Epigraph
These little Limbs, These Eyes and Hands which here I find, These rosy Cheeks wherewith my Life begins; Where have ye been? Behind What curtain were ye from me hid so long? Where was, in what Abyss, my new-made tongue?
From ‘The Salutation’, Thomas Traherne, 1637–74
Introduction
There comes a moment in your life when you realize that you are probably not, after all, going to be the first person to live for ever. This realization is normal, or at least I assume so, but it is quite contrary to your rightful expectation. It is a shock.
Let’s be clear. Your mind has no problem with the idea of living for ever. What’s wrong with just carrying on as it is doing now? It can see no reason not to. No. Your body’s the problem. It begins to work less well. And it starts going on about itself, sending you ever more frequent messages, nagging, needy messages: What about me? Is nobody listening to me? Stop that, it hurts. Or: ‘I need to go to the loo.’ ‘What, now?’ your mind sleepily responds. ‘It’s three in the morning.’ ‘Yes, now.’
At school, I was obliged to give up biology at the age of thirteen, even though I was beginning to veer towards the sciences. One lesson a fortnight became no lesson at all. It now seems to me astonishing that this should be allowed to happen, not only because it was by then already clear that biology was the scientific speciality which offered the greatest scope for discovery, but also because we are each the owner-operator of our own human body, and this surely would have been the time to learn something about it. Instead, I was left in charge of a complex biological organism about which I knew next to nothing and yet, if I was lucky, I would be instructing and inhabiting for another seventy years or so.
One consequence of this educational omission and my own intellectual laziness is that I have no answer to the bathroom-at-three-in-the-morning problem. I have no idea how my bladder works, or why it seems to work differently now from the way it worked when I was younger. And the chances are that you haven’t either.
I have only a vague picture of some sort of watertight balloon that fills and empties itself, located somewhere in my abdomen. For more precise information, I find I must consult an undergraduate textbook. The book is like a paving slab, and it’s full of colourful but artless drawings. I look up ‘bladder’ in the index. It is not there. I see I’m going to be forced to translate my simple enquiry into an alien jargon. I consider the matter briefly, and then turn to the Us to find an entry for ‘urinary system’.
The bladder, I learn, is an elasticated bag made of thin layers of muscle. It is lined internally with mucus to make it watertight. When full, it distends to the size and shape of a large avocado and contains about a pint of urine (or a litre, according to another textbook, nearly twice as much). An accompanying X-ray image, referred to – as if I’m meant to know the meaning of the word – as a pyelogram, shows the arrangement of the urinary system within the body, highlighted by a contrast agent that has been injected into the human subject. I see a bulbous reservoir cradled by the pelvic bones at the base of the spine. Running out of it are the two thin lines of the ureters, which hug the spine on their way up to the kidneys, where each branches into two, and then five, and then many more thinner tubes that terminate in the depths of each kidney, somewhere about level with the bottom rib of the rib cage. The image is rather beautiful, like two long-stemmed irises in a bulb vase.
The ureters are muscular tubes that squeeze the urine produced by the kidneys down into the bladder. As the bladder reaches capacity, stretch receptors in the muscle wall are stimulated, sending signals to your brain that you construe to mean that you should get up and relieve yourself.
Well, not exactly. In fact, the system is smarter than that. The bladder sends out its first signals simply to test your readiness. On this occasion, your brain responds to the news by sending a message back to the bladder that causes its muscles to contract a little, increasing the pressure of fluid within. The purpose of this is to gauge whether another set of muscles, the ones that allow the bladder to drain when they are relaxed, will hold for a bit longer. The brain is stalling, asking the bladder in effect: ‘Do you really mean it?’ When the bladder sends back signals admitting that it was just a bluff, your brain responds with an instruction to the muscles of the bladder wall to relax again and allow more urine to accumulate. All this happens in your sleep, and saves your being awoken until you really need to be. It’s like the snooze button on an alarm clock.
The textbooks gloss over the deterioration of this admirable system in middle age. I try to reason it out. Maybe your bladder contracts, meaning that it must be emptied more often. Or maybe it expands, triggering the stretch receptors sooner. Maybe the stretch receptors themselves become more twitchy. Maybe the neural telegraph between your brain and your bladder goes a bit haywire and starts sending the wrong messages. Maybe your ageing brain just panics and thinks better safe than sorry. There are so many possibilities. I run my theories by a friend who is a hospital consultant. ‘I’ve been trying to look it up myself,’ he tells me after a while, but the process has left him as baffled as I am. Finally, he passes my questions to a colleague who is a urologist. In fact, I’m told, you simply produce more urine in your sleep as you get older. It’s an inconvenient truth to say the least.
It seems absurd that finding an explanation of this most banal of bodily functions has required so much expert consultation. But I have more awkward questions, too. Is the bladder just a ‘bag’ or is it something more? Is it an organ? What qualifies as an organ? Where do organs stop and start? Student doctors often buy themselves a plastic skeleton and a plastic model of the body in which brightly painted organs hook neatly into place alongside one another. Is this really what the body is like? Or are the organs perhaps cultural inventions, better regarded as repositories for various ideas that we have formed about life than as discrete entities in biological reality? Does it even make sense to talk about the body in parts? For whom does this make sense? And if so, is the human body merely the sum of those parts, or is it something more? For Aristotle was indeed thinking about the human body when he coined this now overworked phrase – ‘more than the sum of its parts’ – in his Metaphysics. And if the human body is more than the sum of its parts, then what is this ‘more’?
Anatomies is my attempt to make amends for my missing education in human biology and to find answers to these questions. Like most of us, I know shamefully little about how my body actually works – and occasionally doesn’t. Those who do know – our doctors – seem keen to keep the knowledge to themselves, guarding their professional status with their long words, their simplified attempts at explanation, and those famously illegible prescriptions.
It is obvious that the human body is a difficult subject. Perhaps we are too close to it. The human body is routinely described as a marvel of nature, but it is surely the marvel of nature we least stop to observe. When all is well, we simply ignore it. I suppose this is as it should be – no other animal spends time pondering its wellbeing, after all. But for us, ignorance is not bliss. We are frequently ashamed of our bodies and embarrassed by them.
At the same time, we are bombarded with images of the human body. These are invariably presented as more perfect versions of ourselves. They look better (supermodels) and perform better (action heroes), but essentially they are doing things we do. These proxies remind us that our body, too, is out there in the world. It is through our body that we sense the world and must interact with it. And it is through our body that we are seen and recognized for who we are.
Yet still our bodies trouble us. We disguise them with clothes. We distract attention from them with accessories, a hairstyle, a gait, a repertoire of gestures, a voice, a way with words, to the extent that these become the greater part of our personal identity. Helped by modern medical techniques, we are becoming bolder with these manipulations. From Brain Gym to boob job, we now seek to transform our minds, personalities, faces and bodies. And in truth we have always altered ourselves in both psychological and physical ways. This is just the latest chapter in a continuing story. The idea of the body as a canvas is not new. It’s just that more people than ever are starting to paint.
Then there is our attitude to medicine, the science of maintaining and restoring bodily health. In most sciences, there is some respect for history. Scientists may not refer much to the past in their field, or even know its key figures and dates, but they readily concede that the discoveries of today are built on those of the past, and that we see further because we stand on the shoulders of giants. The history of human biology and medicine, on the other hand, is easily mocked. We laugh at the once widespread belief that you can deduce somebody’s character from the bumps on their head. We laugh at the hopeless cures and painful procedures of the past – the idea, for example, that field-mouse pie was an effective remedy for whooping cough. We laugh because laughter is a response to fear, and we fear for the fragile workings and the ultimate disposability of the human body – of our own human body.
Meanwhile, science is taking us in a new direction – deeper. Slowly, we are getting used to the idea that we will learn most about our bodies by zooming in on them – to examine the cells, the genes, the DNA, the proteins and other biological molecules that make us the way we are. We are given to understand that the key to the body’s functions and its malfunctions – our diseases – lies in the codes and sequences that determine the character of these minute components, and in the chemical reactions that occur and the electrical signals that pass between them.
This is exciting and specialized work. For a privileged few, it offers a newly informed view of the body. But it is a very partial view. It may be that the human person can be described as a string of letters or numbers based on these new methods of investigation, and that such a description is useful in some kinds of research. But this is not the description that interests me. This is not the description we have lived by these past tens of thousands of years as a species. This is not the image we have of ourselves. Knowing that each human body has a set of chromosomes called a genome containing more than 20,000 genes, each of those genes being described by a given sequence of DNA, and that all of these genes are present in every cell of that body is important, but it does not supersede the older knowledge that the body contains a heart, two eyes, 206 bones and a navel. It merely augments it. In its technical detail, it is the sort of description that for many of us seems to miss the point. It doesn’t tell us about ourselves in the round.
‘Know thyself’, famously ran the inscription at the temple of the oracle at Delphi in Ancient Greece. Yet, for all our scientific prowess, we seem to know ourselves, and above all our physical selves, less and less. Perhaps it’s even the case that the quest for scientific understanding of the body becomes a substitute for actual bodily experience: a recent survey of students at an American university found the highest levels of virginity among students studying biology and other sciences (the lowest levels were among those studying art and anthropology).
Something of this kind of displacement has certainly happened in medical schools. The emphasis now is on the detail, not the whole. The sense of the wholeness of the human body has been diminished by the rise of specialization, which insists that the body is regarded in terms not just of parts but of isolated parts. The need to grasp the basics of genetics, molecular biology, pharmacology, epidemiology and public health has all but forced out the teaching of human anatomy, which was central to medical education for hundreds if not thousands of years. In 1900, a medical student might have attended 500 hours of gross anatomy – the anatomy of the whole body. Today, the figure might be one-third of that. And increasingly, that anatomy is seen not in the literal flesh but as a digital image on a screen.
In short, the body is taken as read. It is assumed not only that the medical profession know all they need to know about its general arrangement and function, but that, at our much lower level of understanding, the rest of us do too. I am no medic and naturally try to avoid hospitals. Before embarking on this project, I had never seen an opened body. It’s almost as if somebody has figured it’s better that way. It’s better that we don’t know too much. Then we won’t question our doctors. Then we won’t worry about what actually happens to us when we fall ill and when we die.
Still, chin up. Unique among species, we are blessed as well as cursed with this awareness of our selves and our bodies. Shouldn’t we use this critical distance to come to a more informed view, indeed to come to some kind of reconciliation with our mortal flesh?
Anatomies is a personal attempt to do this. As you’d expect for a subject with such a rich cultural history as the body, it draws not only on past and present perspectives in medical science, but also on views of the body and its parts taken by philosophers, writers and artists. The body is not just a thing, whether that’s the object on the anatomist’s table or the subject in a life-drawing class. It is animate. So I will look also at the body in action – the body that moves and performs, and expresses thought and emotion. This, as much as our genes, makes us what and who we are. But don’t worry. I will spare you descriptions of my own body’s shortcomings. To misquote Montaigne: ‘I myself am not the subject of my book.’
Anatomies is arranged in chapters based on significant body parts. This provides a familiar structure, although it will quickly be seen that the content of these chapters ranges well beyond the bounds of those parts. We have an idea about all of the parts I have singled out, whether they are internal organs or visible features of our bodies, an idea that owes relatively little to modern science or medicine. Instead, it is shaped by our culture, which has bestowed symbolism and meaning on the parts of the body through long and intimate familiarity with them. To rediscover these meanings, we need to touch and feel, look and listen to the body that we think is so familiar, and which we have preferred to consider in the abstract.
One of the most powerful of these associations, for example, is the idea that the heart is the seat of love. ‘Come bring your sampler, and with art / Draw in’t a wounded heart’, the English poet Robert Herrick wrote four centuries ago in his great poem of unrequited love. But is this meaningful now? It surely is to the shops which see Valentine’s Day spending of more than £2 billion in Britain alone. It is not just as the visual icon on a million cards that the heart lives in our culture. Its pulsing rhythm may underlie the pleasures of the iambic metre in poetry and the beat of rock music.
The eye at the moment of death has long been said to retain the image of the last thing it saw. Has this myth been dispelled? Only just, maybe. In 1888, the Metropolitan Police in London photographed the eyes of Mary Jane Kelly, the last presumed victim of Jack the Ripper, in the desperate hope that they might hold the residual image of her killer.
Such beliefs reflect early attempts to understand and come to terms with our bodies. Often, modern medicine is influenced by these ideas more than it cares to admit. Take blood. Old taboos still echo through the questionnaires one must complete in order to give blood, with their strange hints at tribal purity. Our feelings about organ donation, too, are coloured by deep cultural prejudice. If donors or their kin place restrictions on the organs that may be harvested, they are most likely to be on the heart and the eyes, based on the belief that the heart is the essential core of the person and the eyes are the window into the soul.
The arts can tell us things about our body that medicine and biology do not. The head is an important part, so much so that it can stand for the whole body, as we see in the sculptor’s bust or your own passport photograph. But what happens when the nose alone stands for the head? In Nikolai Gogol’s short story ‘The Nose’, a man’s nose detaches itself from his face and goes off on its own around St Petersburg, pursued by its nasally challenged owner. Importantly for the satirical bite of the tale, the nose takes on the man’s social pretensions. The story raises questions about the way in which certain parts of the body constitute our personal identity and others do not. But most of all it reminds us that the body and its parts are funny, if not ridiculous – or at least our constant self-awareness makes them so.
Separated from their bodies, organs and parts sometimes multiply in alarming ways, gaining strange powers as they do so. In Gargantua and Pantagruel, Rabelais imagines a wall of vulvas protecting the city of Paris. ‘I have noticed that, in this town, the thingummybobs of women are cheaper than stone,’ observes Pantagruel’s companion Panurge. ‘You should build walls of them, arranging them with good architectural symmetry, putting the biggest ones in the front ranks, then sloping them back upwards like the spine of a donkey, making ranks of the medium ones next and finally of the smallest.’ A portrait of Queen Elizabeth I painted towards the end of her reign around 1600 shows her wearing a dress covered with appliqué eyes and ears, emblematic of the all-knowing state of which she, of course, was the head. The artist Marcus Harvey caused uproar when he created a vast painting of the child-murderer Myra Hindley using children’s handprints as individual pixels. The work adapted a photograph of Hindley much reproduced in the newspapers at the time of her trial. Was there evil in that face? Is there good in a child’s hand? What did it mean to bring the two together?
This book is about our bodies, their parts, and their multiple meanings. It is also about where we draw the limits of the body, and how we are always seeking to extend those limits, never more so than right now. For ‘extend’, I should perhaps write ‘redraw’, for although we like to think of ourselves as constantly extending the human frontier, the fact is that from time to time we choose tactical withdrawal. We draw the limits closer in, not further out. We think we like the idea of being all-capable, but in fact we’d rather not test our capacity for pain, or even make much use of our senses of smell and touch, for example. We think we’d like to live longer – or is it just that we’d prefer to avoid dying? We dream of escaping our bodies and existing in transformed or dematerialized ways. We may think these dreams are the product of recent or promised advances in biomedical technology. But in fact they are the timeless product of our imagination.
Overarching this part-by-part progress, then, is another idea: the idea of the body as geography, as territory to be discovered, explored and conquered. This powerful metaphor is found throughout human culture, from the plays of Shakespeare to the 1966 film Fantastic Voyage, in which miniaturized humans journey through a man’s body in a quest to save his life. It also seems to reflect how science has proceeded, claiming new-found lands, dividing them into parts, proclaiming dominion over them on behalf of specialist new disciplines. It is, I might add, a very male approach, never more so than when it is the female body that is being explored.
At one point in my research, I noted something peculiar about my reading list. I was being curiously drawn to books set on islands – Robinson Crusoe for its all-important human footprint, Gulliver’s Travels for the changes in human scale it imposes, Typee for the tattoos and the cannibals, The Island of Dr Moreau for the vivisection and the human-animal hybrids. Why was this? Islands present isolated populations. Here, humans are almost a subspecies of Homo sapiens, ripe for the kind of anthropological scrutiny that might seem impertinent among the home population. Islands are places where, for a time, you can observe and control a community as if it is part of an experiment. But the situation cannot be sustained. Eventually, the hero escapes to tell his improbable tale (or not, in the case of Dr Moreau’s visitor, who pretends amnesia because what he has seen is so incredible). As John Donne famously reminds us in his Meditations: ‘No man is an island, entire of itself; every man is a piece of the continent, a part of the main.’
These fictional island laboratories are places for the exploration not just of human nature writ large, but also of the identity of the individual. The body may be seen as territory with parts that have been more or less thoroughly explored, but somewhere within that territory, we are convinced, is a special place, the seat of the soul, as we once said, or of the self, as we might say today. In medieval times, a person’s heart was often preserved or buried separately from the rest of the body because it was the part thought to be most closely associated with the soul. During the Renaissance, a more sophisticated notion took over. The soul was to be found in the divine proportions of the human body, which was the answering microcosm to the macrocosm of the ordered universe.
The ideal bodies and the anatomies of this period, from Leonardo da Vinci’s Vitruvian man to Rembrandt’s paintings of dissections, reflect this belief. With the progress of science, however, the urge to find a focal point was soon reasserted. Attention settled on the head, as physiognomists sought their answers to the problem of the self in human expression and phrenologists in the bumps of the skull. Today, we look at magnetic resonance imaging scans of the brain and believe these bring us closer to knowing our selves. It seems that only a visual image will give us the reassurance we seek.
This need to see the self is strong because we live in a society that prizes human individualism, and also because we sense that the self is susceptible to manipulation in ways that it never has been before. We are aware that our personal identity may be altered – and perhaps improved – by consciously undertaken extension. Such extension may be psychological (self-help books), physical (cosmetic surgery), chemical (mind-altering drugs) or technological (virtual environments). At the moment, these possibilities are perhaps only crudely being tested. However, it seems certain that in future it will be increasingly easy, and probably increasingly acceptable, to manipulate both the external appearance of the body and our genetic make-up, and that this may disrupt what one bioethicist calls the former ‘naturalness of the self’.
These are exciting and troubling times for the human body. We seem both excessively aware of it and yet at the same time profoundly dissatisfied with it. The biological sciences promise many things about the way we will live in future. But, however beautiful we are, however super-capable we become, however long we live, we still must inhabit our bodies. Perhaps, by recognizing the human body as a site of continual invention, we may overcome the distortions of the present moment.
Finally, one barrier to a broader comprehension of the body is the profusion of Greek and Latin names – names that those in the medical professions were themselves once put to great labour to learn. There is an argument that these provide a universal language much like the Mass sung in Latin, but I am not convinced. So I have tried to minimize my use of these words, many of which were baffling to me as I set out. I won’t use ‘anterior’ where ‘front’ will do, or ‘femur’ for ‘thigh bone’. It seems wrong that the parts of our own bodies should be described in a vocabulary that is alien to us.
Now, if you’ll excuse me, I have to go and pee.
