How is The ‘Body’ Culturally Constructed?

‘The body is a model which can stand for any bounded system’ (Douglas 1966: 115).

In her work Purity and Danger, Mary Douglas describes the body as a symbol of society, where society is able to regulate the variety of bodies we have in relation to notions such as body size, fitness, health and beauty. The physical body, and the way in which it is both perceived and embodied, indicates the nature of the culture that the body exists in; the body is therefore a cultural construction. In this essay I will analyse the ways in which the body is culturally constructed, looking in particular at: body images; the gendered body; embodied selfhood; the body as a microcosm of society; the body as a site of control; and the medical body.

In the popular media, we are presented with certain body images that influence the way we perceive our physical bodies. These images are linked bodily ideals that are predetermined and set by each culture and society. For instance, from the 19th century onwards the values of western industrial capitalism have played a large role in the way we perceive ourselves in relation to our physical body, our identity and in intersection with other social constructs such as race, class and gender. The emphasis on individual responsibility and self-management propelled by capitalism have in particular become key values in relation to ideas of health, healthy lifestyle and in understanding how we become ill (Benson 1997: 123). As a result, we are continuously bombarded with biomedical statistics from both the government and commercial bodies about the ‘risks’ of getting sick through ‘risk inducing’ behaviour and habits such as overeating and not exercising (Benson 1997: 123). These social institutions advertise that we have the power to reduce our own risks of getting sick by achieving good health through maintenance and control over our own bodies (Benson 1997: 123). As Benson reiterates, these body images and ideals perpetuated by western culture aim to slow bodily failure through mastery over ‘nature’, the body and the ‘self’ (Benson, 1997: 124).

In terms of the gendered body, female corporeal representations are strictly regulated in terms of what is considered ‘feminine’, ‘sexual’ and ‘beautiful’. In particular, the shape and slimness of the female body is constantly under surveillance, where a recent shift towards maintaining a controlled, healthy body has facilitated an extremely negative view towards fat. A dichotomy between what is perceived as a ‘bad’ body and a ‘good’ body has been created, using body size and fatness as a moral and physical indicator of inner and outer health. As a consequence of these cultural constructions that centre fatness as a moral and physical index of well-being, the body has become a materialisation of the will where we are expected to master our bodies through will power.

As a result of this, issues of self-control and autonomy are often central to the relationship between the body and the self in the West (Benson 1997: 122). Within this relationship, the destructivity and disobedience of the body is of primary concern (Benson 1997: 122). The body is seen as something to be tamed – a thing, a contending will, or a territory (Benson 1997: 122). To tame and control the body is to display, both to others and to ourselves, our ‘true’ inner self: who we ‘really’ are. As Benson argues, the body acts as a channel through which our identities are revealed and transferred (1997: 123). In other words, people are embodied subjects; we experience the world and other people through our bodies. This can be discussed in a contemporary setting through the issue of disordered eating, and in particular, anorexia. As Benson mentions, many feminist writers have argued that disordered eating is a reaction to the requirements and restrictions of modern femininity by conforming to and revolting against cultural conventions around the gendered body (1997: 124).

In accordance with this argument, there appears to be a very clear link between contemporary representations of the female body, and disordered eating. Eating disorders such as anorexia are therefore heavily linked to notions of bodily control, where mastery of diet and appetite become key ways for anorectics to demonstrate the will of the ‘self’ (Benson 1997: 124). For this reason, anorexia can be best described as an exaggeration of self-control and femininity, as self-starvation and meticulous monitoring of food intake offers anorectics a sense of autonomy and self-sufficiency. The construction of a new body through excessive regulation of self-control acts to re-establish the relationship between an ‘inner’ self, the social self that is created through communication with others, and the broader cultural framework (Benson 1997: 125). Moreover, the production of our preferred embodied self through our physical bodies can be seen as a type of performance. Judith Butler argues, for instance, that gender is a performance that provokes, disrupts or confirms societal perceptions (Benson 1997: 130). In this way, the body is a manifestation of society and social ideas, including gender.

The body can also be seen as a microcosm of society. In Martin’s study of immunology for example, the body is compared to a nation-state: ‘the immune system is an elaborate icon for principal systems of symbolic and material “difference” in late capitalism’ (Haraway 1989: 4). Scientific discourse on immunology often relies on societal narratives that liken the body to a nation-state and a police state, where the immune system defends the body (the nation and its citizens) against foreign invaders (Martin 1990: 412). This establishes a clear boundary between the ‘self’, the body, and the ‘nonself’: the outside world, which is maintained through the systematic killing of the nonself by the immune system (Martin 1990: 414). While the biological mechanisms of the immune system are completely natural, the use of societal metaphors to describe these processes indicates the much larger preoccupations of the society and culture in which our bodies are situated. Most importantly however, Martin has argued that the metaphors of war, nation-states and the violently dichotomised ‘self’ and ‘nonself’ used to describe the immune system domesticates and naturalises violence (Martin 1990: 417). These depictions also naturalise societal inequalities and hierarchies through the use of gendered and racialised analogies such as the subordinate ‘female’ phagocyte cells and the invading ‘illegal aliens’ (Martin 1990: 412, 417).

The body can also be viewed as a direct point of control by the state, who employ ‘an explosion of numerous and diverse techniques to achieve the subjugation of bodies and the control of populations’ (Foucault 1976: 140). Foucault argues that through biopolitics, society and the state regulate and train bodies to produce culturally sufficient ways in which people function, with the aim of producing ‘docile’ and ‘useful’ bodies (Benson 1997: 129). The inscription of power relations upon the body also function to justify control and subjugation, similarly to Foucault’s theory of biopolitics. For instance, the system of structural and institutional racism that seeks to maintain white supremacy and subjugate non-white peoples, prescribes certain racial identities onto non-white bodies. While white people remain ‘unracialised’, and therefore the norm, the racialised bodies of non-white peoples are seeped with negative, biological and social stereotypes. An example of this is the construction of ‘blackness’ as a signifier of criminality and thuggery, while ‘whiteness’ has been established to symbolise normative and positive physical, cultural and socio-economic qualities. The caste system in India also functions in a similar way to racism, where boundaries of the physical and social body are policed based on caste hierarchy. The policing of such physical-moral boundaries renders lower-caste ‘untouchable’ bodies ‘polluted’ and dangerous to the ‘pure’ upper-caste Brahmans (Deliege 2011: 49).

One other way in which our body is constructed is through western biomedicine, what O’Neil has termed the ‘medical body’ (1985). The biomedical industry perpetuates a view of the body that has been culturally and historically formulated in the west over centuries. It maintains that the body and the mind are mutually exclusive, the reputed Cartesian dualism (Scheper-Hughes and Lock 1987: 9). Through this, pain and to a larger extent illness, are seen as being either mental or physical and biological or psychological, never both (Scheper-Hughes and Lock 1987: 10). Social information is seen as peripheral to the ‘real’ biomedical diagnosis, which allows biomedicine to pursue a materialist and reductionist approach to the body and mind, which constructs the two as being naturally and universally opposing categories (Scheper-Hughes and Lock 1987: 8). An alternative non-Western epistemology is the ancient Chinese holistic yin/yang cosmology that represents balanced complementarity rather than opposing dualisms (Scheper-Hughes and Lock 1987: 12). Scheper-Hughes and Lock argue that understandings of the healthy body emphasised under this cosmology include value on ‘order, harmony, balance and hierarchy within the context of mutual interdependencies’ (1987: 12).

Our bodies are therefore culturally constructed through and by society, where they are the outcome of invested interests from our wider society, and simultaneously the creations of our own embodied selfhoods. Culture creates, sustains and controls ideas about the body, which in turn reflect the wider interests of that cultural and social universe in which those bodies are located (Benson 2000: 234). Each culture maintains different ideal constructions of the body, the functioning of the body, and the relationship between the body and the self. Societies present us with images of the ‘ideal’ body that we are supposed to aspire to, and in doing so, revere those who do confirm, while marginalising those who do not.

— Short academic paper written in May 2014 for Anthropology of Health class

Is Depression Universal?

Psychiatric and medical professionals export and utilise western models of mental illness that prescribe a fixed set of symptoms which correlate to form what is termed ‘depression’. According to the DSM-IV-TR criteria for Major Depressive Disorder (MDD), depression is described as ‘depressed mood or a loss of interest or pleasure in the daily activities for more than two weeks’ (2000: 356) as well as impaired social, occupational and educational function, followed by 9 symptoms, 5 of which have to be present for someone to be diagnosed as ‘depressed’. This model assumes that depression can be applied universally across cultures, despite cultural variation. In response to this, several anthropologists have argued that depression as a disorder is a Western cultural construction that mobilises western biases of mental illness, personhood, self and suffering, amongst others, while simultaneously ignoring depressive symptoms that fall outside its parameters (Kleinman 1977: 3). They maintain that the meanings and significance of these expressions may differ substantially across cultures (Tsai and Chentsova-Dutton 2010: 468). These anthropological analyses view depression as a mood, rather than a syndrome. In this essay I will analyse the biomedical approach to depression, which assumes a universal description, juxtaposed with the ethnographic model used by anthropologists, which argues for depression’s relativity. The debate on the universality of depression prompts us to re-evaluate the ways in which culture effects the diagnosis and symptoms of mental illness and to what extent western biomedical models should, and can be exported cross-culturally.

The biomedical approach contends that depression is universal by assuming that despite the cultural context, the disorder exists if members report having the symptoms associated with it (Tsai and Chentsova-Dutton 2010: 468). This model relies on survey data and data from structured diagnostic interviews to illustrate cross-cultural frequency rates of depression (Tsai and Chentsova-Dutton 2010: 468). It draws on notions of universality similar to that proposed by Darwin, where in Expressions of the Emotions in Man and Animals, he hypothesised emotions and feelings to be ubiquitous amongst all humans, despite cultural, social and racial variation. We can therefore see this biomedical approach to mental illness as part of an attempt to provide a universal framework for human suffering. In doing so, it assumes that the feelings of loss, hopelessness and emptiness associated with the western model of depression are perceived as deviant or abnormal states of being cross-culturally.

Assuming such universality has been critiqued as ethnocentric, where western cultural categories mobilised through psychiatric theories of mental illness are imposed on other cultures as though their own classifications of illness were culture-free (Kleinman 1977: 4). In positioning western cultural categories that shape the diagnosis and definition of depression as neutral and normative, the biomedical model does not take into account that, as Kleinman reiterates, ‘illness is by definition a cultural construct’ (1977: 9). Instead, this model deems culture to be both secondary and separate from the disorder (Tsai and Chentsova-Dutton 2010: 470-71). Consequently, when this model is implemented in non-western cultures and in diasporic ethnic minority groups, the ‘illness’ aspect of mental illness, which is shaped by human experience, culture and understandings of the self, is effectively ignored. In addition to this, biomedical models of depression, as mentioned earlier, usually rely on survey and interview data. The data taken from these studies do not take into account the different perceptions of mental illness across cultures, which may effect the resulting data variation. Negligence to take this into account therefore impedes the accuracy and value of the resulting data when evaluating depression cross-culturally.

On the other hand, the relativist argument, which has been adopted by many anthropologists who have taken an ethnographic approach to understanding mental illness, conjectures that even if individuals of a particular culture experience the symptoms classified by western psychiatrists as ‘depression’, the meanings and significance of these expressions may differ substantially across cultures (Tsai and Chentsova-Dutton 2010: 468). The argument against the universalism of depression emphasises that while feelings of loss, hopelessness and emptiness may be universal, the structures, norms and values that determine the meaning of these feelings vary cross-culturally. Moreover, anthropological works also suggest that the westernised presentations and conceptualisations of mental illness that are exported to non-western countries are largely only effective as medical models on western populations. This is due to not only theoretical models of depression being cultural constructions, but to the term ‘depression’ itself being a product of western culture. Kleinman has termed this overlay of western cultural categories as the normative ideal on other cultures a ‘category fallacy’ (1977: 4). He argues that, in order to overcome the issue of creating a category fallacy in cross-cultural psychology, one must systematically analyse and compare the relevant illness categories before studying the illness (1977: 4).

Moreover, anthropologists also assert that current models of depression are based on western perceptions of human nature, the self, the body and the mind. In Crazy Like Us: The Globalisation of the Western Mind, Watters argues that the advancement of western notions of mental health imposes western beliefs about human beings, deviance, and what types of life event may trigger psychological traumatisation (2011: 4). For instance, in the West, depression and other forms of mental illness are often characterised as deriving from either mental or biological interferences. This is particularly reflected in the way depressive disorders are treated. Recent shifts in treatment patterns for instance, have resulted in the popularisation of neurobiological treatments such as the prescription of anti-depressants, over psychological remedies such as talk therapy. Many non-western cultures however, do not identify with the Cartesian dualism that separates the body from the mind (Scheper-Hughes and Lock 1987: 6). Instead, Tsai and Chentsova-Dutton maintain that many non-western cultures believe that the body and mind are integrated, which may explain why some symptoms exhibited by non-western people are excluded in the DSM diagnostic specifications (2010: 475). For example, many non-western cultural groups such as the Chinese often exhibit somatic symptoms of depression, which relates to the belief of mind-body integration (Kleinman 1977: 5). This is also indicated in many indigenous treatment methods such as acupuncture and yoga, both of which treat the body and mind together. This cross-cultural variation in the phenomenology of depression is evidenced in Kleinman’s psychiatric studies amongst Chinese patients in Taiwan. He found that a substantial number of his patients reported somatic complaints, and 40% of those who somaticised their illness believed their physical sickness to be the problem, rather than having a psychological basis (1977: 5).

Diagnosis of depression is also based on western ideas of the self and personhood. This is reflected in western models of mental illness, where depression is described as an individual, internal state. Lewis-Fernandez and Kleinman elaborate on this by arguing that in relation to notions of personhood, autonomy is very important in western culture, and so the concept of personal control is closely linked to both the definition and diagnosis of depression (1994). Defining depression as a bound, individualised and internal illness is relative to western culture, but does not apply to non-western cultures that function on collectivist, rather than individualist, ideas of the self. Diagnosis of depression does not take into account the conceptualisation of the self in collectivist societies, where shared inter-subjective emotions may influence depression in people through defective relationships and other social sources.

In addition to this, anthropologists have argued that biomedicine has endeavoured to impose rational, Eurocentric frameworks on modes of suffering (like depression). Not only is the institutionalisation of suffering dehumanising, but it also portrays suffering as something unnatural and treatable. Obeyesekere, in his paper on depression and Buddhism, argues that some cultural groups normalise and naturalise suffering (and as a result, depression) (1985: 135). Through analysing the ways in which depression in Sri Lanka is not free-floating like it is in the west, but tied to the ideology and culture of Buddhism, he argues that suffering for many Sri Lankans is seen as the natural product of the shifts in life (1985: 135). In such a context where suffering is naturalised and being ‘depressed’ is not seen as an abnormal state of being, western models of depressive disorder are to a large extent inapplicable.

One criticism of ethnographic models of relativity however, is that since ethnographies tend to be in-depth and personal, they do not usually include large sample sizes. For instance, Kleinman’s study amongst Chinese patients in Taiwan only used a 25 patient sample size, which limits the generalisability of the research findings. The degree of influence of a researcher’s cultural bias on their observations is also questionable (Tsai and Chentsova-Dutton 2010: 470). Moreover, many of these studies are not conducted comparatively, which brings into question whether the meaning and consequences of depressive symptoms differ cross-culturally as extremely as ethnographic accounts suggest (Tsai and Chentsova-Dutton 2010: 470).

By comparing the western biomedical model that argues for depression’s universality and the ethnographic model used by anthropologists to argue for its relativity, it is clear that illness is itself a cultural construct. Depression is therefore relative to its cultural context, where its affects are given cultural meaning and significance. Consequently, anthropological understandings of the ways in which cultural experience effects the meaning and consequence of symptoms are integral to our conceptualisation and understanding of mental illness.

Short academic paper written in May 2014 for Anthropology of Health class