Cost of living. Energy prices. Interest rates. Inflation. Tax. Currency values. These measures are mapping a new cartography of economic crisis. But this politics of global disruption is strangely abstract. Public debate is conducted largely in numbers. It is peculiarly clinical, in the sense of being aseptic, without feeling, and coldly detached from human reality. And yet it is indeed the human body that will suffer the harsh effects of a societal catastrophe caused by the toxic mix of war and government ineptitude. Our skin is the canvas on which political failure is being cut.
In Édouard Louis’ latest memoir, A Woman’s Battles and Transformations, he documents the humiliation and misery that inscribed his mother’s existence in an industrially emaciated region of northern France. He describes how the forces of poverty, society, and masculinity (notably his father) deformed her “between the ages of twenty-five and forty-five, a time when others experience life, freedom, travel, learning about oneself”. He cries out against “the injustice of her destruction”. Louis’ aim is not only to tell his mother’s story, but also to anatomise the insults to her body, “those sentiments that the body cannot express”. “It’s because of you all that I smoke”, she would say. Tobacco was her response to deepening stress and shame, to deprivation and destitution. She became a prisoner in her own domestic life, a daily victim of her husband’s physical and psychological aggression. Sometimes the doctor was called to help. But “our bodies changed because of his very presence—we held ourselves differently, spoke differently, afraid that a simple gesture would reveal our social inferiority.” Medicine offered nothing to a family engaged in multiple acts of socially determined self-harm—our stress and shame. In an interview for The New Statesman, Louis put it like this: “The body is the material expression of the violence of the social world.” As a writer, he sees himself as a surgeon conducting a “sociological autopsy”. “For me, bodies express what the world is, what society is. If you expose bodies properly, you expose the world properly…And for me bodies are a means to talk about those issues”—class domination, racism, homophobia. There is a literature about embodiment in medicine. But, as a rule, medicine has stripped the body from medical science. There have been efforts to bring the body back. Nancy Krieger wrote a landmark glossary of embodiment for epidemiology in 2005. She made three claims. First, that bodies tell the stories of the conditions of our existence, stories that must be heard. Second, that the stories that bodies tell may not perfectly match a person’s stated account. And third, that bodies reveal stories that people may not be able to tell. Krieger and Louis are insisting that the biological and social dimensions of our lives are entangled in ways we often prefer to ignore. Krieger criticises the way medical science is “concerned mainly with decontextualised and disembodied ‘behaviours’ and ‘exposures’ interacting with equally decontextualised and disembodied ‘genes’”. Too often the doctor and medical scientist conspire to hide the embodied injustices surrounding us.
As medical students, we learn the causes of disease and we are taught to do what we can to reduce the harmful effects of those causes. We support campaigns to control tobacco use, to promote healthy diets, to encourage physical activity, to minimise alcohol consumption. All epidemiologically correct, of course. And often misguided. As Louis observes: “In our world, medicine and relationships with doctors had always been considered a way for les bourgeois to feel important by taking meticulous and extreme care of themselves.” His point is that “people from a certain milieu socialise only with those of the same milieu, and…there is virtually no possible mixing between social classes”. The result is “the unbreakable cycle of a curse”. As medicine faces communities that are enduring extreme financial hardship, diminished futures, and pervasive fears, we should avoid the terms of engagement commonly promulgated by our governments—and our own teaching. Instead of the language of epidemiological abstraction, we must instead argue that the deteriorating material conditions of our communities are inflicting biological violence on the bodies inhabiting those communities. Krieger’s injunction is that medicine must move from a disembodied to an embodied study of human society and health. Her message has never been more urgent.
Published: 15 October 2022
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