Ethics, Embodiment Re/Production and the Lifecourse

Written following a symposium I was involved in organising, held on June 6th 2014 at the University of Edinburgh.

“[B]ioethics is out of touch. It is out of touch with bodies themselves” (Shildrick 2005; p. 2)

Feminist theorists such as Margrit Shildrick have been prominent in critiquing bioethical discussions which take for granted bodies and embodiment. In Ethics of the Body: Postconventional Challenges, an edited collection by Shildrick and Mykitiuk, this is explored via papers addressing a range of topics which both invoke bioethical engagement, but also unsettle and question notions of embodiment and what bodies are. For me, the book has been a useful and enduring resource, since different chapters within it address areas of empirical research or teaching I’ve been involved in: addictions (Helen Keane), mental health (Nancy Potter), disability (Jackie Leach Scully), and sex/gender (Katrina Roen).

On 5th June 2014, a symposium, Ethics, Embodiment, Re/Production and the Lifecourse, at the University of Edinburgh, interrogated questions about the relationship, and potential for mutual collaboration between, theories of embodiment and bioethics. The symposium was part of a Wellcome Trust strategic award, The Human Body, its Scope, Limits and Future, on which Sarah Cunningham-Burley, my co-organiser, is co-investigator.

What can theoretical work on embodiment contribute to discussions about the ethical implications of biomedical innovations? What can bioethics contribute to theoretical work on embodiment?

The focus of the symposium on re/production and the lifecourse reflected an attempt to look at embodiment and ethics in terms of reproduction, and especially the challenges raised by new reproductive technologies, but also to consider how biomedicine increasingly works across the lifecourse to produce different types of bodies. Such biomedical innovations and interventions raise significant ethical questions. They also raise important questions about the nature of bodies and embodiment.

My own interest in embodiment and bioethics, and what the two might contribute to one another, led from work I undertook during a postdoctoral fellowship at IASH (Institute for Advanced Studies in the Humanities). While there I was working broadly on ethics and self-harm, but I focused especially on exploring the ways that academic discourse about the ethics of treating self-harm addressed embodiment. Perhaps unsurprisingly, most of what I found, which was itself limited, tended not to engage much with self-harm as an embodied practice. Indeed, this is reflective of the vast majority of academic work on self-harm – it tends to gloss over the messy, lived, corporeal aspects of being or caring for someone who self-harms.

The relative lack of engagement in (some) bioethical work with embodiment, and especially fleshy, lived bodies, was raised by many of the speakers who contributed to the symposium. I’ll be writing a more detailed blog and report of the day; but here is a brief overview of the speakers and their talks:

Session 1: Reproduction, ethics and embodiment

  • Elizabeth Ettorre, opened the day sketching out the need for an embodied ethics, which is open to and engages with bodily, embodied diversity; is empathic; and attends to embodied emotions as a part of ethical reflection.
  • Danielle Griffiths followed, taking an embodied perspective to ethical debates about new reproductive technologies; particularly those that have been proposed but not yet realised: male pregnancy and ectogenesis.

Session 2: Ethics, medicine and disabled bodies

  • The second session addressed disability and medical treatments or ‘fixes’. Fadhila Mazanderani discussed the role of patient’s embodied experiences in guiding their decision making regarding controversial treatments for MS; contrasting this type of evidence with, for example, Randomised Control Trials that are often prized in clinical decision making.
  • Jackie Leach Scully raised a series of provocative arguments regarding the development, use and representation of prosthetics. She suggested that the use of prosthetics contributes to the normalisation of certain types of disabled body; and the marginalisation of others.

Session 3: Biomedical innovations and enhancements

  • Next, Gill Haddow addressed a different type of assistive device (ICDs), though this one designed to prolong/extend/save life; discussing the embodied and relational consequences of being a ‘cyborg’.
  • Finally, Sarah Chan addressed bioethical debates about enhancement, using this discussion to problematize dominant bioethical discourse about normality, especially as applied to gender and disability.

The third session was also to have included a paper from Anne Kerr, discussing body work and emotional labour in biomedical innovation. Anne couldn’t present on the day unfortunately, but her paper would have been a great addition.

There were a number of common themes and threads running throughout the day, which I need more time to think about in order to do them justice. What was very clear was that there is a great deal of scope for further work which engages with bioethics and embodiment, especially when this explicitly includes attention to emotions.

References

Shildrick, M. (2005), ‘Beyond the Body of Bioethics: Challenging the Conventions’, in Shildrick, M. and Mykitiuk, R. (eds.), Ethics of the Body: Postconventional Challenges, London, MIT Press.

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Publication of Men, Suicide and Society

Another CRFR blog I wrote, this one in September 2012, reflecting on the media coverage following the publication of the Men, Suicide and Society report. For some reason (?!) I don’t think I ever submitted this, so nice to have somewhere to put it now. The experience of having academic work I’d spent months on interpreted for the mass media was certainly interesting, to say the least. The response I liked most was a column by Catherine Bennett in the Guardian, which you can see here.

On 20th September 2012 a report was published by the Samaritans titled Men, Suicide and Society. This report was co-authored by a group of economists, psychologists and sociologists, including myself and Julie Brownlie, a CRFR associated researcher. In the report, we set out to explore the reasons why men in midlife, from deprived backgrounds were more likely than any other group to complete suicide. The report was partly designed to highlight the greater risk faced by this group of men, in contrast to the more usual focus on suicide among younger men. Findings from the report were covered widely in the media, with articles appearing in the Telegraph, Guardian, Daily Mail, on the BBC, and on ITN.

My section of the report examined how social scientific work on masculinity might help to explain why this group of men are so vulnerable to suicide. However, the overall report was multi-faceted, developing a number of potentially important explanations including: psychological aspects; the impact of relationship breakdown; differences in emotional communication; and the impact of socio-economic disadvantage, recession and unemployment.

I drew together a range of qualitative research which had examined the particular experiences and accounts of men, often living in conditions of economic disadvantage. I argued that these accounts indicated that for men, in mid-life, from lower-socioeconomic groups, the constraints and rigours of hegemonic masculinity (or a ‘gold standard’ of masculinity as in the media-friendly press release) might be particularly damaging. I was more cautious as to why this might be the case, though I suggested that a lack of material and cultural resources might contribute. The group of men who are currently in mid-life, as argued in Julie Brownlie’s section of the report, might be especially vulnerable because a) they have lived through huge changes in the nature of the labour market (crudely, the move from ‘masculine’ heavy manufacture and industry, to ‘feminine’ service professions); and b) they have lived through a change in expectations about emotional literacy (caught between the stoicism of their fathers, and the –apparently – greater openness of their sons).

One issue that was overlooked in most (though not all) of the media coverage, was that the restrictive masculinities discussed in the report impact negatively on everyone, not just men in this particular social group. For instance, although we characterise young men as relatively more emotionally liberated, there is evidence that men and women of all ages have different attitudes towards emotional expression and help-seeking; and men of all ages are more likely to complete suicide.

The implications of the report are far-reaching, suggesting that restrictive gender identities in general should be challenged, among people of all ages. Boys and girls should be encouraged and supported to explore diverse ways of being and becoming men and women. While including gender awareness teaching on the curriculum in schools would be a good start, changes need to be made across society (2014 edit: so, not really asking for much then?!).

Personal troubles and public issues: Suicide among disadvantaged men in mid-life and the importance of sociology

Suicide and society

BBC Newsnight ran a story on 5th March 2013 exploring the reasons why men in the UK are around three times more likely to complete suicide than women. As well as gender, other social factors affect suicide rates, particularly age and socio-economic position. While suicide is the leading cause of death for men aged 30-44, the suicide rate among men aged 45-59 has been “increasing significantly” since 2007 (ONS 2013) becoming almost equal to the 30-44 year old rate. The group of men most likely to die by suicide is men in mid-life (aged 35-54) in the lowest socio-economic group, a fact highlighted in a report published by Samaritans last year.

The Newsnight programme featured the work of both Samaritans and CALM (The Campaign Against Living Miserably), as well as including powerful testimony from men who had experienced suicidal thoughts, and the family of a man who had completed suicide. Much of the discussion focused on the difficulties faced by men in acknowledging distress and seeking help. Barriers include ‘masculine’ ideas about appropriate behaviour, especially around communicating about distress; the design of mental health services; and wider stigma about mental ill-health. In light of these barriers, it was heartening to see suicide among men discussed so openly and in such a public setting. It was encouraging also to see the involvement of a range of professionals, perspectives and views.

What the programme also showcased (albeit not explicitly) was the importance of sociological perspectives in contributing to understanding suicide. The discussion demonstrated the extremely wide-ranging factors that impact on suicide among men including: economic hardship, changing labour markets, relationship breakdown, drug and alcohol use, socially proscribed expectations of what men and women should do, as well as mental ill-health. Many of these issues are explored in detail, using sociological approaches, in a report from Samaritans, which I contributed to: Men, Suicide and Society (2012). The report argued that the complex nature of suicide necessitates wide-ranging attempts at explanation, which go beyond clinical or psychiatric perspectives which – while important – have historically dominated suicidology.

Suicide research, policy and practice should incorporate a similarly wide disciplinary lens; and suicide prevention strategies too need to be wide-ranging. Although suicide is very much a ‘personal trouble’ it is also an inherently ‘public issue’ (Mills 1959). As such, policy and practice in a range of areas can and do impact on suicide. It already appears that the current economic climate is impacting negatively on rates of suicide, particularly among men living in areas with high rates of unemployment (Barr et al., 2012). These ‘public issues’ will not be solved by improvements in mental health services alone; but require bolder action in terms of addressing gender inequalities and gendered expectations of men and women, tackling socioeconomic inequalities, reducing social isolation, and improving the chances that men and women have of living fulfilled and content lives.

References and Resources

Barr, B., Taylor-Robinson, D., Scott-Samuel, A., McKee, M. and Stuckler, D. (2012), ‘Suicides associated with the 2008-10 economic recession in England: time trend analysis’, BMJ, 13, 345.

Mills, C. W. (1959) The Sociological Imagination New York, Oxford University Press

ONS (2013) Suicides in the United Kingdom 2011

Samaritans (2012) Men, Suicide and Society, why disadvantaged men in mid-life die by suicide
 

The social contexts of suicide: sociological contributions to understanding suicide

Blog originally published on the Institute of Mental Health blog in 2012. I’ve edited this a wee bit, but not much. I was asked to do the blog following a book review I wrote that was published in the BSA magazine, Network, in 2012.

Suicide is a complex issue that touches many lives, and is the concern of a range of social and health-care professionals. It is also an important public health problem, being the “tenth leading cause of death worldwide” (Windfuhr & Kapur 2011: 28). While suicide is strongly related to poor mental health; it is widely understood that suicide often occurs in the absence of a psychiatric diagnosis. Although psychiatry and related mental health professionals have an important role to play in suicide prevention, the complexity of suicide necessitates the involvement of multi-disciplinary researchers and practitioners.

Published in 2011, Understanding Suicide: A Sociological Autopsy (Fincham, Langer, Scourfield & Shiner 2011) presents research from a broadly sociological (though incorporating other social scientific approaches) investigation of 100 suicide case files from a coroner’s office. The study incorporated both qualitative and quantitative analysis of the files, in an adaption of the more well established psychological autopsy approach to studying suicide. The research findings illuminate important, but often overlooked, social factors relating to suicide:

  1. That the group of people most at risk of suicide are men in mid-life.

Fincham et al combine a quantitative analysis of the 100 case files they studied, with official statistics on suicide rates. Through this, they highlight that suicide rates for men peak between the ages of 35 and 45, with suicide being a relatively rare occurrence among young men. However, many suicide prevention programmes have focused on reducing suicide among young men. This reflects an increase in the suicide rate among young men; but obscures the fact that the men in mid-life complete suicide in greater numbers. Fincham et al’s analysis examines the ways that age and stage of life might be implicated in suicides. In particular, they highlight the varying strength and importance of social relationships and social bonds in youth, mid-life and old-age.

  1. The importance of social relationships in understanding suicide.

A commonly held understanding of suicide is that it is related to social isolation – leading from Emile Durkheim’s pioneering work on the sociology of suicide, which argued that social isolation increased the chances of suicide. However, Fincham et al argue that social relationships – or more accurately, unravelling social relationships – might be a more appropriate way of explaining suicide. Their research found that the deceased in the case files had often recently experienced a break-up in a relationship or had lost contact with their children. This approach to understanding suicide provides one way of explaining the connection between suicide and unemployment, with work being an important source of social relationships – particularly for men, particularly men in mid-life. A related finding was that suicide can be seen as a way of trying to work on social relationships. Analysis of the suicide notes included in just under half of the case files studied suggested that the notes were often used to attempt to heal, create, or sever social ties. Fincham et al suggest that “[r]ather than seeing death as the end … suicide notes can be a means to continue or even to initiate relationships through which agency can be exerted” (p. 89)

  1. The role of gender in understanding suicide

In an earlier paper, Jonathan Scourfield (2005) highlighted the importance of gender in seeking to better understand suicide. Scourfield’s approach emphasised the problematic way in which much previous research on suicide had addressed gender: that is in a rather straightforward way, looking at ‘males’ and ‘females’ as two separate, largely similar groups. In Understanding Suicide, a more nuanced gendered analysis is presented. This takes account of the importance of differences within men and women, rather than focusing on the differences between men and women. Thus, in Understanding Suicide, greater attention is paid to the complex interactions between gender, life stage, and employment, family-life, and intimate relationships.

Each of the above points serves to improve our understandings of why people die by suicide. By examining the role of life-stage, social relationships and gender on individual suicides, Fincham et al propose novel ways of explaining why certain groups of people are more vulnerable to suicide. Additionally, their approach further confirms the usefulness of qualitative approaches to researching suicide. Perhaps most importantly, Understanding Suicide demonstrates the need for wide-ranging approaches to suicide prevention, which incorporate social interventions alongside medical and psychological treatment (p. 185).

This blog draws on an earlier review, published in Network, the magazine of the British Sociological Association (Chandler, 2012).

Chandler, A. (2012), ‘Understanding Suicide: A Sociological Autopsy, by Ben Fincham, Susanne Langer, Jonathan Scourfield and Michael Shiner, Book Review’, Network, 111, 37.

Fincham, B., Langer, S., Scourfield, J. and Shiner, M. (2011), Understanding Suicide: A Sociological Autopsy, London, Palgrave Macmillan.

Scourfield, J. (2005), ‘Suicidal Masculinities’, Sociological Research Online, 10, 2.

Windfuhr, K. and Kapur, N. (2011), ‘International Perspectives on the Epidemiology and Aetiology of Suicide and Self-Harm’, in O’Connor, R.C., Platt, S. and Gordon, J. (eds.), International Handbook of Suicide Prevention: Research, Policy and Practice, Chichester, Wiley-Blackwell.