More than meets the eye.
Feminist poststructuralism as a lens towards understanding obesity.
Firstly this paper by Aston et al (2011) opens by accepting the framing of obesity as a health emergency or ‘concern’ and it does so by referencing the World Health Organisation’s (2011) ‘global epidemic’ phrase. Thus it contributes to a value position that obesity is indeed a medical issue with negative health consequences. The position is then taken that obesity is a ‘disease’ arising out of social and environmental conditions. That is to say it accepts that obesity is a disease but that its causes are not rooted only within individuals and their behaviour but as arising from their social position and the environment they live in (the ‘obesogenic’ environment). They argue “Obesity now represents a major public health issue” (p1188) and according to the WHO (1998) is the second most modifiable cause of ill health after smoking. Aston et al use the word alarming to describe Canada’s population where 60% are overweight or obese. The issue as to whether obesity is simply a disease that needs curing regardless whether its aetiology is individual or social, is open to question. However for the purposes of this paper I wish to explore what feminist post structuralism (FPS) can bring to understanding obesity.
Feminist Post Structuralism.
Aston et al argue that FPS seeks to understand the meaning and experience of obesity as arising from our social relationships. It also seeks to understand how power relationships work between individuals as they are constructed through social, institutional and political structures. In other words, what are the power relationships involved in for example daughter-mother family relationships “mum’s on a diet again…and my bum does look big in this!” (social); worker-employer relationships “oi! lard arse, get off yer bum back in the office or we’ll put you on a fitness course!” (institutional); and patient-health policy relationships “I note Mrs Jones, that you BMI is well into the overweight category…we need to reduce that to reduce your risk of diabetes and heart disease…what weight loss programme shall we use, have you seen Change for life?” (policy-political), and how do they affect the individual’s life experiences and chances? In this context, we would seek to examine the talk between the ‘fat’ and the nurse, we would want to understand both their beliefs and values and stereotypes and how this talk and interaction (including body language) constructs the experience of being fat in this encounter. This also examines how the fat are observed and measured, what questions are asked of them and how those questions are put to them and what solutions are put forward (e.g. eat less, exercise more!).
FPS seeks to examine the personal experiences, the relationships people have, and how they understand how power operates in each social setting, be it the family, the workplace or the health clinic. This point of view (perspective) accepts that life is social and therefore our personal experiences (personal troubles) can be understood through examining how social, cultural and institutional beliefs, stereotypes and norms (public issues) affect us.
This perspective is an alternative to a medical discourse (a medical way of thinking and talking about) which accepts as axiomatic, as self-evident, that a person’s health is predominantly under the control of the individual. Therefore a good deal of research within this sort of thinking seeks to understand obesity as arising from psychological and genetic factors and examines personal behaviours involved in weight gain.
Furthermore, health interventions and health professionals may tacitly accept this medical discourse and design interventions around changing personal and behavioural factors (e.g. ‘Change for Life’). This approach has not and will not work. It is largely ineffective in reversing population obesity. Roberts and Edwards (2010) in ‘The Energy Glut’ suggest that whole populations across the globe are ‘getting fatter’; waist circumference and BMI measurements are increasing in developing as well as developed nations. If obesity needs to be understood as part of social relationships and relationships of power at that, then we need to challenge the notion of obesity as only a personal problem (a personal trouble). Applying the sociological imagination (Wright Mills 1959) to obesity we would seek to understand the personal trouble of obesity as a public issue, relating the personal biography of the ‘fat’ individual to historical changes and social structures.
So how does FPS throw light upon this issue?
1. By focusing on discourse.
2. By focusing on power relationships.
3. By focusing on subjectivity (one’s ‘subject position’) and agency.
One’s experience, beliefs and values are shaped by and shape the language we use about obesity. By examining how we talk about it to uncover our stereotypes and beliefs allows us to clarify our personal understanding and how we come to our understanding. When we listen to healthcare professionals talking about obesity as a disease and the need for personal responsibility for behavioural change we may believe that it is down to us to eat less and exercise more. After all that is the main message. We may even use this language to describe our battle with weight.
Individuals and groups have the power to impose a discourse onto interactions. These are supported by contextual factors (where that interaction takes place, for example the GP surgery). Health policies such as Change for Life position the fat as needing to take personal responsibility. Being overweight and its negative connotations is supported by medical research into the health risks and positions it as a ‘bad thing’. The fat can’t challenge this discourse as they don’t have a counter position. There are plenty of places where fat is seen as negative and as a disease (hospitals, clinics, surgeries, health centres, leisure and sports centres) and where it fat and fat people are excluded except as negative stereotypes (magazines, film and TV programmes, advertising, jokes, comedy).
Subjectivity and Agency.
We can come to see our subjective selves as being constructed through the above discourses and power relationships but through our agency (our ability to act) can come to challenge dominate negative or ‘disease’ discourses through dialogue, research, speaking out and open communication. So, on the one hand our subjective self can be beaten down with an acceptance that it is my personal responsibility to get thin and if I cannot then it is my fault. My subjective self may even accept the need for doing so in an attempt to align my body image with some thin ideal and as part of healthy living to prevent disease. I may accept that I am already ‘ill’ by being overweight. However by engaging my ‘agency’, my ability to act, I may challenge some of these assumptions and want evidence for the positions taken. For example, at what stage does extra weight really become unhealthy? How do I balance enjoying life with all that it offers with a rigid abstinence regime in the hope of achieving a thin ideal? Do I want to live longer as a thin person (if that is actually what may occur) if I have to count every calorie and give up beer?
“You call me fat, I feel fat, but actually I don’t think it is my fault entirely…this is not about blame or making me out to be a victim…you have to realise that the food choices I am faced with, the transport options I have are having an impact. It is not easy to change everything about my life when society continues to encourage weight gain. In any case the athletic thin ideal is unobtainable for me and I like a glass of wine and cheese, it what makes for a bon viveur”.
However, what is so F about FPS?
It seems clear from the paper that we need to challenge health, media, medicine and education organisations in their understanding about obesity. Society and the healthcare system has to recognise that the modernisation of our world (Wright Mills’ historical and structural changes) has set the global populations up for failure with respect to maintaining a healthy body weight through increases in opportunity for food intake and decreases in opportunity for energy expenditure, but I fail to see the feminism in this piece. What is the gendered nature of social relationships which would presumably affect women’s experiences? This paper does not make that clear. The obese in this paper are neither male or female.
Aston M, Price S, Kirk S, and Penney T. (2011) More than meets the eye. Feminist poststructuralism as a lens towards understanding obesity. Journal of Advanced Nursing.
Benny Goodman. 2012
‘We are all locked in’ but can we escape the system?
“the apparently independent and autonomous system of industrialism has transgressed its logic and boundaries and has thereby begun a process of self-dissolution” Ulrich Beck.
Sociologically we can make the following observations about our current high carbon ‘economy-society’ (Urry 2011). The starting point for an analysis of why society engages in particular practices and habits is the observation that energy is the base commodity upon which all other commodities exist (Urry 2011) and which therefore underpins behaviours, habits and practices.
Consider a society that does not have or has never had access to coal, gas or oil. All they have is the wind and water for energy. You don’t have to imagine it, those societies have been well documented and some still exist. Their habits and social practices are then based on the energy form that water and wind gives them. This is not to say that the energy commodity determines the social forms they create otherwise they would all look the same. It is to say however that energy as a base commodity has a good deal of influence.
Since the discovery of steam power based on coal, and then power based on oil and gas, our western societies were able to develop in particular ways until we designed a society that needs this form of energy. Thus, our community behaviours are implicitly locked into high carbon systems that are taken for granted. We live within a cluster of interdependent systems: 1) coal/gas electric grid power; 2) petrol, steel and automobile; 3) carbon military industrial complex; 4) suburban housing and domestic technologies; 5) airlines, leisure, foreign tourism. These are all oil/carbon based. To that add a food system: agribusiness, farm, supermarkets. Some of these have become very fashionable and then embedded into our everyday practice. We have become carbon addicts unable to go cold turkey even if we wanted to.
To date we have to accept that much of social science has been carbon blind and has analysed social practices without regard to the resource base and energy production that we now know are crucial in forming particular social practices. Economics as a discipline tries to explain human behaviour, but has limits as it has an overly ‘instrumentally orientated, rational planning, utility maximizing’ model of human behaviour (in its non Marxist form). That is to say it assumes we make our choices based on our consideration of our own needs and self interests. The Thatcher-Reagan revolution was predicated upon seeing the consumer as king and the individual as the best master of their own destinies. The market is where rational actors come together to make the best choices, so it follows that nothing should get in the way of market activity. John Urry critiques modern economics for failing to address the fundamental relationship between people and the material physical world:
“most of the time people do not behave as individually rational separate economic consumers maximising their individual utility from the basket of goods and services they purchase and use given fixed unchanging preferences…(we are) creatures of social routine and habit…fashion and fad…(we are) locked into and reproduce different social practices and institutions, including families, households, social classes, genders, work groups, schools, ethnicities, generations, nations…. (Urry 2011 p4).
This really muddies the waters, it requires understanding that behaviour change results from myriad inputs raging from the ideological and analytical to the pragmatic availability of material resources at hand. It also requires us to consider issues of power over ‘rational’ actors, who has it and who exercises it and in whose interests? Therefore any new technological developments will operate in this ‘economy-society’ space. So how do new habits form? What is fashion and what are the effects of this? Do we need ‘the fashionable imagination’ – is there a quality of mind that spots and encourages low carbon fashions which are supported by technologies and commodities that use less carbon based energy? This way of thinking may be doomed however, for even if we could spot the next low carbon fashion, the structure of the economy as it currently is run would militate against it for the reasons set out below.
So, we live in societies that are locked into high carbon systems. We are also being asked to change our behaviour to adopt low or zero carbon habits, fashions and social practices. “Deep greens” ask us to fundamentally change everything about how we live. This rejects all high carbon systems, and that means consumer capitalism. ‘Mainstream’ sustainability adopts a less radical approach. The focus is not on complete system overhaul but on incremental individual behaviour change while encouraging and being encouraged by (‘nudged’) governments and corporations to do the right thing.
The emphasis on individual behaviour change through mechanisms of ‘behaviour change technologies’ (for example social marketing techniques or nudge theory) sit within a taken for granted neoliberal paradigm which sees the citizen consumer exercising their freedoms within deregulated markets. This is a technical-rational approach which assumes that there is no contradiction between greening our lifestyles and the capitalist system’s need for growth and consumption to increase.
This individual focus also obscures questions of collective social responsibility and power. Thus we have the project of the ‘carbon calculating’ consumer who may be nudged to do the right thing, to exercise choice within frameworks of governance that does not challenge the fundamentals of consumer capitalism chasing GDP growth.
A technology of behaviour change is the UK’s ‘Pro-environmental Behaviours Framework’. Social conduct can be divided up into segments (e.g. our travel behaviours) which are then amenable to intervention. We can re-engineer choices step by step. Behaviour forms under certain conditions which then can be manipulated using social marketing techniques. Concepts include: ‘Behavioural entry points’, ‘wedge behaviours’, ‘behavioural levers’, ‘choice editing’. There is a set of 12 headline behaviour goals categorised within 3 areas of consumption: 1) personal transport 2) homes and 3) Eco-products. This is the ‘change the lighbulbs approach’ to climate change.
The paradigm within which all of this sits is that of neoliberal consumer capitalism. This requires, no, has to have, 3% capital accumulation (Harvey 2010), deregulated markets and accelerating consumption. GDP growth is the central goal of economic policy. This form of capitalism also externalises costs, has cycles of crises due to the surplus capital accumulation problem (Harvey 2010) and relies on technological solutions (Ben-Ami 2010). It also wishes to rely on individual responsibility for health, welfare and social problems (e.g. Big Society solutions). Baumann calls it “a parasitic form of social arrangement which may stop its parasitic action only when the host organism is sucked dry of its life juices” (1993:215). The contradictions between consumer capitalism and sustainability are obscured, power and collective responsibility issues are marginalised. It produces two main approaches to carbon reduction:
1. Macro economics cap and trade systems, e.g the EU’s Emission Trading System.
2. Micro economic techniques designed to encourage pro environment consumer choice.
It is also based on the idea of the ‘self governing individualised subject’ (Homo economicus) which is a model of human behaviour not born out by the evidence.
What this seems to imply is that consumer capitalist societies will not address carbon reduction other than within this paradigm. If we are locked into clusters of high carbon systems and given the limits to growth (Meadows, Randers and Meadows 2004), planetary boundaries arguments (Rockstrom et al 2009) and ecological devastation then we will need to focus more and more on disaster management. David Selby made this point in 2007 in ‘as the heating happens’. Behaviour change technologies such as the pro-environment behaviours change framework cannot address the fundamental driver of carbon emissions in anything like the time frame required because neoliberal capitalism will always outrun sustainability due to its need for growth and consumption. Its very mechanism is antithetical to sustainable living.
Webb (2012) suggests citizen consumer knowledge on climate change is patchy at best. Short term concerns over the practicalities, convenience and cost of domestic and social life unsurprisingly dominates longer term concerns. Surveys demonstrate that we on the one hand identify with the need to adopt a low carbon future but on the other hand adopt high carbon choices. This ‘value-action gap’ is seen by government as a non reflexive fact about self interest (we don’t think about the contradictions in our answers) which is then seen as a barrier to change. In other words, self interest is supposed to drive behaviour but from a governments point of view we are not seeing our self interest as lying towards a low carbon future. We are paradoxically acting against our self interest. We value a low carbon future but we act as if we don’t because we are not reflecting on the connections.
However, surveys do not pick up the ‘situatedness’ of our response and the meaning we give to questions about low carbon living; cultural perspectives, social institutions and political values mediate the responses to attitudinal surveys and interpretations of climate science (Leiserowitz et al 2010). Therefore survey responses cannot be taken to be any true account of our actual preferences because our actual social practices are bounded by the material life we live in (the sorts of houses we have, the cars we drive, the products we buy).
We may be already in an era of peak oil, peak US power, peak welfare states and inequality reduction, peak water and gas availability. Given the limits to growth thesis, our ‘lock in’ to high carbon systems, the resistance to change and the needs of the economy for consumption and GDP growth which fuels that resistance there may be little else to do than prepare for the catastrophes to come. Sociology’s role will be in the field of disaster studies (Nursing will be part of that). Mental Health and Adult nursing may need to emphasise disaster and trauma management during ‘Peak Everything’.
Baumann, Z. (1993) Postmodern Ethics. Oxford Blackwell..
Ben-Ami, D (2010) Ferrari’s for all. Polity Bristol
Douglas, M., Wildavsky, A.B. (1982) Risk and Culture : An Essay on the Selection of Technical and Environmental Dangers. Berkley, University of California Press.
Harvey, D. (2010) The Enigma of capital and the crises of capitalism. Polity. Cambridge
Meadows, D., Randers, J., and Meadows, D. (2004). Limits to growth: the 30 year update. Earthscan. London.
Leiserowitz, A., Maibach, E., Roser-Renouf, C., Smith, N. and Dawson, E. (2010) Climategate, public opinion and the loss of trust. Yale Project on Climate Communication. July. [online] http://environment.yale.edu/climate/publications/climategate-public-opinion-and-the-loss-of-trust/
Urry, J. (2011) Climate Change and Society. Cambridge. Polity Press.
Rittel, H, and Webber, M. (1973) Dilemmas in a General Theory of Planning pp. 155–169, Policy Sciences, Vol. 4, Elsevier Scientific Publishing Company, Inc., Amsterdam [Reprinted in N. Cross (ed.), Developments in Design Methodology, J. Wiley & Sons, Chichester, 1984, pp. 135–144
Rockström, J. Steffen, W., Noone, K. et al (2009) A safe operating space for humanity. Nature. 461. Pp 472-475. 24th September. http://www.nature.com/nature/journal/v461/n7263/full/461472a.html accessed 8th January 2011
Selby, D. (2007) ‘As the heating happens: Education for sustainable development or education for sustainable contraction? Discourse, Power, Resistance Conference, Talking Truth to power’, http://www.esri.mmu.ac.uk/dpr_07/abstracts_07/index.php accessed 25th March 2009
Webb J (2012) Climate change and society: The chimera of behaviour change technologies. Sociology. 46(1): 109-125.