CONSEJO MUNICIPAL DEL DEPORTE DE GUADALAJARA

By way of example, I will sketch two discourses of the heart. 1 The ‘heart as pump’

Here the heart is primarily conceived of as a mechanism, a pump. Knowing about the heart means knowing which parts it consists of and how it works. Here is an example from a textbook of over 1,000 pages called Principles of Anatomy and Physiology:

The heart is magnificently designed for its task of propelling blood through an estimated 100,000 km of blood vessels. Even while you are sleeping, your heart pumps 30 times its own weight each minute, about 5 liters to the lungs and the same volume to the rest of the body.

(Tortora and Grabowski, 1996: 579) The same discourse can also be found in a Knowledge Adventure CD-ROM for children titled ‘3D Body Adventure’ (1995):

The heart is a very well designed pump indeed. It is more reliable and energy- efficient than any pump ever created by man.

And just as mechanical technologies such as cars now also incorporate some digital technology, so does the heart, in this CD-ROM:

The AV-node is smart and delays its signal just long enough to allow the atria to finish contracting.

It is clear that this discourse, this way of knowing about the heart, underlies many instances of text and talk, sometimes in detail, sometimes in sketchy outline. It can even be fictionalized, as in this excerpt from a piece of school homework, produced when a high school teacher had asked his students to write a story describing the life of a red blood cell in its journey about the body:

Dear Diary,

I have just left the heart. I had to come from the top right chamber of the heart (right atrium) and squeeze my way through to the right ventricle …

(Kress et al., 2000) The ‘heart as pump’ discourse originated in William Harvey’s Exercitatio of 1628. In its time it was heavily criticized by key medical authorities. As I will discuss in some detail below, it is typical of the scientific rationality which has, for centuries now, served the interest of economic and technological progress so well, even though in this case the surgical applications it makes possible had to wait until 1925. 2 The heart as risk factor

Here the heart is conceived of primarily as a risk factor, and knowing about the heart is in the first place knowing which foods to eat and which to steer clear of, which activ- ities to engage in and which to avoid, so as to minimize the risk of heart disease. The following quote is from an American book called Mind, Body and Sport:

In October 1992, the American Heart Association (AHA) added physical inac- tivity to its list of major risk factors for heart disease. This placed lack of exercise in the same category as smoking, high blood pressure and high cholesterol levels. ‘We are not born with this disease’, said Dr Gerald Fletcher, chairman of the AHA committee that wrote the position statement. ‘We really develop this disease because of our lifestyle’.

(Douillard, 1994: 45) The children’s CD-ROM I have already quoted from above also uses this discourse, with slight variations:

The risk factors for having a heart attack are well known. These risk factors include a diet high in fat and cholesterol, smoking, obesity, physical inactivity, high blood pressure, diabetes and a family history of heart attacks. It is thus possible for persons to lower their risk of a heart attack if they choose to. Of note, the incidence of heart attacks is four times lower in Japan than in the United States. This is because the major risk factors are much less common in that country.

This discourse is of more recent date. Over the past few decades it has become apparent that our increased rate of consuming natural resources and our highly devel- oped technologies in fields such as nutrition and medicine have brought about risks which are both invisible – and hence for practical purposes exist only in discourse, in our beliefs – and probably irreversible, at least in the short term. As Beck (1994) has pointed out, this signals the end of the monopoly of scientific rationality, and the emergence of a new kind of social rationality or ethics which will have to work together with scientific rationality. Discourses such as the ‘heart as risk factor’ are in the mainstream interest as they suggest that the solution lies with individuals and leave out the role of industry. That this can only be done by people with the money, time and expertise to turn their lifestyle into a science is usually also excluded from these discourses.

These two examples do not exhaust the discourses of the heart. Others relate to heart disease and construct knowledge of the symptoms and complaints of patients and of relevant treatments. They can operate at different levels, from first aid to open heart surgery. And then we have not even mentioned other kinds of discourses of the heart, for instance the discourse of the heart as the site of love. As Roland Barthes analyses it, in A Lover’s Discourse: Fragments:

The heart is the organ of desire (the heart swells, weakens, etc., like the sexual organs), as it is held, enchanted, within the domain of the Image-repertoire. What will the world, what will the other do with my desire? That is the anxiety in which are gathered all the heart’s movements, all the heart’s problems.

(1978: 52) I will return to this kind of discourse below. For the moment, let me summarize the key points that emerge from these examples.

Discourses are finite

As Foucault has formulated it, discourses contain a limited number of ‘statements’. Below I will discuss in more detail what kind of statements – or more generally, ‘ele- ments’ – discourses contain, but I hope the quotes above do establish that certain bits of knowledge such as that of ‘the heart as pump’ are shared between many people, and recur time and time again in a wide range of different types of texts and communica- tive events, even if they are not always formulated in the same way, and not always complete. But then, once I know a discourse, for example, the ‘heart as risk factor’ discourse, a single part of it can trigger the rest. Hearing only the phrase ‘risk of heart failure’, can immediately bring other elements of the discourse to mind, for example, smoking, obesity, lack of exercise, etc.

Discourses have a history

This is another one of Foucault’s key contributions to the theory of discourse. As with any other discourse, it is possible – and enlightening – to study how and why the ‘heart as pump’ discourse came about, as well as how it eventually became common sense, repeated everywhere, taught in schools, etc., until it finally became contested once again, as is now, gradually and tentatively, happening as a result of the emergence of competing discourses, such as the ‘heart as risk factor’ discourse. This is why I pay particular attention to discourse history in this chapter.

Discourses have a social distribution

We are not likely to encounter the ‘heart as pump’ discourse in ‘lonely hearts’ adver- tisements, or in fitness magazines, or in books with titles like Mind, Body and Sport. Nevertheless, all the various ‘health’-related discourses of the heart, despite their differences and conflicting aspects, do belong to one and the same ‘discursive forma- tion’, to use Foucault’s term. They rest in the end on the same kind of social authority, the medical authority (see the reference to the American Heart Association in the quote above) are continuously reported and supported by the same types of media, and emanate from the same sources of professional and institutional power – hospitals, laboratories, etc. As a result they can happily appear together in the encyclopaedia, that authoritative compendium of knowledge – in which, however, you will not find the ‘lover’s discourse’, at least not under the heading of ‘heart’.

Discourses can be realized in different ways

A given discourse can be realized in many ways. The discourse of ‘the heart as risk factor’, for instance, can be realized through action, through the actual enactment of a certain healthy lifestyle, or through representations of such a way of life – which is not to say that there cannot be contradictions between the way people act and the way they represent their actions. These representations again can take many forms – conversations, textbooks, school ‘lessons’, school ‘homework’, encyclopaedia entries, media reports, television programmes, advertisements, magazine advice columns, books on healthy lifestyles and natural medicine, etc. And they can be realized not only through speech and writing but also through sound and pictures, for instance in advertisements, which may either show the unhealthy food or the unhealthy lifestyle as particularly unappetizing, or their healthy counterparts as particularly attractive.