03 Shildrick 087529F 29/2/08 4:10 pm Page 31

Corporeal Cuts: Surgery and the

Psycho-social

MARGRIT SHILDRICK

The post-conventional notion of embodied subjectivity – which has become the

sine qua non of contemporary cultural theories of the self – relies on an under-
standing of selfhood as constituted equally through a substantive materiality and
through an attention to affect, beliefs and values. The two are irreducibly inter-
twined in our everyday understanding of ourselves to the extent that the old
Cartesian split between mind and body is put into doubt. One area in which the
Cartesian model still has currency, however, is in traditional biomedical surgery
where the practices of cutting the body are engaged, apparently without expec-
tation of psychic consequences. The surgeon’s knife is wielded in the interests
of repair, restoration and sometimes regeneration, so that the patient may feel
herself again, able to resume her life with the least possible impediment. Yet, as
a more discursive reading shows, the corporeal cut is not confined to the clinic,
but operates more widely through two apparently contradictory, yet intimately
related, perspectives. On the one hand, the body in Western culture is character-
istically cut off, isolated, from its others, established as whole and bounded; while
on the other it is increasingly cut open, breached, treated in its parts and reorga-
nized. And yet the rigidity of the first model – the very basis of our modernist
privileging of the binary distinction between self and other, between your body

Body & Society © 2008 SAGE Publications (Los Angeles, London, New Delhi and Singapore),
Vol. 14(1): 31–46
DOI: 10.1177/1357034X07087529

www.sagepublications.com
Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015
03 Shildrick 087529F 29/2/08 4:10 pm Page 32

32 ■ Body & Society Vol. 14 No. 1

and mine – is secured by the necessary plasticity, the amenability to reconstruc-

tion, of the singular body. Paradoxically, it is those ‘fluid’ characteristics that hold
out the promise of a reassembled corporeal unity that sidesteps the ever-present
threat of excessive proliferation, and of disintegration and decay. Should I be born
with extra digits, a surgeon will excise them; should my heart stumble, a restora-
tive pacemaker may be inserted in my body cavity; the cancer that compromises
my flesh can be cut out; and when I die, my internal organs may be transferred
to give continuing life to another. We demand of modern biomedicine that all
disruptions to the self’s ‘clean and proper body’ should be dealt with, that the
actual vulnerability of the embodied self and its propensity to diverge from the
normative structures of health and well-being should be covered over, or managed
out of existence, by a technologically driven bioscience. In short, corporeal
difference is badly tolerated. But what happens when, instead of limiting the
parameters of the body and closing down its anomalous capabilities, technology
seeds an eruption of the very elements of embodied being that generate anxiety?
In this article I shall both outline some intended normalizing strategies of the
corporeal cut, and show how those strategies are simultaneously disturbed by the
body’s plasticity. If all bodies can be effectively queered by the cut, then there
are good grounds to revalue the putative disorder of corporeal anomaly.
To say that the body has a history is no mere truism but appeals to an under-
standing not simply that there is no one standard of normality, but that there is
no naturally given body either. The body as we know it is always a discursive
construction, and as Haraway insists: ‘Biology is discourse, not the living world
itself’ (1992: 298). Where certain strands of feminist theory tend to use the terms
‘nature’ or ‘the natural’ as reified signifiers of something intrinsically good,
enduring and desirable, and particularly as an oppositional modality that stands
against the capacity for depersonalization and artificiality associated with modern
interventionary technologies, Haraway insists that nature has no value as such,
that it is in effect just another discursive construction fully involved in the
discourses of normativity. Her understanding of the embodied subject calls to
mind Foucault’s dictum that:
. . . we should try to discover how it is that subjects are gradually, progressively, really and
materially constituted through a multiplicity of organisms, forces, energies, materials, desires,
thoughts, etc. (1980: 97)

In short, we must constantly remind ourselves that what is called normal or

natural is always normative, and at the very least devolves on some form of
unstated value judgment that may well require intervention and manipulation to
achieve. In modernist terms, the model of a ‘normal’ body implies one in which

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 33

Corporeal Cuts: Surgery and the Psycho-Social ■ 33

everything is predictable, well-ordered and functional within a narrow set of

parameters that reflect only the bodily capacities of the majority. In the effort to
banish all the actual and potentially chaotic aspects of biological variation, the
body must be constantly maintained and occasionally modified – which often
quite literally entails the cut – to forestall the lurking threat of disruption
(Shildrick, 2002). It is scarcely noteworthy that the bodies of those with achon-
droplasia are stretched; vaginas and clitorises are reshaped; foreskins circumcised;
and multiple foetuses are selectively reduced.
It is customary to think of such technological interventions as the vehicles of
restoration and repair, directed towards just some exceptional bodies that – for
their own sake – need or indeed demand reclamation to the norm. But as the
technologies themselves both open up new possibilities of intercession and
move out of the relatively unknown terrain of the clinic – not least into the spate
of reality shows and medical documentaries that dominate television program-
ming – it becomes increasingly evident that all bodies are more or less unstable.
The image of the skin as some kind of inviolable boundary no longer makes
sense, for it is continually breached by a series of biomedical technologies in the
interests of maintaining the illusion of a normative body. At the same time,
nonetheless, a weeping, bleeding, leaky skin is a matter of some abhorrence. It
remains an insult to the ideal closure of human embodiment and figures an
instance of what Julia Kristeva (1982) calls the abject. Yet although, in the
contemporary world, it is the end result of therapeutic cutting that we want to
see, and not the process itself, the recoil from the breach is somewhat curious.1
During the pre-modern and even early modern period, the body was considered
intrinsically open to the world – open to the other – and permeable (Bakhtin,
1984). As Claudia Benthien (2002) outlines, the porosity of the skin, far from
being a matter of disgust or even horror, was an essential component of good
health. The skin was seen not as a protective layer against the insults of the
external world – as a barrier that might hold disease at bay – but as the conduit
through which the materiality of internal disturbance might leave the body.
Where the present-day biomedical breach in the skin is a matter of access
intended to facilitate restorative procedures to the interior organs, or to excise
hopelessly degenerated tissue, and is invariably followed by a form of resealing,
the early modern physician intended quite the opposite. His purpose was to
draw out malignance within by applying to the skin itself a series of procedures
– Benthien (2002) lists bleeding, scalding, leeches,2 fontanels (artificial ulcers
opened up with pox ointment) and scarification – which broke through the
surface and kept it in a state of flow. A quite literal and active leakiness was seen
as highly therapeutic.

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 34

34 ■ Body & Society Vol. 14 No. 1

I want to concentrate, however, on some specific types of surgery where the

issue of the cut is not about facilitating outward flow, but is about an acute,
condensed and violent intervention. In each, the desire for bodily autonomy,
independence and wholeness both confronts and relies on the malleability and
incompletion of corporeal being. In arenas as disparate as the separation of
conjoined twins, transgender surgery, the amputation and possible prosthetic
replacement of damaged or diseased limbs, and in organ transplantation, the
creation or restoration of a normative corporeality that is intended to enhance
and perpetuate the unity of being, entails precisely its opposite: a deconstructive
intervention that temporarily reduces the embodied subject to simply an assembly
of parts that may be rearranged or transformed at will. What is at work here is
surely that the fundamental socio-cultural belief in the fixity of corporeal bound-
aries – which is taken-for-granted with regard to the normative body – is easily
set aside in the case of the extraordinary body at the margins. Surgeons, their
patients and an admiring lay public effect an expedient suspension of any phenom-
enological understanding and experience of corporeality, and simply become prag-
matic and contextual Cartesians. The desire to allay anxiety where the normative
has failed effects an abandonment of the notion of integrated embodiment and
reduces the corpus to its component parts. This is especially clear in the case of
corporeal doubling, usually in the form of conjoined twinning, which has always
contested the investment of the Western imaginary in notions of bounded indi-
viduality and personal identity.
The question of whether such forms should be treated as one or two auton-
omous persons has an extremely rich history, which with the advent of poten-
tially clinically effective separation surgery in the mid-20th century has been
opened up to the corporeal cut at its most literal. Following previous work on
such issues (Shildrick, 1999, 2001, 2002, 2005), I shall limit my comments here to
the significance of surgery itself, though it is worth recalling that in his lecture
series Abnormal, Foucault (2003) claims that for two centuries at least in the early
modern period, conjoined twinning was the privileged form of the monstrous,
gradually losing prominence to the equally disturbing figure of the hermaphro-
dite. Not surprisingly, both those unusual morphologies reappear in our own time
as candidates for the corporeal cut, for what was once more or less tolerated
according to local custom and belief is now unambiguously defined as a morpho-
logical failure that should, if possible, be corrected. As the refashioning of anom-
alous bodies becomes both technically possible and putatively desirable, both the
surgically driven separation of conjoined twins and the gender reassignment of
intersexed infants have emerged as relatively commonplace. That the individuals
involved are known to often suffer physical damage and psychological distress is

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 35

Corporeal Cuts: Surgery and the Psycho-Social ■ 35

taken to be insufficient reason to fundamentally rethink the strategy of interven-

tion (see Dreger, 1999; Morland, 2005). The anxiety that surrounds the acute
failure of intelligibility attributed to anomalous embodiment is nothing new and,
as Foucault points out, what changes is not the problematic, but the way in which
it is managed: ‘We pass from a technology of power that drives out, excludes,
banishes, marginalizes and represses, to a fundamentally positive power that
fashions, observes, knows, and multiplies itself’ (2003: 48). The public reception
of the corporeal cut figures both a voyeuristic engagement with the abject nature
of surgery – a trend that is sustained by the consistent prevalence of medical
documentaries on mainstream television – and a high level of positive endorse-
ment for the regulatory outcome of wielding the knife.
Where the overvalued attributes of bodily autonomy and self-identity appear
to be at stake – as with many both large and small corporeal anomalies that
occasion disability – the recourse to surgical management is hardly surprising. It
is worth noting in passing, however, that the procedures of so-called ‘aesthetic’
surgeries on the otherwise normative body speak to an equivalent anxiety that
may be triggered by relatively minor differences to the culturally accepted
standard. Although many of the technologies currently in use were developed
initially in response to severe war-time facial injuries, the aim now – and perhaps
always – is more about constructing at the very least a conformist, if not ideal-
ized, appearance rather than about restoring or creating a particular functional-
ity (Goering, 2003). The widespread acceptability of the reconstruction of facial
features, marked by the willingness of many ‘ordinary’ women and, increas-
ingly, men to undergo non-medically indicated procedures themselves, speaks
loudly to the belief that difference – even when simply age induced – signals
disfigurement. While simultaneously demonstrating the plasticity of the body,
the ready resort to the cut is too often about eradicating the difference of
disability, racial diversity, gender disconformity, or simply what we cruelly term
ugliness. The popular linking of non-normative bodily appearance with inferi-
ority complex, or low self-esteem – that is with mental states to be avoided –
further acts to justify the extension of reconstructive technologies, which remain
after all somewhat risky medically managed procedures. As Sandor Gilman
succinctly notes: ‘Medicine’s job became the appearance of illness as well as its
pathology’ (1999: 16). And indeed, given the acceptability of sometimes quite
considerable pain in the pursuit of reconstruction, we might see that what is
treated is a pathology in the cultural imaginary, rather than in the individual
body. When Catherine Waldby defines that imaginary as, ‘the deployment of,
and unacknowledged reliance on, culturally intelligible fantasies and mytholo-
gies within the terms of what claims to be a system of pure logic’ (2000: 137), she

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 36

36 ■ Body & Society Vol. 14 No. 1

catches precisely the contradictions that underlie the whole enterprise of the
corporeal cut.
Those contradictions arise, I think, because despite the analysis offered by
Goering and Gilman, there is much more than surface appearance at stake.
Aesthetic interventions into the body certainly allow for a very different outward
show, but in common with less ‘playful’ modifications, they also enable more
profound changes in self-presentation. What is interesting is where we locate the
limits of what is currently socially tolerable in terms of reconstructive surgery
and what is still beyond the pale. As recent press reports indicate, the reality of
facial transplants maintains a high yuk! factor – a potent illustration of the abject
rejection of an otherness that is indistinguishable from the selfsame – explained
in large part because of anxieties about the perceived assault on personal identity.
At the present stage of surgical sophistication in this newly emerging technique,
it is perhaps unlikely that the recipient of a new face would appear less than
normative, but it is the anticipated transfer of personality, and not the physical
effects of cutting, that is the perceived problem.3 I shall return to this in my
later discussion of organ transplantation. For now, what should be noted is that
although lesser surgeries may also be seen as enacting enhancements or trans-
formations of identity, the crucial difference is that they can be justified as
instances of self-determination. The paradox, then, is that the procedures – and
it is particularly clear in the context of elective surgery – are understood as being
within the control of the sovereign subject who, in Western terms, is a more or
less fixed and pre-given entity, and at the same time are intended to mobilize
some sort of transformation of identity. The body is viewed both as a canvas to
be inscribed at will by a transcendent subject, and an integral element of selfhood
in which any change extends throughout the constitution of the whole person.
The effect of modifications to the body might be read as no more than the equiv-
alent of my saying that if I wrote a great work of literature I would think more
highly of myself, but it seems to go much further. The changes wrought are not
simply the achievements of an unchanging self displaying new facets, but are
spoken of as transformations in personality and identity. The term ‘makeover’
used in relation to ‘aesthetic’ surgeries catches something of this so that on tele-
vision programs like The Swan we can see the subject simultaneously standing
back as it were and commenting on the new appearance of her old self, and
claiming to be a different person.
In a certain sense, then, surgery is not just reconstructive in the sense of
restoring or even rearranging existing components of the embodied self, but is
fully constructive in creating something new. The corporeal cut is not seen as
destructive as such but as an act of generation. The way this plays out in the

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 37

Corporeal Cuts: Surgery and the Psycho-Social ■ 37

context of conjoined twins illustrates the point, where the rhetoric surrounding
separation refers constantly to the need to ‘free’ two already existing persons
from the stifling embrace of a singular monstrous body, in order to take up the
autonomous selfhood that our society privileges as the right and proper form of
human being. Despite the grave dangers – many previously thriving infants, and
more rarely adults,4 do not survive the cut – the need for separation surgery is
rarely challenged. The question of where to cut to separate the one from the
other is viewed merely as a bio-technical problem with few, if any, existential
implications for survivors. Certainly, there is little acknowledgment that the
consequences of what is effectively a phenomenological split, as well as a surgical
procedure, might need to be addressed with the same gravity afforded the clinical
planning. In the few narrative accounts available, it is clear, however, that many
conjoined twins themselves, while sometimes expressing a preference for full
independence or an appreciation of independence post-surgery, maintain a
conflicted relationship to their self-other. Where embodiment is co-extensive, the
desire for, or putative acquisition of, corporeal autonomy is seldom straight-
forward, and varying degrees of psychic trauma, including strong feelings of loss
and incompletion, offset the imagined abstract and material gains. In one very
telling video documentary following the post-separation lives of twins Hussein
and Hassan, we see them as thoughtful teenagers many years on from their
decidedly successful surgery, praising their mother for making the decision that
has given them independent lives (Joined at Birth, 2003). As the video footage
shows, both young men are highly mobile and healthy, and in an interview they
are placed on either side of their mother as though supporting her rather than
each other. What is interesting, however, is that she reports that the twins –
without conscious intention it seems – will often sleep together in a position that
reflects their previous morphology as conjoined. Moreover, as Hussein and
Hassan reveal, their favourite workout is the use of an exercise bike, which – by
dint of removing their individual single prosthetic legs – they are able to pedal
together with their original two legs in perfect synchronicity. Clearly proprio-
ceptive achievement imbricates here with unspoken psychic attachments. In other
words, their own ongoing phenomenological sense of corporeal unity relates back
to their pre-separation state.
Once again, although the corporeal cut represents the attempt through bio-
scientific means to repair and recuperate the body to the cultural imaginary, it
fails to encompass the full phenomenological and psychic significance of embodi-
ment. However severe the modification, however strongly the body is subjected
to regimes of regularization and control, the very plasticity of corporeal being
that makes intervention possible also mobilizes an escape from the imposition of

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 38

38 ■ Body & Society Vol. 14 No. 1

a fixed normative form. I have already outlined some of the paradoxes in play, and
want now to turn to yet another complication that disturbs the apparent certainty
of biomedicine that the body can be remoulded either without consequences to
the embodied subject, or at least in the case of some aesthetic procedures with
only controlled consequences. In operations like both separation and gender
reassignment surgery, the incursion intends to cut apart or cut away, and the
excision will be followed contingently by more or less degrees of reconstruction
of self material enhanced by prosthetic supplements. In transplant surgery, by
contrast, the whole point is to replace some intrinsic part of the corporeal self
with living organs taken from the body of another. If the question with regard
to the excision of body parts is how far may the process be supposed to go
before it radically affects embodied subjectivity, then the pertinent concern in the
context of transplantation is the very opposite: to what degree is the self altered
by the assimilation of ‘alien’ body parts? In a strange way the implications of
attempting – as with conjoined twins – to split a singular morphology into self
and other are paralleled by the incorporation of the organs of another into an
existent self. Although it is perhaps not widely known, many recipients have
multiple transplants, and the most ‘heroic’ procedure of a heart graft often involves
a combined heart-lung transplant. Alongside that, some patients may require at
other points kidney and/or liver grafts in addition, effectively replacing a whole
set of major organs with non-self material.5 In such circumstances, only the most
committed Cartesian could fail to ask what has become of the embodied subject.
That both additive and reductive surgical processes are surely acts of creation that
throw Western ideals of embodiment into doubt is, however, strongly denied. In
the biomedical and public narrative alike, separation surgery – and indeed gender
reassignment procedures – is deemed to liberate a ‘true’ self from a contingently
anomalous form, while organ transplantation is understood to give renewed life
to a self threatened with imminent death by the failure of specific bodily
components. For all that our everyday understanding of ourselves is broadly
phenomenological in tone, it is, I suggest, only because of an underlying retreat
to the notion that the body consists in a conglomeration of individual and alien-
able parts that transplant surgery becomes acceptable.
The metaphor of the body as some kind of machine that is either in good
working order or malfunctioning is particularly clearly deployed in the context
of biomedicine, where the purpose of the enterprise is to effect interventions that
may be essentially violent in nature. Whether that takes the form of drug regimes,
radiotherapy, the setting of bones or cutting the flesh, the clinical care of the
body frequently entails what, in other circumstances, would constitute the legal
category of battery. And yet we implicitly contract and explicitly consent to such

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 39

Corporeal Cuts: Surgery and the Psycho-Social ■ 39

assault in the provisional and convenient artifice that our corporeality has no
bearing on our selves. As phenomenologists like Kleinman (1988) and Leder
(1990) have indicated, even when we have an integrated everyday understanding
of the relation between mind and body, the onset of corporeal breakdown or
disease is likely to precipitate a new-found awareness of the body, not as an
intrinsic element of the self, but as an alien other threatening to the self. At such
a moment, the machine model that treats the body as like other utility allows
for a range of reparative interventions that may include both the corporeal cut
and the incorporation of spare parts. Many transplant recipients explicitly refer
to their operations as though they were repair jobs, of no more consequence
than replacing the clutch in a car, and there is growing anecdotal evidence to
support the observation that patients who adopt a machine model approach
display both faster clinical recovery rates and, initially at least, less psychic distur-
bance following transplant. It is, however, hardly surprising that complications
should arise subsequently, for where the spare parts rhetoric would appear to
refer to inanimate interchangeable objects, the reality of transplant surgery is that
what is cut from one body and grafted into another is a living organ. I do not
mean to suggest the acquisition of an artificial prosthesis is necessarily without
disturbance – for a phenomenological approach would indicate that all changes
to corporeality are significant to the self – but that the incorporation of an
animate body part that has been an element of an other is substantially more
likely to provoke anxiety. Moreover, the distinction between organs obtained
from living donors and those from what used to be called living cadavers may
itself generate different levels of anxiety, though it remains unclear what the
implications are for a phenomenological perspective.6 In my own work relating
primarily to heart transplants, where the donor is necessarily brain dead, recipient
anxiety is allayed not only by deployment of an ‘objective’ spare parts model,
but also by the paradoxical and ubiquitous use of the term ‘the gift of life’ to
describe the donated organ and the process of reassignment.
The rhetoric of the gift of life – through which transplant units both appeal
for organ donations and justify their operative practice – is intended to evoke a
generous transfer of body components that, in the case of living donors, can be
cut from one and grafted into another without loss or gain to the subjectivity of
either. In the many cases where a quasi-cadaver is the source of the donor organs,
it is treated on the one hand as a disposable source of transferable spare parts,
and yet on the other has the status of a willing subject, at least by proxy. Not
surprisingly the recipient may feel some guilt that acquisition of an organ that
will likely prolong her own life relies on the death and evisceration of another,
but that may be the least complex response. It is widely reported that recipients

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 40

40 ■ Body & Society Vol. 14 No. 1

experience a range of reactions following transplant surgery that all tend towards
an image of the embodied self not as autonomous, discrete and having the same
irreducible self-identity over time, but as mutable and open to otherness.7 Even
where there is a positivist attitude towards corporeality as intending some kind
of personal property that a subject alone may dispose of, the question of who
owns a transplanted heart, for instance, is not easily resolved. Does the act of
cutting the organ from its originary body and grafting it elsewhere mean that it
no longer belongs to the donor but has become an inalienable part of the recip-
ient? When speaking of their transplants, patients may clearly slip between the
two possibilities of ownership, referring to both ‘his/her’ and to ‘my’ heart. The
underlying reality, of course, is that the DNA of transplanted material remains
unchanged in its new location to the extent that the receiving body perceives it
for life as non-self material that should be ejected. Although very high doses of
immuno-suppressant drugs may damp down that biological reaction, it remains
the case that the ‘new’ organ will never be less than alien, while at the same time
providing the sine qua non of the self that attempts to reject it. Even on the
simplest reading, the gift of life is double-edged, and while patients may be
expected to finally view the organ as their own, they are also implicitly reminded
of its provenance. The strict requirement of confidentiality prohibits the dis-
closure of information that might identify individual donors, but recipients are
encouraged to anonymously write a letter to the donor family, and – in the
jurisdiction where my own research is situated – to attend an annual cathedral
service that brings together families on both sides of the transfer. In other words,
the recipient is scarcely allowed to forget that the transplant organ is not simply
a circulating spare part.
None of that, however, elicits the degree of anxiety and disturbance that
comes from the inability to view the corporeal cut as a decisive break in the
materiality of embodiment. The well-recorded tendency of recipients to invest
the incorporated organ with at least some vestiges of the donor’s supposed
identity and personality is a move that the biomedical professionals of transplant
teams find difficult to countenance. Nothing in the extensive briefing material
given to prospective patients indicates that such an outcome is likely, and for all
the painstaking effort to ensure that consent to the transplant procedure is
properly obtained, the focus is on the clinical risks, the burden of life-long drug
regimes, the continuing disruption to everyday life, and never on the possibility
of disorder to one’s sense of a unified self-identity. Yet a substantial number of
recipients do report that the graft of a replacement heart introduces, among
other transformations, unanticipated feelings and emotions, unexplained changes
in dietary preferences, and even new attitudes and values (see, for example,

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 41

Corporeal Cuts: Surgery and the Psycho-Social ■ 41

Inspector et al., 2004; Potts, 1998; Sharp, 1995; Sylvia, 1997). It is not the purpose
of this article to judge the veracity of the competing explanations given to such
experienced changes, but rather to note that the recipients’ belief that the person-
hood of the donor has become intertwined with their own is indicative of an
intuitively phenomenological understanding of intercorporeality. The corporeal
cut both fails to solidify the boundaries of self and other, and enables a quite
literal incorporation of otherness that cannot fail to disturb the dominance in the
socio-cultural imaginary of a sovereign self. But just as the phenomenological
implications of cutting a concorporate body apart – although the whole discourse
around phantom body experiences might teach us much – are rarely addressed,
so too the embodied significance of stitching together previously distinct modes
of corporeality are not just ignored but even suppressed. That at least is how it
appears on the surface, but in parallel with some recipients’ needs to express their
anxieties about the persistence of self – their own and that of others – through
sometimes lurid narrative accounts of transferred identities, the biomedical
professionals shelter their own anxieties behind the ambiguity of the ‘gift of life’
rhetoric. One cardiologist prominently involved in transplant procedures has told
me that the phrase acts as a useful reminder to post-op patients that prompts
more treatment-compliant behaviour. There is no reason to doubt the effect, yet
I would suggest that the transplant teams themselves are invested not only in the
utility and altruism of the gift, but also in the implied but undiscussed notion of
the transfer of what constitutes the extra-organic aspects of life.
What, then, does the operation of the corporeal cut and its related implications
tell us about embodiment? Insofar as the bodies addressed here are marked by
some corporeal anomaly, they might be characterized simply as falling outside
the normative parameters of the embodied subject as defined within modernist
discourse, and therefore exceptional. They are, in a sense, contingently queer,
and yet, as postmodernist theory reminds us, no body is safe in its normativity
and the standards themselves are based on an illusion. What is interesting is that
the positivist operations of bioscience – the cutting up and reconstruction of
individual bodies – fully imbricate with the abstract speculations of contemporary
theory that would queer all bodies regardless of their specific morphology. As
Jane Prophet puts it, ‘the transformative journey from human to posthuman
involves a keen awareness of the physicality of the flesh through the experience
of surgical . . . intervention’ (1999: 55). Even as the body is cut open, it re-forms
not only corporeality but an embodied self. The conventional distinctions
between the normative and non-normative body are becoming increasingly
redundant as highly sophisticated prostheses – both organic and mechanical –
or cosmetic alterations, for example, operate not just as tools for those with

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 42

42 ■ Body & Society Vol. 14 No. 1

anomalies, but as potential enhancements for any body. The bio-clinical trans-
formations undertaken by performance artists like Orlan exemplify the possi-
bilities by taking them beyond the usual elective limits, but the point she makes
is that the external interventions that would seem to rely on a modernist and
somewhat Cartesian view of corporeality as manipulable – precisely because it is
separable from the self – also expose the inherent plasticity of embodiment in
general. Orlan’s project may appear to be fully intentional and under her own
specific control, but in a sense each performance exceeds its own strictly corporeal
limits and demonstrates the performativity of the self. Against the drive to repair
and recuperate the damaged or anomalous body to the cultural imaginary,
Orlan’s work uses the corporeal cut as a tactic of queering the embodied self. It
may seem to be a long way from the conventions of surgery, but it nonetheless
uncovers the inherent ambiguity of every intervention into the body.
The resistance of the flesh to normativity is, perhaps, less surprising when we
consider the illusory status of any fixed and given morphology. The body, no less
than the self, is a construction in process, and although open to deliberative
transformation, it does not necessarily change or develop in predictable ways.
What are laid down as the normative parameters of corporeality are necessary
conveniences that allow for calculated manipulation, without limiting the possi-
bilities that may arise. In any case, cultural theorists are already familiar with the
notion that the body image through which we identify ourselves and mark our
place in normative society is a precariously grounded concept. In both the
Freudian and Lacanian view, we all rely on a constructed and imaginary anatomy
that is dependent on a certain corporeal introjection, which relates to, but is not
determined by, the infant’s own bodily boundaries and sensations. What is
perhaps less well known is that neuroscience has provided its own version of an
imaginary body in the work done on somato-sensory mapping, most notably by
Wilder Penfield in the 1950s and more recently by V.S. Ramachandran. In the
early experiments, Penfield studied the brain cortex of fully conscious human
subjects to generate a body-image map in which the visible features of the body
– eyes, hands, legs and so on – each had a corresponding site on the cortical
surface. What Penfield’s somato-sensory map reveals is that some features – and
notably the hands and lips, which have the largest numbers of nerve endings at
the skin – take up far more space proportionally than they do in the visible body.
Clearly, this experimentally constructed map is not quite the same as the experi-
ential map of the imaginary anatomy, but it does share elements in common.
Both rely in part on the input of both touch and sight messages, and from propri-
oceptive elements, rather than on what we take to be the fixed dimensions of the
visible body. Similarly, both approaches posit a model of the corporeal that is

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 43

Corporeal Cuts: Surgery and the Psycho-Social ■ 43

consolidated in infancy. Indeed, in the case of the the somato-sensory map, it was
thought for many decades that once the neural pathways were set in early life,
then the brain became, as it were, hard-wired. In other words a particular cortical
area would always correspond to the same point on the body, and that therefore
any critical, and irreparable, cut or break in surface continuity and functionality
would result in permanent loss of equivalent brain activity. What could never
be adequately explained, then, was how the experience of phantom limb arises
following accidental or elective amputation. If an arm is excised above the elbow
say, how could sensations be felt in the missing hand – that is in the correspond-
ing area of the somatosensory cortex – in the absence of any external input?
To experience a so-called phantom limb is by no means rare, and some studies
indicate that, immediately following amputation, up to 95 percent of people have
phantom experiences, which may persist for years in around two-thirds of the
cases. The body, in other words, not only resists the traumatic cut, but incorpo-
rates new extensions of itself which reflect, but are rarely identical to, the lost
body part. Moreover, like ‘real’ corporeality, phantom augmentations tend to
change over time. Nonetheless, despite much neurological research around such
notions as cortical reorganization, where active areas migrate to nearby areas
deprived of input, or of the regeneration of existing overlapping pathways that
had laid dormant (Ramachandran and Blakeslee, 1998), for example, no single
explanation of the phenomenon exists. But whatever the attempts at bioscientific
rationalization, it appears that the image of a hard-wired body is redundant, and
that an intrinsic neural plasticity is in play. Indeed, as some of Ramachandran’s
experiments appear to show, all bodies have the capacity to produce phantoms,
to experience strange extensions in space, displacements of affect, and super-
numerary limbs. Going beyond the potentially reductionist approach associated
with bioscience, Ramachandran’s explication of neural plasticity opens on to a far
wider scene. As he puts it:
. . . the so-called body image, despite all its appearance of durability and permanence, is an
entirely transitory internal construct that can be profoundly altered by the stimulus contingen-
cies and correlations that one encounters. (Ramachandran and Hirstein, 1998: 1623)

Yet, although admitting a multifactorial input to image formation, which includes

a passing acknowledgment of somatic memory,8 Ramachandran nevertheless leaves
unaddressed a whole set of phenomenological implications that, not surprisingly,
have intrigued philosophers like Merleau-Ponty. As the latter remarks of phantom
limbs: ‘The psycho-physiological equipment leaves a great variety of possibilities
open . . .’ (1962: 189). In short, the bioscientific explanations, far from pinning
down the very elusiveness of phantom phenomena – and their implicit insult to

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 44

44 ■ Body & Society Vol. 14 No. 1

the normative body and the assumed finality of the corporeal cut – is pleasingly
postmodern in the questions it raises, rather than in the answers it provides.
What, for example, are we to make of the cortical map of conjoined twins, both
prior to and after the cut? Do the lost parts of self-embodiment reappear as a
rejoined phantom? How are we to understand the psychic incorporation of
organic transplants like a facial transplant, or even xenotransplantation? What
part do prosthetic limbs play in body image when what they seem to replicate
has never existed in reality?
Contemporary prosthetic technologies, which can be understood as either
replacement or enhancement procedures, speak not only to the capacity for
human becoming to engage with both the organic and mechanistic other in just
the manner that Deleuze predicts, but also to a psychic transformation of flesh-
and-blood materiality. The point is that there are multiple ways in which we can
inhabit bodies, and the current binary division of normal and abnormal, whole-
bodied and diseased, disabled and able-bodied, is extraordinarily reductive and
prohibitive. Moreover, we cannot really be sure of having any fixed location of
selfhood. As Donna Haraway asks: ‘Why should our bodies end at our skin?’
(1990: 220). The increasingly potent Western turn to the notion of embodiment as
intrinsically hybrid and continuously open to transformation should encourage us
to rethink the implications of the corporeal cut, both in terms of the dominance
in the cultural imaginary of autonomous subjectivity and individualism, and as a
material intervention that seeks to (re)normalize the body. If the technological
cut, and its corollary of prosthetic development, were to be seen as essentially a
move to open up the possibilities of embodiment, then in place of anxiety the
turn away from the hegemony of sameness would entail a revaluation of morpho-
logical difference. Given an ethical strategy of refusing to cover over difference
and instead queering the norms of embodiment, we could note that the corporeal
cut already demonstrates a deconstruction of the apparent stability of distinct
and bounded categories. It might effect just that replacement of a humanist
politics of norms and identity by a biopolitics of hybrids and transformation that
Haraway calls for. However we understand the process of intervention, then – as
neurological, phenomenological or psychically invested – the fluid corporeality
of the embodied self is not to be denied.

Notes
Parts of this article are based on an original presentation given at the HCTP Annual Workshop,
‘Repair, Regeneration, and Reproduction’, University of Toronto, 2005. I am grateful to HCTP for
their continuing intellectual and financial support.

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 45

Corporeal Cuts: Surgery and the Psycho-Social ■ 45

1. Contemporary media may feed an underlying and increasingly public fascination with surgery
itself, but we still anticipate a return to the closure of the normative body.
2. Leeches remain in use in contemporary wound management, but are rarely spoken of.
3. In her recently published diary, Le Baiser d’Isabelle, Isabelle Dinoire, the world’s first face trans-
plant recipient, says of the donor: ‘I cannot forget her. I cannot and I will not. She exists in me’ (Davis
and Allen, 2007).
4. Surgery on adult conjoined twins is very unusual, with most procedures being attempted in
infancy or early childhood, at least before the age of 7, when both different developmental concerns,
and psychological factors, are believed to complicate recovery rates. The widely publicized case of the
professionally successful Iranian twins Ladan and Laleh Bijani, who demanded separation in their 20s,
ended in the death of both (Guardian Unlimited, 2003).
5. As part of an ongoing empirical project in North America into the significance of heart trans-
plants, I have personally observed a recipient of four different organ grafts – who had also suffered
amputation of some digits due to kidney failure – expressing a desire for a further kidney. The will to
live on is extraordinarily persistent, but who is the ‘I’ who makes the demand for continuing surgical
intervention?
6. The term ‘living cadaver’ – now renamed ‘deceased donor’ – refers to a fully non-sentient, brain-
stem dead yet still organically functioning body. The vital organs of heart, lungs, kidney and liver are
optimally ‘harvested’ for transplant at this point.
7. Early results from a small pilot study to the collaborative project on the phenomenology of heart
transplantation (see note 5 above) have reiterated such reports. The theoretical reflections presented
here, however, precede that project. For a fuller deconstructive approach to the notion of ‘the gift of
life’, see Shildrick (2008 forthcoming).
8. Ramachandran identifies five sources of input to the cortical image (Ramachadran and Hirstein,
1998: 1624).

References
Bakhtin, Mikhail (1984) Rabelais and his World. Bloomington, IN: Indiana University Press.
Benthien, Claudia (2002) Skin: On the Cultural Border Between Self and the World, trans. Thomas
Dunlap. New York: Columbia University Press.
Davis, Barbara and Allen Peter (2007) ‘I Still Fear My Own Reflection’, Daily Mail 5 October, URL
(consulted October 2007): www.dailymail.co.uk/pages/live/femail
Dreger, Alice (ed.) (1999) Intersex in the Age of Ethics. Hagerstown, MD: University Publishing Group.
Foucault, Michel (1980) Power/Knowledge: Selected Interviews and Other Writings, 1972–77, edited
by Colin Gordon. Brighton: Harvester Press.
Foucault, Michel (2003) Abnormal, trans. G. Burchell. New York: Picador.
Gilman, Sandor (1999) Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton,
NJ: Princeton University Press.
Goering, Sara (2003) ‘Conformity through Cosmetic Surgery: The Medical Erasure of Race and
Disability’, in Robert Figueroa and Sandra Harding (eds) Science and Other Cultures. New York:
Routledge.
Guardian Unlimited (2003) ‘Special Report: Ladan and Laleh’, 7 July.
Haraway, Donna (1990) ‘A Manifesto for Cyborgs’, in Linda Nicholson (ed.) Feminism/Post-
modernism. London: Routledge.
Haraway, Donna (1992) ‘The Promises of Monsters: A Regenerative Politics for Inappropriate/d
Others’, in Lawrence Grossberg, Cary Nelson and Paula Treichler (eds) Cultural Studies. London:
Routledge.

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015

03 Shildrick 087529F 29/2/08 4:10 pm Page 46

46 ■ Body & Society Vol. 14 No. 1

Inspector, Y., I. Kutz and D. David (2004) ‘Another Person’s Heart: Magical and Rational Thinking
in the Psychological Adaptation to Heart Transplantation’, Israeli Journal of Psychiatry and
Related Sciences 41(3): 161–73.
Joined at Birth (2003), directed by Bill Hayes, Discovery Channel.
Kleinman, Arthur (1988) The Illness Narratives: Suffering, Healing and the Human Condition. New
York: Basic Books.
Kristeva, Julia (1982) Powers of Horror. New York: Columbia University Press.
Leder, Drew (1990) The Absent Body. Chicago, IL: University of Chicago Press.
Merleau-Ponty, Maurice (1962) The Phenomenology of Perception. London: Routledge and Kegan
Paul.
Morland, Iain (2005) ‘Narrating Intersex: On the Ethical Critique of the Medical Management of
Intersexuality’, unpublished PhD thesis, University of London.
Potts, Michael (1998) ‘Morals, Metaphysics, and Heart Transplantation: Reflections on Richard Selzer’s
“Whither Thou Goest”’, Perspectives in Biology and Medicine 41(2): 212–24.
Prophet, Jane (1999) ‘Imag(in)ing the Cyborg’, in Cutting Edge Women’s Research Group (ed.) Desire
by Design: Bodies, Territories and New Technologies. London: I.B. Tauris.
Ramachandran, Vilayanur S. and Sandra Blakeslee (1998) Phantoms in the Brain. New York: Wm.
Morrow and Co.
Ramachandran Vilayanur S. and William Hirstein (1998) ‘The Perception of Phantom Limbs’, Brain
121: 1603–30.
Sharp, Lesley (1995) ‘Organ Transplantation as a Transformative Experience: Anthropological Insights
into the Restructuring of the Self’, Medical Anthropology Quarterly 9(3): 357–89.
Shildrick, Margrit (1999) ‘This Body Which is Not One: Dealing With Differences’, Body & Society
5(2–3): 77–92.
Shildrick, Margrit (2001) ‘ “You Are There Like My Skin” – Reconfiguring Relational Economies’, in
Sara Ahmed and Jackie Stacey (eds) Thinking Through the Skin. London: Routledge.
Shildrick, Margrit (2002) Embodying the Monster: Encounters with the Vulnerable Self. London: Sage.
Shildrick, Margrit (2005) ‘Unreformed Bodies: Normative Anxiety and the Denial of Pleasure’,
Women’s Studies: An Interdisciplinary Journal 34(3–4): 327–44.
Shildrick, Margrit (2008 forthcoming) ‘The Critical Turn in Feminist Bioethics: The Case of Heart
Transplantation’, International Journal of Feminist Approaches to Bioethics 1(1).
Sylvia, Claire (1997) A Change of Heart. New York: Little, Brown.
Waldby, Catherine (2000) The Visible Human Project. London: Routledge.

Margrit Shildrick is Reader in Gender Studies at Queen’s University Belfast, and Adjunct Professor
of Critical Disability Studies at York University, Toronto. She works on feminist theory, bioethics and
philosophy, all with a focus on the notion of embodiment. Her publications include the books: Leaky
Bodies and Boundaries (Routledge, 1997), Embodying the Monster: Encounters with the Vulnerable
Self (Sage, 2002) and the co-edited collections Vital Signs (Edinburgh University Press, 1998), Feminist
Theory and the Body (Edinburgh University Press, and Routledge 1999) and Ethics of the Body (MIT
Press, 2005).

Downloaded from bod.sagepub.com at University of Bucharest on May 22, 2015