The Slumbering Masses: Sleep, Medicine, and Modern American Life

3. Sleeping and Not Sleeping in the Clinic: How Medicine Is Remaking Biology and Society

79 3 .................. Sleeping and Not Sleeping in the Clinic How Medicine Is Remaking Biology and Society One of the most curious cases I witnessed at the MSDC—not for the symptoms, but for the solutions—was that of an eleven-year-old boy named Ted. The presenting physician described the boy as evidencing insomnia and excessive daytime sleepiness, the latter affecting Ted only between 6:30 and 10:30 a.m. When left to his own devices, the boy would sleep until 10:30 and be fine for the rest of the day. But when he had to go to school, his parents would wake him at 6:30, and he struggled, often unsuccessfully, to stay awake throughout the morning . While at school, rather than simply letting the boy take a nap, his teacher forced him to ride a stationary exercise bike to keep awake. When he would stop pedaling, his teacher would know to wake him or at least call on him. The physicians agreed that the cause was a “clock problem,” that is, a dyssynchrony between the child’s sleep requirements and the timing of his sleep on one hand and the social obligations of school on the other. Other than an occasional little snore, which the attending physician punctuated with a slight snort-snore, the boy was considered totally physiologically normal. The physicians all agreed that the exercise bike treatment was inappropriate. Given the family situation of the child, reorganizing his waking time and school attendance was impossible. What the family embarked upon was the use of set times for bed and a lightbox in the morning. An earlier bedtime to get his desired amount of sleep and the exposure to bright light upon awakening helped Ted get Sleeping and Not Sleeping in the Clinic 80 through his mornings at school. If he were to slip from his schedule and fail to use the lightbox in the morning, his “clock problem” might reassert itself. Similarly, without the demands of his parents and school, Ted’s sleeping might again extend until 10:30 a.m. Ted’s situation may seem extreme, or comedic, but it offers a glimpse into the many forces that make up everyday life and the management of sleep. In this chapter, I am interested in the ways that the abstract and theoretical content of sleep medicine is applied to a body of individuals to explain their disordered sleep. What might seem at first glance a straightforward and unproblematic process of aligning symptoms with nosologic categories is, upon closer scrutiny, about more than individuals and disorders. Medical diagnosis is always also an effort at prognostication , of augury: allopathic medicine produces particular futures that depend on rhythmic therapeutic interventions. One rhythm, the disordered , is replaced with an orderly one. This ordered rhythm is produced through pharmaceutical, prosthetic, or behavioral intervention, or any combination of these. Through these means, medical professionals align the everyday lives of individuals with the spatiotemporal demands of the institutions that patients interact with. In the following, I focus on a series of cases addressed by the physicians with whom I conducted my primary fieldwork. Throughout the cases, what I am interested in is how physicians identify disordered rhythms, what they pose as solutions, and how these remedies often, but not always, take as their site of intervention the individual physiologies of patients. Lurking in many of the discussions of cases is the possibility of altering the institutional obligations of individuals and thereby mollifying their symptoms. Before I turn to these clinical discussions, I first examine the increasing popular media representations of sleep, particularly that of the National Sleep Foundation. Sleep is being rendered abstract: it is becoming a means through which to understand a wide variety of social and biological symptoms. These concerns of media and abstraction, spatiotemporal ordering, and the clinical practice of allopathic medicine are in the service of a more fundamental question: How does the expanding horizon of medicine and its applications allow for both increased medicalization of phenomena once accepted as natural and a fundamental need for “difference” in allopathic medicine? In this chapter, I pursue three interlocked theoretical concepts to address this question: normative ideals, therapeutic normalcy, 81 Sleeping and Not Sleeping in the Clinic and integral medicine. Allopathic medicine depends on two fundamental differences: that between the pathological and the normal and that between cause and cure. By focusing...