiatrist’s diagnosis of ‘anxiety hysteria’ Sacks says this to a
junior doctor: ‘But have you ever seen a hysteria like this? Think phenom-
enologically — take what you see as a genuine phenomenon, in which her
state-of-body and state-of-mind are not fictions, but a psychophysical
whole. Could anything give such a picture of undermined body and mind?’
(Sacks 1985: 44).
Our body sense revolves around vision, our vestibular system (balance
organs) and proprioception. Proprioception is the sense of the position and
movement of the body. The sense you have of where your arm is, even
when you lie still with eyes closed, is the product of proprioception, and it
was this sense that Christina had lost. Over time Christina’s visual and
vestibular systems compensated for her loss of proprioception. While ini-
tially she had been ‘floppy as a ragdoll, unable even to sit up’, three months
later Sacks observed her sitting ‘statuesquely, like a dancer in mid-pose’.
Although there was no recovery from the anatomical nerve damage she had
sustained she had recoverd a good deal of function. She now did everything
by vision — including operating her computer — rather than by feel. Sadly,
her use of vision to coordinate her body had not arrested her sense of
dimembodiment, continuing to feel that her body was ‘dead, not real, not
hers — she cannot appropriate it to herself’, or in Christina’s own words, ‘I
feel my body is blind and deaf to itself. . . it has no sense ofitself’.
Remembering Freud’s assertion that ‘The ego is first and foremost a
body-ego’, Sacks (1985: 50) states that Christina has ‘lost, with her sense of
Sensing self 43
Unpossessed bodies
Hear sounds with no source can see. Not clearly. Ceiling. Slides past.
Fuzzy. Can’t focus. Whiteness. Is this death? No! Don’t want to die. ’m
somewhere between life and death.
(Howell 2003: 35)
Howell asks him if what they have discovered is really that ‘the mind can
do without a body’. James replies: ‘Me. I’m proof. Mind has own energy.
Nothing but pure consciousness’ (ibid.) Such a sense of independence from
a body must surely indicate disembodiment, at least in the sense of emo-
tional identification, if not a physical extraction of mind. But for Hall, his
being-in-the-world, as he describes it in the early days after his stroke, is not
mediated through any normal aspect of human sensation; his eyes do not
afford him a human perspective; his limbs give no sense ofhis being there, in
that body. His experience is of ‘being’ — like Descartes, because he is thinking,
he knows he is existing — but he cannot think through his body, as he previ-
ously did. We may wonder whether without being rooted to the world
through his hearing he would have anything to think about at all, and if not,
would that be death, or ‘just’ complete disembodiment?
,
Chapter summary
6 Even when symptoms have clear organic origins the way in which
they are lived through may have a metaphorical relationship to their
broader life context. Psychological distress may be painted on the can-
vas of the body more effectively when it is biologically challenged in
some way.
Whatever its origin, physical illness is physical illness, and too simplistic,
or too extreme, an interpretation of the meaning of the illness may
diminish the integrity of the person who has the illness experience.
Some health care contexts necessarily predispose to finding physical
problems when a somatic origin is of less significance than other factors.
Some perfectly normal and healthy experiences (for instance, child-
birth) have been set in a healthcare narrative that pathologizes them to
such an extent that we feel specialists and special facilities are needed for
them.
For some working in the area of brain damage, the ‘who has the prob-
lem’ has been replaced by the ‘what is the problem’. Brain damage has
been depersonalized. We can develop a more valid representation of
people’s experiences, by taking those experiences as being meaningful
idata
10 Ownership of the body requires a sense that it is there — proprioception.
Without such a sense disembodiment may be experienced.
if The ability of emotion to render motor action when focused attention
cannot should encourage us to understand a person’s disorder as a
gestalt, as well as breaking it down to isolated neural systems.
In locked-in syndrome there is little to root the experiences of the
person to their body and they, for all intents and purposes, may feel
disembodied, even though this sense may itselfbemediated through the
only shred of physical being they experience and can communicate
with.
Disembodiment may not be an all or none experience — it may be ona
continuum, or indeed, it may be highly localized to certain areas. The
extent to which a person who is completely disembodied — where the
brain receives no sensory inputs and is thus unable to sense being-in
the-world — could meaningfully exist, is problematic.
Discussion points
Key reading
Bauby,J.D. (1998) The Diving-Bell and the Butterfly. London: Fourth Estate.
Morse,J.M. and Mitcham, C. (1998) The experience of agonising pain and signals
of disembodiment, Journal of Psychosomatic Research, 44: 667-80.
Sacks, O. (1984) A Leg to Stand On. London: Picador.
Somatic complaints
I've been staring at this screen for half an hour now. I’ve
got to write something and it’s difficult. | don’t know how
to say this, how to start. My father’s got Alzheimer’s. No.
Alzheimer’s has got my dad, and it won’t let go, ever ...
It’s got him and it’s slowly, capriciously losing him, rubbing
him out so that in the end, all that will be left is the
whine of dementia and a hieroglyph that looks like him.
(A. A. Gill, The Sunday Times Magazine
2 March 2003)
Stress
with embodiment, the fact of their strong association is none the less of
great importance. As Cassidy (1999: 35) puts it, summarizing the relation-
ship between biology, emotion and stress: ‘Clearly, external demands exert
an influence on the physical body through physiological mechanisms that
prepare living organisms for fight or flight’ (italics added).
There is a vast array of physical systems and organs that may be aroused
by the psychological experience of stress mediated through (effortless)
stimulation of the autonomic (i.e. self-governing or involuntary) nervous
system. These reactions range from dilation of the pupils to release of
glucose by the liver, dilation of the bronchi and acceleration ofthe heart,and
to inhibition ofintestinal motility and relaxation of the bladder. While each
of these reactions has recognized short-term benefits in the momentary
‘fight or flight’ situation, it is the inability of contemporary human beings to
allow a homeostatic return to a physiological ‘steady state’ that is problem-
atic. Because we have evolved so rapidly, in the psychological and social
sense, we now experience stressful situations that cannot easily be ‘escaped’
from (for instance, inter- or intra-personal stress). What is ironic is that our
biology has evolved less rapidly, and physically we continue to react to our
guilt, boss’s criticism or lover’s rejection, as if they were the literal dragons of
our mythology, which we must flee or fight. Thus, in the sense that we
physically respond to fear, we literally embody that fear, although that literal
embodiment is the product of an atavistic and essentially metaphorical
reaction.
Heart ache
depression (i.e. the clinical diagnosis), was significantly associated with the
likelihood of dying from CHD. Another prospective study conducted by
Kawachi et al. (1994) found that responses to five anxiety-related questions
(concerning fear of people and places, sense of nervousness, feeling keyed up
and jittery, getting suddenly scared for no good reason and often breaking
out in a cold sweat) significantly predicted fatal coronary heart disease at
32 years’ follow-up. Specifically, those who responded ‘yes’ to two or more
of the items were over three times more likely to develop fatal coronary
heart disease than were those who responded ‘no’ to all five.
Type A personality describes someone who displays an exaggerated sense
of time urgency, great competitiveness and ambition, and aggressiveness and
hostility, particularly when they encounter resistance to their goals. Much
research suggests (though not unequivocally) that type A behaviour is
associated with increased risk of CHD. More recently, however, research has
indicated that it is the hostility component of type A behaviour that is
associated with the greatest risk of future CHD. In Barefoot et al.’s (1983)
classic study, where they followed up 255 physicians 25 years after they
completed the MMPI (Minnesota Multiphasic Personality Inventory), their
initial scores on the hostility scale of the MMPI significantly predicted
subsequent CHD events (myocardial infarction or cardiac death).
Current emphasis is on the anger—hostility—aggression (AHA) syndrome
in CHD (Richards et al. 2000). The pinpointing of which aspect of type A
behaviour is risk inducing is of great importance, as programmes targeting
other aspects of type A behaviour may be giving false reassurance to their
participants. One possible explanation for the AHA—CHD link is that hostil-
ity increases cardiovascular responsivity, which in time produces physio-
logical damage and predisposes to CHD. In essence, then, research in this
area 1s an example of how a particular behavioural trait can be ‘laid down’ in
the physiological functioning of the body, with potentially catastrophic con-
sequences. CHD may be the physical consequence of psychological frustra-
tion; at least in some instances, CHD may therefore be seen to embody — be
a physical expression of— hostility. Of course, other behaviours have also
been linked to CHD and to many other physical diseases, including cancer,
ulcers, asthma and so on. Rather than considering possible causal mechan-
isms for these many associations, it is perhaps more valuable to consider
the role that immunology plays in mediating the physical production of
psychosocial distress.
Immunology
Health economics
The link between socio-economic prosperity and physical health has been
obvious for many centuries in the sense that the materially better-off enjoy
better health. It has been reasonable to assume that this is because of factors
such as better hygiene, better access to health care, consumption ofhealthier
food and so on. However, in the past couple of decades research on socio-
economic ‘gradients’ has suggested that it is not simply one’s absolute socio-
economic position that is important for health, but also one’s relative
position within the hierarchy. Simply being lower in a hierarchy may be
detrimental to health. This appears to be the case even within relatively high
socio-economic groups (Adler et al. 1994). However, socio-economic
position does not exist as a variable by itself and is inextricably linked to
other factors, such as ethnicity, gender and age.
52 Embodiment
Somatoforms
Somatization
If dysmorphia, and its variants, are concerned with the projection of distress
on to the body,we now consider the ‘projection’ ofdistress through the body.
Somatization disorder is believed to be a constellation of physical symptoms
that generally group together so that some, but not all, of the symptoms that
constitute the syndrome need to be present for a DSM-IV diagnosis to be
made. While the syndromal nature of DSM-IV disorders is explicitly
acknowledged, the requirements of a DSM-IV diagnosis of somatization
disorder may seem somewhat bizarre if taken out of this context. It is worth
considering the necessary symptoms in some detail. For a diagnosis to be
made the following is required:
| A history of physical complaints with onset before the age of 30, that
has occurred over several years, resulting in treatment being sought, or
significant impairment in social, occupational or other important areas of
functioning.
in) Each of the following symptoms:
(a) Four distinct pain symptoms; for instance, from extremities, chest,
rectum, during menstruation or sexual intercourse, or urination.
(b) Two gastrointestinal symptoms, other than pain, such as nausea, bloat-
ing, vomiting, diarrhoea or intolerance of several different foods.
(c) One sexual symptom, such as erectile or ejaculatory dysfunction, or
indifference to sex.
(d) One pseudoneurological symptom; that is, a history of at least one
symptom or deficient that suggests a neurological disorder.
It is also required that these symptoms are not feigned or attributable to any
known medical condition. While somatization disorder as defined above
may be quite rare, having a combination of physical complaints (without
Somatic complaints 55
obvious organic cause) that don’t meet all of the requirements of somatiza-
tion disorder is much more common. This has led to suggestions that a new
diagnosis — multisomaform disorder — which would require three chronic
somatic symptoms (without organic cause), be introduced (Kroenke
etal. 1997).
A study of personnel working in a mortuary during the first Gulf War
(McCarroll et al. 2002) found an increase in somatization from before to
after the experience. The somatic symptoms recorded included pains in the
chest, nausea, faintness, difficulty breathing, feeling weak, numbness and
hot and cold spells. The study compared those who had no exposure to dead
bodies, those who only observed them, those who had direct exposure and
those who actually handled the bodies. There was a clear linear relationship
between those personnel who had greater exposure to the dead bodies
and those who experienced the most somatic symptoms. This elegant, if
gruesome, research design provides strong contemporary evidence for the
existence of some mechanism that presents the distress associated with
exposure to dead bodies in the form of somatic complaints.
Whatever the nosological complexities of the experience of somatic
symptoms that have no discernible organic cause, perhaps the ultimate ques-
tion of interest is what they mean, if anything. The answer to this is also
somewhat complex but lies at the root of much of our culturally con-
structed notions about somatization. For instance, Kleinman (1980) has sug-
gested that the way in which depression manifests itself varies across cultures.
He has studied a condition known as neurasthenia, commonly reported in
China, and characterized by a lack of energy and physical complaints such as
a sore stomach. Kleinman has suggested that while depression and neuras-
thenia are different illness experiences, they are both products of the same
underlying disease processes — depression. In other words neurasthenia is the
Chinese version of the North-Western’s depression.
Somatized depression
Functional syndromes
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Somatic complaints 61
do with diagnostic fashions, and a person’s entry points to the health system,
than with their own experience oftheir complaint. Let us now consider one
of the classical conditions of psychiatric and psychological folklore.
Hysteria
Mass hysteria
next week 10-20 pupils a day developed this behaviour, 105 in total, close to
one-fifth of the school’s students. Most students subsequently reported
being quite unaware of their behaviour at the time, and subsequently unable
to remember their bizarre behaviour.
This is by no means an isolated case and a couple of weeks later in our
home town of Zomba, there was a similar, but more limited, ‘outbreak’ in
a mixed (boys and girls) primary school. Similar cases have also been
reported in the UK, USA, Japan, several African countries and elsewhere
(see MacLachlan et al. 1995). While the ‘hysterical’ nature of symptoms
differs it is usual that both mental and physical symptoms are ‘transmitted’
through a process that has been referred to as ‘social contagion’, but is
probably a form of social learning under high anxiety. As such, it is clear
that people can, in an immediate, dramatic and painful way, ‘learn’ how to
express their emotional distress through bodily symptoms of distress. An
individual’s display of symptoms can act as a template for others. One can
‘infect’ many.
The phenomenon of koro suggests that it also works the other way
around. Here the anxiety of many can produce in an individual the sensation
of their sexual organs shrinking. I have described this in more detail in
MacLachlan (1997) and that account draws heavily on Cheng (1994). Koro
is believed to be a fatal condition and occurs mostly in southern China and
Southeast Asia (Cheng 1994). Although it usually occurs in isolated cases,
epidemics of koro may also occur. It is, of course, overly simplistic to assume
that koro is an alternative form of aNorth-Western disorder, as it occurs in
cultural settings that North-Western diagnostic systems have not been
designed — and in my view are often unable — to encapsulate. Indeed, in
terms of North-Western diagnostic criteria, koro has at one time or another
been subsumed as a variant of dissociative disorder, somatoform disorder,
panic disorder and even psychosis.
Although koro is most commonly associated with males through their
fear of penis shrinkage, it is also found in women (although much less
frequently) as a fear of retracting nipples, breasts or labia. For both sexes the
fear of shrinkage is associated with the fear of imminent death, the shrinkage
being only a precursor to this. Cheng (1994: 7-8) gives a vivid description of
the onset of koro:
Usually, the malady begins with a feeling on the part of the victim that
his or her sex organ is shrinking. Believing that the condition is critical,
the victim becomes extremely anxious, doing whatever he or she can to
stop the sex organ from further retracting and crying vigorously for
help. A man may be seen holding his penis, ‘anchoring’ it with some
clamping device, or tying the penis with a piece of string. Similarly a
woman may be seen grabbing her own breasts, pulling her nipples, or
even having iron pins inserted through the nipples, all to prevent the
retraction of the respective organs.
64 Embodiment
A full account of the way in which this disorder, when viewed from
a sociocultural perspective, has both a social function and a meaningful
order is beyond our scope here (see MacLachlan 1997). A vital point,
however, is that koro cannot be adequately understood from the perspective
of the individual’s (psycho)pathology, but should be approached from the
perspective of the expression of acommunity’s anxiety.
Chinese folklore includes the notion of a ‘fox spirit’, which can seduce
people, sap their ‘vital energy’ and thereby make them weak. The ‘fox spirit”
is able to shrink tissue and this provides a direct link, in folklore, to koro. A
community may come to expect or experience misfortune in, for instance,
its (agricultural) production or the health of itsmembers. The ‘fox spirit’, it is
believed, roams the world in search of victims. When things are not going
well this may be taken as an indication that the ‘fox spirit’ has visited a
community. A fortune-teller’s prediction of its visitation will create con-
siderable uncertainty and anxiety. The community becomes hyper-vigilant
to detect the first arrival of the ‘fox spirit’. Cheng suggests that the failure to
identify any objective signs of aghost heightens tension to such a degree that
victimization becomes an inevitable outlet for the community’s anxiety.
An individual’s behaviour may lead others to ‘realize’ that the person
is suffering from a koro attack. On the other hand, an individual himself
may suspect a koro attack is beginning (cold sensations or insect bites in the
genital area which can temporarily reduce the size of the genitalia, as can
weakness or sickness, may be interpreted as the onset of an attack). Through
the identification of a victim the anxiety of the whole community may
be relieved. As people rush to help to rescue the victim, the failure of the
victim’s genitalia truly to retract is taken as evidence that the ‘fox spirit’ has
been exorcised and moved on. The community is thus saved and tension
reduced. Kirmayer and Santhanam (2001: 257) suggest that in koro, ‘as with
other epidemics of hysteria, social stresses create widespread feelings of
vulnerability in a population or group,and combine with individual vulner-
abilities to anxiety to give rise to symptoms that follow culturally available
symptom schemas? (italics added).
Somatic complaints 65
These ‘symptom schema’, it has been argued, are not stable phenom-
ena but, like culture itself, are continually changing ways of patterning
meaning in life. Kirmayer and Santhanam (2001: 266) also stress that seeing
hysteria as ‘social communication, interaction and positioning can go
further to explain the clinical phenomena than purely psychological or
physiological explanations that ignore the social matrix of expermence « It
may follow then, that as the ‘social matrix’ changes, so do the disorders it
cultivates.
Hystories
Elsewhere I have argued that changes within a society over time can affect
mental health, perhaps because of the way in which they challenge people’s
identities and positions within society (Smyth et al. 2003; MacLachlan and
Smyth 2004; MacLachlan et al. 2004b). Thus the rate of depression, binge
drinking or suicide, for instance, may increase in a specific population as it
undergoes change. To the extent that society ‘sculpts’ the sort of disorder
through which people can express their discontents, a changing society
may well change the ways in which distress can ‘legitimately’ (i.e. while
still being taken seriously — being believed) be presented. This also applies to
the physical embodiment of distress. While it is widely acknowledged that
‘hysterical conversions reactions’ are less common now than in their hey-
day of the eighteenth and nineteenth centuries, when they were adminis-
tered to by luminaries such as Charcot and Freud, it has also been argued
that different types of somatization and conversion are now 1n ‘style’. As
Shorter (1994) puts it, there is an ever changing ‘symptom pool’ that
constitutes the legitimate contemporary idioms of distress and this symp-
tom pool creates ‘great pressure on the unconscious mind to produce
only legitimate symptoms’. Following Ferrier’s description of hysteria as
a ‘chamelion-like condition’ in 1794, Showalter (1997: 15) describes it
as a ‘mimetic disorder; it mimics culturally permissible expressions of
disorder’.
Previous centuries have populated the ‘symptom pool’ with very visible
neurological disorders in the form of limps, palsies and paralysis, that arose
from birth defects, venereal disease, industrial accidents and so on. Although
these still occur, they are much less frequent than previously, and therefore
less ‘available’ as a recognized means ofexpressing inner pains (Porter 1993).
Showalter (1997) argues that hysterical epidemics require at least three
ingredients: physician enthusiasts and theorists to give authority to a new
idea (disorder); unhappy and vulnerable patients to adopt that way of
expressing their discontents; and a supportive cultural environment (perhaps
of great anxiety) to facilitate its expression. This plasticity and indeed the
recently enhanced mobility of hysterical epidemics is clearly indicated by
Showalter (1997: 5):
66 Embodiment
Neuropsychiatric disorders
even the most vivid autoscopic hallucinations are more hazy than would be
a true mirror reflection, and they may also appear as a profile or a figure at a
distance rather than as a conventional reflection.
Cutting suggests that such experiences are also described as ‘near death
experiences’ and ‘out-of-body’ experiences by psychic researchers. Interest-
ingly, Cutting notes that, while what he refers to as autoscopy may be
associated with brain damage, it most commonly occurs in unusual physio-
logical and psychological conditions, especially where social isolation, sleep
deprivation and fatigue are combined (e.g. lone mountaineers, shipwrecked
sailors). In such instances the experiences may be that someone is ‘with
them’ rather than it being another self.
In relation to out-of-body experiences, Blanke et al. (2002), using focal
electrical stimulation on a person with epilepsy, found that such experiences
could be induced by stimulating the brain’s right angular gyrus. When this
was done (with 3.5 mA) the patient they reported on said: ‘I see myself
lying in bed, from above, but I only see my legs and lower trunk’. She
subsequently reported feelings of‘lightness’ and ‘floating’, about two metres
above the bed, close to the ceiling. A lower voltage (2.0-3.0 mA) at this
same site produced feelings of ‘sinking into the bed’ and ‘falling from a
height’. When asked to watch her legs, stimulation (4.5 mA) resulted in her
experiencing her legs as shortening. These visual distortions were appar-
ently restricted to her own body only, rather than generalizing to other
people or inanimate objects. The researchers concluded that:
Out-of-body and body-transformation experiences are transitory and
may disappear when a person attempts to inspect the illusory body
or body part. Our findings suggest that changes in visual attention and/
or current amplitude in the angular gyrus could bring about these
phenomenological modifications.
(Blanke et al. 2002: 269)
In a further category of neuropsychiatire disorders, ‘morbid emotional
attitude’, Cutting (1990: 198) suggests that what might be thought of as
defence mechanisms occur so frequently with damage to just one side of the
brain that ‘one is forced to conclude that the particular pattern of brain-
damage is the prime cause’. He includes here anosodiaphoria (minimization
of a disability in a very jocular fashion), misoplegia (intense hatred for a
paralysed limb) and exaggerated preoccupation with a limb that may not even
be disabled. Cutting’s main point in describing these disorders is to relate
them to one hemisphere or the other. He concludes that a sense that body
parts don’t belong, have changed in size or shape or are displaced from their
usual position is usually associated with right hemisphere damage. A sense
that body parts don’t exist or are duplicated is usually associated with left
hemisphere damage. False bodily experiences (phantom limb, somatic hal-
lucinations and autoscopy) are not associated with laterality. Interestingly,
Blanke et al. (2002) reported some shortening and movement effects in their
Somatic complaints 69
stimulation study, for the person’s left arm and hand only (controlled by the
right hemisphere; see also Berlucchi and Aglioti 1927)
Misidentification
On being in-valid
Whatever the physical basis of a disorder, the way in which its effects are
experienced is usually through a social context, one that continues to con-
struct the consequences of many disorders as ‘invalidity’, a horrible term
implying that one is not a valid person. Just how to refer to the situation where
some people have fewer physical possibilities than others continues to be
problematic. Frequently the term ‘impairment’ is used to refer to loss of
72 Embodiment
approach may deny what Lupton and Seymour (2000: 1853) describe as the
‘phenomenological physicality of the body’ (see also Lupton 2003).
How to talk about physical disability, and even how to think about it, is at
the heart of a concern with embodiment. What or who is disabled, and
what or who disables them? The World Health Organization (WHO) ori-
ginally promoted a linear conception of disability from ‘Disease/Disorder’
to ‘Impairment’ to ‘Disability’ to ‘Handicap’. Thus, an intrinsic biological
condition would be exteriorized to create a loss or an abnormality of ‘psy-
chological, physiological or anatomical structure or function’ (WHO 1980:
27) that would constitute impairment. This impairment, through prohibiting
the execution of certain functions, would produce disability, and the way in
which society responded to the needs of such a person would determine the
extent of handicap they experienced. In the new conceptualization, while
the first two elements remain it is now proposed that ‘Activity’ and ‘Partici-
pation’ be used and ‘Disability’ and ‘Handicap’ dropped. The implied
linearity of the model has also been modified so that ‘Impairment’ and
‘Activity’ are seen to be in reciprocal relationship, as are ‘Activity’ and
‘Participation’. The new conception also acknowledges the role of personal
and environmental factors, while being wary of ‘any diagram ... [that
could] be prone to misrepresentation because of the complexities of
interactions in a multidimensional model’ (WHO 1997: 12).
However, Turner (2001: 257) argues that even this revision overly privi-
leges a biomedical account of impairment: ‘It does not attend ... to the
subjective world view of patients as constitutive of the condition and does
not recognise the role of politics and culture in shaping human suffering.’
Later on Turner (2001: 258) notes: ‘Because our biographical narratives are
carried in our embodiment, disability has to be mediated by its meaning for
the self.’ Schilling (1993) argues that in modern Western society the body 1s
held to be a representation of the self: a mirror of the soul. Featherstone
(1991) has suggested that the pull of rehabilitation is towards refashioning
old and impaired bodies to conform to our contemporary values of youth-
fulness, beauty and athleticism. Zola (1993) has also noted that people with
disabilities (were in 1993, and still) are facing barriers similar to ethnic
minority groups in terms ofgetting their perspective recognized as being of
equal value as ‘able-bodied’ mainstream society. For some people who are
disabled, it may be difficult for them to establish just what their ‘own’ per-
spective is. While conjoined (‘Siamese’) twins may not be acommon form of
disability, its implications for embodiment are important to consider.
Self-division
Siamese twins (a term dating back to the twins Chang and Eng, born in
Thailand, or Siam, in 1811) create discomfort in many people for not only
may they be difficult to distinguish physically, but psychologically too. Piaget
(1958) argued that at birth a child is not capable of making the distinction
between selfand non-self. However, through the interaction of motor activity
and perception, the child develops a sense oftheir physical self, and ‘incorpor-
ates’ (Plugge 1970) aspects ofitself (such as arms and legs). Murray (2001)
suggests that in the case of Siamese twins such exploration produces a sen-
sorial experience not only oftheir ‘own’ body but also oftheir ‘twin’s’ body.
As such, the distinction between self and other may never be made in the same
complete manner. Considering sensation and function to be two defining
aspects of embodiment, Murray (2001: 119) discusses the common sentient
tactile surface shared by Siamese twins, and their shared volitional movement
oflimbs, arguing that they have ‘an experience ofself through the other’.
Noting Harré’s assertion that ‘touch sketches out the rim of felt
embodiment’, Murray (2001: 23) presents evidence that Siamese twins have
areas of common sensation. For instance,in the case of Chang and Eng, they
both perceived touch if that touch was along the midline of where they
were joined (side-by-side), but if it was more than half an inch to either side
only one of them felt the touch. For other Siamese twins there also appear
to be regions of common and distinct sensation.
O’Shaughnessy’s conception of bodily actions emphasizes the bringing
about of events by trying and in trying our volition is given ownership over
the action, in a way that movement without trying cannot convey. ‘When
movement occurs without this intentional component, it cannot be said that
an action has occurred’ (Murray 2001: 120); however, see Chapter 6 where I
argue that one important sense of embodiment is achieved exactly when
movement occurs without conscious intention. As an example of shared
intentional action over a common limb, Murray cites the Russian twins
(aged 11 when reported on) Macha and Dacha, who each had a leg and a
‘third leg’ between them that was deformed and had a double foot. Each of
the twins controlled the leg on her ‘own’ side,and each of them could move
the atrophied leg in the middle.
In twins who have been surgically separated, how do they feel about
themselves, if in some sense prior to their separation they have some com-
mon sense of embodiment? Katie and Eilish Holton (Galloway 1995) were
born joined from the shoulder to the pelvis and sharing two legs only. At
three and a half years old they were surgically separated and sadly Katie died.
Somatic complaints 75
Stigma
may ignore those with disabilities for fear of saying the wrong thing, or
because they find encounters with disabled people anxiety provoking, and
experience unease in their presence (Gething 1991). The extent to which
the disabled physical body can ‘frame’ an interaction has been illustrated in
experimental studies. Kleck et al. (1966) found that when a person with a
simulated amputation conducted an interview with students, the students
showed elevated physiological arousal as assessed by their galvanic skin
response. In addition, those who expressed discomfort in the presence of a
person who had an ‘amputation’ terminated the interview sooner than
those who did not express such discomfort.
In Kleck’s (1969) subsequent study, students were required to teach ori-
gami (the Japanese art of paper folding) to a confederate either with or
without a simulated leg amputation. If the confederate had an amputation
they were given significantly greater social distance by the students on the
first trial, but not on the second trial. In fact, students in the study formed a
more positive impression of the ‘disabled’ confederate than of the non-
disabled confederate. Kleck argued that the formation of a more positive
impression might have arisen because of atendency in society to be kind to
‘disadvantaged’ individuals. Newell (2000: 80) suggested: “The supposed
tendency to kindness may, indeed, be little more than an aspect of establish-
ing our dissimilarity from the disabled person.’ In a sense it 1s almost as
though the greater social distance afforded disabled bodies is an implicit
statement that ‘Iam not embodied in (comfortable with) that body.’ Kleck
et al. quote Davis (1961) in arguing that disabled people need to develop
techniques that will help them to ‘move beyond fictional acceptance’. This
should also be considered in terms of their own self-acceptance, so often
mirroring society's ‘acceptance’.
Extending our discussion beyond disability to include disfigurement, it
seems that the further a disfigured body deviates from the desirable, beauti-
ful, ‘norm’, the less people want to occupy space next to that body. Houston
and Bull’s (1994) study of seat occupancy on a train found that occupancy
ofthe seat next to the confederate was highest when the confederate had no
visible defect, next highest when they had bruising, then scarring and lowest
when they had a birthmark. If this is the ‘mirror’ society — possibly unwit-
tingly — holds up to those who are disabled (Taleporos and McCabe 2002),it
is a reflection of discomfort that cannot easily be ignored and may often be
internalized — I want to get away from my body too. How then do indi-
viduals with newly acquired disabilities develop a sense of self and identity
that incorporates their altered body functioning and body image?
and bodily functions that were previously taken for granted. The disruption
of previously automatic tasks, including walking and dressing, now becomes
central to the self-concept, challenging previously held ideas about the self.
The self may become embodied in what can only just be achieved with
focused attention and effort. If such tasks were previously so menial or
incidental as to be executed without conscious thought, then they will
clearly not have been the seat of previous conscious embodiment. As
Corbin and Strauss (1987) state, ideas of body failure ‘strike at the core’ of
the individual. According to them, self identity is affected to the degree that
these changes create a loss of valued functions and abilities. The newly
disabled person must incorporate their newfound limitations into a revised
self-concept.
Morse’s (1997) ‘responding to threats to integrity of the self’ model
describes several stages to this process. Vigilance and disruption: enduring to
survive, the first two stages, describe the acute phase of physical illness and
how these overshadow any sense ofidentity, disruption or change. The third
stage, enduring to live: striving to regain self, describes how individuals are
forced to recognize the physical changes and loss of function that they have
experienced. In this stage they start to seek to restore as much of their
physical function as possible. The fourth stage, suffering: striving to restore self,
describes how the effects of what has happened are now being recognized,
and how the person begins to struggle with grief and mourning for what
has been lost. It is at this stage that individuals also start to hope and set
realistic goals for themselves. Although learning to live with setbacks and
difficulties, they may none the less refuse to accept their limitations and seek
a more complete physical recovery than is likely to be possible. In the fifth
stage, learning to live with the altered self, the person comes to accept his or her
body and the limitations it now brings. They revalue their lives, accepting
that some things will now be ‘out of their reach’, but learn to appreciate
alternative things. In this stage their focus shifts more to the inner person
rather than the outer body. In this sense they become more embodied in
‘what they are’, and less embodied in what they physically can do. As such
they have incorporated physical changes into a new self-identity and
learned to ‘live with the altered self’. This last stage is sumilar to what Norris
et al. (1998) refer to as ‘reimaging the self’
The process of adaptation to a disability may also be influenced by prior
positive bodily experiences and by being able to identify certain aspects of
the current body as being positive (Taleporos and McCabe 2002). It is also
interesting to note that adaptation may not be linearly related to the severity
of disablement. For example, children with spina bifida who have more
severe disabilities associated with the condition tend to have higher levels of
self-esteem and global self-worth than those with less severe disabilities
(Minchom et al. 1995). These authors suggested that people become more
distressed about having less severe disabilities because they are closer to
functioning at what they perceive to be ‘normal’ levels. Those with more
78 Embodiment
severe disabilities are further away from functioning ‘normally’ and, con-
sequently, may find it easier to accept that they cannot physically function in
the same ways others do.
To end this chapter let us consider the effects, especially subsequently upon
the body, of experiences of sexual abuse or rape. This section may seem to
be somewhat out ofplace in terms of what has preceded it.I want to discuss
it here because sexual abuse is often a psychologically and/or physically
disfiguring and disabling experience, where the victim effectively stigma-
tizes their own body, and where they may develop a variety of reactions
to the abuse, including somatic and somatoform conditions. As the con-
sequences ofsexual abuse for embodiment incorporate several of the themes
we have already discussed in this chapter, I hope to heighten awareness
that symptoms, distress and disability never occur in isolation from their
psychosocial context, and personal history, including “body history’.
The experience of physical complaints implies a sense of difficulty with
living comfortably in the body. Young (1992) suggests that survivors of
severe sexual abuse must come to terms with having to live with a body that
has been the medium oftheir abuse. Often they will have a ‘disrupted’ view
of the specific body part(s) violated during the abuse; possibly hating those
parts, and possibly mutilating them through cutting or burning (Fallon and
Ackard 2002). These feelings may also generalize to the entire body, or parts
of it may be distorted (for example, perceived as much larger than their
actual size), or intense shame and guilt felt about them. The survivor of
severe sexual abuse, especially if they felt aroused at any time during the
abuse, may feel that their body has betrayed them (Fallon and Ackard 2002).
We strive to maintain a coherent sense of self over time. Under usual
circumstances good and bad events alike can be fitted into a personal bio-
graphy that maintains personal coherence and continuity. When severely
traumatic events occur they may create incoherence and discontinuity.
Young (1992) suggests that the Japanese saying ‘trauma stops time’ accur-
ately encapsulates this. In the case of severe sexual abuse, trauma is inscribed
on, and often in, the body of the victim. In writing about this physical
violation of the body Young (1992: 91) poignantly states:
What is meant here by ‘violation’ is that the boundary between ‘inside
me’ and ‘outside me’ is not simply physically crossed against a person’s
will and best interests, but ‘disappeared’ (to borrow a term from Latin
American terror) — not simply ignored but ‘made-never-to-have-
existed’,
She goes on to ask two fundamental questions: How do I know what is me?
And how do I know what was me? In answer to the first, she suggests that
Somatic complaints 79
probably get for the rest of my life. Ihate even going to the bathroom or
taking a shower or looking in the mirror.
(Young 1992)
Moving bodies on
Chapter summary
11 Siamese twins who share a common part of their body may experience
common sensations and be able to have control of function over the
same body part. It is unclear to what extent the desire to separate such
twins is derived through a wish for physical independence or psycho-
logical individuality that may be constrained when joined.
12 The mirror that society ‘holds up’ to people with a physical disability is
often a stigmatizing experience. The disabled body questions cultural
ideals of normality and beauty, and as such may be rejected, not only by
society, but also by those with a disability.
13 A process of adaptation to an acquired disability, or a physical illness that
permanently prohibits some aspects of bodily function, may be identi-
fied. This process of learning to ‘live with an altered sense of self” is
closely tied to re-evaluating the significance of the body to the self.
Some degree of“disembodiment’ may therefore be therapeutic.
14 The body is a memory of past trauma. In the case of prior child sexual
abuse there may be confusion between what is ‘me’ and what is not
‘me’. The body may be ‘disowned’ on the one hand, or the presence of
somatization may ‘background’ prior abuse on the other hand. The
body may become seen not just as the medium of abuse but also as the
instrument of abuse.
15 There are a variety of experiential therapies that seek to help people to
‘learn’ their body in a positive and contradictory manner to the abusive
experience they may have previously had. In essence these approaches
seek to make the body a welcoming place to live. Such techniques may
have power beyond the reach of spoken words or ingested drugs.
Discussion points
Key reading
‘We’ have now mapped the human genome, celebrated the fiftieth anni-
versary of the discovery of DNA and cloned that now famous ewe, Dolly.
Genetic enhancement of our lives could become an almost mundane aspect
of our being, were it not for us swinging between utopian speculation about
achieving our full potential, and dire predictions ofa biological totalitarian-
ism that would keep us all perfectly humming the same tune. We are both
the producers and consumers of a social order that prescribes to rid our-
selves of what is proscribed: short people can be given synthetic growth
hormones, inattentive school kids can be given Rutalin, introverted folk can
get Seroxat; because shortness, poor academic performance and shyness are
stigmatized. Those who market these treatments aim them at parents who
are afraid of having stigmatized children.
Elliot (2003) reminds us of the tale of The Wizard of Oz, and the salience
of our ideas about self-improvement. As you may recall, the Scarecrow
(who wants brains), the Tin Woodman (who wants a heart) and the Cow-
ardly Lion (who wants courage) all travel along the Yellow Brick Road to
meet the Wizard, only to find that they are, in fact, already intelligent,
compassionate and courageous, respectively. The problem of these seekers
lies not in what they are, but in who they think they are. Self-doubt is the
source of their angst and thus what the Wizard provides them with is not a
brain, heart or courage, but self-esteem. The Wizard’s real trick, however, is
not only to sell the Lion a vision of himself at odds with what he fears
himself to be, but also to convince the Lion that this is how he really is; it is
his true self. Elliot notes that whether it be cosmetic surgery, Prozac or a sex
change, ‘No transformation is so dramatic that it cannot be described as a
means to achieve the “true self” ’ (Elliot 2003: 14). In this chapter we
consider the relationship between the self and ideas about how the body
Body sculpturing 85
appears, how it can be shaped by personal, cultural and market forces and the
contemporary roads that people may travel, sometimes seeking new bodies,
at other times seemingly trying to rid themselves of their ‘old’ bodies.
In this chapter, as if by sculpturing a form, I move towards and away from
several themes, returning to some of them many times. We begin, however,
with a very brief history of how the body has been related to personality.
Physiognomy
Always and everywhere, the normal blond has positive, dynamic, driv-
ing ...and variety-loving characteristics; while the normal brunette
has negative, static, conservative,. . . characteristics.
(Blackford and Newcomb 1915: 141)
Perhaps one reason why we are attracted to the idea that how someone
looks relates to what they are like as a person is that physical characteristics
are among our most easily measured features. I had to dig into LaPiere and
Farnsworth’s third edition oftheir Social Psychology (1949), first published in
1936, to unearth some of the morg ‘quaint’ and quite unhelpful stereo-
typing that has occurred concerning the relationship between physical chara-
cteristics and personality. It was Aristotle’s treatise on “‘physiognomy’ that
first described how character could be judged from physical features.
Lavater’s Essays on Physiognomy, published in 1878, detailed 100 physiog-
nomical rules by which to judge people. For example, Rule 77 states “a broad,
brown wart on the chin is never found in truly wise, calmly noble persons’.
Such ‘insights’ were preceded in 1876 by the famous French criminolo-
gist Cesare Lombroso’s own physiognomical rules. It is worth quoting
LaPiere and Farnsworth’s (1949: 212) appropriately sarcastic recounting of
these:
Lombroso, however, presented the ingenious and intriguing theory that
all mankind was divisible into the criminal type and the non-criminal
type and that, since nature had fortunately stamped the criminal per-
sonality with a criminal physiogamy, all that was necessary to prevent
further crime was to round up the people who looked like criminals.
After long study, Lombroso provided criminologists with a set of
pictures showing the types of physiognomy indicative of personalities
typical of people who would commit specific types of crimes.
Phrenology
Somatotypes
I think that we may now have come full circle: despite the lack of credible
evidence of somatic—personality links, in our modern consumer culture,
people, or more precisely their imagés, are commodities that we ‘consume’.
“You are what you eat’ and ‘what you see is what you get’ are strange bed-
fellows of embodiment; representing both a health-foody emphasis on purity,
naturalness and goodness on the one hand, and an ‘I’m not too deepish’ focus
on (usually) cosmetic beauty on the other hand. Let us look at the young, and
how they are acquiring bodies that ‘we’ never had (sorry, you may be one of
them), and how they are striving to acquire bodies that nobody has.
Tweenagers
The idea of‘adolescence’, as a period of storm and stress, always was a social
construction. While some societies have an adolescent period, others quite
simply don’t. In some societies, for instance, people move from childhood
through to adulthood directly, often facilitated by some sort of initiation
ritual. In other societies ‘adolescence’ is a rather long and drawn out process
of moving slowly and sometimes with conflict from dependence into
independence. If the boundaries between adolescence and adulthood may
be blurred, those between childhood and adolescence have been seen as
less blurry, at least until very recently. A couple of years ago, Kidscape,
a child protection charity, championed a campaign opposing the selling of
G-strings, targeted at preteen girls, which were embossed with a cherry and
the words ‘Eat Me’. The Channel 4 documentary Skinny Kids reported on
the availability of padded bras for seven-year-olds, and children of nine
shaving their legs and wearing full make-up. The cropped tops and high
heels that even little girls of four and five seem to adore are also adored by
88 Embodiment
Svelte as a gazelle
There has been a good deal of research on how the female body has
changed in shape, particularly over the past few decades. In the now classic
study, Garner et al. (1980) got access to the self-reported measurements of
Playboy centrefolds across the years 1959 to 1978. They also got measure-
ments for Miss America contestants in the same period, and compared
these to the population norms. The mean weight for ‘playmates’ (expressed
as a percentage of the mean weight for all women of the same age and
height) showed a statistically significant decline from 91 per cent in 1959 to
83.5 per cent in 1978. While the average height and waist sizes actually
increased, bust and hip sizes decreased, suggesting a decrease in the curva-
ceousness of the ‘preferred’ female body. However, over the same period,
the average weight of Miss America contestants reduced by 0.13 kg per
year, and for pageant winners the average decrease was 0.17 kg. Further-
more, during this same period the population mean for women under 30
had actually increased by an average of 0.14 kg per year. In a more recent
study Voracek and Fisher (2002) looked at the trends in Playboy centrefold
models’ body measurements from the magazine’s inception in December
1953 to December 2001. They concluded that significant change had taken
place over time:
The typical body mass index of Playboy centrefolds has further des-
cended below corresponding population levels, whereas their typical
waist: hip ratio now approaches population levels. In sum, centre-
fold models’ shapely body characteristics have given way to more
androgynous ones. These temporal trends are at odds with claims that
Body sculpturing 89
centrefolds’ body shapes are still more ‘hourglasses’ than ‘stick insects’
and that the maximally sexually attractive female waist:hip ratio is
stable.
(Voracek and Fisher 2002: 1448)
that ordinary people believe that they should be like non-existent gorgeous
people, and that we are living in a ‘lunatic world’.
To her credit, Winslet subsequently commented on her GQ cover image:
‘I don’t look like that and, more importantly, Idon’t desire to look like that.
It isn’t real ... I want to be clear that I haven’t suddenly lost 30 Ib. It is
important to say that magazines do this; they make perfection’ (Woods
2003). Thank God for those unofficial opportunistic trashy photographs
that portray our icons in ways that we can hardly recognize them; in fact,
they look rather like us. The popular portrayal of celebrity soma is an area
deserving of much more serious study and research, not least because it at
least partly contributes to our continuing desire to recast our bodies in new
likenesses.
Regenesis
we deserve them; ‘real me-isms’ again; because ‘I’m worth it’,no doubt. Thus,
on the one hand we have digitally manipulated bodies that we can’t possibly
hope to be like, while on the other hand we have a simple (and relatively
inexpensive) oral spray that promises us the possibility of inhabiting just
such bodies. No wonder we are uncertain about our bodies. But what has
happened to the eugenic-cosmetic dream of celeb-somas when the inhabi-
tants of the largest constituency of this dreamland are fatter than ever? In a
time when thinness is increasingly valued, why are we getting fatter?
Fat land
Greg Critser’s Fat Land (2003) presents some frightening statistics: 61 per
cent of US citizens are overweight, such that they will experience health-
related problems associated with their weight; while 20 per cent meet the
criteria for morbid obesity, qualifying for gastroplasty, a radical surgical
technique that limits the amount of food being digested. The percentage
under 19 who are overweight or obese has doubled in the past 30 years.
Critser ponders on Ivan Illich’s assertion that ‘every man is his own author’;
if each of us is responsible for what has been made of us, what does this say
about citizens of the USA? Critser charts the increase in the girth of his
nation’s average body through a number of interlocking social, economic
and psychological forces.
He explains that when retailers attempted to get their clientele to buy
more when at the movies, for instance, they hit a plateau. They could not
get people to buy two burgers, or two packets of chips, or two Cokes each.
People didn’t want to look gluttons, it seemed. Then a marketing ‘genius’
struck on the idea not of selling more, but of selling bigger. So a serving of
McDonald’s ‘French fries’ rose from 200 calories in 1960 to 320 calories in
the late 1970s to the whopping 610 calories of today. People had come to
see big as the norm, and getting bigger was smartly priced to be pro-
portionately cheaper than staying smaller. Being bigger was not just about
more intake, it was also about power — wimps don’t eat Big Macs. The
increasing culture of permissiveness in consumption, and what might
be called ‘individualized authenticity’, banished notions of gluttony and
shame.
The argument about what harm overeating does has raged for years and
has political, commercial and many other interests feeding into it. What does
seem clear, however, is that obesity has some obvious health consequences,
diabetes possibly being one of the most widely recognized. With possible
consequences ofblindness, limb amputation and immobility, diabetes 1s now
being taken very seriously. Indeed, pharmaceutical giant Eli Lilly’s new
insulin production facility (the biggest single-drug production facility in the
world) was built in response to its increasing sales, with 24 per cent growth a
year (Critser 2003).
92 Embodiment
Xapotecas and even I can get more’’. They can afford supersized burgers and
fries — and so they get them’. Critser concludes that ‘the price of abundance
is restraint’ (p. 175). So how do ideas of restraint translate to ideas about our
bodies?
Fallon and Rozin (1985) had undergraduate students (in the USA) evalu-
ate nine figure drawings of female body builds and nine of male body
builds, scaled so that they ranged from being very thin to very large. The
students were asked to identify the same-sex figure that most closely cor-
responded to their own current shape, their ideal shape and the shape they
believed would be considered most attractive to the opposite sex. They
also rated the opposite-sex figure that they themselves considered most
attractive — other attractive. There were no significant differences between
self-reported current, attractive and ideal figures for males, but for females
their current figure was significantly heavier than what they rated as the
most attractive figure, which was in turn heavier than their own ideal
figure. This ties in with the idea, at least for female US college students,
of striving for an ideal that is excessive in the sense of being ‘beyond’
attractive.
Following various other comparisons between the above variables, Fallon
and Rozin (1985) suggested that women’s ideal figure was influenced by
factors other than a desire to attract heterosexual partners, and argued that
weight loss may be used as a means of establishing control over their lives, or
that women believe that others, including other women, view thinness as a
positive characteristic in females, possibly connecting it with higher social
class. However, it is important to point out that while various studies have
used the methodology of comparing current, attractive and ideal ratings of
figures, they do not all produce the same findings. For instance, Cohen and
Adler (1992) found that female college students rated their current figure as
significantly heavier than their own ideal figure; however, they estimated
their peer ideal figure to be significantly thinner than their own ideal
figure. Thus in this study women felt that other women wanted to be
significantly thinner than they themselves wanted to be. In agreement with
previous studies, the figure women thought was most attractive to men was
significantly thinner than men preferred.
The suggestion that men are less troubled by their body image than are
women has, however, been challenged on the grounds that most studies have
been concerned with body shape, while muscular definition 1s of greater
concern to men. That cultural preferences for male muscular definition have
changed was supported by Pope et al.’s (1999) study of the muscularity of
popular action toys, which showed increasing muscularity over a 30-year
period, and their contemporary observation that today many such toys are
94 Embodiment
Eating disorders
The diagnostic criteria for anorexia nervosa have changed from when it first
entered medical parlance in the 1870s, although the fear of weight gain has
continually been seen as its primary motivational factor (Habermans 1996).
Currently the DSM-IV (Diagnostic and Statistical Manual of theAmerican
Psychological Association, fourth edition — which is very similar to the
World Health Organization’s International Classification of Disease, tenth
edition, ICD-10) identifies four key symptoms: (a) refusal to maintain
normal body weight (less than 85 per cent of that expected for height);
(b) intense fear of weight gain, even though underweight; (c) disturbance in
the way in which one’s body weight or shape is experienced, self-evaluation
being overly influenced by body weight or shape, or refusal to recognize the
significance of low body weight; and (d) amenorrhea in postmenarcheal
females, specifically the absence of at least three consecutive menstrual
cycles. Two subtypes of anorexia nervosa are identified: a binge-eating /purging
type, where the person regularly eats in binges and may use various methods
of purging, such as self-induced vomiting, misuse of laxatives, diuretics or
enemas; and a restricting type, where the person has not regularly engaged in
binging/purging. However, as with’ so many attempts at classification of
people’s distress, the validity of these subtypes has been called into question
by a recent longitudinal study that showed significant cross-over between
people in these groups and no difference in impulsivity, assumed to be a
factor in the binging/purging subtype (Eddy et al. 2002).
Clinical classification of anorexia nervosa, however, hardly captures the
desperate anguish of those caught up in the tragedy ofself-starvation: obses-
sive preoccupations with food, struggles to control hunger, the ‘shutting
out’ of loved ones, the mood disturbances and the ‘diminishing’ of that
person, not only physically, but also through a slipping away of the person
that others feel they can identify with. Self-starving also has a profound
effect on blood pressure and body temperature, and these changes in the
body’s environment can result in changes in the bones, teeth, hair and skin,
as well as impaired renal and cardiovascular functioning. Indeed, some
people with anorexia die from multiple organ failure. To spend time with
those who suffer through anorexia nervosa is to witness a frightening trajec-
tory where the progressive embodiment ofa desperate belief undermines
the person’s possibilities for life.
From the perspective of embodiment, perhaps the most intriguing pri-
mary symptom of this syndrome is the presence of body weight or shape
disturbance. Distorted body size perception has long been considered a core
aspect of anorexia nervosa. The person’s actual physical appearance and
their own experienced appearance are discrepant. Even though people with
anorexia may intellectually appreciate that they are dreadfully underweight,
they still perceptually see themselves as being bigger than they actually are.
For those not familiar with this phenomenon a similar experience 1s perhaps
F
96 Embodiment
the experience people have when viewing their own image in a distorting
mirror, except then you are very much aware it is a distortion.
Research on this issue has indicated that some people who do not have
an eating disorder still experience distorted body perception. Cash and
Deagles’s (1997) meta-analysis of over twenty years of research on body
image disturbance found that on average people with an eating disorder
distort their size to a greater extent than 73 per cent of the non-eating
disordered comparison groups used in the research studies. Garner’s (2002)
recent summary of research on aspects of size distortion suggested that for
those who are anorexic, overestimation oftotal body size seems to be greater
than overestimation ofthe size of particular body parts (such as face, chest or
hips). He suggests that this may be because whole-body estimation involves
more direct exposure to one’s self-image, rather than the more ‘indirect’
estimation of width of a particular body part. Most importantly, Garner
concludes that while people with anorexia and those in ‘control’ groups
may differ in the accuracy oftheir estimation of their own body size, they do
not differ in estimating the size of objects in general, and thus the distortion
is motivated around the self, rather than a general perceptual distortion.
While this is interesting, it is a mistake to make too much of body size
overestimation in eating disorders, as it appears to be an unstable effect
(being influenced by mood, viewing thin images of other women or per-
ceived overeating). While not all of those who have anorexia nervosa
experience body size overestimation, its occurrence is often associated with
the presence of other symptoms ofgreater severity — for instance, depression
and eating problems — which are associated with poorer outcomes (Garner
2002). Oltmanns and Emery (2004: 341) cite an anonymous student’s
attempt to explain how a person with an eating disorder sees a distorted
image of herself:
It’s almost like she sees herself as bloated — of course she sees herself,
she recognizes herself, but as bigger than usual. Also, the skinnier she
gets, the more she notices fat deposits around the waist, under the arms,
etc., because the more fat is lost, the more attention is drawn to the little
bit of fat that still exists ... Also, it’s the point of reference in the
background that may sometimes be distorted. She looks at the bath-
room mirror and thinks, ‘Did I take up that much space against this wall
yesterday?’
This description clearly indicates processes of thinking and focusing that
may be found to a lesser extent among many ‘non-eating disordered’
members of Western societies.
There have of course been many different explanations put forward to
account for anorexia nervosa, and it is well beyond our scope to discuss
them here. However, some are relevant to the concept of embodiment.
Williamson et al. (2001) characterize the cognitive approach as emphasizing
the interplay between environmental pressure for thinness because of its
Body sculpturing 97
cultural association with social acceptance and prosperity, the social model-
ling of dieting through media outlets, the existence of cognitive biases
for body-related information and the principle of reinforcement. Thus fear
of gaining weight, it is suggested, motivates restricted food intake, excessive
exercise and/or purgative behaviours, and thereby releases the individual
from the anxiety accompanying weight gain. This negatively reinforcing
cycle —1.e. escaping from a feared situation — becomes very difficult to break.
Furthermore, evidence of weight loss can be positively reinforcing because
it may be associated with feelings of achievement and self-control through
the ability to deny strong biological urges to eat.
From a more psychodynamic perspective it has been suggested that
anorexia may be seen as a phobic avoidance ofadult weight and body shape,
and sexuality (Crisp 1997). The anorexic is able to avoid these fears (and
often the onset of menstruation). Related to this is a systems theory perspec-
tive that sees anorexic symptomatology as symbolically representing the
individuals’ fear of negotiating and failure to negotiate, the separation/
individuation aspects of family life. Thus the anorexic symptoms represent
an attempt to establish power, autonomy and independence while not hav-
ing to engage with the challenges (including body changes) of adolescence
(Casper 1982). f
Up to this point, masculinity has been conspicuously absent from my
description of anorexia nervosa, and with good reason. It is a predominantly
female preoccupation, although when it does occur in men (about one
in ten cases) it is often more difficult to treat, perhaps because it does not
reflect compliance to Western male cultural values, but a rejection of them
(Anderson 2002). Indeed, Western male cultural values might be thought of
as quite the opposite of the anorexic figure and this realization has led to the
coining of anew term.
I have argued that popular culture has had a strong impact on how both men
and women view their bodies. Gordon (2000: 1) claims that ‘eating dis-
orders are unique among psychiatric disorders in the degree to which social
and cultural factors influence their epidemiology, development and perhaps
their aetiology’. This is perhaps too conservative a claim in its suggestion of
uniqueness, and in only suggesting the possibility of social and cultural
factors being implicated in the cause of eating disorders (MacLachlan, in
press). However, Gordon’s point is to emphasize the rapid acceleration in
reports of anorexia from the 1960s through to late 1980s, and also the
appearance of the previously unknown condition of bulimia in the late
1970s, and its rise to a position of greater prominence than anorexia in only
a few years by the mid 1980s. This ‘modern epidemic’ of eating disorders, it
is suggested, reflects a number of societal forces in the West, such as: the rise
of the consumer economy, with its concomitant emphasis on achieving
individual satisfaction, often at the expense of more collective goals; increas-
ing fragmentation of the family and intergenerational conflict; and changes
in traditional gender roles (Gordon 2000; see also Keel and Klump 2003).
It remains unclear whether the nvedia simply reflect or actually produce
the trends in wider culture that seem to impact on our value judgements
about our own and other people’s bodies. Whatever the cause-effect rela-
tionship, it is clear that not all people are affected equally by a culture’s
somatic iconography. It is likely that those least sure of themselves and their
identity — whose self-esteem is more anchored in being accepted by com-
plying with cultural standards, and who experience personal difficulties for
situational, constitutional or personality reasons — are most inclined to
embark on eating behaviours that lead eventually to disorders of eating. For
many women in the latter part of the twentieth century, the possibilities and
expectations for high performance and personal achievement often contra-
dicted traditional demands for dependency and submissiveness, resulting 1n
self doubt that, for some, has been channelled into the cult of the physical,
and ofthe less curvaceous (and traditionally feminine) woman’s body. Gor-
don (2000: 3) suggests: ‘the contradictions and transitions in female identity
represent the most profound basis of eating disorders throughout history
and across cultures’. If this is true, how do different ‘cultural vocabularies’
express such conflict through the symptoms of eating disorders?
While once considered a culture-bound disorder, anorexia nervosa 1s
now recognized in many non-Western countries, perhaps because they have
recently undergone rapid industrialization and experienced facets of global-
ization. Gordon (2002) notes that almost all the countries that had reported
instances of eating disorders prior to 1990 were European or North
American (with the exception of Japan and Chile), while countries report-
ing eating disorders since 1990 include Hong Kong, mainland China, South
Korea, Singapore, South Africa, Nigeria, Mexico and Argentina. It is
100 Embodiment
The symbolic meaning of anorexia nervosa has been much debated and
a recent and unusual perspective on it that resonates with the notion
of embodiment has been provided by Nasser (1999), who has linked it to
the increasing popularity among some Muslim women, particularly in the
Arab world, of wearing a veil. Nasser argues that one must look beyond the
notion of reactivation of tradition, an Islamic revival or Western stereotypes
of veil wearing. She sees the voluntary adoption of the veil by educated
working women as a kind of‘veiled resistance’ (see also Nasser 2001) to the
experience of conflicting gender roles. Nasser notes a similarity between
anorexia and veiling in terms of them both being means of reproducing the
self through hiding or evading, or of negating the body. In each case the
body ‘appears to disappear’.
Arguing for a common dialectic between the visible and the invisible,
Nasser (1999: 176) notes: “The ever-diminishing body is clearly disappear-
ing while remaining firmly visible and ironically more noticeable, imparting
a clear message through its apparent invisibility.’ Both veiling and anorexia
may be seen as attempts to establish boundaries around the self through
what is perceived as a morally elevated position which encompasses purity
and superiority: ‘Each woman pursues her externally different but psycho-
Body sculpturing 101
Cosmetic surgery
Curtaining off the body may be one way to alter its appearance; cosmetic
surgery is another. According to the American Society of Plastic Surgeons
over 1.3 million North Americans underwent cosmetic surgery in 2000,
and this figure represents a 225 per cent increase on the year 1992. In order
of decreasing popularity these included liposuction to remove fat, breast
augmentation, blepharoplasty (or eyelid surgery), Botox injections (see
Chapter 1) and ‘facelifts’. It is often implied that those seeking cosmetic
surgery are driven by feelings of personal inadequacy that represent basic
neurotic insecurities. In a comprehensive review of the literature Sarwer
et al. (1998) found that interview-based research on individuals who sought
cosmetic surgery indicated some evidence of ‘psychopathology’, while
research conducted using standardized psychometric measures did not.
With no obvious reason for these different findings, the ‘neurotic-vanity’
debate looks set to run. However, what probably can be agreed upon is that
cosmetic surgery is a psychological intervention, or, at least, a surgical
procedure with psychological consequences.
So what are those consequences? Once again, according to Sarwer (2002),
the research is equivocal. Post-operatively some studies indicate slight
‘improvement’ psychologically, while others report no such changes. How-
ever, at the very least it seems reasonable to assume (if somewhat circular) that
people motivated to have cosmetic surgery have a higher level of body image
dissatisfaction than those who do not consider it. Sarwer and colleagues
(2002) found that while people who undergo cosmetic surgery report less
dissatisfaction post-operatively with the body part altered by the surgery, they
do not report any greater overall body satisfaction as a result of a specific
procedure. It would therefore seem that while specific body parts may be a
focus of (and embody?) a sense of dissatisfaction, alteration and ‘improvement’
of that body part still leaves a more diffuse embodiment of dissatisfaction.
this may have kept them from seeking help. Equally there are probably now
many psychosexual problems being held at bay by medication, without their
underlying causes being addressed. In sexuality, the subjective and objective
relationship to the body may collide in emotion and contradiction.
Bending gender
The importance of biological sex and social gender are becoming increas-
ingly recognized with regard to health. Many genetic, hormonal and meta-
bolic factors shape distinctive male and female patterns of morbidity and
mortality (Doyal 2001). While sex-specific diseases such as cancers of the
cervix and prostate are very obvious examples, the incidence, symptoms and
prognosis of other diseases differ between the sexes. For instance, men seem
to have a much greater propensity to develop heart disease early in life.
Continuing gender inequalities in income and wealth place women at
greater risk of ‘disorders of oppression’ such as depression and anxiety,
disorders for which there is no evidence that women are at greater consti-
tutional risk (Bushfield 2000). While Doyal calls for greater sensitivity to sex
and gender in terms of current health research, service delivery and social
policy, her concern is with what might pejoratively be called ‘normal’ sex
and gender. Even greater challenges confront us with regard to sex and
gender that fall outside our bipolarized norms.
Gender identity disorder, if ‘disorder’ is what it is, refers to dissatisfaction
in one’s sense of being either male or female. For most people their gender
identity reflects their physical anatomy: those with a penis learn that they are
boys and those with a vagina learn that they are girls, and this sense is
established from very early on (at about two years ofage). Sex roles (mascu-
line and feminine behaviours) are influenced by cultural norms and in many
Westernized countries they have changed and indeed merged to a certain
extent in recent decades. But sex roles and gender identity are different.
Having a certain gender identity may imply the adoption ofcertain sex roles
in particular cultural settings, but the degree ofinfluence that social factors
have in gender identity remains controversial, and for some, problematic.
Money (1975) reported the case of a7-month-old identical twin whose
penis was accidentally destroyed during circumcision. Because there was no
satisfactory way ofreplacing his penis, Money recommended that the boy be
castrated, an artificial vagina created and the child raised as a girl. In addition
to this, at puberty, oestrogen was administered so as to feminize the boy.
This ‘nurturing’ was thus pitted against nature’s male genes and prenatal
hormones. In 1975 Money reported that at the age of 12 the child was a
‘normal female’. This work is often taken as providing strong support for
the social-learning theory of gender identity. However, a follow-up by
Diamond and Sigmundson (1997), neither of whom were involved in the
initial treatment decisions, reported that as a child she tended to act in
104 Embodiment
masculine ways and rebelled against the oestrogen regime she was put on,
because she didn’t want to develop breasts and refused to wear a bra. At age
14 she decided to live as a male, subsequently requesting a mastectomy
(surgical removal of the breasts), phaloplasty (surgical creation of a penis)
and androgen treatment. He subsequently married at the age of 25. He is
now completely heterosexual, able to ejaculate and experience orgasm, but
his early castration destroyed his ability to reproduce.
On the face ofit, this long-term follow-up documenting the distress and
anguish of aperson biologically born male, but forced into a female identity
only subsequently to reclaim his manhood, seems to support the primacy of
biology over social learning when it comes to gender identity. However,
Phillips (2001a) cites another similar case where again a Canadian baby boy
suffered the same type of injury and at the age of 7 months was ‘surgi-
cally remodelled’ into a girl. Although Tomboyish as a child, she is now a
young woman, who is bisexual but firmly convinced she is a woman.
The term ‘transgendered’ refers to ‘anyone who doesn’t conform to the
most rigid definitions of male and female, from the teenage boy rebelliously
wearing eyeliner and nail polish to the most committed candidate for sex
change surgery’ (Phillips 2001a: 33). There is also a spectrum of‘intersexed’
conditions where up to 1 in 500 people are born with sex chromosomes
that don’t correspond to their anatomy. It can be argued that transsexualism
(where, for instance, a man feels that he is really a woman and therefore has
the wrong body for the gender he identifies with) is a type of intersexualism,
where the organ at odds with the chromosomes is in fact the brain. Trans-
sexuals, who want to escape a body that does not embody their gendered
experience, draw into question both social learning theories (they have been
reared in accordance with their biological sex) and hormonal theories (they
have the same hormonal complement as other members of their biological
sex). However, perhaps the real problem is with the thinking of the sexually
conventional rather than the experience ofthe intersexed. The comfortable
dichotomy of male/female (male or female, male versus female) may be
more of a social comfort than a biological or phenomenological reality. We
make freaks out of what we are scared of, are unfamiliar with or find
incomprehensible. Furthermore, while officialdom may be adamant that a
child be either male or female on their birth certificate, for some people the
reality is that this is a nonsensical distinction.
Phillips (2001b) reports that 1 in every 200 babies in Western countries
(more than the number born each year with Down’s syndrome) have surgi-
cal interventions because their bodies fail to conform to our categories of
male and female. The Intersex Society of North America (ISNA) is cam-
paigning against the ‘normalization’ of babies born with intersex conditions
or ambiguous genitalia, because they question the benefit of such interven-
tions and some members give testimony to the associated sexual and emo-
tional difficulties that follow. Just as previously ‘treatment’ was suggested for
homosexuality, which was illegal (and still is in some jurisdictions) and
Body sculpturing 105
Paraphilias
Paraphilia literally means love (philia) beyond the usual (para). The psychi-
atric classification system DSM-IV includes under this category sexual
masochism, sexual sadism, exhibitionism, voyeurism, frotteurism (sexual
arousal through rubbing up against other people), paedophilia fetishism and
transvestic fetishism. Beyond objectification of the body as a source of erotic
stimulation, most of these conditions are beyond the scope of our immedi-
ate concern with embodiment. However, transvestic fetishism is worthy of
further consideration in this context. A transvestite enjoys dressing in the
clothes of the ‘other’ gender — cross-dressing. The ‘diagnosis’ of transvestic
fetishism is applied only to heterosexual men. Their behaviour may involve
just wearing a single item of women’s clothing, such as knickers, underneath
male clothing, but usually the person will completely dress as a woman,
often including using make-up and jewellery. The person may then
masturbate while cross-dressed.
Docter (1988) identified five key characteristics of this behaviour: (a) a
heterosexual orientation; (b) sexual arousal to cross-dressing; (c) the cross-
dressing is periodic; (d) there is no desire for surgical or hormonal gender
106 Embodiment
Chapter summary
Discussion points
1 If there is little evidence ofa link between somatic form and personality,
why is it such a compelling idea?
2 To what extent are cultural forces responsible for making us fat or thin?
3 How mutable are gender and sexuality?
Key reading
Bogin, B. and Loucky,J. (1997) Plasticity, political economy, and physical growth
status of Guatemala Maya children living in the United States, American Journal of
Physical Anthropology, 102: 17-32.
Diamond, M. and Sigmundson, H. K. (1997) Sex reassignment at birth: long-term
review and clinical implications, Archives of Paediatric and Adolescent Medicine, 151:
298-304.
Gordon, R.A. (2000) Eating Disorders: Anatomy of a Social Epidemic, 2nd edn. Oxford:
Blackwell.
eSpy illusory body experiences
I’m tired of this, I'm tired of that,
Tired of everything in fact,
Tired of eating such a chore,
Tired of drinking through a straw,
Tired of having no hands at all,
Frustration drives me up the wall,
Can’t hug a child nor pat a dog,
Just sit here helpless like a log,
Can't shed a tear unless someone knows,
Cos | can’t dry it up and | can’t blow my nose,
Can’t scratch an itch or rub my head,
And | can’t turn over in my bed.
But this does not mean I’m always blue —
What matters the loss of a limb or two?
-(An elderly person (name not reported),
cited in Day 1998: 101)
We respond viscerally to the spectre of amputation: it
challenges our own sense of bodily integrity, and conjures
up nightmares of our own dismemberment. We feel an
instinctive sympathetic identification with the amputee by
virtue of our own embodied being, but our identification
frightens us; thus we are drawn toward and repelled by
amputees simultaneously, both feeling and afraid to feel
that we are (or could be) ‘just like them’.
(French 1994: 73-4)
Tis but thy name that is my enemy.
Thou art thyself, though not a Montague.
What’s Montague? It is not hand, nor foot
Nor arm, nor face, nor any other part
Belonging to a man. O, be some other name!
What’s in a name?
(Juliet, reflecting on her lover being of a family that is her
family’s enemy, in Shakespeare’s Romeo and Juliet 2.2)
known of these are phantom limbs. Phantom sensations occur when there 1s
an ‘attribution of a sensation to an absent body part’ (MacLachlan ef al.
2003). Most of this chapter is given over to phantom experiences and associ-
ated aspects of the rehabilitation of people with these experiences, especially
with reference to the use of prostheses. Some of the major thinkers on
embodiment, including Merleau-Ponty, have recognized the importance of
phantom phenomenon for understanding embodiment, and it is for this
reason that we consider them in some depth.
A phantom limb is likely to be experienced after an amputation: the
person continues to experience the presence of a limb when all the evi-
dence is to the contrary and they can clearly ‘see’ for themselves that there is
no limb there. They experience a being-in-the-world, even when there is
nothing there to be in. The often accompanying phantom limb pain (PLP)
can for some people be excruciatingly painful, last decades and be very
disruptive to daily functioning. The understanding and treatment of such
pain is also therefore a clinical imperative.
Phantom experiences very greatly. Some, or all, of an absent body part
may be experienced and this experience may be painful or pleasurable, or
simply of the missing part’s presence. Phantoms have been reported after
the removal of limbs, breasts, colon and rectum and even teeth. However,
they have also been reported without the removal of body parts: in people
with spinal cord injury, stroke, lesions of the parietal lobe of the brain, in
people born without limbs (congenital limb absence), in some people who
have had an anaesthetic ‘block’ and in people who have suffered avulsion of
brachial plexus (when nerves from an arm are ripped from the spinal cord,
most commonly in a motor vehicle accident) (see Horgan and MacLachlan
2004 for a review). Below we consider historical, psychological and neuro-
logical perspectives of phantom phenomena and illustrate some of the
fascinating aspects of this very real and very intriguing problem. We also
outline how such phantom phenomena may be turned to the person’s
advantage.
the Aztec god of creation and vengeance, was a right foot amputee; and the
Irish Celtic god New Hah was a left arm amputee with a four-digit silver
prosthesis.’ ;
While there is much evidence of prostheses being worn in ancient times
(by the Egyptians, Greeks and Romans) and during the ‘Enlightenment’,
one of the earliest available accounts of phantom phenomena comes from
Ambroise Pare, who in 1552 wrote:
Verily it is a thing strange and prodigious, which will scarce be credited
unless by such who have seen with their own eyes and heard with their
own ears, the patients, who have many months after the cutting away of
the leg, grievously complained that they yet felt exceedingly great pain
of that leg so cut off.
(Cited in Sherman 1997: 72)
Herman (1998) asks why certain phenomena are reported in the medical
literature but not others. For instance, he asks, if Galen could report in
detail on gout and migraine, then why not on phantom limb pain?
Indeed, Pare’s description of PLP, although recorded in his momumental
ten-volume work, lay dormant for over 300 years. Riddoch (1941) states
that Lord Nelson took the phantom fingers he experienced — after having
had his arm amputated due to injuries incurred in an unsuccessful attack
on Tenerife in 1797 — as direct proof of the existence of the soul. In
literature, Captain Ahab, in Melville’s Moby Dick (1851), has the follow-
ing exchange with the ship’s carpenter who is making him a new
‘prosthetic’ leg:
Le ye, carpenter, I dare say thou callest thyself aright good workman-
like workman, eh? Well, then, will it speak thoroughly well for thy
work, if, when I come to mount this leg thy makest, I shall nevertheless
feel another leg in the same identical place with it; that is, carpenter, my
old lost leg; the flesh and blood one, I mean. Canst thou not drive that
old Adam away?
Truly, sir, I begin to understand somewhat now. Yes, I have heard
something curious on that score, sir; how that a dismasted man never
entirely loses the feeling of his old spar, but it will still be pricking him
at times. May I humbly ask if it really be so, sir?
(Melville 1851: 435)
and summons up his amputated legs. He walks a few steps on them, but
then they shorten until he is again walking on ‘his stumps’. During the
American Civil War amputation was very common, as it was used (in
the absence of antibiotics) to prevent gangrene setting in. Five years after
‘The Case of George Dedlow’ was published, Silas Weir Mitchell (who as it
turns out was its author) published his first accounts of PLP in a scientific
journal. It is widely presumed that he published the Dedlow case in Atlantic
Monthly to gauge reaction to the ‘risky’ (as in ‘wacky’, not scientifically
respectable) suggestion of the existence of the phantom limb phenomenon.
This is an illuminating illustration of how the scientific community may
not be open to empiricism, unless it is nested in the comfort of well woven
established theories. At that time, phantom phenomena simply weren't
explicable.
Basically, with most stumps you'll just see a scar. Mine has skin grafts, so
it’s all home-made. That’s the bottom of my old foot there, that’s the
heel. They actually took it off my old foot, and they sewed it on. And
that skin’s grafted off this leg here . . .
Sometimes I’m transfixed, nearly. You know, I’ll be just staring at it.
I can’t believe it, like.
Yea, yea.
Ah, I know it is, but I don’t believe it, you know. It’s kind of aweird way
to phrase it, but in some ways I don’t believe that I don’t have the leg.
You know,I still get shocked if Ilook down, and it'll take me aback fora
second, you know.
Here Colin is expressing his difficulty in coming to terms not just with the
emotional aspect of his leg loss but also with the ‘mechanical’ aspect of how
‘bits’ of him can be moved about, to make up the stump. There is not only a
sense of disbeliefat what is not there ‘when I look down’, but also a sense of
disorientation regarding what is there — on his stump. Thus the integrity, the
‘natural’ orderliness, of his body parts has has been disturbed, and possibly
along with that his view of himself.
Colin then describes his phantom pain:
Oh, when I first had phantom pain, it was months ago. I was, I think,
shortly after the amputation. You know, because when I had the leg and
it was still there, there was a lot of pain in the leg and the foot. And, so
maybe that’s instilled in my head for a little while.
Sometimes, sometimes. I’ll get pain in my phantom ankle, I’m not sure
that’s the correct term. Em, and I had a problem spot on my ankle.
114. Embodiment
Q: Was that after the accident you had the problem spot?
Yeah. I forgot what it was, it was like a sore basically. But, like right now
I have it. It kind offeels like my toes, almost like they’re asleep.
Raght now, its at the stump ... At the stump, yeah. Kind of toes, feel
the toes .. . If I’m wearing the leg [i.e. the prosthesis] they'll go down
to the foot. Where the, my new foot is. They’ll end up going down
thereen
Q: Can you draw on the diagram where you feel the phantom pain?
That’s really about it, toes and ankle. There’s also just regular pain, and I
won't be able to hit a spot per se, but [ll just feel like there’s pain.
... With that, itll tend to be just the stump. Because if I’m wearing
the limb, a lot of times I won’t feel, I won’t feel it sometimes. But
basically, If ’'m wearing the limb or not, itll just be like a jabbing
pain, like I’m being stuck with a big hot poker or something like
that.
Colin refers at the beginning of this quotation to ‘the leg’ and ‘the foot’,
and not ‘my leg’ or ‘my foot’, when describing himself before the amputa-
tion. It may be that just as they have been physically taken away, he now
attempts to place them outside of himself, and in doing so objectifies
them. However, he also experiences the prosthetic leg as object — ‘the
leg’ — and the phantom toes, as object (‘they’ as opposed to my toes), will go
down to ‘the foot’ of the prosthesis (object). But then, reflecting his
ambivalence towards the prosthesis, he says, ‘where the, my new foot is’.
Clearly there is confusion and possibly conflict over how to identify with
what has been lost and what has replaced it. While he refers to ‘the leg’
(meaning the prosthesis), he at the same time accepts ownership of ‘my
new foot’.
He doesn’t know what to call the pain in his phantom ankle. Or even if
there is such a thing. He also refers to what may be described as ‘pain
memory’, the idea that pain prior to an amputation is somehow ‘instilled
in my head’ after the painful limb is removed. There are other pains as
well, more diffuse, but these may not be felt when wearing the prosthesis.
Regardless — and unsure if it is phantom or stump pain — there is still that
treacherous pain, ‘like ’m being stuck with a big hot poker’.
Four months later, again talking about phantom pain, he says:
Illusory body experiences 115
There’s . . . actual times when I, when it’s hard to tell which one is
phantom which one is real, yeah. And this stabbing pain could actually
be a phantom pain as well, like . . .’cos it’s hard to tell . . . the stabbing
pain I'd almost think to be phantom pain, because eh, as far as I know
there’s nothing wrong with the leg, like, you know, it wasn’t like I em,
I smacked it against something, ’cos if I do, it’ll hurt like, you know,
ae that just, it wouldn’t be, unless I banged it against something, you
now.
Here Colin distinguishes between ‘phantom’ and ‘real’ pain, seeming to
suggest that only if there is something physically ‘wrong’ with the leg (like it
being banged) should it hurt. In the second interview (eight months after his
accident) Colin was asked whether his feelings towards his prosthesis had
changed since he left the hospital as an inpatient:
I have grown accustomed to wearing it and em, maybe I’ve eh, I don’t
know, the word ‘relationship’ isn’t really appropriate . . . cos I still think
of it as like a tool, kind of thing. But em, you know, it’s, it’s become part
of my day, and having to deal with it every day, yea you just get used to
I and, but it’s still, it’s not really, I don’t, don’t talk to it or nothing, ha!
Or make it coffee! ¢
There is an awkwardness here in the way Colin tries to convey to us
alternative impressions of the prosthesis as a ‘tool’ in one sense, and also
something much more personal, that you might talk to. He tries to navi-
gate a mid-line (‘you know, it’s become part of my day’) but almost blows
it with ‘yea you just get used to [’: ‘T’ and ‘it’ are interchanged, possibly
just in a random slip of speech, or possibly not. He humorously reassures us
that he knows it is not a person and doesn’t talk to it, or make it coffee!
Colin’s skilful use of rhetoric and humour is an excellent defence, not just
against how he anticipates others will react, but also against his own reac-
tions. The very conversation he is having positions him in a bizarrely ‘meta’
perspective where he is observing himself, commenting on ‘himself’.
When asked about the loss of his leg later in the same interview he says:
I’m still at the point where I feel like a little child having a tantrum, you
know, wanting my leg back . . . it brings me down quite often thinking
about it . . . it’s almost like there’s still hope that my leg’ll come back.
You know, which I know is complete rubbish, like, but it’s still kind of
there, you know. And I would say in, in time it'll just realize or just see it
isn’t going to grow back like, you know, you know plant little leg seeds
or something . . . its almost, almost like I had this weird idea that if I
give up hope of having my leg back, you know, kind of thing, even
though I know I'll never have it back, you know, ah, it’s almost like I
don’t want to lose it yet. You know, it em, I never hada +. .L don't
know if this has anything to do with anything really, but when I first,
em, had, like had it taken off, I was told that they hold on to it for
116 Embodiment
months, you know, and em, you tell them what to do with it, or that
eh, just eh burn it up with the rest of the rubbish, which is what they
do like, or if they, to burn it and let you have the ashes, or let you
actually take it and bury it or whatever like. And em, so at first, I was
like you know, ‘maybe I'll have the ashes, ’cos I don’t want the leg
itself’, like. ‘I'll have the ashes and sprinkle them somewhere’, like, you
know, just to, after watching these talk shows, you know, the term
‘closure’, and all this business, like you know. But as it turns out,
immediately after the operation, they, they, they em, they burned it
with all the rubbish
It was em, like a month later, something like that. 1 thought that em. . .
but em, I really wanted it, you know and then, it was almost like em, it
wouldn’t be near as bad, but its almost like if you lose a friend, kind of
thing, and you do, and you know, its almost like, if, ifa friend, if'a friend
of yours or a family member works on a boat, and the boat goes down,
and they never find the body, you know, and you don’t, you can’t really
go to a funeral, like, you can’t eh, you can’t say goodbye kind ofthing.
You know, I never had a chance to say goodbye, like, so it’s almost like
‘it’s still out there’, ha, ha, ‘it’s hopping its way towards me’. Which is
kind ofa scary notion, Stephen King kind of thing. But em, yeah, uugh.
I, I kind of hated that aspect. I didn’t have a chance to do something
with it really — whatever.
When Colin says ‘it’s still kind of there, you know’, what we don’t know is
whether he is referring to the wishing that he still had his leg, or to the
phantom experience of it being there. He feels like a child having a tantrum
and punishes himself for it — ‘complete rubbish’. Yet he cannot resist the
childlike notion that somehow the leg will grow back, like ‘Jack and the
Beanstalk’, if only he could ‘plant little leg seeds’. Again in a child-like
magical thinking way, he says that he is not ready to give up hoping it might
return, because if he does, he really will have lost it.
Colin then comes out with a phrase every therapist lives for: ‘I don’t
know if this has anything to do with anything really, but...’ He goes on to
describe that he had heard that the patient has some say in what happens to
their limb; for example, it could be buried or they could — and he uses a very
gentle word — ‘sprinkle’ the ashes. But, almost as a second wrenching of the
limb from his being, he hesitates to say that immediately after the operation,
in fact, ‘they, they, they em, they burned it with all the rubbish’. This is sad
punishment, resonating with the, ‘complete rubbish’, selfpunishment of his
child-like tantrum.
In the third paragraph, he is out with it: ‘I really wanted it’. He compares
the experience as being like losing a friend at sea and not having their body
Illusory body experiences 117
Paradoxes of pain
mediated, while other peripheral pains continue to be felt, despite the use of
powerful nerve blocks to prevent the transmission of impulses up the spinal
cord. Ofcourse, it is very likely that the one mechanism may not underlie all
pain experience. Although the consensus is that pain is felt centrally, we
must be careful, from the perspective of embodiment, not simply to replace
mind-body distinctions with central—-peripheral distinctions.
Neurologically, there are three very interesting paradoxes concerning
pain (Pinel 2003). First, despite it being so unpleasant, we actually need to be
able to experience pain in order to avoid situations that might do us damage.
Melzack and Wall (1982) described a woman who was unable to feel any
pain whatsoever. As a child she bit off the tip of her tongue when chewing
food and suffered third degree burns after kneeling on a radiator to look out
a window. Strong electric shock, very hot water and prolonged ice baths
produced no sensation of pain or changes in blood pressure, heart rate or
respiration rate. She required several orthopaedic operations to relieve
pathological changes in her knees, hip and spine that her surgeon attributed
to a lack of feedback from these areas. She failed to shift her weight when
standing, to turn in her sleep or to avoid certain postures that would be
painful after a short time for most people. Sadly, she died at the age of 29
from infections, skin and bone trauma.
A second paradox concerning pain is that although we now know that
our sensations are represented in the cortex, pain itself has no obvious cor-
tical representation. For instance, removal of SI and SII (primary and
secondary somatosensory cortex) does not appear to be associated with
changes in pain threshold, and patients who have had one complete hemi-
sphere removed (hemispherectomized) can still feel pain on both sides of
their body. Although both analgesia and hyperalgesia may be produced by
central stimulation, it seems unlikely that pain is mediated in the same way as
touch, sight or sound (Pinel 2003).
A third paradox of pain is that despite being such an utterly compelling —
physical — sensory experience, it can none-the-less be effectively suppressed
by emotional and cognitive factors. Such factors can effectively situate pain
in contexts that appear to override a simple physical transmission of sensa-
tion. Episodic analgesia is said to exist when injury occurs in the absence of
the pain normally expected to be associated with it. In such instances, it is
not that the people don’t feel pain, as in the case described above, but that
for a fixed period of time after the injury they are ‘pain free’, although pain
is subsequently experienced.
The example of Indian hook-swinging rituals is now well known.
‘Celebrants’ have hooks, from which they are suspended, inserted into the
small of their back under the skin and muscles. They are then wheeled,
swinging supported only by these hooks, through neighbouring villages in
order to bless the children and surrounding fields. This ritual is intended to
represent the power of the gods (Kosambi 1967: 105) and indeed there is no
evidence that the celebrant is in any pain. There are also numerous reports
120 Embodiment
Referred sensations are sensations attributed to one part of the body but
experienced in a different part of the body. If someone has an arm ampu-
tated, parts of that arm may be experienced through stimulating (touching)
either the stump area, or bizarrely, the face. Intriguingly, both the stump and
face may have mapped on to them the ‘plan’ of the missing limb as a result
of neural plasticity. Thus touching the face on certain ‘trigger points’ may
produce the experience of fingers being touched (see Figure 5.1) and touch-
ing the stump may produce similar experiences. The explanation for sensa-
tions being referred to the face is that once the limb is amputated the area of
the somatosensory cortex normally innervated by the hand has no ‘inputs’
and effectively becomes vacant. The areas on the somatosensory strip
IIlusory body experiences 121
™ Base of fingers
8
Palm
Lower arm
=| BO.
Figure 5.1 The areas depicted on the right side of the face in this patient elicited
the precisely localized referred sensations in the phantom hand, shown in supine
position (reproduced by permission from Halligan et al. 1999)
that border this vacant area (the face) then infringe upon it and provide it
with alternative inputs. So while the neural ‘image’ of the amputated limb
remains on the somatosensory strip, it is actually stimulated by inputs from
elsewhere. While this remapping occurs rather quickly, it appears to be a
transitory phenomenon, diminishing over time. However, of greatest inter-
est here is that the reorganization in both motor and somatosensory cortex
following amputation is associated with PLP (see Horgan and MacLachlan
2004).
Flor et al. (1995), using neuromagnetic imaging techniques, found a
strong relationship (r= 0.93) between the extent of cortical reorganization
and the extent of phantom limb pain experienced. Birbaumer et al. (1997)
hypothesized that if pain was reduced by anaesthesia this would lead to a
reduction in cortical reorganization. When the stump was anaesthetized,
three of the six people with amputations who experienced pain reduction
also showed a reduction in cortical reorganization. However, the reasons for
this are unclear. First, stump anaesthesia may have reduced input that could
have affected the cortical reorganization. Second, the anaesthesia may have
eliminated the PLP, which then affected the cortical reorganization. Third,
122 Embodiment
input from the stump may maintain PLP and the cortical reorganization.
Finally, PLP and cortical reorganization could be different manifestations of
the same process. While establishing a functional relationship between cor-
tical reorganization and PLP, a causal relationship seems unlikely, as half of
the participants failed to experience a reduction in phantom limb pain or
cortical reorganisation.
It is important to note that not all studies have found a relationship
between PLP and somatosensory reorganization (see, for instance, Grusser
et al. 2001b; Schwenkreis et al. 2001). Furthermore, significant levels of
reorganization have actually been found prior to amputation (Grusser ef
al. 2001a) and cortical reorganization is also related to chronic and acute
pain in the absence of amputation (Knecht et al. 1998). Thus while
research points to an association between plasticity and PLP, it is far from
conclusive. Despite this there has been a recent surge of interest in
research that takes this relationship as its theoretical backdrop, and seeks
to explore and even treat phantom experiences with various forms of
virtual reality. Experimental inductions of ‘phantom sensations’ with people
who have had an upper limb amputation have recently attracted much
interest.
Plastic Bodies 4
Augmenting reality
pe = mT
cdots _ ceraoess
ee
ORR
oSee‘sath.
le
‘ eeoS
i
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aaa
ee
zWES
Pw
Bob
What is me?
Based on the Rubber Hand Procedure described above, it would seem that
in the event of conflict between information provided through the differing
modalities of vision, touch and proprioception, information derived
through vision and touch overrules that provided by proprioception. Those
who referred the tactile sensations to the rubber hand during the induction
procedure also reported that they had a sense ofthe rubber hand being ‘their
own’. Admittedly this is hard to accept in the abstract. In my own experi-
ence, as I watched the rubber hand being stroked and felt the stroking on the
same fingers of my obscured hand, initially I was fully aware that my hand
was obscured and it was the prosthetic hand that I could see being stroked.
However, less than a minute after this strange procedure started, and without
consciously thinking it through, the sense of ‘my hand’ seemed to ‘jump’ to
the prosthetic hand that I could see. Even being aware of this process did not
revert my experience to what it was before the ‘jump’: the prosthetic hand
seemed like ‘my hand’, although I was aware also that I had a hand obscured
behind a screen.
What you see and what you sense being touched may be the key factors
in helping to identify ‘what is me’. Interestingly, Graziano et al. (1994),
working with monkeys, identified neurons in their premotor cortex that
responded to stimulation on the hand, but the same neurons also had recep-
tive fields extending outwards from the tactile field into the space around
the hand. In other words, when these cross-modal neurons were activated by
visual stimuli delivered near the hand, the corresponding visual representa-
tion of the hand was also activated in the brain. We now know that these
neurons respond to both tactile and visual stimulation, with their visual
receptive fields (those areas that stimulate them) extending outward from
their tactile receptive fields (Farne et al. 2000). There is thus very close
integration of visual and tactile information in the brain: what you feel is
(usually) what you see.
In an intriguing experiment, Rorden et al. (1999) found that the rubber
hand illusion could be used to improve tactile sensations in a 64-year-old
man who had severe left spatial neglect and impaired tactile awareness due
to intercranial pressure from a large right hemisphere fronto-temporal
arachnoid cyst: he only reported being able to feel taps on his left hand
when he could actually see the hand being tapped. Prior to surgery, which
successfully restored the man’s normal sensations, Rorden et al. (1999)
obscured the man’s hands under a table. They attached a solenoid (a mech-
anical device that delivers taps) to his left index finger, which had impaired
Illusory body experiences 127
tactile sensitivity. In addition, a pair of rubber hands were placed above the
table with a small light attached to the index finger of the left hand. This
light flashed regardless of whether a tap was delivered or not, its function
being to attract the man’s attention. This complex procedure revealed that
the patient was able to correctly identify 51 out of 100 taps, significantly
more than when the light was attached to the (misaligned) experimenter’s
finger rather than the rubber finger that had been aligned in a natural
position (32 of 100 taps correctly identified). Rorden et al. concluded that
visual and tactile stimulation interacts more when applied to the same limb.
Subsequently, Farne et al. (2000) showed that people with right-brain dam-
age, again with left tactile extinction (loss offeeling), can form visual repre-
sentations of peripersonal space (the space immediately adjacent to a limb)
of a rubber hand as if it were their own hand. Their results suggest that
people can unwittingly treat a prosthetic body part as if it were a part of
their own body as long as it is aligned in a life-like orientation to their body.
At a more technical level these results imply that visual—tactile sensory inte-
gration occurs in the “peripersonal’ space of an artificial limb, as if it were a
personal belonging.
In general, the above experiments support the idea that when visual and
proprioceptive information about the body is contradictory, the visual sense
predominates. In these experiments people tend to ‘feel’ what they see. How-
ever, in the case of phantom limb sensations it is the other way around: they
feel what they don’t see. Perhaps for them proprioception is dominant (at
least in the absence ofsalient visual information). As reported, for instance,by
Colin (earlier in this chapter), if phantom toes are experienced at the stump
end anda prosthetic limb is then put on the stump, the phantom toes may “go
down’ to where the prosthetic toes are. Thus when presented with a suitable
visual stimulus, phantom sensations may again be dominated by vision.
Prosthetic embodiment
Chadderton (1983) asks: ‘Is there any reason why the amputee should not
regard his prosthesis in the same way as he regards other consumer (durable)
goods such as automobiles?’ I believe that a prosthesis may become more
than a mechanical device, it may become psychologically invested into the
self, and hence the person’s relationship with it may symbolize how they
relate to the world: the extent to which their prosthesis embodies their
disability and to what extent it embodies their ability. Ramachandran and
Blakeslee (1998) suggested that one could think of the whole body as a
phantom, but, equally, the body may be construed as a prosthesis. Another
participant in one ofour studies, a young women who had to have both her
legs amputated after she was caught in a fire, described her anguish at having
to replace her prosthetic legs as being more disturbing than the loss of her
own ‘original’ legs, because at least she didn’t know in advance she was
going to lose them. For some people, and no doubt to varying extents,a
prosthesis can become a ‘part of you’. This can be described as ‘prosthetic
embodiment’ (Desmond and MacLachlan 2002).
130 Embodiment
Body imagery
had suffered phantom limb pain for 27 years, whom they treated with
antidepressants (he also had longstanding PTSD) and hypnosis. During the
hypnosis he was encouraged to imagine his phantom limb retracting into his
stump. Within three months the phantom limb had contracted to the extent
that only two toes and a foot, or at times only a foot-like image at the end of
his stump, were experienced. Associated with this hypnotic-induced tele-
scoping was a dramatic reduction in pain.
While body imagery clearly has a central role in illusory body experi-
ences, its intricate role in people with an amputation has yet to be fully
understood. For instance, Noble et al. (1954) reported that people judged
to be poorly adjusted to their amputation drew their amputated limb
either larger or more exaggeratedly on the projective “draw-a-person test’
than those who were judged to have adjusted well to their amputation. In
another study, Rybarcyzk et al. (1995) found that people with amputations
who, when asked to draw an image of their body, drew their body with all
limbs intact were significantly more likely to experience PLP than those
who drew their body with the amputated limb missing. In each of these
studies there is some sense in which people who have had an amputation are
representing their relevant limb in a non-veridical fashion, and this represen-
tation is associated with greater phantom pain. Not only is the spatial repre-
sentation of the limb important, so too may be the characteristics of the
prosthesis worn in its place. Thus, Murray and Fox (2002) reported a nega-
tive association between body image disturbance and prosthetic satisfaction,
and Fisher and Hanspal (1998) have found an association between body
image and anxiety, especially in younger people and those who had an
amputation as a result of traumatic accidents rather than for vascular disorder
(see also Breakey 1997). Panning back further from the conventional clinical
neuroscience and body imagery of amputation and phantom experiences,
we end by briefly considering the broader context and meaning of these
phenomena.
Psychodynamic perspectives
Socio-economic factors
for living but also with emotional support, which in turn gave a sense of
hope and a stronger desire to integrate. While non-supportive families
could also provide the basic necessities for living, they did not provide the
necessary emotional support. This resulted in lower ‘emotional health’
(isolation, depression and suicidal ideation) and a lower desire to integrate
socially. Ritchie et al. also found that peer support could facilitate a
similar beneficial rehabilitation process to that found with an emotionally
supportive family.
At a broader societal level they found that social barriers could result in
both a lack of economic opportunity and a lack ofaccessible transport, each
of which contributed to reduced physical and emotional health and thus
prohibited the ability of people with amputations from being productive
citizens. Ritchie et al. state that ‘The ability to be productive and to provide
for one’s own basic needs and those of one’s family was a central and core
issue for many survivors.’ This ongoing research project will, it is hoped,
provide insights into the ‘meaning’ oflimb loss in different cultures and how
these social constructions relate to the practicalities of rehabilitation. One
well known example of this is the study by French, who argues that “even
the most apparently subjective personal experience — the experience of
one’s own body — is shaped in important ways by the relations of power and
domination in which the body is involved’ (French 1994: 69). Working on
the Thai-Cambodia border between 1989 and 1991, French was based in a
site where amputations due to landmine explosions were ubiquitous. French
wondered what the impact ofliving amidst so many mutilated bodies must
be and how these bodies were ‘read’. While initially looking to psycho-
logical and culturally constructed meanings to interpret what she observed,
French found that such an interpretation could not be divorced from the
political, economic, historical and spiritual context through which people
with amputations lived.
French had also expected to find that people with amputations were an
‘inexorable’ reminder of the war and that their physical presence generated
a compassionate Buddhist response. Instead she found that people with
amputations did not elicit general anxiety about the war, but a specific
anxiety about personal safety: ‘people were afraid of them’. Particularly
among the young males (mostly former soldiers) with limb loss, a reputa-
tion for violence, extortion and theft had been established, and they were
invariably looked down upon; they were rarely regarded with compassion.
Their own overriding sense was one of degradation and abandonment, by
each of their families, leaders and society as a whole. At the crux of French’s
analysis, as it applies to our interest in embodiment here, is the idea that
while we have personal experience as individuals, what we experience is
socially and culturally mediated. To follow through this point, I can only
abstract in the briefest manner from French’s compelling, but lengthy,
analysis. For instance, the Theravada Buddhist hierarchy of merit, or virtue,
and its relationship to ideas of karma and reincarnation, were an important
Illusory body experiences 135
Chapter summary
Discussion points
Key reading
Farne, A., Pavani, E, Meneghello, FE and Ladavas, E. (2000) Left tactile extinction
following visual stimulation of a rubber hand, Brain, 123: 2350-60.
French, L. (1994) The political economy of injury and compassion: amputees on
the Thai-Cambodia border, in T. Csordas (ed.) Embodiment and Experience: The
Existential Ground of Culture and Self. Cambridge: Cambridge University Press.
Gallagher, P. (2004) Psychological adjustment to amputation, Disability and Rehabili-
tation, Special Issue. Includes a substantial literature review by Horgan and
MacLachlan giving more detail of areas covered in this chapter.
Gow, D., MacLachlan, M. and Aird, C. (2004) Reaching with electricity: externally
powered prosthetics and embodiment, in M. MacLachlan and P. Gallagher (eds)
Enabling Technologies: Body Image and Body Function. Edinburgh: Churchill
Livingston.
Note
The minutiae of biological detail about the human body at once both
astound us and estrange us from those very bodies. How can it be that your
100 billion brain cells, each with about 1000 connections to other neurons,
are a part of the same self that you usually experience in an coherent,
integrated and continuous way? For that matter, how can you possibly
stretch yourself once around the world, never mind your entrails making it
around two and a half times? It is clear that not only is the human body
fantastically complex, but we in our everyday being are quite estranged from
its workings, at least when it is working. Indeed, it can be difficult not to see
the heart as simply a brilliant machine, albeit one that can embody our
palpitating emotions or our sense of physical exhaustion — ‘I don’t think I’m
going to manage all 7200 litres today folks.’
With the vast array of innovative technologies that can enable people to
overcome many difficulties it is tempting to think of the human body as a
sort of master computer, with numerous ‘ports’ that gadgets and gismos can
be plugged into, in series, or in parallel, in order to compensate for whatever
‘you’ are missing. Much of the technology used today in clinical settings is
Enabling technologies 139
beyond the ken of most of us using it. Technology, like the body, is taken as
an act of faith, with converts ‘linking-up’ users and appliances. One could
imagine a situation where to ask a patient how they feel about their dialysis
machine could be almost as ridiculous as asking them how they feel about
the 96,000 km of blood vessels busily at work inside of them. Sure, how
would they know? Taken to extremes the person — ‘you’ — becomes only an
interface between a biological wonder on the one hand and a technological
wonder on the other hand.
Biotechnology can lead us to objectify and depersonalize those it is
intended to benefit: recently a nurse walked into a patient’s private room in
a Dublin hospital, conscientiously and professionally checked the monitors
above the bed and to each side of it, and strode towards the door; the
patient, of whom these machines gave some impression, barked ‘Hey, I’m
fine too!’ However, not only can technology lead us literally to overlook
those it is intended to benefit, it can also lead us to think of people through
the lowest common biological denominator — reductionism. Apparently
there are more cell meeting points in the human brain (100,000 billion)
than there are stars in the galaxy. This is certainly mind-boggling informa-
tion, especially when it is presented without meaning. Of course, there is
nothing wrong with reductionism pef se, but it is insufficient to explain life,
it is only partial. Perhaps what makes it feel wrong to many people is that it
offers explanations at an explanatory level that do not coincide with
people’s experience of the world. So, for instance, if we take Donne’s
famous lines:
Do not ask for whom the bell tolls,
It tolls for you.
we could be astounded because the probability of each letter following the
previous one in the sequence that they do is inconceivably small (1/26 x
1/26 X 1/26 X 1/26 etc.) and I suppose we would end up somewhere in
the billionths. However, to be impressed by such a statistic would indeed be
folly, not because it is untrue, but because we live in a world of meaning,
and we comprehend things because they appeal to that world of meaning.
Perhaps it is often because the meanings we give to the biological world do
not in fact accord with our conscious experience that we are estranged by
its ‘facts’.
In a National Geographic article on skin, Joel Swerdlow (2002) describes in
fascinating detail how the skin ‘works’ and how it can be reworked in the
case of people who suffer with burns or various skin disorders. In addition
to this explication of the ‘nanoscience’ of the skin’s structure and function,
Swerdlow also sensitively and lovingly tells us of the visit he made to his
86-year-old mother who was in hospital after collapsing. The doctors had
informed him that she might not be able to see or hear him:
I try to comfort her by talking, singing songs from my childhood, or
just sitting quietly. I’m not sure what she can sense, but her skin feels
140 Embodiment
Much has been written on the interface of technologies and the human
body, but most of this has been with regard to bodies that are free of
physical disability, with these ‘techno-bodies’ (Balsalmo 1995) representing
enhanced functioning — super-bodies. We need to develop a greater under-
standing of how technology, intended to assist those who are disabled,
affects people more broadly. Lupton and Seymour (2000) set out to explore
the ways in which technologies contribute to the meanings and experiences
ofthe ‘lived body/self”. They argue that
By augmenting or substituting particular bodily functions and
transcending time and space, new technologies offer people with dis-
abilities the possibility of facilitating entry and participation in
previously inaccessible activities and domains . . . However, technolo-
gies also bear with them negative meanings and implications ...
technologies may be offensively represented as ‘corrective’ to or
‘normalisation’ of impairment, or as allowing people to ‘overcome’
their impairments.
(Lupton and Seymour 2000: 1853)
The rationale for technology being used to ‘make something better’ is
reasonable and this rationale may be applied to ‘able-bodied’ and “disabled-
bodied’ people equally, whether it be wheelchairs ola
1 1 r i yo | Ghats up i a deficit | Laer
[ pplic yn InNoLO
sense of, you’re actually a real person and you actually have a brain yourself.
It’s a sense of reality, it gives you a sense that you’re living in the real world.
So it gives you that sense of first freedom from your isolation’ (Lupton and
Seymour 2000: 1856). Another participant, Tom, illustrated concern about
how technology can work against its intentions by being stigmatizing and
how alternative technology can overcome this:
142 Embodiment
I think its not so much technology as what the technology refers back
to the user of the technology. That is, as soon as you pull out a long
white cane, then people start making assumptions, sometimes right,
sometimes wrong, about your level of vision, about your level ofintel-
ligence or sorts of things like that, sort of indirect associations that are
formed. And you know, I think the best example is something where
that does not happen, like the little [electronic] business memo that I
use. I have to explain to people ‘Look I'll just take a note of this. ’m
going to speak into my business memo’. People think “Gee, that’s really
cool’, you know because anyone can use that, its not specially related to
people with disability.
(Lupton and Seymour 2000: 1858)
This theme of wanting technology that has positive value for the person
using it — because it is good to use such a thing — is important.
What could be called the ‘negatively distinguishing’ feature of, for
instance, a wheelchair was raised as a concern by many people. Likewise,
several people with cerebral palsy described the intrusiveness of using a
communication board (where a pointing device selects letters in order to
spell out words rather than speaking them). Ron argued that: ‘I can go into
a party [in a wheelchair] and I'm Ron, but if I took a computer in there
or a communicator I'd be viewed as Ron and the computer, or Ron and
the communicator’ (Lupton and Seymour 2000: 1859). A further theme
that arose from Lupton and Seymour’s interviews with disabled people
was the way in whic Tone
ment, whN omy,
a e un
ah
logy can thus both ex. ility and at hance feel-
ings of self-worth and add to one’s abilities.
can accentuate how ‘useless’ you are without it. To use some technologies
can therefore be experienced as becoming ‘entrapped within a framework
of meaning, that suggested helplessness, dependence, and above all, differ-
ence, try as the participants might to resist or reframe these meanings’
(Lupton and Seymour 2000: 1861). Overall, in Lupton and Seymour’s study,
the two broad ways in which technology was conceptualized were as
(a) being a tool that assisted bodily functioning and (b) being a means of
experiencing and presenting the self to others.
Nesting babies
Sadly, the video that Goslinga~Roy produced from this study, which
included Julie’s narrative and gave recognition of her role, has, should it be
distributed, been threatened with a lawsuit for libel and fraud by Pamela and
her husband. Goslinga-Roy (2000: 142) concludes that ‘We urgently need
to problematize oversimplistic, abstracting, and unitary representations of
embodiment, power, and technology.’ Whether, in the instance described
here, Julie’s body should be seen as one that simply ‘stops at her skin’
(Haraway 1991) or whether it should be seen more as a ‘collective body’
(Goslinga-Roy 2000), where others’ aspirations can be realized, is probably
ultimately a value judgement, no doubt influenced by any reasons one may
have for needing to make such a judgement.
New developments in reproductive technologies have been greatly
advantageous in many ways but they have also presented us with increas-
ingly more complex choices and opportunities, particularly for feminists
(Wolf 2001). The pro-choice movement (i.e. the right of women to choose
whether to carry their pregnancy to full term or to have a termination) has
been a central plank of the feminist agenda. Wolf, after seeing her own baby
at three months gestation, realized that she could never abort the child.
When she subsequently had a blood test that showed her foetus to be at risk
for spina bifida, she declined to have’ amniocentesis (extracting some fluid
from the womb), a test that would have given a definitive result. In one sense,
technology can be seen here as giving an informed choice, which might
be thought of as the essence of feminist empowerment, yet perhaps there
is an assumption of cold blooded rationality here, a rationality that may
not be equal to the emotional attachment facilitated by ultrasound. Wolf
also describes the tragic case of a friend who conceived in vitro, resulting in
three foetuses. She was given the choice ofselectively aborting one of them,
thus increasing the chance of having two healthy children. She decided
against selective abortion, placed her faith in God and lost all three of them.
Technology presents use with improbable opportunities, choices, tragedies
and joys. Yet it also often depersonalizes us. However, recently, through the
medium of birth plans, some individuals have tried to ‘individualize’ their
experience of giving birth.
Birth plans have become people’s way ofreasserting their role in bringing
children into the world. Sometimes these plans can be seen as attempts to
neutralize, or even contradict, the sterile clinical environment of hospital
delivery rooms. Bernstein (2002), in her wonderfully entitled article ‘It
ain’t over ’til the fat lady sings’, describes the plan that Tina Vervane, from
Michigan, USA, came up with for her second child: no drugs, a warm
shower during contractions, her husband videotaping the birth, and, oh yes,
just one other thing — her five-year-old daughter to deliver the baby, while
dressed in her favourite Scooby-Doo sundress. Other requests range from
live violin duets at the appropriate point to bringing home ‘placenta prints’.
Consumerism, patients’ rights and much sought after maternity revenue
have dawned a new age of permissiveness, at least in some delivery rooms
150 Embodiment
Hello Dolly!
Organ transplantation
transplant pig organs into humans, estimates the market for ‘solid’ organs to
be worth US$6 billion. They estimate that cellular therapies, such as trans-
plantable cells for insulin production in people with diabetes, to be worth
another $6 billion. Of the approximately 180,000 people around the world
awaiting organ transplants, only about a third will receive one, due to their
shortage and the increasing demand for transplants. Xenotransplantation —
transplanting organs across species — is seen as an answer to this problem and
pig organs seem to be especially suitable for human implantation (Dobson
2001). Xenografting (cross-species transplantation) is one way of addressing
the shortage of donor organs and would also allow transplantation to occur
before people became critically ill. As well as pig organs being transplanted,
two people have received baboon-to-human liver transplants and one per-
son received a porcupine liver transplant. However, these xenografts have
largely been unsuccessful due to the vigorous responses mounted by the
human host’s immune system (Martin 2000). Regardless of the biological
efficacy of xenografts, they raise important ethical issues about abuse of
animals, as well as profound concerns about incorporating non-human
biology into the human body.
Transplant Surgery (1994-96). This task force documented many abuses that
result from the traffic in organs, such as the sale of organs in India and
the use of organs from executed prisoners in China. It also noted the com-
plex sources of rumours regarding organ theft, which although not docu-
mented, ‘nevertheless point to the pervasive fears of aloss of bodily integrity
by vulnerable populations’ (Organ Watch website, 20-03-03). Scheper-
Hughes and Cohen conducted ethnographic research in Brazil, India and
South Africa during 1997—98, which they claim has revealed:
1 Strong and persistent race, class and gender inequalities and injustices in
the acquisition, harvesting and distribution of organs.
Violation of national laws prohibiting the sale of organs.
OWThe collapse of cultural and religious sanctions against body dis-
memberment and commercial use in the face of the enormous market
pressures in the transplant industry.
4 The appearance of new forms of traditional debt peonage in which the
commodified kidney occupies a critical space.
5 Persistent and flagrant human rights violations of cadavers in public
morgues, with organs and tissues removed without any consent for
international sale.
6 The spread and persistence of narratives of terror concerning the theft
and disappearance of bodies and body parts globally.
Body organs are not considered surplus to requirement by all. For at
least some, body organs are too strongly identified with the present and
future health of a person to be simply sold oft. However, in addition to the
sense of ‘body integrity’ that might be associated with resisting the tempta-
tion to ‘sell bits off’ (out of economic despair), perhaps resisting the market
value of the organs is related to the psychological value of retaining them;
that is, of them embodying the value of the person. As such, the biological
integrity of the body may be seen as integral to the value of self, at least
for some.
Brain dead?
the first dressing caused major anxiety, all the more since he could then
see the demarcation between his forearms and the donor’s hands. The
grafted hands were lifeless and the donor’s skin colour was slightly
different . . . the limit between the two bodies is obvious as a result of
the stitches, swells and seams. At this stage the patient’s anxiety was
never verbally expressed. It showed through abundant sweats, some
agitation, somatic complaints about difficulties swallowing, and the
obvious refusal to verbally express what he felt.
(Burloux and Bachman 2004: 170-1)
A few days later he did express his anxiety that the hands might come ‘un-
stitched’ and the fear of losing the newly grafted hands was associated with a
return of traumatic dreams about the explosion that caused him to lose his
hands originally, and acute reliving of the trauma previously experienced.
About three months after receiving the grafts, on his first returning
home, GH’s two-year-old son immediately noticed the difference between
the grafted hands and the prostheses he had previously worn; he caressed
his father’s hands saying ‘hands, daddy’, kissing them with delight and
amazement. While the significance of such an event cannot be under-
Enabling technologies 157
Technological enframing
Haemodialysis has been used to treat end stage renal failure since the 1960s
and is one of our most enduring and ‘invasive’ health-related technologies.
Yet ‘invasive’ is not really the right description ofit, and possibly “exvasive’
would be more appropriate: blood leaves the body, is essentially cleansed and
160 Embodiment
Perhaps one of the most dramatic examples of how this sense of identity can
go astray in high technology environments is the case of the, continuingly
controversial, intensive care unit (ICU) syndrome. Dyer (1995a) describes
how during the 1950s, when intensive care developed as a speciality, short-
term psychological problems became apparent in ICU patients. It is a matter
of controversy to what extent ICU syndrome 1s attributable to the illnesses
that justify admission to the ICU, the toxic nature of the physical treatments
that patients receive, the environment, routine and type of care provided by
staff, or some combination of these (Dyer 1995a, b; McGuire et al. 2000;
Bennun 2001, 2003; Ely et al. 2001). ICUs are highly specialized treatment
facilities, usually for a small number of patients with acute life-threatening
conditions. Usually busy, with a variety of clinicians milling around, they are
quite different from the normal hospital setting: with numerous monitors,
bleeps, alarms and the hum of technology dominating the atmosphere,
invariant with time of day. Here, the lives of both staff and patients become
‘entwined with the technology’ (Walters 1995: 338).
Bennun (2004) vividly describes the experience of Clifford in an ICU
who required respiratory support, monitoring of tissue oxygenation, fluid
administration, cardiovascular monitoring, nutritional feed and intravenous
drug lines following surgery for the removal of two aneurysms. Such tech-
nology assumes an omnipotence that effectively detracts from the person,
the patient’s progress being ascertained from the machinery, which speaks
on the patient’s behalf, both in a visual and auditory fashion. It is widely
accepted that the physical environment of most ICUs is a source of stress
for patients, family and staff alike (Jastremski 2000). Dyer (1995a: 130)
quotes Hopkinson and Freeman (1998):
notice is taken of this unless the patient becomes overtly agitated and
deluded, causing disruption to the care of both themselves and other
patients.
While our interest here is in exploring psychological aspects of the techno-
logical environment of the ICU and its implications for embodiment, there
are clearly many physical factors that can contribute to ICU syndrome,
including cerebral hypoxia, metabolic imbalance and effects of the plethora
of drugs administered. However, the fact that a syndrome may have at least
some physical causes doesn’t mean that we should ignore psychological
factors, for these may at least cause distress, and quite probably interact with
physical imbalances, if they do not directly produce such effects themselves.
The ICU syndrome may be defined as a ‘constellation ofclinical signs that
include fluctuating levels of consciousness, poor orientation, hallucinations,
delusions and a number of behavioral anomalies such as aggression and
passivity’ (Bennun 2004: 247). Hallucinations and delusions may include
persecutory themes, including the idea that staff are actually out to harm
them, indeed to kill them. In Laitenen’s (1996) study of patients following
cardiac surgery it was found that many people reported dreams of being
imprisoned, tortured and dehumanized in various ways, both during and
after their ICU experience. Other studies conducted in Sweden (Bergbom-
Engberg and Haljamae 1988; Granberg et al. 1998) found that ICU patients
felt they could not trust the machinery surrounding their bed, fearing that it
might break down and they would die. The various tubes and monitoring
lines restricted their movement and made them feel insecure. They also felt
as if they could not trust the staff caring for them; they developed perceptions
of body distortion and changed self-concept. Altered self-concept particu-
larly occurred when nurses appeared to pay more attention to the technol-
ogy than to the patients. Bennun (2004) points out that limited mobility
within the ICU environment causes patients to feel isolated and fearful, and
that in these circumstances there is a risk that they lose their integrity, body
sensations and functions: ‘Gradually, the patient may feel that their body does
not exist or they develop a perceptual distortion so that they do not know
where their body begins and ends’ (Bennun 2004: 243).
Torturing patients
It is important to note that not all patients in ICUs have the sort of experi-
ences described above, and to acknowledge that their dire circumstances
may require an oppressive level of technical control which, none the less,
may hugely benefit them. However, in a provocative article entitled
‘Preventing the ITU syndrome or how not to torture an ITU patient’, the
suitably pronounced Dyer (1995a) draws out parallels in the sort of
environment created in ICUs and the various categories of torture, as out-
Enabling technologies 163
Virtual realities
Citing Stone (1992: 20) to the effect that ‘No reconfigured virtual body . . .
no matter how beautiful, will slow the death of acyberpunk with AIDS’,
Murray and Sixsmith agree with Stone that the virtual experience is an
embodied experience. They also cite Fisher’s (1973) description of the
psychiatrist John C. Lilly submerging himself in a tank of water, where the
water was the same temperature as his body. Floating in this tank, isolated
from any light or sound, Lilly felt ‘merged and indistinguishable’ from his
surroundings, unable to tell where his ‘body left off and the water began’
(Fisher 1973: 22). Here the temperature of his body did not ‘frame’ him
against that of the surrounding environment’s temperature. If there is an
analogy to VR here it is that perhaps it works through a trade-off between
sensory deprivation on the one hand, and sensory augmentation on the
other.
Murray and Sixsmith note that we effectively neglect the body when we
are unaware of it, which is most of the time. Only when there is something
wrong with it do we pay it attention. This slipping in and out of our
attention
reveals that the body in the world is both foreground and background.
It constitutes our locus, so that we are ‘here’, rather than ‘there’. Yet, at
the same time, the body recedes from conscious reflection. At once a
holistic sense organ, and yet an assemblage of sense apparatus, the body
recedes from awareness in its perceptual activity. It is the very disclosure
of the world the sense organs provide that leads to their mindful
demise.
(Murray and Sixsmith 1999: 323—4, emphasis added)
It therefore follows that if the ‘sense organs’ can be engaged sufficiently
then there are infinite possibilities for the sorts of objects in which people
can feel embodied in a virtual environment. While it may seem more
natural to represent a person in a human body anthropomorphically, if the
actual body can be ‘surpassed’ in the everyday functioning sense then
alternative identities, such as birds or pigs or fish, become possible. In this
scenario the person is ‘using’ two identities, their ‘real world’ physical
identity and their ‘virtual world’ chosen identity. .
If it becomes possible to experience ‘physical expression’ in a virtual
world then such a world may offer opportunities denied to many — for
instance, people who are quadriplegic — in the real world. In the virtual
166 Embodiment
world we all use prosthetic devices and are enabled through them. There is
also great scope for combining the physical embodiment of the real world
with fantasy identification in a virtual world, and using the interplay
between these to therapeutic ends. McDarby et al. (2004) present an innova-
tive application of biofeedback technology that they refer to as affective
feedback. This involves using biofeedback in combination with sensory
immersion, novel signal processing and compelling computer game playing.
They incorporate narrative and intelligent technology into the biofeedback
loop from which people can learn about their responses. They describe the
case of Peter, a 9-year-old boy disabled by anxiety attacks who, as part of
his therapy, was taught to relax by playing the ‘Relax to Win’ game. In this
game your dragon races against another dragon (either another person or
your previous best time). What is intriguing about this game is that while
competitive racing is intuitively associated with tension — both physical and
psychological — to win here you have to be the most relaxed competitor.
The speed ofthe dragon, presented on an engrossing screen with impressive
graphics, is determined through galvanic skin response (GSR): the more
relaxed you are the lower the GSR and thefaster your dragon goes. It is hard
to describe the calm satisfaction derived from watching your dragon take
flight and glide to the finishing line, over the head of the other poor fella,
who is simply trying too hard!
Cybersickness
As if to remind us that people do not just slot into machinery, at least not
all in the same way, Riva (2000) notes that during and after immersion in
VR environments, some people develop unpleasant ‘side effects’. Such
‘simulator sickness’ includes ocular problems (eye strain, blurred vision and
fatigue), disorientation and balance disturbances and nausea; and these
effects can occur with less than ten minutes’ immersion in VR. However,
not everybody experiences them (Regan and Price 1994; see also the
Simulator Sickness Questionnaire (SSQ), Kennedy et al. 1993). Nichols
and Patel (2002) report a comprehensive literature review of 35 studies
concerned with health and safety issues in VR environments. ‘Cybersick-
ness’ was the effect most frequently reported across these studies and is
thought to occur because of conflicting input to the visual and vestibular
senses. The sensory conflict occurs because different sensory systems are
registering different types of experience: the visual system may be pre-
sented with simulated movement, but as far as the vestibular system is
concerned, everything is static. Nichols and Patel (2002: 252-3) note that
‘simulator sickness’ is polysymptomatic — no one symptom predominates
in all people — and that it is polygenic — ‘equipment, simulator usage and
variables associated with participant characteristics may all have an influ-
ence on the type and severity of symptoms experienced’. They note that a
Enabling technologies 167
Chapter summary
Discussion points
Key reading
¢ Body social: where the social spectre of the body is obvious to the person,
such as in the case of cosmetic surgery, or where a disabled person feels
that only their body is seen, and not ‘them’.
¢ Body emotion: where the immediacy of emotional experience produces
physical reaction beyond the ability of rational reflection; for instance, an
otherwise paralysed limb responding by movement to music.
¢ Body expression: where the body conveys distress though symbolism, as in
anorexia nervosa.
@ Body unawareness: where physical or social agents inscribe their effects
upon the body without conscious awareness; for instance, viral infections
or socio-economic gradients.
@ Body memory: where the immune systems ‘learns’ how to respond to
environmental threats, or becomes hypersensitive to them, without
conscious mediation.
¢ Body anomaly: where through either brain damage or illusory induction
procedures people ascribe human embodiment to inanimate objects, or
treat others or the self as an inanimate object.
¢ Body delusion: where an extreme and false beliefisheld about some aspect
of the body, such as in body dysmorphic disorder.
@ Body contagion: where, perhaps through a process of social contagion, one
body reproduces the symptoms of another body.
@ Body agency: where a sense of being-a-body is created by the coordination
of intention and motor action.
@ Body sensation: where the boundaries of the body are known through the
rim ofits felt sensation, as in the case of Siamese twins.
@ Body absence: where a lack of awareness of the body is taken for granted
because functionally it is unproblematic.
Body plasticity: where a sense of the self is not necessarily restricted to
aspects of biological inheritance, but may extend to include identification
with transplanted organs or limbs, belongings worn on the person or
distinct inanimate objects.
¢ Body indifference: where the body, its appearance and functioning seem of
little consequence to a person who may be invested in ideas, abstract
concepts or ideals.
This is not an exhaustive range of forms of embodiment, and it certainly is
not exclusive either. It is intended simply to be illustrative of how the body
is used as the vehicle of a sense of being-in-the-world. For instance, often
body awareness is combined with a lack of awareness, when some regions
are focused on and others therefore ignored. Body anomaly may be com-
bined with body agency, body plasticity, body expression and so on. These
different facets of embodiment represent various ways in which we can
relate to, and through, our bodies. It is this flexibility of our ‘perceiving
perceptible’ (Merleau-Ponty 1962) that offers alternative forms of embodi-
ment, that may be most therapeutic in the clinical context as we strive to
Forms of embodiment 175
find better ways for people to ‘live their bodies’. I conclude now by con-
sidering some fundamental issues regarding embodiment that I have not
previously dealt with sufficiently.
of us, which excites a blush.’ Ironically, by standing back from our self and
considering the perspective of others, we induce an intimate biological rush
of shame in the very body we are escaping through our objectification.
Shame is the entwinement of negative self-evaluations and the fear of this
being made public, and this is exactly what our betraying body does when
it pushes through a blush. Shame (and its anticipation through an ever-
present Foucauldian gaze) motivates compliance with social norms for
appearance, where ‘body ideals are taken as moral ideals’ (Fredrickson et al.
1998: 272).
Fredrickson et al. (1998), in their wonderfully entitled paper ‘That
swimsuit becomes you’, set out to test the predictions that self-
objectification in women produces shame, which leads to restrained eating
(the cultural ideal being thin), and also consumes attentional resources, thus
interfering with performing on a maths test (because if you are thinking
about your body it is harder to do maths). In their first experiment, partici-
pants tried on either a swimsuit or a sweater in front of amirror (unaware
of the other condition). They were then given cookies to eat (as part of
another sham market research procedure). Those women in the swimsuit
condition, who had high (trait) self-objectification, reduced their sub-
sequent intake of cookies, relative to those in the sweater condition. In a
subsequent experiment comparing men and women, the effect was repli-
cated for women but not found for men. Subsequent ability on a maths test
(replacing the cookies) was also diminished for women in the swimsuit
condition but not for men. This latter finding was interpreted as women’s
experience of shame interfering with their ability to do cognitively
demanding tasks, such as maths.
Assuming a third-person perspective on one’s own body diminishes that
body’s inclinations (consuming cookies) and performance (maths test). The
objectification of the body seems at once to distance the self from it yet also
to accept it as a symbol of, or metaphor for, self-worth. This sort of what
might be called ‘proximate distancing’ makes the body an inescapable pro-
jection of the self. Fredrickson et al.’s studies also, however, indicate that
there is considerable individual variability in the extent of body objectifica-
tion. There is also variation in the extent to which people will project
‘themselves’ into physical entities other than their biological body. Certain
situations may promote these responses more than others, and it would seem
that Fredrickson et al.’s swimsuit condition ‘reduced participants to feeling
“I ama body” — in effect, that the swimsuit becomes you’. Increasingly the
sexual objectification of girls and women is also applying to boys and men
(see Chapter 4) and so the processes alluded to above are becoming a more
pervasive and probably more destructive cultural norm, at least in the
North-Western world.
178 Embodiment
Transitional objects
Winnicott (1971) coined the term transitional object (TO) to refer to the
child’s ‘first not-me possession’. Examples include a teddy bear or a blanket,
and such TOs can be seen as a normal part of healthy development occur-
ring around six months. The TO was understood to represent the breast, or
mother, and its use protected against the anxiety associated with the process
ofindividuation — the child recognizing that he or she is a ‘separate’ person.
Although there is little empirical research in the area, Arthern and Madill
(1999, 2002) suggest that TOs continue to be used by some throughout
adolescence and indeed into adulthood.
I believe that the ethos of Western science, with its historical emphasis on
the primacy of the ‘mind’, has in effect created a context for the body itself
to become a transitional object. Moreover, increasing Western cultural
objectification of the body has provided a mechanism for this to happen and
the creation of the body as an iconic cultural object has provided a reason
for it to happen. So how do TOs work in practice? Arthern and Madill
(1999a) asked therapists to describe the way in which transitional objects
came into being as a part of adult psychotherapy, and what they believed
their function was. Based on interviews with the therapists, they derived a
four-level theory based on the process of embodiment and stated that: ‘The
TO literally “embodied” (gave body to) the [therapeutic] relationship in
the absence of the actual presence of the therapist’ (Arthern and Madill
1999a-16):
Just as a physical object can represent and give comfort regarding the
absence of an idealized figure (the therapist, or mother), so too can the
human body be sculptured into an idealized form, the possession of which, it
is assumed, will be comforting because ofits association with idealized figures:
actors, singers, models; cultural icons; the ‘beautiful people’. In essence, the
human body can act as a TO, but in reverse. Conventionally the TO is identi-
fied with in order to alleviate anxiety associated with loss of, or removal from,
an idealized object (mother). However, the transitional object in reverse
(TOR), in the form of the human body, is a mechanism for the person to
approach an idealized object, it is an acquisitive project. Thus rather than the
significance of the TO reducing over time, it increases over time, as the
person is able to shape and mould their body increasingly in the image of
their idealized object. Sugarman and Kurash (1982: 59) also argued that the
body acted as a transitional object in bulimia nervosa, and noted that ‘the
body of the infant is the first transitional object, a precursor of the later
external transitional objects’. We have already noted, however, that in
objectifying the body it came to be viewed from the third person, to be
externalized. Sugarman and Krush (1982: 62) saw the bulimic’s feeding of
her body as being to ‘lose herself in the experience of being one with
mother’ in terms of reuniting her with the physical sensation ofsatisfaction.
However, this maladaptive use of the body as a TO is not necessarily the case.
Forms of embodiment 179
Sugarman and Kurash (1982: 62) note the increasing importance of TOs
during adolescence:
transitional objects can become more diverse during adolescence
than they were in childhood. Clothing, living space, and their culture’s
concept ofart replace the blanket or teddy bear, but in a more symbolic
sense. It is what they stand for, the symbol of the adolescent member-
ship in his peer group, rather than their tactile or sensory qualities
which imbue them with transitional qualities for the adolescent.
Although we have noted previously that the ideal celeb-soma is, realistically,
unobtainable, at the same time our contemporary technologies, surgeries
and medicines allow fewer reasons not to try. Indeed, our increasing secular-
ism demands alternative world-views, views that are crammed with the
apparent pleasures of consumption and celebrity. Through making our
bodies transitional objects in reverse we consume the trail to bodily
perfection, achieving two goals in one.
We are all affected to some extent by the reach of Western cultures, but
their reach may be particularly unfortunate for those combating physical
distress, disease or disability. For such an ethos literally adds insult to injury:
loss of self-esteem to prospects of mortality. It is the omnipotence of the
contemporary body that has made the concept of embodiment so relevant
for understanding the experience of alternative physical beings. Ultimately,
however, one may well ask how such a constructivist view of the human
body, how any transitional object-like status it may have, relates back to the
hard wiring of the brain, which it must do. How can a socially constructed
consciousness and a biologically inherited neurology be reconciled?
Their key point here is that seemingly chaotic phenomena can in fact be
considered as complex systems. .
A second aspect of much consciousn ess research is the concept of
emergence; that is, of consciousness being an emergent property, something
180 Embodiment
that exists but is not present in its constituent parts, or predictable from
them. This resonates with the notion of aGestalt where the whole is taken
as being greater than the sum ofits parts. As Chapman et al. (1999: 44) state,
‘the concept of emergent property helps one escape from the constrained
thinking of Cartesian clockwork mechanics’.
Combining these, Chapman et al. (1999: 44) understand consciousness as
a ‘dynamical self-organising process operating in a distributed neural net-
work’, with some on/off aspects (coma, sleep, anaesthesia) but generally
varying with degree of arousal. An essential point is that the brain deals not
with reality, but with an internal representation of reality, and this representa-
tion is subjective and continually being reconstructed (updated). The ‘drivers’ of
this revisioning include sensory stimuli, emotions, cognitions and it ‘always
has a point of view. The point of view is the sense of self, which is closely
tied to the sense of body-self’ (Chapman ef al. 1999: 45). Chapman et al. go
on to describe how pain is both an event that produces biological events and
one that calls for a meaning to be made ofit; consciousness seeks to ‘form
meaningful wholes’ of both internal and external events, of both biological
and social representations ofthe self.
The spotlight of consciousness is always ‘about something’ and often
patterned by emotions. Chapman ef al. (1999: 46) note that the biological
processing of pain involves not simply sequential processing along single
pathways, but, in fact, massive parallel and distributed processing in the
cerebral cortex, which ‘integrates, produces coherence, and sets the stage for
the individual’s construction of immediate experience and meaning’. Sucha
conception of consciousness is enthralling and encouraging from the point
of view of embodiment, yet it does not, I believe, go far enough; for it
locates the conscious ‘mind’ only on top of the shoulders. Yet the mind is
not only of the brain; I believe that the essence of embodiment implies that
it 1s also ofthe body. Organs are emotional.
In Chapter 1, I quoted Carey (2000: 38) to the effect that ‘because the
cells of the body, not just the brain, receive and secrete information-bearing
chemicals, the whole body is an intelligence-bearing organism’. My heart, as
it beats with excitement, passion or anxiety, is not only providing signals to
a cerebral relay station, it is also living a meaning. How my heart reacts
tells me how I feel about things, just as my eyes and ears tell me how things
look and sound. Not only my heart is at once a sensory and reactive organ,
so too are my many organs innervated by the autonomic nervous system,
which prepares me for fight or flight (Chapter 2). If a‘chicken might be an
egg’s way of making another egg’, then might a brain be a heart’s way of
responding to another’s heart?
We can take the concept of emergence and apply it beyond the confines
of cerebral neurology, to include all aspects of the human body. Merleau-
Ponty argues for a perception of the world that is particular because of the
being that one is embodied in. However, this body does not just constitute a
point of view (as in astride a mountain or down a valley), it also constructs a
Forms of embodiment 181
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Index
The book:
MeOl1OOW Drawing a parallel with innovative work on neural plasticity, the author
illustrates how we are now in an age of body plasticity. Our body
boundaries are becoming increasingly ambiguous, allowing more
degrees of freedom and offering more opportunities than ever before
to overcome physical limitations.
From anorexia to amputation, Botox to one, smorphic disorder,
phantom limbs to acute and chronic pain, the k considers a broad
range of bodily experiences.
}1!H Drawing on research from diverse areas, including health and clinical
psychology, neuroscience, medicine, nursing, anthropology, philosophy
and sociology, this book is essential reading for students across all tee
disciplines.
NadO
ALISUAAIN()
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ISBN 0-335-20959-9
WWW.openup.co.uk |80335"209590
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