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JOANNA BOURKE

Mastectomy, Fear, the Body: A History





In August 1812, eminent novelist Frances Burney described with alarming precision her mounting sense of terror as she prepared to undergo a mastectomy without any anesthetic. Having two hours to wait until the dreaded event (her ‘execution’, as she put it), she wandered into the room where the operation was going to take place. ‘I strolled to the Sallon’, she wrote, and

 

saw it fitted with preparations, & I recoiled….  the sight of the immense quantity of bandages, compresses, spunges, Lint -- -- made me a little sick: -- I walked backwards & forwards till I quieted all emotion, & became by degrees, nearly stupid – torpid, without sentiment or consciousness.

 

As seven men, all dressed in black, entered her room and began laying down two ‘old mattresses’ and covering it with an ‘old sheet’, Burney ‘began to tremble violently, more with distaste & horrour [sic] of the preparations even than of the pain’. When she was told to mount the bed, she described standing ‘suspended, for a moment, whether I should not abruptly escape – I looked at the door, the windows – I felt desperate’. Submission was necessary, though. The surgeon spread a cambric handkerchief over her face, and took up the knife. Burney was consumed by a ‘terror that surpasses all description’. When ‘the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves’, she wrote, ‘I needed no injunctions not to restrain my cries. I began a scream that lasted intermittingly during the whole time of the incident – & I almost marvel that it rings not in my Ears still! So excruciating was the agony’. Her fear and pain were so intense that ‘for Months I could not speak of this terrible business without nearly again going through it!’

 

Burney’s attempt to capture in words her terror is a particularly eloquent example of a fear-narrative. In fact, historians still know remarkably little about how people actually experienced fear in the past. The alleviation of fear has been explored much more frequently than its expression. In both historical and contemporary writings about fear, the prominence of phrases such as ‘the conquest of fear’ or ‘the fight against fear’ implies that the emotion of fear required a ‘battle’ of mind over body. However, the sensation of fear is not merely the ornament of the emotion: fear is ‘what hurts’ – the most irreducible ‘real’ of an individual’s history. The mind/body distinction is profoundly unhelpful in understanding the importance of this emotion in constituting the self.

 

Perhaps part of the reluctance of historians to focus on the history of fear is because it is such a subjective experience. After all, how can historians know what fear ‘really felt like’ in previous centuries? As Elaine Scarry argued in relation to pain, fear is often thought to exist outside of language: the emotion is essentially private and unable to be accurately transmitted.

 

In contrast, when looking back into the past, what is most striking is the fundamentally social aspects of fear and its ability to generate language. Even terrified people adhered to societal norms and rituals. Indeed, Burney’s insistence on the need to communicate her fears was typical of fearful people. Frightened people were often highly creative in expressing their suffering to friends, family, or physicians. As Virginia Woolf put it in her essay ‘On being Ill’, a person in an extreme state, such as pain or fear, was ‘forced to coin words himself, and, taking his pain in one hand, and a lump of pure sound in the other (as perhaps the inhabitants of Babel did in the beginning), so to crush them together that a brand new word in the end drops out’. Metaphoric languages were particularly important in conveying the ‘feeling’ of fear. To be understood, individuals communicating their fears needed to conform to certain narrative structures, including genre, syntax, form, order, and vocabulary. The ways in which these discourses changed over historical time enables historians to access emotional states.

 

The ways people in the past have narrated their fears were highly influenced by theories of the body and mind that existed at the time in which they were writing. Emotional responses to illnesses such as breast cancer were constructed discursively by particular interpretive communities. All emotional experiences were filtered by the prevailing emotionology, or those rules and assumptions governing the expression of emotions. In terms of fear-narratives, it mattered whether a person believed that cancer was a punishment from a deity, or was inherited, or was infectious. For Fanny Burney, her terror was also profoundly altered by her position as a ‘patron patient’: at the time she was writing, wealthy patients still lorded it over their physicians, and her humiliation of being progressively stripped of her authority and exposed to the gaze of unknown men was an integral part of her terror.

 

While we may argue that discourses shaped bodies, it is also true that bodies shaped discourse. People were ‘weak or pale with fright’, ‘paralysed by fear’, and ‘chilled by terror’. As implied earlier, the act of speaking (or writing) one’s fear changed the sensation of fear. Emotional utterances or acts had a ‘unique capacity to alter what they ‘referred’ to or what they ‘represented’’. Shifts in the way people narrated fear altered their subjective experience, giving historians a way to analyzing how fear may have actually changed over historical time.

 

Finally, narratives of fear are important because they were used to create a hierarchy of sentient beings. The ability to feel, both in terms of physical sensation as well as inner sensibilities, was ranked hierarchically, with white men at one end and slaves and animals at the other. Historically, there are innumerable examples of this use of emotions. One example about the role of emotions such as fear in distinguishing the human from the animal would be Sir Charles Bell’s The Anatomy and Philosophy of the Expression as Connected with the Fine Arts (1806). This book was the most influential exploration of the emotions in the first half of the nineteenth century. For Bell, God had designed the human body differently from the animal – and the possibility of expressing emotions was central to his argument. As an illustration, Bell instructed his readers to imagine a man who was terrified. Upon looking at the object of his fears, his eyes would be staring or ‘wildly searching’; his eyebrows would be raised. These expressions were nothing more than responses of his mind to his fears. ‘But observe him further’, Bell directed:

 

There is a spasm on his breast, he cannot breathe freely, the chest is elevated, the muscles of his neck and shoulders are in action, his breathing is short and rapid, there is a gasping and a convulsive motion of his lips, a tremor on his hollow cheek, a gulping and catching of his throat; and why does his heart knock at his ribs, while there is no force of circulation? – for his lips and cheeks are ashy pale.

 

Since the mind had no control over these innate corporeal responses, what was their purpose? According to Bell, God had created the human body as an expressive instrument to aid communication between humans. Unlike the faces of animals, in whom there were no ‘expressions’, only ‘acts of volition or necessary instincts’, human muscles enabled people to both express their fears and speak of them. The human face was a unique and ‘special apparatus, for the purpose of enabling him to communicate with his fellow-creatures’: it was a ‘natural language’.

 

Bell’s theological anatomy was a world away from post-Darwinian notions of emotions, in which emotional behaviour and expressions were not unique to human-beings. As Darwin argued in The Expressions of the Emotions in Man and Animals (1872), emotional expressions were the outcome of evolutionary forces. Just as Bell’s Natural Theological theory of the emotions posited a hierarchy of living beings, so too Darwin’s evolutionary theory was generally understood in the late-nineteenth century as affirming the Great Chain of Being, with (certain) humans at its apex. The range and sophistication of emotional responses were crucial in forging this hierarchical vision of humanity. In his notebook of 1838, Darwin had urged his readers to

 

visit Ourang-outang in domestication, hear expressive whine, see its intelligence when spoken [to]; as if it understood every word said – see its affection. – to those it knew. – see its passion & rage, sulkiness, & very actions of despair; let him look at savage, roasting his parent, naked, artless, not improving yet improvable & let him dare to boast of his proud preeminence. – not understanding language of Fuegian, puts on par with Monkeys.

 

Indeed, it was Darwin’s meeting with native Fuegians in Tierra del Fuego that made him interested in emotional expressions in the first place: Darwin believed that the ‘very signs and expressions’ of these people were ‘less intelligible to us than those of the domesticated animals’. Emotional expression relegated certain peoples to a lower stage in evolutionary progress than others.

 

What these two examples of Bell and Darwin reiterate is the need to be acutely aware of the various meanings given to emotions such as fear in the past. The crucial question becomes ‘what is fear doing?’ This emphasis on what fear is doingavoids the constructivists’ dilemma that the fear-speak or fear-act is the fear, inviting the conclusion that if men neither acted frightened nor said they are frightened, then they were not frightened. In the words of the historian and anthropologist, William Reddy,

 

emotives do things to the world. Emotives are themselves instruments for directly changing, building, hiding, intensifying emotions. There is an ‘inner’ dimension to emotion, but it is never merely ‘represented’ by statements or actions. It is the necessary (relative) failure of all efforts to represent feeling that makes for (and sets limits to) our plasticity.

 

In other words, the act of actually saying or writing the phrase ‘I am afraid’ changed the state of fear. Emotions were not simply reports of inner states; they were interactive.

 

Crucially, as I argued in Fear. A Cultural History (2005), emotions such as fear mediate between the individual and the social. They are about power relations. Emotions align individuals with communities. In other words, fear is a form of ‘emotional labour’ that endows ‘objects and others with meaning and power.’ In the process of ‘emotion-work’ (negotiating relationships between individual psychology and social institutions), fear sorts people into positions of social hierarchy. As in Fanny Burney’s account of her mastectomy, Sir Charles Bell’s theological explanation for the superiority of humans over animals, or Charles Darwin’s evolutionary schema, narratives of fear were a form of social enaction. At the level of personal accounts, as much as at the level of scientific treatises, emotions were concerned with the constitution and distribution of power.

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