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Preface An epidemic of chronic pain stalks America today. Nearly half of all Americans suffer from one or more chronic conditions, includingillnesses and impairments, and the number is growing.1 Even as tens of millions struggle with such established chronic diseases as arthritis, diabetes, hypertension , and heart disease, millions more are afflicted with the new chronic conditions of late-twentieth-century civilization.2 The past two decades have brought a dizzying number of such ailments: chronic fatigue syndrome, repetitive strain disorder, Gulf War syndrome, environmental hypersensitivity, and, among the newest entrants, fibromyalgia. Although the symptom mixes vary, these disorders share many features. All lack a known organic basis and are difficult to diagnose. All lack a recognized cause but are worsened by stress. All are syndromes of related symptoms rather than true diseases. All are chronic and treatable to a certain extent, but incurable. Most target women in larger numbers than men. In a culture that worships science, it is to scientific (or conventional) medicine that we first turn for help. Women desperate for someone to acknowledge and alleviate their suffering go to their doctors to name and ease their new pains. Professionally obligated to heal and motivated by humanitarian impulses, our doctors try to live up to our expectations. Although the treatment of chronic pain is one of scientific medicine's most visible failures, in a time of shrinking resources, medical specialists are only too happy to have a new domain in which to apply their skills. Research scientists develop diagnostic criteria for a new syndrome, clinical scientists work out treatment protocols, and a new group of specialists emerges with a guaranteed stable of patients for life. Before long, a bona fidenew disease has entered the medical and cultural mainstream. In this way, distress is transformed into disease, and the "diseasing" of social life moves ineluctably forward. Most of us think that medicine can reveal the truth of our bodies because medicine is a science that claims to have direct, privileged access 3 4 / Understanding Chronic Pain to the truths of nature. But does scientific medicine convey The Truth or only a truth of our bodies? In recent years growing numbers of scholars in the humanities and social sciences have maintained that medicine's truth is only one truth. Moreover, they contend, it is a partial, interested, and value-laden truth that conceals these weaknesses in the discourses of scientific objectivity and in the rhetorics of physician heroism. These limitations of the scientific approach to healing matter, because scientific medicine wields prodigious power over our lives. This power is produced by the workings of the "medical gaze," a term coined by the French philosopher Michel Foucault.3 Through the knowing gaze of the physician, medicine claims to "see" diseases that liedeep within the body, bringing them into being as objects of consciousness and intervention. This distinctive way of seeing permits the doctor to know and label our diseases and, on those grounds, to orchestrate interventions in our bodies , with effects that spill over into our lives. How medicine works—what it can and cannot do—affects every one of us, and some of us deeply. In the medical profession today, there are encouraging signs of greater openness to criticism and growing willingness to address the shortcomings of the scientific, or "biomedical," approach to illness. There is more talk than ever of holistic approaches to healing, partnership relations with patients, and open disclosure of medical mistakes. Yet change has been late and limited. Today medicine at large remains aloof from the more radical critiques of the humanists and social scientists. For good institutional , economic, and legal reasons, most physicians remain inside the discourses of scientific medicine, unable or unwillingto seethat their scientific worldview is but one among others. The public actively participates in the mythmaking. We marvel at medicine's high-tech "breakthroughs ," while readily forgetting its low-tech mistakes—the wrong leg amputated, the wrong part of the brain excised, and so on. We are awestruck by its promises to overcome human biology and reengineer our genes, neglecting the social, economic, and cultural costs involved. We know the larger system is troubled, but we trust our individual doctors because they have taken the Hippocratic oath—above all, do your patient no harm. And we trust because we have little choice in any case. Many forces have begun to chip away at the power and authority of biomedicine , but its mystique retains a powerful hold on the public and the...


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