Medicine, Religion, and the Body [1 ed.] 9789047444008, 9789004179707

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Medicine, Religion, and the Body

International Studies in Religion and Society Series edited by

Lori G. Beaman and Peter Beyer, University of Ottawa

VOLUME 11

Medicine, Religion, and the Body Edited by

Elizabeth Burns Coleman and Kevin White

LEIDEN • BOSTON 2010

This book is printed on acid-free paper. Library of Congress Cataloging-in-Publication Data Medicine, religion, and the body / [edited] by Elizabeth Burns Coleman, Kevin White. p. cm. — (International studies in religion and society ; v. 11) Includes bibliographical references (p. ) and index. ISBN 978-90-04-17970-7 (hardback : alk. paper) 1. Medicine—Religious aspects. 2. Human body—Religious aspects. I. Coleman, Elizabeth Burns, 1961– II. White, Kevin, PhD. III. Title. IV. Series. BL65.M4M43 2009 201’.661—dc22 2009030366

ISSN 1573-4293 ISBN 978 9004 17970 7 Copyright 2010 by Koninklijke Brill NV, Leiden, The Netherlands. Koninklijke Brill NV incorporates the imprints Brill, Hotei Publishing, IDC Publishers, Martinus Nijhoff Publishers and VSP. All rights reserved. No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher. Brill has made all reasonable efforts to trace all right holders to any copyrighted material used in this work. In cases where these efforts have not been successful the publisher welcomes communications from copyright holders, so that the appropriate acknowledgements can be made in future editions, and to settle other permission matters. Authorization to photocopy items for internal or personal use is granted by Brill provided that the appropriate fees are paid directly to The Copyright Clearance Center, 222 Rosewood Drive, Suite 910, Danvers, MA 01923, USA. Fees are subject to change. printed in the netherlands

CONTENTS Acknowledgments ............................................................................. Contributors ......................................................................................

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The Meanings of Health and Illness: Medicine, Religion and the Body ......................................................................................... Elizabeth Burns Coleman and Kevin White

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SECTION I

THE SOCIAL AND SPIRITUAL BODY Chapter One Contested Sites: Aboriginal Health and Healers Engaging Western Medicine ...................................................... Brian F. McCoy

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Chapter Two The ‘Religionated’ Body: Fatwas and Body Parts ................................................................................................ Roxanne D. Marcotte

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Chapter Three The Body and the World in Buddhism .......... Peter G. Friedlander

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Chapter Four Subtle Anatomy: The Bio-metaphysics of Alternative Therapies ................................................................... Jay Johnston

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Chapter Five Piety, Prolongevity and Perpetuity: The Consequences of Living Forever ........................................ Bryan S. Turner

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SECTION II

NEGOTIATING MEDICINE, HEALING AND RELIGIOUS BELIEF Chapter Six ‘Pity and also Horror’: Public Mourning, Breast Cancer, and a French Queen ..................................................... Thérèse Taylor

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contents

Chapter Seven Spiritual Boundary Work: How Spiritual Healers and Medical Clairvoyants Negotiate the Sacred ...... Ruth Barcan

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Chapter Eight Moments of Grace and Blessing: Rites and Rituals in the Process of Healing .............................................. Roy J. O’Neill

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Chapter Nine Limitations in Death: Negotiating Sentiment and Science in the Case of the Hospital Autopsy .................. Philomena Horsley

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Chapter Ten The Care of the Body ............................................ Jeremy Shearmur

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SECTION III

VIRTUE, HEALTH AND THE STATE Chapter Eleven Deadly Sin: Gluttony, Obesity and Health Policy .............................................................................................. William James Hoverd

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Chapter Twelve Painful Paradoxes: Consumption, Sacrifice and Man-Building in the Age of Nationalism ........................ Christopher E. Forth

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Chapter Thirteen Freezing Sacred Man: Myth, Philosophy, and Medicine’s Practice of Curing Undesirables .................... Peter Arnds

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Bibliography .......................................................................................

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Index ...................................................................................................

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ACKNOWLEDGMENTS Many of the chapters in this volume were presented at the conference ‘Negotiating the Sacred: Medicine, Religion and The Body’ held in the Centre for Cross Cultural Studies at the Australian National University, Canberra in 2006. The conference was the third in a series entitled ‘Negotiating the Sacred’. The first, held in November 2004 examined ‘Blasphemy and Sacrilege in a Multicultural Society’ (edited Coleman and White, ANU ePress 2006); the second, held in November 2005 examined ‘Blasphemy and Sacrilege in the Arts’ (edited Coleman and Fernandez-Dias, ANU ePress, 2008). In 2007 ANU hosted the fourth ‘Tolerance, Education and the Curriculum’ (publication in preparation) and Monash University, in 2008, hosted ‘Governing the Family’. The aim of these conferences and books is to make a sustained contribution to academic and public debate about the role of the sacred in contemporary social life. This is particularly important where religious difference is central to much national and international discord. We are very grateful to The Australian National University for the intellectual space provided by the then Chancellor of the University, Professor Peter Baume AO and by Professor Ian Chub AO, ViceChancellor. We are especially indebted to Professor Howard Morphy, Director of the Centre for Cross Cultural Research, for opening his Centre unreservedly to us, and for his enthusiasm for the overall project. Without the support of his staff—Maria-Suzette Fernandez-Dias, Alan Wyburn, Suzanne Groves, Glenn Schultz, Ursula Frederick and Katie Hayne—we would have met insurmountable obstacles. We also acknowledge the Ian Potter Foundation, which provided a grant-in-aid for the attendance of Professor Bryan S. Turner who was the international key note speaker, and the Centre for Applied Philosophy and Public Ethics at the ANU for editorial support. Finally, we would like to thank those scholars who have contributed to this volume for their openness and their intellectual commitment to negotiating the sacred, both at the conference and in preparing the chapters for publication.

CONTRIBUTORS Peter Arnds is a Lecturer in comparative literature and literary translation, as well as German and Italian at Trinity College Dublin. He previously taught at Kansas State University and in 2007 spent some time at the University of Kabul teaching comparative literature and foreign language methodology. He is the author of two books, one on Wilhelm Raabe and Charles Dickens, and Representation, Subversion, and Eugenics in Günter Grass’s The Tin Drum. He has published numerous articles on comparative literature from the 18th to the 21st century as well as on German and migrant literature. Ruth Barcan is a Lecturer in the Department of Gender and Cultural Studies at the University of Sydney. She is the author of numerous articles on cultural approaches to the body, the co-editor of two collections (Planet Diana: Cultural Studies and Global Mourning, and Imagining Australian Space: Cultural Studies & Spatial Inquiry) and the author of Nudity: A Cultural Anatomy (2004). She is currently in the early stages of a research project on alternative therapies. Elizabeth Burns Coleman is a Lecturer in the School of English, Communications and Performance Studies at Monash University. She has held postdoctoral fellowships at Monash, and at the ANU’s Centre for Cross Cultural Research. Her published books include (2005) Aboriginal Art, Identity and Appropriation (2005) and two edited collections: Negotiating the Sacred II: Blasphemy and Sacrilege in the Arts (coedited with Maria-Suzette Fernandez Dias, 2008) and Negotiating the Sacred: Blasphemy and Sacrilege in a Multicultural Society (co-edited with Kevin White, 2006). Christopher E. Forth is the Howard Professor Humanities and Western Civilization at the University of Kansas (USA). A specialist in the cultural history of the body, he is the author of several books, including The Dreyfus Affair and the Crisis of French Manhood (2004) and Masculinity in the Modern West: Gender, Civilization and the Body (2008). He is currently writing a cultural history of obesity.

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Peter G. Friedlander is Senior Lecturer in Hindi at Singapore National University. He teaches Hindi language and Buddhist studies and his research interests include the history of Hindi teaching, Hindi literature and Buddhist Studies. He is also involved in online projects about the development of colonial literature such as the Digital Colonial Documents Database. His recent publications include ‘Buddhism and Politics’ in J. Haynes (ed.), Routledge Handbook of Religion and Politics (2009), ‘Dhammapada: Translations and Recreations’, in R. Palapathwala and A. Karickam (eds.), One Word, Many Versions (2007), ‘Prayer and Meditation’, Encyclopedia of Language and Linguistics (second edition) (2006), and (with Harry Aveling) The Songs of Daya Bai (2005). Philomena Horsley is a final year PhD student based at the Centre for Social Health, University of Melbourne. Her thesis is entitled ‘A social anatomy of autopsies’. She was a long standing member of the Community Liaison and Education Unit at the Australian Research Centre in Sex, Health and Society at La Trobe University. William James Hoverd is a PhD candidate in Religious Studies at Victoria University of Wellington, NZ. He is author of Working Out My Salvation (2004) and has published in The Journal for the Scientific Study of Religion. Jay Johnston is a Lecturer in the Department of Gender Studies and Department of Studies in Religion at the University of Sydney. She is the author of Angels of Desire: Subtle Subjects, Aesthetics and Ethics (forthcoming). Her research interests include crosscultural philosophies of embodiment, intersubjectivity and desire, philosophy of religion and alternative medicine. Roxanne D. Marcotte is Lecturer in Arabic and Islamic Studies in the School of History, Philosophy, Religion and Classics, The University of Queensland, Brisbane. Her recent key publications on contemporary Islam include book chapters and articles on ‘Muslim Veils: the Dynamics and Paradox of Resistance’ (2008); ‘The Qur’an in Egypt I: Bint al-Shati’ on Women’s Emancipation’ (2008); ‘What Might an Islamist Gender Discourse Look Like?’ (2006); ‘Identity, Power, and the Islamist Discourse on Women: An Exploration of Islamism and Gender Issues in Egypt’ (2005); ‘The Relation between Freedom and Reli-

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gion: An Iranian Discussion’ (2005); ‘How Far Have Reforms Gone in Islam’ (2003); and the forthcoming ‘Gender and Sexuality Online on Australian Muslim Forums’ and ‘Dialogue between Activism, Spirituality and Scholarship’. Brian F. McCoy has lived and worked in a number of Aboriginal communities since the early 1970s, particularly in north Australia. His doctorate, completed through the Centre for Health and Society at The University of Melbourne in 2004, explored the health of Aboriginal men in a remote desert region of Western Australia. Using an ethnographic and qualitative research method, the views of men around a wide range of health belief and experience were gathered. Since completing his doctorate, he has received an NHMRC postdoctoral fellowship in Aboriginal and Torres Strait Islander Health at La Trobe University. His project involves working with desert Aboriginal men to develop health programs that are culturally appropriate, sustainable and that can be evaluated. Roy J. O’Neill (MSC M.Min. B.A. B. Rel. Stud., Dip. Ed., M.A.C.E.) is a Catholic priest and a member of The Missionaries of the Sacred Heart. He is the Coordinator of Chaplaincy Services for the Randwick Campus of Hospitals in Sydney, comprising The Prince of Wales, The Prince of Wales Private, The Royal Hospital for Women and The Sydney Children’s Hospital. Previously, he has been involved in teaching at both Secondary and Tertiary levels, both in Australia and overseas. Publications in Compass: A Review of Topical Theology. He is a member of the Australian Health and Welfare Chaplains Association and a serving member of the Civil Chaplains Advisory Committee in New South Wales. Jeremy Shearmur is Reader in Philosophy, Australian National University, and lectures in political and moral philosophy. He worked for eight years as assistant to Professor Sir Karl Popper, and is author of The Political Thought of Karl Popper, 1996. He has taught at the University of Edinburgh, the University of Manchester, and at George Mason University, where he was a Research Associate Professor. He was also Director of Studies of the Centre for Policy Studies, in London.

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Thérèse Taylor is Lecturer of Modern History at the School of Humanities, Charles Sturt University—Riverina. Her recent publications include Bernadette of Lourdes, Her Life, Death and Visions (2003), ‘Images of Sanctity: Photography of Saint Bernadette of Lourdes and Saint Thérèse of Lisieux’, Nineteenth-Century Contexts 2005 27(3), ‘“Purgatory on Earth”: An Account of Breast Cancer from NineteenthCentury France’, Social History of Medicine 1998 11(3). Brian S. Turner is Professor of Sociology in the Asia Research Institute at the National University of Singapore, where he leads the research team for the Religion and Globalisation cluster. Prior to this, he was Professor of Sociology in the Faculty of Social and Political Sciences at the University of Cambridge. Professor Turner is the author of The New Medical Sociology (2004) and Society and Culture: Principles of Scarcity and Solidarity (with Chris Rojek, 2001), and is the founding editor of the Journal of Classical Sociology (with John O’Neill), Body & Society (with Mike Featherstone), and Citizenship Studies. He is currently writing a three-volume study on the sociology of religion for Cambridge University Press. Kevin White is Reader in the School of Social Sciences at The Australian National University. He has held appointments at Flinders University in South Australia, Wollongong University, and the Victoria University of Wellington. His publications include The Sage Dictionary of Health and Society (2006), Inequality in Australia (co-authored with A. Greig, and F. Lewins, 2004), An Introduction to the Sociology of Health and Illness (2002) and two edited collections: Negotiating the Sacred I: Blasphemy and Sacrilege in a Multicultural Society (co-edited with Elizabeth Burns Coleman, 2006) and The Early Sociology of Health and Illness (2001).

THE MEANINGS OF HEALTH AND ILLNESS: MEDICINE, RELIGION AND THE BODY Elizabeth Burns Coleman and Kevin White As a result of differing interpretations of the nature of health and illness between health care professionals and parents, Lia Lee, a child, died after a series of epileptic fits.1 For her doctors, Lia’s epilepsy was an illness that could be treated, but for her parents, Hmong immigrants to the USA from Laos, the fits were not a sign of illness or disease, but a sign that a divine spirit moved her. Both the doctors and the parents were well intentioned, both wanted what was in Lia’s best interests, but their cosmological understanding of ‘the problem’, and the meaning of the illness and its management differed. The relationship between doctors and parents was characterised by misunderstanding and distrust. Indeed, as Amy Gutmann has pointed out, ‘Their views are not complementary, but conflicting, and it is hard even to conceive of how they could have been made sufficiently complementary in the short run to overcome the many misunderstandings that resulted in tragedy’.2 The object of scientific study of medicine is the physical body. As Ivan Varga points out, modernity has meant ‘materialising’ as well as ‘scientificising’ the body, which is studied as subject to the laws of nature. ‘Advances in biochemistry, genetics . . . dietetics, etc., together with their often watered down popularisation, spread the image of the scientifically determinable natural body. The healthy body—in itself not a bad thing—is more and more associated with scientific advances’. Yet in medicine, such treatment of the body may limit our perspective and communication about who or what is being treated. We need to ask ourselves whether this treatment concerns only the disease, or the human being. To treat the human being is to recognise they way in

1 This case is discussed in Amy Gutmann, Identity in Democracy, Princeton: Princetom University Press, 2003, pp. 67–8. The story is told in full by Anne Fadiman in The Spirit Catches You and You Fall Down, New York: Farrar, Straus and Giroux, 1999. 2 Gutmann, Identity in Democracy, p. 68. See also Shui Chuen Lee, The Family, Medical Decision Making and Biotechnology: Critical Reflections on Asian Moral Perspectives, Dordrecht: Springer, 2007.

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which their world view inscribes the body with value, and makes illness and health meaningful. The secular state and debates in medical ethics Contemporary political philosophy presents the ideal of a state that is neutral in respect to religion, and the differing value systems accepted by its citizens. In medicine and the health care system, however, we find that the state cannot be neutral. It must have a view (or an implied view) on different conceptions of life and death, for instance, to manage the legislation of organ donation, euthanasia, abortion, and stem-cell research. In all of these issues, religious perspectives on moral issues are seen in contrast to science. ‘Science deals with facts, not values, and medicine is a science’. Hence, we can have an ideal of the medical system being concerned with ‘health’, as opposed to morality, values or ‘religious preferences’, and religious preferences or values understood as personal choices relating to autonomy. It is not that there should be no limits to what medical research or what medical procedures should be undertaken based on moral concerns, but our policy approach to this should respect the ‘facts’, as these are considered ‘value neutral’ laws of nature. It appears there is little within the framework that makes distinctions between facts and values to accommodate religious perspectives. These are seen as empirically untrue, and based on authoritarian dogma, or sentiment. Not every perspective can be, or should be, permitted to be expressed. The law must limit our choices to those that are morally acceptable, specifically in relation to the harm we may do others. But, what is morally acceptable depends upon constructions of the body and the world that are contested. The way in which we frame our moral and political discussion, therefore, is limited both to a particular conception of the body, and a particular approach to religion. The approach to the body is that of the individual, limited organism, and our approach to religious values is an example of the privatisation of religious belief to a preference. The objective of this book is to broaden these horizons. This book addresses this issue through presenting different disciplinary and religious perspectives to medicine, religion, and the ethics of illness and well-being. These alternative perspectives enable us to move beyond our preconceptions about the ‘value-free basis’ of science and medicine, as

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well as to shift our stereotypes of ‘a religious perspective’ on medicine and health. In doing so, the essays presented shift the boundaries of the debate in such a way so that the difference between medicine and medical research and practice and religious perspectives begin to overlap and to engage with one another. Religion, belief and the body In many respects the privatisation of belief is inevitable. The sociologist Bryan Turner has pointed out that in contemporary multicultural societies, pluralism in culture and religion ‘leads to a market situation in religion where within a global and cosmopolitan environment modern people can choose religious styles and beliefs rather like they choose commodities’.3 This situation leads to a devaluation of ‘traditional, lifelong commitments based upon training faith, and conversion. Within the post-modern life style we do not simply choose things; we know that we choose them’.4 Touching on similar themes, Charles Taylor acknowledges that ‘The tight normative link between a certain religious identity, the belief in certain theological propositions, and standard practice, no longer holds for many people. Many of these are engaged in assembling their own personal outlook, through a kind of “bricolage” ’.5 The ideals of the ‘New Age’ spiritual seeker may be trivialised as being extensions of the human potential movement, wholly concerned with the immanent, and being a variety of self-absorption. However, Taylor suggests that the emphasis on choice is informed by an ethic of authenticity in which people seek their individual routes to wholeness and spiritual depth.6 This seeking may involve a sense of ‘spirituality’ that opposes itself to ‘religion’, understood as doctrine and tradition. Yet to acknowledge that for many people the normative link between religious identity, belief and standard practice no longer holds is not to deny that for many it still holds, and is fundamental to their integrity as believers. The assumption within secular political frameworks

3 Bryan S. Turner, ‘The body in Western society: social theory and its perspectives’, in Sarah Coakley (ed.), Religion and the Body, Cambridge: Cambridge University Press, 1997, p. 36. 4 Ibid. 5 Charles Taylor, A Secular Age, Cambridge: Harvard University Press, 2007, p. 514. 6 Ibid., pp. 507–8.

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that religion can be described as dogma or sentiment is inadequate if we are to understand the ways in which religious belief is negotiated in relation to health and illness. Dogma is a system of principles or tenets, authoritatively laid down by a church or religion. We should not assume that because religious frameworks may be developed or articulated in terms of such tenets, that this is what people ‘believe’. Indeed, as Wittgenstein has pointed out, this suggests that belief may be articulated as an empirical hypothesis that may be tested, rather than as the foundation of a world view within which any such questioning may occur.7 Wittgenstein emphasised the groundlessness of belief; once our justifications have reached bedrock, we are left saying ‘this is simply what I do’.8 The idea of religious belief as dogma over-intellectualises religious activity. Conversely, the idea that religious beliefs are preference or sentiment gives religion the characteristic of a personal (emotional or aesthetic) taste, rather than something that is an organising force of one’s life that provides it with meaning. Religion may give meaning both in the sense that it provides a structure for interpretation of the world, and also in that it provides values for what counts as a ‘meaningful life’. The idea of religion as a sentiment is also problematic in that it fails to explain the intersubjective aspect of religion, as a means of communication, a means of criticism of oneself and others, and as a form of community. The papers presented here conceive of religion outside the framework of dogma or sentiment, as a kind of embodied behaviour. Varga has pointed out that the body ‘is at the intersection of nature and culture, of the individual and society . . . of corporeality and spirituality (mind), and as such, it is subject to social control but it is also the seat of individuality, the material substrate of our physical existence, thought and social relations’.9 As such, the conception of the body must be central to understanding what illness, or health, is. We need to understand how the body is conceived within religious frameworks to understand different perspectives on health and illness. Recent scholarship on religion and the body has emphasised embodiment as fundamental to religious commitment and experience. As Thomas P. Kasulis has 7 Cited in Robert Plant, ‘Blasphemy, dogmatism and injustice’, International Journal for Philosophy of Religion, vol. 54, 2003, pp. 101–35, at p. 103. 8 Ludwig Wittgenstein, On Certainty, (§217) cited in Plant, ‘Blasphemy, dogmatism and injustice’, pp. 101–35, at p. 103. 9 Ivan Varga, ‘The Body—The new sacred? The body in hypermodernity’, Current Sociology, vol. 53, no. 2, 2005, pp. 209–235, at p. 210.

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pointed out, ‘Religious beliefs are embodied through religious practices. In fact the practices may be said to precede the beliefs’.10 Sarah Coakley has interpreted this to mean that, ‘devotional “practice” is no optional frill attendant on metaphysical theories acquired somewhere else; rather it is the very medium of such belief, ultimately transcending the thought/action divide’.11 In the terms of contemporary political theory, therefore, we need to recognise the importance of the observance of certain kinds of religious practices in a medical context. It might be understood as recognition of the importance of the integrity of action and belief. Conceiving the body In medicine, the body is the unproblematic basis of our natural, biological existence, and the site of disease. In the social sciences the argument is that our experience of, and knowledge of, our bodies is a product of our specific historical, cultural, political and gendered existence. In this sense the body is not a biologically objective entity but the canvas on which social relationships are painted. In classical sociology Marx, Engels and Weber demonstrated the shaping of the body as it was harnessed to the discipline of factory labour, and in this sense the malleability of its ‘natural’ form, which they took for granted. One of the earliest anthropological accounts of the body was produced by Marcel Mauss who noted that every aspect of bodily deportment—from breathing, through to marching and swimming—was specific to the society which produced it and reflected hierarchies of inequality, especially based around education levels.12 Mary Douglas went on to argue that ‘the social body constrains the way the physical body is perceived. The physical experience of the body, always modified by the social categories through which it is known, sustains a particular view of society. There is a continual interchange between the two kinds of bodily experience so that each reinforces the

10 Cited in Sarah Coakley, “Introduction, Religion and the Body”, in Coakley (ed.), Religion and the Body, p. 8. 11 Ibid. 12 Marcel Mauss, ‘Techniques of the Body’, Economy and Society, vol. 2, 1973, pp. 71–88.

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categories of the other’.13 Douglas argued that ‘The care that is given to [the body], in grooming, feeding and therapy, the theories about what it needs in terms of sleep and exercise, about the stages it should go through, the pains it can stand, its span of life, must correlate with categories in which society is seen in so far as these draw upon the same culturally processed idea of the body’.14 Contemporary research goes further in rejecting the ‘naturalness’ of the body providing alternative definitions and accounts of the body that highlight both the social shaping of our understandings of our body and our body as a lived reality. As Simone de Beauvoir, the French feminist philosopher put it, ‘it is not the body-object described by biologists that actually exists, but the body as lived in by the subject’.15 Feminist analyses of medical representations of the body highlight the way in which medicalisation produces women’s bodies as sick and in need of constant care and surveillance. At the cultural level women’s bodies have been shown to be construed as inferior to men’s, as less amenable to control and as dangerous.16 Historians, particularly those influenced by Foucault, have also demonstrated how specific religious, political and economic contexts produce our knowledge of the body.17 In the context of medical thought, for example, Foucault argues that the crucial concepts of the body and disease must be seen as historical products. In our culture we believe ‘that the body obeys the exclusive laws of physiology and that it escapes the influences of history but this too is false. The body is moulded by a great many regimes’.18 One of these is medical, but in many respects medicine itself has been shaped by religion. This position is sustained and demonstrated by the historical perspective adopted by many of the authors, demonstrating both the long term intertwining of medical and religious beliefs as well as their evolution. Within the collection, traditional Aboriginal medicine, historical understandings of the body and religion in Islam and Buddhism and the interplay of traditional Chinese medicine, yoga and spiritual healing 13 Mary Douglas, Natural Symbols: Explorations in Cosmology, Harmondsworth: Penguin, 1973, p. 93. 14 Ibid. 15 Simone de Beauvoir, The Second Sex, Harmondsworth: Penguin, 1953, p. 69. 16 Elizabeth Grosz, Volatile Bodies: Towards a Corporeal Feminism, Sydney: Allen and Unwin, 1994. 17 Michel Feher et al. (eds.), Fragments for a History of the Human Body, (3 volumes). New York: Zone, 1989, (especially volume one). 18 Michel Foucault, ‘Nietzsche, Genealogy and History’, in Donald F. Bouchard (ed.), Language, Countermemory, Practice, Oxford: Basil Blackwell, 1977.

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practices are explored. What is important about the logic of the historical, cross cultural practices and analyses is that they also play out in the west. The connection between good behaviour, proper life practices and salvation are central to western medicine and Christianity. The contributions highlight the interplay of purity, religion and medicine in seventeenth century Austria, links between German Nazism, salvation and medicine, and the long-term historical development in Christianity of the relationship between bodily practices and morality, culminating in debates on obesity today. Thus the historical record is central to understanding today’s social and political processes around medicine, religion and the body. The sacred in western medicine Western medicine may present itself as a value free and objective natural science, yet it is a cultural achievement, incorporating central social values. Bio-medicine is a cosmological system, historically replacing religion by claiming to provide answers to the relationship of human beings to their bodies, their experience of pain and suffering, and the answer to the question ‘what is the good life?’ However, as Ludwik Fleck argued in Genesis and Development of a Scientific Fact in 1935, bio-medicine is the product of the social, political and cultural values which support it, and which in turn it supports.19 A key feature of biomedicine is that it will embody profound religious values. As Fleck put it, ‘the devil haunts the scientific specialty to its very depths’.20 This central insight has informed social theoretic understandings of the social role of medical knowledge, especially in the works of feminists such as Simone de Beauvoir,21 anthropologists such as Mary Douglas,22 historians of the body such as Thomas Laquer,23 and researchers influenced by Michel Foucault,24 such as Judith Butler.25 The claim by western medicine to

19 Ludwik Fleck, Genesis and Development of a Scientific Fact, Chicago: University of Chicago Press, 1979. 20 Ibid., p. 117. 21 de Beauvoir, The Second Sex. 22 Douglas, Natural Symbols. 23 Thomas Lacquer, Making Sex: Body and Gender from the Greeks to Freud, Harvard: Harvard University Press, 1990. 24 Michel Foucault, The Birth of the Clinic, London: Tavistock, 1973. 25 Judith Butler, Bodies That Matter: On the Discursive Limits of Sex, New York: Routledge, 1973.

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present an unmediated knowledge of nature has thus been significantly challenged. The western, legal idea of the body as ‘sacred’ arose from the English nineteenth century anatomy acts, which secured the body of the dead person against anatomical experimentation.26 Much of medical practice itself was originally considered sacrilegious: the opening up of the body, the touching of women, the touching of ‘private’ parts of the body and many of the original medical instruments and techniques, such as tasting a patient’s urine, reflect these earlier concerns.27 With the development of organ transplantation and the commodification of both ‘natural’ and ‘manufactured’ body parts, the idea of the body as sacred is weakening, yet the concept of the sacred is still central to Western medical practice.28 Mary Douglas has pointed out that in many societies, the concept of contamination is central to understanding the concept of health and purity, and that famines, plagues and illness may be considered to be caused by ‘sin’.29 Similarly, definitions of a bodily state as a disease in biomedicine are often as much a product of moral concerns as they are of scientific ones. In fact, bio-medicine can be seen to be a set of moral claims about the good life and the healthy body, delivered in the language of an objective and value free science.30 This is especially the case with public health programs which are based on moral judgments about ‘good citizens’: those people who maintain their body weight within a normal level, and conduct their lifestyles in appropriate ways by keeping fit, drinking in moderation and not smoking. This targeting of individuals as immoral when they get sick from obesity, alcohol use, or smoking obscures those social, political and economic facts that produce and distribute disease, and which shape and limit individual’s lifestyle choices.31

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Ruth Richardson, A Dissection of the Anatomy Act, Sussex: John Noyce, 1976. Joan Lane, A Social History of Medicine, Health, Healing and Disease in England, 1750–1950, London: Routledge, 2001; Stanley Reiser, Medicine and the Reign of Technology, Cambridge: Cambridge University Press, 1978. 28 Michele Goodwin, Black Markets: The Supply and Demand of Body Parts, New York: Cambridge University Press, 2006. 29 Douglas, Natural Symbols. 30 Allan Brandt and Paul Rozin, Morality and Health, New York: Routledge, 1997. 31 Allan Peterson, ‘Risk and the regulated self: the discourse of health promotion as politics of uncertainty’, Australian and New Zealand Journal of Sociology, vol. 32, no. 2, 1996, pp. 44–57. 27

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The papers collected here are organised into sections that question where the body begins and ends, how practices of healing may be negotiated, or fail to be negotiated, by western medical practices, and how health and hygiene relate to personal virtue, a concern that may be projected onto the nation and reflected in public health. The essays shift the discussion of the ethics of life, death, care and illness from a focus on what should or should not be permissible in law to the various meanings and values of illness, death, and health. They illuminate the ethics of health for the ‘patient’ rather than the health professional, and emphasise the social and political interpretations of health. The social and spiritual body The first section of the book presents a variety of religious interpretations of the ‘body’ and the significance of the body. Brian McCoy shows how in an Aboriginal culture the transition to adult male status is simultaneously a social and spiritual event. The physical body cannot be separated from its membership of the social body and on the individual’s body are inscribed cosmic and spiritual meanings. Western medical practices threaten the health of Aboriginal men by separating his body from his group and his spirituality. In examining this system of thought, McCoy mobilises Deleuze’s concept of ‘the pleat’, of the body as doubling, of a doubleness of body and self, and a doubling of interior and exterior, with social and cosmic meanings inextricably linked. In chapter 2, Roxanne Marcotte examines the meanings associated with Muslim bodies in rulings (fatwas) published on Islamic web sites to illustrate the importance of the body in Islam as a reflection of social meanings and its significance as the object of power relations. In Sunni and Shiite traditions, bodies are ‘religionated’, that is, made religious, and fatwas are made on issues such as blood and organ donation, organ transplants and the dissection of cadavers for medical training. In Islam, the central principle is that human beings and their bodies are created by God and are therefore not ours to alter. As with the Jewish tradition, Islam upholds the sanctity and integrity of the live and dead body. Yet some fatwas allow the donation of blood and body parts from the living and the dead. Ideally, however, the donation of human tissues will move from non-Muslim to Muslim, as many fatwas insist that Muslims may not donate to non-Muslims, or to the enemies of Islam.

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This privileging of the human body, or the body of a person from a specific religion, is in contrast to religious conceptions that do not see ‘a break’ between the human body and the world. Peter Friedlander describes the ways in which the relationship between the body and the world was described in ancient Buddhist texts of the Pali canon and how the body is visualised in contemporary Theravada Buddhist traditions. In early Buddhist meditative practices (called insight meditation) the body was thought of in terms of physiology, elements and humours. For Buddhists, illness is related to environmental factors and the result of blockages in the flow of the humours around the body. There is no individual, rather, there is a combination of Khandas working together, which we mistakenly perceive as individual consciousness. Ultimately, in Buddhism, there is no self, so there is no body separate from the world. Rather the body and the world are interdependent, co-existing phenomena. Jay Johnston’s paper presents an account of the bio-metaphysical model of the body present in Spiritualist and New Age religions. This, which she calls the ‘subtle’ body, has its origins in Hindu and Buddhist texts, as well as in early modern Europeans such as Paracelsus. These spiritual healing practices use energy for healing, derived from a divine source which the practitioner channels. In these approaches there is a radical refiguring of subjectivity, and the body is seen as comprised of energetic sheaths which extend beyond the physical body. Hence, there is a concept of embodiment that extends beyond the corporeal, and, by acting on these extensions, healing can occur in a process that engages directly with the spiritual aspect of the human being as well as with the universe. Our final paper in this section, by Bryan Turner, explores the relationship between Christian interpretations of health and illness as indicators of virtue, and speculates on the relationship between death and morality. The body is central to the possibility of morality, and the meaning of life. Christians have lived a moral life to prevent damnation and achieve salvation. However, radical gerontologists are speculating seriously that the possibility of prolongevity (of extending life interminably) is a serious option in developments coming out of stem-cell research. If the gerontologists are correct, the link between life, death and morality has been broken and people now have no reason to live ethical lives as a sacred duty. This in turn will raise new issues about how to give life meaning in a seemingly endless future.

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Negotiating medicine, healing and religious belief The ways in which medicine relates to healing, and well being, are complex. Medical practice focuses itself on the body of the individual, attempting to cure, or to alleviate symptoms. At the same time, as the above essays have shown, for the patient, the significance of illness, and of death, is broader than the physical body. The social body, the environment, and the integrity of the individual are at stake. Individuals are not concerned merely with medical ‘cures’, but with ‘healing’. In many respects this terminology is arbitrary. If the distinction is of use, it is of use in that it identifies a different focus, often one that may be described as ‘wholistic’. How do these people, then, negotiate the difference between their broad spiritual conception of health, and the predominantly physical focus of the medical system? What role should alternative medicine and healing practices have within the medical system? And, how should medical practice engage with or acknowledge the spiritual and religious beliefs of others? Ruth Barcan’s paper on spiritual boundary work presents an account of spiritual healing and medical intuition, thereby demonstrating the existence in Western societies of sacred healing systems. In sacred healing practices, conducted by women, the body is conceptualised as an energy field connected to higher spiritual energies. It develops a non-dualist model of the body, in which the self is an organised assemblage of many interpenetrating layers and rejects any binary distinction between mind and body, while emphasising values such as intuition and the ‘gift’ of clairvoyance. Barcan reports that allopathic practitioners use these services themselves. Such use of intuition and spiritual healing practices, is socially unacceptable, and operates clandestinely within society. Different religious conceptions must influence our experience of health and illness, and this highlights the need for understanding of the ethics of medicine from the perspective of the ill. Therese Taylor examines the sermons delivered around the death from breast cancer in 1666 of the Queen Mother of France, Ann of Austria. The suffering body can be seen to be presented in the sermons from two perspectives: one is that suffering is punishment for narcissism and conceit; the other is that it is pain that purifies the soul. Ann is presented in turn as a heroic martyr, a victim of fate, and sinner. While medicine offers her the false hope of a cure, she seeks acceptance of her fate

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through religion. This involves comporting herself in a certain way in the context of extreme pain and the certainty of death. Roy O’Neill reminds us of D. H. Lawrence’s words that illness ‘is wounds to the soul, to the deep emotional self’ and this is why people turn to religion and spiritual resources at times of illness. Western health practices fail to recognise the conjunction of human suffering and spiritual searching, and that individuals do embark on a quest for religious meanings in the context of their illness. O’Neill insists that these spiritual needs should be recognised at the level of everyday functioning in the hospital, and in particular that there have to be rituals which are the structures for representing the community to the individual and which provide a sacramental context for the process of healing. There is, however, some form of accommodation of religious belief. Even in the realms of the hardest science—the autopsy—practice is influenced by concepts of the sacred, or what Horsley calls ‘the marginally sacred body’ as it is treated by medical specialists. The development of the marginally sacred body develops when, for religious and cultural reasons, the relatives resist a full autopsy. The development of the limited autopsy of the brain allows the relatives of the dead space to respect the sacred body and leaves the medical scientists with scope to explore the cause of death. Horley’s fieldwork shows that ritualist attitudes still pervade medical practice; such attitudes may be described as a secular sacred respect for the body. Jeremy Shearmur’s paper discusses how the recognition that the maintenance of health is importantly a virtue, in the sense of a way in which we care for the self complicates our moral arguments concerning the development of a regulated market in live kidneys. The sale of kidneys in the third world is problematic because it is often culturally unacceptable. But the more general inquiry is into whether people who sell their kidneys are taking proper care of themselves and whether we should be concerned with it. In short, it is a concern about the virtue of other people, their reasons for sale, their attitudes towards the alienation of kidneys, and the attitudes of people around them. What should our responsibilities for the decisions of other people be? And what does the commodification of the body tell us about the status of the body? Shearmur shows that we cannot decide ‘in abstract’ terms what we should do, or what we should allow, as the religious beliefs of others impact on the acceptability of our choices.

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Virtue, health, and the state The above chapters explore the ways in which the body engages with a spiritual, physical and social world. In this section we consider how disease is made meaningful, and relates us to the broader narratives of nation and the state. These chapters explore the idea of a virtuous society, created through the discipline of bodies. While it may be widely recognised that medical science is deeply coloured by cultural and religious beliefs embedded in the past, just how deeply that shaping is can still come as a surprise. For example, most branches of Christianity involving ascetic and mystical spirituality include dietary control as the principal means for the control of the inner body. William James Hoverd demonstrates that contemporary medical understandings of obesity are almost in a straight line from fourth century Christian monk John Cassian, who brought the seven deadly sins into the Christian canon. While we like to think that discussions of obesity are conducted in ‘value free’ scientific terms, Hoverd demonstrates that they are in fact couched in the language of Christianity. Theological ideas are thus intrinsic to the rhetoric surrounding the obesity epidemic, with gluttony and sloth taking centre stage as explanations for people’s behaviour that contributes to their obesity. The next two chapters explore how such ideas about the relationship of virtue and illness, and the disciplinary ‘cures’ of medicine, have been exploited, and perverted, by the state. If the shock of Hoverd’s research is to show how public health programs may be based in religious morality, the shock of the next two papers is found in the ways in which such ideas about health and the virtue of individuals may become a part of the fabric of nationalism. Christopher Forth examines the creation of male bodies in the interests of the sacred nation. The strength of the nation was linked to the strength and virility of men in the eighteenth century. As civilisation came to Europe the concern was that it would lead to a feminisation of males’ bodies. Pain and suffering, backed up by a Christian ideology, were prescribed. Nation building was the product also of man building, and involved the painful shaping of men’s bodies. It also required the exclusion of problematic bodies, such as the effeminate Jewish body. Continuing this analysis of the relation between individual virtue and the nation, Peter Arnds examines the bio-politics of the body in Nazi Germany through literary fiction. In this, a sacred duty to the fatherland is blended with medical practices around the body

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in which extermination becomes disguised as medicine through the use of ‘cures’. Healing and killing become integrated into the production of the strong ArPyan body and the destruction of Jewish bodies. There is a reversal of the sacred duty to save life as medicine is harnessed by the state to a ‘thanopolitics’. Conclusion As our opening example of the death of Lia Lee demonstrated, the way the body is conceptualised is central to one’s experience of health, disease, the self and others. Thus, how we frame the body impacts on our relation to others, to the experience of illness and disease, and indeed, of the meaning of life and death. In A Secular Age, Charles Taylor discusses what he calls ‘closed world structures’ within contemporary societies. These structures are ways of restricting our grasp of things, and are common to religious and secular believers alike. For secular society, however, it may manifest itself as a disinterest in, and contempt for religion. The protocols of scientific and analytic thinking, for example, privilege the impersonal ‘view from nowhere’, and devalue insights that might arise from other contexts, such as prayer, or love relations.32 These papers provide reflections on the notion of the sacred in medical practice, and invite us to engage with the way in which relationships between health and illness may be experienced as meaningful. The chapters in this book assert the centrality of our conceptions of the body to our experience of the world and our social relations with others, and ask how the importance of this experience and these relationships may be accommodated within medical settings. Medical practice may still impose a conception of the good for humans under the auspices of state medical care, as indeed it must in certain circumstances, but it may also tread more lightly on the world view that makes life meaningful for others. But the chapters here also demand that we recognise the religious perspectives that inform medical practice and the conception of the good life it imposes. The denial that medicine is influenced by religion allows policies to take on the frameworks of religion under the guise of science, and may enable medicine to serve the ‘false god’ of nationalism. 32

Taylor, A Secular Age, p. 555.

SECTION I

THE SOCIAL AND SPIRITUAL BODY

CHAPTER ONE

CONTESTED SITES: ABORIGINAL HEALTH AND HEALERS ENGAGING WESTERN MEDICINE Brian F. McCoy Despite many predictions that traditionalist healing practice would cease, many Aboriginal peoples continue to engage a world of health and sickness very different from that understood by western medical health care. This paper draws on recent research amongst people of the south-east Kimberley desert region as they describe what it means to be well and sick. As they describe the work of their traditionalist healers (maparn) they reveal important cultural values that link the physical with the spiritual, the personal with the social. These cultural values impact on the human and social body as people engage in historical, generational and contemporary contexts. A challenge continues to exist for western medical health care in its ability and willingness to understand, respect and engage the physical, social, and spiritual Aboriginal ‘body’. In a number of Aboriginal languages there is a close relationship between the words used for ‘man’ and ‘person’, and also with those words associated with male ceremonial initiation.1 In Kukatja, for example, the word yarnangu has been translated into English as ‘physical body’ and also as ‘person’.2 This link between the physical body and adult (male) personhood is particularly well captured by yarnangurriwa (literally, ‘yarnangu’, body/perso n and ‘rriwa’, becoming’) when

1 Nicholas Evans and David P. Wilkins, ‘The complete person: networking the physical and the social’, in Jane Simpson, David Nash, Mary Laughren, Peter Austin and Barry Alpher (eds.), Forty Years On: Ken Hale and Australian Languages, Canberra: Pacific Linguistics, Research School of Pacific and Asian Studies, Australian National University, 2001, p. 495. 2 Kukatja belongs to the Western Desert Group of Central Australian Aboriginal Languages. It is spoken in the south-east Kimberley region of WA. In this paper all Kukatja language references will be placed in italics followed by an English translation. For further information see Hilaire Valiquette (ed.), A Basic Kukatja to English Dictionary, Wirrimanu: Luurnpa Catholic School, 1993.

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describing the adolescent or growing young man. He is understood as growing into an adult male body and an adult male person.3 Desert people might also say, describing a young man’s initiation, ‘tjiitji-tjanu yarnangu punturringu’, ‘from being a child his body/person became that of a man’.4 At the time of initiation he was physically transformed into becoming an adult male person. He was also transformed socially and spiritually. In this paper, I would like to draw on an extensive relationship I have shared with desert people over more than three decades, and with health research I conducted with them between 2001 and 2004. In the research that focussed specifically on men and their understanding of being well and healthy (palya), I came to understand some of the richness and complexities around their understanding of the human ‘body’, and how an understanding of the desert male body and person reveals different layers and interconnections or ‘foldings’ of meanings. The work of the maparn, the traditionalist healer, also points to these meanings as he or she offers healing within a framework of traditionalist beliefs and values.5 However, desert health beliefs largely lie outside the interest of Western medical and the health care provided by the clinic. They are beliefs that are premised on interrelated and multiple relationships that a healthy desert and human person is understood to embody. There is no simple ‘inner’ and ‘outer’ body in this desert world, no physical body separated from social and spiritual meanings. As I explore later in the paper, the metaphor of the ‘pleat’, as suggested by Gilles Deleuze, offers an approach to understanding this embodied desert self: the self with others and the self within a particular spiritual world. The pleat also offers a way of understanding how the desert body can become a place of contest between desert understandings of the body and those health beliefs as expressed within western medicine. In what might seem an unusual place to begin, let me turn to the sporting arena of football, Australian Rules, in particular. It was here 3 Some desert people would also say that yarnangurriwa can also be applied to young women. 4 Any quotations found in this paper arose of out field work in the Kutjungka region between 2001–04 and are referenced in the doctoral thesis: Bryan F. McCoy, ‘Kanyirninpa: health, masculinity and wellbeing of desert Aboriginal men’, Ph.D diss., Melbourne University, 2004. This thesis is available as an eprint at Melbourne University: . 5 I use the term traditionalist in preference to traditional to suggest that this continues to be a dynamic practice, but one that has been influenced by contact and mission history, and also by Western medical healing practices.

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that new and significant meanings about the desert body were revealed to me. As men attend ceremonial Law during the hot summer months, the dry, warm winter season provides an alternative, socially significant and enjoyable space of ‘men’s business’. The game of football offers a wide range of body and social skills that many men enjoy. These skills hold similarities with those that desert men developed and learned over many years as they hunted, and as they continue to hunt, in the desert. Hunting requires finely honed and practised skills. It requires the concentration, coordination and focus of many senses. To be successful as a hunter the body needs physical balance as movement combines strength with speed, timing with coordination. Men have learned how to move quickly, patiently and silently through the bush, sometimes pursuing low lying or low flying objects of prey. Sometimes they hunt in groups where non-verbal communication occurrs through the use of facial signs and hand gestures. The male body seeks to move across a physical landscape in harmony with other male bodies, forming together a concentration of energy and purpose. The close attentiveness and heightened sensitivity that men bring to the football field reveals a strong and deeply embodied connection between men and particular physical activities, men and the earth, but also between men and other men. These components of human and male expression, while suggesting separate physical and social aspects of human activity, reveal further inter-connections of cultural meaning and embodiment. When men adopt the Kartiya (non-Aboriginal) expectations of this game, where they are expected to tackle and put pressure on one another with great vigour, they also deal with cultural expectations, particularly around a wide network of kinship and other relationships, where respect for the other person is expected to be shown, even on a football field.6 As each player puts pressure on opposition players, while avoiding encounters that might be construed as too personal or confronting, he also learns to refine his own skills to avoid being tackled. Australian Rules football is played in the public space where a person’s behaviour becomes clearly manifest. Tackling another player can become problematic, especially where games are played on rough, dirt ovals and one’s behaviour is open to public scrutiny. It does not take much force for a tackle or a bump to be interpreted by an opponent as excessive and personal. This can lead to strong words. Sometimes 6 The word Kartiya is used within a number of desert communities and across a variety of desert languages to refer to people who are not Aboriginal.

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there are fights and sometimes games stop. Playing football can create further tensions, particularly when men play against those to whom they are culturally obliged to show particular deference and respect. For example, a man should never fight or hurt his yalpurru (the one with whom he shared initiation), and he should show great respect to his tjamparti (those who helped initiate him). Ideally, he does this on the football field by avoiding personal or excessive contact. However, and quite obviously, such demands cannot be easily exercised on a competitive playing field. Such observances can become even more difficult when teams are trying to win games: supporters call out, forceful physical contact is made and tensions rise. Men handle these challenges in different ways and some feel these tensions more keenly than others. A number of men would say, ‘football is football, there is no family inside’. They leave their cultural obligations at the boundary to the oval. ‘This is a Kartiya game’ others say, suggesting that football requires new expressions of relationship and respect. At the same time they will all admit, ‘one is not supposed to hurt family’. It is not always easy to resolve this tension, as arguments after the game between players and their families can testify. Most Kartiyas who watch Aboriginal men play football rarely notice how kinship relationships affect the way men play football. Much less do they notice how other relationships, particularly those that have originated through Law ceremonies, continue to operate strongly and publicly off the football field. What football offers men is a way of expressing a wide range of physical and social skills within an environment where such skills can be publicly enjoyed and celebrated. As men learn to put pressure on opposition players, while avoiding encounters that might become too personal or confronting, they have also learned to refine their skills to avoid being tackled. That men can negotiate these tensions reflects the obvious enjoyment they experience in such an activity. At the same time, it also reflects the risks they take in potentially transgressing important relational boundaries. For desert men the physical body cannot be simply separated from being a member of a social body. Nor can it simply separate itself from being a body upon which important cosmic and religious meanings have been inscribed. Some years ago, during a football carnival in a remote community, play stopped late in the afternoon and everyone gathered at the oval. The men formed a semi-circle, with the older men sitting in front; the women sat to the side and rear. A young man in his early 30s was brought before the assembled group. An older man was accused of

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performing sorcery and being responsible for making him seriously ill. The older man came forward and made his protestations. He denied any involvement in causing harm to the young man. Then, he knelt down and began to work as a maparn, a traditionalist healer or medicine man.7 He carefully attended to the sick body that lay on the ground before him, as everyone sat around and patiently waited. He drew on his own spirit (kurrun), located within his stomach (tjurni), to help him. His hand would squeeze his stomach to draw out the healing power that lay within and, by using that power, that he was able to locate and remove the young man’s illness. After some time, he stood up and announced that he had done what he could for the young man. Everyone had seen him at work and, as the sun set, they went home satisfied. He had used his maparn powers to help the young man recover. The football carnival provided a public, geographical space where a serious accusation of sorcery could be addressed. That games might cease for that afternoon, and the carnival temporarily postponed, was never questioned. The gathering confirmed the place and priority of the young man in the concern of family and friends. It served to test and prove the integrity of the older man, and it strengthened the network and priority of social relationships that transcend the sporting space of football. The gathering also located the physical body within a much larger spiritual and cosmic world, where forces that strengthen sociality and multiple kin relationships were being threatened by those that sought harm, illness and even death. Maparn, or ngangkari as they are called in some other desert languages, continue to be sought for their healing powers. Their powers are often associated with country that was shaped and formed by the ancestral figures of the tjukurrpa (dreaming), and they are powers that continue to be handed down from one generation to the next. As people can go to certain places and sites to receive special maparn powers, they can also draw on familiar or guardian spirits, to help them in their work of healing. Maparn act across a wide range of human sickness: from headaches to bleeding, from sick stomachs to the removal of foreign objects. Their engagement is with the unseen sources of human illness. There 7

See the work of maparn or ngangkari as described in Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council Aboriginal Corporation, Ngangkari Work— Anangu Way: Traditional Healers of Central Australia, Alice Springs: Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council Aboriginal Corporation, 2003.

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are, for example, ‘lids’ or foreign objects that fly up and move through the air; they can enter a person’s body. These invisible objects can be especially active and dangerous during ceremony time. Maparn have the ability to see these lids and remove them. The maparn can also heal a person’s spirit or kurrun, which is located within the person’s stomach (tjurningka). Sometimes a person’s spirit wanders, gets injured or lost. Maparn can find that kurrun and put it back into the person.8 Maparn are also called to deal with sorcery, or where someone is dangerously or seriously ill, often due the harmful interventions of another. Despite contact with Kartiyas for nearly 70 years, and more recent forms of sickness, such as cancer and diabetes, if people hear that someone is seriously sick their first thought will be that someone has caused that person to be sick. Maparn have the power to locate the effects of the sorcery and, in some cases, block or prevent its activity. More than thirty years ago health providers and others considered that the traditionalist healer would die out before the end of the twentieth century. This would come as the result of the combined influence of the Western health clinic and that of the Christian church.9 Whatever the influence of these healing forces, and however they have influenced contemporary desert beliefs and practices, people continue to place great faith in a wide range of sicknesses that lie beyond those understood and promoted by western biomedicine and symbolised in that care provided by the community health clinic. As Freund and others have argued, ‘the foremost reason why people use indigenous healing is that it makes sense to them’.10 Desert people believe that the physical body does not sit in isolation from those other, and sometimes quite powerful, forces that operate within their social and spiritual world. 8 Anthony Rex Peile, Body and Soul: An Aboriginal View, Peter Bindon (ed.), Victoria Park: Hesperian Press, 1997, p. 170. Also, Ngangkari 2001, Video Recording, Ronin Films, Ngaanyatjarra Pitjantjatjara Yankunytjatjara Media Production and Australian Film Commission. 9 John Cawte, Medicine is the Law: Studies in Psychiatric Anthropology of Australian Tribal Societies, Honolulu: University Press of Hawaii, 1974, p. 27; Ernest A. Worms, ‘The changing ways of our Aborigines’, Catholic Weekly, Thursday, 16 June 1960. See also Freund et al. who comment on the effect of colonial contact on Indigenous health and belief systems: ‘The early literature, however, generally assumed that as societies became modernized and Westernized, they [Indigenous peoples] would shed these “primitive” beliefs and practices and substitute the biomedical system, but this expectation has not been borne out’. Peter E. S. Freund, Meredith McGuire and Linda S. Podhurst, Health, Illness, And The Social Body (fourth edition), New Jersey: Prentice Hall, 2003, p. 187. 10 Freund et al., Health, Illness, and the Social Body, p. 190; italics the author’s.

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As they believe in forces that unite and strengthen the human body within this larger world, they also believe in forces that can weaken and harm that same body. For many, such a holistic belief system simply makes sense. As I have already mentioned, the transformation of a boy into an adult person is accompanied by important cultural meanings that are intimately linked with his physical body. His body, like the earth, sustains physical, social and spiritual meanings. These meanings are inscribed upon and within his body by the use of song, dance, ochre and painting and reinforced every time he enters into the secret and sacred of men’s Law. His body is not just a vehicle of entry into men’s ‘business’, a world that is carefully separated from that of women. His body becomes part of that secret and sacred men’s business that belongs to all of desert life and its cosmic ‘business’. Initiation transforms him, person and body, into an adult social body where new social and cosmic relationships are configured and old ones are strengthened and extended. Hence, key to understanding the health of this desert body is the transformation of individuals into becoming adult persons, as they also grow into becoming adult physical bodies. This ‘becoming’ of adulthood, expressed in the suffix ‘-rriwa’, and in such words as yarnangurriwa (becoming an adult person) or punturriwa (becoming an adult male), links those moments of ceremonial initiation with the importance of social activity and the guidance and knowledge of older people. It also locates the presence of the ancestral tjukurrpa (dreaming/cosmic world) as active within these moments of transition. Not only do these ancestral moments possess the powers to engage and change the human person, but they continue to engage the social and individual body. They keep desert people reminded of the power of hidden and spiritual forces, forces that can bring health as well as sickness upon them. When a wati (adult male) enters a health clinic he cannot separate his physical body from his relationship with the adult social body. His physical body, his membership of a male and ancestral social body and his identity are all intimately connected. Attention to his health and wellbeing, as Saltonstall has described the interplay between health, self, body and gender, ‘need[s] to take account of the body as personal and socially situated in the construction of self (and other selves)’.11 While 11 Robin Saltonstall, ‘Healthy bodies, social bodies: men’s and women’s concepts and practices of health in everyday life’, Social Science and Medicine, vol. 16, 1993, p. 7.

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his physical body is his vehicle of entry into the clinic’s social space, it is not the only part of him that claims respect and attention. Sometimes this often gendered, small, and artificially constructed and confined social space evokes a dissonant response to his sick or injured body. A Kartiya nurse (most nurses in this remote area have been women) would likely say that she would treat a male Aboriginal patient as she would a Kartiya. She would likely treat all footballers the same, for example. However, this approach risks ignoring and marginalising a desert man and his health needs as the clinic attempts to socialise him into its space using a biomedical approach to the human body. In this model, his physical body can be treated separately from kinship or social relationships and responsibilities. However, the male wati who presents himself in a clinic cannot separate his physical body from his adult and social identity. His gendered body represents his experience of being and feeling well. The issue for such a man is not that he won’t be treated—although frustration can lead him to walk out of the clinic—but the cost and risk of being treated. In the process of receiving treatment, other forms of care, important for his personal sense of wellbeing, can be ignored, and sometimes trivialised. Hence, it is not surprising that young men, in particular, will avoid the clinic but seek the help and advice of older men, as they learn to carefully negotiate their newly transformed adult and physical status. Elizabeth Teather introduced the idea of ‘the pleat’ in her exploration of the geographies of ‘life crises’ or ‘rites of passage’.12 In Embodied Geographies: Spaces, Bodies and Rites of Passage—where researchers discussed very different geographies such as ‘schoolies week as a rite of passage’, ‘the transition into eldercare’, and ‘spaces and experiences of childbirth’—she sought to challenge that body of knowledge that neatly separated the human body into an ‘inside’ and an ‘outside’. Her argument was more than a criticism of Cartesian dualism and the separation of mind and body. She sought new ways to describe the embodied self, the self and others, the self and the world. Teather turned to Elspeth Probyn, who had used Gilles Deleuze’s description of ‘the fold’ or ‘the pleat’, to explore ‘the doubledness of the body constituted in the doubledness of body and self’.13 This process 12

Elizabeth Kenworthy Teather (ed.), Embodied Geographies: Spaces, Bodies and Rites of Passage, London: Routledge, 1999, p. 1. 13 Elspeth Probyn, ‘This body which is not one: Speaking an embodied self’, Hypatia, vol. 6, 1991, p. 119.

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of ‘doubledness’ was subjectification, whereby the self was constructed within the world, and by the process of ‘folding’. The ‘outside’ became enfolded within the ‘inside’ and the ‘inside’ within the ‘outside’. Probyn approached the embodied self from a feminist perspective, wanting to include the body within a theoretical discourse, not simply as an objective entity separated from the self. She described Deleuze’s idea of the pleat: this pleating (‘la pliure’) is thus the doubling up, the refolding, the bending-on-to-itself, of the line of the outside in order to constitute the inside/outside. While the outside and the inside are to an extent distinct, Deleuze’s metaphors can be used as ways of figuring the intricacy of the one stitched into the other.14

In the desert, the process of becoming an adult male reveals an embodied process where the adult male body ontologically changes in relation to social relationships and cosmic powers. At the time of male initiation important meanings are enacted, inscribed and effected upon this male body. Simultaneously, these meanings fold back between the individual self and a wider social and cosmic world. This is an example of what Deleuze described as, ‘foldings that together make up an inside: they are not something other than the outside, but precisely the inside of the outside’.15 The pleat as metaphor, but also as an epistemological and ontological concept, offers a helpful insight into this desert male body that is neither an exteriority, separated from the activity of one’s inner kurrun (spirit) or larger cosmic forces, nor an interiority, disconnected from social, spiritual and relational meanings. Dichotomies that can be imposed upon this desert body—separating the physical from the spiritual, the body from the cosmic, the person from the social—deny important relational aspects for desert people that are dynamic and essential for living healthy and well (palya). The pleat offers a way of understanding this process of subjectification, where an adult male or wati lives within a dynamic of interior and exterior worlds, and with social and cosmic meanings that are inextricably linked with one another. As it helps explain some of the meanings that men bring and embody as they enter upon the football oval or within the Western health clinic, it suggests the tensions, contestations and frustrations that can also be experienced. 14

Teather, Embodied Geographies, p. 120. Gilles Deleuze, Foucault, Minneapolis: University of Minneapolis Press, 1995, p. 97. 15

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As desert people move across the healing spaces offered by their own maparn, the health clinic, and also the Christian church, they remain pragmatic in their search for a cure.16 They also remain committed to beliefs that continue to link their physical and social worlds, all within a dynamic and active cosmic and spiritual world.

16 Janice Reid (ed.), Body, Land and Spirit: Health and Healing in Aboriginal Society, St Lucia: University of Queensland Press, 1982, p. 196.

CHAPTER TWO

THE ‘RELIGIONATED’ BODY: FATWAS AND BODY PARTS1 Roxanne D. Marcotte If we accept claims that the body is important for one’s self-experience of others, that it plays a role in the production and reflection of social meanings, and that it is significant as the subject and object of power relations,2 then we can legitimately explore the meanings that bodies possess in particular religious traditions. Nobody would deny that religious traditions impart particular meanings to social and individual bodies. We can look at some of the issues that arise with meanings that are associated with Muslim bodies to illustrate the importance of the body in Islam as a reflection of social meanings and its significance as the object of power relations. In order to investigate how the body is imagined in Islam, it may be useful, for our purpose, to resurrect an obsolete mid-17th century verb in order to discuss the specific religious ontological statuses that are attributed to persons and bodies: to ‘religionate’ literally means ‘to make religious’.3 In the Qur’an, non-Muslim bodies, like those of the polytheists (mushrik) (Q 9:28), are, from the time of Ibn ‘Abbas (d. ca. 686–8), considered unclean and ‘impure’ (najes). Contrary to most 1 A draft version of this paper titled ‘Regulating the Muslim body’ was presented at the ‘Negotiating the Sacred III: Religion, Medicine and the Body’ (2–3 November 2006) conference, held at the Centre for Cross Cultural Research, Australian National University. I would like to thank especially Professors Vardit Rispler-Chaim, Ebrahim Moosa, and Khaleel Mohammed for having graciously agreed to read and comment on an earlier version of this paper and for which I are immensely grateful. It goes without saying that any infelicities remain mine. Diacritics have been omitted for the transliteration of Arabic terms. 2 Meredith B. McGuire, ‘Religion and the body: Rematerializing the human body in the social sciences of religion’, Journal for the Scientific Study of Religion, vol. 29, no. 3, 1990, pp. 283–96. 3 The term was used by Andrew Marvell in his Mr. Smirke, or, The Divine in Mode, being certain annotations upon the animadversions on the naked truth: together with a short historical essay concerning general councils, creeds, and impositions, in matters of religion (1676), cf. Oxford English Dictionary Online 2006, Oxford: Oxford University Press, http://dictionary.oed.com/ accessed 7 Oct. 2006.

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Sunnis, Zaydis and Twelver Shiites (Iran) have opted for a literal reading of the Qur’anic verse that requires ritual ablution if one is touched by a polytheist.4 The concept was also applied by Sunnis to Christians and Jews to forbid them the sacred enclave of the Great Mosque in Mecca and later to expel them from the Arabian Peninsula.5 ‘Religionated’ bodies are not, however, a phenomenon specific to the Islamic tradition. Ultra-orthodox Haredi Jews remind us of the sanctity of God-given bodies when they meticulously collect with tweezers every scattered pieces of the flesh of Jewish victims of suicide bombings and consider post-mortems to be a desecration of the Jewish body. Religious meanings attached to bodies equally determine their fate after death: the bodies of excommunicated Christians do not rest with their kin in Christian cemeteries, with similar reservations for Muslims in early Islamic traditions. Ethico-religious, social and physical segregation of ‘religionated’ bodies often finds its religious justification in the theological or religiolegal realms. Meanings attached to bodies in Islam cannot, however, be fully understood without introducing the Islamic concept of persons expounded by classical Islamic jurisprudence. While persons may be defined in a variety of sociological, psychological, anthropological, philosophical, and even theological manners, in the Islamic (and Judaic) tradition, this includes a religio-legal dimension. Classical Islamic jurisprudence was, however, developed in particular social, political and historical contexts. Some have noted that the statuses of persons in Islam, and by extension those of their bodies, were defined within the context of a distinctive ‘cognitive system’ that is quite different from the cognitive system of contemporary ‘secularised societies’ that are driven by modern notions of equal rights all citizens are deemed to possess. The traditional Islamic cognitive system orders the world in accordance with what some call Islam’s ancient ‘mythical’ construction of reality.6 This socially constructed mythico-historical reality of the origins of Islam took shaped with the encounter of the revealed truths of the 4 A. Kevin Reinhart, ‘Contamination’, in Jane D. McAuliffe (general ed.), Claude Gillot et al. (assoc. eds.), Encyclopaedia of the Qur’an, 5 vols., Leiden: Brill, 2001, vol. 1, pp. 410a–412b. 5 Uri Rubin, ‘Jews and Judaism’, in McAuliffe (general ed.), Gillot et al. (assoc. eds.), Encyclopaedia of the Qur’an, pp. 21b–34a. 6 Mohammed Arkoun, Rethinking Islam; Common Questions, Uncommon Answers, Boulder: Westview Press, 1994, pp. 99–100.

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Qur’an and the actual life of the early Muslim community (early seventh century onwards). Such an Islamic ‘mythical’ cognitive system that assigns strict Islamic definitions to persons and bodies has, it should not be forgotten, implications for the understanding of human nature. Individuals are attributed quasi-ontological natures via Islam’s ‘religionation’ of individuals and bodies. Bodies become Muslim bodies, nonMuslim bodies that belong to Christians and Jews, the protected People of the Book (ahl al-kitab), non-Muslim heretic bodies, and so on.7 This ‘religionation’ of bodies aptly illustrates the manner in which the body becomes significant as the object of power relations in the Islamic tradition. Arkoun notes that: The access to this status [of ‘person’] depends, indeed, on the principle for legitimation of authority upheld in these societies. Legitimation is acquired only by appeal to the pious predecessors (al-salaf al-salih) of the inaugural age in the community promised salvation (al-firqa al-najiya). Not every individual is a person, and persons are more eminent (afdal) [than others] insofar as they approach the ideal of piety called for by the Qur’an and the family of the Prophet (ashraf ).8

The statuses of individuals are thus defined by principles that underpin Islamic society, like notions of piety, and whose sole measure is the Qur’an and the sunna preserved in the collections of hadiths (reports) and which embody the normative practices of Prophet, the members of his family and his early Companions. Relationships between individuals need to conform to those prescribed by the Scriptures and the practice of the early religious community. These new Islamic relationships were grounded in the novel power relations Islam established between believers and non-believers, between Muslims and non-Muslims, free men and slaves, and so on. Some of these boundaries were fluid and individuals could cross a number of them.9 Statuses of non-Muslims, for example, changed with their conversion, those of Muslims with their relinquishing of Islam (apostasy), or with the manumission of slaves. The Islamic tradition, nonetheless, developed a religio-political construction of persons that 7 Including intermediate categories of persons, e.g., slaves, women, children, etc., cf. Arkoun, Rethinking Islam, p. 100. 8 Arkoun, Rethinking Islam, pp. 99–100. 9 Paula Sanders, ‘Gendering the ungendered body: hermaphrodites in medieval islamic law’, in Nikki R. Keddie and Beth Baron (eds.), Women in Middle Eastern History; Shifting Boundaries in Sex and Gender, New Haven: Yale University Press, 1991, pp. 74–95, esp. 75–6.

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established what Arkoun has labelled ‘an “ontological” foundation for the transcendentalisation of an essentially anthropological dichotomy’, a dichotomy between believers and unbelievers that found its way into Islamic legal texts:10 . . . the strategies of orthodox interpretations engendered more or less narrow dogmatic closure according to the cognitive (i.e., philosophical, theological, or mystical) and/or ideological (legal, militant) questions addressed to the Qur’an as a whole. The ‘Muslim’ person develops and asserts himself or herself within dogmatic closure, portrayed as the only, irreplaceable domain of orthodox ‘truth’ within the whole domain of the Muslim thinkable, as opposed to the unthinkable, to which no-one can accede without violating the boundaries of dogmatic closure.11

Classical religio-legal constructions of persons, grounded in what Arkoun identifies as the traditional Islamic ‘mythical cognitive system’ and its ‘dogmatic closure’ remain, however, in dissonance with the modern cognitive system. This is particularly true in the legal reasoning of contemporary jurists who rely on what Moosa has labelled the ‘premodern epistemes’ for their contemporary legal interpretations.12 It is precisely these premodern epistemes that still shape and mould Islamic law and of which elements find their way into contemporary religious rulings, many of them eventually appearing on the Internet. In order to grasp how meanings associated with bodies reflect social meanings in the traditional episteme of the Islamic tradition, we need to remember what Mary Douglas has pointed out about the ‘body as a code or metaphor of socio-cognitive mappings of reality’, as the human body, its parts, such as specific organs, and its products epitomise social relations and social concerns about boundary maintenance.13 The body can thus possess a variety of meanings, often simultaneously, and be ‘conceptualized within a variety of dimensions and frameworks’, as 10

Arkoun, Rethinking Islam, p. 89. Ibid., p. 99. 12 Ebrahim Moosa, ‘Interface of science and jurisprudence: Dissonant gazes at the body in modern muslim ethics’, in Ted Peters, Muzaffar Iqbal and Syed Nomanul Haq (eds.), God, Life, and the Cosmos; Christian and Islamic Perspectives, Aldershot: Ashgate, 2002, pp. 329–56, esp. 353. 13 Quoted in Bryan S. Turner, ‘The body in western society: Social theory and its perspectives’, in Sarah Coakley (ed.), Religion and the Body, Cambridge: Cambridge University Press, 1997, pp. 15–41, esp. 17; for Douglas’ anthropological perspective on pollution and rituals of purification, cf. Mary Douglas, Purity and Danger: An Analysis of Concepts of Pollution and Taboo, Harmondsworth: Penguin Books, 1970; and Mary Douglas, Natural Symbols: Explorations in Cosmology, Harmondsworth: Penguin Books, 1973. 11

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Turner reminds us.14 In what follows, let us focus on the ‘religionated’ meaning of bodies. Medico-ethical values associated with the preservation of life and of its sanctity, epitomised in the ‘Hippocratic Oath’, would lead one to believe that any ethical issue raised by new medical developments would transcend notions of ‘gendered’ or ‘religionated’ bodies. On some issues, such as the Islamic lawfulness of autopsies for forensic purposes or determining the cause of death, Muslim jurists have come to acknowledge the importance of such practices and have begun to find, what Moosa calls, ‘a common epistemic vocabulary’ that aligns Islamic law with new medical developments.15 Nonetheless, bodies still often retain their ‘religionated’ constructions in contemporary fatwas on such issues as blood and organ donation, organ transplant, or dissection of cadavers for medical training. Contemporary medical issues Needless to say that with the advent of in-vitro fertilisation, contraception, abortion, cosmetic surgery, and transplants of all sorts, perplexed and troubled religious Muslims have turned to religious leaders for guidance. This guidance often takes the form of fatwas, the (non-binding) legal opinions or responsa of religious scholars to questions on every imaginable aspect of Muslim life, both religious and secular. Fatwas are issued by religious scholars, many of whom are trained as specialists in Islamic law (muftis). In an age of globalisation, however, new communication technology now provides religious scholars, whether they are specialists of Islamic law or not, with novel means to negotiate religious authority online. The Internet also provides religious Muslims with online virtual guidance with its easy, global access to a variety of religious authorities. The traditional formats and the very public nature of fatwas make for easy transmission. Fatwas are published in collections of individual muftis, in annual fatwa collections, as sporadic fatwas, or in special religious columns of periodicals and newspapers that provide readers with weekly or monthly updates of fatwas. In the last decade, an increasing number of Muslim web sites have been providing believers 14 15

Turner, ‘The body in western society’, p. 17. Moosa, ‘Interface of science and jurisprudence’, p. 331.

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with online fatwas, some with ‘Ask your Imam’ sections, others with interactive online fatwa sessions (e.g., on Islam Online). Our examination of online fatwas focuses only on a selected few Sunni and Shiite web sites that provide easily accessible English fatwas considered ‘authoritative’ in their own rights by Sunnis and Shiites themselves. What ‘authoritative’ exactly means in general and with respect to this new medium in particular still remains to be fully explored, but this is beyond the scope of this chapter. Members of Fiqh (jurisprudential) Councils or similar bodies are not, for example, necessarily all specialists of Islamic Law. In some cases, completing the pilgrimage (hajj) casts the ‘veneer of scholarship’ on people whose opinions would not normally count. In other cases, membership to Fiqh Councils can be based on service to the community, rather real jurisprudential knowledge.16 The first web site selected is the Sunni Islam Online site which makes available over 3700 English fatwas. Its Arabic mirror site is far more extensive and includes an even greater number of fatwas. Muslims from all over the world send their queries to Islam Online. Some Muslims live in the west (e.g., Canada, Denmark, Italy, United States), some live in countries with important Muslim communities (e.g., Gambia, Eritrea), and some live in Muslim countries (e.g., Pakistan, Turkey). Others are Muslims who live in Arabic countries (e.g., Egypt, Yemen, Algeria, Saudi Arabia) which would suggest that some of the fatwas may have originally been issued in Arabic and then translated into English for the benefit of all online visitors, illustrating the increasing globalisation of Islamic guidance and da‘wa (mission). The other web sites are Shiite sites that provide again easily accessible English fatwas. The first is the Ahlul Bayt Digital Islamic Library Project web site (five different languages) which can receive more than a thousand visitors at any one time. It has posted the English translation of one of the fatwa collections of Iraqi Grand Ayatollah al-Sayyid ‘Ali al-Husayni al-Sistani. The second Shiite site is the official web site of Iranian Grand Ayatollah Ali Hosseini Khamenei, the present spiritual leader of Iran. Both sites include English translations of a number of fatwas on contemporary medical issues put out in the last decades by these two prominent contemporary Shiite religious scholars. The online presence of an increasing number of fatwas provides us with a window onto contemporary Muslim religious concerns with

16

Information graciously shared with us by Professor Khaleel Mohammed.

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regards to a number of new medico-ethical issues. It also makes readily accessible excellent sources of contemporary normative rulings that comprise what some have called the ‘juristic’ type codes of contemporary Muslim medical ethics.17 A look at a number of online fatwas can provide insight into elements of online normative contemporary Islamic legal opinions about some of these new medical and ethical issues and the ways in which bodies are conceived. There are a number of quite legitimate methodological issues associated with the use of Internet to gather such data, but if we assume that the enquirers’ questions are genuine in nature, then we are in the presence of the genuine concerns of many ordinary Muslims and the authentic spiritual guidance with which they have been provided via these online fatwas. Online fatwas provide us with an equally legitimate venue to explore notions of ‘sacredness’ or ‘inviolability’ associated with the bodies of both Muslims and non-Muslims and the similarities and/or differences that may exist between them. With the advancement of medical knowledge and the development of new medical technology, a number of new ethical and religious issues have come to the fore.18 It is not surprising that a number of fatwas address a number of new contemporary and unprecedented medical issues associated with the body, such as organ donation, organ transplant, post mortems, and burial of bodies that have been used for a variety of medical purposes (teaching and/or research). Islamic principles of positive law and the body The fatwas, or contemporary legal opinions, of Muslim religious scholars who grapple with a number of novel medical and ethical issues usually rely on traditional Islamic jurisprudential (fiqh) reasoning and on the extremely long history of legal precedents previously generated by the religious tradition. Some have noted that religious proofs based on the Scriptures (Qur’an and hadiths) or on Islamic principles have been used to argue both for and against particular positions. Indeed, fatwas 17 Vardit Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, Leiden: E. J. Brill, 1993, p. 143. 18 Vardit Rispler-Chaim, ‘The right not to be born: Abortion of the disadvantaged fetus in contemporary fatwas’, in Jonathan E. Brockopp (ed.), Islamic Ethics of Life: Abortion, War, and Euthanasia, Columbia: University of South Carolina Press, 2003, pp. 81–95.

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remain legal opinions that individuals, institutions, or religious bodies produce. Since no single fatwa producing body exists, some issues are met, at times, with contrary recommendations.19 Organ transplantation has been discussed in Sunni fatwa literature since the 1950s.20 A number of arguments against organ transplant rely on principles such as the sacredness of human life, and the human body being a trust from God to be protected and the benefit for the public good,21 but the same principles have also been used to legitimise the practice.22 Rispler-Chaim identified at least nine ‘dogmas’ or principles that guide the rulings of Muslim scholars, but notes, that in spite of Islamic principles, there is a ‘willingness of Islamic medical ethics to overlook Shar‘i [i.e., Islamic law] prohibitions when saving life is at stake’.23 Moosa aptly illustrates these paradoxical outcomes of Islamic law with the example of contemporary fatwas on organ donations. He shows how ‘mainstream’ Muslim authorities have issued fatwas that reached completely different conclusions. In the late 1960s, Pakistani scholar-jurists (affiliated with the Deoband School) concluded that organ transplantation was prohibited.24 About a decade later (late 1970s), the Egyptian Dar al-Ifta’, an autonomous fatwa-issuing body under the Ministry of Religious Endowments and Religious Affairs, issued a fatwa that permitted cadaver or live kidney donations, stipulating that organs could only be taken once death was ascertained via the application of the traditional understanding of death associated with vital cardiopulmonary signs.25 A further development occurred in 1986, when the consultations of the Academy of Islamic Jurisprudence 19 Ghulam-Haider Aasi, ‘Islamic legal and ethical views: Organ transplantation and donation’, Zygon, vol. 38, no. 3, 2003, pp. 725–42, esp. 730. 20 Birgit Krawietz, ‘Brain death and islamic traditions: Shifting borders of life?’, in Brockopp (ed.), Islamic Ethics of Life, pp. 194–213, esp. 195; Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 28. 21 Abul Fadl Mohsin Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation: An Islamic View, Markfield, Leicester: The Islamic Foundation, 2001, pp. 49–67, esp. 51–5; Aasi, ‘Islamic legal and ethical views’, pp. 730–1, 733–4 (who makes extensive use of Ebrahim, 2001). 22 Moosa, ‘Interface of science and jurisprudence’, 336–40. 23 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 29–30 and p. 30 n. 11; cf. with the principles identified by Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, pp. 55–8; cf. Dariusch Atighetchi, Islamic Bioethics: Problems and Perspectives, Derdrecht, The Netherlands: Springer, 2007, pp. 161–97. 24 Moosa, ‘Interface of science and jurisprudence’, pp. 334–6. 25 Ibid., pp. 336–8.

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(AIF), a special committee of the Organization of Islamic Conference (OIC), resulted in the recognition of brain death as an Islamically valid criterion of death.26 Islamic law is not different from other types of legal systems. It is inscribed in particular cultural and historical contexts from which it emerges and develops as it responds to a variety of social, scientific, medical, etc. developments. The fluidity that it exhibits, as shown by Moosa’s study of contemporary fatwas on organ donation, provides us with a ‘wider picture of the religious-cultural situation’ in which these particular legal opinions originate.27 On the whole, however, an important feature of contemporary fatwas on new medical and ethical issues remains the highly pragmatic or ‘instrumentalist’ approaches of contemporary Muslims jurists’ rulings in their responses to the challenges posed by new medical advancements.28 Human beings as ‘creation of God’ The advent of plastic surgery, whether reconstructive or cosmetic, the possibilities of altering the body, of ‘harvesting’ human organs for transplants, receiving organs, and post-mortems have all presented Muslim jurists with new moral, ethical and religio-legal challenges. Most religious authorities have, indeed, been quick to advise caution. Jurists and religious scholars appealed to a central Islamic principle that forbids any alteration to God’s creation. Human beings and their bodies are ‘creations of God’ (khalq Allah). As creations of God, our bodies are, in a sense, not completely ours. The main reason for this remains that Islam upholds principles of sanctity (or inviolability) (hurma) and dignity (karama) of the human body, that embrace both the living and the dead (body),29 sharing much with the Jewish

26 Ibid., pp. 338–40. For a discussion of religious rulings on brain death in Iran, cf. S. M. Akrami, et al., ‘Brain death: Recent ethical and religious considerations in Iran’, Transplantation Proceedings, vol. 36, 2004, pp. 2883–7. 27 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 144. 28 Donna L. Bowen, ‘Contemporary Muslim ethics of abortion’, in Brockopp (ed.), Islamic Ethics of Life, pp. 51–80, esp. 74–5; Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 30, 145; Moosa, ‘Interface of science and jurisprudence’, p. 353. 29 Krawietz, ‘Brain death and Islamic traditions: Shifting borders of life?’, pp. 196–8.

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tradition.30 One could surmise that we have no rights over our bodies. Like life itself, the body acquires a type of ‘sacralised’ status. One cannot commit suicide or dispose of one’s life or one’s body as one pleases. This also raises ethical issues, for example, over both cosmetic and sex change surgeries.31 The sanctity of the bodies of the deceased needs to be, for the same reasons, equally preserved at all costs.32 In addition, a Qur’anic verse (Q., 17:36) alludes to the eschatological need for the preservation of the body (save for circumcision or Islamic punishments).33 It was, therefore, quite disturbing to read reports in Iranian newspapers that poor Iranian villagers were selling their kidneys, as neither concerns for ethical issues, nor for the socio-economic reasons behind what

30 In Jewish law, ‘Individuals, according to halakhah, have no rights to their body or in the bodies of others. The ban on touching the body and the loss of civil rights after successful suicide are means of introducing and maintaining this view in the minds of the members of society’, cf. Nissan Rubin, ‘From corpse to corpus: The body as a text in Talmudic literature’, in Albert I. Baumgarten with Jan Assmann & Guy G. Stroumsa (eds.), Self, Soul and Body in Religious Experience, Brill: Leiden, 1998, pp. 171–83, esp. 174. 31 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 44–9; cf. Vardit Rispler-Chaim, Disability in Islamic Law, Derdrecht, The Netherlands: Springer, 2007, pp. 69–74. 32 This is based on a well-known hadith found in Malik’s Muwatta (Book 16, Number 16.15.45) and in Abu Dawud’s Sunan (Book 20, Number 3201): ‘Breaking the bone of one who is dead is like breaking it while he is living’ that Muhammad used to reproach a misbehaving gravedigger, cf. University of Southern California’s Muslim Students Association 2006, USC-MSA Compendium of Muslim Texts, http://www.usc .edu/dept/MSA/fundamentals/hadithsunnah/, accessed 12 December, 2006. 33 Krawietz, ‘Brain death and Islamic traditions: Shifting borders of life?’, pp. 196–7. Khamenei’s fatwas stipulates that the ‘circumcision of boys is obligatory in itself and as a condition for the validity of tawaf [i.e., circumbulation of the Kaaba] in both hajj [i.e., the pilgrimage] and ‘umra [i.e., lesser pilgrimage outside the prescribed month]. If it is left until the boy attains adulthood, it becomes obligatory on him to have circumcision’ (Q1297), while girls’ circumcision ‘is not obligatory’ (Q1299). ‘Q’ refers to the question number (and ‘A’ to the answer or response), cf. Grand Ayatollah Ali Hosseini Khamenei (a), Replies to Inquiries about the Practical Laws of Islam. The English Version of (Ajwibah al-Istifta‘at), no date, http://www.islam-pure.de/imam/ books/ajvab.pdf/, accessed 28 October 2006. This is a Shiite web site which explicitly states that it is not an official site, but the work of Shiis living in Germany; nonetheless, a hard copy (PDF file) of the work available on this site is identical to the online version of the Practical Laws of Islam found on one of Khamenei official web sites, cf. Grand Ayatollah Ali Hosseini Khamenei (b), Practical Laws of Islam. Medical Issues, no date, http://www.leader.ir/langs/EN/index.php#, accessed 7 October 2006. Further fatwas from Leader’s Office in Qom on medical issues are available at Grand Ayatollah Ali Hosseini Khamenei (c), ‘Fatwas from leader’s office in Qom’, no date, http://www .islam-pure.de/imam/fatwas/further.htm, accessed 14 December 2006.

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appeared to be a kind of Islamically-endorsed commodification of body parts were raised.34 In another sense, however, our bodies are temporarily entrusted to us as a ‘trust’ (amana) from God. In the modern world of privatization and commodification, individuals demand greater rights over their own bodies. Muslims are no exception. Although individuals who might request the right to end their lives via euthanasia or suicide may be quite rare in the Islamic world, an increasing number of Muslims do decide, to undergo medical procedures, like in-vitro fertilisation to try to remediate infertility35 or, for various reasons, to alter their physical bodies through surgery. A new medicalisation of physical defects and/or ‘perceived’ physical defects, such as small breasts and penises or large noses, has emerged with the development of new medical advances. Concerned Muslims have quite naturally sought religious guidance; this has generated new contemporary fatwas that eventually find their way online. ‘Religionated’ bodies: Muslim and non-Muslim bodies Islamic legal opinions have always, however, rested on certain assumptions about human nature and human bodies. One of these assumptions remains the ‘religionated’ nature of bodies. One may, however, ask to what extent have bodies remained ‘religionated’ in the developing corpus of contemporary fatwas regarding new medical issues? We would like to focus on this idea of ‘religionated’ bodies in Islam to look at how the body embodies social meanings. In order to illustrate this, we can look at a number of medical issues such as blood and organ donation, post-mortems and anatomical dissection.

34 B. Larijani, F. Zahedi and E. Taheri, ‘Ethical and legal aspects of organ transplantation in Iran’, Transplantation Proceedings, vol. 36, 2004, pp. 1241–4; Javaad Zargoushi, ‘Iranian kidney donors: Motivations and relations with recipients’, The Journal of Urology, vol. 165, no. 2, 2001, pp. 386–92, and Javaad Zargoushi, ‘Quality of life of Iranian kidney “donors” ’, The Journal of Urology, vol. 166, no. 5, 2001, pp. 1790–9. 35 For very insightful analyses from a medico-anthropological perspective, cf. Marcia Inhorn, Local Babies, Global Science: Gender, Religion and in-vitro Fertilization in Egypt, New York: Routledge, 2003; cf. Marcia Inhorn, ‘ “He won’t be my son”: Middle Eastern Muslim men’s discourses of adoption and gamete donation’, Medical Anthropology Quarterly, vol. 20, no. 1, 2006, pp. 94–120.

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The Sunni context When it comes to certain contemporary medical procedures, there is no doubt that Islam is, to some extent, willing to ‘de-religionate’ bodies. For instance, once religious scholars had resolved the major issues raised by blood donation,36 there was no Islamic counter-indication for its practice. Saving the life of another individual is a righteous deed (‘amal salih) and giving blood for that particular purpose renders the action legitimate or permissible ( ja‘iz),37 the donor being rewarded in the Hereafter.38 In a 2004 fatwa (9 June) posted on Islam Online, the authoritative Yusuf al-Qaradawi, substantiating his ruling with a number of scriptural proofs from the Qur’an and the hadiths, ruled that it was lawful for a Muslim to give blood in order to save the life of another human being, explicitly writing ‘whether he is a Muslim or not’:

36 The first issue pertained to the purity of blood used for transfusion (as blood ‘spilled’ (dam masfuh) is considered impure) and the second issue pertained to the possibility of establishing a kin relationship between a man and a woman that would prevent their marriage, the latter being explained away as blood is not a barrier to marriage, unlike milk which ‘establishes a semi-brotherhood relation only during the first two years of a baby’s life’, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 41–2. Ebrahim adds that it was considered part of the human body and extraction and transfusions were seen as violating the ‘honor/dignity’ of a person, cf. Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, pp. 35–6. On blood transfusion more generally, cf. Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, pp. 29–46; Abul Fadl Mohsin Ebrahim, Organ Transplantation: Contemporary Islamic Legal and Ethical Perspectives, Kuala Lumpur: A. S. Noordeen, 1998, pp. 37–50. 37 From al-Sah‘rawi’s collection of fatwas (1981) and the Fatwa Committee of AlAzhar publication of 1991, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 41 n. 66; from Shaykh Ahmad Fahmi Abu Sinnah’s (Islamic Fiqh Academy of the Muslim World League in Mecca) ‘Hukm al-‘Ilaj bi Naql Dam al-Insan aw Naql A‘da’ aw Ajza’ minha’, in Majallat al-Majma‘ al-Fiqhi, (1987), pp. 23–4l; and based on the notion of necessity, from ‘Abd al-Salam al-Shukri (Professor of Shari‘ and Law at alAzhar), Naql wa Zira‘at al-A‘da’ al-Adamiyya min Manzur al-Islam, al-Dar al-Misriyya lil-Nashr wa al-Tawzi‘, Nicosia, 1989, pp. 182–4; and based on the notion of human welfare, from the late Shaykh Jad al-Haqq, Buhuth wa Fatawa al-Islamiyya fi Qadaya Mu‘asira, 4 vols, Cairo: al-Azhar University, 1994, vol. 3, 451 as a form of cure, and from Shaykh Hasanayn Muhammad Makhluf (former Grand Mufti of Egypt), Fatawa Shari‘a, 2 vols, Cairo: Matba‘at al-Madani, 1971, vol. 2, 218, cf. Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, p. 36, who also notes that some, like the late Mufti of Pakistan Muhammad Shafi‘, consider it impure, but still legitimate if required out of necessity, e.g., in his 1967 Insani A‘da’-i ki Paiwandkari—Shari‘at Islamiyya ki Roshni Main, Karachi, Dar al-Isha‘ at pp. 24–6. 38 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 41.

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Blood donation is the best assistance a man can offer a patient who needs a blood transfusion due to blood loss or surgery. Donating blood is a highly estimated deed, as it saves the life of a human being whether he is a Muslim or not. It is an act whose virtue is explicitly clarified in the Qur’anic verse in which Allah the Almighty says: ‘Whosoever killeth a human being for other than manslaughter or corruption in the earth, it shall be as if he had killed all mankind, and whoso saveth the life of one, it shall be as if he had saved the life of all mankind’ (Al-Ma’idah: 32).39 [Our italics; bold omitted]

Another fatwa reiterates the same position. In a similar fashion, Muzammil Siddiqi, chairman of the Fiqh Council of North America (FCNA) and one time president of the Islamic Society of North America, wrote in 2006 that it is permissible for Muslims to give blood to nonMuslims: Blood transfusion for medical purposes is permissible in Islam. It is permissible to take blood from a non-Muslim and it is permissible to give blood to non-Muslims. These matters are related to human life. It stands to reason that Islam teaches us to feed the hungry, to take care of the sick and to save the life of people. In these matters it does not make any difference between the life of a Muslim and non-Muslim.40 [Our italics]

Muslims are, therefore, enjoined to give blood to save lives. Not just Muslim lives, but all lives, including those of non-Muslims.41 In the present Australian context, it is worth noting that Muslims are asked to give blood to perform a good deed and to save the lives of all Australians, only some of which will be Muslims.42 Other recent fatwas on blood and organ donation, however, illustrate how a ‘religionated’ notion of bodies, as part and parcel of a ‘premodern 39 Yusuf al-Qaradawi, ‘Virtues of blood donation (9 June 2004)’, available at Islam Online.net, 2004, http://www.islamonline.net/servlet/Satellite?cid=1119503548624and pagename=IslamOnline-English-Ask_Scholar/FatwaE/FatwaEAskTheScholar, accessed 13 Oct. 2006. 40 Muzammil al-Siddiqi, ‘Blood donation to non-Muslims (21 June 2006)’, 2006, available at IslamOnline.net, http://www.islamonline.net/servlet/Satellite?pagename= IslamOnline-English-Ask_Scholar/FatwaE/FatwaEandcid=1119503543286, accessed 13 Oct. 2006. 41 Throughout the fatwa, a notion piety of believers and ‘brothers’ would appear to make them somehow more worthy, at least, than those who are less pious, or impious. 42 NSW Muslim Community 2006, ‘NSW Muslim Blood Drive Campaign July-August 2006’, 2006 http://www.muslimblooddrive.org.au/, accessed 14 December; cf. Muslim Community Cooperative (Australia) Ltd (MCCA), ‘Muslims of Australia Saved 900 Lives’, http://www.mcca.com.au/page.php?id=FirstBloodDriveMelboandproduct_id=113, accessed 14 December 2006.

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episteme’ (Moosa) and ‘ “mythical” cognitive system’ (Arkoun), manages to survive. Rispler-Chaim summarises what we identified as the ‘religionated’ nature of bodies in her discussion of Islamic medico-ethical understanding of organ donation and organ transplant: In the first place donors should be harbis (members of the enemy party), because their blood is violable; or they should be people who deserve to die for a crime committed, for apostasy (ridda) or because they murdered and deserve qisas (death penalty).43 [. . .] It is permitted that the donor be a heretic (kafir) and the recipient a Muslim (at least when the donation is of an eye). Heretics themselves, or their relatives, are still required to grant permission. Muslims may not donate to heretics.44 This is related to the value of human life under Islamic law: Muslims’ lives are venerated and should be prolonged by all possible means. Those inferior to Muslims or their enemies are preserved as long as Muslims can benefit from them. For this reason al-Sha‘rawi objects totally to donations from living people. However, he permits donations from the dead [Muslim], analogously to the Shar‘i permission to eat from a corpse in order to survive.45 [Our italics]

The sanctity of the body decreases with the status of outcast, such that the sanctity of some bodies is forfeited; hence, some have ruled that the organs of those who have been executed can be ‘harvested’ (only after their execution).46 Rispler-Chaim notes ‘the preference for donors whom Islamic law grades as second-rate citizens, and the acceptance of “ordinary Muslims” only as the last resort, derives from the infavorable [sic] Islamic view of the foreigner, the non-Muslim and the criminal’.47 In a similar fashion, the late Mufti of Pakistan Muhammad Shafi‘ noted in the late 1960s that Muslims were to avoid blood from nonMuslims as far as possible, because blood may negatively affect them, as Ebrahim reports, ‘through the evil inclinations that permeate the blood of rebellious sinner or unbelievers’ (similar to the contamination that 43 From a fatwa of Ibrahim al-Ya‘qubi 1986, Shifa’ al-Matarih wa al-Adwa’ fi Hukm al-Tashrih wa al-A‘da’, Damsacus, 1986, p. 108, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 36. 44 From a fatwa of Muhammad Abu Shadi, in Majallat al-Azhar, October (1973): 669, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 37 n. 41. 45 From a fatwa printed in the Egyptian weekly al-Nur, February 22 (1989): 1, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 36–7 and p. 37 n. 42. 46 According to a 1979 fatwa by Muhammad Sayyid Tantawi (mentioned in the Egyptian weekly al-Liwa’ al-Islamiyya, vol. 10: 370215) and the statements of ‘Abd alFattah al-Shaikh, the Rector of al-Azhar University, in the Egyptian al-Ahram, January 5 (1990): 15, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 35. 47 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 43.

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can occur via the wetnurse’s milk)48 and ‘polluted’ with the food and drink (alcohol and pork) forbidden to Muslims.49 Such ideas might have been derived from the Qur’anic verse which alludes to the impurity of non-Muslims (Q 9:28 ‘Believers, know that the idolater pagans (mushrikun) are unclean (najas)’). This has not prevented jurists to rule that Muslims can be recipients of non-Muslim blood and organs.50 A recent fatwa posted in 2006 (23 May) on Islam Online, that quotes the ruling of the same authoritative scholar-jurist Yusuf al-Qaradawi, aptly illustrates the survival of this ‘religionated’ notion of bodies: Donating an organ is like giving charity in terms of its being permissible for a Muslim or a non-Muslim. However, it is not permissible to donate an organ to a non-Muslim combatant who wages war against Muslims and a person who wages attacks on Islam. By the same token, it is not permissible to donate it to an apostate as he is no more than a traitor to his religion and his people and thus deserves killing. However, if there is a Muslim and a non-Muslim and both are in need of organ or blood donation, the Muslim must be given priority for Allah Almighty says in the Qur’an: ‘The Believers, men and women, are protectors one of another’. (At-Tawbah 9:71) Here we are to make it crystal clear that a practicing Muslim takes preference to a deviant sinful one who makes use of the divine gifts given to him to disobey Allah and harm his fellow brothers. [Our italics; bold omitted]

The fatwa quite explicitly re-affirms that individuals are not all equal. In fact, they remain ‘religionated’ by their individual religious beliefs, on the one hand, as Muslims and non-Muslims. It is forbidden for Muslims to donate their organs to the enemies of Islam and of Islamic society, like non-Muslim combatants51 who wage attacks on Islam or apostates, since this would amount to Muslims helping the enemies of Islam. On the other hand, not only do the needs of the afflicted bodies of Muslim believers take precedence over those of non-Muslims, but the needs of the afflicted body of the pious Muslim take precedence 48 From his Insani A‘da’ (1967), 28, cf. Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, p. 28. 49 Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, p. 109. 50 ‘Abd Allah ‘abd al-Rahman al-Bassam, ‘Zira‘at al-A‘da’ al-Insaniyya fi Jism alInsan,’ Majallat al-Majma‘ al-Fiqhi (1987), 22, cf. Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, pp. 45–46 and Ebrahim, Organ Transplantation; Contemporary Islamic Legal and Ethical Perspectives, pp. 50, 66. 51 Infidels ‘nonpersons’ inhabit the zone of war (dar al-harb), cf. Arkoun, Rethinking Islam, p. 100.

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over those of the ‘deviant sinful’ who ‘disobey[s] Allah and harm his fellow brother’. The issue of ‘religionated’ bodies also remains an underlying assumption of the 2002 (4 August) fatwa posted on Islam Online regarding the donation and the selling of organs during life or after death. Muzammil Siddiqi’s response is interesting as he relies on the legal opinions of a number of different ‘authoritative’ religious Islamic bodies, such as the Supreme Council of ‘Ulama in Riyad, the Fiqh Academy of the Muslim World League in Mecca, and the Fiqh Academy of the Organization of the Islamic Conference in Jeddah. The online format of the fatwa allows him (or anyone for that matter) to summarise the conclusions of authoritative jurists or religious bodies. Siddiqi notes that the fatwas issued by the Muslim bodies he consulted have only allowed the donation of organs, but not their sale, but, he adds, ‘Some jurists suggest that because people have become too materialistic and it may not be possible to find a free organ, under necessity one can purchase the organs, but a Muslim should never sell his/her organs [our italics]’.52 The sale of organs damages the dignity of the body of the person and is considered, by some as a major sin,53 but Siddiqi’s fatwa-like response clearly implies that the bodies of non-Muslims, whose organs can be sold, do not enjoy a similar level of dignity. In a similar fashion, the various rulings of religious scholars on the legitimacy or illegitimacy of the sale of blood can illustrate the fluid normative nature of fatwas.54 Muslim scholars, who reject the sale of blood, ‘claim that it is a part of the body, which is owned by Allah alone, not by any human being’,55 whereas some scholars have recommended to donate blood for no compensation, and others, having even supported its sale, have legitimised the practice by comparing it ‘to the hiring of a wet-nurse, which is legitimised by Qur’an 2,233’.56 Others have allowed the selling of blood based on arguments of necessity; for 52 The fatwa is reprinted in John J. Donohue and John L. Esposito, Islam in Transition (2nd edn.), Oxford: Oxford University Press, 2006, p. 215. 53 A fatwa from the Egyptian al-Ahram, April 15 (1983): 13, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 81. 54 Ebrahim, Organ Transplantation; Contemporary Islamic Legal and Ethical Perspectives, pp. 72–7. 55 According to the mufti ‘Abd al-Munsif Mahmud (1991) and the Fatwa Committee of al-Alzar (1991), cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 42 and n. 70. 56 According to al-Sah‘rawi’s collection of fatwas (1981), cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 41 and n. 69.

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example, The Islamic Fiqh Academy of the Muslim World League ruled that there is no sin for the one who pays to obtain blood, but that the one who sells is committing a sin.57 More generally, ethical considerations surrounding the sale of blood do not appear, however, to be at the heart of these rulings. Although Muslim scholars usually do not rule on blood donation within the framework of ‘religionated’ bodies, the above-quoted 2006 (23 May) fatwa does.58 Individual scholars, like the prominent and influential scholar-jurist al-Qaradawi who has, in other contexts, provided a number of progressive rulings and individuals like Dr. Muzammil Siddiqi, can continue to hold fast to elements of these premodern epistemes. Islamic rulings regarding the dead body can be equally instructive, as attitudes toward death teach us much about society’s approach to life.59 Post-mortems have now become part of legal medicine and have become instrumental in determining the exact cause of death. The major issues, however, with post-mortems in the Islamic tradition are that the body needs to be buried immediately after death and that it should remain as intact and whole as possible. This may be the reason why, in medieval Muslim societies, dissection appears to have been primarily based on animal anatomy, although voluminous and quite detailed anatomical works were written. So, it is not clear to what extent dissection may have been prohibited by law, as few sources appear to substantiate the claim that it was, although most sources do discourage or disapprove of the practice.60 In 1982, the religious scholars of al-Azhar allowed post-mortems based on the principle that it may help others. The benefits of post-mortems, hence, outweigh the infringement on the sanctity of the body of the deceased.61 Religious scholars allowed the donation of one’s body to science, based on this principle of public benefit, although few individuals 57 The Islamic Fiqh Academy, Qararat al-Majma‘ al-Fiqhi (19–26 Feb. 1989), 83, cf. Ebrahim, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation, pp. 42–3. 58 The donation of blood from living donors, can ‘serve as a model for donations made in the lifetime of the donor’ of an organ, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p 41. 59 Peter Metcalf and Richard Huntington, Celebrations of Death: The Anthropology of Mortuary Ritual (2nd and rev. edn.), Cambridge: Cambridge University Press, 1991. 60 Emilie Savage-Smith, ‘Attitudes toward dissection in medieval Islam’, The Journal of the History of Medicine and Allied Sciences, vol. 50, 1995, pp. 67–110, esp. pp. 105–9. 61 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 82.

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do.62 The same is true of organ donations, organ transplants and anatomical dissection which all contribute to the public benefit when the outcome can be the saving of lives.63 The Shiite context The notion of ‘religionated’ bodies appears to remain a feature of contemporary Muslim religious scholars’ rulings, as the notion pervades not only the contemporary Sunni Islamic tradition, but also the Shiite tradition. Shiite clerics, for example, also needed to tackle similar contemporary medical issues, sometimes even reaching opposite conclusions to the rulings provided by Sunni jurists. Iranian clerics have found no difficulty, for example, in legitimising an Islamic practice of organ selling.64 In cases of necessity and when there is a need to discover the exact cause of death, medical procedures such as post-mortems have equally been deemed quite lawful, as testified by Grand Ayatollah Khamenei’s fatwa (Q1274).65 A number of medical issues including post-mortems, anatomical dissection and transplantation are addressed in Khamenei’s Replies to Inquiries about the Practical Laws of Islam and provide us with yet another opportunity to examine Islam’s contemporary religious scholars’ conceptions of bodies. The rulings on anatomical dissections are quite interesting, as they again reveal the presence of ‘religionated’ notions of bodies. In one question on research into heart and vascular diseases of individuals who died of those diseases, it was asked if it was permissible for the research to be carried out on the dead bodies of those Muslims. In his responsa, Khamenei ruled that: A: There is no objection to dissecting a corpse when saving a respectful life, exploring new ideas in medical science that are necessary for the society, or obtaining information regarding a disease that threatens life. However, it is obligatory not to make use of the dead body of a Muslim, where possible. Extracted parts of the dead body of a Muslim must be buried with the same body unless burying them with the body proves 62

Ibid., pp. 72–7. Bodies of Muslims without kin to claim them are bodies whose organs are more readily ‘harvested’, as they come under the ‘guardianship of the state’, cf. Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 35–6. 64 Larijani et al., ‘Ethical and legal aspects of organ transplantation in Iran’, pp. 1241–4. 65 Khamenei, Replies to Inquiries about the Practical Laws of Islam and Khamenei, Practical Laws of Islam. Medical Issues. 63

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difficult or unbearable. In this case, it is permissible to bury them separately or alongside another dead body (Q1273). [Our italics]

A similar question, but this time regarding the anatomical dissection for histological research on the body of an aborted foetus as part of medical training, is provided with an answer that again reiterates the notion of ‘religionated’ bodies: A: It is permissible to dissect the body of an aborted baby if saving a respectful life, achieving new medical information necessary for the society, or getting more information about certain diseases that threaten life. However, it is advisable, where possible, not to make use of the dead fetus of a Muslim or of one who is ruled as a Muslim (Q1275). [Our italics]

In both these fatwas, bodies remain similarly ‘religionated’. Muslim bodies somehow garner more respect than non-Muslim bodies. Whenever possible, one should avoid using Muslim bodies for such practices. To a query about the permissibility to dig the graves of Muslims or nonMuslims in order to exhume the bones for training purposes in medical schools, Ayatollah Khamenei again ruled that: A: As to the graves of Muslims it is not permissible to do so unless there is a pressing need for the bones for medical purposes and it is impossible to obtain such bones from the graves of non-Muslims (Q1277). [Our italics]

Even in death, the remains of bodies retain their ‘religionated’ ontological natures and are to be treated differently. This is what determines the fate of their remains after death, thus making the use of bones contained in the graves of non-Muslims lawful. The fatwas explicitly attributes greater dignity to a person’s remains according to the religion they professed while they were alive. In a similar fashion, replying to the permissibility of dissection of a corpse after death for a criminal investigation or for medical teaching purposes, Iraqi Grand Ayatollah al-Sistani ruled, in 1995, that: A: It is not permissible to dissect a Muslim corpse for these kinds of reasons. The dissection of the body of an unbeliever whose blood is not protected during his lifetime is permissible, and likewise when the protection of his blood is doubtful, if there is no shar’i sign of it being so (protected) (Q133).66 [Our italics] 66 Mavani notes that the fatwa is found in Ayatollah al-Sayyid ‘Ali al-Husayni alSistani’s al-Fatawah al-Mu‘assarah, compiled by ‘Abd al-Hadi Muhammad Taqi alHakim (Qum: Maktab Ayatullah al-‘Uzma al-Sayyid al-Sistani, 1416/1995), p. 416.

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Once more, we see that the remains of bodies retain the ‘religionated’ ontological natures that determine the fate of their remains after death. These few examples selected from contemporary Sunni and Shiite fatwas available online illustrate how the ‘religionation’ of bodies provides specific ontological natures to the bodies of the adherents of the Islamic tradition and those of the adherents of other religious traditions. Reaffirmed is the idea that there are Muslim bodies and there are ‘other’ types of bodies, the latter being somehow considered less sacred and less worthy of dignity and sanctity, because of their distinct and religiously defined ontological natures. These contemporary fatwas attribute different legal statuses to bodies that reiterate distinct ontological natures that have everything to do with what Daly identified as the reaffirmation of social relations that aim at maintaining boundaries. In life and in death, bodies partake in a specific ethico-religious ontological system that determines the sanctity of the body of individuals: they are not all equally worthy of the same sanctity. Finding coherence in spite of dissonance Some have argued that during the classical period of Islam an ‘epistemic coherence’ existed between science and Muslim jurisprudence which has been lost with the advent of the modern period. Moosa, for example, has identified the prevailing contemporary ‘dissonance’ between science and contemporary Muslim legal rulings, especially those that pertain to bioethical issues,67 a dissonance that finds an echo in Arkoun’s analysis. Contemporary Muslim jurists cling to premodern epistemes that make for ‘instrumentalist reasoning’,68 whereby Muslim jurists resort to ‘pre-modern notions of law, body, and science [that] are employed in a conversation with phenomena of a radically different and utterly modern provenance’.69 Premodern epistemes or cognitive systems remain grounded in the body of Islamic law literature. Not only do Sunni Pakistani and Egyptian fatwas on organ transplants demonstrate that the ‘language and social imagery of the pre-modern legal discourse is

67 68 69

Moosa, ‘Interface of science and jurisprudence’, pp. 329–30, 341, 343. Ibid., p. 353. Ibid., p. 341.

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alive and well in the modern era’,70 but so do the medical fatwas that are available online. We would like to suggest that it is also equally important to highlight the epistemic dissonance that exists between religious knowledge and philosophical and anthropological understanding of human nature, as something distinct from scientific knowledge. Such dissonance accounts for what Arkoun calls Islamic thought’s entrapment in ‘dogmatic closure’,71 which is aptly illustrated with Sunni and Shiite medical fatwas in which bodies remain ‘religionated’. Moosa notes that it is, however, inaccurate to present contemporary fatwas as mere transmission of pre-modern Islamic legal rulings into the present.72 The dynamics of religious interpretation are far more complex. Although one might build a case for the incoherence of instrumentalist and pragmatic approaches favoured in contemporary Islamic fatwas that remain grounded in premodern epistemes, we are reminded that Islamic law always proceeded with a case-based jurisprudential approach. This makes for Islamic ethics that is ‘entirely casuistical’,73 what some view as Islamic ethics’ ‘utilitarian considerations in the field of medicine, but in a strictly limited fashion’.74 Islamic legal rulings generate an ethics in practice. Rispler-Chaim, for example, rightly observes that an Islamic ‘ethical code is being constantly shaped and reshaped, that it never reaches a final stage, and that it needs always to be reassessed against a defined chronological or temporal framework in order to be considered valid’.75 Although one can distinguish between a ‘popular ethics’, the product of lay people, and a ‘legally authorised ethics’, the product of scholars, jurists, doctors and scientists, no legal opinion is the only one on a topic or the final one. Other fatwas will be issued, so that the rulings of Muslim jurists need to be studied for their implicit and explicit social, economic, political or

70

Ibid., p. 343. Arkoun, Rethinking Islam, pp. 100–1. 72 Moosa, ‘Interface of science and jurisprudence’, pp. 342–3. 73 A. Kevin Reinhart, ‘Afterword: the past in the future of Islamic ethics’, in Brockopp (ed.), Islamic Ethics of Life, pp. 214–9, esp. p. 218. 74 Jonathan E. Brockopp, ‘The “good death” in Islamic theology and law’, in Brockopp (ed.), Islamic Ethics of Life, pp. 177–93, esp. p. 177; Khaled Abou El Fadl, ‘Between functionalism and morality: the juristic debates on the conduct of war’ in Brockopp (ed.), Islamic Ethics of Life, pp. 103–28, esp. pp. 120–1. 75 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, p. 142. 71

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other imports.76 This is what we hope we have been able to show with the notion of ‘religionation’ of bodies. It is, nonetheless, very important to highlight the flexibility of Islamic law, because the: . . . most frequent principle employed by the muftis is al-darurat tubih al-mahzurat (‘necessities render the prohibited permitted’). This principle allows flexibility in practice, when the law seems strict and might lead to conservatism. In fact, this principle of maslaha (public interest), namely, provided that the public benefits and no major Islamic principle is [sic] violated, a new idea or method may be admitted into the code of proper Islamic conduct. By this principle Islamic medical ethics has legitimized artificial insemination, organ transplants, postmortems and the use of certain medications and advanced medical treatments.77

The pragmatism of Islamic law is evident when even plastic surgeries intended to solve emotional and psychological problems ‘are legitimized despite the theological encouragement not to change the form of the body as created’.78 Pragmatism appears to quickly override theological principles when the saving of a life is at stake. Appeal to traditional Islamic law principles and concepts and to the past rulings of Muslim jurists can equally provide authority and legitimacy to new medical practices when these are ruled permissible, without there being necessarily much concern with any of their ethical dimensions or implications. Although Muslim jurists translated contemporary medical issues into jurisprudential (fiqhi) principles and/or concepts without much concern with the coherence between different (premodern and modern) epistemes, in some cases, however, as is the case with autopsies, there are signs of the emergence of ‘convergences’ between the ‘common epistemic vocabulary’ of science and Islamic law.79 These are indications of a ‘tradition-in-the-making’,80 whereby jurists attempt to provide some sort of continuity ‘via the texts of the legal tradition’, while at the same time, and this is what is quite significant, the ‘law is expanded and made sufficiently elastic in order to seemingly

76 Ibid., p. 145; cf. Lawrence Rosen, The Anthropology of Justice: Law As Culture in Islamic Society, Cambridge: Cambridge University Press, 1989; cf. Baber Johansen, Contingency in a Sacred Law: Legal and Ethical Norms in Muslim Fiqh, Leiden: E. J. Brill, 1999. 77 Rispler-Chaim, Islamic Medical Ethics in the Twentieth Century, pp. 145–6. 78 Ibid., p. 146; cf. Ebrahim, Organ Transplantation; Contemporary Islamic Legal and Ethical Perspectives, p. 69. 79 Moosa, ‘Interface of science and jurisprudence’, pp. 341, 331. 80 Ibid., p. 345.

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solve even the most complex and challenging bio-ethical issues’, thus providing Islamic legitimacy to new social and medical practices.81 This ‘tradition-in-the-making’ allows, by the same token, for the preservation of the authority of religious scholars. Some, however, may question the credentials of some Sunni religious scholars whose fatwas Islam Online reproduces and the authoritative nature of their fatwas. While Islam Online provides a disclaimer to the fact that these fatwas ‘do not necessarily form a juristic approach upheld by this website’, it, nonetheless, affirms that ‘All Fatwas published on this website (Islamonline.net) represent the juristic views and opinions of eminent scholars and Muftis’. What is significant is that Islam Online is vying for cyber-authoritativeness in the realm of globalised Sunni Islamic guidance, which also holds true for the Shiite web sites. Indeed, a number of these authoritative online fatwas have provided insight into contemporary Islamic notions of sacredness associated with Muslim and non-Muslim bodies and into ‘religionated’ notions of bodies grounded in epistemes of another time that many online fatwas reiterate.

81

Ibid., pp. 341–3.

CHAPTER THREE

THE BODY AND THE WORLD IN BUDDHISM Peter G. Friedlander Introduction There have been followers of the Buddha for over two thousand years, now in areas as far apart as India, China, Central Asia and Indonesia. There have been enormous variations in how people understood the Buddha’s teachings, his dhamma, in these different cultures. I will present here some understandings of the body from ancient India and consider their influence on different cultures today. I will concentrate on examining early Indian notions of the body and lightly touch on modern understandings of some points in some other cultures. Buddhism is famous for its emphasis on the importance of meditation as a means of investigating the nature of ultimate reality. This is actually something which it shared in common with other Indian traditions such as those represented in the Vedas and the Upanishads, traditions which I shall refer to here as Brahminical traditions. The body itself, along with the mind and the world, is seen as a focus for meditative investigation, and it is important to realise that the boundaries between mind and body are not fixed in the way that we now see them in the West. Moreover, there are indications in Buddhist and Brahminical texts that there were secular understandings of the body, and in particular medical understandings, which were seen as ‘givens’ in all Indian traditions.1 The Sanskrit word āyurveda means ‘the knowledge for longevity’. Āyurveda is often said to go back to two legendary figures called Caraka and Suśruta to whom treatises of medical lore are attributed. Both treatises go back to around the sixth century BCE, but in their present forms are from around the sixth century CE. One of the features which is found in these medical traditions is a belief in there being three humours (doṣa), wind (vāta), bile (pitta), and phlegm (kapha or śleṣman). These each have two manifestations, one 1

Dominik Wujastyk, The Roots of Ayurveda, New Delhi: Penguin, 2001.

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in the body, and one in the world. Classical Āyurvedic sources such as Caraka, Suśruta and Sārangadhara, hold that wind has two manifestations ‘world-wind’ (loka-vāyu) which, amongst other things, makes the sun, moon, and planets etc. move, and ‘body-wind’ (śarira-vāyu) which has amongst its functions keeping in motion the factors of bile, phlegm, etc. in the body.2 The seat of wind in the body is around the intestine, the seat of bile the navel, and the seat of phlegm the chest. These three humours are also mentioned by the Buddha in the Pali canon, the earliest collection of Buddhist texts, and are regarded as factual aspects of existence which account for disease and well-being in the body. The body tissues (dhātu, a word which also means ‘element’) are seen as falling into seven types, chyle, blood, flesh, fat, bone, marrow and semen. Starting with digestion as the central process each element transforms into the next in a sequence and in that transformation waste products are also produced (mala). Digestion is seen as being like cooking, like a fire in the belly (jāṭharāgni). Food in the stomach’s heat turns into chime or chyle (rasa) then pitta acts upon it and it is turned into blood, the blood into flesh and so on until finally the supreme essence of life force is produced, semen. As part of this process an energy is created (ojas) which powers the body. The veins etc. were understood as being carriers of the blood, wind, humours, sensations and even the mind. Illness was seen as being basically the result of blockages in the flow of the humours and the elements around the body, and its causes as relating to humours not being in their proper seats in the body, environmental factors, such as climate and diet, and mental factors or divine causes. The main methods of treatment are dietary regulation, herbal medicines and purgatives. Along with the humours there were other sets of givens in early Indian thought. Buddhist and non-Buddhist teachings held that material matter was made up of tiny atoms (parmānu) of certain basic elements in varying combinations. The basic elements (mūlabhūta) are: earth, fire, water, air, and space according to Caraka (26: 11) who describes them in this way:

2 C. Dwarkanath, Introduction to Kāyachikitsā, Bombay: Popular Book Depot, 1959, pp. 111–2.

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Earth-substances (pārthiva): heavy, rough, hard, inert, dense, opaque; smell sensations. Water-substances (āpya): liquid, viscous, cool, inert, soft, slippery, fluid; taste sensations. Fire-substances (tejasa): hot, penetrative, subtle, light, dry, clear; visual sensations. Air-substances (vāyavya): light, cold, dry, transparent, rarified, rough, subtle; tactile sensations. Ether-substances (nābhasa): soft, light, subtle; sound sensations.3

A third set of givens were the three qualities (guṇ a), which in Sāṁkya are seen as sattva, the quality of consciousness, rajas, the quality of energy and expansion, and tamas, the quality of inertia and matter.4 It is clear that there must also be some relationship between the guṇas and the doṣas, but it is not normal to speak of there being a one-to-one relationship. The body and the world are thus conceived of in terms of them being made up of these elements: the humours, basic elements and qualities. The idea of spirits, and spirit possession, was also part of how people understood the functioning of the mind and body. There are references in Buddhist texts to people suffering from spirit possession, and trying to avoid spirit possession. This was also an important element in understandings of how the mind and body interacted with the outside world. In other words, the notion of health could be understood in terms of the body being composed of different elements, the interaction of the humours and the possibility of spirit possession. It is also notable that in early Buddhism the understandings of consciousness and the seats of consciousness were not the same as in modern thought in relation to where consciousness resides in the body. In particular, the idea that the brain is the place where all mental activity takes place is not found at all. In Āyurveda the seat of consciousness (citta or cetanā) was thought to be the heart.5 However, the notion that all mental activity was restricted to one site in the body was also not present; instead, consciousness was seen as residing at different times in different parts of the body. In Indic traditions the concept of ‘mind’ was differently constructed, the heart 3

A. Mookerjee and M. Khanna, The Tantric Way, London: Thames and Hudson, 1977, p. 109; Dwarkanath, Introduction to Kāyachikitsā, p. 225. 4 Mookerjee and Khanna, The Tantric Way, p. 96. 5 Wujastyk, The Roots of Ayurveda, pp. 249, 328.

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was the seat of consciousness and emotional thought, and the kidneys (the ‘pluck’) was the seat of courage etc. In Buddhist traditions, each sense was conceived of as having its own consciousness, and there were thought to be six senses, as the mind, manas, was seen as a separate sense whose role was the perception of thoughts. This is similar to ideas found in the Āyurvedic tradition. Caraka says that manas is found in combination with self (ātma), sense organs (indriya) and sense objects (indriyārtha).6 The Buddhist concept of citta and the Indic concept of ātma are overlapping in these two views of the relationship between mind and perception. In Āyurveda, wind has amongst its functions the conduction of sensory impressions (udvahanam), and the control of mental states such as enthusiasm (utsaha) and natural urges (vega).7 In Tibetan medical systems the wind humour (vāta) is also regarded as being mainly responsible for mental activity. There are also lists in Buddhist texts of the parts of the body, both external and internal, which show an intense interest in analysing the body. To a great extent these correspond with modern understandings, although they are not in any sense as exhaustive as modern medical understandings. However, to lay people they still seem pretty detailed. One of the four objects of contemplation for monks and nuns was the human body itself and one way of investigating it was to contemplate the body. Consider this list from the Mahāsatipaṭṭhāna Sutta: head-hairs, body-hairs, nails, teeth, skin, flesh, sinews, bones, bonemarrow, kidneys, heart, liver, pleura, spleen, lungs, mesentery, bowels, stomach, excrement, bile, phlegm, pus, blood, sweat, fat, tears, tallow, saliva, snot, synovic fluid and urine.8

In meditation texts there are numerous references to the practice of contemplating the inauspicious (asubha) aspects of the body. These are aimed at breaking the attraction we have to bodies, and to promoting the realisation of the body as a collection of bones, hair, skin, flesh, pus etc. which is actually not that attractive when thought of in terms of constituent parts. What is sometimes forgotten in this is that there are also very positive images of the body in Buddhism. 6

Dwarkanath, Introduction to Kāyachikitsā, p. 165. Ibid., p. 112. 8 Maurice Walshe [trans.], Thus Have I Heard, the Long Discourses of the Buddha, London: Wisdom Publications, 1987, p. 337. 7

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Positive evaluations of the body include the 32 characteristics of the body of the world conqueror and the body of woman as one of the seven treasures a king might possess. The word translated as ‘characteristic’ is lakkhaṇa (Skt lakṣaṇa) which also means symptom in a medical context. The 32 characteristics of a Buddha or a World Conquerer (cakkavatti) were probably a pre-existent element of Indian culture that was taken into the Buddhist teaching. In the Lakkhaṇ a Sutta of the Dīgha Nikaya there is a detailed description of these characteristics, which starts like this: (1) He has feet with level tread. (2) On the soles of his feet are wheels with a thousand spokes, complete with felloe and hub. (3) He has projecting heels. (4) He has long fingers and toes. (5) He has soft and tender hands and feet. (6) His hands and feet are net-like. (7) He has high raised ankles. (8) His legs are like an antelope’s. (9) Standing and without bending, he can touch and rub his knees with either hand. (10) His male organs are enclosed in a sheath. (11) His complexion is bright, the colour of gold. (12) His skin is delicate and so smooth that no dust can adhere to his body. (13) His body-hairs are separate, one to each pore.9

This is in some ways an odd collection of auspicious characteristics of the body; other points include having a very long tongue for instance, sometimes said to be long enough to touch the crown of the head. But even so, the main point is they show an interest in what makes a body auspicious (subha) in contrast to the meditations where monks contemplate why the body is inauspicious (asubha). Equally, the woman’s body is said to be a positive thing when conceived of in terms of being a treasure. The description of a woman as Woman-Treasure in the Mahāsudassana Sutta of the Dīgha Nikaya of the Pali canon is like this: The Woman-Treasure appeared to King Mahāsudassana, lovely, fair to see, charming, with a lotus-like complexion, not to tall or too short, not too thin or too fat, not too dark or too fair, of more than human, devalike beauty. And the touch of the skin of the Woman-Treasure was like cotton or silk, and her limbs were cool when it was hot, and warm when it was cold. Her body smelt of sandal-wood and her lips of lotus.10

These descriptions of the body seem in some ways to be similar to those found in texts like the kāma sutra tradition where bodies are 9 10

Ibid., pp. 441–2. Ibid., p. 282.

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seen as positive attributes of human existence. For instance consider this description of one of the four types of women in the kāma sutra traditions. The lotus-woman (padminī) is delicate like a lotus bud, her genital odour is of the lotus in flower, and her whole body divinely fragrant. She has eyes like a scared gazelle’s, a little red in the corners, and choice breasts that put to shame a pair of beautiful quince fruits; she has a little nose like a til-flower. She is religious, paying honour to Brahmins, the gods, and her elders—her body is attractive as the lotus leaf, and yellow like gold.11

Buddhist meditation as practiced in the Theravada traditions of southeast Asia features prominently a practice called Insight meditation (vipassanā) and the practice of meditating on the divine abidings (brahma vihara), especially the quality of Loving-Kindness (metta). In this paper I will talk about Insight meditation first, and then LovingKindness meditation. Insight meditation In Insight meditation, the body and mind is investigated in terms of its physiology, elements, and humours, along with sensations and mental activity. This type of meditation is described in several suttas in the Pali canon including the Satipaṭt ̣hāna Sutta.12 The practice of Insight meditation starts with meditation on awareness of the body itself (kayanupanasa) beginning with awareness of the breath (anapanasati) and then moves onto awareness of phenomena arising and passing away in the body. The next stage in the meditation is analysing sensations in the body by classifying them as falling into one of the physical elements. Thus a heavy solid feeling is the manifestation of the earth element in the body, a hot feeling that of fire, perspiration that of water and agitation that of air. It then focuses on developing awareness of the four postures, walking, sitting, standing and lying and what is done while in each of them: And further, monks, a monk, in going forward and back, applies clear comprehension; in looking straight on and looking away, he applies

11

Alex Comfort, The Koka Shastra, London: George Allen and Unwin, 1964, p.

103. 12 Ñāṇamoli and Bodhi [translators], The Middle Length Discourses of the Buddha, A Translation of the Majjhima Nikāya, Boston: Wisdom, 2005, pp. 145–58.

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clear comprehension; in bending and in stretching, he applies clear comprehension; in wearing robes and carrying the bowl, he applies clear comprehension; in eating, drinking, chewing and savouring, he applies clear comprehension; in walking, in standing, in sitting, in falling asleep, in waking, in speaking and in keeping silence, he applies clear comprehension.

The next stage of the meditation is the reflection on how the body is repulsive and involves focusing awareness on different parts of the body in succession. A monk contemplates this very body, up from the soles of the feet [and] down from the crown of the head, bound by the skin [and] full of manifold impurities. ‘There is in this body [the following]: hair of the head, hair of the body, nails, teeth, skin, flesh, sinews, bones, bone marrow, kidney, heart, liver, pleura, spleen, lungs, bowels, intestines, stomach, excrement, bile, phlegm, pus, blood, sweat, fat, tears, grease, saliva, mucus, serous fluid, and urine . . .’ There is in this body ‘earth element, water element, fire element, and wind element’.13

The next stage of the meditation is to meditate on how a corpse decays and the various stages in the decomposition of the body, including when it was just thrown onto the charnel ground, when it putrefies, when it bloats, when being devoured by animals and when the bones separate and when they eventually turn to dust. In modern westernised versions of the practice this is often deemphasised, since perhaps for lay people the results of such a practice can be very disturbing. But, on some Insight meditation retreats run by followers of S. N. Goenka there is a custom of showing videos of autopsy procedures which follows this tradition and in modern South-East Asia monks will still on occasion sit and watch the gradual decomposition of a body over time. This almost clinical analysis of the body’s constituent parts might also be mirrored in the next phase which is to understand how all feelings (vedana) can be understood as falling into one of three types: pleasant, unpleasant and neutral sensations. This three-fold distinction is analogous to what are called the three poisons (dosa) in Buddhism: attraction, aversion and delusion. But remember the Sanskrit term for a humour, which is also dosa, and it will be apparent there is another connection here. Whether an exact correspondence is to be drawn is not explicit. 13 Kenneth Zysk, Asceticism and Healing in Ancient India, Oxford: Oxford University Press, 1991, p. 34.

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peter g. friedlander Table 1 The Humours, Poisons and Sensations

Humour (dosa)

Poison (dosa)

Sensation (Vedanā)

plegm (kapha) bile (pita) wind (vāta)

attraction (rāga) aversion (dosa) illusion (moha)

pleasant (sukkhā) unpleasant (dukkhā) neutral (adukkha-masukhā)

It is notable that the words for humour, poison and aversion are all dosa. However, dosa, in the sense of aversion, comes from the Sanskrit dveṣa, whilst the senses of poison and humour come from Sanskrit dosa itself. English translations for the poisons vary. They may appear as infatuation, greed and delusion, amongst other terms. The meditation then moves onto the analysis of mental phenomena. One important set of mental objects are the five aggregates (khandha): material form (rūpa), feeling (vedanā), perception (saññā), formation (sankhārā) and consciousness (viññāṇa). Unfortunately the translation of the term khandha is not a straightforward one, and the term aggregate is often used, but is perhaps misleading. Richard Gombrich has suggested that it should rather be understood as having derived from the term used to describe the bundles of twigs which were used on Vedic sacrificial fires, and, in a sense, these are the five fuels. The Blessed One said, ‘Now what, monks, are the five aggregates? Whatever form is past, future, or present; internal or external; blatant or subtle; common or sublime; far or near: that is called the aggregate of form. Whatever feeling is past, future, or present; internal or external; blatant or subtle; common or sublime; far or near: that is called the aggregate of feeling. Whatever perception is past, future, or present; internal or external; blatant or subtle; common or sublime; far or near: that is called the aggregate of perception. Whatever (mental) fabrications are past, future, or present; internal or external; blatant or subtle; common or sublime; far or near: those are called the aggregate of fabrications. Whatever consciousness is past, future, or present; internal or external; blatant or subtle; common or sublime; far or near: that is called the aggregate of consciousness’.14

This lengthy quote is, I hope, useful to include here, as the khandha is an important concept to understand. Here it is also very relevant to us 14 Bhikkhu Thanissaro [trans.], ‘Samyutta Nikaya XXII.48’, in John Bullitt (ed.), Access to Insight, Somerville MA, 2006, viewed 9 January 2007, http://www.accesstoinsight .org/canon/samyutta/sn22-048.html.

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as it points to the idea that there is no individual. The body is the rūpa khandha, and together with the other four khandhas makes up what in conventional thought is thought to be an individual. This points us then towards one of the fundamental teachings of Buddhism, the doctrine of anatta, that there is no ultimate ‘self ’ but only the combination of the khandhas working together, which we mistakenly perceive to be an individual consciousness in an individual body. But, as we are considering here the relationship of the body to the world, perhaps the relevant point here to consider is simply this, ultimately in Buddhism there is no self, so there is no body as separate from the world, the body and the world are interdependent co-arisen phenomena. Loving-Kindness meditation (metta-bhavanā) Another set of developmental meditation practices, often now called Loving-Kindness meditations, were aimed at transforming the inner and outer worlds. They are often practiced along with Insight meditation as many teachers say that it is only once the mind is focused and clear from Insight meditation practice that Loving-Kindness meditation can meaningfully be performed. This practice is described in a number of Suttas in the Pali Canon including the Metta Sutta of the Sutta-Nipata.15 Loving-kindness (metta) is one of four boundless states which can be developed along with the states of compassion (karuna) sympathetic joy (mudita) and equanimity (upekha). However, meditation on LovingKindness is often done as an independent practice separate from the other three divine abidings. There are a variety of methods all starting with centering yourself in your body. In one method the basis is focusing on thoughts of wellwishing towards individual people, starting with figures such as one’s teacher and family then moving on to others including both loved ones and your enemies: May [such and such a person] be free from hostility, free from affliction, free from distress; may s/he live happily.16

15

H. Saddhatissa, The Sutta-Nipāta, London: Curzon Press, 1994, pp. 15–6. Buddharakkhita, Metta: The Philosophy and Practice of Universal Love, Kandy: (The Wheel Publication no. 365/366) Buddhist Publication Society, 1989, p. 25. 16

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A second technique aims to develop similar feelings of well-wishing directed at suffusing the directions. It is sometimes said to be suitable for practice after the development of metta to individuals as described above. Buddharakkhita, a modern Buddhist teacher, describes it in this way: Imagine the people residing in your house as forming an aggregate, then embrace all of them within your heart, radiating the metta thoughts: May all those dwelling in this house be free from hostility, free from affliction, free from distress; may they live happily’. Having visualized one’s own house in this manner, one must now visualize the next house, and all its residents, and then the next house, and the next, and so on, until all the houses in that street are similarly covered by all-embracing loving-kindness. Now the meditator should take up the next street, and the next, until the entire neighbourhood or village is covered . . . You should then extend your thoughts gradually outward, from your village or town, to your province to your country and then the whole world and the universe. Thinking about each focus of meditation you should contemplate ideas like these. May everyone in this great land abide in peace and well-being! May there be no war, no strife, no misfortune, no maladies! Radiant with friendliness and good fortune, with compassion and wisdom, may all those in this great country enjoy peace and plenty.17

A third technique is to visualise yourself projecting loving kindness in all of the traditional ten directions of Indic thought: One should now project into the vastness of space powerful beams of metta towards all beings living in other realms, first in the four cardinal directions east, south, west and north-then in the intermediary directionsnortheast, southeast, southwest, northwest—and then above and below, covering all the ten directions with abundant and measureless thoughts of universal love.18

Clearly, one of the interesting features of this in the context of this discussion is that this is a body-based practice; it starts from contemplation of your own body, but then develops to encompass the concept of well being for family, society, nations, the world and the universe. In older Pali texts the basic formula for silent inner recitation is sometimes given as: May they be free from hostility. (avera hontu) May they be free from affliction. (abyapajjha hontu) 17 18

Ibid., p. 31. Ibid., pp. 31–33.

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May they be free from distress. (anigha hontu) May they live happily. (sukhi attanam pariharantu)

It is also worth considering the advantages which practicing LovingKindness meditation is said to confer. In Aṇguttara Nikāya (11:16) the Buddha taught that there are eleven advantages of Loving-Kindness: If, O monks, the liberation of mind by loving-kindness is developed and cultivated, frequently practiced, made one’s vehicle and foundation, firmly established, consolidated and properly undertaken, eleven blessings may be expected. What eleven? One sleeps peacefully; one sees no bad dreams; one is dear to human beings; one is dear to non-human beings; one will be protected by devas; fire, poison and weapons cannot injure one; one’s mind becomes easily concentrated; one’s facial complexion will be serene; one will die unconfused; and if one does not penetrate higher, one will be reborn in the Brahma-world.19

Seven of these advantages are easy for modern Western people to relate to: going to sleep easily, waking up easily, having no bad dreams, being dear to human beings, dear to non-human beings (misunderstood in the sense of animals, etc.), easily able to concentrate, having a serene complexion and dying unconfused. Indeed many of these seem to be health-related benefits. Three are a bit more difficult to relate to. That one will be reborn in the Brahma-world does not make much sense if one does not believe in the Brahma-world. That one will not be injured by fire, poison and weapons sounds very unlikely indeed, and that devas will protect one sounds very hard to credit. To get round this, one strategy is to reinterpret the meanings in a modern context: rebirth in the Brahma-world could be regarded as a synonym for being in a peaceful state of mind, not being injured by weapons as not getting into situations where you might be injured and that the devas (gods) will protect you as that you will be lucky. However, to do this ignores the reality of these benefits for Buddhists during most of history for whom these advantages seemed to have been as reasonable as the advantages modern people easily accept. In this context, it is also interesting that the benefits of LovingKindness meditation include not only personal bodily and mental benefits for the practitioner but also that they aim to produce circumstances 19 Nyanaponika and Bodhi [translators], Numerical Discourses of The Buddha, New Delhi: Vistar Publications, 2000, p. 273.

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conducive to universal well being in the wider community and world. I argue that this supports the central argument of this paper, the practice of meditation is seen in Theravada Buddhism in south-east Asia as being not only beneficial to the individual’s body but to the body of the community. The practice of morality (sīla) There is a tendency in the west to regard Buddhism as a world renouncing tradition which does not value the body or the world and seeks only liberation from existence. However, this is not at all correct. Buddhist tradition has always had aspects which were to do with renunciation and aspects which focused on life in the world. The combination of the practices of Insight meditation and LovingKindness meditation helps to create a situation in which conditions in the world were developed that matched the balanced body and mind developed through the practice of Insight meditation. An important indication of how Buddhists have generated completely positive images of how the body can interact with the world is found in contemplation of the Buddha himself. A popular form of devotional activity is to recall how the Buddha overcame various physical obstacles during his life and in all of these the body of the Buddha himself is seen as the vehicle through which the dhamma is made manifest. Indeed, there is a teaching that ‘he who sees me sees the dhamma’. In other words, the physical body of the Buddha is synonymous with the dhamma itself and you cannot separate one from the other. In this light you may also wish to consider the common formula for daily recitation which pays honour to the three objects of veneration: I salute all the shrines (cetiya), which stand in all places. Bodily relics (sārirīka dhātu), the Bodhi tree and all Buddha images.20

Here, in paying homage to the body of the Buddha, made manifest as his relics, we are also paying homage to the dhamma itself. It might also not be inappropriate to mention that the worship of the relics of the Buddha has three parts, worship of the sites he visited, things he touched and relics of his body itself. This is yet another sense in which

20 K. Dhammananda, Daily Buddhist Devotions, Kuala Lumpur: Buddhist Missionary Society, 1993, p. 67.

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in Buddhism the body and the world are linked, as his body is now spread out throughout the world in the form of relics. Contemporary lay Buddhists often speak of Buddhism as being founded on three tenets: alms (dāna), morality (sīla) and wisdom (paññā). I would like to consider ways in which the practice of morality (sīla) has been put into practice beyond the sphere of everyday morality. The first example is of Aryiratne, a Sri Lankan who organised a program for universal uplift (sarvodaya). Ariyaratne re-interpreted the four Divine-Abidings and understood Loving-Kindness as meaning ‘respect for life’ and karuna as ‘compassionate action’. He based his practice on the idea that people could interpret the values of morality to include making voluntary gifts of labour (sramadāna) for the benefit of the community.21 The second example is that of Sulak Sivaraksa, a Thai social activist, who argued for a radical social reinterpretation of the virtues of the pañca sīla.22 The pañca sīla are the five precepts which Buddhists take before undertaking an activity like a meditation retreat. The first precept is to refrain from killing. Sulak argued that this would imply on a social level to avoid taking part in activities which led to killing: In industrial society, meat is treated as another product. Is the mass production of meat respectful of the lives of animals?23

The second precept is to not take that which is not freely given. Here Sulak makes a radical step and argues that, as international capitalism leads to the exploitation of one country by another, we should not take part in a consumer culture which sources products from exploited peoples in the developing world. He comments: People should be encouraged to study and comment on the ‘New World Order’ from a Buddhist perspective, examining appropriate and inappropriate development models, right and wrong consumption, just and unjust marketing, reasonable use and degradation of natural resources, and the ways to cure our world’s ills.24

21 George D. Bond, ‘A. T. Ariyaratne and the Sarvodaya Shramadana movement’, in Christopher S. Queen and Sallie B. King (eds.), Engaged Buddhism: Buddhist Liberation Movements, New York: State University of New York Press, 1996, p. 127. 22 Sulak Sivaraksa, Seeds of Peace, Berkeley: Parallax Press, 1992. 23 Ibid., p. 74. 24 Ibid.

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I won’t look here at Sulak’s interpretations of the remaining three precepts, to not speak untruthfully, to abstain from harmful sexual conduct and to not take intoxicating substances and cloud the mind. What I would like to do is briefly mention that the precepts often have bearing on other aspects of ethics which are very much in the minds of many Buddhists nowadays. How should Buddhists respond to issues like euthanasia, abortion, cloning, in-vitro fertilisation treatments, contraception and other issues which involve in one way or another harming life? I would like to make two points. First, at a gathering in Melbourne in the late 1990s when asked for a Buddhist view on contraception, the Buddhist monk Ven. Wujiro replied that ‘As Buddhists we are not interested in birth control, but in re-birth control’. This, I think, is actually a serious comment as well as being funny. After all, in Buddhism the issue is not just how things affect this life, but their implications on a broader level about people and their existence in future lives. Second, Damien Keown and Peter Harvey and a number of other Western academics have been involved over the last few decades in fostering a debate on these difficult topics. In a recent work on Buddhist ethics Keown also points to a central difficulty in this discussion, can there be such a thing as the ‘Buddhist view?’ He proposes that, despite the wide diversity of opinions and traditions, it may be possible to work out some consensus views. In a recent book he suggests Buddhist views on ethics should be judged by various criteria. First, by whether the views are found in canonical texts. Second, whether they are found in commentaries. Third, whether the views are contradicted in the sources. Fourth, whether they are found in Mahāyāna and non-Mahāyāna sources. Fifth, ‘confirmation that the view has a broad cultural base’, and sixth, that it has been held over time.25 In 2005, Pema Chodron published a modern commentary on Shantideva’s eighth century Buddhist text, ‘The way of the Bodhisattva’. In parts of this text there are extensive discussions of how a Bodhisattva might regard their own body. A Bodhisattva is one who develops bodhicitta, ‘awakened heart’, and vows to continue existing in the phenomenal world in order to help all beings attain liberation, until all beings attain liberation. In regard then to the true value of the body,

25

Damien Keown, Buddhist Ethics, Oxford: Oxford University Press, 2005, p. 37.

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she says that the following verse contains ‘without question, the main point’: Regard your body as a vessel, A simple boat for going here and there. Make of it a wish-fulfilling gem To bring about the benefit of beings.26

I would agree that this is indeed a cardinal teaching in Buddhism, the true value of the body is that it makes it possible to benefit beings, both oneself and others in the world. Finally, I would like to turn to the ways in which the Vietnamese monk Thich Nhat Hanh through fostering lay Buddhist came to be regarded as the founder of Engaged Buddhism. Developing out of his personal involvement in the anti war movement in his homeland, Thich Nhat Hanh developed the idea that lay Buddhists themselves were capable of taking action to improve social conditions in the world, to campaign against war, poverty, exploitation and environmental destruction. One of the striking features of Engaged Buddhism is that it has become a form of global Buddhist movement in which Asians living in Asia and in the west, and westerners in the west and in Asia, interact. A recent collection of essays has been published entitled Mindful Politics in which the authors argue that what is needed now is an active engagement in politics. In the words of its editor, Melvin McLeod: Buddhism is unique in its range of meditation practices that can transform the way we live together, which is to say, the way we live politically.27

A recent edition of the Buddhist journal the Shambhala Sun also focuses on the issue of mindful politics and the lead article is ‘Who does God vote for? Seeking an Alternative to the Christian Right’. Boyce points to the issue of how Buddhists are now going to have to articulate a response to the Christian right lobby on issues related to the body and the world mentioned above.28 I would like to conclude this section by drawing attention to what another prominent Western Buddhist teacher, Joseph Goldstein, has

26

Pema Chodron, No Time to Lose, Boston and London: Shambhala, 2005, p.

141. 27

Melvin McLeod (ed.), Mindful Politics: A Buddhist Guide to Making the World a Better Place, Boston: Wisdom Publications, 2006, p. 11. 28 B. Boyce, ‘Who does God vote for? Seeking an alternative to the Christian Right,’ Shambhala Sun, vol. 15, no. 1, 2006.

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said on this topic. In his 2002 publication One Dharma: The Emerging Western Buddhism, he highlighted the centrality of the Bodhisattva ideal in the emergence of Engaged Buddhism but also provided a perspective which shows how modern western Buddhists are seeking to understand the relationship of Buddhist and western traditions: This movement draws strength both from the Buddhist teachings on bodhicitta, which remind us that the practice is not for ourselves alone but for the welfare and happiness of all beings, and from the deep wellsprings of social action found in the Western Judeo-Christian tradition. Compassion and care for the world now provide common ground in the many inter-religious dialogues now taking place.29

Conclusion The outcome of this understanding of the body and the world in contemporary Buddhist practice in Asia and the west is, I argue, profound. The Buddhist tradition is able to articulate a relationship between an individual’s investigation of their own mind and body and communal Buddhist activity related to social and environmental engagement. Indeed, it is only through work on ourselves that we are able to work to help others. I have heard a number of monks and other Buddhist teachers suggest that the situation is not perhaps that different from that on a flight where you are asked to put your own air mask on before helping others. I would also argue there is an important difference between the Abrahamanic traditions and Buddhism in their attitudes to the body. For Buddhists, the body is not ultimately something which in any sense is wrong and that we need to feel guilty about. The body is simply part of the world, and like all things in the world, it is a conditioned phenomena which arises due to dependent origination like all other phenomena. This understanding of the body and the world as consisting of mutually dependent phenomena has contributed, I think, to the growth of Engaged Buddhism and contemporary Buddhist interaction with social and environmental movements.

29 Joseph Goldstein, One Dharma: The Emerging Western Buddhism, San Francisco: HarperSanFrancisco, 2002, p. 193.

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In conclusion, many of us may feel that the world today is embroiled in a clash between different religions as much as between political dogmas. I would argue therefore that it is vital for us to consider what contribution Buddhist views concerning the body and the world can make to the cross-cultural debates which we must now address.

CHAPTER FOUR

SUBTLE ANATOMY: THE BIO-METAPHYSICS OF ALTERNATIVE THERAPIES Jay Johnston The physical body of flesh, viscera and membrane is not the only ‘body’ towards which alternative therapies focus their intervention. There is another body—the subtle body—common to many types of alternative therapies that is understood to be the locus where healing takes place. Although subtle bodies are variously conceptualised (informed by diverse religious and spiritual traditions) in general this ‘body’ is understood to be ontologically energetic, nebulous and invisible. Such subtle anatomy is ‘worked with’ by spiritual healers, energetic healers, herbalists, traditional Chinese medical practitioners, medical intuitives, Reiki healers, Tai Chi and Yoga practitioners to name but a few of the healing modalities which utilise various subtle body schemas in their treatments. This chapter’s specific focus will be on considering the subtle body as an embodied interface between the metaphysical and the physical: as bio-metaphysical. Elsewhere I have considered the philosophical— especially ontological and ethical—ramifications of the subtle body as a model of subjectivity.1 Subtle bodies blur clear boundaries between ‘matter’ and ‘spirit’, and indeed their very conceptualisation can be understood as disrupting the type of binary logic that sharply distinguishes the physical from metaphysical, matter from spirit, the self from concepts of the divine, I from Other. In exploring the role of the subtle body as bio-metaphysical, two forms of subtle anatomy will be considered: firstly, subtle bodies as found in spiritual healing, especially those practices informed by Spiritualism, and secondly, the networks

1

See Jay Johnston and Ruth Barcan, ‘Subtle transformations: Imagining the body in alternative health practices’, International Journal of Cultural Studies, vol. 9, no. 1, 2006, pp. 25–44; and Jay Johnston, Angels of Desire: Esoteric Bodies, Aesthetics and Ethics, London: Equinox, 2008.

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of energetic meridians in traditional Chinese medicine, especially as utilised in acupuncture treatments. Known by many names, for example, subtle body, esoteric anatomy, sidereal body, etheric body, suksma sharira, concepts of the subtle body exist in various forms in eastern, western and Esoteric philosophical and religious traditions. Broadly considered, subtle bodies can be divided into two types. The first is as a series of energetic sheaths or ‘bodies’ which extend beyond the physical body and interpenetrate and exceed each other (and the physical body). This is the type of subtle body found in Spiritualist and modern Theosophical traditions. The second type is that of esoteric anatomy, wherein individual organs have energetic subtle matter counterparts and/or the body has an internal series of pathways along which subtle energy travels, as in traditional Chinese medicine. Of course, both types of subtle anatomy can exist together, as in Yoga and Tantra versions. The type of subtle body ‘used’ by spiritual healers has its source in both the adaptation of Hindu and Buddhist concepts of subtle bodies by the Modern Theosophical Society, which have been carried into New Age beliefs and practices2 and also, the already existing models of the subtle body in the west, for example the sidereal (or star) body of fifteenth century physician Paracelsus.3 The subtle body in Theosophical accounts is a series of energetic sheaths that extend beyond the physical body (and are roughly the same form as the physical body). Each ‘body’ is presented as being comprised of both matter and consciousness (or spirit) to various degrees. That is, these subtle bodies are neither thought to be purely metaphysical or purely physical, but

2 See Wouter J. Hanegraaff, New Age Religion and Western Culture: Esotericism in the Mirror of Secular Thought, Albany: State University of New York, 1998; and Paul Heelas, The New Age Movement: The Celebration of the Self and the Sacralization of Modernity, Oxford: Blackwell, 1996. 3 Paracelsus (Theophrastus Bombast von Hohenheim), c. 1494–1541, proposed in Opus Paragranum (1531) four pillars of medicine: Astronomia, Philosophia, Alchimia and Virtus (the physicians). Paracelsus believed that celestial bodies could effect the physical body and were a significant cause of disease. In addition, he proposed the human to be comprised of two bodies, one the visible body of matter, the other the invisible body, which was intimately related to the stars. Udo Benzenhöfer and Urs Leo Gantenbein, ‘Paracelsus’, in Wouter J. Hanegraaff, Antoine Faivre, Roelef Van Den Broek and Jean-Pierre Brach (eds.), Dictionary of Gnosis and Western Esotericism, Leiden and Boston: Brill, 2006, pp. 922–31. See also: Heinrich Schipperges, ‘Paracelsus and his followers,’ in Antoine Faivre and Jacob Needleman (eds.), Modern Esoteric Spirituality: World Spirituality An Encyclopedic History of the Religious Quest, vol. 21, New York: Crossroad, 1995, pp. 154–85.

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an amalgamation of both. However, the subtle bodies are arranged in a hierarchy based upon degree of ‘spirit’ content: the more ‘spirit’ the more ephemeral and refined that particular subtle body (and the further it is understood to extend beyond the physical body). The number of sheaths or bodies vary, however, in popular New Age and alternative medical practices, the presentation of seven bodies is common, with the ‘lower’ three bodies of central significance. In Theosophical nomenclature these are called: physical, etheric and astral. It is these three bodies which are the most common focus for healing.4 In this schema, the physical body is considered the densest subtle body, comprised of the greatest matter content and the least spirit content, following which is the etheric body, the astral body (strongly linked to the emotions), the mental body (manas), and the intuitive body (buddhic). The following three bodies, termed ‘atmic’, ‘monadic’ and ‘logoic’ in Theosophical schemes, do not figure as strongly as the preceding five in discourses of alternative healing practice. However, they are often associated with the Yogic chakra network (chakras are conceived as energy cross-points in the subtle body system). Each chakra is closely associated with a particular subtle body. So, for example, the seventh chakra positioned at the top of the head, is often aligned closely with the seventh body; the logoic subtle body as in Theosophical discourse it is presented as drawing its substance primarily from this body. The systems of association between various aspects of this subtle energetic anatomy are quite complex, vary between each tradition and a detailed discussion is beyond the scope of this essay. However, where possible I’ll illustrate associations with specific examples, as the style of thinking behind these associations—the theory of correspondences—is a core epistemological framework for healing practices which utilise this model of the body, as it provides a logic for the healing modalities efficacy. Each of the subtle bodies is intertwined with one another through an energetic network of channels or paths. For example, in a Yogic system, they are called nådi (Sanskrit for ‘channel’ or ‘vein’) and these pathways (of which the number is debated, for example, the thirteenth to fifteenth-century text, Íiva Saμhita, outlines 72,000) carry pråna, or 4

For detailed discussion of the role of individual subtle bodies in the Theosophical schema see Charles W. Leadbeater, Man Visible and Invisible, Wheaton Ill. and London: Theosophical Publishing House, 1969; and Charles W. Leadbeater, The Chakras, Wheaton Ill. and London: Theosophical Publishing House, 1972.

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‘life-energy’ throughout the body.5 The apprehension of these subtle channels and bodies—how one can become conscious of their existence and actively modify them—has in eastern and western esoteric practices been the work of spiritual leaders and healers. Two broad approaches can be identified towards the perception of esoteric anatomy as it has been adapted by New Age religious practices, and in some cases, alternative medicine. The first is that select people are born with ‘gifts’ of highly attuned perceptive capacities and, therefore, they have always been able to perceive subtle bodies. The second broad approach carries more of an influence from Buddhist and Hindu religious practices regarding the cultivation of perception and has as its premise that esoteric anatomy can be apprehended through various types of body-mind training, including, for example, certain types of meditation practice. In this model, perceptual literacy can be developed and extended enabling the eventual apprehension of one’s own and another’s subtle body, through the dominant sense of vision. Touch is also particularly important, especially in spiritual healing practices that developed from Spiritualism, in which practitioners of the modality feel the space around the physical body to discern illness including emotional distress. Before moving on to examine specific healing practices in more detail, it is salient to highlight the more radical refiguring of subjectivity that is proposed by subtle body schemas. In these schemas of the self, the ‘body’ is multiple, comprised of numerous energetic bodies and channels. The self is radically open; these bodies are comprised of (and interconnect with) the wider environment and cosmos in intimate and numerous ways, and, as these bodies are ephemeral and processural, they are beyond ever being known in their entirety. How can one discern the limits of subtle bodies? What happens when they meet another’s subtle body? As each individual is attributed a number of subtle bodies or subtle anatomy networks that link inextricably with others and the environment, issues regarding intersubjectivity are crucial to a consideration of this body model: how is one responsible for bodies that extend far beyond the flesh and that one cannot ‘see’ with the eyes of empirical vision? Such considerations are core to exploring the realms of alter-

5 John Bowker (ed.), The Oxford Dictionary of World Religions, Oxford: Oxford University Press, 1997, pp. 674, 906.

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native health practices (where this model of the body figures strongly) where the intersubjective relations between healer and patient are central to healing efficacy. In considering these intersubjective relations, it is apparent that subtle bodies themselves are comprised of an intersubjective ontological relation: between the physical and metaphysical, and that at an individual level, they can be considered a type of interface between the biological and metaphysical. That is, subtle bodies’ ontological constituents cannot be pulled apart into discrete substances of pure spirit and/or pure matter; the physical and/or metaphysical. The neat dualism of consciousness (spirit) and matter is disrupted. Rather, the physical body and the spirit (or metaphysical agency) are conceived as radically interpenetrating one another in the energetic ‘substance’ of which subtle anatomy and subtle bodies are comprised. It is from this perspective that the subtle body can be understood as an embodied interface between the religious/spiritual and the biological. To illustrate the operation of subtle bodies as bio-metaphysical interfaces two modes of alternative medicine practiced in western culture will be examined: traditional Chinese medicine and spiritual healing. The practice of traditional Chinese medicine in the west can be distinguished by its ‘disciplinary purity’ (for want of a better term), that is, that although considered a form of alternative medicine, it is most usually practiced as a singular medical model that is not combined with other healing modalities as readily as other alternative practices. Where, for example, it is not unusual to find western herbalists that also practice iridology and homeopathy, or reiki healers that are also homeopaths. The travels of Qi The basis of traditional Chinese medicine (TCM) is found in The Yellow Emperor’s Classic of Internal Medicine, Emperor Huangdi (c 2695– 2589) is attributed the authorship of this text. However, the earliest reference to the text is recorded in the Han Dynasty (206BC–25AD) and it is thought that this medical manual—both philosophical (Tao) and practical—is a compendium of numerous authors.6 Its contents 6 Enqin Zhang, Basic Theory of Traditional Chinese Medicine, Shanghai: Publishing House of Shanghai College of Traditional Chinese Medicine, 1990, p. 2; Yanchi Liu, The Essential Book of Traditional Chinese Medicine, vol. 1: Theory, New York:

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cover anatomical descriptions, guidelines for the identification of illness and disease, various types of therapeutic modalities, and extensive philosophical discussion of the ontological constituents of the human body and its interrelation with the wider environment and cosmos.7 The cosmological relations detailed in The Yellow Emperor’s Classic of Internal Medicine (and in the different schools of TCM) are Taoist, and consider the individual human being as a microcosm of the universe. The Tao or Way is the underlying ontological principle: ‘primordial source of order and the guarantor of the stability of all appearance’,8 and an individual’s task is to regulate their behaviour (including physiology) to be in harmony with the Tao. Lao-Tzu’s Taote Ching prescribes ways of achieving such a union.9 Central to this is the development of Te, a mode of understanding, which requires the individual to change and transform themselves both ‘internally’ and ‘exernally’. To this end, physiological cultivation techniques are employed, for example nei-tan (Chinese, ‘inner cinnabar’), or ‘inner alchemy’ practice, advocates breathing or sexual techniques. Such techniques are understood to both effect the physical anatomy and have a purifying effect on the ‘inner self ’. However, the boundaries between inner and outer are not hermetically sealed from one another, rather they are understood to be interrelated. Therefore the inner purity attained will enable the establishment of harmonious external relations: the inner and outer in a relation of mutual effect.10 The philosophical analysis of contemporary scholar Karyn Lai has noted that the concept of the self in Taoist traditions is both interdependent and contextualised: ‘Notions of development, self-fulfilment and meaningful action are embedded in the conceptual framework of interdependence’.11 The subtle anatomy worked with by TCM practitioners is an element of this ‘framework of interdependence’, it is one of the way in which the individual is deeply interconnected with the broader environment.

Columbia University Press, 1988, p. 2; Anonymous, The Yellow Emporer’s Classic of Internal Medicine, Berkeley: University of California Press, 1966, p. 8. 7 Anonymous, The Yellow Emporer’s Classic of Internal Medicine. 8 Bowker (ed.), The Oxford Dictionary of World Religions, p. 951. 9 Ibid., p. 953. 10 Ingrid Fischer-Schreiber, The Shambhala Dictionary of Taoism, Boston: Shambhala, 1996, pp. 106–9. 11 Karyn Lai, Learning from Chinese Philosophies: Ethics of Interdependent and Contextualised Self, Aldershot: Ashgate, 2006 p. 47.

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Linking the individual self and the cosmos is qi (or chi), Chinese for ‘air, vapour, breath, ether, energy; also “temperament, strength, atmosphere”’,12 a life force or vital energy that is thought to be present in all phenomena and to enliven the universe. It is this ‘material’ that comprises subtle body networks. The therapeutic treatments employed by a TCM practitioner, for example acupuncture, aim to regulate, or redirect the travels of qi through the human body. There are understood to be several types of qi: grain qi (from food); protective qi (the energetic field surrounding the physical body); cosmic qi (from breathing) and nutritive qi (from blood). In Taoism, there are two other ‘forces’ in addition to qi which comprise the individual self: jing and shen. Shen is often correlated with spirit and/or consciousness whilst jing is associated with creative processes including conception as well as other ‘basic bodily functions’. Interestingly shen also refers ‘to both the deities that inhabit the universe, which in the Tao-Chiao (religious Taoism) Inner Deity Hygiene School also inhabit the body, and to the “personal spirit” of the individual’.13 For optimum health, an individual must keep the forces of qi, jing and shen in harmony. These three elements link the physical to the metaphysical by way of the subtle anatomy. Indeed, in TCM, the body’s organs are also a part of one’s subtle anatomy: ‘organs are considered energetic, not anatomic’.14 An esoteric anatomy is central to the operations of TCM, even though the individual is not understood to have numerous subtle body sheaths, but rather a network of interconnecting energetic meridians, multiple spirits and multiple types of qi. The TCM healer’s craft is the modulation of this energetic anatomy, to adjust the travels of qi in an individual’s physiognomy (body—mind). An exceptionally intricate system (given only basic exemplification here), TCM is a healing modality (receiving ever increasing acceptance in western societies15) that engages with the physical and ‘spiritual’ constituents of the patient. These are ‘spirits’ broadly conceptualised,

12

Fischer-Schreiber, The Shambhala Dictionary of Taoism, p. 16. Ibid., p. 136. 14 Deidre Pearl and Erika Schillinger, ‘Acupuncture: its use in medicine’, The Western Journal of Medicine, vol. 171, no. 3, 1999, p. 177. 15 ‘Whereas in the early 1880’s, “Chinese Medicine” in the West meant primarily acupuncture practiced by elder doctors from Taiwan . . . Chinese Medicine in the mid90’s means thousands of new young practitioners licensed every year, practitioners who often also have Western credentials in medicine, physical therapy, pharmacy, 13

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spirits that belong to the weather, to internal organs, to another being, to the divine; spirits that can simultaneously inhabit the self and another and the cosmos. Hands of health Spiritual healing is a term that is used very broadly to designate any type of hands-on healing that has, as a foundational premise, the use of ‘energy’ for curing illness. Specifically, it designates energy coming directly from a divine source as the healing agent, and the practitioner considers that they are a ‘channel’ for the distribution of this healing energy.16 The type of spiritual healing discussed herein exists within a specific tradition that has emerged from Spiritualism, and which is still taught within Spiritualist churches today. In the wake of the popular press reports of the Fox sisters ‘rapping’ communication with spirits in 1848 (New York State) Spiritualism developed a popular following. Its popularity has been attributed to many factors, including the appeal that the communication with the departed held for nations grieving from the huge loss of life from WWI, as well as its appeal to the suffragette movement as Spiritualism was—along with Blavatsky and Olcott’s Theosophical Society and Bailey’s Arcane School—a public forum where women could (and still do) take up positions of authority (for example as Reverends in Spiritualist Churches who lead the congregation in a manner similar to mainstream Christian clergy).17 Healing takes place in two ways within Spiritualist churches. Firstly, counselling is received or ‘channelled’ from departed love ones by the Spiritualist medium. This ‘healing’ is both the apparent confirmation naturopathy, or psychotherapy’. Richard Grossinger, Planet Medicine, Berkeley: North Atlantic Books, 1995, p. 336. 16 See for example: Barbara Ann Brennan, Hands of Light: A Guide to Healing Through the Human Energy Field, Toronto: Bantam Books, 1987; William Collinge, Subtle Energy: Awakening the Unseen Forces in Our Lives, New York: Warner Books, 1998. 17 For a discussion of these issues see: Joy Dixon, Divine Feminine: Theosophy and Feminism in England, Baltimore: John Hopkins University Press, 2001; Jenny Hazelgrove, Spiritualism and British Society Between the Wars, Manchester and New York: Manchester University Press, 2000; Jill Roe, Beyond Belief: Theosophy in Australia 1879–1939, Sydney: New South Wales University Press, 1986; Ann Braude, Radical Spirits: Spiritualism an Women’s Rights in Nineteenth Century America, Boston: Beacon Press, 1989.

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of the continuation of life after death—an individual maintains the personality of their living self—and by the specific guidance that they give, for example directions about upcoming events, warnings about health conditions or recommendations for the consumption of medicines and supplements. What is also curious about this practice is that often the medium will—when addressing a congregation—commence trying to find the recipient of the message he/she is ‘receiving’ by describing the physical symptoms of disease. These are symptoms the medium experiences directly but attributes to the spirit with whom they are communicating. These physical symptoms are most often related to the illness that led to the person’s physical world death. The second form of Spiritualist healing practice is called ‘hands on’ healing. This involves an energetic transfer: one individual—the healer—is passing on healing energy to another through their hands. This modality is founded upon concepts of the subtle body. In training, healers are taught to feel the ‘etheric’ body around a particular individual and to discern different type of energy quality: prickly, smooth or jagged. They are also taught to develop psychic forms of vision able to apprehend subtle bodies visually. Crucial to this mode of healing is the intersubjective relation, as one spiritual healer (who had been trained in a Spiritualist church) explained: So the procedure would be that I sit with them and begin connecting intuitively with them. And then I start beginning to focus on their aura and their chakras and the feel and sensing them, and there’s particularly areas of their aura that I would be very drawn to. I start to get maybe feelings and sensations in my own body of what may be going on with them. And so I usually speak to them about what I’ve picked up. And then I lie them down on the healing table and I begin channelling light energy into that part of their energy field . . .18

Like the more mediumistic practice of identifying the spirit ‘speaking’ from the other side, the passing of physical symptoms between patient and healer is a feature of spiritual healing. Underlying this practice is the understanding that this information is accessed via ‘reading’ the subtle body. As in TCM, treatment involves adjusting or changing the subtle body in some way: moving ‘energy’, adding energy, settling energy.

18

Interview with author, 1 March 2005, Leichhardt, New South Wales, Australia.

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Spiritualist forms of healing are quite eclectic (reflecting New Age syncretism in general) in the terminology they use to explain esoteric anatomy; one healer when describing the practice employed terminology from TCM, Yogic traditions and modern Theosophy (western esoteric tradition): There’s a physical very dense part of the body, the part that we tend to see and touch and feel, and then there’s the energetic body, the aura, the energies all around the physical body. The chakras, the meridians . . .19

Again, it is the role of these subtle bodies, the esoteric anatomy, to act as an embodied interface between the physical and metaphysical. Indeed, Spiritualist mediums that take on the physical ailments of a communicating spirit themselves, also act as such an interface. Subtle bodies are located—in a forever mobile manner—as an interface between conceptualisations of spirit and matter. It is not only that they are envisaged (as these examples have hopefully shown) as a type of ‘between-body’, their very ontology proposes that discrete substances are not clearly identifiable. Subtle bodies and energetic anatomy are considered (in the western adaptations popular with New Age and alternative healing practices) as neither comprised solely of ‘matter’ or of ‘consciousness’ or ‘spirit, but of a ‘substance’ that is an admixture of both. Such a conceptualisation disrupts the matter— spirit binary, and draws the biological and metaphysical into an intimate (and essentially unknowable) relationship. It is this very body that is the site of intervention in many alternative healing practices from acupuncture to spiritual healing. Part of this body’s appeal is its very conceptualisation as both ‘of the physical body’ and ‘not of the physical body’. The subtle body enables an understanding of embodiment that is not necessarily tied to corporeality and operates as a dynamic interface—that can through various interventions—be acted upon to elicit healing.

19

Ibid.

CHAPTER FIVE

PIETY, PROLONGEVITY AND PERPETUITY: THE CONSEQUENCES OF LIVING FOREVER Bryan S. Turner And I believe in One Holy Catholic and Apostolic Church; I acknowledge one Baptism for the remission of sins And I look for the resurrection of the Dead, And for the life of the world to come. (Book of Common Prayer)

The argument: the reward-punishment model In traditional societies (by which I mean pre-industrial societies in which religious notions were dominant cultural forms) customary behaviour (‘morals’) had a strong component of psychological and social threat. Good conduct on this earth was rewarded by some form of life after death. By contrast, transgression of customary norms was threatened by eternal punishment, damnation or a miserable and indeterminate existence as a ghost. There was a strong element of resentment in these conformity-reward moral systems—the rich who were proud and haughty would suffer extreme miseries cheered on by the erstwhile poor. This spiritual resentment was expressed in the joke that it is more difficult for a rich man to enter heaven than for a camel to pass through the eye of a needle. The Christian religion added an important dimension to this religio-moral system by developing the theological belief that life after death would be corporeal in some sense. The Book of Common Prayer recognised the resurrection of the dead and the life of the world to come as essential components of Christian faith. The Christian hope is for resurrection in real terms. Christ came to save us from our sins in order to have eternal life, not as a transparent or lonely ghost but as an embodied person. The affirmation at the opening of the Eucharist— ‘This is my body’—points to the centrality of corporeality to Christian faith. There are many aspects of this doctrine, but philosophically it

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rests on the argument that the continuity of a specific soul has to be conscious. It must also be in some way a continuous existence and it has to have a recognisable identity. The unique embodiment of individuals satisfies these criteria provided it is a substantial resurrected body. There were many problems with this belief, for examples, was the foreskin of the circumcised also resurrected when the righteous man arises from the grave? The reward-punishment model of moral conformity was directed initially at subordinate social groups—slaves, peasants or workers. It was essentially an aspect of social control.1 Alongside this system, dominant social classes experimented with medical practices (elixirs of life) to gain immortal life. In the Christian west, the notion was that the human race had declined from the Biblical paradise and, as a result, they were confronted by the limited expectancy of life. The elites believed they could possibly escape such a fate by the discovery of elixirs, but they also recognised that such medical interventions were in some sense the black arts—they were dangerous and these secrets should not be shared with the generality of men. In Chinese traditions, elixirs were also much sought after by the imperial court. The ability to retain semen during intercourse was also held to prolong life and hence these medical practices also produced a set of erotic conventions for good health and prolongevity. The desire to continue life appears to be a basic aspect of human life—not overly subject to cultural, historical or contextual differences. A Mori research inquiry in 2006 into attitudes towards longer life found that four out of ten Britons would forgo sex if they could live to one hundred years. In modern societies (by which I mean post-industrial societies in which religious beliefs have to compete with scientific specifically medical doctrines about life), recent medical advances in therapeutic stem-cell research have led some radical gerontologists to argue that in principle human beings could live forever. While many of these claims are either about the future or are literally fantastic, they do raise interesting questions about the socio-economic and religious implications of ‘life extension’. In this chapter, I am mainly concerned with the moral, psychological and theological implications of the proposition that humans could live for indefinitely long periods, that is, enjoy

1 Nicholas Abercrombie, Stephen Hill and Bryan S. Turner, The Dominant Ideology Thesis, London: Allen and Unwin, 1980.

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the benefits of prolongevity. My argument is that there is in one sense little change from the past. Life extension will be enjoyed by the rich not the poor, and by the north and not the south. Prolongevity, if it is achieved, will also prolong the social divisions of this world. In terms of morality and theology, however, the promise of longer life on this earth breaks the connection between moral behaviour and life expectancy. We do not need to lead morally upstanding lives in order to have a reasonable expectation of continuity. However, good healthy practices—primarily diet and abstinence—may improve our chances. These life style norms (jogging, not smoking, moderate consumption of alcohol, safe sex and so forth) enhance longevity, and in this sense morality has been medicalised. Sin no longer blocks the roads to eternal life, but obesity does. But what about the more fantastic claims of utopian gerontology towards ‘living forever’? In the conclusion of this paper, I want to explore at least one possible aspect of prolongevity, namely the prospect of spiritual boredom and the need to create a new morality, namely a senescent ethic. Much of my chapter draws heavily on the philosophy of Friedrich Nietzsche. The idea that the promise of heaven was in fact a feature of resentment by the poor against the rich has been taken from Nietzsche’s doctrine of ressentiment, but Nietzsche’s philosophy is ultimately optimistic, for example, in his notion of the ‘eternal return’ (the notion of amor fati). People can enjoy self-overcoming only when they can embrace their fate without demanding it have any additional meaning. In Zarathustra, Nietzsche proclaims, ‘To redeem the past and to transform every “it was” into an “I wanted it thus!”—that alone do I call redemption!’2 In other words, life does not serve any other purpose. The experiences of living are not metaphorical stepping stones to a preferred future state of affairs. ‘Living like loving must be its own reward’.3 Something like Nietzsche’s affirmative philosophy of healthy living in which conventional (Christian) morality is a type of disease might be necessary to give some life-affirming quality to mere prolongevity. However, the Nietzschean life affirmation for a life Beyond Good and Evil4 will also have to address a theology of boredom. How

2 Friedrich Nietzsche, Thus Spoke Zarathustra, New York: Penguin, 1969, pp. 161–2. 3 Leslie Paul Thiele, Friedrich Nietzsche and the Politics of the Soul, Princeton: Princeton University Press, 1990, p. 201. 4 Friedrich Nietzsche, Beyond Good and Evil, New York: Penguin, 1972.

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will the elite who live forever cope with the endless repetition of the same without chronic ennui? Is there a medical cure for endless chronic mental fatigue? Can boredom itself become a spiritual condition? While utopian gerontology has been enthusiastically celebrating the prospects of living forever, it has yet to address these moral and psychological problems of fatigue, ennui, boredom, and despair. Although I have sought to address these questions sociologically, I return constantly to a theological framework, precisely because any discussion of interminable boredom has the same quality as any discussion of evil. It appears to demand an answer that goes well beyond the self-imposed limitations of a secular theory of the soul. Defining terms The possibility of ‘living forever’ has recently received a lot of attention partly as a consequence of a realisation of the implications of stem-cell research and related advances in medical science, through the prospects of enhancing life has been a concern of ancient philosophy, both east and west.5 Modern science has clearly brought about a whole new consciousness about age and ageing.6 However, in order to discuss these issues, we need to be clear about terminology. Probably one of the most useful historical accounts of these issues was developed by Gerald Gruman in his ‘A History of Ideas about the Prolongation of Life’.7 Apparently Gruman coined the term ‘prolongevity’ to mean ‘the significant extension of life by human action’.8 In unpacking this definition, he argues that ‘length of life’ or ‘longevity’ has two meanings. The first is simply the number of years the average person may expect to live, and hence if the average age of death in the advanced countries is in the late 1970s, we can refer to this as ‘life expectancy’. The second meaning is ‘life span’ which refers to the longevity of the most longlived human being. In modern times, the life span can reach over a

5 Bryan Appleyard, How to Live Forever or Die Trying. On the New Immortality, New York: Simon and Schuster, 2007. 6 John A. Vincent, ‘Ageing contested: anti-ageing science and the cultural construction of old age’, Sociology, vol. 40, no. 4, 2006, pp. 681–98. 7 Gerald J. Gruman, ‘A history of ideas about the prolongation of life: The evolution of the prolongevity hypotheses to 1800’, Transactions of the American Philosophical Society, vol. 56, no. 9, 1966, pp. 1–10. 8 Ibid., p. 6.

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hundred years, but life span has not in fact changed significantly. By contrast, life expectancy has risen dramatically with improvements in health care, diet and standards of living. What then constitutes a ‘significant’ extension of life? Gruman divides scientific and philosophical opinion into two schools, namely those who believe that a major increase in life span is simply not possible, and those who believe it could be extended either greatly or indefinitely. The optimists include the Marquis de Condorcet (1743–1794) who wrote his famous Sketch for a Historical Picture of the Progress of the Human Mind ,9 which was published posthumously in 1795, William Godwin in 1793, in Enquiry Concerning Political Justice10, and C. A. Stephens in Natural Salvation.11 These were early optimistic proponents of prolongevity. Gruman usefully points out that these radical advocates of prolongevity were fundamentally influenced by a more general belief in (scientific) progress, and, as a result, they were more likely to perceive the shortness of the human life span as socially determined. They were committed to secular progress and were consequently hostile to traditional or religious views of the inherent and unalterable limitations on life. The moderate supporters of ‘prolongevitism’ were typically hygienists such as Luigi Cornaro (1475–1566), whose ‘common-sense’ dietetics in his treatise on sobriety recommended life style changes as the basis of an enhanced life span. The moderate debate is therefore essentially around the idea of prolonging the life span by medical intervention to bring about dramatic and significant increases. Furthermore, the medical goal of prolongevity must be also to reduce the disabilities, suffering and mental disorder that so often accompanies ageing. Modern prolongevitism is quite definitely secular; the means to achieve prolongevity will come from secular bio-medical sciences rather than supernatural means. The discourse of prolongevity is necessarily secular, according to Gruman, because Christian confidence in an after-life has been shaken by the decline of religion as a general framework of belief and practice. Thus, ‘the modern era has been characterised by a marked decline of faith 9 Marie Jean de Condorcet, Sketch for a Historical Picture of the Progress of the Human Mind, New York: Library of Ideas, 1955. 10 William Godwin, Enquiry Concerning Political Justice, and its Influence on Morals and Happiness, Toronto: University of Toronto Press, 1946. 11 Charles Asbury Stephens, Natural Salvation, the Message of Science. Outlining the First Principles of Immortal Life on the Earth, Norway Lake, Me: The Laboratory, 1903.

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in supernatural salvation from death, i.e. immortality and resurrection by divine fiat’.12 Gruman is essentially correct, but in my view the theology of prolongevity will not go away so easily, because the promise of everlasting life in this world raises huge questions about the nature of humanity—questions that in many respects demand a theological answer. Body and soul In traditional societies, death, especially the ubiquitous but unpredictable presence of death in everyday life, was an essential feature of mundane expectations and religious practice. With rampant infectious disease, infantile mortality rates were high and life expectancy at birth was low. In much of northern Europe, the completed fertility of cohorts of women who were born at the start of the nineteenth century was five. The consequence was that women spent most of their lives coping with pregnancy, lactation and rearing their children. In Spain, for example, around one fifth of children born in 1900 died in their first year. With relatively short life expectancy, few children would have grown up to see their grandparents. In demographic terms, the efficiency of reproduction was very low. There is an anthropological argument that emotional attachment to children was not highly developed, because parents had to learn the art of ‘death without weeping’.13 Death, especially rampant and malevolent death, was an inescapable feature of the public domain and this traditional world of dying is often contrasted with the more private, predictable and individualised form of death in modern society.14 In such traditional societies, the presence of death was a routine feature of everyday life and the promise of an afterlife had greater salience and immediacy. Death as an escape from the turbulence of this world was a significant feature of the medieval imaginary. This ever-present threat of death and the promise of life eternal were periodically underscored by plagues, famine and warfare; these were more

12

Gruman, ‘A history of ideas about the prolongation of life’, p. 5. Nancy Scheper-Hughes, Death Without Weeping. The Violence of Everyday Life in Brazil, Berkeley: University of California Press, 1992. 14 Philippe Aries, Western Attitudes towards Death from the Middle Ages to the Present, Baltimore and London: Marion Boyars, 1974. 13

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or less constant features of medieval society. The Black Death created a new type of consciousness of death as an active agent, malevolently destroying human society. The centrality of tragic death to art and theology remained important ingredients of human culture. Reactions to the plague were obviously mixed, but they included a smouldering resentment from the peasantry which may have contributed to political unrest and anti-clericalism in the late fourteenth century. Aware of the danger that society might collapse, the elite poured money into the Church as a key institution in the maintenance of medieval society.15 In more recent times, the prevalence of tuberculosis and the theme of early, tragic death sustained a consciousness of death in the literary imagination of the elite. Throughout the nineteenth century, the scourge of ‘the white death’ focused the minds of the cultural elite in Europe and beyond.16 This aspect of western literary tradition in relation to early death found its epitome in Joseph Severn’s 1821 sketch of ‘Keats on his deathbed’. Given these difficult demographic and social conditions, millenarian and messianic movements were a common feature of traditional societies, promising a new kingdom to compensate for the deprivations of this world. In less dramatic terms, the Christian Church offered the promise of salvation and eternal life—under a range of soteriological doctrines and conditions. We know from the history of western theology that justification can be narrow—the Calvinistic doctrine of a small company of the saved—or broad in the Armenian doctrine of the salvation of all believers. However, the Christian doctrine of heaven and hell recognised a strong connection between moral behaviour in this life and the promise of salvation. The Ten Commandments were an essential feature of Christian ethical teaching in preparing men and women for death and eventual resurrection. In this discussion, I am out of convenience referring primarily to Christianity, but a similar theology of death and justification is shared more or less by Islam and Judaism. By contrast the ancestral worship of many ‘eastern religions’ such as Shinto did not assume a corporeal resurrection on the Day of Judgment and was more concerned to promote filial piety towards ghostly forebears. The concern of the

15

Philip Ziegler, The Black Death, London: Collins, 1969. Thomas Dormandy, The White Death. The History of Tuberculosis, London: The Hambledon Press, 1999. 16

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living was to avoid ‘hungry ghosts’ and haunted households. The need to placate ‘hungry ghosts’ continues to be an integral part of popular Chinese religion, but it is not compatible with Christian notions of ‘the life of the world to come’.17 However, the ‘world religions’ in general developed an ethical discipline for mankind based on personal piety, the reward for which was the promise of some form of salvation and freedom from sin. The Nicene Creed of the First Council of Nicaea in 325 and the First Council of Constantinople in 381 affirmed belief in ‘the life of the world to come’, which was regarded a central article of faith. Although the Nicene Creed has been rejected by many fundamentalist Protestant groups because it is not to be found in the Bible, it is evident that the doctrine of the Resurrection and the promise of eternal life are building blocks of Christian belief. There is no doubt therefore that the moral life of individuals was (at least in official teaching) regulated by the promise of heaven and the threat of damnation. This connection was often dramatically and compelling underscored by artistic imagination. Perhaps the most important was the work of artists such as Hironymous Bosch (1450–1516) whose triptych of The Garden of Earthly Delights (after 1466) portrays hell as a bizarre surrealistic environment of hideous animals and demons. Although Protestantism abandoned such visual representations of hell, Baroque art and architecture from around 1600 to 1760 continued with the visual contrast between the torments of hell and the leisurely, luxurious world of heaven. Such images of punishment and reward remained important in the Catholic world. The doctrine of heaven served, therefore, as an official part of the Church’s teaching on salvation, but it also played an important role in underpinning the Christian view of a moral life. Life in this world was primarily a preparation for the next; it was assumed that this mortal life was typically short and unhappy. Heaven was a reward for thisworldly asceticism and piety, but hell was also a punishment for the worldly and the wealthy. The Sermon on the Mount promised rewards for the lowly and down-trodden of this world and the New Testament criticism of the arrogance of riches was summarised in the graphic image of the camel that cannot pass through the eye of a needle. There is, therefore, another way in which one can read the promise of heaven,

17 Jean DeBernardi, Chinese Popular Religion and Spirit Mediums in Penang Malaysia, Stanford: Stanford University Press, 2006.

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which was brought out in Friedrich Nietzsche’s theory of resentment in On the Genealogy of Morals.18 Because the sermons of Jesus declared that the poor are blessed, heaven can function as an aspect of psychological resentment. In a society characterised by grinding poverty and injustice, the resentment of the lowly expressed through a millenarian doctrine in which the rich will be confined to everlasting punishment. It is the rich who have exploited the poor who will suffer, while the poor but righteous person will enter into heaven. Hell functions not only to reward good behaviour, but as part of a psychologically satisfying resentment of the dominant classes. A modern version of this argument might be detected in the robust pragmatism of William James in the Varieties of Religious Experience where he condemns the ‘sick soul’ for its ‘manufacture of fears and preoccupation with every unwholesome kind of misery’. There is, he declared, ‘something almost obscene about these children of wrath and cravers of a second birth’.19 Genealogy of the elixir of life The promise of eternal life was a central feature of the Nicene Creed and in societies with high mortality rates and short life expectancy belief in an afterworld played a significant role in religious belief and practice. Christianity was itself originally a millenarian religious movement in which the expectation of a Second Coming and resurrection was a dominant religious theme of the early Church. The human body was a recurrent issue in medieval theological works including speculations about the physical survival of the Virgin Mary after death and about how devils possessed the human body. In Christian eschatology, there was a consensus that body and soul could not be separated without damage to human happiness and survival beyond life. Caroline Bynum, in her superb Fragmentation and Redemption, notes that Aquinas, for example, argued that a ‘full person does not exist until body (matter) is restored to its form at the end of time’.20 Of course, the doctrine of physical resurrection raised acute conceptual difficulties 18 Friedrich Nietzsche, On the Genealogy of Morals, New York: Vintage, 1967; Richard Schacht, Nietzsche, London: Routledge and Kegan Paul, 1983. 19 William James, The Varieties of Religious Experience, New York: Longmans, Green and Co., 1922, pp. 162–3. 20 Caroline Walker Bynum, Fragmentation and Redemption. Essays on Gender and the Human Body in Medieval Religion, New York: Zone Books, 1991, p. 228.

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for Christian theologians. Would, for example, the figure nails of an individual all be restored with resurrection? Could a person eaten by a dragon enjoy resurrection? The issue of the resurrected body was not, of course, merely an issue for theologians. It formed the basis of popular religious belief and practice with respect to the relics of saints and their miraculous healing of the laity. In these respects, Christianity has a decisively corporeal cosmology of the world. There is an alternative of course to life after death, namely the secular quest for longevity in this world. The fascination for an elixir of life motivated pre-modern science. Belief in the existence of natural substances or elixirs produced from them that could prolong life was a significant aspect of Chinese medicine at least from the time of the Warring States. Because these substances included mercury, lead and arsenic, many alchemists suffered far early deaths rather than enjoying prolongevity.21 The preparation of these substances was costly, and therefore the alchemists were typically members of the imperial court, providing services to the elite. The occupation of alchemist was thus precarious, since they were often accused of poisoning the emperor and hence were executed by the new incumbent. Needham raises the issue of where longevity could be spent. Confucianism did not have a clear idea of an individual soul and was in any case more interested in promoting social success and mobility in this world. It was reluctant to engage in any debate about personal survival. In orthodox, atheistic Buddhism, the notion of the persistence of the soul in an afterworld was wholly contrary to its teaching. Taoism recognised a range of forms of existence, but after death they simply dispersed. The aim of the medical elixir was to sustain existing life on this earth and to make it more enjoyable. It was, therefore, a distinctively secular medicine of this-worldly prolongevity. The secular quest for life extension in China was not confined to experiments with elixirs. The Chinese notion of matter recognised the fluidity of material existence in which matter can become formless only to later congeal and solidify. From these beliefs, there was the view that human life could be prolonged more or less indefinitely. Longevity (for men) depended on the production of semen and its

21 Joseph Needham, ‘Elixir poisoning in medieval China’, in Clerks and Craftsmen in China and the West: lectures and addresses on the history of science and technology, Cambridge: Cambridge University Press, 1970, pp. 316–39.

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retention in sexual intercourse. Taoist teaching on sexual relations involved correct adherence to appropriate seasons, time and rhythm. These views supported the idea of sexual intercourse as a therapeutic activity in which women supplied the yin components of life. A variety of sexual techniques were developed to prolong sexual intercourse and to delay orgasm thereby promoting longevity.22 In the Christian west, the search for an elixir of life was equally prevalent, at least among the elite. My account here depends heavily on the brilliant analysis of The Pope’s Body by Agostino ParavinciBagliani—originally published in 1994 as Il corpo del Papa.23 He shows how speculation about longevity was an important dimension of medieval theology, especially insofar as the spirituality of the pope was related to questions about the nature of longevity. Medieval popes had remarkably short lives and this fact was often taken as an indication of their profound spirituality. Nevertheless, popes were apparently as keen as the next man to extend life. The vision of paradise in which the incorruptible body was everlasting was an important dimension of utopian thought. The imaginary world of Prester John—a world filled with abundance and wealth— was an object of considerable fascination during the rise of the papacy to supremacy, that is, between the Concordat of Worms in 1122 and the Peace of Venice in 1177. For example, Lothar of Segni (later Innocent 111) wrote a commentary on old age in his De miseria conditionis humane. In this he developed a mythical history in which, at the beginning of time, men lived for over nine hundred years, but with the onset of human decline God, addressing Noah, created a new limit for men of one hundred and twenty years (Gen. 5:3). After which time, human life became shorter until the Psalms declared that the years of our life are merely threescore and ten. Life was characterised by its ‘toil and trouble’. The Flood was a dividing point in human existence in which human decline is measured by the brevity of life. Lothar argued, however, that this brevity was important in squashing human delusions of the prolongation vitae and on this point he agreed fully with the Salerno medical school that the prolongation of life was not possible. 22

Paul U. Unschuld, Medicine in China. A History of Ideas, Berkeley: University of California Press, 1985. 23 Agostino Paravicini-Bagliani, The Pope’s Body, Chicago and London: University of Chicago Press, 2000.

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Thinking about age and ageing in this period was associated with the De retardatione accidentum senectutis—on delaying the misfortunes of old age—a work that was addressed either to the pope or the emperor. This work has occasionally but mistakenly been attributed to Roger Bacon (1214–1294), a Franciscan and leading Aristotelian. The attribution is related to the fact that Aristotle’s On Generation and Decay itself played an important role in western medical doctrines about ageing, including the Salerno school, an important centre for translating Greek and Arabic texts. Salerno thus contributed to the Latinisation of western medicine and produced such texts as the Regimen sanitatis salernitanum which, in verse form, offered useful tips for healthy living (diet, exercise and temperance).24 While the Salerno school had rejected the idea of prolonging life, the De retardatione kept alive in medieval society the possibility of extending life through the discovery of ingredients. Ageing was seen to be an effect of losing two of the humours that compose the human body (heat and moisture) over two other humours (coldness and dryness). The secret of longevity was to discover those ingredients that retained heat and moisture while delaying the negative impact of cold and dry elements. The knowledge required to delay such developments was occult ‘because he who possesses the secret of all their properties sooner or later transgresses the divined law; it follows that only the “wise in speculation” (sapiens in speculatione) and the “expert in the ways of things” (expertus in operatione) can derive “noble and sublime” profit from such substances’.25 The treatise was largely concerned to provide a list of such substances. The principal elements were gold and amber. Paravinci-Bagliani points out some important differences between Roger Bacon’s writings on the prolongation vitae and the De retardatione, resulting in what he calls Bacon’s ‘extraordinarily audacious and coherent “theology of the body”’.26 For Bacon, humans can extend their span of life by drawing upon the empirical knowledge made possible by astronomy, alchemy and optics. In short, longevity does not have to depend on resurrection, but can take place in the here and now. The promise of prolongevity is natural not supernatural. The

24 Roy Porter, The Greatest Benefit to Mankind. A Medical History of Humanity from Antiquity to the Present, London: Harper Collins, 1997. 25 Paravicini-Bagliani, The Pope’s Body, p. 203. 26 Ibid., p. 205.

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experimental sciences which Bacon defended and promoted can repair the defects of human nature that resulted from their expulsion from Paradise with the Fall. Empirical knowledge would assist humans to manage their humoral decay, thereby arresting the apparently inexorable decay and corruption of the mortal body. In this respect, Bacon’s thought was revolutionary. It proposed that through science—in this case alchemy—men could gain control over their own natures and did not need to succumb to mortality, but these thoughts were indeed so radical that the proper understanding of the secrets of life should be reserved to those who have a duty ‘to rule themselves and others’. These secrets should be entrusted to the few to rule over the many, and in particular these secrets should be at the service of the body of the sovereign and the pope. This prolongevist alchemy therefore played an important role in the evolution of western attitudes. It involved a radical view because it assumed that man could achieve power over nature. Bacon’s defence of experimental and empirical science against scholarly speculation was seen by his contemporaries as a revolutionary doctrine. Bacon asserted in his Opus majus that an ‘extension of life’ was possible with the aid of an ‘experimental art’ that could overcome the defects of existing medical knowledge. Morality and the healthy body Bacon’s precocious empiricism and commitment to science against the fruitless speculation of idle clerics provoked great controversy, and Bacon was imprisoned in 1278 in Ancona, partly for his dissemination of Arabic alchemy. His work raised in an acute form the conflict between religious and secular views of the body. There is an important, albeit complex, relationship between the healthy body and the immortal soul. There is apart from anything else an etymological connection between the idea of saving the soul and the health or salus of the body. The verb ‘to salve’ means to heal a wound by an unguent, or in a more extended sense, to heal a person of either disease or sin. The theological notion of the verb ‘to save’ has a similar meaning—to deliver a soul from sin. The verb is related the idea of making something safe and we might be permitted therefore to draw a connection between ‘to comfort’ (that is to fortify), to make safe, and to salve. These interrelated notions therefore usefully bring out the connections between healing the body and healing the soul.

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There is also a connection in Christology in the sense that Jesus is a prophet who exorcises devils, heals the sick and saves their souls. The idea of Jesus as a healer plays an important part in affirming the authenticity of the message of Jesus and hence the New Testament account of his ministry is attentive to his healing powers.27 It is perhaps unsurprising that Christians drew the conclusion that the healthy body was a sign of the healthy soul and that deformity and disability were signs of human sinfulness. The etymology of the idea of malady is useful in pointing to both the presence of disease and the possibility of evil. Christ came to heal sinners and it is ironic that there is in the New Testament the suggestion that Jesus may also have suffered from some debilitating condition when he is admonished—‘heal thyself!’ From these basic assumptions, the view developed that there is a basic connection between the moral life and the healthy life, and in turn that people who conduct themselves properly (in terms of living a ‘clean life’) may expect both to live longer and to enter into heaven having avoided such obvious sins as gluttony and lust. There is, however, a basic theological problem here. If heaven is the desired goal of the Christian soul, why not commit suicide in the anticipation of accelerating entry into paradise? This was in fact an option for Christians in the early Roman Church until it was declared to be a heresy. There is, however, a second version of this problem. It was notoriously the case that popes had very short lives and there was a recognised tradition that popes were only in office for relatively short periods. The solution to this puzzle was to claim that the spirituality of the pope was so intense that his body could not house such charismatic power and that the inclination of the papal soul was to flee to its maker. In later ‘rationalised’ forms of Protestant spirituality however, there developed the doctrine that the Christian soul had a duty of care towards the body. There was, therefore, an idea of stewardship towards the body. We can see this clearly in the pastoral advice of Protestant leaders such as John Wesley. In Greek medicine, diet (diaita or ‘mode of living’) referred to the general conduct and organisation of life, including forms of dress, behaviour and attitudes. In its more restricted sense of a mode of eating, diet was an essential element of the Greek

27 Stevan L. Davies, Jesus the Healer: Possession, Trance and the Origins of Christianity, London: SCM Press, 1995.

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medical regimen. A medical regimen is a set of rules or guidelines imposed upon a client to secure his or her well-being. When the body is conceived as an input-output system, the regimen restores the equilibrium of the body through a regimen of purges, fasting, sweating and diet. Regimen also, of course, has the somewhat antiquated meaning of ‘government’ and is the root of ‘regime’, and ‘regiment’. The diaita was a mode of living set within a particular government of the body by medical practices. We can envisage such regimens occurring along a voluntary/involuntary continuum. Voluntary governments involved a social contract between patient and doctor, whereby, in exchange for the medical fee, the patient contracted into a mode of living to achieve the restoration of health. Like other political contracts, the medical regimen involved a certain loss of autonomy: the regimen works if it is followed. Involuntary regimens may be illustrated by enforced incarceration of the insane or the seclusion of lepers. Regimens imply, therefore, an element of choice and responsibility on the part of patients, but if we take a wider view of the whole process of nourishment of the body we need a more complex model. In medical terminology, a diet is a regimen of the life style of the patient to restore health through a combination of diet, exercise, moderation and relaxation. ‘Diet’ is also in political terminology a government of the state.28 It was relatively obvious therefore to combine the idea of a diet of the body and a government of the state. A similar idea is to be found in Michel Foucault’s theory of governmentality.29 Foucault’s study of celibacy and chastity in the Christian world can be interpreted therefore as an account of ‘virtue ethics’ in which the regulating of the passions is intended to produce a particular self.30 This notion of discipline was thus a significant feature of the history of how diet evolved in relation to both medical science and religious observance. The theory of diet in George Cheyne’s work on The English Malady was adopted by John Wesley as a method of regulating bodies in the Methodist Chapels. Dietetics and religious practice can be seen as forms of pious regulation.

28 Bryan S. Turner, Regulating Bodies: Essays in Medical Sociology, London and New York: Routledge, 1992. 29 Michel Foucault in Graham Burchell, Colin Gordon and Peter Miller (eds.), The Foucault Effect: Studies in Governmentality: With Two Lectures by and An Interview with Michel Foucault, London: Harvester Wheatsheaf, 1991. 30 Michel Foucault, ‘The battle for chastity’, in Ethics: The Essential Works, vol. 1, London: Penguin Press, 1997, pp. 185–97.

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Two important figures in the history of dietetics as contributions to prolongevity were Leonard Lessius (1554–1623), the author of the Hygiasticon, or the Right Course of Preserving Life and Health unto Extreme Old Age, and Luigi Cornaro (1475–1566), the author of Trattato della vita sobria (1558), which was translated by George Herbert in 1634. Diseases are frequently interpreted as manifestations of a deeper malaise in the social structure. Just as cancer is often regarded as a disease of civilisation, so obesity in the sixteenth and seventeenth centuries was regarded as a physical manifestation of the social flabbiness of the social system, especially as it impinged upon the life-style of the rich. The disorders to which Cornaro drew attention were the ‘bad customs’ of the time, namely ‘the first, flattery and ceremoniousness; the second, Lutheranism, which some have most preposterously embraced; the third, intemperance’.31 Cornaro, who was an Italian nobleman from Venice, saw the corruption of Italian cultured society by the Reformation, the falsity of court life and indulgence as leading necessarily to the corruption of the body. The solution to social and physiological pathology was to be sought in the government of the body through diet and discipline. Dieting, especially among the rich, was the main guarantee of health, mental stability and reason. A life founded on temperance and sobriety was the principal defence against the aristocratic affliction of melancholy and the disruptive effects of passion on reason. For Cornaro, therefore, the discipline of diet was formulated within a religious framework as the antidote to the temptations of the flesh. Cornaro and Lessius came to have a long-term significance for the development of a medico-religious discourse concerning the physical, personal and social benefits of dietary management. The combination of leisure and luxury had especially damaging consequences for unmarried women in the gentry class and, while serving women rarely suffered from melancholy, noble women were the principal victims of the English malady. Virginity and nobility both led to idleness and isolation, and hence to melancholy. The cure for this condition was marriage, diet, exercise and religion. When these failed to produce the remedy of unruly desires, physicians such as Robert Burton the author of The Anatomy of Melancholy recommended ‘labour and exercise, strict diet, rigour and threats’.32 The government

31

Luigi Cornaro, Discourses on a Sober and Temperate Life, London, 1833, p. 14. Robert Burton, The Anatomy of Melancholy, London: Chatto and Windus, 1927, p. 273. 32

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of female bodies was thus linked via patriarchy with the government of the household. Since Burton saw a great affinity ‘betwixt a political and economical body’, his dietary was necessarily a political treatise.33 Society presupposed a hierarchy of political control, descending from the state, through the patriarchal household, to the body and desires. Many of Burton’s anxieties and solutions were reproduced in the following century in the dietetics of George Cheyne, who noted that the expansion of trade and the growth of mercantile wealth brought exotic and rich foods into the market place. The result of these civilised luxuries was to ‘provoke the Appetites, Senses and Passions in the most exquisite and voluptuous Appetite’.34 Cheyne’s medical discourses were primarily addressed to the urban, idle rich, who were the most exposed to the moral danger of strong drinks and exotic foods. The sedentarised life of London and Bath provided a sharp contrast with the natural vigour of primitive man: ‘When Mankind was simple, plain, honest and frugal, there were few or no diseases. Temperance, Exercise, Hunting, Labour and industry kept the Juices Sweet and the Soldis brac’d’.35 In order to reduce the destructive impact of affluence on the digestive system, Cheyne recommended, especially for sedentarised merchants and professional men, a strict diet, regular evacuation, exercise on horseback and ‘a Vomit that can work briskly’.36 Cheyne’s dietary regimen was intended to subordinate the passions of the urban rich which had been inflamed by excessive consumption of exotic food and drink. While Cheyne was heavily influenced by Cartesianism and the iatromathematics of the Leiden school of medicine, he regarded diet, exercise and regularity as moral activities which promoted the control of unruly passions. It is, therefore, not surprising that his views were highly congenial to the religious outlook of John Wesley and the early Methodists. Cheyne’s dietary regulation was easily incorporated within the Methodist code of ascetic behaviour and Wesley embraced Cheyne’s medico-morality as the basis of his own Primitive Physick of 1752. Wesley also recommended Cheyne’s Essay of Health and Long Life to his mother in 1724, partly because it was ‘chiefly directed to studious and sedentary persons’. It can thus be argued that the traditional norm of fasting as an ascetic practice within the monastery was

33

Ibid., p. 63. George Cheyne, The English Malady, 1733, p. 49. 35 Ibid., p. 147. 36 George Cheyne, An Essay on Regimen, Together with Five Discourses, Medical, Moral and Philosophical, London, 1740, p. 47. 34

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gradually transformed by the Protestant dietaries of Burton, Cheyne and Wesley into a suitable exercise of regulation for the laity and that the elitist dietetics of Burton eventually reached the working class via the popular views of Wesley and the Methodist chapels. The spread of dietary management into the home was eventually combined with the broader movement of general hygiene for the working-class family under the auspices of the medical profession. It represented a rationalisation and secularisation of food which ceased to be a stimulant of desire and became instead, under scientific dietetics, a condition of efficient labour. The vocabulary of passions, desires and humours was replaced by the discourse of calories and proteins. The dietary requirements of specific categories of people became increasingly detailed and rationalised. Whereas writers like Cheyne used very general classifications, ‘the idle’, ‘the gentry’ and ‘sedentary scholar’—dietetics now came to analyse the requirements of prisoners, workers, pregnant women, the schoolchild and the athlete. Each illness had its specific diet—pulmonary tuberculosis, diabetes, allergic diseases and rheumatism required individualised dietary regimens. Diets become specific to persons individuated by age, class, sex and condition. My argument is, therefore, that dietary disciplines of the body in the nineteenth century became progressively individuated, secularised and rational. With this process, the idea of diet as a control of the soul in the subordination of desire gradually disappeared. Body self and society The sociology of the body has generally attempted to show that the metaphors of good health also apply to social organisation. An effective corporation is thus said to be lean and mean. There are, however, two more fundamental issues to consider. The first is that the orthodox doctrine of the Christian Church involves a belief in the resurrection of the body. In modern theology, after Rudolf Bultman’s program of the de-mythologising of Christian belief, there is probably a tendency to treat ‘resurrection of the body’ as a metaphorical statement about immortality, but, in traditional theology, the resurrection was understood to be a factual statement about the tangible existence of the body as a miracle of the resurrection. Otherwise the resurrection of Christ cannot function as a fundamental confirmation of his divinity. If Christ only metaphorically emerged from the tomb, it is difficult to

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make sense of the faith that is so powerfully manifest in the Gospels. The continuity of a ghostly and immaterial soul is not part of the evangelical faith of the Christian gospel. My second issue is more complex, namely, that the Christian doctrine of physical resurrection is the only guarantee of spiritual continuity. The Christian doctrine assumes not my general or indeterminate salvation, but something very particular, namely that if I am to enter into eternal life, it is eternal existence of a specific person. If it is not this specific form of justification, why would I lead a moral life at all? Religious or spiritual continuity requires some manifestation of the continuity of a specific, historical and unique creature. I assume that the New Testament story of the resurrection of Jesus has this notion of specific identity. The narrative of Christ’s re-appearance in material form is told very graphically in the account of Thomas’s doubt when he put his hands into the wounds of Christ. One cannot hope for a more corporeal account than that, but in order for the wounds to prove Christ’s resurrection, Thomas must recognise Jesus the man by his shape, size and comportment. He has to recognise the embodied Jesus; otherwise how could we be sure that Thomas had not by mistake encountered a wounded person whom he mistakenly thought was Jesus. The doctrine of physical resurrection is necessary to overcome a problem of identity. My continuity after death requires (in some sense) my (more or less) continuous embodiment. The alternative position would entail some belief in a ghostly presence floating inconsistently between this world and the next. Belief in ghosts has never been an aspect of orthodox Christian doctrine. The body, or more specifically embodiment, cannot be divorced from the self, especially from the idea of the self existing over time. Who I am, from a sociological point of view, depends on other people routinely and unambiguously recognise me in social encounters. Persistent misrecognition would lead to confusion, anger and eventually paranoia. It has become fashionable in sociology to ‘deconstruct’ the self, thereby denying its coherence or continuity. In terms of everyday practice, however, it is difficult to see how the fragmentation of the self could be a viable condition of successful interaction. One reason why misrecognition is not a persistent feature of everyday life is that I recognise people by the very facticity of their embodiment. The nexus between body, self and society is sufficiently tight to minimise misrecognition. This phenomenal fact of everyday life is also the condition under which I recognise myself as myself. If my body changed

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uncontrollably over short periods of time—rather like a human chameleon—I would not recognise myself. The same sociological and phenomenological conditions apply to life after death at least in the Christian framework of resurrection. I must be sufficiently embodied continuously to know that I have been resurrected and not somebody else. Sociology of ageing What is the implication of this philosophical discussion? There is in traditional religious systems an important connection between health, longevity, morality and sanctity. In the Christian doctrine of justification, the saints have mastered their bodies and their souls. Christian theology does not in fact create a gulf between moral behaviour, healthy living and life after death. In this respect, it does not recognise any hiatus between ‘the good life’ of the body in this world and resurrection in the next. There is with respect to justification a clear relationship between how we behave towards our bodies in this life and the expectation of life everlasting. This connection could be either based on moral self reflection—I shall get my just rewards for my conduct in this mortal life—or on resentment—the rich and powerful will be punished hereafter. We can express this somewhat complex picture in terms of simple demography. In the majority of traditional societies, a long life was the exception. There was therefore a dramatic relationship between a short life in the secular here and now bracketed by either oblivion or eternity. Of course strict Calvinism said nobody can know whether they are in the Elect, and no ‘good works’ can guarantee immortal bliss. According to Max Weber’s The Protestant Ethic and the Spirit of Capitalism,37 the bleak and brutal picture of Calvinism was modified to suggest that riches were indeed a sign of election. We could re-read the Weberian narrative to suggest that a healthy life (ascetical restraint) resulted in secular longevity and the hope of paradise. It is within this framework that I want to consider the implications of ageing and the possible arrest of ageing by life prolongevity.

37 Max Weber, The Protestant Ethic and The Spirit Of Capitalism, Great Britain: Routledge, 2000.

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It is unclear what causes ageing. Medical interest in ageing goes back at least to writers such as Luigi Cornaro (1464–1566) who in his Discourses on the Temperate Life of 1558 argued that his own longevity was a consequence of temperance, exercise and a good diet. The body’s finite supply of vital spirits could be husbanded by temperate practices of diet and exercise. The idea that ageing is inevitable has been the basic presupposition of gerontology ever since. If ageing is an inevitable process of cellular degeneration, then the question ‘Do we have a right to live forever?’ does not arise, apart from fanciful speculation. It is obviously the case that life expectancy increased dramatically in the late nineteenth and twentieth centuries, but in the second half of the twentieth century it had reached a plateau. If we take men in the United Kingdom, the expectation of life at birth in 1901 was only 45.5 years, but by 1991 this was 73.2 years. However, subsequent demographic data indicate only a modest increase from 75.4 in 2001 to a projected 77.6 by 2020. In conventional gerontology, living forever might in practical terms mean living a full life and achieving the average expectation of longevity. More recently, however, there has been considerable speculation as to whether medical science could reverse this ageing process. Between the 1960s and 1980s the view put forward by biologists was that normal cells had what was known as ‘replicative senescence’, that is normal tissues can only divide a finite number of times before entering a stage of quiescence. Cells were observed in vitro in a process of natural senescence, but eventually experiments in vivo established a distinction between normal and pathological cells in terms of cellular division. Paradoxically, pathological cells appeared to have no such necessary limitation on replication, and therefore a process of ‘immortalisation’ was the distinctive feature of a pathological cell line. Biologists concluded by extrapolation that finite cell division meant that the ageing of whole organisms was inevitable. These laboratory findings supported the view that human life had an intrinsic and predetermined limit, and that it was only through pathological developments that some cells might out survive the otherwise inescapable senescence of cellular life. Ageing was both normal and necessary. This conventional framework of ageing was eventually disrupted by the discovery that human embryonic cells were capable of continuous division in culture and showed no sign of any inevitable replicative crisis or limitation. Certain non-pathological cells (or stem cells) were

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capable of indefinite division, and hence were ‘immortalised’. The cultivation of these cells as an experimental form of life has challenged existing assumptions about the distinctions between the normal and the pathological, and between life and death. Stem-cell research begins to redefine the arena within which the body has reserves of renewable tissue, suggesting that the limits of biological growth are not immutable or inflexible. The body has a surplus of stem cells capable of survival beyond the death of the organism. With these developments in micro-bio-gerontology, the capacity of regenerative medicine to expand the limits of life becomes a plausible prospect of medicine, creating new economic opportunities in the application of life sciences. The theological notion of an afterlife would probably disappear, since most survivors would literally experience eternal life or at least indefinite life on earth. However, if we assume that, while genomic sciences could reduce mortality, it would, at least in the short term, increase morbidity as chronic illness and geriatric diseases increased. Living forever would mean in practice living forever in discomfort that is in a morbid condition. There would, therefore, be increasing psychological problems including depression, ennui and despair as surviving populations discovered new levels of boredom through the endless repetition of the same, resulting periodically in bouts of collective boredom, hysteria, ennui and suicide. The prospect of indefinite life would thus raise an acute Malthusian crisis and make Cornaro’s vision of a healthful long life a living nightmare. These transformations imply an interesting change from early to late modernity. In the early stages of capitalism, the social role of medical science was to improve health care thereby making the working class healthy. The application of medical science was to produce an efficient labour force, but late capitalism does not need a large labour force at full employment, because technology has made labour more efficient. In the new biotechnological environment, disease is no longer a negative force in the economy but on the contrary an aspect of the factors of production. This new biological technology goes to the core of Nietzsche’s views on morality and the ‘overman’. Can biology replace morality by allowing us to live forever, regardless of our behaviour in this world? If medicine can offer a certain cure for such conditions as venereal disease, lung cancer and obesity, would I change my behaviour towards my sexual partners, would I abandon my preference for cigars and chocolate cakes in favour of asceticism? The new medical technologies

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imply that human beings could in principle live forever. If the new biological sciences make possible the idea of living forever, then we can have a life beyond ethics. The Christian idea of an afterlife and the Buddhist quest for release from the karma-rebirth cycle would become problematic obscure beliefs. It is difficult to see how the ethical determinism of Buddhist doctrine could, for example, survive the genetic determinism of modern medical sciences. Technology thereby cuts the relationship between ethics and the bodily regulation of life. If we can live forever through medical technologies, why bother with ethics? .

Conclusion: The theology of prolongevity The utopian aspect of scientific technology declined in the twentieth century as the prospects of nuclear disaster and environmental pollution became dominant aspects of public debate. René Dubois, who coined the expression the ‘mirage of health’, has argued that ‘technological innovations commonly have disastrous secondary effects, many of which are probably unpredictable’.38 This public unease with scientific advance has been reflected in opposition to genetically modified food and in growing awareness of the hitherto unforeseen consequences of global warming. This lack of confidence and trust in science possibly explains the academic success of the concept of risk society as a general explanation of our dilemma.39 In this discussion of technology and the body, I have tried to suggest that current stem-cell research has potentially far greater consequences for society and the status of the human. Such research is difficult to regulate and its medical results appear to be beneficial for the individual. Stem-cell research perfectly illustrates an interesting problem in the idea of rationality. It is rational for me as an individual to want to live forever, even if this means that I shall spend much of my life bedevilled by geriatric disease as I wait for future cures for my contemporary morbidity. One example would be the prevalence of Type 2 diabetes in old age. We could imagine a situation where stem-cell research has cured various forms of heart disease, Parkinson’s disease and high blood pressure, but it has found

38 René Dubois, Of Human Diversity, Worchester: Clarke University Press, 1974, p. 147. 39 Ulrich Beck, Risk Society: Towards a New Modernity, London: Sage, 1992.

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no cure for diabetes. We are living longer but with mounting problems from our (as yet) incurable diabetes. While it may be rational for me as an individual to live forever, this desire to exist whatever the personal costs creates huge problems for the society in which I live. The prospects of living forever are at present remote, and the moral arguments against such a goal are considerable. It is here also that Heidegger’s notion of boredom might become useful. Prolonged life with no purpose will result in a profound boredom when we are trying to kill time, or passing the time by diversions. Heidegger believed however that at the end of this process there was the possibility that one could find an emptiness that would release one from boredom. This development is, with modern technology, an unlikely outcome. If medical technology can in principle make it possible, at least for the affluent west, to live forever, technology will corrode ethics, because there will be little motivation to follow an ethical diet, that is a government of the body. At least religious culture will be undermined by the prospect of an eternal secular life, even if that secular existence is one of boredom and discomfort. At this point, humanity will have progressed well beyond the conventional division between culture and technology, and the division between animality and humans will become meaningless. One pessimistic conclusion would be that while the life span could be extended indefinitely, it would expose human beings to significant mental instability and infirmity. The boredom that would be associated with the endless repetition of life might be intolerable and as people become bored with life as well as bored from life, it is unlikely that psychiatric medicine could discover anti-depressive drugs that could inoculate us against perpetual ennui. The other issues are moral, namely the sheer injustice of the current prospects of prolongevity where both the average African life span and life expectancy have declined significantly against northern hemisphere changes. Can we assume that a new senescent ethics would be developed in response to these dystopian changes? Let us return to Michael Raposa’s Boredom and the Religious Imagination.40 Raposa identifies different levels of boredom: being bored by something or we can be bored by ourselves. In these circumstances, we are forced to ‘spend time’ or ‘kill

40 Michael L. Raposa, Boredom and the Religious Imagination, Charlottesville: University Press of Virginia, 1999.

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time’. It is here that one can see the overwhelming threat of prolongation—how much time can one kill? However, turning to Martin Heidegger’s The Fundamental Concepts of Metaphysics,41 Raposa identifies a deeper level of boredom where the world becomes boring for one in which ‘nothing matters’. In this deep boredom of the world, one can enter a spiritual state of indifference. This spiritual boredom can lead to a transcendence and overcoming, when we are liberated from the particular character of the here-and-now. We are no longer caught up in trivial tedium, but in a more profound boredom that exposes the real nature of existence. But Heidegger’s notion of a revelatory boredom means that we recognise ourselves as beings-towards-death. This notion of a spiritual boredom still requires therefore an end to life which prolongevity seeks to deny.

41 Martin Heidegger, The Fundamental Concepts of Metaphysics, Bloomington: Indiana University Press, 1995.

SECTION II

NEGOTIATING MEDICINE, HEALING AND RELIGIOUS BELIEF

CHAPTER SIX

‘PITY AND ALSO HORROR’: PUBLIC MOURNING, BREAST CANCER, AND A FRENCH QUEEN Thérèse Taylor In 1666, breast cancer claimed a high profile victim. Anne of Austria, Queen Mother of France, died in the royal palace of the Louvre, in Paris. She was surrounded by her extensive household, numerous religious figures, and her son Louis XIV. She had endured months of agony while in the grip of terminal cancer. Breast cancer is often thought of as a disease of the twentieth century, but it does have a long history. In medieval France it was already known by the same title it goes by to this day—cancer du sein. The documents generated by the death of Anne of Austria indicate that breast cancer was widely dreaded. In terms of her physical profile, Anne of Austria was a typical subject for the disease. She was an otherwise healthy woman, and encountered cancer in later life, being sixty five years old when she died. The disease ran its course and progressed from a lump which she alone was aware of, to a suppurating tumour, to a profusion of cancerous growths which infested her back, neck and arm. She underwent repeated surgical treatments which failed to cure her. These are characteristic experiences. Anne of Austria was no different from any other woman with the disease, but her experiences are recorded because she was Queen of France. Her public status caused many observers to write, and publish, accounts of her death and also, it could be argued, the disease itself was such an ordeal that witnesses were motivated to record their emotions. As the environment of the French court was uniformly Catholic, Anne’s illness was extensively represented and interpreted in religious texts, most particularly funeral sermons. Other observers with an interest in her illness were medical writers, and court memoirists. Most historical writing about Anne of Austria concentrates on her earlier years. Historians seem to assume that her illness and death are

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the least significant period of her life. My own research indicates that her death from breast cancer was an event of significance, touching on numerous topics in cultural and social history. The existing historical literature gives no more than a narrative outline of the main events of her terminal illness, and I wish to add to this with an analysis of the funeral sermons.1 The primary sources which relate Anne of Austria’s death give us access to the dark world of the seventeenth-century cancer patient. They describe matters otherwise not spoken of, and give some indications of the presence of cancer both in people’s bodies and minds. The funeral sermons explain, as much as they describe, Anne of Austria’s terminal illness. They inform the reader of the meaning of her death, and illustrate their points with anecdotes about Anne’s exemplary responses to her illness. When they give accounts of the Queen’s words and actions, they immediately state the pious interpretations which constitute their meaning. These interpretations gravitated toward humility, penance, expiation of sin, and resignation before death. Yet any reader is aware that there is another side to the story, and despite the flowing rhetoric of the sermons, themes of despair, protest and unendurable agony can be discerned as alternatives readings of the material. There are also hints of Anne’s individual tactics of coping, which were undertaken by a woman who has the opaque nature of someone who is always observed. Spanish princess—Queen of France Anne (1601–1666) was the daughter of Phillip III of Spain. The Hapsburg dynasty practiced an extraordinary amount of inter-marriage— Anne’s family tree shows only a few ancestors, as she was the offspring

1 Anne of Austria’s breast cancer has not been much discussed in the secondary historical literature. The main sources are: Ruth Kleinman, Anne of Austria: Queen of France, Columbus: Ohio State University Press, 1987, and also her article, ‘Facing cancer in the seventeenth century’, in Ronald H. Fritze et al. (eds.), Reflections on Civilization: A Reader 1600 to the Present, New York: Harper Collins 1990. Claude Pasteur, ‘Les médecins et le sein d’anne d’autriche’, L’Histoire, 1980, pp. 40–5. An account of Anne’s terminal illness is also found in, Marilyn Yalom, History of the Breast, New York: Ballantine Books 1998.

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of many cousins. Inevitably, some Habsburgs suffered from illnesses and insanity, but Anne herself was healthy. Anne, infanta of Spain, was a daughter of the Baroque period, and therefore devout, in a mannered way, cultivated, and part of the European culture of the absolute monarchs. She was married at the age of fourteen to Louis XIII of France. They were incompatible, as Louis showed an aversion to her, and even avoided having sexual relations. Therefore, for years she had no children. In appearance, Anne was described as fair and graceful. She was slender as a young woman, and became fat and voluptuous after the age of forty. This seemed to have been admired—a large body set off the fashions of the era and created a better outline. Even as a widow, she wore elegant black costumes that contrasted her hair and complexion. She loved perfumes, lace trimmed clothes and was known to refuse to wear anything but satin against her skin. Anne combined several qualities of the Spanish aristocracy. In the words of a French historian: ‘she was beautiful, flirtatious and extremely pious’.2 Anne’s favourite place was Val de Grace, an extensive Benedictine abbey which she had built in Paris. It was at Val de Grace that she would retreat to rest from court life, and it was there that she would take advantage of the privacy to conduct a secret correspondence with her Spanish relatives. Her husband’s chief minister, Cardinal Richelieu, spied on her and discovered these secret letters, which caused a considerable scandal in 1637. Despite this, Anne managed to recover her position by finally giving birth to a son—after more than twenty years of marriage. The future King Louis XIV was born in 1638. The great drama of her life was confronting a revolt of the nobility, the Fronde, which plunged France into civil war after her husband’s death. This was a crisis which lasted for years, but was eventually overcome by Anne of Austria and her chief minister Cardinal Mazarin. According to popular rumour, Mazarin was her lover. During the years of the Fronde, pornographic leaflets were circulated, defaming her and Mazarin.3 It is hard to estimate the impact of these representations. They show an obvious hostility and disrespect, but also, there may have been an element of glamour and fascination.

2

Pasteur, ‘Les médecins et le sein d’anne d’autriche’, p. 40. Jeffrey Merrick, ‘The cardinal and the queen: Sexual and political disorders in the Mazarinades’, French Historical Studies, vol. 18, 1994, pp. 667–99. 3

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The fact that Anne of Austria had been a subject of controversy was never really forgotten. The funeral sermons made delicate reference to this. They pointed out that the Queen had lived through a period of torment, in the civil wars, and had been libelled by many, but had shown the Christian virtue of forgiveness. A typical statement is this, by Père Senault, ‘we do not wish to talk about the impure sources of that unhappy conflict’. Having been the victor, he says: ‘She then had more glory in pardoning her enemies than in defeating them’.4 Later, when discussing her way of life, he cites the example of her restraint when she, ‘read a slanderous billet against herself but burnt it with no further comment, and made a sacrifice of her resentment’.5 Throughout all the panegyric literature, there are constant references to Anne of Austria’s ‘forgiveness’ in the face of many trials including ‘libels’. This is a euphemism for the profusion of lurid speculations about her during the Fronde. As a blonde beauty, Anne was famous for attracting all men—except her own husband. The coldness of her marriage was in contrast to her loving relationship to her two sons. She was the subject of endless gossip, and often maligned, but no one in the seventeenth century ever seemed to lose interest in her. Her habit of visiting hospitals and prisons, where she comforted the sick, gave her the reputation of someone who was sensitive to the pain of others.6 There were dozens of Funeral Orations produced upon her death. One is reminded of Lady Diana, Princess of Wales. The people of France appear to have liked her. When she was dying, a Paris doctor commented that the classical authors had said that Herod died of cancer, and that it was a malady for tyrants. ‘But that does not apply to the Queen Mother, who has always been very kind. . .7

4 Oraison Funebre d’Anne Infante d’Espagne, Reine de France, et Mere du Roy. Prononcée en la presence de ses Domestiques dans l’Eglise de S. Eustqche, par le R. P. Jean François Senault, Superieur General de la Congregation de l’Oratoire de IESUS. A Paris, Chez Pierrele Petit. M. DC. LXVI., p. 32. 5 Ibid., p. 37. 6 Ibid., p. 46. 7 Lettre DCLXXIX, á Falconet, 18 Aug 1665. J.-H. Reveilleé-Parise (ed.), Lettres de Gui Patin mouvelle édition augmentée de lettres inédites, Tome 3, Paris chez J.-B. Baillieère, libraire de l’académie royale de médecine, 1846, p. 549.

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Funeral sermons The sermon delivered at the funeral of an important person was often printed and distributed. The profusion of printed sermons about Anne of Austria indicates that there was a market for them. These orisons drew upon the traditions of classical scholarship, rhetoric, and also Christian philosophy. Funeral sermons dwelt on the subject of death, with gloomy relish. Clerics always described the death-bed, and reminded their congregations that their turn would come. Despite the importance of illness in the sermons, the actual malady was of little interest to the speaker. People died from a slow malady, or a sudden malady, or not from any illness at all but simply from the approach of death. The preacher usually mentioned whether they had suffered pain, and whether they had been afraid of death or resigned to it. But the clerics were writing the very opposite of medical texts, and a diagnosis was not important. Thus, M. de Villars, Archeveque de Vienne is reported to have died ‘because an illness gained on him’.8 The Prince of Conde appeared well, but was to die from ‘weakness’. Messire de Villeroy, Archeveque de Lyon, died from ‘the vigour of his pains’.9 The case of Anne of Austria is a most important exception to this general treatment of terminal illness in funeral orations. Her breast cancer is described in unprecedented detail. Almost every funeral oration made the point that she had died from a terrible illness, and had suffered in an extraordinary way. Instead of hurrying through the illness, in order to arrive at a speech about the deathbed, they went on to describe her symptoms, and the state of her body. Some sermons broke even further with convention and spoke the dreaded word ‘cancer’. Even in the twentieth century, it is rare for obituary notices in France to mention cancer. They usually restrict themselves to the statement that it was ‘a long and painful illness’. In Anne of Austria’s case, a digression from the usual pattern was caused by the nature of the disease. It was so distinctive a malady, and its effects were so shocking, that they called forth comment.

8

Sermons de M. Massillon, Évêque de Clermont, Oraisons funébres et profess. religieuses. A Paris, Rue S. Jacques, Chez M. Th. Herissant, 1755, p. 40. These are sermons from the seventeeth century, reprinted in 1755. 9 Ibid., p. 84.

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The Queen Mother’s breast cancer would also have had a particular psychological impact. As mother of the King, in some ways Anne was mother to the nation, and some of the grief expressed at her death might have reflected other personal losses. Anne was attractive, even late in life, and her body had been the subject of admiring gazes, romantic longings, and even pornography. This, obviously, was not mentioned in the funeral sermons, but they do constantly point out her grandeur, her high status and her love of magnificence. When she had to shed her brocade robes and have her diseased breast cut open, it was a shocking reversal of fortune. The funeral sermons for Anne of Austria give significant information about the profile of cancer during this era. We have no means of knowing the incidence of cancer in the population, still less of calculating how many women had breast cancer. But the disease was frequently mentioned in surgical textbooks of the seventeenth century, and the funeral sermons show that it had a presence in public consciousness. It is significant that when the clerics referred to Anne of Austria’s cancer, not even one of them found it necessary to define cancer or to explain that it can attack the breast. Their audience evidently already knew that. These documents also show that breast cancer had shock value, which it would not have had if it had been very prevalent. It was common enough to be recognised, but rare enough to be sensational. Before she became ill, Anne of Austria had seen women with breast cancer, and she in her turn was to be a spectacle for others. The sermons demonstrate that even among clerics who made a practice of attending death beds, the sight of a woman with breast cancer was dreadful and striking. The disturbance which they felt in attending Anne of Austria is reflected in their sermons, which dwell so specifically on her terminal illness. Père Jean François Senault noted that: If ever a Christian had endured extreme pains, and endured them with patience, one must avow that it was our estimable Princess. Because the cancer which God wished to try her with, had all which can render an illness unbearable; it was violent, and attacked the most sensitive parts of the body. Its violence did not prevent it from also being agonisingly slow; for it lasted more than a year, and could have worn away the patience of the most courageous man. It was hideous, and of the number of those afflictions which do not only cause pity, but also horror.10

10

Senault, Oraison Funebre d’Anne Infante d’Espagne, p. 60.

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In this sermon, one finds that the terminal illness is being described in unprecedented detail, and is being given a particular nature. It is not only death which is an actor in this drama—as it is in every funeral sermon—it is death in the form of cancer. Causes and reasoning The illnesses of women were often explained as a punishment for narcissism and conceit. Anne was willing to blame herself for these faults, and her lady in waiting, Mme de Motteville, records that Anne used to sigh and point to her bed and say ‘satin sheets!’, as a rueful comment on the years of self-indulgence which preceded her illness.11 The clerics usually did not ascribe any particular cause to the disease, other than the Divine Will, which has prescribed pain and penance as the fate of humanity. Obviously, it would not have been very tactful for them to say otherwise. A priest preaching before the recently bereaved Louis XIV was not going to say that his mother died because God found her sinfully vain and therefore made her have breast cancer. Nor could anyone in France publish anything detrimental to the dignity of the royal family—that was an offence which carried the death penalty. It is difficult to judge whether the priests were censoring their thoughts on this matter. The constant references to the Book of Job indicate a reliance on the notion of misfortune as striking anyone, at any time, according to the inscrutable will of God. They found it appropriate that Anne herself offered her illness as a penance, but the sermons also show that they found the illness extremely appalling, and this leaves the impression that scarcely anything she did could have merited this fate. In some ways her high status, rather than her actions, could justify the illness, as it confirmed the even higher status of God. One preacher is quoted as having told her that God, ‘asks of your spirit and heart that you humble yourself before him. Sovereigns never please God more than when in that state: believing in Him, loving Him uniquely. . .’12 There was, however, at least one text which stressed the role of luxury and decadence in court life. Sieur Boyer des Roches wrote a 11

Motteville’s memoir cited by Kleinman, ‘Facing cancer’, p. 48. Lachambre quoted by M. Roland, Dictionnaire des caracteres et portraits tirés des oraisons funebres, qui ont paru depuis 1530 jusques en 1777, Paris, 2 vols, Chez Gogué, p. 13. 12

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Paris pamphlet entitled The Public Tears for Anne of Austria. This text was probably commercial and entertaining, like a magazine article. It recorded the great degree of popular mourning at her death, and also spoke at length about the decadence of aristocratic life. In this commemoration of the former Regent, the writer notes that women are not born to rule, because ‘the softness of their pleasures engages them in distractions, and takes them away from the efforts of important affairs’. He suggested that ambition is not the only fall of the great, ‘pleasure is for them the most dangerous pitfall to fear’.13 These aristocrats in their wealth are like delicate fruits which spoil easily: ‘abundance is an invariable mark of dissolution’.14 After a lengthy reflection on the dangers of ‘those two unhappy passions, lust and ambition . . . which lead on to other misfortunes’ he returned to the topic of the Queen Mother. He praised her virtues, but in a peculiar way, saying that she ‘had banned the most odious vices from the court’.15 This leaves the impression that she tolerated minor vices. He also said that her death was a loss for the entire nation, and that the crowds going to the Louvre to pass by her coffin were ‘incredible’ in number.16 At the beginning of his text, he had already noted that in France the monarchy was ‘pure and perfect’.17 That seems to be a disclaimer—and it was very wise of him to put in—because otherwise this text seems to be hinting very strongly that Anne of Austria was a corrupt, pleasure-loving aristocrat. The mentions of dissolution, temptation, and above all the delicate fruit which suddenly rots away, are like a hostile interpretation of breast cancer as a graphic enactment of her flaws. The Public Tears is not a funeral sermon, but it drew on religious and moral rhetoric, as well as sensationalism. It seems to indicate that there was a minority opinion of voyeuristic pleasure at Anne of Austria’s downfall. This would be a natural sentiment, considering her public life. Other printed circulars praised her in vigorous language. Two Carmelite nuns, Sisters Françoise de la Croix and Sister Thérèse de Jesus,

13 Sieur Boyer des Roches, Les larmes publiques á la mort d’Anne d’Austriche, Reyne de France & de Navarre en l’année 1666, Paris, Chez Jean B. Nego, 1666, p. 11. 14 Ibid. 15 Ibid., p. 14. 16 Ibid., p. 19. 17 Ibid., p. 8.

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whose convent had been patronised by Anne of Austria, published a leaflet which proclaimed Anne as someone who lived always at court, and yet belonged to God. According to them, Anne of Austria was ‘good, sincere, humble, mild, friendly, just, generous, charitable, forgiving and knowing no excesses except those of her virtues, forgetful of offences which she never revenged. Thus teaching the world that the greatest trials are benefits when they are received as she did; dying with the tranquility of the martyrs, from a death no less painful, but longer than theirs’.18 Anne could be described as a heroic martyr, or a victim of fate. These types of explanations were favoured, because no one knew what caused cancer. Some physicians thought that Anne could have saved herself by regular purging and bleedings, but few believed them. If there is no human cause for the illness, then it must be the will of God, however inexplicable. One funeral sermon broke with this consensus, and told the people of France that they should feel guilty about her death, because they caused it. Père Fuiron claimed that: The cause of her death, my brothers, is the love she felt for France. For it is certain that the origin of her malady is none other than the great fatigues, which she suffered . . . while she was in charge of the State [i.e. during the Regency]. If her death was not sudden: it is without doubt, that God wanted to add to our obligations in her regard, and make known the extent of her sufferings. If we honour those who die for their country, how much more do we owe to that great Queen who suffered so long, and who had no other cause for her illness and her death than the worries, pains and fatigues which she had suffered for the good of France?19

To our own day, there are observers like Père Fuiron who explain cancer as the long-term result of emotional stress. Definite proof is lacking, but some patients and their carers find this explanation meaningful. Within the seventeenth-century context Père Fuiron is taking a benign version of the explanation that women are not born to rule— 18 Lettre circulair de soeur Françoise de la Croix et de Soeur Thérèse de Jésus, annonçant la mort de la reine Anne d’Autrice, 20 janvier 1666. 19 La Reyen Tres-Crestienne Discours Funebre sur la vie et la mort de tres-Haute, tres-Puissante & tres-Auguste Princesse Anne d’Austriche Reyne de France & de Navarre, Prononcé en L’Elise D. Sauveur à Paris, Par M. Antoine Fuiron, Paris, Chez Jean Couterot, 1666, pp. 35–6.

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such responsibilities can kill them. To a hostile eye, her feminine body was soft and corrupted by the misuse of power. To an admirer, her femininity was expressed through care and worry that wore her away, in a sacrifice of maternal love for the nation. In either case, the cancer has inflicted a spectacular form of retribution for misuse of the body. Her illness Epidemics of various kinds were a leading cause of death. Anne’s own husband, Louis XIII, appears to have died from a fever—perhaps dysentery or typhoid. His was no isolated case. But Anne of Austria was rarely ill, and passed through her fifth decade without any sign that she would need to take to her bed. She was not one of those sovereigns who would flee an area at the first sign of plague. But, as she passed into middle age, Anne showed signs of fearing one particular disease, which was neither common nor contagious—breast cancer. After Anne of Austria’s death, many people commented that she had often said that she hoped that she would never die from breast cancer. She visited hospitals and other places where there were sick people, and was seen to stop in front of someone with cancer and said, ‘Lord, any disease but not that one’.20 ‘She told me’, said Mme de Montville, ‘that having seen cancers in nuns who died all rotted with them, she had always had a horror of this disease which she found so frightful even to imagine . . .’.21 One cleric, in the obituaries, stated that: ‘God did not want that presentiment to be in vain; the illness appeared, and as soon as the Doctors had declared it, she went to that Convent and prostrated herself before the Cross, asking that her pains be in pardon for her sins’.22 Different interpretations might be offered for Anne’s long-standing fear. It could be said that she had a presentiment, which chance or fate proved true, about the nature of her own death. Or, she may have had

20 Oraison funebre prononcee dans l’eglise des augustins du Grand Convent de Paris, au service solemnel fait par l’Assemblée generale du Clergé de France, le 13 Mars 1666 pour la Reyne Mere du Roy. Par Monseigneur Hyacinthe Serrony, Eveque de Mende. A Paris, Chez Antoine Vitré, 1666, p. 24. 21 Quoted in Kleinman, ‘Facing cancer’, p. 40. 22 Serrony, Oraison funebre prononcee dans l’eglise des augustins du Grand Convent de Paris, p. 25.

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some reason to fear breast cancer, or she may have known of cases in her own family. When her breast cancer became known Gui Patin, the Paris doctor, made the relevant observation that her grandfather, Phillip II of Spain, was reputed to have died of cancer.23 We do not know of the exact cause of death of all the Habsburg women. It is above all significant that Mariana, Anne of Austria’s cousin, and Queen Mother of Spain, died of breast cancer on May 16th 1696. She was in the next generation, but closely related to Anne, being a cousin several times over, a niece, and also her sister-in-law—such was their family tree. It is most likely that Anne of Austria’s fears, and presentiments, were no prophecy at all. While she stood at those beds in the infirmary, Anne of Austria was probably already in the early stages of breast cancer. As the sermon noted, death was something which ‘she carried for a long time in her breast’. Anne revealed the breast cancer to members of her household in 1665, and a consultation with medical specialists followed. She had only a year to live. This was evidently an advanced cancer, and she probably knew for a long time that she was very ill. Upon discovering a lump, she may have lived through years of fear and anticipation, waiting to see if it was malignant, and if she had the disease. If she confided in anyone, we do not know of it. At a requiem for Anne, Père Senault commented that: ‘God regards with joy a sick person who hides their malady, regarding it as the chastisement for their sins and as the opportunity for the exercise of virtue, suffering with humility and praising the hand which struck them’.24 This was the established moral standard, and it is probable that Anne of Austria was living up to it, during the silent years of her cancer. Miraculous religion There are patron saints for cancer sufferers, and some are said to have been miraculously healed from the disease. Saint Peregrine (1265–1345) was said to have a cancer eating his leg and foot, however, on the very night before he was to have the limb amputated, he was cured. This miraculous side of Catholicism was not much in evidence for Anne of

23 Reveilleé-Parise (ed.), Lettres de Gui Patin mouvelle édition augmentée de lettres inédites, p. 549. 24 Senault, Oraison Funebre d’Anne Infante d’Espagne, p. 58.

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Austria. She did not seem to visit any shrines, or undertake devotions associated with miracles. Abbé de Fromentieres says specifically that even with so cruel an illness ‘she never asked at all for a cure’.25 The only saint mentioned in the documents pertaining to Anne of Austria was Saint Aldegonde, a seventh-century noble abbess, who died from the disease. Anne asked that relics of Saint Aldegonde be brought to her chapel, and ‘she said as saints have suffered this so must sinners, for the expiation of their sins’.26 The life of St Aldegonde was the subject of several printed texts during Anne’s lifetime, and she may have been aware of these descriptions of breast cancer. They were daunting, rather than consoling. Catholic hagiography is full of stories of sudden and improbable miracles, but the death of St Aldegonde, which took place centuries before, does not appear to have faded into a golden legend. It was reported in the grimmest tones. In order to prepare herself for death, according to the advice of St Suislain her Director, she made a daring request to God: to know if it pleased him according to his divine and paternal bounty to send her some extraordinary malady. No sooner asked for than granted. For suddenly an evil growth established itself in her virginal breast, and began to discolor and distort it with infection, the pain being beyond what you can imagine. All the possible medications were nothing but further torments: because these irons, lancets, cauterisations and ointments only served to raise hope then redouble her sufferings. She did not ask to be cured, nor even soothed, from these ills which she had prayed for so ardently, but asked only that she be faithful to her divine spouse, and that she always have as much courage as illness. Aldegonde’s breast was putrified and fell piece by piece, and her heart which was immediately below smiled with satisfaction, seeing that this suffering was for Jesus, the sole object of all her loves, and she said with St Paul: ‘Whatever ills I suffer, the joy of my soul surpasses by far the martyrdom of this miserable body’.27

Before concluding this triumphant account, the story of St Aldegonde does suddenly make a diversion and says that, however holy one might

25 Oraison Funebre d’Anne d’Austriche, Infante d’Espagne, Reine de France, et Mere du Roi. Abbé de Fromentieres. A Paris, Chez Sebastien Mabre-Cramoisy, 1666, p. 45. 26 Senault, Oraison Funebre d’Anne Infante d’Espagne, pp. 64–5. 27 Les belles morts des fondateurs des religions, Par le R. P. Jean Hanart, A. Douay, Chez Baltazar Bellere, 1649.

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be, we are unwilling to suffer in this world unless God gives us the strength. The author states that: . . . the good Saint found the duration endless, and she asked her Guardian Angel why her devastating sickness lasted so long . . . The angel informs her that this is a favour of God. Favour—she exclaimed, Alas! Alas what sort of favour? Indeed says the Angel, truly a favour and extremely precious . . . This little moments of pain will soon be exchanged for an eternity of incomparable glory.28

It is difficult to say whether this report of St Aldegonde’s complaints about her illness is a rhetorical flourish, or if it is a reflection of source material relating to the biography of this pre-medieval Saint. Other seventeenth-century accounts of St Aldegonde’s life omit these questioning words, they maintain that she was willing to suffer her illness to the end and only wished for more of an ordeal for the sake of penance.29 Père Hanart’s Les belles morts des fondateurs des religions was published in 1649, and several elements in the stories about St Aldegonde are startlingly similar to the accounts of Anne of Austria’s ordeal— especially the medical treatments, which appear anachronistic and more typical of the post-Renaissance era than the seventeenth century. Anne of Austria would have been familiar either with this account, or others similar to it. The miracle which it offers is not a cure from cancer, as is found in the hagiography of St Peregrine. Rather, devout readers are offered the spectacle of a saintly woman courageously overcoming her pain. This was the only miracle on offer for Anne, Queen of France. It is the miracle of acceptance, of wanting one’s fate, or at least, of being able to bear it. By taking an attitude of heroic acceptance, the sufferer can do little for themselves, but they ease some of the stress on their care-givers, who are otherwise obliged to hear unanswerable complaints. The story of St Aldegonde invited Anne of Austria, and every other seventeenthcentury woman who read it, to understand that even the unimaginable burden of breast cancer could be a favour of divine grace. And if the 28

Ibid. This is found in Un frere Capucin de la Province Wallonne, Histoire de la vie, mort et miracles de Saint Aldegonde. Vierge, Fondatrice, Patrõne & premiere Abbesse des nobles Dames Chanoinesses de la Ville de Maubeuge. En Arras. Imprimerie de Guillaume de la Riviere, 1623. 29

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patient is reduced to asking: ‘Alas what sort of favour?’ then at least they should not say so more than once. Words of protest Throughout her illness, Anne managed to make all the right responses, as if she was engaging in a diplomatic conversation, or reciting a prayer ritual. Many people admired her serenity, but there were occasional outbursts, which indicate her conflicts and changing moods as she approached death. On one occasion, Mme de Motteville found a noblewoman leaving Anne’s chamber, apparently having been given leave by the Queen. Anne exclaimed that the Countess de Flex had been talking to her about the Cross: To so Christian a sermon, the Queen Mother in the grip of horrible suffering, but filled with faith, gave the following reply: ‘Ah Madame, do not say anything to me: I feel as if I am about to lose my reason; and in the state I am in, I would not be able to receive what you have to say to me with sufficient respect’.30

Clerics, by contrast, said that in dying she received the impressions of the Cross, which she wished to reign imperiously over her. ‘The painful blows, burdens which she had to suffer, the final fatality, were all means by which she had the grace to suffer with resignation, and which she endured by necessity’. This is ‘the counterstroke of the cross, pain for the body but grace for the soul’.31 This rhetoric drew little response from Anne of Austria. She did not have authority over priests as she did over noblewomen. She did not tell them to stop talking and go away, but neither did she join in this particular form of theology. Anne spoke in terms of faith, resigning herself before the agonising lancing of a tumour with the words, ‘Lord, I offer you this pain: receive it in payment for my sins. I suffer willingly, Oh Lord, for it is as you will’.32 It is a direct and edifying statement. However, one notices that

30 Mme de Motteville, Mémoires de Madame de Mottville, t iv, Paris, Charpentier, 1869, p. 404. 31 Sermons des Vestures, Professions Religieuses, et Oraisons Funebres, M. Jacques Biroat. Predicateur du Roy. A Paris, Chez Edme Covterot, 1671, p. 404. 32 Anne of Austria, cited by Motteville, Mémoires de Madame de Mottville, p. 393.

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she did not elaborate on the theme of the Cross, as others around her seemed to have wanted to do. Her statements of penance and resignation do not have the exultant tones of those who interpreted her illness. Overall, her tone was of fatalism. ‘She said to God, as I have received health from your hands, why not also sickness’.33 During the late seventeenth century, a series of funeral notices of Visitation nuns described fatal breast cancers, and in these texts the wound in the breast, and the process of dying, is elaborately compared to the crucifixion and the lancing of Christ’s side.34 This particular form of religious discourse does not seem to have appealed to Anne. Her words seem to indicate that her prayers were directed to the first person of the Trinity—God the creator, who judged her and subjected her to whatever fate He willed. An emotional identification with the second person of the Trinity—God as the suffering saviour would have been natural, but did not appear in her discourse. It is possible that Anne had no affinity to the idea of substantive suffering, which is the notion that one person can pay for the faults of another. When someone said to her that God was punishing the people through her, she replied: ‘Alas, he only punishes me’.35 Was she being ironic? Serious? Irritable? Resigned? It is difficult to say. We know that her words made an impression, but not exactly what she meant by them. The effort of seeing Anne in such pain must have affected the clerics. One of them tells his audience not to see her ‘with the pale and wounded face of death, but let us stop with reverence, to see her image in the clear fountain of life, and uncover with respect the treasure of her virtues’.36 But then, later in the text, he returns to the subject. He cannot take his own advice, and continues to describe the cruel malady, ‘a devouring cancer’ and the suffering, which cannot be described, ‘the measure of her pains’.37 This type of oscillation is found in the words of other observers. As they recount the event, they advance and retreat, because they are still trying to come to terms with it.

33

Senault, Oraison Funebre d’Anne Infante d’Espagne, p. 62. These texts are described in Jacques Le Brun, ‘Cancer serpit. recherches sur la représentation du cancer dans les biographies spirituelles féminines du Xviie Siècle’, Sciences Sociales et Santé, vol. 2, no. 2, 1984. 35 Biroat, Sermons des Vestures, p. 413. 36 Fuiron, La Reyen Tres-Crestienne Discours Funebre sur la vie et la mort de tresHaute, p. 5. 37 Ibid., p. 36. 34

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Many sermons did try to offer the consolations of the next life. Monseigneur Hyacinthe Serrony, the Bishop of Mende, said that: ‘It seems to me that I can see her now near to that Divine Master, who had so laden her with agonies. It seems to me that I can hear her thanking her Creator for the mercies he showed her, making her enjoy an infinity of blessings in heaven for a small number of ills which she suffered on earth’.38 It is not his fault that this sounds laboured, and that his description of the illness is by contrast vivid: ‘It is not an exaggeration by a speaker to say that she suffered really in her body all the maladies of which one can only have an idea. She experienced all the torments of the martyrs, in the prison of her bed, the razors, the fire and the iron, and all the other instruments of pain and martyrdom which were found in her illness’.39 In this text, the consolations sound very contrived and distant. The torments sound completely real—they are the idea that is actualised. Life as a dying person Anne of Austria’s public life was so total and extensive that the private self was remote. Without protest, she adhered to the formalities of court life, and made every word and move under the gaze of others. Her recorded responses to illness often took the form of replying to the interest of onlookers. To judge by the obituaries, she rarely posed questions, freely communicated with others, or even simply said what she thought. There are only a few instances where she expressed her own wishes about the treatment of her illness, and one finds that her requests were soon set aside. Anne, although revered and respected, was not powerful. As a Queen, she inhabited a role which gave a woman a great deal of celebrity but very few choices. An example of this is that, during her last months, Anne wanted to go and live at Val de Grace, the convent which was her favourite retreat. She did go there, and Madame de Motteville records that on the night she arrived there ‘where she had

38 Serrony, Oraison funebre prononcee dans l’eglise des augustins du Grand Convent de Paris, p. 28. 39 Ibid., p. 26.

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for so long desired to be, she said: ‘Here I am content. May God dispose of me as he wishes’.40 But she could not remain there, as her doctors and ladies in waiting began to complain to the King that the Val de Grace was not a place of easy access for them. They said that the ceremony of opening the grill, in order to enter the convent, took too long. Mme de Motteville suggests that they emphasised this, ‘in the thought that this return [of the Queen] would please the King and the Court’.41 Soon, she was back at the Louvre Palace, a residence which she never preferred. Like many people who are gravely ill, during her last days Anne returned to the beginning of her life, and was speaking Spanish. The courtiers excluded the Spanish priests from her bedroom, in order to force her to speak French, so that everyone could understand her. They did not want to miss her last words. A distinctive feature of the seventeenth century was the lack of privacy around royal persons, whose bodies belonged to the public. In any other era, a woman in Anne of Austria’s position would have been able to hide her breast, and indeed, would have been expected to do so. Breast cancer has always been a ‘hidden disease’. But a Queen of France could not hide any important aspect of her life and death. The clerics who wrote about Anne’s death lauded the humility which she showed before the symptoms of her cancer. They indicated not merely a correct attitude of verbal acceptance, but her actions, which put the diseased state of her body on display. When preaching before members of her household, Père Senault reminded them that one of their mistresses’ virtues had been that she always left herself open to their ‘praiseworthy curiosity’. He addresses her servants as ‘the witnesses of her actions, the confidants of her thoughts, the depositories of her secrets, you knew all the movements of her heart . . .’42 Whether out of devotion, or praiseworthy curiosity, or simply raging curiosity, the household of Anne of Austria needed a great deal of information in order to adjust to her illness. In keeping with her responsiveness, Anne allowed them to see her breast, and examine the signs of advancing cancer. She also did not hide her own eyes from it, but sometimes set up a mirror in order

40 41 42

Motteville, Mémoires de Madame de Mottville, p. 401. Motteville, Mémoires de Madame de Mottville, p. 402. Senault, Oraison Funebre d’Anne Infante d’Espagne, p. 3.

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to examine the advancing tumour. She dryly referred to the tumours as ‘my parents’ and their discharges as ‘my cousins’.43 The fact that Anne was willing to put her body on display was praised in the sermons as a rebuttal of vanity, for instance, her use of the mirror to reflect the approach of death was very different from its usual service by women. The duty to display her illness was taken to an extreme when Anne was subjected to a series of operations by Dr Alliot. This was a public ceremony, and after the court had assembled, Anne was seated upright on a chair, stripped to the waist, and was incised by the surgeon. This caused great agony, and despite her usual stoicism, Anne cried when his razor cut into her live flesh. Mme de Motteville tells us that: That operation was astonishing to witness. It took place morning and evenings, in the presence of all the royal family, the doctors and surgeons, and all the people who had the honour to serve her. She had no doubt much pain to expose her body to the view of so many persons, while the cancer which she carried in her breast did not prevent there being much still to admire.44

It is remarkable that so many people would want to witness the operation, and also that Anne’s unwillingness to be seen did not lead to any consideration of her feelings. The fact that her audience still found the sight of her breasts glamorous, even though she was sixty-five years old and suffering from a disease, is a notable example of her enduring celebrity. When helping Anne to change out of her nightdress, the waiting woman Mme de Motteville found that her back was covered in lumps from the spreading cancer. De Montville said that she only discovered this when she felt her, ‘and I was astonished that she had suffered so painful a progress of the disease without saying anything’.45 Anne’s experience of the disease is locked in this silence. Her symptoms are noted when others notice them, not when she does. The rich and extensive primary sources about her terminal illness are records of Anne being observed, and often of her not expressing her feelings.

43

Ibid., p. 64. Mme de Motteville quoted by, Claude Pasteur, ‘Les medecins et le Sein d’Anne d’Autriche’, p. 44. 45 Motteville, Mémoires de Madame de Mottville, p. 425. 44

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Exhausted by both the illness and the treatments by doctors, Anne of Austria spent her last weeks in bed, still playing her public role, and receiving visitors. She was barely able to talk, and asked the Archbishop of Auch, ‘I suffer a lot. Will I die soon?’46 The orisons tell us that she was able to receive the sacraments, and follow prayers, until her last hours. Like many invalids, she slipped away in the period known by nurses as the ‘dying hour’—the dark period about two hours before dawn. It was between four and five AM of a winter’s day, on the 20 January 1666. Reflections on the past In 1666, Père Antoine Fuiron reassured his congregation that: ‘She is not dead, but entered into eternal life, a pearl lifted from the sea of trouble, into a divine crown. But let us console ourselves about the loss of that illustrious queen, and think no more about her death, rather imitate her life’.47 His own account of her terminal illness suggests it was all too vivid in his mind. One suspects that he did not forget. The final proof of the great shock caused by the demise of Anne of Austria is that, contrary to the usual custom, her death was retold yet again in the Funeral Orations of other royal women. The death of a subsequent French Queen, Marie-Terese, wife of Louis XIV, in 1683, was specifically analysed by comparison with that of Anne of Austria. Jacques Benigne Bossuet, the celebrated clerical writer, reminded people that: France had seen, their days, the wonderful example of two queens of whom the deaths, although in different circumstances, were equally precious before God. Anne, in an age already advanced, and Marie Terese in her vigour, but both with such a good constitution that they seemed to promise the happiness of keeping them for a full age. They were taken contrary to our expectations, one by a long malady, the other by an unexpected blow. Anne was warned from afar by the approach of a disease as cruel as it is incurable, she saw death advance slowly, and in the form which she always judged the most frightful: Marie-Terese was suddenly

46

Anne of Austria quoted Ibid., p. 45. Fuiron, La Reyen Tres-Crestienne Discours Funebre sur la vie et la mort de tresHaute, p. 41. 47

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Bossuet then temporarily abandoned the subject of the funeral oration altogether. Marie-Terese was set aside, in order to recount—yet again—the details of the death of Anne of Austria. He put her breast cancer into a general context by reminding his readers that we are always sick, always dying. What we call the last illness is merely the final form of the sickness which came with our birth. ‘What health conceals from us the death which the Queen carried in her breast?’ He suggested that the long ordeal of cancer might have been providential, because it allows preparation for death: ‘And in what situation would that great Queen have been, with all the majesty which surrounded her, if she had been less prepared?’49 These words are enigmatic. Is Bossuet saying that the great privileges of her rank might justify a great chastisement? There are some suggestions, here, that long after Anne’s death people were able to rationalise its horrors by criticising the dead woman. Her illness could have been a means by which Providence counteracted ‘all the majesty that surrounded her’. This allows for divine justice. Expiation and penance is the traditional Catholic way of reading the meaning of illness. It was an idea present in the original obituaries, and over the subsequent years, it could have become more acceptable and overt. However, if this was the trend in Bossuet’s thinking, he certainly did not state it openly. The sense of mourning, wonder and loss is still present. Bossuet concluded that Anne of Austria ‘is mourned with a love still strong although twenty-three years have passed’.50 This discussion is unexpected. The entire text should have been devoted to Marie-Terese, and it was extremely rare for a funeral sermon to compare one person’s death to that of another. The long passage of time makes it amazing that the oration would mention Anne of Austria at all. But, in 1683, Marie-Térèse was laid to rest amid comparisons with her mother-in-law, which developed at such length that it is Anne of Austria’s illness which becomes the theme of the sermon. 48 Jacques Benigne Bossuet, Oraison funebre de Marie Therese d’Austriche, infante d’Espagne, Reine de France et de Navarre. Prononcee à Saint Denis le premier de Septembre 1683. Paris: Chez Sebastien Mabre Cramoisy, p. 54. 49 Ibid., p. 55. 50 Ibid., p. 56.

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It was true, as Bossuet stated, that the French public had seen both these deaths within their generation, but by 1683 the death of Anne of Austria was very old news. Its revival on the occasion of the death of Louis XIV’s wife indicates how long people wondered at it, and how difficult it was to close the chapter and say the last word. In the Catholic world, suffering can be given a constructive meaning. But the seventeenth-century experience of cancer was so devastating that it was difficult to provide an edifying rhetorical account. The clerics of 1666 wrote sermons which dwelt on Anne’s illness, but which never managed to ‘close the circle’ of experience and meaning. Their statements indicate awe, distress and an on-going effort to understand. In this sense, it is the religious documents, not the medical documents, of the seventeenth century which are realistic about the nature of cancer. The medical documents are always chasing the hope of a cure. This was outside the power of medical science at the time. The religious documents are always trying to console people about suffering and death. Of the two, the latter was a more valid response to the reality of cancer. The French clerics around Anne of Austria were challenged to explain death from breast cancer and the emphasis on description in their sermons indicates that they have not arrived at an easy explanation. Before she became ill, Anne of Austria said that breast cancer was ‘terrible even to imagine’. She was right, and the attempts of her entourage to create a description, which our imaginations can engage with, leave us with a record where eloquent preachers struggle with an outpouring of words.

CHAPTER SEVEN

SPIRITUAL BOUNDARY WORK: HOW SPIRITUAL HEALERS AND MEDICAL CLAIRVOYANTS NEGOTIATE THE SACRED1 Ruth Barcan Intuitive/spiritual medicine: Definitions and descriptions It is impossible to separate out intuitive/spiritual medicine as a discrete branch of alternative medicine: first, because it shares so many core precepts with other alternative therapies, including the energetic, or so-called ‘subtle’, model of the body; second, because both intuition and the sacred form an important part of many other alternative therapies; and third, because alternative therapies are characterised by a high degree of combination, hybridisation and customisation by both practitioners and clients. It is therefore neither desirable nor possible to invoke an inflexible taxonomy whereby spiritual healing, for example, might be separated distinctly from psychic healing, or from medical intuition. The following descriptions are thus general pointers only. Medical intuition is a subset of clairvoyance: the use of clairvoyance for the purposes of diagnosis and/or treatment or healing. While all clairvoyants are regularly called upon to give information about illnesses, not all specialise in health. Those who do may call themselves medical intuitives, medical clairvoyants or medical psychics, or other perhaps more euphemistic titles like ‘intuitive counsellor’. Medical intuitives give a clairvoyant ‘reading’ of their clients’ health, whether

1 This chapter arises from a project on alternative therapies, which sees them as rich and complex body technologies that are at once medical and recreational, spiritual and consumerist, sensual and pedagogical. Here, I draw on interviews with a number of medical psychics, clairvoyants and spiritual healers. These interviews were carried out as part of research towards a book on alternative therapies and the senses, provisionally entitled The Body in Alternative Therapies: Cultural Practice and the Boundaries of the Senses, to be published by Berg Publishers. Some participants’ names are pseudonyms. I would like to thank interviewees for their time and expertise. I would also like to thank the organisers of the Negotiating the Sacred conference for providing an open forum in which to test my ideas.

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in general terms or focussed on a particular issue. The client may be present in the room or the process may occur in absentia—for example, over the telephone or by email. Physical touch is not required. Medical intuitives detect medical problems; they carry out intuitive ‘diagnosis’, whether or not they use orthodox anatomical or medical labels. Some, though not all, also suggest treatment regimes (for examples, by prescribing naturopathic remedies) and some also carry out healing techniques as part of the consultation (for example, by using visualisation), which is where the process may overlap with spiritual healing. Some practitioners see their central role as the passing on of medical information; others integrate information and healing. Spiritual healing (sometimes simply known as ‘healing’) is a blanket term for a range of techniques underpinned by a model of the body as an energy field connected to ‘higher’, ‘spiritual’ energies. Practitioners work with the body’s own ‘life force’ and/or channel ‘universal energy’ (often known as God or spirit), sometimes assisted by spirit guides.2 Daniel Benor, a psychiatrist and spiritual healer, defines spiritual healing as ‘the intentional influence of one or more people upon one or more living systems without utilising known physical means of intervention’.3 He breaks it down into two main approaches: techniques involving the physical ‘laying on’ of hands (or hands held slightly above the body), and a hands-off approach using ‘focused intent’, such as meditation or prayer. Both approaches are often combined with visualisations (such as imagining a cloud of healing light surrounding the patient), and the two approaches (hands-on and-off) may be used simultaneously.4 Many spiritual healers work actively with entities from a spiritual realm—spirit guides, deceased relatives and so on. As with medical intuition, some practitioners may also prescribe naturopathic, homeopathic or essence remedies, especially if they are also formally trained in these fields. In such cases, guidance about what to prescribe may arise spiritually or psychically and/or it may derive from their formal training. Some practitioners differentiate between psychic and spiritual healing. For them, psychic healing involves ‘work[ing] with energy in a very deliberate and conscious manner, with awareness of where and 2 Kathleen MacDonald, ‘Healing’, in Fiona Toy (ed.), Directions: The Directory of Holistic Health and Creative Living, Rozelle, NSW: Fiona Toy Trading, 1997, p. 56. 3 Daniel J. Benor, ‘Spiritual healing: a unifying influence in complementary therapies’, Complementary Therapies in Medicine, vol. 3, 1995, p. 234. 4 Ibid.

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how the energy is moved’.5 Examples might be chakra balancing and the channelling of universal energy into the client.6 Not all practitioners make this distinction, however. A full understanding of these practices requires a detailed consideration of the New Age conception of intuition, which lies at their heart.7 In this chapter, however, my focus lies elsewhere, so I will make only some schematic comments here, before going on to focus on some of the social and institutional dimensions of medical intuition and spiritual healing as sacred ‘medical’ practices. In alternative medicine, intuition is seen as a universal capacity, but one that can be ‘developed and cultivated’8 to greater or lesser degree depending on the person. It is still usually described in feminine terms, but it is not conflated with that other classic feminised Other to reason: emotion. In spiritual healing and intuitive medicine, the relations between different modes of knowing—reason, emotion, professional experience, empathy and intuition—are complex. But the simplest—and indeed the most significant—thing that can be said of this alternative knowledge regime is that, by and large, it inverts the valuation of the mainstream binary between reason and intuition. Intuitive knowledge is considered the highest knowledge of all; rationality is seen at best as useful, at worst as deceptive. Now, to a deconstructionist, the fact that this system more or less inverts an established binary rather than destabilising or undoing it would come as a political and intellectual disappointment. But the situation is actually a little more complex, in that while this inversion of a binary is a very visible component of the discourse, energy medicine is actually based on a non-dualist model of the body, in which the self is an organised assemblage of many interpenetrating layers rather than a binary between mind and body. In practices based on this so-called ‘subtle body’ model, the binary between reason and intuition is therefore caught up in a much more complex epistemological/anatomical system.9

5

MacDonald, ‘Healing’, p. 58. Ibid. 7 Ruth Barcan, ‘Intuition and reason in the new age: A cultural study of medical clairvoyance’, in David Howes (ed.), The Sixth Sense Reader, Oxford & New York: Berg Publishing, (forthcoming, Sept. 2009). 8 Jonas Salk, Anatomy of Reality: Merging of Intuition and Reason, New York: Columbia University Press, 1983, p. 79. 9 For an outline of the subtle body model see the essay by Jay Johnston in this collection, and also Jay Johnston, Angels of Desire: Esoteric Bodies, Aesthetics and Ethics, London: Equinox, 2008. 6

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The subtle body model used by most medical psychics is an anatomical schema in which various different ways of knowing are intimately bound up in anatomy itself (for example, the emotional body, the mental body). All levels of reality are ‘conscious’.10 Hence the body is a knowing organism and, likewise, modes of knowledge are understood as inherently embodied. Intuition is the highest form of knowing. It allows you to arrive at truth rather than to be bound by cultural and contingent expectations, received truths, mental habits, assumptions, prejudices and judgments. The knowledge it provides is universal, non-judgmental, true—all the attributes traditionally associated with reason. Indeed, knowledge acquired intuitively may contradict the seeming truths arrived at by reasoning. As the medical psychic (or, as she prefers it, ‘intuitive counsellor’) Mary put it: Everything that I know about the psychic realm or the spiritual realm or healing or health or whatever you call it—probably 99 per cent of what I actually know, logically know—is given psychically. Often I have to unlearn what I think I knew from other means. I mean I’ve learnt so much about who we are physically and mentally and emotionally and the intricate workings of how we’re put together which no textbook could ever teach.

In a rationalist epistemology, intuition is a series of patterns learnt through cultural conditioning and experience, and perhaps augmented by heightened empathic abilities. In the words of Miller and McHoul, it ‘is no more than the inference-making machine used by every member of “rational society” ’.11 Psychological or spiritual discourse ‘super-adds’ intuition to the socio-cultural rules of everyday life, thus turning the ordinary, learnt process of daily living into ‘something extraordinary’.12 This is not, however, how it is seen by its advocates. While they recognise the importance of both professional experience and everyday empathy in their ability to ‘read’ clients, they believe their intuition derives clearly from the spirit realm because it often involves knowledge they couldn’t possibly infer or guess (for instance, proper

10 Barbara Ann Brennan, Hands of Light: A Guide to Healing Through the Human Energy Field, Toronto, New York, London, Sydney and Auckland: Bantan Books, 1987, p. 137. 11 Toby Miller and Alec McHoul, Popular Culture and Everyday Life, London: Sage, 1998, p. 126. 12 Ibid.

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names), because it sometimes involves precognition, or, for some, because they experience different bodily sensations as they pass it on. The clairvoyant Rhondda, for example, describes the bodily sensations she experiences when this kind of intuition, in her words, ‘drops in’: Everybody gets their intuition in lots of different ways. But the way it happens for me, it’s like a touch. It’s like your whole body becomes alive. I get a feeling going all the way down my back and it’s like goose bumps and it gets so strong.

The question of how medical intuitives and spiritual healers work with this capacity—how they negotiate with a medical system based on entirely different principles—occupies the remainder of this essay. Negotiating twin systems: Professional boundary work Spiritual healing and medical intuition interest me in at least three ways: medically (and here I need to ‘confess’ that I’ve visited one of my interviewees as a client as well as a researcher); politically (Are we seeing a growth in popularity of a system built on forms of knowledge traditionally associated with the feminine, and if so, how will these opposing epistemologies be operationalised as workable ‘alternatives’ or ‘complements’?); and systemically (How does this rather secret system of medicine operate institutionally? How does it sit alongside and intersect with orthodox medicine? And how do both practitioners and clients negotiate radically different medical systems, often simultaneously, and the radically different conceptual bases of these systems?). I have explored some political questions elsewhere;13 in this chapter I address questions of system. My purpose is neither to endorse nor to debunk clairvoyance, medical intuition or spiritual healing, but, rather, to investigate some aspects of their conceptual underpinnings and social functioning. I am fascinated by the existence of a quasi-clandestine yet publicly available network of sacred healing practices and its relationship with mainstream medicine. These practices are both widespread and hidden, legal yet outside medical regulation, sacred, yet also recreational and consumerist. Moreover, as a quasi-medical system, these practices operate in a relationship with orthodox medicine that is much more complex than simple oppositionality.

13

See Barcan, ‘Intuition and reason in the New Age’.

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While intuitive healing techniques may appear to be at the fringe of the complementary and alternative medicine scene, a number of the pragmatic, philosophical, conceptual and political questions they provoke are the same as for alternative therapies generally. These rather more ‘fringe’ practices push to the limits the question of how to model the relations between different medical systems and they suggest questions about the mental, philosophical and social practices by which consumers negotiate different medical paradigms, the cosmologies that underpin them, and the movement between them. These techniques are paradigmatically almost incommensurable with orthodox medicine and yet there are plenty of people—myself included—who utilise both systems. However ‘wacky’ medical intuition and spiritual healing may seem to many members of the public, they are nonetheless not just philosophical systems, but everyday medical choices made by a group of individuals on a daily basis, and practised by professionals who have to organise a working relation to a special gift that is extremely highly valued by some, and ridiculed by others. How, then, do they work as systems? It seems to me that for a practitioner this involves negotiating both systemic questions (How do I relate to orthodox medicine as an institution?) and psychological/perceptual matters (How do I personally understand and manage the relation between reason, intuition and emotion?). And, given that intuitive and spiritual practitioners’ work is based on an embodied perceptual skill, it must also involve the social management of perception (When and how do I stop picking up information? When I am not at work? Whom do I tell about my gift?). Before exploring these questions, I want to make some general points about how intuitive and spiritual medicine currently operates as a system. The first point is that it shares—and pushes to the limit— many of the qualities of alternative medicine more broadly. It is highly feminised, in terms of practitioners, clients and the more abstract gendering of its philosophical base. In the USA, as in Australia, alternative medicine is used more by the following categories of people: people who are in poorer health; people who suffer from chronic illness; people who have more education; people who have higher income; whites; women; people aged 35 to 55; people who live in the western states.14

14 Mary Ruggie, Marginal to Mainstream: Alternative Medicine in America, Cambridge: Cambridge University Press, 2004, p. 46.

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The hidden nature of the sacred medical system makes it hard to formally confirm these demographics for intuitive and spiritual medicine, but my interviewees confirmed it anecdotally. One of the commonly reported motivating factors for taking up alternative medicine—the failure of other options—appears to be true of Mary’s clientele: I get a lot of people coming because they’ve tried the conventional medical routes and a lot of them have even done the alternative medical searches and they’ve not got themselves sorted out. So then finally they hear about me . . . Like this is the end of the line kind of thing for most people.

This hints at medical clairvoyance as the fringe of the fringe—located at the edge even of alternative medicine. This may be true, systemically, but not necessarily in the experience of individuals, for there may well be people for whom it is such a naturalised practice that it is their medicine of first resort. To me, it seems most realistic to consider intuitive and spiritual medicine in the west as a more or less ‘clandestine’ parallel system, with interesting leaks into and out of the medical mainstream. To say this is not to doubt or demean it (nor, for that matter, to applaud it), but to look at its social functioning. (Not all medical intuitives would agree with or approve of a term like ‘clandestine’. One medical intuitive didn’t like the term at all; others considered it a reasonable descriptor). By ‘clandestine’ I mean a system legal yet secret, known about more hypothetically than concretely, or known via spectacularised forms (for example, TV clairvoyants) more than as a working, daily medical system—even though it does function in this way to those who have become part of its networks. I also mean a system in which both practitioners and clients think rather carefully about questions of disclosure, naming, advertising, and location. When it comes to disclosure, this form of medicine again pushes to the limit that which is true of alternative therapies more generally. In the USA, most users of complementary and alternative medicine (up to 72 per cent) do not disclose their use of other systems to their doctor.15 If this is true of relatively mainstream therapies like naturopathy and chiropractic, we can reasonably assume it is even more

15 Institute of Medicine of the National Academies, Complementary and Alternative Medicine in the United States, Washington: National Academies Press, 2005, p. 35.

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the case for sacred medicine. Many clients won’t even tell their friends (let alone doctors) that they’ve been to see one—or, more accurately, they are selective in whom they tell. As the spiritual healer Regina put it: ‘Well, it does get told to people who are receptive. Somebody would tell their friend if their friend was that way inclined’. Lack of a broad public acceptability is a feature of the field. As Mary puts it: I think I get a bit frustrated that these people who do what I do are not accepted as mainstream healers. And that often they’ll come and say ‘well I can’t tell my partner that I’m here’ or ‘please don’t ring home because somebody might answer the phone and they don’t know that I’m seeing a psychic’. That’s a bit frustrating considering that often this is a fast track to finding the answers. But I guess that’s more to do with society and how we view people on the fringe rather than the value of the help that is given.

This must be all the more exasperating given that Mary numbers many doctors among her clients: I get a lot of medical people like doctors themselves. I get a lot of doctors who know themselves the value of getting the correct diagnosis for their own ailments, and not necessarily having to take the drugs that they so readily have to prescribe for their patients.

Obviously, doctors who work with spiritual or intuitive healers in a professional capacity may be reluctant to acknowledge this too widely. The second form of secrecy is in the very act of naming the practice. Spiritual healing may be perhaps more safely known as ‘healing’ or ‘energy healing’; medical clairvoyance as ‘intuitive counselling’. Again, it’s important to note that not everyone buys into the need for euphemism. One of my interviewees was very straightforward about naming her practice: ‘I’m a medical psychic’. In any case, like everything, naming is context-driven, deployed differently for different audiences. A similar reticence may pervade advertising and marketing strategies, though again this depends on the location of the practice. Regina, for example, initially wouldn’t use the word ‘spiritual’ in her marketing, using the word ‘reiki’ instead (although they’re not completely synonymous). Over the last six years, though, she has perceived a greater acceptance of the term ‘spiritual healing’, and has begun to use it, though this again depended on the suburb in which she practised. Even so, she doesn’t always tell people she meets that she is a spiritual healer:

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I would probably only mention that if I thought the person was receptive to it. I would tell people I was a naturopath, but I would only mention it if I felt that they were receptive to it—because of that sort of stigma. You know, I’ve known some people to have this expression like you’re some raving lunatic.

In some regions (in Australia, the so-called ‘Rainbow Region’ of the north coast of New South Wales), clairvoyance and the spiritual are highly normalised and valued, and so tend to be more openly advertised than in other areas. But working in a middle-Australian suburb of a major Australian city, Mary does not advertise at all, and can’t be found in the phone book. Her clients come from word of mouth. She is often booked out for a couple of months in advance. Some practitioners, however, do advertise. Some use a form of ‘code’, in which ‘holism’ points subtly to the spiritual, and ‘intuition’ is a euphemism for clairvoyance. Take the following extract from an advertisement for a meditation/intuition development workshop published in the local newspaper of an outer suburb of a major Australian city: Finding Your Passion for Living [Practitioner name] Dip. Counselling & Holistic Insight *Intuitive Counselling* Stress Management This amazing 1 day introductory seminar can be a catalyst for profound change. Its content assists you to connect with and sustain the creative life force within. . . . I give you the practical techniques that:— Bring awareness to what real passion is; its source, how to feel it and where it goes. Awakens, reconnects and aligns the energy between body, mind and creativity. The tools with which to have real open, heartfelt, communication in all relationships with others. . . . . I am a Professional, Intuitive Life Counsellor who has a passion for assisting others re-ignite the spark of life. . .16

16

Publication details omitted for reasons of privacy.

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When I first read this advertisement, I kept wondering if it was a form of code. Did ‘intuitive counsellor’ mean clairvoyant? What did ‘holistic insight’ mean? I eventually phoned (and then interviewed) the advertiser. She did, happily, admit that the advertisement was written in ‘code’, and that it had been crafted for two audiences. The physical locations in which some intuitives and healers work may accentuate this sense of secrecy. Like many different types of alternative therapists (and indeed, like many female spiritual healers and mediums in the nineteenth century),17 many—though of course not all—clairvoyants work from home, at least in the suburbs. But whereas a suburban masseur may sometimes have a sign in their garden advertising their profession, a clairvoyant is less likely to be so publicly visible. Visiting a clairvoyant who works this way involves arriving at an ordinary looking home or apartment—a physically unmarked space, with no signs—all of which might heighten the client’s sense of excitement and/or subversion. The medical intuitive I visited worked this way. For me as a client, entering an unmarked private home in a large suburban apartment block involves a slight sense of frisson. As a physical space, it has neither the official status of a doctor’s clinic, and entering it does not constitute the kind of public declaration as does entering, say, a clinic located in a New Age shop. I find myself wondering, do her neighbours know what she does? If not, do they wonder what this steady stream of visitors is all about? All of this might make it sound rather romantic. The secrecy, euphemism, and the conceptual underpinnings of these practices, so different from those of biomedicine, might lead one to think of intuitive sacred medicine as an opposing system to orthodox medicine—the kind of knowledge practice that Cultural Studies loves to romanticise as clandestine, feminised, and repressed. It is tempting to see it as one example of what Bob Hodge, drawing on Foucault’s concept of teratology, calls ‘monstrous knowledge’: ‘Within its own limits, every discipline recognises true and false propositions, but it repulses a whole teratology [i.e. the study of monsters] of learning’.18 In this romantic vein, Hodge calls on Humanities scholars to ‘be open to the monstrous’, urging us to: 17 Alex Owen, The Darkened Room: Women, Power and Spiritualism in Late Nineteenth Century England, Virago, 1989, p. 107. 18 Michel Foucault, Archaeology of Knowledge, quoted in Bob Hodge, ‘Monstrous knowledge: doing PhDs in the new humanities’, Australian Universities’ Review, vol. 2, 1995, p. 36.

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Take especially seriously those problems, beliefs and experiences that are annulled by (‘quaint’, ‘naïve’, ‘outrageous’, unthinkable in terms of) a dominant discipline, whether they are intractably personal or contaminated by the disreputable demotic or popular, by passion or anger or delight, by the desire to change the world or to dream a new one.19

One part of me has responded to Hodge’s call, in that spiritual practices do not represent the kind of monstrosity Cultural Studies prides itself on championing. Elsewhere I have described Cultural Studies’ reluctance even to consider, let alone to champion, this particular form of the popular, quite against the grain of the interest, nuance and respect it normally accords to popular practices.20 Cultural Studies’ habitual suspicion of both the middlebrow and the spiritual21 means that an ethnography of medical intuitives and spiritual healers might be received quite differently from, say, an anthropological study of ritual or magical practices outside of the modern West. So in that sense, this study is a teratology. But respect for my interviewees—who may not see or live out their profession this way—combines with my own pragmatism and, ironically, my Cultural Studies training as an analyst of everyday life and urges me not to succumb too much to the lure of this romanticism. For sacred and intuitive medicine is also an everyday life practice. For practitioners, it is their bread and butter; for regular clients, perhaps little more unusual than having an annual check-up with the doctor. And for those medical intuitives who work regularly with mainstream medicine, terms such as clandestine might be offensive or inaccurate, though there were quite a number of my interviewees who agreed with it. So how do the alternative practitioners I interviewed understand and operationalise the relations between their own, relatively marginalised or invisible, practice, the medical mainstream, and a wider public? How do they manage a professional identity and practice based on a perceptual mode unrecognised by rationalism, denounced or distrusted by (some) religion, and yet highly valued in other discourses? How do they organise both their professional world and their own interior landscape? It’s not just a matter of negotiating the external, social

19

Hodge, ‘Monstrous knowledge’, p. 37. Ruth Barcan and Jay Johnston, ‘The haunting: cultural studies, religion and alternative therapies’, Iowa Journal of Cultural Studies, vol. 7, 2005, p. 18. 21 Nick Couldry, Inside Culture: Re-Imagining the Method of Cultural Studies, London: Sage Publications, 2000, p. 3. 20

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workings of a pluralistic medical system, it also involves working out their own relation to rationality and to their gift. In other words, they negotiate both the relations between two different systems of medicine and the philosophical categories of reason, logic, intuition and emotion that to some extent underpin these twin systems. This is the kind of identity work that Christena Nippert-Eng, in her classic study of the way people negotiate work and home as different life realms, and the transitional or other rituals they use to ease their passage across these different life realms, termed ‘boundary work’.22 In considering these boundary crossings, I’ll start with the bigger systemic questions and work down to how some of my interviewees manage their own interior world. Professional relations with the medical mainstream are modelled and practised in a variety of ways. For some practitioners, the relation between the medical mainstream and medical intuition is overt and professional. Well-known US medical intuitive Caroline Myss, for example, works and publishes with medical doctor Norman Shealy. In a sense, this model splits the reason/intuition binary by personifying each and operationalising them as mutually respectful and complementary professional skills. A number of my own interviewees likewise saw medical intuition as a legitimately public part of a health system: ‘It’s a complementary. It is one form of a health practice’, replied Glen Margaret, without hesitation. She works in private practice, sometimes in conjunction with orthodox medical practitioners. She has worked in nursing homes and hospitals, where doctors and surgeons have called her in to help with intractable or puzzling cases. This mode of work involves finding sympathetic doctors who are open to the unorthodox and professionally secure enough to act on this. It relies on a network of doctors with whom she enjoys a professional relationship, albeit one with a degree of secrecy involved: ‘Generally they don’t let too many people know they’ve called in a medical psychic’. So how are such doctors to be found? Some have heard of me and just ring and just say I’m absolutely stuck on this. Some of them have patients who have said ‘Look, I’ve just been to see this lady and she says it’s this and this, could it be?’ and they’ve

22 Christena E. Nippert-Eng, Home and Work: Negotiating Boundaries Through Everyday Life, Chicago: University of Chicago Press, 1996, p. 7.

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sort of explored that and found, yes that’s right and therefore have been happy with my work.

Another medical intuitive I contacted works for a business consultancy with a specialisation in health matters, but also works one day a week for a general practitioner (GP). The interchange between the medical systems works in two directions. Although it is markedly asymmetrical, both sides have something to lose. A medical psychic is at risk of being publicly and critically evaluated by sceptical doctors and patients. But so too any GP who works with a medical psychic puts his or her own reputation at risk. For this reason, sometimes the collaboration is covert. The medical psychic Glen Margaret was quite admiring of those doctors she knew who referred patients to medical intuitives: The doctors who are open to it, I actually think they make fantastic doctors because they’re using both sides—[including] intuitive knowledge of energy fields, knowledge that the body isn’t just a material thing.

Many spiritual or clairvoyant healers do not collaborate with doctors, but they may still operate a one-sided ‘dialogue’ with mainstream medicine. The spiritual healer Regina, for example, does not have any doctors who refer patients to her for spiritual healing (although some do for naturopathy). She, on the other hand, refers patients back to GPs, but she instructs them not to tell their doctor they’ve been referred by a naturopath (let alone a spiritual healer!) She tells them to tell the doctor that they suspect they may have a particular illness, or that they want to be sent for a blood test and so on. I asked her how she imagined such conversations would actually run. Would patients tell their GP why they suspected they had a particular illness (or were at risk of it), even if they were asymptomatic? I kept imagining conversations that went a little like this: Patient: I’d like to get a blood test for Type 2 diabetes. GP: Why? What symptoms are you experiencing? Patient: Well, not much really. But a spiritual healer told me I should have a test.

When I discussed this with Regina, she said that she tells clients to describe in detail the symptoms she is able to pick up naturopathically, via case history and iridology. But given the avowed ability of iridology to see weaknesses before they actually manifest as illness, there must

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still be some interesting conversations, in which the (mostly female) patients risk being stereotyped as neurotic, hysterical or irrational. For medical intuitives with more overt and formalised relations to medical doctors, the cross-referral system can work more transparently. Glen Margaret, the intuitive who works quite overtly with doctors, makes her clients sign a form to say that they’ll go back to GP since her emotional release work may require them to change their medication. As with so much in this field, it’s hard to gauge how much of this overt cross-referral between GPs and clairvoyants and healers goes on. Certainly, it’s more common to see clairvoyants or healers who work isolated from the medical profession and thus have to negotiate the relations solo and privately. These different institutional and professional arrangements are bound up in the question of how to manage the relation between reason and other forms of knowing. I noted above that some practitioners see rationality as an important but limited tool, a tool capable at times even of being counter-productive. We saw that some intuitives see their work as at times involving a form of ‘unlearning’ some of the truths arrived at by rational thought. One specific question often arises for those working in this area—the question of whether to learn and use medical and anatomical terminology. There are legal dimensions to this quandary—alternative practitioners are not legally allowed to diagnose or to promise or claim a cure. But there are also perceptual and cognitive dimensions to the dilemma: does having a detailed orthodox medical understanding of the body help or hinder the perceptual processes of intuitive healing? As one might expect, the answer to this question varies between practitioners. Glen Margaret, for example, has made a very conscious choice not to learn medical terminology. She has trained in a number of alternative therapies, and is an avid reader of new philosophies—anything that, in her words, ‘works with the mind to enhance my knowledge of it’. But she has made an exception for anatomy and physiology, despite the temptation to learn more about it: What happens then is that your own logical brain gets in the way of what you are seeing. So you might see somebody who has a problem, and your logic says if there’s a problem in that area it has to be this. So your logic dictates to you what you see and colours what you see. So by not doing medicine and very definitely refusing to do anatomy and physiology and all the rest of it—what I see is what is actually there, rather than what I expect to be there.

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She is aware that being able to speak the language might give her more standing with doctors and with a certain type of client, but it would, paradoxically, make her less good at her job. Regina, on the other hand, works as both a naturopath and a spiritual healer, and so she has had to find some internal mechanism for changing cognitive and perceptual modes: Often when you are doing spiritual healing you have to get your head out of the way, because when I’m doing a naturopathic consult I use my own intuition, but I also use my [spiritual] guides to help me with choosing herbs for instance, or what the best plan is for their health. But in a naturopathic way I am much more logical. When I’m doing spiritual healing I’m trying to get my head out of the way and breaking down logic—you need to get that part of you out of the way because it’s a different type of information that comes through.

As a trained naturopath, she initially found it hard to ‘get the logical brain out of the way’ when she first started doing spiritual healing, but now she has found a way of managing her different perceptual worlds. She has two professional roles—naturopath and spiritual healer. She advertises herself primarily as the former. Clients come via one of two means—for naturopathy or for spiritual healing—but they may, in time, cross over from one modality to the other. Our interview was conducted in her treatment room and during that time it became clear to me that this one room comprised two different professional and psychic spaces. As we spoke, she repeatedly gestured to the massage table on her left (where she does spiritual healing), saying ‘here’, and then to the consulting desk and chairs where the naturopathic consultations take place (also saying ‘here’). These two ‘heres’ signified, perhaps unconsciously, two equally present but different professional capacities and the different corresponding mental states that underpinned and animated them. She has, it seems to me, found an unconscious mode of materialising and spatialising a distinction between the mode in which she needs the logical brain in the foreground, and the other in which it needs to recede. Regina, then, wears two professional hats and has both internal and overt external mechanisms for dealing with them (for example, alerting clients to the different modalities she practices, and sometimes explicitly shifting her patients from one to the other in response to their interest). For the clairvoyant and meditation teacher Rhondda, professional hat-wearing is even more complicated. She has two quite distinct professional roles. She regularly works the ‘psychics’ circuit’ as a clairvoyant

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travelling to psychic expos. In this role, she works away from home, in a public venue where there are many other clairvoyants giving readings to the general public in the same room at the same time. These engagements with clients are one-offs, and she is unable to do ongoing therapeutic work as it’s purely a twenty-five minute reading in the public space of an expo. For this type of engagement, she has a kind of professional ‘costume’—the crushed velvet, dangly earrings and so on, and is quite self-reflexive about this as an aspect of professional performance. Meanwhile, even within her own practice back home she also has to manage split roles—as a clairvoyant and a counsellor. She has clients who come to her for one or other of these services, and the counselling clients are not necessarily aware of her other role as clairvoyant. Thus, even within a counselling session, she may constantly have to manage her own perceptual faculties and professional demeanour. She uses, for want of a better word, ‘normal’ intuition as would any counsellor—that blend of empathy, professional experience, reading of body language and so on that constitutes a kind of embodied, naturalised experience.23 But at times she is also picking up signals using her specialised intuition, and in a split second she has to decide how to manage these unbidden insights. Sometimes, she keeps them to herself. At other times, she (in my words) ‘shifts gear’ and passes on clairvoyant insights. Does this ever backfire, I ask her? After all, there’s a tacit contract between clients and practitioners, and no doubt some of her clients aren’t happy at a rupture of this contract. And indeed, she has at times made people angry because, in her terms, she has ‘touched a raw nerve’. She admits that ‘bringing the intuitive in’ can be ‘ethically . . . challenging’ and requires her to second-guess her clients’ potential reactions. This question of ‘switching’ intuition on and off occurs not only during professional practice, but is also a psychological and social skill that clairvoyants must manage all the time. Given that their professional skill is an embodied perceptual mode, how do they manage the boundaries between work and non-work? How do they switch this

23 For a rational analysis of intuition as pattern-making, see Hubert L. Dreyfus and Stuart E. Dreyfus, Mind Over Machine: The Power of Human Intuition and Expertise in the Era of the Computer, New York: Free Press, 1986. They isolated six discrete aspects of what they term intuitive judgment: pattern recognition, similarity recognition, commonsense understanding, skilled know-how, sense of salience, and deliberative rationality. (Quoted in Patricia Benner, and Christine Tanner, ‘How expert nurses use intuition’, American Journal of Nursing, vol. 87, no. 1, 1987, p. 23.

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mode of perception off? Does the clairvoyant pick up information about people when they’re out and about, or socialising, and if so, what do they do with it? How is this perceptual faculty ‘managed’ in everyday life? They may not always tell people they’re a clairvoyant, to avoid being pestered by curious acquaintances and to avoid having their every last statement read as portentous and meaningful, as emanating from special insight. Regina’s ability to read people isn’t able to be switched off, but she doesn’t mind, as she quite enjoys it: I actually quite enjoy it. I really enjoy going out and observing and picking up and sort of assessing. It doesn’t disturb me at all and I don’t think I would switch it off (if I could).

Mary, on the other hand, concurred that her skill can be difficult for her on social occasions. People often subtly fish for information (rather like the cliché of the doctor being pestered at a party). She has had to learn to be very careful about what she says, so that any chance comment she might make, for example, about the future, doesn’t get interpreted as being a prediction. It is hard for her to be off-duty and tiring to be constantly on call: It is a hassle in that I like to kind of shut down; it’s very draining being in tune. It’s also very enlivening and enriching but it takes a lot of energy. It’s like if somebody’s watching a movie and they’re describing every movement, every word, you get exhausted doing that all day. Well, that’s what it’s like. So socially when you’re out, you don’t want to go there. You just want to flip out.

Glen Margaret agrees that it can be a terrible social burden. When she is out socially, she tries to ‘switch it off’, but occasionally she forgets. When this happens: You go into a restaurant and you see not only the people sitting in the restaurant, but you can see all their rellies [relatives] who are with them. You know, Auntie Jo who has died—and so and so here, and you can see all of their medical problems ‘cos you’ve got x-ray vision of everybody. You can see the whole thing, so it becomes like this conglomeration of people.

Her default setting, as it were, is ‘off ’ for socialising; ‘on’ for working. Her friends, however, don’t like to have it ‘switched off ’ when they go out: ‘They were sticky beaks as to what was going on’. To conclude, my purpose here has been neither to validate nor to endorse, but rather to analyse the way these practitioners effect

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a mental, material, spatial, temporal and social ‘crossing-over’. My research has made it clear that psychics and healers themselves must manage all the crossing-overs, hat-switching, language switching and role management that comes from centralising a personal and professional identity around a perceptive faculty that hegemonic discourses do not agree exists. Nippert-Eng considers the kind of boundary work I’ve been describing to be first and foremost a mental activity ‘enacted and enhanced’ through a range of practical and physical activities and choices.24 Making these practical choices involves positioning oneself in relation to some core metaphysical categories, especially intuition and reason, and taking one’s place in a gendered system of knowledge and authority. Moreover, although the crossing-over is systemically asymmetrical, I was fascinated to find that there are two-way ‘leaks’ and that the mainstream is not always as orthodox as it may appear.

24

Nippert-Eng, Home and Work, p. 7.

CHAPTER EIGHT

MOMENTS OF GRACE AND BLESSING: RITES AND RITUALS IN THE PROCESS OF HEALING1 Roy J. O’Neill In his poem, Healing D. H. Lawrence says: I am not a mechanism, an assembly of various sections And it is not because the mechanism is working wrongly, that I am ill. I am ill because of wounds to the soul, to the deep emotional self And the wounds to the soul take a long, long time, Only time will help.2

Lawrence recognises the significance of respecting the spiritual aspects of people in healing, and the necessity of including such needs in an integrated protocol of caring for people. Human illness and disease is not just a physiological problem that can be fixed technologically like a machine that has broken down. Nor is it just an imbalance in human chemistry that can be restored through pharmacology. Illness is ‘wounds to the soul, to the deep emotional self’. Among medical professionals there is an increasing recognition that ‘spiritual distress’ is a part of the experience of illness and is in as much need of ‘healing’ as is the physiological, the psychological, or the emotional. No amount of pharmacology can impact on unease of soul. On the other hand, research is confirming what has really been known since the foundation of medicine. Religious faith and/or the practice of a personal spirituality does impact on the emotional and physical well being of

1

Material for this presentation is taken from my original Masters thesis Roy J. O’Neill, ‘Moments of grace and blessing: Rites and rituals in the process of healing, Melbourne College of Divinity’, MA diss., University of Melbourne, 2005. A copy of this thesis is available at the Medical Library at The Prince of Wales Hospital. Some material was also published as Roy J. O’Neill, ‘The ministry of the skilled stranger: Religion and spirituality in public hospital ministry’, Compass Theological Review, vol. 40, 2006, pp. 25–33. 2 Vivian de Sola Pinto and F. Warren Roberts, (eds.), The Complete Poems of D. H. Lawrence, London: Penguin Books, 1994, p. 620.

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individuals and families and, ‘during illness or other painful experiences, people do turn to their spiritual resources finding them helpful’.3 In different traditions, rites and rituals, or various ways of connecting to the sacred, are the expressions of these spiritual resources, demonstrating in mythic ways what is beyond the concepts of ordinary words, no matter how consoling. Health care exits at the juncture of human suffering and spiritual searching. Harold Koenig, one of the founders of research into spirituality and health, says: ‘When physical or emotional illness strikes, spiritual issues become even more important, as issues of meaning and purpose become relevant’.4 Health care attends to people when they are suffering, and a time of suffering is often when people re-evaluate their lifestyle and ask significant questions about what is ultimate and how it is to be included at this moment. Thomas Moore comments that: during illness the soul comes out of hiding, and shows itself in fresh realizations and new priorities . . . It is a mistake to think of illness only as an affliction of the body. Not only is the ‘whole person’ involved, but so is the family, and the sick person’s life and world. Serious illness is often a dark night of the soul. As such, it requires soul doctors as well as body experts . . . You deal with issues of life and death, and you discover the importance of love and caring from family and from skilled strangers.5

Unfortunately, the predominant biomedical mindset within the health professionals often sees health care, with its intense emphasis on scientific diagnosis and its immense dependence on technological means, as in opposition to the spiritual dimension of humanity. Gerald May, a priest and medical practitioner, says: ‘This is the curse of a health-care

3 Larry VandeCreek and Laurel A. Burton, ‘Professional chaplaincy: Its role and importance in healthcare’, 2001, . For a detailed examination of the research literature supporting these contentions, see J. Cohen, Report on Spirituality, Health and Healing in South Eastern Sydney, Sydney: South East Sydney Area Health Service, 2002. The major conclusion of this report is that There was a general consensus that spirituality, beyond religion, was an important component in health care. Those interviewed who had come through Nursing were more comfortable with ‘spiritual distress’ as part of the nursing taxonomy. Others recognized its importance, at least intellectually, even though they themselves may or may not be connected with an organized faith community. 4 Harold G. Koenig, ‘Religion, spirituality and health: An American physician’s response’, Medical Journal of Australia, vol. 178, no. 2, 2003, p. 51. 5 Thomas Moore, Dark Nights of the Soul: A Guide to Finding Your Way Through Life’s Ordeals, London: Piatkus Books Ltd., 2004, pp. 267–268.

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system dedicated only to fixing problems, a system too streamlined to be concerned with what’s happening to peoples’ souls’.6 The juncture of human suffering and spiritual searching really should be a confluence of two streams of thinking, resulting in a stronger flow of learning and healing. As Erich Segal commented: Faith can lift the fallen, even heal the sick, better than the scientist, whose powers are circumscribed by frontiers of knowledge—which is where belief in God begins.7

In Australia, communities of religious belief founded many health care institutes, and today some still remain linked to those foundations, providing a kind of care that unashamedly includes the spiritual as well as the physical.8 The public hospital system, however, followed the basic secular model of other public institutions such as schools, and, while not entirely dispensing with the spiritual, were more inclined to maintain a ‘scientific’ focus. But, as Veronica Brady has observed: Religion, it seems, is a scandal that refuses to go away, even in the most secular of societies . . . the impulse continues and must be acknowledged and lived through, especially perhaps in a secular society since it has to do with negative and midliminal experience . . . as common to the unbeliever as to the believer.9

For those entering our hospitals, religion and the spirituality associated with those religions, or with personal practice, are still significant even when regular attendance at religious services is no longer the case. Across the Randwick Campus of hospitals where I work and carried out my research over four years, we see a distribution of religious identity that is consistent with our wider community. As well we see

6 Gerald G. May, The Dark Night of the Soul: A Psychiatrist Explores the Connection Between Darkness and Spiritual Growth, San Francisco: HarperSanFrancisco, 2004, p. 6. Gerald May practised medicine for over twenty-five years. He is now the Senior Fellow in Contemplative Theology and Psychology at the Shalem Institute for Spiritual Formation. 7 Erich Segal, Acts of Faith, New York: Bantam Books, 1993. 8 The philosophy of the Sisters of Charity had always been that healing involved both the physical and spiritual welfare and that all clergy, regardless of religion or denomination, would be welcome at their hospital. Hazel Elliot, ‘Hospital chaplaincy in the context of religion in contemporary Australia’, Ph.D. diss., Department of Studies in Religion, University of Sydney, 2001, p. 58. 9 Veronica Brady, Caught in the Draught: On Contemporary Australian Culture and Society, Sydney: Angus and Robertson, 1994.

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a clear and increasing trend towards not identifying with particular denominations or religious traditions, or declaring a stance of nonpractice within such traditions. While the figures for the major Christian denominations—particularly Anglican and Catholic—remain relatively consistent with a slowly declining trend, there is a marked increase in the ‘no religion’ or ‘not stated’ and ‘inadequately described’ aggregate to the point where it reaches a combined 36.64% of the aggregate admissions to the campus over the four years 2000–2003 inclusive. Taken together, this category, in fact, exceeds any of the single major denominations over that same four-year period. The Christian denominations maintain a relative consistency across the state, region and campus. The numbers for the major non-Christian faith communities (Buddhism, Hinduism, Islam, Judaism and other religions) show some interesting variations. A clear example of discrepancy from the norm in the religious demography of the region is seen with the figures for Judaism—0.5% for New South Wales (NSW), but 2.8% at regional level, and 3.04% of admissions to the Campus over the time. The south-east Sydney area health region has a high concentration of Jewish families. Buddhism and Hinduism, on the other hand, maintain consistency over state and region, and also in terms of admissions to the campus, remaining at around 1%. Islam remains at a little over 2% in all areas. The consistency in these groups show that the ethnic topology, and hence the religious demography, of the region is normative with the wider area of the state, without a concentration of these particular faith communities in the south-east health area of Sydney. Admissions to the campus reflect that. Graphically, these variations in Religion across State, south-east health region (SEH) and Randwick Campus are seen in Figure 1. The two large columns to the left in Figure 1 are the Anglican and Catholic populations. In both there is a relative decline moving from state to region to campus. In contrast, at the right-hand end of the chart, are the columns representing the ‘no religion’, ‘inadequately described’ or ‘not stated’ categories. Here, in all cases, the trend is clearly in the other direction, which would indicate that there has been a shift in attitudes to religious identity of those entering the campus, especially since the time of the 2001 census. Many are now stating that they do not have any religious affiliation. At the same time, however, data from my recent research project carried out on campus indicates that this is not a relinquishment of all spiritual values, but rather dis-

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Religious Trends 35.0

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Anglican Baptist Brethren Catholic Church of Christ Jehovah’s Witnesses Latter Day Saints Lutheran Oriental Christ Orthodox Presbyterian & Reformed Salvation Army Seventh-day Adventist Uniting Church Pentecostal Other Protestant Other Christian Buddhism Hinduism Islam Judaism Other religions No Religion Inadequately described Not stated Overseas visitor (a)

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Figure 1. Percentage Comparison of Religions across State, SEH Region, and Campus

sociation from an institutionalised practice of religion.10 The ‘spirituality’ of these traditions, however, has not been abandoned. It would be a mistake to believe that because someone no longer attends religious services of their faith tradition or no longer identifies with that tradition that they no longer need their spiritual source at critical times in their lives. Bruce Rumbold, writing for The Medical Journal of Australia, says: Spirituality may be described as the web of relationships that give coherence to our lives. Religious belief may or may not be part of that web. Often we only become aware of strands in the web when they are

10

O’Neill, ‘Moments of grace and blessing’.

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roy j. o’neill stretched or broken, as happens with a life-changing event like a diagnosis of serious illness in ourselves or in someone we love. . . . A religion-based understanding of spirituality—spirituality as beliefs about the sacred—tends to be more acceptable in healthcare contexts because it provides definitional clarity that assists the division of professional responsibilities. However, many patients do not observe this conceptual neatness, applying the term ‘spiritual’ to core values, meanings and practices that integrate their experience, often with only tenuous connections to ideas of transcendence.11

There is an increasing tendency to see ‘spirituality’ and ‘religion’ as quite separate aspects of human experience—separated and in conflict with each other. David Tacey has commented that: Religion needs spirituality to keep the tradition alive and linked to the contemporary time. Secondly religion needs spirituality to keep dogma and creed connected with human experience, and thirdly to keep the orthodox tradition related to the creativity of mysticism. . . Spirituality needs religion to offer a language to express itself. Religion offers spirituality a history to be connected to, and a sacramental community in which to find sanctuary and support.12

There is an inherent danger in separating religion and spirituality exclusively. David Ranson argues for exploring the extent of this binary experience and asks ‘how might we imagine “spirituality” and “religion” in a way that respects their distinctiveness and yet maintains them in a creative and constructive tension?’13 Ranson concludes: The re-awakening of spirituality is a moment pregnant with possibility. But it is also a moment in which the dangers are not to be discounted. The divide that has occurred between ‘spirituality’ and religion’ has attributed to the first a fresh authority and credibility, and to the second, a retrieval of its fundamental role in the spiritual quest. But the divorce of ‘spirituality’ from ‘religion’ runs the risk of sundering a vital tension that is foundational to a mature transcendent quest.14

11 Bruce Rumbold, ‘Caring for the spirit: Lessons from working with the dying’, Medical Journal of Australia, vol. 179, no. 6 suppl., 2003, pp. S11–S13. 12 Tacey’s address at the Australian Health and Welfare Chaplain’s Association Conference deals with this in detail: David J. Tacey, ‘Australian spirituality and health’. Paper presented at the Australian Health and Welfare Chaplains’ Association Conference. Keynote Addresses, Australian Health and Welfare Chaplains’ Association, Alice Springs, 2003. He takes up these similar concerns in David J. Tacey, The Spirituality Revolution: The Emergence of Contemporary Spirituality, Sydney: Harper Collins Publishers, 2003. 13 David Ranson, Across the Great Divide: Bridging Spirituality and Religion Today, Sydney: St Pauls Publications, 2002, p. 14. 14 Ibid., p. 76.

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There is a fundamental flaw in some ‘popular’ spirituality movements,15 which try to place ‘spirituality’ outside the scope of any structured belief system. Tony Kelly confronts such spirituality, questioning if: the generalised spirituality now in vogue (is) a kind of spiritual autism, a self-enclosure incapable of the ultimately Other-world ecstasy of adoration, self-surrender and praise . . . What if this whole spiritual phenomenon were nothing more than the re-emergence of Gnosticism, or at least a kind of elitist soul-culture amongst connoisseurs of special experience?16

Zuesse defined rituals as ‘those conscious and voluntary repetitions and stylised bodily actions that are centered on cosmic structures and/ or sacred presences’.17 He goes on to explain that ‘Ritual as such is constituted by the longing to place the self in enduring contact with the absolute or source realities’.18 As we participate in a ritual, we are operating at the multiple levels of mind, senses, and emotions. The words reach our intellect, the sights, smells and sounds impact on our perceptive abilities, bodily movements incorporate our sensual self, and all combine to touch the emotions of the moment. It is precisely because ritual works on this multidimensional level, or what Victor Turner called the ‘multivocal’ level, that it is such a powerful means of striving to reach the transcendental.19 It is a fear of losing power by allowing ritual to operate on all these levels that has held many faith

15 When spirituality becomes popular we can almost be certain that some vital element or ingredients of spirituality have been left out of the popular conception. Things become popular by being distorted, especially by leaving out the hard bits, and emphasizing those aspects that seem easy or desirable . . . The tendency to idealise and distort the idea of spirituality has been facilitated in our time by New Age industries and enterprises. These industries service the contemporary hunger for spiritual expression, and they often style spirituality as an ego-friendly or utopian experience, presenting the encounter with the spirit as a ‘feel-good’ encounter. Tacey, The Spirituality Revolution, pp. 141–142. 16 Tony Kelly, ‘Reflections on spirituality and church’, Compass Theological Review, vol. 38, no. 8, 2004, pp. 19–27, p. 25. Kelly also examines this whole question of New Age ‘spirituality’ in Tony Kelly, An Expanding Theology, Faith in a World of Connections, Sydney: E. J. Dwyer, 1993, especially pp. 40–48. 17 Evan M. Zuesse, ‘Ritual’ in Mircea Eliade, The Encyclopedia of Religion, New York: McMillan Publishing Company, 1987. 18 Ibid. 19 Victor Turner, The Ritual Process: Structures and Anti-Structures, London: Routledge and Keegan Paul Ltd., 1969, p. 52. A single symbol, in fact, represents many things at the same time: it is multivocal, not univocal. Its referents are not all of the same logical order but are drawn from many domains of social experience and ethical evaluation. Turner’s work is considered seminal in this field.

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communities bound to traditionalism, to the detriment of allowing creativity and enlivenment in ritual practices. Anthropologists have described the various attributes and the role of ritual in a number of ways.20 They have pointed out that, for those that take part in it, ritual has important social, psychological and symbolic, often religious or supernatural, significance. Driver goes so far as to claim that ‘in a very real sense, to study humanity is to study ritual; and this has prompted me to think that to ponder the future of humanity is to consider the future of ritual’.21 All human societies feature some form of ritual as an important part of the way in which that social group celebrates, maintains, and renews the world in which it lives, and the way it deals with the dangers and uncertainties that threaten that world. ‘Rituals occur in many settings, take on many forms and perform many functions both sacred and secular’.22 It is not surprising that rituals, ‘both sacred and secular’, are found in hospitals and health care facilities. Trying to define ritual, or to distinguish between rites and rituals, is a daunting task.23 Often the terms are used interchangeably. By their very nature, rites and rituals defy exact definition, and are so connected as to be, at times, indistinguishable. At best, we can provide a description of what is involved in rituals. Rites then become the structured means of implementing the values or the beliefs, usually of spiritual or religious significance, represented in the rituals. The community

20

For a summary of how ritual has been investigated, see Edmund R. Leach, ‘Ritual’, in David L. Sills (ed.), International Encyclopedia of the Social Sciences, New York: The Macmillan Company and The Free Press, 1968, vol. 13, pp. 520–526. 21 Tom F. Driver, The Magic of Ritual: Our Need for Liberating Rites that Transform Our lives and Our Communities, San Francisco: Harper, 1991, p. 10. 22 Cecil G. Helman, Culture, Health and Illness: An Introduction for Health Professionals, Oxford: Butterworth Heinemann Ltd., 1990, p. 156. Chapter 9 is entitled ‘Ritual and the management of misfortune’. It deals with both the sacred and secular rituals found in hospitals, as interpreted from Turner’s insights. This whole work is an excellent study of an anthropological view of rites and rituals and its application to the medical profession and practice. 23 Citations in the Oxford English Dictionary from the fourteenth century on reveal two distinct trends of common usage for the words rite (ritual), ceremony (ceremonial) and custom (customary). On the one hand, these terms have been used interchangeably to denote any non-instinctive predictable action or series of actions that cannot be justified by a ‘rational’ means-to-end type of explanation . . . The other trend of usage has been to distinguish the three categories: ritual, ceremony, and custom. Ritual is then usually set apart as a body of custom specifically associated with religious performance, while ceremony and custom become residual categories for the description of secular activity. Leach, ‘Ritual’, pp. 520–526.

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to which the participant belongs generally sanctions them.24 Kenneth Mitchell also provides such a description of ritual: A ritual is an ordered or patterned sequence of interpersonal behavior, often occurring in connection with a particular event or circumstance, performed in the same (or a very similar) way each time it occurs, sometimes embodying a reference to a historical event, and symbolizing—pointing beyond itself to—a value or a belief commonly held by the individuals or groups who perform it.25

Such a description can include the very formal performance of rituals, as carefully defined and described by a religious tradition.26 The informal rituals that individuals may have developed for their own personal use may also be included. These, too, are patterned sequences of behaviour, since such actions have taken on particular significance for them personally, even if of no particular consequence to others. More so today than in previous times, it would seem, more and more individuals from any religious tradition or from none, are turning to ask for rituals. ‘Even today, maybe especially today, when the bonds of traditional daily religious practice are loosening, people look for religious language to express the important events in their lives; they look for liturgy and they look for ritual’.27 As they find the traditional rites or rituals lacking in significance, or simply not available to them, many are creating their own ways of celebrating life-cycle events that mark a turning point or a crisis in the unfolding of their human journey.28

24 Turner quotes Monica Wilson writing in American Anthropologist, vol. 56, no. 2, 1954. Rituals reveal values at their deepest level . . . men (sic) express in ritual what moves them most, and since the form of expression is conventionalised and obligatory, it is the values of the group that are revealed. Turner, The Ritual Process, p. 6. 25 Kenneth R. Mitchell, ‘Ritual in Pastoral Care’, The Journal of Pastoral Care, vol. XLIII, no. 1, 1989, p. 69. Others have refined the description of ritual to included the idea that what is done is symbolic and does not have a ‘technical effect’ on the situation. ‘Loudon has defined these public rituals as “those aspects of prescribed and repetitive formal behaviour, that is those aspects of certain customs, which have no direct technological consequences and which are symbolic” ’. Helman, Culture, Health and Illness, p. 156. 26 The Rites of the Catholic Church 1990, vol. 1, and The Rites of the Catholic Church 1991, vol. 2, Collegeville, Minnesota: The Liturgical Press. These two volumes contain the most recent formally approved rites within the Catholic tradition. 27 Sylvia Rothschild and Sybil Sheridan (eds.), Taking up the Timbrel: The Challenge of Creating Ritual for Jewish Women Today, London: SCM Press, 2000, p. 10. 28 A collection of such rituals from all around the world designed to provide strength and inspiration to those who want to celebrate their God-given sexuality in

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Spiritual experience is not always personally comforting. Often, through our experience of illness or approaching death, our entry into a spiritual experience or an encounter with the sacred, divine, or holy is difficult, painful, problematic, anything but serene and peaceful to begin with. Rudolf Otto, in The Idea of the Holy, a small, but significant, publication in the early part of last century,29 examined this paradox of encountering the Divine, consisting, in his view, of the experience of both the mysterium fascinans and the mysterium tremendum. The former is the wonderfully elevating and blissful moment of entering the numinous. This is Paul’s experience of being ‘caught up to the third heaven’ (2 Corinthians 12:2). The latter, however, is when we come face to face with some power that confronts us with our own sense of powerlessness and frailty and the brevity of our present life. This is when our corporeal nature recognises the limits of its existence in the face of the immensely Eternal One. We sense our ‘creaturehood’ (Geschöpflichkeit) as ‘impotence and general nothingness as against overpowering might, dust and ashes as against majesty’.30 It is this latter nature of the holy that is such a challenge to the ego-centric individualism of our western cultures and is so assiduously avoided by those who would promote ‘spirituality’ in opposition to ‘religion’. Encountering the mysterium tremendum needs, what Tacey calls, ‘a sacramental community for sanctuary and support’.31 Like Moses in the cleft of the rock, we meet God indirectly, in a sacramental way within a community of like-minded believers. St Augustine of Hippo, writing at the beginning of the fifth century CE, said that a sacrament is ‘a visible sign of a sacred thing, a visible

the face of continuing rejection and hostility from church leaders is presented in Geoffrey Duncan, Courage to Love: An Anthology of Inclusive Worship Material, London: Darton, Longman and Todd, 2002. Another book designed for those who have moved away from traditional religious practice is Dorothy McRae-McMahon, Rituals for Life, Love and Loss, Sydney: Jane Curry Publishing, 2003. 29 Rudolf Otto, The Idea of the Holy: An Inquiry into the Non-Rational Factor in the Idea of the Divine and its Relation to the Rational, London: Oxford University Press, 1923. 30 Ibid., p. 21. 31 David J. Tacey, ‘Recovering Faith in a Faithless Age: the Post-Modern Spiritual Landscape, and a Case Study of a Student’, Paper presented at Australian Health and Welfare Chaplains’ Association Conference, 2003. Keynote Addresses, Australian Health and Welfare Chaplains’ Association, Alice Springs, 2003.

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form of an invisible grace’.32 This is a very broad description of any kind of actions that can be seen as pathways or beacons to an awareness of mystery. Rites and rituals are those moments open to grace and blessing when the invisible actions of God are made visible in the use of material creation. In the broadest sense of the word, ‘sacrament’ is the sign of something sacred and hidden. In this sense, the whole world is a vast sacramental system, in that material things are for human beings the ‘signs’ of things spiritual and sacred, even of the Divinity. ‘The heavens are telling the glory of God; and the firmament proclaims his handiwork. Day to day pours forth speech, and night to night declares knowledge’ (Psalm 19:2). The writer to the Romans acknowledged this sacramental universe as the most telling sign of God’s presence and the one most easily available to anyone who would dare to look. ‘Ever since the creation of the world his invisible nature, namely, his eternal power and deity, has been clearly perceived in the things that have been made’ (Romans 1:20). If we dare to look, McFague argues: ‘we might begin to see (for the first time, perhaps) . . . the extraordinariness of the ordinary. We might realize that we live and move and have our being “in” God. We might see ourselves and everything else as the living body of God’.33 While it is true that ‘grace is everywhere’,34 human beings need a focused way of viewing such a reality, some specific symbols and actions that attempt the connectedness with metaphysical realities. McBrien says: ‘A sacramental perspective is one that “sees” the divine in the human, the infinite in the finite, the spiritual in the material, the transcendent in the immanent, the eternal in the historical’.35 Rites and rituals are limited ways in which we strive ‘to make God present to us, allowing, as Gleeson does, for the fact that there can be no pretence that in any human experience, even in a special sacramental ritual like the Eucharist, we can capture the full reality of God. There can

32 Sacramenta signacula quidem rerum divinarum esse visibilia, sed res ipsas invisibiles in eis honorari. In De Cathechizandis Rudibus XXVI 50. Latin text on line. Augustine De Cathechizandis Rudibus, 33 Sallie McFague, The Body of God: An Ecological Theology, London: SCM Press Ltd, 1993, p. 132. This whole work is a consideration of the sacramentality of creation. 34 Georges Bernanos, The Diary of a Country Priest, London: The Bodley Head, 1937, p. 317. 35 Richard P McBrien, Catholicism, Melbourne: Collins Dove, 1994, pp. 9–10.

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be no question of objectifying God, of delivering God in a package, as it were’.36 Rites and rituals, however, are grounded in the context of a sacramental worldview and are not somehow a separate reality. Sacrament and sacramentals are rites that specify or localise what Hopkins called ‘God’s grandeur’ which ‘flames out like shining from shook foil’37 in the sacramental experience, if we but attend to it. But the grounding is in the everyday ordinary things. Moore asserts that ‘To the soul, the ordinary is sacred and the everyday is the primary source of religion’.38 Within the context of illness and suffering, common as it is to the human condition, human beings, viewing their experience in a ‘sacramental way’, can find a path to Mystery. The mystic traditions of a number of the major religions of the world acknowledge suffering as one of the ways of touching the holy and of reaching ‘holiness’—an encounter with the Divine. The ‘Book of Job’ is a classic struggle to make sense of the senseless and to find God in the midst of chaos.39 Mystics within the Christian tradition called this the via negativa (the way of negation) or ‘the dark night of the soul’.40 May41 and Moore42

36 ‘The God whom we encounter in sacraments is . . . Mystery. Real though it is, the sacramental encounter is limited. Even as we experience the presence of God, within and through the signs of the presence of God, we experience also the absence of God . . . And yet, one does not hesitate to claim that in sacraments of all kinds, God does meet us, and we do meet God’. Brian Gleeson, ‘Symbols and sacraments: Their human foundations’, 2004, 37 Gerard Manly Hopkins, ‘God’s Grandeur’ in W. H. Gardner (ed.), Poems and Prose of Gerard Manly Hopkins, Middlesex: Penguin Books, 1953, p. 27. 38 Thomas Moore, Care of the Soul: How to Add Depth and Meaning to Your Everyday Life, London: Judy Piatkus Publishers Ltd., 1992, p. 203. 39 This theme from The Book of Job was examined in detail in a series of keynote addresses by Norman Habel, an Australian Lutheran theologian, to the Australian Health and Welfare Chaplains’ Association National Conference held in Alice Springs in April 2003. In these, Habel argues that it is the suffering of what he terms ‘spiritual abuse’, perpetrated by those who would crush the spirit with creed and dogma, that has driven people from the church and ‘religion’ into seeking ‘a bold new spiritual experience’ in a ‘post-religion age’. 40 Perhaps the best known of these is St John of the Cross with his Noche Oscura which he prefaced with Canciones de el alma que se goza de haber llegado al alto estado de la perfección que as la unión con Dios por el camino de la negación espiritual. (Songs of the soul, which is possessed by being called to that higher state of perfection in union with God by way of spiritual suffering.) In J. V. Rodrigues (ed.), Lira Mistica: Poesias de Santa Teresa y San Juan de la Cruz, Madrid: Editorial De Espiritualidad, 1988, p. 136. 41 May, The Dark Night of the Soul. 42 Moore, Dark Nights of the Soul.

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have returned to these insights as a way of helping, as people who are sick and suffering make sense of what is happening to them, and of finding meaning and God in the oscura of these liminal experiences. In recent history, we find Dietrich Bonhoeffer writing from his prison cell in 1944: ‘Suffering is a way to freedom. In suffering, the deliverance consists in our being allowed to put the matter out of our own hands into God’s hands’.43 With the collapse of our ordered world, when the people and possessions we prize most, when the things that are most important to us, are suddenly stripped away from us, we are left, like Job, naked. When there are no familiar props and supports which help to make some sense of the senseless, even in the religion that has served us well, it is then, and perhaps only then, that we may begin to see the face of Mystery.44 This is the searing experience of gold being tested by fire (Peter 1: 6–7).45 A period of protracted illness can give time to reflect on the experience and seek some meaning. Kirkwood outlines alternative ways in which this might be done when faced with the reality of suffering in our personal lives.46 When it comes to facing the mysterium tremendum, people of our present generations are not asking the kind of questions that might arise for theologians and dogmatists. They are asking what Hellwig calls ‘the gut-level questions about personal experience and personal responsibility and the personal effort to make sense of life’.47 Beaudoin 43 Dietrich Bonhoeffer, Letters and Papers from Prison, London: Fontana Books, 1959, p. 161. 44 Illness (or disease) can be the beginning of a deep spiritual quest. It may offer you the challenge of confronting—perhaps for the very first time—the fact of your human mortality. Jeanne Achterberg, Barbara Dossey et al., Rituals of Healing: Using Imagery for Health and Wellness, New York: Bantam Books, 1994, p. 12. This idea is also in Gleeson, Symbols and Sacraments. 45 ‘In this you rejoice, though now for a little while you may have to suffer various trials, so that the genuineness of your faith, more precious than gold which though perishable is tested by fire, may redound to praise and glory and honor at the revelation of Jesus Christ’. (Peter 1: 6–7). This image of purification runs through both Testaments, and is present in the Apocrypha as well. ‘Then the tested quality of my elect shall be manifest, as gold that is tested by fire. “Hear, my elect,” says the Lord. “Behold, the days of tribulation are at hand, and I will deliver you from them” ’ (Esdras 16:73–74). 46 Any regular visitor to a hospital will inevitably be asked the question ‘Why? Why me?’ That question involves more than the Kubler-Ross explanation of it as a response of anger. Fundamentally, it is a theological question. Neville A Kirkwood, Pastoral Care in Hospitals, Sydney: E. J. Dwyer, 1995, p. 201. This whole chapter considers the role of suffering in life from a Christian perspective. 47 Monika Hellwig, The Meaning of the Sacraments, Dayton, Ohio: Pflaum Press, 1981, p. 3.

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argues that Generation X (born in the 1960s and 1970s) is a deeply sacramental generation, searching for authentic spiritual guides and dependable, genuine communities in which to encounter God and interpret their own experience of the divine, especially when faced with suffering. ‘Suffering is a catalyst for GenX religiosity’.48 Some communities of faith have a unique charism in their sacramentality that has the potential to speak powerfully to this generation’s spiritual yearnings and experiences of suffering. I believe that there is such potential within the Catholic tradition. But in order to speak, powerfully or otherwise, there needs to be a common ‘language’, acceptable to both the community of faith and the individual caught in the experiential moment. Finding that common language is one of the tasks of the chaplain who is striving to meet the spiritual yearnings in the midst of suffering. Like music, rituals have the ability to ‘speak’ in many languages. When the web of relationships that gives coherence to our lives begins to unravel under the spiritual distress of severe pain, illness or approaching death, spiritual reserves are recalled and put into practice in the form of rites or rituals, either as the official rites of a community of faith (sacraments or recognised prayer forms) or in the rituals of popular piety or non-specific celebrations of a ritual nature. In the minds of the dogmatists and theologians there may be a distinction in kind between these, but in the midst of spiritual distress many would regard such distinctions as passé. The quantitative statistical data for my research was very limited, since it was only part of the overall methodology. However, 36% of the questionnaires distributed over the four hospitals were returned. Having established some background information regarding a patient’s family of origin and religious practice, one question enquired about recent hospital experience and contact with the chaplain.

48 ‘Xers’ relation to suffering lays the groundwork for religiousness. This knowledge of suffering sparks our spirituality, because suffering is a sort of ‘boundary experience’ that forces us to confront questions about our own human limits. After all, when you suffer, you want to know why, for how long, and who or what is responsible. If you ask that question broadly enough, you wonder about God and religious experience, whether in emotional, resentful, dismissive, ironic, debased, or intellectual ways. Suffering is a catalyst for GenX religiosity’. Tom Beaudoin, Virtual Faith: The Irreverent Spiritual Quest of Generation X, San Francisco: Jossey-Bass, 2000, p. 97.

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RECENT HOSPITAL EXPERIENCE Prayed Read together Bible 28 (62%) 7 (15%)

Holy Annointing Prayers Communion Sick/Dying for the Baptism/ Dead Confession Naming 14 (31%)

11 (25%)

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1 (2%)

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3 (6%) 12 (26%) Very helpful: 23 (68%) Definite helpful: 5 (12%) Helpful 12: (30%) Not helpful: 0 No response 5: (11%)

Figure 2. Respondents’ Experience of Religion in Hospitals

The data from the section on recent hospital experience (Figure 2) held some notable features. The majority of respondents were in hospital for more than a month (64%) and only half (49%) had actually requested a visit from a chaplain. Five of the respondents, however, had not received a visit from a chaplain at all during their time in hospital, probably among those who were in hospital for less than a week. The interesting trend here is in the spread of the non-sacramental activities (rituals) reported in comparison with the sacramental (rites). There is a high percentage for the ‘prayed together’ (62%) and ‘other’ categories (26%). (‘Other’ was often identified as a ‘comforting talk about God’). Some respondents were from non-sacramental traditions and this would be reflected in these figures. Not surprisingly, for those from a sacramental tradition, Anointing of the Sick and Holy Communion are significant sacraments in the hospital situation. What is interesting is the very low reporting of Confession—only one person in the sample—which would be in keeping with my personal experience of ministry in the hospitals as well. There has been a massive decline in the practice of this particular sacrament, identifying it as one of the rites and rituals that are no longer perceived as relevant to people today.49 This is interesting and may be evidence of a shift in thinking, away from the ‘fear of hell’ practices of the past, especially in providing pastoral care for the dying. Or it could indicate what Beaudion identified as ‘spirituality . . . only loosely connected to the public

49 A recent symposium looked at this phenomenon. The consensus there seemed to be that while a particular form of confession—auricular confession—had declined there were other ways of celebrating ‘the sacrament of reconciliation’. One of these is the Sacrament of Anointing. For this discussion see Jerry Filteau, ‘Theologians, historians explore decline in confessions’, 2004,

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face of religious institutions’.50 Some people will seek a spiritual connection without necessarily wanting to participate in all the institutional practices. The central focus of my research was the significance or otherwise of rites and rituals in helping people heal. The section of the questionnaire that focused on this asked how the presence of the chaplain/minister of religion and the spiritual care provided in hospital helped in recovery or coping with the hospital experience (Figure 2). There was no response from five of the sample, consistent with the group that had not been seen by a chaplain. All of the other respondents indicated ‘helpful’ or better, with the largest response being in the ‘very helpful’ category (58%). This result is comparable to the Steinhauser (et al.) study that canvassed the importance to patients and their families of meeting with a clergy member (69% of patients and 83% of families).51 This is significant when we note that a little over half (51%) had not specifically requested a visit from a chaplain, yet found the visit of a chaplain more than helpful in their coping with their hospital experience.52 In the present climate of fear around The Privacy Act, and the consequent difficulties encounter by some chaplains in obtaining lists of patients, this fact should be noted. In order to provide spiritual care, chaplains must have access to the lists of patients who have indicated their religion and must be proactive in making contact on the wards. Elliot’s research also recommends this.53

50

Beaudoin, Virtual Faith, p. 164. Karen E. Steinhauser, Nicholas A. Christakis et al., ‘Factors considered important at the end of life by patients, family, physicians, and other care providers’, Journal of the American Medical Association, vol. 284, no. 19, 2000, pp. 2476–82. Table 4. p. 2480. 52 VandeCreek and Burton, ‘Professional Chaplaincy’. This is an extensive White paper prepared for HealthCare Chaplaincy, a centre for training chaplains based in New York. Section IV, The Benefits of Spiritual Care Provided by Professional Chaplains details the positive advantages of providing chaplaincy services. 53 When discussing a series of surveys conducted in Australia and New Zealand between 1976 and 1997 she says: ‘The surveys also showed that most chaplaincy visits were made routinely, with few being initiated by patient request. However, most of the visited patients indicated satisfaction with the chaplain. The statistics show that large numbers of patients are not being visited, supporting the conclusion that it is essential for chaplains to initiate visits, as patients may not request ministry, which they want and need’. Elliot, ‘Hospital Chaplaincy in the Context of Religion in Contemporary Australia’, p. 206. 51

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In 2006, a more extensive Spirituality and Health Survey was undertaken at Prince of Wales Hospital.54 It was a project run conjointly by The Diversity Health Department and Chaplaincy Services. This was a hospital-wide survey of 228 patients and their family members. Their findings confirm what had already emerged in my own limited research. Over 80% of people surveyed think that health is affected by beliefs, and that these beliefs become more important when a person is ill. Seventy-nine per cent of respondents observed religious rituals and/or spiritual practices and the majority would want them to continue if/ when they were in hospital. One particularly significant result was that over 70% of respondents felt it was helpful for hospital staff to know about their religious and/or spiritual beliefs, and said it was alright for staff to ask them. This contradicts the popular idea that patients find it intrusive to be asked about their beliefs and practices—one of the basic reasons given by many in the medical professions and by public hospital administrators for not acknowledging religious beliefs and practices. Over 40% of people who completed the survey said they would like to speak to a chaplain, while a further 17% thought they might like to see a chaplain ‘if I feel that I might need support and comfort’. The conclusion is clear. Overall, the findings strongly suggest that healthcare professionals need to find ways of supporting people’s beliefs and practices as part of patient-centred and family-sensitive treatment and care regimes. Even if not connected with their traditional sources of religious belief, the majority of patients and their families still acknowledge that some attention needs to be given to their spiritual needs and that the ministrations of those who can best meet those needs is beneficial to their healing. It is the task of the hospital chaplain to do so. Those responsible for the implementation of health care protocols and policy within our hospitals should recognise those needs as integral to the processes of healing and incorporate them into the everyday functioning and operations of our health care facilities.55 Some indi54 A. Haynes, J. Hilbers, J. Kivikko and Ratnavuyha, Spirituality and Health Survey at Prince of Wales Hospital, Sydney: South East Sydney and Illawarra Area Health Service, 2006. 55 Departmental policy, from the New South Wales Department of Health, is that this should be implemented. In introducing A Model Plan for Chaplaincy and Pastoral Care Services in Hospitals prepared by the Civil Chaplains Advisory Committee in New South Wales, the Director of Health said: ‘This Circular and the Model Plan take

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viduals may have a spirituality closely connected with the traditions of a community of faith, and the practice of specific rites or rituals. Others may not. As regards our Australian attitude to things spiritual, Tacey argues that, within our national psyche, there is a deep artesian stream that carries a hidden connection to spiritual matters. He uses the image of the Todd River in Alice Springs, flowing always underground but only at times of climatic intensity being seen on the surface.56 The spiritual connections of many of the patients and families within our hospitals are like our desert rivers in the centre of our arid continent, flowing silently underground and emerging at times of life intensity. Their spiritual experience may often be nourished in personal prayer and private rituals at significant moments in life, rather than in the public expressions of communal worship. Lopez notes this phenomenon as well: The sacred is a reality that is prior to and independent of organized religion. Various surveys have indicated that a majority of those who do not belong to any religious body nevertheless continue to believe, pray, experience the sacred and engage in behaviour they explicitly label as religious.57

The hospital chaplain meets the full spectrum in ministry and helps to heal through spiritual care, with due respect for each individual’s belief system. The modern role of hospital chaplain is multifaceted, combining a broad range of health concerns. They operate within a holistic framework incorporating an understanding of the behavioural, emotional, physical and spiritual perspectives of their patients, families and staff. Additionally their role requires a high level of professional expertise in matters relating to spiritual guidance, management, accredi-

into account changes that have occurred regarding chaplaincy and pastoral care services in the health system. They apply to hospitals and to community based facilities and services. Health Services will need to consider access to chaplaincy services across the continuum of care and ensure appropriate services are available. Co-operation and religious tolerance should be promoted and encouraged to ensure the needs of our diverse community are met’. M. Reid, 1998, File No A4534, Chaplaincy Services to the New South Wales Health System. www.health.nsw.gov.au. This policy was reinforced in a more recent Circular from the present Director General Roby Kruck (2004/91). 56 Tacey, ‘Australian Spirituality and Health’. This is reminiscent of Isaiah 35: 6–7. ‘For waters shall break forth in the wilderness, and streams in the desert; the burning sand shall become a pool, and the thirsty ground springs of water’. 57 Frank Lopez, Pastoral Care in an Emerging World, Sydney: Marist Centre for Pastoral Care, 1994, p. 132.

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tation and quality improvement in the healthcare setting, which has placed them firmly in the allied health arena. They are professional people, professionally trained and acting in a professional capacity. The limited size of sampling in my research does not preclude drawing conclusions or making recommendations. My research does demonstrate the growing place of the spiritual/religious aspects of healing, and the role of rites and rituals in that process. It is only a beginning. Especially within the Australian context, there is a clear need for extensive research into how this integration of the spiritual into best medical practice might be achieved. Providing spiritual care for patients and their families is considered a requirement for accreditation as a hospital or health care facility in Australia. To date, little attention has been given to a consideration of any detail of what ‘adequate spiritual care’ might mean in practice. There are many conscientious and dedicated chaplains and pastoral carers in our health facilities who are providing as best they can. Within the public hospitals, however, they are often relegated to the periphery, even in the geography of the site.58 They are certainly not yet considered as integral members of the hospital’s professional staff. Based on the findings of my research, their integration into the mainstream processes of health care would be facilitated by the following: • Hospitals and other health care facilities should be proactive in including the spiritual/religious in patient’s health care protocol as a matter of course. Such a protocol might include the taking of a simple ‘spiritual inventory’ as part of the process of admission to the hospital so that appropriate spiritual care can be provided. The irony is that the present confusion around issues of privacy, in some hospitals, is preventing the distribution of even minimal data on religious beliefs to chaplains and pastoral care workers. And, this is at a time when the greater part of research recommendations, mostly coming from overseas, is for an inclusion of spiritual care and a greater incorporation of chaplaincy services at a professional level. Both the quantitative and the qualitative data from my research show the

58 Frances Norwood, ‘The ambivalent chaplain: Negotiating structural and ideological difference on the margins of modern-day hospital medicine’, Medical Anthropology, vol. 25, 2006, pp. 1–29. This is an excellent examination of the ways in which chaplains need to work within the health care system.

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high percentage of patients who identified personal benefit from the ministry of a chaplain, even if they had not specifically asked for a visit. Chaplains must be given the means of accessing patients and patient information so that they can attend to their spiritual needs. Federal and state legislators should be lobbied to amend the relevant legislation. • Just as patients are referred on to medical specialists, so should they be referred to accredited chaplains and pastoral care workers for appropriate spiritual assessment and care. They are the ones on staff most qualified to do so. As recognised professionals, they should also be included in the critical case management of patients, and not simply summoned when all else has failed. The myth of the last rites and the ‘send-for-the-priest’ syndrome needs to be seriously challenged. • Those being trained in the medical professions, at whatever level, need to have specific courses available to them to enable them to integrate this aspect of healing into their practice of medicine. This requires far more than an incidental inclusion of chaplains in the general orientation programs for staff commencing at the hospitals. As a start, an elective unit at tertiary level should be offered in all training hospitals, or in medical faculties of universities. Koenig argues that there is an urgent need to expose medical students in Australia to the role that religion plays in coping with illness.59 This is one area requiring further research. Establishing such a programme within Australian university faculties of medicine is a necessary first step. The process of healing is other than just a physical recovery from illness. Healing is the holistic integration of the entire experience of illness, regardless of the medical outcome. As a result of this research, the positive benefits of acknowledging religious beliefs and practices as an integral part of a holistic health care protocol in a hospital or 59 Harold G. Koenig, who has been a leading advocate of spirituality/religion and health in the USA proposes that: ‘Exposing medical students in Australia to the role that religion plays in coping with illness and the research connecting religion and health should not be delayed. . . . Certainly, . . ., ongoing research is necessary. Nevertheless, religion is a powerful factor that can influence health, wellbeing, and medical decisions for better or worse. It should not be ignored or neglected by physicians.’ Koenig, ‘Religion, spirituality and health’, pp. 51–52, p. 52.

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health care facility are revealed. The proactive inclusion of the spiritual needs of patients in the everyday team management of cases ultimately improves the quality of care being offered to patients and their families. It is time for the medical professions in our country to recognise this fact.

CHAPTER NINE

LIMITATIONS IN DEATH: NEGOTIATING SENTIMENT AND SCIENCE IN THE CASE OF THE HOSPITAL AUTOPSY Philomena Horsley Preamble It’s 11.20 am in Anatomical Pathology. I’m in a group observing the demonstration of a new tissue slicing machine. An autopsy worker1 appears and moves quietly behind me. He whispers in my ear, ‘We’re doing another PM [post-mortem] shortly if you want to observe. It’s just a brain’. I head off to gown up and enter the autopsy room. Shortly the trolley is retrieved from the cold room and wheeled in. As usual, the tag outside the body bag is checked first: it’s the name of a prominent politician, and wry comments are made about the possibility of the said man being within. The body bag is unzipped with a flourish, and an unknown face exposed. Of course it’s not him, and a worker dryly observes, ‘Why would a politician be in a public hospital?’ A bright white towel is neatly tucked around his neck like a scarf, the bag re-zipped, leaving only his head protruding. The medical records indicate that the man had a medical condition which required chemotherapy. This treatment depressed his immune system, allowing some infection to take hold in his brain. He died yesterday. If the infection was what clinicians suspect, it would have been ‘a quick death’, according to one worker. The family originally consented for a full post-mortem, but then changed their mind and opted for a form of limited autopsy—a ‘brain only’ as a ‘fresh cut’. ‘This is a pain’, according to one of the workers. He explains that the brain will be removed, sections of it will be sliced, photographed and examined, and then all the brain, minus samples, will be immediately

1 For reasons of confidentiality, I use the term ‘autopsy worker’ in this article to refer to all staff engaged in autopsy work: pathologists, registrars, mortuary scientists and mortuary technicians.

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returned to the skull. In a fresh state, without the solidifying effect of formalin, the brain is much more fragile, so the task will be both more difficult and take longer. This will indeed prove to be the case. [Fieldnotes, Nov 2005] Introduction We all die. Most of us will die simple, obscure deaths. The majority of us will expire in a hospital or nursing home setting, and then languish in the near anonymity of a mortuary.2 Few of us will ‘feel’ the scalpel blade in a post-mortem. We will be farewelled in a largely private and simple fashion, and likely disposed of through cremation.3 Our kinfolk will create, even ritualise, a coherent story of our life and subsequent death. We will have lived complex, yet ordinary, lives, and endured (perhaps) unwanted but unremarkable deaths. The death of others provides an opportunity for the living to contemplate our inevitable demise. The failure of so many people to register post-mortem wishes via wills, funeral plans and organ donation registries suggests we are somewhat reluctant to do so. I have been unusually absorbed by death and its mortal remains as I researched the issue of autopsies at ‘Hillside’, a Victorian public hospital.4 The ethnographic method I employed required my presence at a range of adult and perinatal autopsies. Being there in the mortuary demanded some reflection on both the fleshly disturbance of the body, and the grief heaped upon those who knew the deceased well. Grief is a titanic emotion. As Graham Little once wrote, it includes ‘sadness at loss, sorrow, swelling remorse, moments of wild panic, groans of despair and sudden heaving sobs that clutch at the familiar face in a dream. “Oh no”, we say. “Oh no” ’.5 Reason is grief ’s stead-

2 In Victoria, where my fieldwork was conducted, in 2004–5, 56.6% of deaths occurred in public and private hospitals and 30.5% of deaths occurred in nursing homes. The remaining 13% died at home or in a public place. These proportions are similar to averages Australia-wide. 3 Cremation, a relatively recent fashion, is currently employed in around 70% of body disposals in Australia. See Robert Nicol, ‘Australian burial customs’, in Allan Kellehear (ed.), Death and Dying in Australia, South Melbourne: Oxford University Press, 2000. 4 ‘Hillside Hospital’ is a pseudonym for reasons of confidentiality. 5 Graham Little, The Public Emotions—From Mourning to Hope, Sydney: Australian Broadcasting Corporation, 1999, p. 81.

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fast companion: ‘Why?’ we say, ‘Why?’ Loss demands a narrative of comfort, the need to make sense of it, to find meaning or purpose. When words fail and thoughts are addled, metaphors must suffice: it’s life’s ‘final chapter’, we’re ‘closing the book’, it’s ‘the end of the road’. Story is a narrative bound by inquiry. We have always been ‘narrating animals’ according to Roland Barthes;6 we are culturally dependent on tales that provide a conceptual coherence to human life. We fear, or are unsettled by, the chaotic and the incomplete. The late modern era has deposed, unsettled or obscured the grand narratives of death. To what effect? Zigmunt Baumann suggests that we now live in a constant state of uncertainty, engendering a fear that characterises ‘our liquid modern age’.7 He argues the unknowability of death, its defeat of reason, evokes the greatest anxiety.8 Ethicist Margaret Somerville concurs, arguing that, ‘We have lost our sense of mystery and reverence in relation [to death] and replaced those senses with anxiety and fear’.9 As religious adherence wanes in the western world, spiritual inquiries become splintered, eclectic and individualised, or simply irrelevant.10 The cultures of death are now heavily influenced by the scriptures of science. Medicine provides a reassuring script (in both senses): it seeks to manage dying and death through its diagnostic, treatment and explanatory practices. When medicine fails the human body, as it must, the clinical reason, the ‘cause of death’, is determined and officially recorded. Grief’s ‘closure’ is understood to depend upon it. But what if a person’s death lacks sense or clarity? What if, despite our expectation and preparation, the end appears untimely? What if we remain unsatisfied as to ‘the real culprit’, its cause? In such cases, the body may hold the final answers; for these people there is the autopsy. Those whose deaths are ‘unexpected’, ‘unnatural’, ‘violent’, ‘accidental’

6 Roland Barthes, ‘Introduction to the Structural Analysis of Narratives’, in Susan Sontag (ed.), A Barthes Reader, London: Cape, 1982. 7 Zigmunt Bauman, Liquid Fear, Cambridge: Polity Press, 2006. 8 Zigmunt Bauman, Mortality, Immortality and Other Life Strategies, Stanford: Stanford University Press, 1992. 9 Margaret Somerville, The Ethical Imagination: Journeys of the Human Spirit, Carlton: Melbourne University Press, 2006, p. 133. 10 A recent Sydney report of patients and their family members found that one in four of the 74% who identified as having spiritual or religious beliefs of some kind identified as only spiritual beliefs. The authors suggest this ‘supports evidence that Australian society is becoming less religious but more spiritual’. See Prince of Wales Hospital 2006, ‘Spirituality and Health Survey at POWH: Initial Findings’, Diversity Health News Bulletin.

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or of unknown cause will fall under the purview of the coroner.11 For others, there is the hospital autopsy. With explicit consent of families, medicine will commence its work: doctors will incise the corpse’s abdomen, saw open the skull, and delve deep into cavities to expose its visceral secrets. But the fleshly intrusion of a post-mortem can be a confronting concept. It challenges widely held sentiments about the dead body. It necessitates a degree of equanimity about the treatment of a loved one’s material remains. Those relatives discomforted by the idea of autopsy will require a motivation sufficiently compelling to overcome the feelings of distaste, concern or repulsion that such a procedure commonly inspires. This chapter explores the realms of sentiment12 and science, as embodied by the dead and negotiated by the living. It trails the tangle of emotions and reasons uncovered when death does not follow ‘the’ script. Rather than taking a theoretical, philosophical or historical stance, it situates itself within the very practical, material space of the hospital mortuary. Here perhaps, amidst its autopsy work, a lens can be held over the thoughts and feelings of those engaged in autopsy work, and the family members who strive to make sense of their loss.13 In this instance, the view it holds in place is the limited autopsy. A lens on the body The authority of the family ultimately generates, and limits, the cadaveric work of any hospital mortuary. In most cases, deceased patients now pass through such doors intact. Where previously most public patients who died were autopsied (often without the knowledge of families), recent decades have witnessed a relentless decline in autopsy rates. In Australia, as with most western societies, the national rate for

11 These requirements relate to Victoria’s Coroners Act 1985 s 3(1), and also include ‘deaths involving anaesthetics’, and ‘deaths of persons in custody’ or whose identity has not been established. 12 By ‘sentiment’ I am referring to an anthropological sense of sentiment as ‘culturally constructed patterns of feeling and behaviour’ which bind us to a social entity, such as honour and respect, as employed by Jane Fajans, ‘Shame, social action, and the person among the Baining’, Ethos, vol. 11, no. 3, 1983, pp. 166–80. 13 This article draws upon field notes, in-depth interviews with 36 Hillside staff and 14 next of kin of recently deceased patients, and 102 surveys completed by relatives about their experience of the autopsy process.

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autopsies has fallen well below 10 per cent of hospital deaths.14 At Hillside, it hovers around five per cent, although nearly one in five families who are offered the option will take it.15 Its decline is a source of continuing professional anguish to bodies such as the Royal Australasian College of Pathologists.16 At Hillside, some of its practitioners view its decline as a loss to families because, I am told by involved staff, ‘it is the last service the hospital can offer the family’. The impending demise of the hospital autopsy may be surprising. The popularity and predominance of dissections (both fabricated and factual) that are currently played out across national television suggests otherwise. Our screens hum nightly with the science of the corpse, images of a ‘body in ruins’ displayed for entertainment and education: forensic mysteries, true crime, funeral home sagas, documentaries on anatomy and decay. The media coverage of material death is currently devoured by a public compelled by these mysteries and disclosures of death. It seems morbidly ironic then, that at a time of its greatest exposure the practice of autopsy, in hospitals at least, is near death.17 To some, such public exposure of the eviscerated corpse is distasteful and disrespectful. It evidences a loss of social reverence for human death, at very least a ‘morbid fascination’ that is unsettling.18 Others welcome it. They applaud its revelations of hitherto hidden, medical knowledge and practices. Such debates are not new: the western treatment of the human corpse is an eventful history which cannot be adequately summarised here.19 Nevertheless, from its stories we know that among different social groups, and for different reasons, the integrity of the dead body has been both upheld as sacred and torn asunder

14 The Royal College of Pathologists of Australasia Autopsy Working Party, ‘The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia’, Medical Journal of Australia, vol. 180, 2004, pp. 281–5. 15 Internal hospital data presented at Medical and Surgical Grand Rounds in 2004 and 2005. 16 The Royal College of Pathologists of Australasia, ‘Is the autopsy dead?’ Royal College of Pathologists of Australia, 2004. 17 Forensic autopsies face greater challenge in Victoria as families become more aware of their rights to object to autopsy. See State Coroner’s Office, ‘Submission to the Law Reform Committee of the Parliament of Victoria’, 2005. 18 From title of a public event held in London by the Institute of Ideas, ‘Morbid fascinations: the body and death in contemporary culture’, May 16, 2003. 19 Ruth Richardson, Death, Dissection and the Destitute (2nd edn.), London: Phoenix Press, 2001; Michael Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America, Princeton: Princeton University Press, 2002.

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for science. Contrary to some views, religion has been as much a promoter of dissection as a protector of the body. Gonzalez-Crussi, for instance, argues that the Catholic Church of the sixteenth and seventeenth centuries granted anatomists their full protection because its authorities believed the astonishing revelations of their work confirmed the powers of the ‘Supreme Maker’.20 But it is also true that a cultural repugnance to interference with the body has stemmed from a variety of religious influences. As historian Ruth Richardson observed of the relevant nineteenth century debates: ‘Dissection represented a gross assault upon the integrity and identity of the body and upon the repose of the soul’.21 But the influences of enlightenment thinking, particularly its medical adherents, countered such concerns with a strong embellishment of dissection as a ‘triumph of scientific investigation and rationalism over theological conceptions of the sanctity and dignity of the body’.22 In current times, major religions, eastern and western, impose no prohibition on autopsy, though cultural constraints are shaped by the residue of their traditional negativity. The scientific discourse of the ‘machine-body’23 is more prevalent and authoritative in lay cultures than ever before. Yet, regardless of one’s secular or spiritual identity, many people retain an aversion to any medical interference with the dead, whether through autopsy, organ donation or body donation.24 Attitudes to the corpse now appear more flexible, less ordered, more contextual, less regimented.25 The body is recognised as a multi-vocal, multi-sited construction. Emerging from it is a dialectic that negotiates

20 F. Gonzalez-Crussi, On Seeing: Things Seen, Unseen and Obscene, New York: Overlook Duckworth, 2006. 21 Richardson, Death, Dissection and the Destitute, p. 76. [Her emphasis] 22 Colin Samson, ‘Biomedicine and the body’, in Colin Samson (ed.), Health Studies: A Critical and Cross-Cultural Reader, Oxford: Blackwell Publishers, 1999, p. 5. 23 Drew Leder, ‘A tale of two bodies: The Cartesian corpse and the lived body’, in Drew Leder (ed.), The Body in Medical Thought and Practice, Dordrecht/Boston/ London: Kluwer Academic Publishers, 1999. 24 S. McPhee, K. Bottles, B. Lo, G. Saika and D. Crommie, ‘To redeem them from death: Reactions of family members to autopsy’, The American Journal of Medicine, vol. 80, 1986, pp. 665–71; Margareta Sanner, ‘A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection: A Swedish survey’, Journal of the American Medical Association, vol. 271, no. 4, 1994, pp. 284–288; H. G. Brown, ‘Perceptions of the autopsy: Views from the lay public and program proposals’, Human Pathology, vol. 21, no. 2, 1990, pp. 154–158. 25 Elizabeth Hallam, Jenny Hockey and Glennys Howarth, Beyond the Body: Death and Social Identity, London: Routledge, 1999.

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numerous paths through the scientific and sentimental fabric of the dead, late modern body. Relatives’ responses to medical interference with a corpse are now sited more frequently in the specific story of a particular body. This is perhaps most obvious in the example of the autopsy. Here, most particularly in the limited autopsy, the tensions sometimes fiercely generated by the entanglements of science and sentiment may be exposed. Limiting the autopsy—the marginally sacred body The limited autopsy is employed in cases where next of kin equivocate. It can proscribe areas of the body to be touched, determine what tissue can be removed and if relevant, the manner in which it may be disposed. While theoretically an option for some decades, it is only in very recent times that the prospect of organ retention has become better known and understood by both families and general clinical staff. The option of limited autopsy should be presented during any autopsy consenting process, although often it is not. Relatives increasingly appear to be choosing this option when offered. At Hillside Hospital, as overall autopsy rates drop precipitously, a growing proportion involve limitations. While trend figures are not available, mortuary staff tell me that they have worked on a rising numbers of autopsies that are ‘limited’ in some way. Now around one in three undertaken at Hillside has some form of restriction imposed.26 At this point it is important to acknowledge that many relatives of deceased patients largely dismiss the importance of the material remains. Those in contact with me used terms such as ‘carcass’, ‘shell’, ‘broken machine’ and ‘cast-off’ to describe the dead body of their loved one. They draw on discourses of the scientific and the natural world to explain a form that, in itself, is largely empty of meaning to them. This man, for instance, proactively offered his wife’s body for autopsy, knowing it was her wish to contribute to medical knowledge:

26 Hillside is contracted to conduct autopsies for other hospitals as well as having its own caseload. Of the total number of 72 postmortems completed at Hillside in 2005, 27 were limited in some way (38%); internally, its limited autopsies totalled 15 out of 38 (39%). In the first six months of 2006, the total limited autopsies were 12 of 47 autopsies (26%), with eight of 21 (38%) of those internally completed.

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philomena horsley To me, I believe that it’s just a body, like an old car . . . so to me [consenting to autopsy] wasn’t a big issue . . . I believe that the spirit leaves the body and it’s just like when your car comes to an end . . . the body has served its purpose, like an old car, or you know like you boil your kettle everyday to make coffee until suddenly one day it doesn’t work so you throw it out . . . I think—you can take the garden, the garden, the trees and that grow and then in the winter they seem to die off then and come back. That’s the way I see life. Life to me is a continual renewal.

From these perspectives, autopsy (and organ donation) becomes a relatively unproblematic procedure as they pertain to the literal disruption of the body. However, for others the body carries a vivid emotional topography, both on and beneath its surface. The option of the limited autopsy provides some guidance for a family caught in a maze of indecision. It straddles the emotional repulsion, the cultural resistance that the interference with human remains provokes, and the need of an understanding, a logic, of death. Reasons for its employment will vary. For some relatives in my study, the barriers to autopsy reflect cultural preferences for intactness and concerns about authorising further ‘harm’ to the dead person. Anxiety about procedures that involve ‘cutting up’, ‘disfiguring’ or ‘maltreating’ the dead body have long existed in western societies. In the past, such practices transgressed boundaries of the religious sacred. I would argue that some ritualistic elements are still present in the scientific settings of contemporary hospital settings. The medical cadaver attracts the status of ‘secular sacred’—namely through the formal demands for ‘respect’.27 Respectful practices in relation to the deceased body are required, though not always delineated, in national, state and local guidelines relating to cadaveric handling.28 Some research participants who declined the hospital’s offer of autopsy expressed a desire to preserve a ‘natural wholeness’ or a ‘peacefulness’ in death. One family member, with extensive professional experience in nursing the dying, argued:

27

A term suggested by Somerville, The Ethical Imagination. For instance, ‘Hillside’, Mortuary Methods and Procedures Manual, 2004; the Human Tissue Act 1982 (Vic.); The Royal College of Pathologists Australia, Post-mortem guidelines, October, 2003; the NATA Guidelines (Australia’s national laboratory accreditation and inspection body); and the National Code of Ethical Autopsy Practice, 2002; among others. 28

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I think once you are dead, that should be it . . . It was more important to me that my mother be left whole . . . Why can’t you die in peace, as you are, as it’s intended . . . We all die and I think that is the way it is. I didn’t want my mother cut up.

Others described concerns about causing further harm, even ‘pain’, self-consciously privileging their emotions, their ‘irrationality’, over their own reason. Their relative had ‘suffered enough’, had ‘gone through enough’ from previous medical procedures. As one respondent put it, [We] preferred to leave Mum intact, that she had had enough poking and prodding while ill, and anymore was unnecessary. I know it’s not wholly rational—Mum was dead and wouldn’t feel or know (?) about it, but still Mum . . . Our family is very medical (nurses, scientists etc.) so we understood the issues, and discussed them frankly. We were also curious about the infection Mum had, but decided against it for emotional reasons, I suppose.

People’s relationship with the dead body is manifestly temporal. For some the body remains ‘Mum’ or ‘Dad’ in some form—whether literal or symbolic—at least until its disposal (with burial, perhaps for years afterwards). For others, the ‘essence’ of their loved one departs immediately at the time of physical death,29 reducing the body to mere carapace that has little spiritual or social worth. The issue of autopsy undresses these threads of relationship, for autopsy consent is ideally obtained within hours, at most a day or two after death. In some proposed autopsies, there is no obvious necessity for a full examination. This may, in itself, limit family concerns. In the case of Creutzfeldt-Jakob disease, for instance, a definite diagnosis can only be made after examination of the brain of the deceased patient. Almost inevitably, this requires the removal of the whole brain because, I’m told, it’s almost impossible to diagnose through biopsy. A fuller examination of the body is unnecessary for the specific diagnosis, although such a procedure might throw light on co-existing morbidities.

29 And sometimes before death is declared. ‘Time of death’ is a scientific construction of certainty assailed by social and experiential counter-constructions. A number of participants, both staff and relatives, described the experience of people ‘leaving’ their bodies before the medical death was declared. Hallam et al., Beyond the Body. Also refer to a matrix of body/selves that includes hybrids of social and biological life and death.

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In other cases, though, families will restrict access to, on procedures on, parts of the body irrespective of what cause of death is suspected. This may particularly be the case when the elements of the body’s interior hold special significance. Identifiable organs carry considerable historical and cultural significances (both scientific and sentimental). More recently, debates about their (literal and symbolic) value as medical ‘commodities’ haunt international debates about transplant programs.30 Both collectively and individually, the emplacement of organs and tissues generates an internal sense of ‘intactness’ that sits a level beneath that of the integrity of the body’s exteriority. The prospect of autopsy, however, may conflict with these cultural concerns for ‘completeness’. This issue was a key focus in the recent international organ retention ‘scandals’ at Alder Hey and Bristol Hospitals among others, and prompted local changes to autopsy consent protocols.31 Those next of kin who consent to autopsy in Victoria can now explicitly determine what, if any, organs (and tissues) may be removed and kept for testing, and the manner by which they may be disposed. The heart, for instance, can be of prime importance to families. It has long represented the metaphorical seat of human emotion, particularly love and grief.32 In medical culture, it single-handedly held open the doors of life, until the extension of the definition of death to include the cessation of most brain function. In the official investigations of hospital mortuary practices at Alder Hey, Bristol and subsequent disclosures here in Australia, the revelations relating to the removal and retention of children’s hearts without parental knowledge caused particular distress. But so, too, did revelations about brain retention. The New South Wales government’s 2001 investigation into the practices of the Glebe forensic morgue found that disclosures about the regular removal and retention of brains to

30

Stuart J. Youngner, Renee C. Fox and Laurence O’Connell (eds.), Organ Transplantation: Meanings and Realities, Wisconsin: The University of Wisconsin, 1996; Margaret Lock, Twice Dead: Organ Transplants and the Reinvention of Death, Berkeley: University of California Press, 2002; Lesley A. Sharp, ‘Commodified kin: Death, mourning and competing claims on the bodies or organ donors in the United States’, American Anthropologist, vol. 103, no. 1, 2001, pp. 112–133; M. Potts, and D. W. Evans, ‘Does it matter that organ donors are not dead? Ethical and policy implications’, Journal of Medical Ethics, vol. 31, 2005, pp. 406–9. 31 The Royal Liverpool Children’s Inquiry—Summary and Recommendations 2001, The House of Commons, London. 32 Stuart J. Youngner, ‘Some must die’, in Stuart J. Youngner et al. (eds.), Organ Transplantation.

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determine cause of death were ‘the single most fraught topic’ of the investigation.33 To some of my participants, the brain (commonly understood as ‘the mind’) represents the very essence, ‘the personality’, of the deceased. It retains, with the body entire, a reverence as the site of ‘person’, spirit or soul—the essence of what makes us both human and individual. Biomedicine’s discourse may eschew an emotional salience with regard to its machine-body, but its everyday practices provide a roomier, less bounded space for practitioner dissent. I sat in an office talking to a doctor about a recent autopsy that we had both attended. We reflected on the options provided by limited autopsies. The thoughts of the doctor mirrored the cultural mix of science and sentiment that entangles material remains. They were expressed as medical fact, but laced with inquiries and uncertainty: [W]hen you say ‘yes’ to a PM, the body goes to the burial without a brain . . . like I’ve studied all my life and all science and biology, and we know that when we die . . . the soul, whatever, is not there anymore? [questioning tone] But then you think, a person’s going to get buried separated from part of itself? I mean, with the rest of the body, we just take bits and pieces and other bits get put in, returned, but the brain itself, the whole thing, just doesn’t go back to the person. And you feel that’s umm . . . I don’t know if I would allow that to happen to me if it was that instance. PH: What significance does the brain have that’s different to other organs? I guess, to me actually, it’s everything. It’s your brain. I have this feeling, this opinion where you’re buried whole, to do something like cremation whole. It just feels like you’re going off somewhere, ummm, not whole. But that’s one part of me, the superstitious part. But then on the one hand, I’m thinking, in the logical sense, it doesn’t matter, whatever, the person’s gone. [Autopsy worker]

Other people affix little sentiment to this organ after death. Recent brain research initiatives such as the national Using our brains program, established in 2003, claim a 60 per cent agreement rate from families they approach.34 Many people, both lay and clinical, regard

33 Bret Walker, ‘Inquiry into matters arising from the post-mortem and anatomical examination practices of The Institute of Forensic Medicine’, The Government of the State of New South Wales, NSW, 2001. 34 Tony James, ‘Banking on brains’, PathWay—The Royal College of Pathologists Australia, Winter, 2006, pp. 8–11.

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the (dead) brain as mechanical debris; one scientist referred to it as just ‘a bunch of electrical connections that no longer work’. The brain presents particular problems in some cases where families wish to limit autopsies. Other organs can be removed, samples taken, and then returned before body closure. Brains, however, require fixing in a formaldehyde solution to preserve and harden them before examinations occurs. This process takes two weeks to complete, impacting on funeral plans if the brain is to be reunited with the body. An alternative, unpopular with pathologists, involves the employment of the fresh cut technique, introduced at the beginning of this chapter. I did not speak to the family of that deceased man. However, I can surmise that there was some uncertainty, perhaps some questions remaining about the situation. The man’s death, while not unforseen, was unexpected. He was old and sick, but it appears, in one sense, that the curative treatment killed him. It allowed some infection to ravage and kill him, an infection ‘uncontrolled by antibiotics’, according to the death certificate. The hospital’s Deceased Patient Checklist indicates that ‘PM form needs discussion’. The autopsy consent form displays scrawled amendments; a large, emphatic ‘NO’ is written and circled next to the question on tissue retention. The scenario suggests a series of conflicted decisions, perhaps in the wife herself, or within the family more broadly. The kin clearly needed some clinical answers that only an autopsy could provide, but the scenario conveys reluctance about body disruption and the prospect of farewelling an incomplete body. When strong emotions and sentiments about the body emerge at a time of grief, yet scientific or social questions about death remain, the limited autopsy offers one pathway through the dilemma. It can be understood as an attempt to negotiate a compromised state of body, a body that is ‘marginally sacred’. But will efforts to reconcile the demands of reason and emotion in a compressed period of grief themselves disrupt the narrative of completion that is sought? Interlude The man’s hair is combed to create a horizontal part across the back of his head. The mortuary worker grasps the scalpel and a firm incision is made along this line. Gloved fingers push inside to separate the scalp from its attachments. Minutes of cutting, pushing, tearing tick by. Then the scalp is released, refracted. The face falls forward off the skull like a discarded glove. Humanity seems shrouded as the bloody paleness of the

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skull lies exposed. The technician starts the saw. It’s deafening. Instantly there’s a strong smell of hot bone and grinding motor. Small wisps and spirals of whitish dust gently rise from the skull as the saw labours on. Blood seeps out from the crack and gathers at the base of the man’s neck, pooling onto the trolley beneath. Someone enters, stops short: Oh, it smells in here. It’s just the brain dust is the cursory response. CRACK! The skull cap is off, the brain revealed. Its bulk has oozed slightly over the bottom edge, exposing blood vessels that are prominent and purplish. It’s less firm than usual, I’m told, but its condition is pronounced not too bad. Cases like this require considered, delicate work. Scissors and scalpel are inserted inside the skull to sever connections to the eyes and spinal cord. The sagging organ is coaxed out onto one gloved hand. It is carried, dripping, to the sink bench and placed gently on a green plastic tray. The newest worker inquires of another: How many of these have you done? Thousands? I wouldn’t say that, in the hundreds, is the matter of fact reply. He remains with the body, mopping out its gaping cavity with a towel, while the rest of us move across the room to the bench. We crowd around to discern the mysteries of this particular brain, the pungent smell of blood and tissue wafting around us. Slicing this brain is a particularly delicate process, requiring very sharp knives, good technique and minimal handling. It involves both sweat and awe: the cerebellum is identified and is variously pronounced the fun bit, so artistic and such a pretty piece! Brain portions gradually spread across the trays before us. A soft necrotic mass in the basal ganglia garners most attention. Now we stand waiting for the pathologist on duty to arrive to oversee the examination. They have been paged but there is no response. Meanwhile the autopsy workers discuss ways to prevent the fragile tissue slices from drying out. It’s a visible concern. A delay may affect the quality of the samples, hence the diagnosis. Frustration rises: We’ll have to wait for [the pathologist], there’s nothing else we can do. Two staff exit to do other work while the rest of us wait. One worker turns to me: This is what families don’t realise. If they go for the fresh cut we can stand around for ages. [Field notes cont.]

Limiting the science of death Dead bodies are failures; they represent the regularity by which death defies, even humiliates, the vast technological armamentaria of medical science. The practice of determining cause of death can be construed as a charade of control over death—it can be tracked to its lairs, reduced to its components, somehow understood. The process maintains the profession’s confidence in its epistemologies of the body. There is also the legal imperative. Doctors are required by law

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to conclude the story of a patient’s demise with some clinical conviction: they have a responsibility to form an opinion as to the ‘probable cause of death’. However, decisions that proscribe pathologists’ access to the body can result in autopsies that are medically ‘limited’. Any restrictions will potentially reduce the availability of visual and material evidence, as will a delay in giving consent.35 It will also restrict the technologies that pathologists can draw upon to create a fuller picture of the body’s pathologies, including cause of death. The situation for each patient will vary according to the questions unresolved, the amount of existing clinical data available, and the nature of the death. Pathologists vastly prefer the traditional autopsy, the complete body tableau, to do their work. It seems logical that full access to a body would be the most helpful option for doctors charged with the autopsy investigation. The most likely of answers prior to dissection can be completely refuted by what is revealed once inside the body or subsequently, when tissue samples have been analysed. Indeed, there is abundant international evidence that in 25 to 35 per cent of cases, full hospital autopsies reveal key discrepancies between the cause of death nominated by the treating doctors and what was revealed by post mortem examination.36 As one pathologist describes it to me, instigating an autopsy process is inviting a doctor to embark on ‘a little mini detective story I suppose . . . It is problem solving at its most pure. You are given a problem and you have to solve it’. Foreclosing access to material evidence breeds frustration. As forensic pathologist, David Ranson, succinctly explained to a recent Victorian parliamentary inquiry:

35 An autopsy worker explains: ‘The longer the delay, the less likely you are to get useful information because autolysis, the process of decay in the body, will obscure certain amounts of information’. 36 A Hillside review of 128 autopsies from the year 1997 indicated a discrepancy between death certificate diagnosis and autopsy findings in 40 cases [Data presented at Surgical Grand Round, December 2005]. Also see Department of Health and Human Services 2001, ‘The Autopsy, Medicine, and Mortality Statistics’, Centers for Disease Control and Prevention and National Center for Health Statistics, USA; T. Kircher, J. Nelson and H. Burdo, ‘The autopsy as a measure of accuracy of the death certificate’, The New England Journal of Medicine, vol. 313, no. 20, 1985, pp. 1263–1269; J. Roulson, E. W. Benbow and P. S. Hasleton, ‘Discrepancies between clinical and autopsy diagnosis and the value of post-mortem histology; a meta-analysis and review’, Histopathology, vol. 47, 2005, pp. 551–9.

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The issue for a pathologist when carrying out an autopsy is you are being asked to carry out an investigation, the extent and end of which you do not know until you have come to a point where you are satisfied that you have collected all the relevant information.37 A Hillside pathologist echoes these frustrations. This doctor sympathises with the complexities of distress that families feel when they have unanswered questions about a death but hold significant reservations about one of their own being ‘hacked about’ (as one relative put it to me). Nevertheless, the pathologists’ professional responsibility to the family is to track down the clinical ‘culprit’ to the best of their ability. It’s a dilemma, as one explains: The figures [regarding limited autopsies] are a reflection of the increasing autonomy of families and I applaud that. However as an intellectual exercise it leaves unanswered questions. For instance, you can have an abdo only [abdomen only], open someone up and find a PE [pulmonary embolism] and that’s OK. But if you don’t find the cause of death, then it’s a practical and intellectually frustrating exercise, and quite possibly a waste of time and resources. You can’t cross the t’s and dot the i’s . . . An autopsy is a systematic process. Sometimes you can open up a body and see it clearly. But what if you get in and . . . Perhaps there are questions about a surgery. But perhaps it’s an infection, or there are no obvious answers? How can you say if there are constraints?

Fresh cut autopsies, such as the one I have been describing, can present some particular technical difficulties for autopsy workers. I was informed that: Some organs are better than others when it comes to fresh cuts. For instance, the brain has the consistency of well-made junket when cutting it fresh. It’s very hard to do, and easy to make mistakes . . . Lungs are also difficult, but the liver, spleen, bowel are almost as good as preserved specimens.

How important is the autopsy’s outcome, or more broadly, a singular cause of death? For lay people, a medical narrative of death has become an increasing imperative in a public culture dominated by scientific discourses about the living body. Science offers a ‘valid’ knowledge for all, a systematic authority on the workings of the world

37 Victorian Parliament Law Reform Committee 2006, ‘Coroners Act 1985—Final Report’, Parliament of Victoria, Melbourne, p. 504.

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that religion traditionally held.38 Anthropologists such as Emily Martin have vividly illustrated the infiltration of such discourses into lay knowledge of disease and understandings of illness.39 The traditional territories of scientific and lay discourses of the body have shifted, infiltrated, sometimes merged. As Shaw argues, the extent to which researchers hold and apply the concept of ‘a laity who holds a separate and distinct set of beliefs from expert knowledge systems’ is now problematic.40 Lay influence on medicine’s institutionalisation of the death process—its sites, processes and meanings—has also been widely critiqued.41 Patients and relatives are more engaged and more demanding when searching for the scientific sense in dying and death, even as the dying process becomes increasingly sequestered in ‘these silos we call hospitals’, as one consultant labelled them. Uncertain, ambivalent or unknown causes of death, as Timmermans observes, interfere with the efforts of medical authorities to ‘broker’ culturally meaningful, ‘ideal’ deaths.42 At Hillside Hospital, the acceptance of medical rationalisation of death is evident among the relatives of deceased patients. When I surveyed 102 of Hillside’s next of kin about autopsy, three out of four who were approached about autopsy by staff refused the option mainly on the basis that ‘they knew’ why their relative had died. It appears that the confidence that clinicians place in their pre-mortem diagnostic technologies is largely shared by relatives (which has contributed to the demise of the autopsy). Of those who did consent, the desire to know why death had occurred and to advance medical knowledge about the medical condition that killed their relative formed their main motivation. Interestingly, though, one in three people who were not approached about autopsy would have liked the option offered to them.

38

Ernest Gellner, Postmodernism, Reason and Religion, London: Routledge, 1993; Peter L. Berger, The Social Reality of Religion, London: Faber, 1969. 39 Emily Martin, Flexible Bodies: The Role of Immunity in American Culture from the Days of Polio to the Age of AIDS, Boston: Beacon Press, 1994. 40 Ian Shaw, ‘How lay are lay beliefs?’, Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, vol. 6, no. 3, 2002, pp. 287–99. It is also important to note the diversity of beliefs, meanings and practices within medicine itself are now widely acknowledged in social science. 41 Kellehear, Death and Dying in Australia; Tony Walter, The Revival of Death, London and New York: Routledge, 1994. 42 Stefan Timmermans, ‘Death brokering: constructing culturally appropriate deaths’, Sociology of Health and Illness, vol. 27, no. 7, 2005. pp. 993–1013.

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What is actually produced in the act of locating or naming cause of death? Social scientists such as Bruno Latour43 and Anne Marie Mol44 have demonstrated that, in its practice, science produces realities as well as describing them. These realities are multiple: the exercise of power enacts one reality over another. Such is the case, I would argue, with medical cause of death.45 Medical institutions are neither unitary nor inherently logical in their practices. Deceased patients are accompanied to the mortuary with a signed death certificate. There is no requirement that it be amended in light of dissenting findings from an autopsy, nor can pathologists demand it. In everyday practice, the decision of the certifying doctor generally overrides that of the verifying doctor. The death certificate is forwarded to the Registry of Births, Deaths and Marriages, from which data is collated, collapsed and categorised, forming the public health statistics that underpin research and prevention programs. Each step in the process provides a scientific camouflage for the multiple realities of death: physiological, social, psychological and inevitable (old age). Within its own realm, medical cause of death is often an inexact and unverified construction, practised in an ad hoc way, and hostage to the legalised epistemology of medicine’s the machine body. So where does the science of ‘fact’, ‘truth’ and certainty reside in such a process: The vulnerabilities beneath the medical (and social) reification of ‘cause of death’ are acknowledged inside medical territories. The Victorian Institute of Forensic Medicine, for instance, gives the following guidance to doctors with regard to death certificates: One does not need to know the diagnosis as a fact—if this was the standard, then every death would require an autopsy. The doctor should

43 Bruno Latour and Steve Woolgar, Laboratory Life: the Construction of Scientific Facts (2nd edn.), Princeton: Princeton University Press, 1986; Timmermans, ‘Death brokering’, pp. 993–1013. 44 Anne Marie Mol, The Body Multiple: Ontology in Medical Practice, Durham and London: Duke University Press, 2003. 45 There are, of course, the socio-cultural understandings employed by the family and others, which are not regarded as authoritative by medicine. It is interesting, however, that these may legally be applied to formal paperwork, although it is uncommon. For example, at one Hillside Grand Round the audience was assured by an expert that they could write their own interpretation of a death, and that, ‘Yes, writing ‘old age’ is reasonable in some cases. It’s your certificate, you are the treating doctor, its your belief ’ [Field notes July12/06]. I also heard of a past case at Hillside where a pathologist had written ‘died of loneliness’ on the autopsy report form after exhausting all clinical evidence.

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But can an autopsy confidently provide such ‘fact’? While autopsy has long been regarded as the ‘gold standard’ of medical diagnosis, even its enthusiastic proponents are conscious of its weaknesses. One autopsy worker laments the medical and public expectations of the autopsy, the myth-making that prevails in some quarters even as its ‘corpse’ is confined to the technological wastebasket: It’s unrealistic. It’s more likely to be, ‘We found this and this and this and this—and this more than that may have caused the death’. There is an expectation that somehow, ‘the answers are hidden in the corpse’. They can be, but they may not be . . . Have their [family’s] expectations been raised unrealistically? Do they expect punchy one liners? The pathologist looking up with dripping gloves, and giving the one line verdict?

Another agrees: It’s possible that the cause of death can be told from a [full] autopsy, but it is quite possible on some occasions that it can’t. So it’s really a case by case thing. I would say that more often than not you can at least see the diseases that contributed to death and hypothesise a cause of death based on that . . . And that may still hold answers for the clinicians, for the family, depending really on what the family wants.

Do families know this when they consent? Do they understand the implications of their decisions? Does it represent a calculated risk, a supreme trust in medicine’s capacity to deliver, or simply an option grasped while floating in grief? And what, ultimately, is each consenting family seeking, particularly those who have laboured to shape the fabrics of sentiment and science into a shroud of acceptability? Interlude The pathologist has arrived and examined the brain slices, directing certain areas for further examination. Samples have been taken and one worker is left gathering up the remnant pieces into a small plain plastic bag. It’s sealed with a plastic loop and taken to the waiting skull. It’s hard to stuff the bag in, there are problems. Apparently they never go in well.

46 Victorian Parliament Law Reform Commission 2005, ‘Coroners Act 1985—Discussion paper’, Parliament of Victoria, Melbourne, p. 22.

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He snips of the end of the tie; it now easier to cram into the space. The skull cap is replaced and the scalp flaps are pulled over to hold it in position. A recognisable face returns. Then the stitching is completed, the entire head washed, the wet hair combed neatly over the incision line. The head is re-submerged in the plastic bag, the long zip is drawn and the trolley is wheeled back to the cold room. Is it intact? Is it whole? The small samples of retained brain tissue are prepared for later examination. Will the answer be sufficient to close this book?

Conclusion All of us subscribe to a mix of beliefs, counter-beliefs and non-beliefs about death. Human explorations of its mysteries are culturally constitutive of religious and scientific interpretations, both historical and contemporary. A death narrative fills an expected, even compelling, role for many mourners. An absence of clarity, or the dissonance between the medical and social story, can detour or rupture a sense of ‘closure’. Into this void steps ‘the body multiple’, itself an ‘intricately coordinated crowd’.47 Its human lineage engages reason and emotion, sacredness and profanity, science and spirituality. In order to find coherence in their grief, some mourners clutch an option that negotiates intensely with this body. The route involves both corporeal preservation and dissection so that death’s mystery might be ‘distorted into clarity’48 and the security of reason may prevail. A body of marginal sacredness emerges. As time nurses inconsolable grief, it recedes, leaving its watermark: we are still alive. The human myth of death reasserts itself: ‘we remind ourselves that everyone dies, and a small voice deep inside demurely agrees, “Everyone”. Then it whispers, “Everyone—except me” ’.49

47

Mol, The Body Multiple, p. viii. John Law, After Method: Mess in social science research, London and New York: Routledge, 2004, p. 2. 49 Inga Clendinnen, Agamemnon’s Kiss: Selected Essays, Melbourne: Text Publishing, 2006, p. 70. [her emphasis] 48

CHAPTER TEN

THE CARE OF THE BODY Jeremy Shearmur Introduction1 Today, many people die—or endure an unpleasant time on dialysis— because their kidneys have given out. It is likely that there will be many more such people, because kidney failure is often a by-product of Type 2 diabetes, the rates of which are currently soaring. Kidney transplantation is now a relatively straightforward matter. But it is difficult to obtain sufficient kidneys from corpses. Clearly, there is room for improvement here;2 but a fundamental problem is that as health care improves, people are more likely to die when they are old, and when their kidneys are likely to be of less use for the purposes of transplantation.3 The issue was brought home to me graphically when I met a kidney specialist in upstate New York, who said (clearly, from the perspective of his patients) that he welcomed the fact that Spring had come, as this was the time of year that young men went out on their motorbikes again. All this puts into the spotlight the issue of live kidney transplants. Let me refer to a few of the relevant factors here. Developments in the handling of the immune system now mean that people can receive transplants from those who are unrelated to them.4 Typically we have two functional kidneys, but can get by perfectly well with one.5 Kidneys

1 This ‘Introduction’ briefly covers ground treated at much greater length in Jeremy Shearmur, ‘Kidneys and the care of the self’, Paper presented at the Australasian Association of Philosophy in Canberra in July 2006. 2 For example, if one switches from an opt-in to an opt-out system, increases advertising, and follows best international practice. 3 But as the Mayo Clinic notes, organs have been successfully used from people in their 70s and 80s. See Mayo Clinic, . 4 For example, if they take Cyclosporin. 5 Pertinent here is analysis that has been undertaken of those giving kidneys in the USA, who are able to obtain life and medical insurance without financial penalties.

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from live donors are reportedly medically preferable to kidneys from corpses.6 Many people with kidney failure are comparatively wealthy; while the possibility of selling a kidney may look attractive to some people who are poor. In the light of this, several writers have argued that the rational course of action is the development of a regulated market in live kidneys;7 something that—in the light of the existence of a black market in illegal sales—could also draw support from Margaret Radin’s broad arguments for ‘incomplete commodification’8 something which I will discuss later. However, there is a problem. For while the experience—and health consequences—of those who have given kidneys to family members in the US has been good, the experience of some of those who have sold kidneys in other countries has been problematic. A particularly interesting account is that given by Zarghooshi,9 about what is, in effect, kidney sale in Iran.10 This is regulated by the state—but the results for those who have sold seem not to have been good. Why? The explanation seems to be threefold. First—and this, clearly, could be addressed—promises made by the recipients of kidneys (for example, about benefits that will be given to donors above the state-mandated As such commercial insurance rates are extremely sensitive indicators of risk, this is a striking result. See Aaron Spitul and Tomoko Kokomen, ‘Health insurance for kidney donors: How easy is it to obtain?’, Transplantation, vol. 62 no. 9, 1996, pp. 1356–8. 6 See Michael M. Friedlaender, ‘The right to sell or buy a kidney: Are we failing our patients?’, Lancet, vol. 359, 2002, pp. 971–3. 7 See, most recently, James Stacey Taylor, Stakes and Kidneys, Aldershot: Ashgate, 2005. E. A. Friedman and A. L. Friedman, ‘Payment for donor kidneys: Pros and cons’, Kidney International, vol. 69, no. 6, 2006, p. 960 reviews the arguments that have been offered; see also Amy Friedman, Interview on National Public Radio, . Subsequent issues of Kidney International in 2006 contain a range of discussion on the same topic. See also Tarif Bakdash and Nancy Scheper-Hughes, ‘Is it ethical for patients with renal disease to purchase kidneys from the world’s poor?’, . As I revised this paper for publication, The Economist, November 21, 2006, published an editorial in which it favoured kidney sale and commended the Iranian model (discussed in my text, below). 8 Cf. Margaret Jane Radin, Contested Commodities, Cambridge, MA.: Harvard University Press, 1996. 9 See J. Zarghooshi, ‘Iranian kidney donors: motivations and relations with recipients’, Journal of Urology, vol. 165, no. 2, 2001, pp. 386–92; and J. Zarghooshi, ‘Quality of life of Iranian kidney “donors” ’, Journal of Urology, vol. 166, no. 5, 2001, pp. 1790–9. 10 See, most recently, Alirezha Bagheri, ‘Compensated kidney donation: An ethical review of the Iranian model’, Kennedy Institute of Ethics Journal, vol. 16, no. 3, 2006, pp. 269–282.

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price) seem frequently not to have been fulfilled. Second, people who have sold kidneys seem to have frequently done so out of sheer desperation, often driven by pressures from family members from whom they have borrowed money, or from money-lenders. In addition, it would appear as if these creditors have been ruthless in extracting money, to the point where the donors cannot afford essential medical follow-up treatment. (This, clearly, could be addressed, by way of the introduction of non-fungible entitlements to such treatment as part of the deal). Third, however, the real problem seems to have been that donors are very unhappy about selling, because they have been driven to do something that is culturally unacceptable. Zarghooshi reports donors as experiencing nightmares, hiding what they have done from their spouses, and being taunted in the street as ‘kidney sellers’. His reports on conditions in Iran are close to what anthropologists have reported about kidney sales in Southern India.11 This leads me to the first problem. This is: is it OK to meet genuine need, by way of allowing people to be given incentives to participate in what are culturally stigmatised activities? Or, is it OK to prevent them from being able to sell? This issue also arises in respect of the sale of blood plasma in the USA. Blood plasma is needed—in considerable quantities—for the preparation of a variety of medicines and medical reagents. For technical reasons, it is not clear that one could expect what is needed to be given by volunteers. (While volunteers do donate plasma, the process is time-consuming, yet people can give up to twice a week. As there is a premium on collecting from regular donors, and in principle from as few people as possible, the result would seem to be that in countries such as Australia where we rely just on donors, and on outdated fresh blood, there is a shortage of plasma and thus of plasma-derived products.12) Now, while blood donors have been studied extensively—almost, I suspect, beyond the point where further such study is useful13—there have been relatively few academic studies of those who sell plasma or, more generally, of those who are undertaking stigmatised activities for 11 Cf. Lawrence Cohen, ‘Where it hurts: Indian materials for an ethics of organ transplantation’, Daedalus, vol. 128, 1999, pp. 135–65. 12 As I discovered when participating at a workshop on the effect of restrictions on those who might have been exposed to mad cow disease on the blood supply, one member of which was a representative of a patients’ group. 13 Cf. Jane Pilliavin and Peter Callero, Giving Blood, Baltimore: Johns Hopkins University Press, 1991.

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money. In some ways, this is all too understandable. If you or I were involved in this trade, it is not clear that we would wish to be studied. There is, I suspect, a lot of suspicion on the part of those who are purchasing or enabling the purchase to take place that researchers from a university environment will be highly unsympathetic, and may wish to show them in a bad light. Accordingly, it was interesting to discover some work—on American students—that threw light on those students in one large midwestern university who sold their blood plasma.14 What was interesting—at least in my reading of the results—was that these students were not doing this out of financial need but, rather, because the sale of plasma (for which one can obtain between $20 and $30, up to twice a week)15 enabled them to support their favoured lifestyle. The impression that this work conveyed is that these students—some of whom were quite affluent—enjoyed themselves. They smoked, drank, and hung out in bars. The researchers who reported upon them seemed largely concerned with their health but my conjecture is that they were the kind of student—familiar enough to all those who teach in universities— who is hedonistic, and is not concerned with the somewhat moralistic controls on behaviour that are more usual in the societies from which they come. This leads me to the second problem: if one is going to purchase plasma—or, indeed, kidneys—would it not be from these students, and others who share their values, that it would be appropriate to buy? Similarly, if people were going to purchase kidneys overseas, one might think that, rather than purchasing from people in India (the Iranian market is closed to foreigners), the proper course of action would be to purchase from, say, those men in the Philippines whom Nancy Scheper-Hughes, a staunch critic of such sales, has depicted as being willing to sell for reasons that relate to the cultivation of a ‘macho’ personality?16 The issue, here, is clearly that we—as outside

14 Cf. Leon Anderson, Kit Newell and Joseph Kilcoyne, ‘ “Selling blood”: characteristics and motivations of student plasma donors’, Sociological Spectrum, vol. 19, no. 2, 1999, pp. 137–62. 15 Cf. for a recent popular account, Bartleby, ‘Donating plasma for money’, Associated Content: Health and Wellbeing, 16 Cf. Cohen, ‘Where it hurts’; See also Nancy Scheper-Hughes, ‘The theft of life’, Anthropology Today, vol. 12, no. 3, 1996, pp. 3–11, Nancy Scheper-Hughes, ‘The global traffic in organs’, Current Anthropology, vol. 41, no. 2, 2000, pp. 191–211, and Nancy

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spectators—may feel that there is something problematic about these people’s conduct; we may, perhaps, feel that they are not exhibiting proper care for their bodies or of their selves. But if we take such a view—and we may be able to advance arguments for it—is it in fact something that is in any sense our proper concern? This, then, leads to my second question: what about cases in which we may feel—and can give reasons for our judgment—that other people are not properly caring for their bodies? In this case—as in that of a stigmatised sale—it is worth recalling, the problem is posed in the context of the supply of something that seems genuinely worthwhile. That is, not only do people need kidneys, and also products developed from blood plasma, but we would certainly have no concern about their obtaining these things should they be offered as gifts.17 To these questions there are, obviously, two dimensions. First, what should our personal attitude should be to such matters; for example, should there be the opportunity, what would we think about the commodification of our own body? Second, there is the issue of what public policy should be about such matters. In the next section, I will briefly discuss these, before turning to what seems to me to pose the most difficult of problems—our attitude to, and our responsibilities for, the decisions of other people. Some aspects of commodification Let me start with the issue at a personal level. In various societies, a range of different things are commodified. When, recently, I visited Stanford University to undertake some research, I was struck by advertisements offering cash for human eggs (up to $US15,000) and sperm (up to $US900) in the student newspaper18 (sums for sperm

Scheper-Hughes, ‘Global justice and the traffic in human organs’ in R. Gruessner and E. Bendetti (eds.), Living Donor Organ Transplantation (forthcoming). For a more detailed discussion of the situation in the Philippines, see Francis Aguilar and Lalaine Siruno, ‘A community without kidneys’, 17 Cf., on this, Richard Titmuss, The Gift Relationship, New York: Pantheon, 1971. What is involved here, however, may be somewhat more complex than it might seem, if one bears in mind the kinds of appeals that may be made in the context of recruitment. 18 Cf. The Stanford Daily (online), November 17, 2006; http://daily.stanford .edu/classified/ accessed on November 26, 2006. See the section ‘classified’, subsection

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are, in fact, normally much more modest).19 There is also a notorious website, which solicits bids for both eggs and sperm from models.20 Human hair is also sold, with reports of sales of up to $US2500 for well-cared-for female European-style hair.21 In the USA one can sell blood plasma, and in several countries, kidneys. While, in Canberra, interested customers can engage in legal prostitution, and, presumably, in the making of hard-core pornography.22 Suppose one heard of these opportunities and one might qualify; what might be one’s personal reaction? In all of these cases, one is confronting an expressed need accompanied by cash. In the case of kidneys, it has been suggested that the government might go into the market, on behalf of the poor, in the event of their not being able to afford to purchase a kidney for themselves. There may—in the case of pornography and sexual services—be misgivings about whether it is appropriate that there be institutions to address anonymous needs in this way, or concerns about the legitimacy of the needs or tastes in question. This is an issue that I will address a little later, when I address wider social and public policy issues. My concern, here, is, rather, with the commodification of the self. My suspicion is that, while we may well express admiration for the donors of kidneys and of plasma, the sale of these things, of eggs and sperm—and even of hair—might be somewhat stigmatised (you might ask people: what would your reaction be if I told you that I had sold?). In an interesting phenomenologically-oriented reflection on her own sale of plasma, Wendy Espeland certainly found that this was the attitude of other people to the fact that she had sold her plasma.23 But are there any good grounds for this?

‘Donors wanted’, for information about eggs. The company that is advertising is . 19 The Sperm Bank of California offers from $65-$75 per ejaculate, provided that the sperm count is high. See . 20 See . 21 See . 22 There are from time to time advertisements which seek to recruit people to work in brothels, in the Canberra Times (the only daily newspaper published from Australia’s Federal Capital). Those working there include school students over the age of 18, and university students. See . 23 See Wendy Espeland, ‘Blood and money’, in Joseph Kotarba and Andrea Fontana (eds.), The Existential Self in Society, Chicago: University of Chicago Press, 1984.

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A general point of unease concerns the borderline between the personal and what is commodified. This is a complex issue. Typically— and despite Marx—we don’t think that there is any moral problem about the commodification of our labour power. However, there may be some unease with regard to certain kinds of creative activity, for example, artists’ concern for the integrity of their work of art. (One might wonder, say, just what the attitude of the painters of old works of art actually was to having to include their patrons in perhaps uncharacteristically humble stances in religious paintings.) Such issues are today often now addressed by way of ideas about ‘moral rights’, and may also occur in cases of the production of intellectual material. In the cases of prostitution and pornography, there would seem to be some further issues. There are problems in part simply because of the intimacy of the activities in question; in part because of how commodification relates to people’s subsequent engagement in intimate behaviour in their day-to-day lives. In addition, Wendy McElroy’s interviews with people involved in the production of hard pornography in the USA suggest that it produced a certain coarsening of their attitudes towards sexuality.24 Similarly, if one can take the comments of pornography star Nina Hartley at face value, it would seem as if, for some people, engaging in this work can be unproblematic, if they already have a particular kind of exhibitionist streak to their character. That her opinion may be reliable is suggested by the fact that she also stressed that it can be damaging for those who feel unhappy about this kind of activity.25 However, one might wonder at what people engaged in this activity make of what they have become, or of their attitudes towards themselves when they reflect on their lives. At the same time, there is a risk that my final comments here may be doing little more than exercising my own prejudices. Consider, perhaps, what the reaction might be of an athlete from the Australian Institute of Sport to me.26 ‘How can you let your body go?’ in the way in which I have done, he or she might wonder. ‘How can you live with yourself?’ My response, however, would be one of indifference: while I may have concerns about the consequences to my health of eating too

24 See Wendy McElroy, XXX: A Woman’s Right to Pornography, New York: St Martin’s Press, 1995, . 25 Just because her comments include this reservation, it would seem to me that it is not implausible that she is telling the truth; cf. McElroy, XXX, chapter 7. 26 The author weighs a lot more than he should.

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much and getting insufficient exercise, I certainly don’t feel bad about myself, or feel that the time that I spend at my computer or reading really should have been spent jogging. Accordingly, at one level while one does not necessarily have to say that there is nothing more than subjective taste here, at another level we may be willing to leave these issues up to the individual. However, there is another side to all this, which I wish now to explore. The care of others’ bodies: Political As I was suggesting, we might agree that, at a certain level, what people choose to do should be up to them. But there are two other levels, at which more is involved. Let us consider the level of public policy. Take the issue of prostitution. Here, there would seem to be two kinds of problems involved. First, there are the kinds of questions posed by Radin’s work, to which I have referred briefly before. Radin has argued that, in respect to the practices concerning consensual, commercialised but stigmatised activities, there are advantages to partial commodification. The idea here is that, given that the activities will occur whether or not they are legal, there are obvious advantages to the legalization of the activity. In this way, it can be regulated—for the safety and health of all concerned, and also to provide legal protections. In addition, if the activity is likely to take place whether or not it is legal, partial commodification also means that one may avoid a major source of police corruption (although this clearly does not rule out corruption taking place round the issue of the enforcement of regulations). There is, however, also an obvious enough cost to all this. If something is legal, albeit regulated, then it is accessible in a way in which it may not have been previously—for both customers and providers of services. In particular, it would seem likely that, if brothels are able to advertise legally for people to work in them, then the idea of so doing may well become a possibility for people to whom it might not have occurred otherwise. At the very least, it is presumably the case that the opportunity of being involved may become an option for certain kinds of vulnerable people, who otherwise would have been protected from such things. Similarly, the presence of a legal industry (albeit one that is zoned, as in Canberra) will mean that it has a presence in the society of a kind that it would not have had previously; for example,

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by way of showing up in the Yellow Pages, or in advertisements in the Canberra Times. I do not know how we should assess the pros and cons of such things. But clearly there is a sense in which decisions one way or the other about public policy have implications for the situations in which others make personal decisions. This, in turn, poses a question about our responsibilities for others’ decisions: while we grant that the decision as to what to do with their bodies is up to them, just what responsibility do we have for issues that affect the circumstances under which other people will decide? The second kind of issue relating to public policy, concerns the underlying issue about the operation of a market in this area. In the background to my first considerations was the image of what was involved as being tastes, wealth and voluntary decisions. Yet the acceptability of such a picture may clearly be questioned. For some potentially voluntary transactions between adults are rendered illegal, for example, the outlawing of consensual voluntary servitude, and of transactions concerning narcotics. Others are legal but are actively discouraged, for example, the consumption of tobacco products. In response to arguments by some feminists, prostitution was made illegal in Sweden in 1999.27 The ideas behind this involved the view that prostitution was an act of violence against women, or more generally that those who were in the position of sellers of their services, are vulnerable and in need of protection—if necessary, against their own wishes. There has been considerable discussion of the pros and cons of the Swedish legislation;28 the criticisms relating in part to the unintended consequences of the legislation, in part to the devaluing of the perspectives of those who sell—and wish to sell—their sexual services. Some investigators who have done comparative work on different regimes of prostitution have endorsed the Swedish model.29 A recent article which surveys work in the field makes out an interesting case for there being a risk of a somewhat essentialised stand-off between different moralised perspectives in the controversy between different

27

Cf. . See, for links to criticism, . 29 See, for example, the report by Julie Bindel and Liz Kelly at . 28

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approaches in this field.30 However, the work of these authors seems to me to leave open the possibility that we might be able to weigh up the pros and cons of different specific approaches, if sufficiently detailed study is undertaken of what is going on, and that this might give us a way of evaluating at least some of the alternatives. Let me turn, however, from public policy to the other aspect of my concern: to that of personal relations. The care of others’ bodies: Personal Aside from issues of public policy (whether governmental or private in its character), there are, surely, issues concerning the care for others’ bodies which face us at a personal level. If someone, say, has a problem with alcohol—or with ice cream—there is something to be said for our not facing them with a choice concerning such things, or of allowing them only a one-off choice, rather than placing them in a situation where they have, again and again, to make difficult choices. Similarly, if someone is vulnerable, for example, if they are on the rebound from a relationship that has collapsed, if they are feeling miserable, or have had a bit too much to drink, there is surely a case for self-restraint, in the sense of treating them with a degree of paternalism. We routinely do this with regard to children, those of diminished capacity, and the very elderly. Is it not something that we should do, whenever we judge that someone is in a vulnerable position? More generally, is there not, then, a case for self-restraint with regard to those of our needs and tastes, the voluntary satisfaction of which by others might seem to be problematic, if they are vulnerable? The situation here, however, is difficult. If there are objective incapacities, or if—because of some kind of conventional decision—there has been a public policy decision to, say, deem anyone in a particular category incapable of giving voluntary consent, then the issue of our individual conduct is fairly straightforward. Clearly, there is room for argument about what should be treated in this way; but once an (in

30 See Jackie West and Terry Austrin, ‘Markets and politics: Public and private relations in the case of prostitution’, Sociological Review, vol. 53, 2005, pp. 136–48.

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many ways conventional) decision is taken is made, it seems reasonable enough that people should be guided by it.31 What is trickier are cases that fall outside of the area of such legal restrictions. Clearly, we may feel that someone who is engaged in conduct that looks as if it involves taking advantage of someone else is doing something that is morally dubious. But what—in such cases—are we to make of the consent of the person who is taken advantage of? In some cases, we may very reasonably anticipate that, the next day, they may feel dreadful about what happened, and feel used. But in other cases this is not so clear and it could be argued that an offence is done to others, if they are treated paternalistically against their wishes, that is, if there is not a general public policy decision to protect an entire class of people categorised in a particular manner. This is the stuff of day-to-day moral conduct. But I am genuinely unsure what our attitudes towards it should be. It was reported of Marmaduke Pickthall,32 a British traveller and writer who went on to convert to Islam, and to produce the first English ‘translation’ of the Qur’an by a believer, that when he was a comparatively young man, an attempt on his part to convert to Islam while he was in the Middle East was rebuffed, on the grounds that he was thought to be vulnerable. The judgement seemed a very reasonable one; but one wonders what the young Pickthall himself made of it at the time. Does one commit a moral offence when one is unwilling to take others as they present themselves to you? We are here in very difficult territory. For much of our lives we are, surely, in situations that fall far short of autonomy. Should the would-be recruit to the armed forces be debarred because they are too full of patriotic fervour, or because they are taking an over-romanticised view of the possible adventures of military service? Should many people wishing to marry be debarred because they are in love and are thus likely to have an over-romantic view of the merits of their partner? And are we really in any position to assess those who wish 31

Clearly, there may be all kinds of problems in this area. But to discuss them would open up more issues than would be appropriate for an already wide-ranging paper. 32 On whom see Peter Clark, Marmaduke Pickthall: British Muslim, London: Quartet, 1986; and Anne Fremantle, Loyal Enemy, London: Hutchinson, 1938. A useful brief overview, in which the claim noted in the text is made, is .

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to transact with us—in the broadest sense of this term—and to judge their interests better than they can themselves? Do we behave in a less than moral way towards them if we do not treat them as they present themselves to us, rather than second-guessing their motivation and true interests? The image of fully informed consent, exercised by people who are properly appraising their interests is surely one which may be damaging to our inter-relationships with others, if we were to insist upon it as the only basis on which one can legitimately interact with people as equals, and treat paternalistically anyone who does not in our judgement measure up. But if we reject such paternalism, it means that some people are going to be hurt, or treated badly. Conclusion In this chapter, I have introduced and discussed some issues relation to the commodification of the human body. I have explored some aspects of these matters—relating both to personal conduct and to issues of public policy—in a manner that, I hope, has been interesting, even if my conclusions have been less clear-cut than one might have hoped for. What is not clear, however, is that I have really been able to contribute usefully to the central problem before us: that of the commodification of the body. For we are, I believe, left with a range of different issues, none of which is at all easy to resolve. As my space is limited, I will comment only upon two of these. The first is: is there anything wrong with commodification, in cases where there is a genuine need which, on the face of it, will be difficult to meet without commodification? If this is not the case today with the case of kidneys, it will certainly be the case soon. In this situation, the only alternatives would seem to be telling people whose lives could be usefully prolonged that they should reconcile themselves to death, or conceivably—and this is also the case with regard to blood plasma—attempting to change people’s sensibilities, such that level of donation goes up to meet social need. It is not, however, clear that there is here anything wrong with commodification as such,33 or that

33 The notion—from Titmuss’s The Gift Relationship—that a regime of gifts must be practically superior to that of commodification, is, I believe, incorrect. While in some cases there may be adverse selection problems from purchase, Titmuss’s wider

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we should be sanguine about giving government the degree of power to try to manipulate our preferences, that a non-commercial voluntaristic solution would require. While it might be distasteful for us to see the rich purchasing kidneys from the poor, it would also seem distasteful—to put it mildly—for the rich simply to die (they, after all, are people too!), or for poor people to have an opportunity for improving their situation removed from them, simply because of our moral scruples as third parties. It would seem, here, more to the point to find ways in which such transactions might genuinely operate in the interests of all. The second concerns prostitution. Here, the issues are difficult. While, as I have suggested, the argument at the level of public policy is complex, there is an important personal dimension to the issue, too. At the very least, those who might feel inclined to use such services could well reflect on just what is involved—of just how they are asking another person to behave. At the same time, there is the problem of what one might call near-prostitution—of, say, the character of relationships between the elderly, rich or powerful, and the young, poor and attractive, more generally. This again might well merit some moral scrutiny from the parties involved. But at the same time, it is so pervasive that one wonders what the consequences of taking it seriously, would be! But with this, I must conclude.

argument is faulty. See, for some discussion, Jeremy Shearmur, ‘Trust, Titmuss and blood’, Economic Affairs, vol. 21, no. 1, 2001, pp. 29–33.

SECTION III

VIRTUE, HEALTH AND THE STATE

CHAPTER ELEVEN

DEADLY SIN: GLUTTONY, OBESITY AND HEALTH POLICY William James Hoverd There are eight principal vices that attack humankind. The first is gluttony, which means the voraciousness of the belly, the second is fornication; the third filargyria, which is avarice or the love of money; the fourth is anger; the fifth sadness; the sixth is acedia, which is anxiety or the weariness of the heart; the seventh is cenodoxia, which is boastfulness or vainglory; and the eighth is pride.1 —John Cassian (360–430 CE approx), ‘The Conference of Abba Serapion: On the Eight Principal Vices’ (Translated and Annotated by Boniface Ramsey) Should obesity be blamed on gluttony, sloth, or both? 2 —House of Commons Health Committee Report on Obesity: Third Report of Session 2003–04 Volume 1. (Emphasis unchanged from the report)

John Cassian, writing for monks in the fourth century, was to bring the ‘eight principle vices’, today known as the ‘seven deadly sins’, into the western Christian canon from the oral traditions of the Egyptian desert fathers. Strangely, two of these ‘sins’ are replicated in the British House of Commons Report on Obesity (2003–04), some 1600 years later. The purpose of this chapter is to argue that the linking of the language of Christian sin to obesity demonstrates that social understandings of fatness are far more complicated than the medical terms in which obesity usually finds expression. This chapter sets out to explore how and why patristic theological ideas, intrinsic to the ascetic practice of ancient Christian monks, are being used in health rhetoric surrounding the twenty-first century obesity epidemic. The chapter will initially focus on how these terms (gluttony and sloth) are being

1

John Cassian, The Conferences, New York: The Newman Press, 1997, p. 183. House of Commons Health Committee Report on Obesity: Third Report of Session 2003–04, vol. 1, p. 23. 2

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used in health policy and medical research. Then, it will explore the links between obesity and popular ideas of gluttony and sloth. These terms have specific historical, theological practices and meanings associated with them stretching back to the eight principle vices in the work of John Cassian. It will turn to the relationship between Protestant Christianity and popular perceptions of health. Finally, the chapter will discuss the implication of these the interaction of Christian ideas of sin with general understandings of health behaviors and policy. In 1997, the World Health Organisation declared that obesity, the leading cause of heart disease, was the greatest health threat facing humanity.3 Obesity is a leading causal factor for type 2 diabetes, cardiovascular diseases, certain musculoskeletal disorders, and endometrial, colon, and postmenopausal breast cancers.4 Obesity is becoming increasingly common in children as well as adults. The American Surgeon General’s report in 2000 suggested that obesity may be a factor in the deaths of as many of 300,000 Americans each year.5 The disease of obesity has a simple aetiology: it is generally understood to be a product of an individual’s prolonged consumption of more calories than they expend. Widespread obesity is a disease primarily caused by the concentrated calories and sedentary lifestyles made available to western populations by modernity. Increasingly, obese individuals are suffering social consequences of the disease. The obese have more trouble forming romantic relationships and are regarded as less likeable than people of more normal weight distributions.6 Obesity also has negative implications for employment and socio-economic status as overweight employees are thought to be lazy, sloppy, rude, and poor role models.7 This bias against the obese is also held by doctors.8 It has also been demonstrated that obese people hold the same discriminatory view

3

John Speakman, ‘Obesity part one—The greatest health threat facing mankind’, Biologist Journal, vol. 50, no. 1. 2003, p. 13. 4 Yvonne Jackson, William H. Dietz, Charlene Sanders et al., ‘Summary of the 2000 Surgeon General’s listening session: Toward a national action plan on overweight and obesity’, Obesity Research, vol. 10, no. 12, 2002, p. 1299. 5 Ibid., p. 1300. 6 Michelle Pearce, Juli Boergers and Mitchell J. Prinstein, ‘Adolescent obesity, overt and relational peer victimisaton, and romantic relationships’, Obesity Research, vol. 10, no. 5, 2002, p. 386. 7 Rebecca Puhl and Kelly D. Brownell 2001, ‘Bias, discrimination, and obesity’, Obesity Research, vol. 9, no. 12, 2002, p. 790. 8 Ibid., p. 798.

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regarding other people who are obese.9 The obese are considered to be people who eat too much of the wrong forms of food and are apathetic about exercise, suggesting they are a product of their own fault and lack of discipline or willpower.10 Their disease is perceived as being a product of a lack of personal responsibility creating a situation where the obese become the objects of allowable public discrimination.11 Gluttony, sloth and health policy One would expect that ideas of gluttony and sloth, while sometimes evident in popular culture and some contemporary Christian practice, would not appear in objective medical research or health policy. However, in the United Kingdom, connections between gluttony, sloth and obesity have been linked explicitly in both medical research and health policy. The British Medical Journal in 1995 published an article by Andrew Prentice and Susan Jebb entitled ‘Obesity in Britain: Gluttony or sloth?’12 This article has been heavily referenced by researchers and policy makers in the United Kingdom. It outlines the problem that, in Britain, obesity has been becoming more and more of a health cost and problem to the general population. Utilising a wide literature review the article begins by disputing the metabolic genetic causality conditions of obesity. It argues that obesity is more likely to be caused by behavioural problems or environmental conditions. The article states that the causal factors of obesity can either be understood as gluttony or sloth or a combination of the two together.13 Under the heading ‘Evidence implicating gluttony’ Prentice and Jebb discuss the proportional rise in the consumption of fat by the British population over the last 50 years. They specifically point out that it is this consumption of fat, rather than consumption of carbohydrates or sugars which causes obesity. Thus, the consumption of carbohydrates

9 Kelli Friedman, Simona K. Reichmann, Phillip R. Costanzzo, Arnaldo Zelli, Jamile A. Ashmore and Gerard J. Musante, ‘Weight stigmatization and ideological beliefs: relation to psychological functioning obese adults’, Obesity Research, vol. 13, no. 5, 2005, p. 913. 10 Louis Aronne, ‘Classification of obesity and assessment of obesity-related health risks’, Obesity Research, vol. 10, Suppl. 2, 2002, p. 105S. 11 Friedman et al., ‘ Weight stigmatization and ideological beliefs’, p. 907. 12 Andrew Prentice and Susan Jebb, ‘Obesity in Britain: Gluttony or sloth?’ British Medical Journal, vol. 311, 1995, pp. 437–439. 13 Ibid.

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and/or sugars is much less likely to be associated with causing obesity. Under the heading ‘Evidence implicating sloth’ they point to the relationship between increasing societal affluence and sedentary lifestyles. They point to evidence suggesting that it is the environmental factor of energy expenditure (sloth) which has decreased more markedly than a corresponding increase in the consumption of calories (gluttony) in Britain. Overall, the paper concludes with the suggestion that whilst these two causal factors of obesity are heavily intertwined, it is sloth associated with sedentary lifestyles that is slightly more of a causal factor than gluttony. The Prentice and Jebb article demonstrates an easy association between the language of deadly sin with the causal factors of obesity. A close reading of this article indicates that if the authors possess any critical awareness at all of the implications of their language, it would appear that they endorse a negative association between moral fault and obesity. The enduring influence of the Prentice and Jebb article is made evident in the ‘House of Commons Health Committee report on Obesity’14 (referred to as the HOC report). In the introduction of chapter two of the report, under the title ‘Gluttony or Sloth?’, the causes of obesity in Britain are examined. This section of the HOC report is almost solely reliant upon the earlier Prentice and Jebb article and, in a direct quotation of the 1995 article, the report suggests that a key research and policy question lies in understanding the causal factors of obesity. It is certain that obesity develops only when there is a sustained imbalance between the amount of energy consumed by a person and the amount used up in everyday life. But which side of this energy balance equation has been the most altered in recent decades to produce such rapid weight gain? Should obesity be blamed on gluttony, sloth, or both?15

The original Prentice and Jebb article is slightly altered in the HOC report by the addition of a highlight to the quote, emphasising the terms ‘gluttony’ and ‘sloth’. This alteration of the original text is not noted. The effect of this highlighting further stresses the links between the language of sin and the causal factors of obesity. Oddly, it is this

14 House of Commons Health Committee Report on Obesity: Third Report of Session 2003–04, vol. 1. 15 Ibid., p. 23.

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public report designed to facilitate effective policy into practice which further emphasises a connection between sin and obesity. Again, there is no apparent critical awareness of the language reinforcing a connection between moral fault and obesity. The HOC report demonstrates a direct shift of the use of a language of sin from medical discourse into practical implementations of health promotion and policy. There are also American medical examples demonstrating obesity researchers also associate this language of sin and moral fault with obesity. Charles M. Clark Jr, former national president of the American Diabetes Association and Associate Dean of Continuing Medical Education at Indiana University School of Medicine, published an editorial in the Annals of Internal Medicine, April 2000, entitled ‘Combating sloth as well as gluttony: The role of physical fitness in mortality among men with Type 2 diabetes.’16 The editorial focuses on the relation between cardio-vascular fitness and mortality rates for men with Type 2 diabetes, with specific discussion of the scientific evidence demonstrating regular cardiovascular exercise decreases mortality rates. Aside from the title, the terms gluttony and sloth are never employed within this text. This leads to the question, why use the terminology of sin in the title and not use these ideas in the editorial? At no point in any of these documents are the moral dimensions or religious connotations associated with gluttony and sloth acknowledged. In this supposedly objective medical discourse, the language of causality (gluttony and sloth) implies moral fault. When these terms are employed uncritically by medical researchers there is a constitutive gap between their usage and the content of the research. It is difficult to discern whether this association is a conscious or unconscious application on the part of the authors. Certainly, if pushed, it is likely that they would be, at the least, guarded in regard to this language association. The question arises ‘why use these terms and what exactly do these terms imply?’ A gap becomes apparent between this language and its application, however, some form of moral implication is clear. The moral issues concerning the terminology of gluttony and sloth in the House of Commons report have not gone unnoticed. In The

16 Charles Clark Jr., ‘Combating sloth as well as gluttony: The role of physical fitness in mortality among men with Type 2 diabetes’, Annals of Internal Medicine, vol. 132, no. 8, 2000, pp. 669–70.

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Guardian Unlimited newspaper on Thursday June 17, 2004, geneticist Stephen O’Rahilly, Head of Department and Professor of Clinical Biochemistry and Medicine at the University of Cambridge, critiqued the ‘Obesity: Gluttony or Sloth?’ headline from the HOC report.17 O’Rahilly argued that this heading vilified sick people and effectively implied that obese individuals are a product of their own faults. He points out that this discourse of fault would be an unthinkable in application to other illnesses such as cancer. O’Rahilly is specifically interested in the genetic research into obesity and one would assume that his position could make him critical of moral fault arguments surrounding the causal factors of obesity. The terms gluttony and sloth indicate that an individual has empowered agency over their physicality which they then choose to ignore. O’Rahilly, himself, has used the terms gluttony and sloth in his own work giving a public lecture in 2003 in Cambridge entitled ‘Genetics and obesity: Beyond gluttony and sloth’. His seminar evidences a critical awareness their presence in the language of obesity research and a desire to move beyond the confines of these ideas. More critically aware work is emerging focusing on the effects of the terminology used in the House of Commons report. Bethan Evans recently published an article entitled ‘ “Gluttony or Sloth”: Critical geographies of bodies in (anti) obesity policy’. Evans bases the article’s title on the House of Common’s report and focuses on how the understandings of obesity are contestable, arguing that the HOC report creates and reproduces certain moralities of obesity drawing on the language of sin: ‘a critical reading of the HOC report, reading for and highlighting the points at which it draws on and reproduces certain moralities regarding (fat) bodies; such as the notion of sin implicated in using the terms “gluttony” and “sloth” ’.18 Evans is a human geographer and understandably does not develop the religious link further, instead arguing that the power of this language of health categories justifies and constructs social frameworks in which individuals are to constitute themselves in hierarchies of right and wrong as fat/thin, rich/poor and morally good/bad.

17

Vivian Perry, ‘Bottom line on obesity’, The Guardian Unlimited Newspaper, June 17, 2004. 18 Bethan Evans, ‘Gluttony or sloth: Critical geographies of bodies and morality in (anti) obesity policy’, Area, vol. 38, no. 3, 2006, p. 261.

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I am questioning how ideas about ‘right’ and ‘wrong’, and the association of guilt with some practices, are formed through and rooted in, the discourse surrounding medical interpretations of obesity. Thus, in discussing ‘the medical’ I am referring to specific (re)presentations (arguably the most pervasive and widely read representations) of bio-medical science through policy documents (the HOC report) and the media, rather than any generalised notion of a homogenous medical knowledge.19

Evans notes that while obesity is easily definable as a disease, it is not easily socially measurable, and that human bodies are situated ‘. . . in multiple psychoanalytical, discursive and material spaces and that ‘fat and fatness cannot be decoupled from history, geography and culture’.20 Disease is only one very recent context of obesity. How recent then is a context of applying the language of sin to the obese? The implication of this language is a moralisation of the causal factors of obesity. The social and economic discrimination against the obese is more complicated than the causal factors surrounding a medical disease. The question is, then, to what extent does this moral language of sin used by obesity researchers draw on its religious history? First, let us consider the possibility that there is no relationship. Robert Solomon gives a very modern and secular rereading of the seven deadly sins as being solely health related. What are (archaically) called the ‘deadly sins’ have nothing to do with damnation or degeneracy but rather with poor health. They lead to a reduced lifespan, an unappealing appearance, the inability to attract a mate at the health club. What is deadly about the seven deadly sins is that they shorten our lives . . . The seven deadlies are not sins (except in the sense that triple fudge chocolate cake is a sin), not vices (except in the sense that smoking is a vice), not offences against God but against yourself—not your soul but your body and thus, perhaps, an offence against your doctor. But with our new managed health care plans, we can rest assured that he or she, too, no longer cares.21

He argues that these ideas are not sins or vices against God but rather they are purely individual offences against one’s own health. His argument is that these sins are metaphor for offences against the body nothing else, nothing less. His reading is utilitarian and completely divorces the sins from any relationship with religion. This relationship 19

Ibid. Ibid. 21 Robert Soloman (ed.), Wicked Pleasures: Meditations on the Seven “Deadly” Sins, Maryland: Rowman and Littlefield Publishers, 1999, pp. 10–11. 20

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between secularised sin, personal responsibility and health could be an explanation for the content of the HOC report. However the religious roots of these words ‘gluttony’ and ‘sloth’ still imply a certain moral fault in the individual which draw on ancient ideas of the sinner. This discrimination against the obese led Anne Scott Bellar to exclaim that ‘Fat is suicidal: a sin, that is, at best, and at worst, a sort of felony’.22 Her implication being that fatness leads to a form of selfcreated social and eventual mortal death which no rational person would desire. Her use of the term ‘sin’ is not accidental and implies an immorality to the physicality and causal factors of obesity. The usage of the term sin implies that the fat person is metaphorically a bad person. The basic premise suggests that those who overeat (gluttons) who do not exercise (sloth) will die a social and physical death like the sinner. I have argued, elsewhere, that there is a parallel between the actions of the fat person and the sinner. The fat person was essentially regarded as being in a self-induced and sinful condition. If a sinner knew what was good and did not do it, they had no one to blame except for themselves. The flaw that is the hardness of heart of the Christian sinner finds a parallel in the hardening of the arteries of the fat person.23

So we begin by investigating this parallel between ideas of the sinner and the obese person. The obese person, like the sinner, suffers the mortal consequences for their failings. These particular failings (sins) are unregulated eating (gluttony) and laziness or inertia (acedia or sloth). In this particular case the increased probability of mortality emphasises the deadliness of these sins. Popular ideas of sin, food and health The deadly sins have filtered into contemporary culture through film and literature. The first person to perpetuate an enduring image of the seven deadly sins in popular literary culture was Italian writer Dante

22 Anne Scott-Beller, Fat and Thin. A Natural History of Obesity, New York: Farrar, Straus and Giroux, 1977. 23 William Hoverd, Working Out My Salvation. The Contemporary Gym and the Promise of ‘Self ’ Transformation, Book Seven, Sports, Culture and Society, Aachen: Meyer and Meyer Sport, 2005, p. 95.

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Alighieri, in his visions of hell in The Inferno24 (Cantos V–VII) where the gluttonous and slothful found themselves special designations in the circles of hell. More recently, the deadly sins have found cinematic expression in the David Fincher film Se7en. In Se7en, the mysterious serial killer murders his victims with an excess of their particular sin. The glutton is an enormously huge man who is killed by being forced fed spaghetti until he dies of internal injuries. The victim of sloth is found alive but irreparably traumatised after being tortured and tied to a bed for a year. The sin itself is associated with the cause and motive for the individual demise of each of the sinners in the film. One way in which we can understand a possible association between gluttony and sloth with obesity in popular culture is through metaphor. Susan Sontag in her discussion of tuberculosis and AIDS observes that metaphor is often used to describe diseases which are not fully comprehended by the health establishment or the general population.25 The development of the medical gaze26 was, supposedly, to objectify disease, rendering it definable and able to be mapped. The use of a language of sin in application to obesity offers a throwback to pre-eighteenth century forms of descriptive medicine. In the case of obesity there is certainly a general lack of understanding of why a rational individual would let themselves get that overweight. However, this metaphor undoubtedly possesses power and effects individuals’ actions, perceptions of themselves and others. The obese are certainly perceived to embody the negative characteristics, and we evidently associate ‘sinful’ food with poor diet, which contributes to the causal factors of obesity. Yet, to label an association ‘metaphor’ doesn’t provide an effective explanation either. It suggests a parallel or double meaning, but offers no actual explanation of the association. Popular culture associates certain ideas of sin and death with particular foods. The idea of food being physically and morally detrimental is associated with certain deserts ‘Death by Chocolate’ and cakes ‘Devil’s Food Cake’. Another way that we can see between a relationship

24 Dante Alighieri, Dante’s Inferno: The Vision of Hell, London: Cassell and Company, 1892. 25 Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors, New York: Picador Press, 2001. 26 Michel Foucault, The Birth of the Clinic, London: Tavistock, 1973.

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between deadly sin and food being played out, this time in a amusing and ironic way, is at my local extremely, successful pizza delivery company branded ‘Hell Pizza’27 who roll in the immorality of their food, employing the slogan ‘Putting the Vice in Service’. Initially supplying their pizzas modelled on the seven deadly sins, they have expanded into deliberately marketing every form of delicious vice (excessively unhealthy food) they possibly can. Hell Pizza demonstrates the paradox of sin in that the sinner knows what is good and still chooses to dial up a delivery and follow the easy mouth-wateringly sinful path of cheese-laden pizza. A vague and generally unhelpful position could argue that the association between obesity and deadly sin is ‘like’ religion. There has been a wide range of literature discussing how contemporary body culture is ‘like’ religion. This literature often tends to be undefined and fairly subjective. These studies compare contemporary body practices to religion and explore the similarities of practices and ideas. Third-wave feminist Naomi Wolf 28 argued that the cosmetics industry is like a patristic religion subjugating women today. Michelle Mary Lelwica argued that contemporary women’s magazines and culture perpetuate a patriarchal form of Christian salvation in the ideal of ‘thinness’ for American women and girls regardless of actual religious belief.29 I have argued that the contemporary gymnasium has a salvational nature promising the individual an opportunity to protect themselves from the deadly sin of fat.30 These studies are somewhat subjective but do point to a relationship between Christian practice and health being kept alive in contemporary culture. Whilst these parallels above give some examples of the language associations of deadly sin in contemporary society, they offer little insight into explaining why ideas of gluttony and sloth are being drawn upon in the HOC report.

27

Hell Pizza Deliveries, http://www.hell.co.nz, accessed on 29 January 2007. Naomi Wolf, The Beauty Myth: How Images of Beauty are Used Against Women, London: Vintage Press, 1991. 29 Michelle Lelwica, Starving for Salvation. The Spiritual Dimensions of Eating Problems Among American Girls and Women, New York: Oxford University Press, 1999. 30 Hoverd, Working Out My Salvation, p. 95. 28

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Theological origins of the deadly sins The chapter now shifts to looking at the theological tradition behind the terms gluttony and sloth. Theologically, the seven deadly sins are not understood as the explicit laws of God, instead they are understood as personal faults, which can lead the believer away from the love of God and their community. ‘All the seven deadly sins are demonstrations of love that has gone wrong. They spring from the impulse which is natural in man, to love what pleases him, but the love is misplaced or weakened or distorted.’31 The sins are counterbalanced by virtues which redirect the believer back towards Christ. They have a Christian theological history stretching back to John Cassian writing in the fourth century on the eight principal vices. In the Catholic tradition the eight principle vices were reformulated into the seven deadly sins by Pope Gregory the Great in the sixth century, who conflated the vices of vainglory and pride.32 Gregory reordered the list of sins, beginning with pride as the root sin, and the list is ordered as follows: pride, lust, anger, envy, sloth, gluttony and avarice. Thomas Aquinas referred to the seven deadly sins in his discussion of virtue.33 John Cassian, while heavily overshadowed by his contemporary Augustine of Hippo,34 is remembered primarily for contributing to the formalisation of the ascetic tradition of ancient Christianity into the monasticism of later Christianity. Cassian’s writing was to be influential in the development of the monastic practices of early Christianity. He is credited with bringing the oral eastern Christian disciplines from the desert fathers of Egypt into the western tradition. In his lifetime, Cassian travelled throughout almost the entire ancient Christian world and wrote two primary texts, The Conferences and The Institutes of Cenobia and the Remedies for the Eight Principal Vices. Many of Cassian’s teachers and theological influences were to leave either no written legacy or were seen, at the time, to have bordered

31 Henry Fairlie, The Seven Deadly Sins Today, Washington: New Republic Books, 1978, p. 34. 32 Robert Markus, Gregory the Great and his World, Cambridge: Cambridge University Press, 1997. 33 Thomas Aquinas, The Cardinal Virtues. Prudence, Justice, Fortitude, and Temperance, Indianapolis: Hackett Publishing Company, 2005. 34 Boniface Ramsey, ‘John Cassian: Student of Augustine’, Cistercian Studies Quarterly, vol. 28, 1993, p. 12.

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on heterodoxy35 such as John of Chrysostom, while another was later declared heretical in the case of Evarigus Ponticus.36 Cassian’s first text, The Conferences, chronicles some of the Egyptian Desert Fathers’ oral teachings. Of particular interest are those on disciplining the self from the temptations and demons which threatened to cloud the purity of heart desired by the desert ascetic. Cassian saw the goal of asceticism as achieving and maintaining this purity of heart. This ideal of asceticism is reinforced even further in The Institutes, which contains specific instructions on what is required in the daily practice of the monk, followed by a lengthy dissertation on the eight principal vices. In The Institutes, Cassian uses the metaphor of the monk37 as athlete contending lawfully in a contest to create purity of heart. Purity of heart was the ideal condition to which the monk should strive toward in this world. It was the sole prerequisite for entry into the Kingdom of Heaven.38 The monk was constantly exposed to the rigours of life and, like Jesus, believed they were surrounded by demons in the desert. These demons could manifest themselves in the actions, desires and thoughts of the individual. Cassian understood the individual to be in three parts: flesh, spirit and will. In the fourth Conference, ‘On the Flesh and Spirit’, the whole individual39 is described in the following way: For the desire of the flesh is against the spirit, and that of the spirit against the flesh. But these are opposed to one another, so that you may not do what you want to do. Since both of these namely, the desires of the flesh and those of the spirit—exist in one and the same human being, an interior battle is daily waged within us as long as the desire of the flesh, which swiftly descends into vice, rejoices in those delights which pertain to present repose.40

35 There is work demonstrating the ancient pagan influence of ideas of the seven deadly sins in Morton Bloomfield, ‘The origin of the concept of the seven cardinal sins’, Harvard Theological Review, vol. 34, no. 2, 1941, pp. 121–128. 36 Evarigus Ponticus is also known to have written on the deadly sins a few years earlier than Cassian. 37 John Cassian, The Institutes, New York: The Newman Press, 2000, p. 183, p. 7. 38 Cassian, The Conferences, p. 19. 39 Boniface Ramsey argues that this discussion of flesh by Cassian has marked similarity to the writing of Augustine. See Ramsey, ‘John Cassian: Student of Augustine’, pp. 12–13. 40 Cassian, The Conferences, p. 161.

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The flesh was the materiality of the body, unique to every individual created by God yet it was also the source of temptation and the logismoi (bad thoughts). It was the responsibility of the will to discern what is good through the cloud of the logismoi. For Cassian, the logismoi were foremost bodily manifested in the eight principal vices. From these principal eight vices, or root sins, other threatening passions can arise, which are more numerous than Israel.41 Vice was understood to be something which had been absent in Jesus Christ. The monk was required to renounce the world and orient themselves towards Christ. Cassian describes the goal of the relationship between renunciation and desire for the monk in the fourth book, The Institutes of the Renunciants (Chapter XXXIV): Renunciation is nothing else than a manifestation of the cross and of a dying. Therefore you should know that on this day you have died to the world and to its deeds and desires and that, according to the Apostle, you have been crucified to this world and this world to you . . . Thus in the words of David, fixing our flesh by the fear of the Lord, we may have all our desires and yearnings fixed to his dying and not subservient to our lust.42

The monk needed to be constantly sublimating his desire in continual systematic regulation and discipline of the threat of the vices and body as distraction from their purity of heart. Cassian divided the eight vices into two particular forms of vice. The natural vices are those that arise from within the body, namely gluttony and lust and, whilst we breathe, these vices will always threaten the possibility of purity of heart. Yet, they require interaction with external matter, and tend to be the least insidious of the vices and are remedied by a constant watchfulness and solitude. The other six vices, including acedia (sloth), are regarded as ‘spiritual’ and affect the mind. Acedia is understood by Cassian to be a ‘lack’, meaning that sloth is not always considered to be wilful disobedience of action, rather it should also be considered as a passive inactivity on the part of the monk. The eight principle vices are cured through discernment and the maintenance of a simple heart. Cassian systematises the eight vices in such a way that each particular vice interlinks finding its root in

41 42

Cassian, The Conferences, p. 197. Cassian, The Institutes, p. 97.

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the previous. Thus, gluttony becomes the root or primary vice which begets fornication, fornication begets avarice, and so on. For the desert ascetic, temptation to gluttony was a constant and imposed environmental condition of their hardship. Indeed, Peter Brown argues that ‘It was widely believed in Egypt as elsewhere, that the first sin of Adam and Eve had not been a sexual act, but rather one of ravenous greed.’43 Gluttony had induced the fall and was the primary vice which the monk needed to overcome, and could affect the monk in three ways. First, it could drive the monk to eat before the allotted time. Second, it could constantly demand a full stomach. Third, it could constantly demand refined and delicate foods.44 Gluttony was the primary vice from which all others sprang. The cure for gluttony was constant discipline, regular fasting and dietary control which would, in turn, assist in purging the monk of the other vices and passions. Brown further argues that the discipline of the fast enabled the Christian ascetic power over the sin of Adam: ‘To fast for Lent was to undo a little of the fateful sin of Adam. To fast heroically, by living in the desert, the land without food, was to relive Adam’s first and most fatal temptation, and to overcome it, as Adam had not done’.45 For Cassian, the importance of conquering gluttony is that it allows the monk to then go on and combat the other vices. For Cassian, the root vice of gluttony offered both the pathway to damnation and salvation. The necessity to eat was a basic fact of material existence as was the spiritual necessity for constant self-discipline. Virtue was to be found in discernment. Discretion between what was truly good and what was only the mere appearance of good (false desire or deception by demons) occurred through constant discipline and submission to the insight of others in the desert community. Hence this is the moderate and consistent measure of abstinence that we have spoken about, which is also approved by the judgement of the fathers—that daily hunger should have its ration of bread, keeping both the soul and body in one and the same condition and not letting the mind either waste away from weariness with fasting or grow heavy with repletion.46

43 Peter Brown, The Body and Society. Men, Women, and Sexual Renunciation in Early Christianity, New York: Columbia University Press, 1988, p. 220. 44 Cassian, The Conferences, p. 190. 45 Brown, The Body and Society, pp. 220–1. 46 Cassian, The Conferences, p. 102.

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Cassian focuses on continual systematic eating practices with an emphasis on moderation. He specifically notes that this practice is going to be subjective for monks, as some will require more basic sustenance than others. He also warns the monks against intemperate fasting as it can have negative consequences and may potentially weaken the monk, making him susceptible to other vices. What Cassian offers, which contemporary accounts of gluttony do not, is a logic behind gluttony. Cassian, writing in a time of food scarcity, viewed the temptation to overeat as a constant trial of the human condition. Gluttony and sloth were temptations which focused desire away from the proper orientation towards God. Constant hunger affects even the most pure of heart. It is a natural impulse of the body which should be understood, moderated and never indulged. The ascetic life was understood to be a systematised response to the vices. It is these vices, and this systematic asceticism of the monk, which lie at the theological root of the words gluttony and sloth. Contemporary health accounts using these terms are unwittingly drawing on specific techniques of disciplining the self and body that are at least 1600 years old. However, contemporary accounts of gluttony and sloth exist in a very different environment from Cassian’s day. It is unlikely that health policy and practitioners have any idea of the theological history of the deadly sins which they unwittingly draw upon when they use terms such as gluttony and sloth. Today, we are faced with an excess of food, and when a language of sin is used in a secular environment it bears no relation to any Christology. Now, it is the problem of an excess of food rather than scarcity which preys upon human desire. Today, gluttony and sloth are the causal sins of obesity, not the root causes of new vices further divorcing the monk from God. The failure of the individual to be disciplined in their eating habits is no longer known only to God but is physically visible to all. It appears that the usage of these terms, by health practitioners, is moral and provides a call demanding ascetic health practices focusing on the necessity of moderation in the consumption of calories in western populations. Protestant Christianity and health One possible way to understand how these terms have been inherited in an intersection between religion, medicine and social structure is

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through the Protestant ethic. This ethic, a product of the sixteenth century Reformation, is discussed by Max Weber in his book The Protestant Ethic and the Spirit of Capitalism.47 He argues that western Protestant cultures had an ethical relationship combining economic success with the Calvinist and Lutheran Protestant ideas of election and worship of God. Weber argued that in the Protestant Reformation, asceticism strode out of the monastery into the marketplace of the everyday life. The ascetic ideas and practices of the monks, such as John Cassian’s tradition of the vices, became appropriated into, and practiced in, the everyday life of the Protestant. The Calvinist effect on the Protestant ethic was to demand a lifetime of constant and systematic good works. For the Calvinist ‘ waste of time is thus the first and in principle the deadliest of sins’.48 This was combined with the Lutheran idea of the call which demanded that the highest form of worship of God was found in performing one’s calling (in this case one’s job) to the utmost. The worship of God was to be found then in contributing to economic production. Weber argues that this Protestant ethic valued: . . . the religious valuation of restless, continuous, systematic work in a worldly calling, as the highest means to asceticism, and at the same time the surest and most evident proof of rebirth and genuine faith must have been the most powerful conceivable lever for the expansion of that attitude toward life which we have here called the spirit of capitalism.49

Weber suggested that it was this Protestant ethic which provided the utilitarian impetus to the systematic accumulation of capital and the commercial success of the Protestant nations in eighteenth century Europe. Weber argued that the religious root of the ethic was to die out leaving it purely utilitarian. As a result, he was suspicious of the personal and social asceticism the Protestant ethic demanded. He labelled it an ‘Iron Cage’50 which forces people into living lives focused towards the accumulation of capital. Anything that turns the individual from this focus on capital is regarded as being immoral and a waste of time.

47 Max Weber, The Protestant Ethic and The Spirit of Capitalism, Great Britain: Routledge, 2000. 48 Ibid., p. 157. 49 Ibid., p. 172. 50 Ibid., p. 181.

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The evidence of the historical Protestant influence on western culture can be found in growing amount of religious studies literature focusing on explicit Christian dieting and muscular Christian movements51 and the nineteenth century temperance movement.52 These studies demonstrate the historical confluence between Christian practice and public ideas of the body and health. Movements such as the temperance movement, muscular Christianity, and the social gospel were to affect mainstream nineteenth and twentieth century ideas of health. These Protestant movements were to directly influence everyday health practices of citizens in western societies. Specific examples of this interaction were to be found in the gyms attached to the meeting halls of the YMCA movement which were popular well into the 1980s, the health policy and food marketing of Harvey Kellogg and in the idea of British muscular Christianity found in the Rugby schoolyard in Tom Brown’s School Days.53 All of these were popular Protestant movements explicitly focused on the good health of the Christian body. Marie Griffith offers one of the most recent and comprehensive books offering informed commentary on the interaction of Protestant Christianity with popular body culture through her study of the explosion of Christian dieting movements in America. Many of these movements actively combine health practices with religious practice, instructing that an excess of body fat is sinful. Griffith’s book begins by discussing evangelical Christian diet queen Gwen Shamblin and her controversial headline that ‘Fat People Don’t Go to Heaven!’54 Griffith is interested in devotional dieters, whom she defines as individuals that believe the fitness and condition of the body is directly related to the worship of Jesus, God or another sacred figure. An example of the devotional dieter can be found in evangelist Frances Hunter’s book God’s Answer to Fat . . . Loose it!, where she rewrote Romans 6:16 in the following way: ‘don’t you realise you can

51 See Tony Ladd and James Mathieson, Muscular Christianity, Evangelical Protestants and the development of American sport. Grand Rapids, Michigan: Baker Book House, 1999. And also Clifford Putney, Muscular Christianity: Manhood and Sports in Protestant America 1880–1920, Massachusetts: Harvard University Press, 2001. 52 James Whorton, Crusaders for Fitness. The History of American Health Reformers, New Jersey: Princeton University Press, 1982. 53 Tom Hughes, Tom Brown’s School Days, London: Oxford World Classics, 1999. 54 Marie Griffith, Born Again Bodies: Flesh and Spirit in American Christianity, Berkley: University of California Press, 2004.

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choose your own master? You can choose sin (food) (with death) (fat) or else obedience . . .’55 (parentheses in original). Hunter clearly identifies food and fat explicitly with ideas of sin in devotional dieting. Unhealthy food is evil, a source of temptation, and for Hunter Devil’s food cake really is a manifestation of the devil.56 Hunter goes further to state ‘Isn’t it interesting that we look down upon the alcoholic, and yet God puts the glutton in exactly the same category’.57 For Hunter, the glutton is as destructive and as immoral as the alcoholic. The glutton is someone who is not honest with themselves, others, and in their personal relationship with God. Hunter offers her gluttonous followers the following prayer: Lord Jesus, I am a foodaholic. I recognise that my problem is overeating and not a glandular problem. I admit that I like food. I admit that I love all kinds of rich food. I admit that I love too much of the kinds of food that puts weight on me. I have tried diets, Lord Jesus, and they haven’t worked, because I have been doing them with my own carnal self, still desiring the things I wasn’t eating; but this time Lord Jesus, I give you my appetite. I give you my desires, and I ask you to give me YOUR desires so that I will not overeat.58

In this prayer to Jesus we see that overeating is a sin which can affect all people. Hunter believes there is no genetic excuse for fatness. It is apparent that one will never be cured of one’s propensity to gluttony without the help of Jesus. The problem of the glutton is misplaced desire and the solution lies in the sublimation of this desire. Echoing Cassian’s discussion of the renunciation of the monk, one must fix one’s desires to Jesus rather than to the pleasures of eating. Hunter states that ‘my belly is not my God’.59 For Cassian and Hunter, gluttony is a sin of the body which distracts the believer from a proper orientation towards God. Any use of terms such as glutton or sloth in Christian dieting movements would imply a very direct and negative relationship between the obese individual and God. Fat people are simply not going to heaven according to Gwen Shamblin. For the

55 Francis Hunter, God’s answer to fat . . . LoØse It!, Houston: Hunter Ministries, 1976, p. 85. 56 Ibid., p. 88. 57 Ibid., pp. 61–62. 58 Ibid., pp. 62–63. 59 Ibid., p. 96.

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Christian dieting movement, any usage of the terms gluttony and sloth are not metaphors, they are very real indicators of physical grace. Marie Griffith extends her work from discussing devotional dieting to demonstrate the Protestant influence on the development of the American interest in body culture in the nineteenth and twentieth centuries. This influence is characterised by a manipulation of diet and exercise in order to promote health and well-being as a religious imperative. As a result, she is suspicious of accounts of slimming techniques and ritual which suggest that these practices borrow religious metaphors or are a secular form of religion.60 She argues that there are constant confluences between Protestant American religious practices and secular body culture. If Griffith is correct, then these confluences have tied some loose form of Christian morality to popular understandings regarding the physical appearance of the body allowing for good/bad bodies and sinful/virtuous bodies. Deadly sin and contemporary health practice There have been several investigations into possible relationships between Christian beliefs about food and body weight. Drawing on ideas of ascetic practice surrounding food, there have been a number of books focusing on Christian practice and food. Rudolph Bell argues that the fasting practices of many of the ancient and medieval women saints would today be pathologised as anorexia.61 Caroline Bynum Walker describes in detail the role food played in the religious lives of medieval women.62 The denial of food for these women was both a subversion of authority and a method to get closer to God. Certain contemporary investigations argue that Christianity provides certain food regulations, focusing on moderation and an aversion to gluttony, which may suggest that practicing Christians may be more healthy than non-Christians. Karen Kim and Jeffery Sobal argue that there is such a thing as a general religiosity in the USA which encompasses theological teachings surrounding the ‘body as a temple’, which may affect health-related

60

Marie Griffith, Born Again Bodies, p. 12. Rudolph Bell, Holy Anorexia, Chicago: The University of Chicago Press, 1985. 62 Caroline Walker Bynum, Holy Feast and Holy Fast: The Religious Significance of Food to Medieval Women, Los Angeles: University of California Press, 1987. 61

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behaviours.63 Kim and Sobal found no significant relation in their investigation into the possible relationship between religious belief and bodyweight. Kenneth Ferraro, however, found a positive correlation between religious practice and obesity.64 However, subsequent studies, such as the work of Lee Ellis and David Biglione,65 have failed to find any relationship between Christian belief and body weight. These studies suggest that researchers want to explore this potential relationship between Christian ideas and obesity, expecting certain results, but have failed to conclusively locate any concrete correlation between the two. We can be certain that some form of Christian legacy has some form of influence over health and body practice, but it is still proving difficult to ascertain what the effects of these ideas are in western societies. In obesity research it appears that the Protestant ethic is being used as a partial explanation of the influence of Christianity on discourses of health. Obesity researchers do, in some cases, make reference to a combination of religious ideas, personal success and obesity. John Peters makes an oblique reference regarding the future challenges of obesity to suggest that one of the problems in the treatment of obesity can be found in social ideas of personal value: It can be argued that obesity is a social problem, driven in many dimensions by our deeply held values and beliefs and the systems that we as a society have constructed to develop, reward, and perpetuate this value system. Our forefathers founded this country on strongly held beliefs about the value of personal liberty and being able to pursue one’s own dream. At the core of these values is the seemingly inherent drive to secure a better future for ourselves and our children.66

His concern is that ‘environmental factors’ are impeding attempts to prevent the increase of obesity in western workforces. He argues the insistent demand for economic growth resulted in employees becoming more and more sedentary. Time saving mechanisms, designed to

63 Karen Kim and Jeffery Sobal, ‘Religion, social support, fat intake and physical activity’, Public Health Nutrition, vol. 7, no. 6, 2004, p. 773. 64 Kenneth Ferraro, ‘Firm believers? Religion, body weight, and well being’, Review of Religious Research, vol. 39, no. 3, 1998, pp. 224–244. 65 Lee Ellis and David Biglione, ‘Religiosity and obesity: Are overweight people more religious?’ Personality and Individual Differences, vol. 28, 2000, pp. 1119–23. 66 John Peters, ‘Combating obesity: Challenges and choices.’ Obesity Research, vol. 11, Supplement, 2003, p. 8S.

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increase economic efficiency and production has simultaneously and paradoxically decreased energy burnt by the employee in the day. As a result, Peters argues that part of the problem of treating obesity will be found in addressing the values surrounding personal success held in America. Peters never explicitly refers to the Protestant ethic itself, but his argument for a historical inheritance of personal success is tied into a relationship with his undefined ‘values’ and ‘beliefs’. Could it then be that some form of deeply held general Christian values affects our social understanding of what it means to be a successful person? Is there a relationship between obesity and morality which could be understood in the ethical terms of the Protestant ethic? Psychological approaches to the cause of obesity have argued ‘It is also possible that the Protestant work ethic valued in American culture’ (that is, the belief that hard work leads to success and that lack of success is caused by self indulgence and lack of self discipline) contributes to obese individuals ‘being critical of themselves and internalising views of society’.67 An explicit exploration of the possible links between the Protestant ethic and obesity can be found in the work of Dianne Quinn and Jennifer Crocker from the University of Michigan in their paper ‘When ideology hurts: The effects of belief in the protestant ethic and feeling overweight on the psychological well-being of women’.68 Quinn and Crocker attempt to measure if there is a relationship between the Protestant ethic and the psychological well-being of overweight women in America. Drawing on previous psychological studies which indicate that belief in the Protestant ethic is associated with more negative attitudes to disadvantaged groups in society, Quinn and Crocker suggest that the Protestant ethic is understood as a psychological variable which they label and test as an ideology held by individuals. For Quinn and Crocker, the Protestant ethic is a core value which contributes to America’s focus on individualism. However, while they reference Weber, their understanding of the Protestant ethic appears to have only a cursory reference to his ideas.

67

Friedman et al., ‘Weight stigmatization and ideological beliefs’, p. 907. Diane Quinn and Jennifer Crocker, ‘When ideology hurts: The effects of belief in the Protestant ethic and feeling overweight on the psychological well-being of women’, Journal of Personality and Social Psychology, vol. 77, no. 2, 1999, pp. 402–14. 68

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william james hoverd The Protestant ethic is an ideology that includes the belief that individual hard work leads to success and that lack of success is caused by the moral failings of self-indulgence and lack of self-discipline. Thus those who receive positive outcomes deserve them because they worked hard and are morally superior, whereas those who receive negative outcomes deserve them because they are self indulgent, lack self discipline and are morally flawed.69

Their ethic is constructed as a political ideology rather than a religiously-oriented approach to the world. Quinn and Crocker point out that this value system tends to view those stigmatised as victims as a product of their own fault rather than a discriminatory social system. As a result, the Protestant ethic could be one possible vulnerability factor for decreased psychological well-being in overweight women. Linking the Protestant ethic to weight control, they suggest in their hypothesis that ‘The Protestant ethic dictates that those who are overweight lack the self discipline to control their weight, deserve any negative outcomes they experience because of their weight, and are moral failures’.70 Their first study showed a significant correlation between ideological belief (the Protestant ethic) and weight in the 257 American college women who participated. Their results suggested that those women who held to the Protestant ethic tended to be in the normal weight category of their study, whereas those who did not hold so strongly to the ethic tended to be those recorded as overweight. An explanation of this might be that the ethic is held to most strongly by those who might benefit from it. The second study of 122 American college women suggested that those who were overweight and did endorse the Protestant ethic tended to have lower psychological well-being. The paper establishes a relationship between this version of the Protestant ethic and the overweight. Thus, the two studies suggest that endorsement of this Protestant ethic as a personal ideology tended to increase psychological distress of women who felt overweight. In this case the Protestant ethic is regarded as an ideology and is utilitarian in nature; however, it equates personal negative feelings of self worth in the obese with an overall lack of morality. There is a linking of religious concepts to negative perceptions of the obese and, while the religious root of these ideas is obscured, we see a haphazard application of ideas drawing on 69 70

Ibid., p. 402. Ibid., p. 404.

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religious tradition being used to discuss the negative bias held against the obese. Another space where the Protestant ethic appears in discussions of obesity is in the attribution of the economic costs of obesity. Wellington gastric surgeon Richard Stubbs believes the New Zealand public views his patients as immoral economic burdens. ‘Paying for public hospital surgery so the supposedly greedy, slothful and unmotivated can climb onto operating tables instead of into running shoes isn’t going to go down well with the 50 per cent of tax payers who aren’t overweight’.71 Richard Stubbs’ statement reinforces the links between the causal factors of obesity with ideas of sin. It also provides evidence to suggest that some form of the Protestant ethic has been tied to the obese body in three ways: (1) usage of theological ascetic language of sin (gluttony and sloth) to describe irrational behaviour; (2) the assumption that discipline and a regimen of exercise and diet will alleviate obesity; (3) an economic rationale suggesting that the obese lack a work ethic. If obesity is indeed a self induced condition, then why should the public purse pay for treatment? The economic argument becomes an argument about personal responsibility. The implication is that the obese person tends to come from or end up joining lower socio-economic groups, who indicate through their lack of material success their moral failings. Under the Protestant ethic, this would a failure to signify material success, which is the only possible indicator of election. Understanding religious influence on health policy The House of Commons Report on Obesity demonstrated that the language of sin is being used in health policy; and that this language has direct links to earlier medical research on obesity. This language situates overeating, framed in the term ‘gluttony’, and a lack of exercise, framed in the term ‘sloth’, as the primary causal factors of obesity. This language combined with the negative health and social consequences associated with being obese suggest that there may be an idea of the sinner being associated with fatness.

71 Jenny Chamberlain, ‘Getting heavy with fat’, North and South Magazine, May 2004, p. 36.

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This led to the question what, if anything, is being evoked when the language of sin is being associated with the obese? Popular culture examples of the usage of a language of deadly sin demonstrate the continued usage of this language but offer little in explanation of why these associations still exist. As a result, the work turned to focus on the theological origins of these terms in the work of John Cassian. Cassian’s idea of the person, desire, and environmental conditions were very different from contemporary accounts of gluttony. For Cassian gluttony is the root vice from which all others spring, turning the believer’s desire from God to their own gratification. Indeed, gluttony in a time of scarcity was also a crime against the people in the community who may potentially go hungry as a result of another’s gourmandising. Today, in a secularised environment characterised by sedentary lifestyles and an excess of food, gluttony is regarded as the causal factor of obesity. The similarity between the two usages of the same words seems to be twofold: first, the same words and behaviours are causing fundamental problems to each society even though they are 1600 years apart in history; second, both societies demand an ascetic moderation from the individual for the benefit of the community and the individual themselves. As a result, it can be assumed that health professionals may unwittingly draw upon an ancient theological history when they use the language of sin to describe obesity. However, it is more likely that they are concerned with what they see as immoral behaviour on the part of the obese. The chapter then turned to an alternative explanation for the health professionals association of a language of sin with obesity. Some obesity researchers have suggested that there is a relationship between ideas of the Protestant ethic and obesity. This suggestion is certainly a more flexible explanation of the language association. Max Weber argued that the Protestant ethic demanded working in one’s calling as the highest form of moral devotion an individual could exhibit. The Protestant ethic allows for an explanation of Christian ideas and values being passed into secular culture. The Protestant movement has certainly had an active interaction within ideas of health in the nineteenth and twentienth centuries. The YMCA movement, ideas of muscular Christianity and food reformers such as Harvey Kellogg are evidence of this interaction. Marie Griffith argues that there was and still is a constant confluence between Protestant Christianity and ideas of health and the body

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in America. Griffith’s discussion of the devotional dieter, such as evangelist Francis Hunter, is the most effective example of an explicit language and practice association between gluttony and sin in this chapter. Hunter argues that unhealthy food is sin and that gluttons and the overweight have sublimated their desire for Jesus to their belly. In the words of devotional dieter Gwen Shamblin, ‘Fat people do not go to heaven’. The links between sin and obesity are explicit in the practices of American devotional dieters. For the Christian dieting movement, any usage of the terms gluttony and sloth are not metaphors, they are very real indicators of physical grace. There have been attempts in obesity research to investigate the relationship between Protestant Christianity and obesity. Kim and Sobal in their study of relationships between religion and body weight argued that there is a distinct ‘body as a temple’ theology evident in America. Investigations have shown no reliable correlation between religious belief and body weight in America. However, obesity researchers, such as Quinn and Crocker, are suggesting that the Protestant ethic could be colouring negative perceptions of the obese. Quinn and Crocker have found some evidence to support that position. However, the ideas of the Protestant ethic currently present in obesity research are utilitarian and quite obscure in their reference to the ethic’s religious roots. While we know that obesity researchers are using a language of sin to describe the causal factors of obesity, and there is evidence that the moral bias against the obese could be related to a form of the Protestant ethic, it is difficult to demonstrate an association between this ethic and ideas of sin. What we can conclude is that, in the moral language surrounding the obesity epidemic, there is some form of Christian legacy at play in ideas of health. At times this legacy is utterly explicit, sometimes Christian terms are used in a utilitarian form of morality, and at other times it is simply implicit in the background of ideas of what is good and bad for the individual. This legacy is theologically incoherent and haphazard in application. It draws on ancient patristic ideas of sin, but is primarily Protestant in its effects on the marketplace of the everyday life. It is difficult to pinpoint where and how these ideas entered popular perceptions of obesity, however, we can point to a nineteenth and twentieth century Protestant Christian influence on health and health behaviour. Thus, it appears that medical discourse has not escaped the influence of Christian ideas and values and what we see in the obesity epidemic is an example of a secularised appropriation of Christian values applied to the obese.

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The idea of the obese person as immoral or a ‘sinner’ is extremely powerful. So powerful that it has explicit influence on what we would expect to be the secular and objective discourses of health policy and obesity experts. As obesity is currently the most pressing health concern of the twenty-first century, this is potentially problematic. A moralisation of obesity has crept in to policy, research and the language of the people given the task to prevent this health problem. Obesity is not always being discussed in objective terms. The problem becomes how we can actively and positively approach the obesity epidemic when we encounter it with a certain undefined set of moral values and beliefs which provide a negative bias against the obese.

CHAPTER TWELVE

PAINFUL PARADOXES: CONSUMPTION, SACRIFICE AND MAN-BUILDING IN THE AGE OF NATIONALISM1 Christopher E. Forth Man is everything in the formation of this sacred thing which is called a people. —Ernest Renan, ‘What is a Nation?’ (1882)

Although Renan approached the nation as a ‘spiritual’ entity and rejected arguments that sought to ground nations in biology, this chapter places considerable emphasis on the body as an integral component of nation formation, especially as it pertained to male bodies. After all, Renan described the nation as ‘a large-scale solidarity, constituted by the feeling of the sacrifices that one has made in the past and of those that one is prepared to make in the future.’2 If this ‘sacred thing’ called the nation is indeed constituted by what its members are willing to endure, then we must attend to the material dimension of nationalism as a corporeal as well as an imagined construction. This is especially germane when considering the origins of nationalist sentiment in the late eighteenth century. Not only was the diminishing vitality of male bodies widely cited in the medical and political discourses of this period, but emerging militaristic concepts of the nation emphasised the very male qualities that were everywhere said to be disappearing. In what follows I argue that, in early nationalist discourses, concepts like pain and suffering existed on a continuum with ideas about privation and discomfort, and that all of these ideas forged connections between body and mind, self and community.3 During

1 For a more detailed discussion of the issues raised in this chapter, please see Christopher E. Forth, Masculinity in the Modern West: Gender, Civilization and the Body. Plagrave: Basingstoke, 2008. 2 Ernest Renan, ‘What is a nation?’, in Geoff Eley and Ronald Grigor Suny (eds.), Becoming National: A Reader, New York: Oxford University Press, 1996, p. 53. 3 Greg Eghigian, ‘Pain, entitlement, and social citizenship in modern Germany’, in Paul Betts and Greg Eghigian (eds.), Pain and Prosperity: Reconsidering TwentiethCentury Germany, Stanford: Stanford University Press, 2003, pp. 19–20.

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an age in which men were said to have been ‘softened’ by modern civilisation, measured doses of violence and pain were prescribed as means of defining national bodies and thus of bringing them into being as imagined and corporeal realities. I should begin by defining my key terms. A great of deal of scholarship has been devoted to the most spectacular and extreme examples of pain and violence, ranging from murder, torture and executions to warfare and domestic violence.4 In their broadest senses, pain and violence refer to actions inflicted by or upon bodies of a forcible and laborious nature capable of creating physical and emotional damage; yet in none of these cases do such actions need to result in debility or death, nor are they only inflicted upon other people. Just as ‘violence’ can refer to a number of forcible actions or motions, there is a spectrum of painful sensations that range from the uncomfortable to the excruciating.5 Adopting a broader approach to pain and violence brings us closer to the kinds of individualities that were recommended from the sixteenth and seventeenth centuries onward, partly as a consequence of the neo-Stoic philosophies that emerged across Europe. Many of these discourses articulated what Charles Taylor sees as ‘the growing ideal of a human agent who is able to remake himself by methodical and disciplined action. What this calls for is the ability to take an instrumental stance to one’s given properties, desires, inclinations, tendencies, habits of thought and feeling, so that they can be worked

4 The key theoretical work on such extreme forms of pain is still Elaine Scarry, The Body in Pain: The Making and Unmaking of the World, New York: Oxford University Press, 1985. 5 As defined by the OED, ‘pain’ refers to a spectrum of physical and emotional experiences, from ‘a continuous, strongly unpleasant or agonising sensation in the body’ and a ‘state or condition of consciousness arising from mental or physical suffering’ to less excruciating yet still burdensome activities like ‘labour, toil, exertions; careful and attentive effort.’ The OED’s approach to ‘violence’ has a similar semantic latitude. Of course topping the list is the ‘exercise of physical force so as to inflict injury on, or cause damage to, persons or property’; yet among the other definitions of violence are ‘Force or strength of physical action or natural agents; forcible, powerful, or violent action or motion’. Not surprisingly, both pain and violence bear a contrast to ‘comfort’, which, among other things, suggests ‘Pleasure, enjoyment, delight, gladness’ as well as ‘state of physical and material well-being, with freedom from pain and trouble, and satisfaction of bodily needs’. In those rare instances where comfort provides ‘strength’ or ‘refreshment,’ the point is mainly moral. Most of the physical connotations of a comfort that strengthens are therapeutic, referring to the recuperation from an illness or injury that returns the body to its ‘normal’ state (which may or may not have been particularly strong to begin with).

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on, doing away with some while strengthening others’.6 Through such disciplinary techniques as military training and other forms of physical fitness, certain forms of ‘pain’ are welcomed (or at least tolerated) as productive and even empowering experiences that bring into being things that were not there before, at least not in the same way. The roots of the slogan ‘no pain, no gain’ thus extend at least back to the early modern period, in which classical ideals were updated for a new era. Yet these neoclassical ideals and practices were often mobilised against other developments taking place in western societies, especially the putative ‘softening’ of men as a result of modern civilisation. While a distinction between ‘civilised’ and ‘coarse’ peoples has been around for millennia, the notion of la civilisation did not come into general usage until the 1750s, when, as Jean Starobinski points out, ‘it drew together the diverse expressions of a preexisting concept [that is, le civilisé]. That concept included such notions as improvements in comfort, advances in education, politer manners, cultivation of the arts and sciences, growth of commerce and industry, and acquisition of material goods and luxuries’.7 This concept has had particular implications for normative conceptions of masculinity in the west, especially those that invoke the robust bodily ideals associated with warriors. As a moral ideal, civilisation was implicitly ‘patriarchal’, and by insisting upon the domestication of women it transformed mothers and wives into the moralising agents of society while refusing them access to the world of politics, the professions and ideas.8 Yet, since even the least ‘manly’ of men is capable of exercising (or benefiting from) control over women, patriarchy is not necessarily co-extensive with masculinity. Although the idea of civilisation ultimately mutated and became open to a variety of interpretations and applications in the nineteenth century, middle-class masculinity has remained haunted by developments implicit to the experience and conceptualisation of civilisation described by Starobinski: refined manners, education and culture, and material comfort and luxuries. Sedentary lifestyles constitute a fourth development pertaining to the body that has accompanied modern

6 Charles Taylor, Sources of the Self: The Making of Modern Identity, Cambridge: Cambridge University Press, 1989, p. 159. 7 Jean Starobinski, Blessings in Disguise; or The Morality of Evil, Cambridge: Harvard University Press, 1993, p. 3. 8 Alice Bullard, Exile to Paradise: Savagery and Civilization in Paris and the South Pacific, 1790–1900, Stanford: Stanford University Press, 2000, pp. 14–15.

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civilisation, less as a value to be celebrated than as a common denominator of the other three. Emerging as lived realities for western elites from the early modern era onward, these four overlapping aspects of civilisation have formed the principal terms against which modern men have expressed their dissatisfaction with the world they have created and which in turn has shaped them. When they were not being condemned for encouraging deception and manipulation, the refined manners that greased the wheels of sociability during the period of the court society were frequently contrasted to the more direct emotional expressions of simpler times, when less inhibited men expressed their aggression and lust more freely and happily.9 For centuries the cerebral regimens that constitute the training ground for most modern professions have been counterposed, both morally and medically, to more physically active and risky male occupations, especially as an increasingly demilitarised nobility turned to law and letters. Indeed, throughout the modern era, excessive study has been repeatedly identified as causing a range of illnesses and unhealthy practices, from nervousness, masturbation and constipation to same-sex vice. Despite being defended as a spur to industry, the consumer indulgence that inevitably accompanies material abundance is frequently denigrated as fostering an ‘effeminate’ submission to appetite, appearances and immorality supposedly absent in earlier, simpler times. Luxury has been historically identified as softening male bodies in a way that led to masturbation, sodomy, obesity, laziness and weakness. Finally, the sedentary existence that seems implicit to these polite, cerebral, and consumer-oriented lifestyles is almost always condemned as the exact opposite of manly action and health, a main cause of the obesity and muscular atrophy that promised to be ‘cured’ through sports and military training at the end of the nineteenth century. Whether condemned together or individually, these four aspects of civilisation have been cited across the western world as the main environmental factors that threaten to turn men into weak and ‘effeminate’ creatures. At stake in this critique was not merely the fact that cerebral, comfortable and sedentary lifestyles made many noble and middle-class men ill-suited to the rigors of war, 9

Michèle Cohen, ‘ “Manners” make the man: Politeness, chivalry, and the construction of masculinity, 1750–1830’, Journal of British Studies, vol. 44, no. 2, April 2005, pp. 312–29.

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but that, if left unchecked, they threatened to create beings whose gender was undecidable under any circumstance. When viewed in terms of male bodies, what Norbert Elias famously called ‘the civilising process’ has been widely viewed as a feminising process.10 Civilisation’s relationship to the male body and the problem of pain has thus generated a series of paradoxes. If traditional Christianity recommended sacrifice and suffering as important parts of life, in the eighteenth century new approaches to consumer goods and the cult of sensibility stigmatised both the sensation and spectacle of pain as barbarous, cruel and unnecessary. This was complemented by medical innovations that sought to control and banish pain from everyday experience as much as possible. Nevertheless painful sensations have continued to exercise a hold on the imagination. Spectacles of torture and violence not only became commonplace in the pornographic texts of the eighteenth century, but they also played an increasing role in the Gothic fiction and sensationalist crime stories that proliferated throughout the nineteenth century.11 That spectacles of pain could attract as well as repel were accompanied by a lingering suspicion that the administration of pain could build as well as

10

Norbert Elias, The Civilizing Process, Oxford: Blackwell, 1994. A number of key developments punctuate the modern history of pain: the use of nitrous oxide gas (1773), the isolation of morphine (1808), the use of ether as an anesthetic (1847), the chemical synthesis of aspirin (1899), etc. In many areas of modern life pain and violence were roundly condemned, from the beating of children to the violently punitive practices of the armed forces. However much the parental use of the rod as a disciplinary instrument was gradually replaced by more psychological forms of self-control, David Savran sees a correlation between the gradual disappearance of the problematic rod as a punitive instrument and its recurrence as one of the most common sexual fantasies of the modern period: ‘delivered from its severe and obligatory service to children’s buttocks, it was left increasingly at the disposal of the fantasmatic . . . is it any wonder that masochism, since the seventeenth century, has become the most universalized and ubiquitous of the perversions?’ David Savran, Taking it Like a Man: White Masculinity, Masochism, and Contemporary American Culture, Princeton: Princeton University Press, 1998, pp. 25–26. Even humanitarian efforts to reduce suffering unwittingly eroticised pain through titillating language that encouraged readers to imagine scenes of torture and punishment for themselves. Thus as elite culture came to redefine pain as forbidden and even obscene, the capacity of violence and suffering to shock and stimulate increased as well, contributing to what Karen Halttunen calls a ‘new pornography of pain: a heightened awareness of the close relationship between the revulsion and the excitement aroused by pain’. Karen Halttunen, ‘Humanitarianism and the pornography of pain in Anglo-American culture’, American Historical Review, vol. 100, no. 2, April 1995, p. 318. 11

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destroy.12 As we will see, the same physicians who sought to relieve pain also criticised the complete removal of pain and hardship from daily life, appealing to both the fitness of the personal body and the body politic in an age where the corporeal demands of national military readiness were at odds with the unflattering portrait of elite bodies drawn by physicians.13 Despite celebrations of industrial productivity, especially in Britain, the ease, comfort and luxury that accompanied the ‘first consumer revolution’ in the eighteenth century generated considerable alarm. As the luxury debates of the period made clear, nations whose rising standards of living made life more peaceful and enjoyable also threatened to render their men soft, weak and cowardly. Significantly, discussions of ‘luxury’ were almost always accompanied by the spectre of ‘effeminacy’. That this transformation was at heart a bodily one was explicit in the medical warnings of the period, which inflected many of the associations social thinkers made between the personal body and the body politic. Thomas Laqueur has influentially described how a two-

12

The internal pacification of society that ensured the preeminence of the state still required all men to take up arms, but in defense of the nation rather than for merely personal reasons. As the state gradually secured a monopoly on the legitimate use of violence, warfare and policing became the only truly ‘civilised’ forms of aggression. Insofar as it sprang from raison d’état this bellicosity was depicted as less of an ‘impulse’ than a rationally-calculated and administered deed, a matter of ‘policy’ as the Prussian war theorist Carl von Clausewitz said. In this way the violence that was more or less proscribed in everyday life acquired a new kind of legitimacy through the ‘disciplined’ violence of the conscripted soldier or, in a different vein, the regimented worker and the trained athlete. 13 The roots of these anxieties about civilisation extend to the early modern era. As Richard Slotkin observes, since the fifteenth-century Europeans had looked at the New World through the lens of Arcadian poetry and romance epics, and thus imagined it as providing the space and opportunity for a regeneration of European culture, but without the excesses and extravagance of civilisation. This regeneration was imagined as being moral and intellectual (new knowledge might purify corrupt institutions) as well as physical (muscular or sexual vigor might be restored in a more ‘natural’ context). In North America, Slotkin observes, this regeneration was also thought to be effected mainly through violent methods, all of which would help to construct the uniqueness and superiority of America as a nation. The distance from ordinary civilisation was a key to this process, but distance from the metropole did not entail a complete break with many of its basic features. The relative lack of social restraints on behaviour reinforced the association of the New World with a bracing wildness that also allowed one to shrug off the shackles of European convention; yet however much one might even envy Indians their wildness the point was to encounter wildness while remaining civilised, almost like an initiatory ordeal. Richard Slotkin, Regeneration through Violence: The Mythology of the American Frontier, 1600–1860, Middletown, CT: Wesleyan University Press, 1973, pp. 29–30, 34, 191.

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sex model of the human body emerged by the late eighteenth century, thus producing a sexual dimorphism that defined male bodies as being naturally firmer, hardier and more bounded than those of females.14 Although this medical model provided a material foundation for the ‘separate spheres’ ideology that would characterise bourgeois society in the nineteenth century, the ‘natural’ foundation of such discrimination was undermined by the fact that the lifestyles of male elites often had little to do with nature anyway.15 Despite their elevated social and sexual status, noble and middle-class males displayed bodies that had been ‘softened’ by their own ‘civilised’ conditions. The nervousness that George Cheyne dubbed the ‘English Malady’ in the early eighteenth century was a common feature of life among sedentary and luxurious elites, whose material consumption was mirrored in the ‘wasting’ disease of the same name. It was for similar reasons that the French alienist Jean-Etienne-Dominique Esquirol later considered insanity a ‘disease of civilisation’, and even claimed that ‘the number of the insane is in direct proportion to its progress’. Masturbation was also seen as a special vice of the civilised, one partly traced to a sexual appetite precociously awakened in urban environments. Sodomy too was cited as being more or less a result of urban lifestyles, as was constipation, which would be described by more than one Victorian doctor as the ‘scourge of civilisation’. Although a cultural history of haemorrhoids is yet to be written, piles must have counted among the less glamorous diseases that civilisation could generate. Long considered an easy way to purge oneself of excess humours (thus obviating the need to pay a physician to do the honours), haemorrhoids were sometimes praised as a cost-saving ‘golden vein’. Many physicians even approved of haemorrhoidal bleeding as a healthy male counterpart to menstrual flux, perhaps as a sign that men could withstand losses of blood just as women did every month. This was good news for the penny-pinching patient, but a mixed blessing when viewed against the background of anxieties about modern life. In probing the causes of piles, German doctors like Franz 14 Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud, Cambridge: Harvard University Press, 1990. 15 Anne C. Vila, Enlightenment and Pathology: Sensibility in the Literature and Medicine of Eighteenth-Century France, Baltimore: Johns Hopkins University Press, 1998, p. 248; Ludmilla Jordanova, Sexual Visions: Images of Gender in Science and Medicine Between the Eighteenth and Twentieth Centuries, Hemel Hempstead, UK: Harvester Wheatsheaf, 1989, p. 58.

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Anton May and Johann Kaspar Stunzer cited a range of predictable sources, including frequent bloodletting, lack of exercise, and studious pursuits as well as warm drinks and rich foods. Whereas gout could be embraced as a kind of ‘luxury tax’ on the well-to-do, haemorrhoids were condemned as a punishment for slothful, gluttonous, and otherwise decadent lifestyles. If this were not feminising enough, more than one physician associated a bloody anus with ‘pederasty’, thus implicating ‘unnatural’ sexuality within the spectrum of civilised vices.16 With its obvious similarity to menstruation and hints of sodomy, the bleeding anus further undermined ideals of masculine self-containment by revealing the male’s capacity to be just as ‘leaky’ as a woman. Christoph Hufeland was certainly not alone when he allowed himself ‘one melancholy remark, which is, that the enemies of our life have, in modern times, dreadfully increased; and that the degree of civilisation, luxury, refinement, and deviation from nature in which we at present live, by so highly exalting our intensive life, tends also to shorten, in the same proportion, our existence’.17 The two-sex medical model may have reduced gender differences to a bedrock of biology, but none of these claims could guarantee that male bodies would also be masculine bodies. Among the well-to-do one was more likely to encounter obesity, gout, muscular weakness, sodomy and haemorrhoids as well as nervous fits and crying jags. These amorphous and leaky figures paled in comparison to the energetic, firm and well-defined bodies praised by physicians. The gendered and national implications of corporeal softness are nicely encapsulated in the French word lâche. When defining lâche in 1765, the Encyclopédie glided effortlessly from an adjective meaning ‘loose’ and ‘flabby’ to a noun denoting a ‘coward’, addressing along the way a spectrum of corporeal, moral and mental defects. That which is lâche is: the opposite of taut . . . It is the opposite of firm, and a synonym for flabby [mol] . . . It is the opposite of active . . . It is the opposite of compact . . . It is the opposite of compressed [reserré]; one has a flabby stomach [le ventre lâche]. Figuratively it is the opposite of brave; he is a coward [un lâche].

16 Uli Linke, Blood and Nation: The European Aesthetics of Race, Philadelphia: University of Pennsylvania Press, 1999, pp. 178–80; Susan Kassouf, ‘The shared pain of the golden vein: The discursive proximity of Jewish and scholarly diseases in the late eighteenth century’, Eighteenth-Century Studies, vol. 32, no. 1, 1998, p. 101. 17 Christoph Wilhelm von Hufeland, The Art of Prolonging Life, London: John Churchill, 1859, pp. 83–4.

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It is synonymous with the abject and shameful; he has done a cowardly deed [une action lâche]. Someone guilty of cowardice is commonly more despised than someone who has committed an atrocity. It is better to inspire horror than pity. Treason is perhaps the most cowardly of all actions.18

In a culture where the personal body and the body politic were viewed as closely connected, it was a slippery slope from flabby bodies to the more distressing vices of cowardice and treason. Worried observers in Britain, France and Germany reported that the refined, self-indulgent and sedentary lifestyles of their elites promoted rather than discouraged softness among men. This is one reason why, in German-speaking lands, the notion of ‘pain’ has typically been contrasted to ‘prosperity’, which draws attention to advances in material life whereby bare necessities have been provided for, diseases have been cured and greater numbers of people can expect longer lives relatively free of scarcity and the need for sacrifice.19 The opposite of pain was therefore not some abstract pleasure, but a range of concrete sensory experiences connected to modern advances in medicine, consumption and rising standards of living. In the face of this comfortable new world, reformers from John Locke and George Cheyne to Jean-Jacques Rousseau and Immanuel Kant identified childhood as the first school of hardness. Forcing the body to do without luxuries and conveniences was part of Kant’s recommendations for the proper ‘training of the sense of pleasure or pain’, where ‘we must see that the child’s sensibility be not spoilt by over-indulgence. Love of ease does more harm than all the ills of life’. ‘All that education can do in this matter is to prevent children from becoming effeminate. This might be done by accustoming them to habits of hardiness, which is the opposite of effeminacy’.20 That weakened male bodies had collective implications were noted by many, especially during a period in which nationalist ideologies were arguably emerging for the first time. At once a sacred space and community of believers, the nation is also a discursive construct that

18 ‘Lâche,’ Encyclopédie, ou Dictionnaire Raisonné des Sciences, des Arts et des Métiers, Neufchâtel: chez Samuel Faulche, vol. 9, 1765, p. 165. 19 Greg Eghigian and Paul Petts, ‘Introduction: pain and prosperity in twentiethcentury Germany’, in Paul Betts and Greg Eghigian (eds.), Pain and Prosperity, pp. 1–15. 20 Immanuel Kant, On Education, Boston: D. C. Heath and Co., 1900, pp. 44, 46, 52–53.

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seeks to ensure its coherence by marginalising or expelling its difference. Yet while this act is most evident in the case of persecuted individuals and groups, the nation does not spare the bodies of those who ‘belong’ to it. A product of the developmental and forward-looking outlook of the eighteenth and nineteenth centuries, the nation is also a Janus-faced entity that orients its members along a temporal axis that finds continuities between a mythical past and an imagined future, especially in regard to the bodies and moralities of its members. Moreover, the techniques for integrating people into this community have differed for males and females. ‘Women are typically constructed as the symbolic bearers of the nation’, notes Anne McClintock, ‘but are denied any direct relation to national agency’. While it is fair to say that women are often conceived as the nation’s ‘conservative principle of continuity’, both in regard to their reproductive capacity and attachment to ‘custom’, a look at the corporeal requirements for nationalism suggests that men have not always been securely located on the side of the ‘forward-thrusting, potent and historic’ elements of national progress.21 Given the importance of military prowess to many nationalist representations of masculinity, in order to be effective agents of the nation men have been repeatedly implored to draw upon bodily habits and experiences more closely associated with the idealised past than with the soft conditions of modern society. When combined with the representational work of creating a national culture based on collective symbols, images and texts, military training, compulsory sport and physical fitness have been integral to the processes of masculinisation that are the historical concomitant of nation-building. Through such disciplinary techniques the well-trained male body becomes a prime example of what Ana María Alonso calls ‘the fusion of the ideological and the sensory, the bodily and the normative, the emotional and the instrumental, the organic and the social, accomplished by these tropes and particularly evident in strategies of substantialization by which the obligatory is converted into the desirable’.22 I will suggest that, when governed by legal or cultural codes,

21 Anne McClintock, ‘“No longer in a future heaven”: Nationalism, gender, and race’, in Geoff Eley and Ronald Grigor Suny (eds.), Becoming National: A Reader, New York: Oxford University Press, 1996, p. 261. 22 Ana María Alonso, ‘The politics of space, time and substance: State formation, nationalism, and ethnicity’, Annual Review of Anthropology, vol. 23, 1994, p. 395.

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violence of this sort performs various kinds of boundary maintenance. Whether delivered by others or inflicted upon oneself, violence against the male may be called ‘hygienic’ when its ultimate aim is to maintain the hardness and cohesion of the self and/or the collective, and ‘therapeutic’ when a restoration of such boundaries is thought to be in order. Administered to the weak, violence can function as a form of therapy that, when it does not crush or kill the patient, might better prepare him for membership in a male group; when applied to boys its punitive aspects merge with its hygienic potential. However much the prostration or ‘penetration’ that inevitably occurs during this process may momentarily ‘feminise’ a male, this ritual subjection may also be approached as a stage on the path toward redemption, precisely the form of creative destruction of the body that is routinely practiced in military and sporting institutions. This is one of the reasons that the encounter with harsh environmental conditions and confrontations with other people has so often been lauded in the west as a form of ‘regeneration through violence’, to borrow Richard Slotkin’s phrase. While elements of this scenario resonate with heroic ideals from the classical period, the hero that emerges from nation-building ordeals is meant to be collective rather than singular, an example of Everyman rather than Superman. As a collective body, the nation thus demanded an antagonistic stance toward the bodies and pleasures of modern existence. If in the Middle Ages the word ‘comfort’ had suggested the capacity to make one strong (com-fortis),23 in the midst of the consumer revolution more and more observers prescribed measured doses of discomfort as essential for the hardening and strengthening of the body. This was precisely what military training promised to deliver. Removed from comfortable urban lives and thrust into harsh rural conditions, hitherto soft males might be hardened through physical ordeals that taught them how to conquer fear and pain as well as to inflict violence upon others. The rigorous military drill that modernised European armies in the seventeenth century was an important technique for later nation-building projects, not least because it subjected growing numbers of men to

23 John E. Crowley, The Invention of Comfort: Sensibilities and Design in Early Modern Britain and Early America, Baltimore: Johns Hopkins University Press, 2001, pp. 3–7, 69–73.

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harsh new forms of regimentation.24 As the military became democratised, this practice aimed to reduce men of different backgrounds to a shared corporeal maleness, thus instantiating the ‘deep, horizontal comradeship’ that is central to most conceptions of the nation.25 When combined with the discursive work of creating a nationalistic culture, military training was a method of making up people who would both embody and serve the interests of the state. Nation-building and manbuilding were coextensive processes, and the rigorous and even painful working of the body was the cement of each. If military training aimed at constructing bodies whose movements could be shaped, calculated, coordinated and deployed at will, its success varied according to the quality of the raw materials at hand. This had been an issue in the 1750s, when Rousseau, well-known for his recommendations about hardening boys, expressed concern about the French army being corrupted by men unaccustomed to hardship: ‘With what courage . . . can it be thought that hunger and thirst, fatigues, dangers, and death, can be faced by men whom the smallest want overwhelms and the slightest difficulty repels?’26 As a number of cultural historians have remarked, the French Revolution effected a transfer of sacrality from the body of the bloated and impotent ‘pig-king’ to that of the male citizen whose virility was expressed through bodily vigour and sexual potency. The corporeal superiority of this ‘new man’ was enshrined in the symbol of Hercules and in the levée en masse of 1792, which demanded military service of all men (rather than just nobles).27 At the centre of nationalist discourses is the male bond, whose inner cohesion and external boundaries are to a significant extent defined by

24 By adapting ancient military practices to the peculiar demands of gunpowder weapons, in the late fifteenth century Prince Maurice of Orange developed training methods that instilled in soldiers the ability to perform, upon command, stylised movements efficiently and simultaneously. Through such practices an esprit de corps or ‘muscular bonding’ was cultivated among men from different social backgrounds whose devotion to their fellows allowed them to eagerly defend their nations on the field of battle. William H. McNeill, Keeping Together in Time: Dance and Drill in Human History, Cambridge: Harvard University Press, 1995, pp. 2–3, 127–131. 25 Benedict Anderson, Imagined Communities: Reflections on the Origin and Spread of Nationalism, London: Verso, 1996, p. 16. 26 Jean-Jacques Rousseau, A Discourse on the Moral Effects of the Arts and Sciences, in The Social Contract and Discourses, London: J. M. Dent, 1993, p. 21. 27 Antoine de Baecque, The Body Politic: Corporeal Metaphor in Revolutionary France, 1770–1800, Stanford: Stanford University Press, 1997, pp. 54–75; André Rauch, Le Premier Sexe: Mutations et Crise de l’Identité Masculine II, Paris: Hachette Littératures, 2000, p. 48.

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the physical encounter with effort, deprivation and endurance. In this way, as Norman Bryson suggests, the male body is ‘no longer leased to the state, it is the state; the state emerges as a new kind of biopolitical entity . . . [that] is no longer figured in the king, but in the male body itself, and the body’s destiny for glory or defeat is that of the nation as a whole’.28 What was true of French nationalist practices may also be observed in central European states, whose conquest and annexation by Napoleon’s army in 1806–07 energised a pre-existing nationalist movement that asked hard questions about the physical and moral qualities of its men. Along with most countries in the eighteenth century, Prussia too deplored the sheltered and sedentary lives of noble and middle-class men, and made it clear that this emasculation was legible in their weak bodies and frazzled nerves.29 Coupled with a lack of physical exercise, culinary and sexual excess had resulted in the physical degeneration of the once powerful Germanic warrior, a decline that physicians thought could only be reversed through vigorous training. Compulsory military service was recommended as a means of toughening up ‘commercial and academic classes’ who tend to manifest ‘unwarlike and cowardly’ attitudes.30 When enacted in 1813, just as the Prussian army was preparing to expel the French, the law for compulsory military service performed the function of gender therapy for burghers who were distanced from a warrior lifestyle. Like the patriotism that enlistment in the army was supposed to reflect and create, ultimately the manliness of elites had to be crafted through harsh measures. A century before the Futurists provocatively dubbed war ‘the world’s only hygiene’, compulsory military service was proudly celebrated as a form of therapy for weakened elites, an example of regeneration

28 Norman Bryson, ‘Géricault and “masculinity” ’, in Norman Bryson, Michael Ann Holly, and Keith Moxley (eds.), Visual Culture: Images and Interpretation, Hanover, NH: Wesleyan University Press, 1994, p. 247. 29 Teresa Sanislo, ‘Models of manliness and femininity: The physical culture of the Enlightenment and early national movement in Germany, 1770–1819’, Ph.D Diss. in History, University of Michigan, 2001; Suzanne Zantrop, ‘The beautiful, the ugly, and the German: race, gender, and nationality in eighteenth-century anthropological discourse’, in Patricia Herminghouse and Magda Mueller (eds.), Gender and Germanness: Cultural Productions of Nation, Oxford: Berghahn, 1997, p. 29. 30 Ute Frevert, A Nation in Barracks: Modern Germany, Military Conscription and Civil Society, Oxford: Berg, 2004, pp. 18–19.

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through violence.31 Compelling all men to submit to military training and the prospect of combat was conceived as hygienic measure for the nation as whole, especially one becoming engaged with a modern culture of commerce and consumption.32 However much the theorist of Realpolitik, Carl von Clausewitz, would later insist that warfare is a tool of state policy, he too agreed that it was also a method of gender hygiene for advanced nations. ‘By it alone’, he claimed, ‘can that effeminacy of feeling be counteracted, that propensity to seek for the enjoyment of comfort, which cause degeneracy in a people rising in prosperity and immersed in an extremely busy commerce’.33 For many men the daunting prospect of universal conscription was sweetened by the creation of a national cult of heroism. Whereas the ancient myth of the ‘death for the fatherland’ had only valorised fallen nobles, now every man of military age was deemed qualified to sacrifice himself for the country and, if necessary, to die in its name.34 Just as combat could function as a form of therapy for softened bodies and flagging resolve, its transformative potential also made it a rite of passage, as much for adolescents entering adulthood as for ethnic minorities seeking membership in the nation. The history of European

31 As in France and Britain, among Prussian reformers comfort and luxury counted among the main enemies of the fit soldierly body. ‘Hence, the noble-minded man will be active and effective’, explained Johann Gottlieb Fichte, ‘and will sacrifice himself for his people’. Fichte added that ‘Life merely as such, the mere continuance of changing existence, has in any case never had any value for him, he has wished for it only as the source of what is permanent. But this permanence is promised to him only by the continuous and independent existence of his nation. In order to save his nation he must be ready even to die that it may live, and that he may live in it the only life for which he has ever wished’. Fichte, Address to the German Nation, 1807. 32 ‘In this way’, declared the propagandist Ernst Moritz Arndt, ‘we’ll produce a handsome, strong, and magnificent sex, protected from effeteness and lasciviousness by the ultimate appeal of manliness’. Quoted in Frevert, A Nation in Barracks, p. 28. 33 Carl von Clausewitz, On War, London: Routledge and Kegan Paul, Ltd., 1949, p. 191. 34 In addition to the introduction of the Iron Cross, a badge of honor which allowed commoners to be rewarded for their service just like nobles, militant Prussians promoted the cult of heroism through widely circulated monuments, songs and poems. Karen Hagemann, ‘German heroes: The cult of the death for the fatherland in nineteenthcentury Germany’, in Stefan Dudink, Karen Hagemann and John Tosh (eds.), Masculinities in Politics and War: Gendering Modern History, Manchester: Manchester University Press, 2004, p. 120; Karen Hagemann, ‘Of “manly valor” and “German honor”: Nation, war, and masculinity in the age of the Prussian uprising against Napoleon’, Central European History, vol. 30, no. 2, 1997, pp. 187–220; George L. Mosse, The Image of Man: The Creation of Modern Masculinity, New York: Oxford University Press, 1996, p. 44.

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Jews provides a useful case in point. In France inquiries into the Jewish question had been made just before the Revolution, and even the most well-meaning observers concluded that Jewish men needed to reform themselves in order to be accepted into the national body of men. In the late 1780s the Abbé Henri Grégoire famously observed how an outer layer of ‘burlesque traditions’, ‘physical degradation’, and ‘odious practices’ distracted most people from the shared qualities that qualifying the Jews as members of the ‘universal family’ of humanity. By improving their weak bodies and ‘effeminate temperaments’, Grégoire proposed, Jews could be completely assimilated into the nation, which he implicitly cast as a strong and masculine entity.35 Bellicosity and physical robustness were thus cherished as potentially transformative qualities that created the conditions under which men could engage with each other on an equal footing that promised to render differences of race, ethnicity and class irrelevant. These were strenuous and violent examples of what Grégoire termed ‘regeneration’. Thus, when Napoleon introduced his so-called ‘Infamous Decrees’ in 1808, he insisted that all Jews conscripted into the army had to perform military service themselves, and thus could not hire replacements as wealthy non-Jews were permitted to do. However inequitable this double standard was, arguably the emperor felt he was furthering the regeneration of the Jews through mandatory schooling in hardness and male codes of civility. Moreover, this was very much in keeping with the Jewish enlightenment project known as the Haskalah, where assimilationist Jews agreed that adopting the robust warrior ways of Gentiles was an indispensable step toward full membership in the nation (even though Gentiles too fell short in these areas).36 In many countries Jews valued military service for precisely these reasons: it was a ‘ritual masculinising’ that affected Jew and Gentile alike.37 Nevertheless, in Prussia the presumed unfitness of the Jew for military service was often taken for granted, and treated as a hereditary defect that no amount of military training could overcome. For some the alleged shortcomings of the Jew’s body were at the heart of the problem. Johann David Michaelis, for example, had insisted in 1783

35 Abbé Henri Grégoire, Essai sur la Régénération Physique, Morale et Politique des Juifs, Paris: Stock, 1988, pp. 57–64, 163, 168, 175. 36 John M. Efron, ‘Images of the Jewish body: Three medical views from the Jewish Enlightenment’, Bulletin for the History of Medicine, vol. 69, 1995, pp. 349–366. 37 Frevert, A Nation in Barracks, 162.

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that Jews as a race were much too short to meet the standard height of European soldiers (5 feet, 2 inches).38 Despite the fact that many Jews were conscripted and acted bravely in the wars of liberation, the assumption of Jewish effeminacy persisted in military circles, and after the French were expelled many Prussian Jews were ousted from their civil service jobs and banned from the armed forces. According to the Jewish writer Gabriel Riesser, among Jews during the 1830s an accusation of effeminacy represented the ‘most defamatory of all slurs’ that could only be answered with a challenge to a duel. When more liberal political currents caused Prussia to reinstate mass conscription in 1845, Jewish enlistment was encouraged because it might improve their physical prowess, foster a sense of patriotism and prompt them to convert to Christianity.39 Membership in the national body thus requires the rigorous and painful reworking of private bodies, but only so long as those bodies are deemed recuperable. With the rise of scientific racism and an even more militant nationalism towards the end of the nineteenth century, the alleged effeminacy of German Jews would be viewed as irredeemably other. Perhaps one reason that nations have Janus-faces is because the modern civilisation that gives rise to them is itself double-edged, capable of bolstering masculine dominance while destroying its corporeal foundations in the same movement.40 In bodily terms, nations are thus always in a state of tension with the modernity that creates them; one might even say that it is the present that Janus-faced nations have most difficulty seeing clearly. Nationalist discourses thus enact what Ulrich Beck calls ‘constructed certitudes’ that deny the problems posed by civilisation to dwell instead on the hardiness of male bodies in the ancient past and the dream of reproducing such bodies in the future. As Beck suggests, a more complex view of modernity would discover ‘the simultaneity of contradictions and dependencies of reflexively modern and counter-modern elements and structures in the image of

38 Patricia Vertinsky, ‘Body matters: Race, gender, and perceptions of physical ability from Goethe to Weininger’, in Norbert Finzsch and Dietmar Schirmer (eds.), Identity and Intolerance: Nationalism, Racism, and Xenophobia in Germany and the United States, Cambridge: Cambridge University Press, 1998, p. 355. 39 Quoted in Frevert, A Nation in Barracks, p. 69; Gregory A. Caplan, ‘Militarism and masculinity as keys to the “Jewish question” in Germany’, in Paul R. Higate (ed.), Military Masculinities: Identity and the State, Westport, CT: Praeger, 2003, p. 180. 40 Marshall Berman, All That is Solid Melts into Air: The Experience of Modernity, London: Verso, 1995, p. 15.

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“modern” society’.41 Even though militaristic nationalism would not fully emerge until later in the nineteenth century, what wafts from the crucible of the late eighteenth century is a tension that would fracture western masculinities throughout the modern era: the disjunction between a civilisation that encourages ‘soft’ male bodies and a warrior ideal that thrives on pain and endurance. Making the ‘ultimate sacrifice’ for one’s nation is merely the last of a series of sacrifices that render men hard in the face of modernity’s softness.

41 Ulrich Beck, The Reinvention of Politics: Rethinking Modernity in the Global Social Order, Cambridge: Polity, 1997, pp. 63, 67.

CHAPTER THIRTEEN

FREEZING SACRED MAN: MYTH, PHILOSOPHY, AND MEDICINE’S PRACTICE OF ‘CURING’ UNDESIRABLES Peter Arnds In the North German spa town of Bad Nenndorf shortly after the war, the British established camp-like conditions in their interrogation of German communist prisoners. A common practice was to hold these prisoners in bare, freezing cells ‘for up to two weeks at a time’ and douse them ‘in cold water every 30 minutes from 4:30 am until midnight’.1 Cold water torture in a spa resort—it is clearly a perversion of the original purpose ascribed to such a place, but it was also a practice in many camps in Nazi Germany.2 In Dachau, for example, cold water immersion of the inmates was part of a common medical experiment. The doctor responsible for these hypothermia experiments, Sigmund Rascher, was working towards more pragmatic ends than the British in Bad Nenndorf, namely the survival of Luftwaffe pilots who were shot down over the North Sea. For the purpose of finding out how long these pilots could survive in ice-cold water, ‘some 300 prisoners were immersed in ice-cold water, or strapped naked to a stretcher in the [middle of the] winter, while rectal temperature, heart rate, level of consciousness and shivering were meticulously monitored and charted. Most were allowed to freeze to death; in some resuscitation by various methods was attempted, with active reheating in a warm bath proving the most effective. The results were presented at a medical conference in Berlin in 1942’.3

1 Ian Cobain, ‘The postwar photographs that British authorities tried to keep hidden’, The Guardian, 3 April 2006. 2 Cf. Robert N. Proctor, Racial Hygiene: Medicine under the Nazis, Cambridge, Mass.: Harvard UP, 1988, p. 217. 3 Cf. David Bogod, ‘The Nazi hypothermia experiments: Forbidden data?’, in Anaesthesia, vol. 59, December 2004, pp. 1155–6.

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The camouflage involved in torture and killing in a place openly advertised as a healing institution, as it took place in Bad Nenndorf, has its precursor primarily in one Nazi camp, which was initially disguised as a spa resort: Theresienstadt. In these spa resorts healing perverted ‘curing’ ‘Verrücktheit’ (madness) in the sense of ‘aberrance’ or deviance from the norm, whether it was from the racial norm during the Nazi years (Theresienstadt) or from the ideological norm of the capitalist west during the Cold War (Bad Nenndorf). This chapter explores the role of water in the expulsion, persecution, and torture of humans at the interstices of literature, myth, history, religion, and cultural studies. It aims to create links between history, cultural theory, and post-war German literature in view of Germans as victims, a paradigm that comprises a number of groups including but not limited to the victims during the Third Reich (German euthanasia and camp victims) and post-war German victims, of the air raids, for example, or, as we can see in the case of Bad Nenndorf, Germans as victims of the interrogation techniques performed by the Allied Forces. Two chief figures who sparked the debate about the question whether Germans can claim victim status are Günter Grass with his novel Crabwalk (2002) and Sebald with his book Air War and Literature (2001). In the following pages, I want to look at a set of key scenes in two other works, Grass’s The Tin Drum (1959) and Sebald’s Austerlitz (2001), in light of the history of healing insanity broadly defined as mental aberration, a cultural history that encompasses the paradigms of class, race, the body, and ideology, and has its apex in the twentieth-century perversion of therapy into torture, healing into killing, patients into prisoners. The approximation of the two spa resorts with such a cultural history will elucidate the common root and divergence between the Nazis’ racial hygiene and the use of water as torture when it comes to eradicating ideological aberrancy or other forms of extremism. The contextualisation of the history of the use of water in ‘curing’ undesirables, which ranges from the segregation of the insane on rivers to water boarding terrorists, with two literary examples will reveal the deeper relationship between the persecution of mental insanity, of Jews, Germans, and Muslims. That such a cultural history within the context of myth and bio-politics extends to the domain of religion will be demonstrated in the third section of this paper, which shows the connection between the homo sacer as discussed by Giorgio Agamben and religion’s, the sacred’s, ambition to protect humanity from onsets of the satanic and the profane.

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Healing versus killing in Grass and Sebald One of Günter Grass’s most memorable characters in his 1959 novel The Tin Drum, the greengrocer Greff has to hide his homosexuality from the Nazis. He celebrates his own body and those of teenage boys with whom he engages in boy-scout games. Greff, Grass tells us, ‘liked everything that was hard, taut, muscular. When he said “nature”, he meant asceticism. When he said asceticism he meant a particular kind of physical culture. Greff was an expert on the subject of his body’.4 If Greff’s homosexuality were discovered and made public he would become a German victim.5 Through his exaggerated body culture, Greff, however, seems to chastise himself for his desire for teenage boys, thus following a strange logic that Hitler once outlined in Mein Kampf: ‘The youth who achieves the hardness of iron by sports and gymnastics succumbs to the need of sexual satisfaction less than the stay-at-home fed exclusively on intellectual fare’.6 Unlike Oskar Matzerath, the insane and physically misshapen protagonist of the novel, Greff is an incarnation of the National Socialist politics of health, their bio-politics vis à vis the ‘degenerate body’, and their idea of hardening the male body into a likeness of the statuesque classical body. One aspect of his body culture is that Greff likes immersion into the icy waters of the Baltic: He began to undress. He took off his clothes and he was soon stark naked, for Greff’s nakedness was always stark . . . twice a week during winter months, Greff the greengrocer bathed in the Baltic. On Wednesday he bathed alone at the crack of dawn. He started off at six, arrived at half-past, and dug [a hole into the ice] until a quarter past seven. Then he tore off his clothes with quick, excessive movements, rubbed himself with snow, jumped into the hole, and, once in it, began to shout. Or sometimes I heard him sing: ‘Wild geese are flying through the night’ or ‘Oh, how we love the storm . . .’ He sang, shouted, and bathed for two minutes, or three at most. Then with a single leap he was standing, terrifyingly distinct, on the ice: a steaming mass of lobstery flesh, racing round the hole, glowing, and still shouting.7

4

Günter Grass, The Tin Drum, New York: Vintage, 1990, p. 293. Cf. Proctor, Racial Hygiene, p. 214: ‘In the mid-1930s, thousands of individuals identified as homosexuals were arrested and sent to concentration camps, where they were detained so as not to “infect” the broader population. Thousands of camp inmates wearing the pink triangle were ultimately sent to the gas chambers, as part of the attempt to rid Germany of this “pathology” ’. 6 Adolf Hitler, Mein Kampf, Boston: Houghton Mifflin, 1943, p. 253. 7 Grass, The Tin Drum, p. 294. 5

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In W. G. Sebald’s novel Austerlitz (2001) it is the musician Schumann who jumps into the icy waters of the river Rhine. In this story about a traumatic loss of parents, home and memory, the protagonist Jacques Austerlitz suddenly remembers after 50 years that as a child he was transported from Prague to Wales on the infamous Kindertransport thanks to which he was—unlike his parents—able to escape deportation to Theresienstadt. Austerlitz’s search for traces of his parents ultimately leads him to a deeper understanding of the camps, specifically of Theresienstadt, but it also confronts him with the psychiatric clinic. As the discovery of his past temporarily clouds his mind and makes a sojourn in the clinic necessary, Austerlitz thinks of the musician Schumann who, at the height of the Düsseldorf carnival, suddenly ‘took a leap over the parapet of the bridge into the icy waters of the Rhine, from which he was pulled out by two fishermen. He lived for a number of years after that [. . .] in a private asylum for the mentally deranged’.8 In similarity to Grass’s greengrocer Greff for whom the cold water bath offers a way of curing himself of a passion that if discovered could potentially cost him his life, Schumann’s jump into the icy Rhine River at the height of the Düsseldorf carnival, no doubt performed with the intention of committing suicide, is intended as a way to cure himself of his own madness. The novel Austerlitz is particularly interesting for our discussion, not only because it touches on the topic of madness but also because it comments on the disguise of mass murder behind mechanisms of healing and therapy, the disguise of certain death through life-giving images, of terror through joy. On his repeated journey to the Czech Republic Austerlitz encounters the Bohemian spa resorts, which Sebald ironically approximates with the terror of the camps. In Marienbad: one of the most fashionable European resorts . . . the mineral waters and particularly the so-called Auschowitz Springs had gained a great reputation for curing the obesity [. . .] so common among the middle classes, as well as digestive disturbances, sluggishness of the intestinal canal and other stoppages of the lower abdomen, irregular menstruation, cirrhosis of the liver, disorders of bile secretion, gout, hypochondrical spleen, diseases of the kidneys, the bladder, and the urinary system, glandular swellings and scrofulous deformities, not to mention weakness of the nervous and muscular systems, fatigue, trembling of the limbs, paralysis,

8

W. G. Sebald, Austerlitz, New York: The Modern Library, 2001, p. 214.

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mucous and bloody fluxes, unsightly eruptions on the skin, and practically every other medical disorder known to the human race.9

The comic and the terrible, the profane and the sacred lie closely together in this passage, particularly in the image of the Auschowitz Springs, a word that in itself combines death and life, terror and joy. The healing of the obese bourgeois citizens of their various ailments of civilisation conjures up, by way of opposition, images of the diseases and the emaciated corpses of Auschwitz. In his obesity, the bourgeois citizen is the chief representative of a diseased sedentary world. By trying to heal himself with spring water he partakes of a medium that in its flow is the very antithesis of this sedentary world. ‘Water and madness’, Michel Foucault argues, ‘have long been linked in the dreams of European man’.10 So have madness and passion, madness and animality. Before the mentally disabled were ever exposed to water they were allowed to roam freely in towns. Before the first steps in their segregation were taken by way of the ship of fools they were still part of the polis, a part of being, according to Heidegger who informs us that ‘the word polis is, in its root, identical with the ancient Greek word for ‘to be’, pelein’.11 In sending the ship of fools down the river, however, the civitas still conceded to a harmony between water and madness in their relationship with wandering, with straying from the sedentary world. In the age of Enlightenment then water, the stillness of cold water, in its non-flux an apt image for the immobility of the new sedentary bourgeois class, is used as a form of therapy for excessive wandering, for the excessive wanderers of the mind, the mentally insane. Finally, in the totalitarian methods of the twentieth century, immersion in ice-water becomes a deadly practice to those not on the side of prevailing ideology. Specifically, the migrating Gypsies were targeted after numerous attempts to make them settle down. This association of wandering and crime, the labelling of pernicious wanderers as psychopaths, as insane, is reflected also in Grass’s Oskar Matzerath, the wandering picaro who is eventually locked up in a mental institution.

9

Ibid., p. 210. Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, New York: Random House, 1988, p. 12. 11 Martin Heidegger, Parmenides, Bloomington: Indiana UP, 1992, p. 90. 10

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The opposition inscribed into Sebald’s ‘Auschowitz Springs’ between the flowing springs as an element of healing and a camp in which the Nazis viewed pernicious wanderers as unworthy of life then repeats itself in the image of Theresienstadt. Theresienstadt holds a central place in Sebald’s novel, since it is here that Austerlitz discovers traces of his mother. The principle of camouflaging crime behind the façade of a healing institution as well as a respectable city is especially prevalent for this camp. In order to lure their victims to Theresienstadt, the Nazis emphasised its role as Theresienbad, as a bath, a pleasant spa resort or Luftkurort ‘with beautiful gardens, promenades, boarding houses and villas’.12 Such a disguise can be seen as a cynical reaction to the Weimar Republic’s social reforms, which included in the language of the Nazis ‘ “palaces for the mentally ill” [and] “wonderful parks and gardens” for those inferior beings that inhabit Germany’s mental institutions’.13 Similar to the Auschowitz Springs, death (nonbeing) versus life (being) collide in the three appearances associated with Theresienstadt (bath, city, and ghetto). Theresienstadt is disguised not only as a bath allowing for promenades but also as a city, the camp inmates as citizens. When an international Red Cross committee consisting of two Danes and one Swiss visited Theresienstadt the Nazis briefly, for the duration of the visit, turned the camp into a beautiful city, an action of embellishment that was captured in the documentary Der Führer schenkt den Juden eine Stadt (The Führer gives a city to the Jews) and was intended to fool the public into the conviction that Theresienstadt was a place in which life flourished. From madness in the Middle Ages to racial hygiene in the Third Reich What are the cultural, psychological, and philosophical contexts of these practices and of their perversion from therapy to torture? Greff’s exaggerated subscription to the Nazis’ body ideal and body culture reveals a fear of discovery and of persecution at a time that sees manliness in crisis and aspires to reassert its own heterosexuality not only by eliminating all homosexuals but also by rooting out any effeminacy in

12 13

Sebald, Austerlitz, p. 239. Proctor, Racial Hygiene, p. 185.

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the male body whether in real life or in its artistic representations14— in countless representations of the fascist imagination of the body that reflect the way in which the body is expected to ‘pull itself together’ (sich zusammennehmen) as opposed to a society in which the body is allowed to ‘let itself go’ (sich gehenlassen).15 If we look at Greff’s pursuit of a taut body from a psycho-analytic perspective we can assume that he tries to hide his effeminacy behind an exaggeratedly male body. Unlike the Nazis who assert their own identity by persecuting those groups to whom they do not wish to belong, Greff hides his true identity through self-denial, by coating his effeminate inner self with a male body. On the other hand, just like the Nazis, Greff accentuates his masculinity through his body culture, thus reflecting the Nazi party’s own struggle in imaging their patriarchal, heterosexual politics. Unsure of his masculinity, Greff is eager to emphasise through his body that part of his identity that he fears is missing. As Alan M. Klein has pointed out, ‘bodybuilders tend to be hyper-masculine and there is a link between their hyper-masculinity and gender-based insecurity’.16 Quoting Theodor Adorno’s The Authoritarian Personality (1950), Klein further argues that ‘hypermasculinity is an exaggeration of male traits, be they psychological or physical’ and that ‘there is embedded in it a view of radical opposition to all things feminine. Male self-identity is the issue here. The more insecure the man, the greater his tendency to exaggerate, to proclaim his maleness’.17 Greff’s body culture is, however, more than a psychological problem. It implies the idea of camouflage, a common practice in totalitarian regimes both on the side of victims as well as perpetrators. It is his way of hiding from the homophobic Nazis, who, in order to uphold the image of a healthily heterosexual society, eradicate those who do

14 Cf. Siegfried Kaltenecker, ‘Weil aber die vergessenste fremde unser körper ist: Über männer-körper repräsentationen und faschismus’, in Marie-Luise Angerer (ed.), The Body of Gender, Körper, Geschlechter, Identitäten, Vienna: Passagen Verlag, 1995, p. 99: ‘Distancing himself from the female, homosexual, Jewish or proletarian Other makes aggressive expansion the modus vivendi of the fascist man’s compulsive identity, which desires the disappearance of everything that is not identical with it’ (my translation). 15 Ibid. 16 Alan M. Klein, Little Big Men: Bodybuilding Subculture and Gender Construction, Albany: State University of New York Press, 1993, p. 222. 17 Ibid., p. 221.

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not fit into this image: the effeminate Jew18 and the homosexuals. As Klein informs us, it is the athlete’s identity that society rarely questions. As the highest embodiment of masculinity in our society male athletes are allowed to behave in a way that other men are not. They are, for example, allowed to hug in public, precisely because their masculinity is beyond the shadow of a doubt. Klein talks about American society, but the same can be observed in other conservative societies, and National Socialism was no exception.19 Although Greff hardens his body through exercise, his body corresponds to what Foucault has described in Discipline and Punish: The Birth of the Prison as the ‘docile body’. Greff ’s eagerness to please the boys with whom he surrounds himself is offset by an eagerness to please a society that would condemn him if it knew the truth about him. Discipline, according to Foucault, produces subjected docile bodies.20 Greff makes his body docile, that is, obedient to a patriarchal society that through hyper-masculinity tries to eradicate any femininity that it may contain. More than ever before in the capitalist world, however, for Nazi Germany disciplining the body also has to be seen in connection with the relation between docility and utility. In the Third Reich the obedient, docile body was the one that the state could use for work and war. More than in any other period ‘a policy of coercions’ was made to ‘act upon the body’21 and the less docile the body was, the less useful it was to society, and consequently, the more this society felt threatened by it and was eager to get rid of it. The mentally or physically disabled body in particular eludes this process of being made docile, and no amount of discipline can increase the potential of such a body in economic terms. Foucault argues that the age of great confinement that has its beginning in the foundation of the Hôpital Général in Paris in 1656 is based on a fear of idleness. What all the inmates of these early institutions—the mad, the poor, vagrants, and criminals—‘shared in spite of their great differences was their failure to work’,22 their escape from the constraints of a productive society.

18 Cf. Monica Rüthers, ‘Der Jude wird weibisch—und wo bleibt die Jüdin? Jewishstudies—gender studies—body history in traverse’, Zeitschrift für, Geschichte 3.1, 1996, pp. 136–45. 19 Klein, Little Big Men, p. 219. 20 Michel Foucault, Discipline and Punish: The Birth of the Prison, New York: Random House, 1995, p. 138. 21 Ibid. 22 David R. Shumway, Michel Foucault, Charlottesville: UP of Virginia, 1992, p. 33.

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Foucault’s discussion of madness and its relationship to social constraints and the phenomenon of space, madness’ isolation from society, is of paramount significance in connection with the disciplined body, the body in constriction. According to eighteenth-century beliefs, ‘the more easily penetrable the internal space [of the body] becomes the more frequent is [madness], [especially] hysteria [as a form of madness associated primarily with women] and the more various its aspects; but if the body is firm and resistant, if internal space is dense, organised, and solidly heterogeneous in its different regions, the symptoms of hysteria are rare and its effects will remain simple’.23 Fearing ‘the torment of all effeminate souls whom inaction has plunged into dangerous sensuality’24 it becomes understandable why Greff suppresses his sexuality, why he makes his body impenetrable and firm through excessive exercise. He is eager to avoid being classified as feminine and as hysterical by a patriarchal society that not only had an extremely antiquated understanding of gender roles but also condemned all effeminate natures as homosexuals and hysterics. His self-immersion in the icy waters of the Baltic is thus an attempt to cure himself of his ‘madness’, his passion for young boys. As Foucault informs us, the classical age in which confinement became the norm believed the origin of madness to lie in the passions, in an unchained animality that could be mastered only by discipline and brutalising. The practice of immersion in cold water became a part of this brutalisation of the patient so that the maniacs would forget their fury.25 Cold water shock treatment was a means of constricting the body, depriving it of its ‘openness’ and thus curing it of its mental transgressiveness, since madness is a transgression of the confines of the mind and body which were seen as one. As Georges Vigarello has pointed out, in the eighteenth century the increasingly widespread use of water for bathing promoted not only hygiene but also vigour.26 The use of cold water became a distinguishing factor for the classes in that the bourgeois class celebrated its newly gained strength and power through the use of cold water in opposition to the aristocracy’s habit of bathing in warm water, which the bourgeoisie associated with

23

Foucault, Madness and Civilization, p. 149. Ibid., p. 157. 25 Ibid., p. 167. 26 Georges Vigarello, Concepts of Cleanliness: Changing Attitudes in France since the Middle Ages, Cambridge: Cambridge UP, 1988, p. 156. 24

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pestilence and degeneracy.27 As we can see, these views of earlier centuries determine the European consciousness deep into the twentieth century. Especially the association of warmth with disease and degeneracy seems to be a precursor of the Nazis’ promotion of cold water baths for building a healthy Nordic race. And yet, conceivably, there is a substantial rift between the early forms of segregation and the cold water treatment vis a vis the perversion of this practice in late modernity. What was initially a spectacle for the public lent itself to an ever increasing brutalisation linked to the isolation of the mentally disabled as well as to medicine. While ‘less than ever linked to medicine’28 in the classical age, cold-water immersion recurs under totalitarian mechanisms as a camouflaged brutalisation tightly intertwined with medicine; it recurs as killing disguised behind the pretext of healing, the healing of the Volkskörper. We see this at work in Dachau, where torture was disguised as a medical experiment, as much as in Bad Nenndorf, where torture hides behind the walls of the bath houses of a respectable spa resort. Especially in the Nazi ‘euthanasia’ institutions, performed in mental institutions and in many ways the testing grounds for the concentration camps, we observe these mechanisms of extermination disguised as medical therapy and healing. Here, for the first, time gas chambers were disguised as shower rooms and a range of euphemisms concealed malice under the cloak of benevolence: patients received the so-called Sonderbehandlung (special treatment), they were ‘brought to therapy’, or given the Sonderkost, a special ration consisting of nothing but water and a few vegetables that would condemn the victims to slow starvation.29 In their ever more expanding range of targeted groups these Nazi institutions are to an extent reminiscent of the internalisation of the various groups of unproductive people in the classical age, in which the vagabonds, criminals, and the poor were all thrown into one pot with the insane. Yet while the classical age institutionalised the unproductive for the purpose of segregating them from productive society and operated under the hope of making them productive again, the Nazi ‘euthanasia’ institutions and the camps became a new experiment in the sovereignty of power. Giorgio Agamben argues that they were ‘an 27

Ibid., p. 119. Foucault, Madness and Civilization, p. 75. 29 Michael S. Bryant, Confronting the “Good Death”: Nazi Euthanasia on Trial, 1945–1953, Boulder: UP of Colorado, 2005, p. 156. 28

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exercise of the sovereign power to decide on bare life in the horizon of the new bio-political vocation of the National Socialist state’.30 In the extremely close integration of medicine and politics observable in the totalitarian regime, bio-politics now had the potential to pervert into thanatopolitics, in which absolute sovereignty over the decision of life and death lay with a few politicians and their accomplices, the doctors. Under thanatopolitics, what was once an attempt to discipline the body for the sake of the bourgeois modus vivendi and its productivity, perverted into aimless torture, a torture albeit that if we think of the medical experiments of Dachau was still camouflaged by the notion of usefulness for the sake of society at large. Under thanatopolitics, willynilly operations could be implemented, such as the Operation Brandt, by which ‘National Socialist euthanasia branched outward from allegedly incurable mental patients to embrace a variety of victims’.31 In the Hadamar killing centre in Hessen-Nassau, for example, not only the mentally and physically disabled were killed but also Mischlingskinder, half-Jewish children, many of whom were healthy before they were killed,32 and there were also plans ‘to exterminate the inmates of workhouses’ beggars, the homeless, and prostitutes.33 Even World War I veterans, members of old-age homes, as well as so-called war hysterics became the victims of this apparatus of killing the insane. ‘Hamburg women deranged by the trauma of the firestorm [of 1943] [for example] were transported to Hadamar, where, it is believed, they were all murdered’,34 thus becoming victims in the twofold sense, first under the Allied forces, then under their own people. The final solutions of the Nazis, their racial hygiene ambitions, resulted in a complete medicalisation of all forms of ‘social, sexual, political, or racial deviance; Jews, homosexuals, Gypsies, Marxists, and other groups were typecast as “health hazards” to the German population’.35 At the level of cleansing the population of undesirables camouflage and disguise were some of the principal methods in guaranteeing the success of this enterprise. As insane asylums turned into killing centres and as the ‘quarantine’ of Jews in ghettos created conditions of 30 Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life, Stanford: Stanford UP, 1998, p. 142. 31 Bryant, Confronting the “Good Death”, p. 52. 32 Ibid., p. 77. 33 Ibid., p. 78. 34 Ibid., p. 52. 35 Proctor, Racial Hygiene, p. 7.

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ill-health that would justify further quarantine in concentration camps, the bio-politics that had initially been implemented for the regeneration of the Germans had now turned into wholesale slaughter. In the state of exception: Theresienstadt—Bad Nenndorf— Guantanamo Bay There is a clear connection between religion as a buffer against the onsets of the satanic and the persecution of the insane and terrorists today, a context this section will explore in more detail. Sebald’s image of Schumann jumping into the Rhine during carnival reflects the proximity of joy and terror that is also implied in the closeness of healing and killing. Schumann’s own madness becomes a part of the Düsseldorf carnival, madness as disease next to a joyful madness. His attempt to cool himself off by jumping into the icy Rhine before being institutionalised captures the central dichotomy arising with the Enlightenment between unreason and reason, between uncontained madness and modernity’s various efforts in containing it. In its conflation of madness and the carnival this scene, however, also captures the duality of the state of exception as the place outside of law where individuals can resort to carnivalesque transgressions or find themselves stripped of all human rights. As Giorgio Agamben has shown, carnival is closely linked to the expulsion of undesirables in the Middle Ages. The state of exception relates to the persecution and murder of undesirables not only in the form of the camp but also as the joyful charivari, which functioned as a re-enactment of the expulsion of the homo sacer, that undesirable whom ancient Germanic law expelled from the polis and whom anyone was allowed to kill.36 In the expulsion of homo sacer politics and religion touch, since this figure represents a criminal to the secular domain as much as he is associated with the satanic by Christianity. In its transgressive nature the charivari is a subform of the Bakhtinian carnival, its madness and profanity being forms of temporary escape from the power of religion. And yet the escape is illusory for the homo sacer who is sacrificed on the altar of Christian faith and medieval bio-politics. The proximity of the sacred and the profane that one can observe in carnival, with its disruption

36

Cf. Giorgio Agamben’s chapter ‘the Ban and the Wolf’ in Homo Sacer.

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of the sacred through the profane, is also inherent to the homo sacer. As a profane character he is condemned to dwell outside of the polis, outside of the temple (pro-fanum), but is at the same time sacred in that anyone who comes across him can kill but not sacrifice him. In the homo sacer, crime, madness, and animality are in close proximity with one another37 and reflect the loss of home that characterises modernity. Insanity has traditionally been perceived as an expression of this loss of home, as unheimlich (uncanny), since it is located in that ominous twilight zone between the human and the animal, at home in neither category. The Nazis’ exclusion tactics hark back to the nineteenth-century fear of the bourgeois class of falling back into pre-Enlightenment savagery as well as to historical moments in which the demarcation line between human and beast, between the familiar and the uncanny, was blurred. As Heidegger notes, having no home, no dwelling as he calls it, means having no peace.38 As historical fact, Friedlosigkeit has its beginnings in that ancient Germanic custom I have already addressed of excluding criminals and other undesirables from the community, from the polis, thus excluding them from ‘being’, from pelein. By denying these outcasts access to the polis the community reduced them to what Agamben has called ‘bare life’. In a limbo between human and animal these so-called ‘wolf-men’ were roaming the countryside without peace, since anyone was allowed to kill them.39 The expulsion of the wolf-man in the Middle Ages echoes Foucault’s expulsion of madmen from the city on the Ship of Fools. The river and the sea signify that these outcasts are left to their own destinies,40 as were the wolf-men in the forests. Before the Great Age of Confinement for criminals and the insane in prisons and mental institutions society’s outcasts were surrendered to what Gilles Deleuze and Félix Guattari call rhizomatic smooth space, ‘the river with its thousand arms’41 and the vast expanses of forests. Their wandering was still tolerated.

37 Foucault, Madness and Civilization, p. 74: “For classicism, madness in its ultimate form is man in immediate relation to his animality.” 38 Martin Heidegger, Vorträge und Aufsätze, Frankfurt am Main: Vittorio Klostermann, 2000, pp. 150–1. 39 Agamben, Homo sacer, p. 104. 40 Foucault, Madness and Civilization, p. 11. 41 Ibid., p. 11.

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Waxing ever more fearful of the roaming beast lurking from inside the insane the seventeenth century then imprisons them as the dichotomy of man versus animal widens with the distinction into reason versus unreason, reason versus myth, dwelling versus wandering. Through its sedentary modus vivendi the bourgeois class, having emerged enlightened from the eighteenth century, tries to distance itself from the creaturely, and in the eyes of Christianity devilish, impulses of all forms of unreason while at the same time starting to lament the loss of home and nature. Heidegger’s notion of ‘being’, Sein or Dasein, is central to this notion of home and the awareness of its loss. Heidegger argues that the Old High German buan, etymologically to both the word Bauen and to Sein (ich bin), implies ‘being at peace’. Friede, he says, contains the old German root das Frye, and being free means being preserved from harm and danger, that is, being taken-care-of (geschont). The fundamental character of dwelling is this caring-for.42 As a descendant of the wolf-man expelled from the polis the madman locked up in a Heim (institution/home) in particular seems to have become a reflection of the loss of home and absence of Schonung (caring) felt ever more strongly in the wake of Enlightenment. In spite of its insistence on roots modernity’s loss of home implies a detachment from the ground, from earth and nature, which are increasingly being destroyed during the Age of Industrialization. This sensation of a growing detachment from the environment is reflected also in the madman’s transference into the other medium, water. The madman is mad, verrückt (displaced or detached), in the sense that his own mental detachment displaces (ver-rückt) him from one medium to another, from the earth, the rational sedentary medium, into water. This sensation of detachment from one’s own Dasein and the earth becomes most intense among the victims of the camps, whose lack of Schonung, of being cared for, suspended them between life and death. The Nazis called them ‘Figuren’ (figures) or ‘Muselmänner’ (Muslims) due to their unconditional surrender to the will of God43 after having been driven insane by their camp existence. As a consequence they 42

Heidegger, Vorträge und Aufsätze, pp. 148, 150–151. Giorgio Agamben, Remnants of Auschwitz: The Witness and the Archive; New York: Zone Books, 2002, pp. 44–5: The Muselmänner were the living dead in the camps, who had given up on life but were not yet dead; the term is derived from ‘the Arabic word Muslim: the one who submits unconditionally to the will of God . . . [W]ith a kind of ferocious irony, the Jews knew that they would not die at Auschwitz as Jews’. 43

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became completely detached from their own lives, and once clinically dead also never became mortals in the way Heidegger uses this term as being part of one of the ‘Geviert’ (the fourfold, the other three being earth, sky, and divinities) necessary for good dwelling. These victims will remain forever without peace in the earth that covers them in their mass graves. Theirs is a Verrücktheit that transcends life itself. Undoubtedly, with their withdrawal of all freedom and peace from their inmates, who have become completely uncared for into death and beyond, the camps are an extreme expression of the loss of dwelling that characterises modernity, but so is the victim’s immersion in ice-cold water. Freezing ‘homo sacer’ to death, however, also still implies the notion of the classical age that cold water consolidates a body that was not sufficiently constricted, a body that was too open for its own good and the good of society. Interestingly, in the context of a religion in cohoots with the thanatopolitics of fascist governments, freezing homo sacer takes on an image that is directly opposed to the heat of Hell. Freezing homo sacer is meant to close the openness of the body and to kill completely an animality perceived as residing within the victim, within the Jew, the Gypsy, or the mentally and physically disabled, who were all perceived in their proximity to animality due to their pernicious physical or mental aberrations, their wandering so to speak and consequently their obstruction of Germany’s quest for roots. In the totalitarian regimes of the twentieth century homo sacer is no longer allowed to roam the woods ante portas of the city. He is made to settle, forced into dwelling ante portas, namely in the camps of eastern European forests, a dwelling which in its very lack thereof is the ultimate cynical reflection of modernity’s own strange polarisation between its search of roots and feelings of destitution. While the Medieval homo sacer was allowed to roam in his suspension between man and beast, the twentieth-century victims of thanatopolitics were deliberately stripped of their human identity to render visible their animality, if we think of the cattle cars, the delousing, the gassing, and ultimately the Muselmann, that figure between life and death whose Verrücktheit revealed the stupor of beasts. These reduction methods in the animalisation of man were side effects of an extermination based on an ideology that exploits myth, Germanic and Greek (Heidegger), for national autochthony, while at the same time leading ad extremis the nineteenth-century bourgeois selfdistancing from myth’s aspects of beastliness, the primordial, and savagery. Freezing man in water, this primordial element of all life, plays

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a fundamental role in modernity’s totalitarian attempts to render the primordial condition of man, the a-rational beast within enlightened man, visible, tangible, and therefore more easily eradicable, thereby also irretrievably eradicating its own tie with a primordial home for which it has felt a nostalgia ever since the end of pre-Socratic, mythical times. And yet, the insane and other undesirables were locked away or expelled also for being believed to possess a forbidden kind of knowledge. The fear of the madman in particular that resulted in his expulsion was also a religious fear, for the madman possessed a kind of forbidden knowledge that was associated with the satanic and apocalyptic visions of the end of the world: On all sides, madness fascinates man. The fantastic images it generates are not fleeting appearances that quickly disappear from the surface of things. By a strange paradox, what is born from the strangest delirium was already hidden, like a secret, like an inaccessible truth, in the bowels of the earth. When man deploys the arbitrary nature of his madness, he confronts the dark necessity of the world; the animal that haunts his nightmares and his nights of privation is his own nature, which lay bare hell’s pitiless truth; the vain images of blind idiocy—such are the world’s Magna Scientia; and already in this disorder, in this mad universe, is prefigured what will be the cruelty of the finale. In such images—and this is doubtless what gives them their weight, what imposes such great coherence on their fantasy—the Renaissance has expressed what it apprehended of the threats and secrets of the world.44

It is this truth of the great finale, the animal that haunts man at night, that the Age of Reason locked away by locking away the insane. In The Songlines Bruce Chatwin has discussed this spectre as the Dinofelis, that ancient beast that used to hunt man, the saber tooth tiger, from which the Christian Satan may be derived. Chatwin was aware that this is a figure ‘whose presence has grown dimmer and dimmer since the close of the Middle Ages [when, I might add, the expulsion of undesirables started]: the Prince of Darkness in all his sinister magnificence’.45 And yet, it is a figure that can be seen to recur in various cultural manifestations such as the Roman Saturnalia, the harlequin of the commedia dell’arte, the medieval fool with his fool’s cap that recalls the horns of Satan, Till Eulenspiegel or Nietzsche’s Dionysus. Human-

44 45

Foucault, Madness and Civilization, pp. 23–24. Bruce Chatwin, The Songlines, New York: Penguin, 1988, p. 256.

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ity seems to be caught between nostalgia and fear regarding its mythical beginnings, a conflict that filters into the healing/killing dichotomy in the treatment of undesirables and mental extremism. Like a palimpsest we see the image of the Hôpital Général behind twentieth-century institutions of torture that claim to be places of healing: from Theresienstadt to Bad Nenndorf to Guantanamo Bay. The two spa resorts in particular locked away their dirty secrets behind soundproof walls. At a more abstract level, they reflect both Heideggerian and Freudian theory. Heidegger’s discussion in his ‘Parmenides Lectures’ (1942/43) of lethe as secrecy and oblivion versus aletheia as undisclosedness and truth applies to these places as does Freud’s pseudo-dichotomy of the Heimlich/Unheimliche. They display lethe (the river of oblivion in Greek mythology) in the sense that their prisoners are forgotten and concealed (heimlich) behind the façade of respectable resorts. Once revealed what they really are, these places display their aletheia, their un-concealed truth, at the same time evoking Freud’s Un-heimliche (=a-letheia). Bad Nenndorf and Theresienstadt are both heimlich as well as unheimlich: heimlich in the sense that a spa resort pretends to be a temporary home for its inmates, but also in the sense of being a secret (the German heimlich means both). They are unheimlich in the sense of literally ‘not being a home’ but by torturing or even killing their inmates being the opposite of the idea of a home, unheimlich that is in the sense also of being uncanny or ominous. The Freudian pair heimlich/unheimlich acquires its most ominous potential in an institution that makes madness heimlich in its double sense of giving mental aberration a home (cf. also ‘ein Heim’ in the sense of an institution) which in its secrecy can potentially establish conditions that lead to a complete loss of home, conditions that are extremely unheimlich, unhome-like, in their cruelty. Torture through cold-water immersion the way it happened in Dachau and Bad Nenndorf is possibly one of the most transparent images for such unheimlich[e] conditions. In the case of Bad Nenndorf cold water ‘therapy’ becomes a form of ideological adjustment countering the ideological aberrance of communist Germans. Torturing German communists may doubtless have been primarily for the purpose of ‘seeking information about Russian military and intelligence methods’,46 but the simultaneous victimisation of suspected Nazis and former SS members in Bad Nenndorf

46

Cobain, ‘The postwar photographs that British authorities tried to keep hidden’.

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suggests that the British were ‘treating’ an aberrant ideology as a form of madness and that the cleansing and healing qualities of water may have subconsciously contributed to this form of torture, as they once did also during the water experiments of the Nazis. As the Nazis once performed racial hygiene on the Jews and other groups including communists, a different political system now performs ‘ideological hygiene’ on Germans as an extreme form of both de-Nazification and re-education or eradication of Communists. In retrieving secret information, the west may have subconsciously also demonised an ideology ‘aberrant’ from itself. This echoes the Foucaultian notion of madness in the Middle Ages as a revelation of the madman’s possession of a forbidden knowledge that had a satanic element to it, at a time when the wisdom of fools presaged ‘the reign of Satan and the end of the world’.47 If we look at the development in the treatment of the homo sacer we can isolate four distinct phases. In the Middle Ages the undesirables were expelled from the city but they were mobile. The criminals were roaming the woods, the fools were sent down the river on a ship. In the early modern age, what Foucault calls the classical age, i.e., primarily during the Enlightenment, the undesirables were immobilised in that they came to be locked up in institutions, hidden from the public eye. Instead of forcing them to wander, modernity tries to settle them, it forces them into dwelling, which is ultimately a bourgeois concept, that of sedentariness. The aberrant mind of the insane and the aberrant behaviour of the criminal are constrained through institutionalisation, the insane asylum and the prison cell, both still in the service of correcting aberrancy. Yet by being given such a ‘home’, a Heim, well hidden from the bourgeois eye and its enlightened mind, these undesirables had been made a secret. With the Heim (home) comes Heimlichkeit (secrecy), which prepares the third phase in the treatment of undesirables in the twentieth century, their extermination, an extermination disguised as healing, as we have seen. The twentieth century saw times in which torture, which Foucault bans into the Middle Ages, comes back but is hidden behind medicine’s attempt to heal, if we think of the agony experienced by countless ‘euthanasia’ victims whose death lasted up to four days. It had to last up to four days so that their relatives would not have suspected anything other than an

47

Foucault, Madness and Civilization, p. 22.

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illness taking its slow toll. The fourth phase during the cold war and in various governments’ contemporary fights against terrorism no longer reflects a concern with racial hygiene but with ideological hygiene. The controversial use of water boarding is, however, still caught in the limbo between therapy and torture, between healing and killing. In simulating the act of killing (drowning) water boarding tries to heal society from the elements that threaten it with their mental extremism. On the other hand, it could be argued that the fact that water boarding penetrates the body deliberately shows that the original purpose of therapy in treating the insane with water, which implied making their bodies and minds impenetrable through the cold water shock, has become completely inverted into torture of the worst kind. The water’s penetration of the body is not only physically harmful but also causes long-term psychological damage. In any case, terrorism perceived as insanity is still locked away, it is still demonised, and it is still in possession of a forbidden knowledge, which has to be retrieved for the protection of the majority whether in the case of torturing Communists in Bad Nenndorf or water boarding prisoners in Guantanamo Bay. Finally though, it has evolved from the nationalist project of the Nazis into a transnational project, as the cleansing qualities of water still come into play in protecting the west from aberrant minds, especially from those with apocalyptic visions.

BIBLIOGRAPHY Aasi, Ghulam-Haider, ‘Islamic legal and ethical views: Organ transplantation and donation’, Zygon, vol. 38, no. 3, 2003, pp. 725–34. Abd al-Salam al-Shukri (Professor of Shari‘ and Law at al-Azhar), Naql wa Zira‘at alA‘da’ al-Adamiyya min Manzur al-Islam, al-Dar al-Misriyya lil-Nashr wa al-Tawzi‘, Nicosia, 1989, pp. 182–84. Abercrombie, Nicholas, Stephen Hill and Bryan S. Turner, The Dominant Ideology Thesis. London: Allen and Unwin, 1980. Abou El Fadl, Khaled, ‘Between functionalism and morality: The juristic debates on the conduct of war’ in Jonathan E. Brockopp (ed.), Islamic Ethics of Life; Abortion, War, and Euthanasia, Columbia: University of South Carolina Press, 2003, pp. 103–28. Achterberg, Jeanne, Barbara Dossey et al., Rituals of Healing: Using Imagery for Health and Wellness. New York: Bantam Books, 1994. Adams, Jenny, ‘Counsellors understandings of complementary therapies and the meaning of referral’, Master of Public Health thesis, The University of Melbourne, 2006. Adorno, Theodor W., The Authoritarian Personality. New York: Harper and Brothers, 1950. Agamben, Giorgio, Homo Sacer: Sovereign Power and Bare Life. Stanford: Stanford University Press, 1998. ——, Remnants of Auschwitz: The Witness and the Archive. New York: Zone Books, 2002. Ahearn, Frederick L. Jr., ‘Psychosocial wellness: Methodological approaches to the study of refugees’, in Frederick L. Ahearn (ed.), Psychosocial Wellness of Refugees: Issues in Qualitative and Quantitative Research. New York: Berghahn Books, 2000, pp. 3–23. Akrami, S.M. et al., ‘Brain death: Recent ethical and religious considerations in Iran’, Transplantation Proceedings, vol. 36, 2004, pp. 2883–7. Alighieri, Dante, Dante’s Inferno: The Vision of Hell [trans. Rev. Henry Francis Cary]. London: Cassell and Company, 1892. Alonso, Ana María, ‘The politics of space, time and substance: State formation, nationalism, and ethnicity’, Annual Review of Anthropology, vol. 23, 1994, pp. 379–405. Al-Sistani, Grand Ayatollah al-Sayyid ‘Ali al-Husayni, al-Fatawa al-Muyassarah, compiled by ‘Abd al-Hadi Muhammad Taqi al-Hakim, Qum: Maktab Ayatullah al-‘Uzma al-Sayyid al-Sistani, 1995. Anderson, Benedict, Imagined Communities: Reflections on the Origin and Spread of Nationalism. London: Verso, 1996 [1983]. Anderson, Leon, Kit Newell and Joseph Kilcoyne, ‘ “Selling blood”: Characteristics and motivations of student plasma donors’, Sociological Spectrum, vol. 19, no. 2, 1999, pp. 137–62. Andrews, Edmund L., ‘Anatomy on display, and it’s all too human’, New York Times, 7 January 1998. Angerer, Marie-Luise (ed.), The Body of Gender, Körper, Geschlechter, Identitäten. Vienna: Passagen Verlag, 1995. Anne of Austria, Mme de Motteville (ed.), Mémoires de Madame de Mottville. Paris: Charpentier, 1869. Anonymous, The Yellow Emporer’s Classic of Internal Medicine (Huang Ti Nei Ching Su Wen) [trans. Ilza Veith]. Berkeley: University of California Press, 1966.

270

bibliography

Antonovsky, Aaron, ‘The life cycle, mental health and the sense of coherence’, Isr J Psychiatry Relat Sci, vol. 22, 1985, pp. 273–80. ——, Unravelling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco: Jossey-Bass Publishers, 1987. Appleyard, Bryan, How to Live Forever or Die Trying: On the New Immortality. New York: Simon and Schuster, 2007. Aquinas, Thomas, The Cardinal Virtues: Prudence, Justice, Fortitude, and Temperance [edited and translated by Richard J. Regan]. Indianapolis: Hackett Publishing Company, 2005. Aries, Philippe, Western Attitudes towards Death from the Middle Ages to the Present. Baltimore and London: Marion Boyars, 1974. Arkoun, Mohammed, Rethinking Islam; Common Questions, Uncommon Answers [edited and translated by Robert D. Lee]. Boulder: Westview Press, 1994. Aronne, Louis, ‘Classification of obesity and assessment of obesity-related health risks’, Obesity Research, vol. 10, Suppl. 2, 2002, pp. 105S–115S. Atighetchi, Dariusch, Islamic Bioethics: Problems and Perspectives. Derdrecht, The Netherlands: Springer, 2007. de Baecque, Antoine, The Body Politic: Corporeal Metaphor in Revolutionary France, 1770–1800 [trans. Charlotte Mandell]. Stanford: Stanford University Press, 1997. Baer, Hans. A., Toward an Integrative Medicine: Merging Alternative Therapies with Biomedicine. Walnut Creek: Altamira Press, 2004. Bagheri, Alirezha, ‘Compensated kidney donation: An ethical review of the Iranian model’, Kennedy Institute of Ethics Journal, vol. 16, no. 3, 2006, pp. 269–82. Bailey, Alice A., Esoteric Healing. New York: Lucis Publishing Co., 1989 [1953]. Baker, Gordon, and Katherine Morris, Descartes Dualism. London: Routledge, 1996. Barcan, Ruth, and Jay Johnston, ‘The haunting: Cultural studies, religion and alternative therapies’, Iowa Journal of Cultural Studies, vol. 7, 2005, pp. 63–81. Barcan, Ruth, ‘Intuition and reason in the New Age: A cultural study of medical clairvoyance’, in David Howes (ed.), The Sixth Sense Reader. Oxford & New York: Berg Publishing, (forthcoming, Sept. 2009). Barry, Christine, ‘The role of evidence in alternative medicine: Contrasting biomedical and anthropological approaches’, Social Science and Medicine, vol. 62, 2006, pp. 2646–57. Barthes, Roland, ‘Introduction to the structural analysis of narratives’, in Susan Sontag (ed.), A Barthes Reader. London: Cape, 1982. Bauman, Zigmund, Mortality, Immortality and Other Life Strategies. Stanford: Stanford University Press, 1992. ——, Liquid Fear. Cambridge: Polity Press, 2006. Beaudoin, Tom, Virtual Faith: The Irreverent Spiritual Quest of Generation X. San Francisco: Jossey-Bass, 2000. de Beauvoir, Simone, The Second Sex. Harmondsworth: Penguin, 1953. Beck, Ulrich, Risk Society: Towards a New Modernity. London: Sage, 1992. ——, The Reinvention of Politics: Rethinking Modernity in the Global Social Order [trans. Mark Ritter]. Cambridge: Polity, 1997. Bell, Rudolph, Holy Anorexia. Chicago: The University of Chicago Press, 1985. Benner, Patricia, and Christine Tanner, ‘How expert nurses use intuition’, American Journal of Nursing, vol. 87, no. 1, 1987, pp. 23–31. Benor, Daniel J., ‘Spiritual healing: A unifying influence in complementary therapies’, Complementary Therapies in Medicine, vol. 3, 1995, pp. 234–38. Benzenhöfer, Udo, and Urs Leo Gantenbein, ‘Paracelsus’, in Wouter J. Hanegraaff, Antoine Faivre, Roelef Van Den Broek and Jean-Pierre Brach (eds.), Dictionary of Gnosis and Western Esotericism. Leiden and Boston: Brill, 2006, pp. 922–31. Berger, Peter L., The Social Reality of Religion. London: Faber, 1969.

bibliography

271

Berman, Marshall, All That is Solid Melts into Air: The Experience of Modernity. London: Verso, 1995. Bernanos, Georges, The Diary of a Country Priest. London: The Bodley Head, 1937. Bernstein-Carlson, Eve, and Rhonda Rosser-Hogan, ‘Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees’, Journal of Traumatic Stress, vol. 7, 1994, pp. 43–58. Biroat, M. Jacques (Predicateur du Roy), Sermons des Vestures, Professions Religieuses, et Oraisons Funebres. A Paris, Chez Edme Covterot, 1671. Bloomfield, Morton, ‘The origin of the concept of the seven cardinal sins’, Harvard Theological Review, vol. 34, no. 2, 1941, pp. 121–28. Bodeker, Gerard et al., ‘Traditional medicine use and healthworker training in a refugee setting at the Thai-Burma border’, Journal of Refugee Studies, vol. 18, 2005, pp. 76–99. Bogod, David, ‘The Nazi hypothermia experiments: Forbidden data?’, Anaesthesia, vol. 59, 2004, pp. 1155–6. Bond, George D., ‘A. T. Ariyaratne and the Sarvodaya Shramadana Movement’, in Christopher S. Queen and Sallie B. King (eds.), Engaged Buddhism: Buddhist Liberation Movements in Asia. New York: State University of New York Press, 1996. Bonhoeffer, Dietrich, Letters and Papers from Prison. London: Fontana Books, 1959. Bossuet, Jacques Benigne, Oraison funebre de Marie Therese d’Austriche, infante d’Es[pagne, Reine de France et de Navarre. Prononcee à Saint Denis le premier de Septembre 1683. Paris: Chez Sebastien Mabre Cramoisy, 1683. Bowen, Donna L., ‘Contemporary Muslim ethics of abortion’, in Jonathan E. Brockopp (ed.), Islamic Ethics of Life; Abortion, War, and Euthanasia. Columbia: University of South Carolina Press, 2003, pp. 51–80. Bowker, John (ed.), The Oxford Dictionary of World Religions. Oxford: Oxford University Press, 1997. Boyce, B., ‘Who does God vote for? Seeking an alternative to the Christian Right’, Shambhala Sun, vol. 15, no. 1, 2006, pp. 48–55, 100. Boyer des Roches, Sieur, Les larmes publiques á la mort d’Anne d’Austriche, Reyne de France and de Navarre en l’année 1666. Paris: Chez Jean B Nego, 1666. Bradley, Randall S., ‘Philosophy of natural medicine’, in J. E. Pizzorno and M. T. Murray (eds.), Textbook of Natural Medicine (second edition). Edinburgh: Churchill Livingstone, 1999. pp. 41–9. Brady, Veronica, Caught in the Draught: On Contemporary Australian Culture and Society. Sydney: Angus and Robertson, 1994. Brandt, Allan, and Paul Rozin, Morality and Health. New York: Routledge, 1997. Braude, Ann, Radical Spirits: Spiritualism an Women’s Rights in Nineteenth Century America. Boston: Beacon Press, 1989. Brennan, Barbara Ann, Hands of Light: A Guide to Healing Through the Human Energy Field. Toronto, New York, London, Sydney and Auckland: Bantan Books, 1987. Brockopp, Jonathan E., ‘The “good death” in Islamic theology and law’, in Jonathan E. Brockopp (ed.), Islamic Ethics of Life; Abortion, War, and Euthanasia. Columbia: University of South Carolina Press, 2003, pp. 177–93. Brown, H. G., ‘Perceptions of the autopsy: Views from the lay public and program proposals’, Human Pathology, vol. 21, no. 2, 1990, pp. 154–58. Brown, Peter, The Body and Society. Men, Women, and Sexual Renunciation in Early Christianity. New York: Columbia University Press, 1988. Bryson, Norman, ‘Géricault and “masculinity” ’, in Norman Bryson, Michael Ann Holly and Keith Moxley (eds.), Visual Culture: Images and Interpretation. Hanover, NH: Wesleyan University Press, 1994, pp. 228–59. Buddharakkhita, Metta: The Philosophy and Practice of Universal Love. Kandy: (The Wheel Publication no. 365/366), Buddhist Publication Society, 1989.

272

bibliography

Bullard, Alice, Exile to Paradise: Savagery and Civilization in Paris and the South Pacific, 1790–1900. Stanford: Stanford University Press, 2000. Burton, Robert, The Anatomy of Melancholy. London: Chatto and Windus, 1927. Butler, Judith, Bodies That Matter: On the Discursive Limits of Sex. New York: Routledge, 1973. Bynum, Caroline Walker, Holy Feast and Holy Fast. The Religious Significance of Food to Medieval Women. Los Angeles: University of California Press, 1987. ——, Fragmentation and Redemption. Essays on Gender and the Human Body in Medieval Religion. New York: Zone Books, 1991. Caplan, Gregory A., ‘Militarism and masculinity as keys to the “Jewish Question” in Germany’, in Paul R. Higate (ed.), Military Masculinities: Identity and the State. Westport, CT: Praeger, 2003. Cassian, John, The Conferences [annotated and translated by Boniface Ramsey]. New York: The Newman Press, 1997. ——, The Institutes [annotated and translated by Boniface Ramsey]. New York: The Newman Press, 2000. Cawte, John, Medicine is the Law: Studies in Psychiatric Anthropology of Australian Tribal Societies. Honolulu: University Press of Hawaii, 1974. Chakraborty, Ajita, ‘Culture, colonialism, and Psychiatry’, The Lancet, vol. 337, 1991, pp. 1204–7. Chamberlain, Jenny, Getting Heavy with Fat. Auckland: North and South Magazine, 2004. Cheyne, George, The English Malady. London, 1733. ——, An Essay on Regimen, Together with Five Discourses, Medical, Moral and Philosophical, London, 1740. Chodron, Pema, No Time to Lose. Boston and London: Shambhala, 2005. Chung, Rita and Marjorie Kagawa-Singer, ‘Interpretation of symptom presentation and distress: A south-east Asian refugee example’, Journal of Nervous and Mental Disease, vol. 183, 1995, pp. 639–48. Clark, Peter, Marmaduke Pickthall: British Muslim. London: Quartet, 1986. (also see http://www.central-mosque.com/biographies/pikhtall.htm) Clark Jr., Charles, ‘Combating sloth as well as gluttony: The role of physical fitness in mortality among men with Type 2 diabetes’, Annals of Internal Medicine. vol. 132, no. 8, 2000, pp. 669–70. Clarke, Desmond, Descartes’ Theory of Mind. Oxford: Oxford University Press, 2003. Clausewitz, Carl von, On War [trans. J.J. Graham]. London: Routledge and Kegan Paul, Ltd., 1949 [1832]. Clendinnen, Inga, Agamemnon’s Kiss: Selected Essays. Melbourne: Text Publishing, 2006. Coakley, Sarah, ‘Introduction, religion and the body’, in Sarah Coakley (ed.), Religion and the Body. Cambridge: Cambridge University Press, 1997. Cohen, Lawrence, ‘Where it hurts: Indian materials for an ethics of organ transplantation’, Daedalus, vol. 128, 1999, pp. 135–65. Cohen, Michèle, ‘ “Manners” make the man: Politeness, chivalry, and the construction of masculinity, 1750–1830,’ Journal of British Studies, vol. 44, no. 2, 2005, pp. 312–29. Collinge, William, Subtle Energy: Awakening the Unseen Forces in Our Lives. New York: Warner Books, 1998. Collyer, Fran, ‘The corporatisation and commercialisation of CAM’, in P. Tovey, G. Easthope and J. Adams (eds.), The Mainstreaming of Complementary and Alternative Medicine: Studies in Social Context. London: Routledge, 2004. Comfort, Alex, The Koka Shastra. London: George Allen and Unwin, 1964. Condorcet, Marie Jean de, Sketch for a Historical Picture of the Progress of the Human Mind. New York: Library of Ideas, 1955. Cornaro, Luigi, Discourses on a Sober and Temperate Life. London, 1833.

bibliography

273

Cottingham, John G., Philosophy and the Good Life: Reason and the Passions in Greek, Cartesian and Psychoanalytic Ethics. Cambridge: Cambridge University Press, 1998. Cottingham, John, Robert Stoothof and Dugald Murdoch, The Philosophical Writings of Descartes [vols. 1, 2 and 3]. Cambridge: Cambridge University Press, 1985. Couldry, Nick, Inside Culture: Re-Imagining the Method of Cultural Studies. London: Sage Publications, 2000. Crowley, John E., The Invention of Comfort: Sensibilities and Design in Early Modern Britain and Early America. Baltimore: Johns Hopkins University Press, 2001. Davies, Stevan L., Jesus the Healer: Possession, Trance and the Origins of Christianity. London: SCM Press, 1995. DeBernardi, Jean, Chinese Popular Religion and Spirit Mediums in Penang Malaysia. Stanford: Stanford University Press, 2006. Deleuze, Gilles and Félix Guattari, A Thousand Plateaus: Capitalism and Schizophrenia. London: Athlone Press, 1988. Deleuze, Gilles, Foucault [edited and translated by Sean Hand]. Minneapolis: University of Minneapolis Press, 1995 [1986]. Dennett, Daniel C., The Intentional Stance. Cambridge, MA: MIT Press/Bradford Book, 1987. Des Chene, Denis, Spirits and Clocks: Machines and Organisms in Descartes. New York: Cornell University Press, 2001. Dhammananda, K., Daily Buddhist Devotions. Kuala Lumpur: Buddhist Missionary Society, 1993. Diderot, Denis and Jean le Rond d’Alembert (eds.), ‘LACHE’ in Encyclopédie, ou Dictionnaire raisonné des sciences, des arts et des métiers. Chez Samuel Faulche, Neufchâtel, vol. 9, 1765. Dixon, Joy, Divine Feminine: Theosophy and Feminism in England. Baltimore: John Hopkins University Press, 2001. Donohue, John J. and John L. Esposito, Islam in Transition (second edition). Oxford: Oxford University Press, 2006. Dormandy, Thomas, The White Death. The History of Tuberculosis. London: The Hambledon Press, 1999. Douglas, Mary, Purity and Danger: An Analysis of Concepts of Pollution and Taboo. Harmondsworth: Penguin Books, 1970. ——, Natural Symbols: Explorations in Cosmology. Harmondsworth: Penguin, 1973. Dreyfus, Hubert L., and Stuart E. Dreyfus, Mind Over Machine: The Power of Human Intuition and Expertise in the Era of the Computer. New York: Free Press, 1986. Driver, Tom F., The Magic of Ritual: Our Need for Liberating Rites that Transform Our lives and Our Communities. San Francisco: Harper, 1991. Dubois, René, Of Human Diversity, Worchester: Clarke University Press, 1974. Duncan, Geoffrey, Courage to Love: An Anthology of Inclusive Worship Material. London: Darton, Longman and Todd, 2002. Dwarkanath, C., Introduction to Kāyachikitsā. Bombay: Popular Book Depot, 1959. Ebrahim, Abul Fadl Mohsin, Organ Transplantation; Contemporary Islamic Legal and Ethical Perspectives. Kuala Lumpur: A. S. Noordeen, 1998. ——, Organ Transplantation, Euthanasia, Cloning and Animal Experimentation: An Islamic View. Markfield, Leicester: The Islamic Foundation, 2001. Eckman, Peter, In The Footsteps of the Yellow Emperor: Tracing the History of Traditional Acupuncture. San Francisco: China Books and Periodicals, 1996. Efron, John M., ‘Images of the Jewish body: Three medical views from the Jewish Enlightenment’, Bulletin for the History of Medicine, vol. 69, 1995, pp. 349–66. Eghigian, Greg, ‘Pain, entitlement, and social citizenship in modern Germany,’ in Paul Betts and Greg Eghigian (eds.), Pain and Prosperity: Reconsidering Twentieth-Century Germany. Stanford: Stanford University Press, 2003, pp. 16–34.

274

bibliography

Eghigian, Greg and Paul Petts, ‘Introduction: Pain and prosperity in twentieth-century Germany,’ in Paul Betts and Greg Eghigian (eds.), Pain and Prosperity: Reconsidering Twentieth-Century Germany. Stanford: Stanford University Press, 2003. Elias, Norbert, The Civilizing Process [trans. Edmund Jephcott]. Oxford: Blackwell, 1994. Ellis, Lee and David Biglione, ‘Religiosity and obesity: Are overweight people more religious?’, Personality and Individual Differences, vol. 28, 2000, pp. 1119–23. Espeland, Wendy, ‘Blood and money’, in Joseph Kotarba and Andrea Fontana (eds.), The Existential Self in Society. Chicago: University of Chicago Press, 1984. Evans, Bethan, ‘Gluttony or sloth: Critical geographies of bodies and morality in (anti) obesity policy’, Area, vol. 38, no. 3, 2006, pp. 259–67. Evans, Nicholas, and David P. Wilkins, ‘The complete person: Networking the physical and the social’, in Jane Simpson, David Nash, Mary Laughren, Peter Austin and Barry Alpher (eds.), Forty Years On: Ken Hale and Australian Languages. Canberra: Pacific Linguistics, Research School of Pacific and Asian Studies, Australian National University, 2001. Fadiman, Anne, The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux, 1999. Fairlie, Henry, The Seven Deadly Sins Today. Washington: New Republic Books, 1978. Fajans, Jane, ‘Shame, social action, and the person among the Baining’, Ethos, vol. 11, no. 3, 1983, pp. 166–80. Falconet, [18 Aug 1665] 1846, J.-H. Reveilleé-Parise (ed.), Lettres de Gui Patin mouvelle édition augmentée de lettres inédites, Lettre DCLXXIX, Tome 3. Paris chez J.-B. Baillieère, libraire de l’académie royale de médecine. Feher, Michel, et al. (eds.), Fragments for a History of the Human Body (3 volumes). New York: Zone, 1989. Ferraro, Kenneth, ‘Firm believers? Religion, body weight, and well being’, Review of Religious Research, vol. 39, no. 3, 1998 pp. 224–44. Fichte, Address to the German Nation. 1807. Fischer-Schreiber, Ingrid, The Shambhala Dictionary of Taoism [trans. Werner Wünsche]. Boston: Shambhala, 1996. Fleck, Ludwik, Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press, 1979 [1935]. Foucault, Michel, The Birth of the Clinic. London: Tavistock, 1973. ——, ‘Nietzsche, genealogy and history’, in Donald F. Bouchard (ed.), Language, Countermemory, Practice. Oxford: Basil Blackwell, 1977. ——, Madness and Civilization: a History of Insanity in the Age of Reason. New York: Random House, 1988. ——, Burchell, Graham, Colin Gordon and Peter Miller (eds.), The Foucault Effect: Studies in Governmentality: With two lectures by and an interview with Michel Foucault. London: Harvester Wheatsheaf, 1991. ——, Discipline and Punish: The Birth of the Prison. New York: Random House, 1995. ——, ‘The battle for chastity’ in Ethics: The Essential Works 1. London: Penguin Press, 1997, pp. 185–97. Fremantle, Anne, Loyal Enemy. London: Hutchinson, 1938. Freund, Peter E. S., Meredith B. McGuire and Linda S. Podhurst, Health, Illness, And The Social Body (fourth edition). New Jersey: Prentice Hall, 2003 [1991]. Frevert, Ute, A Nation in Barracks: Modern Germany, Military Conscription and Civil Society [translated by Andrew Boreham and Daniel Bruckenhaus]. Oxford: Berg, 2004. Friedlaender Michael M., ‘The right to sell or buy a kidney: Are we failing our patients?’, Lancet, vol. 359, 2002, pp. 971–3.

bibliography

275

Friedman, E. A. and A. L. Friedman, ‘Payment for donor kidneys: Pros and cons’, Kidney International, vol. 69, no. 6, 2006, pp. 960–2. Friedman, Kelli, Simona K. Reichmann, Phillip R. Costanzzo, Arnaldo Zelli, Jamile A. Ashmore and Gerard J. Musante, ‘Weight stigmatization and ideological beliefs: Relation to psychological functioning obese adults’, Obesity Research vol. 13, no. 5, 2005, pp. 907–16. de Fromentieres, Abbé, Oraison Funebre d’Anne d’Austriche, Infante d’Espagne, Reine de France, et Mere du Roi. A Paris, Chez Sebastien Mabre-Cramoisy, 1666. Fuiron, M. Antoine, La Reyen Tres-Crestienne Discours Funebre sur la vie et la mort de tresHaute, tres-Puissante and tres-Auguste Princesse Anne d’Austriche Reyne de France and de Navarre. Prononcé en L’Elise D. Sauveur à Paris, Paris, Chez Jean Couterot, 1666. Gaukroger, Steven, Descartes: An Intellectual Biography. Oxford: Oxford University Press, 1995. Gellner, Ernest, Postmodernism, Reason and Religion. London: Routledge, 1993. Godwin, William, Enquiry Concerning Political Justice, and its Influence on Morals and Happiness. Toronto: University of Toronto Press, 1946. Goldstein, Joseph, One Dharma: The Emerging Western Buddhism. San Francisco: HarperSanFrancisco, 2002. Gonzalez-Crussi, F., On Seeing: Things Seen, Unseen and Obscene. New York: Overlook Duckworth, 2006. Goodwin, Michele, Black Markets: The Supply and Demand of Body Parts. New York: Cambridge University Press, 2006. Gorham, Geoffrey, ‘Mind-body dualism and the Harvey-Descartes controversy’, Journal of the History of Ideas, vol. 55, no. 2, 1994, pp. 211–234. Grass, Günter, The Tin Drum [trans. Ralph Manheim]. New York: Vintage, 1990. Grégoire, Henri , Essai sur la régénération physique, morale et politique des juifs. Paris: Stock, 1988 [1788]. Grene, Marjorie, Descartes. Indianapolis: Hackett Pub, 1998. Griffith, Marie, Born Again Bodies: Flesh and Spirit in American Christianity. Berkley: University of California Press, 2004. Grossinger, Richard, Planet Medicine. Berkeley: North Atlantic Books, 1995. Grosz, Elizabeth, Volatile Bodies: Towards a Corporeal Feminism. Sydney: Allen and Unwin, 1994. Gruman, Gerald J., ‘A History of ideas about the prolongation of life: The evolution of the prolongevity hypotheses to 1800’, Transactions of the American Philosophical Society, vol. 56, no. 9, 1966, pp. 1–10. Gutmann, Amy, Identity in Democracy. Princeton: Princetom University Press, 2003. Hacking, Ian, The Emergence of Probability: A Philosophical Study of Early Ideas about Probability, Induction and Statistical Inference. London: Cambridge University Press, 1975. Hagemann, Karen, ‘Of “manly valor” and “German honor”: Nation, war, and masculinity in the age of the Prussian uprising against Napoleon’, Central European History, vol. 30, 1997, pp. 187–220. ——, ‘German heroes: The cult of the death for the Fatherland in Nineteenth-Century Germany,’ in Stefan Dudink, Karen Hagemann and John Tosh (eds.), Masculinities in Politics and War: Gendering Modern History. Manchester: Manchester University Press, 2004. Hallam, Elizabeth, Jenny Hockey and Glennys Howarth, Beyond the Body: Death and Social Identity. London: Routledge, 1999. Halttunen, Karen, ‘Humanitarianism and the pornography of pain in Anglo-American culture,’ American Historical Review, vol. 100, 1995, pp. 303–34. Hanart, le R. P. Jean, Les Belles Morts des Fondateurs des Religions. Par, A Douay, Chez Baltazar Bellere, 1649.

276

bibliography

Hanegraaff, Wouter J., New Age Religion and Western Culture: Esotericism in the Mirror of Secular Thought. Albany: State University of New York, 1998. Hanegraaff, Wouter J., A. Faivre, R. ven der Broek and J. P. Brach (eds.), Dictionary of Gnosis and Western Esotericism. Leiden and Boston: Brill, 2006. Hartz, Paula R., Taoism: World Religions. New York: Facts on File; Brown Publishing, 1993. Hasanayn Muhammad Makhluf, Shaykh (former Grand Mufti of Egypt), Fatawa Shari‘a [2 volumes]. Cairo: Matba‘at al-Madani, 1971. Hatfield, Gary, ‘Descartes’ naturalism about the mental’ in Steven Gaukroger (ed.), Descartes Natural Philosophy. London: Routledge, 2000. Hay, Louise L., You Can Heal Your Life. Concord: Specialist Printing, 1988 [1984]. Hazelgrove, Jenny, Spiritualism and British Society Between the Wars. Manchester & New York: Manchester University Press, 2000. Heelas, Paul, The New Age Movement: The Celebration of the Self and the Sacralization of Modernity. Oxford: Blackwell, 1996. Heidegger, Martin, The Fundamental Concepts of Metaphysics. Bloomington: Indiana University Press, 1995. Hellwig, Monika, The Meaning of the Sacraments. Dayton, OH: Pflaum Press, 1981. Helman, Cecil G., Culture, Health and Illness: An Introduction for Health Professionals. Oxford: Butterworth Heinemann Ltd., 1990. Higginbotham, Nick, and Anthony J. Marsella, ‘International consultation and the homogenization of psychiatry in Southeast Asia’, Social Science and Medicine, vol. 27, 1988, pp. 553–61. Hitler, Adolf, Mein Kampf [trans. by Ralph Manheim]. Boston: Houghton Mifflin, 1943. Hodge, Bob, ‘Monstrous knowledge: Doing PhDs in the new humanities’, Australian Universities’ Review, vol. 2, 1995, pp. 35–9. Hoverd, William, Working Out My Salvation. The Contemporary Gym and the Promise of ‘Self ’ Transformation. Aachen: Meyer and Meyer Sport, 2005. Hughes, Tom, Tom Brown’s School Days. London: Oxford World Classics, 1999. Hunter, Francis, God’s answer to fat . . . LoØse It!. Houston: Hunter Ministries, 1976. Inglis, Brian, Natural Medicine. London: Collins, 1979. Inhorn, Marcia, Local Babies, Global Science: Gender, Religion and In Vitro Fertilization in Egypt. New York: Routledge, 2003. ——, ‘ “He won’t be my son”: Middle Eastern Muslim men’s discourses of adoption and gamete donation’, Medical Anthropology Quarterly, vol. 20, no. 1, 2006. pp. 94–120. Institute of Medicine of the National Academies, Complementary and Alternative Medicine in the United States. Washington: National Academies Press, 2005. Jackson, Yvonne, William H Dietz, Charlene Sanders et al., ‘Summary of the 2000 Surgeon General’s listening session: Toward a national action plan on overweight and obesity’, Obesity Research, vol. 10, no. 12, 2002 pp. 1299–305. Jad al-Haqq, Shaykh, Buhuth wa Fatawa al-Islamiyya fi Qadaya Mu‘asira [4 vols.]. Cairo al-Azhar University, 1994. Jagtenberg, Tom and Sue Evans, ‘Global Herbal Medicine: A Critique’, The Journal of Alternative and Complementary Medicine, vol. 9, 2003, pp. 321–9. James, Susan, Passions and Action: The Emotions in Seventeenth-Century Philosophy. Oxford: Oxford:University Press, 2000. James, Tony, ‘Banking on brains’, PathWay—The Royal College of Pathologists Australia, Winter, 2006, pp. 8–11. James, William, The Varieties of Religious Experience. New York: Longmans, Green and Co., 1922. Jaynes, Julian, ‘Problem of animate motion in 17th Century’, Journal of The History Of Ideas, vol. 31, no. 2, 1970. Johansen, Baber, Contingency in a Sacred Law: Legal and Ethical Norms in Muslim Fiqh. Leiden: E. J. Brill, 1999.

bibliography

277

Johnston, Jay and Ruth Barcan, ‘Subtle transformations: imagining the body in alternative health practices’, International Journal of Cultural Studies, vol. 9, no. 1, 2006, pp. 25–44. Johnston, Jay, Angels of Desire: Esoteric Bodies, Aesthetics and Ethics. London: Equinox, 2008. Jordanova, Ludmilla, Sexual Visions: Images of Gender in Science and Medicine Between the Eighteenth and Twentieth Centuries. Hemel Hempstead, UK: Harvester Wheatsheaf, 1989. Kant, Immanuel, On Education [trans. Annette Churton]. Boston: D.C. Heath and Co., 1900 [1803]. ——, The Critique Of Judgement [trans. James Cree]. Oxford: Clarendon Press, 1952. Kassouf, Susan, ‘The shared pain of the golden vein: The discursive proximity of Jewish and scholarly diseases in the late Eighteenth Century’, Eighteenth-Century Studies, vol. 32, 1998, pp. 101–10. Kellehear, Allan, (ed.), Death and Dying in Australia. South Melbourne: Oxford University Press, 2000. Kelly, Tony, An Expanding Theology, Faith in a World of Connections. Sydney: E. J. Dwyer, 1993. ——, ‘Reflections on spirituality and church’, Compass Theological Review, vol. 38, no. 8, 2004, pp. 19–27. Kenny, Anthony, ‘Descartes the dualist’, Ratio, vol. 12, no. 2, 1999, pp. 114–27. Keown, Damien, Buddhist Ethics. Oxford: Oxford University Press, 2005. Kim, Karen, and Jeffery Sobal, ‘Religion, social support, fat intake and physical activity’, Public Health Nutrition, vol. 7, no. 6, 2004, pp. 773–81. Kircher, T., J. Nelson and H. Burdo, ‘The autopsy as a measure of accuracy of the death certificate’, The New England Journal of Medicine, vol. 313, no. 20, 1985, pp. 1263–9. Kirkwood, Neville A., Pastoral Care in Hospitals. Sydney: E. J. Dwyer, 1995. Kirmayer, Laurence, ‘The body’s insistence on meaning: Metaphor as presentation and representation in illness experience’, Medical Anthropology Quarterly, vol. 6, 1992, pp. 323–46. Klein, Alan M., Little Big Men: Bodybuilding Subculture and Gender Construction. Albany: State University of New York Press, 1993 Kleinman, Arthur and Joan Kleinman, ‘Suffering and its professional transformation: Toward an ethnography of interpersonal experience’, Culture, Medicine and Psychiatry, vol. 15, 1991, pp. 275–302. Kleinman, Arthur, ‘What is specific to biomedicine?’, in Arthur Kleinmann (ed.), Writing at the Margin: Discourse between Anthropology and Medicine. Berkeley: University of California Press, 1995, pp. 21–40. Kleinman, Ruth, Anne of Austria: Queen of France. Columbus: Ohio State University Press, 1987. ——, ‘Facing cancer in the seventeenth century’, in Ronald H. Fritze et al. (eds.), Reflections on Civilization: A Reader 1600 to the Present. New York: Harper Collins, 1990. Koenig, Harold G., ‘Religion, spirituality and health: An American physician’s response’, Medical Journal of Australia, vol. 178, no. 2, 2003 pp. 51–2. Krawietz, Birgit, ‘Brain death and Islamic traditions: Shifting borders of life?’, in Jonathan E. Brockopp (ed.), Islamic Ethics of Life; Abortion, War, and Euthanasia. Columbia: University of South Carolina Press, 2003, pp. 194–213. Ladd, Tony and James Mathieson, Muscular Christianity, Evangelical Protestants and the Development of American Sport. Grand Rapids, MI: Baker Book House, 1999. Lai, Karyn, Learning from Chinese Philosophies: Ethics of Interdependent and Contextualised Self. Aldershot: Ashgate, 2006.

278

bibliography

Lane, Joan, A Social History of Medicine, Health, Healing and Disease in England, 1750–1950. London: Routledge, 2001. Laqueur, Thomas, Making Sex: Body and Gender from the Greeks to Freud. Cambridge: Harvard University Press, 1990. Larijani, B., F. Zahedi and E. Taheri, ‘Ethical and legal aspects of organ transplantation in Iran’, Transplantation Proceedings, vol. 36, 2004, pp. 1241–4. Latour, Bruno and Steve Woolgar, Laboratory Life: The Construction of Scientific Facts (second edition). Princeton: Princeton University Press, 1986 [1979]. Law, John, After Method: Mess in social science research. London and New York: Routledge, 2004. Le Brun, Jacques, ‘Cancer serpit. recherches sur la représentation du cancer dans les biographies spirituelles féminines du XVIIe Siècle.’ Sciences Sociales et Santé, Vol. II, No. 2, 1984, pp. 9–31. Leach, Edmund R., ‘Ritual’ in David L. Sills (ed.) International Encyclopedia of the Social Sciences, vol. 13. New York: The Macmillan Company and The Free Press, 1968, pp. 520–26. Leadbeater, Charles W., Man Visible and Invisible. Wheaton Ill. and London: Theosophical Publishing House, 1969. ——, The Chakras. Wheaton Ill. and London: Theosophical Publishing House, 1972. Leder, Drew, ‘A tale of two bodies: The Cartesian corpse and the lived body’, in Drew Leder (ed.), The Body in Medical Thought and Practice. Dordrecht/Boston/London: Kluwer Academic Publishers, 1992. Lee, Shui Chuen, The Family, Medical Decision Making and Biotechnology: Critical Reflections on Asian Moral Perspectives. Dordrecht: Springer, 2007. Lelwica, Michelle, Starving For Salvation. The Spiritual Dimensions of Eating Problems Among American Girls and Women. New York: Oxford University Press, 1999. Linke, Uli, Blood and Nation: The European Aesthetics of Race. Philadelphia: University of Pennsylvania Press, 1999. Little, Graham, The Public Emotions—From Mourning to Hope. Sydney: Australian Broadcasting Corporation, 1999. Liu, Yanchi, The Essential Book of Traditional Chinese Medicine. Volume 1: Theory. New York: Columbia University Press, 1988. Lock, Margaret, Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: University of California Press, 2002. Lopez, Frank, Pastoral Care in an Emerging World. Sydney: Marist Centre for Pastoral Care, 1994. MacDonald, Kathleen, ‘Healing’, in Fiona Toy (ed.), Directions: The Directory of Holistic Health and Creative Living. Rozelle, NSW: Fiona Toy Trading, 1997. Manly Hopkins, Gerard, ‘God’s grandeur’ in W. H. Gardner (ed.), Poems and Prose of Gerard Manly Hopkins. Middlesex: Penguin Books, 1953. Markus, Robert, Gregory the Great and his World. Cambridge: Cambridge University Press, 1997. Martin, Emily, Flexible Bodies: The Role of Immunity in American Culture from the Days of Polio to the Age of AIDS. Boston: Beacon Press, 1994. Massillon, M. (Évêque de Clermont), Sermons in Oraisons funébres et profess. religieuses. A Paris, Rue S. Jacques, Chez M. Th. Herissant, 1755. Mauss, Marcel, ‘Techniques of the Body’, Economy and Society, vol. 2, 1973 [orig. 1935], pp. 71–88. May, Gerald G., The Dark Night of the Soul: A Psychiatrist Explores the Connection Between Darkness and Spiritual Growth. San Francisco: HarperSanFrancisco, 2004. McBrien, Richard P., Catholicism. Melbourne: Collins Dove, 1994. McClintock, Anne, ‘ “No longer in a future heaven”: Nationalism, gender, and race,’ in Geoff Eley and Ronald Grigor Suny (eds.), Becoming National: A Reader. New York: Oxford University Press, 1996.

bibliography

279

McFague, Sallie, The Body of God: An Ecological Theology. London: SCM Press Ltd., 1993. McGuire, Meredith B., ‘Religion and the body: Rematerializing the human body in the social sciences of religion’, Journal for the Scientific Study of Religion, vol. 29, no. 3, 1990, pp. 283–96. McLeod, Melvin (ed.), Mindful Politics: A Buddhist Guide to Making the World a Better Place. Boston: Wisdom Publications, 2006. McNeill, William H., Keeping Together in Time: Dance and Drill in Human History. Cambridge: Harvard University Press, 1995. McPhee, S., K. Bottles, B. Lo, G. Saika and D. Crommie, ‘To redeem them from death: reactions of family members to autopsy’, The American Journal of Medicine, vol. 80, 1986, pp. 665–71. McRae-McMahon, Dorothy, Rituals for Life, Love and Loss. Sydney: Jane Curry Publishing, 2003. Merrick, Jeffrey, ‘The Cardinal and the Queen: Sexual and political disorders in the mazarinades,’ French Historical Studies, vol. 18, 1994, pp. 667–99. Metcalf, Peter and Richard Huntington, Celebrations of Death: The Anthropology of Mortuary Ritual (second revised edition). Cambridge: Cambridge University Press, 1991. Miller, Toby, and Alec McHoul, Popular Culture and Everyday Life. London: Sage, 1998. Mitchell, Kenneth R., ‘Ritual in pastoral care’, The Journal of Pastoral Care, vol. XLIII, no. 1, 1989, pp. 68–77. Mol, Anne Marie, The Body Multiple: Ontology in Medical Practice. Durham and London: Duke University Press, 2003. Mookerjee, A. and Khanna, M., The Tantric Way. London: Thames and Hudson, 1977. Moore, Thomas, Care of the Soul: How to Add Depth and Meaning to Your Everyday Life. London: Judy Piatkus Publishers Ltd., 1992. ——, Dark Nights of the Soul: A Guide to Finding Your Way Through Life’s Ordeals. London: Piatkus Books Ltd., 2004. Moosa, Ebrahim, ‘Interface of science and jurisprudence: Dissonant gazes at the body in modern Muslim ethics’, in Ted Peters, Muzaffar Iqbal, and Syed Nomanul Haq (eds.), God, Life, and the Cosmos; Christian and Islamic Perspectives. Ashgate, Aldershot: 2002. Mosse, George L., The Image of Man: The Creation of Modern Masculinity. New York: Oxford University Press, 1996. Ñāṇamoli and Bodhi (trans.), The Middle Length Discourses of the Buddha, A Translation of the Majjhima Nikāya. Boston: Wisdom, 2005. Needham, Joseph, ‘Elixir poisoning in medieval China’ in Clerks and Craftsmen in China and the West: Lectures and addresses on the history of science and technology, Cambridge: Cambridge University Press, 1970. Newman Turner, Roger, Naturopathic Medicine: Treating the Whole Person. Wellingborough: Thorsons Publishers, 1984. Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council Aboriginal Corporation, Ngangkari Work—Anangu Way: Traditional Healers of Central Australia. Alice Springs: Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women’s Council Aboriginal Corporation, 2003. Nicol, Robert, ‘Australian burial customs’, in Allan Kellehear (ed.), Death and Dying in Australia. South Melbourne: Oxford University Press, 2000. Nietzsche, Friedrich, On the Genealogy of Morals. Vintage. New York: 1967. ——, Thus Spoke Zarathustra. New York: Penguin, 1969. ——, Beyond Good and Evil. New York: Penguin, 1972. Nippert-Eng, Christena E., Home and Work: Negotiating Boundaries through Everyday Life. Chicago: University of Chicago Press, 1996.

280

bibliography

Norwood, Francis, ‘The ambivalent chaplain: Negotiating structural and ideological difference on the margins of modern-day hospital medicine’, Medical Anthropology, vol. 25, 2006, pp. 1–29. Nyanaponika and Bodhi (trans.), Numerical Discourses of the Buddha. New Delhi: Vistar Publications, 2000. Nye, Andrea, The Princess and the Philosophy: Letters of Elisabeth of the Palatine to René Descartes. Lanham, ML and Oxford: Rowman and Littlefield Publishers, 1999. O’Neill, Roy J., ‘Moments of grace and blessing: Rites and rituals in the process of healing, Melbourne college of divinity’, M.A. Dissertation, University of Melbourne, 2005. ——, ‘The ministry of the skilled stranger: Religion and spirituality in public hospital ministry’, Compass Theological Review, vol. 40, 2006, pp. 25–33. Otto, Rudolf, The Idea of the Holy: An Inquiry into the Non-rational Factor in the Idea of the Divine and its Relation to the Rational. London: Oxford University Press, 1923. Owen, Alex, The Darkened Room: Women, Power and Spiritualism in Late Nineteenth Century England. London: Virago, 1989. Paravicini-Bagliani, Agostino, The Pope’s Body. Chicago and London: University of Chicago Press, 2000. Pasteur, Claude, ‘Les médecins et le sein d’anne d’autriche,’ L’Histoire, 1980, pp. 40–5. Pearce, Michelle, Juli Boergers and Mitchell J. Prinstein, ‘Adolescent obesity, overt and relational peer victimisaton, and romantic relationships’, Obesity Research, vol. 10, no. 5, 2002, pp. 386–93. Pearl, Deidre and Erika Schillinger, ‘Acupuncture: Its use in medicine’, The Western Journal of Medicine, vol. 171, no. 3, 1999, pp. 176–80. Peile, Anthony R., Body and Soul: An Aboriginal View (edited by Peter Bindon). Victoria Park: Hesperian Press, 1997. Peters, John, ‘Combating obesity: challenges and choices’, Obesity Research, vol. 11, Supplement, 2003, pp. 7S–11S. Peterson, Allan, ‘Risk and the regulated self: The discourse of health promotion as politics of uncertainty’, Australian and New Zealand Journal of Sociology, vol. 32, no. 2, 1996, pp. 44–57. Pilliavin, Jane and Peter Callero, Giving Blood. Baltimore: Johns Hopkins University Press, 1991. Plant, Robert, ‘Blasphemy, dogmatism and injustice’, International Journal for Philosophy of Religion, vol. 54, 2003. Porter, Roy, The Greatest Benefit to Mankind. A Medical History of Humanity from Antiquity to the Present. London: Harper Collins, 1997. Potts, M. and D. W. Evans, ‘Does it matter that organ donors are not dead? Ethical and policy implications’, Journal of Medical Ethics, vol. 31, 2005, pp. 406–9. Prentice, Andrew and Susan Jebb, ‘Obesity in Britain: Gluttony or sloth?’ British Medical Journal, vol. 311, 1995, pp. 437–439. Probyn, Elspeth, ‘This body which is not one: speaking an embodied self’, Hypatia, vol. 6, 1991, pp. 111–24. ——, ‘Everyday shame’, Cultural Studies, vol. 18, 2004, pp. 328–49. Puhl, Rebecca and Kelly D. Brownell, ‘Bias, discrimination, and obesity’, Obesity Research, vol. 9, no. 12, 2001, pp. 788–805. Putney, Clifford, Muscular Christianity: Manhood and Sports in Protestant America 1880–1920. Massachusetts: Harvard University Press, 2001. Quinn, Dianne and Jennifer Crocker, ‘When ideology hurts: The effects of belief in the Protestant ethic and feeling overweight on the psychological well-being of women’, Journal of Personality and Social Psychology, vol. 77, no. 2, 1999, pp. 402–14.

bibliography

281

Radin, Margaret Jane, Contested Commodities. Cambridge, MA: Harvard University Press, 1996. Ramsey, Boniface, ‘John Cassian: Student of Augustine.’ Cistercian Studies Quarterly, vol. 28, 1993, pp. 5–15. Ranson, David, Across the Great Divide: Bridging Spirituality and Religion Today. Sydney: St Pauls Publications, 2002. Raposa, Michael L., Boredom and the Religious Imagination. Charlottesville: University Press of Virginia, 1999. Rauch, André, Le premier sexe: Mutations et crise de l’identité masculine. Paris: Hachette Littératures, 2000. Reid, Janice (ed.), Body, Land and Spirit: Health and Healing in Aboriginal Society. St Lucia: University of Queensland Press, 1982. Reinhart, A. Kevin, ‘Contamination’, in Jane D. McAuliffe (general ed.); Claude Gillot et al. (assoc. eds), Encyclopaedia of the Qur’an, 5 vols. Leiden: Brill, 2001, vol. 1, pp. 410a–412b. ——, ‘Afterword: The past in the future of Islamic ethics’, in Jonathan E. Brockopp (ed.), Islamic Ethics of Life; Abortion, War, and Euthanasia. Columbia: University of South Carolina Press, 2003. Reiser, Stanley, Medicine and the Reign of Technology. Cambridge: Cambridge University Press, 1978. Renan, Ernest, ‘What is a nation?’ in Geoff Eley and Ronald Grigor Suny (eds.), Becoming National: A Reader. New York: Oxford University Press, 1996 [1882]. Rethy, Robert, ‘Descartes’ Passions of the Soul’, Review Of Metaphysics, vol. LIII, no. 3, 2000, pp. 657–83. Richardson, Ruth, A Dissection of the Anatomy Act. Sussex: John Noyce, 1976. ——, Death, Dissection and the Destitute (second edition). London: Phoenix Press, 2001 [1988]. Rispler-Chaim, Vardit, Islamic Medical Ethics in the Twentieth Century. Leiden: E. J. Brill, 1993. ——, ‘The right not to be born: Abortion of the disadvantaged fetus in contemporary fatwas’, in Jonathan E. Brockopp (ed.), Islamic Ethics of Life; Abortion, War, and Euthanasia. Columbia: University of South Carolina Press, 2003. ——, Disability in Islamic Law. Derdrecht, The Netherlands: Springer, 2007. Rodrigues, J. V. (ed.), Lira Mistica: Poesias de Santa Teresa y San Juan de la Cruz. Madrid: Editorial De Espiritualidad, 1988. Roe, Jill, Beyond Belief: Theosophy in Australia 1879–1939. Sydney: New South Wales University Press, 1986. Roland, M., Dictionnaire des caracteres et portraits tirés des oraisons funebres, qui ont paru depuis 1530 jusques en 1777, 2 vols. Paris: Chez Gogué. Rosen, Lawrence, The Anthropology of Justice: Law As Culture in Islamic Society. Cambridge: Cambridge University Press, 1989. Rothschild, Sylvia and Sybil Sheridan (eds.), Taking up the Timbrel: The Challenge of Creating Ritual for Jewish Women Today. London: SCM Press, 2000. Roulson, J., E. Benbow and P. Hasleton, ‘Discrepancies between clinical and autopsy diagnosis and the value of post-mortem histology; A meta-analysis and review’, Histopathology, vol. 47, 2005, pp. 551–9. Rousseau, Jean-Jacques, The Social Contract and Discourses [trans. G. D. H. Cole]. London: J. M. Dent, 1993. Rozemond, Marleen, ‘Descartes on mind body interaction: What’s the problem?’ Journal of the History of Philosophy, vol. 37, no. 3, 1999, pp. 435–67. Rubin, Nissan, ‘From corpse to corpus: The body as a text in Talmudic literature’, in Albert I. Baumgarten with Jan Assmann and Guy G. Stroumsa (eds.), Self, Soul and Body in Religious Experience. Leiden: Brill, 1998.

282

bibliography

Rubin, Uri 2003, ‘Jews and Judaism’, in McAuliffe (general ed.), Gillot et al. (associate eds.), Encyclopaedia of the Qur’an. Pp. 21b–34a. Ruggie, Mary, Marginal to Mainstream: Alternative Medicine in America. Cambridge: Cambridge University Press, 2004. Rumbold, Bruce, ‘Caring for the spirit: Lessons from working with the dying’, Medical Journal of Australia, vol. 179, no. 6 Suppl., 2003, pp. S11–S13. Rüthers, Monica, ‘Der Jude wird weibisch—und wo bleibt die Jüdin? Jewish studies—gender studies—body history, in traverse’, Zeitschrift für Geschichte, vol. 3, no. 1, 1996, pp. 136–45. Saddhatissa, H., The Sutta-Nipāta. London: Curzon Press, 1994. Salk, Jonas, Anatomy of Reality: Merging of Intuition and Reason. New York: Columbia University Press, 1983. Saltonstall, Robin, ‘Healthy bodies, social bodies: Men’s and women’s concepts and practices of health in everyday life’, Social Science and Medicine, vol. 16, 1993, pp. 7–14. Samson, Colin, ‘Biomedicine and the body’, in Colin Samson (ed.), Health studies: A critical and cross-cultural reader. Oxford: Blackwell Publishers, 1999. Sanders, Paula, ‘Gendering the ungendered body: Hermaphrodites in medieval Islamic law’, in Nikki R. Keddie and Beth Baron (eds.), Women in Middle Eastern History; Shifting Boundaries in Sex and Gender. New Haven: Yale University Press, 1991. Sanner, Margareta, ‘A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection: A Swedish survey’, Journal of the American Medical Association, vol. 271, no. 4, 1994, pp. 284–8. Sappol, Michael, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America. Princeton: Princeton University Press, 2002. Sarup, Madan, ‘Home and identity’, in George Robertson, Melinda Mash, Lisa Tickner, Jon Bird, Barry Curtis and Tim Putnam (eds.), Travellers’ Tales: Narratives of home and displacement. London: Routledge, 1998. Savage-Smith, Emilie, ‘Attitudes toward dissection in medieval Islam’, The Journal of the History of Medicine and Allied Sciences, vol. 50, 1995, pp. 67–110. Savran, David, Taking it Like a Man: White Masculinity, Masochism, and Contemporary American Culture. Princeton: Princeton University Press, 1998. Scarry, Elaine, The Body in Pain: The Making and Unmaking of the World. New York: Oxford University Press, 1985. Schacht, Richard, Nietzsche. London: Routledge and Kegan Paul, 1983. Scheper-Hughes, Nancy, Death Without Weeping. The Violence of Everyday Life in Brazil. Berkeley: University of California Press, 1992. ——, ‘The theft of life’, Anthropology Today, vol. 12, no. 3, 1996, pp. 3–11. ——, ‘The global traffic in organs’, Current Anthropology, vol. 41, no. 2, 2000, pp. 191–211. Scheper-Hughes, Nancy and Margaret Lock, ‘The mindful body: A prolegomenon to future work in medical anthropology’, in P. J. Brown (ed.), Understanding and Applying Medical Anthropology. California: Mayfield Publishing Company, 1998. Scheper-Hughes, Nancy, ‘Global justice and the traffic in human organs’ in: R. Gruessner and E. Bendetti (eds.), Living donor organ transplantation. New York: McGraw Hill, 2007. Schipperges, Heinrich, ‘Paracelsus and his followers,’ in A. Faivre and J. Needleman (eds.), Modern Esoteric Spirituality. World Spirituality An Encyclopedic History of the Religious Quest, vol. 21. New York: Crossroad, 1995. Schrödter, Willy, History of Energetic Transference: Exploring the Foundations of Modern Healing. York Beach, ME: Samuel Weiser, 1999. Scott-Beller, Anne, Fat and Thin. A Natural History of Obesity. New York: Farrar, Straus and Giroux, 1977. Segal, Erich, Acts of Faith. New York: Bantam Books, 1993.

bibliography

283

Senault, R. P. Jean François, Oraison Funebre d’Anne Infante d’Espagne, Reine de France, et Mere du Roy. Prononcée en la presence de ses Domestiques dans l’Eglise de S. Eustqche. Superieur General de la Congregation de l’Oratoire de IESUS. A Paris, Chez Pierrele Petit. M.DC. LXVI. Serrony, Monseigneur Hyacinthe (Eveque de Mende), Oraison funebre prononcee dans l’eglise des augustins du Grand Convent de Paris, au service solemnel fait par l’Assemblée generale du Clergé de France, le 13 Mars 1666 pour la Reyne Mere du Roy. A Paris, Chez Antoine Vitré, 1666. Sharp, Lesley A., ‘Commodified kin: Death, mourning and competing claims on the bodies of organ donors in the United States’, American Anthropologist, vol. 103, no. 1, 2001, pp. 112–33. Shaw, Ian, ‘How lay are lay beliefs?’, Health: An interdisciplinary journal for the social study of health, illness and medicine, vol. 6, no. 3, 2002, pp. 287–99. Shaykh Ahmad Fahmi Abu Sinnah’s (Islamic Fiqh Academy of the Muslim World League in Mecca) ‘Hukm al-‘Ilaj bi Naql Dam al-Insan aw Naql A‘da’ aw Ajza’ minha,’ in Majallat al-Majma‘ al-Fiqhi, 1987, pp. 23–41. Shearmur, Jeremy, ‘Trust, Titmuss and blood’, Economic Affairs, vol. 21, no. 1, 2001, pp. 29–33. Shumway, David R., Michel Foucault. Charlottesville: University Press of Virginia, 1992. Sivaraksa, Sulak, Seeds of Peace. Berkeley: Parallax Press, 1992. Slotkin, Richard, Regeneration through Violence: The Mythology of the American Frontier, 1600–1860. Middletown, CT: Wesleyan University Press, 1973. de Sola Pinto, Vivian and F. Warren Roberts (eds.), The Complete Poems of D. H. Lawrence. London: Penguin Books, 1994. Soloman, Robert (ed.), Wicked Pleasures: Meditations on the Seven “Deadly” Sins. Maryland: Rowman and Littlefield Publishers, 1999. Somerville, Margaret, The Ethical Imagination: Journeys of the Human Spirit. Carlton: Melbourne University Press, 2006. Sontag, Susan, Illness as Metaphor and AIDS and Its Metaphors. New York: Picador Press, 2001. Speakman, John, ‘Obesity part one—the greatest health threat facing mankind’, Biologist, vol. 50, 2003, pp. 1–5. Spitul, Aaron and Tomoko Kokomen, ‘Health insurance for kidney donors: How easy is it to obtain?’, Transplantation, vol. 62, no. 9, 1996, pp. 1356–8. Starobinski, Jean, Blessings in Disguise; or The Morality of Evil [trans. Arthur Goldhammer]. Cambridge: Harvard University Press, 1993. Steinhauser, Karen, Nicholas A. Christakis, et al., ‘Factors considered important at the end of life by patients, family, physicians, and other care providers’, Journal of the American Medical Association, vol. 284, no. 19, 2000, pp. 2476–82. Stephens, Charles Asbury, Natural Salvation, the Message of Science: Outlining the First Principles of Immortal Life on the Earth. Norway Lake, ME, The Laboratory, 1903. Strawson, P. F., Individuals: An Essay In Descriptive Metaphysics. London: University Paperbacks, 1959. Strickmann, Michel, in Carl Bielefeldt and Bernard Faure (eds.), Chinese Magical Medicine. Stanford: Stanford University Press, 2002. Tacey, David J., The Spirituality Revolution: The Emergence of Contemporary Spirituality. Sydney: Harper Collins Publishers, 2003. Tansley, David V., Subtle Body: Essence and Shadow. London: Thames and Hudson, 1977. Taylor, Charles, Sources of the Self: The Making of Modern Identity. Cambridge: Cambridge University Press, 1989. ——, A Secular Age. Cambridge: Harvard University Press, 2007.

284

bibliography

Taylor, James Stacey, Stakes and Kidneys. Aldershot: Ashgate, 2005. Teather, Elizabeth Kenworthy (ed.), Embodied Geographies: Spaces, Bodies and Rites of Passage. London: Routledge, 1999. The Royal College of Pathologists of Australasia Autopsy Working Party, ‘The decline of the hospital autopsy: A safety and quality issue for healthcare in Australia’, Medical Journal of Australia, vol. 180, 2004, pp. 281–85. Thiele, Leslie Paul, Friedrich Nietzsche and the Politics of the Soul. Princeton: Princeton University Press, 1990. Timmermans, Stefan, ‘Death brokering: Constructing culturally appropriate deaths’, Sociology of Health and Illness, vol. 27, no. 7, 2005, pp. 993–1013. Titmuss, Richard, The Gift Relationship. New York: Pantheon, 1971. Topps, G. and K. Busia, ‘The concept of synergy: Time for a new paradigm’, Australian Journal of Medical Herbalism, vol. 17, 2005, pp. 45–54. Turner, Bryan S., The Body and Society. Explorations in Social Theory. Oxford: Basil Blackwell, 1984. ——, Regulating Bodies. Essays in Medical Sociology. London and New York: Routledge, 1992. ——, ‘The body in western society: Social theory and its perspectives’, in Sarah Coakley (ed.), Religion and the Body. Cambridge: Cambridge University Press, 1997. Turner, Victor, The Ritual Process: Structures and Anti-Structures. London: Routledge and Keegan Paul Ltd., 1969. Un frere Capucin de la Province Wallonne 1623, Histoire de la vie, mort et miracles de Saint Aldegonde. Vierge, Fondatrice, Patrõne and premiere Abbesse des nobles Dames Chanoinesses de la Ville de Maubeuge. En Arras. Imprimerie de Guillaume de la Riviere. Unschuld, Paul U., Medicine in China. A History of Ideas. Berkeley: University of California Press, 1985. Valiquette, Hilaire (ed.), A Basic Kukatja to English Dictionary. Wirrimanu: Luurnpa Catholic School, 1993. Varga, Ivan, ‘The body—the new sacred? The body in hypermodernity’, Current Sociology, vol. 53, no. 2, 2005, pp. 209–235 Vertinsky, Patricia, ‘Body matters: Race, gender, and perceptions of physical ability from Goethe to Weininger’, in Norbert Finzsch and Dietmar Schirmer (eds.), Identity and Intolerance: Nationalism, Racism, and Xenophobia in Germany and the United States. Cambridge: Cambridge University Press, 1998. Vesalius, Fabrica De Humani Corporis. 1543. Vigh, Henrik, E., ‘Social death and violent life chances’, in Catrine Christiansen, Mats Utas and Henrik E. Vigh (eds.), Navigating Youth, Generating Adulthood: Social Becoming in an African Context. Uppsala: Nordiska Afrikainstitutet, 2006. Vila, Anne C., Enlightenment and Pathology: Sensibility in the Literature and Medicine of Eighteenth-Century France. Baltimore: Johns Hopkins University Press, 1998. Vincent, John A., ‘Ageing contested: Anti-ageing science and the cultural construction of old age’, Sociology, vol. 40, no. 4, 2006, pp. 681–98. von Hufeland, Christoph Wilhelm, The Art of Prolonging Life. London: John Churchill, 1859 [1796]. Walker, Bret, Inquiry into matters arising from the post-mortem and anatomical examination practices of The Institute of Forensic Medicine. NSW: The Government of the State of New South Wales, 2001. Walshe, Maurice (trans.), Thus Have I Heard, the Long Discourses of the Buddha. London: Wisdom Publications, 1987. Walter, Tony, The Revival of Death. London and New York: Routledge, 1994. Weber, Max, The Protestant Ethic and the Spirit of Capitalism. London: Allen and Unwin, 1930.

bibliography

285

Weisz, George, ‘A Moment of synthesis: Medical holism in France between the wars’, in Christopher Lawrence and George Weisz (eds.), Greater than the Parts: Holism in Biomedicine, 1920–1950. New York: Oxford University Press, 1998. West, Jackie and Terry Austrin, ‘Markets and politics: Public and private relations in the case of prostitution’, Sociological Review, vol. 53, 2005, pp. 136–48. Westermeyer, Joseph and Aleksandar Janca, ‘Language, culture and psychopathology: Conceptual and methodological issues’, Transcultural Psychiatry, vol. 34, 1997, pp. 291–311. Whorton, James, Crusaders for Fitness. The History of American Health Reformers. New Jersey: Princeton University Press, 1982. Wittgenstein, Ludwig, On Certainty, (§217) cited in Robert Plant, ‘Blasphemy, dogmatism and injustice’, International Journal for Philosophy of Religion, vol. 54, 2003, pp. 101–35. Wolf, Naomi, The Beauty Myth: How Images Of Beauty Are Used Against Women. London: Vintage Press, 1991. Wujastyk, Dominik, The Roots of Ayurveda. New Delhi: Penguin, 2001. Yalom, Marilyn, History of the Breast. New York: Ballantine Books, 1998. Youngner, Stuart J., ‘Some must die’, in Stuart J. Youngner, Renee C. Fox and Laurence J. O’Connell (eds.), Organ Transplantation: Meanings and Realities. Wisconsin: The University of Wisconsin Press, 1996. Youngner, et al. (eds.), Organ Transplantation—Meanings and Realities. Madison: University of Wisconsin Press, 1996. Zantrop, Suzanne, ‘The beautiful, the ugly, and the German: Race, gender, and nationality in Eighteenth-Century anthropological discourse,’ in Patricia Herminghouse and Magda Mueller (eds.), Gender and Germanness: Cultural Productions of Nation. Oxford: Berghahn, 1997. Zarghooshi, Javaad, ‘Quality of life of Iranian kidney “donors” ’, Journal of Urology, vol. 166, no. 5, 2001, pp. 1790–9. ——, ‘Iranian kidney donors: Motivations and relations with recipients’, Journal of Urology, vol. 165, no. 2, 2002, pp. 386–92. Zhang, Enqin, Basic Theory of Traditional Chinese Medicine [trans. Xu Xiangcai]. Shanghai, Publishing House of Shanghai College of Traditional Chinese Medicine, 1990. Ziegler, Philip, The Black Death. London: Collins, 1969. Zuesse, Evan M., ‘Ritual’ in Mircea Eliade (ed.), The Encyclopedia of Religion, New York: McMillan Publishing Company, 1987. Zysk, Kenneth, Asceticism and Healing in Ancient India. Oxford: Oxford University Press, 1991. Other Sources Aguilar, Francis and Lalaine Siruno, ‘A Community Without Kidneys’, al-Qaradawi, Yusuf 2004, ‘Virtues of Blood Donation (9 June 2004)’, available at IslamOnline.net, al-Siddiqi, Muzammil 2006, ‘Blood Donation to Non-Muslims (21 June 2006)’, available at IslamOnline.net, Al-Sistani, Grand Ayatollah al-Sayyid ‘Ali al-Husayni 1996, Contemporary Legal Rulings in Shi’i Law in Accordance with the Rulings (Fatawa) of Ayatullah al-‘Uzma

286

bibliography

al-Sayyid ‘Ali al-Husayni al-Seestani, Hamid Mavani (trans.) Organization for the Advancement of Islamic Knowledge and Humanitarian Services, Montreal, Augustine De Cathechizandis Rudibus. Bakdash, Tarif and Nancy Scheper-Hughes, ‘Is It Ethical for Patients with Renal Disease to Purchase Kidneys from the World’s Poor?’ Bartleby, ‘Donating plasma for money’, Associated Content: Health and Wellbeing,

Bindel, Julie and Liz Kelly Cobain, Ian, ‘The postwar photographs that British authorities tried to keep hidden’, The Guardian, 3 April, 2006. Cohen, J., Report on Spirituality, Health and Healing in South Eastern Sydney. Sydney: South-East Sydney Area Health Service, 2002. Department of Health and Human Services, ‘The autopsy, medicine, and mortality statistics’, Centers for Disease Control and Prevention and National Center for Health Statistics, USA, 2001. Eggs solicited from models Elliot, Hazel, ‘Hospital chaplaincy in the context of religion in contemporary Australia’, Ph.D. dissertation, University of Sydney, Sydney, 2001. Filteau, J. 2004, Theologians, historians explore decline in confessions. Friedman, Amy, Interview on National Public Radio Gleeson, B. 2004, Symbols and Sacraments: Their Human Foundations. Haynes, A., J. Hilbers, J. Kivikko and Ratnavuyha 2006, Spirituality and Health Survey at Prince of Wales Hospital. Sydney, South East Sydney and Illawarra Area Health Service Hell Pizza Deliveries., New Zealand, House of Commons Health Committee Report on Obesity: Third Report of Session 2003–04 vol. 1. Human Tissue Act 1982 (Victoria) Institute of Ideas, ‘Morbid fascinations: The body and death in contemporary culture’, London, May 16, 2003. Khamenei, Grand Ayatollah Ali Hosseini (n.d.) (a), Replies to Inquiries about the Practical Laws of Islam. The English Version of (Ajwibah al-Istifta‘at), Khamenei, Grand Ayatollah Ali Hosseini (n.d.) (b), Practical Laws of Islam. Medical Issues, Khamenei, Grand Ayatollah Ali Hosseini (n.d.) (c), ‘Fatwas from Leader’s Office in Qom’, Lettre circulair de soeur Françoise de la Croix et de Soeur Thérèse de Jésus, annonçant la mort de la reine Anne d’Autrice, 20 janvier 1666. Mayo Clinic, McCoy, Bryan F., ‘Kanyirninpa: health, masculinity and wellbeing of desert Aboriginal men’, Ph.D. dissertation, Melbourne University, 2004. McElroy, Wendy 1995, XXX: A Woman’s Right to Pornography, New York: St Martin’s Press. Muslim Community Cooperative (Australia) Ltd. (MCCA), ‘Muslims of Australia Saved 900 Lives’,

bibliography

287

National Code of Ethical Autopsy Practice (2002) Ngangkari 2001, Video Recording, Ronin Films, Ngaanyatjarra Pitjantjatjara Yankunytjatjara Media Production and Australian Film Commission. NSW Muslim Community 2006, ‘NSW Muslim Blood Drive Campaign July–August 2006’, Perry, Vivian, ‘Bottom line on obesity’, The Guardian Unlimited Newspaper, June 17, 2004. Prince of Wales Hospital, ‘Spirituality and health survey at POWH: Initial findings’, Diversity Health News Bulletin, 2006. Prostitution illegal in Sweden, Recruitment to work in brothels, Canberra Times, Reid, M. 1998, File No A4534, Chaplaincy Services to the New South Wales Health System. Sacramenta signacula quidem rerum divinarum esse visibilia, sed res ipsas invisibiles in eis honorari. In De Cathechizandis Rudibus XXVI 50. Latin text on line. Augustine De Cathechizandis Rudibus. Sales of human hair, Sanislo, Teresa, ‘Models of manliness and femininity: The physical culture of the Enlightenment and early national movement in Germany, 1770–1819’, Ph.D. dissertation, University of Michigan, 2001. Se7en, Directed by David Fincher, New Line Cinemas, 1995. Sperm Bank of California, State Coroner’s Office 2005, ‘Submission to the Law Reform Committee of the Parliament of Victoria’. Tacey, David. J., ‘Australian spirituality and health’, Paper presented at Australian Health and Welfare Chaplains’ Association Conference Keynote Addresses, Australian Health and Welfare Chaplains’ Association, Alice Springs, 2003. ——, ‘Recovering faith in a faithless age: the post-modern spiritual landscape, and a case study of a student’, Paper presented at Australian Health and Welfare Chaplains’ Association Conference 2003 Keynote Addresses, Australian Health and Welfare Chaplains’ Association, Alice Springs, 2003. Thanissaro, Bhikkhu (trans.), ‘Samyutta Nikaya XXII.48’, in John Bullitt (ed.), Access To Insight, Somerville MA, 2006, The Rites of the Catholic Church 1990, Volume 1, The Liturgical Press, Collegeville, Minnesota. The Rites of the Catholic Church 1991, Volume 2, The Liturgical Press, Collegeville, Minnesota. The Royal College of Pathologists Australia, Post-mortem guidelines, October, 2003. The Royal College of Pathologists of Australasia, ‘Is the autopsy dead?’ Royal College of Pathologists of Australia, 2004. The Royal Liverpool Children’s Inquiry—Summary and Recommendations 2001, The House of Commons, London. The Stanford Daily (online), November 17, 2006; Section ‘classified’, subsection ‘donors wanted’ . University of Southern California’s Muslim Students Association 2006, USC-MSA Compendium of Muslim Texts, VandeCreek, L. and L. Burton, Professional Chaplaincy: Its Role and Importance in Healthcare, 2001. . Victorian Parliament Law Reform Commission, ‘Coroners Act 1985—Discussion paper’, Parliament of Victoria, Melbourne, 2005.

288

bibliography

Victorian Parliament Law Reform Committee, ‘Coroners Act 1985—Final Report’, Parliament of Victoria, Melbourne, 2006. Worms, Ernest A., ‘The changing ways of our Aborigines’, Catholic Weekly, June 16, 1960.

INDEX Aborigines, Australian See Australian Aborigines, Kimberley desert abortion and Buddhism 64 abortion and the State 2 acupuncture 70, 75 affluent society 234–238 See also life style; male body; masculinity afterlife See life after death Agamben, Giorgio 250, 258–259, 260–263 age and ageing 90, 98–101 aggregates (Buddhist mental phenomena) 58–59 al-Sistani, Grand Ayatollah Al-Sayyid ‘Ali al-Husayni 32 alchemy 88, 91 Aldegonde, Saint 118–119 alternative medicine 69–78, 129–146 and mainstream medical systems 11, 133, 139–146 social status 135–138 treatments 130 See also medical intuition; spiritual healing; traditional Chinese medicine alternative medicine practitioners See medical practitioners ancestral worship 85 Anne of Austria, Queen Mother of France 107–127 biography and reputation 108–110 response to breast cancer 108, 113, 116–124 asceticism 86, 95–96, 100, 205, 215–228 Augustine of Hippo, Saint 156–157, 215 Australian Aborigines, Kimberley desert adult male status 9, 17–18, 23, 25 body, concepts of 9, 18–19, 21, 22–23 cosmology 21 embodied relationships 18–21, 25 health beliefs 18, 21–24 holistic world view 9, 18, 21, 23 kinship relationships 19–21 language and culture 17–18

male initiation ceremonies 17–18, 23, 25 autopsies 169–187 attitudes of relatives 172, 173–180, 183, 184 brain 169–170, 177–178, 180–181 Buddhist meditation on 57 Christianity 174 Islam 9, 31, 37, 43–45, 48 Judaism 9 limited 175–180 western society 12, 169–187 See also corpses; death Ayatollah Khamenei See Grand Ayatollah Ali Hosseini Khamenei Ayurveda 51–54 Bacon, Roger 90–91 Bad Nenndorf 249, 258, 260–267 belief, religious 2–3 in multicultural societies 3 New Age 3 bio-metaphysical model of the body 10, 69–78 birth control and Buddhism See contraception and Buddhism blood donations and sales 191–196, 200–201 Islam 31, 37–41, 42–43 Bodhisattva 64–65, 66 body, abnormal 37, 250, 253–260 body and soul See soul body, as sacred autopsies 12, 173–180 Christianity 28, 223–224, 229 Islam 8–9, 28, 29, 33, 35–46 Judaism 28, 35–36 the law 8–9 body, concepts of 2, 3, 14 Australian Aborigines 9, 18–19, 21, 22–23 Buddhism 10, 51–67, 70 Christianity 10, 80–81, 87–88, 156–158, 216–217 as commodity 193–196 as energy field 11, 69–76, 129, 130, 131–132

290

index

Hinduism 10, 51–53, 70 historical influences 6–7 India 51–56 Islam 27–49 as man and beast 261–264 Nazi Germany 251, 254–256, 263–264 social sciences 5 spiritualist religions 11, 69–76 Taoism 74–76 two-sex medical model 236–237, 238 See also self, concepts of; subtle body body culture 214, 221–223 body, dead See autopsies; corpses body, female See female body body, male See male body body parts See brain; heart; kidneys; organ donations and transplants; organs, sale of body, physical See body, concepts of; female body; male body body politic See nation and nationalism; the State body, ‘religionated’ See body, as sacred body, social 5–7, 9–10 Bonhoeffer, Dietrich 159 Book of Common Prayer 79 boredom 81–82, 102–103 Brahminical world view 51–54, 56 brain 178–181, 186–187 Buddhism 53 Islam 34–35 breast cancer See cancer Buddha 62 body characteristics 55 Buddhism 51–67 concepts of body 10, 51–55, 70 cosmology 10, 51–55, 62–63 ethics 63–66 meditation 10, 51, 56–62 Buddhism, early Indian 51–67 burial of bodies in Christianity 28 in Islam 33, 43, 44–45 Burton, Robert 94–95, 96 cadavers See corpses Calvinism 220 CAM (Complementary and Alternative Medicine) See alternative medicine; medical intuition; spiritual healing cancer 107, 111–127, 210 capitalism 100, 220, 224–225 Buddhism 63

Caraka 51–54 Cassian, John 13, 205–206, 215–2190, 228 Catholic Church 160 autopsies 174 pain and suffering 118, 126–127 punishment and reward 86 seven deadly sins 215 cause of death 12, 31, 43, 44, 181–186 Anne of Austria, Queen of France 116–117 cell biology 99–101 chakras 71, 77, 78, 131 channelling of energy 71–72, 76, 77, 130, 131 chaplains, hospital 160–167 Chatwin, Bruce, Songlines 264 Cheyne, George 95–96, 237 Chinese traditional medicine See Traditional Chinese medicine chiropractic 135 choice in Islam 37 choice in religious beliefs 3 Christianity cosmology 79, 88, 156–158 creed 79 health and morality 91–98 and madness (See madness) salvation 79, 85, 86, 91–92 See also Catholic Church; Protestant Christianity; sin; virtue circumcision in Islam 36 civilisation 246–247 concept of 233 since 16th century 231–247 clairvoyance 11, 129–130, 143–146 See also medical intuition; medical practitioners clients of medical systems See patients cloning and Buddhism 64 cold water See water complementary and alternative medicine See alternative medicine concentration camps See Bad Nenndorf; Dachau; spa resorts; Theresienstadt confinement See social exclusion conflicts in health beliefs Australian Aborigines 18, 23–24 Hmong people 1 consciousness Buddhism 53 in modern Theosophy 70, 73 in spiritual healing 132 consent

index autopsies 172, 175–176, 177–178, 180, 184, 186 sale of body parts 198–201 consumption See affluent society contraception and Buddhism 31, 64 Cornaro, Luigi 94 corpses Christianity 173–181 donation of 34, 43, 174–176 Islam 9, 31, 35, 36, 40, 43, 45 Judaism 9, 35–36 meditation on 57 secular attitudes 174–176 See also autopsies correspondences, theory of 71 cosmetic surgery 31, 35–36 counsellors See medical intuition; medical practitioners cowardice 236, 238–239, 243 crime and criminals 253, 256, 258, 261, 266 Islam 40 See also killing Dachau 249, 258, 260–267 Dante Alighieri 212–213 dead bodies See autopsies; corpses death 170–171, 177 Christian interpretations 108, 113–124 Islam 34–35 and medical science 171–172, 179–187 and religion 85, 171 (See also funeral sermons) traditional societies 84–85 See also autopsies; dying process; killing death, cause of See cause of death death certificates 185–186 death, untimely 171–172 Deleuze, Gilles 261 concept of the pleat 9, 18, 24–25 desert body See Australian Aborigines, Kimberley desert desert fathers of Egypt 205, 215–219 devotional dieters 221–223, 229 diabetes 22, 101–102, 199, 206, 209 diet 13, 52, 81, 83, 90, 92–96 in asceticism 13, 218–219 cause of obesity 213 and Protestant Christianity 219–227 See also gluttony; life style dieting culture 214, 221–223, 229

291

digestion 52 disabled body 250, 253–260 discipline of the body 23 in childhood 239 Christianity 93–96, 216–219 Greek medicine 93 and masculinity 232–233, 238–239, 240–241 Nazi Germany 251, 255–257, 259 and virtue 23 See also life style; pain and suffering discomfort 231 discrimination 206–207 Nazi Germany 250, 253–267 against the obese 206–207 against unemployed 226 disease See illness dissections of bodies See autopsies the Divine 122, 136, 156–158 See also life energy or force divine abidings (Buddhism) 56, 59–62, 63 divine grace See grace Divine will 113, 115, 116, 121 doctors See medical practitioners dogmas, Islamic 33–34 dying process 118–124, 156, 160, 161, 184 See also death economic status and health 46, 80–81, 206, 234–238 economic status and masculinity 234 Egyptian desert fathers 205, 215–219 Egyptian fatwas 33, 46–47 eight principal vices 205, 206, 215–217 elements, material in Buddhism 52–54, 56 elixirs of life 80, 88–89 embodied beliefs, Australian Aborigines 18, 25 embodied perception 132, 134, 144 embodied relationships, Australian Aborigines 18–21 embodiment (Christianity) 96–98 emotions See humours of the body energy and body 11, 69–73, 75–76 See also subtle body energy in healing See spiritual healing; Traditional Chinese medicine energy, universal See life energy or force Engaged Buddhism 65–66 Enlightenment 174, 253, 260–266 esoteric anatomy 70, 72, 74–75

292

index

eternal life See life after death ethics Buddhism 63–66, 101 Christianity 85–86, 101 Islam 33–35, 47–49 prolongevity 100–101, 102 sale of body parts 191–201 See also medical ethics euthanasia in Buddhism 64 in Islam 37 in Nazi Germany 250, 258, 259, 266 exercise See life style; obesity faith, religious 3, 147, 149, 151–152 See also spiritual healing; spirituality, personal fasting See asceticism; diet fatwas 9, 31–35, 38–45, 47–49 See also Islamic law feelings See humours of the body female body 236–237 cancer 107, 111–116 causes of illness 113–116 cultural status 6 ideal in Buddhism 55–56 life style and health 94–95, 223 therapeutic sexual behaviour 90 feminine in medicine 131, 133, 134, 138 feminisation of males 13, 235, 238, 241, 244, 255–257 Fincher, David 213 Fiqh Councils and Academies 32, 39, 42, 43 food See diet football and embodied relationships 18–21 forensic science See autopsies; pathology and death Foucault, Michel 6, 7, 256–258, 261, 266 concept of teratology 138 on madness 253, 257–258, 261, 266 theory of governmentality 93 funeral sermons 107, 108, 110–116, 125–127 Generation X 160 German literature 250–257 Germans as victims 249, 250, 262–263, 265–266 Germany See Nazi Germany

gerontology See age and ageing gluttony 13, 92, 205–239 cause of obesity 205–212 health policy 207–212, 227–230 moral judgements 13, 205, 221–223, 238 popular culture 212–214 theological origins of the term 215–219 See also diet Goenka, Satya Narayan 57 grace 119, 120, 157 Grand Ayatollah al-Sayyid ‘Ali al-Husayni al-Sistani 32, 45 Grand Ayatollah Ali Hosseini Khamenei 32, 44 Grass, Günter, The Tin Drum 250, 251–257 Greek medicine 92–93 grief 170–171, 180, 187 Guantanamo Bay 260–267 gypsies 253, 259 hands on healing See spiritual healing Haredi Jews See Judaism healers See medical practitioners healing, spiritual See spiritual healing health and economic status 46, 80–81, 206, 234–238 health care, holistic 147–149, 164–167 See also spiritual healing health care systems 2 alternative medicine 134–142 Australia 149–151 mainstream 139–142, 148–151 relationships between 139–143, 146 secular 148–149 health, concept of in Buddhism 53, 61–62 health policies 163, 165–167 obesity 205–206, 207–212, 227–230 See also health care systems; the State heart 53–54, 178, 206 heaven See life after death Heidegger, Martin 102, 103, 261–264, 265 hell 85, 86, 97, 161, 213 See also life after death Hell Pizza 214 Hindu concept of body 10, 51–53, 70 homo sacer 250, 260–263 homosexuality 251, 254–256, 257, 259 hospital autopsies See autopsies

index hospital patient experiences 110, 126, 160–163 hospital work, alternative medicine 110, 140 hospital work, Christian chaplains 160–167 hospitals and spirituality 149–151, 160–167 House of Commons Health Committee Report on Obesity 205, 208–209, 214, 227 human body See female body; male body humours of the body 10, 51–52, 56 and ageing 90, 91 illness 1, 147 17th century France 108, 113–127 19th century 237–238 Buddhism 10, 51–52 Christianity 10–11, 92, 108–127 and prolongevity 101–102 as punishment 10–11, 113–116, 238 sacramental view 156–160 scientific approach 148–149 immortality See life after death in-vitro fertilisation Buddhism 64 Islam 31, 37, 48 India and sale of body parts 191–193 Indian religion See Buddhism insanity See madness insight meditation 56–59 internet and Islam 31–33 intuition 131–133, 144 intuition, medical See medical intuition intuitive healing See medical intuition Iran and sale of body parts 190–192 iridology 141 Islam 6, 9 body as sacred 9, 27–28, 29 concept of body 27–49 law (See fatwas; Islamic law) and modern medicine 31–49 Muslims and non-Muslims 27–30, 39–42, 45–46 world view 28–29 See also Shiite Islam; Sunni Islam Islam Online 32, 38–39, 41, 42, 49 Islamic law 29–35 and the body 33–35 and modern medical issues 31–35, 37–49 traditional 30, 33–34, 47–48 See also fatwas

293

IVF See in-vitro fertilisation Jesus the healer 92 Jews See Judaism Job (Biblical figure) 158, 159 Judaism body as sacred 9, 28 and Islam 28, 29 masculinity and national identity 245–246, 256–257 Nazi Germany 250, 259–260, 264, 266 Khamenei, Grand Ayatollah Ali Hosseini 32, 44 khandha (Buddhist mental phenomena) 58–59 kidneys 54, 189–201 sale of 12, 36, 190–196, 200–201 transplants 33, 189 See also organs, sale of killing disguised as medicine 252, 254–260 See also crime and criminals Koran See Qur’an Lawrence, D. H., on illness 12, 147 legal rulings in Islam See fatwas Lessius, Leonard 94 life after death Buddhism 88 Christianity 79–80, 83–84, 86, 87–88, 96–97 Confucianism 88 Shinto 85–86 Taoism 88 See also death; hell; resurrection life energy or force 71–72, 130, 137 See also the Divine life expectancy 82–83, 84, 87, 99 and morality 81 life saving, in Islamic law 34, 39, 40, 45 life style 81, 83, 93–96, 113–116, 148 See also affluent society; diet; discipline of the body; male body; obesity; personal responsibility; sin life style, sedentary 95, 233–234 and economics 224 and male body 234, 239, 243 and obesity 206, 208, 228 See also obesity; sloth longevity 82–83, 88–91, 99 loving-kindness meditation 59–62

294

index

lust 92, 114, 215, 217, 234 Lutheran religion 220–221 luxury See affluent society madness 250–260 mythical origins 261–262, 264–265, 266 religious fear of 264–265, 266 and the state 260–267 treatment 252–254, 256–260 male body 236–237 Australian Aborigines 17–26 Buddhism 55 and economic status 234–235, 236, 237 health and life style 234–235, 237–238 loss of virility 231–232, 234–235 and nationalism 13–14, 231–232, 236, 239–243 Nazi Germany 251, 254–256, 263–264 therapeutic sexual behaviour 88–89 See also masculinity; military Marie-Terese, Queen of France 125–127 masculinity 233, 234, 235, 238, 246–247, 255 and male identity 241–243, 245–246, 255 and nationalism 231–233, 239–240, 245–246 Nazi Germany 251, 254–255 See also male body; military mass murder See killing matter and spirit See mind and body matter, concepts of ancient India 52–53 China 88 spiritualist religions 69, 70, 71, 73, 78 medical ethics 2 Buddhism 62–66 Islam 31, 33–49 Nazi Germany 249–267 See also ethics medical experiments See medical ethics medical intuition 11, 129–146 as medical system 134–142 social status 134–139 See also clairvoyance medical practitioners 166, 259 alternative medicine 136–146 professional identity 140–141, 143–144

professional relationships 139–143, 146 medical systems See health care systems medical terminology 93, 142 Nazi Germany 250, 252–254, 258, 259, 265 medical traditions, early Indian 51–56 medicine and totalitarian regimes 249–267 meditation Buddhist 51, 54, 56–62, 63 health benefits 61–62 in spiritual healing practices 72 mediums 76–77, 78, 86, 138 men’s bodies See male body meridians 70, 75, 78 Methodism 95–96 military 231, 233, 234–235, 236 compulsory service 242–244, 245, 246 and pain 233 training 233, 241–243 See also male body; masculinity mind and body 131 alternative medicine 69 Buddhism 51, 53–54, 58–59 miraculous healing 117–120 Modern Theosophy 70–71 monks 95–96, 205, 215–219 moral conduct See ethics; life style; morality; sin; virtue moral conformity 79, 80 moral language in health 205–212, 214 morality and biology 100–101 Buddhism 62–66 Christianity 80, 85–86, 91–98 and health 91–98 pre-industrial societies 79–80 and prolongevity 81, 85–87, 91–98 and science 2, 80–81, 100–101 See also ethics; sin; virtue morals See ethics; sin; virtue murder See killing; medical ethics Muslim law See Islamic law Muslims See Islam nation and nationalism 13, 231–232, 239–240 concepts of 231, 240, 242, 246–247 European origins 231, 239, 242–246 gender differences 240 and the male body 231–232, 236, 239–247 nation building 241–242, 244

index and violence 240–241, 243–244 National Socialism See Nazi Germany naturopathy 135, 137, 141, 143 Nazi Germany 249–267 New Age beliefs 3, 70, 78, 131 concepts of body 10, 72 See also spiritualist religions Nietzsche, Friedrich 81–82, 87, 100, 103 non-dualist model of the body 11 obesity 7, 8, 13, 94, 100, 205–230 causes 206, 207–211, 227, 228 and health policy 207–212, 227–230 medical consequences 189, 206, 211–212 moral judgements 8, 13, 205, 208, 210, 221–227 and Protestant Christian ethic 219–230 research on 207–212, 224–227, 229 social consequences 206–207, 212 social understanding 94, 210–214, 224–226 See also life style online fatwas 32, 38, 41, 42, 47, 49 organ donations and transplants 174–176, 178 Islam 9, 31, 33, 35, 39–44, 48 Judaism 9 and the state 2 See also organs, sale of organ retention 175, 178, 180 organs, sale of 12, 190–201 attitudes to 194–201 India 191, 193 Islam 36, 42 personal responsibility 198–200 and the state 190–196 welfare of sellers 190–193, 198–201 See also blood donations and sales; kidneys; organ donations and transplants Orthodox Jews See Judaism pain and suffering 158–159, 235 attitude of medical practitioners 236 Christianity 11–12, 113, 117–127, 158–159 mystic traditions 158–159 as nation building 13, 231–232, 241–242 as a paradox 11, 234–236, 239 as punishment (See penance; punishment by illness) See also discipline of the body

295

Pakistani fatwas 34, 46–47 Pali canon (Buddhism) 10, 52, 55, 59, 60 panca sila 63–64 Paracelsus (Phillip von Hohenheim) 10, 70 pathology and death 180–183, 185–187 patients in alternative medicine 134–136, 141–142 in hospital 160–163 as prisoners 250, 254, 256–259 relationship with healer Australian Aboriginal 20–22, 34 Greek medicine 93 in spiritual healing 72–73, 77, 141, 144 spiritual needs 160–167 penance 113, 116, 119, 121, 126 See also pain and suffering perceptual abilities, alternative medicine 72, 134, 144–146 perceptual abilities, Buddhism 54, 58 person, concept of Australian Aborigines 17–18, 23, 25 Islam 28–30 Judaism 28 personal faults See seven deadly sins; sin personal responsibility 195–200, 207, 210–214, 219, 227 Philippines and blood sales 192–193 physical body See body, concepts of; female body; male body physiology 27–49 Ayurveda 53–54 Buddhism 54–62 piety, personal See virtue plastic surgery in Islam 35, 37, 48 pleat concept (Gilles Deleuze) 9, 18, 24–25 politics and Buddhism 65–67 pornography 194–195, 235 post-modern life style 3 post-mortems See autopsies privacy 122–125, 162, 165 prolongevity 80–83, 88–89, 90–91, 98–103 prostitution 194–198, 201 Protestant Christianity 95–96, 206, 219–223 dieting movements 221–223 and health policy 227–230 and obesity 223–230 psychic healing 129, 130–131, 132, 143–144 public good in Islamic law 34, 43–45, 48

296

index

public policy See health policies; the State punishment by illness 79–80, 113–115, 121, 238 See also pain and suffering purification by illness 158–159 quality of life 100, 101–103 Queen Anne of France See Anne of Austria, Queen Mother of France Queen Marie-Terese of France See Marie-Terese, Queen of France Qur’an 39, 41, 42, 199 body as sacred 36 and non-Muslims 27–30, 39–41 racial discrimination 245–247, 250, 256–260, 266 racial hygiene See racial discrimination reason and intuition 131, 132, 142–146 referrals 141, 142, 166 reiki See spiritual healing religion and spirituality See spirituality and religion religious faith See faith, religious Renan, Ernest 231 resentment theory 81, 87 resurrection 83–84 See also life after death resurrection of the body 79–80, 85, 87–88, 96–98 reward-punishment morality 79–80, 85–87 rites and rituals 153–154, 157–158, 160–165, 176 Islam 28 Rousseau, Jean-Jacques 239, 242 sacramental perspective 156–162 sacraments, Christian 160, 161–162 sacred healing See spiritual healing sacrifice 231, 235, 244, 247 salvation, Christianity 79, 85, 86, 91–92 Satan 264 Se7en (film) 213 Sebald, W. G., Austerlitz 250, 252–254, 260 sedentary life style See life style, sedentary self, concepts of Australian Aborigines 18, 23–25 Buddhism 10, 59

Christianity 96–98 as commodity 193–196 as energy field 11, 72, 131 in Taoism 74–75 See also body, concepts of senses and sensations 54, 72 in meditation 56, 57–58 seven deadly sins 205, 211, 215–219 sex-change surgery in Islam 36 sexual behaviour 88–89, 237–238 Shari’i See Islamic law Shiite Islam 9, 28, 32, 44–46, 49 See also Islam sin 114, 205–230, 239 sexual behaviour 237, 238 See also life style sin, language of 205–230 and health policy 205–212, 227–230 and popular culture 212–214, 221–223 theological origins 205, 215–219 al-Sistani, Grand Ayatollah al-Sayyid ‘Ali al-Husayni 32, 45 sloth 13, 205–212 and health policy 207–212, 227–230 moral judgements 13, 205, 222–223, 238 in popular culture 212–214 theological origin of the term 215–219 social action and Buddhism 65–67 social exclusion 253, 256–257, 260–267 social relationships, Australian Aborigines 19–24 social relationships, Islam 29–30 social status and health 46, 80–81, 94–95, 206, 234–238 social status and morality 79, 80, 86–87, 95 social status in Islam 29–30 sorcery 21, 22 soul 11, 12, 80, 82, 84, 92 and illness 147–148, 158–159 See also spirituality, Christian spa resorts 249–250, 252–253, 254, 258 spirit guides 130, 132–133, 143 spirits 53, 75–76, 130, 132–133 spiritual healing 6, 11, 76–78, 129–146 Australian Aborigines 21–22 Christianity 91–92 in hospitals 160–167 as a medical system 134–137 social status 134–139

index See also health care, holistic; spiritualist religions; Traditional Chinese medicine spiritual searching 12, 148, 158–160 Spiritualism 69–70, 76–78 See also spiritualist religions spiritualist religions concepts of body 10, 69–76 healing practices, spiritual healing See also New Age beliefs; Spiritualism spirituality and illness 3, 147–148, 151–152 and religion 3, 147–148, 151–153, 156 Christian 13, 92, 161–162 See also soul spirituality, personal 147, 151–152 Starobinski, Jean 233 the state and medical ethics 2, 13–14, 258–259, 260–267 and the military 236 and prostitution 196–198 and sale of body parts 190–192, 196–198, 201 stem-cell research 82, 100, 101–102 subtle body 10, 69–78, 129, 131–132 hierarchy of bodies 71–72 relationships with other bodies 72–73 suffering See pain and suffering Sunni Islam 9, 28–44 See also Islam Sunni Islam Online See Islam Online surgery 37, 39 surgery, cosmetic See cosmetic surgery surgery, plastic, in Islam See plastic surgery in Islam Tantric concepts of body 70 Taoism 74–76, 88–89 teachers 143–144 temperance movement 221 terrorism 260–267 Theosophy See Modern Theosophy Theravada Buddhism 10, 56–62 Theresienstadt 252, 254, 260–267 Third Reich See Nazi Germany Tibetan medical systems 54 tissue transplants See organ donations and transplants

297

torture 232, 235, 249–250, 254, 258–259, 265–267 touch in spiritual healing 72, 130 traditional Chinese medicine 69, 73–76, 80, 88 traditional healing practices, Australian Aboriginal 21–22 Twelver Shiite Islam See Shiite Islam ultimate reality See the Divine; life energy or force United Kingdom and German prisoners 249, 265–266 United Kingdom and obesity 205, 207–212 United States of America dieting culture 214, 221–223, 228–229 Protestant ethic 221–226 sale of body parts 192–194 universal energy See life energy or force vices See sin violence 232, 235, 240–242 virtue 86, 93, 110, 113–118, 122–127, 215–219 See also ethics vision in spiritual healing 72, 77 visualisation 10, 60, 130 war and masculinity 243–245, 247 water 249–267 cold versus warm 257–258 as “cure” 251–254, 257–258, 267 and madness 251, 252, 254–258, 263–264 use as torture 249, 250 water boarding 267 Weber, Max 5, 98, 220, 225, 228 websites, Islamic 32, 39, 49 Wesley, John 92–93, 95–96 will of God See Divine will wills (testaments) 170 wind and the body 52, 54 women as spiritual healers 133–138, 140–145 women in western society 233 women’s bodies See female body Yoga

69, 70, 71–72, 78

Zaydis Shiite Islam See Shiite Islam

INTERNATIONAL STUDIES IN RELIGION AND SOCIETY ISSN 1573-4293

1. HAAR, TER, G. & J.J. BUSUTTIL (eds.) Bridge or Barrier. Religion, Violence and Visions for Peace. 2004. ISBN 90 04 13943 5 2. VEN, VAN DER, J.A., J.S. DREYER & H.J.C. PIETERSE. Is there a God of Human Rights? The Complex Relationship between Human Rights and Religion: A South African Case. 2005. ISBN 90 04 14209 6 3. GIESEN, B. & D. ŠUBER (eds.) Religion and Politics. Cultural Perspectives. 2005. ISBN 90 04 14463 3 4. PRATAP KUMAR, P. (ed.) Religious Pluralism in the Diaspora. 2006. ISBN-13: 978 90 04 15250 2, ISBN-10: 90 04 15250 4 5. HAAR, TER, G. & Y. TSURUOKA (eds.) Religion and Society. An Agenda for the 21st Century. 2007. ISBN-13: 978 90 04 16123 8, ISBN-10: 90 04 16123 6 6. BEYER, P. & L. BEAMAN (eds.) Religion, Globalization, and Culture. 2007. ISBN-13: 978 90 04 15407 0, ISBN-10: 90 04 15407 8 7. MCCLOUD, S. & W.A. MIROLA (eds.) Religion and Class in America: Culture, History, and Politics. 2008. ISBN 978 90 04 17142 8 8. DOSENRODE, S. (ed.) Christianity and Resistance in the 20th Century. From Kaj Munk and Dietrich Bonhoeffer to Desmond Tutu. 2008. ISBN 978 90 04 17126 8 9. SJØRUP L. & H. RØMER CHRISTENSEN (eds.). Pieties and Gender. 2009. ISBN 978 9004 17826 7 10. HVITHAMAR A., M. WARBURG, B. JACOBSEN (eds.). Holy Nations and Global Identities. Civil Religion, Nationalism, and Globalisation. 2009. ISBN 978 9004 17828 1 11. BURNS COLEMAN E. & K. WHITE (eds.). Medicine, Religion and the Body. 2010. ISBN 978 9004 17970 7