The Body in Health and Social Care

The body is central to both health and social care, but this fact has not always been reflected in the literature that analyses the area. Health and social care are increasingly constituted as a unified field, encompassing policies and interventions across the health and social care boundary. But the analytic traditions used to explore this territory have until recently remained narrow. The cultural turn that has been so marked across the humanities and social sciences has been slow to make an impact in this area. In particular the topic of the body has yet to achieve the prominence that it has elsewhere, with the result that, what is mainstream in sociology and cultural studies has remained marginal in social and public policy. The purpose of this book is to redress this imbalance, and to suggest some of the ways in which the subject of the body, and new cultural analyses within which its analysis is embedded, have much to contribute to the area of health and social care.

Over the past two decades, the body has become the focus of vigorous debate across the social sciences and humanities. In this chapter, I will review some of the central themes in this literature, concentrating on three areas: feminist writings; the influence of poststructuralism particularly the work of Foucault; and debates concerning the body in consumer culture. Early work on the body was often highly theoretical, and at times the body seemed, paradoxically, to disappear in a cloud of language. More recently there has been a welcome revival of empirically grounded work that focusses on real bodies and real embodiment, and in the main part of the book, I will draw on this. Though gender has been a major concern in this literature, other dimensions of difference are also significant; and in the second part of this chapter, I will explore these cross-cutting dimensions, focussing in particular on class, ‘race’ and sexuality. Age and disability are dealt with in separate chapters.

It may seem strange to start the main part of a book with a chapter on old age. Typically, ageing comes late on, forming the final chapter. Partly this mirrors the progress of the life course, but it also reflects the marginal status of old age, something to be covered quickly at the end. I have chosen, however, to start with ageing because it encapsulates many key themes of this book. Older people, after all, represent the majority client group for health and social care. The bulk of health and social care interventions, and certainly expenditure, in advanced societies are focussed those of late middle age onwards, though this reality is sometimes obscured in order to protect the social and political status of the institution in the context of a wider societal ageism.

The last three decades have witnessed a flowering of disability theory. Driven forward by disabled activists, this challenges not just the day-to-day oppressions that disabled people face, but the implicit theoretical structures that underlie them. The approach is particularly associated with the social model of disability, which provides a unifying and politically oriented account of the field. It rejects the dominant medical account with its emphasis on physical impairment and discourse of personal tragedy, and presents disability as arising instead from a disablist society that erects barriers, both physical and mental, to the inclusion of disabled people, confining them to segregated and stigmatised spaces and social conditions (UPIAS 1976, Oliver 1990, Morris 1992, 1993, Campbell and Oliver 1996). It is a civil-rights approach that presents disabled people as a politically oppressed minority on a parallel with other groups, and locates the problem in the social environment, not in the individual.

There is hardly an aspect of medicine that is not centrally concerned with the body, its treatment and management; indeed from some perspectives, the body represents the whole subject of medicine, its very ubiquity meaning that no aspect of medicine or health care is untouched by questions of its interpretation and construction. In this chapter, I will concentrate on four areas. Each, in its different way, illustrates some of the tensions within health care in regard to the body; and each rests, to some degree, on an alternative conceptualisation to that presented within dominant orthodoxy. The first part of the chapter will explore the historical emergence of the dominant paradigm of modern medicine, and the ways in which it has rested on a particular conceptualisation of the body. The rise of anatomy and the growth of dissection are crucial in this, and we will explore the implications of these techniques for the treatment and understanding of the body. The growing use of dissection in the late eighteenth and early nineteenth centuries produced pressure on the supply of bodies, and in Britain this resulted in the Anatomy Act which in the nineteenth century effectively commandeered the bodies of the poor for medical dissection. Direct links were thus made between the state, poverty and organ sequestration. These still resonate today in the debates around organ donation, proposed policies for assumed consent, and the emergent commercial traffic in organs rooted in Third World poverty. How we view body parts is still a sensitive matter in medicine, and I will discuss the ways in which these debates illustrate some of the enduring conflicts around rival meanings of the body in health care.

In this chapter, I will explore the territory of health, eating and the body, concentrating on two areas: eating disorders and obesity. Both have become significant arenas of public health concern, and both illustrate the ways in which private troubles around the body, weight and weight control link to larger policy issues. In Britain, public health since its inception in the nineteenth century has been concerned with the structural factors that support or undermine the health of the population, and food has been an important element in these debates. Food raises the classic public health issues around the relationship between the State, the individual and the forces of capitalist production as they act on and shape the lives and bodies of people. There are also important links to be made between diets and dieting and the wider culture of consumption in which the body and its appearance assumes new significance, raising further questions concerning the representation and evaluation of the body in high- or postmodernity.

In this chapter we will explore the body in social care, focussing on the provision of personal care within the domestic space of home. Domestic life is ordered spatially and temporally, and this ordering intersects with that of the body in ways that have implications for the provision of social care.

In this chapter, we will explore the category of bodywork as it applies to the activities of staff employed in the social and health care sectors. We have already touched on some of these themes in relation to health care in Chapter 5, in particular in the sections concerning the embodied work of doctors and nurses. In this chapter, I will concentrate on social care, and the provision of personal care to frail, older and disabled people living at home. The chapter thus also links to Chapter 7 and its discussion of the management of the body in home care.

The focus of this final chapter is the body in public space, and within that the particular issues raised by the gendered body in public policy. I will take two examples to explore this: the public provision of toilets, and breastfeeding in public. Both represent responses to the needs of the body in the context of public space and both have implications for public health. I will trace the historical changes that have occurred around these issues, and the current responses of government and other public bodies; and in doing so, will raise questions about the nature of the body in public space and in particular about the kinds of bodies that are acceptable in such settings. As we shall see, public space in the West is an example of a social reality that although overtly neutral and universal in regard to gender — open to all people, all sexes — is in fact implicitly gendered; for the sorts of bodies that are assumed and acceptable in these spaces are those of men, or of women in so far as they can conform to the male model.

The burden of the argument of this book is, I hope, clear: that the new cultural approaches to the body have an important contribution to make to the policy-related fields of health and social care. Bodies, embodiment, bodywork and bodycare are central to these areas; and focussing our analyses more directly on these can bring considerable gains. The body, however, has a protean quality as a subject, and there is no aspect of life or policy that is not relevant, at some level. As a result it is impossible to cover all its dimensions so that, even within the relatively confined areas of health and social care, I have concentrated on only certain, selected areas. Partly these have been chosen to reflect my interests in an inner core of subjects: age, disability, health and care; but partly also to display the central themes of the book in relation to topics such as space, gender, identity, consumption, and their interaction with questions of the body and of public policy. Other analysts might have chosen different subjects; the potential range of these is great. The point, however, remains that the body is a subject of central importance to public policy and one that deserves greater emphasis.