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CHAPTER 9 A Life Shrunk, a Mind Gone Nearly Mad During the summer months S. had followed her doctor's treatment program closely, monitoring her activities to find the source of her fibromyalgic symptoms and limiting those that seemed to contribute to the pain. But that strategy had yielded limited success: at summer's end the new symptoms remained dismayingly serious. Finding alternative therapies of little use and desperate to rid herself of the debilitating headaches and insomnia, in the fall S. redoubled her efforts to make her doctor's discourses work. This chapter shows the lengths to which she took that project and what happened when it failed. In mid-September S.'s husband drove to Maine to fetch her. After a brief vacation on Vinalhaven, a charming island off the coast of Maine, they returned together to their New York country home, where S. had planned to spend the fall working on her book. But things did not work out as planned. As S.'s bodily and emotional health declined, she drew away from people into an inner universe of terror and dread. Her husband , the only person who saw her regularly, grew increasingly worried about his wife's mental stability. Yet he could not find the way into her inner world. To his intense dismay he was helpless to stop the erosion of her life. Carrying the discourse of self-surveillance and self-restriction to an extreme, in the fall S. began to slice off more and more parts of her life, until not only her activities but her whole personality was put on the chopping block. But instead of getting better she grew markedly worse. Beginning in September she suffered recurring headaches, tenacious fogginess , and cognitive distortions that ravaged her ability to work. ByOctober , when she had lost everything but the symptoms, she began a steep descent into insanity. Unable to halt the decline, she shut everyone out of her life, drastically reduced her intake of food, and drowned herself in tears, edging ever closer to the brink of madness, before a small miracle occurred that saved her life. The madness that came on her in the fall was the logical result, the 226 chapter 9 A Life Shrunk, a Mind Gone Nearly Mad / 227 end product, of the discourses and practices that had been applied to the patient's body since she came under the gaze of Dr. D.'s brand of biomedicine . The treatment discourse that did not work pounded the nail into the coffin of S.'s sanity, but the coffin was built of other discourses that had been put in place earlier in the process. Among the most important was the symptom discoursethat attributed all the new symptoms to fibromyalgia and then omitted them from the evaluation of the doctor 's success. Another critical plank in the coffin was the diagnostic discourse that bestowed on her "tender points" where usually there was no tenderness and defined her as "fibromyalgic" when she lacked the condition 's cardinal symptom. Last but most fundamental was the discourse of objedification that dismissed S.'s emotions as irrelevant to her bodily state and named the doctor the sole expert on the patient's health. In the spring the gap between the lived reality of her body and the medical discourses imposed on it produced a profound sense of epistemological and ontological invalidation. In the fall the gap widened, leading to mental disintegration. The chapter also records the doctor's continued use of rhetorics that furthered the biomedical cause but impeded doctor-patient communication by silencingthe patient. Faced with escalating complaints in the early fall, D. opted not to listen to them, but to deflect them with the same sorts of linguistic devices he had used to create a perfect patient in the spring (seechapter 3 for details). Foremost among these were accusations, threats, and trivializations of the patient's concerns and rhetorical augmentation of the doctor's own prowess in conquering the patient's disease . Finally,this chapter charts S.'s slow, halting realization that her doctor might not be the solution to her problems but the cause of them.Slowly and sputteringly, the growing gap between her doctor's rhetorics of "stupendous success" and her own reality of emotional and physical distress began to undermine the trust on which everythinghad depended. In this void between the two truths—doctor's and patient's—lay the seeds of S.'s eventual revolt against biomedical authority. But that...


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