The general
conception of the body that underpins
most health psychology research derives from assumptions that underlie
psychology as a quasi-science. However, when applied to questions of
illness, these assumptions are worked through in a special way.
As well as sharing certain basic premises of the parent discipline,
health psychology takes as its questions problems defined by medicine,
including a particular attitude to the bodies of its clients.
As a result,
health psychology journals are filled with articles that deal
with how patients cope with, recover
from, are liable to, or in some way think, talk or act in relation to
their having a particular diagnostic label attached to them.
The body in
these terms is physically defined,
can be diagnosed, investigated and treated. Its natural variations (sex,
age, height, weight, and performance levels) can be
studied in relation to various psychological measures, as can its many
but specifiable forms of pathology. The correlate of the physical body
is, of course, the subjective self who inhabits it. This subjectivity
(conceptualized as self, feelings, or discourses) is by now a field
of study for health psychologists who provide accounts of particular
treatments.
However,
recording how people perceive their own or others condition
assumes an approach that depends upon the assumption of a physical body
considered to pre-exist as object. For that reason, and in spite of
intentions to move away from the medical approach, subjectivist
positions
risk continuing to accept the body as being properly located in the
realm of biomedicine.
No amount of
cross-correlations of physical and
psychological indices can ever provide this understanding,
which, I will argue,
is essential to a thorough going psychology of health. That is why
experimental
psychology is of limited help in addressing the key issue of health
psychology’s problematic: illness and healing. It is also why it falls
to health psychologists-among others, admittedly- to provide theories
of embodiment having implications for the rest of psychology as a whole.
While no
longer a generalized object (a ‘thing’
which, gender permitting, we all share), has become a universal
issue for study in the social sciences.
It is against this background that health psychology will need to
examine
its position with regard to specific issues concerning embodiment and
to the wider debate about health care in society.
Vulnerability and the ‘Doctor (psychologist)-Patient’
relationship
At the outset
of this chapter I said that health
psychology’s assumptions about the body are shaped by the moral and
ethical values that medicine has adopted. These values involve aspects
of the relationship of practitioner to patient, which are sidelined
by a focus upon issues of communication and control. These issues
concern,
among other things, the relation of suffering by practitioners
concerned.
Those health
psychologist who work in a clinical context might justify taking
this (clinical) attitude themselves.
But most health psychologists do not have the same role as the doctor,
and therefore are not justified in adopting a totalizing emotional
defiance
against suffering or death. Not having undergone the training that
produces
the idea of the body as object, they are not well placed to see that
being objective therapeutically.
Making the
latter point this way is actually to
understate something crucial-and also to distort it some what. It is not that we
experience the world with the body as a medium of perception
only, but that through our participation in the world we also help to
shape it. In the aesthetic fulfillment of life we may feel plenty
– as with the course of things
done well, or with pleasure, alone and with others. With the onset of
disease we may feel lack, deriving from a disruption to our
ability to signify with the body in this way.
This notion
of plenty
and lack is useful in showing that
being embodied is always more than being able to do things, important
as this might be. The loss of power to signify is the subject of many
illness accounts in which people with chronic disease speak of inability
to enjoy specific things like dancing or making love. Acknowledging
this, one must then recognize that the experience of illness is it self
gendered, but is constituted within social and institutional practices,
and hence is varying and changing. Any theory of embodiment in health
psychology will also have to be a social theory.
New Medical Technologies and Social Change: Values
and Ethics
The idea of a
generalized physical body is also
maintained by medicine’s moral and ethical practices , with which
health psychologist align themselves. This related to the development
of the relationship of doctor to patient and to the institutionalization
of medical practice in the clinic and the hospital. The social world-a
world of changing values and identities-prescribes problems and invites
solutions that require that people engage with the world both
functionally
and expressively. Medical innovations create new areas of decision
making
for people with respect to their bodies.
This means
that the problematic of health psychology,
too, is being defined by moral and ethical values that attach
to medicine as it is practiced in the modern world. It is not just what
it means to be ill that is socially defined, but what it means to be
treated and make a good recovery. We can imagine developments in these
two spheres-medicine and the social world- to be reaching out and
crass-crossing
each other. With this image in mind, it is possible to see the
intersections
of new medical interventions and changing social conditions as defining
the spaces where health psychology will continue to find it’s
problematic.
In talking
about these instances it might seem
that I am falling back upon examples that are relevant just because
they involve the (physical) body being altered in some way. This
appears to detract from the argument that what important is embodiment,
rather than ‘the body’ per se. health psychology will have to
deal with problems like these – and others that we don’t yet know
about- if only because of the personal and social issues involved. In
conclusion, I would argue that the ‘issues of the body’ for health
psychology is one of commitment to practical theory, not one of
methodological
preferences. In the end, it is by virtue of our being embodied, as men,
women, patient, doctors and even psychologists, that we bear our
illnesses
and retain our grasp on the world of health. That is where we have to
begin.
credited by Khoirotul Awwaliyah/PBI/Psi.Regular/3D
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