Rhetoric and the Social Construction of Sickness and Healing (original) (raw)

1999, Social History of Medicine

"COMMENT "Social construction" was already problematic when I published this (cf. Ian Hacking), but I wanted to acknowledge an earlier article by Ludmilla Jordanova. My approach had always been comparable to that of the Strong Programme, even if not explicitly so. My purpose here was, in part, to participate in the breaking of the separation between the social and intellectual history of medicine, treating them symmetrically and as entangled. I felt that my earlier work had given me the credibility needed. However, I tried to avoid references to European philosophers, as far as possible. I felt that I could make the same sort of points, using people who wrote in the Anglo-American traditions. I did not want to stud the text with allusions to the kinds of author that are too readily dismissed by Anglophones. This was a rhetorical manoeuvre. Unfortunately, pressure on space led to many of the references to English and American philosophers being cut, along with pages of case histories, on Lyme disease, for example. I used the early modern period in the hope that it would be recognizable to both those who studied earlier and later periods. It was not my intention to reduce the body to idealist description, but to stress the crucial role of mediating categories and concepts. "Rhetoric" is not here conceived as a matter of conflict but rather of narrative and persuasion, whether verbal or symbolic. ABSTRACT An important element in recent science studies has been the analysis of the social rhetoric involved in the construction of disciplines and knowledge. An explicit use of rhetorical and semiotic frames of reference would illuminate many aspects of the history of medicine and could provide a unifying framework for the field. Medical theories were always intended for use and therefore had to be plausible in the eyes of patients. The interpretation of signs and the construction of explanations lie at the heart of diagnosis, therapy and prognosis. These are usually interactive processes and the efficacy of medical interventions therefore depends upon meaning, narrative and persuasion. Since mental processes are not rigidly separated from bodily functions, trust and expectation have physiological effects that are required for successful healing in all cultures at all times. The conduct of patients and practitioners always turns on the expectation of cure and the establishment of confidence. The efficacy of rhetoric was more readily recognized by practitioners in the past than it has been by social historians of medicine. Once mind—body dualism has been discarded, it can be seen that historians are not studying the context of healing but its very heart."