The bodies of question – An anthropology of post-surgical complications

By Luke Walker

Nothing is quite as ubiquitous as the body. Over the years, anthropology has dragged the body in all kinds of directions, thus making it a formidable epistemological concern in its own right. Once regarded as an implicit taken for granted feature of social life, the body is now what anthropologists use to rethink the self and society. Nowhere is this more obvious than in theories of embodiment, a lens that is increasingly sharp in theories of phenomenology, and specifically in medical anthropology. By way of an example, Novas and Rose brilliantly describe how advances in predictive and predisposition genetic testing expand the ability to identify someone with their genetic flaw. This identification is not only diagnosed clinically, but increasingly embodied by both carriers of these genes and potential carriers of various genetic conditions.

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Daniel Leighton: ‘Opening up’. Part of the ‘opening up‘ collection

Furthermore, not only does genetic testing introduce a new qualitative dimension into the genetic risk category defined at the cellular level, it also forces the individual to reformulate life strategies as a responsible subject in order to maximise their chances of survival. Using the example of Huntington’s disease, Novas and Rose argue that this “mutation in personhood” extends beyond just them considering their own body, because they are forced to consider the quality of life in the body of their hypothetical future children.

Another recurring theme pops up in these discussions, that of the physical and social implications for pain. Pain is culturally and socially inferred to be an experience of who we are and how we are different. It is visible in the rituals, social movements, or even religion, but anthropologists are often blind to the role of the body. For example, in his study of circumcision rituals in Madagascar among the Malay, Maurice Bloch looks at the role of these rituals for in social integration, ideology, and power. By dealing with circumcision, he is confronted by an explicit act that is performed on the body, by one body to another. However, Bloch bypasses the body altogether by treating it as secondary to culture, as something that plays a minor role in creating the social.  Pain in itself, and the significance of pain, are not discussed. As anthropologists, it is important to treat pain as seriously as other anthropological ubiquities such as kinship and ritual, as it can show us something else related to those cultures.

People’s biosocial experiences in hospital is in need of further exploration. By biosocial experiences I mainly refer, but by no means exclusively to, anomalies and accidents such as phantom limb syndrome, clinical death, and cryptic pregnancies for example. I also talk about organ transplants as a way to underline the significant contributions that have been made to exemplify the case for anthropology to investigate the out of the ordinary in biosocial experiences of the hospital. Physiological injuries and accidents can sustain and advance anthropological theorisation for the body.

A fact of life is that our bodies are fragile and malleable. Advances in biotechnology have excelled in enhancing the capabilities of the body, as Amber Case famously stated that “we are all cyborgs now”. However, we are as of yet unable to immortalise the physical body and make it free from going wrong somehow. Technology and medicines cannot always fix an injury or condition. Sometimes injuries have a permanent affect. When an injury becomes a permanent feature of our bodies – a disability or surgical accident for instance – it can turn our world upside down. People with phantom limb syndrome report sensations in parts of their body long after they are removed for example. Some people that have had a proctocolectomy feel incomplete by their missing colon, while others feel invaded by an alien organ after transplant. Procedures that are performed on the bowel for people with inflammatory bowel disease have an added effect of being performed on someone with an invisible illness. Surgical complications can sometimes induce clinical death, and many experience spiritual encounters and connections. Science can rationalise these as chemical reactions in the brain, but the fact that people have recalled very different experiences begs the question that it is not just a mouthpiece of the biological that is going on when people recall these moments.

As another clinical example, what happens to mothers of cryptic pregnancies, who have to come to terms with the fact that they have not felt this foetus in their womb up until delivery? Having been denied the physical bond that develops during the pregnancy, the biological mother, should she choose to keep the child, has to then make sense of her body and the child’s without the luxury of time. Questions of kinship, motherhood, morality, and somatisation are thrown into the mix as key epistemological modes of inquiry that we can use to understand this conventionally speaking unusual occurrence. Does this woman see herself as a mother with a duty towards this new life that she has birthed into the world? Does the tension and shock that she may feel say something unique about western conceptions of motherhood, in that motherhood requires feeling a biological connection develop and grow before the child is born in order to feel that they are what we understand as being a mother?

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Daniel Leighton: ‘Tied up at the hospital’. Part of the ‘opening up‘ collection

What can be said about these so-called biological peculiarities? There are some lessons that we can learn from a pre-existing anthropological take on kidney donation. However, it is important to bear in mind that kidney donation is not part of a discussion on donation as an exclusive phenomenon of the hospital. Kidney donation creates bio-social ties with another body that has not necessarily been in social contact before. In contemporary society these ties are formed at the intersection of social and cultural customs reacting to the global economy. Nancy Scheper-Hughes in her paper ‘The global traffic in human organsdoes not recognise such a sharp distinction between the biological and the social, and invites us to treat the relationship between the global economy and the individual socio-economic transactions that takes place in organ transplants seriously. Her fieldwork with Lawrence Cohen in countries such as Brazil, India, and South Africa demonstrates that the fact that underground criminal activity is spilling out into commercial domains is reason to believe that ‘gifting organs’ is actually part of a global transformation of the body that commodifies body parts to act as an alternative to capital. Despite the contribution of Scheper-Hughes to this field, this cannot be the only possible explanation for organ donation. Her analysis predominantly deals with people that donate parts of their body to an unknown body, usually through a middle man, but it does not explain why people donate to save someone else’s life. The power of modern medicine has had devastating consequences for people’s organs, and is often the cause for patients to require transplants. There is thus another question to answer. How do we think of transplants and surgery when the need for surgery is often a consequence of pharmaceutical stress or malpractice? These are pressing questions about blame, guilt, and victimhood, all of which have particular dimensions when played out in hospital.

These are in effect speculative questions based on a brief consideration of some pre-existing anthropological theory. The only way that this can be resolved is if anthropology introduces itself as a more visible actor on the frontlines of this largely untapped site. True, that it does raise some practical issues about how to do ethnographic research with people subjected to post-surgical complications that are by definition not intentional. Similarly, there is also the issue of ethics, particularly if highly sensitive and vulnerable people do not wish to be seen, and there are institutional gatekeepers and obstacles that prevent access to such groups. Anthropology has a rich history of encountering these kinds of obstacles, and has often found various solutions to these problems which is testimony to the numerous works that are done on vulnerable and sensitive groups. One approach would be to experiment with autoethnography, as the increases in specific medical conditions have surely affected some anthropologists. In addition, and as a commitment to reciprocity, para-ethnography can offer another solution because it offers a collaboration with the people and groups we are interested in learning from.


Luke Walker is a third year Anthropology and International Development student at the University of Sussex. His interests are in medical anthropology, the body, and biosciences.

The pictures used in this post are part of Daniel Leighton’s ‘Opening up’ gallery. Daniel is an augmented reality artist who combines highly emotive, often personal expressions with digital art techniques. For more examples of his work, you can follow this link: https://www.danielleighton.com/opening-up-gallery/

 

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