Biology as destiny? Rethinking embodiment in ‘deep’ old age

Abstract

Despite sociological understanding that bodies are social and morphological, material and discursive, there is a persistent, prevailing tendency within sociology to approach the old body – particularly in ‘deep old age’ – as non-social. No longer amenable either to reflexive (consumerist) choice, or expressive of the self, it is viewed rather through a biomedical explanatory framework in which it is held to succumb to ‘natural’ physiological processes of decline that lie outside culture. This paper critically questions such assumptions which it links to sociology's acquiescing in modernity's age ideology rather than taking it as a starting point for critique. This means that sociology's sensitivity towards ageing is displayed not in challenging models of the older body but in diverting attention away from the body altogether and focusing on structural and cultural determinants which are not considered to encompass physiology. Arguing, however, that biology and society do not exist on separate plains, and that the body in deep old age is, like other bodies, first and foremost a social body, the paper draws upon feminist methodology and epistemology for the purpose of dismantling such essentialism. It suggests that the sociological imagination will benefit from the eradication of age ideology through a clearer understanding not just of ageing but of embodiment at all stages of the lifecourse.

Introduction

Sociology approaches the body in older age – especially in that period which is sometimes referred to as ‘deep old age’ (Featherstone and Hepworth 1989) – as if it is determined by the parameters of biology and ‘nature’. The very term ‘deep old age’, first coined by Featherstone and Hepworth (1989), connotes ‘the body's failure’ (Twigg 2000a: 146) and thus, where it is the marker of the fourth age, ‘old age’ proper becomes tautologically synonymous with decline; it is, as Twigg puts it, ‘perceived to be all about the body and … dominated by bodily issues of a discouraging kind’ (2000a: 146).

Here, sociology reflects everyday perceptions. Woodward notes: ‘An 85 year old … will be perceived, first as old and only second as a woman or man’ (2006: 177). This evokes memories of precedents for such essentialism, for example in Fanon's account of the reaction he provoked in white Parisians in the 1940s, where he found himself ‘sealed into a “crushing objecthood”’ (1973 [1952]: 77), his identity as a ‘black man’ overwhelming all other identities. Where the comparison with Fanon is most striking, however, is in the sense that such explicit ‘othering’ would neither be an ordinary social reaction today nor indeed an individual perception, which underlines the absolute malleability of bodily-based identities (Hall 1988).

One of the reasons for the intractability of such views towards older people perhaps is that all societies, throughout time, have conceptualised stages of life, with old age included as the last stage, and that the sensation of passing through these stages has a powerful phenomenological meaning to us all (Phillipson 1998). Of great relevance, then, is Bourdieu's observation that: ‘The eternal, in history, cannot be anything other than the product of a historical labour of eternalisation’ (2001 [1998]: 82).

In this paper I argue that no natural objects, including older or any other bodies, exist in separation from social relations. A starting point in attempting to explode intractable myths to the contrary, especially those that consider older bodies to be an exception to this rule, I suggest, might be to carefully revisit the key tenets of feminism. After all, they succeeded in undermining ‘the long and remarkably tenacious view … that to be male/female, black/white were matters of nature or fate, not culture, unchanging biological facts’ (McCarthy 1996: 112) and might similarly be put to work in the case of older bodies. Thus far, feminist methodologies and epistemologies have mainly been employed sociologically to critique social and economic inequalities that particularly afflict older women (Arber and Ginn 1995; Estes, Biggs and Phillipson 2003), as well as to highlight the marked problematisation of older female bodies (Krekula 2007; Woodward 1999) but not to deconstruct the supposedly given nature of older bodies generically. I suggest feminist approaches can help us challenge ‘age ideology’, which Gullette defines as a ‘system’, including an ‘age gaze’ (Woodward 2006), that perpetuates the belief that constructed stages of the lifecourse are real (Gullette 1997). This system then frames the stage of old age within an ontology of decline and inferiority that is ‘given’ or ‘natural’ to the ‘human condition’.

In what follows I thus utilise tools from the feminist methodological toolkit. I focus firstly on the conceptual distinction between sex and gender, indicating how it was key in exposing the ideological nature of the assertion that women's inferior position in society was the inevitable outcome of an inferior biological constitution. I then discuss standpoint theory, which argues that the epistemology and methodology of (social) science more generally derived from an androcentric perspective. I discuss how the early work of Judith Butler introduced a more nuanced approach to the sex/gender distinction, highlighting the effects of power both on the body (‘sex’) and on the role and practices of the body in society (‘gender’). I then adapt the conceptual distinction between sex and gender in proposing a similar distinction between what I call ‘geras’, or the material and physiological aspects of the older body, and ‘elderhood’ or role. In the final section, I draw out the implications of the discussion, suggesting that some of sociology's key theoretical concepts require reformulating, taking age ideology as a point of critique not a foundation for this. Until this occurs, despite the best intentions, sociology itself may be said to be contributing to the problematisation of old age. Finally, I note, before commencing, that although the work draws on feminism, the paper seeks to address the situation of all older people, men and women equally.

The conceptual distinction between materiality and role: the case of sex and gender

Put simply, the distinction between sex and gender detaches biological and physiological differences associated with women and men from the social roles accorded them. Pioneering feminist scholarship, beginning with that of Oakley (1972), distinguished between sex, referring to the pre-social raw material, the natural, physiological ‘given’, and gender, signifying the normative roles performed by bearers of particular sex characteristics. This distinction then made possible a critique of the sexual division of labour, instated through these roles. Subsequent historical evidence further demonstrated how this strict body-based binary classification emerged during a distinctive phase in modernity, in which the new practices of pathology and anatomy, interlinked with broader social changes, underpinned the practice of highlighting difference between bodies (Laqueur 1990). The male body was taken as a standard from which the female body deviated: a move of particular utility at a time when women's legal, political and social rights were being circumscribed. A long period followed in which biology continued to be used in arguments regarding women's ‘natural’ (that is, inferior) position in society (see Lock 1993; Martin 1987; Showalter 1997).

Feminist scholarship from the 1980s demonstrated how such normative technologies, masquerading as dispassionate objectivity, held for the scientific method more generally including the identification of problems and assessment of evidence, in such a way as to help maintain the hegemony both of capitalism and patriarchy in its varied manifestations in modernity. Feminist standpoint theory (FST), associated with Smith (1987, 1990), Haraway (2004) and Harding (1986), among others, argued that all knowledge was ‘situated knowledge’ (Harding 2004), conditioned by perspective, such that rational knowledge is a ‘process of ongoing critical interpretation among “fields” of interpreters and decoders’ (Haraway 2004: 93). One variant of FST employed a Marxist historical materialist epistemology to highlight the distinction between appearance and essence, the concrete and the abstract (Hartsock 1983). This suggested that, just as Marx uncovered the ‘truth’ of the capitalist system by assuming the proletariat standpoint, which enjoys a less partial understanding than that of the ruling class, so feminists, through adopting a woman's viewpoint, were able to penetrate to a more fundamental level of truth still, buried beneath the layers not only of bourgeois but also of patriarchal institutions and ideology. In more recent discussions, standpoint theory has also been extended, beyond that of women, to acknowledgement of the added insights pertaining to all marginalised groups because, as Lawson puts it succinctly:

unlike the dominant groups, the marginalised are forced both to be aware of the practices, belief systems, values and traditions of the dominant group as well as to live their own. (1999: 41)

Butler (1990, 1993) attacked the ‘material realities’ of biology from a different angle, through extending understanding of the nuanced interplay between sex and gender. She explained this interplay in terms of the ‘sedimentation of gender norms’ that ‘produces the peculiar phenomenon of a “natural sex” … which, in reified form, appear as the natural configuration of bodies into sexes existing in a binary relation to one another’ (1990: 191). This identity, she argued, is not stable but must be constituted and reconstituted ‘through stylised repetition of acts’ (1990: 191). As historical research had done for the original sex/gender delineation, feminist research in biology has subsequently supplied added weight to this aspect of Butler's thesis, suggesting that ‘mattering’ of the body through performativity has ‘real’ consequences biologically with social context key to, for example, the development of the brain's structure (Fausto-Sterling 2003).

How can these insights help with a deconstruction of age ideology?

By contrast with feminism, mainstream sociology does not have semantic concepts at its disposal with which to distinguish the roles demarcated for the older person from the older body and thus, for the purpose of this argument, it may be helpful to construct such terms. I propose provisional use of ‘geras’ (from the Greek meaning ‘old age’) to signify the material and physiological aspect of the older body and ‘elderhood’ to indicate role. In what follows I examine these separately, as far as possible, tracing their development historically as well as looking at the way each impacts on the other to produce the image of an older person as ‘other’ to the standard younger body.

Geras: material and physiological aspects of the older body

In medieval cosmologies, older bodies were seen as continuous with younger bodies, and death as external to both (Katz 1996). However, since the birth of patho-anatomy in the 19th century, physicians have attempted to explore and record the physiological characteristics of older bodies, both internal and external, that separate them from younger people. This was also germane to the disciplinary project of geriatricians who were able to validate their professional jurisdiction by stressing older bodies' difference from other bodies which, like female bodies, were constructed as unstable, irrational and in need of expert intervention (Pickard 2010). This is the basis for medicine's increasingly prominent assertion that old age and disease are synonymous (Pickard 2012). Such an approach, however, assumes a highly contestable binary distinction between health and disease/illness (Antonovsky 1979) and thus cannot accommodate the co-existence of self-reported good health with impairment or illness (Siddell 1995).

Sociological approaches to ageing in many respects accept the biomedical model of old bodies, resulting in its removing attention from the body and focusing on social and cultural determinants – such as retirement and welfare – which are not, however, considered to shape physiology itself (Tulle-Winton 2000; Twigg 2004). Biological capital is assumed to be uncontestably depleted in old age as in the following statement by Wainwright and Turner: ‘Our stock of physical capital is transient: it grows and then declines with age’ (2006: 242). The biomedical body is also the body that appears in medical sociology's discussions of health in old age. So, for example, Bury and Wadsworth state that many health problems are strongly associated with biological age and of these ‘the very old emerged as the most affected by disability’ (2003: 116). Health problems, they note, are removed from society and culture, constituting as much a feature of the ‘biological clock’ as are growth spurts earlier on. What is striking is that, where in earlier phases of the lifecourse they describe ‘the dynamic character of the developmental processes at work’ (2003: 112) identifying social context as key, for example, to prenatal development, they at least partially withdraw this possibility from older bodies, reverting to a view of them as succumbing to ‘nature’.

In making these points, I am not suggesting that there is no such thing as a ‘real’ body: rather, I am questioning why it is that ‘real’ happens to take the form it does, physiologically as well as phenomenologically and symbolically, and I posit that it is not ‘given’ in any sense that puts it somehow outside of culture. Thus, it seems more helpful to explore whether, to paraphrase Judith Butler, a ‘sedimentation of age norms produces the peculiar phenomenon of a naturally aged body or a “real old person”’; and whether ‘this is a sedimentation that over time has produced a set of corporeal styles which, in reified form, appear as the natural configuration of bodies into age’ (see Butler 1990: 191).

Butler's approach here has much in common with Bourdieu's more sociologically informed depiction of the habitus as embodied social structure. In discussing female embodiment, Bourdieu sees women's subordinate social position mirrored in a physical demeanour indicative of a performed inferiority. So:

Female submissiveness finds a natural translation in bending, stooping, lowering oneself, ‘submitting’ – curved and supple postures and the associated docility being seen as appropriate to women. (Bourdieu 2001 [1998]: 27)

It seems to me that the striking resonance between this image and the stereotypical posture associated with kephosis in old age should at least give us pause before we accept it as ‘natural’, attributable to osteoporosis, or muscle wastage, but not to embodied social inferiority, nor, for that matter, to subtle resistance to productive norms – presenting oneself strategically as enfeebled – in a way which mirrors symbolic representations of old age (Hockey and James 1993). Whilst certainly ‘real’ bodies yield to ‘real’ time-related changes, attributing these changes one-dimensionally to biological aspects of ageing is to acquiesce in an individualisation and privatisation of life-long social insults, which is the essence of biopower. This is not to dispute the fact that in the ‘fourth age’ the body can be experienced as an obstacle: weakening senses, slowing gait, chronic pain and so forth. But here too it is at least partly the meaning imputed to these changes that give them their unique phenomenological, and indeed material, aspect. So, in a historical era that did not bear the imprint of today's biomedical assumptions towards the older body, the 17th-century Quaker merchant William Stout could write, in a way that assumes bodily possibilities virtually unthinkable today:

I began to use spektacles [sic] at 50 years of age and could not see to read or write without them till I was 70 years old; but since then my eyesight had recovered gradually [sic], so that I can now see to write and read without them. (quoted in Thane 2000: 69)

The notion that slowing gait is a deleterious change may not be such a doxic assumption, to use a Bourdieusian term, in other cultures which do not possess our modernist intent to control the environment and master both ourselves and the world in pursuit of competitive achievement (Yalom 1980).

Moreover, late modernity construes bodily changes in old age not only as functionally problematic but also as aesthetically offensive. Twigg's home-care workers ‘couldn't stop staring’ at older people's ‘weird’ bodies; on their part older people felt themselves to be ‘ugly lumps’ (2000a: 155) compared to the ‘young and beautiful’ care-givers (2000a: 154). Both reactions derive from the fact that ‘we have little sense culturally of aesthetic pleasure in old flesh, or of what a beautiful old body might look like’ (Twigg 2000b: 46). This has consequences beyond that of surface appearance: in matters of bodily performativity, function and appearance, viewing older bodies ‘through the eyes of the youthful structure of the look’ (Woodward 2006: 167) normatively determines the distinction between ‘positive’ and ‘negative’ changes. Indeed the distinction between normal and pathological in medicine can be read simultaneously as a clinical, social and aesthetic evaluation, where images of aged organs can appear ‘wrong’ to physicians held captive in the Wittgensteinian sense by the ideal anatomical type represented by younger organs (Synott 1993).

At this point, I turn to an examination of elderhood.

Elderhood

Roles for older people in society are mainly defined with reference to what they are not: primarily that means in terms of not engaging in the workforce. Since the institutionalisation of retirement, policy rhetoric, backed by pronouncements by geriatricians suggesting that older people are ‘unfit’ for anything but the lightest work (Pickard 2010), has depicted older people as socially burdensome. However, sociologists, including Phillipson (1982), Estes (1986), Townsend (1981) and Walker (1981), have demonstrated that this label functions ideologically at several levels. Far from occupying a privileged position, older people are, through retirement, reduced to poverty or comparative poverty; removed from valued roles and positions of influence; and simultaneously discouraged from resistance in terms of emotional responses such as anger, which are deemed inappropriate in old age (Woodward 2003). Today, where older people are exhorted to remain in work, the underlying rationale similarly is that of forestalling this potential ‘burden’ of old age (Biggs 2001).

One way that age ideology accommodates the new fluidity of the lifecourse is by separating old age into a third and fourth age, with the latter alone coming to represent ‘real’ old age (Gilleard and Higgs 2011). Older people in the third age category are indistinguishable in many ways from middle-aged adults, and decline proper is associated with fourth agers (Gilleard and Higgs 2011). Medical practices both shape and are shaped by this conceptual division, increasingly separating biological and chronological age on the basis of lifestyle and (self) surveillance seen as integral to continuity of adult status (Pickard 2012). This shift has an economic underpinning, where economies which once relied on older people leaving the labour market now require their continued productivity as consumers and increasingly, indeed, encourage their continuation in the labour market as part of reducing the ‘pensions burden’ (Pensions Commission 2004; Phillipson and Smith 2005). This introduces something of a Cartesian split between the two versions of the older body-self. The third age represents the ‘masculine’ ideal comprising a body amenable to the autonomous, rational will, where health and ageing are a ‘choice’. The fourth age, by contrast, is determined by biology and discussed almost entirely in terms of physiological processes requiring expert surveillance.

However, these categories are constructed from the perspective of younger people; standpoint theory enables a shift to older people's perspective, and thence an opening up of ideological structures. This is particularly vividly realised where older people, unlike Marx's proletariat, were once young and therefore integrated into that (and possibly other) dominant groupings. Now removed from the public to the private or domestic sphere, many will take on lower-status ‘feminine’ tasks such as home maintenance and care-giving, a shift which may be particularly acute for older men (Harper 1997). Whilst this insight may simply augment a lifetime of similar experiences for many women, what extends beyond this is the experience of the ending of productivity and of social obsolescence as well as acquaintance with finitude and death. Mainstream society's moral sequestration of these existential facts (Giddens 1991), described by Heidegger in terms of ‘inauthenticity’, is from this perspective revealed as an ideology which ensures continued meaningfulness to the endless cycle of capitalist productivity but which may render life itself curiously devoid of meaning. Indeed, removed from the mesmerising cycle of productivity, facing the reality of fragility and death, older people's perspective can precipitate profound psychological growth and self-actualisation (Biggs 1999). However, in order to avoid essentialising old age here, I stress that this is not the prerogative of old age per se and indeed may very likely be a perspective shared widely in societies where reflection on death is a traditional concern for individuals at all life stages, for example, medieval societies and Buddhist and other cultures.

Recasting the sociological imagination

The above observations require, I suggest, a reformulating of the sociological imagination. Where feminist scholars in the 1980s highlighted how the subject matter of sociology was organised from the perspective of the male ruling class, this paper suggests that conceptualisation of the ruling class be redefined to include the existence of age as well as sex hegemony with both sustained through ideologies based on biological essentialism. Age ideology has impacted substantially on sociology's key theoretical concepts, including notions of power, freedom and resistance, as well as health, illness and embodiment. These concepts sit uneasily with evidence that the older they are, the more men and women are satisfied with their body as compared with younger people (Oberg and Tornstam 1999; see also the positive experiences described by Diana Athill 2008 in her age autobiography); also that many experience their bodies, which may be impaired or diseased, as healthy (Siddell 1995). Attributing authority to experience, after C. Wright Mills and Dorothy Smith (Howson 2005), would suggest that, rather than explaining away these statements, we adjust our understanding of ‘health’ and embodiment, currently conditioned by the ‘youthful structure of the look’ (Woodward 2006), a gaze employed by doctors, policy makers, lay people and social scientists. However, remedying this requires more than just ‘adding on’ an understanding of age to existing theories (Witz 2000): it requires that we ‘rethink antitheses’ such as mind/body, fact/value, growth/decline so that they no longer serve as ‘weapons’ between the ruling class and others (Midgeley 1988).

But in reformulating our concepts certain seductive traps lurk. The first is the temptation to cede ‘geras’ to biomedical scientists where we should rather employ our critical perspective to identify where ideology exists under the guise of ‘objectivity’ and the most ‘commonsense’ understandings which we share with biomedicine about our bodies (Klinge 1997). Another trap is that of asserting either that there are no changes accruing to old age, or that such changes are uniformly positive. Merleau-Ponty's (1962 [1945]) suggestion that both the body and the world are ‘real’ to the extent that the fit between them can be more or less comfortable, more or less enabling, is one way of suggesting the limits of resistance, the point where resistance perhaps becomes denial: the world can constrain but the older body, for a variety of reasons, can, on its part, falter and lose its grip on the world. Thirdly, the aim cannot be to substitute the ‘age gaze’ with a ‘gaze from nowhere’: Haraway (1991) reminds us of the embodied nature of all vision and this requires that we recognise ourselves, situated as scholars and researchers with a variety of other co- or parallel identities, in our own gaze. The insights of standpoint theory are every bit as relevant to sociological practice as to the natural sciences (Bauman 1991).

More profoundly still, exorcising age ideology from the sociological imagination requires reformulating our entire view of the ontology of the body, including rethinking the relationship of old age to youth and to all other life stages. Delphy (1993) notes that hierarchically arranged categories are linked to each other in a specific social order in such a way that this structural relationality determines the content of each category. So, for example, what ‘youth’ is, is as dependent on the existence of a certain meaning attributed to old age as vice versa, and therefore neither category would survive the end of age hierarchy either in its material or symbolic forms. This process would require a recognition firstly of the uncomfortable truths that apply to all bodies: their serving as vehicles for regulation especially through medicalisation whilst at the same time being resistant to rational control and mastery; their profound vulnerability and ultimate finitude (Turner and Rojek 2001). But, equally, positive experiences of embodiment in the ‘fourth age’ point the way to extending the space of self-actualisation to the whole lifespan, where currently the fear of ageing casts its long shadow far into youth, as well as encouraging increasing recognition of, and research focus upon, ambiguous categories such as the good life in old age.

In that the ‘sequestration of experience’ has protected mainstream society from recognition of shared ontological vulnerability, in turn facilitating late modern subjectivities such as that of the entrepreneurial self, good citizenship as healthy citizenship and fulfilment through consumerism, such rethinking of the ontology of embodiment can thereby herald radical social change. Unlike Marx's bourgeoisie, however, such change would not sacrifice the young to the old but rather enhance the freedom of all ages. Bourdieu (2001 [1998]) very eloquently describes how, in hierarchical societies, although the dominated suffer most obviously, the dominant also suffer: ‘active differentiation’ from their opposite category requires a particular socialisation and the very dominance it inculcates ironically bestows upon the dominant a profound vulnerability. In the same way we can recognise that the symbolic violence meted out to older people in the maintenance of age ideology comes at a great price for society as a whole, its individuals and its institutions, its science and its everyday practices.