Academic journal article Health Sociology Review

The Ill-Health Assemblage: Beyond the Body-with-Organs

Academic journal article Health Sociology Review

The Ill-Health Assemblage: Beyond the Body-with-Organs

Article excerpt

Health and illness are phenomena that are material, experiential and culturallycontextual: diseases affect organs and cells, but also influence experience and identity, and manifest within contexts and across populations. Health and illness are shaped by social institutions and cultural beliefs (Cromby, 2004, p. 798; Turner, 1992, p. 36), as well as by biology. The social of health and illness has provided myriad illustrations of the social character of health and illness (for example, Armstrong, 1983; Conrad, 2007; Helman, 1978; Kleinman et al., 2006).

Despite this work, and the elaborations of a social model of embodiment over the past 20 years, sociologists generally work with an implicitly or explicitly biomedicalised bodywith- organs as the location of 'health' and 'illness', and as the ontological unit of sociological analysis. The institutions of medicine established this organic model of the body, founded upon a medical discourse on the body that has been elaborated from Hippocrates and Galen to the present day. Foucault and others have described the development of this discourse over the past 300 years, as modern hospitals emerged as locations for observation of the organic body (Foucault, 1976), and the establishment of an archive in which the biomedical body is fully documented (Foucault, 2002, p. 145). The body-with-organs is the focus for economic and political activity, for the disciplines of modernity and for the stratification of society by gender, ethnicity and age. This discourse has also entered the popular domain, and medical advice or self-help books about the biomedical body are legion (Bunton, 1992, pp. 232-234). These ideas about the body and health create the body-with-organs (Deleuze & Guattari, 1988, p. 158) in which biology and the medical sciences define the body in health and illness.

In this paper, I want to suggest that this ontology of the body, and consequently of health and illness, has unnecessarily constrained sociological analysis. For example, the human body's individualisation in biomedical care has been recapitulated in many social studies of health and illness, in which the individual is taken as the unit of exploration and analysis, with a focus on individualised experiences of ill-health and healthcare. Ill-health is too quickly accepted as an attribute of an individual body, rather than a wider, ecological phenomenon of body organisation and deployment within social and natural fields.

I shall apply an alternative perspective on embodiment and ill-health, deriving from the work of Gilles Deleuze, in partnership on occasions with Félix Guattari (see, for example, Deleuze & Guattari, 1984, 1988, 1994). Deleuze's perspective on the body emerged from his reading of Spinoza (Deleuze, 1992), in which the focus is not upon what a body is but upon its relations and its capacities to affect and be affected. Deleuze contrasted the medicalised body-with-organs with a body-without-organs (BwO), the latter being an organic/non-organic confluence of biology, culture and environment (Deleuze & Guattari, 1984, p. 9). The BwO emerges from a sea of relations that may be physical, psychological or cultural. This approach de-centres the biological aspects of embodiment, while retaining biology and physicality as a (necessary but not privileged) component of the body.

This perspective, I will argue, holds substantial promise, focusing on health and illness as assemblages of the relationships and connectivities that constitute non-organic bodies-without-organs (networks that may incorporate other bodies, inanimate objects, institutions and ideas). Within these assemblages, organs are but one element, and neither biology nor the social is privileged over the other (Deleuze & Guattari, 1988, p. 336). Health and illness assemblages are disseminated effects, no longer properties of an organic body, but emergent features of relationships between bodies and other elements (Buchanan, 1997; Duff, 2010; Fox, 2002; Fox & Ward, 2008a). …

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