Book: Unbearable Weight. Feminism, Western Culture, and the Body by Susan Bordo
Lessons from the medicalisation of anorexia
This is a collection of essays written by Susan Bordo in the late 1980s/early 1990s (it was published in 1993) and it’s very ‘of its time’. However, she raises some really interesting points about culture, medicine, power and the body, and while she uses anorexia as her focus point, I believe there are some elements which are easily translatable to the issue of sexuality, in particular ‘female sexual disorders’, which I’m exploring in my research. The four key themes which spoke to me are 1) power, and how it functions in culture and inscribes itself on the body; 2) norms of femininity and a denial of appetites and desires; 3) the medicalisation of ‘women’s problems’; and 4) mind/body dualism and its impact on our relationship with our bodies. I’ll give a brief summary of these elements here, and muse on how I might explore them further.
Power
Bordo discusses power in a Foucauldian sense and I’m planning to discuss his writings in depth in a future post, so I won’t go into too much detail here. However, in a nutshell, Foucault views power not as a ‘top-down’ hierarchical force, not as something individuals or groups ‘have’ innately and exercise over others. Instead, power is something which is sustained by multiple processes of regulation, in all areas of society. So, for example, in relation to the body, we are all subjected to power through the practices and bodily habits of everyday life, and our bodies are a key element in establishing our role within society. Power works upon us through policy and regulation (eg abortion laws) as well as norms (eg beauty standards, or equating ‘femininity’ with ‘docility/domesticity’). Power is distributed through other people who are observing and judging us (‘the gaze’) but we also internalise these norms and reproduce this power upon ourselves self-surveilling and self-correcting to norms.
It’s not just Foucault, of course, Bordo is quick to point out that feminist and social movements since the 60s have also contributed to our awakening consciousness of the body as ‘an instrument of power’. Feminists have long critiqued the public/private divide and the focus and scrutiny placed on women’s bodies. Bordo discusses at length the way beauty standards, and how they are internalised by women, have a direct impact on our freedom, as well as our potential. She also critiques the way patriarchal, post-industrialist capitalist consumer culture creates a world in which women are subjected (and subject themselves) to constant critique, alteration, modification and containment. From corseting to forced sterilisation, compulsory heterosexuality to forced birth, the explicit commodification of women through slavery, right through to plucking, shaving, dieting, surgery, skin tone altering etc etc.
Desire as taboo
This cultural exercising of power upon the body is wrapped up in social expectations of women (in particular) to deny and constrict their appetites. Bordo is primarily focussed on hunger and the impact of norms in bringing about suppression of (literal) appetites in order to take up less space in the world. But she relates this also to sexual appetites, which I’m interested in exploring further in my research.
“the symbolic and practical control of female hunger (read: desire), [is] continually constructed as a problem in patriarchal cultures” p68
Power as reproduced through social norms affects sexual selfhood, how we view ourselves as sexual beings, how we express (or not) our sexual desires. How might I extrapolate this out to my examination of people’s sexual selfhood post-cancer treatment? How does this affect women’s relationships with their bodies after cancer treatment has modified their bodies outside of their control? How do healthcare professionals internalise norms about sexuality and how does this manifest itself in their priorities for patients? (EG insisting on breast reconstruction, or focussing on ‘sexual function’ viewed as restoring reproductive potential rather than taking a broader view of pleasure and sexual selfhood?) How are social norms about women not being overtly sexual (and yet always being sexually available) impacting people’s priorities about their bodies post-treatment? Lots to unpick here, and I’m also interested in what themes are brought up by my research participants themselves.
Another point which Bordo explores, linked to this theme, is around women’s role as feeding and nourishing others rather than themselves, the inherent femininity of self-sacrifice, and the internalised shame many feel about their own needs and appetites. Again, another point to watch out for as I carry out my research.
The medicalisation of ‘women’s problems’
“Since the seventeenth century, science has "owned" the study of the body and its disorders. This proprietorship has required that the body's meanings be utterly transparent and accessible to the qualified specialist (aided by the appropriate methodology and technology) and utterly opaque to the patient herself.” p66
Partly as an extension of the way in which power operates in society, Bordo heavily critiques the medicalisation of women’s bodies. While she focusses again on anorexia, she charts a history from hysteria and agoraphobia through to anorexia and bulimia. By ‘medicalisation’ she is referring to the way these ‘disorders’ are defined and bestowed by medical science on (primarily) women, thus bestowing ‘ownership’ and ‘expertise’ over people’s bodies to the representatives of medical science, or ‘qualified specialists’. For example, Freud enabled psychoanalysis to make decisions about the meaning of ‘hysteria’ as a disorder, creating frameworks for the ‘disorder’ and providing guidance for its diagnosis and treatment, bringing “the hysterical body under the proprietorship of the scientist/analyst”. Bordo’s critique is around the way that medicalisation obscures the role of culture and the way that power is wielded through culture to create norms and divergence from norms.
In the medical model, the body is viewed as a “passive tablet on which disorder is inscribed”. The specialist determines or diagnoses the ‘disorder’ and its causes, and their expertise is required to “unlock the secrets of the disordered body”.
Bordo’s argument is that in a feminist analysis, “the disordered body, like all bodies, is engaged in a process of meaning making, of ‘labor’ of the body”. Rather than disease being the purview of the ‘expert’ few, she cites Joan Brumberg’s conclusion that “disease is a cultural artefact, defined and redefined over time”.
There is huge potential to breakout out from this medical model and see the body as always and necessarily being involved in this process of meaning making, placing it in the realm of culture and non-specialists. Valuing lived experience, for example. Bordo dismisses claims that there is some ‘natural’ body from which we must not deviate, but asserts instead that the body is always “in the grip of cultural practices”. Psychopathologies themselves are in fact “characteristic expressions of [a] culture” rather than “anomalies or aberrations”.
“But women, as study after study has shown, do not feel very good about their bodies. Most women in our culture, then, are ‘disordered" when it comes to issues of self-worth, self-entitlement, self-nourishment, and comfort with their own bodies; eating disorders, far from being ‘bizarre" and anomalous, are utterly continuous with a dominant element of the experience of being female in this culture.” P57
We all know what has happened to ‘hysteria’ as a diagnosis. It had its heyday but is now widely debunked, although one could argue that its ripples are still felt in the medical profession today in the statistically supported facts about women not being listened to in medical contexts. But it is a ‘disorder’ of its time. Could anorexia go the same way?
And for that matter, ‘female sexual disorders’? I can see so many parallels with the medicalisation of sexuality and the way this is used to inscribe norms. Rather than restricting analysis of sexuality to medical science, interpreting sexual ‘dysfunction’ requires “awareness of the many layers of cultural signification that are crystallized in the disorder”, to follow Bordo’s logic. How can we bring culture back into our analysis?
Mind/Body dualism
We have seen this theme come up in previous readings (see In the Body of the World and Hunger) but Bordo explains it really well here, so I will summarise her summary(!). She charts the Cartesian mind/body dualism through time and philosophical thought, focussing in particular on Plato, Augustine and Descartes.
“The body as animal, as appetite, as deceiver, as prison of the soul and confounder of its projects: these are common images within Western philosophy.” P3
Throughout history, this view of the mind and body being separate comes back to the image of the body as “something apart from the true self… and as undermining the best efforts of that self”. The body is depicted in various negative ways, including:
as ‘alien’ - the not-self, the not-me
as ‘confinement and limitation’ - from which the soul/will/mind struggles to escape
as the ‘enemy’ - obscuring thinking, distracting us, tempting us, failing us
as ‘the locus of all that threatens our attempts at control’ - it overtakes, overwhelms, erupts and disrupts
The solution to this posed by many philosophers is to strive to regain control over the body, to enact “mastery over bodily desires that are continually experienced as threatening to overtake the self”. This feeds into the ethics of anti-sexuality and subduing the spontaneities and urges of the body. The ‘soul’ should rule and govern, believes Plato, while the body should serve.
So this was a whistle-stop trip through some of the themes covered in this classic text. While I got a lot from reading this, the book did feel very dated, and there was a distinct lack of the intersectional thinking that is thankfully much more prevalent in feminist writing today. But while mindful of its very white, Western viewpoint and blindspots I did feel it has given me a lot of food for thought, and sparked some useful thinking towards future research.