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In Pursuit of the Study of Pleasure: Implications for Health Research and

Practice
John Coveney and Robin Bunton
Health (London) 2003; 7; 161
DOI: 10.1177/1363459303007002873
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health: An Interdisciplinary Journal

for the Social Study of Health,
Illness and Medicine
Copyright 2003 SAGE Publications
(London, Thousand Oaks and New Delhi)
[13634593 (200304) 7:2]
Vol 7(2): 161179; 031873
In pursuit of the study of

pleasure: implications for
health research and
practice
John Coveney & Robin Bunton
Flinders University, Australia & University of Teesside, UK
Many public health interventions attempt to promote health

and well-being while simultaneously engaging with or negating pleasureseeking activities. Yet the examination of pleasure is under-researched,
especially within health and health-related areas. We examine pleasure as
both an innate drive and a socially constructed phenomenon. Using the
development of religious ideas in western cultures, we identify four forms of
pleasure: carnal pleasure, disciplined pleasure, ascetic pleasure and ecstatic
pleasure. These pleasures dramatically affect the construction of social and
cultural identities. Moreover, they influence approaches to our understandings of health in general and interventions to public health in particular. The
pursuit of the study of pleasure opens up a number of worthwhile areas for
cross-disciplinary discussion and study.
A B S T R AC T
K E Y WO R D S
body; health promotion; history; pleasure; public health; religion
John Coveney, The Department of Public Health, Flinders

University, Box 2100, Adelaide, 5001, Australia. [Tel: +61 (0)8 8204 5862; fax:
+61 (0)8 8204 5693; e-mail: john.coveney@flinders.edu.au]
ADDRESS
In his popular book The pursuit of pleasure, Lionel Tiger (1992) asks why
we are so apprehensive about pleasures, especially those of the body. What,
he asks, is the attraction of saying no and the fear of yes to pleasure?
While not endorsing Tigers evolutionary deterministic approach in
addressing this question, we would side with his curiosity. Working as
researchers involved in social aspects of public health, nutrition, and of drug
use, we are struck by the fact that pleasure is under-examined in public
health research and practice. Given that pleasure is addressed in many
public health policy issues and programmes, this is a curious absence.
Though a great deal of public health research and practice deals tangentially with issues of pleasure, there have been few attempts to focus directly
on the topic. Pleasure appears almost too frivolous a topic to discuss in the
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face of the earnest struggle against pandemics such as global human suffering, and yet many attempts to address these rely on implicit assumptions
about the nature of pleasure and human activity. A reluctance to address
pleasure may be another manifestation of medical sciences preference for
studying the causes of illness rather than health. It may also reflect more
deep-seated difficulties with modern western ideas about pleasure and what
is considered serious scientific pursuit. In this article we attempt to highlight some areas for exploration and further research in the examination
of pleasure in relation to health in general and public health in particular.
We identify a number of issues that might be a fruitful way of opening
discussions about pleasure and health. Some recent discussion has focused
on the related concerns of health, discipline and transgression (Williams,
1998). In a similar vein, we discuss questions about the potential of a focus
on pleasure. Our aim is to roam broadly over a large and, we propose,
largely uncharted terrain. In doing so we appreciate that we run the risk
of an inevitable sketchiness in our approach. We think, however, this is a
risk worth taking, especially if it inspires others to contribute to the arguments and discussions we raise.
Pleasure contributions from the human sciences

When Plato denounced the study of human emotions as inferior to the
study of reason (Gosling and Taylor, 1982) he effectively extinguished an
examination of pleasure as a serious academic subject. Thus while classical
literature is replete with references to the importance of good or of happiness, there is little coverage of pleasure, especially as a bodily experience.
Foucault (1990a) reminds us of this when he discusses Oribasius (500AD)
whose seven-volume work documenting mind and body maintenance in the
classical era contains only two paragraphs on matters sexual.
It is true that during the Enlightenment writers like Locke, Mill and
Bentham addressed pleasure as a motive of human happiness and common
good. But the notion of pleasure in the hands of these philosophers is
heavily sanitized into various forms of virtue (Porter and Mulvey Roberts,
1996).
Yet physical pleasure is not completely absent from philosophical
considerations. Pleasure lurks in the background of western thought like a
ghostly shadow; neither fully present nor fully absent. Take Nietzsches The
birth of tragedy (Nietzsche, 1966 [1888]), for example, in which he draws
on Greek mythology to explicate the tensions that exist in the human
experience. Here we have the god Dionysus, representing the intoxicating,
orgiastic and chaotic (but also fertile) elements of the human condition,
pitched against Apollo, who stands for light, beauty and harmony (Pffefer,
1972). The union between the two deities is Nietzsches way of summarizing the relationship between our pleasure-seeking and ascetic tendencies
(May, 1999). But Nietzsche never quite manages to express it in these terms,
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Coveney & Bunton: In Pursuit of the Study of Pleasure

preferring instead to consider the nihilistic consequences of the forces of
destruction and creativity for human cultures. Nietzsches position may of
course reflect the 19th-century morals that he no doubt tried to rebel
against. But this position in relation to pleasure follows through into the
philosophy of the 20th century. Work like that of Bataille, for example,
purports to explicate the human spirit in terms of pleasure-seeking activities, especially eroticism. Even here, however, Bataille excuses himself from
dealing directly with the resulting pleasures of erotic activities. His main
aim, he says, is to explore the relationship between eroticism, philosophy,
religion and death (Bataille, 1987).
Recent attempts to subvert traditional western philosophical traditions,
especially by feminists writers (e.g. Grosz, 1994), have privileged an examination of the body and experiences such as pleasure and other emotions.
This effort directly challenges the primacy given to the investigation of
thought and reason, the heartland of mainstream philosophy. So presumably in philosophy at least, we can hope to see more work directly related
to pleasure.
In the social sciences, pleasure often makes an appearance in research
on food and eating, sexuality and pornography (Murcott, 1983; Dworkin,
1990; Mintz, 1997; Warde and Martens, 1999). But again, it is only fleeting.
In specific fields of psychology we do see pleasure, as hedonistic scales,
standing as a topic of in-depth examination. Even here, though, the study
of pleasure has become peripheral because of the perceived problems of
objective quantification of emotional, and therefore unstable, measurements (Mellers, 1995).
In relation to health, theoretical and empirical studies of pleasure are
very limited. This is strange, given that pleasure might be considered a
motive for human action (or indeed inaction) and is integral to understanding how humans interact with each other and their environment in
ways that promote health or create disease. Moreover, so many injunctions
to healthy behaviours seem to be concerned with restricting or overcoming
our seemingly natural inclination towards certain pleasures. According to
Freud (1957), neuroses develop when libidinal instinct, or the pleasure
principle, is not resolved satisfactorily into the reality principle through
sublimation as the ego matures. That is, where sexual energies are channelled into so-called productive energies: religion, art, education, science
and the like. Marcuse (1970), who reads Freud as an apologist for the
repressive (and therefore unhealthy) capitalist organization of labour,
arrives at his own solution to the maturation of the ego non-repressive
sublimation, or narcissism. However, Marcuses privileging of individual
libidinal pleasures comes in for trenchant criticism when it is seen to be
incompatible with mutuality and wider social goods (Alford, 1987).
Pleasure, it appears, creates problems.
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Differentiating pleasure
It is useful at this stage to examine the tensions between an essentialist
notion of pleasure which postulates a universal and non-discursive
ontology, and notions that pleasure is a product of culturally and historically specific discourses (Alasuutari, 1992). These tensions have been taken
up in recent literature on the sociology of the emotions (James and Gabe,
1996; Bendelow and Williams, 1998; Williams, 2000). Deborah Lupton
provides a useful summary of the area (Lupton, 1998) pointing out that
fields such as psychology and neurophysiology have developed biological
foundations for emotions, including pleasure. Central neurological
pathways are credited with the passage of pleasure-receiving signals, and
specific parts of the brain have been identified as centres where pleasure
is registered (Bozarth, 1994). Viewed this way, pleasure is an inherent
some may say primitive human phenomenon. An alternative approach is
to see emotions, and with them pleasure, as a socio-cultural construction.
Lupton separates this approach into two schools of thought. The less relativistic (weak) thesis recognizes that the physical sensations created by
emotions may indeed be biologically inherited, but they are context-dependent and therefore socially conditioned. The strong construction supporters differ in that they view emotions as experiences that cannot be separated
from the words and concepts that are already in circulation to define and
describe them. Thus, even to describe something like pleasure (physical
and emotional) in the ways that we do is to draw upon specific discourses
of desire that are themselves culturally and historically situated.
There is certainly evidence to support cultural differences in the experience of pleasure. Lu and Shih (1997), for example, have shown that the
concept and the experience of pleasure in Chinese culture differs from that
in the West. Rozin et al. (1999) demonstrated that pleasure of food and
enjoyment of eating differ widely across cultural groups. Similarly, the
expression and appreciation of food pleasure at mealtimes has been shown
to vary greatly between families in the USA and families in Italy (Ochs et
al., 1996). And eroticism, as expressed in the tradition of the Huli culture
of the highlands of Papua New Guinea (Clarke, 1997), would probably be
unrecognizable in western cultures. So pleasure it seems is differentiated
across contemporary space.
It is also apparent that experience of pleasure has been altered across
time. The ways that we seek and express pleasure today is different from
earlier periods in western history. Foucaults work on the history of sexuality concerns the ways that the management and enjoyment of pleasure
differed from Greek antiquity to early Christianity (Foucault, 1993). Elias
work shows how power and control over urges and desires, through the
gradual internalization of outer institutional constraints, transformed
etiquette, appetites and, importantly, pleasures through so-called civilizing
processes in western history (Elias, 1982). Other work has traced the
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meanings of the pleasures of eating in the West, examining the ways in
which gustatory enjoyment has been manifested and managed at different
historical moments (Coveney, 2000).
The differences in the understanding of emotion and pleasure as either
essential or socially constructed arise as a result of differing epistemological positions and reflect the current debates around the body in the
human sciences. For our current purposes we are not endorsing one or the
other: all approaches are of interest as they apply to health.
We are also interested in the ways that pleasures are defined differently
in different contexts. OMalley and Mugford (1991), for example, point out
that not all pleasure-seeking pursuits, e.g. the taking of drugs, are seen as
desirable or even pleasurable by all people in all cultures and all times.
Pleasures are highly contextual socially, economically and materially.
Turner (1982) demonstrates that the pleasures of the table afforded to elite
classes in 18th-century England were a product of the widening choice of
available foods. The explosion of trade and commerce at that time brought
a variety of new culinary ingredients foods, spices, liquors to whet the
appetites of the wealthy. In contemporary western society, however, such
food choices are, with a few exceptions, available to most people. Pleasure
now does not result merely from the enjoyment of gastronomic riches but
also, paradoxically, from a refusal of them (Bordo, 1993). The ascetic
appreciation that comes from attaining a slim, toned body and regulated
lifestyle in the midst of plenty and pressures to consume demonstrates
that pleasures are situated within specific social discourses and practices
(Turner, 1995).
Forms of pleasure are not only socially situated; they also demonstrate
social location. Bourdieu (1989) has pointed out how holiday leisure activities vary across classes, acting to distinguish ones status by discernment
and taste. The loftier pleasures of alpine walking, for example, are
preferred by middle class groups over a package fortnights holiday on
Spains Costa Del Sol.
Within western cultures, we know then that pleasure comes in various
forms and patterns. Even the experiences of pleasure are quantitatively and
qualitatively different. The pleasures of shopping (Miller, 1997) for
example, differ vastly from the pleasures of smoking (Klein, 1993), the
pleasures of unclad bathing (Sul, 1999), the pleasures of sex (Lowe, 1997),
the pleasures of good food and good company (Warde and Martens, 2000).
Yet the pluralities and complexities of pleasure, as something experienced,
are hardly ever considered. Lupton comes close to differentiating pleasure
when she discusses the ways that ascetic approaches to eating carry their
own pleasures through a sense of self-control and self-discipline (Lupton,
1996), or when she describes the thrills or pleasures associated with risk
taking (Lupton, 1999). Clearly, pleasure comes in many guises.
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Pleasure and public health

By privileging health and well-being, public health aims to develop forms
of the good life for the population as a whole. The broad and positive definitions of health used in more recent public health policy statements appear
to work with an implicit notion of an equitable distribution of lifes
pleasures, as well as production capacity (Aggleton, 1995). However,
pleasure and pleasure-seeking activities are often considered to be at the
root of irrational, often spontaneous actions which predisposes individuals
to unhealthy, so-called risk-taking behaviours. Sexual gratification and
pleasure-seeking activities in gay men, for example, have been linked with
unprotected and therefore unsafe sex (Schoennesson and Dolezal, 1998).
Smoking, excessive drinking and eating unhealthy foods are all sources of
pleasure, which are considered to damage health. Pleasure is considered as
a prime force creating the root of resistance whereby individuals flout the
norms which public health attempts to impose. Lupton (1995) discusses the
ways that pleasure and desire, as libidinal forces, may be regarded as preor non-discursive; they are innately undisciplined and undisciplinable.
Pleasure and pleasure seeking is thus conceived as the weak link in the
chain of command from authoritarian discourses of health governance to
docile compliance for body maintenance.
Efforts of reform in contemporary public health always run the risk of
standing accused of nannyism, through negating individuals pleasure and
spoiling spontaneity and fun. There is a growing body of literature part,
some say, a trend towards the pleasure revenge (Bell and Valentine, 1997)
which accuses the puritanical healthist culture in the West of denying
pleasure and promoting guilt, and therefore stress, in individuals (Klein,
1993, 1996; Warburton, 1994; Warburton and Sherwood, 1996; Lindeman
and Stark, 1999; Rozin et al., 1999).
Pleasure can also be seen as an organizing principle in democratic
societies providing a critical vantage point on public health and health
promotion (Luik, 1996; Netter, 1996). Pleasure thus can act as a rallying
point or clarion call to oppose the forces of unwanted authoritarian
control of individual choice, and the unwelcome incursion of expert reason
into the life-world. Critics wish to defend the liberal subjects right to
freedom and autonomy, thereby protecting the threatened liberal
subjects right to self-determination against the threat of experts who would
interfere in their autonomous (sometimes pleasure-seeking) decisions
(ARISE, http://www.arise.org/).
Although from a differing perspective, and with perhaps a differing
politics, this objection is rather similar to the critical attention that has been
levelled at health promotion and public health which has highlighted the
surveillance potential of newer forms of health care (Armstrong, 1983;
Nettleton and Bunton, 1995; Petersen and Lupton, 1997; Crawford, 2000a).
New sets of rights and responsibilities of citizens, state instrumentalities
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and health-care professionals are being constructed as western health-care
systems privilege public health and self-care. Newer more self-reliant,
empowered citizens are being established who take on more responsibility
for their own health risks. Indeed, risk management is changing in ways
that increasingly involve the personalized policing of pleasure and risk.
Pleasure conceived as the other side of risk cannot escape increased
attention from scientific expertise and new forms of health governance.
Personal pleasure and self-satisfaction, it can be argued, are now derived
from a range of practices appropriate to self-transformation through selfpolicing.
The self-policing, or self-management, of health involves the fashioning
and rationing of pleasure in ways that are highly socially situated. Like risk
taking, and often experienced as risks other side, pleasure is socially
distributed. Risks exposure and risk-taking behaviours have a recognizable
social gradient, with lower socio-economic groups being exposed to and
taking the brunt of available risk (Beck, 1992; Furlong and Cartmel, 1997).
Castel (1991) has pointed to the redistribution of risk management in late
modern societies and argues that, increasingly, those considered economically active are allowed the freedoms to self-manage risks, while those
socially excluded and/or without the economic power to do so, have their
risks, often austerely, managed for them by state agencies. Similarly,
pleasures are managed differentially by social category, often with scarcely
concealed hypocrisy. The pleasures of opium, laudanum and hashish were
much appreciated by a number of romantic artists and writers in late 19thcentury Europe, including for example, De Quincey, Coleridge and Poe
(Plant, 1999). Later, when these drugs began to be used by the newly
urbanized working classes, calls for disciplining the habits and prohibition
ensued, often with the stated purpose of protecting public health and
welfare, resulting in unprecedented restrictive legislation in the early 20th
century.
The origins of many modern public health initiatives have roots in evangelical, often highly disciplined and religious movements in the 18th and
19th centuries designed to reform unwholesome habits, disruptive behaviours and, in the process, transform pleasures. Within this discourse,
pleasure was regarded as emotional (therefore irrational) and in direct
opposition to reason and rationality. By reifying the joys of asceticism,
abstinence and sobriety over decadence, depravity and debauchery, public
health sought to replace one form of pleasure (hedonistic, carnal, libidinal)
with others (aesthetic, ascetic, civilized). We can therefore see public health
as a series of attempts to transform pleasure by constructing new modern
secular moral and rational positions. Public health discourses intersect with
pervasive religious beliefs, which still have an inhibiting effect on risk taking
(Abbott-Chapman and Denholm, 2001). Of course, public health did not
invent these transformations but was a part of an emerging western
episteme influenced by the economico-political regulation of populations
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which changed the understanding of the body and the soul in the modern
period (Foucault, 1980).
A history of pleasure
In seeking to map the transformations in pleasure and pleasure-seeking
experiences, we will now look at the emergence and circulation of different
forms of pleasure in western culture. In doing this, we are not suggesting
that one form of pleasure existed without others. It is to suggest instead
that different systems of thought, different forms of expressivity and,
importantly, different religious influences at different historical periods
prioritized one form of pleasure over others. In contemporary public health
discourse, as we shall see, these different forms of pleasure present multiple
opportunities for engagement and regulation.
The point of departure for our analysis is the research undertaken by
Mellor and Shilling (1997) on the ways that religious influences in the West
have shaped or reformed the body. This work, rightly, reminds us that the
holy trinity of sensuality, embodiment and the sacred have vastly shaped
the relationship between religion and sociality.
Carnal pleasure
We begin with fleshy desire. To talk of carnal pleasures is to talk about
bodily basics: warm flesh, moist orifices and libidinal urges. Carnal
pleasures emerge from the raw, physical body. For the ancient Greeks, the
natural appetite, or energia, formed one of the most important drives for
carnal pleasure. Carnal pleasures are sensuous, and come from the senses.
They are therefore often unanticipated, arising out of nowhere but calling
for attention and gratification. To be sure, carnal feelings and instincts can
be evoked: the smell of good food, the erotic image, the stroking of sensitive body parts. All these produce sensations that conjure fleshy desire from
which carnal pleasures emerge. But it is the unexpected arousal that make
carnal awakenings so startling and therefore problematic. The early Christian John Cassian (360435AD) believed that it was the innateness of the
natural appetite that made it so hard to tame and cure. For Cassian, food
and sex were inextricably linked and an overindulgence in eating and
drinking lead to the urge to fornicate (Foucault, 1990b).
Carnal, physical pleasures connect the body to the world. They literally
open up the body to the influence of other people and the wider environment. The notion of a body open to senses indicates a sharing of values,
rituals and community. Thus Falks discussion of an eating community in
relation to an inclusive society indicates not merely a sharing of food but
the construction a collective boundary (Falk, 1994). It was within the mediaeval period of Europe, where communities were open to all manner of
environmental (plague, pestilence, famine) and human (war) catastrophes,
that Catholicism found its niche (Mellor and Schilling, 1997). Carnal
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pleasures formed the basis of many prohibitions. Rituals of the flesh and
physicality, invoking and inflaming the senses, were important practices in
Catholic worship and penitence. Self-flagellation, penetration of bodies
with pins and irritating the body with harsh clothing were all rituals
designed to curb carnal pleasure by disciplining the physical self. The
important point here is that bodily senses and the physical body itself were
both instruments and targets of Catholic practices. Even the Eucharist
literally the embodiment of Christ through ritualistically eating of bread
and drinking of wine echoes this physicality. The synergism between open,
often volatile, bodies, sensuousness and superstition provided a fertile
environment for the growth of Catholicism in the mediaeval period of
Europe. Despite its apparent strict doctrine and dogma, the Church at that
time absorbed pre-existing pagan rituals and practices, which allowed it to
penetrate and make its mark on social values. The carnival is a good
example of this. Culminating in the mardi gras, the carnival involved
ritualistic, often grotesque practices, including overindulgence in food and
sex to the point of orgy. In one part of France, the patron saint of Shrove
Tuesday was Saint Degobillard, otherwise known as St Vomit (Mellor and
Schilling, 1997). But the carnival was succeeded by Lent, one of the most
important and most pious occasions in the Christian calendar. Lent reminds
Christians of the need to deprive the physical body and with that the soul
of food and pleasure as an enactment of Christs suffering. The breaking
of Lent coincides with the feast of Easter, and the celebrations of fertility
and rebirth. Fertility festivals were of course in place long before the arrival
of Christianity, and again we see a superimposing of religious doctrine on
pagan activities, demonstrating the tolerance to carnality that existed in the
early Christian Catholic church.
Today, the instinctual urges that arise from bodily pleasures are, as we
saw earlier, believed to lead to many risky and health-damaging behaviours
(unsafe sex, over-eating and drug taking). This volatile body, which refuses
to be disciplined, is highly disordered, dangerous and polluting. Like many
forms of pollution it represents matter out of place (Douglas, 1966). Such
pollution presents a threat to the publics health and requires sanitary
measures (Armstrong, 1983; Crawford, 2000b).
Disciplined pleasure
Throughout the late mediaeval period, the power of the Catholic church
was gradually challenged from within its own ranks and from outside. The
emergence of movements we now regard as Protestant brought an understanding of pleasure that had not been fully celebrated outside all but the
most cloistered communities. Much of the early movements of Protestantism claimed they were the vera religion, the true religion. The proof of
this was in the strict interpretation of the word of God. Accusing
Catholicism of practising superstition and worshipping idols, especially
through Mariology (the praising of the virgin Mary), Protestants stripped
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bare the rituals, the revelations and the rites that formed the core of
Catholicism. God was now available to all, not through the ciphers of the
Church the priests and the popes but directly through the reading of
His words. The text became the symbol of God and reading or listening to
the Scriptures with a calm attitude turned into ones self, replaced the open,
public and communal ritual that characterized the Catholic mass. As the
display of emotions and physicality became subordinated to more cognitive practices for worship, narratives of the self and the reification of innerliness flourished and became sacred. These practices were not new. Indeed,
Foucault points out that early Christian writing encouraged the practice of
constantly turning over ones thoughts and feelings to seek out evil, much
as the miller turns over his wheat grains to pick out those which are bad
(Foucault, 1988). The Reformation took these early writings seriously and
turned them into religious practices. Pleasure now does not merely involve
the immediate gratification of carnal urges. Pleasure now assumes a more
sublime quality. Indeed, the stepping back and deferring from immediate
instinctual gratification in order fully to appreciate the world and its offerings gives rise to a range of aesthetic, so-called cultivated and civilised
practices (Elias, 1982). Kants Critique of judgement stands as the sine
qua non of the discourses on reflective beauty (Falk, 1994). The supplanting of words for deeds provides a number of opportunities for disciplined
or deferred pleasure. The categorization of what and how things can please
through the creation of archives, manuals and catalogues allowed for a
vicarious experience of pleasurable acts. The experience of the actual
pleasure itself was no longer a requirement now that the very form and
nature of pleasure was captured in words.
Other written forms allowed for the production of disciplined pleasure.
For example, cooking standards could now be judged by the written word,
as recipe books and cooking manuals become the standards for quality.
Prior to this, recipes were passed by word of mouth leaving many opportunities for misinterpretation, poor translation and poor results. Static and
disciplined in words, the recipe stands for all time. And the practice of
cooking, by the book, takes on a status all of its own. The fact that only the
most privileged in society could actually read and write served further to
elevate the written word as a form of cultivated expression.
Disciplined pleasure is pleasure that has been rationalized. Within the
rational knowledge of 19th-century food science and nutrition, for example,
pleasure was subordinated below rations, reason and science. Too much
flavour from food was considered to overtax the digestive system and
damage health. What was needed was just enough flavour to accomplish
natures economy (Richards and Elliott, 1910).
Discipline in drink was also part of this pleasure. Victorian and Edwardian concerns about the drinking of the newly urbanized working
classes illustrates the coincidence of interests between the public health and
the Church (Harrison, 1971; Alasuutari, 1992) The temperance movement
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of the turn of the 20th century was an ambitious socio-political programme
or moral crusade (Gusfield, 1963). Measures to control and discipline
alcohol and drug consumption stem from this period, when the concept of
addiction re-emerged and eclipsed other ways of problematizing intoxication, such as that encapsulated in the concept of habituation (Levine,
1978). A drinking habit that was amenable to human intention and choice,
was transformed in addiction discourse into a disease of the will that was
in need of correction by medical authorities. Addiction discourse afforded
little, if any, space for the pleasures of intoxication. Rather, there was a
systematic silencing by discourses that pathologize the practice of alcohol
and drug use (OMalley and Mugford, 1991).
Rationalized and disciplined pleasure stands against vulgar and
emotional displays of enjoyment. The first being reasoned, reasonable and
safe, the second being unpredictable, perverse and risky. Disciplined
pleasure is arguably at the foundation of many public health initiatives.
Moderation, restraint and tempered practices are integrated into the very
fabric of public health discourse. Immediate gratification is relinquished for
the pleasure and satisfaction of rationalization and reason. This subtext is
inherent in attempts to improve public health: from smoking cessation,
improvements in diet, to moderation in drinking. You know it makes sense
has been a well-used motto in public health to call up in consumers the
reasoned and rational understanding of what is best for them, and for the
community. But as we shall see shortly, the ability to take this sense to an
extreme is ever-present in public health.
Ascetic pleasures
In contrast to the immediacy of carnal pleasure and the rationality and
intellectualizing of disciplined pleasure, ascetic pleasure requires the
practice of askesis or self-training. Foucault reminds us that for the ancient
Greeks, the careful managing of pleasure actually enhanced ones experience of pleasure (McHoul and Grace, 1995). Virtue was regarded as the
hallmark of ones excellence as a Greek citizen (Kippo, 1975) especially
through the moderation of pleasure. As early Christians incorporated
elements of classical Greek thought into their doctrine, however, virtue
became synonymous with ascetics the denial of all pleasure (Brown,
1988). The Rules of St Benedict, written around 500AD stipulate the importance of loving to fast and not being too fond of pleasure (St Benedict,
1966). Pleasure from ascetics and abstinence reached its apogee in the practices of a number of monks and early Christians. Catherine of Sienna, Claire
of Assisi and Angela of Foligno, for example, all reached heights of ecstasy
through severe fasting and other ascetic rituals (Bynum-Walker, 1987). The
ascetic approach to pleasure was not confined to the Middle Ages.
Throughout the growth of Protestantism, ascetic practices of many kinds
were encouraged often with the aim of purifying the body. The arousal of
pleasure qua passion, was considered to contaminate the soul and was thus
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health: 7(2)
a source of sin. All manner of foods which might be considered as arousing
passions in the body earthy foods producing flatulence, or highly
seasoned foods were considered polluting and were therefore eschewed
(Tryon, 1695).
The basis of ascetic pleasure arises from the acknowledgement of total
control of the bodys natural urges. This is not so much a civilizing of the
body, as we saw with disciplined pleasure, but more a total conquering and
domination of the body. As Lupton explains (Lupton, 1996), modern-day
examples of ascetic pleasure can be found in the testimonies of people who
have self-starved with conditions like anorexia nervosa. Interestingly, while
extreme forms of ascetic pleasure can be seductive, creating feelings of total
control and safety, in public health terms there are of course great risks to
personal health and well-being. In trying to supplant carnal pleasures with
disciplined pleasures, public health always runs the risk of paralleling
religious zeal which reifies ascetic pleasures. Obsessions with ones food,
drink and bodily function can easily arise from pursuing so-called healthy
lifestyles (Turner, 1995). Thus, the punishment of the physical body, in the
name of health, is always a possibility. Ascetic pleasure is almost always a
solitary pursuit and stands in stark contrast to forms of pleasure arising
from collective ecstatic experiences. These are discussed below.
Ecstatic pleasures
Pleasure as a ritualistic, spiritually bonding experience, often with the
assistance of mind/mood-altering substances and rhythmic dance, has a
tradition in many cultures. The suspicions with which such traditions have
been viewed are well evident in the Christian missionary attempts to
dampen and extinguish so-called dangerous tribal practices in distant and
exotic locations. However, we can examine this phenomenon closer to
home in public health attempts to deal with the variety of pleasures emanating from youth club-culture.
The unruliness of bodies under the influence of psycho-active substances
has long since concerned public health specialists (Gusfield, 1963; Berridge,
1989), but remains an abiding focus (Valverde, 1999; Bunton, 2001). More
recent literature, however, has begun to examine issues related to the
aesthetic body. There has been some discussion of a so-called post-modern
pattern of drug use and drug use identity that involves a normalization of
illicit drug use (Parker and Measham, 1994; Shiner and Newburn, 1997,
1999; South, 1999).
The upturn in the use of illicit drugs among the young in the 1990s and
development of pick and mix use patterns of drug use would appear to
mimic more general shifts in the consumption of goods and services under
the influence of consumer society. Intoxicating commodities (OMalley
and Mugford, 1991) can be placed within a response to the increased
rationalization and regulation of the life-world. Indeed, popular music,
dance drugs and club-culture rave or Ecstasy culture as a mass
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cultural phenomenon in the 1980s and 1990s (Thornton, 1995; Shapiro,
1999) is arguably an example of a social form responding to the overrationalization and bureaucratization of everyday life. Interestingly, groups
formed in such mass consumption appear to be self-consciously creating
their own philosophy. Offering liberation, pleasure and communality even
offering alternative spiritual realms these forms of social life and embodiment are the result of what Miles (1992) has called carnal knowing. This
use of drugs appears, almost nostalgically, to seek a period when society
produced an altogether more intense, sensual existence; before the civilizing processes, that Elias documents so well, transformed European society.
Public health seems to have overlooked the obvious point that people take
drugs for the experience of pleasure, however socially defined. Drug use
has many affinities (as well as risk factors) with sexual pleasure (Eisler,
1995; Hart and Carter, 2000).
An example of philosophies that celebrate pleasure can be found among
some groups of participants in the Sydney Gay Lesbian Mardi Gras
Festival. In the early 1990s a wave of resistance reacted against attempts
by Festival organizers to make Australias premier summer community
festival drug free (Southgate and Hopwood, 1999). Indeed drug use during
the Festival was seen by many to be integral to the celebrations of gay pride,
and an anti-drug stance by organisers was considered to be a sellout on the
philosophy of the event. This resistance to authority is an excellent demonstration of the ways in which pleasure seeking itself can be reasoned and
rationalized within and by counter discourses.
The directly spiritual experience of use of the drug Ecstasy is interesting, given the claims made by Maffessoli (1996) and Mellor and Shilling
(1997) concerning the re-consecration of existence through sensual solidarities. Modern tribalistic and ritualistic experiences offer relief from the
alienation of banal association. They present a return to the sacred in
everyday existence by a combination of a range of technologies including:
lighting, sound, space, drug use and crowds.
The ecstatic pleasures derived from collective spirituality are of course
evident in many religious movements. In Christianity, communion is a
collective practice that not only connects individual worshippers with Christ
but also with one another. In more fundamentalist Christian sects the
combination of gospel music, song and prayer can give rise to spontaneous
ecstatic and rapturous responses from congregations. Speaking in tongues
has a similar effect. The connectedness that derives from collective ecstatic
experiences, whether they be within the secular youth culture, the Gay
community or religious church gatherings, bonds individuals both spiritually and pleasurably.
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health: 7(2)
Conclusions
Our aim in this article has been to begin to reflect upon pleasure in relation
to public health and health more generally. Pleasure is so integral to the
challenges of public health, it is surprising that there is not more empirical
or theoretical literature on the topic. In its attempt to transform pleasures,
public health always runs the risk of introducing new and unanticipated
elements that may run counter to the goals of health enhancement. In part,
this is because it has not been able to theorize the place of pleasure in
health and well-being. The rise in ascetic practices, for example, especially
related to strict dieting and associated distortions of body image, is arguably
linked to a focus on the need to restrain eating for the sake of health. Similarly, embodied pleasures can develop in relation to public health behavioural interdictions. Unhealthy, dangerous practices or consumption can
exploit these interdictions to enhance the aesthetic pleasures carnal,
ecstatic or other.
By examining the ways that pleasures are represented and experienced
we can also examine some of the ways that power and social relations are
reproduced the uses of pleasure as Foucault reminded us. The coercive
and governing power of risk discourse and risk management in the name
of health has been analysed and critiqued by those concerned with a
number of perspectives and political positions. The problematization of
pleasure itself and its relationship to health and public health in particular
is also in need of closer examination. While the discourses and experience
of pleasure are normally associated with freedom from interdiction, they
are replete with social regulation or control. Maffessoli observes that
certain consumption phenomena, such as Club Med, may be extensions
of quite regulated consumption socialities (Maffessoli, 1996). The consumption of risk products can in fact merely reproduce other forms of social
identity along traditional class and gender lines, like other forms of
consumption (Bourdieu, 1985; Sulkunen, 1992; Bunton and Burrows, 1995).
Similarly, sexual health education that sought to eroticize sexual activity
was not free from social or ideological influence (Wilton, 1996).
We would argue that the religious elements that influence the dimensions of cultures cannot be underestimated when considering the shaping
of attitudes to, and practices of, pleasure. The work of Mellor and Shilling
among others, is evidence of this. Our understanding of pleasure is
deepened and broadened through historical analysis of the influence of
religion on conceptions of the body and the soul.
In this article we have attempted to sketch some possible approaches
that such an analysis might take, rather than systematically review the range
of work currently being undertaken across a variety of disciplines. In
addressing pleasure more centrally in public and health research, and
attempting to open the topic for further discussion, we are aware of the
potential breadth of such a focus. It would certainly cross many disciplines
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and domains of study, like many other aspects of the study of the body. In
this brief sketch of some possible directions we have ignored important
contributions to the area which would repay closer examination, for
example: psychoanalytic aspects of pleasure, self and subjectivity; antipleasure as a momentum of health promotion and public health; the work
of Deluze and Guttari on desire and the implications for public health; the
understanding of late-modern patterns of drug use; sex, pleasure and
subjectivity; food, pleasure and the problems posed for health promotion
intervention; public health risks and the pleasures of transgression; and the
public health imperative of a disembodied experience of pleasure.
In pursuing the study of pleasure in relation to health, even documenting the absence of a pleasure focus may be of immediate interest. If we are
to avoid opposing pleasure and reason, what complementary experiences
to pleasure would we suggest? Theorizing pleasure has a potentially rich
source of data in the field of health, and one which should be seriously (and
pleasurably) considered.
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Author biographies
JOHN COVENEY is Senior Lecturer in the Department of Public Health at Flinders
University, Adelaide, Australia. He worked in clinical dietetics and public health
nutrition before entering academia. His teaching and research interests are in food
policy and health promotion. His most recent book, Food, morals and meaning: The
pleasure and anxiety of eating, was published by Routledge in 2000.
is Professor of Sociology in the School of Social Sciences, University

of Teesside, Middlesbrough, UK. He teaches and researches in sociology with
particular interests in health promotion, drug misuse and the body. He has published
widely in the field of health and is Editor of the journal, Critical Public Health
(Taylor & Francis).
ROBIN BUNTON
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