Surface Tensions: Surgery, Bodily Boundaries, and the Social Self by Lenore Manderson (review)

How does one adjust to a newly extraordinary body? How do people make sense of who they are when their bodies are changed dramatically by illness or accident? These are the questions animating medical anthropologist Lenore Manderson’s new book, Surface Tensions. Beginning with a catalog of her own physical losses and adjustments, Manderson quickly moves outward, drawing on ethnographic data, visual art and film, and theories of embodiment to explore what happens to the self when the body changes. “Adaptation to bodily change and the consequent reshaping of identity is hard work,” she explains, and Surface Tensions examines the nature of that work, focusing particularly on the stories people tell about their adjustments (262).

As disability studies scholars have been arguing for years, all of us, whether by illness, age, or accident, will live with disability at some point in our lives And yet, Manderson notes, this fact remains largely unacknowledged and unexplored; many people seem to assume that, other than the expected frailties of old age, they will remain able-bodied for the rest of their lives. Surface Tensions explores the intersection between these two facts: How do people hold on to a coherent sense of identity—particularly one grounded in a sense of stable able-bodiedness—when their bodies become disrupted? For some of Manderson’s subjects, rupture comes quickly and unexpectedly; for others, it is a slow process of illness or multiple surgeries and treatments. In either case, people must adjust to bodily changes at the level of the prosaic and the profound: they “change how they manage bodily functions and actions, revise the rhythms and content of everyday activities, reorganize domestic and negotiate public space” while also “challenging conventional ideas of the integrity of the body and mind” and going through an “existential reckoning” (29, 30). This reckoning is often made easier, Manderson argues, when people draw on discourses of normality, seeing themselves as coherent selves living normal lives even if with drastically altered bodies.

Following an introduction and an historical overview, the book is structured around four different categories of bodily change (45): amputation and loss of limb function; stoma (e.g., colostomy); mastectomy; and organ transplants and donations. Throughout, Manderson stresses that those learning to adjust to bodily disruptions do so from particular locations, and that location matters: “Personal, community, and national poverty compounds the difficulties of adjustment to acquired embodied changes, stripping people of the possibilities of regaining ability, maximizing capability, and continuing to participate fully in society” (36). Although she mentions differential opportunities and treatment based on categories such as socioeconomic class, she is primarily concerned with the effects of gender. The adjustment work done by women often differs dramatically from that done by men, even when involving the same conditions or impairments. According to Manderson, both men and women frame their experiences around the need for normality, but women are most concerned with appearing and feeling normal, with looking like “themselves,” while men measure their normality, the success of their adjustment, through “action and achievement” (264).

Surface Tensions will be productive reading not only for those invested in anthropology, medicine, and disability studies—the three audiences hailed on the book’s back cover—but also for philosophers of the body, gender studies scholars, and those interested in the stories we tell about our own bodies and the bodies of others. Clinicians and practitioners, moreover, may be drawn in by the book’s diagnostic organization, which mirrors the structure of many medical texts. Although Manderson is clearly immersed in a wide range of theoretical discourses, her writing style is accessible and dynamic; the book’s extensive illustrations likely help readers unfamiliar with the subject enter into it more easily.

Disability studies readers may be surprised by some of Manderson’s language choices—“wheelchair bound,” for example—that imply a continued investment in a medical model of illness and disability. Indeed, Surface Tensions is not...