Cover of The Distressed Body
The Distressed Body Rethinking Illness, Imprisonment, and Healing
by Drew Leder
University of Chicago Press, 2016
Cloth: 978-0-226-39607-1 | Paper: 978-0-226-39610-1 | Electronic: 978-0-226-39624-8
DOI: 10.7208/chicago/9780226396248.001.0001

AVAILABLE FROM

University of Chicago Press (cloth, paper, ebook)
Amazon Kindle
Barnes & Noble Nook
DeGruyter Multi-User Ebook Program
EBSCO eBooks (formerly NetLibrary)
Google Play
Kobo
University Press Scholarship Online (UPSO)
ABOUT THIS BOOKAUTHOR BIOGRAPHYREVIEWSTABLE OF CONTENTS

ABOUT THIS BOOK

Bodily pain and distress come in many forms. They can well up from within at times of serious illness, but the body can also be subjected to harsh treatment from outside. The medical system is often cold and depersonalized, and much worse are conditions experienced by prisoners in our age of mass incarceration, and by animals trapped in our factory farms. In this pioneering book, Drew Leder offers bold new ways to rethink how we create and treat distress, clearing the way for more humane social practices.
           
Leder draws on literary examples, clinical and philosophical sources, his medical training, and his own struggle with chronic pain. He levies a challenge to the capitalist and Cartesian models that rule modern medicine. Similarly, he looks at the root paradigms of our penitentiary and factory farm systems and the way these produce distressed bodies, asking how such institutions can be reformed. Writing with coauthors ranging from a prominent cardiologist to long-term inmates, he explores alternative environments that can better humanize—even spiritualize—the way we treat one another, offering a very different vision of medical, criminal justice, and food systems. Ultimately Leder proposes not just new answers to important bioethical questions but new ways of questioning accepted concepts and practices.

AUTHOR BIOGRAPHY

Drew Leder is an MD and professor of Western and Eastern philosophy at Loyola University Maryland. He is the author or editor of many books, including The Body in Medical Thought and Practice and The Absent Body, the latter published by the University of Chicago Press.
 

REVIEWS

“Leder here offers a truly creative and compelling study of the nature of distressed embodiment. He identifies one of the key culprits in the mistreatment of humans and animals to be the Cartesian-rooted notion that a fundamental divide exists between mind and body. This, Leder argues, often leads people to consider our own and others’ bodies as passive, commodifiable, machine-like, and/or alien. Leder’s descriptions and diagnoses of these problematic conceptions are truly eye-opening, and he offers rich resources for thinking anew the nature of embodied reality and the many ways we have for recuperating a more holistic relationship to embodiment.”
— Kirsten Jacobson, University of Maine

“Leder invites his reader to focus anew upon the distress, in its full measure of harshness and complexity, of those who find themselves ill. Their plight, Leder emphasizes, has not disappeared, no matter how scientifically enlightened or technologically effective medical practices have become. The investigations that follow offer the fruits of a lifelong engagement on the part of their author into how a phenomenological account of the body is crucial for (re)orienting medicine to its core missions of diagnosis, treatment, and healing. With a novelist’s eye for telling detail but a tone of intimacy with the reader that is uncommon for philosophical texts, he invites us into the philosophical equivalent of medical consultation and demonstrates that working out the paradoxes involved when living bodies are treated by other living bodies is crucial if medicine is to remain true to its charge of healing those who suffer.”
— James Hatley, Salisbury University

TABLE OF CONTENTS


DOI: 10.7208/chicago/9780226396248.003.0000
[illness;pain;medicine;bioethics;imprisonment;organ transplants]
The book draws on literary examples such as Sophocles’ Philoctetes, the author’s own struggles with chronic pain, and clinical and philosophical sources, to understand the ways illness can shatter one’s life world. This leads to a critical, visionary re-examination of treatment modalities, such as our fetishized fascination with pills, and potential uses of touch and healing objects/environments. Along the way, clinical diagnosis and bioethical reflection are also rethought. Real-world predicaments generate “texts” embedded in complex “contexts” which often remain unexamined. For example, organ transplantation as practiced reflects Cartesian and capitalist modes of objectifying the body. Yet lived bodies intertwine from birth to death and beyond, leading to new ways of understanding and performing organ transplants. Similarly, these modes shape our harsh treatment of animal-bodies and prisoners in a way that demands re-vision. The book challenges our contemporary factory farms and penitentiaries. Yet in chapters co-written with prisoners we also see how imprisonment can evoke strategies of resistance and redemption, and even close relations with animals as the two shunned groups assist each other. The book ends with a focus on such human-animal “shape-shifting.” Attending to distressed bodies thus leads to a radical re-envisioning of medical, criminal justice, and environmental practices.


DOI: 10.7208/chicago/9780226396248.003.0001
[illness;exile;cosmos;bodily awareness;suffering;pain;compassion;healing]
A phenomenology of illness-experience is constructed from Sophocles’ play Philoctetes. Having suffered a foul-smelling foot wound, the hero is exiled to a desolate island. So, too, does the seriously ill person suffer a three-fold exile: from the cosmos, the body, and the social world. The sick person may feel the cosmos as punishing or meaningless. One is brought home to a heightened awareness of one’s body, but discovers it as a body in which one no longer feels at home—that is, as a threat and cause of suffering. To fall sick is also to be banished from the daily routines of our conventional identity. We experience exile from the social world. Others cannot experience or relieve our pain, and may turn away from us in fear or revulsion. All this is portrayed in Philoctetes, but so too is the redemptive power of compassion, which ultimately saves the hero from exile. The importance of social support in assisting the process of healing and re-integration and is thus demonstrated in rich literary terms.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0002
[pain;chronic pain;sensation;phenomenology;embodiment]
Pain is far more than an aversive sensation. Chronic pain, in particular, involves the sufferer in a complex experience filled with ambiguity and paradox. The tensions thereby established, the unknowns, pressures, and oscillations, form a significant part of the painfulness of pain. This chapter uses a phenomenological method to examine nine such paradoxes. For example, pain can be both immediate sensation and mediated by complex interpretations. It is a certainty for the experiencer, yet highly uncertain in character. It pulls one to the present, but also projects one outward to a feared or desired future. Chronic pain can seem located in the body and/or mind; interior to the self or an alien other; confined to a particular point and/or radiating everywhere. Such fundamental paradoxes, existential and epistemological, can challenge those living with long-term pain.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0003
[touch;healing;illness;objectification;medical practice;embodiment]
This chapter investigates the healer’s touch in contemporary medical practice, with attention to both allopathic and alternative modalities. Healing is understood as the recovery of an integrated relationship between the self and its body, others, and the surrounding world—relationships that illness has rendered problematic. In this context, touch can play a crucial role in the clinical encounter. Unlike other modes of sensory apprehension, which tend to involve distance and/or objectification, touch unfolds through an impactful, expressive, reci­procity between the toucher and the touched. For the ill person this can serve to re-establish human connection and facilitate healing changes at the pre-linguistic level. The healer’s touch involves a blending of attention, compassion, and skill. The clinical efficacy of touch is also dependent upon the patient’s active receptivity, characteristics of which are explored. All too often modern medical practice is characterized predominately by the “objectifying touch” of the physical exam, or the “absent touch” wherein technological mediation replaces embodied contact altogether. This chapter explores the unique properties of sensitive touch that can make it healing within the diagnostic and therapeutic process.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0004
[pharmaceutical industry;pills;clinical practice;phenomenology;healing;side effects;disease;placebo effect]
The pharmaceutical industry has undergone a vast expansion in recent decades. This chapter explores the central role now played by pills in clinical practice, but also in the public imagination. A phenomenological analysis shows various ways in which pills can serve as ideal consumer items for widespread distribution; and also as model technological “devices” capable of downloading into the body healing chemicals. As such, they seem to promise a disburdening solution to many of life’s ills. Yet negative side-effects are explored not only of pills themselves, but of this exaggerated cultural fantasy of the all-curative pill. It tends to distract us from other more holistic understandings of the locus of disease and healing, including the mind/body’s own “meaning response” as illustrated by the placebo effect. Rather than demonize all pills, the quest is for a model that would help us choose and use them wisely. The pill, it is suggested, can best be re-contextualizing as a multidimensional gift. Suggestions are made for how this may lead to appropriate understanding, gratitude, and discernment. We may thus ingest fewer pills, but with greater efficacy.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0005
[modern medicine;holistic medicine;materialism;healing environments;Cartesian]
The chapter presents a philosophical analysis of the ruling medical paradigm, and a suggested remedy. Modern medicine is often accused by diverse critics of being “too materialistic” and therefore insufficiently holistic and effective. Yet this critique can be misleading, dependent upon the ambiguous meanings of “ma­terialism.” The term can indicate the prevalence of financial concerns in driving medical practice. Alternatively, it can refer to “mechanistic materialism,” the patient viewed as a Cartesian body-machine. However, in each case these do not suggest an authentic materialism, but rather medicine’s focus upon high-level abstractions. “Bottom-line” financial or diagnostic numbers can distract practitioners from the real embodied needs of sick patients. In this sense, contemporary medicine is not materialist enough. Through a series of clinical examples, this chapter explores what an “authentic materialism” would look like in current and future practice. Discussed are the use of prayer/comfort shawls at the bedside; hospitals and nursing homes redesigned as enriched healing environments; and a par­adigmatic medical device—the implantable cardioverter defibrillator—as it might be presented to patients in a holistic context.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0006
[diagnosis;hermeneutics;physician;patient;illness;technology;medicine]
Using tools from Continental philosophy, this chapter suggests that clinical diagnosis can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. Like the literary critic reading a novel, or the judge asked to apply a law, the physician must interpret the “text” presented by the ill person. Or “texts” really: four in turn are examined. These include the “experiential text” of illness as lived out by the patient; the “narrative text” constituted during history-taking; the “physical text” of the patient’s body as objectively examined; and the “instrumental text” constructed by diagnostic technologies. Harmonizing these proves to be no easy matter. Criteria of coherence, collaboration, and clinical effectiveness must all be employed. However, certain flaws in modern medicine arise from its refusal to face up to its hermeneutical nature. Medicine instead pursues a dream of objective truth gained by technologies which will yield a purified vision or mathematics of disease. Yet in seeking to escape interpretive subjectivity, medicine may both impair clinical judgment and lose sight of its primary subject — the living, experiencing patient.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0007
[self understanding;hermeneutics;bioethics;autonomy;disease;empowerment;personal narrative;Kantian]
Using tools from Continental philosophy, this chapter explores how a hermeneutical self-understanding would shift not only clinical practice but the field of bioethics. Bioethicists often seek to resolve a quandary by applying an overarching theory—for example, Kantian “respect for persons”—to the particulars of a case. This chapter suggests something of a reverse approach. Paying careful attention to the interpretations of, and the dilemmas faced by, real-life participants can deepen and change the reading of a case. For example, from the heights of Kantian theory it may seem clear the doctor should “tell the truth” to enhance the patient’s “autonomy.” But what if autonomy (“self-rule”) has already been disrupted by disease and is in dire need of repair? What if medical language and institutions are themselves disempowering? In “telling the truth” medically, the doctor may yet destabilize the patient’s own narrative quest for meaning. A hermeneutical bioethics seeks to disclose such contexts and deepen reflection. The result may not simply be better answers, but some new and better questions for bioethics to explore, including those that challenge prevailing medical institutions and intuitions.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0008
[organ donation;government;consent;capitalism;commodity;body as machine;phenomenology;Cartesian]
Should a person be allowed to sell a kidney to an eager buyer? Should a government “presume consent” to harvest cadaver organs unless one deliberately opt-outs, or is this state intrusion? Rather than engage in standard ethical theorizing I use a hermeneutical approach to examine the contexts that shape practice. These include the capitalist model of the body as a producer, consumer, and commodity for purchase, and the Cartesian notion of the body as a machine with replaceable parts. This chapter proposes instead a phenomenological model of the lived body as in deep connection, even interpenetration, with other bodies from before birth until after death. Such a perspective would reframe, on the individual and policy level, ways in which we practice organ transplants.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0009
[factory farming;industrial;capitalism;alienation;labor;Marx;anthropocentrism;animals;humans;machines]
After surveying some of its cruelties, this chapter explores the cultural and philosophical foundations of factory farming. How did the traditional farm come to be reconfigured as something akin to an industrial factory? Modes of capitalist production play a role: Marx’s analysis of the fourfold alienation of labor can be applied to animal-laborers, who, for example are alienated from their “product” (which in many cases is their own body re-constructed to maximize meat production). Moreover, the harshness with which animals are treated often exceeds that directed toward human workers. At root is a cultural anthropocentrism that prohibits viewing animals as moral subjects, thereby removing ethical restraints. Ultimately, the modernist ways in which animals are treated as both like and unlike human workers are related to the rise of Cartesian mechanism. The very categories of “human” and “animal” are made over in the image of the “machine.” To understand, and hopefully to abolish, factory farms we need to rethink its foundational paradigms.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0010
[phenomenology;imprisonment;embodiment;philosophy;escape;reclamation;discrimination;illness;race;space]
This chapter uses phenomenological tools to show how long-term imprisonment constricts, disrupts, and fragments lived time and space and one’s experience of embodiment. Yet the prisoner is not passive in all this. He or she constructs strategies of creative response. Working with recorded dialogues from a philosophy class taught in a maximum-security prison, the chapter traces out two such inmate strategies respectively called escape and reclamation. Escape-mode involves imaginatively flying beyond the constraints of prison. Reclamation involves working with these harsh conditions in such a way that one can reclaim a positive relationship to space, time and one’s body even while incarcerated. There is also an integrative approach that combines elements of both—examples are provided from the prisoner’s accounts. The resilience of prisoners is compared to others who face sexual and racial discrimination, or who suffer from chronic illness. Even in situations of severe restriction the human being retains some freedom and responsibility – that is the ability to respond.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0011
[prison;penitentiary;reform;education;rehabilitation;community]
This chapter, evolving out of a thirty-person philosophy class in a maximum-security penitentiary, proposes ways in which prisons should be reformed. The men draw on personal experience of what damaged, or occasionally assisted, their quest for positive change. They are critical of the typical “endarkened” prison—it is marked by despair and stasis, and focuses on classifying and isolating inmates, judging and punishing them for demerits. This has often been their experience of penitentiary life. By contrast, the “enlightened” prison they envision would embody opposite values: support for hope, growth, individuality, and community, with merit recognized and rewarded. Perhaps this is a utopian ideal. Yet this chapter also reflects on the conditions under which it was written—the pursuit of education, and positive community—as a sign of hope.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0012
[prison;reform;rehabilitation;animal;racism;media;factory farms;animals;protection;nurture]
This chapter examines the relationship, both in the public imagination, and in actual practice, between prisoners and animals. It was written by a philosopher in consultation with a recently released long-time prisoner, and members of a maximum-security philosophy class. Prisoners are often portrayed in political and media-driven discourse as animal-like, savage and predatory. This image can drive the racist leanings of the criminal-justice system, and be used to justify the caging, and sometimes brutal treatment, to which inmates fall prey. The position of prisoners is compared to that of zoo-animals, and those abused in factory farms. More positively, the second part of the chapter looks at the surprising relationships that inmates are able to form with actual animals, sometimes illicit, sometimes sanctioned by authorities. This can range from pet rodents adopted by prisoners, to official service-dog training programs. The chapter explores how cross-species communication creates an ethos of mutual protection and nurture in an otherwise harsh environment. If prisoners and many animals are “discarded bodies,” they can yet reclaim and rescue one another.
This chapter is available at:
    https://academic.oup.com/chica...


DOI: 10.7208/chicago/9780226396248.003.0013
[embodiment;shapeshifting;animals;nature;mythology;religion;healing;phenomenology;technology;environment]
This chapter explores the ability and desire of the embodied self to "shape-shift"—that is, to experience from within the capacities of animals, or natural phenomena like trees and mountains. Shape-shifting is discussed insofar as it manifests in a broad range of cultural domains, including children’s play, mythico-religious iconography, spiritual practice, fashion, sports, the performing arts, popular movies, and so on. It is all around us, though often not recognized as such. This potential for shape-shifting is found not only in our evolutionary history and biological kinships, but the phenomenology of the lived body. Our own powers are explored, expanded and transformed through our communion with the non-human world. Sadly, to a degree this has been overwhelmed and displaced by our focus on merging with our own human-made technologies. The chapter calls for a reclaiming of an intimate, embodied, and healing relation to the natural world.
This chapter is available at:
    https://academic.oup.com/chica...

Book published by University of Chicago Press, 2016. Page maintained by BiblioVault.