other”) think of them.
“Reflexive embodiment” refers to the capacity and tendency to perceive, emote about, reflect and act upon one’s own body; to practices of body modification and maintenance; and to “body image.” Reflexivity entails that the object and subject of perception, thought, feeling, desire or action are the same. (Crossley 2006: 1)
This notion is central to the experience of health and illness, not least because so many bodily practices and techniques are associated with the maintenance and reproduction of bodies to ensure good health and to manage illness. Many of these themes and issues have been explored by sociologists who have studied how people experience illness to explore how bodies are “lived;” how bodies are visualized especially in virtual, digitized spaces then colonized by commercial agencies to generate value and how embodiment shaped by socio-political power relations.
THE SOCIOLOGY OF THE BODY: SOME ILLUSTRATIVE ISSUES
Illness and Lived Bodies
The literature on the experience of chronic illness and disability drew attention to many of the themes discussed above prior to the more recent emergence of the body and embodiment literature, most particularly the fundamental link between the self and the body. A number of researchers (Broom et al. 2015; Charmaz 2000) have documented how this occurs in the case of chronic illness. Here the relationship between the body and self can be seriously disrupted. Simon Williams (1996) has illustrated this well by drawing on the findings of research into chronic illness. He demonstrates how the experience of chronic illness involves a move from an “initial” state of embodiment (a state in which the body is taken for granted in the course of everyday life) to an oscillation between states of (dys)embodiment (embodiment in a dysfunctional state) and “re-embodiment.”
Attempts to move from a dys-embodied state to a re-embodied state require a considerable amount of biographical work as a result of what Bury (1982) calls “biographical disruption” and can prompt people to engage in what Gareth Williams (1984) terms “narrative reconstruction.” Disruptions and reconstructions are neither isolated nor linear, for while illness may disrupt a biographical trajectory it is more likely to be a series of “ruptures” without clear beginnings, middles or ends. As Riessman (2015: 1057) puts it: “Illness by its very nature disrupts any pretense of temporal continuity, for it lacks the coherence that permits us to identify linkages between cause and effect, before and after.”
Crucially these notions of biographical disruption and narrative reconstruction should not be understood as purely cognitive or mental processes. Engman (2019) asserts that the analytic purchase of these concepts has been so enduring precisely because of their implicit embodied basis and suggests that this needs to be made more explicit. From her empirical study of 36 post-operative organ transplant recipients she finds the salience of biographical disruption as meaningful feature of the illness experience, depends on the degree to which the participants bodily changes involved a distinctive shift between the “intentions of the body and its capacity to manifest those intensions.” In cases where bodily intentions could not be acted upon, in other words the bodies constrained action this was more likely to trigger the articulation of a biographical disruption, than in cases where bodily changes could be incorporated into day to day lives.
When illness pierces a subject’s embodied orientation towards the world, she loses the foundation on which day-to-day life is built. The inability to perform habitual behaviours that results is, essentially, an inability to utilize all of the accumulated embodied knowledge that previously organized daily life. It is no wonder that this prompts people to re-evaluate the ways that they project themselves into the future – stripped of one’s ability to enact routine behaviours, the future is necessarily uncertain. (Engman 2019: 126)
The materiality of embodiment is therefore salient and helps to collapse dualisms between the body as object and subject both as it is experienced and as it is worked upon.
Body Work
As Twigg and her colleagues (2011) argued book on the body in health and social care, the material body is essential to any adequate analysis of health care in practice.
Body work is work that focuses directly on the bodies of others: assessing, diagnosing, handling, treating, manipulating, and monitoring bodies, that thus become the object of the worker’s labour. It is a component part of a wide range of occupations. It is a central part of healthcare, through the work of doctors, nurses, dentists, hygienists, paramedics and physiotherapists. (Twigg et al. 2011: 171)
Medicine, health, care, and the body are inextricably interlinked. Analyses of, or policies on, health and social care which overlook the messy realities of the body will invariably be wanting. The rationalistic approach which has tended to dominate policy debates, “presents a bleached out, abstract, dry account that takes little cognizance of the messy, swampy, emotional world of the body and its feelings” and Twigg suggests that a focus on the body “promises to bring the world of policy into much closer and direct engagement with its central subject” (Twigg 2006: 173).
In what ways can theorizations on the body and embodiment help us to make sense of health care in practice? There are some excellent qualitative studies of health care work within formal settings that can help us answer this question. Julia Lawton’s (1998) study of care within a hospice is an excellent example. Her ethnographic study sets out to understand why it is that some patients remain within the hospice to die whilst others are more likely to be discharged and sent home to die. To address this health policy puzzle, Lawton argues we need to focus on the body of the dying person. She found that those patients cared for within the hospice were those whose bodies became unbounded. By this she means that the diseases they were suffering from involved a particular type of bodily deterioration and disintegration requiring very specific forms of symptom control, the most common examples being:
incontinence of urine and faeces, uncontrolled vomiting (including faecal vomit), fungating tumours (the rotting away of a tumour site on the surface of the skin) and weeping limbs which resulted from the development of gross oedema in the patient’s legs or arms. (Lawton 1998: 128)
It is these forms of bodily (dys)functions that people living in Western society cannot tolerate rather than the process of dying itself. Indeed, in those cases where the boundedness of their bodies could be reinstated, patients would be discharged. To address the question of why unbounded bodies are unacceptable in Western society, Lawton draws upon much of the sociological theorizing outlined above – especially the work of Douglas and Elias. The unbounded body is perceived symbolically, according to Douglas, as a source of dirt – it is matter out of place. The increasingly “civilized” body, according to Elias, has become “individualized” and private, and the “natural” functions of the body are removed from public view.
The fact that natural or intimate bodily functions are problematic for health care practitioners is also been explored by Lawler (1991), who again draws upon the ideas developed by Elias and Douglas in her study of nursing care in an Australian hospital. Quintessentially, the work of nurses is about caring for bodies. This becomes a problem when nurses have to attend to those bodily functions (defecating, grooming, etc.) which in a “civilized” society have become taboo. Consequently, nurses have to learn how to negotiate social boundaries and create new contexts so that both the patient and the nurse can avoid feelings of shame and embarrassment. There is a further fascinating finding highlighted in Lawton’s study, and this relates to the link that we have discussed above between the notion of self and physical body. The two are meshed together. Lawton’s work demonstrates that even where there is a “competent” mind, the lack of bodily controls (Nettleton and Watson 1998: 14–17) affects a person’s capacity to continue with their life projects or their reflexive self. In fact, patients who had the least control over their bodily functions exhibited behavior which suggested
