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01-11-2013 | Scientific Contribution

Through the looking glass: good looks and dignity in care

Author: Jeannette Pols

Published in: Medicine, Health Care and Philosophy | Issue 4/2013

Abstract

There are roughly two meanings attached to the concept of dignity: humanitas and dignitas. Humanitas refers to ethical and juridical notions of equality, autonomy and freedom. Much less understood is the meaning of dignitas, which this paper develops as peoples’ engagement with aesthetic values and genres, and hence with differences between people. Departing from a critical reading of Georgio Agamben’s notion of ‘bare life’, I will analyze a case where aesthetics are quite literally at stake: women who lost their hair due to cancer treatment. The analysis shows a complicated interplay between varying evaluations of female baldness by the self and others, mediated by (often strongly negative) cultural imaginaries, and aesthetic genres depicting conventional ways of ‘looking good’. The paper concludes by arguing for a reconnection of the two notions of dignity, and for a rehabilitation of aesthetics in daily life and care as fundamental values for organizing our societies.

Qualitative studies of dignity in medicine tend to analyse dignity by listing its components, or the elements of dignity mentioned in a particular care situation (see e.g. Chochinov et al. 2002; Jacobson 2009; Baillie 2007). Philosophers look for theoretical coherence, which they often find by focusing on dignity in relation to human rights (see e.g. McCrudden 2008; Hendriks and Kaulingfreks 2011). Most often Cicero’s reference to dignitas as a difference in social status forms the reason for keeping dignitas at a distance: the fear is to legitimize inequalities and first and second class citizens. See Pols (2013a, b).

For example, Hilhorst (2002), Dekkers (1999) and Düwell (1999) discuss the beauty of the body, and Maio (1999) the importance of good manners for doctors.

This contrasts aesthetics with an ethics of justice or principles. In pre-modern ethics of the good life ethics and aesthetics are much more intertwined. The ethics of the good life life do, however, not reflect on society, but on the behaviour of individuals, see e.g. Nussbaum (2001), Foucault (1990). Feminist philosophy has contested these positions by looking for different ways to conceptualise differences and (gendered) aesthetics in political philosophy (Landess 1988).

I suspect that the loss of a notion of aesthetics in everyday life, has also made the way for philosophers and ethicists to do empirical research more difficult to find.

I use the term social imaginaries to point to singular or rare imgages or events that do not depict a conventions (ordered) aesthetic, but disturb these, either as creative suggestions for new aestheticse, or as examples of a threat to any form of aesthetics (anti-aesthetics).

The forcefeeding of hungerstriking prisoners of Guantanamo Bay, Agamben argues, shows that the last discretion these people had, i.e. to die from starvation, is taken from them, They live in a ‘state of exception’ where they cannot be sacrificed (they are outside the law), but they are not allowed to die, a terrible variety on Agamben’s homo sacer (Agamben 2003).

Interestingly, Agamben himself (2003) develops a completely different line of thought, which I understand as a development of a notion of society as a ‘society without characteristics’, or, as he calls it: a ‘common community’, or a ‘community without identity’ where nobody can be banned because all fit in. Rather than ‘dressing up’ the notion of individuality, as I attempt here, Agamben defines a community without specifications which cannot by its norms exclude any person. For ways to develop this thinking in a care setting: see Ceci et al. (2013).

Using the verb ‘doing disease’ rather than being ill (Mol 2002) is a bit awkward in everyday language use, but it avoides assigning an objective state of ‘being’ to medial takes on discovering and treating disease, whereas the other categories (feeling and looking ill) are denied such ontological realities.

The modern way of ‘doing all the tests’ in one day saves patients a scary time of waiting and not knowing, but the speed in which their fate enrolls is very hard for them to keep up with. Most women talk about this time as an emotional whirlwind without them being able to make sense of it in any way.

More tricky is the relation of optimistic feelings with the state of the tumor, that is critized by people with cancer as leading to a ‘terror of positive thinking’.

Female hair needs to be hidden from the other sex under a scarf in many cultures, strongly linking hair to sexuality, shame and feminine identity. It is not known how men perceive this. Baldness is acceptable for men, but when all body hair is gone, this may be different.

Mann (1998) describes dignity violations as not being seen, being seen as a member of a group, violation of personal space, and humiliation by being separated from a group or social norm. Apart from the third, these match the description of what the bald women experience women perfectly (see also Chochinov 2007). Note that the visual metaphors are to be taken literally in my analysis, and metaphorically in Mann’s—opening up the question how other senses then vision might influence dignitas.

In a Dutch movie featuring a beautiful woman with cancer (Oerlemans 2009) one of the most dramatic scenes is when the hair of the woman is being cut off, effectfully showing that she is being ‘de-humanized’. This has a profound dramatic effect, but is quite different from the way my informants described this situation.

Note that this image of the concentration camp leaves no room for any form of dignitas, whereas survivors of concentration camps did keep up forms of dignitas in order to survive (see the works of Primo Levi). This means that people may posess dignitas even if they are being denied humanitas. Think also of music and dance forms that were developed by groups of people who were kept as slaves.

This may also relate to collective Dutch imaginaries referring to the treatment of female ‘collaborators’, women who engaged in love affairs with German soldiers occupying the Netherlands during WWII. After the war, the heads of these women were shaven publicly, sometimes painted with aggressive paint (Diederichs 2006). This was a form of public execution and humiliation. This imaginary was not referred to by my informants, but may have had an influence. It is a strong enactment of social humiliation and a clear attack on dignity.

Turning something that is deemed to be ugly in one place into something likeable is possible, but does imply a resistance to the aesthetic genres that condemn the proposed look, like ‘punk’ or ‘flower power’.

The method of empirical ethics to morally evaluate these situations would be to compare the aesthetics of the different practices and weighing the consequences of these practices for different individuals (see Pols 2013b).

Interestingly, there are other claimants to this kind of dignity: animals (Singer 1975; Foer 2009), which would also bring up the question why we should not include insects, plants or even bacteria. It would be an interesting thought experiment to imagine what dignitas, and hence sociality, would consist of for a cow or a tulip, and what life forms are feasible and valuable to these subjects newly dressed up with dignity.

Chochinov (2002) seems to oppose palliative care concerned with quality of life to cure as concerned with survival. The intimate relation between humanitas and dignitas, however, links death and survival to care situations –one may die with dignity, or live without it. Cure and (palliative) care are no separate domains.

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Title: Through the looking glass: good looks and dignity in care
Author: Jeannette Pols
Publication date: 01-11-2013
Publisher: Springer Netherlands
Published in: Medicine, Health Care and Philosophy / Issue 4/2013
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-013-9483-3

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Through the looking glass: good looks and dignity in care

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