Diferencias entre galería comercial y centro

In one of his most famous works, The Birth of the Clinic, Michel Foucault (1963) endeavors to explain the impact of the modern medical system on the ways we understand identity and power in relation to the human body. As a history of medicine, Foucault charts the making of the patient as a particular identity, in direct relation to the making of the medical professional as expert. Such an understanding necessitated the separation between body and soul, in that medical practitioners were charged with treating the body, not necessarily the soul (or mind). As such, the medical gaze was suggested to penetrate the borders of the patient’s body, as an effort to “see inside”, detect and treat illnesses that remained invisible on the body’s surface. For this reason, the medical gaze encourages a disembodied relationship between body and mind, and promotes the belief that bodily processes can be identified and controlled via prescriptive medical

treatment. Through defining, detecting and treating illness, the medical gaze positions individuals as patients. The concept of the medical gaze has been of particular concern to feminist scholars of medicine (Young,1983; Lupton, 2012; Kristeva, Grosz, 1994; Shildrick, 1997; Shaw, 2012) as they suggest that women’s bodies are particularly targeted by the medical gaze, while simultaneously remaining misunderstood by the largely male medical profession.

The pregnant woman’s status as patient has also been called into question as has the association between pregnancy and illness that precipitates the medical management of pregnancy.

Deborah Lupton argues that, in western societies, women’s bodies in particular are seen as “symbolically leaky, open, fluid, [their] boundaries permeable and blurred” (2012:333). This state of being intensifies during pregnancy (as well as menstruation and menopause) and has the effect of rendering women, and their bodily functions, as “chaotic”. Lupton contends that

because western ideals dictate that the ideal body, or state of being, is “dry, contained, controlled by the mind, closed off from other bodies and autonomous, the female body is therefore

considered inferior, lacking, uncontrollable and disturbing” (2012:333). This is especially true for pregnant bodies as they signify a blurring of lines between self and other. Julie Kristeva (1982) asserts that the pregnant body disturbs the ordered and systematic way in which we understand bodies to function, and rather than accept this difference in functioning, we seek to control it. Following Kristeva (as well as Grosz, 1994; Shildrick, 1997), Lupton suggests that “liminality of body boundaries creates cultural imperatives to control and contain such ambiguity” (2012:333). In western societies the desire to control the ambiguity of women’s bodies, particularly during pregnancy, manifests in numerous ways, including as an intense and intensifying medical gaze.

Many feminist theorists (Oakley, 1984; Petchesky, 1987; Rapp, 1998; Duden, 1993; Haraway, 1997; Rothman, 1989; Shaw, 2012) contend that this medical gaze seeks to understand the particular functioning of pregnant bodies, in order to control them. Jennifer Shaw offers a reading of pregnant bodies through Foucault’s Birth of the Clinic. She distinguishes between male and female bodies by virtue of their capacity for reproduction, and argues that women’s bodies are subject to the medical gaze in relation to their reproductive capacities in ways that men’s bodies are not. Shaw asserts that “this has the dual effect of giving women more perceived control over reproduction (as an internal system that can be potentially monitored and

controlled....) while at the same time rendering that system external, in that the interior of the body becomes a thing to be known, an object of discourse...” (2012:127). In other words, Shaw describes the ways in which the medical gaze as applied to pregnancy, has the effect of

representing women as capable of both more, and less control over their pregnancies and pregnancy outcomes. The idea that pregnant bodies need to be contained, dissected and

controlled has meant concentrating medical research, technology and innovations, in an effort to understand and ultimately control the reproductive process.

Shaw and others (Haraway, 1997; Duden, 1993) suggest that medical discourses of pregnancy seek to undermine women’s embodied and authoritative knowledge as necessary to the

production of knowledge about the fetus. Following Haraway (1997) and Duden, (1993) Shaw (2012) argues that ultrasound is a particularly apt example of medical technology designed to take the “guess work” or subjective knowledge, out of the diagnostic equation. She explains, “the advancement that ultrasound represents is the ability to interpret the signs of the fetus without having to read them through the surface of the mother’s body, or relying on her testimony as an ‘unreliable source’. This is the radical implication of ultrasound: the ability to register the signs emitted by the embryo, independently of the mother” (2012:126). While this independent reading may be the radical implication of ultrasound, it is also a motivation at the heart of its

development. As discussed in the previous chapter, Ian Donald was clear in his descriptions of the development of ultrasound as useful in part, because it meant that physicians did not need to rely on women’s embodied knowledge. Embodied knowledge is framed as subjective, and positioned against the technical knowledge provided by ultrasound, which is framed as objective. Thus the medical gaze renders women as “unreliable source[s]” in regards to their bodily

experiences and instead situates, in this case ultrasound technology and its operators, as authoritative knowers.

The rendering of women’s embodied experiences as non-authoritative, has the effect of

alienating women from their own bodies. Philosopher Iris Marion Young (1983) draws attention to what she calls the medical alienation of pregnant women from their bodies. She argues that the pregnant woman experiences a particular kind of distancing from her bodily experiences that is both similar to, and distinct from, other kinds of patients. That is to say, Young suggests that all patients are alienated in some way from their embodied experience by way of the authority assigned to medical/technical knowledge. Where the pregnant woman differs from other kinds of patients is in her status as a patient at all. Young contends that “a woman’s experience in

pregnancy and birthing is often alienated because her condition tends to be defined as a disorder, because medical instruments objectify internal processes in such a way that they devalue a woman’s experience of those processes, and because the social relations and instrumentation of

the medical setting reduce her control over her experience” (2005: 55-56). The fact that pregnancy is treated, and managed alongside illness, disease and disorder, leads to a logical conclusion that pregnancy is indeed an illness, disease or disorder. With this designation comes the implicit assumption that there is a cure or a fix for the condition of pregnancy.

Young (1983) and others (Rothman, 1989; Oakley, 1984; Petchesky, 1987; Rapp, 1998) insist that medical and technological interventions into pregnancy, such as induction, fetal monitoring and ultrasound, reinforce the notion of a cure by giving the impression of control. Through a separation of woman and fetus, techniques of fetal monitoring position the fetus as a patient in ways that allow for diagnoses and potentially even medical interventions for the fetus, such as fetal surgery (Casper, 2009). Such interventions not only imply that pregnancy can be controlled, but suggest that it is not the woman herself who is able to assert control; it is instead the medical personnel. Young explains that through this assertion of control, women’s embodied knowledge is devalued and replaced with a means of observation that gives the illusion of objectivity. What is able to be observed takes on the status of authoritative knowledge, replacing or at least

devaluing women’s “privileged insider knowledge” (2005: 61). The privileging of “insider knowledge” is not strictly relegated to medical settings, but is rather taken up and internalized by pregnant women as patients.

In a postscript to her essay Pregnant Embodiment: Subjectivity and Alienation, written 20 years after the original text, Young points to ultrasound specifically as a technology that has seen a massive proliferation in use from the time the essay was first published. She suggests that ultrasound has accelerated the objectification process, and made it possible for anyone to experience the fetal image. The democratization of identification has meant that “the pregnant woman’s experience of that image is just the same as anyone else’s who views it” (2005: 61). I will return to this point later in the chapter.

Ultrasound may have accelerated the objectification process, as Young suggests, but it did not initiate it. While ultrasound technology provides the most recent and arguably highest quality fetal image, it is part of a long history of visual representations of the fetus. Karen Newman suggests that anatomical illustrations of the fetus date back to the 9th century, and “illustrate a core schema...: a uterus separated from the female body and a seemingly autonomous fetal

figure” (1996:27). In many of the obstetrical illustrations Newman describes, the uterus was represented as a jar-like container, completely independent of any body. The fetus was often sketched as a tiny, but fully formed man, complete with muscle-definition, facial expressions and a full head of hair. The free floating fetus was pictured in various positions which often

resembled somersaults or swimming through a pool of water towards the cervical opening. Newman contends that until the 17th century, obstetrical illustrations were consistent with the “medical belief in ‘preformation,’ [meaning] the fetus was conceived of as preformed, a fully fashioned though tiny adult that simply grew in size” (1996:33). At the time there was also a pervasive medical belief that women’s bodies were simply “passive receptacle[s]...with birth taking place thanks to the autonomous efforts of the fetus” (1996:33). Newman’s work highlights the long history of visual representations of the fetus, in which she argues that “the human body as object of scientific study is...always already a cultural object invested with meaning” (1996: 4).

The advent of ultrasound technology to produce images of the fetus meant that fetal images were drawn out of obstetrical textbooks and into broad public view. The meaning invested in images of the fetus has been taken up by numerous feminist theorists in the years since ultrasound images first appeared in the social landscape. Barbara Duden (1993) points to a 1965 issue of Life magazine which purported to show the first images of a live fetus inside its mother’s womb. These images also followed the “core schema” Newman described, in that the fetus was pictured completely independent of the maternal body. The high quality and romanticized images were accompanied with captions explaining fetal growth as if the fetus were a kind of explorer of the womb, while it consciously waited for the moment of birth. The images, taken by photographer Lennart Nilsson, were later discredited as not, in fact, images of the life of the fetus in utero, but rather a composite of posed images taken with aborted fetuses. Still, Duden, Petchesky, (1987) Haraway, (1997) Taylor, (2002, 2008) and others, point to these images as an important cultural turning point in how we understand fetal life. Petchesky suggests that the power of fetal images “derives from the peculiar capacity of photographic images to assume two distinct meanings, often simultaneously: an empirical (informational) and a mythical (or magical) meaning” (1987: 269). Ultrasound images appear as empirical due to a privileging of the visual sense, or in other words, the notion that seeing is believing. The mythical or magical meaning Petchesky points to, can be understood as the cultural beliefs we have about fetal life and the value of that life relative

to society. Following this understanding, Petchesky coined the term “public fetus” to refer to the ways that “fetal personhood [becomes] a self-fulfilling prophecy by making the fetus a public presence [that] addresses a visually oriented culture” (1987: 264). Not long after Nilsson’s images were first circulated, ultrasound images began to appear in social spaces. While the clarity and quality of the first ultrasound images barely compare to the highly stylized, 3D images now available, the meaning invested in the images was the same: proof of life in utero. Understandably, these images became popular amongst pro-life and anti-abortion groups in furthering their cause. It was this popularity and political purpose that led to broad feminist critiques of ultrasound and the images created (Petchesky, 1987; Duden, 1993; Newman, 1996; Haraway, 1997; Taylor, 2002; Davies, 2009). Pro-life groups employ ultrasound images in their campaigns and protests, precisely because of the broad associations drawn between fetal images and proof of life. For their purposes, these groups are hoping that women will see these images, understand their representation of life, and change their minds about terminating their

pregnancies. In other words, anti-abortion groups are banking on a particular kind of experience of the fetal image. The association between fetal images and a particular affective response is not relegated to anti-abortion propaganda; it can also be seen in the medical deployment of

ultrasound. In the following section I take up the ways that ultrasound has been employed in medical settings and the sparse research that exists on women’s experiences with medical ultrasound.