Table Of ContentBordering Biomedicine
At the Interface
Probing the Bounderies
Series Editors
Dr Robert Fisher
Dr Margaret Sönser Breen
Advisory Board
Volume 29
A volume in the Probing the Boundaries project
‘Making Sense of: Health, Illness and Disease’
Professor Margaret Chatterjee
Professor Michael Goodman
Dr Jones Irwin
Professor Asa Kasher
Dr Owen Kelly
Revd Stephen Morris
Professor John Parry
Dr David Seth Preston
Professor Peter L. Twohig
Professor S Ram Vemuri
Professor Bernie Warren
Revd Dr Kenneth Wilson, O.B.E
Bordering Biomedicine
Edited by
Vera Kalitzkus and Peter L. Twohig
Amsterdam - New York, NY 2006
The paper on which this book is printed meets the requirements of “ISO
9706:1994, Information and documentation - Paper for documents -
Requirements for permanence”.
ISBN: 90-420-1999-9
©Editions Rodopi B.V., Amsterdam - New York, NY 2006
Printed in the Netherlands
Contents
Introduction
1
Vera Kalitzkus and Peter L. Twohig
Part 1 Humanist, Social Science and Interdisciplinary
Perspectives on Health, Illness and Disease
The Musician, the Diarist and the Construction Worker:
Interdisciplinary Perspectives on Health, Illness and Disease 11
Peter L. Twohig
Stanislaw Wyspiański (1869-1907): The Last Self-Portrait
of the Syphilitic Artist
31
Tomasz Śpiewak
Part 2 The Epistemology of Biomedicine
The Anthropology of Aetiology
49
James Davies
The Social Construction of Disease: Why Homosexuality
isn't Like Cancer
65
Matthew McGrattan
Green Fingers or Pink Viagra? Female Sexual Dysfunction
and Medicalisation in Contemporary Medical Discourse
85
Katherine Angel
The Communication of Diagnostic Information by Doctors
to Patients in the Consultation
103
Peter J. Schulz
Contents
Part 3 Biomedicine in a Socio-Cultural Context
Subaltern Theories of Health and Illness: An Ethnographic
Study of Mexican Women With HIV Disease
119
Betania Allen
When the Diagnosed Talk: Ethnographic Narratives of
Mental Illness
141
Bindhulakshmi
Critical Excess: Sex, Drugs, Intervention
159
Aaron Goodfellow
'Normal Gone Bad': Health Discourses, Schools and the
Female Body
177
Emma Rich, Hannele Harjunen and John Evans
Part 4 Beyond Biomedicine: Ethics, Experience, Voice
Midwifery, Consumerism and the Ethics of Informed Choice 197
Philippa Spoel
Towards a Concept of Hope: A Functional Reconceptual-
ization
215
Stephen Michael Neff
Embodied Practices and Subjectivity in Psychopathology
233
Ian Tucker
Getting By: The Lived Experience of Patients with Cystic
Fibrosis and their Carers of Waiting for Lung Transplant
249
Kath MacDonald
Speaking About the Unspeakable: Cervical Screening in
New Zealand
263
Judith Macdonald
Welcome to a Probing the Boundaries Project
Bordering Biomedicine appears within the Making Sense of: Health,
Illness and Disease project series of publications. These projects conduct
inter- and multi-disciplinary research aiming to explore the processes by
which we attempt to create meaning in health, illness and disease. The
projects examine the models we use to understand our experiences of
health and illness (looking particularly at perceptions of the body), and
evaluate the diversity of ways in which we creatively struggle to make
sense of such experiences and express ourselves across a range of media.
Among the themes these projects explore are:
•
the ‘significance' of health, illness and disease for individuals and
communities
•
the concept of the ‘well' person; the preoccupation with health;
the attitudes of the ‘well' to the ‘ill'; perceptions of ‘impairment'
and disability; the challenges posed when confronted by illness
and disease; the notion of being ‘cured'
•
how we perceive of and conduct ourselves through the
experiences of health and illness
•
‘models' of the body; the body in pain; biological and medical
views of illness; the ambiguous relationship with ‘alternative'
medicine and therapies; the doctor-patient relationship; the
‘clinical gaze'
•
the impact of health, illness and disease on biology, economics,
government, medicine, politics, social sciences; the potential
influences of gender, ethnicity, and class; health care, service
providers, and public policy
•
the nature and role of ‘metaphors' in expressing the experiences
of health, illness and disease - for example, illness as ‘another
country'; the role of narrative and narrative interpretation in
making sense of the ‘journey' from health through illness,
diagnosis, and treatment; the importance of story telling; dealing
with chronic and terminal illness
•
the relationship between creative work and illness and disease:
the work of artists, musicians, poets, writers. Illness and the
literary imagination - studies of writers and literature which take
health, disability, illness and disease as a central theme
Dr Robert Fisher
Inter-Disciplinary.Net
http://www.inter-disciplinary.net
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Introduction
Vera Kalitzkus and Peter L. Twohig
Biomedicine, the dominant organizing framework of modern
medicine, is built upon the foundational concept that disease is located in
the body and that disease is linked to some injury to the body, usually in
the form of a pathological lesion. Biomedicine is a relatively recent
framework, emerging only in the late eighteenth century and articulated
and expanded with increasing rapidity since those first steps. David
Armstrong has described biomedicine as the “most successful theory of
health and illness.”1 Clinical practice within the biomedical model has as
its objective the identification of the lesion and its treatment or
management. Within the biomedical paradigm, there was, initially, little
space for the perspectives of social science or the humanities. While the
metropolis of biomedicine was consolidating its authority, other
perspectives were pushed to the borders. According to Armstrong, “the
first contribution of social science to medicine … lay in offering
complementary and supportive explanatory models for biomedicine.”2 Or,
as Aaron Goodfellow notes in his contribution in this volume, “[c]ulture is
pictured as something crucial to the treatment of disease only in the sense
that it must be worked through if medical science is to operate to its
maximal effect.”3
Many scholarly disciplines border biomedicine and can make a
contribution to social theorizing about health, illness and disease. Recent
discussions take many forms. Critical medical anthropologists, for
example, insist that biomedicine is a cultural system and therefore never
neutral nor objective. Political economy demands that we situate our
analyses within struggles over wealth, inequity and a range of other issues
that unfold on local, national or international levels. Humanists have
consistently and insistently argued that the best physicians were those able
to consider patient values, beliefs and a range of other factors alongside
decisions based on biomedical models. The acclaimed Canadian physician
William Osler, using an appropriate biomedical metaphor, argued in 1920
that the ‘humanities are the hormones’ to suggest their central role in
clinical decision-making and their important place within the biomedical
body.4
If we are to rebalance research efforts in our contemporary
analyses of health, illness and disease, we need some form of social
theorizing. The moral and ethical implications of new medical
technologies, such as the new ‘race-based’ pharmaceuticals targeted for
particular communities, are only the most obvious examples of areas of
biomedicine that are ripe for social theorizing. Reproductive technologies,
