Spring 2013

Medicine and Culture

Mary Shivanandan Download Article

Rebecca Kukla, Mass Hysteria: Medicine, Culture, and Mothers’ Bodies (Lanham, MD: Rowman & Littlefield Publishers, 2005, 264 pages).

I would characterize Rebecca Kukla’s approach in this book to the topic of work/life balance as “soft feminist.” A Senior Research Scholar at the Kennedy Institute of Ethics and Professor of Philosophy at Georgetown University, as well as outgoing co-ordinator of the Feminist Approaches to Bioethics Network, she seeks to present a reasonable alternative to radical feminism, post-modern feminism, and to the traditional feminine role. As such, her book,Mass Hysteria, affirms both woman’s autonomous subjectivity/agency and her maternal role.

Could the book then serve as a guide to how to navigate the work/life balance? While it provides valuable insight, my answer is “no” by reason of its deficient anthropology. Ironically, the author points up the nihilism implicit in Enlightenment democratic ideals crafted after the French Revolution, but falls into a relativism that risks the same nihilism from an anthropology still grounded in Enlightenment dualism. (The Enlightenment privileged human reason over God and Christian Revelation.) At the outset it must be said that Kukla does not propose to offer a complete anthropology. Rather she claims simply to show how contemporary attitudes towards the female body find their roots in Enlightenment ideals.

This review will, first of all, briefly give Kukla’s assessment of what was new in Enlightenment political philosophy, medicine, and culture related to the female body. It will explore her ideas on the function of practices and images for shaping women’s responses to their bodies. It will then examine in more detail the seemingly opposite, but in Kukla’s view, mutually intertwining roles of the “Fetishist Mother” and the “Unruly Mother” in relation to work/life balance for the new mother. It will conclude with brief reflections on her anthropology in dialogue with a Christian anthropology to show where it both contributes and falls short.

There are two parts to the first section: (1) the influence of the democratic idea crafted after the French Revolution by the Enlightenment and Rousseau, and (2) the changing attitude of medicine towards the female body. Kukla argues that “the medical and cultural status of mothers’ bodies went through a profound transformation during the second half of the eighteenth century – a transformation intimately linked to the triumph of the Enlightenment ideology, modern science, and the formation of modern humanist democracy” (p. 6). She notes, however, that throughout Western history the integrity and boundaries of the body have been constituted by the boundaries of the self best represented by the self-contained masculine body. Women’s bodies with their more “permeable” or “penetrable” nature had been considered unstable and dangerous, but by that fact able to bridge the gap between two bodies. Going back to Hippocrates, a notion of the womb had prevailed as a “wandering” and unstable part of a woman’s body, giving rise to all the diseases of women both physical and psychological, and labeled hysteria. Hence the title of Kukla’s book, Mass Hysteria.

The section of Kukla’s book devoted to the influence of the Enlightenment is one of the clearest available expositions of the inconsistencies in the political ideology undergirding modern Western democracy. The following account of Kukla’s critique is necessarily in summary form.

Autonomous individual and contractual relations form the bedrock of modern democratic institutions. While this view of the citizen and society seems to promise freedom from all “oppressive” entanglements, subjecting everything to individual choice without regard to any given human nature, it leads ultimately to nihilism. Twice Kukla names the Marquis de Sade as the epitome of this nihilism, citing his Philosophie dans le Boudoir in which he argues that no restrictions can be put on the way a person wishes to treat his body, and there can be no normative tribunal policing human impulses. To smuggle God back in as the author of nature would simply be religious imposition. His “state” demands only self-legislation from its citizens (p. 36). De Sade spent most of his adult life in jail and ultimately in an asylum for the insane, convicted of pornography, prostitution, and various homosexual acts.

Rousseau’s philosophy of first and second nature served to “rescue” Enlightenment democracy from such a descent into nihilism. Rousseau fabricated the idea of the General Will through which well-formed citizens would put aside the brute passions of a lawless “state of nature” (first nature) and make laws contributing to the common good. But how were such well-formed citizens to arise? The burden was put solely on women to bear and nurture future citizens. Believing in the perfectibility of human nature, in his novel Emile he enjoined on women the duty of nursing their children to ensure the proper development of what he called “second nature.” It was in this way that women’s bodies entered the public domain, ceasing to be private and becoming the direct concern of the new democratic state. To quote Kukla, “Rousseau places mothers at the ‘beginning’ and ‘first point’ in moral remaking and transformation of the state and its citizens – indeed, mothers’ nursing practices ‘alone’ will play this founding role…. the whole moral order stands or falls on whether or not mothers nurse their children” (p. 31, italics in text).

The nursing mother and child became the symbol of the republic itself. Kukla identifies three ways in which this representation took place: symbolic, spectacular, and literal. A bare-breasted woman, given the name Marianne, became a familiar figure in Enlightenment iconography. Images were also designed to mold citizens even to the extent of holding breastfeeding festivals. To breastfeed became a political act (before the Revolution only five percent of Parisian women of all social classes breastfed their own children). The maternal breast perfects nature and induces love of a particular country so that second nature becomes normative. In one Rousseauian representation of Nature a woman is pictured nursing both a black and a white child, illustrating that “true, legitimate natural law is a feat of human engineering” (p. 40).

There was another development that brought the woman’s body, especially her womb, into the public gaze. Up to the seventeenth century midwifery had been a female profession but now a spate of tracts on gynecology and obstetrics began to appear. By the end of the nineteenth century, the idea was entrenched that a physician should monitor the whole process of childrearing. Before moving into a discussion of contemporary medical management of pregnancy and childbearing, Kukla introduces the idea of the “Fetishist Mother” and the “Unruly Mother.” The former is the ideal mother, who, during pregnancy, eschews any outside toxic substances and influences arising from the cravings of her appetite. As a new mother she also guards against any desires for professional or other fulfillment that would take her away from her infant. The opposite is the Unruly Mother, who refuses to be bound by such strictures and thereby endangers her child and the body politic.

In Part II of Mass Hysteria Kukla moves to the last half of the twentieth century, seeing continuities with the Enlightenment especially in the above concepts of the Fetishist Mother and the Unruly Mother. Her thesis is that pregnant bodies are considered unruly and new mothers are fetishized. There is great concern with what pregnant women ingest, leading Kukla to see a “strong ideological and mystical component” of “innocent” fetuses and “guilty” mothers (p. 107). Medical science increasingly exposes the internal space of the womb, especially by prenatal testing. She is particularly concerned with the bonding that is being encouraged with the ultrasound image as early as the twelfth week of pregnancy. There is a change of language from “fetus” to “baby.” Abnormal results can also lead to moral issues. Furthermore, increasingly illustrations are made of the developing fetus within a headless, armless woman, so that the personified fetus replaces the image of the woman herself, casting doubt on her identity and agency.

Kukla would seem to have some legitimate issues here but her concerns may also be driven by ambivalence about abortion, which such ultrasound testing tends to discourage. (Early in the book Kukla prescinds from the question of when the fetus becomes a person, and asserts she is leaving the problem of abortion aside.) Here she says that it is hard to come up with “an ethical account that resists demanding unlimited self-sacrifice and discipline from mothers and at the same time resists turning a blind eye to any moral claims that interrupt a mother’s bodily liberty” (p. 136). Once a decision has been made to carry the pregnancy to term, she considers that such medical information does make a claim on mothers. At the same time it is necessary both to examine any ideological meanings inappropriately attached to it and recognize the way pregnancy forces a woman to renegotiate her social, economic, personal, and public identity when “her bodily self is changing at breakneck speed” (p. 138). Kukla calls this state of “abnormality” of pregnancy “liveduncanniness.” It is a time when a woman’s sense of self can be most easily co-opted.

While pregnancy begins the process of what Kukla calls a state of “abnormality” – because it changes the woman’s body away from the self-contained boundaries of the masculine model of agency – breastfeeding continues the process through forming mother and child into a single unit. The burden of this chapter is that the breastfeeding mother has been fetishized. She defines a fetish as “an object that is granted indefeasible, ahistorical, intrinsic value” (p. 148). This is where Kukla’s ambivalence is most evident. While she acknowledges for the most part, along with medical and scientific literature, that breast milk is best for the infant, she is concerned about the conflation of the proximity of mother and child with the physical benefits of breastfeeding. She charges that the mother’s contribution is reduced to a mere physical relationship which ignores the many other psychological and spiritual ways of caring, thereby excluding adoptive mothers and other caregivers. In fact, “maternal proximity is elevated to a moral principle and symbol, while the ethical structure of mothering is demoted to a mute material arrangement” (p. 149).

The crux of the matter is not bottled formula vs breastmilk – the latter can be pumped for later use. Her concern is rather the festishization of maternal proximity through breastfeeding. In her view, “the spatial bond between mother and infant serves as a mythological and over-determined locus of our lost nostalgic history, of virtue, of health, and of proper mothering” (p. 168). She refers to this requirement of exclusive mother-infant care through breastfeeding as an ideology which significantly limits a mother’s entitlement to engage in outside activities and saddles her with shame and guilt for even minor absences from her baby.

Where that occurs in our society, an ideology may, indeed, be at work, but in seeking to downplay the importance of the mother’s presence (nearness is her term), which is assured by breastfeeding, it seems to me that Kukla risks going too far in the other direction. Noting that “our separation anxieties” are not specifically tied to our present era of bottle-feeding, having been a concern in the age of wet-nursing, she does tend to ignore the large body of scientific studies supporting those anxieties.

The next chapter reveals Kukla’s discomfort even more clearly between what she sees as the fetishization of motherhood through breastfeeding and the risk to a woman’s independent agency. She frames the issue between the requirement that women give their bodies to the “unfettered consumptive demands of our infants” (p. 190) and the training they receive from childhood to protect their bodies from such unfettered use. She asks if “breast is best,” why do only 12 per cent of American women continue to the one-year mark? She goes on to give a catalogue of negative breastfeeding experiences from physical to psychological. Running through the chapter is the concern that a woman’s agency is compromised by regularly insisting another’s interests must be privileged. Her conclusion is that “safe places in which we can negotiate our separateness from our children are at least as necessary as safe places in which we can celebrate and give joys to the oneness” (p. 211).

In the final chapter Kukla recognizes that the binary distinction between the Fetishized and Unruly Mother arising from the Enlightenment is unsustainable. She critiques the traditionally liberal view that the boundaries of the self make it not only independent of, but antagonistic towards others. She sees the ontology of the liberal self set up by Rousseau as either “conflicting” or “unified,” and rejects the idea that the only options are assimilation to or abandonment of our children. For women are deeply invested in their children but they also need to maintain a separate identity, because only such a separate self can empower women to act on behalf of themselves and their children in the social and medical spheres.

Reviewing this book has been both a hopeful and a sad experience. It is hopeful because Kukla is struggling to recognize as real, not simply constructed, the woman’s bodily relationship to her infant. She holds that it needs to be taken into account in both the public and private spheres. It is sad because she remains locked in an Enlightenment dualism and relativism in the name of “freedom.” Engineered for the most part now by technology, it risks the nihilism epitomized by the Marquis de Sade, which she deplores. While she seeks to get out of a binary distinction by according some objective reality to nature, she is constrained by commitment to an anthropology that has no reference to an Other/other, God, or true sexual difference. In other words, she has a deficient anthropology of the person and above all of the communion of persons.

First, let’s look at her emphasis on “fixing the boundaries” of the woman’s body. The language of boundaries stresses closure rather than openness to the Other/other. The person in a Christian anthropology, by reason of being a spiritual entity and a unity of body and soul, is by nature oriented to an Other/other. The body is not just permeable, and the woman’s more so, as Kukla points out, but ordered to union/communion in spousal and maternal/paternal relationships. But this communion, to be a true communion, must affirm the unique nature of the person, whether masculine or feminine, with all that implies of subjectivity and bodily integrity.

What Kukla leaves out is the inter-subjectivity between masculine and feminine. Karol Wojytla has coined the term “participation,” as opposed to alienation. Participation is when the person in a community/communion is fully affirmed as a unity of body and soul. In the family, that means that each must be affirmed as subjects and in their respective roles as husband/wife, mother and father. So Kukla is right in asking for the woman’s agency to be affirmed, but nowhere does she speak of the masculine role, except as taking over the role of bottle-feeding the infant. Rather than downplaying the importance of nearness or presence of the mother to the child, it would be more appropriate to encourage the presence of others to the mother, particularly the husband.

With regard to agency, it is primarily a question of our relationship to God. The early Christian state of vowed virginity affirmed in a radical way the agency of the woman to dedicate herself totally to God, sometimes in direct opposition to the wishes of her parents. In a similar way the development of the theology of marriage in the Middle Ages established consent, not sexual intercourse, as the primary requirement. The canon lawyers were much influenced by the Holy Family, in which Mary’s fiat (her yes) affirmed her separate agency within her true marriage to Joseph. Certainly I am not talking here about forgoing conjugal intercourse in marriage, but of respecting God’s plans for any particular marriage and for each member of the family.

Agency then, is not something I chose by and for myself alone, but something I do in light of my prior relationship with God, the very source of my being, and together with my spouse or another. It takes place in, affirms, and manifests a communion of love. According to Christian Revelation, which gives a fuller account, the human person is made in the image of God not so much as the solitary ruler of the universe but as a communion of persons in the Trinity, because God is Love. Freedom is necessary for communion, the freedom of self-mastery acquired by the virtues. The freedom of license leads to nihilism, as Kukla has demonstrated.

Kukla makes a point of privileging the Unruly Mother over the Fetishist Mother, the supposed ideal. In this she would be in line with Christian anthropology, which acknowledges that human nature is weak and fallen but not in binary opposition with the ideal. The saint is held out as a model. The saint has often struggled with interior conflicts and destructive social structures (which must always be challenged) but has overcome them with the help of grace. Examples are the recently beatified parents of St Thérèse of Lisieux, particularly her mother.

Zélie Martin was a true child of nineteenth-century France. She ran a lace business out of her home and sent her children to wet nurses, losing all her infant sons from incompetent nursing. She died prematurely of breast cancer, probably brought about in part by not nursing her own children. (Incidentally, her husband, Louis, sold his watch business to support her lace-making.) Therese suffered from severe separation anxiety. Nature was unforgiving but grace transformed. Father, mother, and daughter are recognized for their holiness (wholeness) and Thérèse, in addition, has been declared a Doctor of the Church for her doctrine of divine love.