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Notes Works cited in the notes by author and year of publication receive full citation in the bibliography. Preface i. Byepidemic I refer to the culturallycontagious nature of chronic pain syndromes , which are spread by stories in the media and other sites of cultural communication (Showalter 1997). This notion will be elaborated below. On the number of Americanswith chronic conditions, Hoffman, Rice, and Sung (1996) found that in 1987, 46 percent of the noninstitutionalized population, or 88 and onehalf million persons, had one or more chronic diseases or impairments. This statistic does not include people who are institutionalized. Adding the 1.5 million people in nursing and personal-care homes raises the number of chronically ill or impaired to 90 million. Chronic illness is not confined to the elderly. In 1987, 2.5 percent of those seventeenand younger, 35 percent of people eighteen to fortyfour , 68 percent of those aged forty-five to sixty-four, and 88 percent of people sixty-five and older were chronically ill or impaired. The authors projected that the number of Americanswith chronic conditions would continue to rise, reaching 100 million in 1995 and 148 million by 2.030. These statistics are based on data from the household survey component of the 1987 National Medical Expenditure Survey.Detailed information on health conditions was provided by surveyrespondents. Professionalcoders then classified those conditions by ICD-9 (International Classification of Diseases, 9th Revision ) code. The study underestimates the proportion of people with chronic conditions because conditions that did not cause disability or health service use during the survey period were not counted. This book deals with chronic diseases, but not impairments. A chronic disease is one that is not self-limiting,but rather creates persistent and recurring health consequences lasting for yearsrather than months or days (Hoffman, Rice, and Sung 1996, p. 1474). 2,. According to data gathered by the U.S. National Center for Health Statistics , in 1995 the leading sources of chronic pain and disability were arthritis (32.7 million), physical deformity (31.8 million), hypertension (30.0 million), hay fever (25.7 million), hearing impairment (22.5 million),heart disease (2,1.1 million), asthma (14.9 million),chronic bronchitis (14.5 million), and migraine headache (11.9 million). See United States Department of Commerce (1998, p.149). These figures cover the civilian noninstitutional population. 3. See especially Foucault (1975). Scholars such as Armstrong (1984) and Arney and Bergen (1984) have detected a shift, beginning around 1950, from the clinical gaze to a new, more patient-centered mode of medical perception in 325 326 / Notes to Pages 8-19 which the encounter is one between two subjects rather than between subject and object of medical science. Baszanger argues, persuasively I think, that most medical practice today remains based on the older "clinical gaze." Instead of a radical break, her research suggests that there has been a growing heterogeneity in which different modes of medical perception coexist at the same time and even in the same practice. SeeBaszanger (1998, esp. pp. 3-7, 183-88). 4. Schaefer (1997, p. 567). 5. Wolfe et al. (1990). For the subjective experience of these symptoms, see Schaefer (1995; 1997); Soderberg, Lundman, and Norberg (1999); Mannerkopi, Kroksmark, and Ekdahl (1999). 6. Schaefer (1995, p. 96). 7. Tierney et al. (1996, p. 764), Wilson et al. (1991, p. 1487), and many others note its nonprogressive nature. 8. Research on the causes of fibromyalgia has exploded in the last few years, with some pursuing the organic bases of the symptoms and others exploring their psychosocial roots. On organic mechanisms see, for example, Buskila et al. (1997); Bennett (1999); Leal-Cerro et al. (1999); Neeck and Riedel (1999); Schwarz et al. (1999). Psychosocial pathways are traced in Aaron et al. (1997); Walker et al. (1997); Goldberg, Pachas, and Keith (1999); Winfield (1999). 9. For more on treatment options and efficacy, see Levanthal (1999); Rossy etal. (1999). 10. Wolfe et al. (1995). 11. Wolfe et al. (1995). 12.. Smythe and Modolfsky (1977). 13. Bennett (1987). Some proponents have (mis)representedthis as an American Medical Association endorsement of the syndrome. See, for example, Starlanyl and Copeland (1996, p. 8). 14. Wolfe et al. (1990). 15. Outspoken skeptics include Cohen and Quintner (1993); Bohr (1995); Shorter (1995); Quintner and Cohen (1999). Hadler (1997) provides a critical history of this "'committee' of advocates" and its efforts to promote the fibromyalgia construct. 16. Schaefer (1995). 17. On the social lives of commodities, see Appadurai (1986). 18. I had...


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