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Problematique It was a slight slip, really—a misdiagnosis of an emergent chronic-pain syndrome. But when the misdiagnosis was followed by a raft of new symptoms, what started out as a little mistake grew bigger.The new symptoms were misinterpreted as part of the disease and then mistreated with a therapeutic plan that did not fit the problem. When the mistreatment failed to work and the debilitating new symptoms grew worse, threatening the patient's mind, dreams, and life, she went nearly mad. By the end of the eight-month ordeal, a small mistake by a doctor had undone the patient's life. What went wrong? How could medicine, which is supposed to eliminate pain, end up creating it instead? Since the time of Descartes, the work of scientific medicine has been depicted by a metaphor of repair: the body is a machine, the physician a mechanic who fixes its broken parts.1 Contemporary wags have likened the doctor's work to that of the automobile mechanic who fixes the carburetor and gets the vehicle back on the road. Butthis humble metaphor does not capture what transpires when the physician undertakes to treat a patient. The physician's work is not merely restorative, but also productive: he creates fears and hopes, images and identities,perhaps even side effects and symptoms that did not exist before. The repair analogy is also too optimistic, for although the doctor is supposed to fix body parts, he may inadvertently break them instead. The pill, given for the headache, produces stomach pain as well; the biopsy needle, aimed at the liver, punctures the bowel instead. Finally , the artisanal image is anachronistic, for the critical tools of the physician are no longer the physical implements of the mechanic; rather, they are the cognitive and linguistic tools of thescientific-professional expert. Today it is not the stethoscope or scalpel that does the fundamental work of medicine; it is the ideas, conveyed in words, that persuade us that what is done is right and good. Our repair metaphor is not just wrong; it is also dangerous because it is part of a powerful mythology that clouds our perception. It keeps us from seeing the real work of 18 Problematique / 19 medicine and its interventions in our identities, our emotions, and our lives. Metaphors matter more than we think. Michel Foucault, the French philosopher and social critic, grasped these points well. In his 1963 study, The Birth of the Clinic, he described the penetrating "gaze" of scientific medicine and how it gradually gained sovereignty over the care of the ill.2 Following new codes of scientific medicine in which the disease, not the patient, was the object of knowledge, the gaze of the physician gave him the power to know and name the patient 's disease and, on that basis, to organize massive interventions in his life.3 "The eye that knows and decides, [is] the eye that governs."4 The patient comes to the doctor for help, but finds himself first transformed into an object of science and then reduced to a disease, an "endlessly reproducing pathological fact."5 The process is jarring and violent, all the more so because the medical gaze denies its violence,claiming beneficence instead: "[T]o look in order to know ... is not this a tacit form of violence , all the more abusive for its silence, upon a sick body that demands to be comforted, not displayed?"6 Although the patient remains a silent cipher in the Clinic, Foucault's historical study remains one of the most incisive accounts of the conceptual nature of medicine's power and the disruptive effects of scientific medicine on the patient's inner world. With the rise of social studies of medicine,much has been written about the disjunction between the physician's narrow view of his task as finding and fixing disease, and the patient's larger view of her illness as part of a life that needs to be put in order.7 But less has been written about what happens to the patient, not only physically, but also philosophically and psychologically,when her worldview is disturbed, her body and life rearranged according to the rules of an esoteric system she neither understands nor influences.8 The effects of this system on the inner world of the patient is a central focus of this book. To understand how a discipline of the body can deeply intervene in the mind and emotions, it is necessary...


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