Making the invisible body visible. Bone scans, osteoporosis and women's bodily experiences

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Abstract

The imaging technology of bone scans allows visualization of the bone structure, and determination of a numerical value. Both these are subjected to professional interpretation according to medical (epidemiological) evidence to estimate the individual's risk of fractures. But when bodily experience is challenged by a visual diagnosis, what effect does this have on an individual? The aim of this study was to explore women's bodily experiences after a bone scan and to analyse how the scan affects women's self-awareness, sense of bodily identity and integrity. We interviewed 16 Danish women (aged 61–63) who had had a bone scan for osteoporosis. The analysis was based on Merleau-Ponty's perspective of perception as an embodied experience in which bodily experience is understood to be the existential ground of culture and self.

Women appeared to take the scan literally and planned their lives accordingly. They appeared to believe that the ‘pictures’ revealed some truth in themselves. The information supplied by the scan fostered a new body image. The women interpreted the scan result (a mark on a curve) to mean bodily fragility which they incorporated into their bodily perception. The embodiment of this new body image produced new symptom interpretations and preventive actions, including caution.

The result of the bone scan and its cultural interpretation triggered a reconstruction of the body self as weak with reduced capacity. Women's interpretation of the bone scan reorganized their lived space and time, and their relations with others and themselves. Technological information about osteoporosis appeared to leave most affected women more uncertain and restricted rather than empowered. The findings raise some fundamental questions concerning the use of medical technology for the prevention of asymptomatic disorders.

Introduction

The body's interior is objectified and made visible through its subjection to an increasing array of technology leading to the identification of health risks and diseases when they are still unacknowledged by the individual. (Featherstone & Burrows, 1995; Lock, 1993; Turner, 1995). Osteoporosis is an example of a risk condition (a corporal risk), located in the body of the person (Kavanagh & Broom, 1998), which can be unveiled by an examination (a bone scan) of the bone mass (Lock, 1993; Reventlow, Hvas, & Tulinius, 2001; van Wingerden, 1996). Osteoporosis and low bone mass remain invisible in the body and give no symptoms until the time when a fracture may occur. Osteoporosis, however, does not necessarily imply that a fracture will occur, and many people without osteoporosis still risk having a fracture.

The present study raises the question of what happens when medical technology, for the sake of prevention, makes otherwise hidden bodily processes visible. The authors’ background in general practice and medical anthropology creates an interdisciplinary space raising our awareness of the effect of medical technology on healthy women.

The aim of the study was to explore women's bodily experiences after a bone scan and to analyse how a bone scan affects women's self-awareness, and sense of bodily identity and bodily integrity.

Section snippets

Medical technology and osteoporosis

From a biomedical viewpoint, osteoporosis is described as a progressive systemic disease characterized by low bone density and micro-architectural deterioration of the bone tissue, with a consequent increase in bone fragility and susceptibility to fracture (WHO Study Group, 1994). Most frequent are fractures in the wrist, the hip and the backbone, with hip fractures as the most important, because of the association with medical complications and disability and the costs of hospitalisation.

Theoretical framework

The introduction of new technology into biomedicine launches new standard structures for diagnostic and treatment practices. New demands and new issues of acceptability concerning health are developed both in the health care system and among lay people (Koch & Stemerding, 1994). Preventive medicine and people's relationship with medical technology can be approached from a Foucauldian perspective on the disciplining of bodies and lives through an exertion of biopower (Foucault, 1977). Foucault

Methods

A qualitative interview study was chosen to explore women's experience of osteoporosis (Miller & Crabtree, 1999). The study focused on the informants’ experiences and does not address what doctors and the health personnel actually said to the women.

The informants were recruited from the sample of a representative, Danish population-based, age-specific cohort study conducted in the county of Copenhagen. The aims of the cohort study were to describe health and use of health services and of

Findings and interpretations

The women's reasons for being scanned varied (involvement in a research project, referral by their doctor, or personal request for an examination). However, no matter who requested the bone scan, they were all affected by the examination. The experience was exceptional and all gave an unprompted, detailed account of the situation. All the women had great faith in the bone scan technology. Most of them considered the bone scan an opportunity to have their bodies checked for osteoporosis and

Embodiment of the bone scan—theoretical analysis

We found that the participants articulated a change of their bodily experience after their encounter with the medical technology of the bone scan. This concerned issues like their consciousness of their body and bodily signs, and issues concerning bodily identity and bodily integrity.

Women's encounters with the medical technology of the bone scan

This study was in line with other studies demonstrating people's satisfaction with health examinations (Anderssen, 1998). A study from the United States found that most adults believe routine cancer screening is almost always a good idea (Schwartz, Woloshin, Fowler Jr, & Welch, 2004). The women had faith in the results of the bone examinations and most of them in the proposed prevention strategies too, which may also be attributed to their positive attitude to participation in a population

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