Until the 1980s, newborn babies who needed surgery went under the knife with no pain medication or anesthesia. Doctors assumed that they were too young to feel pain – or at least to feel pain the way an adult does, which, for the professionals, was the only way that counted. One 1943 study helped shape this assumption. Myrtle McGraw had pricked resting, swaddled infants with a pin and judged the children’s response to be minimal. She had pricked them, and they did not bleed.

When the babies cried and screamed as a surgeon cut into them, their reaction was dismissed as reflex, not a real experience. The babies could speak for themselves at great volume, but not in a way their doctors were willing or able to listen to.

The vulnerability of our bodies is part of what binds us together into a community. In Jesus’ parable of the Good Samaritan, the story begins with the traveler’s suffering when he is beaten and robbed. His need is what calls neighborliness out of the Good Samaritan, who binds the traveler’s wounds, takes him to a refuge, and ensures his continued care.

This story is Christ’s answer to an expert in the law, who asks Jesus to clarify the limits of the Great Commandment. God calls me to love my neighbor as myself, but who, exactly, counts as my neighbor? And, left as the subtext, who doesn’t count? Whom am I allowed to not love?

The surgeons entrusted with tiny, vulnerable patients managed to pass by the babies’ need. They hurried about their lifesaving business without seeing people in their patients. There should be nothing more unignorable than a baby’s shriek, but, when we don’t believe in the dignity of the person, we find ways of denying her body and her pain.

In abortion facilities, the bodies of babies are painstakingly reassembled in “products of conception” rooms. The doctors must verify that the child is whole, before the body is thrown away as medical waste. A single forgotten limb left in the mother’s womb is an invitation to sepsis and rot. A body ignored is corrosive.

Our bodies are a brute fact. The immediacy of a sprained ankle is an aching interruption to our routines, our sleep, our thoughts. Chronic fatigue poses a constant question: If I do this, how will I pay for it later? But to get help from others, we have to find a way to cry out so that our neighbor will hear us.

Babies are too young to be able to match the expectations of the people who care for them. They are starkly honest. But, as we grow up, only some bodies will be heard and recognized by people in power. Women, people of color, the disabled all find themselves needing to translate their experience in order to be heard.

Making our internal experience externally legible may mean leaving out details, playing up to stereotypes, or otherwise matching what our neighbor expects to hear, whether or not it matches what we need to say.

Legibility, in this sense, is a concept popularized by James C. Scott in his 1998 book Seeing Like a State. He describes legibility as a central problem in statecraft – the larger the state, the more effort it must put into being able to standardize its people so that they can be “seen” by the state apparatus.1 Legibility is why states assign last names to people who previously lacked them or addresses to locations that were described solely by reference to local landmarks.

Scott is suspicious of projects to render people and places legible, finding that they often oversimplify and flatten natural relationships. A planned, gridded forest may suffer soil collapse due to the lack of complementary plants which were treated as irrelevant weeds. Scott recommends cultivating a degree of illegibility, in order to remain more independent of state programs and oversight.

Unchosen illegibility, however, means being overlooked. Women are not more free because they are less thought of. In Invisible Women: Exposing Data Bias in a World Designed for Men (2019), Caroline Criado-Perez assembles a long list of places women’s bodies and women’s needs are ignored. Bricks are sized to be easily held and handled by a man’s larger hand. Drug dosages are calibrated to men’s larger bodies, leaving women overmedicated and struggling with side effects. Even car voice assistants (with their deferential female speech patterns) are tuned to hear male voices. Criado-Perez coaches her own mother to lower her voice into a male register in order to be heard by her car’s computer.2

We are made in the image of God, and some part of him is denied when the goodness of the people he has made is denied.

When confronted with this problem, one auto parts executive suggested that “many issues with women’s voices could be fixed if female drivers were willing to sit through lengthy training,” as Autoblog put it in 2011. In this view, the onus is on women to change for the technology, rather than the other way around.

Altering your voice might seem a trivial example, but this is the least of the ways society pressures women to alter themselves to meet others’ expectations. From unrealistic beauty norms to unnatural footwear, the ways in which women are asked to change their bodies to fit expectations can seem unending. For those with the time, money, and genes to pursue it successfully, this strategy can be effective, but is also exhausting. It requires us to be untruthful, or at least only partially truthful about who we are. We are made in the image of God, and some part of him is denied when the goodness of the people he has made is denied.

Suffering Correctly

In his provocative 2010 book, Crazy Like Us: The Globalization of the American Psyche, Ethan Watters argues that some mental illnesses take their shape from the expectations of the culture. Anorexia, schizophrenia, and post-traumatic stress disorder are more like grief than like a physical ailment such as gangrene. All people grieve, but the form that mourning takes varies by culture. In the United States, we often wear black to a funeral, while in China, the funereal color is white. Jews traditionally rend their garments while sitting shiva, while Victorians had a half-life to their mourning clothes, fading from black to grey to mauve. The clothes make our sorrow legible to our community.

Watters argues that certain disorders are a way of giving voice to anguish in the language it will be heard in. His aim is not to explain away mental illness – the disorder gives voice to something real – but he believes we teach each other how to suffer, just as a community creates norms around mourning. And in an increasingly globalized world, America has, in the guise of aid, been homogenizing the world’s experience of pain, flattening foreign bodies to make them legible to our doctors.

In one of his examples, American medical expectations touch off an anorexia epidemic in Hong Kong. A well-publicized case of a fourteen-year-old who starved herself to death in 1994 prompted a comprehensive program to raise awareness of the disease, and succeeded too well. Dr. Sing Lee, a specialist in eating disorders, had previously seen two to three anorexic patients a year, but, after the publicity blitz, he began receiving that many referrals a week.

His patients’ experience of their disease had changed as its prevalence increased. Initially, the rare anorexics he saw didn’t know there was a name for their condition. They told him that they couldn’t eat, not that they feared being fat. They could accurately describe and draw their bodies, instead of holding on to a distorted self-image. But as the disease was publicized, the women he saw fit the Diagnostic and Statistical Manual of Mental Disorders’ criteria more and more closely.

It’s no coincidence Watters saw this dynamic play out in anorexia, which is most prevalent among women. Women are particularly vulnerable to pressure to make their ailments conform to expectations. Watters cites Canadian scholar Edward Shorter’s theory for this pressure to conform. As Watters explains it, “People at a given moment in history in need of expressing their psychological suffering have a limited number of symptoms to choose from – a ‘symptom pool.’”3 Without actively intending it, people in distress rely on our expectations of illness to find a way of being recognized.

My own middle-school health classes veered close to this approach. With the best of intentions, the teachers gravely instructed us that many girls experienced disordered eating, that high-achieving girls might be drawn to calorie-counting as one more thing to excel at, that it could be an exhilarating way of experiencing control if you lacked it elsewhere. It became a tutorial in how to suffer correctly.

Without actively intending it, people in distress rely on our expectations of illness to find a way of being recognized.

Today, a girl who experiences trauma or distress as her body changes, her desires stir, and men sexualize and harass her is more likely to be told that one option from the symptom pool is to not be a woman. In those same health classes, she may be told that discomfort with her changing body is evidence she might belong in a different body. In Prospect, Emma Hartley considers the flip in gender dysphoria referrals from 75 percent male to 70 percent female in less than a decade and explores what pressures and prejudices may contribute to this trend: “This is a story that needs to be understood at the level of society, not just the individual psyche.”

This theory of gender is just an update and expansion of what women have been hearing for years – that our bodies and our selves are the problem; that when there is a mismatch between us and our society’s expectations, it is we who have to change.

Women routinely alter their bodies to fit these expectations. They dye their hair and receive cosmetic injections in order to avoid the appearance of aging. Women take contraceptive pills to avoid the natural hormonal cycle, and the risk of pregnancy, instead existing in a chemical state corresponding to perpetual pregnancy (minus the baby). Over one in five American women over forty report that they took antidepressants in the last thirty days, more than double the rate of American men. To fit the space allowed, women change their appearance, their bodies, their feelings.

Escaping Expressive Individualism

There is one further demand placed on women and others who don’t fit the “standard” body. They are asked to accept this burden of reshaping themselves as an opportunity for empowerment and self-expression.

In What It Means to Be Human: The Case for the Body in Public Bioethics (2020), O. Carter Snead traces changes in how we view the body, particularly in bioethics. He sees a conflict between two claims about the source of human dignity: is our worth rooted in our existence as living bodies, or as disembodied wills?

If we are primarily wills, the human person is valuable because of his or her ability to choose. Snead refers to this ideology as “expressive individualism.” Former Supreme Court Justice Anthony Kennedy’s decision in Planned Parenthood v. Casey was rooted in this understanding of human worth. In Kennedy’s sweeping declaration, “At the heart of liberty is the right to define one’s own concept of existence, of meaning, of the universe, and of the mystery of human life.”4

This perspective promotes a kind of navel-gazing. “Flourishing is achieved by turning inward to interrogate the self’s own deepest sentiments to discern the wholly unique and original truths about its purpose and destiny,” as Snead puts it. “The truth about the self is thus not determined externally, and sometimes must be pursued counter-culturally, over and above the mores of one’s community.”

The model of expressive individualism sanctifies nearly any choice. In this framework, abortion is liberation for both mother and child. The Planned Parenthood slogan “Every child a wanted child” confers a peculiar dignity on survivors of a pro-choice world – unlike their aborted brothers and sisters, they were chosen.

This emphasis on choice puts a heavy burden on pregnant women. The unplanned, unasked-for child is cast as a failure, along with his or her mother. In an essay for The Atlantic, Sarah Zhang counted the cost of Denmark’s universal screening for Down syndrome. Having more information made some families feel worse than if they were being kept in the dark.

The introduction of a choice reshapes the terrain on which we all stand. To opt out of testing is to become someone who chose to opt out. To test and end a pregnancy because of Down syndrome is to become someone who chose not to have a child with a disability. To test and continue the pregnancy after a Down syndrome diagnosis is to become someone who chose to have a child with a disability. Each choice puts you behind one demarcating line or another.

When their child was a choice, for parents to have or abort a child with a disability became part of their expressive identity. If their child had been disabled after birth in an accident, the parents would not feel that everyone who knew them looked at their child’s condition as a choice that the parents had made. It would be simply who their child was.

Snead sees an alternative to expressive individualism – valuing the givenness of our bodies as they are, in all their vulnerability and weakness. In our fragility, he sees proof that we are relational beings.

Because human beings live and negotiate the world as bodies, they are necessarily subject to vulnerability, dependence, and finitude common to all living embodied beings, with all of the attendant challenges and gifts that follow.… Given the way human beings come into the world, from the beginning they depend on the beneficence and support of others for their very lives.5

Women are bound more tightly to this truth, even when society asks them to deny it. Not every woman will bear a child, but every woman lives with an awareness of her potential for new life, whether she experiences it as a gift or a threat. Even a planned, chosen pregnancy is a tutorial in the limits of the will.

It seems that won’t stop people from using every technological advance at their disposal to bypass those limits nature would impose. In the world of assisted reproduction, meanwhile, the primacy of will radically reconfigures these embodied relationships, parceling out roles – egg donor, gestational surrogate, etc. – that multiply parents while muddying their connection and duties to the child.

Surrogacy contracts assert the rights of the parents to kill their child, even over the objections of the woman who is, moment by moment, sustaining that child. Parents might demand abortion as a resolution to a higher risk pregnancy of twins or triplets, or upon learning that their child carries a congenital abnormality. Their contracts claim that they have the higher claim on their child than the unrelated woman whose body has remade itself to help the baby grow, who to them is merely a commodity. To be a parent, in this understanding, is to have the authority to destroy.

In one case, when a surrogate named Melissa Cook offered to adopt the unwanted triplet rather than allow it to be killed, the father objected, out of a sense of justice. As Katie O’Reilly reported for The Atlantic, “The father of Melissa Cook’s fetuses has stated that he believes singling one child out for adoption would be cruel, and thus he prefers to reduce.” He did not want to let one child live unchosen – judging it better to not be.

Every body is a testimony: we are made in God’s image.

In such cases, a child who does not match our expectations or plans for our expressive identity may be deprived of life. After birth, people who don’t fit in neatly may not face death but may still be negated, forced to be less themselves to be “allowed” to take up space. And, in countries with expansive euthanasia regimes, some people keep hearing the suggestion that suicide is the solution to the problem of their presence.

The narrower our ideas about whose bodies matter – who is our neighbor – the less likely we will be to help, love, or even see others. And with the body unacknowledged, it is easier to overlook the more permanent but more elusive soul.

Every body is a testimony: we are made in God’s image. Our frailties reflect his commandment that we must love each other as he has loved us. When we marginalize our neighbors, we blot out that image and refuse the duty of that commandment. A woman’s body, accordingly, does not need to be rewritten – women must be seen and loved as women. When we fail each other in this duty of love, our neighbor’s body testifies against us.

Footnotes

1.  James C. Scott, Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed ,Yale University Press, 1998.
2. Caroline Criado-Perez, Invisible Women: Exposing Data Bias in a World Designed for Men Harry N. Abrams, 2019.
3. Ethan Watters, Crazy Like Us: The Globalization of the American Psyche (Simon & Schuster, 2010), 32.
4. Anthony M. Kennedy, Planned Parenthood v. Casey majority opinion, 1992.
5. O. Carter Snead, What It Means to Be Human: The Case for the Body in Public Bioethics, Harvard University Press, 2020), 88.