What I think we must consider in analyzing any form of “health” that is encouraged, and even enforced, is that such encouragement comes back in the end to the ability to work, to be “productive,” and, in turn, to spend the money that one earns.
What is “health”? What does it mean to be “healthy”? Physical well-being and energy? Mental and emotional balance? A sense of general control over one’s body and self? I had originally meant to speak of the frequent reduction in our culture of “health” to appearance: sexual attractiveness, muscle tone, body size, etc., but Lesley Kinzel has already given an analysis of this paradigm, twice, in fact. Go read her articles, then come back here and we’ll talk about some other stuff.
Attractiveness as a measure of “health,” which we will consider as being already established as a cultural fact, effectively defines health neither as a personal sense of well-being nor as a set of conditions agreed upon in consultation with a physician. Rather, aesthetic criteria render health a metric that lets other people judge – and judge others on – a level of “health.” This judgment affects women disproportionately and, being external, reduces the value of female subjective experience and the power of subjectivity in the individual. Yet this externalization by no means ends with quotidian social interaction, but also extends to the medical establishment and the regulation of bodies in terms of the normal and the pathological – no great revelation here (Foucault already said it) – and these measures are already part of the intrinsic layout and values of the culture to which a given medical establishment belongs.
Consider the following: if you go to the hospital with the flu in Boston (or Cambridge, or Somerville, or many places in the U.S.), the doctor will at some point ask you if you need a note for work. The doctor, as an authority on your body, has the power to assure the other authority over your body – your employer – that you cannot go to work. It is likely that many readers are lucky enough to have jobs that do not require a doctor’s note for work, and instead only the word of the employee, but wage workers, the people who most need to go to work in order to live in the broader sense of the term, are usually required to provide such documentation.
Many people and institutions define sickness as the inability to work. Consider another example: when people with chronic illnesses – rheumatoid arthritis, multiple sclerosis, etc. – respond to doctors’ questions and medical questionnaires regarding their experience with the disease and the efficacy of their treatment, one of the these questions is always: “Does your chronic illness prevent you from working?”
Imagine in another era that “health” for a woman was measured in terms of the ability to reproduce. Female saints and holy women in the Middle Ages (and later) experienced the cessation of menses (and other bodily functions): perhaps because they starved themselves, refusing all food but the host. Changes to their bodies allowed them to avoid the normal household labors of the wife and mother. They were then able to choose their labor, the labor of worship – and whether we believe that their choice was made possible by miraculous intercession or not, the changes to their bodies were incredibly effective in transforming their social status.
“Health,” in our society and for both men and women, is measured in terms of physical attractiveness on the one hand – imagine a very unattractive or “overweight” person being described as “healthy” – and in terms of ability to work on the other. If you are too sick to work, you must be very ill indeed. People with cancer don’t work (but they will go back to work if they survive their disease). People who are literally throwing up (like, right now) don’t work. People who are psychotic (maybe) don’t work. Everyone else is treated with anti-histamines and anti-emetics and anti-depressants and anti-psychotics – so that they can go to work. If they were not at work, they would be at home resting. The medicalization of many diseases, especially mental illness, has had positive social and cultural ramifications, but medicalization also allows diseases to be better linked to work, and the return to health as a return to labor.
What I think we must consider in analyzing any form of “health” that is encouraged, and even enforced, is that such encouragement comes back in the end to the ability to work, to be “productive,” and, in turn, to spend the money that one earns. Part of the discourse around “health” states that the obese, like addicts or criminals, are expensive to the government. They are expensive to the government, but part of the question has to be “why”? And the answer to “why” is usually reduced to the personal: personal health issues related to obesity. While such issues exist, making these issues a matter of personal responsibility rather than considering obesity as a condition, or questioning how the health care system spends money, shifts blame and responsibility to the obese person. It encourages taxpayers to hold overweight people in contempt. Now, not only are obese people not “healthy” (in part because they don’t look “healthy”), they cost tax dollars. The idea of personal responsibility also pathologizes, or even criminalizes, obesity rather than medicalizing it. This is not necessarily to say that (all) obesity should be medicalized – many activists have convincingly argued that for many people, what is considered “overweight” is in a fact a natural, normal, and “healthy” state (for lack of better adjectives). Yet I would say that more factual, scientific medical data on obesity – rather than the myth and pseudoscience surrounding it now – is badly needed. Even HBO’s relatively level-headed series The Weight of the Nation focuses inordinately on personal responsibility, diet, and exercise, while airing only a couple of episodes on emerging studies of weight and biology – episodes which entirely contradict the notion that people have significant personal control over their weight.
“Health,” again, is a function of money. Not only in the definition of sickness as inability to work, but also in the definition of physical conditions in terms of expense. The US spends a lot of money – a lot more than other countries – on health care. Our government also incarcerates a larger percentage of people than any other country, especially for drug-related charges (the US makes up 5% of the world population and has 25% of the world’s prisoners). And I wonder if these two paradigms are not related: on the one hand to the idea of personal virtue, productivity, and work, and on the other to the push to control a population (as bodies). Let me clarify, again. The thing that is interesting about discourses around health is not that when the Surgeon General makes recommendations regarding “health,” she is thinking about a person’s ability to work. What is interesting about these discourses is that we find them convincing – hence the ubiquity of arguments about the expense of obesity and addiction.
The question I think we must ask, especially as women, is if we can allow ourselves to be defined as bodies, and whether our bodies – or any part of ourselves – should be defined by “productive” labor. Or whether, like some medieval women, we can find other ways to define ourselves.
Stefanie Goyette, Ph.D., completed a doctoral thesis on the Old French fabliaux in relation to medieval religious and medical culture. Her thesis is structured around the theme of bodies: bodies living, dead, and resurrected, as well as bodies of and as language. Outside of her thesis, she is interested Latin exempla, and in the relationships between dietetic texts, bestiaries, and vernacular, secular literature. She also works in cinema studies, specifically on twentieth- and twenty-first century French female filmmakers. Both her work on medieval literature and her explorations of film most often center on the body and its relationship to language.