Transcript Introduction to Social Analysis Week 7

Introduction to Social Analysis
Week 7
Studying Bodies and Dying
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How to study bodies?
• In what sense and in what way is the body
a cultural construction or merely a
biological mechanism?
• How are society and culture are inscribed
on bodies - gendered and aged bodies?
• The limits of social constructionism -–
death and dying as cultural products.
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In what sense and in what way is the body a
cultural construction or merely a biological
mechanism?
• All societies embellish the body with clothes,
ornament and decoration – the way you look
conveys a message about who you are.
• Giddens suggests - “Our bodies are deeply
affected by our social experiences, as well as by
the norms and values of the groups to which we
belong.”
– Social change and the body
– Science and Technology
– Consumerism
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Consider body shape:
• Height, genetic and social component. The
average height in US /UK gone up
systematically for a century. Nutritional change
• Body mass, rise in obesity, rise in eating
disorders (anorexia, bulimia)
• Aesthetic considerations, fashionable or
desirable body
• Manipulation of body shape through surgery,
exercise.
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Body shape illustrations
http://www.bodybuildingcompetition.com/bodcover.jpg
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http://www.ifbb.com/halloffame/1999/CoryEverson2.
jpg
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http://techcenter.davidson.k12.nc.us/spring5/goddess2/earthm
om.jpg
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Anorexia, bulimia, obesity
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Reality of social constructions
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It is a false distinction to contrast social construction as merely the products
of a cultural imagination as opposed to scientific facts which represent the
truth about nature.
There are more fundamental epistemological issues at stake about how it is
possible to have knowledge of nature and it is clearly not possible to have a
knowledge tradition which stands outside of society. Thus social
constructions are ‘real’ in at least two senses.
There is one sense which is pithily put by Thomas that “if men define
situations as real, they are real in their consequences” (Thomas and
Thomas 1928:572).
There is also a further sense in which natural phenomena are social
constructions as they cannot be communicated, discussed and understood
without a social basis of ‘cultural’ concepts held in common. It may be that
the natural world cannot even be thought about without the social precursor
of language.
Cultural concepts and language with which knowledge is expressed are
produced in historical and continuous processes in which the social and the
natural environment are critical components. These resources for
understanding the world are not independent of the social and natural
environment. The social environment includes beliefs about reality, and the
natural environment regularly forces itself into our lives in unanticipated
ways. If an inexplicable or unforeseen natural event is manifest then, if it is
too novel to fit the existing cultural schema, new concepts and language are9
developed to cope with it. Science of course does this routinely all the time.
How society and culture are inscribed on
bodies - gendered and aged bodies?
• Reading:
• Fraser, M. and Greco, M. 2005 The Body:
A reader. London: Routledge. Introduction.
301.2 Fra
• An introduction to the field providing an
explanation of why it has become some
significant within Sociology and the
intellectual origins of the ideas.
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The limits of social constructionism -– death and
ageing as cultural products.
• social constructionist approaches to the study of old age reveals that
ageing not simply a matter of biological determinism, there are
important social processes independent of any physiological
changes as the body ages.
• But what are the limits to social constructionism? Surely death and
the frailties of the fourth age are not social constructions?
• Cross cultural anthropology of ageing enables us to see that
different cultures approach ageing and death in very different ways.
There are many myths and stories told, and rituals re-enacted
through which through notions of resurrection, transformation, reincarnation and others at some level defeat death. But every one
dies.
• Similarly, despite the ubiquity of nostrums about delaying ageing
from green tea to exercise regimes, experience tells us that
everyone ages.
• Is the natural world, and in particular the human body a procrustean
bed on which social constructionism must lie?
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Death contrasts with life. Who is alive and who is dead and
how do we know? This boundary is highly contested and
fraught with moral dilemmas.
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Lock M (1996) “Death in technological time: Locating the end of meaningful
life” Medical Anthropology Quarterly 10 (4): 575-600 DEC 1996
Lock conducted cross cultural studies on the changing medical definitions of
death looking at USA and Japan.
The medical definition of death has shifted in recent history – contemporary
medical protocols for establishing death tend to use a concept of brain
death. This in the US co-incides with the development of transplant
technology and the electro-encephalograph.
Lock argues that the Japanese social view of death did not accept this
definition – the first Japanese heart transplant surgeon was charged with
murder.
For us death has ceased to be a ‘natural’ event. If people die of something it
must be something that science can, at least potentially, understand and
control
There are a number of social constructionist accounts of death; classically
Glaser and Straus (1965), and Sudnow (1967) plus more recent studies of
death as practiced in hospital intensive care units (Timmermans, 1998
Seymour, 2000).
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Death and old age are conceptually
related
• Mortality comes with sexual reproduction, simple single
cell creatures simply divide. For ‘higher’ animals old age
takes its place in developmental cycles alongside
conception, birth and maturity. Thus of humans death is
the boundary marker for the cessation of old age and
important part of its meaning.
• The medical definition of death is clearly a social
construction and has been subject to cultural and
technical change. We can ask, who, within what frame of
reference, and for what purpose, is death being defined?
• Thus cultural variations in the precise time and mode in
which old age is concluded, can be studied and the
significance for old age drawn out.
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Social construction of old age
• In understanding the frameworks of meaning which make up
cultures it is important to study the transitions - the practices,
symbols and rituals - which mark inclusion in and removal from
social categories, including life stages.
• Just as in the modern West the transition out of childhood
associated with sexual maturity and legal and moral responsibility
marks childhood as a period of innocence [think of the symbols
associated with the ‘key of the door’ – coming of age rituals], so the
meaning attributed to death marks old age with distinctive
characteristics. There are various models of the life course, but they
all end in old age.
• Social constructionist approaches to old age have concentrated on
the transition to old age, and examined the markers and social
processes by which old age is distinguished from middle age.
Historical work has identified the ways in which the establishment of
retirement as an institution is linked with the idea of old age as a
post-work phase of life and set chronological markers at age 60 or
65.
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• Old age has always ended in death but death has not in
the past been the exclusive domain of the old.
Demographic changes have meant that old age has
become more and more associated with death.
• As people live their full span with more and more
certainty, and no longer live with death as an immediate
and imminent possibility in the way that our ancestors
did, old age and death become culturally linked in new
ways.
• We may still die by act of God [that is accident of some
kind] or at the hands of our fellow man or through
disease or illness before we are thought to be old but
this is increasingly unlikely.[ caveat about war / global
catastrophe cf risk society]
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Modern western societies organise their response to old
age around the concepts of science and medicine.
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The dominance of Western scientific medicine transforms old age from
natural event to a disease. Old age is no longer experienced from a
religious perspective - as a divinely ordained path through life. Successful
old age is not seen as it was in the 18th and 19th century as the outcome
come of a moral life but rather as the absence of disease.
Professional knowledge and expertise with to explain and control the status
of old age moved from pastor and priest to doctor and geriatrician. Old Age
became an object of scientific and rational knowledge controlled by experts.
It cannot be a subjective experience – you are not only old as you feel –
when there is a scientifically trained expert waiting to tell you basis of your
feelings, how false is your optimism, your probabilities of survival, and which
chemical will make it all better.
Step by step doctors and medical practitioners monopolised the treatment
of disease within that “scientific” knowledge frame and gave them unrivalled
social esteem and professional power - literally the power of life and death.
Old age then ceases to be a social position and status within society, it
becomes primarily a process of physical decline because that is what can
be scientifically studied and to which we believe science will find solutions.
In the modern world, embedded in the belief in progressive science is the
implication that it will provide the solution for death. Scientists claim to have
the techniques for increasing longevity, if not exactly now, at least the
potential for the future. Scientific medicine acts as if it should have and
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eventually will find the cure for death. For the medical technician every
death represents a failure.
Studies:
• Sudnow, David (1967) Passing On: The Social
Organization of Dying. London: Prentice-Hall
International.*
• US study of death in hospitals. Coined the term
social death. Demonstrated that people died
social before they were physical dead, and
similarly could be physically dead but socially
alive.
• Also demonstrated that the social stratification in
life also stratified death.
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Studies
• Timmermans, Stefan 1998 “Social Death as Self-fulfilling
Prophecy: David Sundow’s Passing On Revisited”. The
Sociological Quarterly 39(3) pp.453-472.
– An American study by Timmermans takes Sudnow's description
of how the presumed social value of patients affected the
performance of hospital staff in attempts to revive them.
• Seymour, Jane Elizabeth (2000) “Negotiating natural
death in intensive care”. Social Science & Medicine
21(8):1241-1252.
– Seymour (2000) explains how medical staff in intensive care
settings have to deal with the social expectations of scientific
infallibility.
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What kind of life is worth living
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Since that 1960s study health care has undergone dramatic changes and
Timmermans examines whether the social rationing described by Sudnow is
still prevalent. The study was based on observation of 112 resuscitative
efforts and interviews with forty-two health care workers. Timmermans’s
pessimistic conclusion is that the recent changes in the health care system
did not weaken but instead fostered social inequality in death and dying. He
argues, firstly that the cultural evaluation of old age adversely affects the
way older people get treated in a medical context and secondly that the
domination of medical knowledge limits the possibility of a ‘good death’.
With respect to the first issue, that of cultural evaluation of the old,
Timmermans links older people with the disabled and says: “Unfortunately, the attitudes of the emergency staff reflect and perpetuate
those of a society generally not equipped culturally or structurally to accept
the elderly or people with disabilities as people whose lives are valued and
valuable (Mulkay and Ernst 1991)... The staff has internalized beliefs about
the presumed low worth of elderly and disabled people to the extent that
more the 80 percent would rather be dead than live with a severe
neurological disability. As gatekeepers between life and death, they have
the opportunity to execute explicitly the pervasive but more subtle moral
code of the wider society. ...medical interventions such as genetic
counselling, euthanasia and resuscitative efforts represent the sites of
contention in the disability and elderly rights movements (Fine and Asch
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1988, Schneider 1993)”.
‘beyond the help of science’.
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In terms of the second point, Timmermans’s studies lead him to conclude
that the medicalisation of death creates a number of serious problems,
including precluding an examination of the possibilities of other ways to die
and to bring old age to a close. Aggressive attempts at resuscitation in
emergency departments and relationships with the patients’ relatives are
structured around a belief in the technical omnipotence of medicine. It is
necessary to follow procedures that are intrusive and unnecessary in order
to demonstrate officially that the patient was ‘beyond the help of science’.
“the prolonged resuscitation of anyone – including irreversibly dead peoplein our emergency systems perpetuates a far-reaching medicalization of the
dying process (Conrad 1992). Deceased people are presented more as “not
resuscitated” than as having died a sudden, natural death. The resuscitative
motions render death literally invisible (Star 1991); the patient and staff are
in the resuscitation room while relatives and friends wait in a counselling
room. The irony of the resuscitative set-up is that nobody seems to benefit
from continuing to resuscitate patients who are irreversibly dead. As some
staff members commented, the main benefit of the current configuration is
that it takes a little of the abruptness of sudden death away for relatives and
friends. I doubt, though, that the “front” of a resuscitative effort is the best
way to prepare people for sudden death.... Relatives and friends are
separated from the dying process and miss the opportunity to say goodbye
when it could really matter to them, that is when there is still a chance that
their loved one is listening”.
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Untimely death
• Research by Jane Seymour within a British context points to
significant similarities in the management of traumatic death. In
particular, comparison of the two studies show how the medical,
bureaucratic and legal frameworks in each country set contexts for
death practices. Seymour like Timmermans is able to make the link
between the practices in hospitals by which medical staff deal with
death and the cultural problems caused by the medicalisation of
death. The belief in the power of science to solve the specific
causes of death in particular patients is a reflection of the
dominance of medical institutions to define death and thus old age.
• “Intensive care reflects the modern preoccupation with the mastery
of disease and the eradication of ‘untimely death’. It is the place to
which clinicians may refer a patient when that individual stands at
the brink of death and is beyond the reach of conventional therapies.
Unravelling the nature of complex disease and predicting its
outcome is complicated by the lack of previous familiarity between
health care staff and the patient, by the unconscious state of the ill
person (Muller and Koenig 1988), and by the advanced technical
abilities of modern medicine to blur the boundaries between living
and dying”.
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• Social constructionist perspectives are
relevant to old age and death as modern
society are busy changing the
fundamentals of the meaning and
definition of both conditions.
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