Articles: Gender, Body, Meaning: Anthropological Perspectives on Self-Injury and BPD
By Carolyn Sargent
Philosophy, Psychiatry, & Psychology 10.1 (2003) 25-27
THE CENTRAL THEMES OF "Commodity Body/Sign: Borderline Personality Disorder and the Signification of Self-Injurious Behavior" reflect issues that cut across the disciplines represented by this journal and have received increasing attention from anthropologists. Medical anthropologists, as well as psychological anthropologists and others interested in symbolic analysis of the body, have addressed such topics as the culture of biomedicine and the cultural shaping of psychiatric classification, the multiple meanings of body modifications, power relations in therapeutic interactions between doctor and patient, and cultural variation in understandings of normality and abnormality.
Curiously, there is little anthropological literature that directly focuses on either borderline personality disorder (BPD) or self-injurious acts per se. Indeed anthropological research on psychiatric diagnosis, classification, and treatment, as well as ethnopsychiatry, include scant reference to personality disorders. One exception is Nuckolls' 1992 article, "Toward a Cultural History of the Personality Disorders," which raises pertinent questions for one of Potter's introductory statements—that the majority of those diagnosed with BPD are women. Nuckolls directly addresses gender ideology and gender roles in the United States in his comparison of antisocial personality and histrionic personality diagnoses. In his paper, he argues that these personality disorders have cultural histories and are strongly congruent with prevailing gender stereotypes, such that men are many times more likely to be diagnosed as antisocial than women and women much more likely to be diagnosed as histrionic (Nuckolls 1992, 37). He also historicizes the emergence of certain behavioral styles that have been seen as characteristic of women and men, and the evolution of psychiatric diagnoses that classify extreme manifestations of these behavioral styles.
The issue of why women, rather than men, are more frequently diagnosed with BPD is not elaborated in Potter's article, although she notes the importance of considering the intersection of gender and "identifying behaviors" associated with BPD. Cultural analyses of gender ideology in the [End Page 25] United States might suggest that the connection involves gendered expectations concerning emotionality and relational context but these articulations remain intriguing and underexplored. One might speculate that BPD/self-injury occurs in the context of particular gender ideologies, perhaps in class-based, industrialized societies where the body is highly commodified. It appears that the history of this constellation of symptoms and behaviors remains to be written.
Cultural analysis of self-injury, a theme that runs through Potter's article, tends to be embedded in the anthropological literature on body ornamentation, initiation rituals, and "culture-bound" syndromes. Mascia-Lees and Sharpe (1992, 1) describe the body as "a site of adornment, manipulation, and mutilation," practices with roots reaching back as far as 30,000 years, and include as examples head deformation, scarification, foot binding, tooth filing, lip plates, nose rings, tattoos, subincision, and genital cutting.
However, the concept of self-injury, as Potter notes, is problematic in the discipline of anthropology given the significance historically accorded to cultural relativism. Correspondingly, body "modification" is not "self-injury" as long as it is socially normative, for example, a facet of an initiation ordeal or body ornamentation (e.g., circumcision, scarification, piercing). Among the rare examples of acts that seem readily identifiable as "self-injury" are New Guinea practices of cutting off a finger to demonstrate mourning and Baatombu (West African) male finger amputation to show grief and anger over a wife's infidelity. Both are, however, considered culturally legitimate and not indicative of pathology.
Potter's argument draws heavily on the notion of "body as text," derived largely from literary theory and feminist philosophy (Butler 1990; Jaggar and Bordo 1989). The perspective of "body as text" has influenced anthropological theory over the past two decades, particularly in the interpretive and postmodernist schools of thought. The body as a text of femininity is aptly characterized by Bordo, who argues that the continuum between female disorder and normal femininity is revealed by means of an analysis of symbolic meaning of gender in historical context. Thus, "we find the body of the sufferer deeply inscribed with an ideological construction of femininity emblematic of the periods in question . . . The bodies of disordered women in this way offer themselves as an aggressively graphic text for the interpreter—a text that insists, actually demands, it be read as a cultural statement, a statement about gender" (Bordo 1989, 16).
Anthropologist Terence Turner, in an early work on the body, refers to the "social skin," suggesting that the surface of the body serves as a symbolic stage, and bodily adornment the language through which it is expressed (1980, 113). Following this initial statement, the body has achieved centrality in medical anthropology, as a rich site for cultural analysis and practice (Guarnaccia 2001). The anthropological body is conceptualized as both totally biological and totally cultural, and as a potential vehicle for communication, parallel to Potter's description of the body "used to communicate something that is difficult or impossible to articulate in conventional modes."
Within medical anthropology, "idioms of distress" has served as a powerful concept for exploring the body as a symbolic text for speaking the unspeakable (Nichter 1981). Idioms of distress are alternative modes of expressing distress, where distress refers to a broad range of feeling states ranging from apprehension and dissatisfaction to anxiety states. Direct articulation of these states might generate an unacceptable social or political conflict. Nichter uses a case study from South India to illustrate how somatization is an important idiom through which distress is communicated. Drawing on Nichter's conceptualization, numerous anthropologists have used it to explore syndromes such as "nerves," or "nervios," which have been identified throughout Latin America. (Davis and Low 1989; Jenkins 1996). Researchers describe a very wide range of symptoms including dizziness, fatigue, headache, chest pain, and feelings of anger, anxiety, sadness, and desperation. However, self-injury is not cited among these expressions of the body as text.
Potter's emphasis on interpretation of meanings associated with body modifications is certainly shared by anthropologists, and would be central to most cultural analyses, which emphasize [End Page 26] the insider's perspective. Potter contends that ethical clinical care must rest on eliciting meaning from the patient concerning self-mutilation. This seems unexceptionable, but her distinction between delicate or superficial and severe self-mutilation raises the question of whether these are behaviors on a continuum, in which case one would assume that together with the need to protect the patient from life-threatening self-destructive acts, interpretation of the symbolic meanings of severe self-injury would remain critical, as with delicate self-injury. Given the prevalence of biological psychiatry, cognitive therapy, and a variety of "brief" therapeutic modalities, her reminder of the importance of symbolic meanings is particularly timely, especially in the context of intractable issues such as those discussed in this paper.
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References
Bordo, S. 1989. The body and the reproduction of femininity: A feminist appropriation of Foucault. Feminist reconstructions of being and knowing. Ed. Jaggar, A., and S. Bordo. New Brunswick, N.J.: Rutgers University Press.
Butler, J. 1990. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge.
Davis, D., and S. Low. 1989. Gender, health, and illness. The case of nerves. New York: Hemisphere.
Guarnaccia, P. 2001. Introduction: The contributions of medical anthropology to anthropology and beyond. Medical Anthropology Quarterly 15:423-8.
Jaggar, A., and S. Bordo, eds. 1989. Gender/body/knowledge. Feminist reconstructions of being and knowing. New Brunswick, N.J.: Rutgers University Press.
Jenkins, J. 1996. The impress of extremity: Women's experience of trauma and political violence. Gender and Health. Ed. Sargent, C., and C. Brettell. Upper Saddle River, N.J.: Prentice Hall.
Mascia-Lees, F., and P. Sharpe, eds. 1992. Tattoo, torture, mutilation, and adornment[i/. Albany: State University of New York Press.
Nichter, M. 1981. Idioms of distress: Alternatives in the expression of psychosocial distress. Culture, Medicine and Psychiatry 5:379-408.
Nuckolls, C. 1992. Toward a cultural history of the personality disorders. Social Science and Medicine 35:37-49.
Turner, T. 1980. The social skin. Not work alone. A cross-cultural view of activities superfluous to survival. Ed. J. Cherfas and R. Lewin. Beverly Hills, CA: Sage.
THE CENTRAL THEMES OF "Commodity Body/Sign: Borderline Personality Disorder and the Signification of Self-Injurious Behavior" reflect issues that cut across the disciplines represented by this journal and have received increasing attention from anthropologists. Medical anthropologists, as well as psychological anthropologists and others interested in symbolic analysis of the body, have addressed such topics as the culture of biomedicine and the cultural shaping of psychiatric classification, the multiple meanings of body modifications, power relations in therapeutic interactions between doctor and patient, and cultural variation in understandings of normality and abnormality.
Curiously, there is little anthropological literature that directly focuses on either borderline personality disorder (BPD) or self-injurious acts per se. Indeed anthropological research on psychiatric diagnosis, classification, and treatment, as well as ethnopsychiatry, include scant reference to personality disorders. One exception is Nuckolls' 1992 article, "Toward a Cultural History of the Personality Disorders," which raises pertinent questions for one of Potter's introductory statements—that the majority of those diagnosed with BPD are women. Nuckolls directly addresses gender ideology and gender roles in the United States in his comparison of antisocial personality and histrionic personality diagnoses. In his paper, he argues that these personality disorders have cultural histories and are strongly congruent with prevailing gender stereotypes, such that men are many times more likely to be diagnosed as antisocial than women and women much more likely to be diagnosed as histrionic (Nuckolls 1992, 37). He also historicizes the emergence of certain behavioral styles that have been seen as characteristic of women and men, and the evolution of psychiatric diagnoses that classify extreme manifestations of these behavioral styles.
The issue of why women, rather than men, are more frequently diagnosed with BPD is not elaborated in Potter's article, although she notes the importance of considering the intersection of gender and "identifying behaviors" associated with BPD. Cultural analyses of gender ideology in the [End Page 25] United States might suggest that the connection involves gendered expectations concerning emotionality and relational context but these articulations remain intriguing and underexplored. One might speculate that BPD/self-injury occurs in the context of particular gender ideologies, perhaps in class-based, industrialized societies where the body is highly commodified. It appears that the history of this constellation of symptoms and behaviors remains to be written.
Cultural analysis of self-injury, a theme that runs through Potter's article, tends to be embedded in the anthropological literature on body ornamentation, initiation rituals, and "culture-bound" syndromes. Mascia-Lees and Sharpe (1992, 1) describe the body as "a site of adornment, manipulation, and mutilation," practices with roots reaching back as far as 30,000 years, and include as examples head deformation, scarification, foot binding, tooth filing, lip plates, nose rings, tattoos, subincision, and genital cutting.
However, the concept of self-injury, as Potter notes, is problematic in the discipline of anthropology given the significance historically accorded to cultural relativism. Correspondingly, body "modification" is not "self-injury" as long as it is socially normative, for example, a facet of an initiation ordeal or body ornamentation (e.g., circumcision, scarification, piercing). Among the rare examples of acts that seem readily identifiable as "self-injury" are New Guinea practices of cutting off a finger to demonstrate mourning and Baatombu (West African) male finger amputation to show grief and anger over a wife's infidelity. Both are, however, considered culturally legitimate and not indicative of pathology.
Potter's argument draws heavily on the notion of "body as text," derived largely from literary theory and feminist philosophy (Butler 1990; Jaggar and Bordo 1989). The perspective of "body as text" has influenced anthropological theory over the past two decades, particularly in the interpretive and postmodernist schools of thought. The body as a text of femininity is aptly characterized by Bordo, who argues that the continuum between female disorder and normal femininity is revealed by means of an analysis of symbolic meaning of gender in historical context. Thus, "we find the body of the sufferer deeply inscribed with an ideological construction of femininity emblematic of the periods in question . . . The bodies of disordered women in this way offer themselves as an aggressively graphic text for the interpreter—a text that insists, actually demands, it be read as a cultural statement, a statement about gender" (Bordo 1989, 16).
Anthropologist Terence Turner, in an early work on the body, refers to the "social skin," suggesting that the surface of the body serves as a symbolic stage, and bodily adornment the language through which it is expressed (1980, 113). Following this initial statement, the body has achieved centrality in medical anthropology, as a rich site for cultural analysis and practice (Guarnaccia 2001). The anthropological body is conceptualized as both totally biological and totally cultural, and as a potential vehicle for communication, parallel to Potter's description of the body "used to communicate something that is difficult or impossible to articulate in conventional modes."
Within medical anthropology, "idioms of distress" has served as a powerful concept for exploring the body as a symbolic text for speaking the unspeakable (Nichter 1981). Idioms of distress are alternative modes of expressing distress, where distress refers to a broad range of feeling states ranging from apprehension and dissatisfaction to anxiety states. Direct articulation of these states might generate an unacceptable social or political conflict. Nichter uses a case study from South India to illustrate how somatization is an important idiom through which distress is communicated. Drawing on Nichter's conceptualization, numerous anthropologists have used it to explore syndromes such as "nerves," or "nervios," which have been identified throughout Latin America. (Davis and Low 1989; Jenkins 1996). Researchers describe a very wide range of symptoms including dizziness, fatigue, headache, chest pain, and feelings of anger, anxiety, sadness, and desperation. However, self-injury is not cited among these expressions of the body as text.
Potter's emphasis on interpretation of meanings associated with body modifications is certainly shared by anthropologists, and would be central to most cultural analyses, which emphasize [End Page 26] the insider's perspective. Potter contends that ethical clinical care must rest on eliciting meaning from the patient concerning self-mutilation. This seems unexceptionable, but her distinction between delicate or superficial and severe self-mutilation raises the question of whether these are behaviors on a continuum, in which case one would assume that together with the need to protect the patient from life-threatening self-destructive acts, interpretation of the symbolic meanings of severe self-injury would remain critical, as with delicate self-injury. Given the prevalence of biological psychiatry, cognitive therapy, and a variety of "brief" therapeutic modalities, her reminder of the importance of symbolic meanings is particularly timely, especially in the context of intractable issues such as those discussed in this paper.
--------------------------------------------------------------------------------
References
Bordo, S. 1989. The body and the reproduction of femininity: A feminist appropriation of Foucault. Feminist reconstructions of being and knowing. Ed. Jaggar, A., and S. Bordo. New Brunswick, N.J.: Rutgers University Press.
Butler, J. 1990. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge.
Davis, D., and S. Low. 1989. Gender, health, and illness. The case of nerves. New York: Hemisphere.
Guarnaccia, P. 2001. Introduction: The contributions of medical anthropology to anthropology and beyond. Medical Anthropology Quarterly 15:423-8.
Jaggar, A., and S. Bordo, eds. 1989. Gender/body/knowledge. Feminist reconstructions of being and knowing. New Brunswick, N.J.: Rutgers University Press.
Jenkins, J. 1996. The impress of extremity: Women's experience of trauma and political violence. Gender and Health. Ed. Sargent, C., and C. Brettell. Upper Saddle River, N.J.: Prentice Hall.
Mascia-Lees, F., and P. Sharpe, eds. 1992. Tattoo, torture, mutilation, and adornment[i/. Albany: State University of New York Press.
Nichter, M. 1981. Idioms of distress: Alternatives in the expression of psychosocial distress. Culture, Medicine and Psychiatry 5:379-408.
Nuckolls, C. 1992. Toward a cultural history of the personality disorders. Social Science and Medicine 35:37-49.
Turner, T. 1980. The social skin. Not work alone. A cross-cultural view of activities superfluous to survival. Ed. J. Cherfas and R. Lewin. Beverly Hills, CA: Sage.
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