‘The more relations a body has, the more it is capable of doing‘
Nick J.Fox, 2012
There’s a lot of unrest in a world dominated by pain. In a very literal sense, we can understand this as a lack of rest, fatigue, a disturbance of sleep, or available energy. In another sense, it describes a feeling of turmoil, chaos, uncertainty.
Turmoil, chaos, and uncertainty plunge our body into a perpetual state of distress, which can leave us feeling fatigued or lacking energy. The word distress comes from the Latin dis, meaning “apart,” and stringere, to “press together,” “stretch,” or “bind”. We feel separated or stretched apart from our body, from our loved ones, from who we are (Leder, 2016).
As if we aren’t burdened enough with the sensations of pain, the distress of living with pain separates us from things that we once managed with ease, things that to our body, often went unnoticed. A movie. Dinner with friends. Playing with the kids. And yet, once pain presents itself, the body comes fully into view. At first, the injured body part, but quickly advancing to the whole body. We lose faith in our body, we distrust it, often being unable to truly express what we feel or experience. We recoil from playing with kids, isolate from the movie and stoically, silently, uncomfortably tolerate dinner with friends.
In her book, The Body in Pain (1985), Elaine Scarry describes the totality of pain from within the body to spilling out beyond the body. She writes:
‘the seventh aspect of pain… is its totality. Pain begins by being “not oneself” and ends by having eliminated all that is “not itself.” At first occurring only as an appalling but limited internal fact, it eventually occupies the entire body and spills out into the realm beyond the body, takes over all that is inside and outside, makes the two obscenely indistinguishable, and systematically destroys anything like language or world extension that is alien to itself and threatening to its claims.’ (Scarry, 1985, pg.54)
Much of what has been shared so far is not demonstrable of the biological body. No mention of tissues: muscles, bones, ligaments, discs, nerves. No mention of physiological pain processes: transduction, transmission, sensitization, facilitation, inhibition, modulation. No mention of a privilege to using biological explanations, a biological determinism. No mention of body function reduced to the level of the tissue or cell, biological reductionism (Fox, 2012).
These criticisms of the biological body are symbolic of the writings of French philosopher Giles Deleuze and French psychoanalyst Felix Guattari, as the ‘body-with-organs’ or ‘the organism.’ (Deleuze & Guattari, 1988, Pg.158).
When we think of organs in the body we might think of internal organs like the heart, lungs, or the bowel. It may be less common to think of the skin, skeleton, muscles, and nerves as organs, but indeed, they too are organs. The term ‘organ’ refers to the part of an organism that has a specific vital function.
Deleuze and Guattari describe the body-with-organs as the medicalizing processes of healthcare upon the body (biological processes, terminology, diagnosis, treatment) and the experience of illness into disease (Fox, 2012). A metamorphosis of a person into a patient. I believe many people living with pain can relate to the term metamorphosis. The meaning refers to ‘a change of the form or nature of a thing or person into a completely different one.’
Patients (unlike people) are informed about and told to do things with their bodies under the warm-hearted guise of medical advice. This may be to rest, to not partake in activity or exercise, to be careful. A body-with-organs is the ‘territory’ of healthcare underpinned by biomedicine (Fox, 2012). Noticeable, an object, something to be studied and examined, a patient. Using Deleuze and Guattari’s concept of territory or ‘territorialization’, Fox (2012, pg. 71) describes the impact biomedicine has upon people. He writes:
‘A biomedicine assemblage territorializes an individual consulting a health professional, transforming her/him into a patient and her/symptoms into a disease.’
Intuitively, Deleuze and Guattari contrast the body-with-organs with the ‘body-without-organs’. A body that goes unnoticed is active, dynamic, creative, building relations. It has capacity and capability. It is a body that is capable of doing.
When discussing pain, physiotherapists commonly use biological explanations to educate people living with pain about the processes involved in pain. Physiotherapists talk about tissues, physiology, structure and function using biological explanations. They do this because it can provide tangible, measurable, and reliable ways of explaining what is potentially going on inside a body and offer appropriate treatment. Curiously, whilst most patients and physiotherapists would argue that this is offering care with a view to restoring health, we unknowingly territorialize a person (a body-without-organs) into a patient (a body-with-organs) through use of our biological, structural and physiological explanations. Things that, for the person living with pain or not, go completely unnoticed.
This suggests that the view of the body through a territorialization of biomedicine, accompanied by biological explanations of pain, limits the body to what it can do. It contributes to the familiar term of ‘stuckness’ – the inability to move or to build new relations (Bennett & Oliver, 2019). The treatment of the body through a structural, biological process (despite positive outcomes), we perpetuate the territorialization of the person to a body-with-organs. To reiterate, pain brings attention to our body. Prior to pain, the majority of our days would not involve such vigilance to our body.
How might one curiously address biomedical territorialization? Deleuze and Guattari (1988) explain that one can re-territorialize their body through a line of flight. Providing our patients with different relations or ways of relating to, as Scarry expressed ‘that is inside and outside’ of the body. Understanding the lived experience of patients through empathy and compassion. To ask our patients what else could your body do? How willing would they be to reduce the pursuit of stuckness to their former self? How willing could they be to engage in a different self? A line of flight to re-territorialization. To ‘doing’ more than it is capable of currently.
What wonders might be out there for physiotherapists that diminish their territorialization to biomedicine and view bodies as a body without organs rather than a body with organs?
Thanks for having a read
Bennett, R., & Oliver, J. E. (2019). Acceptance and Commitment Therapy: 100 Key Points and Techniques. Abingdon, Oxon OX14 4RN: Routledge.
Deleuze, G., & Guattari, F. (1988). A Thousand Plateaus: Capitalism and Schizophrenia. Minneapolis: University of Minnesota Press.
Fox, N. J. (2012). The Body: Key Themes in Health and Social Care. Cambridge, UK: Polity Press.
Leder, D. (2016). The Distressed Body: Rethinking Illness, Imprisonment, and Healing. Chicago 60637: University of Chicago Press.
Scarry, E. (1985). The Body in Pain: The Making and Unmaking of the world. The Body in Pain (1st editio). New York: Oxford University Press. https://doi.org/10.2110/jsr.60.160
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