Regulating Bodies

Essays in Medical Sociology

Professor Bryan S Turner, Bryan S. Turner

• Publisher: Routledge
• Year: 2002
• Topic: Social Sciences
• eBook ISBN:
  9781134914029
• Subtopic: Medical Theory, Practice & Reference
• Index: Social Sciences

Bryan Turner is generally acknowledged to have been the key figure in opening up the sociological debate about the body. In this coruscating and fascinating book he shows how his thinking on the subject has developed and why sociologists must take the body seriously.

Part I

Discovering bodies

Chapter 1

The body question

Recent developments in social theory

AN INTRODUCTION TO THE SOCIOLOGY OF THE BODY

In the past decade, both the social sciences and the humanities have turned increasingly to an exploration of the problem of the body in social life in order to understand the complexity of our particular historical conjuncture. In this respect, the work of Michel Foucault and the revival of interest in Nietzsche have been important intellectual developments. Although there are many novel elements to this debate, the issue of the body in human societies has in fact been a persistent theme of Christian culture in the West. The apparently simple questions (What is the body? What is embodiment?) have persistently and perennially dominated academic and public discussion for reasons which are considered in this introductory comment, and throughout this volume. My principal aim here is to offer an introduction to this debate about the body, and to suggest various reasons why this topic is of crucial importance as a focus of research in the social sciences, but in more specific terms I want to suggest that a sociology of the body is an essential underpinning for the sociology of religion and medical sociology. These sub-fields engage with issues, namely theodicy and human suffering, in which the frailty of the human subject as a consequence of embodiment is an unavoidable issue. In fact, frailty is probably the most promising theme for a minimal theory of ontology from a sociological perspective.

Before getting into this debate, it is necessary to consider the absence of the body from traditional sociology, and to criticize many of the existing assumptions about the relationship between mind and body, which have dominated both the medical and the social sciences since at least the seventeenth century. For some philosophers, this subordination of the body under an ethic of world mastery, of which science and technology are major components, is one of the defining characteristics of Western civilization as such, and as a result this problematic status of the body/nature is part of the post-Socratic world of rationalism. This problem of embodied being in relation to technology and rationality can be regarded as the problem of Western philosophy (Heidegger 1989). It was on this basis that Nietzsche in The Will to Power rejected the ‘soul-hypothesis’ and proposed to start (philosophy) again from the premise of the body (Stauth and Turner 1988). This study of the body in the realms of medicine, politics and religion is consequently based on the assumption that the traditional mind/body dichotomy and the neglect of human embodiment are major theoretical and practical problems in the social sciences.

The social sciences have in general accepted the Cartesian legacy in which there is sharp division between the body and mind. Cartesian dualism is based on the principal assumption that there is no interaction, or at least no significant interaction, between mind and body, and therefore that these two realms or topics can be addressed by separate and distinctive disciplines. The body became the subject of the natural sciences including medicine, whereas the mind or Geist was the topic of the humanities, or the cultural sciences (Geisteswissenschaften). This separation was consequently an important feature of the very foundation of the social sciences, especially in the debate about the relevance of (natural) science methodology for the interpretative sciences of ‘Man’. This problem exercised Max Weber more or less continuously in the development of his epistemology in the debate about an appropriate Wissenschaftslehre (Weber 1949).

It was this dualism in the Western conceptualization of science which eventually legitimized various forms of reductionism in which mental events, the life of the spirit and culture are explained by, or in terms of, material causes. It is also common to hear in everyday language and in health discourse that ‘something’ (anorexia, repetitive strain injury, miner's lung or agoraphobia) does not ‘exist’ because it is ‘only in the mind’. The concept of ‘psychosomatic illness’ does not help in these circumstances, because in common parlance it still means ‘only in the mind’; the expression still preserves a mind (psycho)/body (somatic) duality. Thus, the Cartesian division in the medical sciences allowed medicine to treat the problems of the body with minimal reference to social or psychological causes, especially after the curriculum reforms that followed the Flexner Report in 1910. This duality also provided the legitimation for regarding the apparent success of alternative medical world-views such as acupuncture or homoeopathy as a consequence merely of the placebo effect. As a result, allopathic medicine has in general shown little interest in what philosophers refer to as ‘the lived body’ as opposed to the objective body (Leder 1990).

Although Cartesianism had these characteristics (dualism, reductionism and positivism), it is perhaps ironic that contemporary interpretations of the philosophy of Descartes, especially The Discourse on Method, have claimed that Descartes's own position was characterized as ‘dualistic interactionism’ (Wilson 1978). It is clear from a close reading of The Discourse on Method that Descartes believed that there was in fact a close interaction between the body and the mind, and disease was the consequence of a disturbance in this interaction; the role of medicine was to resolve the problems in this interdependency (T. Brown 1985). However, Descartes's ‘dualistic interactionism’ eventually evolved in the natural sciences into a unitary and positivistic view of materialism in which the disciplines which attempt to develop explanations of events in nature and society, body and mind, environment and culture were both isolated and specialized.

Despite Descartes's own version of interactionism, the consequences of the Cartesian legacy have been very significant for both the natural and the social sciences. In this introduction I shall focus mainly on sociology, where the notion of the social actor and social action have been primarily and classically developed within this dualistic Cartesian framework. By treating the body as part of the environment of action, sociology was developed as an interpretative science of the meaning of action in the methodology of Weber; sociology was a discipline within the Geisteswissenschaften whose aim was the cultural understanding of the shared meaning of action.

The importance of the success of economics as a science of rational (economizing) action in shaping the early development of sociology, especially in the work of Weber and Pareto, has often been neglected in the history of the discipline. This critical interaction between sociology and economics was particularly formative in the work of Talcott Parsons (Holton and Turner 1986). Sociology was driven in part by attempts to understand the role of values and knowledge in economic choices. In its emphasis on voluntarism, choice and action (Parsons 1937), sociology placed a special importance on the idea of consciousness or knowledge-ability of the social actor (Giddens 1984). The principal defining characteristics of homo sociologus were, first, the importance of shared meanings to define a social situation and, second, the presence of knowledge and understanding whereby the social actor has an awareness of means and ends. The knowledgeable actor is one who selects between different goals in terms of values and appropriate means in terms of norms. This combination of dimensions was developed classically by Parsons as a critique of economics (Robertson and Turner 1989). Anthony Giddens's ‘structuration theory’ (Giddens 1984) is in many respects very different from Parsons's ‘voluntaristic theory of action’, because, where Parsons was concerned to understand how values are shared (by the processes of internalization and socialization), Giddens has been concerned to understand human action in terms of its reflexivity. Human action is primarily self-monitoring action; human beings cannot avoid the constant confrontation of choice. Consequently, neither Parsons nor Giddens has shown much concern for the embodiment of the human actor. In Parsons's sociology of action, the body is part of the environment of action in his analysis of the unit act and the social system; in structuration theory, Giddens, following the theories of the geographer T. Hagerstrand, treats the body as an aspect of the time-space constraints on human action (Urry 1991).

As a consequence of this interest in the rational and non-rational nature of social action, sociological theory has effectively neglected the importance of the human body in undersanding social action, and social interaction. The nature of human embodiment has, with some important exceptions, not been important in either social research or social theory. As a consequence, the body has been curiously missing or absent from sociological thought (Turner 1991a). Until recently, this absence was true of such sub-disciplines as the sociology of health and illness, where one might imagine in common-sense terms that a discussion of health without any presuppositions about the body would have been impossible (Turner 1987). One might also imagine that in the sociology of religion, where the question of theodicy in relation to issues concerning death, disease and sexuality is an analysis of the body as ‘flesh’, the centrality of the body would have been a topic of major concern, but this has not been the case (Turner 1983). Within the last decade, there has fortunately been evidence of a major interest in the sociology of the body (Deleuze 1983; Feher 1989; Frank 1991; O'Neill 1985; Suleiman 1986; Turner 1991b; Zola 1991), and I hope to reflect upon this growth of interest in this particular volume.

The absence of the body from social theory is not an unimportant or insignificant lacuna. The absent body implies and poses major problems for the formulation of a sociological perspective on the human agent, agency and human embodiment. If we adopt the idea of sociology as a scientific study of action, then we require a social theory of the body, because human agency and human interaction involve far more than mere knowledgeability, intentionality and consciousness. Of course, this statement raises various questions in sociology as to what is to count as an ‘agent’. We need to avoid the conventional conflation of the ‘people’ with the ‘parts’ by being more clear about the difference between social system analysis and social analysis (Archer 1988). If collective action refers to social entities such as class and state, then it might be argued that the question of the body would be relevant. However, if one is concerned with human beings at the social rather than the system level, then it is difficult to comprehend how sociology could avoid the development of a sociology of the body. As a result, in this chapter I am taking seriously Weber's claim (1978) that sociology is the interpretive understanding of social action, and that this social action is undertaken by embodied social beings. I also want to take seriously the problem of the gesture in G.H. Mead's attempt to formulate an understanding of the situated and interactive character of the ‘I’ and the ‘me’. For example, Mead's discussion of the importance of the hand in gesture in relation to the central nervous system and the origins of creative thinking is typically neglected in subsequent accounts of the origins of a symbolic interactionist analysis of the self. Indeed, the hand has been regarded by philosophers like Heidegger as a crucial defining characteristic of human beings, as an agent that shapes the environment as a consequence of ‘handwork’ (Heidegger 1982:116–18).

As a consequence of their embodiment, all human agents are subject to certain common processes which, although they have biological, physiological and organic foundations, are necessarily social in character. These common social processes are related to the conception, gestation, birth, development, death and disintegration of the human body. Because many social practices and rituals are ultimately based upon these obvious, everyday events (such as marriage, burial and rituals of grief), it is peculiar that sociology has, in very general terms, neglected these practices as features of human embodiment. Social anthropology is probably an important exception to this rule (Turner 1991b). By concentrating on the meaningful character of social action from the standpoint of the social agent, sociology and the social sciences generally have avoided this corporeal side of human action, despite the fact that questions of meaning, such as Weber's theodicy problem (Turner 1981), are invariably associated with embodiment, that is associated with suffering, joy, death, pain and so forth.

This corporeal aspect of human agency is not in some sense beyond, alongside or outside the social. By suggesting that sociology has neglected the human body, one does not necessarily endorse any arguments in favour of biologism. The point is to avoid nineteenth-century positivism by embracing biological reductionism and to avoid idealism disguised as a theory of social constructionism. For the sociologist, the social must remain primary. Thus, in emphasizing the importance of the phenomenology of the body, it does not follow that sociology should in some way simply incorporate a biologically reductionist position. As a sociological enterprise, the sociology of the body will deal with the essentially social nature of human embodiment, with the social production of the body, with the social representation and discourse of the body, with the social history of the body, and finally with the complex interaction among body, society and culture. For reasons developed by Marcel Mauss (1979), fundamental aspects of embodied activity, such as walking, standing or sitting, are social construction. These practical activities require an organic foundation, but the elaboration of these potentialities requires a cultural context. It was for this reason that Mauss talked about ‘body techniques’ which, while depending upon a common organic foundation, are nevertheless both personal and cultural developments.

Perhaps more importantly for the sociology of action, the very identity of social agents cannot be easily separated from their embodiment within the interactional situation. In everyday life, in interacting with other social agents, we have in principle to be able to recognize and distinguish between different social agents. At the level of everyday life, therefore, the ongoing identification of other social agents depends fundamentally on their embodiment. In Mead's analysis of social acts and the development of the self, a ‘conversation’ of gestures (internal and external) was important in his understanding of the constitution of the ‘I’. The face and the hand are both fundamental to such an exchange of gestures. For Mead, ‘Speech and the hand go along together in the development of the social human being’ (1934:237). However, it was Erving Goffman in The Presentation of Self in Everyday Life (1959) who showed how the representation of the disruption of order in everyday life can depend on our control over the representation of the body. The management of embarrassment can require considerable body control, if we are to avoid losing face. Incidentally, this notion of ‘face’ should serve to remind us how much of our social and moral language depends on the metaphors of the body: an upright person; a person of some standing; a faint-hearted soul; a person with a stiff upper lip.

Who I am rests crucially on having a specific body which I do not share with other social agents. The platitude (‘I can't be in two places at once!’) has major social importance. In social interaction, therefore, individuation and individuality depend upon a shared agreement about the relationship of the social actor to his or her body. Having a specific body is very important when it comes to questions of impersonation, kidnapping, paternity, legal identity, and nationality; it is for this reason that who a person is may come to depend in the last analysis on a procedure such as genetic finger-printing. In a future society where the transplantation of organs is a routine and widespread surgical procedure, the hypothetical puzzles in classical philosophy about identities and parts will be issues of major legal and political importance. Can I be held responsible for the actions of a body which is substantially not my own body?

I have argued in general that sociology has neglected human embodiment, because it has implicitly accepted a Cartesian tradition, and because sociology has been fundamentally concerned with the social meaning of social action at the level of values and beliefs. The philosophical assumptions behind the mind/body split have been challenged by developments in philosophy which have yet to have a complete or full impact on sociology. I have tried to suggest why a proper appreciation of human embodiment is in fact an essential feature of the development of an adequate sociology of action and interaction. For example, it is difficult to talk about identity without talking about a specific body. We can individuate persons with some certainty only through fingerprints, photographs and genetics. Although memory and social records are important, to be a specific person also requires a specific body. Although this is a general problem in sociology, I believe that the absence of a coherent sociological understanding of embodiment has crucial implications for medical sociology (Turner 1987) and for a variety of other sociological fields, such as the study of human emotions, sexuality, sport, passion and ageing (Featherstone et al. 1991). It is in these areas (health, sport, leisure, sexuality and consumerism), where the interaction between embodiment, society and culture is a crucial feature of social practice, that we desperately need an elaborat...

Table of contents

• Front Cover
• Regulating bodies
• Title Page
• Copyright
• Contents
• Dedication
• Acknowledgements
• Author's preface: towards the somatic society
• Introduction
• Part I Discovering bodies
• Part II Medical sociology
• Part III Regimes of regulation
• Conclusion. Theory and epistemology of the body: an interview with Richard Fardon
• Appendix: Bryan S. Turner's publications on the sociology of the body and medical sociology
• Name index
• Subject index