‘I Know My Own Body’ Power And

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Jeanne M. Lorentzen Medical Interactions

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I Know My Own Body: Power andResistance in Womens Experiences ofMedical Interactions

JEANNE M. LORENTZEN

Theorizing resistance has been a particularly problematic enterprise in feministthought. A wide variety of attempts to advance the feminist emancipatory projecthave been hindered, despite notable efforts, by the inability of feminist theory tosurmount 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 feminineembodiment and precluded identification of resistance. In order to examine thenature of medical power relations, specifically the extent to and manner in whichresistance occurs within such relations, rather than focusing exclusively on thecorporeal it is necessary to address the imbrication of the corporeal and theincorporeal (Colebrook, 2000: 42).

In this article I examine womens experiences of patientdoctor interactions inorder to discover what their embodied experiences can reveal about the nature ofmedical power and the ways in which resistance may be produced. In order tocontextualize the findings, I begin by relating personal experiences that influenced

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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 anexplanation of this studys use of a Foucauldian informed notion of power. Afterpresenting the research methodology used in this study I present the analysis ofthe womens experiences in medical interactions and conclude with a discussionof the implications of my findings for theorizing the relationship betweenmedicalization, womens health care needs and gendered embodiment.

The Researchers Body

A personal experience many years prior to my graduate studies in sociologyserved as the primary catalyst for my interest in medical power relations. In myearly 20s I experienced a problematic pregnancy that required extensive stays inthe hospital and interaction with my gynecologist. I had experienced two normalbirths previously, but after the birth of my third child I experienced severegynecologic pain that led me to consult my doctor on numerous occasions in anattempt to get back to normal, that is, living without pain. On each occasion heurged me to have an elective hysterectomy, which I always refused. The particu-lar medical interaction that convinced me to undergo an elective hysterectomywas quite tense. According to my gynecologist the most important reason Ineeded to have a hysterectomy was not because it would alleviate the pain I wasexperiencing, although he assured me that it would accomplish that as well, butbecause 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 birthcontrol, arguing that without it I would likely die were I to become pregnantagain. When I did not immediately agree, he became quite irate and angrilycontinued to urge me to have the surgery. Finally, he stated that if I died frommy 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, whatI wanted was a relatively small family, which in my estimation at that time wasabout five or six children. At that time my identity fell along traditional genderlines and my life revolved around motherhood. Consequently my doctors wordsproduced a profound sense of guilt even as I focused on the problem of who Icould 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 mequestion 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 womanif I did not accept his version of appropriate gender behavior and sacrifice avitally 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, andperhaps he may have also been trying to dissuade me from following what heconsidered to be a likely harmful, traditionally feminine path. Nevertheless, thesepossibilities do not diminish the gendered nature of his argument in an attemptto produce my agreement with his interpretation of my bodily state and need foran extreme medical intervention, as well as appropriate life course. Interestingly,he did not offer the option of alternative, less invasive medical procedures thatwould have just as effectively produced permanent birth control. Consequently,because he predicted that a future pregnancy, intended or accidental, would resultin 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 confirm with a high degree of certaintythat another pregnancy would be life-threatening for me. At that time there wasa lack of medical research focusing on the rare pregnancy condition from whichI had suffered. Whatever my gynecologists medical expertise, it later becameapparent 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 engagedproceeds by taking this experience of mine, this experience of other women thisline of fault and asking how it is organized, how it is determined, what thesocial relations are that generate it. My experience of obstetric and gynecologichealth care that resulted in elective hysterectomy was my line of fault. Conse-quently, over the ensuing years, prior to and during graduate school, I reflectedon how my physician had gendered his argument in an attempt to effect mycompliance. I came to believe I had been victimized by gendered medicine, andit was this understanding that compelled me to focus my research on medicalpower relations. However, over time, as I engaged other women in conversationsabout their medical experiences, including the women who participated in thisstudy, my perspective shifted. I came to understand that women need not be,nor are typically, passive victims of medical power. Although my experience ofmedical power certainly altered my body and initiated a transformation in mygendered embodiment, as well as a future I could not have previously imaginedchoosing, it also produced a critical and selective consumer of medicine. Perhapsmore importantly it produced a feminist sociologist who studies medical powerrelations and gender. Consequently, my own experience with medical power rela-tions serves as an example of how power relations can have long-term effects andproduce both discipline and resistance.

I Know My Own Body 51



Medical Power

The social process of medicalization has long been of concern to feminist scholarswho contend that womens bodies and lives have become highly medicalized.According to feminist perspectives medicalization, a social process in which bodiesand social circumstances are defined from a biomedical perspective as requiringbiomedical intervention, not only contributes to the maintenance of genderinequality but directly impacts womens health and well-being.1 A more recentperspective argues that women are not passive recipients of medical care andmedicalization, but active participants in medical power relations as they attemptto achieve particular health states and configurations of gendered embodiment.2

The primary point of contention between these two perspectives centers onassumptions about the nature of power. The majority of earlier analyses adopt atraditional notion of power in which medical power relations are understood tobe hierarchical and repressive.3 Although these analyses contribute importantknowledge about gendered medicine, their perspective on power has been prob-lematized primarily because it precludes the possibility of agency and can, there-fore, only define women patients as powerless victims (Broom and Woodward,1996; Dull and West, 1991).

Analyses of medical power relations using a relational/transactional notion ofpower, as does the present study, contend that women are active participants inmedical 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 mannerby medical power relations (Doyal, 1995; Lorber, 1994; Riessman, 1983). Thisperspective explains medical power relations as a process of negotiation in whichwomen experience both benefits and costs.

Despite feminist critiques of Foucault that claim his work cannot contributeto emancipatory politics (Deveaux, 1994; Di Leonardo, 1991; Hartsock, 1990),Foucaults concept of power as developed in his later work (Sawicki, 1998) hasbeen highly influential in feminist analyses precisely because of its capacity toinform emancipatory projects (MacLeod and Durrheim, 2002). In order to explainhow modern power produces normalized bodies, Foucault (1977: 201) used theanalogy of the panopticon; an architectural prison design in which a central towerenables guards to constantly monitor prisoners who are housed in cells encirclingthe tower. This design creates the opportunity for constant surveillance and aminimum of supervision of inmates. Foucault (1977) argues that power relationslike 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 captureobjective reality. In terms of medical power this perspective suggests that bodiesare 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 medicalinteractions 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 theirembodied selves and the world. In this way medical power is seen to produce abiomedical societal ethos that influences the production of medicalized subjec-tivities. Accordingly, patients do not require the constant surveillance of medicalpractitioners to be influenced by medical power because the truth claims ofmedical science are internalized and pervasively accepted in Western societies asaccurate 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 andresistant, through the manner in which knowledge/power moves between shiftingpositions/statuses, that is, for example, through practices such as the negotiationof truth claims (Foucault, 1977). Power is not merely repressive because powerrelations 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, butunstable and, indeed, anarchic (Bruns, 2005: 369) as they are constituted throughthe changing alignment and negotiated practices of individuals and groups.Wartenberg (1990: 150) explains Foucualts notion of power thus:

A field of social agents can constitute an alignment in regard to a social agent if and only if,first of all, their actions in regard to that agent are coordinated in a specific manner. To be inalignment, however, the coordinating practices of these social agents need to be comprehensiveenough that the social agent facing the alignment encounters that alignment as having controlover certain things that she might either need or desire.

Therefore, a physicians attempt to use medical power is only possible whenunderstood in relation to patients, nurses, medical assistants, and all those whoenter 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, ordesire for, that application. As such, the possibility for resistance is always presentin power relations because, as Wartenberg points out:




. . . [a] subordinate agent is never absolutely disempowered, but only relatively so. . . . just asthe 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 beingable 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 intensiveengagement with medical power/knowledge because a physicians expert gaze isdirected explicitly on the individual patients body. As such, it is possible that thetruth claims advanced by physicians in direct interactions with patients may holdgreater salience for a patient than generalized medical truth claims in society. Thisis possible because the end results of diagnosis and treatment are individually andpersonally experienced and may be understood by patients to mean the differ-ence between suffering or relative well-being. Nevertheless, these circumstancesmay be as likely to produce resistance as compliance. For example, Abel andBrowners (1998) study of pregnant women found that medicine was influentialin mediating the womens understandings and experiences of pregnancy, but alsothat the women used embodied experiential knowledge in their decisions toaccept or reject medical advice and treatment. Therefore, although medical prac-titioners are defined as the expert interpreters of the body, they do not hold amonopoly 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 throughconversation with others who have had particular medical experiences, viewingmedical programs on television, reading self-help or lay medical texts (Abel andBrowner, 1998), or by searching the Internet for medical or experiential infor-mation (Ziguras, 2004). In fact, a multiplicity of medical interactions typicallysubject patients to a variety of competing truth claims about the body, throughconsultations with an assortment of medical specialists and health care providers(e.g. a second opinion from another physician or a nurse who imparts medicalknowledge 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 impartmedical and experiential knowledge (Freidson, 1961).

The present situation, in which innumerable medical truth claims are broadlycirculating in society understood to varying degrees and available to be usedby lay individuals in medical power relations is not only due to the explosionin information technology but to the ubiquitous societal impact of medical




power itself. However, according to Ziguras, the power of the medical professionhas been diffused because of the wider array of information available, and hencethe popular awareness of differences of expert opinion and the desire to take amore active part in ones self-care . . . (2004: 131). These and other developmentsin the nature of medical power support Foucaults contention that power producesboth disciplined and resistant bodies.

Resistance in Medical Power RelationsIn terms of the two dominant perspectives of power in feminist analyses ofmedical power relations, a related theoretical debate concerns the question ofwhether 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 positioningthe body from one perspective or the other. Crossley (1996: 99) argues thatalthough these two concepts may appear to be incommensurable they can beunderstood as two sides of the same coin. He contends these two ways ofviewing the body actually refer to the relation between power and agency, withthe notion of the lived body focusing on the experiential aspect of bodies thatenables intentional action, and that of the inscribed body focusing on how bodiesare socially influenced 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, butonly under the assumption of an embodied subjective agency (1996: 108).

Although Oksala (2004) does not focus primarily on the subject of agency, herinterpretation of Foucaults notions of experience and embodiment also clarifieshow power/knowledge networks produce discipline and resistance throughexperiential bodies. In contrast to most feminist readings of Foucaults under-standing of experience, Oksala (2004: 99) argues that Foucaults idea of bodiesand pleasures as a possibility of the counterattack against normalizing powerpresupposes an experiential understanding of the body.

Crossleys and Oksalas often complementary readings of Foucault suggestthat the ability of the body to be trained and to resist depends on awareness ofbodily experience. Crossley argues that it is only through the assumption thatthe human body has an inherent capacity that of awareness that Foucault isable to argue that a body can be trained in particular ways of being, and thus alsobe enabled to use the skills and dispositions that are imposed upon it, and usethem 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 ourbodies and how we understand our bodies and their possibilities through acomplex dance that has no predetermined outcome. Foucault states:

In effect, what defines a relationship of power is that it is a mode of action that does not actdirectly 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 orupon things; it forces it, it bends, it destroys, or it closes off all possibilities. Its opposite polecan only be passivity, and if it comes up against any resistance it has no other option but to tryto break it down. A power relationship, on the other hand, can only be articulated on the basisof 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 asubject who acts; and that, faced with a relationship of power, a whole field 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 chooseto extract ourselves from power relations because they are a manner of relatingthat 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 powerrelations, although how we choose to act and respond certainly depends on ourgoals and how others interacting with us try to reach their goals through suchinteractions. Therefore, resistance is always a potential aspect of power relationsin which negotiation and shifting alignment influence outcomes. According toFoucault:

Power relations are rooted in the whole network of the social. . . . The forms and the specificsituations of the government of some by others in a given society are multiple; they aresuperimposed, 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 asa vehicle by which individuals, all of whom possess creative capacities, constructequally complex and varied subjectivities that are contingent on a wide array ofinteracting physical, psychological and social factors.

From a Foucauldian perspective, medical power relations contribute to theconstruction of both physician and patient embodied subjectivities. Both physi-cians and patients are capable of advancing truth claims that may be challengedthrough the use of competing truth claims based on medical, embodied or othertypes of knowledge. If medical power relations may be accurately understood tofunction in this way, through truth claims participants advance and resist, thenthe production of an uncontested medicalized reality cannot be assumed to be theonly possible outcome of doctorpatient interaction. Consequently, the outcomeof medical power relations cannot be conceived of as predetermined, that is, asonly producing passive, compliant bodies.




Medical Power Relations and GenderAlthough Foucault did not focus on gender, it is:

. . . a fundamental factor in power relations. . . . Gender is a primary feature of the constitutionof the Self, and the basic choices are either to accommodate the culturally specific 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 notnegate the fact that knowledge and bodies are gendered. A large body of feministresearch demonstrates the gendered character of scientific medical knowledge,health care and medicalization.4 Nevertheless, however much womens participa-tion in medical power relations may shape and gender bodies, empirical analysesof womens experiences in doctorpatient interactions suggest that women do resistmedical truth claims and privilege other knowledges under some circumstances.5

Daviss (1988) study of the nature of medical power relations between womenpatients and their physicians concluded that power and resistance were concomi-tantly produced. More specifically, Davis characterized medical power relationsas a moment-by-moment struggle for control with participants gaining and losingtheir foothold as the interaction proceeded (1988: 343). However, Davis alsofound that medical power relations are typically asymmetrical in that physiciansusually prevail in producing an uncontested medical reality. Most important forthe present study is that Davis (1988: 375), on the basis of her empirical findings,argues that the manner in which medical power (or power in general) operatesdoes not differ within gender relations. That is, power relations function similarlywhether based on gendered or non-gendered knowledge. Of additional importfor this study, Davis found that patients use available resources such as troubles-talk, which refers to patients talking to physicians about their health problemsfrom an experiential perspective, in attempts to challenge doctors interpretationsof their bodily states.

Abel and Browner (1998) distinguish between two types of experiential knowl-edge embodied and empathic that influenced the medical decisions of womenin their study.6 Embodied knowledge refers to knowledge developed from anindividuals experiences with and perceptions of ones body as the individual goesthrough changes caused by normal and abnormal body processes such as preg-nancy, bodybuilding, menstruation, weight gain or loss, menopause, illness andinjury, etc. Empathic knowledge refers to knowledge gained from the experiencesof other individuals with whom a person identifies in some way. Neither of thesetypes 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 genderedfeminine, while disembodied rational thought is gendered masculine. Within the




scientific disciplines, including sociology (Howson, 2005) sensory experience orcarnal knowing has historically been invalidated as a source of knowledge (Miles,1992). From a Foucauldian-informed perspective gendered power/knowledgeregimes can be understood to employ power techniques that include the desig-nation of knowledge that is not generated through a regimes approved methodsfor producing knowledge as not knowledge. This power technique is evident inthe scientific paradigm structured by Cartesian dualism in that it rationalizesembodied experiential knowledge as not valid because it lacks objectivity and isnot produced through the scientific method. However, feminist philosophersargue that scientific knowledge contains gender bias and the supposed objectivityof scientific modes of knowledge production actually conceals power relations(Harding, 1991). As Birke (1999: 8) contends, What counts as scientific knowl-edge, as the facts, depends on who counts it as such and in what context.Consequently, within medical power relations, physicians who advance medicaltruth claims do so based on an assumption of objective scientific medical knowl-edge that can lead them to discount the embodied and empathic experientialknowledge of patients.

Women are the primary consumers of medicine, at least partly because theyare socially assigned the responsibility of caring for bodies, their own as well asthose of others (Spelman, 1988). It is reasonable to assume that womens care forthe healthy and sick bodies of their children, partners, friends and elderly parentscan result in extensive embodied and empathic experiential knowledge for womenwho are responsible for such care. Although womens experiential knowledge ofbodies may be understood as a result of gendered disciplinary effects of power/knowledge regimes rather than an inherent biological capacity, the fact that it isgender relations that produce caring experiences does not lessen the knowledgethat women can gain from their close associations with bodies. Consequently,even though gender (power) relations may be repressive, they are also productivein that they produce experiences that engender knowledge that can be employedin attempts to resist power.

Within medical power relations physicians ostensibly rely on knowledge pro-duced through the use of the scientific method because it is deemed as validknowledge according to the scientific paradigm. Despite physicians attempts toadvance this knowledge as objective truth in interpreting womens bodies, anddespite their attempts to ignore, discount or repudiate womens knowledge oftheir bodies, within medical interactions women may choose to privilege theirembodied or empathic experiential knowledge over medical interpretations. Thespecific conditions under which women choose to resist applications of medicalpower, the extent and form of their resistance, and the degree to which their




resistance is successful in producing a compliant or docile physician has notbeen the focus of research.

Methods

The participants for this study were contacted through word of mouth. Prior toresorting to this method to locate study participants I made numerous attemptsto gain access to a variety of physicians and hospitals patients. However, noneof the numerous physicians or hospital administrators contacted (via both writtenletters and telephone calls) provided permission to contact their patients. In fact,medical gatekeeping proved to be such a significant obstacle to obtaining accessto patients who had specifically had elective hysterectomies that many of thephysicians receptionists I spoke to refused to even allow me to speak with theirphysician employers. Consequently, I abandoned the original method I hadplanned to use for obtaining research participants and relied on a very informaland large network of friends, acquaintances and strangers to identify and contactwomen who had this procedure. Only women who had elective hysterectomieswere 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 theyindividually considered to be important factors in their experiences of medicalinteractions that influenced their decision to undergo elective hysterectomysurgery. This resulted in the women choosing to relate their experiences of bothgynecologic and non-gynecologic medical interactions. The women were askedto 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 directlypreceding their hysterectomies. The women were also questioned about thehealth and social interaction problems that motivated them to seek gynecologiccare in general and, in particular, those that resulted in elective hysterectomy.Additionally, the participants were asked about the benefits and costs of electivehysterectomy.

The sample consists of 20 women who had elective hysterectomies. The womenrange in age from 30 to 67 years of age, but most of the women (13) are under50 years of age. The majority of the women are married (18), two are single havingnever married, one is divorced, and one is widowed. All but three of the womenhave 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 betweenthe completion of some high school to advanced college degrees. Two of thewomen completed some high school, five are high school graduates. Six have somecollege, two women completed some graduate work, four have Master degrees,and one woman has a PhD. As a result of sampling occurring in a geographicalarea that was predominantly white and non-urban, all of the participants arewhite.

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 typicallyunproblematic. Within most medical interactions the majority of the womendefined their behavior as knowledgeable and actively contributing to, and insome cases actively directing their medical care. However, most of the womenalso described problematic medical interactions. The women tended to describemedical interactions as problematic when physicians attempted to assert medicaltruth claims about the womens bodies or appropriate gender embodiment that thewomen defined as inaccurate, potentially harmful, demeaning, and as discountingthe womens experiential knowledge of their own bodies. It was these types ofmedical interactions that the women chose to describe in nuanced detail, oftenwith a great deal of emotion, and frequently leaving no room for interruptionby my questions, suggesting that these experiences were highly significant to thewomen.

When asked if shed ever had an experience with a gynecologist that was diffi-cult, upsetting, or problematic, Jill did not immediately refer to the incident inwhich her doctor mistakenly removed both of her ovaries during surgery.Instead, she chose to relate an incident in which her physician refused to write aprescription for her preferred form of birth control.

Only when the doctor and I disagreed about IUDs. He thought a person shouldnt have anIUD and I was very angry with him . . . he just thinks it was something to do, and I got veryupset with him. I wrote him a nasty letter and then later apologized. . . . So I decided it wastime to find somebody else.

Jills knowledge of medically sanctioned birth control, including the fact ofcontradictory expert medical opinion about birth control methods and devices,was acquired from her attention to media coverage of medical research on thetopic, as well as information garnered from previous interactions with otherphysicians. Additionally, Jill had previous experience using an IUD with nonegative repercussions. Therefore, Jill had made her decision to request an IUD




from her doctor based on an assessment of medical knowledge of birth controloptions and her embodied experiential knowledge. This knowledge influencedJill to decide that she was willing to accept some risk in order to gain the benefitsshe believed an IUD could afford.

This interaction between Jill and her physician demonstrates how the knowl-edge resources of individuals influence the manifestation of power relations. Inthis instance, Jills resources included medical and embodied experiential knowl-edge, as well as her capacity to privilege her knowledge over expert medicalknowledge. The resources that enabled Jill to resist a specific application of powerwere at least partly produced through medical power relations, for without herextensive experience within medical interactions, through which she acquired laymedical knowledge and embodied experiential knowledge, Jill might not have feltqualified to challenge a medical expert. This suggests that power relations doproduce 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 truthclaims based on her lay medical and embodied experiential knowledge. Herphysician also engaged in resistance by refusing to accept her counter-claims.Jills final act of resistance was her refusal to be swayed by her physicians truthclaims concerning the risky nature of IUDs and his interpretation of her body asvulnerable to these risks. This medical interaction created firm resistance in Jilland she ultimately terminated her relationship with that physician in order toobtain 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 beviewed not as removing herself from medical power relations, but as strategicallyshifting the field 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 aproblematic interaction prompted her to speak of the incident in which herdoctor directly refused to comply with her wishes and attempted to invalidateher medical and embodied experiential knowledge. The power struggle betweenthem 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 problematicmedical interaction suggests that, despite her emotional response to the loss ofboth ovaries, she did not define that event as highly problematic. In this instanceJill did not perceive her doctor as acting intentionally to harm her or discounther knowledge of her own body. In other words, Jill did not define her doctorsmistake 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 bothovaries. 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 wasprecluded. Jill did not hold her physician responsible for altering her body in away that she had expressly not desired, she did not question his medical expertise,and she eventually accepted his mistake as fortuitous because she reasoned shewould have had to begin hormone replacement therapy (HRT) once she becamemenopausal.

According to Foucault only free subjects enter into power relations, by whichhe means:

. . . individual or collective subjects who are faced with a field of possibilities in which severalkinds of conduct, several ways of reacting and modes of behavior are available. Where thedetermining factors are exhaustive, there is no relationship of power. . . . without the possibilityof recalcitrance power would be equivalent to a physical determination. (1994: 342)

A patient has no field of possibilities during surgery performed under generalanesthesia and determining factors are nonexistent because anesthesia producesunconscious inert bodies. During major surgery a patient is under the completecontrol 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 duringsurgery cannot be consciously experienced or resisted until after a patient regainsconsciousness, and even then a patient may for ever remain unaware of actionstaken on their inert bodies during surgery unless the surgeon or a member of thesurgical team reveals these actions to the patient. Therefore, power relations areprecluded during surgery.7 Nevertheless, body alterations made by a surgeonduring surgery can have significant life-long consequences and can, as in thefollowing case, produce a patient who is inclined to resist in subsequent medicalinteractions.

Terri indicated that she no longer trusts doctors because her physician, likeJills, 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 shehad felt betrayed and violated by her physician, whereas Jill eventually came toview her physicians mistake as latently beneficial. Perhaps the most significantdifference between the two womens experiences is that Jills physician did notrationalize his behavior as being the result of expert knowledge and legal author-ity. Although Terris physician agreed to remove only one ovary when heperformed a partial hysterectomy, during the actual surgery he intentionallyremoved 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 ofhow 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 Iasked 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 themost. His messages were, youll get over it, go with it. So here was this man who had noproblem 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 actionswere based on his objectification of her. That he concealed this dehumanizingperspective was apparent since, prior to surgery, Terris physician led her to believehe 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, froma medical perspective, a normalization of Terris body. Terris resistance, albeitonly possible after the fact, initially consisted of a challenge to her physicianshonesty and integrity. Her physician countered Terris claim by invoking hisexpert medical knowledge in an attempt to produce her acceptance of his inter-pretation of her bodily state and what constituted appropriate medical actions toeffect normalization. He also contended that his medical expertise was legallysanctioned via the surgical consent forms Terri had signed.

Although Terri had received his verbal consent to her request that he conserveone ovary, she did not require that it be included in the legal consent forms.After considering filing a lawsuit against her physician she later abandoned thesuit because she reasoned it could never restore her missing ovary, but she alsoexpressed her belief that the power of the legal system would support hersurgeons actions since, as Terri admitted, she did not read the hospital consentforms thoroughly until after she considered making a legal claim against herdoctor.

Terri also stated that she felt it was possible that her doctors actions may havebeen 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 wonderif 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 aresexist, to the point that they intentionally harm female patients under certaincircumstances. This suggests that some womens experiences in medical powerrelations do indeed produce medical and embodied experiential knowledge thatcan enable resistance and influence a womans behavior in future, unrelatedmedical interactions. More specifically, Terris experience suggests that medical




power relations can produce an awareness of physician gender bias, and the factthat gendered medical bias can result in harmful outcomes.

Terri related that she no longer relies extensively on gynecologists to help hermanage her reproductive health. Obviously her embodied experience of malefi-cent medical treatment produced a significant change in how she views physiciansand their medical truth claims. She states: I see them [physicians] as skilledworkers who do the best that they can and if not, I move on. These examplesdemonstrate that patients, even those who may have highly medicalized under-standings of their bodies, do recognize and challenge medical power techniquesand privilege experiential knowledge (both medical and embodied) when theyencounter physicians who attempt to apply medical power. It also suggests thatwomen do not passively or unquestioningly accept expert medical interpret-ations of their bodily states and the associated interventions physicians deem to bemedically necessary or unnecessary. Similar to Jill, Terris experience demonstratesthat a patients recognition of medical power techniques, defined by patients asincorrect, demeaning or harmful, is likely to produce resistance in some form.

Similarly, Cindy related an experience in which a physician discounted herembodied experiential knowledge.

I had my last experience with a doctor when I had a severe bacterial infection . . . it was rightaround the time my mother was dying. He said, Oh, its stress. I said I cant breath, I said mychest 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 office I was sittingthere and I was so stressed because I did not feel good. I couldnt breath and I sat there andcried. I said, Well fine. I said, When I end up in the hospital youll be the first one I call after I call my lawyer!

Cindy was persistent in her attempts to compel her physician to accept her truthclaims 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 invalidateCindys embodied experiential knowledge. Eventually she resorted to legal truthclaims, that is, a threat of legal action, in order to compel her physician to provideappropriate medical treatment. Cindys efforts to direct her doctors actionssucceeded. Her doctor eventually acquiesced to her demands, although he resisteduntil after he verified 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 thatconvinced her doctor to perform what he considered to be unnecessary medicaltests. Cindy states:

He was trying to tell me there was nothing wrong with me. . . . I know my own body, I knowwhen 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 studywho encountered physicians who advanced interpretations of their bodily statesin direct contrast to the womens individual experiential knowledge of their bodies.Whether a physician interpreted a womans bodily state as abnormal when sheperceived it as normal, or as normal when a woman perceived it as abnormal, eachwoman objected to and resisted a physicians attempt to invalidate her embodiedexperiential knowledge. These types of medical interactions produced a gooddeal of anger in many of the women, as well as the use of particular strategies intheir 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 apower technique whereby some physicians assert medical truth claims that ratio-nalize and justify their medical expertise and authority to interpret normal andabnormal bodily states. Experiential embodied knowledge, from this perspective,is not likely to be considered legitimate/rational knowledge by medicine becauseit is not produced through accepted scientific methods. Nevertheless, many of thewomen in this study chose to challenge physicians who advanced medical inter-pretations of the womens bodily states that conflicted with the womens individ-ual medical and/or embodied experiential knowledge. However, those challengeswere typically met with firm 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, privilegesher experiential knowledge of her own body over medical expertise. Her threatto take legal action if her physician continued to refuse to treat her illness is apower technique in which Cindy demonstrated her capacity to use the combinedtruth claims of medical science and the law. Presumably any legal action takenby 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 herphysician could conceivably be legally sanctioned, a consequence with a host oframifications for his embodied subjectivity, as well as his medical career.

Within medical power relations competing medical truth claims in the formof a second medical opinion, combined with legal truth claims, can be used bypatients to produce a physician as a sanctioned subject. This possibility suggeststhat power, as Foucault suggested, is produced through various techniques ofpower/knowledge regimes. Such techniques are available for use by all partici-pants in power relations, depending on the extent to which individuals are awareof particular knowledges and willing to use them.

When Carol transitioned into menopause she started experiencing extremelyuncomfortable 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 menopauseand the benefits of HRT based on the experiences of other women with whom shehad close personal relationships. She understood there was medical controversysurrounding the use of HRT, but she was willing to risk possible negativeoutcomes to personally determine whether HRT could alleviate her discomfort.Her physicians truth claim, an attempt to de-medicalize Carols perspective onmenopause, was unsuccessful. Carols perspective was that her physician failedto enable her to enact appropriate gender behavior as she defined it. She resistedher physicians attempt to advance a view of femininity that normalized profusemenopausal sweating and defined his interpretation of her bodily state and thepossible effects of HRT as incorrect and potentially harmful. Rather than confronther doctor directly, Carol ended her association with him and located a morecompliant physician, one who concurred with her medicalized definition ofmenopause and willingly supplied a prescription for HRT. Carols experiencedemonstrates not only that some women are active participants in the medical-ization process, but that resistance to specific attempts to employ medical powertechniques may be produced by medical power itself, via the production of laymedical knowledge and medicalized subjectivities.

Kelly described a medical interaction in which a physician refused to prescribea particular drug, one that Kelly had used previously and knew to be effective inalleviating her symptoms. She talked about the message she felt the doctor wassending:

Shes telling me that I know nothing about my body, first of all, and I absolutely do, and theytreat you like youre stupid, you know. . . . So Im not going back to that doctor. . . . Ive hada lot of that through the years.

When in her mid-30s, Debra sought help from her general practitioner forpainful, heavy and irregular menstruation. According to her physician the etiologyof Debras severe menstrual problems, at age 35, was normal aging. She states:

When I first started telling him about my problems heavier and longer flow, pain he wouldbrush 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 definingher symptoms as normal, rather than problematic and amenable to medical inter-vention. Apparently, according to Debras physician, the normal aging of womensreproductive organs constitutes a pathological process. Debra initially acceptedthis medical interpretation of her bodily state but suffered increasingly problem-atic and painful menstruation for a number of years. As her physical conditionand quality of life declined, Debra began searching for answers to her gynecologic




health problems. She describes the medical interaction that compelled her toprivilege 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 andhe kind of turned on me and said, Why would you want to do that? Hes just going to do thesame thing I do here and tell you the same thing. At that very moment, I decided he was ajerk and was not going to have him do gynecologic exams anymore and didnt particularly likehim as a GP [general practitioner] either.

The truth claim advanced by Debras doctor was a contention of indisputablemedical expertise. Debra did not challenge her physician but neither did sheaccept his truth claim. Like the other women, she too eventually located a morecompliant physician. However, since she hadnt had children, Debra had to behighly directive in her medical care in order to convince her new physician toperform an elective hysterectomy.

Similar to the findings of Abel and Browner (1998) these womens experiencesof their bodies were influenced to varying degrees by the biomedical perspective.Nevertheless, the womens experiences of medical interactions and their layknowledge of medicine engendered knowledge that the women used to criticallyassess physicians interpretations of their bodily states and recommendations fortreatment. Similar to Davis (1988) findings, the women used this knowledge,along with embodied experiential knowledge, as a resource for resistance in theirpursuit of efficacious medical care. As Pat states:

By my age Ive been through enough times I can usually tell them whats wrong. . . . I guessyou could say I feel going to a doctor is like getting an educated guess. . . . I dont always agreewith them. I tell them when Im describing my symptoms to them, yes, I think I know whatsgoing 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 medicalcare, 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 avoidgoing 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 thesufficiency of her gendered embodiment. Based on her experiences of medical careand her embodied experiential knowledge, Pat selectively determines which healthproblems require medical intervention. When she pursues medical care, it is in adirective fashion. In choosing to restrict her exposure to medical attempts to applypower techniques, Pats agency is obvious because she is consciously privilegingher own knowledge of her body and limiting the extent to which medical powercan influence her embodied subjectivity.




Most of the women expressed in some manner that they knew their own bodiesand they typically chose to resist medical interpretations of doctors who treatedthem as if they did not. To varying degrees the women were experienced andknowledgeable medical consumers, many of whom sought medical knowledgebeyond that which they gained from individual physicians. For example, Debraand Alice searched for both medical and empathic experiential information onendometriosis. Becky also did extensive research on her health problem. Theknowledge each of these women gained from the often conflicting informationthey gathered eventually influenced each of them in their decisions to activelypursue an elective hysterectomy, despite experiences with a number of physicianswho 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 specific awareness of and resistance to gendered medical power relations.When Becky started experiencing severe gynecologic pain she sought medical carefrom her primary physician. After examining Becky, her physician recommendedshe consult with a gynecologist in order to pursue an elective hysterectomy. Beckyrelates 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 wantedto make sure. I went to another doctor and he told me I needed psychological help and that itwas all in my head. . . . I had a six-page pathology report on my uterus and I wanted to takeand shove it up his nose.

Beckys embodied experiential knowledge and a medical report demonstrating thepathology of her uterus was not enough to produce a compliant physician. Herphysician attempted to negate not only the validity of her embodied experientialknowledge, but that of the medical report as well. Apparently, according to thisdoctor, Becky was a young woman who was still in her prime childbearing years.Therefore, based on a stereotypically medicalized notion of appropriate femaleembodiment in which female bodies are considered only in terms of reproductivepotential, this physician assumed that only a mentally ill young woman wouldseek medical treatment that would eliminate her reproductive capacity. This is anexample of a specifically gendered medical power technique, namely the psycho-logization of womens health problems, whereby the etiology of a health problemis considered psychological, rather than physiological (Goudsmit, 1994). Beckysexperience demonstrates that a physicians gender perspective can influence inter-pretations of bodily states and the resulting treatment recommendations, but thata patients recognition of such power techniques, as in Beckys case, can producefirm resistance.




Becky indicated that this was one of a number of experiences with physiciansthat influenced her to believe that physicians generally discount what she knowsabout her body. Her attitude towards doctors demonstrates that Becky is highlycognizant of physicians attempts to use power techniques. Consequently, shetakes action to be directive of her health care. Becky, like most of the women inthis study, does not unquestioningly accept physicians interpretations of herbodily state, nor does she automatically agree to recommended medical treat-ments. She uses medical care selectively, pursues medical knowledge relevant toher specific health problems and critically assesses competing medical truth claimsin 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 goingto get solved to my satisfaction. Youre just blowing me over with a snow blower. Im veryindependent and I will be an active part of health, whether you let me or not. . . . Youre notgoing 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 goingto end up an argument and Im going to be walking out.

Marie met with similar resistance from her gynecologist when she requesteda 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 tohave 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 ifI 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 themajority of the womens problematic medical interactions. Most of the womenreported that their physicians, even in medical interactions the women defined asnot problematic, inquired about their reproductive status prior to recommend-ing an elective hysterectomy. Although this is an important concern because thesurgery eliminates a womans reproductive capacity, the physicians of women whowere younger or had not yet reproduced encouraged these women to undergoalternative procedures that would retain their capacity for reproduction. Thatthis was the case, even for the women who expressed no desire to have childrenand those who were younger but had already produced as many children as theydesired, demonstrates that specific treatment recommendations may be directedat certain groups of women because physicians medical truth claims are not basedon objective scientific knowledge, but are founded upon gendered beliefs aboutthe 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 thatconstruct 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 specifically because sheis a woman. She related the following experience:

Some of them are very, dont have no bedside manner, I mean, very rude, some of them arelike Why are you here? Well Im sick, thats why Im here. You know? Some of them arecondescending to you, you know, very, and my husband says he sees it a different way. Myhusband says that he likes the doctor. You know, the doctor and him get along. Well, hes aman. You know, this is how I feel, I mean I feel as a woman. For instance I took my daughterto this one, our regular physician, not the one Im going to now, but a different physician, nota gynecologist, but just a regular physician. She was having stomach pains really bad. . . . So Itook her to the doctor. Well he just gave her the third degree, Are you having sex? Are youtaking drugs? Are you doing this, are you doing that? She just says No, No, No. Areyou 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, youresitting here awfully cute and real, you know, Youre sitting there like youre just telling methe 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 andleft and I never went back. . . . I dont like being called a liar by anybody, much less a doctorand I was really aggravated, you know.

Terri, Pat, Becky, Marie and Janices experiences obviously demonstrate notonly awareness of a gender component in medical power relations, but recognitionthat physicians may advance traditional and/or demeaning interpretations ofappropriate gender embodiment disguised as objectively scientific medical diag-nosis and advice. Although Marie and Janice did not choose to directly challengetheir doctors, both resisted their respective physicians demeaning interpretationsof female gendered embodiment by seeking out more compliant and less sexistphysicians. Such behavior can be understood as indirect or passive resistance, aconcept that captures the circumvention of direct and possibly contentiousinteractions, but which results in a desired outcome nevertheless. Additionally,both women shared their experiences with other women, thereby contributingto other womens empathic knowledge and the resources they may draw uponwithin medical power relations.

Paula indicated that she too has had serious problems with physicians in thepast. She stated that previous experiences with certain physicians made her feelthat 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 produceresistance in particular types of medical interactions. The women used a varietyof knowledge, particularly embodied experiential knowledge, to ascertain the




accuracy of physicians interpretations of their bodily states. When the womendetermined a physicians interpretation was inaccurate, or that a treatment recom-mendation was insufficient or undesirable, they commonly resisted by advancingcounter 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 medicalpower techniques utilized an indirect strategy to obtain the type of medical carethey desired.

The women also recognized the gender bias of certain physician truth claims,advanced in attempts to invalidate the womens knowledge. It appears thatgendered medical knowledge that defines womens health problems as having apsychological rather than physiological etiology influences not only how physi-cians conceptualize normal and abnormal female bodies, but womens decisionsto 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 relationshipswith resistant doctors and initiating relationships with physicians who validatedthe womens experiential knowledge and provided medical care and treatment ina manner and of the type the women desired.

A womans attempts to produce a compliant physician, partly through herresistance to medical power techniques, was a direct result of her efforts to effi-caciously produce a particularly configured embodiment with the assistance ofmedical care. Failure to produce a compliant physician also meant failure toproduce a desired bodily state, therefore the women were motivated to remainwithin medical power relations and locate compliant physicians. The data do notprovide the type of information that enables an assessment of the extent orconsistency of the womens resistance, but they do demonstrate that medicalpower relations do produce womens resistance to particular medical power tech-niques, particularly those that are gendered. Physicians who attempt to definewomens health problems as psychological rather than physiological demonstratea type of power technique that is rooted in gender-biased medical knowledge.Such knowledge defines female embodiment in highly prejudicial, inaccurate andultimately harmful terms. However, the very nature of these types of medicaltruth claims helped to produce particularly firm 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 experiencesof the women in this study demonstrate that some physicians use particularmedical power techniques specifically because a patient is female. This suggeststhat although medical power relations may typically function relationally, with




participants advancing and resisting truth claims in attempts to achieve a desiredoutcome through producing an alignment between the participants, gender-biased medical knowledge can influence the particular types of power techniquesemployed. However, women patients, like physicians, may also use genderedknowledge in their efforts to prevail in power relations.

Theoretical Implications of the Study

These specific experiences of medical power relations establish womens capacitiesto act as full participants in medical power relations. However, the fact that thesespecific women are capable of resistance does not mean that all women are equallycapable or likely to resist. It also does not mean that women who do resistmedical power necessarily do so consistently. Additionally, the possibility existsthat the women in this study failed to identify and respond to other types of lessobvious or egregious medical power techniques. Consequently it is not possibleto specify the variety of circumstances under which women may be likely to resistmedical power.

For the women in this study the experience of health problems, particularlygynecologic pain and problematic menstruation, and the attending difficultiesin achieving specific gender norms, produced problematic embodiment. Conse-quently, both bodily states and social interaction difficulties concomitantly influ-enced the womens decisions to seek medical intervention in efforts to normalizetheir embodiment. Although the womens embodied subjectivities were influencedto varying degrees by gendered biomedical conceptions of normal and abnormalbodies (in particular the determination of bodily states that require or benefitfrom medical care) the womens embodiment was not produced exclusivelythrough medical power relations. The women did not unquestioningly acceptgendered biomedical conceptions of their specific bodily states. In fact, thewomen demonstrated through the manner in which they resisted medical powertechniques 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 oftheir embodied subjectivities. If this were not the case it is unlikely that thewomen would have been able to resist expert medical interpretations of theirbodily states since their understanding of their bodies and the possibilities forachieving particular configurations of embodiment would be exclusively shapedby 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 (bothsexual and non-sexual) that produce physical sensations and emotions that canresult in embodied and empathic experiential knowledge. Physical and emotionalexperiences may, but do not necessarily, prompt cognitive or rational consider-ation of such experiences. For example, breastfeeding ones infant is a physical andemotional experience that produces embodied experiential knowledge and mayprompt cognitive reflection, but can influence a mothers embodied subjectivity(negatively or positively) (Schmied and Lupton, 2001) without any mental orrational consideration. Therefore, since embodied experiential knowledge is notnecessarily based on knowledge produced through power/knowledge regimes,embodied subjectivity cannot be defined as exclusively the product of socialinscription. This suggests that embodied subjectivities are shaped through complexprocesses in which lived experiencing bodies are also objects of social inscrip-tion, but that social inscription may be resisted through embodied experientialknowledge.

Access to a variety of knowledges, including embodied experiential knowledge,not only influences the possibilities for embodied subjectivity, but constitutes aresource that may be employed in attempts to resist applications of medicalpower. However, knowledge resources do not always or automatically produceresistance in medical interactions. Resistance by both patients and physicians isproduced within interactions in which participants desires to achieve specificoutcomes (achievements dependent on participation in medical interactions) arein some way oppositional. Within medical interactions defined by the women inthis study as problematic, the women and their physicians held opposing viewsof the validity of various truth claims and what actually constitutes normalfemale bodily states and appropriate gender embodiment. However, the womengenerally reported that they did not typically experience medical interactions asproblematic. Although the data cannot enable a determination of whether thismay be a function of womens lack of knowledge resources, that the womenresisted in particular medical interactions but not in most others suggests thatmedical 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 influential in the womens decisions toresist. That this knowledge was at least partly engendered by their experienceswith medical power/knowledge, and enabled the women to resist medical power,




suggests, as Foucault contends, that power/knowledge regimes produce bodiesthat are disciplined and resistant.

The manner in which the women chose to resist physician attempts to applymedical power frequently included direct challenges to medical truth claims, butthis was not always the case. Some of the women avoided confrontational medicalinteractions altogether and, instead, chose to end their relationships with non-compliant physicians without communicating their opposition. Even if this typeof behavior may be understood as being influenced by traditional gender normsthat define feminine behavior as appropriately passive, it did not prevent thesewomen from resisting, albeit in a more indirect fashion. Such behavior may beunderstood as passive resistance in that an individual acts in a manner thatbypasses direct confrontation but, nevertheless, continues to act in a manner thatachieves desired outcomes. That apparently passive behavior can constitute effec-tive resistance highlights the problematic way in which resistance is mostcommonly understood. The notion that the act of resisting must entail directcommunication or confrontation is based on highly masculinist assumptions andobscures recognition of acts of resistance that are not stereotypically masculinein nature.

Although the differing ways individual women chose to resist may have beeninfluenced by gender norms, adherence to gender norms does not appear to haveinfluenced the womens capacities to resist. Failure to produce a compliant physi-cian did not prevent the women from maneuvering within the broader field ofmedical power relations in order to achieve desired configurations of embodi-ment. By locating compliant physicians the women prevailed in their efforts toachieve particular configurations of embodiment through medical care. Therefore,women who eventually produce the types of medical interactions and outcomesthey desire can be understood as ultimately prevailing in medical power relations.

The manner in which women choose to resist medical power also includesavoidance of medical care. Like Pat, other women may avoid routine medicalexams precisely because they have experienced medical power relations as attemptsto discipline their bodies. Therefore, it is reasonable to assume that women withproblematic embodied subjectivities choose to forego medical management inorder 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 accommodatethemselves to their health problems at least until such a time that a womandetermines that the costs of medical care no longer outweigh the benefits.

This study supports the fact that women can prevail in medical power relationsthrough their use of particular power techniques. However, the data cannot




enable a determination of whether resistance or directive behavior in medicalinteractions actually produces more efficacious health outcomes. Nevertheless,the womens experiences do suggest that they were more satisfied with health out-comes produced through medical interactions in which physicians acknowledgeand act upon the validity of the womens experiential knowledge. Additionally,in comparison to the average female patient it is possible these particular womenmay be more motivated to be directive of their medical care. The womens experi-ences suggest that they believe that the most efficacious medical care results froma relationship with a physician in which physician and patient are equal partners.Additionally, their capacity to resist may have been influenced by the degree towhich the women believed the outcomes of certain medical interactions couldsignificantly impact their health and well-being. The fact that most visits to onesdoctor are for minor health problems may partly explain why the women depictedthe majority of their medical interactions as non-problematic. In attempting toaddress minor health problems through medical care, physician error is not aslikely to produce highly consequential health outcomes. Consequently, under suchcircumstances, the women may have considered resistance unnecessary. Theymay 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, womenshealth care needs, and gendered embodiment, the findings of this study suggestthat although biomedicine may exert influence on how women understand andattempt to address problematic embodied subjectivities, women do not enter intomedical interactions as deterministically medicalized subjects. Rather, subjectivi-ties are produced through a variety of knowledges, including embodied andsubjugated knowledges. The extent to which women accept medical truth claimsas simply accurate interpretations of reality is variable, with some women beinghighly critical and directive of their health care while other women are not.

The demonstration of the embodied subjective agency of the women in thisstudy suggests women are full participants in medical power relations. Thewomens capacity to prevail in medical power relations indicates that the processof medicalization cannot be accurately understood as a top-down process, orone that functions as merely an external imposition on women. Women activelypursue medical care to achieve particular configurations of embodiment and theirresistance has, over time, influenced changes in the provision of medical careand medical policy. For example, challenges to biomedicines medical hegemonyfrom the womens health movement and feminist writings and scholarship haveresulted in numerous changes in organized medicine. These include more womentaking 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 powerrelations that is produced by both patients and physicians (Riessman, 1983). Inthis process women seek to use the technological power of medicine to achievea particular configuration of embodiment, albeit configurations that are ofteninfluenced by gender expectations and norms. Although women seek efficaciousmedical care, they do not necessarily or perhaps even typically do so in a passiveand compliant manner. After all, the non-compliant patient is well known in themedical sociology literature. In the process of medicalization physicians seekto produce medically disciplined bodies, based on medical knowledge that isfrequently gender-biased, in their manifest endeavors to produce normalizationor health. However, in the process of medicalization, gender may often latentlyinfluence both patients and physicians in terms of their desires for, or beliefsabout, normative embodiment.

Gendered knowledge may be employed in attempts to produce compliance inmedical power relations, but it would appear that attempts to produce an uncon-tested medical reality through the use of gendered power techniques is actuallycounter-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 ofefficacious normalization of bodies, as well as its assumption that womensreproductive organs are inherently pathological (Martin, 1987). However, thatproblematic embodiment is also produced through direct negotiation in patientphysician power relations relations that constitute corporeal and incorporealevents in which resistance is not uncommon suggests that medicalization, as anaspect of medical power relations, is also relational and productive rather thanmerely repressive.

Notes1. 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), andKrieger 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 scientific

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 definitions are phrased in terms of pregnant womens experiences, Islightly alter Abel and Browners definitions 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 medicalstudents performed pelvic exams on anesthetized female patients without the patients consent orknowledge.

ReferencesAbel, E.K. and C.H. Browner (1998) Selective Compliance with Biomedical Authority and the Uses

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Auerbach, J.D. and A.E. Figert (1995) Womens Health Research: Public Policy and Sociology,Journal of Health and Social Behavior Extra Issue: 11531.

Becker, G. and R.D. Nachtigall (1992) Eager for Medicalisation: The Social Production of Infertilityas Disease, Sociology of Health and Illness 14(4): 5671.

Birke, L. (1999) Feminism and the Biological Body. Edinburgh: Edinburgh University Press.Bordo, S. (1999) The Male Body: A New Look at Men in Public and Private. New York: Farrar, Straus

and Giroux.Breslau, E.S. (2003) The Continuum: Somatic Distress to Medicalization in Women with Breast

Cancer, pp. 13180 in M. Texler Segal, V. Demos and J. Jacobs Kronenfeld (eds) Gender Perspec-tives on Health and Medicine, vol. 7. Amsterdam: Elsevier JAI.

Broom, D.H. and R.V. Woodward (1996) Medicalisation Reconsidered: Towards a CollaborativeApproach to Care, Sociology of Health and Illness 18: 35778.

Bruns, G. (2005) Foucaults Modernism, pp. 34878 in G. Gutting (ed.) The Cambridge Companionto Foucault, 2nd edn. New York: Cambridge University Press.

Butler, J. (1990) Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge.Colebrook, C. (2000) Incorporeality: The Ghostly Body of Metaphysics, Body & Society 6(2): 2544.Corea, G. (1985) The Mother Machine: Reproductive Technologies from Artificial Insemination to

Artificial Wombs. New York: Harper and Row.Crossley, N. (1996) Body-Subject/Body-Power: Agency, Inscription and Control in Foucault and

Merleau-Ponty, Body & Society 2(2): 99116.Daly, M. (1990) Gyn/Ecology: The Metaethics of Radical Feminism. Boston, MA: Beacon Press.Davis, K. (1988) Power Under the Microscope. Providence, RI: Foris Publications.Denn

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