The Body in Distress

Understanding of oneself and one's world begins with the orderly functioning of the body (G. Becker, 1997). This known body has been described by Leder (1990) as "the absent body" that is taken for granted. But when the body and embodied knowledge become disordered through physical or emotional distress, the body is experienced in its immediacy, whether through pain, physical or emotional discomfort, or even through the absence of expected bodily feeling, such as Sacks (1984) and Murphy (1987) have described for their own experiences. Examining the body in distress has been a central motif in the burgeoning phenomenologically based literature in medical anthropology on a wide range of topics (for example, G. Becker, 1997; B. Good, 1994; Gordon, 1990; Gordon & Paci, 1997; Jenkins & Valiente, 1994; Kaufman, 1988a, 1988b; Kleinman, 1988, 1992; Kleinman & Kleinman, 1991; Ots, 1990, 1994; Pandolfi, 1990; Scheper-Hughes, 1992).

Illness disrupts embodied knowledge. G. Becker (1997) observes that when a serious illness occurs, sense of bodily wholeness disintegrates and individuals struggle to recreate a sense of bodily continuity in order to restore meaning to life. This disruption of taken-for-granted embodied knowledge challenges one's known and seemingly predictable world. Suffering arises not only from the experience of bodily disruption but from the effort to articulate that disruption, as well (G. Becker, 1997). The difficulty of putting suffering into words is especially noted in the literature on chronic pain (Garro, 1992; M. J. Good, Brodwin, Good, & Kleinman, 1992; J. Jackson, 1994; Kleinman, 1992). Phenomeno-logical approaches have also been used to interpret the experience of specific illness syndromes such as nervios (Low, 1994), susto and fallen fontanelle (Castro & Eroza, 1998), and calor (Jenkins & Valiente, 1994).

Phenomenologically oriented work emphasizes the relationship between the esthetics of the known body and healing. Desjarlais (1992a, 1992b, p. 1105) demonstrates how healing by Yolmo shamans is directly tied to the experiencing body and "works to reinstate a visceral sense of harmony, completion, and vitality." Similarly, Roseman (1990, 1991) and Devisch (1993, 1996) trace embodied understandings of selves directly to healing practices, especially to dance forms, while Boddy (1988) finds that women regenerate sense of self and recontextualize experience through a diagnosis of possession and participation in curing rites such as trance. (Other phenomenological studies of healing include Briggs, 1996; Csordas, 1994b, 1996; Laderman & Roseman, 1996; McCallum, 1996.)

Considerable phenomenologically oriented work has been done on the interface between the lived body and biomedicine. A phenomenological approach highlights disjunctures between the practice and philosophy of biomedicine and the experiencing body, and especially the effects of these encounters on people in delegitimiz-ing or destabilizing bodily knowledge and experience (for example, G. Becker, 1997, 2000; Becker & Kaufman, 1995; Estroff, 1991; M. J. Good et al., 1992; B. Good, 1994; Gordon & Paci, 1997; Kaufman, 1988b; Kleinman, 1988; Mattingly, 1998; Mattingly & Lawlor, 2001; Rhodes, McPhillips-Tangum, Markham, & Klenk, 1999; Toombs, 1987, 1993; K.Young, 1997). For example, K. Young (1997) provides a detailed description of how biomedicine intervenes and disregards the known body, and Mattingly (1998) demonstrates how therapeutic plots reshape people's understandings of their bodies and their health. This body of work also addresses the construct of resistance (Kleinman, 1995) and illustrates how people resist biomedical interpretations and how they act on their own behalf (G. Becker, 1997, 2000; Becker & Kaufman, 1995; Kleinman, 1988; Mattingly, 1998; Root & Browner, 2001). Most recently, a phenomenological approach has been applied to biotechnology (G. Becker, 2000; Csordas, 2000; Goslinga-Roy, 2000).

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