Introduction to Social Analysis Week 7

1. Introduction to Social AnalysisWeek 7 Studying Bodies and Dying

2. How to study bodies? • In what sense and in what way is the body a cultural construction or merely a biological mechanism? • How are society and culture are inscribed on bodies - gendered and aged bodies? • The limits of social constructionism -– death and dying as cultural products.

3. In what sense and in what way is the body a cultural construction or merely a biological mechanism? • All societies embellish the body with clothes, ornament and decoration – the way you look conveys a message about who you are. • Giddens suggests - “Our bodies are deeply affected by our social experiences, as well as by the norms and values of the groups to which we belong.” • Social change and the body • Science and Technology • Consumerism

4. Consider body shape: • Height, genetic and social component. The average height in US /UK gone up systematically for a century. Nutritional change • Body mass, rise in obesity, rise in eating disorders (anorexia, bulimia) • Aesthetic considerations, fashionable or desirable body • Manipulation of body shape through surgery, exercise.

5. http://www.bodybuildingcompetition.com/bodcover.jpg http://www.ifbb.com/halloffame/1999/CoryEverson2.jpg Body shape illustrations

6. http://techcenter.davidson.k12.nc.us/spring5/goddess2/earthmom.jpghttp://techcenter.davidson.k12.nc.us/spring5/goddess2/earthmom.jpg

8. Anorexia, bulimia, obesity

9. Reality of social constructions • It is a false distinction to contrast social construction as merely the products of a cultural imagination as opposed to scientific facts which represent the truth about nature. • There are more fundamental epistemological issues at stake about how it is possible to have knowledge of nature and it is clearly not possible to have a knowledge tradition which stands outside of society. Thus social constructions are ‘real’ in at least two senses. • There is one sense which is pithily put by Thomas that “if men define situations as real, they are real in their consequences” (Thomas and Thomas 1928:572). • There is also a further sense in which natural phenomena are social constructions as they cannot be communicated, discussed and understood without a social basis of ‘cultural’ concepts held in common. It may be that the natural world cannot even be thought about without the social precursor of language. • Cultural concepts and language with which knowledge is expressed are produced in historical and continuous processes in which the social and the natural environment are critical components. These resources for understanding the world are not independent of the social and natural environment. The social environment includes beliefs about reality, and the natural environment regularly forces itself into our lives in unanticipated ways. If an inexplicable or unforeseen natural event is manifest then, if it is too novel to fit the existing cultural schema, new concepts and language are developed to cope with it. Science of course does this routinely all the time.

10. How society and culture are inscribed on bodies - gendered and aged bodies? • Reading: • Fraser, M. and Greco, M. 2005 The Body: A reader. London: Routledge. Introduction. 301.2 Fra • An introduction to the field providing an explanation of why it has become some significant within Sociology and the intellectual origins of the ideas.

12. The limits of social constructionism -– death and ageing as cultural products. • social constructionist approaches to the study of old age reveals that ageing not simply a matter of biological determinism, there are important social processes independent of any physiological changes as the body ages. • But what are the limits to social constructionism? Surely death and the frailties of the fourth age are not social constructions? • Cross cultural anthropology of ageing enables us to see that different cultures approach ageing and death in very different ways. There are many myths and stories told, and rituals re-enacted through which through notions of resurrection, transformation, re-incarnation and others at some level defeat death. But every one dies. • Similarly, despite the ubiquity of nostrums about delaying ageing from green tea to exercise regimes, experience tells us that everyone ages. • Is the natural world, and in particular the human body a procrustean bed on which social constructionism must lie?

13. Death contrasts with life. Who is alive and who is dead and how do we know? This boundary is highly contested and fraught with moral dilemmas. • Lock M (1996) “Deathin technological time: Locating the end of meaningful life” Medical Anthropology Quarterly 10 (4): 575-600 DEC 1996 • Lock conducted cross cultural studies on the changing medical definitions of death looking at USA and Japan. • The medical definition of death has shifted in recent history – contemporary medical protocols for establishing death tend to use a concept of brain death. This in the US co-incides with the development of transplant technology and the electro-encephalograph. • Lock argues that the Japanese social view of death did not accept this definition – the first Japanese heart transplant surgeon was charged with murder. • For us death has ceased to be a ‘natural’ event. If people die of something it must be something that science can, at least potentially, understand and control • There are a number of social constructionist accounts of death; classically Glaser and Straus (1965), and Sudnow (1967) plus more recent studies of death as practiced in hospital intensive care units (Timmermans, 1998 Seymour, 2000).

14. Death and old age are conceptually related • Mortality comes with sexual reproduction, simple single cell creatures simply divide. For ‘higher’ animals old age takes its place in developmental cycles alongside conception, birth and maturity. Thus of humans death is the boundary marker for the cessation of old age and important part of its meaning. • The medical definition of death is clearly a social construction and has been subject to cultural and technical change. We can ask, who, within what frame of reference, and for what purpose, is death being defined? • Thus cultural variations in the precise time and mode in which old age is concluded, can be studied and the significance for old age drawn out.

15. Social construction of old age • In understanding the frameworks of meaning which make up cultures it is important to study the transitions - the practices, symbols and rituals - which mark inclusion in and removal from social categories, including life stages. • Just as in the modern West the transition out of childhood associated with sexual maturity and legal and moral responsibility marks childhood as a period of innocence [think of the symbols associated with the ‘key of the door’ – coming of age rituals], so the meaning attributed to death marks old age with distinctive characteristics. There are various models of the life course, but they all end in old age. • Social constructionist approaches to old age have concentrated on the transition to old age, and examined the markers and social processes by which old age is distinguished from middle age. Historical work has identified the ways in which the establishment of retirement as an institution is linked with the idea of old age as a post-work phase of life and set chronological markers at age 60 or 65.

16. Old age has always ended in death but death has not in the past been the exclusive domain of the old. Demographic changes have meant that old age has become more and more associated with death. • As people live their full span with more and more certainty, and no longer live with death as an immediate and imminent possibility in the way that our ancestors did, old age and death become culturally linked in new ways. • We may still die by act of God [that is accident of some kind] or at the hands of our fellow man or through disease or illness before we are thought to be old but this is increasingly unlikely.[ caveat about war / global catastrophe cf risk society]

17. Modern western societies organise their response to old age around the concepts of science and medicine. • The dominance of Western scientific medicine transforms old age from natural event to a disease. Old age is no longer experienced from a religious perspective - as a divinely ordained path through life. Successful old age is not seen as it was in the 18th and 19th century as the outcome come of a moral life but rather as the absence of disease. • Professional knowledge and expertise with to explain and control the status of old age moved from pastor and priest to doctor and geriatrician. Old Age became an object of scientific and rational knowledge controlled by experts. It cannot be a subjective experience – you are not only old as you feel – when there is a scientifically trained expert waiting to tell you basis of your feelings, how false is your optimism, your probabilities of survival, and which chemical will make it all better. • Step by step doctors and medical practitioners monopolised the treatment of disease within that “scientific” knowledge frame and gave them unrivalled social esteem and professional power - literally the power of life and death. • Old age then ceases to be a social position and status within society, it becomes primarily a process of physical decline because that is what can be scientifically studied and to which we believe science will find solutions. • In the modern world, embedded in the belief in progressive science is the implication that it will provide the solution for death. Scientists claim to have the techniques for increasing longevity, if not exactly now, at least the potential for the future. Scientific medicine acts as if it should have and eventually will find the cure for death. For the medical technician every death represents a failure.

18. Studies: • Sudnow, David (1967) Passing On: The Social Organization of Dying. London: Prentice-Hall International.* • US study of death in hospitals. Coined the term social death. Demonstrated that people died social before they were physical dead, and similarly could be physically dead but socially alive. • Also demonstrated that the social stratification in life also stratified death.

19. Studies • Timmermans, Stefan 1998 “Social Death as Self-fulfilling Prophecy: David Sundow’s Passing On Revisited”. The Sociological Quarterly 39(3) pp.453-472. • An American study by Timmermans takes Sudnow's description of how the presumed social value of patients affected the performance of hospital staff in attempts to revive them. • Seymour, Jane Elizabeth (2000) “Negotiating natural death in intensive care”. Social Science & Medicine 21(8):1241-1252. • Seymour (2000) explains how medical staff in intensive care settings have to deal with the social expectations of scientific infallibility.

20. What kind of life is worth living • Since that 1960s study health care has undergone dramatic changes and Timmermans examines whether the social rationing described by Sudnow is still prevalent. The study was based on observation of 112 resuscitative efforts and interviews with forty-two health care workers. Timmermans’s pessimistic conclusion is that the recent changes in the health care system did not weaken but instead fostered social inequality in death and dying. He argues, firstly that the cultural evaluation of old age adversely affects the way older people get treated in a medical context and secondly that the domination of medical knowledge limits the possibility of a ‘good death’. • With respect to the first issue, that of cultural evaluation of the old, Timmermans links older people with the disabled and says: - • “Unfortunately, the attitudes of the emergency staff reflect and perpetuate those of a society generally not equipped culturally or structurally to accept the elderly or people with disabilities as people whose lives are valued and valuable (Mulkay and Ernst 1991)... The staff has internalized beliefs about the presumed low worth of elderly and disabled people to the extent that more the 80 percent would rather be dead than live with a severe neurological disability. As gatekeepers between life and death, they have the opportunity to execute explicitly the pervasive but more subtle moral code of the wider society. ...medical interventions such as genetic counselling, euthanasia and resuscitative efforts represent the sites of contention in the disability and elderly rights movements (Fine and Asch 1988, Schneider 1993)”.

21. ‘beyond the help of science’. • In terms of the second point, Timmermans’s studies lead him to conclude that the medicalisation of death creates a number of serious problems, including precluding an examination of the possibilities of other ways to die and to bring old age to a close. Aggressive attempts at resuscitation in emergency departments and relationships with the patients’ relatives are structured around a belief in the technical omnipotence of medicine. It is necessary to follow procedures that are intrusive and unnecessary in order to demonstrate officially that the patient was ‘beyond the help of science’. • “the prolonged resuscitation of anyone – including irreversibly dead people- in our emergency systems perpetuates a far-reaching medicalization of the dying process (Conrad 1992). Deceased people are presented more as “not resuscitated” than as having died a sudden, natural death. The resuscitative motions render death literally invisible (Star 1991); the patient and staff are in the resuscitation room while relatives and friends wait in a counselling room. The irony of the resuscitative set-up is that nobody seems to benefit from continuing to resuscitate patients who are irreversibly dead. As some staff members commented, the main benefit of the current configuration is that it takes a little of the abruptness of sudden death away for relatives and friends. I doubt, though, that the “front” of a resuscitative effort is the best way to prepare people for sudden death.... Relatives and friends are separated from the dying process and miss the opportunity to say goodbye when it could really matter to them, that is when there is still a chance that their loved one is listening”.

22. Untimely death • Research by Jane Seymour within a British context points to significant similarities in the management of traumatic death. In particular, comparison of the two studies show how the medical, bureaucratic and legal frameworks in each country set contexts for death practices. Seymour like Timmermans is able to make the link between the practices in hospitals by which medical staff deal with death and the cultural problems caused by the medicalisation of death. The belief in the power of science to solve the specific causes of death in particular patients is a reflection of the dominance of medical institutions to define death and thus old age. • “Intensive care reflects the modern preoccupation with the mastery of disease and the eradication of ‘untimely death’. It is the place to which clinicians may refer a patient when that individual stands at the brink of death and is beyond the reach of conventional therapies. Unravelling the nature of complex disease and predicting its outcome is complicated by the lack of previous familiarity between health care staff and the patient, by the unconscious state of the ill person (Muller and Koenig 1988), and by the advanced technical abilities of modern medicine to blur the boundaries between living and dying”.

23. Social constructionist perspectives are relevant to old age and death as modern society are busy changing the fundamentals of the meaning and definition of both conditions.