WHY FEMINIST PHENOMENOLOGY AND MEDICINE?
LISA FOLKMARSON KÄLL AND KRISTIN ZEILER
Feminist Phenomenology and Medicine
brings together two strands in phenomenological research. First, a growing number of feminist, queer, and critical race scholars have shown that the philosophical tradition of phenomenology offers valuable resources for approaching issues concerning the lived experience of marginalization, invisibility, nonnormativity, and oppression. Particularly phenomenological accounts of embodiment, focusing on the lived experience of the body, have provided a useful starting point in examinations of how the singular body, that is, the body as unique and different from other bodies, with a particular sex, of a particular age, race, ethnicity, and ability can form and inform our embodied selves and influence our ways of interacting with others and the world (see Alcoff 1999; Weiss 1999; Fisher 2000; Diprose 2002; Heinämaa 2003; Young 2005; Ahmed 2006; 2007; Käll 2009a; 2010; Al-Saji 2010; Heinämaa and Rodemeyer 2010, Zeiler 2013a). This research points at the value of bringing together phenomenology and feminist theory: both unveil and scrutinize taken-for-granted and in this sense ‘hidden’ assumptions, beliefs and norms that we live by, that we strengthen
by repeated actions and that we also resist, challenge and question. Furthermore, and beyond a feminist application of phenomenology, feminist phenomenology provides ways of deepening the phenomenological framework by asking questions of how experiences of, for instance, sexuality, sexual difference, pregnancy, birth, race, ethnicity, etc. inform phenomenology as a philosophical project (Schües 1997; Alcoff 2000; Oksala 2004, 2006; Heinämaa 2012). Second, phenomenological studies have offered pertinent analysis of relevance for medical practice, such as analysis of experiences of illness, pain, and bodily alienation (e.g., Zaner 1981; Leder 1990, Toombs 2001; Svenaeus 2009, Carel 2008; Bullington 2009), offered analysis of clinical encounters (Toombs 1993, 2001), and the meaning of health (Svenaeus 2001), to mention but a few examples.
Whereas there is a growing area of feminist phenomenology dealing with concrete issues of embodiment and situatedness and whereas phenomenologists have made valuable contributions to the analysis of the nature of medicine, the meaning of illness and health as well as clinical practice, there have been comparably few analyses of such issues that combine insights from feminist phenomenology and phenomenology of medicine. This, however, is now gradually changing, a development to which the present volume aims to contribute.
Feminist Phenomenology and Medicine
demonstrates the value of bringing together research in the fields of feminist phenomenology and phenomenology of medicine in order to advance more comprehensive analyses of issues such as bodily self-experience, normality and deviance, self-alienation and objectification that are central to both fields. It indicates the relevance of feminist phenomenological perspectives to the field of medicine and health by highlighting difference, vulnerability, and volatility as central dimensions of human experience rather than deviations, and vitalizes the field of feminist phenomenology, as well as the field of phenomenology more generally, by bringing it into conversation with a range of different materials, such as empirical research, case studies, cultural representations, and personal narrative. It also takes into consideration and examines normative cultural practices and structures of meaning that situate different bodies in different ways and with different conditions, and seek to lay bare the constitutive conditions of experience. Finally, by taking seriously the embodiment and situatedness of subjective life and experience and by bringing different forms of embodied existence to description and analysis, Feminist Phenomenology and Medicine
seeks to develop and sharpen the methodological tools and conceptual framework of phenomenology.
Situated at the intersection of phenomenology of medicine and feminist phenomenology, this volume contributes to furthering phenomenological work in philosophy of medicine and brings out the large scope of the field of medicine including its strong impact on various areas of life that are perhaps not immediately considered medical areas such as sexuality, bodily appearance, and norms of beauty. The essays in the book draw from numerous fields, such as dentistry, midwifery, cosmetic surgery, and psychiatry, as well as other health sciences, and address topics such as cosmetic surgery and complicity, Body Integrity Identity Disorder (BIID), reassignment surgery for intersex children, experiences of heart transplants, and anorexia, to mention again but a few examples.
Phenomenology and Medicine
Phenomenological studies have offered descriptions and analyses of significant relevance for medical practice since its early days, as is evident with the work of Maurice Merleau-Ponty. Recent years have also seen a raise in the number of such studies and we discern mainly two tendencies. First, there is a growing phenomenological literature that analyzes the nature of medicine; the meaning and lived experience of illness, disability, and health; the distinction between immediate experience and scientific exploration; the nature of embodiment; and the interrelation between body, consciousness, and world in experiences of, for example, pain, illness, and disability. This literature sometimes focuses on first-person experience and seeks to lay bare the structures and meanings of such experience. It may also draw on or involve different forms of empirical research or clinical cases with the aim of theoretical elaboration and conceptual development (see for example Merleau-Ponty 1962; Finlay 2003; Bengtsson et al. 2004; Engelsrud 2005; Zeiler and Wickström 2009). This literature can be contrasted with another strand of literature that is phenomenological in the sense that it examines lived experiences of illness and disability from within the social sciences but without a philosophical analysis of these experiences as its primary aim.1
This first tendency can be exemplified with phenomenological analyses of embodiment and bodily self-awareness when falling ill and when experiencing pain, illness, and/or bodily alienation
(Buytendijk 1973; Zaner 1981, 1988; Leder 1990; Toombs 2001; Svenaeus 2001, 2009; Carel 2008; Bullington 2009) as well as with analyses of the shareability of pain (Käll 2013). It can also be exemplified with analyses of how to understand intersubjectivity, communication, and empathic understanding between health care professionals and the sick person and the different perspectives of health care professionals and patients (Toombs 1993, 2001; Svenaeus 2001). Furthermore, phenomenological work within this strand has contributed with insights of relevance for psychiatry and psychopathology (Sass and Parnas 2001; Fuchs 2002; Parnas 2003; Ratcliffe 2008, 2011; Parnas, Sass, Zahavi 2011; Sass, Parnas, Zahavi 2011; Stanghellini 2011), organ donation (Leder 1999; Perpich 2008; Slatman 2009; Shildrick 2008; Svenaeus 2012), dementia (Matthews 2006, Dekkers 2011, Zeiler 2013b), death (Weiss 2006; Heinämaa 2010), and questioned knowledge production in the development of genetic theory (Diprose 2005).
Feminist Phenomenology and Medicine contributes to this strand with, for example, Fredrik Svenaeus’ analysis of anorexia as an experience of the body uncanny, Abby Wilkerson’s investigation of bodily self-alienation in depression, Margrit Shildrick’s discussion of the intimations of an otherness within experienced by heart transplant recipients, and Kristin Zeiler and Lisa Guntram’s examination of bodily self-awareness in relation to young women’s stories of coming to know that they have no womb and no or a small vagina.
Second, there is a less strong but nevertheless persistently growing body of literature that elaborates phenomenological approaches to ethics and particularly medical ethics. Some such work investigates the phenomenology of specific moral experiences. They examine what it feels like to be in a situation that the subject experiences as ethically sensitive, problematic, or promising, and what being in this situation means to the subject. In the context of medicine, this can be exemplified with analyses of experiences of objectification, shame, or guilt in relation to cases of body dysmorphia and depression (Fuchs 2003). In this volume, Erik Malmqvist’s chapter targets such ethically sensitive situations in a discussion of complicity with unjust social norms and with a particular focus on cosmetic surgery.
Other studies within the field of phenomenological approaches to ethics start in an analysis of human being-in-the-world, which also includes being-with-others and moves from this level of analysis to
an examination of how we ought to live together without examining specific moral experiences. Such phenomenological work can examine how the other is encountered in the forming of the self, including different ways of encountering the other, some of which are seen as better than others (Diprose 2005).2
It may also distinguish ethics from ontology; emphasize human vulnerability, responsivity, and openness to the other as ethical modes of being; and examine what this means for sensitivity and ethical perception on behalf of health care professionals (Nortvedt 2008). In this volume, Lisa Folkmarson Käll for instance thematizes vulnerability and exposure in addressing the question of the possibility of ethical perception within an objectifying framework and highly controlled clinical research setting of medical science.
Still other studies within the field of phenomenological approaches to ethics critically interrogate dominant modes of being, thinking, feeling, and acting in particular cultural contexts. Within the context of medicine, such research examines how certain norms about bodies can become taken-for-granted and motivate what may be called “normalizing” surgery, that is, surgery that seeks to make bodies conform to prevailing norms (e.g., Shildrick 1999; Weiss 2009; Zeiler and Wickström 2009; Malmqvist and Zeiler 2010; Cadwallader 2010) or how the lived experience of a specific embodiment can affect the structures of imagination and interpretation that people use in moral perception and evaluation of specific cases, such as those of, for instance, “deaf designer babies” (Scully 2003). Feminist Phenomenology and Medicine includes discussion of various forms of surgical interventions that in different ways and with different impact contributes to producing “normal” bodies. Gail Weiss, for instance, discusses normalizing interventions in relation to rhetorics of enhancement and notions of naturalness, and Nikki Sullivan raises issues regarding the punitive consequences of resisting and rejecting surgical interventions of normalization in her analysis of how the first hand-transplant recipient was represented in the media.
This last kind of phenomenological ethical work also includes contributions to normative ethics, as when scholars elaborate lines of argumentation for therapeutic cloning (Svenaeus 2007) or engage with phenomenological work in an ethical analysis of the use of new reproductive technologies such as pre-implantation genetic diagnosis (Malmqvist 2008).
Feminist phenomenology may be said to have been a vital dimension within phenomenology already in its early formation with the work of Edith Stein and Simone de Beauvoir. In the 1930s, Stein brought the homogeneity and universality of intersubjective relations into question with her phenomenological descriptions of feminine and masculine types of consciousness (1996) and, in her 1949 classic The Second Sex, Beauvoir radically situated the embodied subject by bringing the question of woman’s being to phenomenological reflection (2010). Beauvoir’s commitment to raising the question of sexual difference as a philosophical question through the method of phenomenological inquiry is present throughout her work and has come to form the foundation for further developments of feminist phenomenology.
Much feminist phenomenology has focused on bringing specifically female experiences to careful description, using the conceptual tools and methodological framework of phenomenology to approach areas of experience left uncharted in the phenomenological tradition. Such experiences include, for example, those of pregnancy and giving birth (Bigwood 1991; Lundquist 2008); of menstruation, of having breasts and lactating, of self-alienation (Young 2005; Beauvoir 2010); of eating disorders (Bordo 1993); of embodying the risk of being subjected to sexual violence (Cahill 2001; Käll 2009b); and of bodily self-awareness in which one’s body stands forth as a thematic object, in a positive and nonalienating way (Young 2005). These phenomenological descriptions and analyses serve as a critical and corrective complement or expansion of the field of describable experiences. While not explicitly questioning or altering the phenomenological methods and concepts, this approach is of importance for drawing attention to a whole range of experience that philosophers have neglected to consider. Furthermore, feminist phenomenological descriptions of women’s experience play a crucial role in dismantling what passes as universal and essential to human experience as reflecting only a limited group and thereby enriching our understanding of the scope and structures of human experience (Oksala 2004, 16–17).
By demonstrating that neglected regions of experience do not all fall into categories of pathology but, rather, belong to the everyday lives of women (and in the case of pregnancy and giving birth, are conditions for the continuation of humanity), feminist
phenomenology also throws a critical light on the constitution of normality, both that of the human and that of woman and man. It furthermore brings out the complexities of experiences that deviate and are excluded from the realms of normality in the double sense of falling outside the boundaries not only of what is the accepted, although false, norm for the human but also of what is considered to be a normally sexed
human being. These circumstances are brought out in this volume in, for instance, Zeiler and Guntram’s contribution, in which the authors discuss norms about female embodiment in the light of young women’s experiences of atypical sexual development, and in Ellen Feder’s analysis of experiences of such double exclusion in her examination of the standards of care of surgical intervention in cases of children born with ambiguous genitalia. In a different way, Cressida Heyes’ discussion of cosmetic surgery devotee Lolo Ferrari also demonstrates this double exclusion in the constitution of normalcy.
Using the method of phenomenological description to complement and enrich the field of describable experience furthermore adds an important perspective in discussions on experiential analysis more generally that has been at the core of the development of much feminist theory (Fisher 2000; Alcoff 2000). As much as the conceptual tools and methodological framework of phenomenology have proved resourceful for feminist purposes, however, they have also been put under critical scrutiny by feminist phenomenologists who, instead of dismissing phenomenology altogether, have pointed to its limitations and contributed to its development. Integrating phenomenological and feminist frameworks for analysis more fully, feminist phenomenologists have brought to the fore how proper investigations into the phenomena of, for instance, sexual difference, pregnancy, and birth radically alter phenomenological analysis of the emergence of conscious experience and the birth of the human being (Oksala 2004; Schües 1997). In this regard, already Iris Marion Young (2005) argues that the experience of pregnancy makes manifest a fracturing of the integrity of the embodied subject and questions the unity of the phenomenological subject as a condition of possibility for experience (see Heinämaa 2012).
Indeed, feminist voices have been key in inquiring into the possibilities of accounting for difference and otherness within the framework of phenomenology as a philosophy of the subject or consciousness. Feminist phenomenologists have been careful to stress and
investigate different forms of interrelations between self and other as constitutive of subjectivity and experience. Feminist Phenomenology and Medicine
testifies to the concern with the role of concrete as well as general others in the constitution and understanding of the self. For instance, Jenny Sla...