MEDICAL ANTHROPOLOGY IN THE UNDERGRADUATE CLASSROOM
These essays, written by undergraduate medical anthropology students at University of Washington are the third in the MASA blog’s series of excellent undergraduate writing. Medical anthropology professors interested in submitting the best work of their students should contact Jonathan Stillo (jstillo@gmail.com) the MASA Chair for more information.
Professor’s Introduction
The essays presented here were written by undergraduate students in an upper level anthropology course at the University of Washington entitled “Anthropology of the Body.” This course was offered without pre-requisites, which attracted not only anthropology majors but also students majoring in biology, public health, political science, international studies, entrepreneurship, and communications. The following works are included here:
Ethical Concerns and the Medical Gaze, by Emily Shavers
Slaves to Society; How we Lost Control and Ownership of our own Bodies, by Natasha Gay
Implications of Sonographic Imaging; In The Absence Of A Cognitive Mediator, by Amber Brown
Each of these essays selects a unique focal point for interrogating the social construction of the body and individual personhood. Emily Shavers recounts a story of a relative’s recent hospitalization to illustrate potential ethical quandaries that arise from the medical gaze. Natasha Gay engages theories of bodily adornment to discuss how the body is rendered coherent through the reproduction of cultural tropes; she argues that personal expression is inherently limited by these social forms. Amber Brown uses Marcel Mauss’ construct of the triple body to problematize the work of building personhood and identity that is accomplished through fetal imaging. Together, these works reveal students’ capacities for applying medical anthropology’s most classic theories in new and innovative ways.
–Jennifer J. Carroll, PhD (University of Washington)
Ethical Concerns with the Medical Gaze
By: Emily Shavers
Emily Shavers graduated from the University of Washington, Seattle with a Bachelor of Science in Public Health. She spends most of her time working as a Certified Nursing Assistant for a diversified community, volunteering in underserved communities, and continuously following her passion in the public health field. She aspires to be part of a team that follows through with compassion, positivity, dedication, and respect in order to make an impact for the greater good of a population. Emily has a passion for music, traveling, and staying physically active.
As a public health student, I have been taught at the University of Washington to examine all factors relevant to a population’s quality of life that affects its health and to find ways in which to improve human health. This view looks at all aspects of human health, not just the physical and mechanical parts of the body. In part, it has given me a new perspective on the medical field.
Through weeks of reading and analyzing classic anthropological literature that studied the ways in which the body is looked at through biomedical means, I noticed a significant connection to a recent personal experience. This personal experience not only accentuated the discourse and enigma of the effectiveness and ineffectiveness of the medical gaze, but rather the need for bridging the gap between patient and physician interaction.
The trip to the hospital occurred on the day my close family member felt an agonizing pain in her body that inhibited her activities of daily living. The physician’s nurse came in and automatically put a blood pressure cuff on my family member’s arm, stuck a thermometer under the tongue, and counted for respiration and pulse. Normal. The physician walked in seeming confused as everything was perfectly in the range of normalcy. Following, the physician asked nonchalant and categorical questions that all physicians are required to ask such as race, age, and ethnicity as well as qualitative questions such as “when did you first notice these symptoms?” and other directed questions based on the patient’s personal history. Check. The answers were not sufficient enough to help determine what may have been the leading cause of my family member’s health status. Lastly, the physician placed her hands over the body to check for abnormal findings. Strange, an inflammation. Notes were written down furiously and later, the patient was asked to wait a few weeks for testing. I was dumbfounded by the promptness and confidence the physician exerted when interpreting the test results and diagnosing the chronic disease as untreatable, however I was also disturbed by the lack of closeness between the physician and my relative. Her identity, opinions, values, spiritual needs, and emotions disintegrated in the authoritative figure and she sometimes felt alone and unimportant as compared to her illness throughout the process.
After taking further courses at the University of Washington, I came to realize that this doctor- patient relationship presented a different way of caring for a human being, which is Foucault’s definition of the medical gaze- objectification of the body. Foucault is a French philosopher of science who wrote The Birth of the Clinic. He devised the term, medical gaze and scrutinized its complications in diagnosing and treating a patient in the 18th century, after the French Revolution, that transformed the roles of physicians as a practitioner and diagnostician and the patient (Hsu and Lincoln 15-34). Foucault further argued that the medical gaze focuses on advancement in medical technologies which assists the physician’s role and “abstracts the suffering person from her sociological context and reframes her as a ‘case’ or a ‘condition’” (Hsu, Hsuan, and Lincoln 23). I believe that advancements in Western medicine and technology are vital in improving human health, however not only does the use of the medical gaze potentially lead to ethical and moral concerns as it mainly focuses on the body and the disease rather than the holistic view of the individual, but it may also lose its effectiveness in diagnosing and treating a patient.
The medical gaze being a taught and learned, institutionalized method for examining and analyzing the body that is standard across all medical training institutions, it disregards other external factors that may be inhibiting a patient’s overall well- being as well as disregarding the emotional and psychological bond between patient and physician (Foucault 25). Looking at the body through the medical gaze may lead to an objectification of the body if the patient’s personal involvement is not considered to be part of the diagnosis. This is a moral and ethical concern because the individual is not being treated as a holistic individual but rather as a case study. As mentioned previously, the public health ideal is to look at other aspects that may affect human health such as social determinants of health and any other factors related to quality of life. When observing the physicians treating my close family member, I could tell that there were step by step procedures they normally followed, such as the nurse taking her blood pressure, pulse, and respiration. The nurse took these measurements in order to check if the body complied with the standard medical knowledge of normal blood pressure, heartrate, and breathing rate. This shared medical gaze amongst physicians shows that obtaining a patient’s measurements can be compared to known normal measurements to determine the patient’s health status.
In the study of Nancy Scheper- Hughes who is a celebrated figure in the current medical anthropology field, she examined similar concepts as Foucault such that her published studies, The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology, examines the controversies of applying biomedicine in understanding the sickness of a body as there may be other underlying causes and solutions to treat and cure sickness of the individual such as understanding the individual’s emotions, feelings, nature, culture, and lifestyle. Both Nancy Scheper- Hughes and Foucault believe that medicine itself cannot effectively treat a patient with a disease or illness and instead, requires input and value from the patient as well.
The Birth of the Clinic goes into greater depths to explain hierarchy in this patient- physician relationship that may lead to unethical means of moving the patient from an individual to ‘it’. Due to the visibility, understanding, and knowing of undetectable physiological happenings, physicians may use this higher power of knowledge to obstruct the view of the powerless and weak patient. This is detrimental to the gap between physician and patient relationship.
Foucault mentions that there was a significant contrast between past centuries and present day in the western medical field such that the question “‘What is the matter with you?’, with which the eighteenth century dialogue between doctor and patient began, was replaced by that other question: ‘Where does it hurt’, in which we recognize the operation of the clinic and the principle of its entire discourse” (Foucault xvii). I agree with Foucault’s statement because I too have noticed the physician asking the procedural, and categorical questions that physicians are required to ask such as race, age, and ethnicity and qualitative questions such as “when did you first notice these symptoms?” and more directed questions based on the patient’s personal history rather than the patient’s perspective.
Especially when comparing past and present day practice in the medical field regarding physician and patient relationship, John Berger as an observer in medicine wrote a short story titled A Fortunate Man: The Story of A Country Doctor that depicts the true nature of how a physician should interact with their patients. It is what is still known as “the most important book about general practice ever written” because of the way it describes the doctor treating his patients in a humane, compassionate, understanding, and genuine manner. The story shows a mature transformation of the doctor’s way of thinking to effectively treating his patients. John Sassall, the doctor, creates several close relationships with his patients just by empathetically listening and figuring out who his patients are. He is emotionally and mentally involved with his patients in order to understand the wholesome of his patients which most likely ended up finding the underlying health problem in his patients. This example clearly illustrates what Foucault believes to be important instead of relying and focusing solely on biomedicine.
Unlike the eighteenth century as Foucault mentioned, the advancement in medical technology has led to a mechanical way of looking at the health of the body which limits the patient to express themselves. Patients no longer must describe in detail every pain or feeling when these can be measured electronically through mechanical means such as Magnetic Resonance Imaging scans. Although the mechanical measurements are exact and informative, it does not completely relieve physicians from the requirements of verbal communications to uncover pertinent information that cannot be found mechanically. The combination of both verbal communications and mechanical measurements leads to a much more effective and efficient means of identifying, diagnosing, and treating medical conditions. This idea of the medical gaze in which students are taught a specific way to examine the body from classifying the patient’s disease to analyzing the body’s features, to outlining actions, and so forth shows that the patient is just a case study for the physician (Foucault 61).
Despite the problems of the medical gaze, the protocols and regulations that go along with it have been very effective at curing diseases. I believe that the medical gaze and advancement in western medicine can be effective when diagnosing and treating patients and is needed to cure those who are ill. However my concerns are the moral ethics that come to play which may triumph the good of the medical gaze. This is how I slowly came to realize that most of my physicians treating my close family member focused solely on how to treat and diagnose her disease.
My underlying ethical concern with the medical gaze is that it amplifies the objectification of the patient’s body. As Foucault writes, the medical gaze draws upon “the fundamental perceptual codes that were applied to patients’ bodies, the field of objects to which observation addressed itself, the surfaces and depths traversed by the doctor’s gaze” (Foucault 1963, 54). Focusing on a patient’s body can quickly become the main concern, rather than considering the person as a whole. Excluding a holistic approach may lead to severe procedures such as invasive surgeries as other effective means may be overlooked. Objectification of the body may also lead to obscuring or hiding certain areas of humanism such as not treating the individual as a valued human being or being able to treat medical conditions with non-surgical means, either of which dehumanizes the patient. My close family member’s identity, opinions, values, spiritual needs, and emotions disintegrated in the medical gaze and she sometimes felt alone and unimportant as compared to her illness. These factors that are most important in valuing a human being is eventually forgotten when the medical gaze is overbearing on the main central focus to cure only the body. As Foucault mentioned, “those looking through the gaze first looked at the medical bipolarity of the normal and the pathological” before studying the inner human being with its emotions and mental well- being (Foucault 1963, 35).
To conclude, Michel Foucault illuminates the concept of the medical gaze by explaining how physicians observe the body carefully, uncovering the mysteries and hidden truths of particular diseases that others without the medical gaze could not. However, as previously discussed, discounting the patient’s emotional and social dimensions of the illness may prevent developing the least invasive procedures of treatment. As to my main argument, my experience has led me to see the ethical concerns of the medical gaze by observing a patient-physician interaction that discounted the patient’s personal involvement in the diagnosis process. It is one thing that the medical profession is to diagnose and to treat the body, however I believe that there is more to just diagnosing the body in order to improve human health.
Works Cited
Armstrong, Peter. “The Discourse of Michel Foucault: A Sociological Encounter.” Critical Perspectives on Accounting 27 (2015): 29- 42. Print.
Feder, Gene. A Fortunate Man: still the most important book about general practice ever written. The British Journal of General Practice 55.512 (2005): 246-247. Print.
Hsu, Hsuan, and Lincoln, Martha. “Biopower, Bodies… the Exhibition, and the Spectacle of Public Health.” Discourse: Journal for Theoretical Studies in Media and Culture: Vol. 29: Iss. 1, Article 2. Fall (2007): 15-34. Print.
Scheper- Hughes, Nancy, and Lock, Margaret. “The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology.” Medical Anthropology Quarterly 1.1 (1987): 6-41. JSTOR. Wiley on Behalf of the American Anthropological Association. Web. 10 Apr. 2015. <http://www.jstor.org/stable/648769.>.
Slaves to Society; How we Lost Control and Ownership of our own Bodies
By: Natasha Gay
Natasha Gay a junior at the University of Washington majoring in Anthropology and sociology. A Student-athlete with the women’s crew, she understands the importance of one’s body and the way in which it is read but different social groups. Natasha hopes to apply her sporting background in to future research for youth development in under-privileged communities and with youths at risk, focusing on current cases in the sports arena.
Our bodies are blank canvases, and as society paints a picture, we begin to realize we have very little say in the final outcome. It is impossible to make a decision regarding our own bodies without being influenced by society in one way or another. The most basic example of this is self-presentation; every choice we make is made to go with or against a current trend of society. I believe that this is just a superficial issue amongst deeper issues of body control and ownership. In this paper I will examine the deep rooted issues of body ownership and control and how society has taken this from us. I will do this by utilizing Marcel Mauss’ essay “Techniques of the Body.” As my argument develops, it will become clear that the social body is not the only body affected by society. The physical and mental are linked and affected as well. This is most adequately summarized by Terrance Turner, who reflects how the boundaries of individuals as biological and mental entities are no longer separate but parts of the “frontier of the social” (Turner 2007:83).
Society’s influence on our bodies is most obvious in Mauss’ essay on techniques of the body (Mauss 2007:66), Mauss suggests that we have three elements of self or three bodies: the physical, mental, and social. The physical body acts as a frontier between the mental and social bodies. Within the physical body, material objects have become a pivotal element of adornment and communication of hierarchy and status. Terrance Turner’s “The Social Skin” (Turner 2007:83) describes the idea that the treatment of the human body responds to societal notions and trends, reflecting the constant influence and control that society has over us. Turner explains how each different bodily adornment is a treatment of society and therefore the norms and structures that are present at the time, it is with this that society turns each individual’s body into a “symbolic stage” (Turner 2007:83). This symbolic stage expresses the social hierarchy in which we stand as individuals as well as the values, beliefs and general attitudes that we associate with. Our bodies then become a slave to society’s values, beliefs and attitudes as we lose ownership of our own bodies with society taking control.
An example of symbolic staging is clothing; the brand and quality of clothing reflects our social status, the cut and style reflects our general attitudes and values. The way that we adorn ourselves with jewelry, piercings and tattoos can materialize our beliefs and views in terms of religion, culture and even tribe. Examples of this can be shown in the tribal tattoos/body paint and particular piecing locations. In many cultures, these tell a story of life events: deaths, marriages, hardships, victories and titles. Hair treatment can also be added to this. The Kayapo tribe (Turner 2007:85), for example, utilizes this as a form to express and represent hierarchy and cultural roles. Another example of this is tattoos which materializes values, beliefs and in some cultures the likes of the wearer of the tattoo. In the past a tattoo would have signified a rebel or an outcast but now as they become more popular they are seen as another way to express individuality. These modes of adornment make aspects of our identity material yet are all influenced by societies. No matter how different societies may be, the adornment they prescribe makes displayed identities an element in the collective society rather than an individual choice. Society is in control of the physical body as well as the social body, as it controls the material markers of an individual’s identity.
Although one would think that our own thoughts and minds are less penetrable to society’s grasp, they are, in fact, some of the most influenced and controlled. With the constant exposure to societal ideas and ideals, our attitudes and beliefs constantly change with society. It is somewhat bewildering that even our values and beliefs are socially constructed and influenced. Stereotypes that society has created, affect us as well as trends; racial, gender and occupational stereotypes being some of the most important. These are pivotal to how our mental selves react to and interact with others. For example, in earlier decades women and minority groups were held in lower regard to others with particular values (fragile, unintelligent etc.) placed on them and therefore individual’s values and beliefs shadowed this. Though these values are not as prevalent today, stereotypes of behavior and appearance are still widely held for women as well as for other groups.
Judith Butler argues that these stereotypical behaviors are prevalent because of “gender performativity” (Butler: 2007:166), in which we are trained to act out the expected social norms and behaviors of our sex. It is not just values and beliefs that society influences, but the ideals that we hold. Ideals of beauty are an example of this. They tend to apply to everyone no matter the group that they may associate with. It is society’s ideas about how our bodies should be shaped and sized that causes the greatest influence in individual ideals and can have such a great influence that it can drive an individual to excessive measures. One such measure is eating disorders. I have had friends who have developed eating disorders due to their feeling that they have no control of themselves. By controlling their eating, they feel they are regaining some sort of control and ownership of themselves and their bodies. This may be the case, but this is a reaction to the influence and ideals of society in terms of body image. By going to these extents we have already lost our bodies to the control and influence of society and this mentally affects us making us feel inadequate. In this case, although society doesn’t directly control our body weight, it has infiltrated our mind and taken control of our thoughts and expectations about how we should appear.
So far I have focused on the way that we view ourselves, examining how society has managed to gain control and ownership of our mental and physical bodies without our consent. Mauss’ third element of the triple body is the social body. The social body is defined by the way that society uses our bodies from their point of view and how we represent their values and attitudes. The social body is defined as the body that society interacts with, and I agree with this but I think it to be short sighted if we cannot see that society now has control and ownership of all three of Mauss’ bodies.
No matter our choice, whether we are acting with or reacting against it, society has infiltrated our bodies and taken control. Using Marcel Mauss’ idea of the triple body, I have segmented our bodies and examined how this has occurred, from the obvious social body to the more personal and closely guarded physical and mental bodies. It is evident that whatever our intentions, we have become a reflection of society in terms of ideals, beliefs and attitudes. As societal trends change so will our bodies, as they are a representation of these values. It can be debated as to whether we ever had any control over our bodies, but it is for sure that we do not at present. In the future we hope to break free of these shackles, but until then we will remain a slave to society as our bodies are owned and controlled.
Works Cited
Mauss, Marcel. “Techniques of the body.” In Beyond the Body Proper, edited by Judith Farquhar and Margaret Lock. 50-68. Durham: Duke University Press, 2007
Turner, Terence S. “The Social Skin.” In Beyond the Body Proper, edited by Judith Farquhar and Margaret Lock. 83-103. Durham: Duke University Press, 2007
Butler, Judith. “Bodies That Matter.” In Beyond the Body Proper, edited by Judith Farquhar and Margaret Lock. 164-175 Durham: Duke University Press, 2007
Implications of Sonographic Imaging; In The Absence Of A Cognitive Mediator
By: Amber Brown
Amber Brown is a senior at the University of Washington where she studies anthropology in the hopes of becoming an archaeologist. She is a mother to two fantastic children, and she her fiancé enjoy road trips, camping, and spending time with their friends and family. Amber hopes to settle in Spokane and focus her archaeological work in Eastern Washington, where she would like to engage in a community based approach to discovering more about the earliest inhabitants of the region. She is currently considering attending law school, where she plans to focus on cultural property rights with the goal of supporting indigenous communities who are asserting authority over their cultural property.
The body is a complex construct, material in that it is the concrete base of how we define the human experience. It is dynamic and varied and interacts with its physical and social environments in a highly unique and individualized fashion. This interaction between the mental and physical occurs from the moment that conception is acknowledged, and it is a process that is enhanced through the use of prenatal imaging. The way in which the body is addressed before life is reflective of communal values and political hierarchies that use the body as a means to convey social information, as evidenced by the current attempt in multiple states to legally mandate that women undergoing abortion must submit to the process of sonographic imaging. Unborn bodies, however, lack the necessary cognitive ability to mediate between the physical and social realms, and are thus susceptible to political exploitation that utilizes prenatal imaging to assign bodily attributes and agenda unto the fetus.
As the famed philosopher and sociologist Marcel Mauss would suggest, the body is a multifaceted construct composed of mental, social, and physical factors that form the idea of a whole person. Mauss drew upon elements of Cartesian dualism in order to establish a triple body approach, one that combines the physical and cognitive factors with cultural values in order to gain a more complete understanding of the body (Mauss 2007:53). This “Total Man” approach suggests that each element contributes an essential part of what it means to be human. They are part of a dynamic and varied system that interacts within a “biological and social [entity] in whom the psychological acts as a mediator” (Farquhar & Lock 2007:22). Thus, a whole body contains a mental presence that regulates the interaction between the physical and the social realms. If one of these attributes is not present, the body ceases to be whole. When the body is not whole, it is fundamentally inhuman and incapable of active agency. This severely alters the way that the body is able to interact with the world. A fetus is representative of this bodily state, for the mental element fails to exist in a functional manner. For a fetus, the psychological element of the total body is incomplete to the point that it is not able to exercise autonomous control over any other factor.
The idea of the body as a complex construct mediated by cognitive actors is further defined by the anthropologist Terence Turner, who is well noted for his description of the surface of the physical body as the “social skin”. Turner suggests that the body is “treated not only as the boundary of the individual as a biological and psychological entity but as the frontier of the social self as well” (Turner 2007:83). This idea is important because it suggests that cultural expression allows the body to be coherent to society, for it to be indicative of a greater meaning or affiliation. As it is the mind that exercises agency and autonomy over bodily decoration, it is the mind that mediates between the physical and cultural factors. Thus the body becomes “the frontier” of a mental and cultural compromise, an “interface between self and society” (Turner 2007:85). As it is the mind that restricts social access to the body, when the mind is not yet fully formed, as in the case of a fetus, the result is a body without the cognitive presence to limit the social element.
Should this cognitive factor not exist, the social influence is no longer restricted by the mind as a mediator and the physical body becomes a channel for social expression. In the absence of a mind, popular culture is then afforded free reign over the body. It is in this way that the unborn body becomes relevant in discussions concerning sonogram requirements for women considering abortion. That which exists before the body comes into being is the subject of a great deal of implied meaning. The body is in this case personified in a manner inconsistent with its capability, as there is the expectation of an a priori level of individual awareness from the hint of inception. The assignment of personal attributes occurs prior even to conception; with active agency being imparted unto the sperm and passive acceptance unto the egg.
This practice of personification continues onto the fetus via sonographic representation, and as Rayna Rapp explains in her essay Real Time Fetus: The Role Of The Sonogram In The Age Of Monitored Reproduction, it is a procedure that “increases the speed with which fetal development is recognized as a process independent of the mother’s imbedded consciousness” (Rapp 2007: 613). Once the fetus is recognized as an independent entity it becomes subject to the enculturation processes of the social factor, representing the aspirations of an entire community as opposed to the individual mother. It is interpreted as an individual, exhibiting personal traits and exercising choice beyond that of its host. The fetus is then construed as capable of being subjected to interpretation and representation independent of realistic constraints regarding agency and autonomy. Without the presence of a cognitive factor to limit access to the “social skin”, a developing infant is subject to the ascription of identity and cultural practices from the moment inception is recognized. In other words, the social factor dominates the physical body when the psychological factor is not present. It is also important to note that “the objects of scientific and medical scrutiny must be rendered; they are rarely perceived or manipulated in their natural state” (Rapp 2007:612). This means that there are multiple opportunities for perspective to influence empirical knowledge, artistic representation, and descriptive narration during this process.
Requiring this process of interpretation as part of a medically induced abortion is currently the target of legislation in the United States. According to the Guttmacher Institute website, as of August 1st, 2014, there are three states that are currently attempting to force every woman undergoing an abortion to first submit to the process of ultrasound imaging and endure the provider’s description of the embryo. As Matthew Schmidt and Lisa Jean Moore explain in Constructing A ‘Good Catch,’ Picking A Winner: The Development Of Technosemen and The Deconstruction Of The Monolithic Male, this is problematic because by “giving personality to biological objects. . . we naturalize socially, materially, and bodily experienced, but nonetheless constructed” inequalities and oppressive social structures (Schmidt & Moore 2007:557). This is problematic for numerous reasons, including that the interpretive method and subsequent description are the product of an individual perspective, and are thus incapable of being applied uniformly. This legislation is reflective of power structures that use the medicalization of pregnancy to subjugate women to a position of passive acceptance as opposed to active agency.
The implications of this are profound; it indicates that each body that we see in this context is but the product of an interpretive paradigm, inherently reflective of the moral and political framework prompting the inquiry. Terence S. Van Dijk explains that once an examination is made, the fetus is then “surgically, chemically, and artistically modified in accordance with prevailing aesthetic standards” in order to make it comprehendible to the viewer (Van Dijk 2007:653). This process is highly problematic, as it presents an a posteriori construct as an a priori reality in order to inform personal decisions and influence public sentiment. It presents a single perspective or interpretation as a single all-encompassing truth. The result of this manipulation of public opinion is effectively illustrated by legislation that attempts to judiciously impose an interpretation of life before birth for political means.
Legislation does not, however, dictate the interpretive paradigm that is to be used during the descriptive process, and so it facilitates full access to the unborn body as a conduit of unmitigated public discourse. Social influences, in the absence of a self-moderating mental presence, are thus able to e