Soc. Sci. Med. Vol. 45, No. 7, pp.

1041-1049, 1997

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M O D E R N M E D I C I N E A N D THE " U N C E R T A I N BODY":

F R O M C O R P O R E A L I T Y TO H Y P E R R E A L I T Y ?
SIMON J. WILLIAMS
Department of Sociology, University of Warwick, Coventry CV4 7AL, England, U.K.
A~tract--This paper (re)considers the role of medical technology at three interrelated levels: first, the
extent to which medical technology renders our bodies increasingly "uncertain" at the turn of the century; second, the analytical purchase which the notion of the (medical) cyborg provides regarding contemporary forms of human embodiment; and finally, at a broader level, the issues this raises in relation
to a (late) modernist or postmodernist reading of contemporary medical practice. Key themes here
include the plastic body, the bionic body, communal/interchangeable bodies, (genetically) engineered/
chosen bodies, and virtual bodies. The paper concludes with a critical appraisal of these themes and
issues, arguing for a late modernist position on medical technology as both a positive and negative
rationalising force, and a "life political agenda" in which the "all-too-human" quality of human nature
is seen as inviolable. 1997 Elsevier Science Ltd
Key words--medicine, (late) modernity, technology, body, cyborg, plastic surgery, genetics, virtual rea-

lity, postmodernism

INTRODUCTION
As we approach the turn of the 21st Century, few
would disagree with the assertion that we live in an
increasingly "mediated" and "contested" age. Here,
late modernist readings of contemporary social life
as a reflexive order--one in which the consequences
of modernity are only now becoming fully realised
and the self remains a pertinent theme--vie with
postmodern critiques of reason and truth, the universalising claims of logocentric metanarratives, and
progressive (linear) notions of history, science and
technology. As a potent metaphor of society, the
body too becomes a contested site upon which
these broader dramas of contemporary social theory
are played out. In particular, the recent upsurge of
interest in body matters within the academy, the
growth of social reflexivity, the postmodern attack
on the disembodied Cartesian rational actor, and
the proliferation of new technologies designed to
control, (re)shape, and mediate our corporeal relations with others, have all meant that our sense of
what precisely the body is and what it might
become is increasingly uncertain. The body, in
short, has become a "project", one which is reflexively open to control amidst a puzzling diversity of
imperatives, choices and options. This, in turn, sets
up something of a paradox, namely: the more control we have over our bodies, the less certain they
become (Shilling, 1993).
Alongside the vicissitudes of the body and selfidentity in consumer culture, a key issue here has
been the advent of the so-called "cyborg". As
Haraway (1991) argues, hypothetically and materially, the cyborg is a "hybrid" of cybernetic device

and organism; a "scientific chimera", but also a

social and scientific reality in the contemporary era;
a "myth and a tool", "representation and an instrument". More precisely, cyborgs exist when two
types of boundaries are simultaneously breached:
that between animals (or other organisms) and
humans, and that between self-governing machines
(automatons) and organisms, especially humans as
models of autonomy. The "cyborg" is a "leaky"
figure born of the "interface" between "automaton"
and "autonomy", nature and culture, masculinity
and femininity, Self and Other, rendering these divisions indeterminate and thus offering the potential
to escape from their oppressive confines (Haraway,
1991).
Whilst this may sound wild and fanciful, it is
clear that the "cyborg", "posthuman", or "transhuman" is not just a creature of science fiction, television or film. Rather, as Gray argues, there are
already many "cyborgs" among us in society, from
fighter-bomber pilots in state-of-the-art cockpits to
our grandmother with a pacemaker (Gray, 1995,
pp. 2-3). Given this broad range, "cyborgs" are
perhaps best conceptualised on a continuum with
the human organism at one end (i.e. the "all-human
pole") and the pure machine (automaton) or artificial intelligence (AI) device at the other
(Featherstone and Burrows, 1995, pp. 11-12).
Within all this, it is clear that developments in
biomedical science, from cosmetic surgery to genetic
engineering, and advancements in nanotechnology,
have played a central role (Featherstone and
Burrows, 1995, p. 3), leading some to contemplate
that the next generation may well be the last of

1041

1042

Simon J. Williams

"pure" humans (Deitch, 1992). Indeed, even the

"quickest tour" of the human body, from head to
toes, reveals the great variety of ways in which
medicine can turn humans into "cyborgs"--from
restorative or normalising, to reconfiguring or enhancing technologies (Gray, 1995, p. 3).
At a broader level, it is also clear, in an increasingly reflexive age (Giddens, 1991), that considerable ambivalence surrounds the public perception
and lay evaluation of (medical) science and technology. On the one hand, perhaps more so now than
ever before, people look to medicine for a solution
to their ills, from hip replacements to organ transplants. On the other hand, these (overinflated) expectations, coupled with increasing awareness of the
risks of iatrogenic medicine and the benefits of holistic therapies, mean that medicine is, at one and
the same time, a fountain of hope and font of despair. These tensions and dilemmas have received an
added spur with the advent of the new genetics.
Here the Frankensteinian nightmare of "science
gone mad", juxtaposed with media reportage of the
"miracles" of the new reproductive technologies in
bringing hope to previously infertile couples, makes
for a heady brew of awe and scepticism at the turn
of the century (Williams and Calnan, 1996a,b).
This, in turn, suggests that it is time to take stock
and to (re)consider the role of medical technology
at three interrelated levels. First, the extent to
which medical technology renders our bodies
increasingly "uncertain" at the turn of the century;
second, the analytical purchase which this notion of
the (medical) cyborg has in terms of contemporary
forms of human embodiment in a technologically
mediated age; and finally, at a broader level, the
issues which this raises in relation to a late modern
or postmodern reading of contempoary medical
practice. As this paper shall argue, whilst postmodern interpretations of these developments are
indeed possible, medicine is still in fact, first and
foremost, a modernist enterprise, steeped in a scientific tradition in which truth, order and progress are
seen as paramount virtues. Seen in this light, current developments in medical technology represent
a further extension of modernist imperatives centred
on rational control and the domination of "nature"
[i.e. the "socialising of biological mechanisms"
through "~internally referential" systems of social
control (Giddens, 1991)]. This, in turn, raises
broader issues concerning the social "costs" and
"'benefits" of these new technologies, and the ethical
basis upon which to judge them. Clearly these are
complex issues, and they shall be returned to later
in the course of the paper. For the moment, however, it is to the first main theme of the paper,
namely the "re-forming" of the body in high technology medicine, that we now turn.

" R E - F O R M I N G " T H E BODY IN HIGH T E C H N O L O G Y

MEDICINE?

As suggested above, whilst current developments

in medical technology offer us unprecedented control over our bodies, they also lead to a growing
crisis of identity concerning what precisely the body
is and what it might become. It is here that the
"leaky" (postmodern) figure of the cyborg can be
seen to render previous forms of human embodiment problematic. In particular, we can see this
process occurring at a number of different levels
within the technological clinic or "transhuman
bodyshop" of late 20th Century medicine.

Plastic bodies
First, advances in medical science and technology
have meant that bodies are becoming increasingly
plastic (i.e. able to be moulded at will).
Technologies of cosmetic surgery, for example, have
greatly expanded the limits of how the body may be
restyled, reshaped and rebuilt (Davis, 1994).
Amongst the rapidly growing array of technologies
on offer are facelifts, rhinoplasties (nose contouring), otoplasty (ear surgery), eyelid corrections, lip
enlargements, chemical peeling and dermabrasion,
breasts correction (mastopexy, reduction, augmentation), the stripping of varicose veins, fat removal,
body contouring (liposuction or suction lipectomy)
and penile enlargement. In these "body sculpting
clinics" flesh is either added or taken away, wrinkles disappear, breast become inflated or deflated,
and body shape is transformed (Davis, 1994). As a
consequence, notwithstanding frequent complic a t i o n s - f r o m scarring, bleeding, secondary infections and skin discolouration to nerve damage, loss
of sensation and impaired motor ability (Glassner,
1995, p. 170)--the constant (re)makeability of the
human body and the power of medical technology
are visually sustained in each "'exhibit" (Balsamo,
1995a,b, 1992).
As Glassner observes, within consumer culture,
"professional body remakers'" function like "surrogate psychiatrists": we literally expect them to make
us into "some body new" (Glassner, 1995, p. 161).
Indeed, the extension of plastic surgery into the
realm of body improvement has led to a "veritable
boom" in cosmetic surgery as a kind of aesthetic
technological "fix" (Clarke, 1995, p. 147). For
example, the number of cosmetic surgery operations
performed in the U.S. doubled between 1981 and
1987. Today, some 600,000 operations are performed annually in the U.S. to make people look
younger or more beautiful, with women making up
the vast majority and a growing male market. Men,
for example, account for a quarter of all nose jobs
(rhinoplasties) and one fifth of eyelid surgery (blepharoplasties). Given our tendency to "'confuse
beauty with health", cosmetic surgery stands a
good chance of winning widespread public accep-

Modern medicine and the "uncertain body"

tance over the next few decades (Glassner, 1995,
pp. 168--170).
Not only does plastic surgery throw into critical
relief the commodified nature of the body in consumer culture, it also indicates the extreme lengths to
which individuals will go in order to mould and
shape their bodies in line with people's self-identities and the prevailing cultural mandates of beauty.
As Glassner states:
Bodies themselves have become objects to be sold in
American society. Surgeons sell not just corrections to the
body.., but something far more transitory, ,fashions. They
alter the size and shape or our buttocks, breasts, noses, or
eyes to fit current styles... No longer can we merely dress
up the body we happen to have, or improve it by losing
weight or having a beauty makeover or straightening out
the curve in our nose. We actually purchase a "new body"
(Glassner, 1995, p. 175).
Viewed within this context, cosmetic surgery is
best seen as "dilemmatic"; both a symptom and a
solution, oppression and liberation all at once.
Something which paradoxically enables women to
feel "embodied subjects" rather than "objectified
bodies" (Davis, 1994, p. 161).
The story of ~'plastic" bodies does not, however,
end here. Rather, recent advances in medical technology are also now busy spinning plastic into tissue. Using biodegradable plastic seeded with cells,
computer-aided "scaffolding" has been constructed
to provide a template for the formation of new tissue. As the cells divide, this plastic structure is covered and eventually degrades, leaving only tissue
ready for implantation in the patient. This
approach has already been demonstrated on animals, and during the past few years, human skin
grown on polymer substrates has been grafted onto
burn patients and the foot ulcers of diabetics, with
some success (Langer and Vacanti, 1995).
Eventually, complex body parts, such as hands and
arms will be produced through these forms of tissue
engineering. Indeed, the structure of these parts can
already be duplicated in polymer scaffolds using
computer-aided contouring, and most of the relevant tissue types (e.g. muscle, bone, cartilage, tendons, ligaments and skin) can readily grow in
culture. Seen in these terms, whilst the engineering
of artificial tissue and organs is a logical next step
in the treatment of injury and disease, this time the
"engineers will be the body's own cells" (Langer
and Vacanti, 1995, p. 100).

Bionic~interchangeable bodies
Moving from its surface to its interior, the body
also becomes increasingly bionic with cardiac pacemakers, valves, titanium hips, polymer blood
vessels, electronic eye and ear implants and even
polyurethane hearts (Synnott, 1993). Closely allied
to this, bodies are also becoming increasingly communal/interchangeable through developments such

1043

as organ donation and transplantation surgery

(Synnott, 1993).
As Hogle notes, body parts are becoming increasingly "widget" like (i.e. standardised items to be
replaced as needed on demand). In particular, the
organisation, procurement and delivery of human
organs has been transformed from an altruist
patient-centred enterprise to an increasingly international "for-profit" market-based industry. As the
production of human organs and tissues becomes
ever more routinised, parallel processes have developed to create; '"product specific' handling, marketing and even accounting systems" (Hogle, 1995, p.
209). Technical developments are therefore increasingly centred on "presentation" of the materials for
transplant (i.e. fast acting liquids for freezing the
contents of the entire peritoneal cavity). Whilst previously the term "presentation" referred to the storage of materials after explantation and during
transplant to the end user:
Now...presentation begins much earlier; within the body
itself. Recognising the considerable market potential of the
human materials industry, pharmaceutical and medical
supply companies have developed new products and entire
new industries designed specifically for use in donor cadavers. These include free-oxygen scavengers, "hibernation
hormones", new perfusion and preservation fluids, and
other chemicals to preserve tissue integrity before being
removed, and to make the materials more "immunologically silent" to prevent problems later when they are
replaced inside another body. In essence, the human materials are being structurally, chemically and functionally
transformed to make them more universal. In this way,
they become not only substitutable mechanical parts, but
more like off-the-shelfreagents, available for use in a variety of end-users (Hogle, 1995, p. 208).
Through these "core technologies", cadavers are
being transformed into what Hogle terms "donor
cyborgs" as the physical body is "reprogrammed"
and "retooled" for new uses. When the donor
cyborg reaches its almost-total-technology state its
parts are dispersed and distributed throughout the
"communal body" to innumerable others. In this
way, transplanted human body parts become the
"seeds" that reproduce and replicate other new
"cyborgs" (Hogle, 1995, p. 207).
Not only are bodily organs interchangeable at the
human to human level, they also now cross species
boundaries, as in xenotransplantation--the use of
animal organs for transplant surgery. To be sure
this raises a number of ethical dilemmas, issues
made all the more pressing with the announcement
in late 1995 of a new development enabling scientists to produce a customised pig whose organs
would be less likely to induce fatal rejection in the
human recipient. The company involved, Imutran,
reported the creation of "Astrid", the first of these
pigs, which was duly given much media attention.
Such developments, along with the creation of
other "transgenic" animals (i.e. animals carrying
genes from another species), and the use of animals
in tissue engineering (i.e. the "mouse with the

1044

Simon J. Williams

human e a r ' ) - - a n o t h e r issue given considerable

media coverage in early 1996--pose many moral,
social and cultural questions about individual and
species bodies, and the constitution of the "natural".
In particular, this again raises, in acute form,
thorny questions about the meaning(s) of corporeality, self identity and the nature of death. If the pig,
for example, is seen as a ritually "unclean" animal,
one involving "matter out of place" and the "transgression" of cultural boundaries (Douglas, 1966),
then how do we see ourselves with an animal heart
inside us, and how does this square with, say,
orthodox Jewish beliefs, or those of a vegetarian or
anti-vivisectionist? Does the body become degraded,
defiled or debased in some way as a consequence,
and if so, what implications does this "grotesque"
body have for our sense of who and what we are?
As Joralemon (1995) argues, transplantation challenges traditional views of body/self integrity by distinguishing between the brain and other, more
replaceable, body parts which, in turn, simultaneously reinforces a traditional Cartesian split
between body and mind. Organ transplantation
thus poses many questions about self-identity.
Cultural beliefs about selfhood may, moreover, conflict with medical images of body parts. Sharp's
(Sharp, 1995) study of how patients undergo some
degree of restructuring of their sense of self after
transplant surgery stresses the disjunction between
the need to personalise and the need to objectify
bodies and organs. Medical personnel put great
stress on objectification; the heart, for example, is
"only a pump". Yet recipients experience conflict
between this mechanistic/reductioinist view of the
body and their wider cultural beliefs about the
embodied nature of self identity and the "sacred"
nature of the heart as the very core of the person.
As suggested earlier, one of the greatest problems
with transplant surgery has been the issue of "rejection". Certainly, immunology can be seen as an important "barrier" which is "limiting" many of these
technologies at present, and it is in this area that
advances can be expected over the next few deca d e s - - a development which, in turn, links up with
the advent of "psychoneuroimmunology" as a new
model within medical science and technology (Levin
and Solomon, 1990). More generally, as Langer and
Vacanti (1995) suggest, medical science, over the
next few decades, will move beyond the practice of
transplantation surgery altogether and into the era
of fabrication; the ultimate goal being to manufacture organs rather than simply move them, and to
produce, through genetic engineering, universal
donor cells (i.e. cells that do not provoke rejection
by the immune system) for use in these engineered
tissues. Here we return to the previous theme of
"plastic" bodies (i.e. the "spinning of plastic into
tissue" and the "mouse with the human ear"). In
addition, we also anticipate the next issue of geneti-

cally engineered bodies

"designer" babies.

and

the

prospect

of

Geneticafly engineered bodies/"designer" babies

As suggested above, developments in modern
medical technology mean that the body becomes
increasingly engineered through new forms of gene
therapy, and even chosen or selected from a growing number of ovum and sperm banks (Synnott,
1993, pp. 34-35). As Anderson (1995) notes, over
the course of medical history there have been three
great leaps in our ability to treat and prevent disease. First, the implementation of public health
measures; second, the introduction of surgery with
anaesthesia; and third, the use of vaccines and antibiotics. Gene therapy, at the turn of the 21st
Century, represents the "fourth great leap". Whilst
todays understanding of the precise genetic bases
for many diseases is sketchy, knowledge will
increase enormously in the next few decades. By the
year 2000, for example, scientists working on the
Human Genome project should have determined
the chromosomal location of, and deciphered parts
of the DNA code in, more than 99% of active
human genes. Similarly, research aimed at uncovering the function of each gene is progressing rapidly.
Such information should make it possible to identify the genes which malfunction in various diseases
(Anderson, 1995, pp. 97-98).
These issues, in turn, suggest a veritable cornucopia of ethical qualms and moral dilemmas. Will
developments in screening technologies, for
instance, lead to recruitment policies involving rigorous genetic testing for "markers" of future disease before acceptance onto the company books?
Would this be legally admissible, and if so, what
are our chances of finding employment in a future
"'genetically discriminatory" labour market? Taking
this argument one step further, would these
"'defects" be screened out before birth, and if so,
where exactly would the process end?
For the next decade, gene therapy is most likely
to be confined to somatic cells (i.e. all cell types
except sperm, eggs and their precursors). Alteration
of these cells only affects the patient undergoing
treatment, as opposed to reproductive, or germ
cells, which would affect all descendants of the original patient. Existing approaches to somatic cell
gene therapy include several different techniques,
including ex vivo ("outside the living body")
therapy, and in situ ("in position") therapy, currently used for the treatment of cystic fibrosis. A
third form of treatment is hi vivo ("in the living
body") therapy (Anderson, 1995). Although still at
the experimental stage, this constitutes a promising
line of future development in gene therapy. Here
physicians will simply inject corrective gene carriers
into the bloodstream of the patient in much the
same way as many drugs are administered now
(Anderson, 1995, pp. 98--98B).

Modern medicine and the "uncertain body"

These forms of gene therapy, in turn, key into
broader debates concerning the new reproductive
technologies. As Clarke (1995) argues, in contrast
to "modern" approaches to reproduction--techniques which centred on achieving and/or enhancing control over bodies and reproductive processes
for a variety of purposes via monitoring, planning,
limiting, bounding and the setting up of boundaries--postmodern strategies, centred around these
so-called new reproductive technologies, concentrate
instead upon the "re/design" and transformation of
reproductive bodies and processes to achieve a variety of goals.
On the one hand, as Stanworth notes (Stanworth,
1987, p. 1), these new technologies--from artificial
insemination to gamete intra-fallopian transfer
(GIFT) and a host of hormonal and other infertility
treatments--appear to offer a range of possibilities
for extending the pleasures of parenthood to those
who, for whatever reasons, have hitherto been
unable to have a child. Not only do they offer the
chance for potential parents to know, before birth,
about any genetic or chromosomal "abnormalities",
they also hold out the promise of the eventual elimination of some of these defects before conception
takes place. In addition, of course, they more or
less completely sever reproduction from the traditional categories of heterosexual experience-what Giddens refers to as "plastic" sexuality in the
late modern age (Giddens, 1991, 1992). Future
developments here include the transplantation of
donated precursors of sperm cells into the seminiferous tubules of the testes of infertile men, whilst
in the field of contraceptives, vaccines (immunocontraceptives) able to disrupt sperm function are currently being developed for men and women
(Alexander, 1995).
On the other hand, however, these new technologies extend the boundaries and possibilities of
medical and scientific practice in ways which threaten to outstrip human understanding, public morality and control. Not only do they bring new
dangers and unknown risk to parents and children
alike who undergo them, they also allow greater
scope for the application of eugenic policies which
place a higher value on some lives rather than
others, interfere with the "naturalness" of reproduction, and threaten to turn babies into "commodities" which can be bought and sold. In this respect,
as Stanworth (1987) notes, the "Frankensteinian
nightmare" of "science gone mad" is readily conjured up in the public mind as scientists start
manipulating the very foundations of life itself, as
well as potential problems across the life course (p.
2).
As this suggests, these new technologies open up
to debate issues which formerly belonged to the
realm of biological "givens". This in turn facilitates
the emergence of "life political" agenda in which
existential, moral and legal issues concerning the

1045

ownership and control of the human body come to

the fore (Giddens, 1991, 1994). Key questions here
include the ethical and practical problems surrounding the manipulation of eggs, sperm and embryos
outside the human body, the problems of "parenthood", especially "motherhood", and the "threats"
to identity which these technologies pose for the
human "products" they create (Stanworth, 1987).
Should these new reproductive techniques be used
"eugenically", for example, in order to produce
"brighter", more "attractive", or more "artistic"
offspring, and should (donor) children have a right,
when reaching maturity, to know who their "real"
genetic parents are? These, and many other dilemmas are thrown into critical relief as a consequence
of the "socialising of biological mechanisms"
(Giddens, 1991).
In short, what is potentially being transformed
through these new technologies is our conceptualisation of what it is to be human, male, female,
reproductive, parent, child, foetus, family, "race"
and even population (Clarke, 1995, p. 149). All
must now be put in brackets and renegotiated as a
consequence of these technological developments.
Slowly but surely, humans run the risk of being
reduced to their ("faulty") DNA codes and genetic
"spelling mistakes". The upshot of this is that
human subjectivity becomes transformed into an
"object" or "collision site" for various types of
detectable and usable information, whilst medicine
oscillates precariously between a new concern with
"codes" (e.g. immunology and genetics) and a traditional preoccupation with "combat" (i.e. disease)
(Montgomery, 1991; Haraway, 1991; Martin, 1994).
Certainly these issues have been hotly debated in
feminists circles. For some, the creation of NRTs is
seen as the endstage of men's desire to control
women and appropriate reproductive power (Corea,
1985; Corea et al., 1985; Rowland, 1992, 1985).
Viewed from this perspective, the danger lurks that
biological mothers will eventually be reduced to
"mother machines" (Corea, 1985) or "living laboratories" (Rowland, 1985), eroding still further
women's
bodily and
metaphysical privacy.
Physiologically, women's bodies are "opened, scrutinised, manipulated, parts extracted and then reintroduced".
This
enables
practitioners
to
unselfconsciously "speak of disembodied parts of
women--'the ovaries', 'ripe eggs', and ~recovering'
these parts even as they materially, scrutinise, alter
or remove these parts of women's bodies"
(Steinberg, 1990, p. 86, original emphasis).
As Casper (1995) argues, a host of contemporary
technologies in both science and medicine have
made possible the emergence of what she terms
"foetal cyborgs" and "techno" mothers. These
include foetal visualisation technologies; foetal diagnostic technologies; technologies which enable a
foetus to live inside a braindead woman's body;
technologies which transform aborted foetuses into

1046

Simon J. Williams

"materials" for scientific research and new forms of

biomedical therapy; technologies which produce
physiological knowledge about foetuses, and finally;
an array of foetal treatment technologies including
"foetal surgery" (Casper, 1995, pp. 186 187). As a
consequence, women not only become "erased" but
also alienated and depersonalised in the process of
reproduction.
Others, however, have argued that it is not so
much the technologies themselves which are problematic, but the context in which they are developed
and applied, including the thorny issue of access
(i.e. who is allowed to conceive). The call for a
return to so-called "natural motherhood" is therefore resisted, and it is argued instead that women
must themselves participate in both the development and (re)evaluation of these technologies,
rather than leaving them in the hands of "malestream" (biomedical) science (Stanworth, 1987;
McNeil et al., 1990). Indeed, as Denny (1996) has
convincingly shown, contra radical feminist arguments, many women undergoing these forms of
treatment view them positively as a "resource"
rather than a mechanism of "control" or "oppression".
More broadly, poststructuralist feminists have
also rejected the notion that the "'real female body"
is passively "'acted upon", instead preferring to
view it as being both inscribed and constituted
through (re)productive discursive practices and processes. From this perspective these new reproductive
technologies are themselves viewed as producing
subjectivity rather than "false consciousness"
(Lupton, 1994). Consequently, there is a focus on
the struggles and resistances between men and
women and the shifting configurations of knowledge/power which this involves (Sawicki, 1991).
Here the ultimate goal is to produce a feminist
body/politics which allows women to speak about
their bodies in their own chosen ways and thereby
to resist dominant scientific and technological discourses (Jacobus et al., 1990). This issue of resistance, in turn, resonates with a more general
postmodernist commitment to difference, generosity
and an endless process of "becoming" within all
walks of life, including the health care arena (Fox,
1993).
Virtual bodies

No discussion of medical technology would be

complete without consideration of new developments in minimally invasive surgery and "virtual"
medicine. Whilst many of these technologies are
still in their infancy/at the prototype stage, they
nonetheless promise a radical transformation of
existing surgical procedures. Keyhole surgery, for
example, despite recent concerns over the standardisation of training and competence, is already well
established. As Wickham (1994) speculates, reduced
trauma from minimally invasive surgery will result

in fewer operations requiring lengthy hospital stays.

As a consequence, traditional surgical wards will
become largely redundant, hospitals will need to
cope with increased patient throughput, operating
theatres will have to be re-equipped with these new
technologies, and hospital staff will need to be
retrained in order to manage it. Many traditional
specialities will also merge, and much conventional
nursing care will shift to the community rather than
the hospital.
In addition to these "cutting edge" technologies,
including microengineering and nanotechnology,
developments such as graphic workstation computers and specialised tracking devices have made it
possible to build an advanced prototype simulator
for minimally invasive surgery called the "virtual
clinic"
(McGovern,
1 9 9 4 ; McGovern
and
McGovern, 1994). As McGovern explains, the system uses tracking devices attached to actual surgical
instruments which are inserted into a fibreglass
body mould. Graphic representations of the body
change as the instruments are moved, whilst interaction is visibly displayed on a high resolution computer monitor located at the head of the "virtual"
patient. Data produced by computer tomography
(CT) and magnetic resonance imaging (MRI) are
used to supply a visual re-presentation of the actual
patient's anatomy. Computer manipulation allows
the "virtual surgical instruments" to interact with
the "virtual tissues" in a way that resembles what
happens in "real life", with new images automatically created as these "virtual" tissues are dissected
(McGovern, 1994, p. 1054).
The benefits of these computerised training systems include the ability to reproduce surgical
anomalies, work out the best operative procedures,
improve surgical techniques and thereby minimise
errors on actual patients. In neurosurgery, for
example, researchers are trying to combine live
video information with three-dimensional computer
images of the brain in order to help in the planning
of operations. These methods help surgeons plan
the best site for a skin incision, craniotomy, and a
brain incision, thus minimising the risk of damage
to normal brain tissue (McGovern, 1994).
Another interesting development here is "tele-presence'" surgery, performed on a patient in an operating theatre containing a stereoscopic camera and
a robot. At a separate location the surgical control
workstation has a three-dimensional monitor with
surgical input output devices which closely resemble actual instruments that would be used in an
operation (McGovern, 1994). On the one hand, the
advantage of this system, which has been developed
for use in battlefields, is that it allows surgeons to
operate on patients at a distance. On the other
hand, however, the issue of what happens to actual
patients when things go wrong and communication
lines break down, render these "virtual" forms of
surgery at present highly problematic.

Modern medicine and the "uncertain body"

More broadly, as Frank (1992) observes, a panoply of "screens" now pervade the modern technological hospital. First, there are those screens which,
as discussed earlier, exteriorise direct images of the
body's interior (e.g. ultrasound screens/foetal visualisation and diagnostic technologies); second, there
are screens which display online digital images,
coded into graphs and pictorial display, of bodily
processes and functioning (e.g. ECG monitors);
third, there are screens which display symbolic
images such as patient charts, schedules and other
secondary data; and finally, there are commercial
television screens found in ever increasing numbers
in hospital waiting rooms, lounges, wards and
patient rooms. In this respect, the Foucauldian
clinical gaze gives way to the Baudrillardian
"hyperreality of images without grounding". The
upshot of this is that bodies become ever more elusive: instead of the patient's body being at the
centre of contemporary medical practice and discourse, we find instead "multiple images and codings" whereby the body is endlessly "doubled and
redoubled" through a self-referential chain of simulacra (Frank, 1992, p. 83). According to this scenario, a modernist concern with corporeality is
slowly but surely giving way to a postmodernist
concern with hyperreality. This, in turn, leads us
into a broader set of theoretical debates on the
nature of medicine at the turn of the century: issues
which shall be discussed in the concluding part of
this paper.
DISCUSSION AND CONCLUDING REMARKS

At the beginning of this paper three main questions were posed. First, what role has medical technology played in the crisis of meaning surrounding
the human body at the turn of the 21st Century?
More specifically, to what extent has increasing
technological control exacerbated our sense of
uncertainty over what precisely bodies are and what
they might become? To be sure, the evidence presented here would seem to suggest that advances in
biomedical science and technology have been central to this moral, spiritual and existential crisis.
From plastic surgery to virtual medicine, our previously held and cherished beliefs about the body
and the "limits" of corporeality are being "placed
in brackets", so to speak. In this sense, medical
"advances" in science and technology are both
instrumental in, and symptomatic of, this corporeal
crisis of meaning in late 20th Century Western society; developing and extending the "rationalisation" of the body in important new ways, but in
doing so, rending it ever more elusive and problematic. Seen in these terms, the "certainties" of
rationality create their own doubts.
Second, what analytical purchase does the cyborg
give us on these contemporary forms of technological embodiment? Certainly, the thrust of the argu-

1047

ments presented in this paper would seem to

suggest that, in an era where human-machine couplings are almost infinite, medical technology has at
its disposal a variety of means to transform us into
cyborgs, from cardiac pacemakers to genetic engineering, and from the nebulised asthmatic to the
accident victim in the intensive care unit. The logic
of this argument suggests that, in a technological
age such as ours, we are all "cyborgs" in some
shape, sense or form. In making this claim, however, the analytical potential and discriminatory
power of the concept is surely reduced. In this
respect, as has been suggested here, it is perhaps
more fruitful to conceptualise cyborgs along a continuum ranging from the all-too-human pole at one
end to artificial intelligence (AI) devices at the
other, with a broad range of human/machine couplings of varying degrees in between. In contrast to
Haraway's (Haraway, 1991) optimistic stance
toward the cyborg as a "leaky" figure in a "postgender" world, it is also possible to argue that the
advent of these technological developments uphold
rather than transcend the gendered forms of embodiment they seeks to unravel (Springer, 1991:
Foster, 1993; Cherniavsky, 1993). This, in turn, reinforces the more general point that rather than
challenging traditional mind/body divisions, contemporary forms of medical practice actually exacerbate them through a high tech form of neoPlatonism: plus ca change, plus c'est la plus la meme
chose!
This leads me to the third main issue I wish to
explore in this concluding part of the paper, namely
whether modernist or postmodernist interpretations
of these technological developments are most
appropriate. Certainly, much of what I have had to
say about these new technologies, from genetic engineering to virtual medicine, lends itself, potentially
at least, to a postmodern reading; one in which a
more direct concern with human corporeality is
slowly giving way to a "digitally mediated" concern
with hyperreality and the growing imbrication of
humans and machines (i.e. cyborgology). Yet, in
the face of this possible postmodern reading, I wish
to stress an alternative interpretation, namely, that
medicine continues to be a thoroughly modernist
enterprise, and that these technological developments enhance rather than diminish the rational
control of bodies and selves in an increasingly
reflexive age. Indeed, as suggested earlier, it is these
very trends of rational control which, paradoxically,
create the crisis of meaning and uncertain status of
the body in late modernity. Modernity, in other
words, as a reflexive social order, "manufactures"
its own (i.e. internally referential) risks and uncertainties. Medicine, as arch-modernity personified,
reflects and reinforces these dilemmas in acute corporeal form. Perhaps on a more rhetorical note, it
is also possible to argue that postmodernism is
really only an option for the "healthy" rather than

1048

Simon J. Williams

the sick. As Charlton (1993) argues, when the

"chips are down", when illness renders our contingent relationship to our bodies problematic, then
modernist medicine offers us a candle of hope flickering precariously in the wind of our malaise.
Modern medicine, in short, despite its limitations
and iatrogenic consequences, is both a fountain of
hope and font of despair. This, in turn, suggests
that lay voices should be the final arbiters in these
broader theoretical debates concerning the role of
medical technology as liberation or oppression,
opportunity or constraint (Williams and Calnan,
1996a).
This raises a fourth and final set of issues to do
with the social costs and benefits of medical technology and the ethical dilemmas it poses. Certainly,
as we have seen, a number of problems arise from
the application of these "cutting edge" technologies,
from the physical and psychological risks of cosmetic surgery, to the spectre of eugenics and the
prospect of "designer babies". Nonetheless, it
would wrong to "write them off" simply on these
grounds. Rather, we should also acknowledge the
significant contribution which medical technology
has made to our lives, from improvements in the
quality of life (e.g. hip replacements, cataract
removal, coronary bypass surgery) to the creation
(e.g. new reproductive technologies) and prolongation (e.g. organ transplants) of life itself.
Indeed, even in controversial areas such as gene
therapy, certain forms of treatment would seem to
be a moral obligation rather than an option
(Caplan, 1995). Clearly, however, the ethical basis
upon which to judge these technologies is a complex
issue which extends well beyond the scope of the
present paper. It is, however, possible to argue that
any such of notion of ethics must ultimately concern itself with a "life political agenda" which is
grounded in our embodied being-in-the-world and
the inviolability of human nature. In this respect,
whilst we have all been put on the "conveyor belt
of biotechnology", the question we must continually ask ourselves is whether our humanity is being
"'compromised" in the process? (O'Neill, 1985;
Scheper-Hughes and Lock, 1987). The rational,
technological imperatives of late modern medicine
also need to be tempered by a more "humanist"
vision of health care: one which is sensitively
oriented to the ill through an approach which treats
human feelings and emotions as central rather than
peripheral to the healing process. This, in turn, resonates with a broader postmodern ethics of care
based on generosity, trust and a spontaneous commitment to the "other" vis-a-vis (modernist) possessive, repetitive, negative forms of dependency which
discipline, smother and envelop the individual (Fox,
1993). Whatever the outcome of these broader
debates, one thing remains clear: if (medical) technology symbolically expresses the dilemmas of life
in an increasingly uncertain age, then the body pro-

vides the metaphor of metaphors so to speak, as

both stability and flux, order and transgression.
Corporeality or hyperreality, only time will tell!

Acknowledgements--I am grateful to the two reviewers for

helpful comments on an earlier draft of this paper and to
Lynda Birke for useful discussion of these themes.

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