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CONCLUSION Re-viewing the Medicine of Chronic Pain This case raises troubling questions the reader may well wish to ponder. Who is responsible for this medical tragedy, the doctor, the patient, both of them, or neither of them? Did the doctor do anything wrong, or was he just doing what he was trained to do? Was the patient culpable as well, or was she doing her best, given the codes of gender and science by which she was taught to live? Consideration of such matters is well and good, since this case poses difficult questions of medical ethics for which there are no ready answers. In this conclusion, however, I want to move on to larger issues. In the preface I posed three sets of questions about the workings of science, gender, and culture in the medical domain. How could scientific medicine, which is supposed to ease bodily pain, end up creating it instead ? How do the dynamics of gender complicate an already powerladen doctor-patient relationship, leaving many women (and men) dissatisfied with their medical care? And,finally,how might popular cultures of alternative medicine sometimes compound the problems of the chronically ill? In the problematique, I drew on a number of literatures in the humanities and social sciences to develop the analytic frameworks and arguments I used in the book. The individual chapters then elaborated those arguments ethnographically. In this conclusion I want to speak more personally to you, the reader. Although this is a scholarly book, it is also, obviously, a deeply personal book. I believe that this tale of senseless suffering will serve a larger purpose if it can help us to understand and undo some of the irrationalities of the medical system we now have. I wrote this book for five groups of readers: patients and potential patients, physicians and medical educators , students of science and medicine in the humanities and social sciences , students of gender and power in American culture, and fellow anthropologists . In the first five sections of this conclusion I write directly to each group of imagined readers to tell you what thoughts I hope you will take away from this book. Although you might read only the sec291 conclusion 292 / Narrating Illness, Politicizing Pain tions that apply to you, I hope you will read other sections as well. In the sixth and final section I take a longer historical perspective to suggest why chronic pain conditions like fibromyalgia—which affect a small minority of Americans—should worry us all. To Patients and Other III People: Choose Your Story with Care Out of this grim experience of medically induced illness has come a deep conviction that we as patients need to revise our understanding of how medicine works. We need to recognize the artful character of the things our doctors tell us. We need to appreciate the choices we have in the stories—both our own and our doctors'—by which we make sense of our ills. Finally,we need to comprehend the crucial consequences of the stories we choose. Many Stories but No Truth: Dispelling the Myths of Scientific Medicine Despite the many critiques of medicine, for many of us medicine retains a special mystique. A kind of secular religion, it is haloed by the myths of truth, objectivity, and no harm. I have sought to dispel these myths, because unquestioned belief in them can be dangerous. Following a storytelling approach to science, I have argued that the fundamental work of clinical medicine is to tell a three-part tale about the patient's body (diagnosis-prognosis-treatment), to coax the patient into believing the story, and then to put it into effect to ease the body's ills. Although scientific medicine calls its stories The Truth, by examining how one such story was fabricated, this ethnography has illuminated their artful, artificial character. Viewing Dr. D. as a working scientist, we saw the inherent shakiness of the methods he used to create the scientific "facts" of the case. We observed too the narrow, reductionistic nature of the discourses from which D.'s story was composed. And we witnessed the emotionally coercive character of the verbal tactics by which the doctor converted his patient into a believer in his cause. By taking the processes of story making and telling apart, we were able to see that Dr. D.'s story undoubtedly seemed like the truth to him, because of his adherence to the methods, discourses, and rhetorics of scientific medicine. Once we...


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