Culture, Bodies and the Sociology of Health

Elizabeth Ettorre

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317155829
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

Culture, Bodies and the Sociology of Health explores the boundaries between bodies and society with special reference to uncovering the cultural components of health and the ways in which bodies are categorized according to a form of culturally embedded 'health orthodoxy'. Illustrating the importance of contextualizing the body as a cultural entity, this book demonstrates that the spaces and boundaries between healthy bodies are becoming more diverse than ever before. The volumes international team of scholars engage with a range of issues surrounding the cultural construction of the body as a site of health and illness. As such, it will be of interest not only to sociologists, especially sociologists of health, but also to scholars of media and communication studies as well as cultural theorists.

PART I
Bodies and Technoscience

Chapter 1
Transplantation, Organ Donation and (In)human Experience: Re-writing Boundaries through Embodied Perspectives on Kidney Failure

Ciara Kierans

New Medical Technologies: Biopolitical Arenas

Organ transplantation is one of the most potent symbols of what social scientists have come to term ‘the new medical technologies’; powerful tools, treatments and procedures that emerged as a result of rapid technological development, innovation and the shift to the paradigm supplied by the new genetics. They have, in turn, profound implications for human embodiment, social identity, forms of medical governance, the distribution of medical resources and our understandings of the borders of life itself (Casper 1994, Davis-Floyd 1994, Dumit 1997, Lock et al. 2000, Rabinow 1996, 2000). In all their various forms, medical technologies involve deeply embedded ways of organising and reorganising the parameters of health, healing and the human body. Integral to contemporary biomedicine, and part of the ‘taken-for-granted’ background against which it operates, medical technologies have been, for some time now, a critical resource for social scientists who wish to examine the complex ways in which the practices and productions of medical knowledge connect up with power relations, the human experience of health and illness and new possibilities for living and dying (Foucault 1998 [1976], Latour 1993, Rabinow 2000). This chapter elaborates on these themes, providing an introduction to work in this area with specific emphasis on the technologically mediated relationship between the reconfigured body-in-transplantation and the experiencing subject.

‘The Shock of the New’: Lessons from the Past

A few words of caution are needed before proceeding. The growth of social scientific studies of technology and medicine in recent years testifies to our contemporary preoccupation with the new. It is critical, however, that we do not fetishise technology as an exclusively contemporary problem. It is important to remember that current attempts to think systematically through the multiple ways in which technology impacts upon society owe a great deal to work that came before. Discussed at length by both Marx and Durkheim, and representing central themes at all stages in the development of sociology and anthropology, technologies have long been recognised as both determinants of social structures and as phenomena forged within the crucible of social relationships (Durkheim 1982 [1912], Marx 1968 [1852], Turner 2007). Within early work on this subject, a key role was given to the body-in-society, as the productive source of technological innovation (Marx and Engels (1940 [1846]). At the same time, the body was also increasingly cast as a key site at which power could be exercised, as bodies come to be increasingly invested, invaded and reconstructed by processes made possible by technological innovation and advancement – principally those associated with the rise of the modern factory system and the disciplinary forces it was able to harness (Foucault 1977).

When carried forward and applied to the new medical technologies (the focus here), these insights about the duality of technology, as both master and slave, product and cause, agent and effect of socio-cultural change, retain their validity. Indeed, it is precisely these ways of thinking about the social, cultural, economic, political and embodied implications of technological practice, which reflect what the philosopher Michel Foucault sought to capture through his studies of ‘biopolitics’ and the production of ‘bio-technico-power’ (Foucault 1998 [1976]). This modality of power centralises the ways in which the human body, individually and collectively, can be altered and augmented ‘making good the deficiencies and finitude of one’s natural endowment’ (Jackson 2005: 120). Tracing biopower thus helps us to see the complex network of connections between, on the one hand, developments in medical knowledge and innovations in medical practices and, on the other, the various social and cultural systems these developments emerge within but which also, once in place, part determine the shape those developments will go on to take and the points at which those processes will terminate.

Turning from theoretical questions to more substantive empirical ones, the main methodological lesson to be drawn is this: when setting out to understand practices like transplantation the researcher must move beyond restricted conceptions of either the medical setting or technical act alone, to take up positions where it becomes possible to see the role those practices play in much larger socio-medical processes. This is easier said than done. These larger processes are highly complex and their significance deeply contested. As a result, the new medical technologies have come to represent, at one and the same time, material promises of utopian futures as well as harbingers of coming human-generated catastrophes (Turner 2007). From bioengineering to nanotechnology, scientists, engineers and doctors conjure the prospect of ‘living forever’ through awe-inspiring advances in such diverse fields as therapeutic cloning, stem cells and ‘immortal’ cell-lines, ‘smart’ pharmaceuticals, and micro-medical disease detection processes that operate at the molecular level (Turner 2007, Williams 2003). Meanwhile, those working at the other end, on the development of reproductive technologies, tell us that we are progressively extending our ability to control the manner in which human life comes into the world by removing the residual uncertainties which surround our entrance on the stage through the gradual ‘taming’ of the ‘wilder’ aspects of conception, pregnancy and birth (Casper 1995, Davis-Floyd and Dumit 1998, Rapp 2000). As Marx prophesised, our biological ‘species being’, our ‘bios’, appears to be being brought under our direct control (Arendt 1969, Marx 1970 [1846]). At the same time, however, those self-same technologies have given rise to deep-seated anxieties about the hubris of knowledge, captured in speculation about unforeseen dangers: fears about iatrogenetic risk in nanomedicine exacerbated by uncertainties in the ways we evaluate the toxicity of nanoparticles (Renn and Roco 2006); about increased population survelliance as genetic screening becomes further embedded as a technology of government (Armstrong 1995, Kaufert 2000); over the bioprospecting of cell lines and the struggle between indigenous communities and multinational biogenetic companies over ‘rights’ to genetic ‘property’ (Lock 2007); over the commodification of the body parts used in organ transplantation (Scheper-Hughes and Wacquant 2002). All these fears and more besides combine to suggest that if the new medical technologies provide a map of the future, it is one in which monsters lie.

Utopian visions and dystopian anxieties notwithstanding, these technological advances, according to Paul Rabinow, stand to be a greater force for reshaping society and life itself than the revolution in physics, because of their far reaching consequences for identity, kinship and reproduction, what Rabinow has termed ‘biosociality’ (Rabinow 1996). The human genome project, to take one of the more remarkable examples, has forever altered our understandings of biology and nature, once viewed as immutable and fixed, but now fundamentally repositioned within the domains of society and culture, collapsing prior and held-to dichotomies of nature/nurture, science/culture, human/machine, individual/group and local/ global (Hellman 2007, Rheinberger 2000). Moreover, how we understand this ‘power’-full domain, has, according to Jackson, been somewhat too restrictive to medicine, obscuring the wider influences of venture capital, political and corporate imperatives. Michael Jackson suggests we have too often neglected how new medical technologies are embedded in the structures of global capitalism, ‘particularly, in the ways in which corporate and state interests in the north compete for control over this new form of power – in roughly the same way that the terms eugenics – the “old genetics” – once disguised insidious state programmes for the manipulation of individual fates and national destinies’ (Jackson 2005: 120). As a consequence, for Jackson, analysis of the new technologies must begin ‘not with an attempt to evaluate their ethical, economic and political implications for our future, but with a critique of the ways in which these technologies are already implicated in global patterns of inequality and injustice’ (Ibid, 120). These position-takings seem to call for clear-eyed evaluation on biomedicine, one neither rejectionist nor duped. However, the extent to which the social sciences might go about providing this is a matter for debate. What I want to do next is look at the main ways in which social scientists have gone about orienting to these problems. To do this, I want to propose three analytical starting points from which a range of social theorists have chosen to open up the problematics attached to technologies. They will form an analytical backdrop against which my later discussion on organ transplantation and ‘recipiency’ will be placed.

New Medical Technologies: Key Methodological and Analytical Constructions

Some key analytical positions have been drawn upon to help us make sense of this rather dispersed domain of inquiry incorporating many biomedical specialities, theoretical concerns and methodological standpoints. Representing alternative ways of addressing similar sets of problems, but beginning from different starting points and moving in different directions, they, in turn, help us to think about how transplant technologies have come to be written and understood within the social sciences. Just as importantly, they also highlight what has been neglected or rendered invisible through the production of debate. While not wishing to review an entire field of research, I want to draw attention to these three dominant modes of thinking about technologies as they relate to intersecting bodies of academic work. For the purpose of this chapter, they will be considered in terms of (1) assemblages, hybrids and cyborg constructions; (2) the social practices and procedural work of biomedicine and (3) anxieties, transgressions and boundary concerns.

Assemblages, Hybrids and Cyborg Constructions

A core construct is that of the cyborg. Cyborgs may be considered as sensitising concepts, theoretical and rhetorical devices that force us to look at the new social relationships produced through biotechnical and biorobotic practices, and the human body as neither entirely natural nor artificial. In her Primate Visions, Donna Haraway defines the cyborg as an entity in which,

… two kinds of boundary are simultaneously problematic: 1) that between animals (or other organisms) and humans, and 2) that between self-controlled, self-governing machines (automatons) and organisms, especially humans (models of autonomy). The cyborg is the figure born of the interface of automation and autonomy (Haraway 1989: 139).

Haraway draws on Marx, to show that cyborgs become a route to looking at ‘the new social means of technoscientific production’; new ways in which we organise our lives (Haraway 1989). This has involved an inevitable re-evaluation of our changing positions as subjects-in-the-world by focusing on the new forms of embodied experience that have become possible through social-technological relations. In health and medical arenas, cyborgs emerge as the result of a wide range of interventions from prostheses, sensory technologies and implantable devices alongside technologically aided ways of seeing, scanning, screening, testing, researching and so on (Casper 1995, Davis-Floyd 1994, Ihde 1990, 2007).

Among the many examples to chose from, Monica Casper’s work on reproductive technologies has been particularly instructive of what we get from using the cyborg concept. Through an examination of the ways in which pregnancy and the bodies of women are put to an increasing range of uses, and with consideration for both the ontological and epistemological construction of cyborgs, Casper questions why we should classify anyone or anything as a cyborg in the first place. While Haraway talked about the new social relations of techno-scientific production, she was not simply talking about the degree to which technology penetrates our everyday lives, she also meant that there are real social, political and economic outcomes to these processes, that necessitate us keeping power as central to our understanding of the cyborg. Casper’s work does just that, as she charts some of these outcomes in relation to the highly contested uterine space of a pregnant woman’s body (Casper 1995). In doing this, she draws on six ways in which cyborg theory can be used to critically examine current developments in medical practice and reproductive technologies and the ways in which pregnant women come to be redrawn into these hybrid ontologies. These include: (1) technologies of vision, such as ultrasound, which enable a foetus in utero to be seen by those outside; (2) technologies of diagnosis, such as amniocentesis, which transforms the foetus into clinical data, and re-configures when pregnancy might be considered to start or end; (3) technologies of life, through postmortem maternal ventilation, altering our understanding of motherhood from a natural embodied state; (4) technologies of death, for example abortion, and the ways in which foetal cyborgs acquire new uses for research and therapy; (5) technologies of pain, such as foetal wound healing mechanisms or cosmetic surgery, where foetal cyborgs are reconstructed through research on animals and in vitro simulations; (6) technologies of healing. Incorporated here are are numerous examples of standardised technological interventions in the course of prenatal care which lead to the construction of medical cyborgs, such as, the use of pharmacological agents, nutritional supplements for foetal development, foetal blood sampling and so on and the prospective inclusion of gene therapy, foetus-to-foetus transplantation and experimental foetal surgery. Casper argues that these technological practices have made possible the emergence of a plethora of foetal cyborgs and technomoms transforming them from natural, organic entities into a very different kind of site within medical practice. These technological complexes change what it is to be a mother and help us to recognise that mothers are not everywhere the same.

Turning to organ transplantation, in very similar ways cyborg concepts have been both key practical and conceptual devices for describing the associated embodied, social and political implications. These include the ways in which the boundaries of the body profoundly change through dialysis (Hables Gray 2001) the reconstitution of categories of life and death through technologies of harvesting from the brain dead (Agamben 1998, Hogle 1999, Lock 1996); the reconstruction of the relationship between self and other through cadaver and live organ donation (Sharp 2006); the ontological implications of hybridity for the experiences of organ recipients (Kierans 2005) and the ontological status of the donor body (Hogle 1995a).

That transplantation practices impact profoundly on the organic unity of the body have for some authors been seen as a threat to the embodied self, an end point in biomedical dehumanisation (Young 1997). For others, cyborg possibilities can be experienced as a means of embracing new conditions for living through extending the boundaries of embodiment. In her attempts to fully engage with hybrid forms, Donna Haraway conjures a vision of the future which suggests ‘… a cyborg world might be about lived social and bodily realities in which people are not afraid of their joint kinship with animals and machines, not afraid of permanently partial identities or contradictory stand points’ (Haraway 1991: 154). In contrast to the horrors, hybridisation can be considered part and parcel of the human existence and social life in societies and cultures, past and present.

We are all Creoles of sorts: hybrid, divided, polyphonic and parodic, a pastiche of our Selves. The contemporary body-self is fragmentary, often incoherent and inconsistent, precisely because it arises from contradictory and paradoxical experiences, social tensions and conflicts (Van Wolputte 2004: 263).

As I will go on to show these aspects of contradiction, partiality and disjuncture are useful for thinking about organ ‘recipiency’ and how renal patients, in particular, piece together new ways of living and experiencing their bodies. Hybrid lives not only reveal new ways of being alive and living, but profoundly alter the phenomenology of bodily experience and bodily processes. These are brought dramatically into relief through the technologies of dialysis and transplantation, where the body’s internal mechanisms are no longer concealed but visible, audible and tangible (Kierans 2001, 2005, Leder 1990).

Social Practices and the Procedural Work of Biomedicine

There has been a tendency to see new medical technologies as constellations of material objects. Social scientists have reacted to this by treating them as phenomena brought into being as the outcomes of particular cultural and institutional practices (Barnes and Bloor 1996, Knorr-Cetina and Mulkay 1983, Latour 1987, Rabinow 1996, 1999, Latour and Woolar 1986). These authors have been major contributors to a growing body of ethnographic work with a concern for how science and technology gets ‘done’, is put to work, within their local contexts and have been hugely influential in helping us to navigate the disjunctures between bodies of knowledge and knowledge construction and the differences between the reconstructed logics of scientific knowledge versus the logics-in-use of scientific practices (Kaplan 1968, Rabinow 1996, 1999). For sociologists of scientific knowledge, scientific communities – like any other community – are characterised by networks and forms of social interaction, and their work – like any other forms of work – couple the informal and accidental along with the formal and procedural.

Consequentially, biomedicine, technology and disease are in no way independent formations, privileged a priori as external to culture. Medicine and its objects are not objects-in-themselves, but, as Anne Marie Mol explains, objects-in-action, enactments, ways of doing things, part of the highly differentiated and mundane work of those who practice medicine (Mol 2002). It is through these everyday practices, that the objects of interest here, diseases, organs, body parts, pharmacological processes, technologies, interventions, organisational rules and bureaucracies, come into being, emerge or recede, becoming matters of concern and action for specific groups of people.

Transplantation technologies therefore emerge as part of a complex socio-technical apparatus, an assemblage composed of bureaucracies, bioethical legislation, power relations, different types of medical personnel, cultural constructions of death, dying and the body, specialist diagnostic methods, technical procedures...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• Notes on Contributors
• Introduction: Re-shaping Bodies in the Sociology of Health
• Part I Bodies and Technoscience
• Part II Bodies and Representations
• Part III Abject Bodies
• Index