While visiting a hospital for a routine blood test, in the midst of a seminar dealing with Porn Studies, I began to wonder about how inpatients could live out their sexualities. I pulled out my phone and quickly found that all websites labeled ‘Pornography’ are blocked on the hospital WiFi, thus implicitly disallowing certain forms of sexual behaviour in patients. In response to this censorship, this article theorizes the institutional barriers and ideological attitudes which deny access to online pornography within a major research hospital in a large Canadian urban centre, and I explore some ways in which patients may get around the desexualizing barriers baked into the public WiFi network. Research shows that in clinical contexts, pornography consumption is restricted to sanctioned medical uses such as research or sexual rehabilitation programs. By thinking with Michel Foucault’s Surveiller et Punir and drawing on scholarship from sexuality, disability, and media studies, I will outline the ways in which the hospital functions as a disciplinary space in the context of internet usage, frames its policies as being in the best interest of patient health, and makes a moral judgement about pornography and the sexuality of patients. Scholars of disability studies and the medical humanities have previously illustrated many ways in which sick and disabled people have been desexualized; their sexualities are stigmatized and ignored. Feona Attwood notes that “[pornographic] texts function in a range of different ways, depending on context; as a source of knowledge, a resource for intimate practices, a site for identity construction, and an occasion for performing gender and sexuality” (65). I argue that the restriction of pornography amounts to the denial of an important avenue for the formation of a holistic sexual identity among hospitalized patients. The browsing restrictions built into the public WiFi serve as a moralizing proscription on the rights of adults to access legal materials online, as well as a prohibition of their identities as sexual beings.
Throughout the paper, I make references to disabled people and chronically ill people; I place these groups together insofar as they are among the populations likely to spend significant time as hospitalized inpatients, and face similarly desexualizing attitudes from people around them. I discuss the sexualities of chronically ill and disabled people together, but I acknowledge that these labels are broad and imperfect, and may fail to represent the full breadth of identities carried through the world by individuals to whom they are applied. By exploring the sexualities of sick, disabled, and hospitalized people as one group, I am highlighting a single aspect of embodiment which these groups share through the stigmatization of their sexualities. As the author of this paper, I also want to acknowledge how my own position informs my writing. I am a chronically ill individual who has spent much of my life in hospitals. From this, I derive a certain embodied knowledge, which will doubtlessly differ from that of other sick and disabled patients. According to disability scholar Tobin Siebers, identities are socially constructed and “contain complex theories about social realities” (33). Siebers asks that we acknowledge both the “effects of disabling environments” as well as embodied affects and factors such as chronic pain, illness, and ageing, not valuing one more than the other, but “considering the varieties of human experience” (25). Here, hospitalized bodies stand in for those bodies excluded by dominant ideologies about sexuality; “these bodies display the workings of ideology and expose it to critique and the demand for political change” (33). The restrictions surrounding pornography in the hospital serve to further stigmatize groups of people always already viewed as asexual, and prevent patients from partaking in self-fulfilling sexual lives, should they desire to do so.
SURVEILLER ET GUÉRIR
Foucault’s Surveiller et Punir (English: Discipline and Punish) offers an analytical framework through which to consider medical methods of surveillance and control. In his discussion of crime and prisons, Foucault sees the body as no longer a target for overtly violent repression, noting the disappearance of the body as a major target of penal repression (14). He outlines corporeal punishment’s descent into obscurity, demonstrating how the prison came to be the crown jewel of the penal system. In time, the prison’s modes of discipline latched onto divergent institutions, namely hospitals. It is the diffusion of the prison’s principles of discipline and the ways in which discipline organizes analytical spaces which concern me here (2008 168). I do not want to suggest that prisons and hospitals have the same goals, nor that health professionals are like prison guards, or that these institutions are comparably repressive; I seek only to draw out the ways in which disciplinary procedures are applied both to repression and to healing, and find in Foucault’s words many tacit parallels left unmentioned. While there are many existing texts which apply Foucault’s writings about discipline, and those about medicine, these analyses remain silo’d and only rarely are his writings on discipline applied to medicine, or his writings on healthcare applied to disciplinary spaces. I am choosing to focus on his contentious canonical text in order to draw out some possibilities of conducting a close reading 44 years after the text’s first appearance.
Mimicking the carceral affinity for continuous and constant inspection, hospitals, like prisons, have come to be defined by their precise investigation of bodies and deployment of strategies to manage them. Hospitals and prisons alike ensure the careful tracking of a body’s state, and construct bodies as bureaucratic data through their management processes. Foucault makes explicit the “force secrète” which alleges a mandate of personal betterment for its subjects (123). The exertion of biopower is nowhere more visible than in hospitals, which create an isolating environment suitable for bodily healing, rather than isolation in the name of punishment: “l’isolement constitute un ‘choc terrible’ à partir duquel le condamné, échappant aux mauvaises influences, peut faire un retour sur soi et redécouvrir au fond de sa conscience la voix du bien” (2008 145); “isolation provides a ‘terrible shock’ which, while protecting the prisoner from bad influences, enables [them] to go into [themselves] and rediscover in the depths of [their] conscience the voice of good” (1995 122). Intentions differ—the sick are not condemned—but the insular nature of the hospital bed nonetheless cuts off the inpatient from the outside and its ‘unhealthy’ atmosphere. It is in the name of cure, the betterment of patients, that a sick body is processed and tracked. A body must be on its best behaviour in order to undertake the necessary labour of rest and repair. In parallel with the variable duration of prison sentences according to behaviour (2008 147), hospital time is unfixed—shifting dependent on a body’s receptivity to cure, rather than the patient’s behaviour and attitude. While the prison-system has for its purpose the shaping of docile individuals through systems for the management of deviant bodies, the hospital seeks the rehabilitation of ailing bodies through systems for the management of health:
La punition est une technique de coercition des individus; elle met en oeuvre des procédés de dressage du corps – non des signes – avec les traces qu’il laisse, sous formes d’habitudes, dans le comportement; et elle suppose la mise en place d’un pouvoir spécifique de gestion de la peine. Le souverain et sa force, le corps social, l’appareil administratif. La marque, le signe, la trace… (Foucault 2008 155)
As for the instruments used, these are no longer complexes of representation, reinforced and circulated, but forms of coercion, schemata of constraint, applied and repeated. Exercises, not signs: time-tables, compulsory movements, regular activities, solitary meditation, work in common, silence, application, respect, good habits … [discipline is] trying to restore … the obedient subject, the individual subjected to habits, rules, orders, an authority that is exercised continually around [them] and upon [them], and which [they] must allow to function automatically in [them]. (Foucault 1995 128)
Patient bodies are made docile through soft coercion; frictionless adoption of medical treatment is demanded of patients, and habitual acceptance of medical authority develops over time. To the best of its bureaucratic ability, a hospital hierarchically decides which bodies are prioritized. Each change in a patient’s bodily state is recorded in order to trace their progress and determine suitable ministrations. Stressors are kept to a minimum, and patients are sheltered with great care; “à chaque individu, sa place; et en chaque emplacement, un individu… Naît de la discipline, un espace médicalement utile” (2008 168-169); “Each individual has [their] own place; and each place its individual… out of discipline, a medically useful space was born” (1995 144-145). In exchange for the privilege of accessing the hospital space within our tax-payer funded healthcare system, patients are asked only to abide by certain regulations. In return for services rendered the task of the patient is, simply, to heal.
A review of the literature concerning sexuality and disability by Margaret Campbell in 2017 found that disability scholars have historically focused on social problems such as discrimination, inaccessibility, and poverty, viewing these issues as more pressing than sexuality. Hegemonic views of sexuality and disability are “medicalized or ableist, treating disability as an unfortunate, individual, biomedical problem requiring rehabilitation” (Campbell 1), and the lived experiences of sexuality among the chronically ill remain under-studied. In the popular imagination, sick and disabled people are simply “not viewed as acceptable candidates for reproduction or even capable of sex for pleasure. We are viewed as child-like and in need of protection” (Tepper 285). Sick and disabled people are judged as too ill to be concerned with sex, and may not ever receive adequate sexual education due to prejudice (Sheridan 70). Literature concerning sexuality and disability has often examined the attitudes of those who work with or care for ill and disabled people. For instance, a 2015 study of Turkish nurses’ attitudes and beliefs towards discussing sexuality with patients found that over 90% of nurses did not want to spend time discussing sexual concerns with their patients, viewing sexuality as a too personal a concern to bring up (Akiran et al 331), and a 2011 Chinese study of oncology nurses had similar results, finding that “63.8% [of nurses] assumed that most cancer patients lacked interest in sexuality because of their illnesses” (Zeng et al 14). A vicious cycle appears, wherein inpatients are deemed asexual regardless of their orientation, and thus not given the opportunity to learn about or explore their own sexualities. Subject to the medical gaze, chronically ill and disabled people are seen as damaged or limited, as unable to inhabit their bodies in productive ways or meet societal expectations of sex and gender. Research has consistently found that there exists a range of stereotypes that label disabled people as “infantilized asexual innocents in need of protection, as undesirable partners, as unfit or unable to have sex or children, and as deviant if they do engage in sexual relations” (Campbell 7).
In 2018, the interdisciplinary journal Sexualities released a special issue on disability and sexuality. In their introduction, editors Cassandra Loeser, Barbara Pini, and Vicki Crowley justify the need for such an instalment by reaffirming the extant lack of discourse regarding pleasure in sexuality and disability studies: “The question of how and in what ways the disabled body can be desired and desiring, a site of sensuality and pleasure that facilitates a corporeal sense of (a)sexual being-in-the-world, has remained largely unaddressed” (258). Even when offering sexual rehabilitation resources to disabled individuals, the institutional programs that are put in place generally focus on heteronormative ideas of sexuality, hailing penetrative orgasm-centric sex as the only suitable outlet for sexuality (Campbell 8). The subjugation of embodied pleasures is in no way exclusive to chronically ill and disabled populations. Tepper notes that by way of hegemonic Catholicism, sexual bodily pleasures were demoted over time to the status of sin (286). Indeed, all sexual activity that was not strictly procreative was deemed ‘unnatural’ and was seen as interfering with one’s responsibilities towards the community (Conrad and Schneider 172). With the rise of the medical profession in the late 18th century, sexual pleasure came to be viewed as “disease or sickness instead of sin, making it now a medical problem” (Tepper 286). As the editors of Sexualities point out, the sexualities of both disabled and queer people have been “presented as a threat to society and in need of containment” (Loeser, Pini, and Crowley 259). Campbell draws further parallels between the experiences of members of the LGBTQ+ community and disabled persons: these include coming out as gay or disabled, passing as cisgendered and heterosexual or non-disabled, and similarities between the alienation and oppression resulting from ableism and homophobia. Public discourse has for a long time framed ‘abnormal’ sexual behaviour as unhealthy. Queer, sick, and disabled people have all been viewed as living immoral lives if they act on their sexualities. Although public attitudes have come a long way, sexualities and identities deemed non-normative still experience repression and discrimination, and
various forms of sexual behaviour or development – such as hypersexuality, homosexuality, or intersexuality – have at some point been diagnosed and treated as medical conditions; later officially classified as disorders in the International Classification of Diseases and/or the Diagnostic and Statistical Manual of Mental Disorders. Therefore, it hardly comes as a surprise, but rather seems a logical continuation, that pornography is now also being framed as a public health issue: warnings of ‘porn addiction’ or the ‘porn epidemic’ are all over the media, and throughout the past year several US states have passed resolutions that officially declare porn ‘a public health hazard’. (Oeming 1)
Now, with the rise of said ‘porn epidemic’, forms of solitary sexual expression are further pathologized regardless of sexual orientation. In 2018, Webber and Sullivan highlighted that warnings of ‘porn addiction’ are rampant, and several US states have recently passed resolutions that classify porn a ‘public health hazard’. Policy hearings were also held in Canada, though the evidence was deemed too irreconcilable to reach a conclusion. In Australia and the UK, anti-porn activists are calling not for an investigation, but for a pre-emptive solution to this ‘crisis’. Although not a single global health agency supports these claims, pornography is treated as noxious to one’s health (Webber and Sullivan 1).
While pornography is regularly labeled a ‘public health crisis’ by anti-porn activists, deciding what is healthy for inpatients ultimately falls to hospital administration and public policy. As Madita Oeming succinctly puts it, “deciding who is ‘healthy’ is always an ideological process that requires defining what is ‘normal’” (1). Despite its apparently unhealthy nature, pornography is medically sanctioned for use in educational, clinical, research, and rehabilitation contexts. A review of medical research on the impact of pornography for individual health and behaviour conducted by Watson and Smith in 2012 found that, while it may occasionally cause harm to some of its users, the negative effects of porn are overestimated. The authors note that research has demonstrated the online viewing of pornography may in fact allow for “the formation of virtual communities where isolated, socially or sexually anxious, or disenfranchised individuals can communicate, find romantic partners, or practice some sexual behaviour in a safe setting” (127). Dikaios Sakellariou uses Foucault’s work on the care of the self to consider attitudes and practices that disabled people embrace in order to form an embodied self to enact sexuality. He notes that in response to care practices provided to disabled people, which are often disempowering and diminutive, individuals choose to embrace certain technologies which allow them to create their desired self. Sakellariou maintains that “care of the self is about enactment of identities and choice of how to live one’s life. It is about control of one’s body, power to guide representations of oneself and access to choices” (195). Patients dealing with conditions such as spinal cord injury, cancer, or chronic pain—to name only a few conditions—want to know that they are still sexual beings and they can still lead fulfilling, pleasurable sexual lives, and pornography is one such resource for personal exploration and sexual freedom. Chronically ill or healthy, disabled or able-bodied, people “have a basic need to be loved and intimate, as well as express love and affection” (Yau), and when one’s time is spent isolated in a hospital ward, online pornography grants individuals an avenue to enacting sexuality.
PUBLIC INTERNET, PRIVATE CONCERNS
The existing literature treating internet usage by hospital inpatients deals primarily with increasing patient engagement with online health portals. In 2015, Ludwin and Greysen conducted a survey examining the use of mobile devices among hospitalized patients in a large urban Californian hospital, with the goal of determining how many of patients a) brought devices to the hospital with them and b) used their devices to access their ‘PHR’, personal health record. They found that 68% of surveyed patients brought at least 1 mobile computing device, and the largest determining factor for device use was age, rather than insurance status or race/ethnicity. 79% of people under the age of 65 used a device, while only 27% of people over 65 did. Ludwin and Greysen stress that 48% of device users accessed their PHR, but omit the largest segment of device usage in their discussion: 79% of device users used their device for ‘entertainment/games’ during their stay. The authors do not expand on what is meant by ‘entertainment/games’, nor does anyone else. I found no surveys that further examine the ways in which hospitalized patients spend their time online.
The prohibition on consuming pornography for pleasure in the hospital space is implicit, never mentioned as an important matter. One only learns of its existence by attempting to visit a website deemed pornographic and landing on a page stating that this website is “known as an unlegitimate [sic] site and not allowed with this public internet access link”. Reason: Pornography (See screenshot: fig. 1). I sought information regarding this censorship decision from the hospital administration, but everyone I spoke with claimed it was another division’s decision, and my call was forwarded from department to department until I landed on a mailbox and received no response. The Wi-Fi service at this particular hospital is provided by a private company which partners with a number of host institutions throughout the city and the rest of the province to provide free internet access to the public. In an email exchange with the company’s general director, it was confirmed to me that host institutions determine which websites are tolerated on their networks, and that restrictions are not the same across the board. Public institutions generally demand more constraints than private businesses, notably regarding pornography (Personal correspondence, May 30 2018). This censorship of all websites labeled ‘Pornography’ on the public internet available at the hospital in question is the result of the history of discrimination faced by ‘disabled sexualities’, and the current dominant attitudes toward pornography.
The hospital’s mission is explicitly to promote health and well-being. They aim to “facilitate healthy choices”, “lead meaningful interventions”, and allow for “free and enlightened decision-making.” That means condemning behaviours and habits that may be detrimental to mental and physical wellness. The public conversation’s effacement of sexual pleasure as a valuable part of daily life works hand-in-hand with the dominant view that chronically ill and disabled people could not possibly be concerned with sexuality to create a habitat that does not think twice about denying its residents access to sexually explicit materials, and reinforces barriers to “sexual expression of disabled people [which] are primarily to do with the society in which we live, not the bodies with which we are endowed” (Shakespeare 161). Foucault states that punishment rests upon a technological sphere of representation (2008 123), by which bodies learn behaviours and habits when led by example. In the hospital space, bodily discipline is implicitly enforced by creating barriers to sexually explicit material which is linked with masturbation and sexual pleasure. Power over the acts permitted an individual is central to the formation of docile bodies; disciplinary power creates a correlation between action and state of embodiment: “le contrôle disciplinaire ne consiste pas simplement à enseigner ou à imposer une série de gestes définis; il impose la relation la meilleure entre un geste et l’attitude globale du corps” (Foucault 2008 178, emphasis mine); “disciplinary control does not consist simply in teaching or imposing a series of particular gestures; it imposes the best relation between a gesture and the overall position of the body” (1995 152). Discipline of embodied gestures is inextricably linked with the betterment of a body’s behaviour. In the case of health, if pornography is unhealthy, then one must not be allowed to consume this poison when attempting to cast off other ills, lest healing as a whole be jeopardized.
PORNOGRAPHY IN DISGUISE
Although pornography now primarily sees the limelight in the form of online videos, sexually explicit GIFs and images are a significant means of access to pornography and community for isolated individuals such as hospital denizens. In 2015, Hester, Jones, and Taylor-Harman noted the impact of the GIF format on participatory porn cultures in the context of female fandom. The experience of consuming pornography is dictated by setting and mediation, and “the context in which a still or clip is embedded ultimately determines whether or not it is legally pornographic” (Hester, Jones, and Taylor-Harman 358). The creation of a GIF metastasizes a muted excerpt from existing media into a loop which lends itself to “easy sharing via mobile, on free porn commercial sites, or within fan communities” (356). They call this GIF-based porn ‘microporn,’ and highlight Tumblr as a GIF-hosting website through which communities form around the re-appropriation and sharing of sexually explicit materials. Since the current article was first written, Tumblr has banned all ‘adult content’ from their website, citing a desire to foster a more positive community. This decision, which came into effect on December 17, 2018, followed a widespread controversy surrounding allegations of child pornography as well as the app’s removal from the Apple App Store. Social media scholar Stefanie Duguay published a piece in The Conversation shortly after the ban was announced, noting that Tumblr’s change in policy will negatively impact people whose sexualities are already marginalized, since the platform was a hub for the formation of community around sexually explicit material. While Tumblr CEO Jeff D’Onofrio states as his bottom line that “there are no shortage of sites on the internet that feature adult content,” (2018) he conspicuously fails to account for the many communities formed on Tumblr that flourished precisely because of the undirected nature of the platform. Unlike mainstream pornographic websites, most of which are not designed with non-normative sexualities in mind, Tumblr’s strength as a place for the formation of community and sexual identity stemmed from its nature as a social networking site. Tumblr is now hardly an option for accessing pornography, having joined the ranks of those platforms and institutions that deem sex untouchable. In its place as a locale for the access of pornography in disguise, Reddit has emerged as a significant platform which hosts a myriad of communities dedicated to the propagation of visual material, explicit or otherwise. However, Reddit’s community differs greatly from that of Tumblr, and like more mainstream pornographic sites, users are more likely to be exposed to stereotypical notions of sex and sexuality which cater to cisgendered heterosexual men. Still, on Reddit, users share content in the form of randomly generated hyperlinks that make it impossible to know what the image will be prior to following or embedding the URL. Reddit (along with widely used unaffiliated image hosting platforms such as Imgur and Gfycat) is classified as a social networking site, and is thus not censored as pornography on the WiFi network. This media specificity allows for pornographic material to meld into the ocean of data flooding these websites each day.
Adults have the right to make choices regarding the media they consume and access to sexually explicit material should not be restricted. By using alternative channels such as Reddit or Tumblr, every chronically ill or disabled patient is “enabled to choose from those technologies that will enable [them] to engage in sexual activities in a way that makes [them] feel comfortable with [themselves]” (Sakellariou 194). By consciously making the choice to consume pornography, individuals actively circumvent the desexualizing laws, policies, and attitudes which concretize ideological barriers. Each act of browsing is an act of validation of individual sexuality in spite of the continued erasure of the sexualities of chronically ill and disabled people.
In the paragraphs above, I have highlighted some ways in which inpatients are further desexualized, and a potential avenue for their transgression of norms by means of online content sharing communities. However, we must consider the inherently inaccessible nature of accessing online pornography outside those that show up on the first page of search engine results. Microporn sharing communities operate on hidden vistas of the internet, accepting all individuals savvy enough to have found their way to the particular corner of the internet serving their interests. The hidden nature of these communities is the key to their bypassing technical barriers, but inherently creates further difficulties for access. Additionally, as was demonstrated by the sudden change of policy on Tumblr, these communities are precarious. Likewise, some independently produced pornography that operates outside the free streaming platforms, and generally exists behind a paywall, may not be flagged by the WiFi’s censors, and as such may be technically available to hospitalized individuals, yet the same problem of knowledge and accessibility remains. Knowledge of porn niches only comes from exploration, from browsing, from searching. Online porn beyond the mainstream requires tacit knowledge of web navigation – knowledge perhaps not available to individuals not born into internet usage, or for whom structural barriers prevented time/opportunities to learn skillful surfing. Because we assume that all individuals in our society are completely self-sufficient, particularly in regard to sexuality, no teaching of webporn usage is offered. And why not? Because, presumably, pornography is the most accessible media on the web. A quick look over the mainstream conversation may lead one to believe that it is in fact inescapable. Type a word into any search engine and endless free tube sites will populate your results pages, offering endless delights to suit all tastes. But when that is not an option, do you know where to turn?
1. For overviews of how disability is considered desexualizing see Cambpell 2017; Cuskelly and Bryde 2004; Esmail et al 2010; Jungels and Bender 2015; Martino 2017. Regarding the choice to use ‘disabled people’ rather than ‘people with disabilities’: The linguistic divide is drawn geographically. Disability studies in North America tends towards ‘disabled people’, while in the UK ‘people with disabilities’ is more common. Sakellariou (2012) provides a succinct explanation: “The use of [disabled people] in this article points attention to an experience lived and expressed by some disabled people themselves. This is that, rather than ‘having’ a disability, people are actively being disabled through social and political attitudes, behaviours, and practices.” (188) Because my discussion is focused on the ways in which an institution disables the sexualities of its patients, I choose to use ‘disabled people’.
2. French edition, 2008. English edition, 1995. Where citations are paraphrased, french page numbers are used.
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