Introduction to Social Analysis Week 7

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Introduction to Social Analysis Week 7

• Studying Bodies and Dying

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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.

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In what sense and in what way is the body a
cultural construction or merely a biological
mechanism?

• All societies embellish the body with clothes,
  ornament and decoration the way you look
  conveys a message about who you are.
• Giddens suggests - Our bodies are deeply
  affected by our social experiences, as well as by
  the norms and values of the groups to which we
  belong.
• Social change and the body
• Science and Technology
• Consumerism

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Consider body shape

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

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Body shape illustrations

• http//www.ifbb.com/halloffame/1999/CoryEverson2.j
  pg

• http//www.bodybuildingcompetition.com/bodcover.jp
  g

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• http//techcenter.davidson.k12.nc.us/spring5/godde
  ss2/earthmom.jpg

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Anorexia, bulimia, obesity
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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
  1928572).
• 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.

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How society and culture are inscribed on bodies -
gendered and aged bodies?

• Reading
• Fraser, M. and Greco, M. 2005 The Body A reader.
  London Routledge. Introduction. 301.2 Fra
• An introduction to the field providing an
  explanation of why it has become some significant
  within Sociology and the intellectual origins of
  the ideas.

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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?

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Death contrasts with life. Who is alive and who
is dead and how do we know? This boundary is
highly contested and fraught with moral dilemmas.

• Lock M (1996) Death in technological time
  Locating the end of meaningful life Medical
  Anthropology Quarterly 10 (4) 575-600 DEC 1996
• Lock conducted cross cultural studies on the
  changing medical definitions of death looking at
  USA and Japan.
• The medical definition of death has shifted in
  recent history contemporary medical protocols
  for establishing death tend to use a concept of
  brain death. This in the US co-incides with the
  development of transplant technology and the
  electro-encephalograph.
• Lock argues that the Japanese social view of
  death did not accept this definition the first
  Japanese heart transplant surgeon was charged
  with murder.
• 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).

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Death and old age are conceptually related

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

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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.

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

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Modern western societies organise their response
to old age around the concepts of science and
medicine.

• The dominance of Western scientific medicine
  transforms old age from natural event to a
  disease. Old age is no longer experienced from a
  religious perspective - as a divinely ordained
  path through life. Successful old age is not seen
  as it was in the 18th and 19th century as the
  outcome come of a moral life but rather as the
  absence of disease.
• Professional knowledge and expertise with to
  explain and control the status of old age moved
  from pastor and priest to doctor and
  geriatrician. Old Age became an object of
  scientific and rational knowledge controlled by
  experts. It cannot be a subjective experience
  you are not only old as you feel when there is
  a scientifically trained expert waiting to tell
  you basis of your feelings, how false is your
  optimism, your probabilities of survival, and
  which chemical will make it all better.
• Step by step doctors and medical practitioners
  monopolised the treatment of disease within that
  scientific knowledge frame and gave them
  unrivalled social esteem and professional power -
  literally the power of life and death.
• 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.

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Studies

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

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Studies

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

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What kind of life is worth living

• 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. Timmermanss
  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).

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beyond the help of science.

• In terms of the second point, Timmermanss
  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.

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Untimely death

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

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• 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.