Athenea Digital - num. 0 abril 2001-
Embodiment, Lived Experience and Anorexia:
The Contribution of Phenomenology to a Critical Therapeutic Approach.
|
Jordi
Sanz Ian
Burkitt |
In this piece we will consider the work of Maurice Merleau-Ponty as it relates to critical psychology and also discuss the possibility of its use as a theoretical framework for empirical studies. We will focus specifically on Merleau-Pontys concepts of perception and embodiment and ask what these may add to perspectives within critical psychology. In terms of these concepts, Merleau-Ponty offers a radically different view of perception from that which is common in mainstream psychology, along with a radically different view of human embodiment. Given this, we believe that many of his ideas are important for critical psychology and could give it an alternative direction. Phenomenological perspectives are also of use in critical, empirical studies, and here we use the concepts of perception and embodiment to reassess the literature on anorexia nervosa. It is our contention that these concepts allow us to rethink the embodied nature of anorexia, particularly in terms of the way that the body is conceptualised in the clinical literature, but also the absence of a notion of the lived body from some feminist accounts. Keywords: Phenomenology, Critical Psychology, Anorexia, Feminism, Embodiment, Introception, Clinical Models |
Merleau-Pontys Phenomenology and Critical Psychology The most obvious contribution Merleau-Ponty (1962; 1964a) made
to psychology was that he developed a radically different concept of perception
in the writings of the middle period of his career. His was not the same concept
of perception that appears in mainstream psychology. In most texts in psychology
we find that perception is viewed primarily as a phenomenon located in the individual,
in the brain or the mind. In this view, perception is a capacity given to humans
by their innate ability to process sensory information drawn from the world
through the structures of cognitive processes. Either that or sensory data is
itself already partly ordered before it reaches self-consciousness through the
structure of the central nervous system and brain. Unlike traditional mainstream psychology, for Merleau-Ponty,
perception is reducible neither to the mind or to the brain of the individual.
Also, his concept of perception and perceptive truth is not to be confused with
the empiricist belief that the direct observation of phenomena can either verify
or falsify our hypotheses about reality. Indeed, Merleau-Ponty is highly critical
of both these positions. In their place, he offers a theory of the phenomenal
primacy of perception in which perception and its truth is located neither in
the individual or in the environment around him or her. Rather, the perceptual
faith in the solid existence of an objective world is something that exists
inbetween persons and the world. That is to say, perceptual truth is
only established in the relation between people and the world, by the way in
which they relate to one another and interact. In this process, it is not the
experience of the individual human being that is primary as each individual
is located in a definite environment or field which guides their perceptive
formation of the world. Although each individual is present at a different location
in this world and sees, hears and touches from their own perspective, their
perception of the totality of the field or topography of the world is enough
to guarantee that each will have a universally similar perception of the perceptual
field. Along with this, each person is also part of a social world and the joint
human understanding of the field will also infuse the perception of each person,
ensuring a reasonably common perceptual faith in reality. Before going any further here it is worth making a further note
on the distinction between Merleau-Pontys view of perception and that
of empiricists. When Merleau-Ponty talks of perceptual faith and the perception
of truth, of the way things really are, he is not speaking of a type of perception
that can support scientific truth. This is not an experience of the world that
can act independently of scientific theory, verifying or falsifying such theory.
Instead, the perceptual faith is the very stuff that we begin with in all scientific
inquiry, including of course the social sciences. It is the fundamental belief
that the things of the world about which we speak really exist, and that this
belief is prior to the beginning of any investigation, or to the questioning
of something or the debating of a specific point. The view that we construct
from that point onwards, whether in scientific theory and hypothesis, or simply
in everyday knowledge and understanding, is just one of many constructions of
the world that is possible through reflective consciousness. However, it is
not possible for the seed of this consciousness to act as guarantor of the truth
of the fruit. That is, the perceptual faith supports many different accounts
and perspectives on the world, as both everyday experience and historical records
testify, and cannot be the guarantor of just one. It is like the soil that our
knowledge and consciousness is planted in rather than being the arbiter of hypotheses. This points up an interesting contrast with the branch of critical
psychology known as social constructionism. In his phenomenology, Merleau-Ponty
is clearly lending credence to the view that all knowledge is a construct, a
particular spin on the world woven out of human discourse in history. What we
know of the given world is clearly a construct of sciences and everyday beliefs
as they exist at this moment in history, informing, as they do, our perception
of the world around us. However, Merleau-Ponty does not say that reality
itself is only a by-product or construct of knowledge or of reflexive and discursive
consciousness. The perceptual faith we have in our world is prior to any constructions
at the level of discursive and reflexive consciousness. Indeed, we can only
have such knowledge of the world and debates about its nature providing we have
a prior sense of the existence of things. Only in that way can we begin to construct
different views and ideas about the nature of our world and the composition
of the things in it. Even to deny that there is any objective reality at all,
as the old solipsists did, is to begin from the premise that we all hold with
certainty such a naïve primary view of the existence of things. What Merleau-Pontys
work challenges in social constructionism, then, is what Gergen (1996) once
referred to as its ontological scepticism. That is, its belief that
nothing meaningful can be said about the world or about the existence of things
independently of our socially and historically constructed knowledge about them. Merleau-Pontys phenomenology would challenge
this on two counts. Firstly, Merleau-Ponty clearly believes that although there
can be no direct reflection of the world or of being in socially constructed
knowledge, nevertheless aspects of the world and of being do come through in
language and knowledge. When we speak and begin to construct sciences it is
in an attempt to capture the perceptual faith, to accurately describe the world
of people and things in which we are constantly located. The fact that this
can never be done successfully in any complete or final way is not in itself
a denial of the perceptual faith, of our continual awareness of our embodied
location in the world and in the universe. It simply means that the field in
which we exist can never be exhausted or described in its entirety by language
and thus internalised in human reflexive consciousness. Instead, the things
themselves only appear in partial and refracted ways in language and reflexive
consciousness. When we engage in discourse, then, at whatever level that may
be, such as scientific debate or everyday conversation, we are constantly talking
about an experience that is not itself fundamentally linguistic. For Merleau-Ponty
(1968), paraphrasing Lacan, embodied perceptual experience in particular
vision is structured like a language and therefore is open to being translated
into language: however, it is not itself composed of language. As a child develops
into adult life, language will deepen and extend its understanding of reality,
adding to it entirely new dimensions, but language does not constitute the entirety
of perceptual faith or of experience. The perceptual field in which we are located
contributes as much to perception as does the constructive human activity
both practical and linguistic that takes place in that field. The second difference with social constructionism is that what
is essential in the constitution of perceptual faith is our embodied being in
the world. Perception takes form in the fundamental relation between embodied
human persons and the perceptual field in which they are embedded. It therefore
emerges from the constitution of our bodies and by the way they relate to the
world in which they exist. We can become aware of the world and certain of its
existence as an objective and stable reality only because we ourselves are partly
objects in the world. However, for Merleau-Ponty, we differ from these other
objects in that we are what he called the sensible sentients, in
that our bodies have the capacity for doubling back on themselves.
We become aware of other people and things because we too are a material presence
in the same way that they are. However, we are also sensible of our presence
in the world in the way that inanimate objects are not: as humans, we can feel
ourselves touching other people or things and are also aware of touching ourselves.
It is in that moment that we are revealed as the sensible sentients, in the
split second between the awareness of one of our hands touching the other hand
and then the awareness in that hand of being touched by the other. In the movement
of that one split second into the next we reveal ourselves as aware of our continual
existence as both object and subect; as present to the touch of self and other,
yet also sensible of being touched and of touching others. We are aware of our
existence as sensible sentients woven into the whole fabric of being, in which
we and other people or things share of the same flesh. This is why Merleau-Ponty
referred to the flesh as being elemental: that is to
say, the flesh is not composed of the brute physical fact of the embodiment
of people and things. The flesh of the world is the relation of all the people
and things in the world to one another and the mutual effects of these people
and things upon one another. It is of this flesh that perception is made. What we initially perceive, and what we carry as perceptual
faith throughout the rest of our lives at some fundamental level of our being,
is the relation between our embodied selves and the world. It is this
relation that orders and forms perceptive awareness rather than any ingrained
structures of the brain or mind, or, in contrast, any prior structure and organisation
of the environment which imposes itself on the form of perception. Perception
is therefore neither a subjective nor an objective phenomenon and, instead,
is prior to the reflexively constructed human ideas of an objective and subjective
world. However, what this means is that perception and the perceptual
faith is not something that is fixed and given for all time. The perception
we have of reality is multidimensional and exists at different levels of our
being. In one of its many dimensions, perception contains an element of universality
as all human beings belong to a world composed of similar fields with similar
horizons, shapes and contours, illuminated by ambient light and enlivened by
sound. In another dimension, the perceptual field of particular groups may be
composed of different details or specific elements special to that field. Viewed
from an individual dimension, each person within the social group is located
in a different relation to the perceptual field from all the others, so that
each one of us perceives from a different point of view. Because of the other
dimensions of the field, and because we are mobile and see from continually
changing perspectives, we all have some idea of the totality of the common perceptual
field, of the existence of things not immediately in the range of our visual,
aural or tactile perception. Presence and absence are therefore constant partners
in the perception of the world. However, particular events are always seen in
the immediate moment, from our own point of view, so that our perception always
has in it an element of our individually situated relation to the world.
The perceiver and the perceived (or two perceivers for that matter) are always
united by a situated relation and therefore perception is always, by its very
nature, partial. Yet this is supplemented once more by another dimension, which
is the views and perspectives of others. As humans we live in a social world
and do not have a purely individual relation to the world. As sensible sentients
we are aware of the fact that other human beings are the same as us and are
therefore able to listen to other points of view and to see from other perspectives.
Indeed, Merleau-Pontys (1968) definition of vision is to be distinguished
from his (infrequent) use of the term sight. To have sight is simply the physical
fact of being able to see, but to have vision is to have a sense of the perceptual
field in which we ourselves are located as a sensible sentient amongst others.
To have vision is to be able to see ourselves as an object amongst others situated
in the world of other things and also sensible sentient things. Having vision
is predicated on the fact that we are aware of others seeing us as we can see
them, and thus we are able to see ourselves as others see us. Perception, then,
is intricately bound up in our belonging to both a perceptual field and to a
social world, so that these elements are themselves enveloped in one another
as different dimensions of the world. In turn this leads us into another dimension, that of culture
and history. For Merleau-Ponty, perception is always swathed in the aura of
culture and history. Not only are we located in a social world on an everyday
level, but our understanding of the world is formed through socially constructed,
historically situated, knowledge. Of course, knowledge and understanding are
not exactly the same thing as perception and Merleu-Ponty would argue that we
never lose the perceptual faith in a basic reality in which we are enmeshed
as human beings. However, socially constructed knowledge and understanding does
alter perception at a certain level: while it may not change perceptual faith,
it does colour and add another dimension to our perception of the world. For
example, through science and technology we have an understanding of the sub-atomic
level of all things. We know they are made up of strings of particles that we
can only see and perceive with the aid of scientific instruments. We therefore
know that at a certain level the things in our world are not as stable and solid
as they may seem to unaided human perception. And yet in everyday activity that
does not alter our perceptual faith in the reality of our world: it does not
stop us placing our books or resting the weight of our bodies on our desk, sure
in the knowledge that it will support us and other things. Perceptual faith
still exists and is one of the main orientations for everyday action. Merleau-Pontys ideas, then, do not contradict some of
the main elements of social constructionism, which has been so important in
shaping aspects of critical psychology. However, through an understanding of
perception, phenomenology can add an extra dimension to critical psychology
by reintroducing the notion of embodied perception that is not reducible either
to physiology or to a material world that is given prior to sensuous human activity.
However, in his later work, Merleau-Ponty (1968) offers another possibility
for critical psychology, that it might be able to develop an ontology. Such
an ontology is to be found not only in Merleau-Pontys work on perception
and activity, but in his developing notion of Being and of how this is composed
of elements and dimensions. This would be an ontology that, as we have already
seen, contains both universal and variable, relative elements. Much more work
would need to be done on developing this ontology within critical psychology. The question we want to address now is how the phenomenological
approach would change research methodology in critical psychology. To bring
forth its potential as a tool for research, we have chosen the study of anorexia
nervosa as an illustration of how phenomenology might add some extra dimensions
to the investigation of a particular social/psychological/physiological dilemma.
First, though, we begin by looking at how the dilemma has already been dealt
with and constructed by different protagonists in the debate. In the clinical literature
on eating disorders, the notion that they are a pathology of the
individual person has been the motor for a wide scope of research. However,
anorexia and bulimia are appearing more commonly in diverse populations of women,
making the possibility of describing a common profile for these cases less and
less likely. As each proposed model is destabilised by the actual diversity
of the phenomena, more and more effort is made by clinicians to create a multidimensional
model for the explanation of eating disorders. However, the
multidimensional model proposed by clinicians tends to leave out the crucial
dimension of culture. The one unifying factor that clearly exists in cases of
anorexia and bulimia is the construction of gender, as most cases are among
women (Bordo, 1992). However, in clinical models the role of gender is merely
a contributory or facilitating factor. The prevailing understanding is that
culture provokes and gives a distinctive form to an already existing underlying
pathological condition, which is medical in its origin. Against this clinical perspective, feminists argue that culture
is not merely a contributory factor in conditions like anorexia. Culture cannot
be a modulator when the vast majority of cases of eating disorders
are among women (Bordo, 1993). Furthermore, it is argued that most cases can
be culturally and historically situated in the advanced industrial societies
within the last one hundred years, so they cannot be primarily physiological
in their causation or else there would be an even occurrence of eating
disorders throughout history. Yet many medical practitioners would not accept the feminist
position. While many would accept that cultural pressures, from advertising
and from the beauty and fashion industries, may make women especially vulnerable
to eating disorders it is nevertheless pointed out that not all
women exposed to these pressures develop anorexia or bulimia. Therefore, other
non-sociocultural factors like perceptual disturbances or deficits
in autonomy are then considered to be primary in the determination of the disorders
(Fairburn, 1993). For example, the Body Image Distortion Syndrome test (BIDS),
often used in the diagnostic criteria of anorexia nervosa, has functioned to
emphasise the discontinuity between the anorectic and normal perception
of body image and body weight. In the clinical literature, the initial theorising
of BIDS as a visual misperception clearly placed anorexia within the medical,
mechanistic model of illness. The anorectic, then, is constructed as a person
with an inner defect that prevents them from forming a realistic
image of their body. In the next stage of development, the medical view of anorexia
was modified so that the distortion of the body image was understood as caused
by an affective/cognitive coloration rather than a defect in the perceptual
mechanisms. According to the affective/cognitive theory, it is not that women
actually see themselves as fat, rather they evaluate what they see according
to extremely self-critical standards (for example, because of a so called lack
of self-esteem) (Szmuckler, 1995). According to the cognitive view, it is not
perception that is the problem, rather it is disordered cognitions
that lie at the root of the problem of anorexia. The elements of this faulty
thinking include: However, from our perspective, what must be questioned in
this model is the conceptualisation of anorexia as the product of the invalid
logic, faulty reasoning or flawed perception of individuals. These constructions
portray the anorectic and bulimic as incorrectly processing data from an external
reality whose actual features are very different from the perceptions and cognitions
of the anorectic. From the phenomenological perspective, clinicians are making
two enormous mistakes in their conception of anorexia. Firstly, they are treating
the body as a mechanism that either functions normally or pathologically: either
way, the body is simply a machine that processes information from an external
environment. The body is clearly not understood as a being - as a living person
who actively participates in and constructs their world. Clinicians are not
only failing to take account of culture in the way that a condition like anorexia
is lived, they are failing to understand how culture is lived in an embodied
and situated way in the experience of an individual. Secondly, clinicians are
taking for granted that they, as medical scientists, have access to an unquestionable
truth about the nature of a stable and unchanging external reality. They are
failing to understand that while there is an embodied perception of the world,
this is lived from a situated perspective that is both individual (the persons
relation to the world and their experience of important life events) and socio-historical.
So while they are trying to build multidimensional models, these do not include
the dimensions of the lived body, nor do they take account of the fact that
the body lives in culture. Because of this, as in most empirical models, the
perspective of the scientist is taken to be universal and a-historical, a Gods
eye view of the world which can comment on the true nature of a patients
reality and then, given that the patients perception of reality is different,
can classify that perception as not according with the true reality. The patients
perception thereby becomes classified as distorted. From the phenomenological perspective, it could not be
said that the anorectics perception is distorted. It could
be noted that there is a difference between the perspective of the anorectic
and of those who are in contact with her, such as family, friends or doctors.
However, if the anorectics perception of her body is of a fat body, then
that is her perception; it is not changed or disqualified by the differing perceptions
of those who surround her. It is her lived perception, the way she feels living
in her body, and this is not changed by others trying to convince her that their
differing perceptions are correct, then becoming frustrated or resorting to
medical explanation when she fails to see [the others] reason.
Instead, phenomenology would inquire into the anorectics perception of
reality: what are the elements that make up her lived, embodied perception of
reality? The feminist approach
has recently challenged the clinical paradigm and the practice of clinical therapy
in the treatment of anorexia. The feminist paradigm has (1) cast into doubt
the designation of anorexia and bulimia as diseases, instead emphasising
the learned, addictive aspect of eating disorders; (2) reconstructed the role
of culture and especially gender as primary and productive in the emergence
of anorexia, rather than as a merely contributing factor; and (3) re-conceptualised
the factors in anorexia usually viewed by the medical model as pertaining to
individual pathology as instead belonging at the level of social pathology. The feminist perspective on eating disorders has, in general,
been distinguished both by a commitment to taking the perceptions of women seriously
and by recognising the necessity of a socio-cultural analysis of the phenomenon.
When a woman insists that the only way to succeed in our culture is to be thin,
then she would be described by clinicians as possessing distorted reasoning
or misperception of reality. From a feminist perspective this approach ignores
that, for most people in Western culture, especially in regard of women, slenderness
is equated with competence, self-control and intelligence. The feminist perspective
does not question the anorectics painful suffering. However, what is at
stake is the question of whether that suffering is caused by individual pathology
which marks a clear difference between the profile of eating-disordered women
and those who do not display such a disorder. For feminists, there is no firm
demarcation between the normal and the pathological, as most women are affected
in some way by the cultural construction of female beauty as involving slenderness.
This means that most, if not all, women have some problems in relation to the
consumption of food. Instead of a strict and discernible demarcation between
the normal and pathological, there is a continuum of eating problems which ranges
from dieting to the extremes of anorexia and bulimia. Behind this lies a culture
which is driving more, and younger, girls and women into the regimes of rigorous
dieting and exercise, largely by encouraging the fear of gaining weight. The
feminist approach does not, then, deny the severity of the anorectics
situation but instead calls attention to the severity of the cultural situation
that has produced it, particularly for women. What we are all exposed to are
homogenising and normalising images and ideologies concerning femininities and
notions of female beauty. (And increasingly for men, images of muscular, fit
and youthful masculine beauty). However, the unique configurations of each persons
life will determine how actual women are variously affected. Although there
is clearly heterogeneity of situations and responses, no one is situated outside
the empire of normalising directives. For example, Bordo (1988) has claimed that anorexia
is a product of three cultural axes which mark the socially and culturally mediated
relation we have with our bodies and the way that, through this mediation, they
are normalised. Firstly, there is the dualist axis on which the body is felt
to be separate from the experience of being a person and a mind. This goes back
to the legacy of Rene Descartes and his separation between mind and body, the
body being a mere automaton whereas the mind was the seat of the person or soul
the I. This leads to the second cultural axis, that of control,
where the body is seen merely as a mute instrument to be controlled by the person.
In fact, in most accounts given by anorectics about their anorexia, the issue
of control looms large, as Bordo illustrates with examples drawn from interviews
with anorectics and also from their writings. The third axis is gender/power,
in which women are subjected to images of female beauty which include youthfulness,
slenderness and, in some instances, a kind of boyish, lanky athleticism. This
is the ideal image of a woman in which she is not yet a woman, and
equates with the noted tendency of anorectics to want to retain their more gangly
adolescent physique and to resist the more developed female form which is often
perceived as fatter and more curved. This latter female physique is often equated
with what is regarded as voracious female appetites that cannot be controlled
on the surface, the desire for food as felt in hunger, but on a more
suppressed level, the appetite for sex, which according to male ideology is
insatiable unless strictly controlled. As Bordo (1988: 108) says, On the
gender/power axis the female body appears, then, as the unknowing medium of
the historical ebbs and flows of the fear of woman-as-too-much. That, as we
have seen, is how the anorexic experiences her female, bodily self: as voracious,
wanton, needful of forceful control by her male will. The feminist approach
is therefore important in the study of anorexia as it analyses the cultural
context in which women experience their bodies. However, it puts more emphasis
on the notion of the womans body as signified rather than signifying:
that is to say, it concentrates on how the female body has been signified in
a male dominated culture with a largely male influenced ideology. There is less
emphasis on the way that women actually live their bodies as a means of expression,
and Iris Marion Young (1990) is one of the few feminists to have attempted an
analysis from a phenomenological perspective. In a phenomenological framework
the body is not only seen as a signified entity, something which is made to
signify in the realms of ideology, discourse or power relations, but is also
seen as an expressive device which communicates something about the lived experience
of women: about their struggles and the contradictions they face in the culture
in which they are situated. Baerveldt and Voestermans (1998) have attempted a phenomenological
study of the body in cases of anorexia nervosa and suggest a similar approach
to the one we are advocating here. They place emphasis on the body as a communicative
entity and stress the importance of bodily communication as a continuous flow
of co-regulative skills deployed in ongoing social interaction. However, a problem
with their phenomenological approach is that they suggest anorexia may be the
product of a disturbance in the realm of these social skills and practices.
While on the one hand they criticise some feminist and social constructionist
approaches to anorexia for rendering the body of the anorectic as a mannequin
that shows the effects of domination and submission, or as a battleground for
feminist arguments, dilemmas and discourses, [which] keeps hidden the anorectics
bodily production of meaning (Baerveldt and Voestermans: 177) they themselves
do not enquire into that bodily production of meaning. Instead they suggest
that; The failure of anorectics, if one may put it that way
without morally judging those women, is a matter not so much of a distortion
of their body image as a lack of co-regulative skills that serve the selfing
process. These skills are not developed adequately. In consequence, the women
who suffer from anorexia are much more vulnerable to the pitfalls of an extreme
dualistic relation to their own bodies, resulting in bodily dissatisfaction
and need for mental control (Baerveldt and Voestermans: 177). The problem with this conclusion, however, is that it is not
phenomenological in essence and delivers anorexia back to the clinicians and
mainstream psychologists. The suggestion that anorexia is a failure
of social skills is a moral judgement, whichever way you look at it, and the
conclusion that the treatment of anorexia should focus more on social skills
training in the anorectics environment is to keep this problem enmeshed
in the world of the clinical psychologist. Indeed, Baerveldt and Voestermans
retain much of the language of the clinician, referring to the anorectics
distortion of body image and failure to develop
adequately. The only resort then is to refer the anorectic for some kind
of clinical treatment. Baerveldt and Voestermans judge both the anorectic and
the feminist response to anorexia far too harshly, failing to attempt to understand
the meanings revealed in the anorectics symptoms and the social meanings uncovered
in the feminist interpretation of the condition. In our phenomenological approach we want to suggest an alternative
building on Merleau-Pontys (1964b) concept of introception.
This concept was developed in an article on child development in which Merleau-Ponty
suggested that introception, as opposed to introspection, is primary in the
psychological development of individuals. Introception is the feel that we have
of what it is like to live in and through our bodies and to perceive other people
and things in our bodily relationship to them. Introception, then, partly depends
on the way my body is, on the presence or absence of body parts, organs and
their functions, and also on the relation of my body both to the world and to
others within culture. Following Merleau-Pontys multidimensional approach
to perception and embodiment, we can now also develop a multidimensional view
of personhood through the idea of introception. That is, identity is constituted
around the physical body and the way in which we develop a feel for what our
body is like, as sensed by ourselves and as visible to others: yet at the same
time the feel and the image we develop of our body is also linked to how we
learn to express ourselves symbolically within culture and the values that a
culture places on certain body types, or parts of bodies. Body-image and self-image
the two must be interrelated if not identical is to be located
neither within the body, in its perceptual organs or cognitive processes, nor
outside the body in culture and discourse. Instead, it is dependent on how these
elements are interrelated in the course of a persons life. In this view,
the meaning of the lived experience of body-image and self-image is not internal
to the body, but depends on how physiology is articulated and identity is formed
within the networks of social relations and practices. From this phenomenological perspective, we cannot
say that anyone has a false or distorted image or perception of their body.
What we can say is that there are always some discrepancies between our own
feeling of being our body and the image we develop of it, and the perceptions
and images that others have of us seeing our bodily-self from another perspective.
Put simply, I never see myself exactly as others see me. In anorexia this difference
between first person experience and second person experience is merely more
exaggerated. But then the question follows as to why that should be and why
the anorectic experiences her body the way she does: what is the meaning of
the anorectics introceptive feel of her body? Given that phenomenology advocates a multidimensional approach
there is no one answer to this question. However, we can outline an approach
in general. To begin with, we must take as primary the culture in which we live
and the social meanings by which we act and live our lives. Yet in phenomenology,
culture is lived from a particular embodied perspective and we develop perceptions
of our body and its relation to the world from that situated position. Therefore,
there are always bound to be personal factors in the introceptive feel we develop
of our bodies and our relation to the world. It is these personal and situated
factors that will contain clues as to why some women but not others develop
anorexia despite the cultural pressures on all women to be sleek and slender. The next distinctive aspect of the phenomenological approach
is that the body is not to be treated as an automaton, as it is in the medical
model, but as a person whose body expresses their life and their relation to
the world in an active, communicative way. The body will contribute something
to this process but that does not mean that the anorectic body is pathological.
For example, Gatens (1996) has argued that there is a contingent yet necessary
relation between the body and culture. An illustration of this is in the relationship
of power and gender where the sexed body acts as a demarcation of what is male
and female and also signifies power. In male dominated societies it is the male
body that comes to signify power and authority, and it also serves as the model
for the order of civil society. This does not mean that the different bodies
of males and females have this signification universally, but that aspects of
different bodies signify in a variety of ways in specific cultures. The same
can also be said of the anorectic. As Bordo (1988) points out, most anorectics
are pursuing the boyish body ideal of today, which seems to be surrounded by
an aura of freedom and independence. However, the body shape of most mature
women does not fit this ideal and therefore they must spend hours each day dieting
and exercising, or simply give up trying to attain it. In opposition to this,
the bodies of mature women tend to have more body fat than the bodies of younger
boys and are also rounder and more full. In turn this womanish fat
seems to symbolise womens supposedly voracious appetites and also, for
many women, the domesticity they associate with their mothers (Bordo, 1988:
102). Thus for many women anorexia appears to be a fight against their
own bodies; not the pathological body, but the average adult female body that
is complexly and ambiguously symbolised in contemporary Western culture. Living
a body so ambiguously symbolised is the problem for many women, rather than
an internally distorted perception of their own body or cognitive malfunctions
in the processing of information. In pursuit of their ideal body image and against
the fact of their embodiment as adult women, most anorectics end up mutilating
their bodies: however, the pathologies that result from this, along with the
effects of prolonged starvation, are a product of and not the cause of their
condition. Perhaps what feminism has not fully explained is why women are driven
to do this to themselves? Bordo remarks that the body of the anorectic is an
illustration of how deeply power relations are etched on our bodies and how
well our bodies serve them. Yet this is a view of humans as cultural dopes,
hopelessly locked into the logic of power relations without a hint of the idea
that these relations are actually lived. However, Bordo does provide a clue in her writings as to what
the motivation of the anorectic might be when she says that the incidence of
anorexia has grown as the power of women in society has increased. We can say
that, looking at the situation through the nineteenth, twentieth and into the
early twenty-first century the power and success of women within society has
slowly increased. Women are now doing far better in education than men and are
gaining the knowledge and skills that put them in a far better position of gaining
good employment and economic wealth. However, looking at positions of power
in society, in government or in leading business corporations, men still outnumber
women in terms of their attainment of power and authority. The contradiction
most women face is of growing achievement within society yet still, in the present
moment, being shut out of positions of power and influence. Although this may
change in the future, in the recent past and the present this has created an
unbearable tension between ambition and apparent success, on the one hand, and
failure to achieve ultimate goals on the other. The tension here may drive women
into control of those things that are at hand and open to being controlled,
such as her own body. In these instances, women are not to be seen as puppets
caught in the webs of power, or as passive bodies inscribed by power relations
or discourses, but as active embodied beings living out the contradictions and
tensions in their lives through the materials at hand, including their own bodies. There is also the question here of what an image of the powerful
female body would be like? As Gatens claimed, the powerful, capable, normal
body traditionally has been symbolised in Western culture by the male body.
Men have expressed their fear of female power in the view of the female body
as insatiable and devouring. But what would a positive image of a powerful female
body be like, one created by women themselves? This we dont yet know.
And neither does the anorectic. When she looks for symbols of power, she finds
the male not the female body image and this may be part of the problem she finds
living her body as a modern woman. What we need to consider now is how all these points relate
to therapeutic work with anorectics and how they may change clinical practice.
Therapy is such an established part of the treatment of anorexia that we cannot
escape it. Also to change definitions of anorexia we need to engage with clinical
practice, as many concepts are formed by clinicians. Clinical practice is the
mainstream in the conceptualisation and treatment of anorexia, so that to ignore
it would be to relegate critical ideas to the fringes of theory and practice
with little effect for the treatment of most women. Our conclusion will then
look at how some of the ideas we are developing here might be applied to and
change clinical practice from within. Conclusion. From the Broken Dialogue
to the Dynamics of Introception: Some Indications for Clinical Therapy. The conceptions of eating disorders clearly have
changed over time, from mythological conceptions (the first recorded cases were
known as holly anorectics) to a mass industry on anorexia incorporating
concepts from clinical psychology and medicine (e.g. articles on anorexia appearing
in newspapers, magazines and so on). However, although ideas within society
about anorexia are constantly changing as they circulate through the media,
in mainstream clinical research and practice very little has changed. The notion
that anorexia is an illness remains basically unchallenged. Clinicians categorize
symptoms into syndromes that are operationally defined and analyzed objectively.
Individual women are offered reductionist explanations and
biomedical cures for their symptoms. From a clinical point of view, the diagnosis of
anorexia is based in the notion of the abnormal body and in the
conception of the body as an automaton (Toro, 1990; Puente Muñoz, 1998). Feminists
already complain about this clear division of normal and abnormal
feminities. Whereas healthy teenagers are assumed to be normal, anorectics are
considered abnormal. In this account, the use of questionnaires, among other
empiricist methodology, is used to classify
and categorize the symptoms in order to determine whether a person has anorexia
or not. Through these methods a dichotomy is created between the normal or abnormal.
This focus on the physical body and the assumption of biomedical factors that
can be observed and measured in an objective manner, remove the potentially
confounding nature of the womans bodily experience. Within the existing research on eating disorders,
each of the variables which appear in the biomedical, psychosocial or multi-factorial
models is clearly operationally defined, reinforcing the assumption that they
are discrete antecedent entities with independent causal influence in the evolution
of specific syndromes. The very premise of causal relationship moves the study
of anorexia to general laws which are applied in a range of cases. In this attempt,
the goal of clinical practice is to remove the possibility of bias or of values,
and to examine research questions by testing hypotheses in a precise and replicable
manner. By the same token, the womans account of her anorexia is considered
to be a biased or subjective form of reasoning (Fernandez-Ballesteros,
1994). The anorectic and her body is treated, in this context, as an object
for medical research and practice. The subjects (doctors), detached from all
objects (including the anorectic patient), fixes the object of the anorectics
body in its gaze, monitoring and knowing it with full certainty. The object
is determinate and definable, with clear boundaries, separated from other objects. In this sense, it can be said that placing anorexia
within the bounds of clinical therapy and objectifying the person and their
body creates a broken dialogue between nature and society, between men and women,
between pathology and normality, between doctor and patient, and between anorexia
as illness and human experience. The language of clinical psychology, which
is a monologue of reason about eating disorders, has been established at the
cost of creating these dichotomies of experience. An important aim in clinical therapy, according
to our view, should be to develop ways in which anorexia can be, in a sense,
un-mastered: that is, stripped of its status as objective and other
and reconfigured in the language of relationship and recognition, a turnabout
with implications for all areas of theory and practice. This path, from a broken
dialogue to what might be called the dynamics of introception, also
necessarily leads to a transformative and political dimension on anorexia. Merleau-Pontys concept of introception was
defined as the feel we have of what is like to live in and thorugh our bodies
and to perceive other people and things in our bodily relationship to them.
The perceiver and the perceived are always united by a situated relation and
its partial perception. Here, presence and absence are constant partners in
the world, no longer a dichotomy. Because of this, it cannot be argued that
the clinician represents objective truth, reason and reality, while the anorectic
is defined only by absence of reason and the correct perception
of reality. Instead, it must be argued that both the clinician and the anorectic
are involved in an ongoing and situated relationship in which they are constructing
their surroundings and being constructed by the other. The phenomenological
approach emphasizes how we see and experience from different perspectives, therefore
a clinical approach informed by this view would involve the necessity of reciprocal
understanding between the therapist and the anorectic. This concept of introception brings us to the metaphor
of the fluid. Fluids, unlike objects, have no definite borders;
they are unstable. This does not mean, though, that they are without pattern.
Fluids surge and move, and a logic that thinks as fluid would tend to privilege
the living, moving, pulsing over the inert dead body of the Cartesian world
view. Furthermore, under this new logic of ambivalence and fluid absence and
presence, the clinician cannot see without being seen and, as a result, the
anorectic is simultaneously active. Her commitments and body practices have
a positive force for change. In this sense, the distress and misery experienced
by anorectic girls cannot be ignored and passed off as the result of illness,
but must be engaged with in the context of a mutual human relationship situated
in a particular culture. In this attempt to see the anorectic experience
as a positive force, we will also use some pragmatist ideas (Rorty, 1989) in
order to give some indications for an alternative therapy. These
include the concept of, · Foundationlessness.
While clinical practice emphasizes universal knowledge, we think that knowledge
is located in the local and the contextual. Therefore our values are grounded
in a society and psychological attempts only reflect local moral orders and
not human essences, so anorexia has a value in itself as a social and moral
condition. The accounts of anorectic women should not, then, be reconstructed
through the language and values of the clinician and instead therapy should
be a dialogic process. · Fragmentation.
The psychological paradigm often considers surface behaviours to be caused by
deeper unconscious motives or mechanisms. But in our view, the depth of emotions
must only be considered a spatial metaphor applied to a person. Instead, we
see ambivalence between opposites as a way of understanding anorectic reality.
The spirit of both rather than either/or predominates, reflecting this ambivalent
reality. For example, we have already dwelt on the contradiction faced by modern
women in the opposition between increasing success in society but continued
marginalisation from positions of power. Such contradictions in society could
become the focus of clinical practice itself, so that clinical practice is not
seen as opposite to, and not engaged with, society. It also takes into account
the ambivalent and fragmentary reality that is often a central aspect of the
anorectics experience. However, even a dialogically informed therapy will
experience limits in effecting social change and cannot be taken as a panacea
for the problem of anorexia. · Pragmatism.
Following Rorty (1989), truth is defined in terms of what is good by way of
belief. In our imperfect construction of reality (what Merleau-Ponty viewed
as partiality), we can never assume that we have arrived at a final and definitive
description of it. Constructions cannot be evaluated in terms of their truth
because there is no ultimately correct way of construing anything. Our constructions
then, are to be judged not in terms of their truth but for their usefulness.
The pragmatic approach would pay less attention to the syndrome criteria, and
emphasizing the practical context of action - more to the meaning that
would allow the anorectic girl to create new possibilities for action. We believe that the above points provide new indications
for an alternative therapy with anorectic women and men. This reflects the multidimensional
approach of phenomenology taking into account the way that people live their
bodies with the world, especially the social world. From this point of view,
where culture is seen as lived through the body, we cannot work with notions
of the defective or pathological body, one which suffers distortions
in perception. Instead, the anorectics experience has to be taken as a
reflection of her lived reality and worked with in a positive and dialogical
manner. As we have indicated in the points above, this would mean the therapist
giving up their objective position, or their privilege of accounting for the
anorectics underlying problem in terms of some favoured theory. Instead,
the therapist has to work in a phenomenological and pragmatic way with the anorectics
own meanings, rather than substituting meanings of their own. Perhaps within
the anorectics own embodied and lived experience there will be elements
that can be used in the alleviation of her suffering.
References Bordo, S (1992) Eating disorders: the feminist challenge
to the concept of pathology, in Leder, D. The Body in Medical Thought
and Practice. . The Netherlands: Kluwer Academic Publishers. Bordo, S. (1988) Anorexia
nervosa: psychopathology as the crystallization of culture, in I. Diamond
y L. Quinby (eds.) Feminism and Foucault. Reflections on resistance.
Boston MA: North Eastern University Press. Bordo, S. (1993) Unbearable
Weight: feminism, western culture and the body. Berkeley, CA: University
of California Press Baerveldt, C. And Voestermans
(1998) The body as a selfing device. The case of anorexia nerviosa,
in Stam, H.J., The Body and Psychology. Sage. London Fairburn, G. and Wilson G.T. (1993) Binge Eating. Nature,
Assessment and Treatment. New York: The Guilford Press. Férnandez-Ballesteros, R. (1994) Evaluación conductual hoy.
Un enfoque para el cambio en psicología clínica y de la salud. Pirámide.
Madrid Gatens, Moria (1996) Imaginary Bodies. London: Routledge. Gergen, K. J. (1996) Realities and Relationships. Cambridge,
Mass.: Harvard University Press. Merleau-Ponty, Maurice (1962) Phenomenology of Perception.
London: Routledge. Merleau-Ponty, Maurice (1964a) A Prospectus of His Work,
in M. Merleau-Ponty, The Primacy of Perception. Evanston: Northwestern
University Press. Merleau-Ponty, Maurice (1964b) The Childs Relation
With Others, in M. Merleau-Ponty, The Primacy of Perception. Evanston:
Northwestern University Press. Merleau-Ponty, Maurice (1968) The Visible and the Invisible.
Evanston: Northwestern University Press. Puente Muñoz, M. L y Gómez, M.A (1998) Anorexia y bulimia, en
M.A. Vallejo Pareja (ed.) Manual de Terapia de conducta . Madrid: Dykinson Rorty, R. (1989): Contingency, Irony and Solidarity. Cambridge.
Cambridge University Press Szmuckler, G. and Dare, C. H. (1995) Handbook of Eating Disorders.
Theory, Treatment and Research. John Wiley and Sons. Chischeter. Toro, J. et al. (1990) Intervención terapéutica en un caso de
anorexia nerviosa, en Méndez, F. X. y Antón, D. M. (ed.) (1990) Modificación
de conducta en niños y adolescentes. Madrid: Pirámide, 1994. Young, Iris Marion (1990) Throwing Like a Girl. Indiana
University Press.