cA{4BRtDGE STUDIES IN MEDICAL ANTHROPOLOGY

LOCK AND KAUFERT Pragmatic

womenandbody politics Carvrnnroot
xii List of contrìbutors

úe various reports of úe Royal Commission on Aboriginal Peoples

(re93-7).
n n ó o x r c R U N D F E S Ts c H o E P F B r o o k e G r u n d f e s t S c h o e p f ,a n e c o -
Introduction
nomic and medical anthropologist, obtained her doctorate from
Columbia University in 1969. She has conducted field research in
Margaret Lock and Paticia A. Kaufen
England, France, úe US, and ten countries in Africa, most recently
in Rwanda. Currently, Schoepf is on faculty at úe Institute for
Health and Social Justice, the Department of Social Medicine of
Harvard University Medical School (Boston), and úe National
University of Rwanda (Butare).
Living in úe twentieth century, women have experienced an increasing
ANNALEE YASSI Annalee Yassi is úe Director of Environmental and appropriation of úeir bodies as a site for medical pracrice, particularly
Occupational Medicine at úe University of Manitoba. She has in connection wiú pregnancy, childbirú, and úe end of menstruaÌion.
published extensively in úe areas of environmental healú surveil- This phenomenon forms one of úe cornerstones of "úe medicalization
lance, occupational healú for healú care workers, and cross-cultural of life" (Illich 1992:230), a process which is likely to become more
environmental and occupational epidemiology. Yassi is currently intrusive wiú úe laboratory manipulation of human conception and
working on a book and an international training program in basic úe routinization of mass screening programs for genetic drsease.
environmental healú úrough úe \7orld Healú Organization. She is Medicalization has been characterized as úe making of a ..body pliant
also working on several environmental healú projects in Latin to power" (Grosz 1993:199), but úe auúors who have conrributed to
America. úis book (úirteen anúropologists, togeúer wiú two epidemiologists
and an historian as co-auúors on two of úe essays)start out from úe
position úat medicalization and power are ideas which must
be
grounded historically and culturally, as must resistance, agency,
and
autonomy. Frowever, alúough we believe úat úe creation of nuanced
relativistic explanations is essential, úese accounrs are not
our f,nal
objective' situated accounrs should stimulate selÊreflection -
an
exercisewhich, if successful,encouragesanalysts of social
and political
events to pay attention to úe way in which "our own
common senseis
structured" (Zito and Barlow 1994, see also
Rabinow 1977).It is only
on úe basis of úis semiotic rurn, in which
certain truth claims are
decentered, including those originating wiú
úe medical sciences,rhat
artempts can be made to generalizeabout
body politics.
In concluding úis introduction, given úe
rapid spread of knowledge
and technoÌogies,we wilr calr for yei
anoúer move) a "semiotic return,,
to local sites ofresearch in
order to understand better how globalization
af[ectsbody politics.
In Putting úis book together, our primary
.. concern was with the
^mtcrophysics of power', (in Foucault,s idiom) and its operation in
everyday life. rve set out
to provide a series of accounts of women,s
about and responsesto body technologies of various kinds,
l131tease
uut we wanted also ro
situate the subjectivity and agency of women in
the context of úeir lived
experience. r(/e have tried to make crear üe
2 MargaretLock and PatriciaA. Kaufen
extent to which biomedical technologies are not autonomous, but are
úemselves the products of úe same historical, cultural, and political
contexts to which women are responding. Finally, we sought to
elaborate furúer on social science úeory in connection with body
politics, and to úis end we build on several books written by feminist
anúropologists and historians (see, for example, Atkinson and Er-
rington 1990; Ginsburg and Rapp 1995; Straúern 1992; Yanagisako
and Delaney 1995; Zito and Barlow 1994).
Practices and discourse which have particular implications for women
and úeir healú are central in all úe essaysin úis book. Their common
aim is to illustrate úe complexity of women's responsesto úe process
of medicalization, responseswhich may range from selective resistance
to selective compliance, alúough women may also be indifferent.
Flowever, úese essayssuggest úat ambivalence coupled with pragma-
tism may be úe dominant mode of response to medicalization by
women.
Focusing, úerefore, on úe complexity of women's relationship with
technology, úese essays take a quite different position from úose
discussions which start from the assumption úat women are passive
vessels,simply acting in culturally determined ways wiú little possibility
for reflection on úeir own condition. Neither do úe authors set off
from úe opposite premise which defines women as inherently suspi-
cious of and resistant to technological interventions. Raúer, the
contributors propose that women's relationships wiú technology are
usually grounded in existing habits of pragmatism. For by force of úe
circumstances of their lives, women have always had to learn how úey
may best use what is available to úem. If t}:.eappareTttbenefits outweigh
úe costs to úemselves, and if technology serves their own ends, úen
most women will avail themselvesof what is offered.
To úe extent that any thinking about women and the body must
confront issuesof reproduction, we have included a number of essaysin
úis collection which deal wiú different aspects of úe reproductive
body. Lisa Handwerker and Karina Kielmann explore úe meaning of
infertility for women living in countries - China and Thnzania - in
which úe state and úe medical system construe women's bodies in
terms of fertility to be controlled. Iris Lopez explores úe decisions
made by Puerto Rican women in curtailing their fertility. Ellen Lewin
discussesúe ways of becoming fertile chosen by lesbian women. Emily
Abel and Carole Browner focus on the relationship between experi-
mental knowledge of the pregnant body and the quasi-scientific
knowledge of úe prenatal advice literature. Janice Boddy reflects on her
experience as a witness to childbirth in Canada and the Sudan, creating
Introduction 3
of the different forms úat the "colonization of
a compelling account
consciousness" with respect to childbirth takes in úese two cultural
settings. Ellen Gruenbaum situates the fertility and childbirth of
Sudanese women as one important element in the wider context of their
overall health'
yet, we also wanted to steer the book away from the current tendency
(encouraged, perhaps, by our fascination with úe new reproductive
technologies) to portray women's lives as though consumed by
reproduction. By privileging for analysisproblems relating to reproduc-
tion, of outstanding importance though they be, úe danger is úat one
-
of úe most intransigent stereotypes woman equals reproduction -
simply slips by unexamined. Hence other essaysin the book have been
deliberately selected because they deal with quite different dimensions
of women's experience. Emily Abel and Carole Browner explore úe
experience of being a daughter to aging parents; Margaret Lock
describesbeing moúer to a child with Down syndrome in Japan. Soheir
Morsy and John O'Neil and colleaguesfocus on women who question
not only úe impact of science and technology, but also úe role of the
state in úe protection of public health. Brooke Grundfest Schoepf
discusseswomen and AIDS ín Zaire, while Patricia Kaufert reviews úe
history of úe breast cancer movement in úe United States.
Alúough diverse in topic, these essaysshare some commonalities of
approach, such as a mutual commitment to the long overdue but
growing recognition that it is inappropriate to conceptualize a "one
culture/one gender system" when representing women. ÌJírhile some
feminist anúropologists have chosen to minimize differences in
economic and power relations between women, we have tried to avoid
úat particular trap, believing úat the behavior and subjectivity of
individual women cannot be explicated on the basis of gender alone,
even when appropriately contextualized. As many of these essaysshow,
gender is cross-cut by other categories of class, religion, language, and
eúnicity, wheúer ar the local level (as in úe village communiries
described by Gruenbaum) or at the level of international politics (as in
the conferencesdescribed by Morsy).
By úeir use of the ethnographic method in which due attention is
paid to both local practices and local knowledge, these essays run
counter to the critique of resistance studies recently made by Ortner,
namely that they are "ethnographicallythin" (1995:190). Consideredas
a whole, úis book displays a wide array of anthropological techniques,
alúough most authors make use of the "ethnographic stance" (Ortner
L995:173) in which they present empirically rich, conrextualized case
studies. The essaysby Janice Boddy, Ellen Gruenbaum, and Brooke
 Introduction 5
4 MargaretLack and Paticia A' Kaufen
-
on years of eúnographic dominant forms in which power enters or, more accurately,is entailedin
Grundfest Schoepf, for example, are based culture. (Comaroff and Comaroff 199I :22)
villages and wiú úe same people' Ellen Lewin'
fieldwork in the same
of allowing women The majority of anúropologists do not úink of culture as a stable
Iris Lopez and Margaret Lock adopt the technique
entity, âs something which coincides wiú a nation, society, ethnic
,opr"r"n,úeirownstories,butúensituateúeseaccountsinthelarger
fertility' and group, or professional organization. Instead úey úink in terms of
context of dominant ideologies about reproduction' - -
on ofÊcial records' landscapesof group identity "ethnoscapes" in which groups are no
infertility. Soheir Morsy and Patricia Kaufert draw
úe scientific literatures' longer conceptualized as tightly territorialized, spatially bounded,
documentary evidence, government reports'
to reconstruct the history of particular protest historically unselfconscious,or culturally homogenous units (Apparudai
using úese materials
and methods of l99L:192). Few populations have lived in total and Permanent isolation
movements. Despite úese differences in materials
preoccupation wiú from oúers, alúough relatively large portions of úe world's population
research, üe essays are linked by a common
responsesof women to have lived for long periods of time wiúin clearly defined boundaries.
medicalization' the politics of úe body and úe
Today virtually no people remain untouched by úe transnational
biopower in its many different forms'
neworks of communication in which we all participate.
This insight does not dispose of culture as a salient concept around
Contesting the commoÍl sense of culture which meanings are mobilized; it does, however, alert one to úe way in
which the dialectics of domination and resistancetake place in a cultural
of female bodies' it
Before specifically considering úe medicalization field which is fluid and continually open to contestation (see, for
our position on úe central concepts of
may be helpful to outline example, Nordstom and Martin 1992). Globalization has ensured that
culture,ideology,andhegemonyrconceptswhichareusedexplicitlyin úe majority of úe world's people are aware, as never before, úat other
many chapters, and implicitly in úe oúers' ways of being exist beyond úe boundaries of their respective commu-
has appeal for
There are several ..aso.rs-why úe idea of hegemony nities. This experienceencouragesreflection, heightens úe possibility of
it appears to offer a
cultural anúropologists. As úe Comaroffs note' resistance to local social arrangements) or alternatively may lead to a
action and úought'
rcady rapprochementbetween practice and úeory' reaffrrmation of tradition. More frequently, úe consequence is an
power - dualities which many cultural anúropologists
u.ra ia.otàgy and unstable mix of ongoing contestation. As a result of globalization,
(Comaroff and Comaroff 1991)' For Antonio
work hard to paste over ..nothing is anchored to . . . master
hegemonic power) "úat order of signs and practices, relations and
Gramsci' úe creator of úe concept, distinctions, images and epistemologies - drawn from a historically
and certain meanings:
narratives, to stable (positive) identities, to fixed situated cultural field - úat come to be taken-for-granted as úe natural
relations are contestable' hence mutable"
all social and semantic and received shape of úe world and everlthing úat inhabits it"
Thus hegemony is not a given' nor simply a (Comaroff and Comaroff l99l:23), is a shrinking domain. In other
(Hebdige 1988:206)'
is realized only
proa,r.I of oppressive forces or class difference' but words, common sense - úe unspoken auúoriry of everyday life -
ihrough negotiation among competing forces' becomes increasingly subject to disputation. Orthodoxy - úat which is
emphasized úat
Gramsci, and later RayÃond Williams (1977)' boú "naturalized," hegemonic, and taken as selÊevident -_ is brought into
should be kept distinct' consciousnessand made recognizable as ideology, and is úerefore laid
úe ideas of hegemony, tulture, and ideology
by' one anoúer'
arguing that úey cannot be reduced to, or subsumed bare for criticism.
Tal.:rngúis lead, the Comaroffs define culture as: It is at úis disjunction, where tacit culturally shaped knowledge lies
exposed, úat úe assertion of power and associated ideological truú
úe semanticground on which human beings
[T]he spaceof signifuingpractice, claims become mosr evident. Eìidence úat individuals who challenge
seekto construct ;.;i.*"; the"'stlut* and Àúers and' hence'societyaod
""d a-repertoireof hstitutionalized power basescan be perceived as a serious úreat is to be
history.As üis ,r-,gg"rt.'1.,,lture] is not simplya pot of messages'
It has form as well as content; round at times
signsio be flashedr.ross u neutial mental screen. in brutal acts of violence. whether it be the murder of
creativiryas well as g]tnecologists
is born in action *.ii". úought; is a product of human who assist women in obtaining an abortion, or úe
". is not all empowered in úe same
mimesis;and, aboveall, is empúered' But ìt ÌI"tght.t of Algerian women who choose not to conform to Islamic
Ìundamentalism.
way,all of the time. Individuals who dispute either physical violence or
' ' They are the t"r'o
This is where hegemonyand ideology become salient

6 MargaretLock and Paticia A' Kaufert
,,symbolic violence" - the institutionalized vioience of everyday life
(Bourdieu 1977:l9o) - are considered dangerous to a conservatlve
moral order, which is itself undergoing a renewed vitalization
with úe
resurgence of various forms of global fundamentalism and the elabora-
tion in North America of úe New Right'
Biopower and subiectivitY
Inthisbookweareconcernedprimarilywithtaken-for-granted
knowledge as it manifests itself in úe practices of medicine and
public
health. The claims of medical knowledge to a privileged status depend
on úe belief, shared by medical professionalsand the public alike' that
scientific knowledge, being factual, cannot be subject to epistemological
scrutiny. Togeúer with a gaúering number of oúer dissidents'
we
re;..t ihis view of science, and start out from úe assumption that
science and technological practices are historically and culturally
produced. Thus biomedicine and its associated technologies, like all
oúer cultural domains, are subject to discursive negotiation'
In Disciplineand Punish (1979), Foucault made a distinction between
two types of power, one in which authoritative control is exerted directly
over others (which is how medicalization is usually thought to be
enacted), and a second) more insidious form which "proliferates outside
úe realm of institutional politics, saturating such things as aesúetics
and eúics, built form and bodily representation, medical knowledge
andmundaneusage',(seeComaroffandComaroff].99|:22).we
believe úat this division is too stark, for alúough úe practice of
biomedicine can be described as paternalistic and exerting authoritative
gross
control, characterizing it by the first rype of power would be a
is particularly with úe second
oversimplifrcation. our concern here
kind of hegemonic power, for we argue úat tacit knowledge not only
shapes the behavior of practitioners) buÌ accounts for úe mixed and
ambivalent reception of medicalization on the part of women'
\7e do not conceptualize power, therefore, simply as negativity'
oppression, and constraint imposed from the top down. Rather we draw
lead,
on Foucault,s norion of biopower which, following Nietzsche's
emphasizes localized, routinized bodily practices in families' commu-
nities, and institutions. This type of body politics, which Foucault
argued emerged in Euro-America from úe beginning of úe nineteenth
century, construes úe body as a corporeal entity, the boundaries
This physical entity has
which are clearly demarcated anatomically'
become the systematic target for disciplinary measures implemented
Biopower is conceptualized by Foucault
experts of various kinds.
Introduction 7
having two poles: that of "anatomo-politics" focused on the manipula-
tion of individual bodies and, at úe oúer pole, úe manipulation and
control of populations, systematized from the mid-nineteenú century
onwards úrough "techniques of úe survey," which ensured the
possibiliry for regulation of boú public and private life (Armstrong
1983; Foucault 1979). One of Foucault's most pertinent insights was
his assertion that biopower, in creating a domain of expertise,
constitutes its own objects of analysis to which it úen responds. In
oúer words, bodily states are labeled by experts as diseases;certain
behaviors are defined as deviant, unnatural, immoral, opening up úe
way for systematic and legitimized attempts at medicalization of both
body and behavior. Nowhere is úis more apparent úan in úe lives of
úose women who do not fit wiúin normalized categories, such as the
infertile women in China (Handwerker) or Tânzania (Kielmann),
Japanesewomen who produce "deficient" children (Lock), the fertile
lesbian women in California (Lewin). Such women become ready-made
targets of úe medic aI gaze.
Our position here is not simply one of social constructivism,
however; for whiie we recognize with Foucault that úe classification of
illness and deviancy is a discursive exercise, we would also argue úat
úe labeling and diagnosis of physical states often serves its denoted
purpose) namely, as an opening to obtaining a úerapeutic regimen for
úe relief of pain and misery and as a barrier against death. Hence for
women with breast cancer, it is úeir dependency on medicine for
úerapy and relief of suffering that defines the central core of úe
relationship with biomedical research and technology (see Kaufert, this
volume).
At the site of úe individual body, úerefore, biopower may be
experienced as enabling, or as providing a resource which can be used
as a defense against oúer forms of power. At the centre of many of úe
essaysin úis book srands a pragmatic woman willing to use whatever
biomedicine can provide in pursuit of her own goals or the protection of
her independence. This rype of pragmarism explains why infertile
women in Zanzibar went to see a gynecologist (see Kielmann, this
volume) or a lesbian woman in California went to her local medical
clinic when she wanted to become pregnant (see Lewin, úis volume).
Boü groups of women were willing to use a biomedical solution if it
would ensure úeir fertility. Similarly,
Japanese women will embrace
reproductive technologies if seen as a valid means to achieve úeir social
of
and culturally defineJ priorities, namely a family in which biological
and social parentage are one and the same (seeLock, this volume). The
by
realities of being a Puerto Rican woman, trying to survive and raise
as
8 MargaretLock and Paticia A. Kaufen Introduction

children in New York, set boundaries beyond úe control of úe produce themselves as irrevocably different * usually as inferior or
individual woman. Continuing life as a fertile woman almost ceasesto wanting in some waY.
be a meaningful choice, as Iris Lopez shows. Yet, given úe wider system Radical feminists point out úat it is necessaryto locate ..new idioms
of economic and social oppression, being sterilized may also be of alteriry" (suleri 1992:1), to seek out úe often subtle ways in whiçh
interpreted as a source of freedom, providing women wiú some úose who do not apparently control úeir own lives actually consritute
minimal control over úeir bodies relative to oúer forms and conditions different local worlds for úemselves, worlds from which ú.v ."r, reflecr
of eiúer contraception or childbearing. Tubal ligation, known familiarly upon úe ironies of úeir situation, both locally and globaliy. Joan, the
as la operacion,becomes accepted practice, its necessiryrecognized, but woman at úe centre of Mark Nichter's contribution to úis book,
resented. observes boú herself and the medical care system, seeking always ro
Foucault himself argued úat subjects of biopower are not passive subvert its accustomed order, relishing her successes,conscious all úe
recipients; on úe contrary úe body becomes úe center of a "dialectical time of úe battle engaged.
force relation" in which it stands as a "metaphor for úe anatomical In a different but related vein it has been argued by feminists that a
focus and embodiment of power; a materiality that acts as a source and widely shared female subjectivity cannot exist, largely because forms of
target of power, wheúer expressedpolitically, sexually, juridically or in patriarchy, tacit knowledge, and power relations are not universal.
discourse. It is not assigneda binary value as eiúer active or passive,as Kumar criticizes úe tendency in many feminist analysesto dehistoricize
úe perpetrator or recipient of power" (Hewitt L99l:231). Alúough and essentializeúe subject, whether it be "women, peasânts)or tribals,,
subjects do not control úe direction of history writ large, Foucault (1994:7). She stressesúe importance of understanding úe power ploy
insisted úat people have úe ability to choose among available discourse involved in the constitution of "woman as subject,, wiú its emphasis on
and practices, to use them creatively, and to reflect on úem. Thus úe úe "inborn" qualities of women defined as femininity, virtu!, punty,
subject is "neiúer entirely autonomous nor enslaved, neiúer úe nurturance, and so on. She goes on to argue úat the implementaiion
of
originator of úe discoursesand practices úat constitute its experiences, such concepts varies úrough time and space and, úerefore, contextua-
nor determined by úem" (Sawicki 199I : I 04). lization is imperative.
Foucault's theory of biopower is clearly insightful, but feminist critics $íiúout historical contextualization these papers could be in
danger
are uncomfortable wiú the way in which subjects, alúough not of being dismissed as anúropological trivia - culturally
rerative, but
rendered passive,remain marginalized. Many argue úat power relations wiú little significance outside the societies in question.
Historica[y
make competing demands on people, and úat úe complex responsesof gro.unded eúnography permits perceptive
comparisons, highlights the
individuals to boú coercive and more subtle "common-sense" hierar- resilience of culturally constructed value
systems, and above all forces
chies and oppression are underestimated by Foucault. For úis reason an engagement wiú body politics wiúin
and between societies. The
alone research should privilege úe standpoint of úose who are úe women around whom úese essays are
constructed all exist in the
usual targets for normalizing discourse and practices, and feminists who context of a densely described
historical past. In Mark Nichter,s
live and work outside the Euro-American tradition have been par- c-hapter,this past is a singre life
history, but in úe oúer contributions
ticularly active in developing important critiques of much of úe past include, ú. hirtory áf cotonial policy in
*. ï:,."T. the Sudan
researchon subjectivity and agency. Gruenbaum), úe more recent impact of the $7orld
Iloooy,. Bank and
Kumar (1994), for example, takes exception to úe idea of subjugated development and population- policies in Eglpt (Morsy),
(marginalized) knowledge as conceptualized by Foucault, because |;ernationalpopulation policies and its culturally
::l"i:: consrrucreá history of
women and oúer disenfranchised people are inevitably understood in (Handwerker), úe cenruries-long history
i:ïl]ly. of the planned
úis scheme as fully constituted by and reacting only to úose at the rogether wiú the cultural history of reproduction rhere,
;:ïrL]1J"Oan,
center of powerful institutions. Limiting analysis to relationships of t::ïr úe production of children who are wanred by socrery
n':||ï ?"
domination directed from úe top down, even when úe subject is made and the remarkable history of la operacion ín puerto Rico
)illlll
\r-opez).
active, fails to decenter the loci of power it is assigned.In a Foucauldian
analysis, úese hubs of hegemonic engagement remain as úe dominant ^"S.im]larlv, üe essaysall locate the developmenr and implementation
ot technologies of úe
"oúer" in terms of which women everywhere are produced and body not only with respect to úe lives of
 Introduction II
l0 hí,argaretLock and Patricia A. Kaufert
join together with women from a wide range of
individual women' but also in larger social, political' and
global respectivecultures and
discussing situated local practices, levels of societies.Yet writing about these meetings, Soheir Morsy describes a
contexts. Flowever, when
the single woman (Nichter)' one or reaction against W'estern feminist dreams of creating an international
analysis shift between a focus on
women of oppression, arguing úat other women saw the Euro-
two women with a single gynecologist (Kielmann), or families of consciousness
of their village community (Gruen- Arnerican tradition in academic and feminist writing as another form of
functioning wiúin the context \While interested in the creation of a shared discourse,
of
baum). By using the comparative method to examine case studies imperialism.
individual women in canada and úe Sudan, Janice Boddy provides a many delegateswanted to emphasize local problems and local needs as
compelling re-creation of the lived experiences of these women, but also defined by local women. Aware of úe problems which this split had
,.,0.u1, significant differences in the form and functioning of úe
family caused in Cairo, some participants in the Beijing conference tried to
in the two settings. In her conclusion, Boddy draws on a careful review bridge úe gap and achieve a mix of sensitivity to the particularities of
of the causes of maternal deaths to make a powerful statement
for local context (thus avoiding the trap of essentialism) while at tfìe same
improved public health and better distribution of global resources rather time speaking out on issueswhich had universal relevance for women,
úan úe increasing medicalization of úe birth process. Similarly,
other including issuesof power and women's potential for resistance.
essays move from micro- to macrolevels to reveal contradictions
and
between the everyday lives of women and dominant discourses Playing with power
policy making, as in Morsy's analysis of úe impact on women of
ielationships berween úe Eglrytian state and international capitalism' Many of úe authors are concerned with the very notion of resistance'
and in Handwerker's exposé of the management of reproduction by the involving as it does úe question of consciousnessof the motives for
to one's own behavior on úe part of the women studied, and also the
Chinese government. ChildÌess women remain subiect in China
raúer úan being lauded for úeir assumption that resistance is úe only form of active (as opposed to
harassment and discrimination,
passive) behaviour available to women (Abel and Brownerl Hand-
contribution to úe nationally recognized problem of "overpopulation'"
as the werker; Kielmann; Lock). Few of the women portrayed in these essays
w'omen have now been provided with accessto IVF technologies
úe "deficiency" of their infertility' are passive, alúough úe constraints under which many must resist, or
means of overcoming
make their choices, are often narrow. Women in the two villages studied
As several of úe essays show, women may react against local
by Gruenbaum maneuver within the changing patterns of constraints
hegemonies which pit women against women) but they may also
a on úeir lives, trying always to maximize their control over their own
collaborate or remain silent. Schoepf, for example, writes about
from her home after the death of her lives and the lives of their children. Their resistance is for essentially
woman telling how she was driven
pragmatic raúer than ideological ends, but it is in direct response to
husband by his sisters, who, falsely accusing her of having given him
male power.
AIDS, seized all his wealth and property' Janice Boddy explores the
Foucault's famous assertion: "\ü(rhere there is power, there is
different reasonsfor a young woman's death, including the reluctance of
resistance" has been too often cited out of context, in order to force an
her moúer-in-law to offend the family of úe local midwife by seeking
assessmentof power as entirely auúoritarian. For Foucault, although
care from a more competent practitioner in a neighboring village. Greed networks of power facilitate surveillance, úey also produce pleasure,
in the first case, respect for convention in úe other, took precedence knowledge, goods, and technologies, and úey are, therefore, seductive,
over solidarity among women. not only to úose who instigate them but to potential recipients who
Personal gain, class interests, or adherence to tradition are powerful may choose to comply. Foucault also recognized a "plurality of
forces capable of withstand.ing efforts to overcome exploitation by resistances" to power networks, but asserted úat resistance is never
"consciousness raising" and appeals to female solidarity (Lock 1993; exterior to power, nor is it necessarily designed to overúrow any given
hooks 1990). Appeals to some universal form of feminist solidarity are regime or institution.
themselves suspect. Many of úe European and Norú American
James Scott, when doing research in Malaysia, described everyday
delegates attending the International conference on Population and activities such as gossip, slander, foot-dragging, and pilfering as the
Development in cairo in 1994 or the united Nations Fourú world "weapons of úe weak" (1985.29). He understood these activities as one
úeir
conference on süomen in Beijing in 1995 wanted to transcend
l2 lVlargaret Loch and Patricia A. Kaufen
of the few forms of resistance available to úose wiú little room to
maneuver in úeir daily lives. As seen by Scheper-Hughes, úe many
different forms of "foot-dragging" used by women are calculated
responsesdesigned to annoy in situations of repression and orúodoxy
(L992). Oúer anthropologists have focused on úe sites where poetry,
laments, trance, dance, and oúer cultural forms are made use of to
express dissent, often in an effort to bring to light the "resilience and
creativity of úe human spirit in its refusal to be dominated" (Abu-
Lughod 1990:42; see also Boddy 1989; Seremetakis 1991; Trawick
19 8 8 ) .
Ellen Lewin (in úis volume), however, suggestsúat: "'resistance' is
rapidly becoming a word úat çovers anything, defines itself, and may be
said to exist because we insist that it do so" (p. 16a). In her view,
feminists have been overeager to accept "úe discovery of evidence of
even indirect or unconscious resistance." She warns us úat those forms
of resistancewhich particularly delight anúropologists, because of úeir
subtlety and their symbolic overlay, are particularly amenable to
misinterpretation.
Like Lewin, Abu-Lughod has criticized oúer anthropologists for
úeir romantic portrayals of resistance. She seesthis as the result of an
overeagernessto show úat subordinated peoples are not unreflecting
automatons, but find ways to respond critically, even if elliptically, to
úeir respective situations. Recognizing úe force of Foucauit's insight,
Abu-Lughod has strategically inverted his statement to read, "where
úere is resistance,úere is power" (L990:42). From this vantage point,
úe behavior and responsesof individuals to their lived experiencescan
be read at times as resistance,but simultaneously as commentaries on
úe workings of networks of power.
How úen is resistance to be defined? Karina Kielmann takes a
relatively extreme position in her essay, suggesting that "we can only
start to attribute meanings of resistance when women themselves
envisageand expressthe possibility of options diverging from orúodox
frameworks of meaning surrounding úe body" (p. 136). This position
is similar to úat of Fegan, who argued several years earlier úat úe
question of intention is important, and that wiúout conscious intention
an act cannot be interpreted as one of resistance (1986). Like Fegan,
Keilmann has chosen to set aside úe Freudian notion of repression, a
move wiú which not all readers may agree.
If Lewin's, Abu-Lughod's, and Kielmann's positions are accepted,
úen it is questionable whether a whole range of subtle forms of
culturally instituted behaviors, many of which are not fully accessibleto
consciousness,constitute resistance.If one accepts úat it is only when
Introduction t3
,,common sense" is liberated from hegemonic discourse into the realm
of ideology úat úe possibility for resistanceis made fully conscious and
availableto clear articulation, úen it may well be appropriate to confine
use of úe word resistance to self-consciously calculated responses to
situations of domination. The breast cancer movement would be one
example of this (see Kaufert, this volume). Yet, úe vast array of
culturally shaped resistance-like behaviors) responses on úe part of
individuals to inchoate feelings of a lack of justice, distress, exploitation,
and so on, neverthelessremain as crucial activities for úe attention of
social scientistsand feminists alike.
In addition to úe question of consciousness, Kielmann is rightly
concerned, as are oúer authors in úis book, with apparent contra-
dictions in the ways in which people selectively pursue strategies of
consent and dissent within the constraints set out by society. She notes
úat practices which women çarry out as individuals may negate úe
dominant ideologies to which úey claim úeir behavior conforms.
Private and public domains are frequently not well articulared with one
anoúer and ambiguities are clearly evident. This is where research into
úe lived experience and pragmatics of behaviors by those who
ostensibly lack power is essential, if úe subtleties of compliance and
resistanceare to be exposed.
Marx cautioned many years ago úat intention evolves úrough
practice. Moreover, as Scott has pointed out) even when public
representations for change in úe dominant system are actively
demanded by subordinated groups, such representations nearly always
have a strategic or dialogic dimension to the form úat úey take
(1990:92). Thus, outright demands for complete reform and potentially
revolutionary activities are unusual. Resistance,as boú Kielmann and
Lock argue in úeir chapters, is shaped by úe existing moral order, even
while simultaneously undertaking a reimagining and challenging of that
order.
\?hat appears to be political resisrance may ar times be driven by
_
delusions and madness, or by anger at purely personal events, as might
be argued in relation to
Joan, the woman portrayed in Nichter,s essay.
Alternatively' resistancemay be dreamt about, but ultimately discarded
as an unrealistic hope. Under conditions of extreme
violence, open
resistance becomes effectively impossible
except for úose willing to
become martyrs. Millions of women
work wiú determination behind
the scenes,often clandestinely in
both úe public and private domarns to
bring about justice and change in
úeir lives and societies.Anúropolo-
gtsts, journalists, and
oúer outsiders are not prily to úe bulk of úis
acdüty which is therefore unlikely
to be publicly articulated except
T4 Margaret Lock and Paticia A. Kaufert
when forcibly routed out and exposed by úose in power. This patient,
resilient form of resistance neverúeless constitutes vital and construc-
tive political activity in local settings. Finally, resistancemay also exist in
úe form of an organized, structured movement or protest, as in the case
of environmentalists protesting to the government in Eglpt (Morsy) or
Canada (O'Neil and colleagues), or women with breast cancer working
úe lobbies on Capitol Hill.
The body as a site for resistance
Medical anúropologists have long argued úat the human body, being
úe prime target for surveillance and control in societies everywhere,
inevitably becomes a contested domain, a quintessential site where
power is enacted, leading to somatic responseswhich are most often
interpreted as illness. Such bodily response has been designated as
"idioms of distress" (Nichter 1981). The very existence of such tropes
tends to focus attention on somatic states,thus muting an exploration of
possible social relations complicit in úe onset of distress. Similarly,
medicalization and more recently geneticization (úe process whereby
diseasesare labeled as genetic in origin, Lippman 1993) individualize
illness and deflect attention away from social relations. Recently, for
example, professional literature and the media have given extensive
coverage to úe discovery of two of úe genes implicated in breast
cancer. These findings are usually presented wiúout the crucial caveat)
namely úat nutritional, toxic, and environmental factors alone are
believed to be implicated in up to 85 percent of breast cancers and úat,
even where inherited susceptibility plays a role, cancer does not manifest
itself unless triggered by some extraneous event (Lock in press). A
displacement occurs from social and political issuesto úe body, for the
maintenance of good health in which individuals can be held respon-
sible.
In contrast to most medical and even much epidemiological litera-
ture, analytical emphasis on bodily praxis tends to foreground úe
sickening social order, while simultaneously paying attention to body
semiosis and individual distress (Lock and Scheper-Hughes 1990). So,
for example, Ong interpreted attacks of spirit possession on úe shop
floor of multinational factories in Malaysia as part of a complex
negotiation in which young women respond to violations of úeir
gendered sense of self, difficult work conditions, and the process of
modernization (1988). Similarly, the refusal of certain Japaneseadoles-
cents to go to school can be understood as a muted form of resistanceto
manipulation by families, peers) and teachers. In addition it can be
Introduction 15
interpreted as an expression of úe malaise widely experienced by many
Iapanese as a result of úe competitive and debilitating learning and
*á.king conditions in úeir society, which is in turn linked to
modernization (Lock l99l). The Kleinmans have analyzed narratives
about chronic pain in China to show an association between chaotic
political change at úe national level, collective and personal delegitima-
tion in local worlds, and úe subjective experience of physical malaise
(leel).
Based on her work in a Brazilian shantytown, Scheper-Hughes
describes an "epidemic of nerztoso"which she interprets as having
multiple meanings. At times, it is úe refusal of men to conrinue
demeaning and debilitating labor: at other times, the response of
women to violent shock or tragedy, and also in part to the ongoing state
of emergency in everyday life. The epidemic signals a nervous agitation,
"a state of disequilibrium" - one of the few means of expressingdissent
in a very repressive society. Individuals may well be conscious of úe
iniustice of úeir situation, but at the same time exhibit ambivalence and
describe úeir own bodies as "worúless" or "used up" (1992 187).
Scheper-Hughes concludes úat the semi-willingness of people to
participate in úe medicalization of úeir bodies is the result of
participating in úe same moral world as úeir oppressors.
Regardless of how people account for the origins of úeir sickness,
they often seek out medical help. For alúough most people will do what
úey can to relieve úeir physical suffering, this does nor necessitateúeir
giving up political explanations for their distress. One does not have ro
share úe same explanatory system as úe medical professional to
procure medicine. Moreover, some medical professionals are acutely
aware of úe political origins of sickness. Susan Love, a physician but
also a fierce opponent of úe "cancer establishment,', is a rare but
powerful example (seeKaufert, this volume).
Yet, political explanations for úe origins of sicknessare relatively rare
ul9ttg physicians, or even within the general population of the
suffering. As a good number of medical anúropologists have
shown,
most people who seek out help for malaise of alr kinds understand
úeir
problem primarily or exclusively
as somatic - an interpretation which is,
of course, reinforced by úe majority
of biomedical practitioners and
also by local explanations for distress
when they focus exclusively on
physical discomfort (Good
and Good lggS). young has shown, more-
over, úat psychiatric treatmenr
for post-traumatic stress disorder is
expressly designed to encourage
úe patient to participate in the moral
world of úe physician (lgg3).
Mark Nichter, however, presents us with
Joan, a woman impressive in her ability to impose
her script on úe
16 MargaretLock and Paticia A. Kaufert Introduction t7

privacy and its impermeability to úe

medical care system and deny physicians úeir customary right of comrnitment to maintaining its
orchestrating úeir medical encounters with patients. In a reversal of úe eaze of male outsiders' Both Joan and Amal, and many of úe other
usual patient-as-obiecÌ of úe clinical gaze,physicians are úe object of ío-rr who figure in úese essays, are remarkable in their capacity to
Joan's gaze and úe victims of her mission to reform medicine in irnpose úeir presence even through úe words of úe observing/listening
accordancewiú her own vision of its proper practice. anúropologist. Mbeya, a Zairian woman, talks about her husband, who
Yet, it is inappropriate to think of biomedicine as a monolithic died of AIDS but refused to use condoms despite úe risk to her. Driven
enterprise. Biomedical knowledge is complex, often not standardized, out by his family, probably herself now dead, Mbeya's resistance is
and always open to contestadon from boú wiúin úe profession and partly úrough úe telling of her story (Schoepf). Yamada-san is úe
outside. Enormous variation exists both within and among the biomedi- mother of a child, and boú of úem have been devalued and rendered
cines institutionalized around úe world today, and tacit knowledge almosr invisible in úeir society of Japan because úe child has Down
embedded in úe cultures of biomedicine makes translation among syndrome. Yamada-san's invitation for úe anúropologist to come to
them exceedingly difÊcult. her home can be interpreted as resistance on her part, as she strove to
Several important lessons can be gleaned from years of research in make her intolerable situation public (Lock). Demands for visibility and
medical anthropology' among úem that úe body in sickness is a voice were central elements in úe resistance of women wiú breast
polysemic system, subject to numerous interpretations which are cancer, and a motivating force in úe emergence of the breast cancer
shaped, but not determined, by culture. Attitudes towards medicaliza- movement (Kaufert).
tion can be positive, negative, or ambivalent, and in any case are not Earlier we cited úe Comaroffs'definition of hegemony as úat part of
stable. The response of women to medicalization is often mixed. They úe dominant world view úat has come "to be taken-for-granted as úe
rarely react to the specific technology, or simply to úe manipulation of natural and received shape of úe world and everything úat inhabits it."
úeir bodies, but raúer on úe basis of úeir perceptions as to how The women in úese essayschallenged úe taken-for-granted social and
medical surveillance and interventions might enhance or worsen their political ordering of úeir world. Resistance may be a single woman's
daily lives. Indeed, for some women in some situations, such as being rejection of medical adüce on úe placement of an aging parent (Abel
diagnosed with breast cancer, medical technology may hold out their and Browner), or úe Tânzanian women who can be seen as rejecting
only hope of survival. Through úeir demands úat funding be increased the usual construction of úe barren body in úeir society by seeking a
and dedicated to researchon breast cancer, women challenged úe usual cure for úeir infertility in biomedical clinics (Kielmann). lVomen in úe
relationship of úe scientific establishment wiú the state (Kaufert). breast cancer movement, and in úe movements described by Soheir
Seen from úis perspective, úe breast cancer movement provides an Morsy and John O'Neil et al., saw úemselves as acting in defense of
opportunity to explore patterns of resistance which are not contingent úeir bodies and úose of oúer women.
upon wiúdrawal outside of medical control, but attack úat control
from within úe system. Raúer úan decrying medical knowledge - as in Medicalization revisited
the case of feminist critiques of childbirú - úese women demand that
The majority of feminists writing about "body politics" seek to alert
úe resources of medical science should be refocused, concentrated on
readers to úe dangers inherent in úe transformarion of úe female body
discovering úe causesand cures ofbreast cancer.
mto a site for technological intervention (Karz Roúman 1989; Basen el
One strengú of anúropological analyses is úe elicitation of sub-
al' 1993), but sociologists (more úan oúer social scientists) have for
jective accounts as told by informants which can then be juxtaposed
some time now tried to contextualize úe process of medicalization,
wiú oúer versions of reality. The networks of the microphysics of ar
least in terms of institutional arrangements.
power remain as abstract constructs of the imagination unless úey are
Conrad (lgg2), following Zola, argues úat for medicalization to take
fleshed out with narratives produced by úose on whom power is -
place, specific behaüors
practiced. Mark Nichter presents Joan also as a woman constantly and conditions must first be conceptualized as
medical or biological "problems', (in other
engaged in úe process of creating and recreating úe story of her body words, úey must be
naturalized" as disease),secondly, recognition by
and its suffering. Janice Boddy uses her essaypartly as an elegy to Amal, medical institutions
and policy makìng committees
a woman who risked úe survival of her body against her deeper is essential so úat appropriate services
l8 MargaretLock and PatriciaA. Kaufert
can be created, and úirdly, rhey must be diagnosed and interpreted in
medical settings as diseasesor abnormalities. If úese requirements are
met, úen úe healú care professions are in a position to claim these
conditions as coming under úeir jurisdiction, making medicine an
institution of social control (Zola 1972). \7e would suggestúat it could
be equally well argued úat recognition of diseasescomes from changes
in medical knowledge which is úen disseminated to society at large
(see,for example, Lock 1993; Young 1995), but the end result may well
be úe same.
Several auúors have argued that analysesof úe social construction of
diseases and the institutionalization of associated medical practices
provide too narrow a lens with which to account for medicalization. The
discussion in úe preceding section suggeststhat an account limited to
úe interests of úe medical profession and of úe state is inadequate,
because medicalization cannot proceed unless a cooperative population
of patients exists on whom techniques can be performed (Conrad
Lgg2). However, Reissman reminds us once again, úis time specifically
in connection with medicalization, úat women are "not simply passive
victims of medical ascendancy.To cast them solely in a passiverole is to
perpetuâte úe very kinds of assumptions about women úat feminists
have been trying to challenge" (1983:3). Thus, as we have been arguing
úroughout this introduction, while bodies inevitably mediate all
reflection and action on úe world, and can be read as culturally
produced (Lock and Scheper-Hughes 1990), individual behavior and
responses are not determined by dominant ideologies. Alúough úe
conflation of knowledge/power postulated by Foucault serves to
legitimize biomedical knowledge as scientific and rational, and thus to
"naluralíze" it, an uncritical reception of its truth claims by eiúer
individuals, populations at large, or medical professionals cannot be
assumed.
Actual medical practitioners are absent or shadowy figures in all but
Mark Nichter's paper and úat of Janice Boddy, where úe Sudanese
midwives play major roles. In úe others essays) physicians appeâr
briefly as âdvice givers to women who are pregnant or caring for an
aging parent (Abel and Browner), sources of assistancewiú methods of
insemination (Lewin), having the power to diagnose and possibly treat
infertiliry (Handwerker; Kielmann), counselors on genetic risk (Lock),
tellers of bad news to women with breast cancer (Kaufert). Alterna-
tivelR physicians may not appear at all, even when female sterilization is
úe subject for discussion (Lopez).
\ü(rhile biomedicine is configured mainly in terms of its diverse
relationships wiú úe reproductive body, many of úese essâyscome
Introduction l9
perspective. Kaufert, for example, looks at úe complex
from a different
relationship between women and biomedicine, when úe presence of
cancerprecludes resistance by wiúdrawal from treatment. Lock looks
ât genetic diseaseas expressedin the lives of a moúer and her son and
in terms of úeir social relationships, rather úan úeir relationship wiú
biomedicine. Boú Gruenbaum and Morsy raise issues in the area of
oublic or community healú, being concerned wiú úe impact on healú
àf agricultural development policies, eiúer úe direct effect of pesticides
and polluted water sources, or the indirect implications of social and
economic changes for women's healú and well-being. Soheir Morsy
discussesúese issues at úe level of state policy, whereas Gruenbaum
focuseson úe position of wives and moúers wiúin a changing Islamic
household, but úe forces are similar.
Furúer, úe essaysin úis book make it clear úat women's lives are
not preoccupied with medicine and that, for most women, reproduction
does not occupy an undue proportion of úeir energy. Feminists writing
in úe Western intellectual tradition have often granted an importance
to medicine approaching that which úe medical establishment gives
itself, but eúnographic accounts in which âttention is paid to everyday
life make it clear úat it is more appropriate to understand women's
responsesin medical settings as reflecting their daily experiencesas part
of a domestic group, a community, or a society. Most of the literature
on medicalization focuses on clinical settings, individual women, and
üe manipulation of their bodies. The contributions by Gruenbaum,
Lopez, O'Neil et al., and Morsy all make clear in úeir different ways
úat women are concerned not simply with their own bodies, but wiú
what might be glossed as public health issues- that is, with the bodies
of oúers. Many of úem are working for better conditions in úeir
communities at large, activities which are sometimes peripheral or even
removed from medicine, but which ultimately have profound effects on
healú.
Creating needs: technologies of naturalization
The concept of "nature" is, of course, culturally constructed, and úe
meanings attributed to it change úrough time and space. A scientific,
post-Enlightenment account
assumes narure to be subject to experi-
mental manipulation and ultimately understandable as a
set of universal
taws. In úeory, this approach
visualizes nature as a domain entirely
separate from úe moral order. In practice.
however. ..nature,' often
continues to serve) as it did p.ior
io the Enlightenment, as a moral
20 Margaret Lock and Patricia A. Kaufert
touchstone, úe effects of which are especially evident at úe culturally
constructed margins between "nature" and "culture" (Lock 1995)'
Nature is usually drawn on as a moral arbitrator in one of úree ways.
People can be chastised if úeir behavior does not conform to what is
understood as "natural" - in scientific parlance, certain behaviors are
understood as biologically "determined" and úerefore inevitable.
Culturally constructed gendered and age-related behavioral norms, for
example, are frequently legidmized as naturally determined: úus in
many cultures women are believed to be "naturaily" nurturant, while
men are inevitably assertive. one logical extension of úis type of
ârgument is úat women must conceive and reproduce in order to be
,,real,, women. A woman who rejects fertility in china is defined as not
"normalr" while the "infertile" woman demonstrates her normality by
seeking treatment (Handwerker, úis volume). A second way in which
nature is used as ideological commentary on úe social order is by
categorizing certain individuals and groups as "wild" or "uncultured,"
closer to nature, and as a consequencepotentially dangerous (Douglas
1970; Yoshid,a 1967). Feminists writing about úe management of
women's bodies cite numerous nineteenú- and twentieú-century texts
which reveal such an attitude toward women in Euro-America (Leys
Stepan 1986; Jordanova 1989; Duden 1993). Nature is used in a úird
way to legitimize moral commentary in connection wiú manipulation
of what is taken to be úe naturâl order itself - attempts to intervene and
destroy or transform nature in inappropriate ways may disrupt sociery
(O'Neil et al. and Morsy, úis volume).
How nature is demarcated from culture in local discourse gives
considerable room for contestation and ideological manipulation'
Alúough scientific accounts tend to dismiss úis polysemy as so much
cultural flotsam to be stripped away to reveâl úe "natural" facts
inscribed in úe universal physical body, it is at üese "blurred
boundaries," at úe "intersection of discourses," úat dissent, doubt,
anxiety, hope, and challenges to structures of power can best be seen.
As Balsamo has noted, "investigating úe interaction between material
bodies and new technologies illuminates úe work of ideology-in-
progress" (1996:10). This is what makes women's responses to
medicalization so interesting and so difficult to interpret. The very act
of medicalizâtion natuÍalizes and hence legitimizes manipulation of úe
,,abnormal,, body as úe source of distress. Attention is deflected away
from hierarchical arrangements) the control of knowledge, and úe
making of úe body docile, because medicalization is perceived as
benevolent - a manifestation of our mastery of úe vagaries of nature'
once understood úis way, as a cultural improvement on nature, then
Introduction 2l
compliance wiú and resistanceto medicalization becomes all úe more
rernarkable, and highly significant for what it can teach us about
hegernonYand Power.
The history of medical knowledge and medical technologies has
usually been transmitted as an heroic tale about the conquest of úe
-
enemy, whether it be human or nature a narrative of progress, and of
úe betterment of humanity in general. This dominant ideology has, for
úe past 100 years at least, been accompanied by a counter-discourse
replete wiú ambivalence and warnings about úe consequences of
rJ7ollstonecraft Shelley to Kurt
technology gone wild. From Mary
Vonnegut, novels have been used to describe úe havoc and misery
which technology can create. The humanities and social scienceshave
also sounded regular warnings: Ellul claimed, for example, úat
"Technique has become autonomous;it has fashioned an omnivorous
world which obeys its own laws and which has renounced all tradition"
(1964, emphasis added). But, as Winner has pointed out, the very idea
of an autonomous technology raises an "unsettling irony, for úe
expected relationship of subject and object is exactly reversed"
(r977:r6).
In this book we understand technology not simply as tools and
machines, but, following Foucault, as also techniques of quantification,
systematization,and routinization: in short, úe gamut of human effort
to manipulate and control what is available to it in order to produce an
effect or an end-product perceived to be beneficial in some way to
individuals and âlso society (seealso Escobar 1995).
A common assumption is úat the driving force behind the creation of
technologies is to meet universal human needs. Boú Marcuse and
Habermas claim úat úere is little inherently quesrionable about
technological developmenrs provided úat we go about úem in úe right
way. Oúers, including Basaila (1988) and Sahlins (1976), rake a more
radical position. They stressúat, aside from úe fundamental requisites
for sustaining life, it is culture and not nature which defines necessity.
Necessity is not úe moúer of invention in any predetermined way: on
üe contrary, human technology is a "material manifestation of úe
various ways men and women úroughout time have chosen to define
and pursue exisrence" (Basalla 1988:14). Têchnology is thus an integral
part of the history of human aspirations
and simply to associareit wiú
power and economic systems,
as do Marcuse, Flabermas, and oúers, is
lo l.au. tacit the dominant modernist ideology of progress as an
inherently rational pursuit to which culture
makes no contribution.
T is easy to presume úat of all forms of technology, medical
technologies exist to meet basic
human needs, above all to reduce
22 Margaret Lock and Paticia A. Kaufen
suffering and avoid premature death. Techniques üat allow us to
penetrate wiú increasing facility into úe recessesof úe body, together
wiú úose úat prolong life, are surely for úe good. But since úe 1970s
it has become increasingly clear úat biomedical technology is by no
means autonomous. Disputes wiú respect to biomedical technology in
societies driven by technological development usually revolve today
around questions of individual rights, autonomy, and justice. Activists
have focused on abuse of individual patients by powerful elites. Very few
commentators have stepped back to look at úe larger picture and ask
why, for example, infertility, menopause) and aging are conceptualized
as diseases,or why we strive so hard to conquer death. Nor do we ask
why manifestations of distress are given labels such as anorexia nervosa)
attention deficit disorder, post-Ìraumatic stress syndrome, or false
memory syndrome. By defining úem as behavioral problems, responsi-
bility is located wiú úe individual and úe family, while úe complex
social and political origins of úese conditions are made opaque.
The view from the margins
'We
have argued úus far for a decentering of certain important concepts
which frequently go unexamined. Such an exercisepermits a contextua-
lization of knowledge production, including that of biomedicine, as well
as a sensitivity to úe ways in which subjectivity and agency are enacted
in different sites. This exerciseis a raúer sophisticated extension of úe
original anúropological endeavor because,ideally, anúropologists have
never been content simply with portrayals of oúer cultural formations,
but use úeir findings to reflect on tacit knowledge embedded in úeir
own belief systems. One major contribution of medical anúropology
has been to introduce a critical approach to biomedical knowledge and
practice, in part an extension of research into úe cultural construction
of medical systems in oúer parts of úe world; úe more sophisticated
forms of úis research succeed in highlighting úe epistemological
foundations of all types of medical practice (see,for example, Farquhar
Lee3).
Recent critiques of cultural anthropology claim that anúropologists
remain insufficiently sensitive to úe way in which úeir interpretations
create an appearanceof a cultural coherence in úe societieswhich úey
studn a coherence which is in fact an artifact produced by úe
intellectual gaze from afar (Said 1978; Clifford and Marcus 1986).
Tsing has argued úat it is important to transgress "conventions of
segregated'internal' and'external' cultural analysis" in order to reveal
cultural heterogeneity and úe "trâns-communal links úrough which
Introduction z)
,communities' are forged" (1993:9). S7e follow Ginsburg and
Rapp in
defining "local" as "any small-scale arena in which social meanings are
informed and adjusted úrough negotiated face-to-face interaction" ând
üansnational or global processes as "úose úrough which specific
arenasof knowledge and power escapeúe communities of úeir creatlon
to be embraced by or imposed on people beyond those communities,,
e995:8-9). $(rhen úe flow of ideas and technology is perceived as
',developing,,
being from "advanced" societies to úe world, úen an
assumption is often made úat recipient societies undergo a process of
secularization and rationalization, an integral part of modernizatron. It
is abundantly clear, however, úat no such simple traiectory occurs, and
úat reversalsand other unanticipated outcomes are common, in boú
"developed" and "developing" societies.
Given increasing globalization and its resultant complexities, a
cultural critique which simply uses knowledge from afar to reflect
intellectually on úe condition of úe so-called advanced societies does
not go far enough. one must make yet anoúer move - a semiotic rerurn
- to local sites of research for further reflection on
the way in which
competing truth claims and practices are contested as a result of üe
ceaselessappearance of new knowledge which in turn provides a
continual challenge to common-sense knowledge. This semiotic rerurn
includes a consideration of body politics - individual and communal.
'whatever
úeir declared ethnicity and wherever úeir geographical
úe majority of women are responding today .rãt ,ì-pty to
lgcatfon,
"tradition" and local hegemonies, but ario to úe effects úat gl,obaÌly
circulating knowledge and practices have on their lives.
Moreover úese
responseshave no close associationwiú exposure
to formal education.
-The impact of circulating knowledge anã technologies on úe bodies
of women may become immediately visible
in úe rapid adoption of
contracepdve technologies to prevent
fertility (Morsg úis volume) or
the adoption of new techniques
ro overcome infertiliry (Handwerker,
úis,volume). But Morsy l,ooks
also at the impact of agricultural
Pesticideson women's bodies, and breast cancer
activists rink úeir own
tumors with an environment
polluted by a cocktail of carcinogenic
úe byproducrs of rechnological development. Such technol-
ll:-*t."Jt,
ogtes' wheúer embraced
or decried b! women, are rarery perceived as
neuüal, by the srate or local governments,
i::]tt
-"ï,."' or by health by women úem_
care professionals,both local and outsiders.
technologies inevitably suggesr possibilities
oj],.*
*'.t-m for increased
inn-ovativechange, but úey also frequently open
'v^u€w Ìorms".rd úe door
of illness, domination, or neo_colonial expansion.
otten such Most
technorogies inspire ambivalence and cause debate
to erupr
24 Margaret Lock and Paticia A. Kaufert
about úe perceived breakdown of moral order. It is in úis analytic
space úat úe contributions to úis book are concentrated * a space
which reverberateswith úe unresolvable tensions created for women by
being marginalized, often in multiple ways' as úey respond boú to úe
power of "tradition" and úe power of technological innovation, neither
of which forces is stable nor situated unambiguously wiúin or outside
their communities.
Increasingly in üe present global political climate, people find
úemselves marginalized úrough isolation or expulsion from commun-
ity and often family. For example, young women in many Asian
countries are sold by their families into servitude as poorly paid labor or
as sex workers. In Central and Souú America and in China úere are
repeated reports of girls and young women being stolen from úeir
families (Anagnost 1995). In Norú America, immigrant labor, fre-
quently women working for úe garment industry, are employed in
illegal, hidden sweat shops for considerably less úan minimum wage or
else are forced into insecure piece work in úeir own domestic space' a
practice which is on úe increase because employers can úus avoid
scrutiny. The possibilities for resistanceor critical reflection in situations
of extreme isolation where structural violence is at its most constraining,
as Scott noted (1990), are minimal. rü(/henúe evil conditions under
which so many women live and work are taken into account, úen úe
type of postmodern analysis which plays wiú úe idea of multiplicity,
wiú úe possibilities for individual remaking of úe world, and with the
invention of "incalculable choreographies" (McDonald 1982) seems
flagrantly irresponsible. Similarly, analyses which understand women
above all as autonomous, rational actors negotiating reality in order to
improve úeir lot are badly flawed. Serious political accounts must
contextualize women's lives and pay close attention to úeir structural
positions in various human groupings. As Lopez notes in her essay,one
must ask exactly what concepts such as "choice" and "voluntary" mean
in úe context of women's lives. At úe same time it is important to
generalize across difference whenever possible, if úe lived experiences
of women as portrayed in eúnographic accounts are to break úrough
the bonds of "common sense."
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