‘Truth isn’t the privilege of those who have succeeded in liberating themselves, but it is a thing of this world’ (Foucault, M., 1980, p72).

Nutrition science, as the name suggests, is teleologically rooted in positivism. Science is assumed to evolve as new discoveries and developments are made. It is thought to make sense of the material world to allow those who live in it to thrive. The findings of nutrition science are used to justify food policy, to market food and to direct world health goals. But does the entangled motives of nutrition science with Western ideals of capitalism, efficiency and convenience effect its efficacy to do social good? To what extent has nutrition science manipulated knowledge production to boost industry and control consumption? How does the history of ideas, geared towards scientific systems of truth to organise food beliefs and in this telling of history, are possible alternative modes of understanding food being overlooked? First we must unpack the origins of nutrition science in order to step back from an a priori position of Science as Truth.

Origins: food as medicine and nutrition science
The Egyptian Imhotep gave accounts of the use of food as medicine about 6000 years ago and has been a stalwart form of treating ailments throughout history (Cannon, G., 2005, p701). Up until the seventeenth and eighteenth century in Europe, women were still using and developing medical cooking. Food was prescribed and curing nutriments were used until, following Descartes’ mind/body philosophy, there was a surge of interest in Science (Turner, B., 1982, p259). The philosophy that the body can function like a machine according to mechanical laws made medicine, pharmacy and botany distinct sciences which could only be studied by men and laid the basis for medical rationalism which provided popular dietary schemes of 18th century Europe (Turner, B., 1982, p259). Women were ‘discouraged from ministering to the sick in the absence of the physician’ and instead encouraged to buy medicine from the pharmacy- monopolised by male academic society (Schiebinger, L., 1991, p116). Thus, cooking was relegated to a domestic duty bound with the role of wife and mother. The move from experiential medical cooking to scientific exploration might be heralded as a progressive moment in history- when society was civilised into rational thinking and began to uncover hidden truths. Certainly it was the catalyst for life saving discoveries such as James Lind’s discovery that citrus fruits prevent scurvy in 1747 (Tulchinsky, T., Varavikova, E., 2014, p10). But, we could also see this shift towards science as an account of the history of ideas. Foucault posits that teleological development of rational knowledge should not be assumed to be progressive and directly associated with or the cause of improvement of the human condition (Turner, B., 1982, p256). In fact, he asks us to question the assumption that the growth of reasoned, systematic knowledge indexes fundamental, continuous, liberal and political freedom (Turner, B., 1982, p256). He suggests that power attracts power, and truth, or belief, manifests truth. He describes how knowledge and power run through trusted discourses such as Science. It is not forced upon a weak and ignorant public, but is mutually conditioning and reproduced through people unconsciously practising systems of truth (Foucault, M., 1980).
In this sense nutrition science, the understanding of the microscopic components of food is an enlightening project, but not an archaeology of truth. Why does this matter? Because the more people believe that truths are being uncovered, the more justified nutrition science based ‘technologies of the self’ and ‘technologies of the state’ become, leaving other modes of understanding unexplored or incomprehensible (Foucault, M., et. al. 1988).
As Post-Enlightenment ideals of positivist science redefined traditional ways of thinking about bodily ailments as biomedical problems with their own treatments, men trained their eye to see what the lay-person could not. Foucault describes this as a ‘medical gaze’ which separates the patient’s body from the patient’s identity and plunges ‘from the manifest to the hidden’ (Foucault, M., 1963, p 166). Scrinis has expanded this idea to describe the ‘nutritional gaze’; since nutrients are unseen, ‘it falls to the scientists (and to the journalists through whom the scientists speak) to explain the hidden reality of foods to us’ (Pollan, M., 2007). This nutritional gaze overwhelms other ways of seeing and sensually experiencing food’ (Scrinis, G., 2008, p46).
The pharmaceutical industry which monopolised the ‘pathological’ public body and funded medical scientists to advance their goals- was followed by similar behaviour within the food industry. Of course, nutrition science differs from medical science however, principles are formulated using similar rationale. Nutrition scientists use ‘individual variables they can isolate’ despite the complexity of whole food’s ‘virtual wilderness of chemical compounds, many of which exist in complex and dynamic relation to one another’ (Pollan, M., 2007). Using nutrients as normative principles of rationality scientists can formulate truthful facts about food; nutrition science is a legitimising force; an exercise of Foucauldian biopower (Rabinow, Rose & Foucault: 2003). Biopower relates to the regulation of citizens by modern states through ‘an explosion of numerous and diverse techniques for achieving the subjugations of bodies and the control of populations’ (Foucault, M., 1976, p140). Despite the advances in nutritional science knowledge ‘rates of obesity and diabetes have soared’ in the US in recent years, making ‘lucrative business opportunities’ for medicine; ‘diet pills, heart-bypass operations, insulin pumps, bariatric surgery’ (Pollan, M., 2007). With nutrition science’s confusing, controlling and constricting information, also comes health promoting and life saving knowledge, such that like biopower it is constricting, yet ‘productive, pleasure inducing and knowledge forming (Foucault, M., 1980). In fact, biopower’s system (or ‘regime’) of truth is so concrete that it becomes impossible for ‘actors, spectator witnesses, or objects’ not to commit the truth acts they are subject to (Foucault, M., 1980, p80-81). This helps to expand the assumption of the essay title- nutrition science must be understood as part of the knowledge forming discourse of biopower.

Nutrient Bias
The relation of power and knowledge is important not only in the way knowledge was taken from and then denied to women in the 17th and 18th century, but also in the way that the food industry manipulates nutritional information to market products. In Europe and the USA, research scientists are mostly dependent on funding from government and its agencies as well as from industry. Often funding comes with expectations favourable to certain findings that the science must meet (Cannon, G., 2005, p704). A U.S. Senate Select Committee on Nutrition released the 1977 ‘Dietary Goals for the United States’ which correlated plummeting heart disease during war years and the rationing of meat and dairy products (Pollan, M., 2007). It was recommended that US citizens cut down on saturated fat rather than animal products (which would damage the meat and dairy industry economy- see Nestle, M., 2000). By focussing on a nutrient rather than whole-food, the food industry began to market ‘low-fat pasta and high-fructose (yet low-fat!) corn syrup’ which fails to address other factors such as ‘if you eat a lot of meat you’re probably not eating a lot of vegetables’ (Pollan, M., 2007). Scrinis describes this ‘nutrient bias’ as an environment that allows the easy manipulation and aggressive nutritional advertising which has caused the current obesity and diabetes epidemic that we see today in America (Scrinis, G., 2008, p46). Nestle describes this phenomena as a ‘nutrition confusion’ about the ‘basic principles of diet and health’ which is ‘conducive to overeating and poor nutritional practices’ leading to the sales of processed products (Nestle, M., 2000, p.vii)
Moreover, nutrition science’s ‘functional’ understanding of the body leads to the development of ‘functional foods’ (Scrinis, G., 2008, p43). The ideologies which the West produce food by are often marketed through food policy markets or even aid agendas, do not take into account digestive differences. Some populations can metabolise sugars better than others; some bodies ‘may or may not be able to digest the lactose in milk’ (Pollan, M., 2007). The medical doctor Guila Enders refutes the functional understanding and nutrient bias and posits that what the body does to the food is just as important. She problematises ‘general dietary tips’ by looking at the unique and ‘specific ecology’ of bacteria that exist in the intestine (Enders, G., 2015, p161). For example, more than 50% of Asians but only 25-30% of Europeans benefit from the protection soya can give against prostate cancer and cardiovascular disease because of the work that certain bacteria do that are found ‘more commonly in the guts of Asians’ (Enders, G., 2015, p161). Similarly – the Maasai have surprising low levels of cholesterol in their blood despite a diet consisting almost entirely of meat and milk because their intestines harbour high levels of lactobacillus fermentus- a bacteria which lowers cholesterol (Enders, G., 2015, p179). Importantly, chemicals added to the food we eat also affect intestinal bacteria- the use of antibiotics in animal farming can be significantly destructive (Enders, G., 2015, p222). This shows the ability that biopower has to create regimes of truth- nutrition science analyses molecular substances inherent in food, but not molecular chemical substances used in food production, such as antibiotics, fertilisers, and growth hormones. Nutrient profiling can add value to food, whereas chemical and hormonal use to produce high yielding crops detract from food value.
In this way, by promoting the nutrient value of food and ignoring the potential devastation to intestinal bacteria, knowledge is being controlled. There is, therefore, no place from which scientists can ‘speak truth to power,’ since they ‘are themselves agents of [a] system of power’ (Foucault, 1977, p207).

Governmentality, technologies of the self and the state, philanthrocapitalism
In the 1980s Illich stated that the personal responsibility individuals were taking in pursuit of a ‘healthy body’ facilitated the ‘smooth integration of one’s body to the requirements of the socioeconomic system’ (Illich, I., 1994). We can see the first signs of this behaviour in the beginning of the 19th century when Sylvester Graham, a Presbyterian minister, started one of the first health organisations to be developed by the USA based on whole food evangelism. Graham promoted a ‘health, individualism and self-reliance’ philosophy- that individuals are responsible for and should promote their own health (Porter, D., 1994, p317). He marketed this with his own brand of commercial foods, including Graham crackers. He encouraged individuals to affirm and confirm regimes of truth which they used to act on themselves through techniques of self-discipline. Foucault calls this governmentality through ‘technologies of the self’. Scrinis describes how by using ‘simplified scientific explanations, the nutricentric person (those vulnerable to the nutrient bias way of decision making) can feel empowered by the ability to count and control their intake- a modern day technology of the self (Scrinis, G., 2008, p46).
Kellogg, a religious leader and Medical Director, swiftly followed Graham in the 1890s, he focussed on diet-based treatments such as breakfast cereal. Kellogg became accepted as one of America’s leaders in nutrition and medicine and he attracted rich and famous patrons such as Ford and Rockefeller. His products are still marketed as health foods in the cereal aisle in supermarkets worldwide (Money, J., 1985)
By the end of the nineteenth century, nutrition science was a credible Western paramedical profession. Wilbur Atwater, the most renown American nutritionist of the time, employed a Cartesian understanding of the body to measure food as an energy ‘input’ and ‘output’ by surveying what the public were eating (Turner, B., 1982, p266). With the help of philanthropists and missionaries Atwater calculated weekly food expenditure and nutrition estimates in impoverished areas which were used to calculate a ‘standard of living’ and daily requirements of nutrients for individuals. The state was able to use this data to engineer food systems to increase yield and bolster human resources to fuel a large and growing body- that of industrialisation (Turner, B., 1982, p266). Moreover, Atwater’s studies were pivotal in making systems more efficient and economical to appease peasant hunger revolts, such as the 1863 Southern bread riots which saw the violent looting of shops and stores Southern America by malnourished people.
The ‘eye of power’ normalises the use of ‘examinations, timetables, taxonomies, classifications and registers’ to provide the means for the detailed surveillance and disciplining of the body . More broadly, Foucault calls this governmentality; ‘an art which attracts the organising technologies of the modern state’ (Turner, B., 1982, p256). Knowledge and power work together and so techniques for knowing the population are valuable and ever-advancing. As we have seen, this knowing extends to a government and surveillance of oneself; the body in the modern West is subject to a scientific discourse which numerates and monitors certain elements of consumption. People are born into technologies of the self which have existed before them. They are socialised into moving towards being a rational, healthy subject by policing their purchases and consumption including the use of nutritional labelling. The reliance on nutritional information to make rational choices reinforces its existence and furthers research into new food technologies. This research is something that is undertaken by those with the trained eye and is in line with the way we treat our medicalised bodies- only with the advice of an expert. Although we have advanced since Atwater’s understanding of the body as an input/ output machine, there is still an assumption that the body is a functional, generic commodity that reacts in the same way as other bodies to nutrients. This core mechanical view promotes the understanding that nutritional science contributes to the perception that food is something to be controlled.
In the early 20th century, the US state, concerned with the rising problem of infant mortality, allowed women to undergo training in the form of ‘Home Economics’. Rossiter’s data shows that in 1921, all the nutrition writers listed in American Men of Science (AMS) were female (Kohlstedt , S., 2004, p2). However, science was beginning to train its eye on nutrition and within a decade it had overtaken the practical understanding of food that women were developing. By 1938, AMS declared that ‘nutrition’ was the fastest growing field for male scientists and by the end of the 20th century men represented 75% – 80% of the 3500-member American Institution of Nutrition (Rossiter, M., 1984, p196).
An increase in men in a particular field signifies an increase in power, money and governance. As male-dominated fields of knowledge gained more attention, the absence of men in the development of practical, ‘traditional’ or alternative knowledges of food and nutrition added to its invalidity as a serious form of knowledge. Nutrition science became the ‘common sense’ and continues to inform female-dominated food practice. In this sense, the primacy of science moves in a reductionist direction and expands only to include other discursive regimes, such as that of policy, trade and the food market.
For example, nutrition science and the British state engineered a national food system during war time when food was scarce. John Boyd Orr did much of this work and became the first director-general of the Food and Agriculture Organisation (FAO) for the UN (Cannon, G., 2005, p703). He was awarded a Peace Prize for his work advocating world food equity. His programs have come to exemplify the huge economic and nutritional impact large scale food programs can have. Boyd Orr’s programs were the first large-scale attempt to feed the poor and embrace ‘the environmental, social, economic, political, ethical and human rights dimensions of nutrition’ (Cannon, G., 2005, p703). Despite his programs acclaim, we should not take this approach for granted and assume all nutritional implementations are long-term improvements, especially when they are scaled up across various nations and cultures. We must ask what is at stake in the complex web of vast wealth of philanthropists, charities, companies and states involved in food policy programs which attempt to reduce poor health, malnutrition and food insecurity in poor communities and in the ‘developing’ world. Rockefeller- a patron of Kellogg- established one of the first philanthropic foundations in line with the principles of ‘scientific philanthropy’ to tackle ‘the root causes of social problems’ (Brooks, S., 2009, p8). However, development agencies understanding of ‘the root causes’ often does not challenge the ‘prevailing social order’ within which those rich agencies made their wealth (Brooks, S., 2009, p9). Moreover, today global nutrition foundations are often controlled by trade groups which distort nutrition advice to protect their own interests (Nestle, M., 2013)
So we see the continuation of philanthropic and capitalist powers acting on impoverished communities with the ruse of doing ‘social good’. Brooks et al explains the rise of ‘grand challenges’; an approach to research and development by a new generation of philanthropists, led by the Bill and Melissa Gates Foundation (Brooks, S. et. al., 2009). These philanthrocapitalists (a term coined by Edwards (2008)) operate by transferring business methods to the social sector, ‘extending leverage’ by linking with the private sector, and rapidly ‘going to scale’, thus maximising returns on investment by transforming ‘complex and diverse needs into ‘demand’ for pre-defined technical solutions’ (Brooks, S., 2009, p4). Some call these initiatives which bypass the usual bureaucracy of interventions in order to see immediate results (referred to as ‘America’s passing gear’(Brooks, S., 2009, p9)) as ‘silver bullet’ solutions; a ‘magical solution to any vexing problem’ (Brooks, S., 2009, p5). This term is often employed in a negative way by those who spurn particular technologies as reductionist; unable or unwilling to comprehend and tackle ‘the complexity of the problem they are supposed to solve’ (Brooks, S., 2009, p5). For example, the Rockefeller and Ford Foundations employed international agricultural centres to start a ‘Green Revolution’ in Asian agriculture in the 1960s and 1970s, which, despite improving productivity and averting famine, also lead to damaging ‘socioeconomic dislocations’ (Buttel, F., et al, 1985, p31). Proponents of the Green Revolution assumed that ‘developing’ countries are developing along the same trajectory as ‘developed’ or high-income countries and doing so they are able to simplify the complexity of nutrition in certain countries (Buttel, F., et al, 1985, p31). Expensive foreign implementations psychologically and socially affect the targeted area by stripping local or ‘traditional’ food systems and knowledge of their independence in favour of a rationalised and seemingly ‘advanced’ Western technology or politically and economically indebting poor countries to rich countries .
Moreover, the agencies involved in nutritional interventions aimed at ‘social good’ direct research with a heavy emphasis on technological, productive and economic innovations rather than social or local ones and especially ignoring any harmful and exploitative ‘corporate interests from which their wealth derives’ (McConnell, 2008, p17). Edwards describes the assumption of social enterprises that ‘the social will take care of itself if the enterprise is successful’ (Edwards, 2008, p9). This social versus technological debate has been discussed elsewhere and I do not have the scope here to address it apart from to say that development agendas neoliberal goals are less geared towards repairing ‘poverty and social inequalities than to manage them.’ (Farmer, P., 2004, p313) This management is rooted in a knowledge which should not assumed to fit with different systems of truth. In this sense, nutrition science strengthens discourse that runs through development agendas that are both constricting to certain social groups and productive to others. This is expressed best by Pierre Bourdieu:
’Scientific rationalism—the rationalism of the mathematical models which inspire the policy of the IMF or the World Bank, that of the great law firms, great juridical multinationals which impose the traditions of American law on the whole planet, that of rational-action theories, etc.—is both the expression and the justification of a Western arrogance, which leads [some] people to act as if they had the monopoly of reason and could set themselves up as world policemen, in other words as self-appointed holders of the monopoly of legitimate violence, capable of applying the force of arms in the service of universal justice.’ (Bourdieu, P., 1998, p25).

This can be seen in the example of infant formula milk. Under a philanthropic guise wealthy food companies such as Nestle implemented solutions to problems raised by nutrition science and development agencies- high infant mortality due to malnutrition in impoverished communities. Social and economic forces shifted feeding from the breast to the bottle in both ‘developed’ and ‘developing’ countries (Muller, M., 2013). After the second World War, soaring birth rates, the liberation of women from the home and the increasing interest and dependence on science helped make powdered bottle formula for infants very popular in Europe an the US (Soloman, S., 1981). It wasn’t long before formula milk companies began aggressively advertising worldwide. Theoretically it is a nutritious product which can save the lives of babies who cannot breastfeed.
Multi-national brands who were selling formula staged saleswomen in traditional nurse’s uniforms in the maternity wards in hospitals. They gave the false impression of being independent health professionals, offering childcare advice to new mothers, promoting formula giving free samples (Soloman, S., 1981). The hospitals, happily created partnerships with these multimillion dollar companies and even signed contracts such as the 1974 contract between New York City and a formula company which gave the guarantee that a free sample would be given to every new mother leaving a municipal hospital (Soloman, S., 1981). By the time the free tin of formula had been used, the baby is less able to suckle from a breast, eventually ‘the mother’s milk can dry up and then the baby is hooked on formula’ (Dr. Carl Taylor, cited in Soloman, S., 1981). Formula companies spread their business internationally to other low income areas such as the Philippines where new mothers were routinely separated from their babies in order feed them with formula. In 1975, after much anecdotal criticism of formula, mothers began demanding to breastfeed their babies. The results showed that as breast-feeding increased, the rate of infant illness and mortality dropped dramatically (Soloman, S., 1981).
Mother’s milk naturally provides a babies underdeveloped immune system with important antibodies that protect against fatal infections. Women in ‘developing’ countries often dilute the formula as a day’s feed could cost up to half the average daily wage (Muller, M., 2013). The powdered formula had to be mixed with water, which was often to be unsanitary causing malnutrition which could be fatal (Muller, M., 2013).
The term structural violence results in the sickness of subaltern people by ‘historically given (and often economically driven) processes and forces [which] conspire to constrain individual agency’ (Farmer, P., cited on http://www.structuralviolence.org/structural-violence/). Forcing babies to be dependant upon a specific product that their family cannot afford is a clear and harrowing example of the structural violence. A structural violence that indexes the biopower of nutrition science with research paid for by multinationals.
The formula company’s unethical practices were exposed in 1974 by War on Want which lead to wide-spread protests, campaigns and boycotts. The W.H.O surveyed formula promotional practices in ‘four underdeveloped countries during 1976 and 1977,’ and concluded ‘the distributors themselves reported that they were not limiting the distribution of products by either geographical or socioeconomic criteria’ (Soloman, S., 1981). In Brazil, for example, infant formula was advertised as a modern and upwardly mobile method of feeding babies. It was the most advertised product after cigarettes and soap (Soloman, S., 1981). The UN World Health Assembly recommended ‘the adoption of an international code of conduct to govern the promotion and sale of breast milk substitutes’ (Muller, M., 2013). Nestlé’ responded to criticism and criminalising trade regulation with the argument that malnutrition wasn’t spread by their formula, but by pathogens in water. They have now produced their own bottled water, making money from a problem that they created (Muller, M., 2013). This shows how power is carried in the discursive regimes which have ‘the financial resources’, ‘the sales personnel, distribution channels and marketing apparatus’ to affect the public health (Soloman, S., 1981).

As well as malnutrition, discourse that favours capitalism, advertising and nutrition also affects low-income communities to cause over-nutrition, starting at school.
School is a powerful influence on children’ behaviour in all life settings and how you interact with food at school often continues into your adult life (Dietz and Gortmaker, 2001). Crooks explains the ‘aggressive marketing of low-quality foods to children’, and reduced physical activity paired with under funded educational services which leads to ‘a higher rate of overweight children in low income communities’ (Crooks, 2003, p183). She studies the sale of snack food to children at a low-income US school. These sales bring in ‘$7,000-$8,000 per year’ and funds programs that are ‘perceived to be fundamental to the education of the children especially those who come from poor families’ (Crooks, 2003, p192). Evidence shows that those with less money are more exposed to low-cost, low-quality foods and have less nutritional choice (Drewnowski and Specter, 2004).

So, is nutrition science a progressive force for social good?
As I have tried to show, nutrition science, as a product of enlightened rational thought, is used by discursive regimes to direct and validate capitalist agenda’s. It is important to mention that, of course, not all nutrition science is funded by and produced for those seeking material or political gain but has been ‘co-opted, promoted, and exploited by the food industry, with the assistance of compliant governments, regulatory bodies, and health institutions’ (Scrinis, G., 2008, p47).
Billions of people, whether they are the consumers of the food industries products, nutrition scientists, advertisers, philanthropcapitalists, factory workers, consumers take part in and strengthen the legitimacy of unsustainable food production and trade. We cannot ‘praise or blame individual actors’ but must see from a wider lens the discursive regimes and truth acts that are being reproduced in order to widen our lens of knowledge (Farmer, P., 2004, p307).
Nutrition science is a very narrow lens in which to understand food, and the food industry exploits this. The idea that bodies need certain nutrients lends itself to the idea that people need nutritional information and ‘nutritionally engineered and functionally marketed foods’ (Scrinis, G., 2008, p46). Nutrition science and ‘nutritionism’ needs to be identified as one of the many ways in which we can make decisions about, access and regulate food production and consumption.
The bigger picture of what food is involves the critical questions of where it has come from, who has produced it, what harm has it done? This reminds us of a Gramscian idea of ‘common sense’ – the rational and ‘common’ use of nutrition science to make consumer decisions which restricts the use of ‘good sense’- to make informed consumer decisions (Gencarella, S., 2010). For example, an individual may feel like they have a lot of choice in the breakfast cereal aisle of the supermarket, however, by what standards is one free to choose? Discourse restricts choice and knowledge, but also the awareness of the choice. Can they choose a product by minimal environmental impact? By minimal damage to the creatures we cohabit with? Or by any other standard that the person might think important? This information is not readily on the label and those specific and controlled ‘specialist’ products that do exist, such as free-range, organic or fair-trade meet some questionable standards (see Luetchford, P. (2008) and Safran-Foer, J., 2009). Moreover, ‘specialised’ products are economically discriminative and targeted at those who can afford to pay double for organic or to take time to visit farmers market; those who can afford to choose. All those whose socioeconomic status denies them fresh and organic and restricts them low-quality, heavily processed food (as we saw in Crooks study in the low-income school) puts them in danger of depression, heart-disease, obesity and other dietary related disease. This puts a twist on Farmer’s description of a structural violence ‘visited upon all those whose social status denies them access to the fruits of scientific and social progress’ (Farmer, P., cited in http://www.structuralviolence.org/structural-violence/). We might argue that Farmer is assuming all scientific ‘fruits’ are heathy and progressive, overlooking the role of food science in making cheap and heavily processed, chemical, modified, disease-causing food. The kind of food that low-income communities can be limited to and the kind of socio-economic forces that inflict structural violence.

The inter-connected foodways that might influence food choice are cherry-picked by food companies- the marketing of ‘fresh’, ‘happy’, ‘whole-grain’ and ‘fortified’ is a meagre impression of that product. How differently might we consume if we were able to choose by our ‘good sense’; the impact on the soil, on water supply, on animal suffering, on chemical use, on political and trade relations, on rainforest destruction etc. By narrowing our standards to a ‘nutrtionised gaze’ food producers can easily monopolise on our nutritional needs, whilst continuing to use food systems which ‘excessive exploitation of the natural resource base, leading to megafauna extinctions, deforestation, soil erosion, salination, water shortages, biodiversity losses (including, now, fisheries depletions), and mobilisation of infections into human populations’ (Lang, T., 2005 p708).
Lang tells us that ‘nutrition is generally blind to the environment despite the geo-spatial crisis over food supply’, it is a system of truth that asks ‘people to eat fish when fish stocks are collapsing’ etc. (Lang, T., 2005 p712). This makes us wonder, what other ways of understanding does it make us blind to? I don’t have the ability to discuss the myriad ways of understanding food, but I can say that nutrition science, despite its benefits, can block us from other ways of understanding food.

Nutrition science as a ‘force’ is perhaps where it intersects with being progressive. If nutrition Science dictates where the consumers spend their money, then alternative foodways are being sidelined.

Bibliography
Brooks, S., M. Leach, H. Lucas & E. Millstone. (2009). Silver Bullets, Grand Challenges and the New Philanthropy. STEPS Working Paper 24, Brighton: STEPS Centre.
Buttel, F., Kenney, M., Kloppenburg, J. and Jr. (1985). From Green Revolution to Biorevolution: Some Observations on the Changing Technological Bases of Economic Transformation in the Third World. Economic Development and Cultural Change, 34 (1). pp. 31-55.
Cannon, G. (2005). The rise and fall of dietetics and of nutrition science, 4000 BCE–2000 CE. Public Health Nutrition: 8(6A), pp.701–705.
Crooks, D. (2003) Trading Nutrition for Education: Nutritional Status and the Sale of Snack Foods in an Eastern Kentucky School. Medical Anthropology Quarterly. 17 (2) pp. 182-199.
Drewnoswki, A. and Specter, S. (2004) Poverty and obesity: the role of energy density and energy costs. American Society for Clinical Nutrition 79 (2) pp6–16.
Edwards, M. (2008) Just Another Emperor? The Myths and Realities of Philanthrocapitalism.[online]. Non Profit Quarterly. Available at: https://nonprofitquarterly.org/2008/03/21/just-another-emperor-the-myths-and-realities-of-p

Enders, G. (2015). Gut:The Inside Story of Our Body’s Most Underrated Organ. Victoria: Scribe Publications.

Farmer, P. (2004) An Anthropology of Structural Violence. Current Anthropology. 45, (3) pp. 305-325

Foer, J. S. (2009). Eating animals. New York: Little, Brown and Company.

Foucault, M., (1963). The Birth of the Clinic. Paris: Presses Universitaires de France.
Foucault, M. (1980). Power/ Knowledge. Great Britain: The Harvester Press Limited.
Foucault, M., Martin, L.H., Gutman, H. and Hutton, P.H., (1988). Technologies of the self: A seminar with Michel Foucault. Massachusetts: University of Massachusetts Press.
Foucault, M., Burchell, G., Gordon, C. and Miller, P., (1991). The Foucault effect: Studies in governmentality. Chicago: University of Chicago Press.
Foucault, M. Rabinow, P and Rose, N. (2003). The Essential Foucault: Selections from Essential Works of Foucault, 1954-1984: New York: The New Press Essential Series.
Illich, Ivan. (1994). BRAVE NEW BIOCRACY: HEALTH CARE FROM WOMB TO TOMB, New Perspectives Quarterly. 11 (1).

Kohlstedt, Sally Gregory. 2004. Sustaining Gains: Reflections on Women in Science and Technology in 20th-Century United States. NWSA Journal, Vol. 16, No. 1, (Re)Gendering Science Fields
Lang, T. (2005). Food control or food democracy? Re-engaging nutrition with society and the environment. PUBLIC HEALTH NUTRITION. 8 (6A). pp730-737.

Money, J., (1985). The destroying angel: Sex, fitness & food in the legacy of degeneracy theory, Graham Crackers, Kellogg’s Corn Flakes & American health history. United States of America: Prometheus books.

Muller, M. (2013). Nestlé baby milk scandal has grown up but not gone away.[online]. The Guardian. Available at:http://www.theguardian.com/sustainable-business/nestle-baby-milk-scandal-food-industry-standards [Accessed 25 Mar. 2016].

Nestle, M. (2000). Food Politics: How the Food Industry Influences Nutrition and Health. Berkeley: University of California Press.
Olbrys Gencarella, S. (2010) Gramsci, Good Sense, and Critical Folklore Studies. Journal of Folklore Research. 47 (3)
Pollan, M. (2007). Unhappy Meals. [online]. The New York Times. Available at: http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?_r=0 [Accessed 26 Mar. 2016)
Porter, D. (ed.)(1994). The History of Public Health and the Modern State. Amsterdam: Rodopi B.V.
Rossiter, Margaret,W. (1984). Women Scientists in America, Struggles and Strategies to 1940. Baltimore: Johns Hopkins University Press
Schiebinger, L. 1991. The Mind Has No Sex?: Women in the Origins of Modern Science. Massachusetts: Harvard University Press.
Soloman, S. (1981) The controversy over Infant formula. [online]. The New York Times. Available at: http://www.nytimes.com/1981/12/06/magazine/the-controversy-over-infant-formula.html?pagewanted=all [Accessed 25 Mar. 2016]

Tulchinsky, T., Varavikova, E. (2014). The New Public Health. 3rd ed. San Diego: Elsevier Academic Press.
Turner, B. (1982). The Government of the Body: Medical Regimens and the Rationalisation of Diet. The British Journal of Sociology. 33 (2) pp. 254-269

Advertisements

Childbirth

Giving birth in a risk averse, medicalised culture is seen as both a natural commonality and something that can also be ‘high risk’, uncertain and controlled by biomedicine. How much does the idea of risk turn the pregnant body into a vulnerability which medical science, ‘content with the normal human body…seeks to restore’ and control (Chesterton: 1987: p40) To what extent does this idea of risk relate to Foucault’s idea of biopower?

In this paper I am interested in unpacking pervasive medicalised ideas of pregnant bodily vulnerability and the opposing views from midwives and birth attendants with an alternative, phenomenological worldview of childbirth whose approach. How are these alternative choices affected by social processes by which their subjectivity is shaped?
At the beginning of the 19th century ailments that were once seen to be caused by moral failures, legal violations or anecdotal explanations were replaced by biomedical treatments (Foucault: 1980). Post Enlightenment physicians adopted empiricist ideas of the body developed by physical phenomena observed by the trained eye- surgically opened bodies, technological imagery and scans (Foucault: 1975). Foucault describes this as a ‘medical gaze’ which separates the patient’s body from the patient’s identity and plunges ‘from the manifest to the hidden’ (Foucault: 1963). The patient’s body is redefined to them by the expert with their esoteric collective knowledge of biomedicine. Foucault describes bio-power as a legitimising force which forms truthful facts in relation to normative principles of biomedical rationality that divide normal from pathological (Rabinow, Rose & Foucault: 2003).
These truthful scientific facts and normative principles change over time- in the case of childbirth becoming increasingly pathologised and risky, correlating with medicalised culture’s propensity for risk assessment and technocratic control over the pregnant body. Many women share an ‘uncritical faith in obstetric expertise’ and express satisfaction with the process and outcome of intervention (Campbell & Porter: 1997: p353). Davis-Floyd posits that those who adhere to obstetric practices or ‘society’s hegemonic core value system’ are likely to ‘feel empowered by and succeed within that system’ (Davis-Floyd: 1994: p1137). Similarly, Scambler states that ‘satisfaction of the physician and patient’ is a ‘non-rational consensus’ born from the power of medical expertise and ‘may not accord with the patient’s true interests’ (Scambler: 1987: p184). So how far are women’s choices informed about childbirth and to what extent are they subject to the truthful facts of biopower?
In the US women were first introduced to a medical interpretation of pregnancy with the public health campaign of the United States Children’s Bureau in the early twentieth century (Barker: 1998). Despite non-medical ideas of pregnancy at that time, women were encouraged by medical experts to see pregnancy as medical and themselves as patients (Barker: 1998). Ultimately, with the dissemination of the book Prenatal Care and other media campaigns, the ‘natural yet precarious’ medical interpretation of pregnancy prevailed (Barker: 1998: p1070). Prenatal Care, first published in 1913, had been distributed to over twenty-two million women by the mid-thirties. Barker’s analysis of this document unpacks ‘discursive mechanisms through which biomedicine re-conceptualised pregnancy as medically problematic rather than as experientially and organically demanding’ (Barker: 1998: p1067). In both versions of Prenatal Care there is a ‘total absence of material on midwifery’ and existing conceptions of childbirth are pulled out of the rhetoric of pregnancy, reinventing women’s maternal health needs (Barker: 1998).
Moreover, Prenatal Care states that ‘all pregnancies’ are potentially ‘pathological and disease-like’ by using host-parasite metaphors to discuss mother and baby (Barker: 1998: p1067). In examining the parasite, the physician is less dependant on patient’s account of their health, isolating the patient from their body and adding ‘a highly persuasive rhetoric to the authority of medicine’, bolstering its field of knowledge and disempowering an individual from dealing with and knowing their own health (Starr: 1982: p137, Illich: 1976).
This detachment of person and health is mirrored in a 1997 US study showing that a varied sample of women expressed ‘distrust of their own bodies’ and of the processes of labour as a site of risk (Miller & Shriver: 2012: p712). Similar studies claim that women felt that to do ‘everything possible to have a healthy baby’ they needed to rely on ‘authoritative knowledge and concomitant technological expertise’ (Davis-Floyd & Sargent: 1997: p133). These ideas dominate many labours and cause ‘technology-intensive care’ to prevail; in 2009 about one-third of women underwent caesarian-section (Kukla et al.: 2009). Therefore biomedicine is replacing natural processes because of the risk they present and these technological practices are seen as better because they introduce human control into the birth process (Mansfield: 2008: p1085). This causes some women to actively choose an induction- the practice of inducing labour for matters of convenience or preference.
In a culture which prioritises efficiency, (Hall: 1983)and productivity (Murphy-Lawless: 1998) the preference for efficient and ‘low-risk’ births is a logical one. However, there is a strong argument and much research produced by midwives to indicate that obstetric interventions developed under the guise of bodily vulnerability and risk are ‘not nearly as efficacious as wider society believes’ and can be ‘positively harmful to women’ (Campbell & Porter: 1997: p354). In identifying a ‘risk’, hospital staff legitimise a course of action to speed up labour, but this may not actually be easier or safer for the woman. In this way, medicalised wider society turns the pregnant woman into the subject and patient, vulnerable to unseen risks and lacking agency. She becomes vulnerable in response to what the medical gaze perceives bodily vulnerability to be. By wielding this control over the body, they may actually be inciting bodies to become vulnerable when they could be exercising bodily agency and control.
A simple example of this is that midwives encourage a mobile labour whereas the hospital technology required to monitor a woman confines her to lying on her back. She ‘become[s] the ‘subject,’ while her birth attendants, standing around her, are the ‘authority.’ (O’Mara: 2007: p161). Moreover, human beings tend to feel ‘more vulnerable and less in control when they lie on their backs’ (O’Mara: 2007: p161). In this sense the vulnerability that the medical gaze identifies does not consider the body as a person with unique vulnerabilities, risks and uncertainties that are not limited to their body.
In a society which deems pregnancy as a risky medical situation, averse to uncertainties and intent on controlling risk, to what extent is the pregnant body free to make choices about her pregnant body? And how does the rhetoric around the subject inform these choices?
The expectation for the pregnant woman to declare her childbirth choice (even if she is choosing to have absolutely no birthing assistance) versus just letting her physically respond to her body suggests that the pregnant body is controlled by biopower, but the pregnant woman can exercise preference of some actions over others. Bourdieu uses the term habitus to unpack how individuals particular patterns of living causes them to make preferences. Within a larger network of beliefs about motherhood, risk and health, a woman’s habitus underlies her decision-making about birth. In this sense women are shaped ‘by the habitus they belong to’, but they also shape current attitudes and structures by their choices (Bourdieu: 1984: p170). Her choice has a dualistic value because it ‘distinguishes’ her in her community, giving her symbolic or cultural capital but it also reifies the institution that she chooses (Gaventa: 2003: p6).
‘Women centred’ maternity care giving women ‘informed choice about where to give birth’ was recommended by the British government in the early 1990s (House of Commons Health Committee: 1992, Department of Health: 1993). The Department of Health asked that providers of maternity care ‘review their current organisation’ to ensure women are free to choose about the ‘place of birth’ (Department of Health: 1993). However, with this recommendation came detailed lists of risk assessment criteria meaning that giving birth outside a consultant obstetric unit was restricted to those ‘very unlikely to develop complications’ (Campbell & Porter: 1997: p351). Therefore, the overall message of choice was counterproductive.
Annadale’s study in a US birth centre which used no monitors, ultrasound or forceps and performed no Caesarean deliveries nor used pain medication, midwives taught women that pain and difficulty was not a result of being at risk or vulnerable, but was ‘normal’ and ‘natural’ (Annandale: 1988: p100). However, if the obstetric expectations deemed a woman to be in danger, they transferred her to the nearby Community Hospital. Therefore, a woman’s choice is only respected to a point, if their bodies do not ‘conform to obstetrical expectations’ then medical treatment intervenes. (Annandale: 1988: p95). When the woman is transferred to the hospital, her labour revolves around her identity as patient and is redefined from normal to pathological (Annandale: 1988: p107).
This propensity for risk avoidance not only controls, but also judges women. In the study women reported hospital obstetricians to advise against ‘unsafe’ and ‘unwise’ birth centre care and thirty-three percent reported that their family and friends had ‘strongly negative responses’ to the news that they had chosen a birth centre, including claims that she was ‘risking both her own and the baby’s life’ (Annandale: 1988: p99). Women who opt for alternatives to a medicalised childbirth are perceived by the wider society as ‘unaware of or even indifferent to the ‘real risks’ of childbirth’ (Wendland: 2007: p225).
A 1994 study describes how pregnant women fell into two broad categories: (1) ‘professional women’ in favour of an induction, believing that ‘technology is better than untrustworthy nature’ and (2) ‘Earth Mothers’ opposed to medical intervention, believing that ‘nature is best, and can be trusted’ (Davis- Floyd, 1994, p. 1136).
A ‘natural’ birth is has varied meanings- for some a natural birth is a vaginal birth, for others it involves absolutely no assistance, no medication, no monitoring (Miller & Shriver: 2012: p713). Despite the difference around what qualifies as ‘natural’, women in medicalised society are ‘never fully independent of obstetrical notions of risk’ (Annandale: 1988: p99). This is because even the most extreme oppositions to hospitalised births are, to some extent, ‘relational concepts created through response to biomedicine’(Annandale & Clark:1996: p30–31). Becky Mansfield’s analysis of self-help natural child-birthing books shows writers urging women ‘be strong’ and fight against obstetrical attempts to intervene in her labour. Having to defend the concept of ‘natural’ against dominant ‘social’ forces is problematic as it reifies the natural-social binary instead of unpacking childbirth as both a natural and social phenomena. To suggest that a woman must fight for her birthing decisions against the all seeing medical gaze whilst she is in throes of childbirth and uncertainty underestimates her need for social support.
However, this does not mean that a natural childbirth is simply the refusal of a medicalised childbirth on the principles that it is ‘unnatural’. Midwives have raised alarming concerns about the prevalent medical treatment of childbirth – especially ‘obstetric spacetime’ and its potential harm to pregnant women and babies. It is not my intention here give an opinion about childbirth models, but to discuss the efficacy of ideologies that mothers give birth under, birth attendants practice under and wider society form truths under. These ideologies are built on concepts of risk and uncertainty.
‘Obstetric spacetime’ describes midwives’ perceptions of the obstetric ideology which standardises and monitors the ‘appropriate temporal location of the matter contained in women’s and babies’ bodies’ (Wickham: 2009: p468). This creates ‘boundaries between what obstetrics perceive to be normal or deviant progression’ and intervenes in this progress via their timescales (Wickham: 2009: p464). Sara Wickham (midwife and scholar) explains that midwives are ‘deeply concerned’ with the widespread medical concept of ‘normal limits’ one midwife in the study describes due dates as an indoctrination; ‘not just as a midwife, but your whole life when you’ve been brought up hearing about women having babies’ (Wickham: 2009: p464). In other studies midwives preferred the notion of ‘unique normality’, over a notion of ‘normal limits’ (Davis-Floyd & Davis: 1997).
Much of the obstetric timescale for childbirth is built around Friedman’s partogram which monitors cervical dilation to detect and treat any delay or deviation from normal. However, researchers have found that the partogram does not represent normal labour progress; in fact cervical dilation patterns are vary widely between women, and on average most women are in labour for much longer than Friedman’s model (Luckas et al. 1998). Further research lead a Cochrane review to conclude:
‘we cannot recommend routine use of the partogram as part of standard labour management and care’ (Lavender, Hart & Smyth: 2013: p2).
Despite this, women still have their labours orchestrated to the narrow timescale of the partogram. This results in over fifty percent of the women who fail to meet the criteria of ‘normal progress’ when having their first baby to undergo unnecessary augmentation (Woods et al. :2001: p6).  
In the birth centre, the time limits imposed by medical standards in the second stage of labour cause midwives to implement ‘directed pushing’ to get the baby out to avoid obstetrical intervention. Directed pushing involves a woman holding her breath and pushing hard. It can damage the pelvic floor and perineum and due to oxygen starvation can restrict oxygen flow to the baby’s tissues (Reed: 2010). Thus we see how miscalculated and pervasive obstetric spacetime can be a dangerous presence even in births performed outside of the hospital.
The purpose of these standardised timeframes is to create norms around labour in order to observe and intervene when labour is deemed as ‘high risk’. The most common intervention is inducing the labour for reasons that include, but are not limited to: high blood pressure, premature rupture of the membranes, maternal infection or medical problems, suspected foetal jeopardy and post-term pregnancy (American College of Obstetricians and Gynaecologists: 2015). Post-term pregnancy is thought to lead to post-maturity which is said to cause placenta deterioration. However, Fox concludes that there is ‘no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not’ (Fox: 1997: p77). Furthermore, the fact that most inductions are implemented due to a woman being post-term should surely make us question why so many women are deemed ‘post-term’- could it be that the framework used to calculate gestation is flawed? The midwives in Wickham’s study claim that obstetric recommendations around ‘post-term’ as a construct are unscientific, illogical and oppressive. They claim that the concepts of ‘term’ and ‘post term’ don’t ‘belong to women’ and are ‘inconsistent with the fact that they view women and babies as individually special’ (Wickham: 2009: p465). Research has found that as much as half of post-term pregnancies are misdiagnosed and less than ten percent of babies born at forty-three weeks suffer from post maturity syndrome (Gardosi, Vanner, & Francis: 1997). This is worrying when we consider that the supposed increase in risk to ‘post-mature’ babies is the most common rationale for labour induction beyond forty weeks and it is even more worrying when many babies considered at risk of post-maturity result from nothing more than an inaccurate due date’ (Annandale and Clark:1996: p32). It seems that the concept of risk revolving around the due date invoke extreme and overcautious reactions.
So where did this pervading forty week standard come from and what medical intervention does it index? Today almost all women in a medicalised culture acquire a ‘due date’ early in pregnancy . The relationship between ‘the current temporal point and their projected due date’ is pivotal throughout their pregnancy not only by obstetricians but also friends and family. It orchestrates the timing of monitoring, interventions and screening tests and the imposed length of gestation (Wickham: 2009: p463). Despite this, for over a hundred years the length of gestation has been debated in medical literature and in actual fact, eighty percent of healthy babies have anywhere from a thirty-eight to forty-two week gestation meaning that only a few babies are born exactly on their predicted due date (Wickham:2009: p466). Studies show different factors contribute to gestation length, such as: first-time mothers often deliver more than ten days after their due date and different ethnicities show different trends in gestation- African-American women often give birth three to eight days before other ethnicities (Collins et al: 2001: p183). Moreover ‘a familial factor’ across generations affects gestation length to which ‘both mother and father seem to contribute’ (Morken, Melve & Skjaerven: 2011). Despite these studies, due dates continue to be miscalculated and enforced through which childbirth intervention legitimised. Caldreyo-Barcia concluded that induction is medically required in only three percent of pregnancies and that approximately seventy-five percent of all inductions put both the mother and baby at risk (cited in Korte and Scaer: 1992: p114) So, in a risk averse culture which routinely misdiagnoses risk and intervenes in healthy pregnancies, are there any risks involved in inducing labour and how are these legitimised by wider society?
There is a multitude of arguments over the methods for inducing women and I do not have the scope here to discuss them all, however I will use the debate around Pitocin to exemplify the rule of biopower over the concerns of midwives, obstetricians and scholars. Pitocin- ‘the most abused drug in the world today’ (Caldreyo-Barcia cited in Stillerman: 2006) has been shown to cause increased pain, foetal distress, neonatal jaundice, and retained placenta. Even more concerning is the research suggesting that Pitocin treatment may be a factor in causing autism (Mann: 2013). Pitocin has been shown to shorten the oxygen intake between contractions and to produce immediate strong contractions which impedes women’s ability to cope with pain (Reed: 2010) and causes first time mothers to be more than three times more likely to ask for an epidural (Selo-Ojeme et al. : 2011). This lack of oxygen can produce life-long damage the baby’s brain (Haire: 1978: p191). Despite these worrying arguments, research shows that eighty-one percent of women in US hospitals receive Pitocin during labour today (Davis-Floyd & Bourgeaultet al: 2004: p96).
Some birth care providers try to protect women from unnecessary routine intervention but in order to ‘maintain this independence’ they have to meet medical criteria (Westfall: 2004: p1398). This can result in bolstering medically dominant institutions. For example, the midwives in Annandale’s study claim that it is ‘normal’ for contractions to stop and start as the uterus rests and they resented the imposing framework that deems second stage labours of over two hours to be high risk. In order to protect women from harmful interventions, the midwives would buy women time by ‘ignoring an hour’ of spontaneous pushing in the second stage and manipulate the woman’s birth record to avoid getting into trouble. However, by manipulating paperwork ‘to fit policies, protect women, and avoid getting into trouble’, midwives are upholding the hegemonic framework that imposes these time limits (Annandale: 1988: p103). This false data becomes evidence in standard maternity documentation which creates the foundation for wider social beliefs and norms (Davis-Floyd: 1992) dictating to women what is a ‘responsible decision’ for the health of their baby (Edwards & Murphy-Lawless: 2006: p37). It confirms the success of existing medicalised models and proves experiential and phenomenological understandings of childbirth to be inadequate, leading to tighter regulations which cement ‘legal, ethical and professional frameworks’ (Arney: 1986, Fahy: 2007).
In this paper I have tried to show the extent to which the concept of human bodily vulnerability is derived from biopower which determines truthful facts and principles from medically constituted human subject (Mansfield: 2008: p1074). Biopower legitimises the obstetric spacetime which allow delays and deviations to be pathologised by the medical gaze of experts and incites vulnerability and risk in the pregnant body. Obstetric ideology is clearly a ‘risk-focused’ and ‘technocratic’ worldview’ however, it was not my concern in this paper to reify or invalidate these risks, but to unpack its influence on the medicalised cultural understanding of bodily vulnerability, to situate it within it’s biopolitical system of truth and not to assume it to be a priori knowledge (Jordan: 1983, Murphy-Lawless 1998). I would recommend further research into the harm that the dominant obstetric interaction may be causing in it’s propensity and methods of labour intervention. These interventions are dictated by time-based frameworks which set the human body to the clock of medical science in order to isolate deviations from the norm. These precautions are taken under the potent idea of ‘risk’. Thus the system of truth that is indexed when ‘risk’ is discussed must be observed and unpacked before we start to make recommendations around childbirth.

Bibliography
American College of Obstetricians and Gynaecologists 2015. ”Induction of Labor,” American College of Obstetricians and Gynaecologists Technical Bulletin.

Annandale, Ellen. 1988. How midwives accomplish natural birth: Managing risk and balancing expectations. Social Problems, Vol 35. No. 2. p95–110.
Annandale, E, and Clark, J. 1996. What is gender? Feminist theory and the sociology of human reproduction. Sociology of Health and Illness, Vol.18 No. 1. p17-44.
Arney WR. 1986. Power and the profession of obstetrics. Chicago: University of Chicago Press.
Barker, K.K. 1998. A Ship upon a Stormy Sea: the Medicalisation of Pregnancy. Soc. Sci. Med. Vol. 47. No.8 p1067-1076
Bourdieu, Pierre, 1984.Distinction: A Social Critique of the Judgement of Taste. Massachusetts: Harvard University Press.

Bourgeault, I., Benoit, C., & Davis-Floyd, R. 2004. Re-conceiving midwifery: Emerging Canadian models of care. Montreal–Kingston: McGill-Queens University Press.
Campbell, Rona and Porter, Sam. 1997. Feminist theory and the sociology of childbirth: a response to Ellen Annandale and Judith Clark. Sociology of Health & Illness. Vol. 19 No. 3 p348-358
Chesterton, Gilbert Keith. 1987. The Collected Works of G.K. Chesterton. San Francisco: Ignatius Press.
Collins JW, Schulte NF, George L, et al. 2001. Postterm delivery among African Americans, Mexican Americans and Whites in Chicago. Ethn Dis. Vol 11. p181–187.
Davis-Floyd, Robbie. 1994. The technocratic body: American childbirth as cultural expression. Social Science & Medicine. Vol. 38. No. 8 p1125–1140.
Davis-Floyd, Robbie and Sargent, C. (Eds.). 1997. Childbirth and authoritative knowledge: Cross-cultural perspectives. Berkeley: University of California Press.
Department of Health. 1993. Changing Childbirth. Part I Report of the Expert
Maternity Group. London: HMSO.
Edwards N, Murphy-Lawless J. 2006. The instability of risk: women’s perspectives on risk and safety in birth. In: Symon A. 2006. Risk and choice in maternity care: an international perspective. Edinburgh: Churchill Livingstone: p35-50.
Fahy K. 2007. An Australian history of the subordination of midwifery. Women and Birth Vol. 20. No. 1. p25-9.
Foucault, Michel.1963. Raymond Roussel: Paris: Gallimard
Foucault, Michel. 1975. The Birth of the Clinic: New York: Vintage Books.
Foucault, Michel. 1980. Power/ Knowledge. Great Britain: The Harvester Press Limited.
Foucault, Michel. Rabinow, Paul and Rose, Nikolas S. 2003. The Essential Foucault: Selections from Essential Works of Foucault, 1954-1984: New York: The New Press Essential Series.
Fox, Harold. 1997. Aging of the placenta. Arch Dis Child Fetal Neonatal Ed. Department of Pathological Sciences.
Gardosi, J., Vanner, T., & Francis, A. 1997. Gestational age and induction of labour for prolonged pregnancy. British Journal of Obstetrics and Gynaecology. Vol. 104, p792–797.
Gaventa, J. 2003. Power after Lukes: a review of the literature. Brighton: Institute of Development Studies.
Haire, Doris. 1978. The cultural warping of childbirth. New York: Monthly Review Press. p185-200.
Hall E.T. 1983. The dance of life: the other dimension of time. New York: Anchor Books.
House of Commons Health Committee, Chairperson Winterton N. 1992. Maternity Services. Vol.1. London: HMSO
Illich, Ivan. 1976. Limits to Medicine; Medical Nemesis: The Expropriation of Health. London: Marion Boyars Publishers.
Jordan, B. 1983. Birth in four cultures: a cross-cultural investigation of childbirth in Yukatan, Holland, Sweden and the United States. 3rd ed. Montreal: Eden Press.
Korte, Diana and Scaer, Roberta. 1992. A Good Birth, A Safe Birth: Choosing and Having the Childbirth Experience You Want. Boston: Houghton Mifflin Harcourt,
Lavender T, Hart A, Smyth. 2013. Effect of partogram use on outcomes for women in spontaneous labour at term (Review). The Cochrane Library 2013, Issue 7.
Luckas, M., et al. 1998. Comparison of outcomes in uncomplicated term and post term pregnancy following spontaneous labor. J Perinat Med Vol. 26. No. 6. p475–79.

Mann, Denise. 2013. Induced Labor Linked to Raised Risk of Autism, WebMD News from HealthDay: http://www.webmd.com/baby/news/20130812/induced-labor-linked-to-raised-risk-of-autism-study-suggests.
Mansfield, Becky. 2007. The social nature of natural childbirth, Soc Sci Med. Vol. 66. No. 5. p1084-94.
Miller, Amy Chasteen and Shriver, Thomas E. Shriver. 2012. Women’s childbirth preferences and practices in the United States. Soc Sci Med. Vol. 75. No. 4. p709-16.
Morken, KK Melve and Skjaerven. 2011.Recurrence of prolonged and post-term gestational age across generations: maternal and paternal contribution. BJOG An International Journal of Obstetrics and Gynaecology
Murphy-Lawless J. 1998. Reading birth and death: a history of obstetric thinking. Cork: Cork University Press.
O’Mara, Peggy. 2007. Mothering Magazine’s Having a Baby, Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth. Great Britain: Simon and Schuster.

Reed, Rachel. 2010. Midwife Thinking. Pushing: leave it to the experts : http://midwifethinking.com/2010/07/30/pushing-leave-it-to-the-experts/

Scambler, Graham. 1987. Habermas and the power of medical expertise. In Scambler,
G. (ed) Sociological Theory and Medical Sociology. London: Tavistock.

Selo-Ojeme D, Rogers C, Mohanty A, Zaidi N, Villar R, Shangaris P. 2011. Is induced labour in the nullipara associated with more maternal and perinatal morbidity? Arch Gynecol Obste. Vol. 284. No. 2. p337-41.

Starr, Paul. 1982. The Social Transformation of American Medicine. New York: Basic Books.

Stillerman, Elaine. 2006. The Truth About Pitocin. Massage Today. Vol. 06, Issue 03

The Obstetrics and Gynecology Risk Research Group, Kukla, R., Kuppermann, M., Little, M., Lyerly, A. D., Mitchell, L. M. Harris, L. 2009. Finding Autonomy in Birth. Bioethics, Vol. 23. No. 1. p1–8.
Wendland, C.L. 2007. The vanishing mother: Cesarean section and “evidence-based obstetrics”. Med Anthropol Q. Vol. 21No. 2. p218-33.

Wickham Sarah. 2009. Ensuring the choice agenda is met in the maternity services MIDIRS Midwifery Digest. vol 19. no. p463–469.

Woods, J.R., Jr., et al. 2001. Vitamins C and E: Missing links in preventing preterm premature rupture of membranes? Am J Obstet Gynecol Vol.185. No.1. p5–10.

Mind, body and Anorexia

Through the critique of the Cartesian mind/body dualism, phenomenologist philosophers such as Husserl, Heidegger and Merleau-Ponty gave anthropology the vocabulary to refuse ‘to transcend lived experience through theory’ (Knibbe, K., Versteeg P. 2008. p47). Phenomenologists place the objective ‘view from nowhere’ (Nagel. 1989) in brackets, suspending a reality that we take for granted as the world, in order to concentrate on a non-thematic lived experience (Bullington, J. 2013. p25). Despite anthropology historically analysing ‘behaviour’, ‘interactions’, ‘praxis’ and ‘practice’ rather than entering the philosophical ‘discourse of minds and bodies’ (Crossley, N. 2007. p81), Jackson criticises the discipline’s Eurocentric ‘fetishisation of products of intellectual reflection’ (Jackson, M. 1996. p1) which side-lines the lived experience. For example, the ‘unduly abstract semiotic’ fruits of Levi-Strauss’ mental gymnastics are ‘an ongoing, open-ended activity’ which say little of the lifeworlds of his subjects (Jackson, M. 1996. p25).

‘Embodiment’ has been used to dissolve the longstanding nature/culture, action/structure and subject/object dualisms that anthropologists have battled with (Shilling, C. 2007. p4). In light of this, what more can an embodied perspective and the scientific study of experience tell us about Anorexia Nervosa than has already been proposed by social theorists?

Western analysts of consumer culture in the latter half of the 20th century described a conversion from Christian belief that the flesh is a vessel of sin to the belief that the body is a ‘project and a form of physical capital’ and an increase in control over physical appearance as it became central to self-identity (Shilling, C. 2007. p7). ‘Second wave’ feminism emphasised there was ‘nothing natural about women’s corporeality which justified their public subordination’ (Shilling, C. 2007. p9). The 1980’s saw the body as a malleable symbol of consumer phenomenon, an object afflicted by sexism, and, in Foucauldian terms, a victim to changing modes of control. There has been a long history of politicising the body.

In ‘Anorexia Nervosa’ Bordo describes obsessive body practices as ‘the logical (if extreme) manifestations of anxieties and fantasies fostered by our culture’ rendering ‘the slim body’ as a symbolisation (Bordo, S. 1993. p15). Bordo contends that because we are embodied, we have ‘perspectival’ thought, thus the only way to comprehend things as they really are is from a dis-embodied view from nowhere (Bordo, S. 2003. p4). In this way lifeworlds can only be explained from with-out, rather than within; the body is better understood as an objective instrument of society, rather than as an experiencing and constituting agent in the world.

This reminds us of Bourdieu’s theory of habitus as a ‘conductorless orchestration’ of internalised durable dispositions that we use to think, feel, and act (Bourdieu, P. 1990. p59). He explains the ‘body hexis’ as the ways our bodies are conditioned to habitually stand, speak, walk, etc. which somatically informs our identity (Bourdieu, P. 1991. p13).

Bourdieu describes habitus as history transformed into nature (Bourdieu, P. 1977 p78) and criticises phenomenology for ignoring generative ‘historical and social determinants of experience’ and placing too much emphasis on agency (Bourdieu, P. 1990. p59). Although Husserl’s version accepts historical and social influence on the body, but argues that an individual can strive ‘to establish habitus voluntarily’; it revolves around the notion that body, world and mind all constitute the lifeworld (Husserl, E. 197. p123).

An interesting junction between the two perspectives of the body can be read in Mauss’ ‘body techniques’ (Mauss, M. 1979. p67). Bodily forms of practical reason ‘vary between societies and exist in and through the actions of concrete individuals’ – thus have agency. They also ‘pre-exist and will outlive’ individuals- thus have historical and social bearing (Crossley, N. 2007. p85). Mauss’ theory would concede body (in our case dieting) techniques may ‘have been learned and passed on’ and ‘embody a logic or principle which the agent learns and to which may constrain the individual’ (Crossley, N. 2007. p85). In this way- dieting might initially be learnt (from mothers, media, healthcare) in order to reap social value by conforming to health /beauty ideals, but may lead to restricting or obsessive behaviour and withdrawal from normative social activities (anorexia). The emphasis here is that we can analyse human knowledge without Bordo’s dis-embodying perspective. This analysis explores the practice of anorexic corporeal schema which reinforces social feedback, and the social moulding of the body, without making the body a mere vehicle of external powers.

Why, then, are eating disorders the most prevalent psychiatric disorders in Western females aged between 14 and 26 years? Often the disorder stems from reactions to contemporary female beauty ideals. However, singular and universalistic logics politicise anorexia as a culture–bound- syndrome and serve to crystallise the understanding of the disorder. Theories which cast bodies as products of social discourse transform the anorexic’s body into a political battleground (see repression within patriarchal arrangements (Nasser and Katzman. 1999; Orbach. 1978), capitalist interests (Wolf. 1991) or symbolic representations of ‘the slim body’ (Bordo. 1993). Jackson’s anti-intellectualist democratisation of anthropological knowledge echoes Merleau-Ponty’s ideas ‘never determinism and never absolute choice, I am never a thing and never bare consciousness’ (Merleau Ponty, M. 1962. p5) thus we turn to studies of being (some)body with anorexia.

Goodlin’s ethnographic study in Israel draws on how ‘the experience of hunger, which involves physical pain and suffering, is transformed into a feeling of self-efficiency, power, and achievement that constitutes a sense of heroic selfhood’. (Goodlin, S. 2008. p275). A sample of quotes from different patients gives an impression of this as lived experience:

‘Look at what my willpower can do /I’m using the feelings aroused by this hunger in order to become a better hunter / It gives you a good feeling. A feeling of “I can do it.” / you feel hunger, you feel weakness and in spite of that you go on / It was like being a soldier [ . . . ] doing what I had to do, and just going for it.’ (Goodlin, S. 2008. p299)

Goodlin describes how the anorexic achieves ‘extraordinary goals’ through creating meaning in her hunger. (Goodlin, S. 2008. p275). In a different study an ‘essential anorexic attitude’ was identified relating to a ‘sense of pleasure, accomplishment, and moral virtue’ (an ‘egosyntonic’ quality) derived from the practice (Orimoto and Vitousek. 1992. p87). Peters explains that anorexics are not mentally ill but are ‘caught up in a phenomenon’ that they find ‘gratifying’ (Peters, N. 1995. p25). Thus Jackson’s contention that ‘use, not logic, conditions belief’ (Jackson, M. 1996. p12) rings true for the anorexics who ‘judge their self-worth largely, or exclusively’ by their anorexic practices (Fairburn CG, Harrison PJ. 2003. p407).

In Dignon et al. when anorexic practice comes to an ‘all absorbing’ point- when patients realise the limits of their emaciation- the egosyntonic characteristics manifest in the mind as an ‘anorexic voice’ (Dignon et al. 2006. p958). It was described by participants as; ‘anorexic mode’, ‘Ana’, ‘negative tape in my head’ which controlled their ‘true self’ (Dignon et al. 2006. p958). Similarly, for participants in Weaver et al. patients’ anorexia took ‘control of their minds’, became a mode of living and an all-encompassing identity but could also be like a comforting friend (Weaver et al., 2005, p194).

Dialogical theory (Hermans. H.M. 1996) describes how healthy mental functioning involves a dominant position- the voice of self- but also dialogues from a variety of positions. These dialogues develop and maintain personal identity; thus the anorexic voice becomes a ‘selfing device’ – a position in which to value the self (Baerveldt C., and Voestermans P., 1996). Moreover, Jackson draws on Mauss’ ideas on inalienable gifts to explain that individuals are embodied in objects; the houses they build, the tools they make, the earth they till and the books they write – they ‘anthropomorphise and talk to the things they work on, blaming their tools when things go wrong, feeling that part of themselves has been violated if the object of their labor is stolen’ (Jackson, M. 1996. p28). The anorexic voice, or position, is a powerful and damaging perversion of this concept, the voice talks, blames and, as they recover, feels the violation of robbery. But does label the body as an inalienable object- the reduction of fat being a measure of anorexic labour? Crossley explains that body techniques ‘modify perceptual, affective and cognitive structures’, thus suggesting that the anorexic practice has internal consequences and it is here that we may broaden social understanding (Crossley, N. 2007. p87).

Empirical studies show irregular autonomic response patterns in anorexics (Murialdo et al. 2007; Zonnevylle-Bender et al., 2005). A study highlights not only ‘problems in recognising certain visceral sensations related to hunger and satiety’ but also ‘reduced capacity to accurately perceive cardiac bodily signals’ (Beate et.al. 2005. p7). Visual self-recognition show the brain structures that stimulate receptors within the gut (interoceptive functions) also influence emotional awareness, suggesting that the ‘central network gives rise to an abstract presentation of oneself that could possibly participate in maintaining a sense of self-awareness’ (Beate et.al. 2005. p9). In other words, interoceptive signals (from the gut) create awareness and reflection upon the self which relates to identity and maintains emotional and physical well-being. Thus, the anorexic body is constantly feeding back to the mind with disrupted interoceptive signals, not only ‘fullness’ signals (correlating with anorexic claims of ‘not being hungry’/‘your body gets used to being hungry’) but also disrupted emotional signals. This disrupted sense of self-awareness and false satiety comply with the willpower of the anorexic, and although there needs to be further research in this area, it suggests that the body (rather than being an instrument of the mind) is in allegiance to anorexic goals.

Conceptually this echoes empiricist thinkers such as James (1890) who described continuous flows of awareness which Merleau-Ponty built on: ‘it is the body which ‘‘understands’’ in the acquisition of habit’ (Merleau-Ponty, M. cited in Reynolds, J. 2004. p95)

Moreover, as Lee explains, anorexia also appears ‘in the absence of a permeative cultural fear of fatness’ concurring with non-fat phobic anorexic studies (Lee et al. 2001. p31)), in non-western settings which do not hold thinness as a beauty ideal (the Caribbean Island of Curacao (Hoek HW et al. 1998.) and to non-female bodies (Latzera, Y. et al. 2014).

Neither can anorexia be attributed as a contemporary phenomena- the 14th century ascetic mystic, Catherine of Siena, starved herself to ‘become Christ through the suffering of starvation’ (Bynum, C. 1989. p179–180). In fact, when Gull officially identified the syndrome in 1873 feminine ideals of beauty were modelled on the curvaceous forms in Renoir’s paintings.

Without denying the importance of dismantling the damage to women’s bodies caused by patriarchal culture, we must heed Jackson’s phenomenological caution of ‘the ways in which we habitually deploy the “culture concept” in our discourse’ (Jackson, M. 1996. p15).

Diagnosing anorexia as a cultural symptom ‘risks being unnecessarily ethnocentric’ (Steiger, H. 1995. p66) and ignores valuable aspects of the disorder which may advance our understanding of it.

In order to move forward in this enquiry it is clear that the body cannot be viewed as an instrument, but as a constituting agent in rendering meaning in the anorexic experience. The conscious experience of the anorexic is transformed by action, which affects the subsequent conscious experience, which affects subsequent actions etc. Dieting is not an anorexic practice, although anorexic practice may stem from it.

Mauss encourages us to ‘survey the pattern and process’ of body techniques (cited in N. Crossley. 2007. p91). In this way we can have a more complete understanding of the evolution of anorexic practice through history, culture, class, gender, race etc. without discussing ‘the body as if it were something cut off from both mind and world’ (Bullington, J. 2013. p27)

Bibliography 

Baerveldt C., and Voestermans P., 1996. The Body as a Selfing Device : The Case of Anorexia Nervosa.Theory Psychology . Vol. 6. SAGE.

Beate M. Herbert and Olga Pollatos. 2012. The Body in the Mind: On the Relationship Between Interoception and Embodiment. Topics in Cognitive Science. vol. 4. no. 4, p692–704.

Bordo, S., 1993. Unbearable Weight: Feminism, Western Culture, and the Body, California: University of California Press.

Bourdieu, P.,1990. The Logic of Practice. California: Stanford University Press

Bourdieu, P., 1991. Language and Symbolic Power. United States: Harvard University Press.

Bourdieu P. 1977. Outline of a Theory of Practice. Cambridge, UK: Cambridge University

Press.

Bullington, J. 2013. The Expression of the Psychosomatic Body from a Phenomenological Perspective. Springer Science & Business Media.

Bynum, C. 1989. Fasting Girls: The History of Anorexia Nervosa. New York: Plum.
Steiger, H. 1995. Review of “Fat phobic and non-fat-phobic anorexia nervosa: A comparative study of 70 patients in Hong Kong.” Transcultural Psychiatric Research Review. vol 32. p64–68.

Crossley, N. 2007. Researching embodiment by way of ‘body techniques’ in Shilling, C., ed. 2007. Embodying Sociology: Retrospect, Progress and Prospects. Norwich, UK: Blackwell Publishing.

Fairburn, CG and Harrison, PJ. 2003. Eating disorders. Lancet; 361: 407–416. PubMed.

Featherstone, M. 1982. ‘The Body in Consumer Culture’, Theory, Culture & Society vol. 1, no. 2, 18–33. (Reprinted in M. Featherstone, M. Hepworth and B.S. Turner [eds] 1991. The Body. London: SAGE.

Dignon, A., Beardsmore, A., Spain, S., and Kuan, A. 2006. ’Why I Won’t Eat’ : Patient Testimony from 15 Anorexics Concerning the Causes of Their Disorder. Journal of Health Psychology. SAGE.

Gooldin, S., 2008. Being Anorexic: Hunger, Subjectivity, and Embodied Morality Medical Anthropology Quarterly, Vol. 22, No. 3, pp. 274–296. The American Anthropological Association.

Hermans, H.J.M. 1996. Voicing the self: From information processing to dialogical interchange. Psychological Bulletin. vol. 119. p 31-50.

Hoek HW, van Harten PN, van Hoeken D, Susser E. 1998. Lack of relation between culture and anorexia nervosa–results of an incidence study on Curaçao.

The New England Journal of Medicine. vol 338. no. 17. PubMed.

Husserl, E., 1973. Experience and Judgment.Evanston, Illinois:  Northwestern University Press.

Jackson, M., ed. 1996. Things as They Are: New Directions in Phenomenological Anthropology. Bloomington: Indiana University Press.

James, W., 1890. The Principles of Psychology. UK: Dover Publications.

Knibbe, K. and Versteeg, P. 2008. Assessing Phenomenology in Anthropology, Lessons from the Study of Religion and Experience, Critique of Anthropology, vol. 28, no. 1, 47-62.

Latzera, Y., Azaizaa, F. and Tzischinskyc, O. 2014. Not just a western girls’ problem: eating attitudes among Israeli-Arab adolescent boys and girls. International Journal of Adolescence and Youth. Vol. 19. No. 3. p382–394.

Mauss, M. 1950. Body techniques in M. Mauss, Eng. transl. 1979. Sociology and psychology essays. London: Allen Lane.

Merleau-Ponty, M. 1962. Phenomenology of perception. London: Routledge & Kegan Paul.

Murialdo, G., Casu, M., Falchero, M., Brugnolo, A., Patrone, V., Cerro, P. F., et al. 2007. Alterations in the autonomic control of heart rate variability in patients with anorexia or bulimia nervosa: Correlations between sympathovagal activity, clinical features and leptin levels. Journal of endocrinological investigation. vol. 30. p356−362.

Nagel, T. 1986. A View From Nowhere. Oxford: Oxford University Press.

Nasser, M. and Katzman, M.A.,1999. Transcultural perspectives inform prevention. In Preventing eating disorders. London and New York: Brunel Routledge.

Ngai, E.S.W, Lee, S. and Lee A.M. 2001. Cross-Cultural Research on Anorexia Nervosa: Assumptions Regarding the Role of Body Weight: The variability of phenomenology in anorexia nervosa. Acta Psychiatrica Scandinavia. Willey Online Library.

Orbach, S.,1978. Fat is a feminist issue. London: Arrow Books.

Orimoto, L., Vitousek, K. B., & Wilson, P. H. 1992. Anorexia nervosa and bulimia nervosa. Principles and practice of relapse prevention. p85-127. Washington: ADAI Library.

Peters, N., 1995. The Ascetic Anorexic. Social Analysis, pp. 49 -56.

Reynolds, J., 2004. Merleau-Ponty and Derrida: Intertwining Embodiment and Alterity. US: Ohio University Press.

Weaver, K., Wuest, J., Ciliska, D., 2005. Understanding Women’s Journey of Recovering From Anorexia Nervosa. Qual Health Res. vol.15. p188-206. SAGE.

Wolf, N., 1991. The beauty Myth: How images of beauty are used against women. London: Vintage Books.

Zonnevylle-Bender, M. J. S., van Goozen, S. H. M., Cohen-Kettenis, P. T., Jansen, L. M. C., van Elburg, A., & Engeland, H. v. 2005. Adolescent anorexia nervosa patients have a discrepancy between neurophysiological responses and self-reported emotional arousal to psychosocial stress. Psychiatry Research. vol 135. p45−52.

where is my mind?

What kind of creatures are we? Are we spiritual creatures inhabited by an immaterial soul? Are we driven by instincts and passions that must be trained and civilised by disciplines and habits?

The psychological complex of the twentieth century that were entangled in war-time experiments and Freudian philosophies gave way to the neurobiological concepts of the 21st. These concepts sat on the crest of the giant wave of pharmaceutical companies- the explaining of abnormal selves by locating the problem in the brain and rebalancing chemicals. In the 1950’s amphetamines were marketed to housewives to aide the frantic and isolating task of running the home. Described as ’mothers little helpers’ and as ‘aspirin for the soul’ their demand soon became greater than any other drug. Pharmaceutical companies profits rocketed and branched out into other neural problems; instead of looking to why women’s souls needed a pain killer they looked for the profit in it. It epitomises the ‘one pill fits all’ attitude which was eventually revealed to be harmful in light of addiction and overdose. Despite this, as more disorders are discovered, and pharmaceutical companies happily fill the market with solutions, Western ideas of our bodies become straitjacketed; we are diagnosed and prescribed by capitalist authorities. Anti-depressants don’t do hat they say on the tin as there is little evidence that chemical imbalances exist or have effects on mental functioning. Pharmaceuticals are given out and swallowed whole as cures and coping strategies for pressures of the 21st century and technology is aimed to bridge the gap between the molecular and the mental or the mindful. Despite this there was concern about increased examples of overuse and a compromise was formed- the ‘of mice and men’ issue- of body and mind. However, medicalisation- turning problems of being human into problems suitable for medical marketing is a concern not only of everyday oppression by the capitalist pharmaceutical giants but one of medicine as a profession- and therefore the public’s trust in medical practitioners. As Despret shows us in Anthrop-zoo-genesis where Professor Rosenthal tells his students that a group of rats are bright and another group are dull. He instructs them to carry out a scientific experiments on them. The results show this to be the case- they reflect what Rosenthal told them. However the rats were not bred specifically and were chosen at random. The experiment shows how authority can authorise belief. How it is not only important what belief is, but what it makes. In this sense medical education authorises the doctor to authorise our own ‘internal pharmacy’ (Thompson, Ritenbaugh and Nichter) and a can affect our bodies and concepts of self. This is shown in the ethnography on the placebo effect, where patients that were given a placebo and told that the ‘medicine’ was very effective showed a significant success in healing when compared to a pill which the patients were told had moderate or little effect. In this way we can see how healing ‘doesn’t happen in a vacuum’ and how taking medicine can ‘index the symbolic power of biomedicine’. Moreover, Levi-Strauss in his piece, ‘The Sorcerer and his Magic’ shows how a charlatan healer affects his patients even when he himself is acting and does not believe in the powers of the healing. This complicates the positivist view of science that one can objectively, impersonally and clinically observe another without affecting them and in this way the way medicine is given and the what mental illness labels do to the social life of a person affect their neurological and physical life in ways that should be considered by medical practitioners. Not only does this information ask questions about the ‘legitimate’ and ‘illegitimate’ use of drugs and who authorises them and why, but also raises questions about the academic process as a whole. Those receiving research grants must predict the impacts and benefits of their work in line with existing knowledge. Knowledge against our belief in medicine doesn’t sit so comfortably with the grant holders nor does it evoke rational benefits to the discourse.

Rose discusses some problems in four key movements in the understanding of ‘neurochemical selves’: 1- neuro-imaging, 2- genomics 3- neuro-plasticity 4- psychopharmacology.

The use of brain-scanning make the brain visible. Images of the brain speak to the Westerners understanding of Aristotle’s law of non-contradiction which Levy-Bruhl explains highlights a cognitive relativity in cultures reliant on metaphysics. In this way if science can explain something and there is visual evidence, other explanations of remedies are ruled out- only one explanation from natural processes exist. With neuro-imagery emotions can be located and explained. However, just as the Azande explain processes by their natural evidence, they also have explanatory space for supernatural explanations, as discussed by Evans-Pritchard, of witchcraft. Here I argue that all explanatory systems hold merit but cannot eclipse others. Thus I see problems in the attempt of neuro-imagery to explain the milieu of the human brain- to sketch out and remedy events in the brain as if they were events in the mind. The use of imagery as media, self-help and courtroom tools creates restrictions on our understanding. To blindly follow a neurologists interpretation of brain scans is to assume all perception is reducible to chemicals and arenas. This not only affects what we believe, but what belief makes.

Moreover, the genomic argument so far has led to no evidence of mental disorder biomarkers being inherited but studies into how early childhood experiences shape the brain show significant affects on mental issues. In this way the brain is a plastic organ which can be shaped by practice and by others and ones own treatment of it and of the idea of self. Brain recovery after injury threw light on just how plastic our brain is and brought about a wave of self-help and brain-training media. The brain was seen as a wired object which can be rewired for our own social gain.

Here we must think about Foucault’s work in ‘Madness and Civilistaion’ where he tells us that:

‘the constitution of madness as a mental illness…thrusts into oblivion all those stammered imperfect words without fixed syntax in which the exchange between madness and reason was made. The language of psychiatry which is a monologue of reason about mindsets been established on that silence’.

These ground-breaking words tell us about the move from the idea of the wise-fool- the mad person as a complex and insightful being with nuances and derangements- to the classical clinical age of psychiatry. This is not true today, as the patient’s words are obligatory to the categorisation and therapy of the patient. But what does this do to the patient? The patient is not imposed upon and struggling against the powers that diagnose them, but is the customer, is listened to and expects a biomedical diagnosis and cure. However, how limited is the scope of the psychiatric institutions and the DSM, the categories of mental illness from which to choose appropriate medicine? How much can we trust the pharmaceutical forces that drive us? How are patients choices coopted? What are the alternatives for one with mental health problems?

To split the world into Western metaphysic believers and non-western mystic one is to play out the stereotype that Maurice Bloch warned us of in his classic work, ‘The Blob’. He tells us that there are as many different kinds of ‘blob’ (or self/ psyche/ ego etc.) as there are cultural variations. This poses questions about the many different ‘Western’s’ there are too. The work of contemporaries and colleagues and their voices of authority suddenly become a historically, culturally and even personally situated voice. This situated ‘blob’ is made up of a core, minimal and narrative self in which the core is the agent of the body, the minimal self is the time travelling understanding of the past and the future in order to situate the present and the narrative self is the autobiographical object. The narrative self is not only the autobiographical understanding of the self, but also the communication of that autobiography. In this way we are drawn back to consider ‘what belief makes’, someone who practices the telling and retelling of a daring or brilliant autobiography in a way which foregrounds themselves as the heroine of the tale, they make believe their own virtue and, arguably, wellbeing. On the other hand, if one is more pessimistic in their role and successes in the story of their life, their understanding and belief might shape them differently. Cultural and social influences of course play their role in what is seen as success and the acceptability of the telling of the narrative self -it might be argued by anthropologists studying England that an autobiography in which one play a dazzling victor would be socially unacceptable- and that modesty humour and self-deprecation would be better received and make a more successful social actor. In this way social skill is imperative. Moreover, Strawson demarcates the narrative self as episodic or diachronic. The episodic self has a weak sense of autobiography as an individual expression of meaning, this group is more likely to exist in communities with a collective sense or where talking about internal states is inappropriate. Whereas the diachronic self has a strong sense of their autobiography and what lead them to be exactly where they are in life and where they are going. This is more likely to occur in an individualistic, reflexive society (also likely to have a lot of selfies on social media). Similarly is Spiro’s discussion on egocentric and sociocentric selves which are delineated by self or collective.

The Western metaphysical sense of personhood that has emerged is coined by Rose as ‘brainhood’ where we can fix our abnormalities with therapy or drugs. One must surely question ‘normal’ before we swallow drugs that will ‘normalise’ us? The birth of the term ‘neuroscience’ in 1962 is another explanatory system among many others which has its uses and its problems, but its not one which we should blindly follow.

bonfire

Of all the Gods, there is one missing from the names

the bricks wrought with iron

wet with dew, lighted by the clouds which are slate against the black sky

this is winter with sharp air poking the smell of mulch up our noses

a cup of tea streams its wedding train of vapour across the fields

as you walk it whips wisps to show where to follow

allowing the mammal of my body to love what it loves

the unnamed bonfire calls to our imagination

snapping its fingers between our ribs

reminding you that the mammal of your body

is a loved, wild cousin of the feral world

our eyes stop blinking, frozen in the heat like mating birds

and we let the images that constitute us go

we watch them lighten the slate clouds of night.