You can usually tell just from the sound of someone’s voice if he or she is worth listening to. Many years ago now, by chance I happened upon the German sociologist Barbara Duden being interviewed on CBC Radio Ideas program about her book The Woman beneath the Skin: A Doctor’s Patients in Eighteenth–century Germany (1997). Hers was the unmistakable voice of an original, creative thinker. I remembered the voice when I came across her book, again by chance, some ten years later. So I read it.
In this, the first of a three part series, I introduce readers to Duden’s ideas about the woman beneath the skin. It has much to teach us about how we experience emotions today.
Duden’s book reconstructs how women in early eighteenth–century Germany experienced their bodies. It returns us to a pre–Cartesian time and illustrates how the experience of feeling emotions is culturally shaped. The women discussed had no conception of a divorce between reason and emotion, head and heart, the mental and the physical, and so they did not experience their lives in these terms. Nor, interestingly, did they have a conception of a sharp demarcation between men and women.
The book’s title, The Woman beneath the Skin, brings to mind Antonio Damasio’s observation that the skin is much more than a sense of touch. It is an organ, the largest viscera of the body. It is where all of our senses are to be found. Skin mediates between inside and outside; it faces both ways; it senses things both internal and external to the organism.
Evolutionarily, before organisms perceived, they were sensitive to sensations: there was a feeling of the body as it touched or saw or heard or moved. As the senses evolved, Damasio argues, attention to their component of perception increased and attention to the feeling of perceiving decreased and became background feeling. But consider: “When you see, you do not just see: you feel you are seeing something with your eyes [rather than your forehead]” (Damasio, 2000, p. 232). The women discussed in this book lived during a time when the feeling of perceiving was rawer and when the vocabulary for describing that feeling was richer.
The women in question were patients of Dr. Johannes Pelargius Storch, a physician in the town of Eisenach, Germany, between 1721 and 1740. Eisenach, at that time, was a thriving market town of around 9,000, the capital of a tiny, absolutist principality (Duden, p. 50). [A map of Eisenach is here.]
Dr. Storch is described by Duden as “a narrow–minded, well–read pedant, who never forgot anything and who lived for his profession and found in it a path of social advancement.” He was a sensible Lutheran, “rooted in the traditional body perception of his female patients, yet at the same time knowledgeable about the medical theories of the time” (p. 50). At university, in Jena, he was introduced to the “mechanical doctrine,” according to which “the body was made up of tubes in which moved fluids composed of minute particles.” He was more familiar “with the idea that the heavenly constellations and diabolical powers could have effects in the body via extremely fine liquids that formed the nervous system” (p. 52). He also learned to dissect.
Remarkably, Storch kept meticulous notes on his communications with his patients. “Each history begins with a brief characterization of the woman, the time of her first consultation, her complaints, her medication, and so on” (p. 66). In his old age, he compiled these notes into a handbook of instruction for younger colleagues, published in eight large volumes entitled Diseases of Women. “Storch did not write as a scholar for other scholars, but as a practical doctor for ‘young, future practitioners’ . . . [He] wanted to publish his record of ‘unembellished notes for the day–to–day usefulness of younger colleagues’” (p. 64).
Each volume of Diseases of Women relates to a “natural state” of the women, and covers the period of 1721 to 1740. Storch presents about 1,800 individual cases, in which a total of some 1,650 different women were treated. The women are nameless. Most “were older women in the ‘middle years,’ between twenty and ‘well into their thirties’” (p. 79).
“Pain is in the body,” Duden argues, but “it leaves no trace for the historian, unless complaints about it are recorded” (p. 62). Storch did precisely that; he was “a witness to an orally transmitted popular concept of the body” (p. 37).
He took patients at their word and wrote down what he heard: their descriptions of their feelings, “the chaotic sensations that were bred in the inner body” (p. 64). Above all, the women described complained about what we would now call their emotional pain—anger, fright, sorrow, excitement, agitation, sadness, and fear—and its physical manifestations. This was a time when good and evil fought for supremacy within the body, a time before emotions—as presently understood—existed.
Many of the consultations took the form of “messages carried by intermediaries. . . . In a great many of the case histories Storch did not see the patient, at least not during the critical stages” (p. 81). “Even when Storch saw the woman with whom he was talking . . . in most instances he did not touch her for the purpose of examination. Here too he acted on the basis of what the patient said and what he could find out in further conversations” (p. 83).
For Storch, the stories of these women’s bodies were more believable than “evidence” uncovered through dissection; according to contemporary anatomy, many of the women’s stories were anatomically and physiologically impossible. “The eyewitness account of a phenomena of the living body was more convincing to Storch than a fact uncovered in a dead body” (p. 70). Duden uses Storch’s notebooks to reconstruct how these women patients experienced the inside of the female body “and how these ideas shaped their actions and gave meaning to their experiences” (p. v). She calls her book a history of corporeality, a sociogenesis of contemporary notions about the body.
It is hard not to wonder how people from a past age could be ignorant of a physical reality that seems to us self–evident. But Duden poses a more interesting question: how can we be so ignorant about the socially constructed nature of our experience of this same physical reality? Our supposedly “natural” perception of the body—the division between physical and mental illnesses—was centuries in the making.
The professionalization of medical terminology, Duden argues, produced two heterogeneous modes of speech and perception, and thereby silenced the patient.
We tend to describe our experience of our bodies in medical terms rather than in terms of our inner feelings. Power over the correct word, Duden argues, became concentrated on the side of medicine. “Today we can only stutter or keep silent in the face of the normative nomenclature of medical language” (p. 88).
But prior to the nineteenth century, this “boundary between diagnostic vocabulary and the feelings of the patient was blurred and permeable, if it existed at all” (p. 62). In Storch’s day, the words of the patients and the terms of the doctors still interacted.
It is now taken for granted that pain is a warning that something is wrong with the body. It is important to note, however, that pain emerged in medicine as the guardian and keeper of life only around the mid–eighteenth century. Until then, body and soul were imagined as inseparable realities, and pain was experienced as the suffering of the soul from the defectiveness of the world. Only later, Duden argues, did “the Cartesian idea of pain as a message from the body to the consciousness become a part of medical thinking: pain turned from a flaw of nature into a protector of life” (p. 88).
The transformation of ideas about pain coincided with the development of the notion of disease. Pain and illness, once considered a burden of life to be endured, became symptoms of an alien presence that could be expunged through medical intervention. In the modern sense, the real object is the body; in the Storchian sense, the real object is the life.
Disease was both a qualitative change in the body and a quantitative deviation from a prescribed physico-chemical norm. Thus there arose a new medical theory and practice focused on normalization. Disease became a mode of analyzing bodies for the purpose of intervention and correction. In the course of this transformation, Duden argues, “being ill” lost its former meaning as a personal event in a life story—something that could be felt—and became a deficiency in relation to a medically described norm—which, for the most part, cannot be experienced by the senses (pp. 30–31).
The examining gaze of the doctor became like a dissection, and the sick patient came to be treated in a way that once had been conceivable only with dead bodies. This medical gaze “penetrated inquisitively into the inside, evaluating the palpated organs and relating them to a visual image of the organs of cadavers.” Fixed in the medical anatomizing gaze, the body was pacified, rendered docile; it became something that we have, rather than something that we are (p. 4).
Duden thus presents us with an account of how the pre–modern body was experienced before mind was separated from body; before the body was separated from its environment; before people became separable from community; and before people became modern “individuals.”
NEXT: How these women experienced their bodies—the imagined inside.
Barbara Duden. The Woman beneath the Skin: A Doctor’s Patients in Eighteenth–century Germany,1997
Antonio Damasio The Feeling of What Happens: Body and Emotion in the Making of Consciousness, Harcourt, 1999.