I Know My Own Body' Power and

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Body & Society
DOI: 10.1177/1357034X08093572
2008; 14; 49 Body Society
Jeanne M. Lorentzen
Medical Interactions
`I Know My Own Body': Power and Resistance in Women's Experiences of
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I Know My Own Body: Power and
Resistance in Womens Experiences of
Medical Interactions
JEANNE M. LORENTZEN
Theorizing resistance has been a particularly problematic enterprise in feminist
thought. A wide variety of attempts to advance the feminist emancipatory project
have been hindered, despite notable efforts, by the inability of feminist theory to
surmount Cartesian thought (Colebrook, 2000). In terms of medicalization,
feminist empirical efforts have commonly proceeded from theoretical orienta-
tions premised on unexamined dualisms. This has frequently resulted in the exag-
geration of the power of medicine to inscribe particular patterns of feminine
embodiment and precluded identication of resistance. In order to examine the
nature of medical power relations, specically the extent to and manner in which
resistance occurs within such relations, rather than focusing exclusively on the
corporeal it is necessary to address the imbrication of the corporeal and the
incorporeal (Colebrook, 2000: 42).
In this article I examine womens experiences of patientdoctor interactions in
order to discover what their embodied experiences can reveal about the nature of
medical power and the ways in which resistance may be produced. In order to
contextualize the ndings, I begin by relating personal experiences that inuenced
Body & Society
2008 SAGE Publications (Los Angeles, London, New Delhi and Singapore),
Vol. 14(3): 4979
DOI: 10.1177/1357034X08093572
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03 Lorentzen 093572F 13/8/08 12:29 pm Page 49
my perspective on medical power relations. The following section provides an
explanation of this studys use of a Foucauldian informed notion of power. After
presenting the research methodology used in this study I present the analysis of
the womens experiences in medical interactions and conclude with a discussion
of the implications of my ndings for theorizing the relationship between
medicalization, womens health care needs and gendered embodiment.
The Researchers Body
A personal experience many years prior to my graduate studies in sociology
served as the primary catalyst for my interest in medical power relations. In my
early 20s I experienced a problematic pregnancy that required extensive stays in
the hospital and interaction with my gynecologist. I had experienced two normal
births previously, but after the birth of my third child I experienced severe
gynecologic pain that led me to consult my doctor on numerous occasions in an
attempt to get back to normal, that is, living without pain. On each occasion he
urged me to have an elective hysterectomy, which I always refused. The particu-
lar medical interaction that convinced me to undergo an elective hysterectomy
was quite tense. According to my gynecologist the most important reason I
needed to have a hysterectomy was not because it would alleviate the pain I was
experiencing, although he assured me that it would accomplish that as well, but
because I had come close to dying from the complications of my last pregnancy.
He believed the surgery was necessary foremost as a permanent form of birth
control, arguing that without it I would likely die were I to become pregnant
again. When I did not immediately agree, he became quite irate and angrily
continued to urge me to have the surgery. Finally, he stated that if I died from
my next pregnancy that my children would be left motherless. He tersely asked,
Is that what you want?
As a young woman from a traditional Catholic family with nine siblings, what
I wanted was a relatively small family, which in my estimation at that time was
about ve or six children. At that time my identity fell along traditional gender
lines and my life revolved around motherhood. Consequently my doctors words
produced a profound sense of guilt even as I focused on the problem of who I
could possibly be if I could not be the kind of person I had always envisioned.
It was only many years later that I fully understood that his words made me
question not only the adequacy of my mothering, but the normalcy of my femi-
ninity. I believed he was telling me that I couldnt possibly be an adequate woman
if I did not accept his version of appropriate gender behavior and sacrice a
vitally important part of my body, my self, for my existing children.
50 Body & Society Vol. 14 No. 3
Obviously my physician was concerned about my future health state, and
perhaps he may have also been trying to dissuade me from following what he
considered to be a likely harmful, traditionally feminine path. Nevertheless, these
possibilities do not diminish the gendered nature of his argument in an attempt
to produce my agreement with his interpretation of my bodily state and need for
an extreme medical intervention, as well as appropriate life course. Interestingly,
he did not offer the option of alternative, less invasive medical procedures that
would have just as effectively produced permanent birth control. Consequently,
because he predicted that a future pregnancy, intended or accidental, would result
in my death, I chose to have an elective hysterectomy.
Only after the surgery did I discover that his argument was not based on un-
disputed medical knowledge that could conrm with a high degree of certainty
that another pregnancy would be life-threatening for me. At that time there was
a lack of medical research focusing on the rare pregnancy condition from which
I had suffered. Whatever my gynecologists medical expertise, it later became
apparent to me during graduate studies that his diagnosis and treatment recom-
mendation was an example of gendered medicine which rationalizes female repro-
ductive organs as inherently pathological.
Dorothy Smith (1987: 49) states, The work of inquiry in which I am engaged
proceeds by taking this experience of mine, this experience of other women this
line of fault and asking how it is organized, how it is determined, what the
social relations are that generate it. My experience of obstetric and gynecologic
health care that resulted in elective hysterectomy was my line of fault. Conse-
quently, over the ensuing years, prior to and during graduate school, I reected
on how my physician had gendered his argument in an attempt to effect my
compliance. I came to believe I had been victimized by gendered medicine, and
it was this understanding that compelled me to focus my research on medical
power relations. However, over time, as I engaged other women in conversations
about their medical experiences, including the women who participated in this
study, my perspective shifted. I came to understand that women need not be,
nor are typically, passive victims of medical power. Although my experience of
medical power certainly altered my body and initiated a transformation in my
gendered embodiment, as well as a future I could not have previously imagined
choosing, it also produced a critical and selective consumer of medicine. Perhaps
more importantly it produced a feminist sociologist who studies medical power
relations and gender. Consequently, my own experience with medical power rela-
tions serves as an example of how power relations can have long-term effects and
produce both discipline and resistance.
I Know My Own Body 51
Medical Power
The social process of medicalization has long been of concern to feminist scholars
who contend that womens bodies and lives have become highly medicalized.
According to feminist perspectives medicalization, a social process in which bodies
and social circumstances are dened from a biomedical perspective as requiring
biomedical intervention, not only contributes to the maintenance of gender
inequality but directly impacts womens health and well-being.
1
A more recent
perspective argues that women are not passive recipients of medical care and
medicalization, but active participants in medical power relations as they attempt
to achieve particular health states and congurations of gendered embodiment.
2
The primary point of contention between these two perspectives centers on
assumptions about the nature of power. The majority of earlier analyses adopt a
traditional notion of power in which medical power relations are understood to
be hierarchical and repressive.
3
Although these analyses contribute important
knowledge about gendered medicine, their perspective on power has been prob-
lematized primarily because it precludes the possibility of agency and can, there-
fore, only dene women patients as powerless victims (Broom and Woodward,
1996; Dull and West, 1991).
Analyses of medical power relations using a relational/transactional notion of
power, as does the present study, contend that women are active participants in
medical power relations (Davis, 1988; Denny, 1996; Gabe and Calnan, 1989;
Oinas, 1998). Feminist scholars also argue that women do not constitute a homo-
geneous group and, therefore, all women are not impacted in the same manner
by medical power relations (Doyal, 1995; Lorber, 1994; Riessman, 1983). This
perspective explains medical power relations as a process of negotiation in which
women experience both benets and costs.
Despite feminist critiques of Foucault that claim his work cannot contribute
to emancipatory politics (Deveaux, 1994; Di Leonardo, 1991; Hartsock, 1990),
Foucaults concept of power as developed in his later work (Sawicki, 1998) has
been highly inuential in feminist analyses precisely because of its capacity to
inform emancipatory projects (MacLeod and Durrheim, 2002). In order to explain
how modern power produces normalized bodies, Foucault (1977: 201) used the
analogy of the panopticon; an architectural prison design in which a central tower
enables guards to constantly monitor prisoners who are housed in cells encircling
the tower. This design creates the opportunity for constant surveillance and a
minimum of supervision of inmates. Foucault (1977) argues that power relations
like those of Western medicine function like the panopticon through the un-
ceasing gaze of power/knowledge regimes positioned as arbiters of truth, with
the use of truth claims based on contentions of expert knowledge that capture
objective reality. In terms of medical power this perspective suggests that bodies
are normalized to varying degrees through the production of medicalized, self-
regulating subjectivities.
This notion of medical surveillance does not only refer to face-to-face medical
interactions for such interactions cannot literally constitute continuous surveil-
lance but also to the self-regulation individuals engage in because they inter-
nalize medicines gaze, they incorporate it into their understanding of their
embodied selves and the world. In this way medical power is seen to produce a
biomedical societal ethos that inuences the production of medicalized subjec-
tivities. Accordingly, patients do not require the constant surveillance of medical
practitioners to be inuenced by medical power because the truth claims of
medical science are internalized and pervasively accepted in Western societies as
accurate depictions of bodies and disease as simply reality. This produces a rela-
tively high degree of rationalized (medicalized) self-regulation of populations.
From this perspective medical power relations are relational and productive,
not merely repressive. Power relations produce bodies that are disciplined and
resistant, through the manner in which knowledge/power moves between shifting
positions/statuses, that is, for example, through practices such as the negotiation
of truth claims (Foucault, 1977). Power is not merely repressive because power
relations depend on the interactions of free subjects, for in order for power rela-
tions to come into play there must be a certain degree of freedom on both sides
(Foucault, 1994: 292). Consequently, power relations are not only alterable, but
unstable and, indeed, anarchic (Bruns, 2005: 369) as they are constituted through
the changing alignment and negotiated practices of individuals and groups.
Wartenberg (1990: 150) explains Foucualts notion of power thus:
A eld of social agents can constitute an alignment in regard to a social agent if and only if,
rst of all, their actions in regard to that agent are coordinated in a specic manner. To be in
alignment, however, the coordinating practices of these social agents need to be comprehensive
enough that the social agent facing the alignment encounters that alignment as having control
over certain things that she might either need or desire.
Therefore, a physicians attempt to use medical power is only possible when
understood in relation to patients, nurses, medical assistants, and all those who
enter into interaction or alignment with a physician in spaces where the knowl-
edge/power techniques of medicine may be employed. In other words, a physi-
cians application of medical power is contingent on others acceptance of, or
desire for, that application. As such, the possibility for resistance is always present
in power relations because, as Wartenberg points out:
. . . [a] subordinate agent is never absolutely disempowered, but only relatively so. . . . just as
the dominant agents actions are subject to the problematic of maintaining power by maintain-
ing the allegiance of the aligned agents, the subordinate agent is always in the position of being
able to challenge the aligned agents complicity in her disempowerment. (1990: 173)
However ubiquitous medical power/knowledge may be in society, consulta-
tions with, and medical examinations and treatments by ones physician consti-
tute a more focused and direct form of surveillance that provides a more intensive
engagement with medical power/knowledge because a physicians expert gaze is
directed explicitly on the individual patients body. As such, it is possible that the
truth claims advanced by physicians in direct interactions with patients may hold
greater salience for a patient than generalized medical truth claims in society. This
is possible because the end results of diagnosis and treatment are individually and
personally experienced and may be understood by patients to mean the differ-
ence between suffering or relative well-being. Nevertheless, these circumstances
may be as likely to produce resistance as compliance. For example, Abel and
Browners (1998) study of pregnant women found that medicine was inuential
in mediating the womens understandings and experiences of pregnancy, but also
that the women used embodied experiential knowledge in their decisions to
accept or reject medical advice and treatment. Therefore, although medical prac-
titioners are dened as the expert interpreters of the body, they do not hold a
monopoly over truth claims medical or otherwise.
Patients, as well as physicians, have access to a wide variety of medical knowl-
edge/truth claims. For example, medical truth claims may be encountered through
conversation with others who have had particular medical experiences, viewing
medical programs on television, reading self-help or lay medical texts (Abel and
Browner, 1998), or by searching the Internet for medical or experiential infor-
mation (Ziguras, 2004). In fact, a multiplicity of medical interactions typically
subject patients to a variety of competing truth claims about the body, through
consultations with an assortment of medical specialists and health care providers
(e.g. a second opinion from another physician or a nurse who imparts medical
knowledge contradicting her physician employer), as well as other power/knowl-
edge apparatuses (e.g. legal truth claims concerning proper medical practice).
Additionally, in attempts to understand their bodily states, prior to seeking medi-
cal care, individuals typically consult with other lay individuals who impart
medical and experiential knowledge (Freidson, 1961).
The present situation, in which innumerable medical truth claims are broadly
circulating in society understood to varying degrees and available to be used
by lay individuals in medical power relations is not only due to the explosion
in information technology but to the ubiquitous societal impact of medical
power itself. However, according to Ziguras, the power of the medical profession
has been diffused because of the wider array of information available, and hence
the popular awareness of differences of expert opinion and the desire to take a
more active part in ones self-care . . . (2004: 131). These and other developments
in the nature of medical power support Foucaults contention that power produces
both disciplined and resistant bodies.
Resistance in Medical Power Relations
In terms of the two dominant perspectives of power in feminist analyses of
medical power relations, a related theoretical debate concerns the question of
whether it is more accurate to conceive of the body as lived or inscribed. Turner
(1992: 57) asserts that there is no compelling theoretical reason for positioning
the body from one perspective or the other. Crossley (1996: 99) argues that
although these two concepts may appear to be incommensurable they can be
understood as two sides of the same coin. He contends these two ways of
viewing the body actually refer to the relation between power and agency, with
the notion of the lived body focusing on the experiential aspect of bodies that
enables intentional action, and that of the inscribed body focusing on how bodies
are socially inuenced or shaped without conscious attention to that process.
Therefore, in Crossleys comparison of Merleau-Pontys and Foucaults concep-
tualizations of body-power, Crossley contends that power conceived as relational/
transactional can be understood as producing both discipline and resistance, but
only under the assumption of an embodied subjective agency (1996: 108).
Although Oksala (2004) does not focus primarily on the subject of agency, her
interpretation of Foucaults notions of experience and embodiment also claries
how power/knowledge networks produce discipline and resistance through
experiential bodies. In contrast to most feminist readings of Foucaults under-
standing of experience, Oksala (2004: 99) argues that Foucaults idea of bodies
and pleasures as a possibility of the counterattack against normalizing power
presupposes an experiential understanding of the body.
Crossleys and Oksalas often complementary readings of Foucault suggest
that the ability of the body to be trained and to resist depends on awareness of
bodily experience. Crossley argues that it is only through the assumption that
the human body has an inherent capacity that of awareness that Foucault is
able to argue that a body can be trained in particular ways of being, and thus also
be enabled to use the skills and dispositions that are imposed upon it, and use
them against those who imposed them (1996: 109).
Foucault saw power relations as necessarily played out between free agents,
and that without such freedom power relations would instead be equivalent to
a physical determination (1994: 342). Resistance and power together shape our
bodies and how we understand our bodies and their possibilities through a
complex dance that has no predetermined outcome. Foucault states:
In effect, what denes a relationship of power is that it is a mode of action that does not act
directly and immediately on others. Instead, it acts upon their actions: an action upon an action,
on possible or actual future or present actions. A relationship of violence acts upon a body or
upon things; it forces it, it bends, it destroys, or it closes off all possibilities. Its opposite pole
can only be passivity, and if it comes up against any resistance it has no other option but to try
to break it down. A power relationship, on the other hand, can only be articulated on the basis
of two elements that are indispensable if it is really to be a power relationship: that the other
(the one over whom power is exercised) is recognized and maintained to the very end as a
subject who acts; and that, faced with a relationship of power, a whole eld of responses,
reactions, results, and possible interventions may open up. (Foucault, 1994: 340)
In other words, as long as we are participants in social relations we cannot choose
to extract ourselves from power relations because they are a manner of relating
that is basic to social life. Society imposes a variety of such constraints, but indi-
viduals have a multitude of options in terms of how to interact within power
relations, although how we choose to act and respond certainly depends on our
goals and how others interacting with us try to reach their goals through such
interactions. Therefore, resistance is always a potential aspect of power relations
in which negotiation and shifting alignment inuence outcomes. According to
Foucault:
Power relations are rooted in the whole network of the social. . . . The forms and the specic
situations of the government of some by others in a given society are multiple; they are
superimposed, they cross over, limit and in some cases annul, in others reinforce, one another.
(1994: 345)
As such, power relations are not viewed as shaping embodied subjectivities deter-
ministically. The vastly complex and varied nature of power relations serves as
a vehicle by which individuals, all of whom possess creative capacities, construct
equally complex and varied subjectivities that are contingent on a wide array of
interacting physical, psychological and social factors.
From a Foucauldian perspective, medical power relations contribute to the
construction of both physician and patient embodied subjectivities. Both physi-
cians and patients are capable of advancing truth claims that may be challenged
through the use of competing truth claims based on medical, embodied or other
types of knowledge. If medical power relations may be accurately understood to
function in this way, through truth claims participants advance and resist, then
the production of an uncontested medicalized reality cannot be assumed to be the
only possible outcome of doctorpatient interaction. Consequently, the outcome
of medical power relations cannot be conceived of as predetermined, that is, as
only producing passive, compliant bodies.
Medical Power Relations and Gender
Although Foucault did not focus on gender, it is:
. . . a fundamental factor in power relations. . . . Gender is a primary feature of the constitution
of the Self, and the basic choices are either to accommodate the culturally specic and histori-
cally situated assignments for members of ones sex or to resist. (Faith, 1994: 61)
Understanding medical power relations from a Foucauldian perspective does not
negate the fact that knowledge and bodies are gendered. A large body of feminist
research demonstrates the gendered character of scientic medical knowledge,
health care and medicalization.
4
Nevertheless, however much womens participa-
tion in medical power relations may shape and gender bodies, empirical analyses
of womens experiences in doctorpatient interactions suggest that women do resist
medical truth claims and privilege other knowledges under some circumstances.
5
Daviss (1988) study of the nature of medical power relations between women
patients and their physicians concluded that power and resistance were concomi-
tantly produced. More specically, Davis characterized medical power relations
as a moment-by-moment struggle for control with participants gaining and losing
their foothold as the interaction proceeded (1988: 343). However, Davis also
found that medical power relations are typically asymmetrical in that physicians
usually prevail in producing an uncontested medical reality. Most important for
the present study is that Davis (1988: 375), on the basis of her empirical ndings,
argues that the manner in which medical power (or power in general) operates
does not differ within gender relations. That is, power relations function similarly
whether based on gendered or non-gendered knowledge. Of additional import
for this study, Davis found that patients use available resources such as troubles-
talk, which refers to patients talking to physicians about their health problems
from an experiential perspective, in attempts to challenge doctors interpretations
of their bodily states.
Abel and Browner (1998) distinguish between two types of experiential knowl-
edge embodied and empathic that inuenced the medical decisions of women
in their study.
6
Embodied knowledge refers to knowledge developed from an
individuals experiences with and perceptions of ones body as the individual goes
through changes caused by normal and abnormal body processes such as preg-
nancy, bodybuilding, menstruation, weight gain or loss, menopause, illness and
injury, etc. Empathic knowledge refers to knowledge gained from the experiences
of other individuals with whom a person identies in some way. Neither of these
types of knowledge need be considered as merely cognitive, but may be under-
stood as bodily sensations or emotions, or as gut feelings.
Embodied and empathic experiential knowledge have historically been gendered
feminine, while disembodied rational thought is gendered masculine. Within the
scientic disciplines, including sociology (Howson, 2005) sensory experience or
carnal knowing has historically been invalidated as a source of knowledge (Miles,
1992). From a Foucauldian-informed perspective gendered power/knowledge
regimes can be understood to employ power techniques that include the desig-
nation of knowledge that is not generated through a regimes approved methods
for producing knowledge as not knowledge. This power technique is evident in
the scientic paradigm structured by Cartesian dualism in that it rationalizes
embodied experiential knowledge as not valid because it lacks objectivity and is
not produced through the scientic method. However, feminist philosophers
argue that scientic knowledge contains gender bias and the supposed objectivity
of scientic modes of knowledge production actually conceals power relations
(Harding, 1991). As Birke (1999: 8) contends, What counts as scientic knowl-
edge, as the facts, depends on who counts it as such and in what context.
Consequently, within medical power relations, physicians who advance medical
truth claims do so based on an assumption of objective scientic medical knowl-
edge that can lead them to discount the embodied and empathic experiential
knowledge of patients.
Women are the primary consumers of medicine, at least partly because they
are socially assigned the responsibility of caring for bodies, their own as well as
those of others (Spelman, 1988). It is reasonable to assume that womens care for
the healthy and sick bodies of their children, partners, friends and elderly parents
can result in extensive embodied and empathic experiential knowledge for women
who are responsible for such care. Although womens experiential knowledge of
bodies may be understood as a result of gendered disciplinary effects of power/
knowledge regimes rather than an inherent biological capacity, the fact that it is
gender relations that produce caring experiences does not lessen the knowledge
that women can gain from their close associations with bodies. Consequently,
even though gender (power) relations may be repressive, they are also productive
in that they produce experiences that engender knowledge that can be employed
in attempts to resist power.
Within medical power relations physicians ostensibly rely on knowledge pro-
duced through the use of the scientic method because it is deemed as valid
knowledge according to the scientic paradigm. Despite physicians attempts to
advance this knowledge as objective truth in interpreting womens bodies, and
despite their attempts to ignore, discount or repudiate womens knowledge of
their bodies, within medical interactions women may choose to privilege their
embodied or empathic experiential knowledge over medical interpretations. The
specic conditions under which women choose to resist applications of medical
power, the extent and form of their resistance, and the degree to which their
resistance is successful in producing a compliant or docile physician has not
been the focus of research.
Methods
The participants for this study were contacted through word of mouth. Prior to
resorting to this method to locate study participants I made numerous attempts
to gain access to a variety of physicians and hospitals patients. However, none
of the numerous physicians or hospital administrators contacted (via both written
letters and telephone calls) provided permission to contact their patients. In fact,
medical gatekeeping proved to be such a signicant obstacle to obtaining access
to patients who had specically had elective hysterectomies that many of the
physicians receptionists I spoke to refused to even allow me to speak with their
physician employers. Consequently, I abandoned the original method I had
planned to use for obtaining research participants and relied on a very informal
and large network of friends, acquaintances and strangers to identify and contact
women who had this procedure. Only women who had elective hysterectomies
were asked to volunteer for this study.
During formal interviewing the study participants were asked numerous open-
ended questions. The participants were also encouraged to raise issues that they
individually considered to be important factors in their experiences of medical
interactions that inuenced their decision to undergo elective hysterectomy
surgery. This resulted in the women choosing to relate their experiences of both
gynecologic and non-gynecologic medical interactions. The women were asked
to describe their early attitudes towards and experiences of (a) menstruation, (b)
reproductive functions and (c) their relationships with physicians. Later ques-
tions asked about these attitudes and experiences in the time period directly
preceding their hysterectomies. The women were also questioned about the
health and social interaction problems that motivated them to seek gynecologic
care in general and, in particular, those that resulted in elective hysterectomy.
Additionally, the participants were asked about the benets and costs of elective
hysterectomy.
The sample consists of 20 women who had elective hysterectomies. The women
range in age from 30 to 67 years of age, but most of the women (13) are under
50 years of age. The majority of the women are married (18), two are single having
never married, one is divorced, and one is widowed. All but three of the women
have at least one biological child.
The womens approximate yearly household income ranges between less than
$10,000 to $250,000. With the exception of four women, all of the women are
employed, either full-time or part-time. The womens education ranges between
the completion of some high school to advanced college degrees. Two of the
women completed some high school, ve are high school graduates. Six have some
college, two women completed some graduate work, four have Master degrees,
and one woman has a PhD. As a result of sampling occurring in a geographical
area that was predominantly white and non-urban, all of the participants are
white.
Womens Experiences in Medical Power Relations
The women in this study related their experiences of medical interactions pri-
marily in terms that demonstrated they viewed these interactions as typically
unproblematic. Within most medical interactions the majority of the women
dened their behavior as knowledgeable and actively contributing to, and in
some cases actively directing their medical care. However, most of the women
also described problematic medical interactions. The women tended to describe
medical interactions as problematic when physicians attempted to assert medical
truth claims about the womens bodies or appropriate gender embodiment that the
women dened as inaccurate, potentially harmful, demeaning, and as discounting
the womens experiential knowledge of their own bodies. It was these types of
medical interactions that the women chose to describe in nuanced detail, often
with a great deal of emotion, and frequently leaving no room for interruption
by my questions, suggesting that these experiences were highly signicant to the
women.
When asked if shed ever had an experience with a gynecologist that was dif-
cult, upsetting, or problematic, Jill did not immediately refer to the incident in
which her doctor mistakenly removed both of her ovaries during surgery.
Instead, she chose to relate an incident in which her physician refused to write a
prescription for her preferred form of birth control.
Only when the doctor and I disagreed about IUDs. He thought a person shouldnt have an
IUD and I was very angry with him . . . he just thinks it was something to do, and I got very
upset with him. I wrote him a nasty letter and then later apologized. . . . So I decided it was
time to nd somebody else.
Jills knowledge of medically sanctioned birth control, including the fact of
contradictory expert medical opinion about birth control methods and devices,
was acquired from her attention to media coverage of medical research on the
topic, as well as information garnered from previous interactions with other
physicians. Additionally, Jill had previous experience using an IUD with no
negative repercussions. Therefore, Jill had made her decision to request an IUD
from her doctor based on an assessment of medical knowledge of birth control
options and her embodied experiential knowledge. This knowledge inuenced
Jill to decide that she was willing to accept some risk in order to gain the benets
she believed an IUD could afford.
This interaction between Jill and her physician demonstrates how the knowl-
edge resources of individuals inuence the manifestation of power relations. In
this instance, Jills resources included medical and embodied experiential knowl-
edge, as well as her capacity to privilege her knowledge over expert medical
knowledge. The resources that enabled Jill to resist a specic application of power
were at least partly produced through medical power relations, for without her
extensive experience within medical interactions, through which she acquired lay
medical knowledge and embodied experiential knowledge, Jill might not have felt
qualied to challenge a medical expert. This suggests that power relations do
produce capacities in subjects that enable resistance.
Jills physician, through the use of medical truth claims based on expert inter-
pretation of medical knowledge, refused to comply with Jills request for an IUD.
Jill attempted to compel her physician to comply by advancing competing truth
claims based on her lay medical and embodied experiential knowledge. Her
physician also engaged in resistance by refusing to accept her counter-claims.
Jills nal act of resistance was her refusal to be swayed by her physicians truth
claims concerning the risky nature of IUDs and his interpretation of her body as
vulnerable to these risks. This medical interaction created rm resistance in Jill
and she ultimately terminated her relationship with that physician in order to
obtain her preferred form of birth control from a different medical practitioner,
one who willingly complied with her request for an IUD. As such, Jill can be
viewed not as removing herself from medical power relations, but as strategically
shifting the eld of play so as to improve her chances of prevailing within sub-
sequent medical interactions.
Interestingly, Jills perception of what type of medical encounter constitutes a
problematic interaction prompted her to speak of the incident in which her
doctor directly refused to comply with her wishes and attempted to invalidate
her medical and embodied experiential knowledge. The power struggle between
them was readily apparent. That she did not offer the incident in which a physi-
cian mistakenly removed both of her ovaries as an example of a problematic
medical interaction suggests that, despite her emotional response to the loss of
both ovaries, she did not dene that event as highly problematic. In this instance
Jill did not perceive her doctor as acting intentionally to harm her or discount
her knowledge of her own body. In other words, Jill did not dene her doctors
mistake as an attempted application of power.
Jills physician mistakenly removed both ovaries during an elective hysterec-
tomy, after Jill had stipulated that she wanted him to retain one ovary. He apol-
ogized to her after the surgery and explained that he accidentally removed both
ovaries. Since the mistake was made during surgery, while Jill was unconscious,
any possibility of Jill being able to impact her doctors actions at that point was
precluded. Jill did not hold her physician responsible for altering her body in a
way that she had expressly not desired, she did not question his medical expertise,
and she eventually accepted his mistake as fortuitous because she reasoned she
would have had to begin hormone replacement therapy (HRT) once she became
menopausal.
According to Foucault only free subjects enter into power relations, by which
he means:
. . . individual or collective subjects who are faced with a eld of possibilities in which several
kinds of conduct, several ways of reacting and modes of behavior are available. Where the
determining factors are exhaustive, there is no relationship of power. . . . without the possibility
of recalcitrance power would be equivalent to a physical determination. (1994: 342)
A patient has no eld of possibilities during surgery performed under general
anesthesia and determining factors are nonexistent because anesthesia produces
unconscious inert bodies. During major surgery a patient is under the complete
control of a surgeon who effects a physical determination (Foucault, 1994: 342)
over a patient for a discrete period of time. A physicians actions on a body during
surgery cannot be consciously experienced or resisted until after a patient regains
consciousness, and even then a patient may for ever remain unaware of actions
taken on their inert bodies during surgery unless the surgeon or a member of the
surgical team reveals these actions to the patient. Therefore, power relations are
precluded during surgery.
7
Nevertheless, body alterations made by a surgeon
during surgery can have signicant life-long consequences and can, as in the
following case, produce a patient who is inclined to resist in subsequent medical
interactions.
Terri indicated that she no longer trusts doctors because her physician, like
Jills, removed both of her ovaries after she had instructed him to retain one ovary.
Her response to having both of her ovaries removed during elective hysterec-
tomy surgery stands in direct contrast to Jills reaction. Terri described how she
had felt betrayed and violated by her physician, whereas Jill eventually came to
view her physicians mistake as latently benecial. Perhaps the most signicant
difference between the two womens experiences is that Jills physician did not
rationalize his behavior as being the result of expert knowledge and legal author-
ity. Although Terris physician agreed to remove only one ovary when he
performed a partial hysterectomy, during the actual surgery he intentionally
removed both of her ovaries. Terri states:
You know, he did his job. I was an insurance claim that he made money off of, thats kind of
how I felt . . . I felt like a number. I did, I felt like I was just another surgery output for him. . . .
I felt totally violated. . . . I was devastated when I came to and found out he had taken every-
thing. . . . I cried like a baby, and my next reaction was, I thought, you know. Why? And I
asked him, Why? And he was like, I had to do this. I had to do this because of all the mass.
I saved you a lot of problems. Wed have to go back in there in another year anyway, at the
most. His messages were, youll get over it, go with it. So here was this man who had no
problem pulling out what he wanted to pull out of me, couldnt see me through the process
is how I felt.
Terris statement demonstrates that she is fully aware that her physicians actions
were based on his objectication of her. That he concealed this dehumanizing
perspective was apparent since, prior to surgery, Terris physician led her to believe
he respected her authority over her body and would comply with her directions.
Nevertheless, when Terri was anesthetized and no longer free to resist his actions,
her physician enacted a destructive and violent alteration of her body or, from
a medical perspective, a normalization of Terris body. Terris resistance, albeit
only possible after the fact, initially consisted of a challenge to her physicians
honesty and integrity. Her physician countered Terris claim by invoking his
expert medical knowledge in an attempt to produce her acceptance of his inter-
pretation of her bodily state and what constituted appropriate medical actions to
effect normalization. He also contended that his medical expertise was legally
sanctioned via the surgical consent forms Terri had signed.
Although Terri had received his verbal consent to her request that he conserve
one ovary, she did not require that it be included in the legal consent forms.
After considering ling a lawsuit against her physician she later abandoned the
suit because she reasoned it could never restore her missing ovary, but she also
expressed her belief that the power of the legal system would support her
surgeons actions since, as Terri admitted, she did not read the hospital consent
forms thoroughly until after she considered making a legal claim against her
doctor.
Terri also stated that she felt it was possible that her doctors actions may have
been motivated by disdain for women in general. She states,
You know, I was just like, I wonder if he doesnt like women? I had that, you know, I wonder
if hes a woman hater, or is this his way of you know? And I switched doctors, of course.
Terri stated that due to this experience she now believes that some physicians are
sexist, to the point that they intentionally harm female patients under certain
circumstances. This suggests that some womens experiences in medical power
relations do indeed produce medical and embodied experiential knowledge that
can enable resistance and inuence a womans behavior in future, unrelated
medical interactions. More specically, Terris experience suggests that medical
power relations can produce an awareness of physician gender bias, and the fact
that gendered medical bias can result in harmful outcomes.
Terri related that she no longer relies extensively on gynecologists to help her
manage her reproductive health. Obviously her embodied experience of male-
cent medical treatment produced a signicant change in how she views physicians
and their medical truth claims. She states: I see them [physicians] as skilled
workers who do the best that they can and if not, I move on. These examples
demonstrate that patients, even those who may have highly medicalized under-
standings of their bodies, do recognize and challenge medical power techniques
and privilege experiential knowledge (both medical and embodied) when they
encounter physicians who attempt to apply medical power. It also suggests that
women do not passively or unquestioningly accept expert medical interpret-
ations of their bodily states and the associated interventions physicians deem to be
medically necessary or unnecessary. Similar to Jill, Terris experience demonstrates
that a patients recognition of medical power techniques, dened by patients as
incorrect, demeaning or harmful, is likely to produce resistance in some form.
Similarly, Cindy related an experience in which a physician discounted her
embodied experiential knowledge.
I had my last experience with a doctor when I had a severe bacterial infection . . . it was right
around the time my mother was dying. He said, Oh, its stress. I said I cant breath, I said my
chest hurts . . . I just dont feel good . . . and he kept telling me, Oh, theres nothing wrong,
trying to insinuate that I was a hypochondriac! The last time I went into his ofce I was sitting
there and I was so stressed because I did not feel good. I couldnt breath and I sat there and
cried. I said, Well ne. I said, When I end up in the hospital youll be the rst one I call
after I call my lawyer!
Cindy was persistent in her attempts to compel her physician to accept her truth
claims that she knew her body and was seriously ill and in need of medical treat-
ment. Her physician advanced medical truth claims in an attempt to invalidate
Cindys embodied experiential knowledge. Eventually she resorted to legal truth
claims, that is, a threat of legal action, in order to compel her physician to provide
appropriate medical treatment. Cindys efforts to direct her doctors actions
succeeded. Her doctor eventually acquiesced to her demands, although he resisted
until after he veried her claims of illness with objective medical tests. Never-
theless, Cindy prevailed in producing a compliant physician because she privi-
leged her embodied experiential knowledge and used legal truth claims that
convinced her doctor to perform what he considered to be unnecessary medical
tests. Cindy states:
He was trying to tell me there was nothing wrong with me. . . . I know my own body, I know
when somethings wrong. . . . You feel it, you know your own body. All theyre [physicians]
going to do is give you a diagnosis of why.
Cindys experience highlights a common problem for the women in this study
who encountered physicians who advanced interpretations of their bodily states
in direct contrast to the womens individual experiential knowledge of their bodies.
Whether a physician interpreted a womans bodily state as abnormal when she
perceived it as normal, or as normal when a woman perceived it as abnormal, each
woman objected to and resisted a physicians attempt to invalidate her embodied
experiential knowledge. These types of medical interactions produced a good
deal of anger in many of the women, as well as the use of particular strategies in
their attempts to prevail in such medical power relations.
From a Foucaldian-informed perspective on medical power relations, the dis-
counting of womens embodied experiential knowledge as not knowledge is a
power technique whereby some physicians assert medical truth claims that ratio-
nalize and justify their medical expertise and authority to interpret normal and
abnormal bodily states. Experiential embodied knowledge, from this perspective,
is not likely to be considered legitimate/rational knowledge by medicine because
it is not produced through accepted scientic methods. Nevertheless, many of the
women in this study chose to challenge physicians who advanced medical inter-
pretations of the womens bodily states that conicted with the womens individ-
ual medical and/or embodied experiential knowledge. However, those challenges
were typically met with rm resistance from the womens physicians.
Cindys attitude towards doctors, similar to many of the other women, demon-
strates that she, under circumstances she determines to be important, privileges
her experiential knowledge of her own body over medical expertise. Her threat
to take legal action if her physician continued to refuse to treat her illness is a
power technique in which Cindy demonstrated her capacity to use the combined
truth claims of medical science and the law. Presumably any legal action taken
by Cindy would include a competing medical truth claim, provided by a differ-
ent physician, verifying her illness. If her claim was upheld in a court of law her
physician could conceivably be legally sanctioned, a consequence with a host of
ramications for his embodied subjectivity, as well as his medical career.
Within medical power relations competing medical truth claims in the form
of a second medical opinion, combined with legal truth claims, can be used by
patients to produce a physician as a sanctioned subject. This possibility suggests
that power, as Foucault suggested, is produced through various techniques of
power/knowledge regimes. Such techniques are available for use by all partici-
pants in power relations, depending on the extent to which individuals are aware
of particular knowledges and willing to use them.
When Carol transitioned into menopause she started experiencing extremely
uncomfortable episodes of profuse sweating and turned to her physician for help.
Her physician refused to prescribe HRT by explaining, Its a natural thing, get
used to it. However, Carol had extensive empathic knowledge about menopause
and the benets of HRT based on the experiences of other women with whom she
had close personal relationships. She understood there was medical controversy
surrounding the use of HRT, but she was willing to risk possible negative
outcomes to personally determine whether HRT could alleviate her discomfort.
Her physicians truth claim, an attempt to de-medicalize Carols perspective on
menopause, was unsuccessful. Carols perspective was that her physician failed
to enable her to enact appropriate gender behavior as she dened it. She resisted
her physicians attempt to advance a view of femininity that normalized profuse
menopausal sweating and dened his interpretation of her bodily state and the
possible effects of HRT as incorrect and potentially harmful. Rather than confront
her doctor directly, Carol ended her association with him and located a more
compliant physician, one who concurred with her medicalized denition of
menopause and willingly supplied a prescription for HRT. Carols experience
demonstrates not only that some women are active participants in the medical-
ization process, but that resistance to specic attempts to employ medical power
techniques may be produced by medical power itself, via the production of lay
medical knowledge and medicalized subjectivities.
Kelly described a medical interaction in which a physician refused to prescribe
a particular drug, one that Kelly had used previously and knew to be effective in
alleviating her symptoms. She talked about the message she felt the doctor was
sending:
Shes telling me that I know nothing about my body, rst of all, and I absolutely do, and they
treat you like youre stupid, you know. . . . So Im not going back to that doctor. . . . Ive had
a lot of that through the years.
When in her mid-30s, Debra sought help from her general practitioner for
painful, heavy and irregular menstruation. According to her physician the etiology
of Debras severe menstrual problems, at age 35, was normal aging. She states:
When I rst started telling him about my problems heavier and longer ow, pain he would
brush me off by saying it was just the aging process and I had to expect some changes.
Debras physician discounted her embodied experiential knowledge by dening
her symptoms as normal, rather than problematic and amenable to medical inter-
vention. Apparently, according to Debras physician, the normal aging of womens
reproductive organs constitutes a pathological process. Debra initially accepted
this medical interpretation of her bodily state but suffered increasingly problem-
atic and painful menstruation for a number of years. As her physical condition
and quality of life declined, Debra began searching for answers to her gynecologic
health problems. She describes the medical interaction that compelled her to
privilege her embodied experiential knowledge:
When he stepped out of the room, I asked his nurse if she could recommend a good gynaecol-
ogist . . . as soon as the doctor came back in she told him as if she were tattle-telling on me and
he kind of turned on me and said, Why would you want to do that? Hes just going to do the
same thing I do here and tell you the same thing. At that very moment, I decided he was a
jerk and was not going to have him do gynecologic exams anymore and didnt particularly like
him as a GP [general practitioner] either.
The truth claim advanced by Debras doctor was a contention of indisputable
medical expertise. Debra did not challenge her physician but neither did she
accept his truth claim. Like the other women, she too eventually located a more
compliant physician. However, since she hadnt had children, Debra had to be
highly directive in her medical care in order to convince her new physician to
perform an elective hysterectomy.
Similar to the ndings of Abel and Browner (1998) these womens experiences
of their bodies were inuenced to varying degrees by the biomedical perspective.
Nevertheless, the womens experiences of medical interactions and their lay
knowledge of medicine engendered knowledge that the women used to critically
assess physicians interpretations of their bodily states and recommendations for
treatment. Similar to Davis (1988) ndings, the women used this knowledge,
along with embodied experiential knowledge, as a resource for resistance in their
pursuit of efcacious medical care. As Pat states:
By my age Ive been through enough times I can usually tell them whats wrong. . . . I guess
you could say I feel going to a doctor is like getting an educated guess. . . . I dont always agree
with them. I tell them when Im describing my symptoms to them, yes, I think I know whats
going on with me physically as I have had a lot of experiences and try to educate myself.
Pat also related that unless her symptoms are especially severe, she avoids medical
care, particularly routine gynecologic exams. She explains:
I still dont care for the experience . . . and I feel they may be judgmental of how I look, phys-
ically. You know, being judged by my physical appearance, being too fat. I sometimes avoid
going to the doctor for that reason, but if the problem is severe enough Ill go.
Pat recognizes that physicians judge not only her physical health state, but the
sufciency of her gendered embodiment. Based on her experiences of medical care
and her embodied experiential knowledge, Pat selectively determines which health
problems require medical intervention. When she pursues medical care, it is in a
directive fashion. In choosing to restrict her exposure to medical attempts to apply
power techniques, Pats agency is obvious because she is consciously privileging
her own knowledge of her body and limiting the extent to which medical power
can inuence her embodied subjectivity.
Most of the women expressed in some manner that they knew their own bodies
and they typically chose to resist medical interpretations of doctors who treated
them as if they did not. To varying degrees the women were experienced and
knowledgeable medical consumers, many of whom sought medical knowledge
beyond that which they gained from individual physicians. For example, Debra
and Alice searched for both medical and empathic experiential information on
endometriosis. Becky also did extensive research on her health problem. The
knowledge each of these women gained from the often conicting information
they gathered eventually inuenced each of them in their decisions to actively
pursue an elective hysterectomy, despite experiences with a number of physicians
who refused to perform the surgery. Eventually these three women located com-
pliant physicians who willingly performed elective hysterectomies.
Similar to Terri and Pat, a number of women related experiences that demon-
strated a specic awareness of and resistance to gendered medical power relations.
When Becky started experiencing severe gynecologic pain she sought medical care
from her primary physician. After examining Becky, her physician recommended
she consult with a gynecologist in order to pursue an elective hysterectomy. Becky
relates what happened during her consultation with a gynecologist:
I was 26 years old and I was to the point where this doctor was saying hysterectomy. I wanted
to make sure. I went to another doctor and he told me I needed psychological help and that it
was all in my head. . . . I had a six-page pathology report on my uterus and I wanted to take
and shove it up his nose.
Beckys embodied experiential knowledge and a medical report demonstrating the
pathology of her uterus was not enough to produce a compliant physician. Her
physician attempted to negate not only the validity of her embodied experiential
knowledge, but that of the medical report as well. Apparently, according to this
doctor, Becky was a young woman who was still in her prime childbearing years.
Therefore, based on a stereotypically medicalized notion of appropriate female
embodiment in which female bodies are considered only in terms of reproductive
potential, this physician assumed that only a mentally ill young woman would
seek medical treatment that would eliminate her reproductive capacity. This is an
example of a specically gendered medical power technique, namely the psycho-
logization of womens health problems, whereby the etiology of a health problem
is considered psychological, rather than physiological (Goudsmit, 1994). Beckys
experience demonstrates that a physicians gender perspective can inuence inter-
pretations of bodily states and the resulting treatment recommendations, but that
a patients recognition of such power techniques, as in Beckys case, can produce
rm resistance.
Becky indicated that this was one of a number of experiences with physicians
that inuenced her to believe that physicians generally discount what she knows
about her body. Her attitude towards doctors demonstrates that Becky is highly
cognizant of physicians attempts to use power techniques. Consequently, she
takes action to be directive of her health care. Becky, like most of the women in
this study, does not unquestioningly accept physicians interpretations of her
bodily state, nor does she automatically agree to recommended medical treat-
ments. She uses medical care selectively, pursues medical knowledge relevant to
her specic health problems and critically assesses competing medical truth claims
in efforts to direct that care. Becky states:
Doctors, uh, basically I have to prove it to them. . . . Im the kind that I have to do it myself.
And unless you [a hypothetical doctor] are going to fully work with me on this, its not going
to get solved to my satisfaction. Youre just blowing me over with a snow blower. Im very
independent and I will be an active part of health, whether you let me or not. . . . Youre not
going to tell me what it is, Im going to tell you what it is. Thats my role with physicians now.
If I cant go in and talk to you and tell you what the problem is and have you listen, its going
to end up an argument and Im going to be walking out.
Marie met with similar resistance from her gynecologist when she requested
a procedure for permanent birth control. She states:
He refused to tie my tubes. . . . I knew when I was probably about 22 that I did not want to
have children and, in fact, tried to have my gynecologist have my tubes tied. I was not married.
He said he didnt feel comfortable doing that because I was single and very young and what if
I met someone who wanted to have children and I changed my mind and blah, blah, blah.
This physicians perspective demonstrates a gender bias that was typical of the
majority of the womens problematic medical interactions. Most of the women
reported that their physicians, even in medical interactions the women dened as
not problematic, inquired about their reproductive status prior to recommend-
ing an elective hysterectomy. Although this is an important concern because the
surgery eliminates a womans reproductive capacity, the physicians of women who
were younger or had not yet reproduced encouraged these women to undergo
alternative procedures that would retain their capacity for reproduction. That
this was the case, even for the women who expressed no desire to have children
and those who were younger but had already produced as many children as they
desired, demonstrates that specic treatment recommendations may be directed
at certain groups of women because physicians medical truth claims are not based
on objective scientic knowledge, but are founded upon gendered beliefs about
the appropriate function of womens bodies. Birke contends that: Women have,
of course, struggled for greater control over their own reproduction and
continue to do so. But women have long been subject to medical ideologies that
construct us as little more than wombs on legs . . . (1999: 12).
Janice related that she doesnt like doctors in general because shes had experi-
ences with physicians who did not appear to respect her specically because she
is a woman. She related the following experience:
Some of them are very, dont have no bedside manner, I mean, very rude, some of them are
like Why are you here? Well Im sick, thats why Im here. You know? Some of them are
condescending to you, you know, very, and my husband says he sees it a different way. My
husband says that he likes the doctor. You know, the doctor and him get along. Well, hes a
man. You know, this is how I feel, I mean I feel as a woman. For instance I took my daughter
to this one, our regular physician, not the one Im going to now, but a different physician, not
a gynecologist, but just a regular physician. She was having stomach pains really bad. . . . So I
took her to the doctor. Well he just gave her the third degree, Are you having sex? Are you
taking drugs? Are you doing this, are you doing that? She just says No, No, No. Are
you making bad grades? She always made good grades but she was just stressed out . . . well,
anyway, it just irritated me that he asked that. Im sitting there, okay, and he says, Well, youre
sitting here awfully cute and real, you know, Youre sitting there like youre just telling me
the truth and I dont believe it, I believe youre lying. And he said You need a psychiatrist.
He says I have a card if you want one. I said Thanks, but no thanks and we walked out and
left and I never went back. . . . I dont like being called a liar by anybody, much less a doctor
and I was really aggravated, you know.
Terri, Pat, Becky, Marie and Janices experiences obviously demonstrate not
only awareness of a gender component in medical power relations, but recognition
that physicians may advance traditional and/or demeaning interpretations of
appropriate gender embodiment disguised as objectively scientic medical diag-
nosis and advice. Although Marie and Janice did not choose to directly challenge
their doctors, both resisted their respective physicians demeaning interpretations
of female gendered embodiment by seeking out more compliant and less sexist
physicians. Such behavior can be understood as indirect or passive resistance, a
concept that captures the circumvention of direct and possibly contentious
interactions, but which results in a desired outcome nevertheless. Additionally,
both women shared their experiences with other women, thereby contributing
to other womens empathic knowledge and the resources they may draw upon
within medical power relations.
Paula indicated that she too has had serious problems with physicians in the
past. She stated that previous experiences with certain physicians made her feel
that doctors typically do not take her health problems seriously, and she hypoth-
esized that this may be because Im a woman.
These womens experiences demonstrate that medical power relations produce
resistance in particular types of medical interactions. The women used a variety
of knowledge, particularly embodied experiential knowledge, to ascertain the
accuracy of physicians interpretations of their bodily states. When the women
determined a physicians interpretation was inaccurate, or that a treatment recom-
mendation was insufcient or undesirable, they commonly resisted by advancing
counter truth claims based on medical, embodied, or empathic experiential knowl-
edge, or knowledge produced by other power/knowledge regimes (e.g. legal).
Those women who did not directly resist physician attempts to apply medical
power techniques utilized an indirect strategy to obtain the type of medical care
they desired.
The women also recognized the gender bias of certain physician truth claims,
advanced in attempts to invalidate the womens knowledge. It appears that
gendered medical knowledge that denes womens health problems as having a
psychological rather than physiological etiology inuences not only how physi-
cians conceptualize normal and abnormal female bodies, but womens decisions
to resist such truth claims. Although the women typically failed to produce com-
pliant physicians, neither did resistant physicians produce compliant patients.
The women prevailed in medical power relations by ending their relationships
with resistant doctors and initiating relationships with physicians who validated
the womens experiential knowledge and provided medical care and treatment in
a manner and of the type the women desired.
A womans attempts to produce a compliant physician, partly through her
resistance to medical power techniques, was a direct result of her efforts to ef-
caciously produce a particularly congured embodiment with the assistance of
medical care. Failure to produce a compliant physician also meant failure to
produce a desired bodily state, therefore the women were motivated to remain
within medical power relations and locate compliant physicians. The data do not
provide the type of information that enables an assessment of the extent or
consistency of the womens resistance, but they do demonstrate that medical
power relations do produce womens resistance to particular medical power tech-
niques, particularly those that are gendered. Physicians who attempt to dene
womens health problems as psychological rather than physiological demonstrate
a type of power technique that is rooted in gender-biased medical knowledge.
Such knowledge denes female embodiment in highly prejudicial, inaccurate and
ultimately harmful terms. However, the very nature of these types of medical
truth claims helped to produce particularly rm resistance in the women.
Although Davis (1988) contends that medical power relations function simi-
larly, whether or not gender is an issue in medical interactions, the experiences
of the women in this study demonstrate that some physicians use particular
medical power techniques specically because a patient is female. This suggests
that although medical power relations may typically function relationally, with
participants advancing and resisting truth claims in attempts to achieve a desired
outcome through producing an alignment between the participants, gender-
biased medical knowledge can inuence the particular types of power techniques
employed. However, women patients, like physicians, may also use gendered
knowledge in their efforts to prevail in power relations.
Theoretical Implications of the Study
These specic experiences of medical power relations establish womens capacities
to act as full participants in medical power relations. However, the fact that these
specic women are capable of resistance does not mean that all women are equally
capable or likely to resist. It also does not mean that women who do resist
medical power necessarily do so consistently. Additionally, the possibility exists
that the women in this study failed to identify and respond to other types of less
obvious or egregious medical power techniques. Consequently it is not possible
to specify the variety of circumstances under which women may be likely to resist
medical power.
For the women in this study the experience of health problems, particularly
gynecologic pain and problematic menstruation, and the attending difficulties
in achieving specic gender norms, produced problematic embodiment. Conse-
quently, both bodily states and social interaction difculties concomitantly inu-
enced the womens decisions to seek medical intervention in efforts to normalize
their embodiment. Although the womens embodied subjectivities were inuenced
to varying degrees by gendered biomedical conceptions of normal and abnormal
bodies (in particular the determination of bodily states that require or benet
from medical care) the womens embodiment was not produced exclusively
through medical power relations. The women did not unquestioningly accept
gendered biomedical conceptions of their specic bodily states. In fact, the
women demonstrated through the manner in which they resisted medical power
techniques that a variety of knowledges, including lay medical knowledge,
knowledge produced by other power/knowledge regimes (e.g. legal, feminist)
and embodied and empathic experiential knowledge, contribute to the shaping of
their embodied subjectivities. If this were not the case it is unlikely that the
women would have been able to resist expert medical interpretations of their
bodily states since their understanding of their bodies and the possibilities for
achieving particular congurations of embodiment would be exclusively shaped
by medical power/knowledge.
Embodied experiences other than medical interactions, entailing the possi-
bility of at least episodic power relations, also contribute to the production of
embodied subjectivities and include, for example, intimate relationships (both
sexual and non-sexual) that produce physical sensations and emotions that can
result in embodied and empathic experiential knowledge. Physical and emotional
experiences may, but do not necessarily, prompt cognitive or rational consider-
ation of such experiences. For example, breastfeeding ones infant is a physical and
emotional experience that produces embodied experiential knowledge and may
prompt cognitive reection, but can inuence a mothers embodied subjectivity
(negatively or positively) (Schmied and Lupton, 2001) without any mental or
rational consideration. Therefore, since embodied experiential knowledge is not
necessarily based on knowledge produced through power/knowledge regimes,
embodied subjectivity cannot be dened as exclusively the product of social
inscription. This suggests that embodied subjectivities are shaped through complex
processes in which lived experiencing bodies are also objects of social inscrip-
tion, but that social inscription may be resisted through embodied experiential
knowledge.
Access to a variety of knowledges, including embodied experiential knowledge,
not only inuences the possibilities for embodied subjectivity, but constitutes a
resource that may be employed in attempts to resist applications of medical
power. However, knowledge resources do not always or automatically produce
resistance in medical interactions. Resistance by both patients and physicians is
produced within interactions in which participants desires to achieve specic
outcomes (achievements dependent on participation in medical interactions) are
in some way oppositional. Within medical interactions dened by the women in
this study as problematic, the women and their physicians held opposing views
of the validity of various truth claims and what actually constitutes normal
female bodily states and appropriate gender embodiment. However, the women
generally reported that they did not typically experience medical interactions as
problematic. Although the data cannot enable a determination of whether this
may be a function of womens lack of knowledge resources, that the women
resisted in particular medical interactions but not in most others suggests that
medical power relations function as negotiations in which participants are fre-
quently able to produce a close alignment, rather than opposition.
The womens resistance ensued only after they assessed the accuracy of a physi-
cians truth claims. These assessments were not based on one type of knowledge,
but on a range of knowledges engendered by a variety of embodied experiences.
For example, their knowledge that expert medical opinion can often be contra-
dictory, as well as gendered, was highly inuential in the womens decisions to
resist. That this knowledge was at least partly engendered by their experiences
with medical power/knowledge, and enabled the women to resist medical power,
suggests, as Foucault contends, that power/knowledge regimes produce bodies
that are disciplined and resistant.
The manner in which the women chose to resist physician attempts to apply
medical power frequently included direct challenges to medical truth claims, but
this was not always the case. Some of the women avoided confrontational medical
interactions altogether and, instead, chose to end their relationships with non-
compliant physicians without communicating their opposition. Even if this type
of behavior may be understood as being inuenced by traditional gender norms
that dene feminine behavior as appropriately passive, it did not prevent these
women from resisting, albeit in a more indirect fashion. Such behavior may be
understood as passive resistance in that an individual acts in a manner that
bypasses direct confrontation but, nevertheless, continues to act in a manner that
achieves desired outcomes. That apparently passive behavior can constitute effec-
tive resistance highlights the problematic way in which resistance is most
commonly understood. The notion that the act of resisting must entail direct
communication or confrontation is based on highly masculinist assumptions and
obscures recognition of acts of resistance that are not stereotypically masculine
in nature.
Although the differing ways individual women chose to resist may have been
inuenced by gender norms, adherence to gender norms does not appear to have
inuenced the womens capacities to resist. Failure to produce a compliant physi-
cian did not prevent the women from maneuvering within the broader eld of
medical power relations in order to achieve desired congurations of embodi-
ment. By locating compliant physicians the women prevailed in their efforts to
achieve particular congurations of embodiment through medical care. Therefore,
women who eventually produce the types of medical interactions and outcomes
they desire can be understood as ultimately prevailing in medical power relations.
The manner in which women choose to resist medical power also includes
avoidance of medical care. Like Pat, other women may avoid routine medical
exams precisely because they have experienced medical power relations as attempts
to discipline their bodies. Therefore, it is reasonable to assume that women with
problematic embodied subjectivities choose to forego medical management in
order to maintain a particular embodied subjectivity. Indeed, rather than attempt-
ing to ameliorate problematic embodied subjectivities through medical care,
depending on the severity of symptoms, some women choose to accommodate
themselves to their health problems at least until such a time that a woman
determines that the costs of medical care no longer outweigh the benets.
This study supports the fact that women can prevail in medical power relations
through their use of particular power techniques. However, the data cannot
enable a determination of whether resistance or directive behavior in medical
interactions actually produces more efcacious health outcomes. Nevertheless,
the womens experiences do suggest that they were more satised with health out-
comes produced through medical interactions in which physicians acknowledge
and act upon the validity of the womens experiential knowledge. Additionally,
in comparison to the average female patient it is possible these particular women
may be more motivated to be directive of their medical care. The womens experi-
ences suggest that they believe that the most efcacious medical care results from
a relationship with a physician in which physician and patient are equal partners.
Additionally, their capacity to resist may have been inuenced by the degree to
which the women believed the outcomes of certain medical interactions could
signicantly impact their health and well-being. The fact that most visits to ones
doctor are for minor health problems may partly explain why the women depicted
the majority of their medical interactions as non-problematic. In attempting to
address minor health problems through medical care, physician error is not as
likely to produce highly consequential health outcomes. Consequently, under such
circumstances, the women may have considered resistance unnecessary. They
may have been more motivated to resist when they believed an incorrect inter-
pretation of their bodily state could lead to highly negative health outcomes.
In terms of theorizing the relationship between medicalization, womens
health care needs, and gendered embodiment, the ndings of this study suggest
that although biomedicine may exert inuence on how women understand and
attempt to address problematic embodied subjectivities, women do not enter into
medical interactions as deterministically medicalized subjects. Rather, subjectivi-
ties are produced through a variety of knowledges, including embodied and
subjugated knowledges. The extent to which women accept medical truth claims
as simply accurate interpretations of reality is variable, with some women being
highly critical and directive of their health care while other women are not.
The demonstration of the embodied subjective agency of the women in this
study suggests women are full participants in medical power relations. The
womens capacity to prevail in medical power relations indicates that the process
of medicalization cannot be accurately understood as a top-down process, or
one that functions as merely an external imposition on women. Women actively
pursue medical care to achieve particular congurations of embodiment and their
resistance has, over time, influenced changes in the provision of medical care
and medical policy. For example, challenges to biomedicines medical hegemony
from the womens health movement and feminist writings and scholarship have
resulted in numerous changes in organized medicine. These include more women
taking an active role in their own health care, the development of alternative
health institutions and practices, and legislative, administrative and policy reform
(Auerbach and Figert, 1995).
Accordingly, medicalization can be understood as an aspect of medical power
relations that is produced by both patients and physicians (Riessman, 1983). In
this process women seek to use the technological power of medicine to achieve
a particular conguration of embodiment, albeit congurations that are often
inuenced by gender expectations and norms. Although women seek efcacious
medical care, they do not necessarily or perhaps even typically do so in a passive
and compliant manner. After all, the non-compliant patient is well known in the
medical sociology literature. In the process of medicalization physicians seek
to produce medically disciplined bodies, based on medical knowledge that is
frequently gender-biased, in their manifest endeavors to produce normalization
or health. However, in the process of medicalization, gender may often latently
inuence both patients and physicians in terms of their desires for, or beliefs
about, normative embodiment.
Gendered knowledge may be employed in attempts to produce compliance in
medical power relations, but it would appear that attempts to produce an uncon-
tested medical reality through the use of gendered power techniques is actually
counter-productive. Nevertheless, the fact that women desire to produce norma-
tively gendered embodiment (e.g. the concealment of problematic menstruation)
through medical care, is at least partly produced by biomedicines promise of
efcacious normalization of bodies, as well as its assumption that womens
reproductive organs are inherently pathological (Martin, 1987). However, that
problematic embodiment is also produced through direct negotiation in patient
physician power relations relations that constitute corporeal and incorporeal
events in which resistance is not uncommon suggests that medicalization, as an
aspect of medical power relations, is also relational and productive rather than
merely repressive.
Notes
1. For examples see Ehrenreich and English (1978), Scully and Bart (1981), Fee (1983), Dull and
West (1991), Stoppard (1992), Auerbach and Figert (1995), Stanton and Danoff-Burg (1995), and
Krieger and Fee (1994). For examples of mainstream sociological analyses of medicalization see Illich
(1976) and Zola (1972).
2. For example see Oinas (1998).
3. For examples see Ehrenreich and English (1978), Oakley (1980), Corea (1985), Daly (1990) and
Breslau (2003).
4. Lynda Birke (1999) discusses the variety of feminist analyses focusing on gendered scientic
practices and knowledge production.
5. For examples see Martin (1987), Davis (1988), Bordo (1999), Oinas (1998) and Abel and
Browner (1998).
6. Although the original denitions are phrased in terms of pregnant womens experiences, I
slightly alter Abel and Browners denitions to provide a more generalized understanding of the terms.
7. For example, Kapsalis (1977) refers to what appears to have been a common and mostly un-
questioned practice in medical schools prior to the late 1970s, in which physicians and medical
students performed pelvic exams on anesthetized female patients without the patients consent or
knowledge.
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