6 The Sociology of the Body
SARAH NETTLETON
In Tom Stoppard’s (1967) play Rosencrantz and Guildenstern are Dead, the two central characters lament the precariousness of their lives. Rosencrantz seeks solace in life’s only certainty when he comments that “the only beginning is birth and the only end is death – if we can’t count on that what can we count on?” To this he might have added that he could reliably count on the fact that he had a body. The “fact” that we are born, have a body, and then die is of course something that does seem to be beyond question. It is something that we can hold on to, as we live in a world that appears to be ever more uncertain and ever more risky (Shilling and Mellor 2017).
But is this fact so obvious? Ironically, the more sophisticated our medical, technological, and scientific knowledge of bodies becomes, the more uncertain we are as to what the body actually is. For example, technological innovations can disrupt boundaries between the physical (or seemingly natural) and social body. With the development of assisted conception, when does birth begin? With the development of life-extending technologies, when does the life of a physical body end? With the development of prosthetic technologies, what constitutes a “pure” human? It seems the old certainties around birth, life, and death are becoming increasingly unstable. It is perhaps not surprising, therefore, that attempts to understand the social and ethical significance of the body have become central to sociological debates. Attempts to develop a sociological appreciation of the body important in the subdiscipline of the sociology of health and illness. Health, disease and illness are fundamentally embodied experiences that are embedded in social contexts (Nettleton 2020). How bodies are conceptualized, maintained, monitored and managed is therefore profoundly political and so contentious. The aim of this chapter is to delineate some of the key developments in the sociological theorizing of the body and to assess their significance for a number of substantive issues in medical sociology. To meet this aim, the chapter will first review the main perspectives on the sociology of the body and social theorists who have informed each of these approaches. Second, the chapter will outline the parameters of the sociology of embodiment or perhaps more appropriately an embodied sociology. Concepts which have emerged from these debates such as flexible immunity bodies, body projects, biovalue and virtual bodies will also be discussed. Finally, a number of substantive issues which are central to medical sociology will be considered to highlight the merits of incorporating the body into the analysis of matters associated with health and illness. These issues are: illness and injury, body work, and embodied health inequalities.
SOCIOLOGICAL PERSPECTIVES ON THE SOCIOLOGY OF THE BODY
There is a substantial literature on the sociology of the body which spans a range of perspectives. There are, however, alternative ways in which the body is understood and analyzed, with the most obvious approaches being rooted within the physical sciences and classified as being part of a naturalistic perspective (Shilling 2012). In this chapter, however, we will focus on three main sociological approaches. First, those which draw attention to the social regulation of the body, especially the way in which social institutions regulate, control, monitor, and use bodies. Our bodies are highly politicized. Whilst we might like to think that we own and have control of our own bodies and what we do with and to them, we do not. What we can do with our bodies is constrained by legal diktats and social norms, as is evident in contemporary debates on topics such as euthanasia, organ transplantation, and abortion. Feminist scholars have illustrated ways in which medicine has for centuries controlled the bodies of women (Martin 1989; Mason 2013; Ussher 2006). Regulatory practices further constrain bodies through processes of categorization which can be difficult to resist, a readily obvious example is the imposition of static gender categories often rooted in biological essentialism (Connell 2012). A view that prompts important questions about the ontology of the body.
A second perspective within the sociology of the body focuses on the ontology of the body. A number of theorists have asked the question: What exactly is the body? Their answer is that in late modern societies we seem to have become increasingly uncertain as to what the body actually is. For most sociologists the body is to a greater or lesser extent socially constructed. However, there are a number of variants of this view, with some arguing that the body is simply a fabrication (Armstrong 1983) – an effect of its discursive context – while others maintain that bodies display certain characteristics (e.g. mannerisms, gait, shape) which are influenced by social and cultural factors. Productive conceptual frameworks however recognize the interplay between the biological body and social relations. Reflecting gender for example, and the “gender-biology nexus” Annandale and her colleagues (2018), outline a theoretical framework that takes into account the “gender-shaping of biology” and the “biologic-shaping of gender” seeing these as co-“constitutive shaping processes.” This approach is helpful not least because it moves beyond an ontological impasse but also helps us appreciated how gender inequalities in health operate (Williams and Bendelow 1998).
The third approach pays more attention to the way the body is experienced or lived. Whilst this phenomenological orientation accepts that the body is to some extent socially fashioned, it argues that sociology must take account of what the body, or rather embodied actor, actually does. In this sense it is perhaps more accurately described as a sociology of embodiment or embodied sociology rather than a sociology of the body. This approach to the study of the body has gained much currency, particularly in relation to illness (Carel 2016; Leder 1990). It has to some extent emerged as a result of creative debates within this field of study which have attempted to counter the dominant structural approach that concentrates on the social regulation of bodies. This research, which has outlined the ways in which bodies are socially regulated however, remains crucial for our understanding of the body in society.
Social Regulation of Bodies
In his book Regulating Bodies, Turner (1992) suggests that late modern societies are moving toward what he refers to as a “somatic society;” that is, a social system in which the body constitutes the central field of political and cultural activity. The major concerns of society are becoming less to do with increasing production, as was the case in industrial capitalism, and more to do with the regulation of bodies. Turner (1992: 12–13) writes:
our major political preoccupations are how to regulate the spaces between bodies, to monitor the interfaces between bodies, societies and cultures … We want to close up bodies by promoting safe sex, sex education, free condoms and clean needles. We are concerned about whether the human population of the world can survive global pollution. The somatic society is thus crucially, perhaps critically structured around regulating bodies.
The concerns of the somatic society are also evidenced by the way in which contemporary political movements such as, pro- and anti-abortion campaigns, debates about fertility and infertility, and disabilities coalesce around body matters (Ettorre 2010), as do politics of environmentalism all of which highlight our embodied vulnerabilities (Bulter 2015). Bodies are regulated within society through the institutions of governance notably law, religion, and medicine. The role of religion, law, and medicine is especially evident at the birth and death of bodies. As society became more secularized it also become more medicalized, with medicine now serving a moral as well as a clinical function (Busfield 2017).
Developing an analytical framework which works at two levels – the bodies of individuals and the bodies of populations – Turner (2008) identifies four basic social tasks which are central to social order. We might refer to these as the four “r” s. First, reproduction, which refers to the creation of institutions that govern populations over time to ensure the satisfaction of physical needs, for example the control of sexuality. Second, the need for the regulation of bodies, particularly medical surveillance and the control of crime. Third, restraint, which refers to the inner self and inducements to control desire and passion in the interests of social organization. Fourth, the representation of the body, which refers to its physical presentation on the world’s stage.
Turner’s conceptualization