Though this isn’t its most vernacular meaning, “embodiment” has a second life as a term of art in a marginal subdiscipline of epidemiology, so-called “social” epidemiology. Depending on the day and my mood, I could articulate social epidemiology as the heir to some kind of real public health, before molecular medicine got in the way, or as the part of epidemiology that traffics the most cynically and shamefully in trauma questionnaires and DEI ambulance-chasing. It is supposed to be, I guess, the part of epidemiology that deals with social conditions and gives them primacy over individual factors like genotype or health behaviors. Social conditions are a hugely important aspect of population health and this is (or at least can be) a hugely powerful line of inquiry — look into any public health problem that is formulated as such (to be a public health problem is to be a technical problem amenable to technical manipulation) and there is a sense of vertigo as one realizes how deeply the roots of the technical problem reach into social organization and history. The concept of “embodiment” (in overwrought language about how “bodies tell stories”) is basically The Body Keeps the Score for the population health scientist — we in-corp-orate, quite literally, the social conditions in which we live. I, for example, embody the thick fug of particulate air pollution constantly lying over my neighborhood, which is a historically redlined one… you get the picture.
But, I have soured a little bit on social epidemiology in recent years. One reason is pretty obvious — this shit is not original. It might be compelling, but it’s not original. It might have been original for Rudolf Virchow in 1848, but it’s absolutely no longer in 2024, though people make interminable, monotonously prolific careers out of announcing over and over again that social conditions matter. Yes, I am subtweeting Nancy Krieger, the person who coined the term “embodiment” in its epidemiological application. I used to really love and admire Krieger’s work, but am coming to view it as quite unsatisfying. This is connected to another of my objections to social epidemiology as such right now, that there’s not really much “there” there. True that everything is connected to everything else. True that we are not isolated laboratory subjects. So what? What are we supposed to do with this information? How to actually link the insights derived from thinking about epidemiology through embodiment with actual practice of public health? It’s not clear, and the practice of social epidemiology seems to be little more than an endless iteration and explication of a familiar parade of social ills: capitalism, racism, environmental destruction, and so on. (Wouldn’t you know? All bad for your health!)
The last reason I will mention and the one I want to focus on is: the very existence of social epidemiology effects the same artificial severance of living individuals from social context that social epidemiology is (at least ostensibly) meant to mend. Are history and “social conditions” external to the human beings that constitute them? Is there any place for experience in public health? A very familiar reference point for me is Lewontin’s Gene, Environment, Organism — tl;dr, all three actively constitute and “make” each other, all the time. A very new and unfamiliar reference point for thinking about this stuff (for me) is Maurice Merleau-Ponty’s Phenomenology of Perception.
Merleau-Ponty makes use of embodiment in a different sense and to a different end, but one that I think is generative for thinking about stale public health concepts. His concern was a philosophical treatment of perception, and as far as I understand it, in Phenomenology of Perception he is trying to argue against both “empiricist” notions of perception (perception is a causal process of sense-experience or stimulus-response, for example, light of a certain wavelength striking certain receptors in my eyes and giving my brain the perception of the color red; unidirectional influence of world on mind) and “intellectualist” notions (my mind synthesizes different objects in the world into a perception of the color red; unidirectional influence of mind on world) in favor of a secret third thing, something like gestalt theory. From the Stanford Encyclopedia of Philosophy entry:
“Merleau-Ponty argues that the basic level of perceptual experience is the gestalt, the meaningful whole of figure against ground, and that the indeterminate and contextual aspects of the perceived world are positive phenomenon that cannot be eliminated from a complete account.”
This is a dilettantish treatment, because I’m no expert on this. What is really interesting to me about it is the emphasis Merleau-Ponty places on the body, not as half of the Cartesian body/mind dualism but as an active, sensing, perceiving organism, a kind of porous living interface with other beings, living and not. Put another way, you literally are your body. I’m most interested in the crude distinction between the “objective” and “lived” body. The lived body is the body of experience (how I experience a piece of art or music) or the body of habit (the body that knows how to do all the operations to make a cup of coffee without thinking too much about it). The objective body is the biometric body of statistics and public health: my height, weight, blood pressure, eye color, and so on.
Embodiment per Merleau-Ponty is obviously very different from Krieger’s concept of embodiment, which is really kind of a one-way deterministic causal process. In Krieger, social forces and processes become “embodied” in us. I completely understand the impulse to bring something of the social into social epidemiology, but embodiment is a metaphor with a one-way causal direction that posits people as passive receptacles of cumulated social exposures. Social forces are active; human bodies absorb (incorporate) the complex interplay of those forces. In terms of interpretation, we are still at the level of the objective body. The research program associated with this cannot escape this paradigm of the objective body: we’ll look at, say, women living in richer or poorer zip codes, tabulate the average birth weights of the babies they have in each zip code, and compare — are the birth weights higher (better) in the richer zip codes? You bet! We can theorize that the poorer babies are born lighter for any number of reasons, including because they and their mothers “embodied” these various, differential social exposures.
This really does, still, reduce people to objects. Where in public health, even social epidemiology, do sense or experience go? They go into (less commonly) psychometric questionnaires about stressful life experiences or (more commonly) into biomarkers of inflammation. Every conceivable kind of experience is poured into a big funnel, shaken up, and precipitated out as the nine or so blood biomarkers of the “allostatic load” construct. In all epidemiology, social or not, the mind and the experience of the world are either absent or mechanistically abstracted and reduced to a “mediator” of some kind of biological causal process.
Is any kind of understanding of the mind needed for public health? I’m genuinely not sure. Public health is an empiricist science, which means an objectifying science. It is easy to measure people or groups as objects with objective properties, to view people as organisms per R.D. Laing. There is such a thing as psychiatric epidemiology, but in my experience this is not concerned with the mind or with the experience of reality in the slightest, but rather with measuring (again, with a Likert scale-type questionnaire) psychosocial stressors and symptoms that are diagnostically or clinically relevant and correlating them with some type of aggregate health behavior or outcome.
I don’t know what to do with any of this and have kind of thought my way into a corner. I sort of feel like if public health were to concern itself with this stuff, it would no longer be public health — public health is biopolitical, it’s about managing the health of the population at the aggregate level. Then again, for a discipline that is so mechanistic, it’s very vague about what the actual mechanisms are — not only by which social forces affect our objective physiological properties, but by which we also actively participate in shaping (dare I say… embodying or, to use a Krieger word, manifesting) social forces. It seems like that kind of thing ought to be important, at least more important than endlessly cataloguing and taxonomizing “social exposures” as discrete experiences.
There’s another line of thinking from some of this reading that I want to follow up in another post; I was hoping to have it done for 9/11 but that is unlikely, so stay tuned. Till next time!