The-Mindful-Body

The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology
Author(s): Nancy Scheper-Hughes and Margaret M. Lock
Source: Medical Anthropology Quarterly, New Series, Vol. 1, No. 1 (Mar., 1987), pp. 6-41
Published by: Wiley on behalf of the American Anthropological Association
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ARTICLES
NANCY SCHEPER-HUGHES
Department of Anthropology, University of California, Berkeley
MARGARETM. LOCK
Department of Humanities and Social Studies in Medicine, McGill University
The Mindful Body: A Prolegomenon to Future
Work in Medical Anthropology
Conceptions of the body are central not only to substantive work in medical anthropology, but also to the philosophical underpinnings of the entire discipline of anthropology, where Western assumptions about the
mind and body, the individual and society, affect both theoretical viewpoints and research paradigms. These same conceptions also influence
ways in which health care is planned and delivered in Western societies.
In this article we advocate the deconstruction of received concepts about
the body and begin this process by examining three perspectives from
which the body may be viewed: (I) as a phenomenally experienced individual body-self; (2) as a social body, a natural symbol for thinking
about relationships among nature, society, and culture; and (3) as a
body politic, an artifact of social and political control. After discussing
ways in which anthropologists, other social scientists, and people from
various cultures have conceptualized the body, we propose the study of
emotions as an area of inquiry that holds promise for providing a new
approach to the subject.
The body is the firstand most naturaltool of man-Marcel Mauss (1979[ 1950])
espite its title this article does not pretend to offer a comprehensive review
of the anthropologyof the body, which has its antecedentsin physical,
psychological, and symbolic anthropology, as well as in ethnoscience,
phenomenology, and semiotics.' Rather, it should be seen as an attempt to integrate aspects of anthropological discourse on the body into current work in medical anthropology. We refer to this as a prolegomenon because we believe that
insofar as medical anthropology has failed to problematize the body, it is destined
to fall prey to the biological fallacy and related assumptions that are paradigmatic
to biomedicine. Foremost among these assumptions is the much-noted Cartesian
dualism that separates mind from body, spirit from matter, and real (i.e., visible,
6
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THEMINDFULBODY
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palpable) from unreal. Since this epistemological tradition is a cultural and historical construction and not one that is universally shared, it is essential that we
begin our project in medical anthropology with a suspension of our usual belief
and cultural commitment to the mind/body, seen/unseen, natural/supernatural,
magical/rational, rational/irrational, and real/unreal oppositions and assumptions
that have characterized much of ethnomedical anthropology to date. We will begin from an assumption of the body as simultaneously a physical and symbolic
artifact, as both naturally and culturally produced, and as securely anchored in a
particular historical moment.
In the following pages we will critically examine and call into question various concepts that have been privileged in Western thinking for centuries and
which have determined the ways in which the body has been perceived in scientific biomedicine and in anthropology. This article is descriptive and diagnostic.
Its goal is both the definition of an important domain for anthropological inquiry
and an initial search for appropriate concepts and analytic tools.
We are writing for three audiences. First, we hope to introduce general anthropologists to the potential contributions of medical anthropology toward understanding an intellectual domain we all share-the body. Second, we want to
draw the attention of medical anthropologists to writings on the body not usually
recognized for their relevance to the field. And third, we wish to speak to clinicians and other health practitioners who daily minister to mindful bodies. The
resulting effort is necessarily partial and fragmentary, representing a somewhat
personal itinerary through paths of inquiry we believe to hold particular promise
for theory building and further research in anthropology generally, and in medical
anthropology particularly.
The Three Bodies
Essential to our task is a consideration of the relations among what we will
refer to here as the "three bodies."2 At the first and perhaps most self-evident
level is the individual body, understood in the phenomenological sense of the
lived experience of the body-self. We may reasonably assume that all people share
at least some intuitive sense of the embodied self as existing apart from other
individual bodies (Mauss 1985[1938]). However, the constituent parts of the
body-mind, matter, psyche, soul, self, etc.-and their relations to each other,
and the ways in which the body is received and experienced in health and sickness
are, of course, highly variable.
At the second level of analysis is the social body, referring to the representational uses of the body as a natural symbol with which to think about nature,
society, and culture, as Mary Douglas (1970) suggested. Here our discussion follows the well-trodden path of social, symbolic, and structuralist anthropologists
who have demonstrated the constant exchange of meanings between the "natural" and the social worlds. The body in health offers a model of organic wholeness; the body in sickness offers a model of social disharmony, conflict, and disintegration. Reciprocally, society in "sickness" and in "health" offers a model
for understanding the body.
At the third level of analysis is the body politic, referring to the regulation,
surveillance, and control of bodies (individual and collective) in reproduction and
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MEDICAL ANTHROPOLOGYQUARTERLY
sexuality, in work and in leisure, in sickness and other forms of deviance and
humandifference. There are many types of polity, rangingfrom the acephalous
anarchyof "simple" foraging societies, in which deviants may be punishedby
total social ostracism and consequently by death (see Briggs 1970; Turbull
1962), throughchieftainships,monarchies,oligarchies, democracies, and modem totalitarianstates. In all of these polities the stabilityof the body politic rests
on its abilityto regulatepopulations(the social body) and to discipline individual
bodies. A greatdeal has been writtenaboutthe regulationand controlof individual and social bodies in complex, industrializedsocieties. Foucault'swork is exemplaryin this regard(1973, 1975, 1979, 1980a). Less has been writtenabout
the ways in which preindustrialsocieties controltheirpopulationsand institutionalize means for producingdocile bodies and pliant minds in the service of some
definitionof collective stability, health, and social well-being.
The "threebodies" represent,then, not only threeseparateandoverlapping
units of analysis, but also three differenttheoreticalapproachesand epistemologjes: phenomenology(individualbody, the lived self), structuralismand symbolism (the social body), and poststructuralism(the body politic). Of these, the third
body is the most dynamicin suggesting why and how certainkinds of bodies are
socially produced.The following analysis will move back and forth between a
discussion of "the bodies" as a useful heuristicconcept for understandingcultures and societies, on the one hand, and for increasingour knowledge of the
culturalsourcesand meaningsof health and illness, on the other.
The Individual Body
How Real is Real? The Cartesian Legacy
A singularpremiseguidingWesternscience and clinical medicine (and one,
we hastento add, that is responsiblefor its awesome efficacy) is its commitment
to a fundamentaloppositionbetween spiritand matter,mind and body, and (underlyingthis) real and unreal. We are remindedof a grandrounds presentation
before a class of first-yearmedical studentsthat concernedthe case of a middleaged woman suffering from chronic and debilitatingheadaches. In halting sentences the patientexplainedbefore the class of two hundredthather husbandwas
an alcoholic who occasionally beat her, that she had been virtuallyhousebound
for the past five years looking afterher senile and incontinentmother-in-law,and
that she worries constantly about her teenage son who is flunking out of high
school. Althoughthe woman's storyelicited considerablesympathyfrom the students, many grew restless with the line of clinical questioning, and one finally
interruptedthe professor to demand "But what is the real cause of the headaches?"
The medical student, like many of her classmates, interpretedthe streamof
social informationas extraneousand irrelevantto the real biomedicaldiagnosis.
She wantedinformationon the neurochemicalchanges which she understoodas
constitutingthe true causal explanation.This kind of radicallymaterialistthinking, characteristicof clinical biomedicine, is the productof a Westernepistemology extendingas far back as Aristotle's starklybiological view of the humansoul
in De Anima. As a basis for clinical practice, it can be found in the Hippocratic
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THEMINDFULBODY
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corpus(ca. 400 B.C.). Hippocrates3and his studentswere determinedto erradicate the vestiges of magico-religiousthinkingaboutthe humanbody and to introduce a rationalbasis for clinical practicethat would challenge the power of the
ancient folk healers or "charlatans" and "magi," as Hippocrateslabeled his
medicalcompetitors.In a passagefrom his treatiseon epilepsy, ironicallyentitled
"On the Sacred Disease," Hippocrates(Adams 1939:355-356) cautioned the
Greek iatros (physician) to treat only what was observable and palpable to the
senses:
I do not believe that the so-called Sacred Disease is any more divine or sacred
than any other disease, but that on the contrary,just as other diseases have a
natureanda definitecause,so doesthisone,too, havea natureanda cause ....
It is my opinion that those who first called this disease sacred were the sort of
people thatwe now call 'magi'. These magiciansare vagabondsand charlatans,
pretendingto be holy and wise, and pretendingto more knowledge than they
have.
The natural/supernatural,
real/unrealdichotomyhas taken many forms over
the course of Westernhistory and civilization, but it was the philosopher-mathematicianRene Descartes(1596-1650) who most clearly formulatedthe ideas that
are the immediateprecursorsof contemporarybiomedicalconceptionsof the humanorganism.Descarteswas determinedto hold nothingas trueuntil he had establishedthe groundsof evidence for acceptingit as such. The single categoryto
be taken on faith, as it were, was the intuited perceptionof the body-self, expressedin Descartes's dictum:Cogito, ergo sum-I think, thereforeI am. From
this intuitiveconsciousness of his own being, Descartes proceededto argue the
existence of two classes of substancethat together constitutedthe human organism: palpablebody and intangiblemind. In his essay, "Passions of the Soul,"
Descartessought to reconcile materialbody and divine soul by locating the soul
in the pinealglandwhence it directedthe body's movementslike an invisiblerider
on a horse. In this way Descartes, a devoutCatholic, was able to preservethe soul
as the domainof theology, and to legitimatethe body as the domain of science.
The ratherartificialseparationof mindandbody, the so-called Cartesiandualism,
freedbiology to pursuethe kind of radicallymaterialistthinkingexpressedby the
medicalstudentabove, muchto the advantageof the naturalandclinical sciences.
However, it caused the mind (or soul) to recede to the backgroundof clinical
theoryand practicefor the next three hundredyears.
The Cartesianlegacy to clinical medicine and to the naturaland social sciences is a rathermechanisticconceptionof the body and its functions, and a failure to conceptualizea "mindful" causation of somatic states. It would take a
struggling psychoanalytic psychiatry and the gradual development of psychosomatic medicine in the early 20th century to begin the task of reuniting mind and
body in clinical theory and practice. Yet, even in psychoanalyticallyinformed
psychiatry and in psychosomatic medicine there is a tendency to categorize and
treat human afflictions as if they were either wholly organic or wholly psycholog-
ical in origin:"it" is in the body, or "it" is in the mind. In her astuteanalysis of
multidisciplinarycase conferenceson chronicpain patients,for example, Corbett
(1986) discoveredthe intractabilityof Cartesianthinkingamongsophisticatedclinicians. These physicians,psychiatrists,andclinical social workers"knew" that
pain was "real" whetheror not the source of it could be verified by diagnostic
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MEDICAL ANTHROPOLOGYQUARTERLY
tests. Nonetheless, they could not help but express evident relief when a "true"
(i.e., single, generallyorganic) cause could be discovered. Moreover, when diagnostic tests indicatedsome organic explanation,the psychological and social
aspects of the pain tended to be all but forgotten, and when severe psychopathology could be diagnosed, the organic complications and indices tended to be
ignored.Pain, it seems, was either physical or mental, biological or psycho-social-never both nor somethingnot-quite-either.
As both medicalanthropologistsand clinicians struggleto view humansand
the experienceof illness and sufferingfrom an integratedperspective,they often
find themselves trappedby the Cartesianlegacy. We lack a precise vocabulary
with which to deal with mind-body-societyinteractionsand so are left suspended
in hyphens, testifying to the disconnectednessof our thoughts. We are forced to
resortto such fragmentedconcepts as the bio-social, the psycho-somatic,the somato-socialas altogetherfeeble ways of expressingthe myriadways in which the
mind speaksthroughthe body, and the ways in which society is inscribedon the
expectantcanvasof humanflesh. As Kundera(1984:15) recentlyobserved:"The
rise of science propelledman into tunnelsof specialized knowledge. With every
step forwardin scientificknowledge, the less clearly he could see the world as a
whole or his own self." Ironically, the conscious attemptsto temperthe materialism and the reductionismof biomedical science often end up inadvertentlyrecreatingthe mind/bodyopposition in a new form. For example, Leon Eisenberg
(1977) elaboratedthe distinctionbetweendisease and illness in an effortto distinguish the biomedicalconception of "abnormalitiesin the structureand/orfunction of organs and organ systems" (disease) from the patient's subjectiveexperienceof malaise(illness). While Eisenbergandhis associates' paradigmhas certainly helped to create a single language and discourse for both clinicians and
social scientists, one unanticipatedeffect has been that physicians are claiming
both aspects of the sickness experience for the medical domain. As a result, the
"illness" dimensionof humandistress (i.e., the social relationsof sickness) are
being medicalized and individualized, ratherthan politicized and collectivized
(see Scheper-Hughesand Lock 1986). Medicalizationinevitablyentails a missed
identificationbetween the individual and the social bodies, and a tendency to
transformthe social into the biological.
Mind/bodydualismis relatedto otherconceptualoppositionsin Westernepistemology, such as those between natureand culture, passion and reason, individual and society-dichotomies that social thinkersas different as Durkheim,
Mauss, Marx, and Freudunderstoodas inevitableand often unresolvablecontradictionsand as naturaland universalcategories. AlthoughDurkheimwas primarily concernedwith the relationshipof the individualto society (an oppositionwe
will discuss at greaterlengthbelow), he devoted some attentionto the mind/body,
nature/society dichotomies. In The Elementary Forms of the Religious Life Dur-
kheim wrote that "man is double" (1961[1915]:29), referringto the biological
andthe social. The physicalbody providedfor the reproductionof society through
sexualityandsocialization.ForDurkheimsociety representedthe "highestreality
in the intellectualand moral order." The body was the storehouseof emotions
thatwere the raw materials,the "stuff," out of which mechanicalsolidaritywas
forgedin the interestsof the collectivity. Building on Durkheim,Mauss wrote of
the "dominion of the conscious [will] over emotion and unconsciousness"
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(1979[1950]:122). The degree to which the randomand chaotic impulses of the
body were disciplinedand restrainedby social institutionsrevealedthe stampof
highercivilizations.
Freudintroducedyet anotherinterpretationof the mind/body,nature/culture,
individual/societyset of oppositions with his theory of dynamicpsychology: the
individualat warwithinhimself. Freudproposeda humandramain which natural,
biological drives locked horns with the domesticatingrequirementsof the social
and moralorder.The resultingrepressionsof the libido througha largely painful
process of socializationproducedthe many neuroses of moder life. Psychiatry
was called on to diagnose and treatthe dis-ease of woundedpsyches whose egos
were not in controlof the rest of theirminds. Civilizationand its Discontentsmay
be read as a psychoanalyticparableconcerning the mind/body, nature/culture,
and individual/societyoppositionsin Westernepistemology.
For Marx and his associates the naturalworld existed as an external, objective realitythatwas transformedby humanlabor. Humansdistinguishthemselves
from animals, Marx and Engels wrote, "as soon as they begin to producetheir
means of subsistence" (1970:42). In Capital Marx wrote that labor humanizes
anddomesticatesnature.It gives life to inanimateobjects, and it pushes back the
naturalfrontier,leaving a humanstampon all that it touches.
Althoughthe nature/cultureoppositionhas been interpretedas the "very matrix of Western metaphysics" (Benoist 1978:59) and has "penetrated so
deeply . . . that we have come to regard it as natural and inevitable" (Goody
1977:64), there have always been alternativeontologies. One of these is surely
the view thatcultureis rooted in (ratherthan against)nature(i.e., biology), imitatingit and emanatingdirectly from it. Culturalmaterialists,for example, have
tendedto view social institutionsas adaptiveresponsesto certainfixed, biological
foundations.M. Harris(1974, 1979) refersto cultureas a "banal" or "vulgar"
solutionto the humancondition insofaras it "rests on the groundand is built up
out of guts, sex, energy" (1974:3). Mind collapses into body in these formulations.
Similarly,some humanbiologists andpsychologists have suggestedthatthe
mind/body, nature/culture,individual/societyoppositions are natural(and presumed universal)categories of thinkinginsofar as they are a cognitive and symbolic manifestationof humanbiology. Ornstein(1973), for example, understands
mind/bodydualism as an overly determinedexpression of humanbrain lateralization. Accordingto this view, the uniquely humanspecializationof the brain's
left hemispherefor cognitive, rational, and analytic functions and of the right
hemispherefor intuitive, expressive, and artisticfunctions within the context of
left-hemispheredominancesets the stage for the symbolic andculturaldominance
of reason over passion, mind over body, cultureover nature, and male over female. This kindof biological reductionismis, however, rejectedby most contemporarysocial anthropologistswho stress, instead, the cultural sources of these
oppositionsin Westernthought.
We should bear in mind that our epistemology is but one among many systems of knowledgeregardingthe relationsheld to obtainamongmind, body, culture, nature, and society. We would point, for example, to those non-Western
civilizationsthat have developed alternativeepistemologies thattend to conceive
of relationsamong similarentities in monistic ratherthanin dualisticterms.
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Representations of Holism in Non-Western Epistemologies
In definingrelationshipsbetweenany set of concepts, principlesof exclusion
andinclusioncome into play. Representationsof holism andmonismtend toward
inclusiveness. Two representationsof holistic thoughtare particularlycommon.
The firstis a conceptionof harmoniouswholes in which everythingfrom the cosmos down to the individualorgansof the humanbody are understoodas a single
unit. This is often expressed as the relationshipof microcosmto macrocosm. A
secondrepresentationof holistic thinkingis thatof complementary(not opposing)
dualities, in which the relationshipof partsto the whole is emphasized.
One of the betterknown representationsof balancedcomplementarityis the
ancientChineseyin/yangcosmology, which firstappearsin theI Chingsomewhat
beforethe 3rdcenturyB.C. In this view, the entirecosmos is understoodas poised
in a state of dynamicequilibrium,oscillating between the poles of yin and yang,
masculineandfeminine, light anddark,hot andcold. The humanbody is likewise
understoodas moving back and forthbetweenthe forces of yin and yang-sometimes dry, sometimes moist, sometimes flushed, and sometimes chilled. The
evolving traditionof ancientChinese medicineborrowedthe yin/yangcosmology
fromthe Taoistsand from Confucianisma concernwith social ethics, moralconduct, and the importanceof maintainingharmoniousrelationsamong individual,
family, community, and state. Conceptionsof the healthy body were patterned
afterthe healthystate: in both there is an emphasison order, harmony,balance,
andhierarchywithinthe contextof mutualinterdependencies.A rebelliousspleen
can be comparedto an insubordinateservant,and a lazy intestinecomparedto an
indolent son. In the Nei Ching, The Yellow Emperor's Classic of Internal Medi-
cine, the PrimeMinistercounsels: "the humanbody is an imitationof heaven and
earthin all its details" (Veith 1966:115). The healthof individualsdependson a
balancein the naturalworld, while the healthof each organ dependson its relationshipto all other organs. Nothing can change withoutchangingthe whole. A
conceptionof the humanbody as a mixtureof yin and yang, forces of which the
entire universe is composed, is altogetherdifferentfrom Westernbody conceptions based on absolute dichotomies and unresolvabledifferences. In ancient
Chinese cosmology the emphasis is on balance and resonance;in Westerncosmology, on tension and contradiction.
Islamiccosmology-a synthesisof early Greekphilosophy,Judeo-Christian
concepts, and propheticrevelationsset down in the Qur'an-depicts humansas
havingdominanceover nature,but this potentialoppositionis temperedby a sacred world view that stresses the complementarityof all phenomena(Jachimowicz 1975;Shariati1979). At the core of Islamicbelief lies the unifyingconcept of
Towhid,which Shariatiarguesshould be understoodas going beyond the strictly
religiousmeaningof "God is one, no more thanone" to encompassa worldview
that representsall existence as essentially monistic. Guided by the principle of
Towhidhumansare responsibleto one power, answerableto a single judge, and
guidedby one principle:the achievementof unity throughthe complementarities
of spiritand body, this world and the hereafter,substanceand meaning, natural
and supernatural,etc.
The concept in Westernphilosophicaltraditionsof an observing and reflexive "I," a mindful self that stands outside the body and apartfrom nature, is
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another heritage of Cartesian dualism that contrasts sharply with a Buddhist form
of subjectivity and relation to the natural world. In writing about the Buddhist
Sherpas of Nepal, Paul suggests that they do not perceive their interiority or their
subjectivity as "hopelessly cut off and excluded from the rest of nature, but
[rather as] . . . connected to, indeed identical with, the entire essential being of
the cosmos" (1976:131).
In Buddhist traditions the natural world (the world of appearances) is a product of mind, in the sense that the entire cosmos is essentially "mind." Through
meditation individual minds can merge with the universal mind. Understanding
is reached not through analytic methods, but rather through an intuitive synthesis,
achieved in moments of transcendence that are beyond speech, language, and the
written word. For, the essence of world meaning is unspeakable and unthinkable.
It is experientially received as a perception of the unity of mind and body, self
and other, mind and nature, being and nothingness.
The Buddhist philosopher Suzuki (1960) contrasted Eastern and Western
aesthetics and attitudes toward nature by contrasting two poems, a 17th-century
Japanese haiku and a 19th-century poem by Tennyson. The Japanese poet wrote:
When I look carefully
I see the nazunablooming
By the hedge!
In contrast, Tennyson wrote:
Flower in the cranniedwall,
I pluck you out of the crannies,
I hold you here, root and all, in my hand,
Little flower-but if I could understand
Whatyou are, root and all, and all in all,
1 should know what God and man is.
Suzuki observes that the Japanese poet Basho does not pluck the nazuna, but
is content to admire it from a respectful distance: his feelings are "too full, too
deep, and he has no desire to conceptualize it" (1960:3). Tennyson, however, is
active and analytical. He rips the plant by its roots, destroying it in the very act
of admiring it. "He does not apparently care for its destiny. His curiosity must be
satisfied. As some medical scientists do, he would vivisect the flower " (Suzuki
1960:3). Tennyson's violent imagery is reminiscent of Francis Bacon's description of the natural scientist as one who must "torture nature's secrets from her"
and make her a "slave" to mankind (Merchant 1980:169). Principles of monism,
holism, and balanced complementarity in nature, which, like those described
above, can temper perceptions of opposition and conflict, have largely given way
to the analytic urge in the history of Western culture.
Person, Self, and Individual
The relation of individual to society, which has occupied so much of contemporary social theory, is based on a perceived "natural" opposition between the
demands of the social and moral order and egocentic drives, impulses, wishes,
and needs. The individual/society opposition, while fundamental to Western ep-
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istemology, is also ratherunique to it. Geertz has arguedthat the Westernconception of the person "as a bounded, unique . . . integrated motivational and
cognitive universe, a dynamiccenterof awareness,emotion, judgement, and action . . . is a rather peculiar idea within the context of the world's cultures"
(1984:126). In fact, the modem conceptionof the individualself is of recenthistoricalorigin, even in the West. It was really only with the publicationin 1690 of
John Locke's Essay Concerning Human Understanding that we have a detailed
theoryof the person that identifiesthe "I" or the self with a state of permanent
consciousnessthatis uniqueto the individualand stablethroughthe life span and
physicalchange until death (Webel 1983:399).
Thoughnot as detailed, perhaps,it would nonethelessbe difficultto imagine
a people completelydevoid of some intuitiveperceptionof the independentself.
We think it reasonableto assume that all humansare endowed with a self-consciousness of mind and body, with an internalbody image, and with what neurologistshave identifiedas the proprioceptiveor "sixth sense," our sense of body
self-awareness,of mind/bodyintegration,and of being-in-the-worldas separate
and apartfrom otherhumanbeings. Winnicotregardsthe intuitiveperceptionof
the body-self as "naturally"placed in the body, a preculturalgiven (1971:48).
While this seems a reasonableassumption,it is importantto distinguishthis universal awarenessof the individualbody-self from the social conception of the
individual as "person," a construct of jural rights and moral accountability
(LaFontaine1985:124). La personne morale, as Mauss (1985[1938]) phrasedit,
is the uniquelyWesternnotion of the individualas a quasi-sacred,legal, moral,
and psychological entity, whose rights are only limited by the rights of other
equallyautonomousindividuals.
Modem psychologists and psychoanalysts (Winnicot among them) have
tendedto interpretthe processof individuation,definedas a gradualestrangement
from parentsand other family members, as a necessary stage in the humanmaturationprocess (see also Johnson 1985; DeVos, Marsella, and Hsu 1985:3-5).
This is, however, a culture-boundnotion of humandevelopment, and one that
conformsto fairly recentconceptionsof the relationof the individualto society.
In Japan,althoughthe conceptof individualismhas been debatedvigorously
since the end of the last century, it is still the family which is consideredthe most
"natural," fundamentalunit of society, not the individual. Consequently, the
greatesttensionin Japanfor at least the past fourhundredyearshas been between
one's obligationsto the state versus obligations to the family. Individualneeds
and wishes (i.e., the unsocialized, uncultivatedside of humans)were met covertly, during "time out" from real society, often in the "flower and willow
world" of the night quarters.
The philosophicaltraditionsof Shintoismand Buddhismhave also militated
against Japaneseconceptions of individualism. The animism of Shinto fosters
feelings of immersionin nature,while many of the techniquesof Buddhistcontemplationencouragedetachmentfrom earthlydesires and gross passions, experiencedin the attainmentof mu or nothingness.Neither traditionencouragesthe
developmentof a highly individuatedself.
In all, Japanhas been repeatedlydescribedas a cultureof "social relativism," in which the person is understoodas acting within the context of a social
relationship,never simply autonomously(Lebra 1976; Smith 1983). One's self-
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identitychangeswith the social context, particularlywithinthe hierarchyof social
relations at any given time. The child's identity is established throughthe responsesof others;conformityand dependency,even in adulthood,are not understood as signs of weakness, but ratheras the result of inner strength(Reischauer
1977:152). One fear, however, which hauntsmanycontemporaryJapaneseis that
of losing oneself completely, of becomingtotally immersedin social obligations.
One protectivedevice is a distinctionmade between the externalself (tatemae)the persona,the mask, the social self that one presentsto others-versus a more
privateself (honne), the less controlled,hidden self. Geertzhas describeda similarphenomenonamong the Javaneseand Balinese (1984:127-128).
Read argues that the Gahuku-Gamaof New Guinea lack a concept of the
person altogether:"Individual identity and social identity are two sides of the
same coin" (1955:276). He maintainsthatthereis no awarenessof the individual
apartfrom structuredsocial roles, and no concept of friendship-that is, a relationshipbetweentwo uniqueindividualsthatis not definedby kinship, neighborhood, or other social claims. Gahuku-Gamaseem to define the self, insofar as
they do so at all, in terms of the body's constituentparts:limbs, facial features,
hair,bodily secretionsandexcretions. An assaulton any partof the body (stealing
feces, for example) is tantamountto an attackon the person, as occurs in sorcery
accusations.Of particularsignificanceis the Gahuku-Gamaconceptionof the social skin, which includesboththe coveringof the body and the person'sparticular
social and charactertraits. Referencesto one's "good" or "bad" skin indicatea
person's moralcharacteror even a person's temperamentor mood. This is compatiblewith a society in which social relationshipis expressed in touching, fondling, stroking,holding, and other immediatephysical manifestations.GahukuGamaseem to experiencethemselves most intensely when in contactwith others
and throughtheirskins (see also LaFontaine1985:129-130).
Such sociocentricconceptionsof the self have been widely documentedfor
many partsof the world (see Shweder and Bourne 1982; Devisch 1985; Fortes
1959;Harris1978) andhave relevanceto ethnomedicalunderstanding.In cultures
and societies lacking a highly individualized or articulatedconception of the
body-self it should not be surprisingthat sickness is often explainedor attributed
to malevolentsocial relations(i.e., sorcery),or to the breakingof social andmoral
codes, or to disharmonywithin the family or the village community. In such societies therapy,too, tends to be collectivized. Ldvi-Strauss(1963) has noted that
in transcendentaland shamanichealing, the patientis almost incidentalto the ritual, which is focused on the communityat large. The !Kungof Botswanaengage
in weekly healing trance-danceritualsthat are viewed as both curativeand preventive (Katz 1982). LornaMarshallhas describedthe dance as "one concerted
religious act of the !Kung [that]brings people into such union that they become
like one organicbeing" (1965:270).
In contrastto societies in which the individualbody-self tends to be fused
with or absorbedby the social body, there are societies that view the individual
as comprisedof a multiplicityof selves. The Bororo(like the Gahuku-Gama)understandthe individualonly as reflected in relationshipto other people. Hence,
the person consists of many selves-the self as perceived by parents, by other
kinsmen, by enemies, etc. The Cuna Indians of Panama say they have eight
selves, each associatedwith a differentpartof the body. A Cunaindividual'stem-
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MEDICAL ANTHROPOLOGYQUARTERLY
peramentis the resultof dominationby one of these aspects or partsof the body.
An intellectualis one who is governedby the head, a thief governedby the hand,
a romanticby the heart, and so forth.
Finally, the Zinacanteco soul has 13 divisible parts. Each time a person
"loses" one or morepartshe or she becomes ill and a curingceremonyis held to
retrieve the missing pieces. At death the soul leaves the body and returnsto
whence it came-a soul "depository" kept by the ancestralgods. This soul pool
is used for the creationof new humanbeings, each of whose own soul is made up
of 13 partsfrom the life-force of other previous humans. A person's soul-force,
andhis or her self, is thereforea composite, a synthesis "borrowed"from many
otherhumans.There is no sense that each Zinacantecois a "brand-new"or totally uniqueindividual;rather,each personis a fractionof the whole Zinacanteco
social world. Moreover,the healthyZinacantecois one who is in touch with the
divisible partsof him or herself (Vogt 1969:369-374).
While in the industrializedWest thereare only pathologizedexplanationsof
dissociative states in which one experiences more than one self (schizophrenia,
multiplepersonalitydisorder,borderline,etc.), in manynon-Westernculturesindividualscan experiencemultipleselves throughthe normativepracticeof spirit
possession and other alteredstates of consciousness. In Haiti and Brazil, where
the spiritsof voodoo or condombleare believed to have distinctpersonalitiesthat
are expressedboth in food, drink, and clothing preferencesand in particularbehavioial traits, those in trainingas "daughtersof the saints" must learn how to
change their own behaviorin order to "invite" possession by particularsaints.
Once possessed and in trance, the spiritvisitors are free to come and go, appear
anddisappearat will, muchto the pleasureandentertainmentof all present.Such
ritualizedandcontrolledexperiencesof possession aresoughtafterthroughoutthe
worldas valuedforms of religious experienceand therapeuticbehavior.To date,
however, psychological anthropologistshave tended to "pathologize" these alteredstatesas manifestationsof unstableor psychotic personalities.The Western
conceptionof one individual,one self effectively disallows or rejects social, religious, and medical institutionspredicatedon ethnopsychologiesthat recognize
as normativea multiplicityof selves. In recent years some psychiatristsand psychotherapistsin the United States have begun to acknowledgethat "possession"
(as the experienceof more than one self) may be a more valid and parsimonious
explanationof certainalteredstates of consciousness in patientsthan recourseto
classical psycho-pathologicaldiagnoses such as Multiple PersonalityDisorder
(MPD) (see Anderson 1981; Beahrs 1982; Crabtree1985; Allison 1985).
Body Imagery
Closely relatedto conceptionsof self (perhapscentralto them) is what psychiatristshave labeled "body image" (Schilder 1970[1950]; Horowitz 1966).
Body imagerefersto the collective andidiosyncraticrepresentationsan individual
entertainsaboutthe body in its relationshipto the environment,includinginternal
andexternalperceptions,memories,affects, cognitions, andactions. The existing
literatureon body imagery (althoughlargely psychiatric)has been virtuallyuntappedby social andespecially medicalanthropologists,who could benefita great
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deal fromattentionto body boundaryconceptions,distortionsin body perception,
etc.
Some of the earliestand best work on body image was containedin clinical
studies of individualssuffering from extremely distortedbody perceptionsthat
arose from neurological,organic, or psychiatricdisorders(Head 1920; Schilder
1970[1950];Luria 1972). The inabilityof some so-called schizophrenicsto distinguishself from other, or self from inanimateobjects has been analyzed from
psychoanalyticand phenomenologicalperspectives(Minkowski 1958; Binswanger 1958;Laing 1965;Basaglia 1964). Sacks (1973 [1970], 1985) has also written
aboutrareneurologicaldisordersthat can play havoc with the individual'sbody
image, producing deficits and excesses as well as metaphysical transportsin
mind-bodyexperiences. Sack's message throughouthis poignant medical case
historiesis thathumannessis not dependentuponrationalityor intelligence-i.e.,
an intactmind. Thereis, he suggests, somethingintangible,a soul-forceor mindself thatproduceshumanseven underthe most devastatingassaultson the brain,
nervoussystem, and sense of bodily or mindfulintegrity.
While profound distortions in body imagery are rare, neurotic anxieties
aboutthe body, its orifices, boundaries,and fluids are quite common. Fisherand
Cleveland (1958) demonstratedthe relationshipbetween patients' "choice" of
symptomsand body image conceptions. The skin, for example, can be experienced as a protectivehide and a defensive armourprotectingthe softer and more
vulnerableinternalorgans. In the task of protectingthe inside, however, the outside can take quite a beating, manifestedin skin rashes and hives. Conversely,
the skin can be imaginedas a permeablescreen, leaving the internalorgans defenseless and prone to attacksof ulcers and colitis. Few medical anthropologists
have examinedsocial dimensionsandcollective representationsof body imagery,
althoughKleinman's work on the somatizationof depression in the aches and
painsof ChineseandChinese-Americanpatientsis one example(1980; Kleinman
and Kleinman 1985). Anotheris Scheper-Hughes'sdescriptionof impoverished
Brazilianmothers'distortedperceptionsof their breastmilkas sour, curdled, bitter, and diseased, a metaphoricalprojectionof their inabilityto pass on anything
untaintedto theirchildren(1984:541-544).
Particularorgans, body fluids, and functions may also have special significance to a groupof people. The liver, for example, absorbsa greatdeal of blame
for many differentailmentsamong the French, Spanish, Portuguese,and Brazilians, but to our knowledge only the Pueblo Indiansof the Southwestsuffer from
"flipped liver" (Leeman 1986). In their nationalfantasy about the medical significanceof the liver the Frenchhave createda mystical "phantomorgan," one
altogetherfierce in its tyrannyover the rest of the body and its ability to inflict
humansuffering (Miller 1978:44). The English and the Germansare, by comparison,far more obsessed with the conditionand healthof theirbowels. Dundes
takes the Germanicfixationwith the bowels, cleanliness, and analityas a fundamentalconstellationunderlyingGermannationalcharacter(1984), while Miller
writesthat "when an Englishmancomplainsaboutconstipation,you never know
whether he is talking about his regularity, his lassitude, or his depression"
(1978:45).
Once an organcapturesthe imaginationof a people, there appearsto be no
end to the metaphoricaluses to which it may be put. Among "old stock" Amer-
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QUARTERLY
ican Midwesternfarmers,for example, the backbonehas great culturaland ethnomedicalsignificance. When illness strikes at these industriousand "upright"
people, being forcedoff theirfeet comes as a grave blow to the ego. Even among
the elderly and infirm,well-being is definedas the ability to "get around," to be
on one's feet. Obviously, the abilityto stay "upright"is not confinedto the mere
technicalproblemsof locomotion; it carriessymbolic weight as well. As Erwin
Strauss pointed out, the expression "to be upright" has two connotations to
Americans:the first, to stand up, to be on one's feet; and the second, a moral
implication"not to stoop to anything,to be honest andjust, to be trueto friends
in danger,to standby one's convictions" (1966b:137). Among ruralMidwesterners laziness is a most serious moralfailing, and "spinelessness" is as reviled as
godlessness. It is little wonderthat a therapyconcernedwith adjustingperceived
malalignmentsof the spine-chiropractic medicine-would have its origins in
middleAmerica(Cobb 1958).
Blood, on the other hand, is a nearly universalsymbol of human life, and
some peoples, both ancient and contemporary,have taken the quality of the
blood, pulse, and circulationas the primarydiagnostic sign of health or illness.
The traditionalChinese doctor, for example, made his diagnosis by feeling the
pulse in both of the patient'swrists and comparingthem with his own, an elaborateritualthatcould take several hours. The doctor was expected to take note of
minutevariations,andtheNei Chingstatesthatthe pulse can be "sharpas a hook,
fine as a hair, tautas a musicalstring, dead as a rock, smoothas a flowing stream,
or as continuousas a string of pearls" (Majno 1975:245). Snow (1974) has described the rich constellation of ethnomedical propertiesand significances attached to the quality of the blood by poor black Americans, who suffer from
"high" or "low," fast and slow, thick and thin, bitterand sweet blood. Linke
(1986) has analyzedthe conceptof blood as a predominantmetaphorin European
culture, especially its uses in political ideologies, such as during the Nazi era.
Similarly, the multiple stigmas suffered by North American AIDS patients include a preoccupationwith the "bad blood" of diseased homosexuals(Lancaster
1983).
Hispanic mothers from southern Mexico to northernNew Mexico focus
some of theirbody organanxietieson the infant'sfontanelle.Open, it exposes the
newbornto the evil influences of night airs, as well as the envious looks and
wishes of neighbors. Until it closes over, there is always the threatof mollera
caida, "fallen fontanelle," a life-threateningpediatricdisorder(Scheper-Hughes
and Stewart1983).
In short, ethnoanatomicalperceptions, including body image, offer a rich
source of data both on the social and culturalmeanings of being humanand on
the variousthreatsto health, well-being, and social integrationthat humans are
believed to experience.
The Social Body
The Body as Symbol
Symbolic and structuralistanthropologistshave demonstratedthe extent to
which humansfind the body "good to thinkwith." The humanorganismand its
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THEMINDFULBODY
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naturalproductsof blood, milk, tears, semen, and excretamay be used as a cognitive map to representother natural,supernatural,social, and even spatialrelations. The body, as MaryDouglas observed, is a naturalsymbol supplyingsome
of our richestsourcesof metaphor(1970:65). Culturalconstructionsof and about
the body are useful in sustainingparticularviews of society and social relations.
Needham, for example, pointed out some of the frequentlyoccurringassociations to right- and left-handedness,especially the symbolic equations, on the
one hand,betweenthe left andthatwhich is inferior,dark,dirty, andfemale, and,
on the otherhand, between the rightand thatwhich is superior,holy, light, dominant, and male. Needham called attentionto such uses of the body as a convenient means of justifying particularsocial values and social arrangements,such
as the "natural"dominanceof males over females (1973:109). His point is that
these common symbolic equationsare not so much naturalas they are useful, at
least to those "on the top" and to the right.
Insofar as the body is both physical and culturalartifact, it is not always
possible to see where natureends and culturebegins in the symbolic equations.
"Just as it is true that everythingsymbolizes the body," writes Douglas, "so it
is equallytruethatthe body symbolizes everythingelse" (1966:122). Forthe psychoanalystsocial practicesare always referredback to their unconscious representationsof the experienceof self with the body; symbolic anthropologistswork
in the opposite direction, takingthe experiencesof the body as representationof
society. WhereBrunoBettleheimattributesthe practiceof Australiansubincision
to male envy of the procreativefemale-mother,since the practicetransformsthe
male penis into a facsimile of the female vulva (1955), Mary Douglas suggests
thatwhatis being carvedin humanfleshduringthis publicritualis a graphicimage
of society: the two halves of the Australianmoiety (1966).
Ethnobiologicaltheories of reproductionusually reflect the particularcharacterof their associatedkinship system, as anthropologistshave long observed.
In societies with unilineal descent it is common to encounterfolk theories that
emphasizethe reproductivecontributionsof females in matrilinealand of males
in patrilinealsocieties. The matrilinealAshantimakethe distinctionbetweenflesh
and blood that is inheritedthroughwomen, and spirit that is inheritedthrough
males. The BrazilianShavante, among whom patrilineagesform the core of political factions, believe that the father fashions the infant throughmany acts of
coitus, duringwhich the motheris only passive and receptive. The fetus is "fully
made," andconceptionis completedonly in the fifthmonthof pregnancy.As one
Shavanteexplainedthe process to Maybury-Lewis,while ticking the monthsoff
with his fingers:"Copulate. Copulate, copulate, copulate, copulate a lot. Pregnant. Copulate,copulate, copulate. Born" (1967:63).
Similarly,the Westerntheoryof equal male and female contributionsto conception that spans the reproductivebiologies of Galen to TheodoreDobzhansky
(1970) probablyowes more to the theory's compatibilitywith the Europeanextendedand stem bilateralkinship system than to scientific evidence, which was
lackinguntil relativelyrecently. The principleof one father,one mother, one act
of copulationleadingto each pregnancywas partof the Westerntraditionfor more
thana thousandyears before the discovery of spermatozoa(in 1677), the female
ova (in 1828), and before the actual process of human fertilization was fully
understoodand described(in 1875) (Barnes 1973:66). For centuriesthe theoryof
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MEDICAL ANTHROPOLOGYQUARTERLY
equal male and female contributionsto conception was supportedby the erroneous belief that females had the same reproductiveorgans and functions as
males, except that, as one 6th-centuryBishop put it, "theirs are inside the body
and not outside it" (Laquer1986:3). To a great extent, talk about the body and
aboutsexualitytends to be talk aboutthe natureof society.
Of particularrelevance to medical anthropologistsare the frequently encounteredsymbolic equationsbetween conceptions of the healthy body and the
healthysociety, as well as the diseased body andthe malfunctioningsociety. Janzen (1981) has noted thatevery society possesses a utopianconceptionof health
thatcan be applied metaphoricallyfrom society to body and vice versa. One of
the most enduringideologies of individualand social health is that of the vital
balance,andof harmony,integration,andwholeness thatare found in the ancient
medical systems of China, Greece, India, and Persia, in contemporaryNative
Americanculturesof the Southwest (Shutler 1979), throughthe holistic health
movementof the 20th century(Grossinger1980). Conversely, illness and death
can be attributedto social tensions, contradictions,and hostilities, as manifested
in Mexican peasants' image of the limited good (Foster 1965), in the hot-cold
syndromeand symbolic imbalancein Mexican folk medicine(Currier1969), and
in such folk idioms as witchcraft, evil eye, or "stress" (Scheper-Hughesand
Lock 1986). Each of these beliefs exemplifies the link between the health or illness of the individualbody and the social body.
The Embodied World
One of the most common and richly detailed symbolic uses of the human
body in the non-Westernworld is to domesticatethe spaces in which humansreside. Bastien has writtenextensively about the Qollahuaya-AndeanIndians' individualand social body concepts (1978, 1985). The Qollahuayaslive at the foot
of Mt. Kaata in Bolivia and are known as powerful healers, the "lords of the
medicine bag." Having practiceda sophisticatedherbal medicine and surgery
since A.D. 700, Qollahuayas"understandtheirown bodies in termsof the mountain, andthey considerthe mountainin termsof theirown anatomy" (1985:598).
The humanbody and the mountainconsist of interrelatedparts:head, chest and
heart,stomachand viscera, breastand nipple. The mountain,like the body, must
be fed blood and fat to keep it strong and healthy. Individualsickness is understood as a disintegrationof the body, likened to a mountainlandslideor an earthquake.Sicknessis causedby disruptionsbetweenpeople andthe land, specifically
betweenresidentsof differentsections of the mountain:the head (mountaintop),
heart(centervillage), or feet (the base of the mountain).Healerscureby gathering
the variousresidentstogetherto feed the mountainand to restorethe wholeness
andwellness thatwas compromised."I am the same as the mountain," says Marcelino Yamahuayathe healer, "[the mountain]takes care of my body, and I must
give food and drinkto Pachemama"(Bastien 1985:597). Bastien concludes that
Qollahuayabody concepts are fundamentallyholistic ratherthan dualistic. He
suggests that
The whole is greaterthan the sum of the parts .... Wholeness (health) of the
andcentrifugalforcespulltogetherand
bodyis a processin whichcentripetal
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THEMINDFULBODY
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disperse fluids that provide emotions, thoughts, nutrients, and lubricantsfor
membersof the body. [ 1985:598]
Possibly, however, the most elaborate use of the body in native cosmology
comes from the Dogon of the Western Sudan, as explained by Ogotemmeli to
Marcel Griaule (1965) in his description of the ground plan of the Dogon community. The village must extend from north to south like the body of a man lying
on his back. The head is the council house, built in the center square. To the east
and west are the menstrual huts which are "round like wombs and represent the
hands of the village" (1965:97). The body metaphor also informs the interior of
the Dogon house:
The vestibule, which belongs to the masterof the house, representsthe male part
of the couple, the outside door being his sexual organ. The big centralroom is
the domainandthe symbolof the woman;the store-roomseach side areherarms,
and the communicatingdoor her sexual parts. The central room and the store
rooms togetherrepresentthe woman lying on her back with outstretchedarms,
the door open, and the woman readyfor intercourse.[1965:94-95]
We could multiply by the dozens ethnographic illustrations of the symbolic
uses of the human body in classifying and "humanizing" natural phenomena,
human artifacts, animals, and topography. Among some of the more well-known
examples are the western Apache (Basso 1969), the Indonesian Atoni (Cunningham 1973); the Desana Indians of the Colombian-Brazilian border (ReichelDolmatoff 1971); the Pira-pirana of the Amazon (Hugh-Jones 1979); the Zinacantecos of Chiapas (Vogt 1970); and the Fali of northern Cameroon (Zahan
1979). In such essentially monistic and humanistic cosmologies as these, principles of separation and fusion, imminence and transcendence influence interpretations of illness and the practice of healing.
Manning and Fabrega (1973) have summarized the major differences between most of these non-Western ethnomedical systems and moder biomedicine.
In the latter body and self are understood as distinct and separable entities; illness
resides in either the body or the mind. Social relations are seen as partitioned,
segmented, and situational-generally as discontinuous with health or sickness.
By contrast, many ethnomedical systems do not logically distinguish body, mind,
and self, and therefore illness cannot be situated in mind or body alone. Social
relations are also understood as a key contributor to individual health and illness.
In short, the body is seen as a unitary, integrated aspect of self and social relations.
It is dependent on, and vulnerable to, the feelings, wishes, and actions of others,
including spirits and dead ancestors. The body is not understood as a vast and
complex machine, but rather as a microcosm of the universe.
As Manning and Fabrega note, what is perhaps most significant about the
symbolic and metaphorical extension of the body into the natural, social, and supernatural realms is that it demonstrates a unique kind of human autonomy that
seems to have all but disappeared in the "moder," industrialized world. The
confident uses of the body in speaking about the external world conveys a sense
that humans are in control. It is doubtful that the Colombian Qollahuayas or the
Desana or the Dogon experience anything to the degree of body alienation, so
common to our civilization, as expressed in the schizophrenias, anorexias, and
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bulemias, or the addictions, obsessions, and fetishisms of "moder" life in the
postindustrializedworld.
Existential psychiatrists have expounded at length on the contemporary
themesof self-alienation,estrangement,and its pathologicalconsequences (see,
for example, May, Angel, and Ellenberger 1958). The alienation may be expressedby patientsas a sense of a disembodiedself, or a selfless body, or to use
R.D. Laing'sterm, a dividedself (1965). The loss of the sense of bodily integrity,
of wholeness, of continuity and relatednessto the rest of the naturaland social
worldis surelythe cumulativeeffect of forces we have discussedabove:the Cartesianlegacy andthe materialismand individualismof biomedicalclinical practice.
However, the mind/bodydichotomy and the body alienationcharacteristic
of contemporarysociety may also be linked to capitalistmodes of productionin
whichmanualandmentallaborsaredivided andorderedinto a hierarchy.Human
labor,thus divided and fragmented,is by Marxistdefinition"alienated," and is
reflectedin the markeddistortionsof body movement, body imagery, and selfconceptionthatE. P. Thompson(1967), amongothers, has described.Thompson
discusses the subversionof natural,body time to the clock-work regimentation
and work discipline required by industrialization.He juxtaposes the factory
worker, whose labor is extractedin minute, recordedsegments, with the Nuer
pastoralist,for whom "the daily timepiece is the cattle clock" (Evans-Pritchard
1940:100), or the Aran Islander,whose work is managedby the amountof time
left before twilight (Thompson1967:59).
Similarly,PierreBourdieudescribesthe "regulatedimprovisations"of Algerian peasants, whose movements roughly correspondto diurnaland seasonal
rhythms."At the returnof the Azal (dry season)," he writes, "everythingwithout exception, in the activitiesof men, women andchildrenis abruptlyalteredby
the adoptionof a new rhythm" (1977:159). Everythingfrom men's work to the
domesticactivitiesof women, to rest periods, and ceremonies, prayers,and public meetingsis set in termsof the naturaltransitionfromthe wet to the dry season.
Doing one's duty in the village context means "respecting rhythms, keeping
pace, not fallingout of line" (1977:161) with one's fellow villagers. The slovenly
housewife, the lazy or the overly eager peasantviolates the fundamentalvirtueof
conformity,which is expressedin a kind of organic solidarityratherlike a piece
of choreography.Although,as Bourdieusuggests, these peasantsmay sufferfrom
a species of false consciousness(or "bad faith") thatallows themto misrepresent
to themselves their social world as the only possible way to think and to behave
and to perceive as "natural"what are, in fact, self-imposed culturalrules, there
is little doubtthatthese Algerianvillagers live in a social and a naturalworld that
has a decidedlyhumanshape and feel to it. We might referto theirworld as embodied.
In contrast,the world in which most of us live is lacking a comfortableand
familiarhumanshape. At least one source of body alienationin advancedindustrial societies is the symbolic equationof humans and machines, originatingin
our industrialmodes and relationsof productionand in the commodityfetishism
of modem life, in which even the humanbody has been transformedinto a commodity. Again, Manningand Fabregacapturethis so well:
In primitivesociety the body of man is the paradigmfor the derivationof the
parts and meanings of other significant objects; in modem society man has
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adoptedthelanguageof themachineto describehisbody.Thisreversal,wherein
manseeshimselfin termsof theexternalworld,as a reflectionof himself,is the
formulafor expressingthe presentsituationof moder man.
representative
[1973:283]
We rely on the body-as-machinemetaphoreach time we describeour somatic or
psychological states in mechanistic terms, saying that we are "worn out" or
"wound up," or when we say that we are "run down" and that our "batteries
need recharging."In recent years the metaphorshave moved from a mechanical
to an electricalmode (we are "turnedoff," "tuned in," we "get a charge" out
of something), while the computerage has lent us a host of new expressions,
includingthe all-too-familiarcomplaint:"my energy is down."
Ourpoint is that the structureof individualand collective sentimentsdown
to the "feel" of one's body and the naturalnessof one's position and role in the
technical order is a social construct. Thomas Belmonte described the body
rhythmsof the factoryworker:
Theworkof factoryworkersis a stiffmilitarydrill,a regimentof armswelded
to metalbarsandwheels.Marx,VeblenandCharlieChaplinhavepowerfully
madethepointthat,on theassemblyline,manneithermakesnorusestools,but
is continuouswithtool as a minute,finalattachment
to the massiveindustrial
machine.[1979:139]
The machines have changed since those early days of the assembly line. One
thinkstoday not of the brutalityof huge grindinggears and wheels, but ratherof
the sterile silence and sanitized pollution of the microelectronicsindustriesto
which the nimble fingers, strainedeyes, and docile bodies of a new, largely female and Asian laborforce are now melded. Whathas not changedto any appreciable degree is the relationshipof human bodies to the machines under 20thcenturyforms of industrialcapitalism.
Non-Westernand nonindustrializedpeople are "called upon to think the
world with theirbodies" (O'Neill 1985:151). Like Adam and Eve in the Garden
they exercise their autonomy, their power, by namingthe phenomenaand creaturesof the worldin theirown image andlikeness. By contrast,we live in a world
in which the humanshape of things (and even the humanshape of humanswith
their mechanicalheartsand plastic hips) is in retreat.While the cosmologies of
nonindustrializedpeople speakto a constantexchange of metaphorsfrombody to
natureandbackto body again, our metaphorsspeakof machineto body symbolic
equations.O'Neill suggests that we have been "put on the machine" of biotechnology, some of us transformedby radicalsurgeryand genetic engineeringinto
"spareparts" or prosthetichumans(1985:153-154). Lives are saved, or at least
deathsare postponed, but it is possible that our humanityis being compromised
in the process.
The Body Politic
The relationshipsbetween individualand social bodies concernmore, however, thanmetaphorsandcollective representationsof the naturalandthe cultural.
The relationshipsare also aboutpower andcontrol. Douglas (1966) contends, for
example, that when a communityexperiencesitself as threatened,it will respond
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by expandingthe numberof social controls regulatingthe group's boundaries.
Pointswhereoutsidethreatsmay infiltrateandpollutethe inside become the focus
of particularregulationand surveillance. The three bodies-individual, social,
andbody politic-may be closed off, protectedby a nervousvigilance aboutexits
and entrances. Douglas had in mind witchcraftcrazes and hysterias from the
Salem trials through contemporaryAfrican societies and even political witch
huntsin the United States. In each of these instances the body politic is likened
to the humanbody in which what is "inside" is good and all that is "outside" is
evil. The body politic underthreatof attackis cast as vulnerable,leadingto purges
of traitorsand social deviants, while individualhygiene may focus on the maintenanceof ritualpurityor on fears of losing blood, semen, tears, or milk.
Threatsto the continuedexistence of the social groupmay be real or imaginary. Even when the threatsare real, however, the true aggressorsmay not be
known, andwitchcraftcan become the metaphoror the culturalidiom for distress.
Lindenbaum(1979) has shown, for example, how an epidemic of Kuru among
the SouthFore of New Guinealed to sorceryaccusationsand counteraccusations
andattemptsto purifyboththe individualand collective bodies of theirimpurities
and contaminants.Mullings suggests that witchcraftand sorcery were widely
used in contemporary West Africa as "metaphors for social relations"
(1984:164). In the context of a rapidly industrializingmarkettown in Ghana,
witchcraftaccusationscan express anxietiesover social contradictionsintroduced
by capitalism.Hence, accusationswere directedat those individualsand families
who, in the pursuitof economic success, appearedmost competitive, greedy, and
individualisticin their social relations. While Foster (1972) might label such
witchcraftaccusationsa symptom of envy among the less successful, Mullings
arguesthat witchcraftaccusationsare an inchoateexpressionof resistanceto the
erosionof traditionalsocial values based on reciprocity,sharing,and family and
communityloyalty. Mullingsdoes not, of course, suggest thatwitchcraftand sorcery are uniqueto capitalistsocial andeconomic formations,but ratherthatin the
contextof increasingcommoditizationof humanlife, witchcraftaccusationspoint
to the social distortionsand dis-ease in the body politic generatedby capitalism.
When the sense of social order is threatened,as in the examples provided
above, the symbols of self-controlbecome intensifiedalong with those of social
control. Boundariesbetween the individualand political bodies become blurred,
and there is a strongconcern with mattersof ritual and sexual purity, often expressedin vigilance over social and bodily boundaries.Individualsmay express
high anxiety over what goes in and what comes out of the two bodies. In witchcraft-fearingsocieties, for example, there is often a concern with the disposal of
one's excreta, haircuttings, and nail parings. In small, threatened,and therefore
often conservativepeasantcommunities, a similar equationbetween social and
bodily vigilance is likely to be found. For example, in Ballybran,ruralIreland,
villagerswere equally guardedaboutwhat they took into the body (as in sex and
food) as they were aboutbeing "taken in" (as in "codding," flattery,and blarney) by outsiders, especially those with a social advantageover them. Concern
with the penetrationand violation of bodily exits, entrances,and boundariesextendedto materialsymbols of the body-the home, with its doors, gates, fences,
and stone boundaries,aroundwhich many protectiverituals, prayers,and social
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customs served to create social distance and a sense of personalcontrol and security(Scheper-Hughes1979).
In additionto controllingbodies in a time of crisis, societies regularlyreproduce and socialize the kind of bodies that they need. Aggressive (or threatened)
societies, for example, often requirefierce and foolhearty warriors.The Yanomamo, who, like all Amerindianpeoples living in the Amazon, are constantly
undersiege from encroachingranchingand mining interests, place a great premium on aggressivity. The body of Yanomamomales is both mediumand message: most adults' heads are criss-crossedby battle scars into which red dyes are
rubbed.The men's mutilatedcrowns are kept clean and shaved for display;their
scars are endowed with a religious as well as a political significance-they representthe riversof blood on the moon where Pore, the Creator-Spiritof the Yanomamo, lives (Brain 1979:167-168). In creating a fine consonance among the
physical, material,political, and spiritualplanes of existence, many Yanomamo
men areencouragedto put theirbodies-especially theirheads-in the service of
the body politic. In many societies (includingour own) the culturallyand politically "correct" body is the beautiful, strong, and healthy body, although the
meaningsgiven to obesity and thinness, to the form and shape of body parts, to
facial and dental structure,as well as the values placed on endurance, agility,
fertility, and longevity (as indicatorsof strengthand health), vary.
Body decoration is a means through which social self-identities are constructedand expressed (Strathemand Strathem 1971). T. Turnerdeveloped the
conceptof the "social skin" to express the imprintingof social categorieson the
body-self (1980). For Turner,the surfaceof the body representsa "kind of common frontierof society which becomes the symbolic stage upon which the drama
of socialization is enacted" (1980:112). Clothing and other forms of bodily
adornmentbecome the language through which cultural identity is expressed.
Nuditymay serve as sexual advertisementor as display of strengthand vitality, a
public warningto potentialenemies. The Nuba of the Sudan, a people known for
their elaboratebody painting, shun clothing which conceals the body in preference for body paintthat celebratesand exaggeratesthe humanform. Clothing is
reservedfor the old, the infirm, and the deformed(Farris1972).
In our own increasingly"healthist" and body-consciousculture, the politically correctbody for both sexes is the lean, strong, androgenous,and physically
"fit" formthroughwhich the core culturalvalues of autonomy,toughness, competitiveness,youth, and self-controlare readily manifest(Pollitt 1982). Healthis
increasinglyviewed in the United States as an achieved ratherthan an ascribed
status, and each individualis expected to "work hard" at being strong, fit, and
healthy. Conversely, ill healthis no longer viewed as accidental, a mere quirkof
nature,but ratheris attributedto the individual'sfailureto live right, to eat well,
to exercise, etc. We might ask what it is our society "wants" from this kind of
body. DeMause(1984) has speculatedthatthe fitness/toughnesscraze is a reflection of an internationalpreparationfor war. A hardeningand tougheningof the
nationalfiber correspondsto a tougheningof individualbodies. In attitudeand
ideology the self-help and fitness movementsarticulateboth a militaristand a Social Darwinistethos: the fast and fit win; the fat and flabby lose and drop out of
the humanrace (Scheper-Hughesand Stein 1987). Crawford(1980, 1985), however, has suggestedthatthe fitness movementmay reflect, instead, a patheticand
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individualized(also wholly inadequate)defense againstthe threatof nuclearholocaust.
Ratherthan strong and fit, the politically (and economically) correct body
can entailgrotesquedistortionsof humananatomy,includingin varioustimes and
places the bound feet of Chinese women (Daly 1978), the 16-inch waists of antebellumSouthernsocialites (Kunzle 1981), the tuberculinwanness of 19th-centuryRomantics(Sontag 1978), and the anorexicsand bulemics of contemporary
society. Crawford(1985) has interpretedthe eating disordersand distortionsin
body image expressed in obsessional jogging, anorexia, and bulemia as a symbolic mediationof the contradictorydemandsof postindustrialAmericansociety.
The double-bindinginjunctionto be self-controlled,fit, and productiveworkers,
and to be at the same time self-indulgent, pleasure-seekingconsumersis especially destructive to the self-image of the "modern," "liberated" American
woman.Expectedto be fun-lovingandsensual, she mustalso remainthin, lovely,
and self-disciplined. Since one cannot be hedonistic and controlled simultaneously, one can alternatephases of binge eating, drinking, and drugging with
phases of jogging, purging, and vomiting. Out of this cyclical resolutionof the
injunctionto consumeandto conserve is born, accordingto Crawford,the current
epidemicof eating disorders(especially bulemia)among young women, some of
whom literallyeat and diet to death.
Culturesare disciplines thatprovidecodes and social scriptsfor the domesticationof the individualbody in conformityto the needs of the social andpolitical
order.Certainlythe use of physical tortureby the modem stateprovidesthe most
graphicillustrationof the subordinationof the individualbody to the body politic.
Foucault(1979) arguedthat the spectacle of state-mandatedtortureof criminals
and dissidents-brutal, primitive, and utterly public-was compatible with the
political absolutismof the Frenchmonarchy.A more gentle way of punishment
(throughprisons, reformschools, and mental institutions)was more compatible
with republicanismand a "democratization"of power. Tortureaddressedthe
soul throughthe vehicle of the body; contemporarypsychiatry, medicine, and
"corrections"addressthe body throughthe soul and mind of the patientor inmate. Both, however, serve the goal of producing"normal" and "docile" bodies
for the state. Tortureoffers a dramaticlesson to "common folk" of the power of
the political over the individualbody. The history of colonialism contains some
of the most brutalinstances of the political uses of tortureand the "culture of
terror" in the interests of economic hegemony (Taussig 1984; Peters 1985).
Scarrysuggests thattortureis increasinglyresortedto today by unstableregimes
in an attemptto assertthe "incontestablereality" of theircontrolover the populace (1985:27).
The body politic can, of course, exert its control over individualbodies in
less dramaticand mundane, but no less brutal, ways. Foucault's (1973, 1975,
1979, 1980c) analyses of the role of medicine, criminaljustice, psychiatry,and
the varioussocial sciences in producingnew formsof power/knowledgeover bodies areillustrativein this regard.The proliferationof disease categoriesandlabels
in medicine and psychiatry, resulting in ever more restricteddefinitions of the
normal,has createda sick and deviantmajority,a problemthatmedical and psychiatricanthropologistshave been slow to explore. Radical changes in the organizationof social and public life in advanced industrialsocieties, including the
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THE MINDFUL BODY
disappearanceof traditionalculturalidioms for the expression of individualand
collective discontent(such as witchcraft,sorcery,ritualsof reversalandtravesty),
have allowed medicineand psychiatryto assume a hegemonicrole in shapingand
respondingto humandistress. Apartfrom anarchicforms of randomstreet violence andotherforms of directassaultand confrontation,illness somatizationhas
become a dominant metaphorfor expressing individual and social complaint.
Negative and hostile feelings can be shapedand transformedby doctorsand psychiatristsinto symptomsof new diseases such as PMS (premenstrualsyndrome)
or AttentionDeficit Disorder(Martin 1987; Lock 1986a; Lock and Dunk 1987;
Rubinsteinand Brown 1984). In this way such negative social sentimentsas female rage and schoolchildren'sboredomor school phobias (Lock 1986b) can be
recastas individualpathologies and "symptoms" ratherthan as socially significant "signs." This funnelling of diffuse but real complaints into the idiom of
sicknesshas led to the problemof "medicalization" and to the overproductionof
illness in contemporaryadvancedindustrialsocieties. In this process the role of
doctors, social workers,psychiatrists,and criminologistsas agents of social consensusis pivotal. As Hopper(1982) has suggested, the physician(andothersocial
agents)is predisposedto "fail to see the secretindignationof the sick." The medical gaze is, then, a controlling gaze, through which active (although furtive)
formsof protestare transformedinto passive acts of "breakdown."
While the medicalizationof life (and its political and social control functions) is understoodby critical medical social scientists (Freidson 1972; Zola
1972; Roth 1972; Illich 1976; deVries 1982) as a fairly permanentfeatureof industrializedsocieties, few medical anthropologistshave yet explored the immediateeffects of "medicalization"in those areasof the world wherethe process is
occurring for the first time. In the following passage, recorded by Bourdieu
(1977:166), an old Kabyle woman explains what it meant to be sick before and
aftermedicalizationwas a featureof Algerianpeasantlife:
In theold days,folk didn'tknowwhatillnesswas. Theywentto bedandthey
died. It's only nowadays that we're learningwords like liver, lung . . . intestines, stomach . . ., and I don't know what! People only used to know [pain in]
thebelly;that'swhateveryonewhodieddiedof, unlessit was the fever ....
Now everyone's sick, everyone's complaining of something ....
Who's ill
Who'swell?Everyonecomplains,butno one staysin bed;theyall
nowadays?
runto thedoctor.Everyoneknowswhat'swrongwithhimnow.
Ordoes everyone?We would suggest the usefulnessto the body politic of filtering
moreand more humanunrest,dissatisfaction,longing, and protestinto the idiom
of sickness, which can then be safely managedby doctor-agents.
An anthropologyof relationsbetween the body and the body politic inevitably leads to a considerationof the regulationand controlnot only of individuals
but of populations,and thereforeof sexuality, gender, and reproduction-what
Foucault(1980a) refersto as bio-power. Priorto the publicationof Malthus'sAn
Essay on the Principle of Population in 1798, there existed a two-millennia-old
traditionof interpretingthe health, strength,and reproductivevigor of individual
bodies as a sign of the health and well-being of the state (Gallagher 1986:83).
Following Malthus,however, the equationof a healthybody with a healthybody
politic was recast:the unfetteredfertility of individualsbecame a sign of an enfeebled social organism. The power of the state now dependedon the ability to
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controlphysical potency and fertility;"the healthy and, consequentlyreproducing body [became]. . . the harbingerof the disorderedsociety full of starvingbodies" (Gallagher1986:85).
In short,the healthyhumanbody, includingits appetitesanddesires, became
problematizedbeginning in the 19th century, and various disciplines centering
aroundthe controlof human(especially female) sexualityhave come to the fore.
B. Turner(1984:91) suggests that the governmentand regulationof female sexuality involves, at the institutionallevel, a system of patriarchalhouseholds for
controllingfertility;and at the individuallevel, ideologies of personalasceticism.
Thus, late marriage,celibacy, and religious ideologies of sexual puritanismwere
a structuralrequirementof Europeansocieties until the mid-19thcentury(Imhof
1985) and of ruralIrelandthroughthe late 20th century(Scheper-Hughes1979).
Biomedicine has often served the interestsof the state with respect to the
controlof reproduction,sexuality, women, andsexual "deviants." A particularly
poignantillustrationof medicalinterventionin the definitionof genderand sexual
normscomes fromFoucault's(1980b) introductionto the diaryof HerculineBarbin, a 19th-centuryFrenchhermaphrodite.At thattime it was the opinionof medical science in Europethatnatureproducedin humans(unlikeotheranimals)only
two biological sexes. Once discoveredto be sexually ambiguous,Herculinewas
forcedin adulthoodto conformto a medically and legally mandatedsex and gender transformation,based on her "deviant" sexual preferencefor female partners. Althoughfully socializedto a healthypersonalandsocial identityas an adult
female, Herculinewas forced to accept a medical diagnosis of her "true" sex as
male, which resultedin her suicide a few years later.
Emotion: Mediatrix of the Three Bodies
An anthropologyof the body necessarilyentails a theoryof emotions. Emotions affect the way in which the body, illness, and pain are experiencedand are
projectedin images of the well or poorlyfunctioningsocial body andbody politic.
To date, social anthropologistshave tendedto restricttheirinterestin emotions to
occasions when they are formal, public, ritualized,and "distanced," such as the
highly stylized mourningof the Basques (W. Douglas 1969) or the deep play of
a Balinesecock fight(Geertz 1973). The moreprivateand idiosyncraticemotions
and passions of individualshave tendedto be left to psychoanalyticand psychobiological anthropologists, who have reduced them to a discourse on innate
drives, impulses, andinstincts.This division of labor, basedon a false dichotomy
betweenculturalsentimentsand naturalpassions, leads us rightback to the mind/
body, nature/culture,individual/societyepistemological muddle with which we
began this article. We would tend to join with Geertz (1980) in questioning
whetherany expression of human emotion and feeling-whether public or private, individualor collective, whether repressed or explosively expressed-is
ever free of culturalshapingand culturalmeaning. The most extreme statement
of Geertz'sposition, sharedby many of the newerpsychological and medical anthropologists,would be that without culturewe would simply not know how to
feel.
Insofaras emotions entail both feelings and cognitive orientations,public
morality,andculturalideology, we suggest thatthey providean important miss
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THEMINDFULBODY
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ing link" capableof bridgingmind and body, individual, society, and body politic. As Blacking (1977:5) has stated, emotions are the catalyst that transforms
knowledge into humanunderstandingand that brings intensity and commitment
to humanaction. Rosaldo (1984) has recently chargedsocial and psychological
anthropologiststo pay more attentionto the force and intensity of emotions in
motivatinghumanaction.
Certainly, medical anthropologistshave long been concerned with understandingthe power of emotion and feelings in humanlife, and it is time thattheir
specific contributionswere recognized beyond the subdisciplineand the implicationsof theirfindingsbroughtto bearon generaltheoryin the parentdiscipline.
We wouldreferin particularto those phenomenological,ethnopsychological,and
medicalanthropologistswhose stock-in-tradeis the explorationof sickness, madness, pain, depression, disability, and death-human events literally seething
with emotion (e.g., Schieffelin 1976, 1979; M. Rosaldo 1980, 1984; Kleinman
1982, 1986; Lutz 1982, 1985; Levy and Rosaldo 1983; Kleinman and Good
1985).4It is sometimesduringthe experienceof sickness, as in momentsof deep
tranceor sexual transport,thatmind and body, self and otherbecome one. Analyses of these events offer a key to understandingthe mindfulbody, as well as the
self, social body, and body politic.
ElaineScarryclaims to have discoveredin the explorationof pain (especially
pain intentionallyinflictedthroughtorture)a source of humancreativityand destructivenesswhich she refers to as the "making and unmakingof the world"
(1985). Pain destroys, disassembles, deconstructsthe world of the victim. We
would offer that illness, injury, disability, and death likewise deconstructthe
world of the patient by virtue of their seeming randomness, arbitrariness,and
hence their absurdity.Medical anthropologistsare privileged, however, in that
theirdomainincludes not only the unmakingof the world in sickness and death,
but also the remakingof the world in healing, especially duringthose intensely
emotionalandcollective experiencesof trance-dance,sings, andcharismaticfaith
healing.
JohnBlacking(1977) refersto the "waves of fellow-feeling" thatwash over
andbetweenbodies duringritualsinvolving dance, music, movement, andaltered
statesof consciousness.These "proto-rituals"occur, Blackingsuggests, in a special space that is "without language, without symbols," drawing upon experiences and capacitiesthat are species specific. The languageof the body, whether
expressedin gestureor ritualor articulatedin symptomatology(the "language of
the organs") is vastly more ambiguousand overdeterminedthan speech. Blacking's insight is reminiscent of Jean-PaulSartre's observation (1943) that language, insofaras it representsabove all a being-forothers, presupposesa prereflexive relationshipwith otherhumanbeings. We might, perhaps,thinkof those
essentially wordless encountersbetween mother and infant, lover and beloved,
mortallyill patient and healer, in which bodies are offered, unreservedlypresentedto the other, as prototypical.In collective healingritualsthereis a merging,
a communionof mind/body,self/other, individual/groupthat acts in largely nonverbal and even prereflexiveways to "feel" the sick person back to a state of
wellness and wholeness and to remakethe social body.
"Belief kills; belief heals," write Hahn and Kleinman(1983:16), although
they might as accuratelyhave statedit "feelings kill; feelings heal." Their essay
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is partof that traditionin psychiatry,psychosomaticmedicine, and medical anthropologythat seeks to understandhumanevents in that murkyrealm (close to
religionand parapsychology)where the causes of "sudden death" or of "miraculous cure" cannotbe explainedby conventionalbiomedicalscience.5At the one
pole for Hahn and Kleinman is "culturogenic" death involving voodoo, bone
pointing,evil eye, sorcery,fright, "stress," andotherstatesinvolving strongand
pathogenicemotions. These they label "nocebo" effects. At the other, and therapeutic, pole are unexplained cures attributedto faith, suggestion, catharsis,
drama,and ritual. These they label placebo effects. Moerman(1983), reporting
on remarkableimprovementsin coronarybypass surgerypatients (in which the
surgerywas a technical failure), attributescause to the powerfully metaphoric
effects of the operationas a cosmic dramaof deathandrebirth.His analysisstrikes
manychordsof resonancewith previous interpretationsof the "efficacy of symbols" in shamanicand other ethnomedicalcures (e.g., Levi-Strauss 1967; Edgerton 1971; Herrick1983). What is apparentis that nocebo and placebo effects
are integralto all sickness and healing, for they are concepts that refer in an incompleteand oblique way to the interactionsbetween mind and body and among
the threebodies: individual,social, and politic.
Concluding Observations
We would like to thinkof medical anthropologyas providingthe key toward
the developmentof a new epistemologyandmetaphysicsof the mindfulbody and
of the emotional,social, andpolitical sourcesof illness and healing. Clearly, biomedicineis still caught in the clutches of the Cartesiandichotomyand its related
oppositionsof natureandculture,naturalandsupernatural,real andunreal.If and
when we tend to think reductionisticallyabout the mind-body, it is because it is
"good for us to think" in this way. To do otherwise, using a radicallydifferent
metaphysics,would imply the "unmaking"of our own assumptiveworld and its
culture-bounddefinitionsof reality. To admit the "as-ifness" of our ethnoepistemology is to court a Cartesiananxiety-the fear that in the absence of a sure,
objectivefoundationfor knowledge we would fall into the void, into the chaos of
absoluterelativismand subjectivity(see Geertz 1973:28-30).
We would conclude by suggesting that while the condition may be serious,
it is farfromhopeless. Despite the technologicandmechanisticturnthatorthodox
biomedicinehas taken in the past few decades, the time is also one of great ferment and restlessness, with the appearanceof alternativemedical heterodoxies.
And, as Cassell (1986:34) has recentlypointedout, thereis hardlya patienttoday
who does not know that his mind has a powerfuleffect on his body both in sickness andin health. We mightalso add, with referenceto ourcombinedexperience
teachingin medicalschools, thatmost clinical practitionerstodayknow (although
often in a nontheoreticaland intuitiveway) thatmind and body are inseparablein
the experiencesof sickness, suffering, and healing, althoughthey are withoutthe
vocabularyand concepts to address-let alone the tools to probe-this mindful
body (Lock and Dunk 1987).
In our experience, most clinicians today know that back pain is real, even
when no abnormalitiesappearunderthe penetratinggaze of the x-ray machine.
And manyare aware, further,of the social protestthatis often expressedthrough
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31
this medium. Most surgeons know not to operate on a patient who is sure she will
not survive what may be a rather minor surgical procedure. And, while most psychiatrists know that the effectiveness of tricyclic antidepressants has something
to do with their effects on brain transmitters, few believe that chemical abnormalities are the sole causes of depression. Therefore, they invariably explore the
painful life events and difficulties of their patients.
Consequently, physicians are increasingly looking to medical anthropology
and to the other "softer" disciplines of cultural psychiatry, medical sociology,
and psychiatric epidemiology for the answers to the ultimate and persistent existential questions that are not reducible to biological or to material "facts." Why
this person, of all people? Why this particular disease? Why this particular organ
or system? Why this "choice" of symptoms? Why now?
What we have tried to show in these pages is the interaction among the mind/
body and the individual, social, and body politic in the production and expression
of health and illness. Sickness is not just an isolated event, nor an unfortunate
brush with nature. It is a form of communication-the language of the organsthrough which nature, society, and culture speak simultaneously. The individual
body should be seen as the most immediate, the proximate terrain where social
truths and social contradictions are played out, as well as a locus of personal and
social resistance, creativity, and struggle.
NOTES
Acknowledgments.This article is based on a chapterof our forthcomingbook, The
Anthropologyof Affliction:Critical Perspectives on Medical Anthropology(New York:
Free Press). We wish to thankElizabeth Colson, George Foster, Stephen Foster, David
Mandelbaum,Anne M. Lovell, Gail Kligman, Aihwa Ong, Vincent Sarich, and various
anonymousreviewersfor theircareful and criticalreadingsof earlierdrafts.
'See, for example, Bateson and Mead 1942; Hewes 1955; Belo 1960; Hertz
1960[1909]; Merleau-Ponty 1962; Darwin 1965[1872]; Strauss 1966a; Brown 1968;
Schilder 1970[1950]; Hinde 1974; Needham 1973; Davis 1975; Englehardt1975; Blacking, ed. 1977; Daly 1978; Polhemus 1978; Betherat 1979; Bateson 1980; Rieber 1980;
Kunzle 1981; Konner 1982; Johnson 1983.
2MaryDouglas refers to "The Two Bodies," the physical and the social bodies in
NaturalSymbols(1970). MorerecentlyJohnO'Neill has writtena book entitledFive Bodies: TheHumanShape of ModernSociety (1985), in which he discusses the physicalbody,
the communicativebody, the world's body, the social body, the body politic, consumer
bodies, and medical bodies. We admit that this proliferationof bodies had our decidedly
nonquantitativeminds stumpedfor a bit, but the book is nonetheless a provocative and
insightfulwork. We are indebtedto both Douglas and O'Neill but also to BryanTurner's
The Body and Society: Explorationsin Social Theoryfor helping us to define and delimit
the tripartitedomainwe have mappedout here.
3Wedo not wish to suggest that Hippocrates'sunderstandingof the body was analogous to that of Descartes or of modem biomedical practitioners.Hippocrates'sapproach
to medicine and healing can only be describedas organic and holistic. Nonetheless, Hippocrateswas, as the quote from his worksdemonstrates,especially concernedto introduce
elementsof rationalscience (observation,palpation,diagnosis, andprognosis)into clinical
practiceandto discreditall the "irrational"and magical practicesof traditionalfolk healers.
4Thisarticleis not intendedto be a review of the field of medical anthropology.We
wouldreferinterestedreadersto a few excellent reviews of this type: Worsley 1982; Young
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1982; Landy 1983. With particularregardto the ideas expressed in this article, however,
see also Taussig 1980, 1984; Estroff 1981; Good and Good 1981; Nichter 1981; Obeyesekere 1981; Laderman1983, 1984; Comaroff 1985; Devisch 1985; Hahn 1985; Helman
1985;Low 1985.
5Seealso "The SurgeonAs Priest" in Selzer (1974).
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