Health and the Embodiment of the Life Course
While bio-medical knowledge and practice are seen as synonymous with ‘the body’, it is medical sociology and anthropology that have provided insight into the body as a social phenomenon. Here the body has become key to understandings of health and illness as social, rather than simply medical, matters. It has, for example, raised questions about deﬁnitions of ‘health’ that draw on related terms such as ‘well-being’ to highlight the historical and cultural speciﬁcity of something popularly seen as a universal feature of the ‘natural’ body (The Scottish Government, 2006; World Health Organisation, 1946). How the concept of ‘illness’ relates to terms such as ‘sickness’ and ‘disease’ has also been explored (Helman, 1990; Lupton, 1994). This focus on the body is, however, fairly recent. In 1993, Shilling (1993) observed that the body had been an absence presence within medical sociology, something assumed rather than interrogated. He called for the return of the body to the social constructionist project, a call this chapter responds to by treating health as an embodied, life course process. Here, we integrate established ways of thinking about and so experiencing and treating our bodies with a consideration of what the body itself might be about, and how notions of the body might change across the life course (James and Hockey, 2007: 21-39). With this in mind, we show that health, illness and ageing across the life course have become insepar-
able. Indeed, medical science has profoundly shaped contemporary understandings of what childhood, mid and later life are, and should be. As Armstrong (1981, 1983) details, in western societies paediatrics developed in the early twentieth century, after an absence of medical or social policy interest in infant health until the late nineteenth century. Following the Second World War, a similar specialism – geriatrics – grew up around later life, and as Armstrong (1981) argues, each, in their own way, produced particular conceptualizations of the young and old body as it changed. However, both disciplines also constituted forms of medical pathologization in that both childhood and later life were treated as periods of vulnerability to disease and death, reﬂected in the relatively rapid processes of bodily change that occur in young and old bodies. None the less, ageing across the life course, as we go on to show, is experienced in relation to medically
normalized trajectories in which corporeal and social experiences intersect (James and Hockey, 2007). Thus, after mid-life, the bodily changes that ageing brings risk dispossessing individuals of their personhood – as they are discriminated against in job interviews or ignored in the media, advertising and the crowd pushing for service at the bar (Bytheway, 1995). This corporeal change acquires negative implications and, as a result, mirrors may be avoided and white lies told. Such embodied experiences contrast
markedly with earlier experiences of ageing, when a child’s growth and normal pattern of bodily development is proudly marked on a wall chart. Moreover, in attracting such negative sets of values, the older body begins to merge with the sick body so that people who are chronologically ‘older’ may not perceive themselves as ‘elderly’ until a particular bodily change becomes categorized as an illness (Conway and Hockey, 1998). However, in other societies, structural conditions can contribute to a very diﬀerent experience of embodied ageing across the life course (Hockey and James, 2003: 134). Poverty, disease, famine and natural disasters all impinge upon the body, leading to shorter life expectancy and higher child mortality rates in less-developed economies (Phillips and Verhasselt, 1994; Scheper-Hughes, 1992). Empirical information such as this provides a starting point for thinking about health and embodiment
across the life course. But, as this chapter argues, in order to understand what happens to the body as it ages, the ways in which its health status changes and how this process is made sense of, we also need to examine experiences of embodiment. This means asking how we identify and respond to what is happening in our bodies on an everyday basis: the lassitude, aching and sweating we treat as ﬂu, the loss of sensation in our hands or feet that we may ‘diagnose’ as ﬂeeting, compression-induced pins and needles, repetitive strain injury, or the onset of stroke or multiple sclerosis. These embodied experiences contrast with the discomfort of stomach contractions when we are hungry, the loss of control of our mouths and eye-lids as we yawn and droop into sleep. Hunger and fatigue may be powerful sensations, yet we seek to diﬀerentiate them, often through subtle cues, from those that we categorize as ‘illness’. And that we can make such diﬀerentiations underscores the necessity of exploring and understanding the process of embodiment and the extended corporeal changes we call ageing. While our bodies can jolt us awake in the night, as hitherto ‘silent’ limbs or organs spasm into cramp or heartburn, it is much harder to feel or observe our ﬂesh losing its elasticity or our hair greying. How, then, do we ‘know’ we are ageing in an embodied sense? As this chapter shows, diﬀerent experiences of the body intersect within everyday and life course temporalities to reﬂect, not only the classiﬁcatory frameworks of medical science, but how these mesh with a range of cultural and social institutions.