Embodiment in the Post-Postmodern Era of Illness
Madeline Behee, MD/MA in Urban Bioethics, class of 2027
In 1995, Arthur Frank wrote “When Bodies Need Voices,” a text detailing how the ill body has been perceived throughout history. As a first year medical student pursuing a Master of Arts in Urban Bioethics, I found this text of particular interest, as how we view the body informs our medical practice and patient interactions. I want to share my thoughts on this text with other medical students and physicians as we are optimally placed to observe and navigate these changes in cultural perspective. Arthur Frank explored this idea and delineated clear distinctions in patient embodiment between the premodern, modern, and postmodern eras of illness. As we shift into a new technology-driven digital age, I would like to argue that we are also entering a post-postmodern era of illness with distinct changes in how we view the body in a medical context.
The body and the illness experience
The body and how we perceive it is at the center of medical practice and the illness experience. How we view the body can be broken down into three distinct conceptions:
- the patient body as seen by the physician
- the diseased body as seen in popular culture, and
- how the patient understands their own body and illness.
These lenses can be referred to as the body as specimen, spectacle, and patient, respectively (Jones, 74, 2011). Our perception of the body is a consequence of prevailing societal norms, events, and culture and thus is fluid throughout time and space. To understand patient embodiment in today’s society, we must understand how it has changed throughout the history of American medicine.
The premodern era: An individual and intimate view of the body
In what is considered the premodern era, medicine lacked standardization. There were few paid positions as hospital staff and most doctors of the time were soloists who had their own practices with private patients. Home visits were also common. Doctors had personal relationships with their patients and intimate knowledge of their lives, which at the time was widely considered crucial to proper treatment. (Berg and Harterink, 16, 2004). Berg and Haterink describe how “rather than ‘bodies,’ patients were individuals constituted by their social class and moral worth” (18, 2004). This view of the body dominated until the early 20th century, when the hospital became the center of healthcare in the United States.
The modern era: The body as numbers and figures
During the early 20th century, when hospitals became prestigious institutions and evidence-based medicine was delivered by professional care teams, we shifted into what can be described as the modern era of illness (Berg and Harterink, 14, 2004). During this time, new technologies such as X-rays, pathology, and laboratory services made medical care more complex. A patient no longer saw just one doctor but an entire team of professionals, facilitating the need for systematization and standardization. This led to the creation of the modern, patient-centered medical record.
As a result, the embodiment of the patient changed. The patient was transformed into numbers and jargon, and the chart became “the official story of the illness” (Frank, 5, 1995). The whole-self narrative is erased beyond what is medically necessary, and the focus is shifted to documenting objective facts.
Moreover, as the hospital developed as an institution, it became increasingly compartmentalized. Physicians specialized in acute care of specific organ systems, chopping the body into parts, each with their own space in the patient chart (Berg and Harterink, 23, 2004). This loss of narrative and breakdown of the body into parts facilitated viewing the body primarily as a specimen. The medical system took ill bodies and ascribed to them numbers and formal diagnoses as an attempt to understand objective truth as it relates to disease, without understanding the person.
The postmodern era: Reclaiming the body through narrative
As we entered the second half of the 20th century, the way we, as a society, began to view illness changed. The modern era saw the personal narrative replaced by the medical narrative as told by the physicians. In 1995, Frank wrote, “Illness has come to feel different during the last twenty years, and today the sum of those differences can be labeled postmodernism” (4). This postmodern era, he argued, is when people reclaimed the capacity to tell their own narratives. The popularization of radio in the 30s, television in the 50s, and the internet in the 90s made the sharing of one’s own narrative easier than ever before. People gained the ability to share and connect with others who had similar lived experiences.
Another shift that characterized the postmodern era was the predominance of chronic disease. As medicine advanced, people were no longer as threatened by acute illness but by chronic disease. Living with complex, chronic illness in a medical system designed to treat acute, single-organ system problems is both physically and mentally taxing — further fueling patients’ desires to share their personal stories with others. These subjective views of illness allowed us to envision the body as patient. From the medicalized perspective that predominated the modern era we viewed the body as numbers and specialized terminology, but in postmodern times, we were given the opportunity to glimpse into the lives of patients and view them as whole.
The post-postmodern era: Diverse bodies on display
Although many of these things are still true today, I would argue that technological advancements in recent years have perhaps brought us into a post-postmodern era with distinct ways of viewing the body that did not exist before 1995, when Arthur Frank wrote, “When Bodies Need Voices.” In the postmodern era, media (newspapers, radio, television, and the early internet) allowed patients to share their narratives with others. During this period, most forms of public media were selected and managed by publishing and broadcasting companies. This limited the scope of stories circulated through our society to those the media companies deemed acceptable. While the range of what was deemed acceptable for public consumption fluctuated over the years, the predominance of white, wealthy, Christian media remained constant. This limited those who were able to share their illness stories with the public and painted a picture of who suffered from certain diseases and what an ill body is “supposed to’’ look like. While the subjective stories that were told in the postmodern era allowed us a glimpse of what it is like to live in an ill body, many people did not feel those narratives embodied their experiences. However, since 2000, I would argue that three distinct factors have changed how stories are shared in our society and thus have changed how illness is embodied once again.
The increased demand for diversity in mainstream media, the rise of streaming services, and the development of social media platforms over the past two and a half decades have allowed for more diverse illness stories to be told. The demand for a broader perspective, perhaps more universal truths that applied to a wider population, was met through these technological advances in the 2000s. Diverse bodies now have a place on television; a range of skin colors, religions, sexualities, and abilities are seen more often as the public demands and holds networks more accountable for diversity and inclusion. Additionally, streaming services, which have exploded in popularity, are not subject to the same censorship laws as cable television. This allows for more intimate and explicit looks into people’s lives, including those who are ill and disabled. Lastly, the rise of social media platforms, including YouTube, Facebook, Instagram, and more, has allowed people of diverse backgrounds to share their unique illness stories with a wider audience than ever before. These three developments allow us to not only envision the bodies of others as patient, but also our own bodies, as we are able to see people like ourselves reflected in the media.
Similar to how increasing the sample size increases the power of a study, increasing the number and diversity of illness stories that are shared allows us to reach more accurate and representative conclusions. In this post-postmodern era, we are shifting away from the one-dimensional subjectivity that predominated the postmodern era. We are still able to see bodies as whole people as opposed to medicalized specimens, but the societal perception of what it means to live in an ill body is broadening. This was made possible by the technological advances that have amplified diverse perspectives, as well as the increasing diversity of practitioners. In the 21st century, how we view the ill body is more comprehensive and multifaceted than ever before.
Madeline Behee is an MD/MA in Urban Bioethics student at Lewis Katz School of Medicine. She graduated with a degree in Biology from the University of North Carolina at Chapel Hill in 2021. Her research interests include AI in healthcare and the ethical challenges presented by emerging medical technologies.
