Saturday, March 31, 2012

Final Close Reading!


            Though the personal details of Hornbacher’s work mark it as autobiography, the identity of her main character, Hornbacher herself, remains ambiguous as the work draws to a close. In the final sections of her work, Hornbacher writes,
In my limbo period after leaving the hospital the last time, I was grasping at straws. . . If you do that long enough, you eventually get a hold of some, enough, anyway, to keep going. I no longer had anything that I understood or could believe in. The situation I was in then is not at all uncommon. The experts say, What did you do before your eating disorder? What were you like before? And you simply stare at them because you can remember no before, and the word you means nothing at all. Are you referring to Marya, the constellation of suicidal symptoms? Marya, the invalid? Marya, the patient, the subject, the case study, the taker of pills, the nibbler of muffins, the asexual, the encyclopedia, the pencil sketch of the human skeleton, the bearer of nightmares of hunger, the hunger itself? (279).
Here Hornbacher’s pronominal switching becomes unmasked as at attempt to negotiate fractured, often antithetical identities. Hornbacher’s narrator, to use the clinical term, is dis-integrated. She exists as several identities – some assigned to her by her disease and by medical professionals, others developed in an attempt to relate her experience in an understandable way – and it becomes apparent that the entirety of her work is the product of these interrelated narrative identities. Hornbacher uses her own first name, Marya, as the label that unifies all of her identities. “Marya” is no longer a name connected to one discrete identity. Rather, Hornbacher’s first name is evidence that her identity can no longer be referred to in the singular. The experts ask “you” what “you” were “like before” (279), and the narrator struggles to tie “you” to a name, which is often the marker of a coherent identity. But the narrator, “you,” cannot find definition in anything but a cluster of behaviors, abstract terms (“hunger”), and medical terminologies, and thus the “you,” in the narrator’s confusion, fails to become an “I.”
            Hornbacher begins this paragraph, which rests after a one-sentence paragraph that reads, “There is, in fact, and incredible freedom in having nothing left to lose” (279), with the singular experience of her often transient “I”. The “I” has just left the hospital. The “I” is disoriented and “grasping at straws” (279). In contrast to the previous short paragraph, which lacks any personal identification and which reads, instead, as a declarative pseudo-philosophical statement, the beginning of this next paragraph betrays the unsteady ground on which the narrator stands. The “I” uses unsure words – “limbo,” “grasping,” a negated “believe” (279) – and an attempt to normalize her situation – “The situation I was in then is not at all uncommon” (279) – as a way of showing that her pronominal identity as “I” cannot stand by itself. Almost immediately, the “I” is traded for an empathetic “you,” functioning to both eradicate the personal details from the prose and to place the reader in the place of the narrator. The “you” handles the “I’s” uneasiness, as it is “you” who “get[s] a hold of some [straws] . . . to keep going” (279). In switching from the personal “I” to an empathetic, stronger “you,” the narrator blurs the boundaries between the “normal” population and the disabled. Because “you” can so easily fit into this situation that is “not at all uncommon” (279), the author shows that “you” are as close to disability as her “I” is and that though the specifics of her situation – for example, the recent release from inpatient treatment – may not apply to “you,” “you,” as someone whose body is constructed (Davis xvii) and who resides in a world “structure[d] for people who have no weaknesses” (243), are in a position to take on a disabled identity yourself.
Despite the apparent strength of the “you” as both a normalizing and empathetic vehicle, though, Hornbacher then places the “you” in a state of uneasiness similar to that in which she placed her “I”. Instead of the narrator controlling the “you,” deliberately projecting it onto the reader, the unquoted questions of medical professionals then step into the paragraph, drawing the “you” into a therapeutic, medicalized culture. As her “I” is subject to the uncertainty caused by external forces, so her “you” is subject to the uncertainty borne of the medical discourse in which she finds herself. Edwards writes that the traditional medicalized discourse disallows effective communication to occur between medical professionals and their patients (241), and this traditional discourse becomes apparent in the above passage. The professionals ask “you” what “you” did “before your eating disorder” (279), never considering the serious fragmentation of identity and the loss of memory that may have occurred as a result of the illness. The same medical institution that assigns identities – “invalid,” “patient,” “subject,” “case study,” “taker of pills,” “constellation of suicidal symptoms” (279) – does not then consider the fact that its own many identities may have aided in replacing an integrated one, and a disconnect then occurs between the “you” and the medical community, as the “you” stares back at the medical professionals because “the word you means nothing at all” (279).
Because “you” no longer has any meaning for the narrator, “you” then switches from applying to the narrator herself to referring to the medical professionals. Hornbacher asks, “Are you referring to Marya, the constellation of suicidal symptoms?” (279), thus shifting the weight of the “you” onto her medical experts. In doing so, Hornbacher conflates “you” as the narrator and “you” as the medical community, projecting the identities assigned to her by the medical community onto the medical professionals themselves. “You” means “nothing at all” (279), and because “you” means nothing, “you” can be anyone. By so closely juxtaposing her normalized, empathetic “you” with a “you” referring to the medical community, Hornbacher rebuts the identities given to her throughout treatment while simultaneously pushing those same identities onto her medical caretakers as if to ask, “How do you understand yourself in the context of these labels?” In her conflation of “you,” Hornbacher effectively highlights the kind of medicalized discourse that prevents effective, empathetic communication from taking place between patients and medical professionals. By forcing medicalzed identities back onto the professionals who assigned them, Hornbacher reflects the lack of understanding that the professionals have of her all-too-common condition. By responding to the medical professionals with a rhetorical question employing “you,” Hornbacher casts their question, “What did you do before your eating disorder?” (279), as somewhat ludicrous. If the professionals had an accurate understanding of her “not at all uncommon” (279) situation, they would not push on their original question with the follow-up, “What were you like before?” (279).
Hornbacher’s “you” not only reflects the detrimental effects of medicalized identities and lack of understanding in the medical community, however. Once again, the confusion of the “you” represents the challenge of politicized life writing for women (Buss 97). The “you” here is uncertain – it means nothing, it applies to no one in particular. The “you” is the reader, the medical professional, or the narrator, and the control of the “you” lies at the mercy of any of these three. The reader controls the “you” either by choosing to empathize or not, the medical professionals control the “you” by giving it identities, and the “I” controls the “you” by introducing its presence into the paragraph. Though the pronoun itself remains stable, ownership of and reference to the pronoun changes. The “you” is fragmented, and in its fragmentation, represents the disabling effects of a culture that politicizes both gender and the body, conflating the two so that the body, in both its perceived weaknesses and its gender, is subject to external forces – here, most notably, the forces imposed by the culture of medicine in its interpretation and treatment of a distinctly feminized illness.
            Near the end of the above passage, Hornbacher refers to “Marya,” a third-person singular character whose identity never settles on any of the identities proposed by the medical community. In contrast to the previously-analyzed passages, here Hornbacher does not use a third-person pronoun – no “them” or “she” – and instead opts for a proper noun – a name. But as the “you” means nothing because the narrator cannot assign an identity to the “you,” so the name, “Marya,” means nothing. “Marya” can only be identified if “you” – the medical professionals – choose an identity for her. “Marya” can be symptoms, an invalid, a patient, an asexual, hunger (279), but until the medical professionals choose an identity through which she is to respond to their questions, “Marya” is meaningless. After the “I” emerges from the hospital, after the “you” displays confusion, after the clinical evaluations and labels, the name of the narrator is secondary to the social constructions of her illness. Through illness and treatment, the narrator lost a coherent self, though she gained weight.
            In the final pages of Horbacher’s memoir, there is no resolution to the narrator’s dis-integrated identity. The narrator is at turns political, declaring that “[w]anting to be healthy is seen as really weird” (283), owning a “healed” identity (“You fix yourself. It is the hardest thing I have ever done” (284)), and unsure, as her “Present Day” section recounts the still very active struggle she has with Anorexia Nervosa. In the context of such a tumultuous disease, which has essentially seeped into every facet of the narrator’s identity, cracking it at its foundations, the narrator and her body stand as a projective surface onto which western medicine and western culture both play out power dynamics between the female and her larger society. Hornbacher ends her memoir with, “And then it [my heart] tumbles into sleep, grabbing me by the hair and pulling me down into these watery sleeps that are so terribly deep and cold” (289), showing the narrator’s ultimate loss of agency due to her illness. In the end, it is a larger discourse – one that has literally defined the workings of her body, one that has told her that her hearts beats irregular – that maintains control over “me.”



Friday, March 16, 2012

2nd Close Reading Passage

This is a continuation of this


We see a shift in the nature of Hornbacher’s “I” as the memoir continues, though. No longer is the “I” decisive and forceful. Instead, it is momentary and visceral, cataloguing what are usually the more mundane moments of the life the memoir is supposedly chronicling. In the passage that follows, Hornbacher again uses pronouns interchangeably yet skillfully, but does so with slightly different effects than in the previously-analyzed passage:
You go insane about now. You understand, it just happens. Crazy isn’t always what they say it is. It’s not always the old woman wearing sneakers and a skirt and a scarf, wandering around with a shopping cart, hollering at no one, nothing, tumbling through years in her head . . . No. Sometimes it is a girl wearing boots and jeans and a sweater, arms crossed in front of her, shivering, wandering through the streets at night, all night, murmuring to no one, nothing, tumbling through the strange unreal dimensions in her head. . . Bedtime, and the house falls darker still. I sit at the window, waiting for the mutterings and shufflings to slow and stop. . . I hold the back of the chair with one hand, do exercises endlessly, waiting for one o’clock. Only four hours till morning, I think. (171-172).
In the above passage, there is a clear divide between the splintered narrator and other people (she is not the woman with the shopping cart), implying a certain cohesiveness of the “I,” “you,” and “she” all used in the passage. By both separating and collecting her narrative self with her pronominal use, Hornbacher negotiates the dilemma articulated by Buss – that the female autobiographer must present herself as stable and unified while acknowledging herself as “fragmented [and] decentered” (97). Since there is a boundary between the woman with the shopping cart (as there is between the narrator and the others characters in the book), evidenced by a distanced perspective, the reader could then conclude that Hornbacher’s distinct pronouns are, indeed, referring to the same narrator, and that instead of reflecting the disintegration of a coherent self into multiple, weaker selves, they are instead evidence of the authorial negotiation involved in female autobiography.
However, Hornbacher’s memoir complicates Buss’ observation about female autobiographical challenges, as Hornbacher’s is also a memoir of illness. Couser writes that autobiographical texts about illness may be written as a “retort” to the “misrepresentation of disability” (400). Here, Hornbacher does this explicitly by defining “crazy” as something other than what she presumes to be the social conception of “crazy.” She writes that crazy is not what society would expect – it is not “always the old woman . . . hollering. . . tumbling. . .” (171). Instead, it is the ‘normal’-looking girl – the girl who defies the social depiction of mental disability – that Hornbacher casts as “crazy” in an obvious attempt to shatter preconceived notions about the face of mental illness. Hornbacher furthers her retort not only by labeling a third-person female crazy, but also by labeling “you” crazy as well. “You” go insane. “It” happens to “you.” By placing “you” at the start of the passage, which comes after a page break and starts off its own section within the chapter, Hornbacher collects her three pronouns – “I,” “you,” and “she” – into her representation of her mental illness, thus resisting social constructions about how eating disorders and the insanity that accompanies them are ‘supposed’ to appear. Mental illness – insanity – can happen to a ‘normal’ girl in a sweater; they can happen to “you,” just as they happened to “I.” Further, as Margaret Price points out, the use of these three discrete yet inherently (by way of the text) intertwined pronouns contributes to a counter-diagnostic culture, in which Hornbacher not only pushes on representations of her mental illness, but also the framework in which those representations exist. By stating that “crazy” is not the woman with the shopping cart, Hornbacher suggests that our contemporary diagnostic culture is structured such that discrete mental sufferings are only recognized within the framework of the shopping cart-woman, thus overlooking individual difference by lumping it into one singular socially recognized category – shopping cart “crazy.”
Hornbacher’s pronominal plurality, in addition to representing a female autobiographical dilemma, then, also represents a rebuff of the cultural construction of mental illness. However, since the three pronouns, though separate, are also connected, and since one pronoun refers to a “girls wearing boots and jeans and a sweater” (171), the reader may assume that the three pronouns are all feminized, in which case Hornbacher is not representing mental illness and autobiographical femininity separately, but it rather exploring what the impact of mental disability means for a female subject, especially when the mental disorder in question is perhaps the most feminized of all mental illnesses – an eating disorder. Hornbacher writes that she “sit[s] at the window, waiting for the mutterings and shufflings to slow and stop” (171). She – I – You cannot leave the house until the morning. It is not permissible for her to leave the house until the morning, and it is in this nocturnal waiting that the social confines in which the narrator moves are made apparent. Here, the house acts metaphorically, working to represent the long history of female domestic confinement and the confinement of the mentally ill to asylums. In morning – when it is allowed – she will emerge. Her actions, as Wendell notes, are governed by cultural authority, which strips the individual of a narrative deviating from ‘proper’ cultural representation.
This cultural confinement, ultimately resulting in the individual’s inability to decide a course of action for him- or herself, is also perhaps the cause of Hornbacher’s weakened “I” in this passage. In contrast to the passage I first analyzed, which encompassed an extremely decisive “I” – “I chose an eating disorder” (6) –, the “I” in this second passage is paired with sedentary verbs. Whereas the “I” in the first passage “chose,” “think[s],” “believe[s],” and “sought” (6-7), the “I” in this passage “sit[s]” and “hold[s].” It is only in waiting – in the “four hours till morning” (172) that the narrator “think[s]” (172). This “I” is static, waiting for morning as she engages in another activity that lies within the scope of the cultural narrative for the female body – exercises. The “I” is confined, and the “I” is engaging in an activity by which she hopes to confine her body to cultural standards. Her exercises are done on a chair; they, too, are sedentary. There is no choice for this “I.” The “I” of this second passage is prescriptive, bowing to the disabling cultural constructions of both mental illness and the female gender (McDermot and Varenne).
Though Hornbacher represents her condition as female and mentally ill as confining (and therefore undesirable to a restless woman who, in the middle of the night, would rather be wandering), she also represents herself within a diagnostic framework that resists labeling confinement negatively. Like many anoretics, the narrator is plagued by insomnia and restlessness, medical hallmarks of malnutrition. She compulsively exercises, which is explicitly listed in the DSM-IV symptoms of both Bulimia Nervosa and Anorexia Nervosa – Binge-purge Subtype. The “she” in this passage “tumbl[es] through the strange, unreal dimensions in her head” (171), reflecting the lack of concentration and confusion reported by many eating-disordered individuals. And Hornbacher’s use of words discussing time – “years,” “one o’clock,” “hours,” “morning” (171-2) – references the obsessive-compulsive thinking characteristic of anoretics, who are often obsessed with various ‘counts’ – calories, minutes, times something ‘must’ be repeated in order to be done ‘correctly’. The language in which her pronouns exist is permeated by a diagnostic undertone, situating the I-you-she within the clinical literature surrounding eating disorders. It is in this situating that Hornbacher strays from a disabilities studies perspective, using disabilities studies only to highlight the cultural constructions that gave rise to and defined her behaviors. By placing her narrator within clinical literature, molding the narrator’s narrative to match the narrative not delineated by a larger society, but by medical professional specifically, Hornbacher develops the language of the medical humanities, namely, as Edwards pointed out, a language that allows patients to describe their experience with illness in a ways that the medical community can understand (241).
In the space of a few sentences, Hornbacher sets up a triangulation of theoretical contradictions. She is at once embracing a diagnostic framework while at the same time refusing its constriction. She is expressing several selves within one narrator, feminizing each self in the process, while maintaining a divide between the I-you-she and a woman with whom I-you-she might identify. Hornbacher straddles the line between individual and collective experience, drawing her reader (through a feminized “you”) and otherwise unnamed “shes” into a collective perception of embodying a disabled and confined gender, drawing eating-disordered individuals together into a discrete diagnostic category, and drawing disabled persons into collective societal constriction, yet, by virtue of the personal details of her narrative account and by virtue of her genre – memoir – Hornbacher also emphasizes the experience of her created I-you-she as individualistic. It is the singular individual who sits in a specific house and waits for specific people to stop shuffling. It is the singular individual who waits “four hours till morning” (172). The details of her narrative define her work as a memoir. Because these details are so specific, even if they sit within a larger discourse of collective experience, Hornbacher reserves an autobiographical label for her work. 

Friday, March 9, 2012

Field Review - Women's Autobiography (From a Feminist Standpoint)

I was supposed to do a field review of feminist theory and of autobiography as a genre, but as I researched I found the two to be united in theories of women's autobiography, and that this unification better supports my work with Hornbacher's memoir. 


            The history of women’s autobiographical writing stretches far back, situating itself as a mark of chastity and virtue (Lamb). In the Renaissance, non-fictional writing – often in the form of diaries – represented the only type of writing permissible for women in good social standing, as women who read or wrote fiction were thought to gain sexually and socially transgressive ideas from the genre (Lamb). Early women’s autobiographies “manifested Christian virtue [which was] an excellent thing in women” (Heilbrun 17). The earliest recognized female autobiography, published in 1656 by Margaret Lucas Cavendish, Duchess of Newcastle, exemplifies the narrow scope of self-representation available to women: “ . . . Likewise, we were bred Virtuously, Modestly, Civilly, Honorably, and on honest principles . . . we lived orderly” (Cavendish 178). Cavendish’s autobiography, among others, represents not the advent of the female autobiographical tradition, but a continuation of the male tradition catalyzed by St. Augustine. According to Georges Gusdorf, male autobiography stresses “the defense and glorification of a man, career, a political cause, or a skillful strategy” (Benstock 8). Female autobiography (up until around 1980, when Estelle Jelinek’s groundbreaking Women’s Autobiography was published) reflected a reinforcement of the “token woman” – the inevitable response to the “masculine man” as presented in male autobiography –  (Heilbrun 16) and a continuation of the “one plot” available to women, which ended either in marriage or death (17).
            Women’s autobiography has a tradition of being “sentimental and passive” (19), bringing only the expected out for the public to see and leaving the private – goals, hopes, anger – to private spheres (19). Disconnect between the private and the public is seen particularly in Jane Addams’ diaries in contrast with her published autobiography. While her autobiography demonstrates the passivity characteristic of female discourse, her diaries – unpublished and private – reveal the challenges and frustrations she had with establishing Hull House (19). Women were expected to speak with authority only of “family and religion” (19). Addam’s status as businesswoman was therefore relegated to her private writing.
            The tradition of women’s autobiography sees a shift in the development of confessional writing, however. This writing, with its emotive and tell-all nature, defied the conventional literary script within which women’s autobiography was expected to operate and opened women to their “uninhibited autobiographical impulses” (23). The advent of such writing marks the beginning of the “rhetoric of uncertainty” (18) that today characterizes women’s life writing. Unlike male autobiographical writing, women’s life writing “has become an exploration of painful experience rather than denial of pain and struggle” (25), moving from introspection outward (24) and extending their experience to a larger population (Benstock 8).
            With the defiance of masculine autobiographical tradition, women’s life writing became inherently politicized. The act of confession, of making the private public, essentially catapulted women’s autobiography into feminist discourse, creating room in women’s life writing to integrate the political and the personal, as Estelle Jelinek demonstrated in her essay, “Political and Personal Autobiography Integrated: The Fusion of Kate Millett.” According to Jelinek in her 1980 publication, Women’s Autobiography, women’s “self-portraits” are informed by “irregularity rather than orderliness” (17), a long-standing distinguishing feature of women’s life writing in contrast to men’s. This “irregularity” is often seen in pronominal switching and disruption of chronology. In her analysis of Millett, Jelinek indicates that “irregularity” has been expanded in women’s life writing to include writing that seems like “a jungle of fragments” (171), with truncated sentences without proper subjects and perhaps consisting only of a phrase or even a single word, resembling “the kind of shorthand writing characteristic of diaries and notebooks” (171), interrupted by passages that are “chronological, progressive, and strictly grammatical” (171). These stylistic trends of women’s life writing, Jelinek argues, are the ways in which politicization of the female text occurs. Through the multiplicity of the singular subject, which Benstock states stands in direct contrast to the male resistance of the “discordant ‘I’ ” (8) and various other structural and stylistic choices that distinguish women’s life writing from the male tradition, women have developed a means by which their selves – coherent, fractured, and multiplied – are represented outside of the traditional prescriptive forms.
            In “Reading for the Doubled Discourse of American Women’s Autobiography,” Helen Buss argues that in the wake of the development of politicized women’s life writing, female autobiographers now face a unique challenge – the much present their autobiographical self in a “stable, unified” (97) way in order to adhere to the conventions of a genre which begs for the “self” as subject and in a way that reveals the “subject as fragmented, decentered, and dominated by forces largely beyond her control” (97). In other words, the female autobiographer is challenged to negotiate between self-perception – the “I” as a unified self – and social politicization, which casts the “I” an unstable result of a history of oppression and representative of a collective larger than the singular self. Combining Jelinek’s observation of the longstanding tradition of fragmentation in women’s writing with Buss’ argument about the doubled discourse in women’s life narratives, it seems that a way of negotiating the demands of the double discourse would be to engage in such self and structural fragmentation. Thus, the fragmentation in women’s life writing is the reflection of the feminized politicized self, acknowledging a history of oppression and disabling cultural forces while speaking for both the unified “I” and a larger female majority.
            Up until this point, I have conflated the terms “women’s life writing” and “autobiography.” In doing so, I have attempted to reflect a movement begun by feminist autobiography theorists, which casts various non-fictional forms, including memoir, letters, and diaries, as sub-categories in the overarching genre of autobiography (Smith and Watson). Hornbacher’s memoir with which I am working will therefore be considered as an example of women’s life writing, and will be evaluated within the history and feminist framework previously delineated. Thus, her memoir will be considered an example of and possible extension to a genre relatively new in its existence, but long in its historical lineage. 

Thursday, March 8, 2012

Field Review - Disabilities Studies


            At a lunch I shared with Margaret Price, Anne Dalke, and a few other students, Price, explaining the difference between the medical humanities and disability studies, told us that while the medical humanities has arisen from within medical schools themselves and thus looked to reform medicine from the inside, disabilities studies instead had roots in academia and looked toward past social reformations – the civil and women’s rights movements, for example – as the basis of its theoretical foundations. Disabilities studies is “both an academic field of inquiry and an area of political activity” (Davis xv) that “aims to challenge the received in its most simple form – the body – and in its most complex form – the construction of the body” (xvii). The field is concerned with the idea that “the world [is] structure[d] for people who have no weaknesses” (Wendell 243), and that weakness in and of itself is a socially constructed paradigm based upon some unspoken human archetype for which everyone is implicitly required to strive.
It has only been recently that disabled individuals have considered themselves a united minority, and it was only in 1990 that the disabled minority gained ground politically with the passage of the Americans with Disabilities Act of 1990 (xvi). Scholarship on disabilities has been limited until recently, with the field’s grassroots originating in the earlier work of Jacques Derrida, Judith Butler, Susan Bordo, Erving Goffman, and David Rothman, among others (David xvii). These earlier writings, published not under “disabilities studies,” but rather under a hosts of other titles – feminist studies, philosophy – all have the social emphasis of a bodily archetype at their core and have since been incorporated into the body of developing work in the field of disabilities studies (xvii). Davis writes,
 [T]he work of a newer generation of writers and scholars looks toward feminist, Marxist, postmodern, and cultural studies models for understanding the relation between the body and power . . . [t]his next generation of writing tends to be created from within the boundaries of disability (xvii).
This newer work, instead of attempting to “share” the disabled experience by showing audiences what it is like to be, deaf, blind, etc., instead refuses to write for normative audiences, and thus shuns the inherently unequal balance between disabled and able-bodied that occurs when works are “sensitized” in such a way (xvii). By upending this power dynamic of sensitization, disabilities studies creates room for critical inquiry into difference without falling into an advocacy trap that promotes emotive, sympathetic understanding and, in doing so, reinforces cultural conceptions of disability as weakness and as disadvantage.
In my examination of Wasted, I will largely be concerned with disabilities studies as a reflective field – as a field that sheds light on the constructions that either name or cause disability. In explaining the traditional view of disability, Davis states,  “disability has been seen as eccentric, therapeutically oriented, out-of-the-mainstream, and certainly not representative of the human condition” (xv). Because of this view, disability may be theorized much in the way that “race, class, and gender have been theorized” (xvi) – namely, in a way that places disability in a sociopolitical cultural context. More than a medical genre, disabilities studies resists the institution of medicine as an explanation for what we as a society are to do with these individuals. Instead, the field considers individual difference in the context of social and political consequence, focusing on oppression as a result of being named disabled and ultimately attempting to de-institutionalize difference. The field is concerned with the power dynamic between the disabled individual and society, showing that being labeled with a disability “exposes affected individuals to inspection, interrogation, interpretation, and violation of privacy” (Couser 400). Couser explains, for example, that “people with anomalous bodies are often called upon to account for them, sometimes quite explicitly: they may be asked, ‘What happened to you?’ ” (400). For the purposes of my paper, disabilities studies will be a means of explaining eating disorders outside of the clinical literature – of answering how culture is constructed in such a way as to facilitate the development of these disorders and of exploring how society might cope with these disorders in non-clinical ways.
            The United Nations defines disability as “[a]ny restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being” (244). Handicap, which refers to the social disadvantage resulting from disability, is “the loss or limitation of opportunities to take part in the life of the community on an equal level with others” (24s4). Thus, social function is inextricably linked to social constructs, like disability, that allow for “normative” experiences of society. Susan Wendell, in “Toward a Feminist Theory of Disability,” points out that the given definitions of “disability” and “handicap” are dependent on recognition of the normative (245), and that “[p]aradigms of health and ideas about appropriate kinds and levels of performance are culturally dependent” (245). She points out that because social conceptions of disability are so dependent on context, “we might eliminate the category of the ‘disabled’ altogether, and simply talk about individuals’ physical abilities in their social context” (245). Thus, disabilities studies, as shown by Wendell, is an examination of functionality within cultural confines and an inquiry as to how degrees of functionality may contribute to a given culture.
            In their article, “Culture as Disability” by McDermott and Varenne, this link between disability and social construct is made apparent. McDermott and Varenne argue that culture is both able-ing and dis-abling in that it selects certain features (i.e. thinness, economic success) and creates a society in which those features make existing easier. For example, the advent of the radio depended on the fact that ours is a “hearing” society, and that the normative, able-to-hear majority would benefit from receiving information in this manner. The appearance of the radio, then, introduced a means of obtaining information that excluded those with a “disability” – here, deafness. McDermott and Varenne point out that it is in these social inventions that disability is created. In the exclusion of a minority feature in an action that favors the majority, a degree of social functionality is lost.
            With these broad conceptions of disabilities studies in mind – culture as constructing disability and disabilities studies providing for a non-medical inquiry into disability – I will now briefly turn to disabilities studies’ interrelation to the medical humanities, theories of autobiography, and feminism. Wendell writes that contemporary medicine “plays into and conforms to our cultural myth that the body can be controlled” (249). She observes that doctors are “trained to do something to control the body” (250) – the body must bend, under various therapies, to the will of the physician, who is ultimately aiming to return the body to a cultural norm. She calls this the “heroic approach to medicine” (250), and labels it an approach in which “[m]edical professionals have been given the power to describe and validate everyone’s experience of the body” (253). The medical humanities, in line with Wendell’s description of western medicine, does not desire to subvert the power or aim of the medical professional. Though change to the existing framework of medicine is desired, the medical humanities does not seek to question the medical nature of the framework in which medicine operates. The field instead seeks reform within the framework. Disabilities studies, by contrast, relies on the non-medical nature of illness to explore how it might be handled, and in doing so, pushes away from traditional medicine. Subversion is key to disabilities studies if change is to be made.
Though disabilities studies is often at odds with the medical humanities, because is has roots in feminism, feminist theory about disability has been crucial in pushing the movement forward. Rosemarie Garland-Thompson writes, “The fundamental premise of Disability Studies is that disability is a culturally fabricated narrative of the body, a system that produces subjects by differentiating and marking bodies” (1). Her observation of the field draws directly from feminist theory. Feminism rejects the cultural narrative of the female identity and body. Disabilities studies rejects the narrative of the disabled identity and body. Wendell claims that disabilities studies cannot be separated from feminist studies, as both force “[you] . . . to realize that other people have more social authority than you do to describe the experience of your own body” (254). Combining the two fields into what she refers to as “feminist disability critical theory,” Garland-Thompson outlines a methodology that allows us to approach the narratives of disabled women:
The fundamental premises of feminist disability critical theory are: that representation structures reality; that the margins define the center; that gender and disability are ways of signifying relationships of power; that human identity is multiple and unstable; and that all analysis and evaluation has political implications (6).
It is this approach to the disabled female condition – that society has constructed gender as a disability, and that a disabling gender and a traditional disability are inseparable when criitically viewing a disabled woman – with which I will be concerned in my examination of Hornbacher’s memoir.
            My final area of interest with disabilities studies lies in its relation to theories of autobiography and representation. Couser writes that “[t]he cultural representation of disability has functioned at the expense of disabled people, in part because they have rarely controlled their own images” (399). In contrast to this historic representation, Couser states that recent life writing exemplifies a way in which “disabled people have initiated and controlled their own narratives” (399). This writing, he suggests, should be considered a “retort” to “misrepresentation of disability” in that the writing resists the cultural narratives that are “inscribed” on the bodies of the disabled (400). Expanding on Couser’s idea, Margaret Price, in “Her Pronouns Wax and Wane: Mental Disability, Autobiography, and Counter-Diagnosis,” describes the ways in which, by showing a multiplicity of selves through the deliberate confusion of a narrative “I,” autobiographical writing by disabled individuals creates a culture of counter-diagnosis that defies the framework that contributes to the institutionalization and oppression of individual difference. As shown by Price, Couser, and others, disabilities studies is largely integrated with cultural and personal narratives of disability and gender, and in its challenging of traditional medical structures, provides a key insight into Hornbacher’s representation of eating disorders, which stretches beyond the clinical and the personal.


Tuesday, March 6, 2012

Field Review - Medical Humanities


            In its earliest practice, before even alchemy was conceived as a discipline, approaches to medicine heavily depended on the humanities. Medical theories rested on a primeval kind of empiricism, with direct observation and patient’s narratives as key diagnostic tools. The philosopher Hippocrates, for example, used direct observation of patients to theorize about the body’s workings and the ethics of medicine. He coined many of the medical terms still in use today – “acute,” “chronic,” “epidemic” – and developed treatments based on the idea that the body’s function depended on the balance of four “humors” – black bile, yellow bile, phlegm, and blood. His philosophy extended beyond the body, however, as Hippocrates also produced a seminal body of literature, known as the “Hippocratic Corpus,” which contains some of the first writing on medical ethics, the Hippocratic Oath. For Hippocrates, as well as other physicians of both his time and time beyond, medical practice was inextricably linked to philosophy, literature, and the social sciences.
            The introduction of Aristotelian empiricism marks the beginning of a long shift in the medicine away from the humanities toward “evidenced-based” theories of diagnosis and treatment. By the twentieth century, medicine was essentially void of any discipline save for the hard sciences and technology. In “Writing at the Margin: Discourse Between Anthropology and Medicine,” Kleinman calls this kind of medicine “biomedicine,” reflecting “the overall trend . . . for the patient narrative gradually to disappear in favor of technical investigation, for symptom to give way to disease entity, and for treatment to become non-negotiable . . . [in response to] the humanities gradually retreat[ing] from medicine” (Ilora et al., 11).
            Beginning in the 1960s, a “perception” of a “crisis” rose in western medicine, which questioned the “underlying authority of modern scientific medicine” (13). Specifically,
. . . the emergence of the anti-psychiatry movement; the inability of science and technology to deal effectively with many chronic and disabling conditions, despite escalating levels of public expenditure on healthcare; and an awareness of the personal insensitivity of much of modern medicine and its failure to take account of the patient’s perspective (13)
all contributed to a growing movement toward reform of medical practice, which catalyzed the development of the medical humanities. David Greaves, in his chapter entitled, “The Nature and Role of the Medical Humanities,” defines the field as “a humanistic perspective . . . [that] embodies a mode of enquiry which is typical of philosophy in particular, but can also be discerned in every subject in its relationship with medicine” (16). Though there is no one agreed-upon definition of the medical humanities (7), Greaves’ definition encompasses both the narrower and broader views of the field, situating the narrow conception within the broader. The first (and narrower) view of the medical humanities “equates [the field] with the medical arts” (18), defined as a view that “subordinates” science and technology to the “art of medicine” by naming science and technology “arts” in and of themselves (14). This narrower view depicts the medical arts as being a counterbalance to biomedicine, allowing neither art nor traditional science to dominate medical practice (18). The second broader view
focuses on the human as relevant to the whole of medicine and so cuts across the traditional formulation of western medicine as comprising separate realms of art and science, with the human aspects restricted mainly, if not exclusively, to the former (18).
Greaves’ definition defies the binary between the sciences and the arts, thus allowing for “and innovative and unified approach” (19) to medicine, which allows both for a reconsideration of medical theory and for “practitioners to develop a more rounded and humane attitude to their practice” (19). For the purposes of this paper, I will use Greaves’ definition of the medical humanities to inform the work I will do on Hornbacher’s memoir.
            In “The Humanities’ Role in Improving Health and Clinical Care,” Richard Edwards describes the goals of the medical humanities, calling the field a response to theories of medicine that are generalized and impersonal. He states that the “study of the humanities . . . may provide valuable opportunities to bridge the ‘organism – mechanisms’ divide” (238). Greaves presents four possible definition of the humanities, but in my discussion of Edwards’ implications for the field of the medical humanities in medicine, I will use Greaves’ fourth definition of the humanities: “[s]ubjects concerned with the uniqueness of individuals rather than generalization” (15) . Edwards points out that evidence-based medicine leads to generalizations that do not necessarily match the needs or situation of the individual, and that “even in ideal circumstances” (238) where the individual does meet a generalized clinical picture of an illness, “it remains imperative to address and respond sympathetically to the emotional consequences of diagnosis and treatment” (238). Medical humanities, then, sets as its ultimate goal the remedying of these two probable situations that arise from clinical generalization.
            Edwards discusses a variety of ways by which the medical humanities works to reform medicine from within its existing structures. First, he argues, the medical humanities provides a language by which patients and physicians may communicate (241). This language allows patients to verbalize their emotions concerning diagnosis and treatment, and the creation of fictional narratives allows for possible courses of action to be explored (241). This discourse provides a frame in which evidence-based theory may situate itself – within fictional narratives and emotive depictions of disease is the decision to apply a particular evidence-based theory. In addition to providing a means of discourse, Edwards points out that, in “[e]stablishing a valid language for communication of issues of emotions” (241), the medical humanities creates space for physicians to express warmth and “human values” (241), thereby allowing them to reassure patients and to explore the benefits and drawbacks of a treatment from  both theoretical and emotional perspectives. Edwards continues that the ability to entirely evaluate a given treatment is conducive to the exploration of alternative and complementary therapies for illness, thus creating the opportunity for western medicine to consider treatments not empirically validated, such as those associated with eastern medicine (242). Expanding on his argument that the medical humanities allows medical professionals to consider complementary therapies, Edwards states that the medical humanities builds upon the “problem-based learning” (245) associated with western medicine in that the humanities beg for a “questioning” (242), critical approach that “promote[s] reflective practice and learning” (242).
            In returning to Edwards’ basic argument – that the discourse created by the medical humanities ultimately combats clinical generalization by establishing an empathetic, critical approach to treatment and diagnosis –, I will now discuss Edwards’ implications for narrative representations of illness. Edwards states:
It is [useful] . . . to employ published narratives or artistic representations of ill health as qualitative input alongside actual patients’ narrative, to widen perspective and facilitate a more sympathetic understanding of the ‘human condition’ (237).
Thus, published narratives of illness work, on a grader scale than oral, unpublished patients’ narratives, to promote the aforementioned ways by which the medical humanities influences change within western medicine. In publishing such a narrative, a patients develops a voice apart from medical generalization, fitting his or her own story into the framework already in place to create the space for a dialogue between reader and text that allows for clinical language to expand beyond the textbook. It is through this combination of clinical and personal narrative, interwoven so as to be inseparable, that the medical humanities is apparent in published personal discourses of illness, and it is in this space that I situate my own analysis of such a narrative. 

Saturday, March 3, 2012

The Beginnings of an Introduction

Here is the introduction to my thesis in its infancy!


“The words are purposes.
The words are maps.
I came to see the damage that was done
and the treasures that prevail.”
- “Diving into the Wreck,” Adrienne Rich, 1973

I am interested in stories. It is a longstanding interest, one that has combined with other interests – psychology, medicine, nonfiction – to produce a professional trajectory that aims toward medicine, but which resists science as the only means to get there. When I began to conceptualize my senior thesis, I was certain only of two things: I wanted to work with memoir, and I wanted to combine my interest in mental health with my stake in English literature. From the beginning, my thesis was an interdisciplinary project. I wanted my thesis to be an experiment – an experiment in how literature represents illness, in how psychology explains prose, in how a text might resist linearity and other traditional devices to defy its given genre. I had lofty ideas about what I wanted to produce, but then I took a step back and realized I had no primary text.
So, ever the scientist, I randomly ordered memoirs off the Internet. And somehow, I ended up with Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher. Though initially hesitant to work with a memoir I found so compelling – I did not want to ruin the narrative for myself with over-analysis –, the complexity in Hornbacher’s memoir begged to be unraveled, and since I knew precious little about eating disorders (and wanted to know more), I decided to take on Hornbacher’s most-famous chronicle of eating disorders.
As I began to unpack Hornbacher’s text, I became interested in her pronominal choices. She was “I”, “we,” “she.” At times, she was “you.” Questions surfaced. How does the prognosis of an eating disorder change when its bearer resists pronominal identity? What is a memoir without a concrete “I”? How do popular culture and diagnostic culture clash in the telling of such a narrative? But most importantly – what disciplines will be most helpful in untangling the mess of pronouns scattered throughout Wasted?
Through a drawn-out process of theory-reading (the particulars of which I will spare the reader), I settled on four areas among which I will situate myself in order to explain how Hornbacher represents eating disorders and how, by extension, her work can exemplify a way in which the humanities can help the medical field understand its patients and constructed diagnostic categories. Eating disorders are inherently complex, finding neurobiology, social surroundings, individual temperament, the family climate and more as their etiological roots, and thus, as can be expected, a comprehensive view of an eating-disorder is similarly complex, requiring seemingly contradictory theories to explain its layers. Because Hornbacher often implicates sociocultural expectations of the feminine body and personality in development of her eating disorder, it was natural that feminist theory would be one of key players in my explanation of Wasted’s pronouns. Further, since Hornbacher also focuses on the disabling aspects of culture, feminist studies seemed to logically combine with disability studies in an explanation of why “you” and “we” should be able to empathize with the singular experience of “I.”
Feminist and disability studies did not seem to encompass the complexity of Hornbacher’s writing, however. Standing in contrast to Hornbacher’s sociocultural explanations of her disease are her clinical explanations – an enmeshed family pattern, a history of mental illness, a personality that errs impulsive. I began looking at Rita Charon’s work at Columbia’s medical school. She focuses on narrative medicine – how patients tell their stories and how those stories can be used to contribute to more accurate diagnoses and treatments as well as greater empathy in physicians.  From narrative medicine, I explored the field of medical humanities, which deals with both the stories of individual patients and the story of medicine itself, looking to offer the most comprehensive healthcare through reformed thought about diagnosis and treatment.  Though medical humanities and disabilities studies stand in contrast to one another, with disabilities studies looking to question the validity of the framework of medical diagnosis and medical humanities seeking reform from within that same diagnostic framework, I found the contradiction between the two fields useful in discussing an essentially contradictory illness.
My final area of interest is one of genre – specifically, in women’s memoir and autobiography. In my analysis of Hornbacher’s work, I will take memoir as a subcategory of autobiography (as many theorists have done) so that I may examine how her shifting pronouns push on her self-proclaimed genre of “memoir.”
The following project seeks to follow Rich’s words – to use words as “maps” and “purposes” to uncover the “treasures that prevail.” By situating myself within the four walls of theory I have chosen, I will ultimately suggest that texts like Hornbacher’s are maps not only to an individual life, but to diagnosis and reformation of diagnosis, so that diagnostic categories might be more comprehensive – taking into account sociopolitical, familial, and like climates in addition to traditional symptoms – to offer a more accurate view of, in this case, eating disorders.