Transcript Lecture seven slides

Introduction to Social Analysis
Week 7
Studying Bodies and Dying
http://www.floridaproject.org.uk/
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Danse Macabre
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History of ideas
• Cultural turn – meanings rather than systems
• Phenomenology – not ‘reality’ but perception of
‘reality’ that matters
• Social construction – cultural methods for
making sense of the world
• Ethnomethodology – reporting on observation
• Grounded theory – bottom up theories v grand
theories
• Illustrated by the development of the Sociology
of the Body.
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How to study bodies? What is a
body?
• 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.”
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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
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Consider body shape:
• Manipulation of body
shape through
surgery, exercise.
http://www.bodybuildingcompetition.com/bodcover.jpg
http://www.ifbb.com/halloffame/1999/CoryEverson2.jpg
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Consider body shape:
• Aesthetic
considerations,
fashionable or
desirable body
http://techcenter.davidson.k12.nc.us/spring5/goddess2/earthmom.jpg
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Consider body shape:
• Body mass, rise in
obesity, rise in eating
disorders (anorexia,
bulimia)
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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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Phenomenology: - reality of social
constructions
• 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.
• it is clearly not possible to have a
knowledge tradition which stands outside
of society. Thomas argues that “if men
define situations as real, they are real in
their consequences” (Thomas and
Thomas 1928:572).
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Phenomenology: - reality of social
constructions
• Understanding nature depends on cultural categories.
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 including
human bodies 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. These resources for understanding the world
are not independent of the social and natural
environment. If a phenomena is too novel to fit the
existing cultural schema, new concepts and language
are developed to cope with it. Science of course does
this routinely all the time.
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Gender as a social construction
• Garfinkel and Agnes
• The practices which
allocate people to
categories.
• Cues, indexicality.
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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.
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.
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• Similarly, despite the ubiquity
of nostrums about delaying
ageing from green tea to
exercise regimes, experience
tells us that everyone ages.
• But what are the limits to social
constructionism? Surely death
and the frailties of the fourth
age are not social
constructions?
• 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.
• 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.
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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.
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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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Age distribution of death
• 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.
• 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. C.f. Foucault
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• 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 eventually
will find the cure for death. For the
medical technician every death
represents a failure.
Cure for old age?
http://www.cryonics.org/images/Op
ening.jpg
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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? What kind of
death is worth dying?
• 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’…medicalisation of death precludes an
examination of the possibilities of other ways to die and to bring old
age to a close.
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Stratification in death practices
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 1988, Schneider
1993)”.
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‘beyond the help of science’.
• “the prolonged resuscitation of anyone – including irreversibly dead
people- in 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.
• 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’.
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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.
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Blurred categories, death practices
• “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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Conclusion
• 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.
• Social constructionist perspectives are relevant
to old age and death as modern society is busy
changing the fundamentals of the meaning and
definition of both conditions.
• Categories and practices useful concepts, give
insight into how people construct the meaning of
the situations they are in.
• Grounded theory a way to explore them
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