Transparency and selfhood:

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Transparency and selfhood: Utopia and the informed body Marc Chrysanthou* School of Community, Health Sciences and Social Care, University of Salford, Allerton Building, Frederick Road, Salford, M6 6PU, UK

Abstract One aspect of the development of a health-orientated consumer culture is the growth of self-screening and selfdiagnosis among the lay public}e.g. over-the-counter diagnostic tests, computerized health assessments, DIY genetic tests. This trend is interpreted as the expression of a distinctively postmodern ‘utopian’ impulse. Postmodernity’s inwardly directed gaze has replaced the communitarian vision of modernity. In the absence of overarching visions, the postmodern utopian telos becomes the attainment of a perfect, imperishable body. Somatopia is the collective expression of these privatized and personalized body projects. The accomplishment and authentication of these body projects necessitates the creation of a ‘transparent body’. This ‘transparent body’ is enabled and constructed by developments in information and medical technologies. The political and health implications of the transparent, ‘informed’ body are explored. # 2002 Elsevier Science Ltd. All rights reserved. Keywords: Body; Information society; Healthism; Utopia

Introduction Conceptions of Utopia as an Ideal Society or Earthly Paradise impinge upon western culture like the cosmic background radiation from a long-dead galaxy. Futuristic visions of the good life are recast as fables of antiquity or of a juvenile modernity. Postmodernity undermines a shared vision of Utopia. In its place are apocalyptic dystopias at the one extreme and heterotopias at the other. And yet, the utopian impulse is not so easily quenched. The anti-foundationalist, dystopian turn of postmodernism}the deconstruction of Grand Narratives and Eternal Truths, the implosion of reality into a Black Hole of simulacra, the triumph of technology over nature}prevents it from considering the human body}a body of flesh, blood and bone (not the postmodernist incorporeal body of surfaces)}as the basis of a new, emergent foundationalism and utopian-

*Tel.: +44-0-161-295-2198; fax: +44-0-161-295-2427. E-mail address: [email protected] (M. Chrysanthou).

ism within western culture. Wittgenstein declared that the best picture of the soul was the human face. Currently, a new aphorism is more apt: the best available picture of utopia is a map of the healthy human body. The physical body has always figured prominently in biomedical discourse but under postmodernity, this rather passive, corporeality is transfigured into an active utopian project. The Maoist revolutionary injunction ‘let a thousand flowers bloom’ becomes ‘let my body endure’. This redefinition of the utopian impulse}albeit as a monadic universe of healthy bodies}can be understood broadly in terms of the widespread political disenchantment of postmodernity. Postmodernity’s scepticism towards visions of a utopian society is traceable to a complex series of connections within the body-self-society matrix. In this article, one particular cluster of anti-utopian connections is unravelled from this larger tangle. The project of ‘the body healthy’ is traced to a specific trend within postmodernity: the rise of the information society; and, more specifically, the alliance of health information, medical technology, health consumerism and self-screening.

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What Barglow (1994) terms ‘the crisis of the self in the age of information’ is represented below as a dialogue between the crisis of utopia in the age of individualism, the crisis of the embodied self in the age of information, and the crisis of information in the age of the utopian body. The Enlightenment dream of social progress through knowledge becomes in the postmodern a fantasy of bodily perfection through information. The main arguments presented are that a medicalized information society has bred a new form of embodied experience}(a) the transparent body; (b) that communitarian visions of utopia are superseded as maps of utopia by the transparent body; (c) the informational technology that fabricates and animates the transparent body also serves to undermine its utopian telos; and (d) that a health project of the utopian body is paradoxically unattainable without, yet may be incompatible (in some respects) with the achievement of a utopian society.

The withering of Utopia A history of utopian thought in the late 20th century would be a slim tome. The confidence and energy of the enlightenment and the 19th-century’s socially progressive ideologies have been sapped by the horrors of Soviet communism and Nazi Germany, as well as the narcotic hold of an increasingly global consumer capitalism. To be called}or have one’s ideas called}‘utopian’ today is to be labelled as an ‘unrealistic dreamer’ (Jacoby, 1999). A ‘corrosive skepticism’ has become the conventional wisdom. Less mournful commentators upon this contemporary ‘end of ideology/utopia’ thesis, may feel a twinge of nostalgia, but apprehend in capitalist democracy’s triumphal march, the best of all possible worlds. In his influential, neo-Hegelian End of History thesis, Fukuyama sees in Western liberal democracy the ‘end point of mankind’s ideological struggle’ (Fukuyama, 1993, p. xi). This end-state, admittedly, has its social problems, but these are due to ‘incomplete implementation of the twin principles of liberty and equality’. In postmodernist writings, Utopia is charged with and found guilty of the crimes of authoritarianism and totality, before being dismantled}like statues of Marx and Lenin}and exploded into a million-and-one ‘heterotopias’ (Foucault, 1986a), contingent values created by interpretive communities (Rorty, 1989), or petits recits (Lyotard, 1979). Lyotard’s formulation of the postmodern as a legitimation crisis besetting discourses making an explicit appeal to some grand narrative has proved remarkably influential. The main reason for its prolific citation and elevation to classic status lies in its encapsulation of the Spirit of the Postmodern Age}an anti-utopian, disenchanted, cynical, individualistic spirit (Lasch, 1991).

Yet, if ‘following Bloch and Mannheim, we can speak of a utopian disposition, a utopian impulse or mentality, of which the classic utopia is but one manifestation’; and ‘this impulse is grounded in the human capacity, and need, for fantasy; the perpetual conscious and unconscious rearranging of reality and one’s place in it. . . the attempt to create an environment in which one is truly at ease’ (Geoghegan, 1987, p. 2), can the utopian impulse be so readily extinguished? Not extinguished, but disorientated. In the vast, complex, contested terrain of postmodernity, there is the concrete problem of ‘identifying points of intervention in an increasingly complex social and economic structure, and of identifying the agents and bearers of social transformation. . . The problem about contemporary utopia is not that it is difficult to produce imaginary maps of the future, but that it is difficult to produce adequate maps of the present which permit images of a connected but transformed future’. (Levitas, 1993, p. 258) Or, not extinguished, but transmuted. a new Narrative, a new Utopia, has crystallized. The shared vision of a metaphorical body politic}the collective scaffolding of the classical utopia}has been dismantled. In its place a fragmented, privatized Somatopia, exemplifying the science fiction command ‘To your scattered bodies, Go!’ (Farmer, 1998).

Somatopia and the new public health Within the space of two decades, sociologists have seen a disembodied academic landscape transformed into one where they can (metaphorically speaking) barely move without bumping into one type of body or another. (Synnott, 1993; Falk, 1994; Turner,1996; Nettleton & Watson, 1998). The bodily turn is related to the wider cultural fragmentation and disorientation that characterize the postmodern landscape. As Csordas (1994) observes, ‘It is probably no fluke of intellectual history that a turn toward the body in contemporary scholarship in the human sciences has coincided with the realization that the postmodern condition is now the uneasy condition of all intellectual activity’ (1994, preface). The cultural and intellectual condition variously labelled late or high modernity or postmodernity creates a disorientating ontological insecurity that predisposes the postmodern self to take uneasy refuge in the most basic shelter of all: his or her own body. In Giddens’ view, high modernity gives rise to ontological insecurity as increasingly individualized self-identities are cut loose from the traditional moorings of religion and community, or from a stable sense of location in gender, class or age (Giddens, 1991). This destabilizing of identity is exacerbated by the death of grand political narratives and the decline of faith in utopia. Warming to Giddens’ theme, Shilling (1993)

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argues that the response of the self, faced with this external uncertainty, is to refocus the source of identity and meaning on the body. The project of the self becomes the project of the body. It is tempting to see the recent plethora of television ‘makeover’ programmes on DIY, gardening, and cookery as examples of the homing inwards of (post)modern selves. The ultimate DIY project becomes the body itself. Bury (1997) interprets the main thesis: ‘In other words, as collectivist ‘‘grand narratives’’ of modern social life and the schools of thought related to them collapse, so the direction of the analytic gaze turns inwards’ (1997, p. 172). The consumer culture generated by flexible capitalism encourages a survivalist mentality (Lasch, 1985; Martin, 1994). Leisure becomes commodified, increasingly taking the form of consumption of sports-themed products (Featherstone, 1991), and, for a minority, ‘working out’ in gyms. The pseudo-religious message is diet, work out, and jog and you can have the ‘perfect’ body (Falk, 1994).The previously impure, profane body undergoes an historical transvaluation, to become the sacred icon of self-worship. Perfectibility is displaced from the political sphere to the personal. The subliminal message is ‘we live in the best of all possible political worlds, so let’s perfect our citizens’ bodies’. This commodification of culture at the level of the individual body fits seamlessly with aspects of the ideology of the New Public Health (Ashton & Seymour, 1988; Lupton, 1995). Echoing the environmental heritage of the 19th century public health movement}but with a recognition of the contribution of personal behaviour to the mortality and morbidity patterns of postmodern society}under successive fiscally and politically conservative regimes across the western world, the New Public Health’s environmental dimension has taken a distant second place to the individualistic lifestyle approach. Health promotion advice exhorts the population to ‘lose weight’, ‘stop smoking’, ‘eat less fat’, ‘reduce alcohol intake’, ‘practice safe sex’, and ‘get fit’. ‘Everyone is, to some extent, caught up within what has become an expanding web of power and knowledge around the problematic of ‘‘public health’’’ (Petersen & Lupton, 1996, pp. 5–6). Health and fitness}in the form of health clubs, gyms, diet foods, exercise equipment, exercise videos, magazines}have become multi-billion dollar-grossing concerns of the postmodern self (Glassner, 1989). In the absence of Grand Narratives or traditional sources of identity}and in the presence of a rampant postmodernist consumer culture}it is hardly surprising that health has become an ideology in its own right. ‘Healthism’ (Crawford, 1980)}a pathological obsession with being healthy}is an entirely new cultural phenomenon. Mystics have pursued ‘healthy lifestyles’ inadvertently as part of a more profound spiritual quest. GrecoRoman citizens practised the care of the self}but this

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care was inseparable from care and concern for the ‘health’ of the wider polis or republic. Accordingly, it seems fitting to designate this individualized quest for the perfected or immortal body as a distorted expression of the utopian impulse under conditions inimical to utopian thinking. The new emerging map of utopia is the human body: external and internal. The gaze of the marketers of consumer culture is targeted at the surface of the body (Turner, in Falk, 1994, p. xiii). Featherstone agrees: ‘Within consumer culture, the inner and the outer body become conjoined: the prime purpose of the maintenance of the inner body becomes the enhancement of the outer’ (Featherstone, in Turner, 1991, p. 171). The agendas of consumer culture and the New Public Health can, therefore, best be differentiated in terms of the former’s concern with the inner body only in so far as it benefits the outer body, whereas the latter is generally only concerned with the outer body in so far as it reflects the inner body. Emily Martin’s account of the ‘flexible’ bodies}with strong, adaptable immune systems}sought by professionals, is suggestive evidence of a growing cultural concern with the inner landscape of the body (Martin, 1994). Colonic Irrigation Therapy is an example of such a concern (Collings, 1996). This shrinkage of the boundaries of what Heidegger termed sorge}or care for the world}to care for the body echoes Macaulay’s much-quoted comment (1866, p. 399): ‘Better an acre in Middlesex than a principality in Utopia’, but takes it to its reductio ad absurdum. With the utopian body, the utopian reach retracts to its smallest extent : Somatopia.

The kingdom of the in-between What is life like in Somatopia? Susan Sontag wrote that: Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. (Sontag, 1978, p. 3) In conventional medical understanding, one is either sick or one is well. The medical definition of health is famously a negative definition}i.e. the absence of disease. That illness is a subjective experience, not always correlated with physical symptoms, and that definitions and concepts of health are subject to individual, social and cultural variability is a contribution of sociologists of health and illness and medical anthropologists (Lupton, 1994; Radley, 1994). Sontag’s

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clear demarcation of the two kingdoms, is, therefore, less clear-cut than it seems. In Somatopia, a third kingdom comes into existence: The Kingdom of the inbetween. We are all at some time dwellers in the inbetween, taking our place alongside hypochondriacs, the worried well, the worried-and-maybe- not- well, and the not-worried-but-think- maybe -they-ought-to-be. In Somatopia, where the ideology of healthism is widespread, and the rituals of self-surveillance are scrupulously observed, the Kingdom of the in-between is routinely crowded. This heightened sensitivity towards the body is a challenge to the ‘absent body’ thesis outlined by Leder (1990). Writing from a phenomenological perspective, he points to the paradoxical nature of embodiment: While in one sense the body is the most abiding and inescapable presence in our lives, it is also essentially characterized by absence. That is, one’s own body is rarely the thematic object of experience (1990, p. 1). The body is recessive: Barring. . . the question mirrors, I find I cannot gaze upon large portions of my back side, especially from the waist up. Furthermore, I cannot see, with the exception of a protruding tongue or nose, most of my face (1990, p. 12). As for the interior of the body, this remains an ‘absent presence’: In physical terms, my body surface envelops a hidden mass of internal organs and processes. The visceral functions that unfold in these bodily depths are crucial for sustaining my life. Yet such processes constitute a hidden depth vis-a-vis myself as perceiver (1990, p. 36). Consciousness of one’s body is often at its most vivid when most unwelcome}for instance, when the body is in pain, or diseased. This appearance of the body is perceived by the embodied self as a ‘dys-appearance’}i.e. a dysfunctional, alienated thing. The dysappearance of the body in contemporary culture is I suggest not precipitated only by pain, or by disease, but by the heightened sensitivity to the body encouraged by ‘healthism’. Healthism encompasses both an anticipatory awareness of the body’s unwelcome appearance (e.g. fear of heart attack, cancer) and a positive encouragement to ‘get to know your body’ and to ‘look good, feel good’ (e.g. through vigorous exercise, or yoga). Existential anxiety is a side-effect of the narcissistic individualism of the somatopian regime. The watchwords of Somatopia are ‘body maintenance’, ‘preventative medicine’, ‘annual checkup’ and ‘constant

vigilance’. A recent two-page newspaper advertisement for a German car pictures a young woman emerging from a swimming pool, with the caption ‘‘Wouldn’t it be nice if everyone’s body could be guaranteed for the next twelve years?’’. Featherstone relates this trend to what Christopher Lasch termed ‘the culture of narcissism’ (Lasch, 1991), in which people are ‘chronically uneasy about (their) health, afraid of ageing and death’, ‘constantly searching for flaws and signs of decay’, as well as ‘haunted by fantasies of omnipotence and eternal youth’ (Featherstone, in Turner, 1991, p. 187) Ageing and death are rejected as dystopian outcomes}to be avoided at all costs (Turner, 1996, p. 21). Death, in particular, presents a challenge to the project of the utopian body. The engraving carved on the headstone, Et in Arcadia Ego, taunts utopians with its reminder of the omnipresence of death; even in Utopia. And while collectivist, ongoing, intergenerational utopias have a life that transcends the deaths of its individual citizens, death and the individualized utopian project are contradictions in terms. The perennial existential theme of ‘the tragic sense of life’ (Unamuno, 1976)}capturing the lived contradiction at the heart of human existence between the desire to live forever, set against the undermining awareness of death}is reformulated as a death-haunted quest for salvation through information. The memento mori of the classical era is reframed in the postmodern as a limit to be pushed back or even overcome. To be - or to strive to be -immortal, the rational, scientific utopian body must also be an informed body.

Infotopia It has become something of a cliche to claim that we are living in an age of information technology: ‘swimming in an ocean of information’, ‘tied to the world by electronic threads’, ‘hooked up to cellular phones, fax machines, digital alarm clocks, CDs, videos, computers and modems, satellite pagers’ (Lubar, 1993). The earlier premonitions of Ellul (1967), McLuhan (1967), Toffler (1981) and Roszak (1988) of a communications revolution ushering in a social and cultural order organized around the flows of technologically mediated information, have materialized in the (post)modern. For many theorists, this dizzying, dazzling Brave New World of computerized knowledge and communications technologies}a hyper-real universe of signs, images, and digital codes}is the hallmark of postmodernity (Lyotard, 1979; Baudrillard, 1994). Manuel Castells’ epic ‘The Information Age’ (1999) is the most exhaustive of the sociological analyses to document and explore the information revolution. Castells’ starting point is that, ‘‘at the end of the twentieth century, we are living through one of these

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rare intervals in history. An interval characterized by the transformation of our ‘material culture’ by the works of a new technological paradigm organized around information technologies’’ (1999, vol. 1, p. 29). This new paradigm is related to the ‘restructuring of the capitalist mode of production’ (1999, vol. 1, p. 14), and has been shaped by ‘the logic and interests of advanced capitalism, without being reducible to the expression of such interests’ (1999, vol. 1, p. 13). Castells begins with a Confucian parable, in which Confucius disclaims being learned or well-read; maintaining that he has simply grasped one thread which links up the rest. Similarly, The Network Society’s intricate digital tapestry}into which the world’s population is being woven}unravels into a single thread. This ‘thread’ represents ‘information technologies’. These include: A converging set of technologies in microelectronics, computing (machines and software), telecommunications/broadcasting and optoelectronics. I also include in the realm of information technologies, genetic engineering and its expanding set of developments and applications. . . because in the 1990s, biology, electronics, and informatics seem to be converging and interacting in their materials, and, more fundamentally, in their conceptual approach. . . (1999, Vol. 1, p. 30) This convergence is facilitated by a common language: the current process of technological transformation expands exponentially because of its ability to create an interface between technological fields through common digital language in which information is generated, stored, retrieved, processed and transmitted. We live in a world that in the expression of Nicholas Negroponte has become digital. (1999, vol. 1, p. 30) In this digital universe of postmodernity, the drift is away from collective utopias and nostalgia for ‘community’, towards the utopian body. In this pursuit, electronic sources of information are highly valued. Formerly, sacred knowledge about one’s destiny was bestowed only upon the few who could decipher the oracle’s sibylline prophecies; today, it takes the form of mass-communicated health advice.

The informed body Foucault’s concept of ‘governmentality’}the techniques and processes through which ‘expert’ knowledge constitutes normalized bodies/subjectivities (Foucault, 1991) has proved influential in medical sociology. From this perspective, the New Public Health and health

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promotion are expert discourses, knowledges and practices embodying the belief that individuals can assess, manage and control risks to their health; thereby ‘taming uncertainty’ (Lupton, 1995). The regulation and restraint of individual bodies in order to achieve this goal is largely entrusted to techniques of self-surveillance, body maintenance, and discipline (Turner, 1984). This voluntary ‘imperative of health’ is supported by a wide range of agencies and institutions}e.g. Mass media, education, health authorities, and families. Education and information about ‘healthy’ lifestyles is intended to change unhealthy behaviour (or encourage healthy behaviour) of the public en masse, not merely those who are sick or at-risk (Lupton, 1995). This imperative of health is reflected in the content and volume of health-related information in The Network Society. The Labour Government in Britain has created NHSDirect (a 24-h telephone advice line staffed by nurses), and promised that every GP surgery will be connected to NHSnet (the NHS’s own information superhighway) (DoH, 1997). Medical informaticians project a vision of a postmodern equivalent of the Great Library of Alexandria, in the form of an open-access ‘globally oriented advanced digital knowledge management system’ that encompasses all biomedical knowledge (Matheson, 1995). The production and dissemination of ‘health’ literature goes far beyond the parameters of government agencies, the medical profession and academic departments. Television has regular health update, health watchdog, and health information programmes and features, as well as highly popular medical and nursing dramas such as Casualty and ER. Women’s magazines have traditionally had sections on children’s and women’s health}articles and ‘problem’ pages}and, more recently, a specialist magazine Men’s Health has identified a men’s lifestyle/health niche in the market. As would be expected, the provision of and use of health resources on the Internet is a fast-growing phenomenon (Eachus, 1996, 1999; Biriotti, 1997). The abundance of and easy access to up-to-date health information often results in patients being more expert about their condition than their GPs (Lupton, 1996; Lenaghan, 1998a; Hardey, 1999). Ironically, the volume of information available to the general public}rather than promoting health}may create information-related illness. ‘Information anxiety’ (Wurman, 1990) defines a condition where people’s identities}e.g. as an executive, academic, or healthy person}are so dependent upon research or data, that these people literally are what they know. However, in a situation of information overload, it becomes impossible to keep up-to-date with information, which, in turn, creates stress (Waddington, 1996). Searching the Internet for ‘information anxiety’ provides the surfer with a weblink to sites on panic/anxiety disorders. The very act of using a computer to search for health information

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again creates perverse outcomes; exposing the user to electromagnetic radiation, eyestrain and migraine, back pain, Carpal Tunnel Syndrome and Repetitive Stress Injury (a modern day counterpart to ‘weaver’s hand’, ‘sprout-picker’s thumb’ or ‘scrivener’s palsy’) (Tenner, 1996). Aside from these paradoxes of health informationseeking, the information that people rely on to ‘tame uncertainty’ may also be uncertain. Patient information leaflets, videos and helplines have been found to contain misleading information (Duman & Farrell, 2000). The British Labour Government has initiated a Centre for Health Information Quality to address this issue. But the issue is not so simple as ensuring health information is consistent with best practice or evidence. How do we know that the ‘best practice’ or ‘best available evidence’ are valid? The 1990s have witnessed a series of health ‘scares’ in which ‘experts’ have dispensed conflicting advice: No consensus has yet emerged as to whether GM foods are safe, whether BSE causes Creutzfeld–Jacob Syndrome, whether MMR vaccines cause Crohn’s Disease or Autism, or whether it is safe to look directly at the sun using a pinhole viewer. In a context of uncertainty, invalid research and untested procedures, the term ‘evidence-based medicine’ has become the new mantra of the medical profession (Davids, Hayes, Sackett, & Smith, 1995; Sackett, Rosenberg, Gray, Haynes, & Scott-Richardson, 1996; Silverman, 1998). We now have ‘evidence-based health promotion’ (Davies & Macdonald, 1998; Perkins, Simnett, & Wright, 1999), and ‘evidence-based social work’ (Corcoran, 2000). In particular, the Cochrane Collaboration has established an internet site that provides a systematic review of all the randomizedcontrolled trials of specific health interventions (Cochrane Collaboration, 2000).The Labour Government’s white paper, The New NHS (DoH, 1997), also establishes a National Institute of Clinical Excellence and a Commission for Health Improvement. In itself, evidence-based medicine does not eradicate uncertainty. The source of uncertainty and false certainty may be located in the scientific convention of using significance tests in order to assess how likely it is that research findings were due to chance factors. Matthews (1998) claims that Fisher’s P-values are ‘startlingly prone’ to find significance in fluke results. We are also reminded that statistical significance is not necessarily clinically important (Baker, 1998) Far from taming uncertainty, information appears to exacerbate it. The intrinsic nature of the scientific enterprise}its commitment to falsificationism, inductivism and probabilism}mean that science cannot deliver certainty (Chalmers, 1982; Barrow, 1999). One option available to the utopian body project is to dispense with general knowledge of the abstract body, or probabilistic epidemiological statements about populations and risk

factors, and to seek some kind of certainty in the evidence of one’s own biology.

The hinterland of uncertainty The phenomenology of uncertainty in The Information Age is partly a consequence of the uncertainty of scientific evidence, but is ultimately grounded in the more basic phenomenological indeterminacy of the inner landscape of the body. Leder’s ‘recessive body’ ‘not only projects outwards in experience but falls back into unexperiencable depths’ (1990, p. 53). MerleauPonty’s ‘lived body’ contains an existential chiasm: ‘The visceral organs, the fetal body from which I emerge, the sleeping body into which I lapse, are regions ineluctably hidden from perception’ (1990, p. 67).The phenomenological body is, therefore, a ‘threatening’ body. For some illnesses, symptoms are undeniably manifested. Writing about the body in chronic illness, Kleinman (1988, p. 44–45) remarks: It menaces. It erupts. It is out of control. One damned thing follows another. . . . The fidelity of our bodies is so basic that we never think of it}it is the certain grounds of our daily experience. The ‘utopian body’ thesis advanced here disavows Kleinman’s assumption of a faithful body. The utopian body attempts to tame uncertainty by adhering to a healthy lifestyle. Although ‘certain lifestyles are presumed to be more ‘‘risky’’ than others. For example, the ‘‘lazy slob’’ who gorges large quantities of food is considered to be at greater risk of a heart attack than the lithe jogger who regularly eats healthy meals’ (Nettleton, 1995, p. 55), lay concepts of luck, randomness and fatalism are given extra force by the fat smoker who lives till ripe old age or the jogger who suddenly and unexpectedly drops down dead (Davison, Frankel, & Davey Smith, 1992, p. 683). Deaths attributable to Sudden Adult Death Syndrome (Gonzales-Crussi, 1987) undermine any simple correlation between the ‘health’ and vitality of the outer body and the health of the inner body. Looking in the mirror can provide rough and ready indicators of the state of the inner body}e.g. waist measurements may predict risk of heart disease, premature grey hair may predict auto-immune disorders of the thyroid gland, yellow skin is an indicator of pernicious anaemia. Iridologists diagnose the health of internal organs and glands by ‘mapping’ the iris. However, there always remains a hinterland of uncertainty}a phenomenological blind-spot to the ‘dark continent’ of one’s inner body. The lived body (leib) is rooted in an ‘alien’ corporeality. Historically, and still today, the body’s interior has been revealed in life only to the gaze of the

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medical profession, and, in death, to the gaze of the anatomist. In Foucault’s ornate prose: The sensorial triangulation indispensable to anatomo-clinical perception remains under the dominant sign of the visible: first, because this multi-sensorial perception is merely a way of anticipating the triumph of the gaze that is represented by the autopsy; and ear and hand are merely temporary, substitute organs until such time as death brings to truth the luminous presence of the visible; it is a question of mapping in life, that is, in night, in order to indicate how things would be in the white brightness of death. (Foucault, 1994, p. 165) The task of the utopian body is to render this hinterland of uncertainty visible in life and to oneself; to make one’s body metaphorically and literally transparent.

The transparent body Waldby (1998) characterizes the history of scientific medicine as ‘a history of the struggle to render the opaque self-enclosed volume of the body transparent, to see inside to the interior space of pathology’ (1998, p. 373). From Vesalius’ s 16th century anatomical drawings of dissected corpses to today’s Positron Emission Tomography and Magnetic Resonance Imaging, the ‘clinical gaze’ (to use Foucault’s phrase) has sought to localize pathology within an objectively charted anatomy considered in abstraction from the person of the patient (Foucault, 1994; Samson, 1999). ‘Inside information’ of the body’s interior landscape became the privileged knowledge of a medical profession and the source of their power (Kapsalis, 1997; Cartwright, 1998). Medical pioneers are viewed as explorers or mapmakers of a strange wilderness. Kapsalis (1997) describes J. Marion Sims’ invention of the speculum thus: The speculum served as yet another instance of man’s progress in that it made visible the inner recesses of the female body, just as the telescope enabled a view of the outer depths of space. The speculum was like a compass in that it helped guide the physician into this unknown terrain. In this rhetorical construction, the female body is metaphorically produced as raw natural territory awaiting discovery and cultivation by the hands of male medical culture. (1997, p. 39). The medicalization of popular culture is evidenced in the sense of wonder elicited by television images of surgeons performing open-heart surgery, or by computer-generated simulations of macrophages swimming in the bloodstream. Commenting on Lyn Randolph’s

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Immeasurable Results (1994)}a painting of a woman undergoing Magnetic Resonance Imaging}Haraway conveys the scale and nature of the technobiopower regime’s hold on popular culture: The material-semiotic event, for which the Hitachi machine is tool and trope, is an articulation of high technology capital, diverse skills, interdisciplinary negotiations, bodily organic structures, marketing strategies, personal and public symbolic codes, medical doctrines, transnational economies, scientific industry’s labor systems, and patient-consumer hopes and fears. (1997, frontispiece). The power to render the invisible visible confers a sacred status upon the object revealed and upon the agent of revelation. The elevated status of revelation }or un-concealment, as in Heidegger’s concept of aletheia (Heidegger, 1972)}is found in many cultures (perhaps most famously in the Judeo-Christian motif of revelation from Genesis to the Book of Revelations) but is especially revered in modernity’s exorbitation of the visual in art, culture, science and philosophy (Levin, 1993). Roentgen’s discovery of X-rays impacted upon popular culture. X-ray mania took hold in the western world. As Kevles (1997) describes, ‘one enthusiast described the experience as ‘‘the mind walking in among the tissues themselves’’’ (1997, p. 2). The opaque body is transformed into the transparent body by the wonders of medical imaging techniques (Ewing, 1996). Just as computerized tomography was allegedly inspired by the difficulty in telling ‘bad’ oranges from ‘good’ from the outside, the medical gaze into the private sanctum of the body seeks to reveal the pathology invisible from the outside (Kevles, 1997). More recently, the Visible Human Project has made available the entire threedimensional anatomy of a male cadaver (a murderer executed by lethal injection) via the Internet (Lindberg & Humphreys, 1995; Jacob, 1999; NLM, 2000; NPAC, 2000). Scanned hundreds of times by CT and MRI machines and then frozen in gel, his body was then sliced into nearly two thousand 1 mm sections and photographed by digital cameras. This male corpse has now been complemented by a female Visible Human (Cartwright, 1998). Theoretically effaced by the post-structuralist inscribed body of panic mythologies (Kroker & Kroker, 1988) or BodyWithout Organs (BwO) (Deleuze & Guattari, 1984), and downgraded by sociologists of consumer culture’s focus on the surface body}‘the mystery of the body is not solved by any biological or physiological knowledge’ (Falk, 1994, p. 1)}the organic body has nevertheless enacted the ‘return of the repressed’. In a society where public and private distinctions are becoming blurred by the mass media,

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‘images of our interiors are especially personal and forceful because they so often foretell our mortality’ (Kevles, 1997, p. 266). Haunted by uncertainty, the utopian body requires access to its own personalized map of its interior landscape. Like the activists of the Women’s Liberation Movement who appropriated the ‘Master’s’ speculum to peer inside the distant cervix and shout ‘Land Ho! We have discovered ourselves and claim the new territory for women’ (Haraway, 1997, p. 193), medical technology is increasingly being appropriated by the worried well of the Kingdom of the In-Between}in between health and illness; in between life and death; and in between the oldfashioned organic body and the futurist vision of a postbiological paradise. This cultural trend is evidenced by the increase in the practice of self-screening and the growing demand for DIY home-based diagnosis (Lowell, 1995). Home test kits for diagnosing bowel cancer, osteoporosis, diabetes, high cholesterol levels are available over-thecounter at pharmacists. A profitable new market in anxiety is being opened up. BodiTech has developed a hand-held diagnostic breathalyser that detects illnesses}and the correct type and quantity of drugs to treat these}from a sample of the user’s breath. In addition, private companies are taking the lead in the setting-up of walk-in clinics, ‘healthy living centres’ or ‘virtual kiosks’ where people can check their health status on a range of indicators}e.g. blood pressure, eyesight, mental health, hearing, height-to-weight ratio. One such company, Egli (http://www.egli.co.uk), carries the following slogan on its promotional brochures: ‘Health Screening, Monitoring and Education leads (sic) to Health Awareness, Action and Improvement’. Another company, Ultramind has developed computerbased biofeedback ‘games’ to teach people to control the symptoms of such conditions as Irritable Bowel Syndrome. One spin-off from the Human Genome Project will be the increase in home genetic testing (Lenaghan, 1998b). Self-screening is one aspect of the extension of ‘telemedicine’ and ‘informatics’ to the general population (Cartwright, 2000). The trend towards defribillators in supermarkets (promised by the Labour Government’s white paper ‘Our Healthier Nation’, (DoH, 1998) and electronic sensors in the homes of older people to monitor changes in movement patterns and room temperature (BT and Anchor Trust) are just two strands in a vast, expanding web of information and communication technologies of The Network Society. In the not-too-distant future, the metaphorical transparence offered by self-diagnosis will be upgraded to a virtual transparence; courtesy of ‘melanoma cameras’ that take weekly comparative snapshots of the body, and, ultimately, home-based diagnostic computers that produce 3-D images of one’s own body (Callaghan, 1999).

The Visible Human Project will be personalized as The Utopian Body Map Project (work in progress).

Trouble in Somatopia The transparent, informed bodies that populate Somatopia are an expression of a new utopian telos. Is such a state utopia or dystopia? Let us consider several factors that undermine the utopian body project. Firstly, it must be said that the culture of anxiety created by a population of ‘worried well’, in a neurotic state of vigilance against potential threats to their bodies from outside or from within, is hardly in keeping with the spirit of utopia. Secondly, the ideal of a transparent body is in the main a virtual transparency. In Baudrillardian vein, Frank (1992) argues that the bodies ‘revealed’ by imaging techniques and by tests}and represented in charts or on the screens of electrocardiographs and computer monitors or in the chemical reactions of urine tests}are but fragmented simulacra or images of bodies}not the real thing. In Baudrillard’s terminology, they are ‘hyper-real’}more real than the real thing. ‘This new techno-anatomy presents the human body as if it were a new geography, an unmapped landscape, almost as if it were a new territory to be colonized, named and controlled’ (Samson, 1999, p. 16). Far from allowing people to view the physical territory of their bodies, imaging techniques are more like maps. In between the map and the territory, uncertainty is kindled. Unlike strong social constructionists, many people believe that ‘beyond the relative discourse of physiology, corporeality remains an obdurate fact. There is a flesh which is formed in the womb, transfigured (for better or worse) in its life, dies and decomposes’ (Frank, in Featherstone et al., 1992, p. 49). Although images on screens or microscope slides are virtual representations of the body, there is a presumption that these representations are somehow connected with a real corporeality. Self-screening and self-spectatorship of the intimate geographies of one’s body may engender a sense of alienation that undermines the quest for the utopian body. Emily Martin’s interviews with medical students seeing cells from immune systems record this alienation and loss of control (rather than mastery); but also a sense of awe I could think, like, I have more control because, there are things you can do to affect something going on in your body, but then you think you could be in less control because there’s so many other things in your body that, maybe, you don’t know about. And they just go on constantly without even you thinking about them. So that I guess that could make you think that I was like, in less control, too. A whole

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other world. (Martin, 1994, p. 173) It’s actually hard for me to picture these things in my body. I mean I’m sure they’re there, but you know, seeing them so, so big, I mean this is really scary (1994, p. 173) ..even though I’ve seen all these kinds of things before and I realize that these are the exact same kinds of things in my body, it’s still distanced somehow, and I think it’s because. . . . these cells act on their own, you know. There’s no connection between. . . me being a conscious human being and this cell that’s inside me. (1994, p. 178) If these are meditations on healthy body processes, how much more alienating and anxiety-provoking must confrontations with one’s own diseased}or feared-to-be diseased-body be? As Annandale (1998, p. 268) cautions, preventive health screening may create anxiety and fatalism. Far from being empowered by screening, the ‘worried well’ may find themselves the ‘worried ill’ or the ‘worried at-risk well’ (Kenen, 1996). Presented with evidence of disease, the vast reservoir of ‘uncertain’ information at the sick person’s disposal may be counter-productive; exacerbating, rather than assuaging anxiety (Annandale, 1998, p. 19). Even for the ‘healthy’ body, the encounter with a metaphorically or virtually transparent body serves to remind that the body is degenerating. Following the health promoters’ guidelines, one may delay ageing, but death (in the absence of a replacement body or a transubstantiation of identity and memory to digital format) is the inescapable endpoint for the decaying body. This discomfiting encounter with corporeality is likely to stimulate the dread beloved of existential philosophers rather than a sense of utopian optimism. As a New Foundationalism, the body is intrinsically a flawed, crumbling foundation. Somatopia, in spite of its technotopian pretensions to perfectibility and progress through information and technology, casts a dystopian shadow. The futurists’ utopia must be postponed until ‘the body’ is posthuman, cryogenic, transgenic, cyborgian, bionic or computerized. But, what of the Other Utopia}the ‘dead’ Grand Narrative of a just and equal society? As argued above, the quest for the utopian body was originally a symptom of a cultural disenchantment with such metanarratives. In time, it has become a causal factor prohibiting the resurgence of Utopia. Absorption with one’s health is, rather like pain (Scarry, 1985) an incommunicable, and fundamentally antisocial experience. The irony of the utopian body project is that it may actually produce an unhealthy society. Speaking of ‘healthism’ generally,}though the message is equally pertinent to the utopian body theme}Crawford (1980, p. 365) states, (Healthism) can best be understood as a form of medicalization, meaning that it still situates the

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problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and, therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being. Care of the self (Foucault, 1986b) is not necessarily at odds with a wider social and environmental concern, but an exaggerated degree of self-absorption obscures the need for an ecological, holistic and political strategy of health. By disregarding this wider philosophical and social landscape, the utopian body paradoxically loses sight and control of factors that undermine its most concerted efforts to attain and maintain health. Starobinski (1989, p. 353) quotes from Paul Valery’s notebook: ‘Somatism (heresy of the end of time). Adoration, cult of the machine for living’. In place of ‘end of time’ one might fittingly substitute ‘End of Utopia’. At the beginning of the new Millennium we may still be no wiser as to what Utopia}let alone a healthy Utopia}would look like. However, in principle it should exemplify the maxim ‘a healthy mind in a healthy body’ whilst adding ‘and both of these in a healthy, fair society’. The relationship between the health of the individual and the health of society is akin to the ‘seesaw effect’. Putting too much weight on either value tends to unseat the other. Utopias derive some of their bad name from over-emphasising the value of society and the collective, the utopian body project embodies the opposite fallacy.

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