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An anthropologist and the pearly (white) gatekeepers

16 January, 2010

I meant to blog this a while ago but as usual it got lost on my rather overpopulated back burner.  Then I read Greg’s great recent post about the American export of mental illness and this popped back into my consciousness.

So, back in October, former Macquarie anthro Kirsten Bell, now resident of Vancouver, mentioned emailed me to say she’d published a “pop anthropology” article on cultural differences between Australian and Canadian dentistry.  Kirsten was always well known, and well liked, as a lecturer who would delight in using embarrassing stories, often from her own experience (and of her own bodily functions) to bring home points about cross-cultural understandings of the body, disgust, smell, etc to first year students.  She would delight in nothing more than using stories of shit and farts to unsettle and titillate students as part of the process of “unteaching” which, it has been suggested, anthropology training is all about.  Kirsten has taken the same approach in her piece on dentistry, using her crooked and not-quite-pearly-white choppers as fodder for an entertaining anthropological tale of some impromptu fieldwork in the dentist’s chair.

A central point of the article is that understandings of dental health are are permeated with ideas of morality, guilt and redemption.  Her off-white teeth, once perfectly adequate, are suddenly found to be lacking in a society which she sees as more obsessed with (American style?) bright whites.  She likens dental surgeries to churches, in which one is given a clear sense of the difference between the saved and the damned:

Like any church, pictures of the object of devotion adorn the office walls: the white, straight teeth of salvation and the horribly decayed teeth of the damned – a warning of the dangers of failing to abide by the ritual ablutions of regular brushing, flossing, mouth washing etc., prescribed by the dentist.

I have a theory that dentists are almost universally feared not because of the torture they inflict upon our mouths, but because of the guilt and shame they inflict upon our consciences. This is because good dentists, like priests, trade in guilt. However, there is no quick fix for the sins of poor dentition, no dental equivalent of a Hail Mary that might return one to a state of grace.

There is only the long, hard road to salvation: sonic toothbrushes, regular flossing, braces, teeth whitening, veneers, dental bonding, mouth guards, fluoride treatments and the like. For my dentist and her hygienist, not wanting to have the best teeth you can is akin to not wanting to be a better person. They are therefore evangelical in their desire to show me the error of my ways and embrace the dazzling toothed, unlined-skinned me I could be.

This is a light-hearted example of how the anthropological gaze can be used quite effectively to show up something of the invisible aura of the taken for granted, those aspects of social life that are both in plain sight and out of view.  In this case it helps us to notice that notions of  “health” is never simply the lack of illness.  Ideas of good health intersect with notions of morality and beauty, and having good teeth could imply something about your character, even your worthiness as a human being.  I’m reminded of discussions of obesity, where notions of health, aesthetics, class and morality are hard to disentangle from each other.

13 Comments leave one →
  1. Kate permalink
    18 January, 2010 2:16 pm

    Well, yes, but …
    It’s very dangerous to extrapolate from her one experience to a statement about an entire ‘American’ culture. I’m from the U.S.A. and I’m still amazed at where and how this obsession with ‘white’ teeth became fixed in certain domains of American culture. But it’s dominant, hegemonic, or common.

    And what she really needs to note is that it’s not so much morality as it is a statement of class. In the U.S., there is a culture of mobility and re-creation of self. Teeth are a marker of the individual’s ability to do that. It is a clear marker of parental wealth (straight, white); or of one’s own upward mobility (getting braces and caps).

    If true, the element of ‘morality’ imbricated with ‘class’ makes for a far more powerful and interesting discussion of dentistry in 21st century North America.

  2. 18 January, 2010 6:41 pm

    Thanks for the thoughtful comments Kate. Good points about the of class and social mobility, and I agree that this kind of relationship would be an important thing to bring into a fuller analysis of the topic. Still I don’t think Kirsten was trying to exhaust the field of analysis here, but rather to point out that dental health isn’t purely an issue of “health” in the narrow sense.

    Also, my tentative nod to a stronger American influence in Canada was not supposed to suggest a universalist argument. Like you say, not all Americans are beholden to the cult of the Straight White Tooth, but like you say there are strong connections between dental modification and “a culture of mobility and re-creation of self” in American society. I therefore still think it’s fair to point to possible influences coming from the US though it’s also important not to see these influences as simply spreading out like margarine. The particular way the relationships between dental health, morality, beauty and class play out is also going to depend a lot on factors specific to Canadian society, or even to specific cities or neighbourhoods. I was thinking that possibly Kirsten’s analysis of differences between “Australian” and “Canadian” society has a bit to do with the fact that she didn’t (as far as I know) visit any dentists in the Easter Suburbs of Sydney.

  3. 25 January, 2010 1:37 pm

    I;ve dropped in from Decomondo. These are interesting thoughts; though dental hygiene and dental health equate with class, they go hand in hand with optimal health conditions as infections and inflammations that start in the mouth affect the rest of the body. Poor mouth health is poor health.

  4. 25 January, 2010 8:44 pm

    Hi Rosaria. Undoubtedly you’re right and I wouldn’t want to suggest that just because notions of dental health are socially constructed that they have no connection to “objective” measures of health such as rates of infection. Kirsten’s observations, though, alert us to the fact that “health” is never just health in a purely biological sense. Poor mouth health might be poor health indeed, but we need to consider what we mean by “poor health”. As well as the absence of infections, which most of us would agree is a desirable thing, what other values and qualities are connoted by good dental health? Straight and white teeth don’t necessarily make us more likely to experience cavities, ulcers or other infections, but they are widely taken to be signs of good health. Health has an aesthetic dimension; what is considered attractive and what is considered healthy are often closely related.

    Often what is deemed to be more healthy in a common sense way actually runs against more objective measures of health, such as disease rates. A good example is sun tanned skin striking people as being “healthy” as well as attractive despite increased risks of skin cancers. This is a perception the Australian Cancer Council has been working against with its recent “there’s no such thing as a healthy tan” campaign.

    In most of Asia (and South America I believe) the relationship between tanning and beauty is exactly reversed. Darker skin is associated with the need to do manual work outside and therefore low status. In Thailand, there are all sorts of ads for skin whitening products, which associated lighter skin with material and romantic success and urban modernity. Connections between class and beauty are pretty clear here. I’m not sure if lighter skin is also deemed to be more “healthy”, but I wouldn’t be surprised if it was.

  5. 1 February, 2010 8:52 am

    Interesting. Goes to show that there are definitely a lot of cultural values informing medical and dental practices.

    It reminded me of something. This is more to do with ideas about pain and your strenght (or the lack of) as an individual rather than ideas about health though. I once visited a dentist in Sydney and it turned out that it was time for my wisdom tooth to be removed. The tooth broke in several pieces which made the process longer and, to me, more painful. At one point, I told the dentist that I was in pain and asked for a short break to rinse my mouth and drink some water. The dentist replied that was he was doing was not all that painful and that as a Mediterranean person I was overly sensitive to pain. I think that statement hurt me more than the rest !

  6. 3 February, 2010 8:26 pm

    Wow, what an interesting (if painful) experience. Thanks for sharing that. Sounds like the dentist was drawing on stereotypes of “Mediterranean” people being “excessively” emotional. What I find most interesting about this example is that the dentist was presupposing a normative subject who feels a “normal” amount of pain. This subject is culture-free and therefore feels pain “naturally”, while because your pain was merely “cultural” it was less real and could be dismissed.

    And apologies for all the scare quotes in that paragraph. I know that can be very “annoying”.

  7. 3 February, 2010 8:43 pm

    Yes you are right Also, your point about a normative subject/patient is interesting. If we assume that the normative subject/patient is understood as “Australian” (versus foreigner) here,
    does this mean that this normal person cannot be an Australian with mediterranean heritage either or can it be ? Is this an Anglo-saxon versus the rest of the world thing ? It could have roots in Victorian medical ideas then.

    I wonder whether these underlying ideas about health and pain and who these relate to the values of the individual are gained at medical/denstist school.

  8. 3 February, 2010 9:23 pm

    Thanks very much for the link to the post about the American export of mental illness, of which I’ve had direct experience, in the form of a letter I received some years ago from a bunch of psychotherapists in Chicago, saying that they were concerned about the mental health of people in Namibia, where I was at the time, and offering to send teams of shrinks to Namibia. I replied to the effect that they would be about as effective as a team of Namibian witchdoctors would be if sent to help with the mental health needs of middle-class suburbanites in Illinois. In either case, they would need to bridge the cultural gap before they could be effective, and that could not be done in a few weeks.

  9. 4 February, 2010 12:06 am

    Yes, I would guess that the normative patient you were being compared negatively against would be an Anglo-Australian. As to whether “normal Australian” could be anything other than anglo, well that’s a very difficult question. I personally think there are enduring notions that “real Australian-ness” is inherent in particular kinds of bodies. This is why only certain people seem to feel entitled to dress in Australian flags on Australia Day and get tattoos of the southern cross. It seems to me that in your encounter with the dentist your relationship to pain was judged purely on the basis of your looks, and perhaps your name, which is to say that you’d been “othered” before you even began. Instead of seeing you as an individual, you became merely the representative of a cultural type.

    I of course couldn’t say where this dentist gained his view of health and pain during his studies. There’s no reason to think he’s doing anything other than reproducing stereotypes widespread in society, as my above points suggest. But one thought that occurred to me while writing my last comment was that maybe he was reproducing something that he’d learned during “cultural sensitivity” training or some such. Various anthropologist commentators on “cultural competence” training in the field of health and medicine have noted the tendency for culture to be something attributed to non-normative subjects who are assumed to have culturally influenced relationships to illness and healing. Of course, this kind of notion is based on there being a supposedly acultural normal subject/patient. The danger of such overly simplistic, reified and deterministic notions of culture are very well illustrated through your own example. It’s also the sort of thing Pal Nyiri and Joana Breidenbach have written about in their book that I’ve just posted about.

  10. 4 February, 2010 12:37 am

    Yes, I just read the introduction to their book on Espace Temps which you just linked to (I cannot wait to read the rest of the book !) and I think you are right, it may very well be a derivative of some form of cross cultural training.

    Also, I would add one very important thing to your list : accent. Alongside looks and name, speaking with an accent has a huge impact in the perception of foreigness.

  11. 4 February, 2010 1:09 am

    Good point about accent, I’d missed that one. One thing to be said about accent though: it indicates difference in a slightly different way to skin colour or name. While the latter two are “given at birth” so to speak, accent indexes something about one’s socialisation, about the life one’s lived. In some ways accent can provide a more nuanced sense of socio-cultural background than either name or physiological features. This is something I’m constantly aware of, given that my Serbian first name has nothing whatsoever to do with my Anglo-Irish heritage.

    And just to clarify though, I wasn’t trying to suggest that the dentist had engaged in any cultural sensitivity training, only that the thought had crossed my mind and the attitudes towards cultural difference seemed to fit.

  12. 12 November, 2010 2:56 am

    I think it is a shame the pressure put on one’s looks to be a successful and accepted in our society. The bottom line though is that the appearance of ones teeth is definately a significant factor when being judged by other; at job interview or just walking down the street, people are going to notice your smile.


  1. Cultural imperialism and mental health « Khanya

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