Culture, Medicine, and Psychiatry

, Volume 41, Issue 2, pp 267–283 | Cite as

The Tipping of the Big Stone—And Life itself. Obesity, Moral Work and Responsive Selves Over Time

Original Paper

Abstract

Why is “everything I know is the right thing to do a million miles removed from what I do in reality?” This question posed by Rita, my main interlocutor and friend in a fieldwork that started in 2001–2003 and was taken up again in 2014–2015, opens up an exploration of moral work and moral selves in the context of the obesity epidemic and weight loss processes. I address these questions through the notion of “moral laboratories” taking up Mattingly’s argument that moral cultivation over time cannot be disconnected from a notion of self. Mattingly has consistently argued for a biographical and narrative self, which is processual and created in community. Along these lines, and by recourse to the German philosopher Bernhard Waldenfels’ phenomenology, I will propose the notion of a responsive self. The responsive self highlights the eventness of ongoing experimentation against the odds and captures equally pathic and agentive dimensions of a self that both persists and is transformed over time.

Keywords

Obesity Phenomenology Self Moral anthropology Denmark 

Introduction

Rita: OK, well, moving along to the important stuff…I still do not eat the way I should, and it is not going too well with the exercise. Hans [Rita’s husband] has also started making little innuendoes – it is not as if he teases me or insults me, and I know that it really is not that big a deal. But at the same time in the back of the mind – after all, he really believed, as I did, that this time it was serious, that this was absolutely the last time I would ever go through all that “nonsense” – that I was finally grown-up enough to take responsibility for my own well-being. God only knows what makes me backslide time and time again – to where everything I know is the right thing to do is a million miles removed from what I do in reality. (Grøn 2005:259)

For the good that I would I do not: but the evil that I would not, that I do. (The Holy Bible 2011, Romans 7:19)

Why don’t I grow-up enough to take responsibility for my own well-being? Why is what I know to be the right thing to do a million miles removed from what I do in reality? These questions were posed by Rita, when I encountered her during my Phd fieldwork from 2001 to 2003 in a Danish patient school, The Lifestyle Center. Patient schools in Denmark are located in both hospital, municipality and NGO settings, and target people suffering from or at risk of what is termed lifestyle-related diseases, teaching them about diet, exercise, medicines and self-care.1 At the time of my Phd fieldwork, the Lifestyle Center offered programs on cardiovascular diseases, diabetes, obesity, chronic obstructive lung disorder and osteoporosis. Rita participated in the obesity program, and she quickly became my main interlocutor and friend. Therefore, when I embarked on a fieldwork on the spread or social contagion of obesity in 2014 I turned to her for help on how to think about this. In this paper, I explore Rita’s reflections on obesity and weight loss, with specific attention to the transformation in notions of self, agency and morality from the first period of fieldwork to the second.

Rita is not alone in raising such questions. “Why don’t they just lose weight?”, is a question posed from many corners of the Danish society. This paper poses, that the problem lies not only in the absent answer, but in also the question posed, which presumes that weight loss can be accomplished most of the time by most people if this is pointed out to them as the right thing to do. In 1922, pragmatist philosopher John Dewey had already referred to the erroneous view of change behind such a line of thinking: “Recently a friend remarked to me that there was one superstition current among even cultivated persons. They suppose that if one is told what to do, if the right end is pointed to them, all that is required in order to bring about the right act is will or wish on the part of the one who is to act.” (Dewey 1922:27) Contemplating the main thrust of public health interventions targeting obesity as a question of individual life style change and will power, it would seem that nothing much has changed since Dewey’s insightful observations.

I start out by juxtaposing Rita’s and Saint Paul’s words in order to complicate this erroneous view of change. Paul’s tone, his dilemma, and aspiration capture those faced by Rita and many other obese or overweight people. References to opposing wills, to fighting the evil will or desire of your body, to sinning and backsliding, are plentiful and situate weight loss in the domain of morality. In addition, reading Rita’s words in the context of the well-known biblical quotation places the concerns and reflections on weight-loss within broader historical and cultural ideas on self, agency, and morality. When Rita talks about her dilemmas and aspirations, she is voicing moral concerns, which have been part of the Western religious and philosophical tradition for more than 2000 years. Finally, both Rita and Paul are concerned with ideas of the self—what kind of self one is able to be in the face of conflicting wills and moral demands. This, I contend, is an important question to ask—both empirically and theoretically—in the field of obesity where neoliberal and individualist notions of the self seem to loom freely in public health interventions, media representations (Boero 2007) and common sense ideas alike.

I address the questions of moral agency and moral selves by exploring Rita’s experiences and reflections in the context of what Mattingly has termed “moral laboratories”, i.e. spaces for experiments in hope and possibility, which take place not in scientific laboratories, but in ordinary “labs” of everyday life (Mattingly 2014). The notion of moral laboratories opens up a space for exploring the highly experimental quality of Rita’s ongoing work on and with herself, rather than the ways actual spaces or bodies become transformed. Specifically, I will take up an argument that Mattingly has put forward and developed for more than a decade now, namely that moral cultivation over time cannot be disconnected from a notion of self (Mattingly 2003, 2010, 2014). Mattingly has consistently argued for a biographical and narrative self, which is processual and created in community (Mattingly 2003, 2010, 2014), emphasizing the subjunctive side of narrative, i.e. the open-ended, processual and engaged position of being in the midst of an unfolding story. Along these lines, and by recourse to the German philosopher Bernhard Waldenfels’ phenomenology, I will propose the notion of a responsive self, which also stresses self-formation in the subjunctive mode. The responsive self highlights the eventness of ongoing experimentation against the odds and captures equally pathic and agentive dimensions of a self that both persists and is transformed over time.

Obesity and Weight Loss in Denmark

Up until the last decade of the second millennium, attention to the relationships between body weight, food, and health were scarce in a Danish setting marked by cultural practices and values of “hygge” (Borish 1991; Jenkins 1999; Grøn 2005, 2017), that is, socializing by sharing food and alcohol (and also smoking), often to excess. Over the past two decades this has changed dramatically, and the consumption of food and drink have become morally charged in all corners of Danish society, from family spaces to workplaces, to the widespread network of institutions constituting the Danish welfare system—kindergartens, schools, hospitals, homes for the elderly, and social services and institutions for people “at the fringes of society.” Specifically, a politically announced “paradigm shift” in the beginning of the second millennium in Danish health care services from attention to the treatment of acute diseases to the prevention of chronic diseases (Sundhedsstyrelsen (Danish Health Authority) 2005), led to the opening of a large number of patient schools in both hospital and municipality settings (Willaing et al. 2005). Here patients at risk of—or suffering from—so-called lifestyle diseases were taught about lifestyle changes, medicines and self-care, and it was in such a patient school that I first met Rita.

With all the state and institutional efforts put into countering obesity and lifestyle diseases, in many ways being obese has become an uninhabitable position (see e.g. Andreassen et al. 2013a, b). In and of itself, obesity is not uninhabitable. Several of the families I have followed during the two fieldworks fondly remember grandparents that were “big,” only to realize that they were about the same size as those now characterized as “obese.” What used to be big and cozy (“hyggelig”) has become obese and alien (Grøn 2017). This shift in ideas about obesity, health and “hygge” places the families I have followed in the position of having to keep finding ways of instigating what Mattingly, following Arendt, terms “the new” or “the miraculous” (Mattingly 2014:82) in the face of overwhelming personal and family histories of unsuccessful attempts at weightloss—or more accurately, temporary success followed by increasing weight gain, a pattern widely documented in the scientific literature on weight loss processes over time (Cawley 2011). It is this existential position of being stuck in an uninhabitable position and striving for “the new” that Mattingly’s formulation “the pitting of the possible against the predictable” (Mattingly 2014:16) so poignantly captures. Both personal and family experience and scientific evidence define success as improbable, yet families struggling with obesity continue to experiment against the odds all the same. Life itself becomes a laboratory.

The Phenomenology of the Alien

In order to accentuate the highly uncertain and experimental nature of weight loss processes, I have drawn on the German philosopher Bernhard Waldenfels’ Phenomenology of the Alien (Waldenfels 2007, 2011a), arguing that, from a phenomenological perspective, obesity appears as a haunting that exceeds one’s grasp, one’s capacities to know, to control (Grøn 2017). I have relied on Waldenfels’ phenomenology, in order to challenge the predominant causal explanation of the obesity “epidemic,” the energy expenditure model, i.e. the simple calculation of how much energy you take into your body by eating, and how much you burn by exercising. Many other types of explanations exist, such as modern and degenerate times and lifestyles, genes, social as well as early childhood determinants, all of which are mentioned by the families I have followed. My argument is not with any one of these in particular—even if the simplicity of the energy-expenditure model does not hold up under phenomenological scrutiny (and many would argue that it does not hold up under any kind of scrutiny, see e.g. Gard and Wright 2005; Wright and Harwood 2009; Boero 2007; Sørensen 2014)—but rather with the apparent certainty that is often associated with the energy expenditure model. Boero terms this “the professionalization of common sense” (Boero 2007), while Sørensen refers to the energy expenditure model as a naïve or intuitive understanding of metabolic processes (Sørensen 2014). My approach has been a phenomenological one through which I have aimed to unsettle this generalized sense of certainty, and to preserve a sense of wonder about where obesity came from and what to do about it. From the perspective of the families I have followed weight gain and weight loss remain mysterious and alien, but this alienness emerges in the context of the ordinary, and the most intimate settings: the home, the family, and one’s own body and desires (Grøn 2017). The following example often used by Waldenfels, a traffic accident that takes place in the opening scene of Robert Musil’s novel, The Man without Qualities, shows how the apparent order of things and their alienness are not two separate domains, but are intimately linked in our experience.

Right in the initial passage (…), a Viennese couple is brought to witness an event, which we usually describe as a traffic accident, just as we designate certain meteorological processes measured by barometric pressure, humidity, and location of the sun as a gorgeous August day. Yet this is not true from the beginning. There are some cliffs, which can break the flow of events. Everything begins with a “crowd,” with a blocked movement. I hear something heavy “spinning sideways, then the sound of abrupt breaking, and what appears to be a big heavy truck is now sitting with one wheel on the edge of the pavement, stranded.” Next to it stands the driver “grey as the pavement,” trying to account for what happened. The gazes of the by standers sink into the “depth of the enclosed space” where the victim is lying as if dead. (Waldenfels 2011a:24)

From here, this event is slowly turned into order: first, by some bystander explaining to another, what it means to have a “too long braking distance,” and then by his evoking American statistics on the number of people killed in car accidents. Order reemerges. Waldenfels cites Musil: “People walked around with that almost justifiable impression that what had occurred was an event within the proper framework of law and order.” (Waldenfels 2011a:25) In working with Waldenfels’ framework, I have sought to reverse the process and move from the apparent certainty of the energy expenditure model to the haunting and being affected by obesity as a demand to which one must respond (Grøn 2017). In order to explore weight loss processes empirically I turn now to Rita’s experiences and reflections, when I first met her during my Ph.d. fieldwork.

Rita 2001–2003: To will with Head and Heart, Body and Soul

When Rita came to the patient school The Lifestyle Center, the main site of my Phd fieldwork (Grøn 2005), she had already tried to lose weight many times. Rita weighed about 220 lb, and she was set on losing 80 lb, preferably within the period of a year. During the first three months, Rita lost close to 30 lb. Then it all started to fall apart. Rita went to the Lifestyle Center in October 2001. By August 2002, she had put on 10 lb and she wrote me in an email:

I keep gaining weight, lying to myself. (…) I scream and yell at myself (…) I scold myself, I think I’m pathetic, but it doesn’t make any difference, I keep pigging out, can eat for hours (…) and it doesn’t give me any relief anyway (…) I’ve also stopped going for walks, even though in my heart of hearts I love it and miss it, I just can’t pull myself up again.

By Christmas time, fifteen months after the first stay at the Lifestyle Center, she had put on all the weight that she had lost again. Initially motivated by the spark ignited by the stay at the patient school, change came relatively easy. At the peak of this experience, Rita explained to me that it had to do with being of one will. We were sitting at her kitchen table talking about people who were not successful with weight loss. Rita said, they had not reached the right conclusion or the right place in which she found herself:

Rita: … you can will with your head without your heart being in it (…)

Me: And so what is the difference between willing something with your head and willing something with your heart?

Rita: Well, you can say to yourself in your head that you have to do so-and-so and that it is the only right thing to do, and if you do not do it things will go wrong. But if your heart is not in it … it’s not enough that you’ve decided in your head that this is what has to happen. (…) You also have to put your heart into it; you have to will it with body and soul, if you know what I mean.

Rita spoke not only from this recent experience of weight loss, but also from a lifetime of experiences with subsequent losses and gains: To will with head and heart, body and soul was the goal one had to set for oneself, if one wanted to succeed. This point, where willing and action become one, emerges as a concrete event in time and space. Sometimes it lies in the present, but mostly it lies in too slowly approaching, hopeful futures, or too rapidly receding pasts.

I applied Mattingly’s perspective on moral or narrative willing to argue against an atomistic perspective on willing as choice made at discrete decision points, which has dominated much of Western philosophical debate (Grøn 2005; Mattingly 2003, 2010), and also public health ideas on individual lifestyle change and weight loss. Through this analytical framework, it was possible to show the immense work—both inner and outer—that went into Rita’s weight loss projects and the importance of the context or scene of that work. Importantly in relation to the concerns of this paper, this framework also pointed to the centrality of becoming a certain kind of moral self. Rita was trying to cultivate a reliable and trust worthy self. In another email, she referred to herself as a “pjok” (loser), somebody who is unable to carry out the projects and plans that she herself had defined. She also talked about condemning not only herself, but also others, if they were not able to will in this way:

I actually think I’m, I don’t know if it’s just me, but I actually think I’m very judgmental in reality. Not just in relation to myself, but also—I mean when other people don’t finish things, then it is not just in relation to myself, but also in relation to others. I don’t know if judgmental is the right word either, but then I think (almost sighing): “Well!” … like all kinds of other people might think about me when I don’t follow through on things, you know: “Well, so nothing came of it this time either,” or “well, it didn’t work out.”

During our talks, I suggested that a very stressful situation at Rita’s workplace posed a major obstacle to her undertaking. Rita acknowledged that this had influenced her ability to carry out the weight loss project. She was perfectly aware that what we could term the “narrative context” within which one acts shapes one’s ability to act. However, she insisted that this should not be an excuse for her actions. Instead, she contended that it is through personal agency in specific contexts that one’s character—or in Mattingly’s words, “one’s narrative self” (Mattingly 2003, 2010, 2014)—is revealed.

Moral Scenes and Moral Selves

One way of thinking about Rita’s experiences and reflections would be to turn to Foucault’s work on bio-power, governmentality and techniques of the self. Taking up Mattingly’s carving out of three moral scenes (Introduction, this volume, Mattingly 2013, 2014): the courtroom in which one stands accused, the artisans workshop in which one trains in becoming a certain kind of self (which refer to the early and late Foucauldian frameworks on bio power and governmentality, respectively) and the moral laboratory, they all offer important insights on Rita’s experiences and reflections. She does stand accused, not the least by herself, for being a “pjok”, an untrustworthy self who do not see projects embarked upon through. She screams and yells at herself, scolds herself, thinks she is pathetic, but keeps “pigging out”. She also—at other times—takes up the training of the artisan’s workshop, the training in regimes of living and being, which she has learned at the Lifestyle Center. These two moral scenes capture the main thrust of anthropological and sociological studies of obesity, which have demonstrated the social construction of the obesity epidemic and its often detrimental and stigmatizing effects on the people in question (Boero 2007; Moffat 2010; Greenhalgh 2015), and the centrality of governmentality and techniques of the self in efforts to control the epidemic (Gard and Wright 2005; Greenhalgh 2015; Wright and Harwood 2009).

I acknowledge the importance of this line of work in showing the powerful ways in which bio-power and governmentality shape moral selves and bodies—which is highly relevant in a Danish welfare state setting of patient schools and programs for the chronically ill. The impact of Foucault’s work has been tremendous. It has formed “a tradition, constituted by assumptions about subject formation that continue to invoke the subject found in Foucault’s earlier work” (Introduction, this volume), i.e. a tradition which tends to downplay moral agency and selves. At a time when the neoliberal subject has emerged as the main protagonist in social and health projects throughout the world (Introduction, this volume), Foucault’s late career work has proven especially useful for anthropologists, because it has allowed us to critique the individual neoliberal self, while still attending to the agency involved in cultivating the self within specific traditions and regimes—whether religious, pedagogical or health oriented.

However, I agree with Mattingly that much is lost if we cannot speak meaningfully of more fully developed experienced and biographical selves, which are ever present in our ethnographic field sites. Mattingly cites Caroline Humphrey’s fieldwork experiences with the Mongolian people she studied, “they do speak constantly of singular subjects and their deeds. They talk about the consequences of someone’s, a named person’s actions.” (Humphrey cit. in Mattingly 2014:55) Mattingly has consistently pointed to the costs of the Foucauldian analytic move: the danger of failing to capture “the vagaries of everyday life and the difficulties of discerning what might constitute the morally appropriate action in the singular circumstances life presents” (Introduction, this volume), as well as a “systematic undertheorizing of first person moral perspectives within anthropology” (Mattingly 2014:55).2 She calls on us to attend to the biographical specifics of given individuals over time, and to conceptually strengthen our ways of considering moral subjectivity and its formation (ibid:57).

Furthermore, over the years Mattingly has consistently argued that in talking about biographical selves, she does not intend a fixed or individual self, but a processual one, created in community (Matttingly 2010, 2014). Moreover, in calling this a “narrative self” she emphasizes not so much the coherence as the subjunctive side of narrative, i.e. the way narrative hold multiple possibilities in suspense. What I propose here, through an exploration of Rita’s biographical self over time and by recourse to Waldenfels’ phenomenology, is the notion of a responsive self, which stresses the eventness of ongoing experimentation against the odds. I will start by introducing my more recent encounters with Rita, which have inspired me to think about this phenomenological, responsive self.

Rita 2014–2015: The Tipping of the Big Stone

It is October 4th 2014, and I have returned to meet Rita. I have written her a letter about reopening the fieldwork I did as a Ph.D. student and trying out new methods. She has welcomed me enthusiastically. I arrive at her place and she shows me around. There are amazing flowerbeds and a first floor attic that the family started building when I last saw her, more than 10 years earlier. This gigantic attic is now covered with paintings: of a tree, a unicorn and a bear, and at the other end, a painting of a dream catcher, the visible signs of Rita’s increasing interest in alternative forms of healing and knowledge. During my Ph.D. fieldwork, she consumed such healing approaches, and now she herself channels words and makes drawings for others. In addition, she has changed careers: She now works as a social and health care assistant at a nearby rehabilitation center. She is very happy about this change, she now works with people, not with numbers, and all the stresses of the previous workplace are gone. So many things have changed, but her weight is more or less the same: 220 lb. In the years that have passed, she has been heavier—and she has also been below what she refers to as “the magic 200 lb” attesting to her ongoing efforts to try to lose weight since we last met. We sit down at her huge kitchen table, where we have sat countless times with cups of coffee, talking. Within a few minutes, the following conversation takes place. I ask Rita whether weight loss concerns her.

Rita: It is not as present as back then. No. It is not at all as big an issue for me. Oh, except that it would be healthier for my body to not weigh so much. And it would be easier for me to weigh less. But I am absolutely certain, you know, I still know that it will come. And now I am going to say something crazy, about a week before you wrote me, then I was standing here at home and I was all alone and suddenly I said out loud – you know that I do channeling and I don’t know where it came from – so I just said: “Within a year you will be normal weight!” And I did not know where it came from and what to think of it. And then the letter came from you. Then I knew right away that it was about that. Isn’t it great?

Me: Yeah, but I cannot …

Rita: I know.

Me: That is not how it is …

Rita: I know. It does not matter.

Me: But how is it?

Rita: It is like you wrote that you have some new tools you want to try out, and I am sure that some of it, if it is not the tools, then for sure it will set off something in me …

Me: But they are not weight loss tools. Because I cannot, I am not someone who …

Rita: I know.

Me: I will ask about things in your life and about the people that you care about.

Rita: Yeah, but I know that it will not be about weight loss tools, it is about tools to get my head right. And, eh … in a way, it is irrelevant what the tools are; because I am certain that they are the right ones. I just think it's so great! Me (reluctantly): Well, it is a pretty amazing coincidence.

After that, several months pass, I make my inquiries into her network of family and friends, take part in parties and social events, and carry out more interviews with her, with her husband, her kids, and other family members. At our last meeting, I mention this first conversation:

Me: I have had this thing in the back of my mind, that when I came here the first day, then you had thought that … you said that now something would happen.

Rita: Yes, within the next year. And I am still convinced of that.

Me: And I was a bit unnerved, because I thought well I …

Rita (teasing me): Yes you were: “I can’t, I can’t be responsible for that!”

Me: “I can’t … I just can’t!” (I mimic her mockery of me, but then try to defend myself) Well, especially because I knew what we were going to do and that maybe it would not be so much about weight loss. It is like I have had this amazing insight into your life because I have been allowed to take part in so much. (…) But what about your weight now?

Rita: Oh. I think that after you are back in my life there is … well it is not as if I have ever put it aside. The weight thing. But it has become more of a discussion issue in my head, than before. Somehow. Hmm … But still I am more relaxed about it than 12 years ago. It is a strange … I am totally relaxed about it and totally annoyed about it at the same time! It is an odd … sensation. And I have no doubt that in one year, well then I won’t be where I am now!

Me: No. Something has happened?

Rita: Something has happened. And it’s like …. So much happens all the time right. There is so much input from all kinds of places. And … I just think every little input gives … You know if you have to … move something. Hmm … if you have to push a big stone, right? Then you can’t do it alone, but each little thing that comes to you, for each extra one that is there, then you can roll. And I think that for each little thing that comes into my life, which … kind of tips my beliefs and ways of doing things (…) then that becomes a whole, which makes me work towards the normal weight.

We spend some time getting Rita’s picture right: the thing is that the stone is too big, too heavy, you cannot move it. If you manage to push it an inch, it will just roll back. However, small things you can move. Small things being incidents, actions, insights, other people, or, as Rita says: “It is everything—it is life itself,” but coupled with luck and the ability to be awake exactly when potentialities emerge. Through this conversation, I also understand that I should not overestimate my own role, since I am just one of these many small things endowed with the potential to affect the tipping point of the big stone. Moreover, there is absolutely no certainty as to how this potential will play out, Rita explains:

Rita: If I have learned something (…) (it is) that things often do not go according to one’s expectations …

Me: So you just let go?

Rita: Yes. You have to (…) you actually cannot use your expectations at all, because things never turn out as you expected.

Me: You can expect it to be different?

Rita: Yes. Yes. And that’s great! You just have to be able to take it.

Responsive Selves and Life Itself

How should we think about the change in vocabulary and imagery between the two fieldworks? From willing with head and heart, body and soul to tipping the big stone with life itself? What kinds of ideas of moral agency and selves are invoked at the two points in time? Before turning to these question, let me introduce shortly Waldenfels’ phenomenology, which is referred to as both the phenomenology of the alien—speaking to the presence of the alien in close proximity to any ordering of experience—and as a responsive phenomenology—speaking to the necessary response to the alien (Waldenfels 2007, 2011a). The alien calls from beyond our grasp and control, and we respond. Waldenfels writes: “Responsivity, taken as a main feature of human behavior, calls for a special logic of response that differs considerably from the logic of intentional acts, from the logic of understanding, or from the logic of communicative action” (Waldenfels 2007:28). He characterizes responsive logic as having four features. Firstly, he argues that a demand takes on the form of singularity, which does not mean that something occurs only once, or that something is classified as a single case among others. Rather, we are dealing with a singularity of events that appear as such, in that they “deviate from familiar events and inaugurate a different seeing, feeling and acting” (ibid:29). Secondly, the demand makes itself seen, heard, thought of or felt with a sort of inevitability—as something that cannot be derived from universal laws, but appears as a practical necessity in our coexistence with others. This means that we cannot not respond, once we are touched by the demand of the alien. Not responding is also a form of responding. Thirdly, responsive logic is marked by a genuine time lag, or what Waldenfels terms diastasis. He writes: “Singular events do not only raise inevitable demands, they also appear with an unreachable previousness (Vorgängigkeit). Correspondingly, our response arrives with an original posteriority (Nachträglichkeit). This strange sort of delay cannot be understood by referring to successive positions on a timeline. It does not only mean that something comes earlier, but that it comes too early to be anticipated here and now (…) Responding takes place here and now, but it begins elsewhere” (ibid:30–31). Finally, hand in hand with this temporal deferment, is an unavoidable asymmetry, the fourth feature of responsive logic. This feature throws traditional dialogue, based on common goals and rules, out of balance and leaves behind moral demands for equality, such as the Golden Rule. The asymmetry depends on the fact that “… demand and response do not converge. Between question and answer, there is no more consensus than between request and fulfillment. The two collide like two glances that meet” (ibid:31).

Returning now to Rita in 2014, we see that she is agentive, she moves things in her life. She not only grooms her garden but each of her four grown-up children and her husband. Since I saw her more than 10 years ago, she has changed jobs; she has planted a big garden full of flowers and developed her creative, healing, and spiritual skills. Even the attic—which the family informs me had become a standing joke, because its construction just dragged on and on—even that is now completed. However, obesity just remains the giant, immoveable stone of 220 lb. Now she does not mind the way she used to. She has learned to live with it. She is able to handle it, somehow, but not completely. She says she has a strange sensation of being simultaneously completely relaxed and completely annoyed. Applying Waldenfels’ terminology we can say that she is affected by the call, the demand of this continuous, alien presence in her life, but compared to the earlier point in time “it is not as present as back then.” Yet she knows by now that she cannot just tip the stone—she has tried that too often. Still, she cannot not respond. As Waldenfels notes, there is an inevitability to the responsive logic: once you are touched by the demand, no response is also a response. I suggest that this inevitability speaks not only to an existential situation, but also to the specific historical context. The health wave that has swept over Denmark in recent decades has carved out new territories for what constitutes the alien and the kn(own) and has made obesity an alien intrusion into both private and public life, an alien intrusion demanding a response.

The singular event that—this time around—triggers the return of the giant stone as a demand, to which Rita must with necessity respond, is her strong premonition, that in one year she will be normal weight. This is strengthened by my letter to her, that I will be returning with new “methods” or “tools,” as Rita calls them. When Rita first went to the Lifestyle Center a process unfolded, which gave rise to new potentialities and with them, new moral demands. With me back in her life, both potentialities and moral demands re-emerge. Weight loss has become “more of a discussion issue” in Rita’s head after my return. Unfortunately, premonitions of potentiality sometimes are just that. The simultaneous occurrence of Rita’s channeling words and my showing up in her life places a demand on me, which, at the time, I resist. Rita sees my appearance as pregnant with potentiality; this event inaugurates in her a “different seeing, feeling, and acting.”(Waldenfels 2007:29) Yet I refuse, I “can’t be responsible,” as she gently mocks me. Where she “pits the possible”, the miracle, the new that could occur, I stay safely within the predictable.

Where I find Waldenfels’ framework especially compelling is in relation to Rita’s more recent idea of how weight loss could potentially transpire: through the constant coming into being or setting in motion of multiple small things, the unpredictable ways of “life itself.” Recall how Musil’s prose backtracks to the open-endedness and indeterminacy of events and the ways of the world. In a way, lifelong experimentation with weight loss has also forced Rita into an inversion of the apparent certainty and order of things. She knows by now that you cannot trust your expectations, or that you can in fact count on them not being met. You can have premonitions, but they change: in this case, from the certainty of normal weight within a year, to the certainty of being “in a different place” in one year. The relationships among—and the timing of—the many small things in her life display no orderly pattern. Even if you can talk about a form of causality in the experience of obesity, it is in the mode of “being affected by,” and “responding to” in complex patterns that will never stand still (Grøn 2017). When the tipping point occurs, you will know, because suddenly the stone rolls, but not before.

The two last features of Waldenfels’ responsive logic stress this complex causal mode: the time lag and the asymmetry between demand and response. If the responsive logic did not come with the genuine time lag, we could see this dynamic as following the kind of temporal scheme we know from a logic of cause and effect, and if it did not come with the feature of asymmetry, we could see the dynamic as two sides of a mathematical equation, where one side equals the other. The responsive logic does not work through these kinds of ordered patterns, though. The new or the miracle appears not only through the call that arises from outside our domain of knowledge and control, but equally from the genuine rupture between demand and response. The responsive self emerges at the point where question and answer “collide like two glances that meet” (Waldenfels 2007:31). Thus responses—and selves for that matter—rest on highly uncertain and potentially transformative grounds.

Rita’s notion of self has changed. Weight loss emerges not through her alignment of the conflicting wills and powers of her self: the head, heart, body and soul, but from her responding to and being in tune with what the philosopher, Jullien has named “the fluctuations of the world” (Jullien [1991] 2004: 59–63 cit. in Kuan 2014). I suggest that we thinks of this self as responsive, as constituted through the asymmetrical demand-and-response dynamic that Waldenfels describes. This would mean that the self is intimately linked to the particularities of the context, situation and the sufferings one undergoes. This would also mean that the self is far from individual or bounded, but originates in the pathos of the demand. This demand could come from an obese body, a sick child, or circumstances of stigma and racism, and from the intersections of these, as they manifest themselves in ever-changing patterns of “life itself.” Thus, the self emerges with the inevitability of the response. The locus of the responsive self remains within the narrative context, involving our particular body, intimate others, specific locations, and what Mattingly with Bernard Williams terms our ground projects (Mattingly 2014:5), which are intrinsically linked to this narrative and biographical context.

Waldenfels makes an important distinction between the event and content of the response (Waldenfels 2007:25–28) that might be helpful here: the response event—the fact that once called, I must necessarily respond—is the continuing locus of the responsive self, whereas the response content can and will shift, depending on the particularity of the situation.3 Rita’s moral work in relation to obesity shows us both foregoing aspects. Certain features have changed over time: Where she used to talk about the summoning of wills—of the mind, heart, body, and soul—as a concrete and reachable point in time and space, she now speaks of the power and unpredictability of multiple small things, small things being events, people, occurrences, life itself. Where there used to be a self—granted, a multiple and conflicted self of head and heart, body and soul—that could gather its forces, there is now a gigantic puzzle of multiple small things and events. She is an important part of this puzzle: she has to be ready to seize potentialities whenever they arise. However, she must also be able to let go—she has learned that by now—and await the next time. She is not determined by the demand, but neither is she the initiator of action. She responds.

Still, there is continuity over time. Rita emerges as a moral self by “pitting the possible against the predictable,” by taking on the “fluctuations of the world” as things that matter, things that belong to her. By going with the flow of time and life itself, “the otherwise insignificant scale of human subjectivity achieves maximization with action that works with rather than against existing circumstances.” (Kuan 2014:23) In the ongoing moral work against the odds, Rita’s idea of the self has changed toward embracing this more “insignificant scale of human subjectivity,” which works with time and life itself. The self that has developed over time also emerges with a different moral tone; the judgment has lessened in intensity. Where she used to scream, scold and judge herself for failing projects that she herself had initiated, she now recognizes that she needs help from life itself. She is still responsible for being ready to grasp potentialities when they occur (like a returning anthropologist) and allowing them to “set something off in her”, “get her head right.” But then again, she has also learned that “things never turn out as you expected.” It is great in fact, she contends, you just have to be able to take it.

The responsive self, thus, speaks to one of Mattingly’s main concerns in her concept of the narrative self, in that it allows us to account for and explore moral cultivation—or learning—over time. The narrative and the responsive self are not, I would suggest, conflicting analytic notions of the self. They both stress that the self emerges within constantly changing narrative contexts and the frailty of human action, and they both suggest that in our experience the self persists over time. They come, however, with different accents: the responsive self backtracks us to the eventness and the highly uncertain conditions, demands and dynamics through which the self emerges, while the narrative self allows us to address moral cultivation within larger temporal frameworks. When Rita responds in 2014, she does so based on the experiences from more than ten years ago, as well as all the other times when she has tried to move the big stone. Yet in another sense, time stands still: the lack of success with weight loss keeps her in the responsive and subjunctive mode, in the eventness of ongoing experimentation against the odds. Had she succeeded we might have seen a stronger sense of the past and future narrative horizons, to account for the unfolding of events in her life.

Conclusion

In conclusion, I will sum up the main points that I have raised here. I have sought to invoke Mattingly’s claim that some notion of the self is indispensable for thinking about moral cultivation and reorientation over time, while also acknowledging that the notion of self is highly charged in the field of obesity studies, where individual and neoliberal selves—and the criticism of them—are omnipresent. I have suggested that taking the experienced and biographical self seriously has allowed us to acknowledge the immense work of moral experimentation that Rita has engaged in over a lifetime. In addition, we have seen many other things and projects that make up her life: the cultivation of healing powers, of a garden of flowers, as well as of a home, family and work life. This has provided us with a picture of Rita’s moral self that could easily be lost if we were only concerned with the “obese” self constituted through workings of the bio-power and governmentality techniques of the Danish welfare state. Rather the analysis points to a highly experimental notion of the self, and I hope to have provided both biographical and conceptual depth to the notion of a responsive self. This responsive self, emerging within the demand response dynamic outlined by Waldenfels, evinces both an event form that persists over the years (“I respond, therefore I am”), but also changes in terms of the content of the response. In Rita’s case, from a moral self, summoning its diverse wills, to a “lesser” self working with the unpredictable ways of life itself. I suggest that this responsive self, shown to us by Rita’s experiences and reflections, has implications for how we understand selves in the making in many other situations and contexts. To sum up, the responsive self:

1. Is pathic in its experiencing and suffering of demands outside its knowledge and control, whether this alien call emerges from one’s own body, the social or the environmental surroundings of the self. In some ways the self is the other or alien to which it responds, in that this is where it originates. (Waldenfels 2011b)

2. Is agentive in the continued and inevitable responding to the alien calls. The responsive self in the moral laboratory of life is experimentally trying out, through trial and error, and the necessity of the response brings us to the core of the phenomenological project characterized by at stakeness and mattering. (Mattingly 2014) We must respond because in being called, things matter to us. We feel the pull of demands and become our selves through them.

3. Is continuous in responding, in “pitting the possible against the predictable” against the odds, against the knowledge that one will probably fail. Our expectations are often disappointed, yet we go on living as if our efforts and responses will make a difference. One could claim that being responsive captures what it means to be human, to be alive.

4. Is disjunctive through the genuine time lag and diastasis between call and response. A fertile ground is already carved out for the transformative and subjunctive self through the demand response dynamic—that to which we respond is alien, unknown. However, by the genuine rift in the demand response dynamic, the nexus of the self is located in the depth of uncertainty of the human condition.

Thus, the notion of the responsive self stresses equally the suffering and the agentive dimensions of action—an active passivity and passive activity. The responsive self emerges as an invested and demanding stance of acknowledging circumstances and facts and the Sisyphean efforts needed to move the big stone—and of keeping a space open for the new, the miraculous. I end with an open question: Could the exploration of moral work and moral selves offered in this paper provide the grounds for what Mattingly (2014) terms an indigenous hermeneutics of critique and hope? I think so. Rita’s formulations of the tipping of the big stone could be read as both: as a critique of a simplified idea that “suppose that if one is told what to do, if the right end is pointed to them, all that is required in order to bring about the right act is will or wish on the part of the one who is to act.” (Dewey 1922:27), and as a hope that the complex interplay between structural conditions, political agendas, singular events, selves and time—in Rita’s words “life itself”—could eventually bring about the miracle of the tipping of the big stone.

Footnotes

  1. 1.

    For analysis of patient schools, see Grøn (2005), Juul Nielsen and Grøn (2012), Nielsen and Grøn (2013).

  2. 2.

    As noted by Mattingly, the self as a crucial site of experience is also contested by most phenomenologically inspired anthropologists (Mattingly 2014, p. 56). Similar concerns are raised by Doug Hollan: “Ironically … what seems to be missing from some of this phenomenologically inspired work is how given individuals become dynamically ‘coupled with’ or ‘attuned to’ their ‘immediate’ environments—that is, how they become marked by a particular set of historically specific interactions with others, and in turn, how historically specific individuals come to mark and infuse, in particular ways, the lives of others.” (2012:42) Hollan advocates the approach of person-centered ethnography, Mattingly (2014) first person virtue ethics to explore the biographical self, while in this paper I propose a notion of the self from within the phenomenological tradition.

  3. 3.

    While cultural comparison is beyond the scope of this paper, there are interesting similarities between the experience of obesity in Denmark and elsewhere—as portrayed to us in in-depth ethnographic studies that have been published in recent years. In Emily Yates-Doerr’s account from postwar Guatemala (Yates-Doerr 2015) and Solomon’s from Mumbai, India (2016) I see a similarity in how the simultaneous global exports of food and preventive obesity programs challenge local perceptions about food, sociality and health—and gives rise to alien demands to which people must respond. The alienness that I have found in the experience of obesity in Danish settings, thus also comes across, I suggest, in these other sites, even if local versions differ markedly in what counts as the “good food life” or how obesity prevention is taken up and organized.

Notes

Acknowledegments

I would like to thank Rita for generously sharing with me her life, her family and her reflections. Much of what I write is a response to the demands of her insights. I wish also to thank Cheryl Mattingly for being such an amazing and inspiring thinker and writer, mentor and friend. This study would not have been possible without a generous grant from the research foundation of Aarhus University, DK (Aarhus Universitets Forskningsfond) for Centre for Cultural Epidemics. I thank my colleagues at EPICENTER and the participants in the AAA panel, which preceded this special issue for ongoing reflections and discussions. Finally, thanks to the editors at Culture, Medicine and Psychiatry and to the two anonymous reviewers for very valuable critiques and suggestions, which helped me clarify and strengthen the argument.

Compliance with Ethical Standards

Conflict of interest

Lone Grøn has no conflict of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.KORADanish Institute for Local and Regional Government ResearchCopenhagenDenmark
  2. 2.Center for Cultural Epidemics, EPICENTERAarhus UniversityAarhusDenmark

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