chapter  28
7 Pages

Conclusion: The Varieties of My Body: Pain, Ethics and Illusio

ByArthur W. Frank

What happened, almost a quarter century ago, to generate research and writing sufficiently focused to now warrant a Handbook? And how has that initial impulse played out, in social scientific practice? These are my first questions in these closing observations. I then turn to a version of the great question that Max Weber (1958) asks in ‘Science as a Vocation,’ quoting Tolstoy: How should we live? Specifically, how can body studies help each of us to live as my body? Two quotations from the posthumously published writing of George Simmel (1858-1918) frame how

body studies started, at least for me, and how these studies have progressed. ‘It is astonishing’, Simmel wrote (Simmel, 2010: 169), ‘how little of the pain of humanity has passed over into its philosophy’. Simmel’s statement comes closest to expressing my motivation when I posted a letter – email still being exotic – to Mike Featherstone, then as now editor of Theory, Culture & Society, asking if he would commission a review essay on books that I perceived as being collectable under the rubric of sociology of the body (Frank, 1990a, 1990b). I believe many colleagues embark upon body studies in order to bring more of the pain of humanity into social science. When social science minimizes bodies, passing by them too quickly, pain is minimized. Focusing my research on the body seemed necessary, both as a moral imperative for social science and as

a means of personal survival, when I was emerging from three years living with critical illness (Frank, 1991). As I encountered my own illnesses and the deaths of people close to me, I was struck by how little useful guidance I found in the medical sociology in which I had been trained during the 1970s. During my illness years, my body called attention to itself as the mediator of my lived experience. My everyday life consisted of enduring my body, caring for it, monitoring it, making it available to medical intervention, and taking pleasure in its small triumphs and eventual recovery to health, a no longer taken-for-granted category of being. In contrast to this experience, academic sociology seemed to ignore the body. Bodies had always been present in social science, but they were generally relegated to the background.

To take an example from a foundational work of sociology, suicide, as an act, requires a profoundly intimate perpetration of violence upon one’s own body, and suicide as an official determination of cause of death requires an intimate examination of another’s body (see Lianna Hart and Stefan Timmermans, chapter 16 of this Handbook). But in Émile Durkheim’s Suicide (1997), although acts with and upon bodies must have happened, nothing is said about them.1 That rendering invisible of the body on which the structure of action depends reoccurs throughout the social sciences, probably least in anthropology. For sociologists in the 1970s and 1980s, bodies seemed like a discovery on which to develop a new,

transdisciplinary social science – encompassing insights from history, cultural studies, feminist and postcolonial studies, and sociological relevant philosophers like Michel Foucault and Gilles Deleuze. What then happened in the wake of the initial enthusiasm that culminated in the founding of the

journal Body & Society in 1995? At the most trivial level, perfunctory mention of the body has become expected as good academic form. Usage of the adjective embodied has certainly increased significantly during the last two decades. But this word too often functions like most citations: as pro forma gestures rather than significant engagements; more like pointing out a landmark from a moving vehicle than actually getting onto the ground and spending time recollecting what has happened and is happening that makes the place memorable. At the opposite end of the continuum, a (very) few studies have managed to convey, as close as prose

can get, actual experiences of embodiment. Loic Wacquant’s ethnography of his participation in amateur boxing, Body Soul (Wacquant, 2006), is worth singling out as a paramount example.2 Looking in the bathroom mirror the morning after I finished Wacquant’s book, which ends with him fighting in a Golden Gloves competition, I half expected to find bruises on my face. In this Handbook, only Ken Plummer’s ethnography of his liver disease and transplant surgery (Chapter 5) attempts this form of writing, although some of the authors have done degrees of such writing elsewhere. Victoria Pitts-Taylor’s writing about her own cosmetic surgery is discussed by Heather Laine Talley in Chapter 24. Between these extremes of perfunctory mention of bodies and intimate exploration that necessarily

pushes the limits of prose – especially academic prose – in order to convey what it is to experience using one’s body, or having it used, in some particular and generally extreme way, there are many studies that begin with bodies but then the focus of research and analysis shifts. Body studies are unfortunately prone to morphing into studies of something else. This morphing process is perfectly described in a second quotation from Simmel, although he was writing about immortality, which on his account has absolutely nothing to do with bodies. ‘In the thought of immortality, we always bump into something no longer properly thinkable’ (Simmel, 2010: 75). Here we reach the crux of the problem for anyone who attempts to study bodies and embodiment.

When social scientists try to think about bodies, we always bump into something no longer properly thinkable (see Richard Shusterman’s debate with Richard Rorty, Chapter 2). As much as sociologists decry ‘Cartesian’ dualisms – and Nick Crossley (Chapter 9) offers what may be the best-ever concise parsing of Descartes’s actual argument – few can deny there is a problem writing about embodiment in a way that avoids substituting something else as the stand-in for bodies. In my own work, try as I have to write about illness as embodiment, I end up talking about ill people’s stories about their bodies (Frank, 1995, 2004). Eventually I end up with stories themselves (Frank, 2010), albeit including reminders, which some readers may find to be perfunctory, that these stories are embodied. Not only storytelling, but stories themselves are embodied. The body is the medium and the mediator of

whether and how any story is told, and bodies respond to stories. But exactly how stories represent bodies takes us back to Simmel. In attempting to describe the body that is both telling the story and told in the story, we bump into something no longer properly thinkable. People tell stories so that the story can stand in for a body that, in itself, is inexpressible. In the rarest prose, the body does seem to speak, rendering the words transparent. One example among illness narratives is the late Reynolds Price’s (2003) evocation of pain caused by surgery on the tumor inside his spinal column, his disgust at bodily changes caused by the paraplegia that radiation incurred, and his eventual accommodation to his disabled body and gratitude for life as he finds it. In Price’s prose, his body remains describable and thus thinkable, but that is a rare achievement. Most social scientific studies, having bumped into bodies and found them neither thinkable nor

describable (each of those acts depending on the other), turn to what social scientists are good at analyzing: texts (written and conversational), images (both of bodies and on bodies), objects that are either accoutrements to the body or enable the body to be, institutional routines and rituals to which bodies are

subjected, ideological commitments (both as objects of analysis and as foundational to analysis), and the logic of bodily practices as opposed to the lived sense of engagement in those practices. At worst, the authors of such studies seem unaware that they have left behind the body that was their ostensible starting point. At best, the work proceeds from a clear recognition that bodies are what institutions, practices, and technologies make of them. Annemarie Mol’s The Body Multiple (Mol, 2002), another of the most extraordinary recent contributions

of body studies, is about a form of embodiment that people know as atherosclerosis, but her topic is how medical technologies and the institutions in which they are deployed enact – Mol’s preferred verb – atherosclerosis. Mol makes no attempt to depict the lived experience of people who are diagnosed with atherosclerosis. Her concern is how the institutional enactments of atherosclerosis – including clinical examination, forms of imaging, and eventually pathology reports – render embodiment knowable and actionable, those actions including amputation. Anticipating her argument in this Handbook’s Chapter 8, Mol refuses to layer the body into the cor-

poreal and the social, or equivalent terms. Instead she studies how different technologies are sufficiently coordinated through the work of translation, so that bodies become knowable as having atherosclerosis. Her solution to Simmel’s problem of bumping into something not properly thinkable is to understand the body as what must be continually enacted to be thinkable for institutional purposes. Non-human actors, including imaging machines and microscopes, are crucial participants in that enactment. Returning to my first quotation from Simmel – his observation of how little of the pain of humanity has

passed over into philosophy, which at present means body studies – Mol’s work demonstrates how body studies can respond to pain and suffering not only by researchers becoming witnesses – a position I advocated (Frank, 1995; Wacquant, 2006) – but also by producing ethnographic descriptions of the networks of multiple actors that both create bodily suffering and respond to that suffering. Life is too complex for clear lines to be drawn between creating suffering and responding to it; most wars obscure that fine line, as do many cancer treatments. Body studies can help humanity think through the complexity of pain as the immanent condition of bodies (I struggle to avoid the dreaded word natural) and pain as the result of conditions that could be otherwise. The task of ethnographic description is to render indisputable that otherwise is possible, even if no clear vision yet exists of how to achieve otherwise. What, then, has been and might be the contributions of body studies? I remain intractably committed to

believing that to inhabit a human body is to make an unending sequence of ethical decisions. To live as a body that requires, at minimum, food, water, and space, and that produces for itself and for others, necessarily engages all of us in a life-long flow of giving and taking, asserting and yielding. I live this flow as my body, and the first and possibly best contribution of body studies seems to me to be sorting out the claims that become embedded – taken for granted as doxa, ideology, or habit – in this dense possessive pronoun my. What claims does this pronoun justify, and what responsibilities does it entail? What are the different boundaries between my body and others, and what are the claims on both sides of these boundaries? ‘Mine, yours,’ writes Pascal (1995: 25). ‘“That is my place in the sun.” That is the origin and picture of universal usurpation.’ To live as a body is to usurp. Bodies impose upon other bodies as soon as we eat and breathe, but most

dramatically in war, when bodies kill each other. Yet bodies are also uniquely equipped to offer compassion and care to other bodies. The extremes of violent usurpation and the capacity to care are both exemplified by terrorist bombings and the Orthodox Jewish ZAKA teams that respond, described by Nurit Stadler in Chapter 15. Terrorism is one move in a complex pattern of usurpations. But whatever the claims and counter-claims to justifications, any immediate violence to bodies calls upon other bodies to respond. Members of ZAKA teams using their bodies to care for the remains of those killed in these attacks are extreme acts of care. That their doing so requires considerable modification of their religious doctrines of appropriate body use makes their ethics more radically compassionate. In forming ZAKA teams, one form of piety, as discussed by Bryan Turner in Chapter 4, yields to the ethical demands for a different form. The

ethics of embodiment begin with which calls to response any of us hears, and how much we are willing to change or give up as we offer a response. Here I turn to my second theme, the question of what body studies have offered in response to the

question of how we humans should live. If life is necessarily usurpation, we live by making claims for our bodies and accepting claims upon our bodies. The chapters in this Handbook can be read as unpacking those claims: how do I live with my ancestry, my race and gender, my health, aging, and, ultimately, my death? My body has an ancestry, which sometimes might claim me, but in Nikki Sullivan’s discussion of

genetic genealogy in Chapter 7, people claim their ancestry. Sullivan shows how ancestry must first be enacted as a form of knowledge, that work involving a network of multiple actors. This knowledge can be variously acted upon: either filed away as curious information or turned into the itinerary for a physical journey, requiring another network of actors, including those at the destination who must take seriously the determination that all parties are related. Sullivan draws me into a form of hermeneutic circle as I note that I feel minimal interest in my ancestry. The common-sense attitude responds to such disinterest by simply moving on. A social scientific response to disinterest is to ask what enables it, and what does it enable. What, for me, has already filled the need that motivates others to take the journeys of genealogical discovery (or they might claim, recovery) that Sullivan describes? If I disqualify others’ passionate need for ancestry and homeland, what do I usurp? But also, what do they, in acting upon their need, risk usurping, especially among those who suddenly find themselves claimed as some version of kin? To whatever degree my body has a race (Maxine Leeds Craig, Chapter 23) and is gendered (Mary

Evans, Chapter 1; Patricia Clough, Chapter 6; Travis S. K. Kong, Chapter 21; Jeff Hearn, Chapter 22), the racial and gender classifications I was subject to at birth have been immensely consequential for my subsequent life. As a white male, both aspects of my body are what linguists would call unmarked categories. The chapters on race and gender, like Sullivan’s on ancestry, remind me how much I have not had to be explicitly concerned with, as I have lived my life – my privilege of disinterest. Again, my disinterest risks becoming a form of usurpation, insofar as my capacity to regard my body’s race and gender as unproblematic makes it more difficult for others to express their problems of identities formed by their racialized and gendered situations (an issue especially apparent in Susan Bordo’s discussion of anorexia, Chapter 17). In contrast to my disinterests in these aspects of my body – which on some ethical and political reflec-

tions might be considered dys-interests, marking their dysfunctional consequences – I have, in my life, been made very aware of my body’s vulnerability to illness (Plummer, Chapter 5). Being ill increases my awareness that my access to diverse resources minimizes my chances of being ill (Kevin White, Chapter 19; Jenny Hockey and Allison James, Chapter 20) and improves my probability of recovery. But advantages never constitute complete protection. Illness imposes itself on my body, or at least so I experience it. Other chapters remind me that my body

need not be accepted as it is. Should I dislike the body that is (never entirely naturally) on offer, bodies are open to modification, as described by Talley, Chapter 24, and Paul Sweetman, Chapter 25. The possibilities of various modifications elicit immediate visceral reactions from me, ranging from potential interest to aversions so extreme that I question whether I and those who do such things are of the same species. These reactions obscure the complexity of the issues. My own earlier research on enhancement medicine has explored the very fine lines between interpreting body modifications as consumer culture operating through medical technology, or understanding them as appropriate therapeutic interventions that align with other medical treatments to reduce suffering (Frank, 2006). When is body modification a means of usurpation – money buying medical resources to support personal vanity – and when does it participate in the impulse that makes humans unique: exploring the variety of life’s aesthetic and sensory possibilities? Some of the most consequential modifications to bodies are not surgical. Religiously motivated practices

that include veiling (Tulasi Srinivas, Chapter 13; Sonja van Wichelen, Chapter 14) are also body modifications, as they affect the capacities of bodies to relate to other bodies and to experience the world. Anyone’s body is a product of multiple institutional memberships, and many memberships make demands

on bodies. Religious memberships often institutionalize especially dramatic bodily effects: surgical (e.g., circumcision), dress, diet, and sexual conduct being paramount. These body practices reflect the complex relation – also an issue in enhancement medicine and its body modifications – between what individuals choose for their bodies and what is prescribed with little effective choice. Controversies over facial covering – van Wichelen’s Chapter 14 and Turner in Chapter 4 – are ethically difficult because they crystallize questions of who chooses what practices of bodies that are always only partially anyone’s own, and which choices rightly accrue to communities. By this point, my, as in my body, seems more like a function of multiple networks than an entity pos-

sessing immanent integrity. Norbert Elias was very much alive and writing when body studies began, and Mike Atkinson’s exposition of his work (Chapter 3) underscores how my body feels its dispositions to be authentically its own, yet this feeling derives from my position within an historically contingent figuration. Elias seems to anticipate Mol’s argument (Chapter 8) that my body is one possible version among all the immanent possibilities of what it could be. In Mol’s example, I taste, therefore I am what I have become – which is a body with particular tastes supporting long supply networks. These networks not only sustain but require such tastes, and such tastes (sugar may be the most consequential historical example) render the practices of the network (the slave economy that sugar production required) self-evidently necessary. My taste is distributed; my body fragmented. Finally I reach the aspect of embodiment that, unlike race and gender, is most notably marked for me,

aging. I write this chapter several months after my 65th birthday. I have become old. I know that, because unlike other birthdays, this one was anticipated by multiple mailings from diverse government agencies, informing me that because of my age, my status with respect to their particular program was changing: I was eligible, or in one case no longer eligible, or I had to make a decision when to exercise my eligibility. Post-birthday, I try to remember to ask for seniors’ discounts. I anticipate retirement from my University position. These acts could usefully be considered as forms of governmentality, in Foucault’s sense (Turner, Chapter 4): they instruct me what kind of subject I am, and what expectations and actions are appropriate to being that subject. They entitle me, in most instances, but at the cost of requiring that I know myself within their classification scheme, inserting myself into their order of things. I do not become old at 65, but on that date I am reclassified, and at 65 I am aware that reclassification is only just beginning. Aging brings its own issues of usurpation. The emerging, or at least promised and well financed, tech-

nologies of hyperlongevity described by Alex Dumas, Chapter 27, and by Tiago Moreira and Paolo Palladino, Chapter 26, might – if they actually work – eventually support usurpations as violent as war. At what cost to whom do I continue to claim what Pascal called my place in the sun – to eat, drink, and breathe, especially as I contribute less to producing what Marx called the use value that my body continues to consume? To become ‘anti-aging,’ as Dumas describes that collection of beliefs and eventual practices, is to make claims for my body against other bodies. Anti-aging emerges as a dark twin of euthanasia; each form of usurpation mirroring the other. To paraphrase Foucault, neither is inherently bad, but both are dangerous. These issues require nuanced responses, because almost all bodies exist in some degree of interdependence with technologies. The ethical questions are not whether, but rather when and how much. Most bodies’ dependence on technologies (beginning, if not with your own first vaccination, then with

the vaccination of the person who did not become contagious and infect you), raises the fundamental dichotomy with which these chapters struggle: the relation between the body itself, in what we experience as its material-corporeal necessity, and the body as constructed by complexes that are glossed as social (Darin Weinberg, Chapter 10). Both aspects are obscure: in what sense is a body ever itself, and how can the flesh be constructed? Aging is more than the evident constructedness of envelopes from government agencies arriving in the post. Aging is still jogging but requiring more rest days between; it is wondering whether my body is telling me that maybe walking might be a better idea. But this common expression, ‘my body is telling me,’ can no longer pass without reflection. Readers of this Handbook will immediately ask what is this voice I hear as my body, and who is doing the hearing, if not the same body? The voice might feel like

it comes from my legs, but I need only consider what other people hear their bodies telling them (again, the anorexic bodies that Bordo describes in Chapter 17, or homecoming bodies in Sullivan’s Chapter 7) to realize that it’s not that simple. Messages from the body are never that direct. Where I notice aging most, however, is not in what my body can do, but rather in what it feels is worth

the effort to do. I have long considered Pierre Bourdieu’s (2000) concept of illusio to be his most useful insight for thinking about differences in how people end up living; specifically in what people feel they have chosen in their lives, what they feel has passed them by, and what they feel excluded from. Illusio, described most simply, is a person’s capacity to know what counts as capital in the field in which she or he is situated, to know what the rules of the game are by which capital can be acquired, and, most important, to be capable of taking seriously both the form of capital and rules for acquiring it. Aging affects illusio. Crossley’s exposition of Merleau-Ponty (Chapter 9), complemented by Turner’s summary of Heidegger

in chapter 4, lays out with exemplary clarity the philosophical position on which bodies studies depend. We humans know the world by virtue of being bodies that engage with the world, and we know our bodies by virtue of the world facilitating and resisting our engagements. We engage through our senses and our projects; we act upon the world and are acted upon by it. There is no boundary between my body and its world; each shapes the other and is shaped by the other. My body leaves its mark on the world, and I know my body by the marks the world leaves on it. How, then, do I know that I am aging?