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CHAPTER 2 Medicating the "Fibromyalgic"-Arthritic Body Once attached to the patient, the new diagnostic-interpretive grid became a powerful force. In the last chapter we saw how it began to reshape S.'s mental world, infecting her bodily identity and emotional state. Now we see that the new grid had a corporeal effect as well. That five-part diagnosis became the rationale and the blueprint for massive interventions in her body. The rationale for the interventions was straightforward. If the generic problem was biological or bodily, the solution was pharmacological alteration of the body. If the specific problems in S.'s case were untreated inflammation of psoriatic arthritis and fibromyalgia-related lack of sleep, the solution had to be a stronger antiinflammatory drug and new medication to make her sleep. The treatment followed logically from the definition of the problem. The diagnostic grid specified chemical intervention in the diseased body, but it did not indicate which medications should be applied or how they should be administered. These matters were parts of a drug discourse that supplemented the diagnostic discourse, fleshing out the last part of the story of S.'s ills (about the treatment plan) that was crafted in the initial meeting. The doctor's drug discourse amounted to a pharmacological philosophy, because it contained both an implicit epistemology (a theory of knowledge) and an implicit ontology (a theory of existence or being) of disease treatment. This philosophy carried the theme of objectification advanced in the diagnosis a great deal further. The doctor's discourse on drugs contained six weighty assertions: drugs are the treatment of choice; there is a best drug for each condition; the patient must be "tolerized" to these drugs; serious side effects might occur; all symptoms must be attacked simultaneously in a multifaceted treatment program ; and the initial phase of treatment must be one of scientific experimentation in which the doctor-scientist uses his superior knowledge of the body and the drugs to experiment on the patient body to find the best pharmacological package for her ills. Implicit in this pharmacological philosophy was an epistemology according to which the doctor's 87 chapter 2 88 / Doing Biomedicine knowledge was the only knowledge that counted and an ontology in which the patient-as-person (as opposed to the patient-as-body) did not exist. The discourse on drugs left the patient with some acute philosophical dilemmas to work out on her own. When put into practice this discourse on drugs had notable effects on the patient's body. The first few weeks of experimentation produced extreme discomfort: huge headaches, sleepless nights, and day-in, day-out fatigue. Eventuallythe doctor found a combination of drugs that helped, giving the patient some welcome relief from the symptoms that had brought her to him. But these benefits were realized at significant cost: the onset of new and even more debilitating symptoms. These new ills included neurological problems such as headaches and, later, mental fogginess as well as conspicuous pain in the neck and upper back. None of these symptoms had been present at the time of the initial consultation. These new ailments compounded the patient's distress: not only did they cause discomfort, but their emergenceafter treatment began simply made no sense. This diagnostic-treatment grid had another effect that may appear esoteric to the reader but provides a critical clue to the mysterious happenings of later months. This second effect was on the doctor's interpretation of the new neurological symptoms. In his tool kit of medical knowledges the doctor had a number of competing explanations that he could have drawn upon to understand these new symptoms. He chose the one that was compatible with his previous discursive constructions of this patient. Becausehe was convinced that the patient "had fibromyalgia ," that fibromyalgia was her most serious condition, and that the antiinflammatory Indocin was the "best drug for her arthritis," he attributed the neurological symptoms to fibromyalgia, rejecting as lessrelevant the well-known evidence that Indocin often produces such mental disturbances . While the choice of interpretation made eminent sense in terms of the doctor's formulations of the situation, it was to have baneful consequences that surfaced in the spring and multiplied during the summer and fall. In this chapter we examine what happened when this six-part discourse was turned into practice. The first section details the doctor's discourse on drugs and draws out its epistemological and ontological implications. The second section describes how S. was turned...


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