Galen and the Rhetoric of Healing

Conclusion

Conclusion P This book is about Galen’s subjective experience and his subjective account of that experience. It is not about what really happened between physicians and patients , which we do not know; we only know how Galen represented those encounters .However,with rare exceptions,we are dependent for the knowledge of almost any event, if any degree of nuance is sought, on subjective narrative of some kind. Medicine is a good discipline in which to study the lens through which reality is filtered. The scientific reality behind the patient’s problem—the disease—is obscure and must be sought through clues, signs, and stories; and today through laboratory tests, though the interpretation of some tests, notably imaging studies, is also subjective. In many cases, the pursuit of the disease—of its identity as well as of its cure—becomes a dramatic narrative of its own, and in the end, the patient may never know what is wrong with him or her. Disease is of course a scientific reality, but it is elusive. I have not attempted to identify the diseases behind the symptoms Galen’s patients exhibited or described. That reality is unknown and inaccessible; we do not have Galen’s patients before us to undergo tests and observation. We have only his descriptions of his patients, their symptoms, the progress of their illnesses, their interactions with himself. It is possible that the patients, if questioned (as Galen did in fact question them) would have told the stories much differently. But this should not be assumed. Galen had much in common with some of his patients: education, lifestyle, and value system. If “disease”is a scientific reality and“illness”is its subjective experience—by patient and doctor—what is illness? Galen’s stories offer many possible answers: a social event; a crisis or turning point; a test of the physician; a challenge to the patient , who may be a householder, a man of action, a competitor temporarily sidelined,his sovereignty over his most basic bodily activities undermined,his ability to take any action obliterated. Illness inhabits its own time and space. Galen’s stories offer few contextual details that tie them to the outer world.Although the clinical encounter may have underlying features in common with other events, such as athletic contests, these do not impinge directly on the story except occasionally as background; the stories float free of their historical context, in the specific world defined by illness. Once therapy is under way time and space contract around the illness,characters become anonymous the world consists of bedrooms, baths, the intimate space around the patient, and the interior of his or her body. Time telescopes to a clinical accounting of hours and days as the art of medicine attempts to predict, rationalize, and manage the organic rhythms of disease—with its cycle of paroxysms, its crises, and its critical moments. Disease is perhaps the original and primal drama, whose resolution only time can reveal; for this reason, the ideal physician is a master of time, with the ability to identify and anticipate the kairos, and to predict the disease’s course or outcome with dazzling accuracy. Creating an illness-world, with its idiosyncratic spatial and temporal organization,with its own rules and attributes,medical narrative turns the terrifying unknown into something that can be understood and potentially controlled. Who inhabits this world? Among its characters, physician and patient contend for top billing and each play multiple roles: the physician is competitor, savior, household master, arguably household servant; the patient may be citizen, master, servant, endangered victim, or even the passive subject of a test or contest. Each of these roles requires ancillary characters: friends, servants, judges, and so forth.And finally, there is the disease, which is also a character in many stories. Some stories are staged like contests in which the physician takes on rivals and emerges victorious from a grueling physical, intellectual, or verbal competition. The competition in this case is not with the disease nor with the patient but with other professional physicians; it is a contest of skill or techne. The profession of medicine is defined to some extent by this competition. Judges or witnesses are important : the cure takes place in a room full of spectators, notably the patient’s male friends rather than servants, children, or female relatives. The friends may test the physician by questioning him or challenging him; they are advocates...