40 Theoretical prspectives
has foslcrcd nledical anthropology as idcological choicc and political mililancy, an cx,
pcricncc uniquc in llaly and hard l,l nurch clsewherc iD thc world. (pandolti 1992:165)
Closor to homc, inspiration is provided by the activism of an .African-
Arnadcan inDllectual ancestor, W. Monrague Cobb. Rankin-Hill and Blakey
(1994:92) rcrnind us that in "applying anthropology, Cobb was nor Iimircd by
the haditional parameters of professionai concerns. He chose activisnr, an ap-
pli(xl irnthropology directed against the effocts of social inequaliry and discrim-
ination." Ncl matter the label we choose to attach to such activism, it remains
a challenging pafl ol the contradictory nature of our anthropological l,erilage.
l\,lo:rEs
l. Cbbal powcr relalions are equally deserving of attention in ft)latioi to the polilics
ol citation (llarrison l99l:7). For e,(amplc, the authors o[ a medical anthropology tcxt-
book ackno rlcdgc only the work ol First World scholars in a discussion ol thc signili
cnnce of laking nccou.rl of social power relatioos, and worldwide polrticfll cconornir
forces (Mdllroy and Townscnd l9tj9:53).
2. It is imporlant to stress once again that PEMA is ,ror reducible to the depcndcncy
varianl of PllH. Dr any other vcriant fcr that ma(er. It is also \ro.1h noting that lhe
flnalytical linritations of the depend( ncy orientation, which have been elaborated in the
develop,ncnt Iitcrature for years, have been long recognized by somc of ils earliest pro-
nroters, induding Andr6 cunder Frank hirnself (Frank l9?7).
3. I conside- pmxis to be dialectically ar.iculated to theoretical produclions, which are
rhenr\cl!cl irs.par;rl)le from llolitical dynamics.
4. Applied social rcsearch, whether mcdical anthropological or olhcrwise, is also rhc-
orctically infofliled l'his is so evcn if the privihged theoretical basis oi a givcn rescarch
paoject rentains unstaled.
5. In Johnson's "global village" "fomrerly isolated, indigenous people [have been
incorporatedl, forcing us to examine and even inleNene in the process of change."
3
A Critical-lnterpretive Approach in
Medical Anthropology: Rituals and
Routines of Discipline and Dissent
Margaret Lock and Nancy Scheper-Ilughes
It is well to
establish the position of the body from rhe outset.
Beckctt, The Unnamable
-Samucl
PROLOGUE: THINKING WITH THE BODY
Wc wisn to suggest at the outset that it is medical anthropology's engagement
with the body in context that represents this subdiscipline's unique vision as
distinct from classical social anthropology (where the body was largely absent)
and from physjcal anthropology and the biomedical sciences (wherc the body
is made into a universal objeat). In the history of social anthropology-as in
sociology-with a lbw notable exceptions such as Be,rthall and Polhemus
(1975), Blacking (19'77), and Needham (1973), the body made only occasional
and cryptic appearances, and most debates about human relations ancl social life
swirlcd around an analytic gap at the corc of thc discipline: the absencc of the
body (Lock 1993a).
Insofar as it was trcated at all, the body figured in the writings of ilocial
anthropologists and sociologists as a mcdium on which to inscribe symbols and
hunologics of thc social ordcr. Thc body "naturalized" the social order, making
socicty and its social catcgories and hierarchies appcar unqucstionably rcal, cer-
tain, and existentially given. In many of these early social anthropological mon-
ographs in which the body in hoalth and illness appears, the authors werc
ostcnsibly studying rcligion, ritual, witchcraft, conrparative modcs of thinking,
and so on, arrd thcy discovcrcd ihat the body r.vas "good to think with," The
bcst-known cxanlplcs arc undoubtcdly E. E. Evans-Pritchard's WitchcraJt, Or-
acles and Magic anrong the Azande (1937), Victor Turner's Forest of Syubols
(1961) and Druns of Africtio (1968), and Purity and Danger by Mary Douglas
,\2 Theoretical Perspectives
tl96(i). l'hor ,lh the body was invoked in dtese studies, it was conceptualizcd as
little rnore lhan a passive participant, part of the domain of the natural scicnces
but allacherl tc a Iivoly, responsive, nomadic mind, the true agent of cullure.
Had sociai anthropologists taken the study of Durkheim on anomic theory,
l\4arx on alicna[ion theory, or even Freud on conversion hysle,ias more scri
ously, or had they anticipated the insights of Foucauit or the risc of tbminisr
anrj Iitcrary criticisrn, they might havc participated in thc cmcrgcncc ol thc hody
irs lhc prirnirry lrclion zon0 ol lltc lillc lw(rIliclh ccnlrtry. As it wirs, lrrrrvr',rr'r,
,ci l unthl.()lnrloliy's hcLrtc(l wrkcl|rng t() tlx' tltc(n1.li(itl sig ilicill(t. {)l llr.
l)(xl), canrc llrgoly through thc crrrpilicill slutlics ol' rllcJical nlllrop{)logrsts lir
lrorirrll ir llrc clirir.,i. lrosltillls. lir.kls, rrrtrl llt'torics lltrolll pt.oplc wlrorrr rir.k
ocss llrir(lrcss, Prrirr, tlisability, itrl(l (lislrcss Ir.rtl rcrrtlctctl eritically Icltcrivr: irs
wcll illi oli(:n nrlt rt vely ;rnd oppositionally ritlrirlc(l in rclirlion lo ir fivr.n sor i;rl
irnrl rroral ortlcI ll w s irr thcsc "clirrics" lhitt nlc(licnl :t ll[()lx,logisls, (,I'tc
criticizcd by ollrcr anthropologists lbr thcir tilck ol thoorctical sophisticrrion,
tlcvckrpctl oonccpts such as sickncss us cultural pcrlrrr"nirncc (lrrnnkcnhcrg
I986), body praxis (Scheper-Hughes 1993), local hiologies (Lock 1993b), illncss
as aerilhctic object (Cood 1994), and hody mnemonics (Comarofl' 1985: Boddy
1989) in understanding ihe social and political relations of illness.
TOWARD A CRITICAL.INTERPRETIVE PERSPECTIVE IN
MEI)ICAL ANTHROPOLOGY
A major division in theoretical approach has crystalized over rhe past twenty
years or more within the social sciences around the question of whether "l'acts"
about the world are uncovered or whether, on the other hand, they are prcduced
as a rcsult of interaction between researcher with ,he subject of research. Much
ol lhc work in contcmporary mcdical anthropology, along with thc clitssicnl
social rrnllrr'rlxrkrgir:irl nrorrog[itphs. lillls int() tllc lirsl ()l tltes(. lw() cilnti)s.'llIrl
is, il is irssul!ru(l l)y c(nrvc,rli(nlill llrc(licitl ntrlltr(,1)ol()gisls llt t Iigor'orrs crtrIrr'icirl
rctlu(lr $rill k,rul lo rr trtllrlirl l(.llrf,i ltlttiol ul llrr. olrlr.r'lr, trrrri.r :,trrrlv
1l)'Artllrrrlc lt)t)5). Whilr rrrrrt.lr r'l tlris rcsr.,rrtlr rrrrry lrr.r.rrltrrr;rlly scl'rrlivc l'l(l
dcsiF.r)c(l lo sl()w lhal D(nrliterittc pcoplcs, ill)lDigrnIts, irntl rclirgecs ar.c r.rr,rrrrrirl
hcinlls. llrcrc is l striking luck ol itwarcncss irr lhcsc "or,icctivist" stldius ol'
(lrc \,/irys i,l wlricl! tltc culturc ol'scicrrco struclurr:s lllc kincl ol qucst:rrIs irskrrl.
ns Allxr Youn! pointcd orrt, "ltl)istcntologicul scnrliny is suspr:ntlcd lirr.Wcsl-
crn socrial sr:icncc ulld Wcstcm nrcdicinc" (1982:260). Whcrcas onc can nrrrluro
a cultural analysis oI tradirtional medical systems, biomedicine by v:rrue ol iLs
"scicntilic" rratulo is held privileged and exempt from such an analysis. How
could irn anl.hropology of religion have developcd if Christianiry wcrc oxcmpr
liom cultuml arDal),sis and its premises leli uncxamined and unquestiorcd'l Yct
this is precisely what happened to medical anthropology. Critical rcscarch on
the body, illncss, and healing was stymied lbr n,any gencrations by a prohibiriun
against cxanrining, and thcreforc "brackcting," sonre of tl,c most esscnlializin!
Fituals and Routines of Discipline and Dissent 43
anil univcrsalizing Western epistcmological assumptions underlying the theory
and practicc of biomedicirre.
Whcn mcdicine is exempt I'rom cultural analysis, several assumptions usually
Iirllow: rhat naturc and culturc ale dichotomous categories, that it is possible to
understand tlrc natural world Iogically and rationally thrlugh the application of
scicnce, and that technological mi.rstery will eventually be obtained over nature
including lhc humln body. With rcsllcct to hcalth and ilincss, this objccrivist
l)(rsl]r,(tiv(,irssurlls lllill lltc cntirr rlngc rrl ltrtntitn cxplitnalions anrl prircticcs
rr1irrrrlirr1' Ircrrlllr. illrrcss, rliscirst., irrul t!(.l lt. ll'o l cvil(.y(. l)clicll\ l(,llr.! (ltitntintl
()l sullits il it tclllplc, clr) llo r'cntlclctl supcrl)uous through univcrsitl cducitti(nt
irr lrrrl'lrt lrr.rltlr rrtrrl llrrrIrrr lriolrl,y trrrrl tlIr,ul,lt tll( rvrrilrrlrility ol'irllirrrlirlrlc
Westerrr rrrttlrclll ri r.'lll(.r,li,(.Ltivisrs rvotrltl irgr'cc wrlll Sl,slllt S(,tttitli tlt l "llrc
Ir)sr rnrrhlirl wity r)l lc,!i[(liIl] illnt'ss anrl th(: heillthicsl wiry ol hcing ill-is
rrrtt prrr'rlir'rl ()1. nr()sl lcsislilnl l(l nlcl.rl)lt(r'ic thilkirrg" ( lt)7li:3).
l"lcr'c wc rvish to aclvuncc n nttcrnittivc thcoroticul position, onc thut bcgins
iiorrr rr rccognition ol Lhc lirnclanrcntal rpistcrrrolrrgicirl irrcconcilahiltty ol an-
thropologicll ancl donrinant biorrcdicll ,vays oI knowing and sccing. Most ar-
thropological knowledgc is Iundan'entally esoteric (concerned with difference,
basic strangencss, and Othcrness), local (in the Geertzian sense), symbolic, and
doggedly relativist. Much biomedical knowledge remains intrinsically universal,
objectivist, and radically materialist/reductionist*the rcsult of its lingering Car-
lcsiln hcrit.rgc. Whcrcas hionrctlicinc, in thcory il not always in practicc, prc-
supposes a universal, a historical subject, critically interpretive medical
. anthropologists are confronted with ,ebcllious and "rnarchic" bodies-bodies
that rclirsc to conlbrm (or submit) to presumably universal categories and con,
: ccpts o1'diseases, distress, and medical efficacy.
This other side ol'thc theoretical divide is less concerned with orderly expla-
nirlions irn(l rn(,rc wilh thc Undcrslnnding ol social lilc as lhc "ncgotilttion ol'
rrr':rrrirryls (Mirrrlrs rrxl lrislr(r l{)11()t.l()). lt is p:rlt rrl ;r lrrrlr,lcr rrrrrvrtrrrrrrt irr
\vlrrlr re(lll(lr('flrst scictrec irs ir rvlrrr[:, irrelrrtlirrg lrirrrrrcdicirrc, llits l)ccI ruill)
;Irrrir.r'rl ,r,, ;r Irorlu(l ol it:, r,1r',rlit lrirlorirtrl rrrrrl utltllll ((,r1.)(l:, tl.orl, turrl
,
(;or,l,,l| lr)SSi l\4 lli'y l')/i) 'li'r'l'nil lr)8-)). ll.r(., rllr(.r ll|lur si rply tlr. rru(ly
rrl rrlk.r lrtrvc rrrerlical systcrrlr it (l Innaliccs, luc(licill illtlu()l)ology lrccorrtr:s
rr rrrrrr'h rrrote rl(licrl ur(lcrlirkilgt lhc wiry iu which irll l:nowlctlgc rclilling I(,
llrr lJo(ly. Ircirlllr. lrrrrl illrrc:is is (rulturillry c()Isttuctcd, ncgr)liiltc(1, ilnd rchcg.,li-
irlc(l in l (ly rnric l)rorcss lllr(nrgh tirnc iIl(l sl)itcc.
I.;vcry irllcrrpt is nril(lo lo lvoid a convcrsion ol thc diaklguc thirt tilkcs plilcc
bctwccn inlo.rnants and thc anthropologist into categories tltat originate in WesG
cln mcdical thought, although ultimatcly it is usually recognized that it is im-
fortant b go bcyond a position ol'cxtrcme cultural relati"ism. Moreover, thc
{rtl)ropologist is highly scnsitivc to thc way in which rcprcsentation ol thc other
is, in cllcct, r llction, a document craated out of an ongoing dialogue. Rabinow
sums up this approach in thc lbllowing way: "Thc cthical is rhe guiding valuc.
'lhis is an opposilioaal position, onc suspicious of sovereign powcrs, universal
44 Theoretical Perspectives
truths, ovcrly relativized preciousncsr, local aulhenticity, moralisrns, high and
low. Understi.nding is its second value, but an [nderstanding suspiciou:i oi its
own imperial tendencies. It a(empts to be highlr attcntive (and rcspectlul ol)
diffcrence, but is also wary of the tendency to eisentialize difference" (1986:
25tt). To this cxtcnt, modical anlhropology is no dilfcrent fronr thc gcncral licld
ol critical-inlerpretive anthropology. Bul or() ever-present constraining tnd ir-
rcduciblc Iact is rathcr spccial to nrcdical anlhropology: thitt ol thc scntiultt
lrulrun body.
Mct pl)oriclrlly, llighls ol-llncy cotrtc orilshing d,)wtt in tho Ilcc ol lhc itrigtrislt
i[](l I)nir tlllrt (rltc surround hirth, illrrr.:ss, att i tlcittlt.'llrt tclitliottship lrclwecrt
thcory and praclicc takes on spccial nreaning in such a contcxt.'lhc nrcclical
anlhropologist is repeatedly studying situations whcre drama is conrmonplitcc
and a(jtion deenred imperatire. Hence, the work cf the medical anthropologist
r.lroly stops at an othnogrirphic description of medical theories and practica but
extends rvilly-niJly into tt.e worid of decision rraking and action. Biomcdical
tcchnology (sr:rnc of it equal or suporior to traditional therapics) is availablc to
sol]rc cxtcnt in most parts ol thc world today. Clcurly cvcryonc should havc itn
oplxnlu0ily lo l)(,lolil liur lhis tccltnology. ()tto trl lltc l)iSgcsl cltirllortgrs li)r
rncdical anthropology is to conre to tcrms with bioroedicinc, to acknttwlcclgc tls
cflicacy when appropriate whilc retaining a constructively critical stanlc. At thc
sanre tinlo it is necessary to be critical, at times, of the cultutal valucs and
tradition ol thc societies under stu(ly. Thc webs ()1 lulture that pcol)lc spir, and
have spun about them are essential for the functioning ol'humankin,l in social
groups. Wc cannot strp all metaphor away, as SontalJ suggests. Flowcver, wher-
cvcr ineqLratitics and hicrarchy are instilutionalizcd, ihey will ol 0cccssity bc
imJrorecl hy nrcans ol a dominant cultural ideology, which is likcly to inlli,:r .r
negalive self-image, distress, and often ill hcalth on the underprivilcgc(l and
discnfranchised.'l'oday we havc tho intellectua! frcedom and impctus to sort oul
hamrlul discourse liom that indispensable to the cor,tinuity of cooperi tive social
groups. The nrcdic.rl anthropologii;t must tread liShtly betwc(in thc polcs ol'cul-
lural in(cDrclcr and cultural critic, dclender ol'tradition and brokc" lirt changc.
'fhc task o, ir criticirl-intcrprctivc ntcdical anthropolt)gy is, Iirsl, lo (lcsc.il)c
thc cultur lly co0slructcd varicty ol nlclitphr)rictl conccl)tions (co0sci()trs itlxl
unconscious) aboul tho body and associated narrittives and thcn to slrow thc
social, political, and individual uses to which these conccptions are applied in
pract.ice. By this approach, medical knowledge is not conceived of as autono-
mous but is ro(,ted in and continually modified by practica and social and po-
litical chaoge. N4edical knowledge ls, of course, also constrainod (but not
rletelmined),bv lhc slructure and functioning of the human body. A nrcdical
irnthropologi'lr therefbre attenrpts lo explore the notion of "entbodied person-
l]orxl" (1'urner 1986:2): the relationship of cultural beliefs and practicJs in con-
noctior witlr hJ:rlth and illness to the sentient human body.
In this chaptcr we will set out a cfltical-interpretive pcrspectivc in whrch wc
draw fr:rr inspiration upon some lacets of general anthropological discourse ahout
Rituals and Routines of Discipline and Dissent 45
the body. Wc belicve that insolar as medical anthropology fails to consider the
way in which thc human body itsclf is culturally constructed, it is destined to
fall prey to certain assumptions characteristic of biomedicine. Foremost among
these assunrptions is the much-noted Cartesian dualism that separates mind from
body, spirit lionr maltcr, od rcal (thar is, measurable) fronr unreal. Since this
cpistcnrological tradition is a c,rltural and historical construction and not onc
thilt is univcrsally slrarcd, it is csscnliirl thnl wc bcgin b1 cxanriniirg tlris irs-
surrrplion.r
THI] THRBE I}ODIES
The body is the first and mosl naturrl tool of man.
Mauss ( l9?9 tl950l).
-Marcel
Esscntial to our task is a consideration ol thc relations among what wc will
rclcr to hcrc jls thc "lhrcc ooclics."'?At thc lirst and pcrhi ps nost scll-cviclcnt
lcvol is tho individual hrxly, un(lclsl(x)d i0 lhc pl.0runcoological scnsc ol thc
lived cxpcriencc ol thc body-sclf. Wc may reasonably assumc that all pcoplc
share at least some intuitivc sense of the embodied self as existing apart from
othcr individual bodies (Mauss 1985t19381). Howerer, the constituent parts of
the body-mind, matter, psychc, soul, soll-and their re:ations to each othcr
and the ways in which th: bod1, is experienced in health and sickness are highly
variable.
At lhc sccond lcvcl ol analysis is thc social body, rcferring to thc rcprcscn-
{ational uscs ol thc body as a nitural symbol with which to think about naturc,
society, and culture (Douglas 1970). Hcre our discussion follows the well-
trodden path of social, symbolic, and structurirlist anthropologists who have
demonstratcd a constant oxchange of meanings .letween the natllral and the
social worlds. Thc body in hcalth otlbrs a model of organic wholeness; the body
in sickncss ollcrs a modcl of social disharnrony, conllict, and disintcgralion.
llcciprocally, socicty in "sickncss" and in "lrcalth" ollbrs a nlodcl lor undcr-
standing thc borly.
At thc third lcvcl ol analysis is thc body politic, referring to the regulalion,
surveillancc, and control of bodies (individual and collective) in reproduction
and sexuality, work, leisure, and sickness. There are many types of polity, rang-
ing from the acephalous groupings of "simple" foraging societies, in which
deviants may be simply ignored or else punished by total social ostracism and
consequontly by death (see Briggs l9?0; Turnbull 1962), through to chieftain-
ships, mcnarchies, oligarchies, democracies, and modem totalitarian states. In
each of these polities fie stability of the body politic rests on its ability to
regulate populations (the social body) and to discipline individual bodies. A
grcat dcal has been writteu about the regulation and control of individual and
social bodies in complex, industrialized societies. MicLel Foucault's work is
 /+6 Theoreticat perspectives
Rituals and Routines of Discipline and Dissent 47
cxcrnllirry in this rcgard (1973, 1975, I979, I980c). t-ess has bccn wrirtcn ahour
who first callcd this dis.asc sacred wcre thc sort of poople that we now call
the nay!; in vrhich preindustrial societies conlrol the,. populations and instrtu
'magi.'"
tionalize mcans lirr producing tlocile bodies and pliant minds in the servicc ol'
The natural-supernatural, real-unreal dichotomy has taken many forms over
r;onre deiinitic,n
of collective stahility, lrealth, and social well-bejng.
the course of Western history and civilization, but it was the philosopher-
Thc lirlhrwing analysis will rncvc back and lorth betwccn a ,tiscussion ol-
mathematician Rend Descartes (159Gi650) who most clearly formulated the
''the bodies" as a usef'ul heuristic concept for understanding culrur s anJ so,
ideas that are the immediate precursors of conter,rporary biomedical conceptions
cielies, on lhe one hand, and frtr increasing knowledge of the c Lural sources
about the hunran organism. Descartes uas determined to hold nothing as true
and meanirgs of health and illncss, or. the other.
unlil hc had cstrtblishcd thc grounds of cvidcncr: lor acccpting it as such. Thc
singlo calcgory to ho takcD on lirith was thc qxistcncc ol thc thinking bcing.
cxprcsscd in l)csca cs'tliciunr: "Cogit(), crgo sum" ("1lhink, tharelbrc I arn").
THT) INDIVIDUAL I}ODY He thcn uscd tlrc conccpt ol thc thinking being to establish "proof' for the
existence ci God whom, Dcscartes believed, had created the physical world.
llorr Ileal Is llcal? The Cartesian Legacy Descartes, a devout Catholic, stated that orle should not question that which God
had created; however, by creating a concept of mind, Descartes was able to
A singuliLr prcnrisc guiding Wcstcrr scicncc and clinical rncdicinc (and rrrc.
reconcilc his religious beliefs with his scientinc curiosity. The higher "essence"
rvc hastcn lo i\(ld, rhar is responsible for its efficacy) is irs comn-rirmcnr ro u
of man, the rational mind, was thus cxtracted from nature, allowing a rigorous
fundamental )pposition belween spirit and matter, mind and body, anrl (rrnder-
olrjectivc cxamination of naturc, including the human body, for the first time in
Iying this) real and unreal. We are icrninded of a prcscntation that conccrned
Western history. This separation of rnind and body, the so-called Canesian du-
the c sE ol'a rniddlc-aged woman suffering from chronic and dcbilitating hcad-
alism, freed biology to pursue the kind of radically materialist thinking expressed
aches. In halting sentenccs thc patient explained befbre rhe large class oi lirsr
by the medical student, an approach that has permitted the development of thc
year rncdical studcnts that her husband was an alcoholic who oc,i.lsionallJ beat
natur.rl and clinical sciences as wc know them today.
her, that shc had been virtually houscbound for the past live ycars looking aiter
The Cartesian legacy to clinical mcdicine and to the n.ttural and social sci-
hcr senilc and incontincnt mothcr-in-law, and thnt she woricd constantly ilboul
hcr lccnillc sorr. rvlro rvrri llut,king ()Ut ol high school. Allltrrrrglt thc wrr:ll,rrr's
clrccs is lrlhcr nrcchlnistic conccplion of lhc ho(iy and its lunclii)ns an(l lt
sl()ry clr(rtrllL('r:ir(k.rrrlrlc:yrrr|);rtLy lrrl t llrc stu([.|llri, ()llr y(,u f w,,nti r r urll)
lirlrrrc lo ( or(\.1)lUllizr' |l ''rrrirrrIIirI ' ,.ItislttirIl (tl-s(IIltti( stlt('s. lt w(ntl(I t|[.
ir stru!18,1,llg |syclroarralytic psychiiitly od rhc griltluill dcvolop lc t ol psycho-
illlrrnrplc(l tll( l)nrli's\{n ti} rlc litn(1, "ll!l wltitt ir thc rr.rrl Iirrrll, rrl llrr. lr.;rrl .toIllllir llr(\lr( i|lt, irr llrt. crrrly l!vcIlirllt ((.Il ty to lrr.gitr tlrr. lrtsl rrl tcrIrrtirrp
rrrrrrrl rrrrrl lrorly irr rlirritrrl tlrt.,,ry irr(l tirnti((. Yt.t (.vrl in psyclrrrrrrrulyticrrlly
llrri lulrcill stu[,cnl, lrlc ol llrl clitssllri,lcr;, lltlcrl)tclc(l rllc sltc. r ()l
riUly
ir)linlr)Lr(l llsycl)iirlry irnrl in psyclrosorrratio nrctlicinc, thcrc is il tcndoncy lo citl-
\(,ciill itrlrurt;rliorr iitt(l ittr lrvlItl lrr ll,t rrirl lriotrrr.rlictrl rlitrlltrr,srs
irs cllr':lrr(olr.i
cgolizc rrrrtl llc:rl hu,rriu,al'llictrorrs:rs il thcy wcrc cithcr wllrlly organic rrr
Sltc rvanlctl illirr'rnlrliorr (n) lhc 0cLtrocllcnlical changcs, whiclr sltc un(lcrst(\l(,
wholly psychological rn or'igin: "il" is in thc body or "it" is in rhc nrind
irs constiluling thc truc causal cxplantlion. ]'his kind ol radicllly n)alcrialist
(Kirmaycr l98li). In hcr analysis oi nultidisciplinary casc conlcrcnces on
thinking is lhe product ol a Western epistemology cxtcnding as lar back as
chronic pain patients, for example, Kitty Corbett (1986) discovered rhe inrrac-
Aristotle's starkly biological view of the human soul in De Anina. As a basis
tability of Cartesian thirrking among sophisticated clinicians. These physicians,
Ibr clinical practice, it can be found in the Hippocratic corpus (ca. 400 D.c.)l
psychiatrists,,rnd clinical social *orkers "knew" that pain was "real," whether
Hippocratcs and his students were determined to eradicate the vestiges ol'rnlg-
icoreligious thinking about the hrman bodv a|d to introduce a rational hasis lbr
or not the source oI it could bc verified by diagnostic tests. Nonetheless, they
could not hclp but express evident relief when a "true" (single, generally or-
clinical practice that would challengc the power of the ancicnt lblk healers or
"chlrlatirns" Lrnd "ntagi," as Hippocrarcs lahclcd his nrcdieal compctirors. ln ganic) cluse coulcl be discovered. Moreover, wh.n diagnostic tests indicated
sonle organic explanation, thc psychological and sociurl aspccts of the pain
l passagc fronr his treatisc on epilepsy, ironically entitlcd ',On rhe Sacred Dis
tended to bc all but forgotten, and \.,hcn severe psychopathorogy could be di-
casc," Hippocrates (Adams 1939:355-56) cautioned physicianr to rrcal only
agnosed, the organic complications and indexes tended to be ignored. Pain, ir
wh.rt was observable and palpable to the senses: "l do not bclieve thJt thc so-
sccrls, was either physical or mental, biological or psychosocial-never both
callcd Slcrccl )isease is any rnore divinc or saorcd than any other discil,c, but
or something not quite either.
lhal on thc contrary, just as othcr discases havc ii naturc and a dcljoitc c.rusc,
As hollr nrcdical anthropologists and clinicians strugglc to ricw humans and
so docs lhis onc, too, havc a naturc and a causc. .. .ll is nty opinion that thosc
thc cxpclicncc ol illncss ancl sullbring from rn intcgiatcd pcrsncctivc, lhcy olien
 411 'llr.! nctr(:itl l1]sl)c(Ilvr,s
littrl lltcrtrselvcs lrirppcrl by llt0 ('itrl,jsiln lcgacy. Wr.: llck ir lrrccisc vocrrl rrlirry
with whir:h to dcal with nr ind- irody-soc icty int('raclions and so nrc lcli suspcndcd
in hyphens, tc:sti[/ing to the disconnectedness ol our thoughts. We are fbrced
to reson to such liagmented conccpts as the "biosociai" or thc "psychoso-
rnatic" as irltogether leebJe ways of expressing the many forms in which thc
mincl spcaks through the body and tire ways in which society is inscribecl on
thc cxpcclanl clnvits ol human llcsh. As Milan Kundcrl (191i4:15) ohsct.vctl:
"'l'hc risc ol scicncc propcllcd nran inlo tunncls ol spcciulizcd kt)owlcdgc. Wilh
vcry stcp lorward in scicntilic knowlcdgc, the lcss clcurly hc could scc thc \,()rl(l
its a rvholc or his own scll." Ironicalll, conscious ilttcn)pts lo tcmpcr tllc llir-
terillism and rcductio:rism of biomedical science often end up inadvcrtcotly
recreating the mind-body opposition in a new fomr. For example, a disti..rion
between disease and illness was elaborated in an effort to distinguish the bio-
medical concuption of "abncrmalities in the structure and/or function of organs
and organ systems" (disease) from the patients' subjective experience o.'malaise
(illncss) (Eiserrberg 1977). While this paradigm has certainly helped ro sensirizc
both clinicians and social scientists to the social c"igins of sickness, one unan-
ticipated efl'ect has been that physicians now olien claim both aspccrs ol'rhe
sickness experience for the medical domain. As a result, the illness dirncnsion
oI human distress is bcing medicalized and individualized rathcr than poli(iuizcd
and collcctivized (see Scheper-Hughes and Lock 1986; Lock 1978b). Mcdical
ization incvitably cntails a misscd idcntifici.tion bclwccn thc indiviciuat and thc
social bodies and a tendency to transform the social into the biological.
Il'lind-body dualism is rclated to other conceptual opposir;cn$ in Weslcrn cpis-
tcmology, srrch as those trctwecn nature and culture, passion and reason, inrji-
vidual and society
-dichotomiei that social thinkers as different as F)mile
tturkhoirn, Marcel Mauss, Karl Marx, and Sigmund F'reud understood as incv-
itablo and oftcn unresolvatrle contmdictions and as natural and univgrsal catc-
Sories. Although l)urkheim was primarily concerned with the relarionship ol the
indiviclual t() $ocicty, he devoted some attention to the rnind-body, naturc-so..iery
dichot(rnries. 111 'Ihe [:lementary Fothts of thc Religious Life Durkheim wrolc
that "nran is tlouble" ( l96l [ 915]:29), reicrring ro rhc biological and thc socir.l.
The physical body provided ibr the reproduction ol society through sexualily
and socialization. fror Durkheim society represented dle "nighest reality in the
intcllectual ancl moral order." The body rvas the storehouse of cmotions thtl
wcro the raw ntatcrials, the stufl', out of which mcchanical solidariry was lorgcd
in tlxr intucsts ol the collectivity. Building on Durkheirn, Mauss wrorc of thc
"cjonrinion oI the conscious Jwill] ovcr cmotion and unconsciousn.:ss"
(19191l9s)ltl22).1hc dcgrcc to which rhc random an, chaolic impuh;cs ol thc
lndy rvcrc tlisciplincrl by social instituti,rns rcvcalcd thc stanrp ol higlrcr crvr
lizations.
Frr:rrcl introducccl yct another ir:terpretation of the mind-body, nalurc-culturc,
individual-socicty sct ol oppositicns witlr his thcory ofdynamic psychr.logy: thc
indivirlual at rvar within hirnsell Frcud proposed a human drlma in which nat
l(llu;rls;[l(l l((nrllrt(1si (, l)ls(ll)ll[c;r,rl l)ls].j(1|l 4l)
rrul, hiokrgical tiivcs krckotl lrotrrs witlr tltc (k)ntcslic,tting rctluilcntcnts ol thc
socirl and nrorrl ordcr.'l'hc rcsulting rcpressions ol thc libido through a largcly
painful process of socialization prodrrced the many neuroses of modern life.
Psychiatry was called orr to diagnose and treat the disease of woundcd psyches
whose egos were not in control of the rest of their minds. Civilization antl lts
l)iscontents^ may hc read as a psychoanalytic parable concerning the mind-body,
nirlrrrc-culturc, antl individrral-socicty oppositions irr Wcstcrn cpislcrmlogy.
Iirlr Marx and his associatcs thc nalural world cxistcd as an cxtcrnal, objcctivc
rcalily th'rt was lronslbrnrcd hy huntirn labor. Hunrans distinguish themselvcs
Irom animals, Marx and Engcls wrotc, "as soon as they begin to produce their
mcans ol subsistcncc" (1970:42). ln Capital Marx wrote that labor humanizcs
and domesticatcs nature. It gives life to inanimatc objects, and it pushes back
the narural frontier, Ieaving a human stamp on all that it touches.
Although the nature-culture opposition has been interpreted as the "very ma-
trix of Western metaphysics" (Benoist 1978t59) and has "peletrated so deeply
... that wc have come to regard it as natural and inevitable" (Goody 1977:64),
therc havc always bcen alternativc ontologies. Onc of thesc is surcly the vicw
that culture is looted in (rathcr than against) nature, imitating it and emanating
directly fiom it. Cultural materialists, fbr example, have tcdded to view social
institutions as adaptivc rcsponses to certain fixed, biological foundations. M.
IJarris (1974. 1979) rclcrs ro culturc as a "banal" or "vulgar" solution to rhe
hunran condition insollr us it "rcsls on thc ground and is built up out ol guts,
sex, energy" (1974:3). Mind collapses into body in these formularions.
Similarly, somc human biologists and psychologists have suggestcd that thc
mild-body, nature-culture, and individual-society oppositions are natural (and
prsumcd universal) categories of thinking insofar as they are a cognitive and
symbolic manifestation of human biology. R. E. Ornstein (19?3), for example,
understands mind-body dualism as an overly detennined expression of human
brain lateralization. According io this view, the uniquely human specializarion
of the brain's left hemisphere for,:ognitive, rational, and analytic functions and
ol'the right hcmisphere for intuitive, expressive, and artistic functions within
lhe contcxt of lclt hcmisphere dominance scts th? stage for the symbolic and
cultural domirance oi reason over passion, mind ovcr body, culture over naturc,
and maie over female. This kind of biological reductionism is, however, rejected
by nost contcmporary social anthropologists, who stress instead the cultural
sources of these oppositions in Western thought.
Wc should bcar in rnind that our cpistenrology is but one anrong r any sys-
tems ol'knowlcJgc regarding thc rclations hcld to obtain among mind, body,
culturc, naturc, and socicty. For cxanrplc, somc non-Westcrn civilizalions havc
ilcvclr:pccl altotnativc cpistcnrologics thilt lcnd (o colccivc ol rclutions anlulg
similar entities in monlstic rather than in dualistic terms. Representations of
lrolisnr in non-Wcstcrn cpistcmologics in dcfining relationships betwccn any sct
ol concepts or principles ol'cxclusio,l and inclusion comc into play. Represen-
tations of holislr'r and monism tend toward inclusiveness. Two rcpresentations
 50 Theoretical persp. ctives
of holistic thought are particulirly common. The 6rst is a conception ol har_
monious rvholes in which cve|r'thing liom the cosrnos down to thc indivi(lual
org.lns ol'lhe human bod\, :s understood as a single unit. This is oftcn cxpresscrl
as tlrii relirtionshjp of microcosm to macrocosm in which thc rcl-ttionship ol.
parts to the rvholt is em|hasized. A second representation of holisric thinking
is that of complemenrary (not opposing) dualities in which contrasts are madc
betrvecn paired entities within Ihe whole. One of the better-known represer,ta-
tions ol'balarrccd complementarity is the ancienl Chinese yin_yang coimology,
which first appear.s in the / Chlflg somewhat before the third cenrury a.C. In t;tis
view, thc cntire cosmos, including the human body, is ullderstood as poised in
a statc of clynantic equilibrium, oscillating between the poles ol yin and yang,
nrnsculinc and lcminine, light and dark, hot and cold. .fhc lradilion ol.itDcicnt
Chincsc mcdicinc acquired thc yin-yang cosnrologv lionr thc'litrists i,orl li.onr
Conllcianisrn a cooccrn with strcial clhics, rnorill conducl, itn(l lhc inlportltncc
rrl rtrrrintairrinll lurrnrorrirrrr:r rclltli()ns llt()nlt irrrlivirhr:rl , lrrrrrill, corrrrrrrrnity,:rrrrl
slutc. (l(ntccl)ti(, s ol tltc llc:lltlly lrody
'yc1rj pitltcl.ICd itlicr lllc hcilltlt! slntc. l
lrollt lltr'tc t,i lttt (,Irltl tris tLlt.t. lll tkrIy. lrtrlrrrrrr., rrrrrl 1rr,.r.,,, ,) ,vrtlrrrr tlr,.
t.rtir\t ,rl rrr,lrrrrl r,tcr rlt.grr.rrrk.rrr.ies. llrc llcilltlt,l ir*livirlrrrrl: rk.lr.rrtl: ,rr ir
halancc in thc tratural workl, irrr,l the hcitltlr ol ditch orgtrn rlrp,:lrls, rr irs rclir
liotrship ttr nll ()llrcr otgluls. Notl,i'rtt clrr cltnnllc wi{lt(,ut ehrrrr3irrg lhc wlrolc
(Unschukl 191i5).
Islrurir; rosmology, a synthcsis cl clrly Crcck philosophy, Jutlco-Chrrsrian
concepts, and prophetic revelations set down in the
eui'an, deDicts humans irs
having dorrrinalcc over nature, but this potential opposition is tempered by a
sacred worldview that stresses thc complementarity of all phenomena (Jachi-
mowicz 1975; Shariati l9?9). Ar tl'. core of Islanric beliel ljes rhe unil-ying
concept of 'l'owhid, which Shariati Tgues should be understood as going beyond
thc strictly religious meaning of "Cod is oae, no morc than onc,' io cnconrpass
ir worldvicu/ lhat reprcsents all cxistence as cssentially monistic. Guidcd by the
principle ol .uwhid, humans are rcsponsible to one power, answerablc to a
single judgc, anrJ guided by one principlc: the achievenrent of unily through thc
complcnleDtiu"ities of spirit and body, this world and the hcrcalicr, suhslancc
ltnd nrr:anin1l, nrlulal itnd supcrnalurnl. itnd so on.
'I hc fi)ncr:pl in Wcslcr.n philosophicr,l
lratlitiorrs ol an ()bscrvioll uo(l l.cll,.xivc
"1." ir rnintllirl scll tlr l stirnrls orrlsi<i. tltc b(\ly iln(litpitrl lir,,rr rr:rtrrIc, is lrrtotltcr
lrr'r'itrrgc.l ('i,'tcsirrn rlrr:rlisrrr tl)irt cr)trtrilsls sltxrl)ly witlr it Il.rl(llrist lin,l ()l
slrbicctiviry ilnd rcl,rio0 ro rhc
n,r.r,l w.rkl. In w.iting .h{nrr rlx'
lrr(r(llrisr
Sltclltirs ol Nelrrl,ll(rlrclt l,irrrl sull,,tcsls tlrnl tlx.y rl(, rtot
Jx.rccivc tlrcir.irrtcliorry
{)a llrcir sul!cftivily ils llol)c!cssly c t t)ll und r:rrcluded liorrr tltc rcsl ol tritlutc,
l)ul lrirrhcr rrsl .. . eorrnccrcrr ro. irrrrr:crl itlcrrricul $irh, rrrc cnlirr csscnrilr r,rurll
ol lhc c()s x)s '(l()76:III). ln llrrtlt rist trxdilir)llr lltc nxlut.irl w(nl(i (lhu ,, n.1(t
,)l rlrlrcilrirfl((\) i .t l)rudltct:rl lltit)(1, in thc scnsc tll.rt llrc clrtirc c,rsrrro, r.
csscrliillly "rrri tl.''llrrough tncdit rio , itrdividual ruinds cit0 Drct-gc witl) lhc
univcrsal mind. U derstanding is reachcd not through analytic mcthods but
Rituals and Routines of Discipline and Dissent 5 t
ralher through an inluitive synthesis, ilchieved in momen(s of transcendence that
are bcyond spccch, language, ard the written word.
Thc Iluddhisr philosopher Suzuki (r960) contrasled Eastern and Wcsrcrn aes_
thetics and attitudes toward nature by comparing two poems, a seventeenth_
century Japa'nese haiku and a nineteenth-cenrury poem by Alfred Tennyson. The
Japanese poet wrote:
When I Iook carefully
Isee ihc nazuna blooming
By the hedgel
In contrlsl, Tcnnyson wrotc:
lrlowcr i0 thc clrrnnicrl wall.
I I)lrk k yoll orn (!t t|(. .I ri.s,
I lx)l(l yrnr ll(,ft', 11xrt ilo(l itll, ifl t)ty hiIxl,
Lrltlc ll'wr.t lnrt rt I r1, hl U rl(.rrtIll(l
Wllnl y,trr Ir(, rnl nl(l nll, i trt ir rJl i,tj.
l slt rrlrl lrrrrw r lt.rt ( j,nl .t Ll llr,l.r i\.
Suzuki ollscrvcs lllitt tllc Jitp ocsc poct, lJ sho docs not pluck thc nilzuna but
is contcnt to admirc it liom a rcspcctlul distancc; his leelings arc ,.too l'ull, too
decp, and he has no desire to conceptualize if,(1960:3). Tennyson, in conrrast,
is activc and analytical. He rips rhe plant by its roors, desrroying it in the very
act of admiring it. "He does not apparently care for its destiny. His curit siry
must be satisfied. As some medical scient;sts do, he would vivisect the Ilower,'
(Suzuki 1960:3). Tennyson's violent imagery is reminiscent of Francis Bacon's
dcscription of thc natural scientist as onc who must ..torture nature,s secrets
fron her" and make her a "slave" ro mankind (Merchant l9g0:169). principles
ol-monistn, holism, and balanced complementarity in nature, which can temper
perceptions of opposition and conflict, havc largely given way to the analytic
urgc in thc reccnt hislory of Westcrn culture.
l'crsolr, Scll, rrrrd Indivi<lrrrrl
'l'lrc Iclitti()n ol inrlivitlual l() s()cicly, rvhiclr has rrccupicd
so tnuch ()l.co,tlcnl_
.,0ltl.,tl" .l)l).silio lx.twccn
ltr,rlrry rrrt irrl llrr..ry, is lrrrscrl ., ll lt(.t( civcrl
llt(
rk rrrirrl(ls ol tlr(.so(.ill i xl rrrolal orrlt.r'arrrl cg{\.crrtric tlrivcs, ilrrlrrrlscs, wislrcs,
ilxl nccds. 'l'hc individuill-socicty oPposition, while lixxlilmcntill to Wcslcn)
cl)istct to logy. is also lirthcr.UniqUc lo it. Clillirrd Cccr.tz has nrgucd th t thc
r
Wcstcfil c(ntccl)ti()I ol tl,c l)rjt.soD ils bou.)dcd, uniquc. . , intcgralcd ntoti-
virli0llirl :rn(l cognitivc univcr.sc, it (lynilrnic cct)lcr ol ilwitrcnoss, ctnolion, judg-
mcnt, .lnd rclion... is a rnlhcr pr:culi r iclca wirhirr thc contcxt ol lhc world,s
cultu.es" ( 1984:126). In lacr, thc modern conception of the individual self is of
52 Tneoretical PersPectives Rituals and Routines of Discipline and Dissent 53

recenl historical origin, even ilr the West. lt was only with thc
publicalion in signs of u,eakness but rathcr as the result of inner strength (Reischauer 1977:
we havc a
1690 of John l,oc,ke;s Essay Concerning llumat Uttlerstandi'.g that 152). But onc f'ear haunts may contempcrary Japanese: .hat of losing oneself
detailed theory of the petson that identifies the I or the self with a statc oi completely, of becoming totall) immersed in social obligations. One protective
pennanent consciousncss that is unique to the individual and stable lhrough the device is a distinction made between the external self (tatemae)-the petsona,
span un'il diath (Webel 1983:399).
lifi: the mask, the social self that one presents to others-and a more privale (honne),
Though n,rt as detailed perhaps, it would nonetheless be difhcult to imrgine that "natural" hidden self. Clifford Geertz has described a similar phenomenon
a pcople r:ompletely devoid of some intuitive perception of the
indepeodent seli among the Javanese and Balinese (1984:127-28).
#" ti irL ;t i,asonabl" lo assume that all humans are endo'red with a self'- Kcnneth Read argues that the Cahuku-Cama of New Guinea lack a concept
consciousness of rnind and body, with an internal body image' and with whai ol'the person altogether: "Individual identity and social identity arc two sides
scnse of
neurologists have identilied as the proprioceptive or sixth sense' our of the same coin" (1955:276). He maintains that there is no awareness of the
body seif-awareness, of mind-body integration, and of being-in-the-world as individual apart from structured social roles and no concept of friendship, that
David Winnicot regards thc intu- is, a relationship between two unique individuals that is not defined by kinship,
,"p"rat" und apart from other human beings,
precultural
itire pe.ccprion of the body-self as "raturally" placed in the body' a ncighborhood, or other social claims. Cahuku-Gama secm to define the self,
givcri (t97t:4lt). Whilc this scerns a rcasonablc assumption, it is imporllnl to insofar as they do so at all, in terms oi-the body's constituent parts: limbs, facial
iistinguish this universal awarcness of the ildividual body-self fronr thc social Ieaturcs, hair, bodily secretions, and excretions, Of particular significance is the
conctipric,n ol'llrc i0dividltrll os "pcrs([''' it cotlstrucl ol .iuml riSlrts rrntl rrrorul Crl)rrxu-CnrrJ cohccplioD ol thc soui l skin, which iicludcs hoth rhc covcring
ircc()LLntability /l aFontaine 1985:124). La yersotrne alotalg' as
Mauss ol tha body and thc pcrson's social and charactc. trai(s. References to one's
(1985119381) pinascd it, is the uniquely Western notion of the individual as a "good" or "bad" skin indicate a person's moral character or even a person's
quasi-sacred, lcg,rl, rnoral, and psychological cntity !r'hose rights are limitcd only tcmperament or mood. Cahuku-Cama seem to experience themselves most in-
by the rights of other equally autonomous indivirluals' tensely when in contact with others and through their skins (see also LaFonraine
Modem psychologists and psychoanalysts (Winnicor among them) havc I985: 129-30).
gratiual estlangc-
tcnded to intcrpret the process of individuation, dcfincd as a Such sociocentric conceptions of the self have been widely documented for
nrenl fio$ parcnts and other family mcmbers, as a nccessary stagc in thc htrnran many parts ol thc world (scc Shweder and Bourne 1982; Dcvisch 1985; Irortes
malu.ation process (see atso Johnson 1985i Devos, Marsclla' and Hsu 1985:3- 1959; Harris 1978) and havc rclcvancc to cthnomrdical understanding. In cul-
5). 'Ihis is, howevcr. a culturc-bound notion ol human rlcvcloptncnt antl onc turcs and socictics lacking a highly individualized or articulatcd concoption ol'
lhat conibnns to lairly reccnt conceptions of the rclation ol thc individual to thc body-scll, it should not bc surprising tlrat sickness is often explained or
society. attributcd to m,rlevolent social relations (that is, sorcery), to the breaking of
In iapan, llthough thc conccPt ol individualism has bccn dcbatcd vigorously social and moral codcs, or to disharmony within (ho l'amily or the village com-
since ,he end of the last century' the Confucian heritage is st'll cvidcn'
today munity. In such societies therapy, too, tends to be collectivized. The lKung of
the nrost natural, fundamentat unit of Botswana engage in weekly healing trance-dance rituals that are viewed as both
in that il is lhe family that is considered
socicty, not the indi;idual. Consequently, the greatest tension in Japan lbr at curative and preventive (Katz 1982). Lorna Marshall has described the dance as
least the past lbur hundred ycars has been bei''c'ir orte's obligations lo thc statc "onc conccrted religious act of the !Kung [that] brings people into such union
and onc's obligations to the family. that thcy bccomc like onc organic being" (1965:270).
'fhc philosophical traditicns of Shintoism and Buddhisnr havc also irilil^lcd In conlrirst to societics in which the individual body-sclf tends to bc Iused
,rgainst Japanesc conceptions of individualisnt The animisnr of Shinto lbstcrs with or absorbcd by the social hody, there are societies that view rhe individual
tielings oi identilication with naturc, anct mary of tho tcchniqucs oi Buddhir;t as conrprising a multiplicity of selvcs. Thc Bororo (likc the Gahuku-Oanta)
coltcrlnplation cncouragc dctachnrcnt lionr cnttltly dcsircs Ncitlrcr lrildilio'l
cn undcrstand thc individual only as rcllcctcd in rclationship to othcr pcoplc. Hcncc,
th" <lcvclopnrcnt of a highly individuatcd sell" tha pcrson consists of nrany selvcs: thc sclf as pcrccived by parcnts, by othcr
.lapirn lrts bccn Icpcittcclty rlcscribccl us a (ullurc ol souinl rclativisrtr' ir
"<r-,rugc* wlrir:lr kinsrncn, hy cncnrics, antl so lortl'. Thc Cuna Indians oi Pananra say thcy havc
thc, perso,r is Lrntlcrstood as uc.ing within the contcxt o[ a soci l rclation;hip' cight sclvcs, each associated with a dillbrent part of the body. A Cuna indivi-
never simply autonomously (Lebra 1976; Smith 1983) Onr:'s selt--identity dual's temperament is the result of domination by one of these aspects or pans
cl',unges rrith the social context, particularly within the hierarchy of social
re- of the body. An intellectual is one who is governed by the head, a thief governed
latiois at any tifire. Thc child's identity is stablished through thc rcsponscs ol by the hand, a romantic by the hean, and so forth.
otlrcrs; conlbrrnity and,lependency, even in adulthood' are not undcrstood
as Finally, the Zinacanteco soul has thirteen divisible parts. Each time a person
 54 Theoretical perspectives
Rituals and Routines of Discipline and Dissent 55
"loses" one or more parts, he or shc becomes ill, and a curing ceremony is
a soul force or mind-self that produces humans even under the most devastating
heid to retrieve the rnissing pieces. At death the soul leaves the body and rcturns
assarrlts on the brain, nervous system, and sense oI bodily or mindful integrity.
to rvhence it came-a soul "depository" kept by the ancesrral gods. This soul
Whilo profound distortions in body imagery are rare, neurotic anxieties about
pool is used for the crcation of nw humar beings, cach of wSose own sour is
the body, its orilices, boundaries, and fluids are qu ite common, S. Fisher and S.
made up of thirteen parts from :he life force of other previous humans. ,\ per-
Cleveland (195d) demonstrated the relationship betwee[ patients' "choice" of
son's soul lorce and his or her self is thereforc a comDosite, a syntlicsis "bor-
symptoms and body image concept;ons. The skin, for example, can be erperi-
rowcd" l-rom rnany other humans. There is no sense that cach Zinacantcco is lr
"brand-ncw" or totally uniquc individual; rathcr, cach pcrson is a Irlction ol' cnccd us a prolcclivc hidc and a dclcnsivc annor protccting thc soltcr and morc
vulnerable internal organs. In the task of protecting the inside, however, the
the whole Zitacanteco social world. Moreover, the healthy Zinacanteco is one
outside can take quite a beating, manifested in skin rashes and hives. Conversely,
who is in touct' with the divisible parts of himsr lf or herself (Vogt 1969:396-
the skin can he imagined as a permeable screen, leaving the internal organs
37 't).
dci'cnsclcss and prone to attacks of ulcers and colilis.
Whilc in the industrialized West there are only pathologized cxplanations ol'
Parliculir organs, body fluids, and functions may also have special signili-
disscrciativc slalcs in which one experiences morc than one sell, in nt.rny non
cnocc lo a group ol'pcoplc. Thc Iivcr, litr cxamplc, lbsorbs a grcat dcal of blnmc
Wcstcrn culturcs, inclividuals can cxpcric.rcc trrultiplc sclvcs through tllc prlctruc
lirl' muDy dilltrcnt ailmcnts anrong the Frcnch, Spanish, i)ortugucse, and Bra-
ol_spirit posscssion irnd othcr illtcrcd statcs ol consciousncss. Such r.ilrralizcrl
zilians, but to our knowlcdge only thc Pucblo Indians o[ the Southwcst sullcr
an(l controllc(l cxpcricnccs ol posscssion nrc soughl alicr lhroughoul ll,r: wo rl
li.rlir "llippctl livcr" (l,co,rtn l9lt(r. 'l'hc lirrglish and lhc Cerntitns irrc, by
ils villucd linrDs ol rcligioLrs cxpericrrcc antl thcrapcutic b llnvior.'lb dllc, how-
conrparisol), iar morc obscsscd witlr thc condition and health ol-thcir bowcls.
evcr', psychological anthropologists have tendcd tu "pathologize" these lltcra(l
Allan Dundcs takes thc Ocrnranic llxation with thc bowels, clcanliness, ancl
states as rnanilcslal.ions of unslaLle or psychotic personalities. 1'hc Wcstcrn con-
anality as a lundamental constellation underlying German nationai character
ceplion oi one individual, one self effectivcly disallows ethnopsycnclogios lhal
(1984), whilc Jonathon Miller writes that "when an Fnglishman complains
rccol:. ize as n(i[mative a multiF,licity oI selves.
about constipation, you never know whether he is talking about his regularity,
his Iassitudc, or his depression" (1978:45).
I)otly lnragery Blood is a nearly universal symbol of human life, and some people, both
ancient and contcmporary, have taken the quality of the blood, pulse, and cir-
Clloscl), rclalcd to conccptionrj ol self (pcrhaps central to th(rn) is whar psy
culation as thc primar/ diagnostic sign of health or illness. The traditional Chi-
chiatlists have labelcd body image (Schilder 1970 U950li Horowirz t966). Body
nese doctor, for example, often made his diagnosis by feeling the pulse in both
inrage rr:lbrs to the collcctive and idiosyncratic representations nn individual
of the patient's wrists and comparing them with his own, an elaborare ritual that
entcrtains about thc body in its relationship to the environmcnl, including in-
could take several hours. Loudell Snow (1974) has described tho rich constel-
ternal and cxtclnrl pcrceptions, memories, alfects, cognitions, a d ilclions.'l'hc
lation ol cthnomcdical properties attachcd to the quarity of the blood by poor
existing literaturc or body imagery (although largely psychiatric) har; irccn vir
hluck,Amcricans, who s.rll'cr liorn "high" or "low," litst antl slow, thick ancl
lurllv rrnlirplxxl lry rncrlical :rntlrropolo;qisls. who coLrkl lrclclit Ii1)ll il r.ntr{nl t()
thin. lrittcl rrnrl srvr.r.t hllorl llli Lilk( ( lr)8(r) hrrs analyzr:rl rh(: (,onccpt ol hlrxxl
lrrly lUrrrr,lrrry (,,ir(.t,li,'r',,, , I I
,,
I ( ,I I I, I i i Ir Irrly 1l.r, , r,t,,,r:, r',',, :,(, ,,'r
' ils il l)rcrIIlrrillrl Ilrlll)lr{n l|r lllrr(,1)rillr uult lc, ts|eetitlly tts usds t lx)ll uitl
Sorllc ol llle clrlicsl irld l)cst work (rt hrxl1, irllagc wits c(ntlitiDLxl i uli icirl
irlr,,,lrgir,r, rrrIlr rrr rlrrrinp tlrr'llir:ri rr|ir Silrilrrrly, thr, nttrltil)lrr xtiIn1fln n lli]rcrl
rlrtrlrr.r lll rrrrlrvrlrrrrls rrrllr.r|ltlt lrlll (.ilrcllt{.ly rlrslort.(l I'rxly I! rr.r.|nIr,:r,r llrrt
,rs(r I',,llr ttc'ttt[lo!tcirl, ,,rE llt, ,,r psytlrrrrt t ,lir(,'(l.rj (ll.il,l lry Norllr Alr(.1(ilr n Il)S t,:rlir"ts irrr.lrrri.rr lrrnx.r,rrpttio,t witlt tlt(."lrr(l
1.r,,{1, S( l,rl,l.l
I970 ll()501i Lrrriir 1972). 'l'lx iftrhil;ly ol'son(' so-cirllcrl sclrizrrl irr.r.nit.s t0 hlrxxl" ol tlisc.rsctl lr{)rDoscxuals (l,i leitstcr l9li-l).
Mollrcr''s rrrilk rssunrcs rcw cullutitl itrxl syrrrl,rrlic rtrcitttiltgs wltctcvct sul)-
rlistinguish scll lrtrrrr rrtltcr'or \ctl'lionr inanirnalc olrjccts lt:rs hccrr analyzcrl
sislcncc cconornics havc bccn rcplaccd by wagc labor. Schcpcr-Hughcs (1992:
liorr psychoirnillytic and phenonrcnological pcrspcctivcs (Minkowski 1951.l; lJin
316-326) fbund that culture of breast fbeding u'rraveled over a brief historical
swanger 1958; Laing 1965; Basaglia I964). Oliver Sacks (1973t19701, l!'85)
period in northern Brazilian sugar plantation society, including poor women's
also has written about rare neurological disorders that wrcak havoc with the
beliefs in the essential "goodncrjs" of what comes out of their own "dirty,"
individual's body image, producing deficits and excesses, as u'cll as meraphys-
"disorganized," and "diseaseC" bodies compared to what comes from
ical trlnsports in mind-body experiences. Sacks s nlessage throughout his poign-
"cloan," "healthy," "modern" objects, like cans of Nestl6's infant formula
ant rncdical case histories ij that hurnanness is not dependent or rationalily or
and clinic hypodcrmic needles and rehyoration tubes. In terms of the "brico-
intclligeDce-that is, an inltot mrnd. Thcrc is, he suggests, something intangiblc,
lage" that governs fanrily formation in the shantytowns of Brazil, the ritual thar
 56 'fheoretical perspeclivs
crcillcs socirl l'irthcrh(Dd rclocalo$ bilby's milk fronr rnothcr's hrcasls, rlistjaincd
by rcsporrsiblc, Lrving wrrrncn, lo lhc prclty clns r)l l)ow(lcrc(l rrrilll lirr.rrrula
(h('irring (()llxlirlf ilrrrl stirtc wilInings irholll tlt('(liIlli(.rs rtl tll(,
luxllt(,t tllirt lltr's.
illilctalc rvrrrrrcn ctrrltol rci(l)cil-t-icd irrto llrc ltorrr,,s by t'r:sporrsihlc, Irvirrg rrtr.rr.
Prlernity is lrirnsilclo(l loday througll the gili ol nrillc l))ilk," tltirt is, 1x^.llt'rcrl
rrrilk. lrallrcr's rrrilk, not his sclncrl, is llis ntcilns,)l conlcrritrg I).tt('l,ltily itn(l
synrbolically cstirblishing thc legitinlacy ol rhc chitd. Sinlilarly Lrafl cr (t9ll8)
has clir;cussi:cl thc rclationship bctwccn nloral o.dcr anC conccpts of spoilcd rnilk
and had blood in Haiti.
ln short, cthnoanatomical petceptions, including body irrragc, ollcr. a rich
soutric ol duta on hoth lhc social and cultural mcanings ol bcing hunran ulld on
the variouri lllleats to health, vrell-teing, and social integratiorr thal hltmtrri arc
belie\,cd to experience.
THI' IjO(:IAL I}ODY
Thc Ilody as Symbol
Syrnholic and strucluralist anthropologists huvc rlcmonstratcd lhc cxtcnt to
which hunrans lind the body "good tLr think with." Thc human organisrn and
its nrtural products of blood, milk, tea$, semen, and excreta may be uscd as a
cognitivc rnap to represent other natuial, supernatural, social, and cven spatial
rclatiorls. Thr l)D(ly, as Mary Douglas observed, is a natural symbol suppl)ing
some of oul richest sourcos of metaphor (1970:65). Cultural constructions of
and about the body are usel'ul in sustaining particular views of scciety and social
i)lati(nrs.
Rodney Needham, for cxample, pointed out some of the frequcntly occur.ing
lssocialions between the lcft and that which is inferior, dark, dirty, and flernule,
and Ihc right and lhat which is superior, holy, Iight, dorninant, lnd nurl.. i.lc
c llcd itttcntion to such uscs ol the tody as thc convcnicnt mcans ol .justilying
pirrlicular sr)ci:tl valucs und solial arangcntcnts, such ils thc ''nitturill" dotDi
llilncc ol r)l lcs ovcr li:rrirlcs (19?3:109). Ilis point ir; tllitt tltcsc c(nllIr)n sylll
hrrlic ur.;uitlirrtts iu( n{)( s() nruch nirtrral its lhcy urc usclitl, itt lcltsl k} llt()sLr on
lhc k)p irnd t() tlrc rigl)t.
Iithnobiolrrgicll tlrcorics ol rcproduction usually r!llc.i( thc chilrxclcr ol thoir
associatcd kirrship system, as anthropologists have long observed. In socicrics
$,ith unilineal dcs(cnt, it is commorr to encounter lblk theories that cmphusize
the rcproductive contributions of females in matrilineal and of malcs in parri-
Iinell socictics. [he rnatrilineal Ashanti make the distinction between tlcsh and
blood that is inherited through women and spirit rhat is inherited rhrough males.
Thc Brazilian Shavante, among whom patrilineages form the core of political
hctions, bclicvc that thc lathe: lashions rhe infant through mary acts o[ coirus,
during which the rnother is oniy passive and receptive. The fetus is "li,lly
made," and conception is completed only in the fifth month of pregnancy. As
Kituals and Rcutines of Discipline and Dissent 57
onc Shavant,: cxplained thc proccss to David Maybury-Lcwis, while ticking thc
rlonlhs oll with his lingcls: "Copulrtc. Copulatc, copulato, copulato, copul tc
llilrtiurt (irlnrIr1.. (ol)rluc, !ol)ulittr. lIolt" (lt)6?:63).
ir L)1.
liirriLrrly. lhc Wcstcrl tlr,1n/ ol'cqrral rrr:rlc :lo(l lcnlltlc c(nltribltliotlr t() c()n,
c(:J)ti()[ thirt sl)ir s tho l.(]l)r(xllrelivc bioloHics li(nD (]illcn to'lhcotl{n'c l)obzltitn
sky ( l9l{)) pnrbably owcs x)r1' to lhc lhcory's conrpirtibiiity with thc ljuropc n
cxtcnded and stcnr bilalcral kinship syslem than to scicntific evidence, which
was lacking until rclativcly rcccntly. The principle of one father, one mother,
one act of copulation leading to each pregnancy was part of the Western tradition
IoI. morc than a thousnnd ycars bcforc the discovery of spcrmatozoa (in 1677)
and thc Icmalc ova (in 1828) and bclbrc thc actual proccss ofhuman fertilization
was fully understood and described (in 1875) (Barnos 1973:66). For centuries
the theory of equal male and female contributions to conception was supponed
by the crroneous bclief that females had the same reproductive organs and func-
tions as nralcs, except that, as one sixth-ccntury bishop put it, "theirs arc insidc
thc body and not outsidc it" (Laqueur, 1986:3). To a great extent, talk ubout
thc borly ancl allout scxu.llity tcnds lo bc tillk about thc n^turc ol socicty.
Ol particular relcvancc to mcdical anthropologists are the frcquently cncoun-
lcrcd synr,)olic cqualions bctwccn conccptions ol' the hcalthy body and thc
healthy society, as well as the diseased body and the malfunctioning sociery.
lohn Janzen (i981) has noted that every society possesses a utopian conception
of health that can be applied metaphorically from society to body and vice versa.
Oie ol the most enduring ideologies of individual and social health is that of a
vital ba,ance and harmony such as are found in the ancient medical systenrs of
China, Creece, India, and Persia, in contemporary Native American cultures of
the Southwest (Shutler 1979), .rnd also the holistic health movement of thc
twentieth cenlury (Grossinger 1980). Conversely, illness and death can be at-
tributed to social tensions, contradictions, and hostilities, as manifbsted in Mex-
ican pcasants' imagc ol thc lirnilcd good (Fosrcr 1965), in tho hot-cold syndronc
lnd synrholic imhalanco in Mcxicrn li)lk mcdicinc (Curricr 1969), and in such
lirlk iclionrs as witchcralt, cvil cyc, <)r "str.css" (Schcpcr-Hughcs ancl l-ock l9tl(r;
Yr)ung l9lto). Liach ol thcsc hcliclis cxcnrplilics links batwccn thc hcalth or
illrcs:: ol thc irrtlivitlull hocly antl tlrc socill borly.
TLc Bmbodicd World
One of thc most common and richly detailed symbolic uses of the human
body in the non-Western world is the personification of the spaces in which
humi ns reside. 'I'he Qollahuayas live at tho foot of I!,It. Kaata in Bolivia and are
known as powerful healers, the "lords of the medicine bag." They "understand
their own bodies in terms of the mountain, and they consider the mountain in
terms oi their own anatomy" (Bastien 1985:598). The human body and the
mountain consist of inteffelated parts: head, chest and heart, stomach and vis-
cera, breast and nipple. The mountain, Iike the boc'y, must be fed blood and fat
 5U Theoretical perspectives Rituals and Routines of Disciplide and Dissent 59
to kccp it stlong Ind hcllth),. Individual sickncss is undcrstood as n disiDtcgra-
lbclings, wishcs, and actions ol'othcrs, inr:luding ipirits and dcad ancestors. Thc
lioo ol thc body, likcned to a mounlain landslide o. in elrlhqurkc. Sickncss
is bocly is not undcrstood as a complex nrachinc hut rather as a microcosm of thc
causcd by between pec,ple and the land, specifically betwcen rcsi_
-disruptions universe.
dents ol-diffc,rent sections oi the mountain: the head (niountain rop), hearr
ter village), rtr feet (he base of the mountain). Healcrs curc by gathoriDg
1cen, As Manning and Fabrega rote, what is perhaps most significant about the
thc syrnbolic and metaphorical extension of the body into the natural, social, and
various rcsidonts togcther to feed the mountain and to restore the w"holenr:ss
and supernatural rcalms is that it demonstratcs a unique kind of human autonomy
wellness lhat lvas compromiscd. Bastien concludcs that
bprly
eollahuaya con_ that sccms to have all but disappea"cd in thc modern, industrialized world. Thc
ccpts are lundamont.rlly holistic rather than <iuelistic. He suggests
thar ,,the conlldent uses of the body in speaking about the external world convey a sense
wholc is gr"eater than the sum of rhe parts.. .. Vy'holeness
ltrea-iir; of tne froay that humans are in control. lt is doubful that the Colonrbian Qollahuayas or the
is a process in whjch centripetal and centrifugal forces pull together
and drsperse Desana or the Dogon experience anything to the degree of body alienation, so
fluitls that proviue emotions, thoughts, nutrients, and lubricaits for members
ol common to Western civilization, as expressed in the schizophrenias, anorexias,
rhe body" (p.598).
and bulimias or the adJictions, ohsessions, and fetishisms of life in the postin-
Possibly the nr:st elaborate use of the body in native cosmology
comes trom rlustrialized world.
{he f)ogon oi'rhc westcrn Sudan, as explained by Ogoternrrreli
to i4arccl C.iaulc Thc mind-body dichotomy and body alienation characteristic of contemporary
(1965) in his dcscription of the groun.l plan oj.the Dogon community. ,fhe
society may be linked rot simply to reductionistic post-Cartesian thinking but
villagc must extend from north to sourh Iike the body oi a man lying on
his also to capitalisa modes of production in which manual and mental Iabors ar
back. The head is the council house, built in the center square. To
ihe?ast and divided and ordered into a hierarchy. Human labor, thus divided and fragmented,
west are the menstrual huts, which are ,,round like womhs antl
represent thc is by MrLrxist definition "alienated." E. P. Thompson discusses the subversion
hands of the village" (1965:97). The body rnetaphor also informs
the interio. of natural, body time to the clockwork regimentalion and work discipline re-
of the Dogon house:
qui'cd by indusLrialization. He juxtaposes the factory u orker, whose labor is
cxtracted in minute, recorded segments, with the Nuer pastoralist, for whom the
Thc vestihukr, which belongs to the master of the house, represcnts thc "daily linrcpiccc is the cattle clock" (Evans-Pritchard 1940:100), or the Aran
malc n.lrl ol.lhc
couple, the outside door being his sexual organ. The big central
room is the dolnain and lslandcr, whose work is managed by the amount of timc left before twilight
the symbol of tl c woman: the store-rooms each side are her
arms, and the ccmmuiicating (Thompson 1967:59).
door her sexual pais. The central room and the store roc:ns tcgether
rcprescnt lhe wontan Sirnilarly, Pi,:rrc Bourdicu describes thc "regulated improvisations" of Al-
lying on hcr back with oulslrctchcd iirms. lhc d(x)r opcn, irn<j
thc wornart r.cluly lor gcrian pcaslnts, whosc nlovcnlcnts roughly corrcspond to <liurnal and scasclnal
inlcrcou.sc. ( I 96-5:94-95)
rhythms. "At lhc rcturn ol lhc Azal (dry scason)," hc writcs, "cvcrything with-
out exception, in the activitics of mcn, women and children is abruptly altered
Other well-known examples of thc syn,bolic use ol thc human
body in cos_ by the adoption of a new rhythm" (19'77;159). Everything riom men's work to
mological classification include the wesrern Apache (Basso 1969), thc
lndorrc- the domestic activities of women, to rest periods, arrd cere.'nonies, prayers, and
sian Atoni (Cr-rnningham 1973), the Desana Indians of rhc Colomhian_Brazilian
pubiic rneetings is sct in terms ol the natural transition from the wet to thc dry
border' (lteiche l- Dolmatoff l97l), rhe pira_pir]na of the r.,mazon (Hugh-Joncs
season. Doing one's duty in the village context means "respecting rhythms,
1979), the Zinacantocos oi Chiaprs (Vogt l97O), and rhe Fali
of north"in Cu,r,- keeping pace, not falling out of line" (19771161) with one's fellow villagers.
eroon (Zahan J979).
Although, as Bourdicu suggests, these peasants may suffor from a species of
Pder lvlanning and Hor,ltro Fabrega (1973) have summarized sonrc of thc
false conscicusness (or "bad faith") that allows them to nisrepresent to them-
rnaj<x dif'fererrccs bctween non-Westerr ethnomedical systlms
and inodcrl bi_ selves their social world as thc only possible way tc think and to behave and
omedicine. ln lhe lattcr, bo.ly and sell are urrderslood ui rlistinct
rnrl st,,_rllabl,: to pcrccivc as "natural" whal arc, in lact, self-imposcd cultural rulcs, thcrc is
cntities; illnoss resicles in either the body or the mind. Social relati<rns
arc sccn li(lc doubt that thcse Algerian villagers live in a social and a natural world that
as partitioncd, segolented, and situational_generillly as discontinuous
witl, has a decidedly human shape and feel to it. Wc might rerer to thir world as
health or sickness. By contrast, many ethnomed;cal systems
do not logically cmbodied.
distinguish body, mind, and self, and therefbre illness cannot
be situated i; nrind In contrast, the world in which most of us live is lacking a comfortable and
or lrody alone. Social relations are also understood as a key contri5utor
to in_ lamiliar hunran shape. At lcrst one source of body alienation in advanced in-
dividual lealth and illness. ln shorr, the body is seen as a unitary,
integratcd dustrial societies is the symbolic cquation of humans and machincs, originaring
ilspcct ol'scll and social relations. [1 is dopendcnt on, ancj
vulncr,ilrlc tl- tn" ir our indust|ial modcs and rclations of p.oduction and in thc commodity fct-
 rio Ih(:{rr{1I( irl l'ctr.])rr( llv(:s
islrirrrr ol rrrrxlcIn lilc, in whielr cvl]D trtL'liulllaI lnrly l)lrs bcrrr lr:ursli,r'rc(l iDt()
ir c{rDm(xlity. n gnin, Man in[l rrnd llatrrcga cilpturc this wcll: "l,t pr.irrrrtivc
socicty ll)c h y rrl rrran is thc par dignr Iirr tltc dcrivation ol tltc l)illts lr)d
nrcirnings ol-othcr signilicant objccts; in modcm socicly rnan has arloptcd thc
litnguagc ol'thc machinc to dcscribc his hody. This rcvcrsal, whcrcin rnan sccs
himself in tcrms of the external world, as a rellection of himself, is the repre-
sentitive formula for expressing the present situation of modern man" (1973:
183 t.
\\t rc)y on the body-as-machine metaphor cach rime we dcscribc our somi,rrc
or psychological states in rnechanistic terms, saying that we are "worn out" or
"wound up" or whcn wc say that we are "rundown" and that our "baltcrics
nced rccharging." In recent yeats the metaphors have movcd from a .nechanical
to irn clc(tric l mode (we iLre "turned off," "tuned in," we "gct a chargc" out
ol !()nlcthing), while the computer age has lent us a hosl of new cxprcs:,tons,
including the all-too-familiar conlplaint: "my energy is down." Our point is
that lhe struclure of individual and collective sentiments down to the "fccl" of
onc's body and thc naturalness of one's position and rolc in thc tcchnical order
is a social conslruct. 'fhomas Belnronlc dcscribcd thc body rhythnrs ol thc lirc,
tory workcr: "The work of factory workcrs is a stiff nrilitary drill, a rcgintcDt
oI arrns welded to rtctal bars and whcels. Marx, \/eblen ancl Charlic Chaplin
havc powerlllly mado thc point that, on rhe asseinbly Iinc, rnan nuithcr rnakcs
nol. Isas lool\, l)lrt is conlinuous with tool as a rninutr:. linxl uttitchntont to lhc
nrrssivr.: inrfustliirl rnilchin0" ( I 979: I :10). 'l'hc ntlcllrircs irirvc chlrngt'<l sirx.c
lllosu.illl) rlirys Lrl lltc Isscrttbly linc. ()n0 tltillis lorl y nol lll lll( l,rUlnlily 0l
lruBc Bri[(liog Llciuir llr]Ll wllo!ls l)ut rnrllur ol lhc stcrilc silcncc rr (l sur,ilizu(l
lxrllutitrrr ol tlrc r!ri(11)clcclr'orics in(luslrios (o which llru rrirrrbic lirrllcls, slr;,incrl
cyes, ancl docilc bodics of a new, lar3ely lcnralc and Asian labor lirrcu arc now
mcldccl. What has oot changcd o any appreciable dcgrec is Lhc relarionship ol
hurnrn bodics to the machines under twentieth-century forms of inciustrial cap,
italisnr.
Non-Western and nonindustriaiizcd peoplc are "called upon to think thc
rvorld rvith tl)cirbodics" (O'l,lcill 1985:l5l). i-ikeAdanr ancl Ilvc in rhc Cxr(lcn.
thcy cxcrcisc lhcir lut(rlonly, llxiir p()wcr, hy nItnin,3 lllc ph('IoIlo0it il,t(l crcit-
Iurcs ol lhc workl in thci[ ow rnr.tgc und likcncss. I]y contrast, wc livc i0 l
world in rvhrch thc human shape ol things (and even thc human shapc ol hunans
\\,ith their mcchanical hearts and plastic hips) is in retreat. Whilc the cosmologies
of nonindust'. rlizcd people speak to.r constant exchange of metaphors fionr
body to naturo and back to body again, our metaphors speak of machinc-to-
body symbolic c:quations. O'Neill suggests that we have been "pur on rhc ma-
chine" ol biotcchnology, some of us transformed by radical surgery and generic
cnginccring inlo "spare parts" or prosthetic humans (1985:153,54). Livcs arc
saved, or at lcast dcaths are postponed, but it is possit)le th{t our humanity is
bcing conrpromised in the process.
l(ltuill:, illr(l l(()tlllrr(:s (,1 l)ls( ll,llrrc il (l l)lss(irrl (il
' i lr()l)Y t'()l,t'nu
lhc r'clationship l)ctwccD irrdividurl anrl srrcial bodics c(,rlcctrls rrtoro tltarl
nrclaphors unC collcclivc rcprcscntiltions ol thc natural and thc cultural. 'l'hcy
arc rlso ahorl powcr rnd control. Mary Douglas (1966) contcnds, for oxamplc,
that when a community cxperiences itself as threatened, it will respond by ex-
panding the number of social controls regulating the group's boundaries. Points
whcre outside thrcats may infiltrate and pollute the inside become the focus of
rcgulation and survcillancc. Thc thrce bodies-individual, social, and body pol-
itic-may be closed off, protected by a nervous vigilance about exits and en-
tranccs. Douglas had in mind witchcraft crazes, including the Salem trials,
coutemporary African societies, and even recent witch-hunts in the United
Statcs, 1o which we must nor,\'add the curent concern about ritual abuse of
children. ln eaclr of these instances, the body politic is likened to the human
body in which what is "inside" is good and all that is "outside" is evil. The
body politic under threat of attack is cast as vulnerable, leading to purges of
iraitors irnd sccial deviants, while irdividual hygicne may focus on the main-
lcnancc ol'ritual purity or on lcars ol losing blood, scmcn, tcais, milk, or cvcn
one's life.
Thrcats to the continued existence of the social group may be real or imag-
inary. Even when the thrcats are real, however, the true aggressors r':ly not be
known. lnd wichcraft or sorccr),can bccome the metaphor or the cultural idiom
lirr distlcss. Shirlcy Lindcnhaun (1979) has shown, lbr examplc, how an cpi.
tlcrrric ol ktrlrr arrrrrrg llrc Soulh l;(nc ol Ncw Cuincit lctl lo sotccry irccusilli(xts
runtl corrnlclaccus lions llnd nllcrrl)ls lo purily hotlr thc irr(livirlu l iln(l collc.tivc
horlies ol tlrcir irrrprrrities antl c(nrtirl!inirlls. l,oittr Mullings slrgltcsts lhat wilch'
crali antl sorccry wcrc widel)/ used irr contemporary Wcst.\liica as "metaphors
lbr social rclations" ( 1984:164). In the context of a rapidly industrializing mar-
ket town in Chana, witchcraft accusations can express anxieties over social
contradictions introduced by capitalism. Hence, accusations were directed at
individuals and families, who, in the pursuit ofeconomic success, appeared most
compctitivo, greedy, and individualistic in their social relJtions. Mullings argues
lhlt wilchcrllll rccusllions irrc rl incho tc cxprcssion ol rcs:stancc lo thc cro\i()n
ol trit(liti(,nll social valuos hascrl on rcciprocity, sharing, and lhmily and conr-
rnunity loyalty. Shc suggcsts that in thc contcxt ol incrcasing commoditizxtion
ol'human lilb, witchcrali accusations poirt to social distortions and disease in
thc body poliric generated h) capitalism.
When the sense oI social order is threatened, boundaries between the indi-
vidual and political bodies become hlurred, and there is a strong concern with
matters of tual and sexual purity, often expressed in vigilance over social and
bcdily boundaries. For example, in Ballybran, in rural Ireland, villagers were
equally guarded about what they took irto the body (as in sex and food) as they
wcre about bcing "taken in" (as in "codding," flattery, and blarney) by out-
si(lers, especially those with a sociai advantage over them. Concem with the
 62 Theoretical pet.spc.tives
ponotration and violation ol bodily cxits, cntranccs. and houndarics cxtcndcd to
nrirt(rial symt)ols ol thc body: lhc homc, wi(h its doors, gatcs, lcnr.r:i, and sLonc
boundaries, around which man) protective rituals, prayers, and sr)ciil customs
scrvcd lo crcatc social distar,c. and a sense of personal conlrol itrd sc,:urity
(Schcper-Hughes I 979).
ln addition to contrclling bodies in a time of crisis, socieries regularly rcpro-
ducc and socializc the kind of bodie. rhat they need. Body decoration is a means
through which social self-identities are constructed and r)xprcssed (Strathern and
Strathern I97 I ). 'f. Turner developed the conccpt o[ the "sociirl skin' ' to exDress
the imprinling ol social categories on the body-self (1980). For Tumer, the
surface of the body represents a "kind of common frontier of society which
becorncs the symbolic stage upcn which the drama of socialization is enacted"
(1980:l 12). Clothing and other forms of bodily adomment become the language
through which ()ultural identity is expressed.
In our oq L increasingly "healthisf' and body-conscious culturc, the politi,
calllr cs11gc1 bad, for both sexes is thc leun, strong, androgcnous, antl physically
fit lirrrrr throLrgh which th(. core cuhurel valucs ol autonomy, oughncss, com-
petitivcnuss, youth, and self-control are readily manifest (Polli( 1982,\. Health
is incrcasingly viera,ed in the United States as an achievcd rather tiran an ascribed
status, and each individuai is expected to "work hard" at being strong, l'ir, and
healthy. Conversely, ill hcalth is no longer viewed as accidcntirl, a nrere quirk
o[ naturc, but rather is attributod to thc individual's hilure to livc right, ro cat
rvell, to exercisc, and so iorth. We might ask what it is our society wants Iiont
this kind of body. Lloyd DcMause (1984) hrs spcculatcd thrt thc lirncss-
lougl[)css (:r zc is lr l'cllcction ol iln intcrn tioDal prcpn(llion lirr. war. A llirrtl
cning lnd toughcning ol thc nrtional libcr cor'.csllo ds 1o il toughcning ol'
individual bodies. I r attitudc and ideology, thc self-help and fitncss movcnrcnls
articulilte botll u rnilitarist and a social Darwinist ethos: the fast and fit win: the
fal and flabby los| and drop out of the human race (Scheper-Hughcs and Stein
1987). Robert Crawlbrd (1980, 1984). however, has suggesred rhar rhc firness
rrovcrncnt nray rcllect instead a palhetic and individualizcd (also vrholly inld-
cquatc) def'cnsc against the thrcat of n,tclear h.iocaust.
Rather than strong and fit, the politically (and economically) correct body can
entail grotesque distortions of human anatomy, including in various timcs and
places lhe bound feet of Chinese women (Daly lg78), the sixteen-inch waists
of antebcllum southern societies rKunzle 1981), and the tuberculin wannoils of
ninetee th-century romantics (Sontag 1978). Crawford (1984) has iDrerprered
the eating disorders and distortions in body image expressed in obsessional
jogging, anorexia, and bulimia as a symbolic mediation of the contiadicrory
dcnrands of p('stindustrial Amcrican socicty. Thc doublc-binding injunction to
be sell-contr olled, fit, and productive rrorkers and.to be at the sanrc time scll-
indulgcnt, plcasurc-seeking corsumers i:- espccially destructivc kr the scll irnagc
ol the Arnerican woman. Expected to be lun-loving and scnsual, she must also
rcmrin thin, lovcly, and sclf disciplined. Sincc one cannot bc hcrlonistic antl
Rituals and Routines of Discipline and Dissent 63
controllcd simultancousiy, onc can altcrnatc phases of bingo eating, drinking,
and dlugging with phases of.jogging, purging, and vomitting. Out of this cyclical
resolution of the injunction to consume and to conserye is born, according to
Crawford, the cuIrent epidenric of eating disorders (especially bulimia) among
young women, sonre of whom literally eat and d,et to death.
Cultures are disciplines that provide codes and social scripts for the domes-
tication of the individual body in conformity lo the needs of the social and
political order. Certainly the use of physical torturc by the inodern state provides
the most gmphic illustration of the subordination of the individual body to the
body politic (Foucault 1979). The history of colonialism contains some of the
most brutal instances of the political uses of torture and the "culture of terror"
in the intcrosts of economic hegemony (Taussig 1984, 1987; Peters 1985). EIaine
Scary suggests that to(ure is increasingly resorted to today by unstable regimes
in an attempt to assert the "incontestable reality" of their contlol over the
pcpulace 11985:27).
Thc body politic can, of coursei oxert its control over individual bodies in
less dramatic ways. Foucault's (1913, 1975, 1979, 1980c) analyses of the roles
of medicine, criminal justice, psychiarry, and the various social sciences in pro-
ducing new fbrms of power-knowledge over bodies are illustrative in this regard.
The proliferation of disease categories and labels in medicine and psychiatry,
resulting in ever more restricted definitions of the normcl, has created a sick
and deviant majority, a problem that rnedical and psychiatric anthropologists
havc bccn slow to explore. Radical changes in the orgauization of social and
public Iilb in advanced industrial societics, including the disappearance of tra-
clition:rl cultural irlionrs lilr thc cxplcssir)n ol individurl and collcctivc discontonl
(suclr s witchcrnll, sorccry, rituals ol rcvcrsal, and lftlvcsty), hrva llowcd rncd'
icinc and psychiatry lo assume a hegcmonic role in shaping and responding to
human distress.
In all, Foucault has explored the "negativity" of the body, paticularly the
destructive ffects of power relations on the socially and politically constituted
botiy. In "Body/Power" Foucault (1980c:55) dismisses the conventional social
anthropological notion of the body as socially constituted through a convergcncc
oi wills: "TLe phenomenon of the soci,rl body is the effect, not of social con-
scnsus, but of the materiality of power operating on the bodies of individuals."
He demonstrates this most forcefully in his histories of medicine and psychiatry
with their overproduction of medicalized bodies anrl psychologized and defeated
sexualities (Foucault 1980a, 1980b).
The "Foucauldian body," as the ;rexus of power struggles originating in the
"state" of thrngs, is readily transierred to critically interpretive medical anthro-
pology, $hcrc thc body in qucstion is nrorc often afflictcd, alicnated, and suf-
lering than it is ccstatic, dccoratcd, an(l allinning. The Foucauldian qucstion-
"What kind ol body docs socicty want tld nced?"-has slimr:lated a great deal
ol critical thinkinS in contcmporary rncdical anthropology.
But thc l)od],ol fio.rcault's irnagining is still, k) a grcat cxlcnt, a hody dcvoid
t)/L llrrorelir ,rl ,1,r.,1x1t ivr's
(), slrl,,cclrvily iur(l litckirrg tlrlj cxl)cricocc ol prlwur irrkt lxlwcl'lc. \ltrss. Wltirl ,s
rrissiIg ir llrc cxislc0lirl. livrrl rlIcrirrrtr ol tlrc InrLti, rrl unrl Irr,r'ticitrg lrrrrlrrrr
subjcct. lroucault's ocgnlivc notio ol (hc l)ody lcavcs Lrs witll,I projcct lh l is
csscntirlly "sdI-dcleating'' in that it ignorcs the lived cxpcricrcc ol thc hody-
scll. ll is this dirnension. the r^cll-conscious. olien-alienated individual ard col-
lcctivc cxpcricnces of the body-self that criticalll/ intcrprctive n,cdical
anthropology rcturns to anthropology in the lbrm of the "mindtul bod)." lt
cloes so through the pressure exerted by its very subject matter: suffering bodics
thal k)fuse Io be ]11(rely aestheticized or metaphorizod. In returning the missing,
subjcctive body ro the center of thcir inquiries, critical medical anthropologisrs
invcrt lhc lroucarrklian qucstion to ask: "Whill kind ol socicly docs thc body
need, wish, arld dtcam ol'1"
BODY PRAXIS
When illness and distress arc conceptualized as conditions that occur to real
pcoplc as they live oul thcir lives in the context of specific social and cultural
milieus, it bccomcs casicr to cnvisiol Cistress asjust one ol thc nurlcrous cv
cryclay lbrms of rcsistancc to what lor many is thc opprcssivc and monotorlous
claily rounrl ol labor itnd sctvicc. Jlmcs Scolt hls l,oirtc(l oul lhll nx)sl sul\)r
dinale classcs throughout lristory havc rarcly bcen al'fordcd thc "luxuty ol opcn,
organized political activity" (1985:xv). This argument can, of coursc, rcadily
be extended ro the situation of the majority of women. Political activity is in
fhct positively dangerous for most people; neverrheless, those who arc relxtively
powcrlcss put up a rcmarkablc assortment of resistance, including "lbot dr':rg-
ging, dissirrulation, desenion, lalse conlpliancc, pilfbring, Itigncd ignorancc,
slandcr, arson, sabotage, and so on" (Scott 1985:xvi), to which we would add
lhose types of institutionalized behavior that appear with grcat frquency rn
ncdical anthropological writings: accusations of witchcrali, sorccry, or lh,j cvil
eyc, gossip, the use of trance or organized rituals ol reversal, and lantilsy phy.
Physical dislrcss and illncss cun also bc thought ol irs acts ol rclusal or ol'
rrrc(Iicry, ir Ib n ol protcst (albcit olicn unconscious) against opprcssivc social
rolcs and idcologics. Ol all thc cultural options lil thc crprcssirrn ol' dissclll,
the use o[ t,-ance or illness is pe:haps the safbst way to portray opposition i'n
irstilLrlionalized space fionl which to communicate fear, anxiety, and anger b:-
causc i Deithcr case are irrdividuals under normal circumstances held lully ac-
countable for their condition (Boddy 1988, 1989; Lewis l97l; Comaroff 1985).
Ol course, not all illness episodes are recognizcd as having political signifi-
canco; mero ailments thought to be of no significance are recognized everv-
wherc. Cilbert I-ewis tclls us, for exarnple, that the Gnau o[ New Cuinca say
oI somc illnesses: "'llrey just come," "he is sick nothingly," "he died by no
purpose or intent" (Lewis l9'75t179). The reductionistic, trrechar.islic cxplana-
tions characteristic ofmainstream bromedicine routinely ignore the social ongins
ol illnoss problenrs (Taussig 1980a), and so too do the explanations olier, nradc
lliluitls atl(l l(outines rl l)lscll)li e a d I)lssenI
rrsr rrl rrr tlrc trarlitrrrrrirl rIctliu l syslcltls ()l llitsl Asiir wltcrc llyl)(]lllcsirc(l
irrrSlrlrrrrtc ol tlrr huly is srrirl to (xigiltlc in tr lnck ol lcrsonltl vigillnca (1,()ck
t9130).
ll, howcver, onc starts with a notion ol "bodily praxis," of someone living
out und rcacting to his or her assigncd placc in thc social order, then thc social
origins of many illnesses and much distress and the "sickening" social order
itself come into sharp lbcus. lt is then possible to interpret incidents of spirir
possession in multinational factories in Malaysia, for example, as part of a com-
p)ex negotiation of reality in which women factory workers are reacring by
bringing production to a halt through the use of possession (Ong 1988). Or
rgain, a traditional int0rprctivc approach would pcrhaps lcad onc to bclicvc that
Japancsc adolcsccnts who rclusc to go to school, who lie mute and immobilc
in their bed all day, often medicated. are reacting against pressures of the Jap-
anese school system or the aspirations of their parents. A critical-interpretive
analysis, in contrast, indicates that this situation is part of a much larger national
concern about modernization and cultural identity of which the school system,
parental values, and the culturally constructed form of resistance of the children
is only onc srnall part (Lock 1988b). Tlrc experielces of women in connection
with nrenslrualiorr, childbirth, and nlonopauso and thc vrrriety of ways in which
thoy ci(lrcr crrrhrircc, cquivucalc irlxrrrl, ul downright rcjcct dorninant idcLrlogir:r
in connectior with thcse lil'e-cyclc cvents provide other telling examples of thc
dynanic, contestqd rclationship bctwccn thc three bodics, in connection with
tho politics oi reproduction and aging (Lock 1993b, 1993c; Manin 1987). Sim-
iiarly, the large body of research on nerves in medical anthropology can be
intcrpreted not merely as a culturally constituted idiom for the expression of
individual distress but also as a dominant, widcly distributed, and flexible met-
aphor lbr expressing malaise of social and political origin and for negotiating
relations of power (Lock 1990; Van Schaik 1989; Scheper-Hughes 1988).
Apart liom ar,archic lbrms ol strcet violcnca and other forms of direct assault
aod conliontation, illness somatization bccomcs a dominant metaphor expressing
incliviclual and social conrplaint. l\ liDritittion, lrowovcr, of thc conveniional so,
matizalion rnodcl is that whilc it prctcnds k) ad /oca(c an indissolublc unity ol'
nrind and botly, indiviclLral and social bodics, and ol-naturc antl cult.rrc, it has,
in practico, Ililcd 1o ovcrcome thc dlalisms ol bionlcdicinc (Kirmayer 198{l).
lllnesses arc understood as the subjective, transparently p;ychological manilbs-
tation of real, identified physical diseases, or else they are nothing at all, except
perhaps the illusory traces, Iigments of imaginaticn, and "bits of undigested
beef'' Charles Dickens attributed to the apparition of the ghost of Scrooge's
dead partner, Marley. But if mind and body are truly one, as even the most
conventional mcdical anthropologists assert, then all diseases and bodily dis-
trcss, without exception, arc ard must be psychosomatic because ell are "so-
matized" as well as "mentalizcd." But herc medical anthropology has rarely
lived up to the full strength of its convictions and rtas not been prepared to
support su rldieul unrl consequcnrirl a thesis.
66 Theoretical Perspeclives
In relbrring Io the "somatic culturc" ol tho displaced and marginalized su
garcrnc workc$ ol northeast Brazil, Schepcr-H,-rghcs (1992) has sugScstc(l thill
thcirs is a social class and a culturc that privilcgcs thc body and instlrrcts (hcn')
in u closc allcntion ltl thc physical scnscs ilrd lo thc lrr)iturllc,rl lhc h.dy xs
cxprcsscd in sympt(nns. Llcrc slrc Ibllows thc Icad cl l-uc i,oltanski ( I994), who
hus arl1ucd lhitl sonratic lhinkin-r- {nd prilcticc is lioqucntly liruntl rtrrttttg tltc
rvorlring and pqrular classcs who cxtract (heir subsistc'nce lionr physical Iabor.
Iloltilnski noled the tendency of the Frcnch working classes to co,-.,municJtc
with itn(l throu!h thc body so th.tt, by contrast, thc body praxis ol thc hourlchi\
rnd technical ciassos appcJrs impoverished.
Anlong thc ag|icultural wage laborers living on the hillside shantytown ol'
Allo do Cruzei[o, in the plantation zon of Pernanrbuco, Brazil, who scll thcir'
latlor lirr irs Iittlc as a tlollar a day, socioeconr)nric irnd political cottt'adictiotts
ollen take shape in the "natural" contradiclions oi angry, sick, and alllictcd
horlics. In acklition to thc wholly cxpcctablc cpi(lcmics ol parasitic inlcctiLrns
ancl corrrnunicable lbvcr's, there are the more unexpectcd outbr'el'ks lnd,:xplo_
sions ol unruly arrd subvcrsive syrptoms lhat will rot rcadily matcrirlizc under
lhc rnic()scopc- An'ollg thcsc rrc thc llui(l sympt(nns ol rclv.r.r (angry, lionzicd
nclvousncss): tronrl)ling, Iilinling, scizrtr'cs, hystcrical wccfing, nlrgry rc(r'irrli
nitli()Ds, l)lirckouls, irnd pilrillysis ol'Iircc rrnd linths. lhcsc ncrvorrsi itllrlcks itrc
i0 porl codcd rnctilphors lhrough which thc workcrs cxprcss thcir d:r0gcrous llnd
unacccptirble condition ol chronic hunger and need and in part arts of dcliancc
and clissent thrt gr.rphically re3irter the relusal to endure what is, irr fact. uncn-
durablc, ancl thcir protost against lhcir availability lbr physical explorralion irnd
abuse at tlre lbot of the sugarcane. And so rural workers who have cut sugarcanc
sincc (hc age ol scvcn or cight yelrs will somctimcs collapsc. thcr" lcgs Sivin!
rvay rrntlcr it') ttld(lu( th ttcrwts (il ncrvous irllllck).'lhcy cirnntrt rvall, tircy
err)nol slln(l lrpriglrl: lhcy arc lclt. likc Olivrir Slrcks (1984), willlolll it icg lt)
stand on.
'llro ncrv()lrs llungry, ncrvous-ilngry hocly ol Lhe c nc cultcr ollcrs ilscll irs
rnetaphor and nrc:lonynl of the rcryous sociopolitical system a d lbr thc p.rra-
lyzed position of the rural worker in the cufent economic and politicaldisordcr.
In "lying down" on thc job, in rcfu;ing to return to the work that has ovcr-
dctclrrincd l', r:ir rrntire lives, the cane cutters' body language signilies both sur-
rcndcr and dcliat. But one also nolcs a drama of mockery and relusdl. For il'
thc li)lk ailmonl ,r1rro.! irltacks tlrc lcgs and thc Iace, it leavcs thc Jnns and
lriinds inlact ar:rl Ilcc Ib| lcss physically ruinous work. 'fhosc who sullcr ;ion')
ncrv()us llltircls lrcss tl)cir claims as sick nrcn on lh.ir vnrious lx)lilicitl b()sscs
:Ir(l l)ltrorls lo lind thcrn il!tcrnitlivc work-cxplicitly "sillitlg-d(^vn" w(nk:1r.tn
work. not clcricirl work, lrrr- thcsc nrcn irrc illitcralc.
'l'lrc iurxlysis ()l /rr,rv.),1 (l()cs rtol enrl hctc, lirr'ttctvous alllck is an cxlr;rrrsrvc
irrrrl lrrrlyscrttic lir'ttt rrl rliscrtsr'. Sh rrlyl(xvrl wr)rll(rl, lrx). sttl'lct litttrt rtr'r trr.r
ln)llr rlrc rr.r-rrr.1 rlt rtrtltrtllnr tttrtito- tltc "trvctwork" r'crvcs lr-orr wlriclr rrlirlc
cirnc cutlcr-s sulli'r, ancl illso thc rrrorc gcndcr-spccilic crNos da tioli-it t utitt,,
Rituals and Routines of Discipline and Dissent 67
thc ncrvcs of thosc who havc endured and suff'ered much. Suffers' nervos attack
those who havc endurcd a rccent, espccially a violent, tragedy. Widows of hus'
bands and molh3rs ol'sons who havc been abductcd and violently disappearcd
arc pronc to thc nrutc, cnragcd, whitc-knucklcd shaking ol sullcrs' ncrvcs. Hcrc
Taussig's (1991) linking ol thc ''ncrvous systcnr,' anatonrical and sociopoliti
cal, is usclul. Onc ccruld rcad thc currcnl "ncrvousncss" ol shantytown rcsidents
as a rcsponsc to thc nervous and unstable democracy emerging in Drazil aficr
more than twJnty years ofrepressive, nrilitary rule. Many vestiges ofthe military
statc rcmain intact, and on thc Alto do Cruzciro, thc military presence is most
oficn fblt ir thc latc-night knock on the door, the scuffle, and the abduction ol'
one's husband or teenaged son.
The epidcmic of aervot .ra.rros (fright sickness), and parnros (paralytic shock)
signilics a stato ol ala:rn, ol panic. 'fhc pcople oi thc shanlytown, thrown into
a state of nervous shock, set off the alarm, warning others in the community
lhat thoir botlics and thcir livcs arc in dangcr. The epidcmics of rd."yoJ arnong
the wives and mothers of the politically disappeared is a form of resistance that
publicizcs the danger, the fright, the "abnormality o,'thc normal," while not
cxposing thc sullcrcrs to lurthcr politicul reprisals. Thc political naturrlol illncss
and lhc conrnrunicativc subvcrsivc buly rcmains an only partly conscious, and
lhcrcl,y prolcclc(!, li)rnl ol ptolcst. Onc cirn hardll' rcducc this oonrplcx, crcativc,
son,atic, and political idiom to thc vapid biomedical discoursc on patient "so-
matization." Whatever clse illness is, and it is many different things-an un-
fortunate brush with nature, a fall from grace, a social rupturc, an cconomic
contradiction
-it is also, at times, an act of rcfusal. The refusal can exprgss
itself in various ways; a refusal to work, a refusal to struggle under self-defeating
conditions, a relusal to endure, a refusal to copc. This is the casc with thc
ncrvorrs collapsc ol llx)sc p rirly'tc(l sugilru0c cullcrs who hlvc had cnough and
rcaclrctl thc cnd ol thcir ropc.
Relusal is available, however, for shaping and t.ansformation by doctors and
psychiatrisi.s into symptoms ol- "discascs" such as PMS (premenstrual syn-
drome), depression, or attention deficit disorder (Martin 1987; Lock 1986a; Lock
and Dulrk 1987; Ruberstein and Brcwn 1984). In this way, exhaustion, misery,
rage, and school phobias can be recast as individual pathologies rather than as
socially significant signs (Lock 1988b, 1988c). This funneling of diffuse but
gcnuinc complaints into thc idiom ol sickness has led to the problem of medi-
caiization and the overproduction of illness in contemporary advanced industrial
societies. In this process, tho role of doctors, social workers, psychiatrists, and
crirninologists rN agcnts oi socirrl conscnsus is pivotal. /\s Kim Hoppcr (1982)
h'ls suggcstc(|, hc.lllh proltssions re prcdisposcd lo "lilil to scc thc sccrct in-
rlignirtion ol thc sick."'l'hc rrc(licfll g zc is, lhcn. a controlling gilzc, lhro tlh
which activc (ullhough llrtivc) Iinlns ol protost arc tfttnlilbrnrcd into passivc
ncls ol hlcirk(lown.
'lllc dcb.rlc irs k) how cullur'al calcgorics c.l l)cst bc subsulrcd undcr hio-
nredical catcgories of disease becomes a rod herring in a critical-interprctivc
 Theoretical Pe spectives
approach. 'Ihe transformation oi'a culturally rich form of comnlunicarion inlo
the inclividualizing language ol physiology, psychology, or psychiatry is inap-
propriate. What is ciucially impo|tant for the medical anthropologist is tc dcrn-
onslrate thc way in which polyscrnic consttucts such as nevra, soLidao, ;Mra'
strcss, and nrcnopausc and the language of trancc, ritual, drclms, carnival, 'tnd
so on can be made use of in order to facilitato the hringing to consciousncss ol-
links bclwccn lhe political and so;ial ordcrs and physical distrcss. Il lhis lorlr)
ol comnrunicxtiol) that kccps bocly nrctaphorically linkcd to holh rtlind itnd so'
cicty is rc(ll,c,yl lr) Ihc "lrulhlirl" )irnguagc ol scicncc, lhcn (rlc ol lllt lll()sl
irrrpr'cssivc' \v( l)()rrs ol llrc r"crrk" (Scoll l9li5)is t't'ttrlc(rrl trsclcss ilt tlrt slItrg
glc lin ,ulicl lir)rrl ol)lncssioll. Sitttilrrlly, it etrlltllnlly rclll!ivisli( lll)lnlrirL'll lhirl
rclics cxclusivaly rttt locr,l crltlitnitlions o: nitrlillivcs is irlil(lo(ltrillc bceltttst itt
volvr:rl rrclors arc olicn trtrahlc lo dislirncc lhcnrsclvcs rrrttl tilkc:t tcllcxivc slllncc
.lhorrt lhcir owr! co dition. Not only opprcssors bul lhc opprcss(11 arc lik:ly to
lcccl)l lhcir l()t iN nilturill irnd incvilablc. cvcn wllon lttrtttan sttcil I rclilli()lls ilt'c
grossly distorted.rnd unjust. A critical intcrprctivc approilill so(rks to go bcytnxl
a culturally sensitive presentation to reveal the conlingency ol power and knowl-
edgc in both their creati()n oi 3nd relationship to the culturally consfucted in-
dividull body.
While the medicalization ol liie (and its political and social coItrol functions)
is undcrstoocl by critical medical social scientists as a fairly pernancnl ,caturc
ol industrialized socicties (Frcidjon 1972:' Zola 1972; lLoth 1972i lllich Iq76;
dcvrics 01 al. l9ll2) fow medical anthropolotlisls l)lvc yel exPlorcd thc iml;lc-
diato elfbcls ol'nrcdicalization in areas ol the world whcrc the proccss is oc-
curring for tlre first time (but see Nichtor 1989), although an old Kabyle woman
cxplaincd to Bourdieu (1977:166) what it meant to be sick befbre an{l after
rnedicalization became a feature of Alggrian peasant lifb:
In thc old drys. tblk didn'l know what illncss wrs. Thcy went to bcd and thc) dic(l ll's
only nowadays that we'rc learnirg words likc liver. lung.. intcstinc, stomach . . ' and
I don't krow whall Pcoplc only uscd to know lpain in] thc belly; that's whrt cvcryonc
who died dicd of, unless il rvas the tever.... Now everyonc's sick, cveryonc's com
plaining ol something. .. Who's ill nowadays? Who's well? Everyorc complains. bul
in bedi they all run to the doctor. Evcryonc knows what's wrong rLith him
::;.". ""r
An nthropology ol rcl tions bctwccr thc body .Lncl rhc borJy politic lncvillbly
lcr(ls lo il consi(lcralion ol thc rcguliltion and c(mlrol Dol otlly ol in(livi(ltlills hul
ol populations and therefbrc ol scxuality, gcnder, and rcprodltction--what Irou-
cault (1980b) rel'ers to as biopower.
Thc medicalized body is not simply thc result ofchanging medical knowlcdge
anil practice; neither is it simply the product of rnedical self'-intcrcst. A'mcdi-
caliz-cd body rcpresents rnorc lhan an individual body, foT it is itlso a nranili:s-
lalion of potent, never settled, f.artially disguised political cortests ahout how
Riluals and Roulines of Dis( ipline and Dissenl
aging and rebellioLrs bodies should bc managed. The female body, as is well
known, is ftcqucntly targeted for control, and one recent manifestation of this
phcnomcnon is the aggressivc medicalization of female aging, particularly in
North Amcrica, cvidcnce of which is the creation of a rrew population charac-
tcrizcd as ' 'postmcnopausal" womcn. As the baby boomers age, increasi:tgly
the postmenopausal woman is targeted as a potential burdcn on the hcalth care
system, and it is now recommcnded by the gynecological associations of the
Unilcd Sliltcs and Canada thal virtually tll wornen should, as thcy cnlcr mid(llc
ir11c, irllhihc Powcrlirl Irr:rrn<lno roplaccrrrcnl lhcrapy ditily, li)r thc rosl ol lhcir
livcs, in o[lc| to lcc(l lhcir "cslr'(,!,:r-(lcl)lclc(l" lrrxlics,'l'hus, it is assrrrrrctl,
llrry rvill irvr)i(l e()0tIirclinB rrtirjoI tlisuascs lwcnty or lhirly ycLlrs dowrr lllc r() Ll.
N(, extcr(lc(l c()ntrollc(l tii ls lr;rvc hccn c(xr(luclc(l wilh Ihis lc(lic li(,0, llrc
cilccls ol long tirrrc usrrgrr ilrc not kn()wn, and lirrthcnnorc. thc cxistcnce r)l'
sinrplc cllusc-untl-cl-lcct ssocinti(nls hctwccn cslrogcn lcvcls, hcart disc sc, 0d
oslcoporl)sis is holly dchirlcd (l,r,ck 199.)c). Moroovcr, incrcascrl risk lirr canccr
is inrplicatcd Iloor cxtendcd orcdication usc, whioh also produccs unplcrsant
siCc effects in many women. The perpetration o[ this debate depends on the
vuinerable "postmenopausal" woman whose body is classed as "unnatural."
Oldor women have been described in both the biological and gynecological
literature as "cultural artifacts," where it is argued drat menopause is evolu-
tionarily nonadaptive (Lock !993b). The bodies ofyoung women are set up as
the gold standard, to which postinenopausal women must be returned with med-
ical hclp. Coopcration with this regirle, offcred in terms of "risks" and "bcn-
elits," is regarded as socially rcsponsible. Clearly the addiction to youth,
characteristic of much North American culture, ensures that many people are
willing to cooperate; indeed, they seek out medical help to counter the process
of aging. For a:imall proportion of women, the physical distress associated with
firenopause is such that use of medication is entirely appropriate: however, the
expcriences of these women are increasingly taken as represcntative of thc pop-
ulation at largc. Mcnopause is constructcl as a universal fact, a dismal limo that
augurs badly lbr the luturc; the postmcnopausal bodv becomes a synedoche lbr
middle-aged wonren in all thcir variety, who are reduced to potential burdcns
on society (Lock I993b). In cornparing female middle agc in Japan and North
America, Lock lbund that "local biologies" have contrihuted historically and
in conternporrry times to both subjectivc experience and discourse production
(Lr.rck 1993b), indicating that the hiopolitics of normalization and control and
thc construclion ol vulncr blc populiltions is an cxcccdingly complcx pr()ccss,
which nrusl bc inlcrprclc(l in contc)(1.
Wc would likc to think of mcdical anthropology as providing thc kcy to thc
development of a new epistemology and metaphysics of the body rnd of the
emotional, social, and political sourccs of illness and healing, If and when we
tend to think reductionistically about the mind-body, it is because it is "good
lbr us tt, think" in this way. To do otherwise, tlrat is, employing a radically
rlillbrcnt metaphysics, would imply thc "unmaking" of our own assumptivc
 Thecretical Perspectives

world and ils culture-bound definitions Df reality. To admit the "as-ifness" of

our othnoepistemology is to court a Cartesian anxiety: the fear that in lhc ab-
sencc of a surc, objective foundation lbr knowledgc, we would fall into tlrc
void, into the chaos oi absolute relativism and subjectivity (sec Gcertz l9'/3a:
2lt-30).
Wc havc tricd to show thc intcractio among thc mind-body ancl thc in(livid-
rral, srrial, rtn(l ho(ly polilic in thc production llnd oxprcssion ol hcilllh rrn(l
illness. Sickncss is not just an isolatcd event or an unlortuna(c brush with 'laturc'
It is a fbrm ol communication-the languagc ol thc organs-through which
naturc, society, .rnd culture speak simultaneously- The individual body should
be seen as the most immediate, the proximate te-rain where social tiuths and
social contradictions are played out, as well as a l(rcus of personal and social
resistance, crcativity, and struggle.

NOTES
L This chapter is not intended to be a reviw of lhe field o: medical anlfropology'
We refer interested readers to a fow excellent reviewil of this type: Landy (1983r);
worslcy (1982); Young (1982). with panicular regard to the ideas exprcssed in this
chapler, however, see also Comaroff (t985), Csordas (t994)' Devisch (1985), Rslroff
(1981), Cood (1994), Cood and Good (1981), Hahn (1985), Hetman (198-5), Kleinrnan
(1986, 1988b); Laderman (1983, 1984), Lindenbaum and Lock (1993)' Low (198'5n),
MorSrn (1993b), Nichter (1981), Obeyesekere (1981)' and Taussig (1980a' 1934)'
2. Mary Douglas refers to "The Two Bodies," the physical and socill bodics, in
Naturat Slnbols (1970). More recen(ly John O'Neil has written F'iv? Bolies: Thc Hunldn
Shape oI Modem Soclery (1985), irr which he disctlsscs the physical body, thc commu-
nicative body, the world's body, the social body, the body politic, consumer bodies' and
mcdical bodies. We are indebted to both Douglas and O'Neil and also to Bry^n Tumer's
The Bort! and Society: Erploratiotts itt Sociol fheory (i984) for hclping us to dclloc rnd
deli,nit the tripartite domain we have mapped out here
3. wc do not wish to suggest that Hippocrates' understanding of the body was !nxl_
ogous lo thnt ot-Descitncs or ol_ modern biomcdical practitioners- Hippocrntcs' irIproach
to nrc(licinc anrl hcalirrg .",, 1't" lcsgiihc(l only ils orqartr ' iln(l In'lislic- Norlclllclcss'
llippocratcs wits,.ts tho quotll,o,l lir)nr llis wo,k dcnlonsl,llcs, cspccirrlly ctxrtcrrtetl to
irrlr'(xhr(c cltrttcrlls ()l filli{n)ill scicnrc (ohsrrvillion. pilllillioll, (liitBnosis. i'l)!l l)'1)Fnosis)
iilo clinical prncticc lnd lo discrcdit all lhc irrationnl" anrl nragicrrl prilcliccs ')l lrx
ditbnal lirk hcalers-
 Eandbook of
"" Medical
Anthropology
Contemporary T'heory and Method
Revised Edition

trdited by
CAROLYII F. SARCENT
...
and TIIOMAS M. JOHNSON

GRDENWOOD PRESS
Westport, Connecticut . trndon

l7q u