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CHAPTER 4 A Most Pleasant Patient A fundamental issue in S.'s relationship with her doctor was that of power: Who would define her conditions and decide how they would be treated? In this contest the doctor enjoyed decided cognitive advantage. As we have seen, the discourses of biomedicine had severed the patient's mind from her body and defined the doctor as the expert on her body. The doctor was also advantaged institutionally: the interaction took place on his turf, he controlled the relevant scientific knowledge, and he possessed the formal qualifications required to order diagnostic tests and treatment protocols. Moreover, his personal power as a representative of institutionalized medicine was buttressed by the cultural authority of science and scientific medicine in American society at large. Given this imbalance of power in the biomedical relationship, the operational question was not so much who would control the process—obviously, the doctor would—as it was how much room there would be for the patient to resist aspects of the process she did not like and to insert her own understandings into the doctor-defined process. S. was caught in the classic patient bind: she had the bodily conditions that her doctor was an expert in treating. How could she gain more control over the medical process when she was dependent on his medical expertise to help her with some real (and some not-so-real) physical problems? She wanted and needed his medical help but activelydisliked the prospect of having to turn control of her body and important parts of her life over to a doctor. And this doctor was a particularly controlling one: he had offered a package deal in which the patient was to accept three to six months of "aggressive treatment"—including massive pharmacological intervention, considerable discomfort and danger, and intrusions into many aspects of her life—and in exchange he promised to produce real bodily improvement while doing no harm in the long run. The hierarchy of science was overlaid with the hierarchy of gender, further narrowing the modes of resistance available to S. Research on women's psychology has shown how, in a society in which achievement 141 142 / Doing Gender in the public domain has long been a male prerogative, the fundamental self of many women is relational, based on intimate relations with others, especially men.1 This is especially so for mainstream—that is, white, middle-class, heterosexual—women, a category to which S. belonged . This research suggests that, in a society that does not want to hear what girls have to say, in adolescence many girls pick up the discourses of "femininity" that teach them to form pleasant exterior selves while silencing inner voices that are critical or angry, attitudes considered unappealing in girls.2 Socialized to adapt their social selves to others ' needs and to cultivate an "ethic of care" in which they care for others ' well-being more than for their own, these girls may become deeply confused about where their self leaves off and the selves of others begin. The blurring of boundaries reduces their ability to recognize abuse and leaves them at psychological risk of depression when they discover that they have no self.3 Although this line of research has not been extended to the psychology of patienthood, we will seethat these are the very psychosocial dynamics that unfolded in S.'s relationship with her doctor. Yet S.'s case is more complicated, for in her the psychodynamics of femininity were overlaid by the psychodynamics of feminism. S. had a complex and contradictory gender identity that merged an iconoclastic feminist self that she had fashioned in college with a more compliant feminine self that had been created for her during childhood and adolescence. Coming of age in the late 19608 and early 19705, she was swept up in the promise of the women's movement, with its discourses of opportunity, justice, and equality between the genders. The foundational text of the women's health movement, Our Bodies, Ourselves became her personal Bible on matters of sexuality and the body, both central to identity construction in her baby-boom generation.4 Inspired by the autobiography of French feminist Simone de Beauvoir, during her junior and senior years at Wellesley College she decided to decline the conventional role of mother and to construct a different life based on work in the wider society.5 In graduate school at Columbia University and then in a high-powered research job in...


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