Healthy bodies, social bodies: Men's and women's concepts and practices of health in everyday life

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<ul><li><p>Sot. Sci. Med. Vol. 36, No. I, pp. 7-14, 1993 0277-9536/93 55.00 + 0.00 Printed in Great Britain. All rights resewed Copyright 0 1993 Pergamon Press Ltd </p><p>HEALTHY BODIES, SOCIAL BODIES: MENS AND WOMENS CONCEPTS AND PRACTICES OF </p><p>HEALTH IN EVERYDAY LIFE </p><p>ROBIN SALTONSTALL Center for Biomedical Ethics, Stanford University, Stanford, CA 94305, U.S.A. </p><p>Abstract-Using interview data from white, middle-class men and women, ages 35-55, the research explores the phenomenological, embodied aspects of health. Health is found to be grounded in a sense of self and a sense of body, both of which are tied to conceptions of past and future actions. Gender is a leitmotif. The body, as the focal point of self-construction as well as health construction, implicates gender in the everyday experience of health. The interplay between health, self, body, and gender at the individual level is linked to the creation of a sense of healthiness in the body politic of society. If social psychological theories of health are to reflect adequately the everyday experience of health, they must begin to take into account the body as individually and socially problematic. </p><p>Key words-self/body-concept, gender, embodiment, health concept </p><p>INTRODUCTION </p><p>Sociologists and anthropologists of medicine have largely focused their research on sickness and illness, thus obscuring social scientific investigations of health and healthiness. Analyses which have taken health as their focus have examined the structural, cultural, and material aspects of health, and not the phenomenological elements, especially those related to the body [l]. </p><p>The body as problematic is beginning to be more evident in some sociological investigations. Recent analyses of fitness have begun to address embodi- ment, health, and self [2]. Espeland [3] and Kotarba [4] examine the explicit role played by the body in the construction of self in their studies of giving blood and experiencing chronic pain. Olesen et al., in their research on the mundane ailment, have proposed a new concept of self, a physical self [5]. This new perspective on the body is due in part to the recog- nition that sociological theory has tended to cast human beings as primarily cognitive and rational actors, while neglecting to account for nondeliberate actions (habits), for affective phenomena (emotions), and for the body as more than simply a surface upon which social and cultural meanings are bestowed [6-M]. </p><p>I argue in this paper that the experience of being healthy is another-instance in which the phenomeno- logical body is explicitly salient. No longer can the body be considered theoretically as an abstract uni- versal concept, but must be considered in its concrete- ness as a lived experience of socially and historically situated men and women. This lived experience en- tails simultaneous processes of interpretation and communication: interpretation of ones own and others particular bodies and communication of ones </p><p>self as healthy and as member of a social group. Gender is an underlying theme. </p><p>I propose that social psychological theories of health need to take account of the body as personal and socially situated in the construction of self (and other selves) as healthy. This requires bringing into the theoretical foreground the processes and practices of everyday life through which the body is con- structed and known in its concreteness and particu- larity. </p><p>Methodology </p><p>This research is based on open-ended, unstructured interviews with 9 white, middle-class men and 12 white, middle-class women, ages 35-55. The sample of convenience was limited in size due to financial considerations. None of the respondents had children and all had significant others. The selection of re- spondents for the research who were partnered and without children alleviated having to address the effects of parenthood and single-hood on health behavior. Interviewees were informed that the inter- view could be as long as necessary or convenient for them. Typical questions included: Do you consider yourself a healthy person? How do you account for your healthiness? What kinds of things do you do for the sake of health? How do you know if someone else is healthy? and so forth. To analyze interview data, I used the grounded theory method of iteratively coding and categorizing data to uncover thematic categories [ 161. </p><p>Findings related to respondents abstract concepts of health are presented first, followed by related findings concerning the body and self in health, the reflexivity of self and body in health, and gendered differences in the phenomenological experience of self </p></li><li><p>8 ROBIN SALTONSTALL </p><p>and body. Findings related to health practices are then presented and include discussions of body main- tenance, body insignia, and the interplay between gender norms and health practices. The concluding section draws out implications of the research for social psychological theories of health. </p><p>MENS AND WOMENS CONCEPTS OF HEALTH </p><p>In general, men and women shared similar ideas about what constitutes health. The cosmos of health depicted in definitions included most aspects of being human: physicality, consciousness, emotions, spiritu- ality, and social situation (family, work, and income level). The idea of health was closely associated with the idea of well being; that is, abstract notions of health and healthiness were identified with the posi- tive aspects of being in the world and were grounded in lived experience. Some definitions were so encom- passing that they approached amorphousness, but their grandness indicated the degree to which contem- porary mens and womens ideas of health have become synonymous with a particular condition or state of life itself. As is discussed below, the homogeneity between mens and womens abstract conceptions of health dissipated into gender specific forms when everyday actions were considered. </p><p>Many men and women defined health compre- hensively, referring to it as a state or condition of being, and often relating this condition to capacity, performance, and function: </p><p>My definition of health would be physical, mental and emotional well being (male). </p><p>(Health is) being balanced in the things you do (female). </p><p>One striking variation was that women frequently alluded to friends or family in their definitions of health (while men rarely did so): </p><p>A really healthy person is a well person, they take care of themselves and their family and friends, </p><p>Its also being loved and being able to love. </p><p>Body and serf in health </p><p>Without exception, men and women cited the actuality of being bodied in their concepts of health. Some references to the body were explicit, as in: </p><p>Im a healthy person because Im in shape physically, Im not overweight,. I have good muscle tone, (male). </p><p>(Health is) . . when Im in shape, I feel energetic, and Ive got good color in my cheeks (female). </p><p>Others were implicit: </p><p>. . . The bottom line is that I am able to go through my day and accomplish what I have to do without any physical or mental encumbrances (male). </p><p>Both men and women conceptualized healthiness as flickering in nature, and health as a transitory state </p><p>and a process related to the lived body. As one man phrased it: </p><p>Health is living. Youre alive and youre healthy or youre not healthy as you go along. Its like a living through. </p><p>The bodys history was also seen as contributing to the temporality and transiency of health [17-201: </p><p>I guess health is a relative term anyway. I dont exercise that much I want to but its a time problem and I have allergies. Theyre only slightly debilitating, but I have them (male). </p><p>Definitions of health often referred to deliberate, intentional action involving the body. Each person was seen as having a biological base, a body, and what one did with that body resulted in various states of health. Both men and women mentioned body-ori- ented protocols such as avoiding smoking, abstaining from drinking, eating good foods, getting sleep, and exercising as being essential to health. In short, health was conceptualized as creation [22,23] and accom- plishment [24,25] of a bodied, thinking individual. </p><p>The concept of self was implicit in concepts of health, either as the intentional actor making de- cisions about health actions, or as the consciousness interpreting bodily signs and signals, or as the being performing an action. The self as healthy had both physical and metaphysical dimensions. When asked to describe health and being healthy, respondents moved back and forth between references to them- selves as physical bodies and as sentient beings. Im in good shape, I have good muscle tone, Ive got good color, and I feel energetic, I feel good, I feel challenged. </p><p>Respondents catalogued a kind of health inven- tory which encompassed internal and external, vis- ible and invisible, physical and metaphysical dimensions of themselves. The health inventory in- cluded things ones self was believed to have and things ones self was expected to do. The former included ones own particular stock of corporeal and incorporeal health-related items such as body size and shape, strength, capacity to do, genetic endow- ment, and friends. The latter included ones health-re- lated activities and practices, as in: </p><p>I get enough sleep, I dont over exercise and I dont starve myself. </p><p>These haves and doings were often intermixed in responses: </p><p>Health to me is the food you eat, how you carry yourself, from the clothes you wear, to the size you are, body fat, skin tone, and whether youre sick. I feel if you take care of yourself by working out and eating right,. . you will be stronger and healthier (male). </p><p>I know Im healthy. Im in good shape. I exercise regularly, I eat a very good diet. I know how to avoid getting colds and flus. I get enough sleep. I dont party and abuse my body. I guess, in a nutshell, I take care of myself (female). </p><p>As these remarks suggest, judging ones self as healthy involved a taking stock of ones health </p></li><li><p>Healthy bodies, social bodies 9 </p><p>inventory--of ones self as both material body and interaction, that each self is individual because of its conscious actor. unique sociality and complement of interactions [28]. </p><p>Respondents regarded the balance of items in the health inventory as fluctuating with time and action. Individuals would refer to themselves as having been healthier at a former time, or as becoming healthier through certain activities. In sum, the sense of being healthy involved both a sense of self and a sense of body (a body self), both of which were tied to a conception of past and future actions. </p><p>Id say its a feeling. Either you feel it or you dont on any given day for me its how I feel and for someone else how they feel (female). </p><p>If a person feels that he or she has physical, mental and emotional well-being, then I would say that that person is healthy from that persons point of view. (Health is) very individual (male). </p><p>The rejexivity of self and body </p><p>Berger and Luckmann refer to the eccentric hu- man relationship between organism and self in which the experience of self involves both being and having a body [26]. In this study, when interviewees took stock of themselves as healthy, body and self were not experienced as divided into two parts; that is, as dichotomous mind and body in the Cartesian positivist sense. Nor, as in the Cartesian fashion, was the body described as a vacuum which had been filled up with a mind and a soul [27]. Rather, body and self were described as reflexive aspects of one wholeness, one being; neither complete without the other. The material, or somatic, and immaterial, or asomatic, represented different dimensions of the same self engaged in action in the world. I referred to this reflexive process as the self-soma process. </p><p>Respondents characterizations of the reflexive, contingent, and unique nature of the experience of self and body in health dramatically demonstrates the integral nature of embodiment and self-hood. The experience of self as body and body as self constitutes the human experience, and as such, is saturated with notions of moral action and responsibility. </p><p>Gendered differences </p><p>While both women and men referred to the reflex- iveness, contingentness, and uniqueness of self and body with respect to being healthy, there were nu- ances of difference between men and women in their descriptions of the interactive relationship between self and body. Men frequently referred to healthiness as keeping or being in control and minding ones body. Men seemed to imagine themselves as having power over relationship to their bodies. </p><p>The reflexivity of self and body could be heard in the alternating grammatical referents used by men and women to describe health. Due to the linearity of language, respondents had to separate references to bodied self and minded self grammatically into sub- ject and direct object. However, the referent of the I continually vacillated such that in one sentence the subject would be the bodied self, and in the next sentence, the subject would be the minded self. This reflected the disjuncture between lived experience and linguistic rules, for in lived experience body and self are related to and contingent on one another. The changing referent is evident in the following example: </p><p>Taking control of your health. is the key to an overall sense of well-being (male). </p><p>Men spoke about their bodies as though they belonged to them (in the same way that an object belongs to one). Women, on the other hand, generally did not use the language of ownership when talking about their bodies, but rather referred to their bodies as though their bodies had a momentum or subject- ness of their own [29-311. </p><p>A lot of times I keep on eating even though I know its not good for me. Its like my body just wants those things right then. . </p><p>when I wake up I reflect immediately on how I feel- whether Im tight from the workout the day before and whether I feel like getting up at all. and whether I cant face the day and what I have to do.. (female). </p><p>These gender differences became even more appar- ent when respondents described their health practices. </p><p>The relationship of self and body also had elements of contingency. That is, the state of one was seen as having the potential to affect the state of the other: </p><p>MENS AND WOMENS HEALTH PRACTICES IN EVERYDAY LIFE </p><p>I know Im healthy by the way I feel. . when I go on a binge of junk food . I feel rotten as a person (male). </p><p>The experience of being situated in a particular social and cultural circumstance was conspicuous when comparing mens and womens descriptions of their everyday health practices with their abstract definitions of heath and being healthy. The homogen- eity between mens and womens abstract conceptions of health dissipated into gender specific forms when translated into action in the everyday world. </p><p>Its (being healthy) all those things I said. Its really a body feeling, but its also my head...</p></li></ul>