Paper short abstract:

Chronic breathlessness is associated with poor interoceptive awareness and difficulty interpreting symptoms. Increased breathlessness is perceived as a barrier to movement and this paper describes a potential rationale and approach to addressing this.

Paper long abstract:

When bodies move breathing becomes apparent to the breather and to the observer. For some, this is a matter for joy and exhilaration but for others, especially those suffering from chronic lung disease, movement becomes something to be avoided as increasing breathlessness is frightening and potentially dangerous. A paradox remains, however, that, exercise is an important management approach helping to sustain lung function even in illness. Chronic breathlessness is difficult to treat and the main approach is to offer patients pulmonary rehabilitation (PR), which consists of an exercise programme run by specialist physiotherapists in a gym-like space. Uptake of this therapy is poor and so far the main explanation is that people with breathlessness do not like being made to feel breathless through exercise. Interdisciplinary research in the Life of Breath project has added nuances to this explanation. Working with neuroscientists has revealed that people with chronic breathlessness have poor interoceptive awareness, which in turn leads to problems of symptom interpretation, discordance between measured and experienced breathlessness, and a sense of lack of control. People are also put off by the language of PR, and by the unfamiliarity of the gym-like space. Using an interdisciplinary medical humanities approach, this paper will explore the links between interoceptive awareness and symptom discordance in chronic breathlessness. I will describe and justify an approach involving dance that has the potential to address barriers to movement and suggest that it is possible to effect change in a sense of embodied awareness.

Paper short abstract:

Across contemplative techniques, practitioners guide their movements by evoking the elements. How one can experience wellbeing by, for example, floating in or flowing as water? I suggest in correspondence with the elements' creative properties.

Paper long abstract:

Unlike the effect-oriented practices of physical rehabilitation or therapy, contemplative movement is open-ended, explorative and it has no definable end. To move contemplatively is to do so without judgment but with attention and care by focusing on the immediate phenomenal experience of being in the world. Across contemplative techniques, both ancient and modern, practitioners evoke the elements such as air, earth or water to realise human interdependence with the environment and to realise the never-finished nature of experience. In this pulling together (co-templation) the ways of the elements become the ways of practitioners' sensations. By moving in (floating) and as water (flowing) participants in improvisational dance techniques becomes metaphorically similar to or metonymically in close contact with this element. Air, meanwhile, is boundless and so are associated with it in the spiritual traditions of the Indian subcontinent immeasurable qualities of compassion and equanimity.

While current sociological accounts tend to explain contemplative techniques in terms of an inscription of predetermined form onto the body, research with contemplative practitioners in chronic care settings in India, Japan, and Israel suggests that moving with the elements might be better understood in terms of correspondence. In particular, contemplative exploration of the elements entails coupling of movement and word (or action and perception) yet, as we shall see, it also brings together intero- and exteroception. I suggest that becoming well in contemplative practices entails learning to move skilfully with the world and its elements by cultivating attitudes such as love, trust or acceptance.

Paper short abstract:

This paper explores the relations among physical disability, movement, and kinesthetic self-making, focusing on the case study of integrated dance of people with and without disabilities. It discuss the ways disability functions in this context as a means of unsettling habitual embodied practices.

Paper long abstract:

Physical disability has been commonly articulated as a static state of being, imagined as the opposite of movement, nonetheless, of dance. Yet, as I demonstrate in my ethnographic research on integrated dance of people with and without disabilities in Israel and the US, disability may engender a sensory and kinesthetic sensitivity.

In my work with dancers with varied physicalities I discovered disability to function as a state that calls for a unique sensory attention, including interoceptive awareness. For example, physical disability challenges the taken-for-granted of everyday tasks such as walking, and an injury requires the person to (re)learn a new skill, adapting the habits acquired to fit with the new body. Disability, therefore, unsettles habitual embodied practices, reshaping people's sense of physical immanence, offering an experience of various rhythms and spaces. Disabled people are indeed experts in moving.

In my research, I focus on the formation of movement and what I call the kinesthetic intellect and self, in the crossroads of two sensory cultures: disability and dance. I ask about the ways the meeting between people with different abilities engaged in activities requiring shared understanding of concepts such as rhythm, partnering, and pacing, construct creative answers to the questions what a body should do and what disability (and ability) is.

Findings reveal that when bodily difference is explored in a movement-oriented context, agency is expressed when participants discover the life of untypical movements such as small gestures, horizontal movements, and movements involving objects such as wheelchairs.

Paper short abstract:

This paper focuses on body transformations in the life trajectories of Tamil Tigers fighters exiled in France. It seeks to understand, firstly, how the warrior body is constructed in the training camps and, secondly, how its social meaning and its experiences change in the context of exile.

Paper long abstract:

This paper focuses on the body of former members of Tamil Tigers (LTTE), a secessionist organization which fought in the Sri Lankan civil war (1983-2009). It is based on long-term ethnographic work (2008-2017) among Tamil militants in Paris. My interviewees enlisted in the 1980s or 1990s and, after nearly ten years of service, went to France during the 2000s. I seek to understand, firstly, how the war has been experienced and embodied, and secondly how in exile the body is seen to provide new meanings and experiences.

In the first part, I will show how the warrior body is produced during military training. While scholarship on non-state fighters tends to focus on narratives, propaganda and symbolic meanings, I will show that discipline and physical conditioning are crucial for building what a fighter is and how he or she perceives him or her self.

In the second part, I will analyse the fighters' body during demobilization and exile. All these fighters have been injured, some have been tortured, others have become invalids. I will show how the embodiment of their history changes their perception of themselves and their place in the world. Moreover, the body is the place where truth is revealed (Fassin and d'Halluin 2005); however, truth changes according the context: does the body have the same meaning when it is shown to Tamil militants, to the anthropologist or to the doctor who writes a medical certificate to be used for an asylum request?

Paper short abstract:

This paper explores tobacco craving historically and cross-culturally as an interoceptive force that plays an important and anthropologically underestimated role in generating and maintaining tobacco-human hybridity in long-term users.

Paper long abstract:

A footnote in Mac Marshall's 'Drinking Smoke' (2013) recounts the tragic tale of a 1950 Micronesian canoe party lost at sea during a journey from Namoluk to Chuuk in search of cigarettes. This presentation interrogates cravings, the interoceptive sensations ('feelings generated by the central nervous system that originate from the interiors of the body') engendered by long-term tobacco-human hybridity that became such a feature of 20th century life and continues to be in the 21st century, particularly in low and middle income countries such as Micronesia. What it is about tobacco that, to quote the 17th century Scottish madrigalist Tobias Hume, 'makes men sail from shore to shore'? The historian E.H. Carr uses the example of a man "crossing the road to buy cigarettes" who is killed by a drunk driver in a car with defective brakes. Such scenarios resonate, anthropologically speaking, with theories of agency, witchcraft and enchantment. Tobacco is often attributed with the agency to make people do things - produce, distribute, use, control and research it. Yet terms like agency and dependence are perhaps too anodyne to capture the reality of tobacco craving for many long-term users, underestimating what Matthew Kohrman (2008) describes as "the biochemical grip that cigarettes can have over people". In this paper, I plan to use a variety of historical and cross-cultural examples to reinstate the importance of tobacco craving as an interoceptive, bewitching force that causes people to move in ways that increase their likelihood of coming to an untimely end.

Paper short abstract:

Learning skills of diagnosis in medicine requires a dynamic reorientation of the body. Drawing on fieldwork in a Dutch medicine school, this paper explores this process of making, measuring and unsettling.

Paper long abstract:

Medical education is a sensory re-education. The bodily reorientation entailed in learning diagnostic skills is explored in this paper in five inventive spaces, where the body as a standard of measurement (Hoel and Carusi 2018) is continually formed and calibrated. First, oscillations are made between figure/ground, as body parts are brought in and out of awareness (Strathern 2002) [e.g. abdomen becomes pregnant]. Second, the body is cut along new axes [e.g. pelvic cavity is divided into five planes, demarcating an emerging infant's head]; this requires landmarks, anatomical points that act as compass and help "grid" the body. Third, in explicit practices of measurement [e.g. umbilicus to pubis in centimeters and gestational weeks] measured (bodies) and measuring (bodies) are visibly co-constituted. Fourth, skills are broken down, their parts isolated and assembled with different technologies [e.g. bony pelvis to show descent, rubber uterus shows scale]. Fifth, skills, while always in movement, are freeze-framed to explore details of technique [e.g. leather of the pregnant mannequin slows down the delivery]. Through this education, habits of perception are altered. I explore these empirical examples from fieldwork in a Dutch medical school (part of a larger comparative ethnographic-historic project, Making Clinical Sense) with focus, as indicated, upon the skills of guiding birth. Looking at teachers' expressive instructions and students' practices, in correspondence with Hoel and Carusi's notion of the "measuring body", the dynamic, ecological nature of learning skill is opened up in refreshing ways, and fleshy boundaries, once again, unsettled.

Paper short abstract:

Moving the body is something many do unconsciously. Medical students, however, (re)learn to move their bodies in relation to patients. In this paper, I explore the role of simulation in training medical students how to move and find that training movement is intimately related to training touch.

Paper long abstract:

Moving the body through space is something many do unconsciously; it is often an unarticulated or embodied experience. Medical students, however, (re)learn movement as a skill to be performed in relation to patients for the purpose of physical examination. I draw on seven months of ethnographic fieldwork, including participant observation and interviews, within the medical programme at the University for Development Studies (UDS) in Tamale, Ghana to explore how medical students and their educators train movement. At the UDS, students begin learning physical examination skills during their first year of medical school. They do so mostly in a classroom setting throughout the first three years of their education. Instead of working with patients, students and teachers often rely on simulations during this time. Sometimes such simulations are improvised—an educator stacks two fists on top of each other to model the knee. At other times, they are quite routine—students practice physical examination skills on each other under their educators' supervision. The routine simulations literally allow students to move and be moved, while the improvised simulations often illustrate the consequences of a doctor's movement for the patient's body. Both types, however, attempt to convey a "feel for movement" to students, making it evident that a doctor's movement is intimately related to his or her touch.

Paper short abstract:

This paper articulates relations between movement and personal change as they are enacted in a Dutch rehabilitation clinic for people with persistent pain and fatigue. I argue that movement is not only understood as a means to health but as constituting health in itself.

Paper long abstract:

Drawing on participant observation and interviews, this paper articulates relations between movement and personal change as they are enacted in a Dutch rehabilitation clinic for people with persistent pain and fatigue. In Western readings of the body, the self's relation to change has typically been predicated on movement of the muscular body (Kuriyama, 1999). The idea is that a willing self may change by directing the body much like a rider rides a horse. While it has been claimed that western medicine establishes and assumes such body/self dualisms, medical anthropologists now argue the upsurge of chronic diseases invites a redefinition of both medicine and embodiment. In the clinic where I did fieldwork, patients who live with the consequences of having done 'too much' are taught to better sense out and accept their limits. The paper details how such bodily awareness is achieved through keeping diaries, performing body scans or breathing exercises. Focusing on physical training sessions and patients' own experiences, I show how at the same time, clinicians encourage patients to not surrender to their pain or fatigue, but to reconquer their ability to take part in daily life. When symptoms stubbornly remain, patients face the difficult task of reinventing themselves, their desires, and habits entirely. The health fostered in rehabilitation practices is thus not a bodily state, but emerges in ways of living and doing. Consequently, movement is not only understood as a means to health but as constituting health in itself.

Paper short abstract:

Interoceptive difficulties have been recently explored as a feature of autism spectrum conditions (Garfinkel et al. 2016). This paper explores the role of interoception in the in/determinate (Roberts 2017) relations between movement and repose in the context of horseback therapy in the UK and USA.

Paper long abstract:

Difficulties with interoception have recently been explored as a symptom of autism spectrum conditions (Garfinkel et al. 2016). Specifically, these difficulties manifest in hypersensitivities to physiological states and relatedly the ability to reflect on one's own emotional experience to understand others. This paper explores the role of interoception in the in/determinate (Roberts 2017) relations between, and inversions of, movement and repose in the context of horseback therapy in the UK and USA.

People on the spectrum are often characterized by inflexibility of thought, and a tendency for becoming 'stuck'. Intense interests are referred to as 'fixed', and idiosyncratic behaviours such as 'stimming' are pathologized as 'stereotypy', implying that they have no aim or goal (APA 2013). However, my interlocutors define these habits actively, as a route to soothing sensory hypersensitivities. Struggling to maintain control of shifting sensorial worlds and living in flux between partial states of sensorial equilibrium, mean that rigidity, stasis, and routine become a route to much needed stability.

Traditional interventions (such as Applied Behavioural Analysis) aim to halt these habitual stimming behaviours. Horseback therapy instead works with, not against, individual's interoceptive idiosyncrasies. By carefully choreographing sensory inputs via horseback movement, the practice aims to soothe 'sensory overload', inculcating a state of 'sensory integration', equilibrium and stillness in the person. Facilitated by horse powered movement, these simultaneous spaces of stillness are understood by practitioners to enable behavioural flexibility and change.

Paper short abstract:

This paper explores the way in which GoodGym activity "unsettles" the embodied, habituated experience of the urban recreational runner and "disrupts" the practice of the urban recreational run. In so doing, it challenges existing concepts of "achievement" in running.

Paper long abstract:

This paper considers the movement of bodies in a non-clinical but health-oriented context; that of "GoodGym" activity. GoodGym is a non-profit organisation that combines "getting fit" with "doing good"; running-based exercise with volunteering activities. Running, as a form of exercise, is known to "unsettle" the body, moving it into varying modes of discomfort, and bringing various sensations to the foreground (the cardio-respiratory workings of the heart and lungs, for example). The recreational, urban runner might modify this embodied experience by running planned or negotiated distances, paces, and routes, in order to challenge, cope with and/ or enjoy their running experience. Drawing on data from mobile ethnography and semi-structured interviews, this paper shows that GoodGym activity unsettles the habitual embodied experience of urban recreational running and "disrupts" the practice of the urban recreational run in three distinct ways; through physical engagements with space and place, mobile sociability, and the sensory experience of the body. By unsettling the habitual embodied experience of urban recreational running, GoodGym activity stimulates the body in ways often appreciated by the GoodGym runners. For example, runners described the unpredictability of GoodGym activity "exciting", enjoyed the sociable aspect as a compliment to their other solitary runs, and appreciated the way in which the run was broken up into chunks. These findings challenge existing concepts of "achievement" in running, whereby the goal is often to run faster paces and longer distances, and instead re-model the concept of achievement upon the embodied experience of the runner.