Август 21, 2009
|07:36 pm - New Ways of Thinking About Old Ways|
I find myself often repeating my idea, in real life, that "alternative" medicine isn't, and that hippies aren't for alternatives anyway. What I mean is that the basic narrative of western medicine is the same, for both "allopathic" and "alternative" schools, and that this is not the only way to think about health and health care, and the fringes and borders are interesting and productive thought experiments.
The narrative of western medicine is this: everybody has a body, which is pretty much the same, under normal circumstances, as everybody else's body in terms of how it works and what organs do what. The body is made up of organs, tissues, and chemicals, all of which are defined by their organization and their function, and they are primarily functional towards a state of health. Occasionally, these chemicals or tissues or organs are somehow deranged, and do not operate as they should. Possibly they were formed wrong, or possibly they were injured, or possibly they were damaged as a result of exposure to an abnormal substance or effect, or a normal substance or effect in abnormal quantities or concentration. The result of this malfunctioning or damaged tissue is a disease which, after a period of development, becomes tangible to you (the person) as an illness. To manage this illness, its necessary to consult a professional, and to transfer some of the custody of that body to them, and introduce either a small quantity of a novel substance, or else a physical rearrangement, to restore function to the damaged tissue, or else compensate for it. This, if done successfully, will remove the illness and possibly the underlying disease. The substance or rearrangement can be herbal tinctures, antibiotics, massage- but the narrative is the same.
The narrative medicine idea, which is gaining ground in the "theory of medical theory" school of thought says that illness- the sense of being unwell- is primary. Around this illness, patients and doctors collaborate to come up with a common narrative that includes a set of defined symptoms ("not feeling well" becomes "nausea after eating" etc) and a diagnosis. I won't talk about this too much here except to acknowledge it as a partial framework for my own critical stance. Narrative theorists are, when they aren't praising memoirs, attempting to create a system of "explanatory models" that detail how a patient is supposed to feel and act, and how they are supposed to understand their body, the origin of their problems, their likely prognosis, treatments, etc, according to a given culture. This is a useful tool, but not what I'm going to go into today.
The narrative of herbal medicine is that herbalism (either western or "traditional chinese") is completely different from allopathic medicine, but there are other medical practices within allopathic medicine that diverge more acutely from this narrative and, not coincidentally, they tend to highly controversial.
Specifically, the examples I'm thinking are: vaccinations, cosmetic surgery, classical musicians using beta-blockers, medical marijuana, giving ritalin to kids to make them behave, and the placebo effect. With the exception of the last example, all of these use medical or medical grade technology in circumstances where "there's nothing wrong in the first place." Nobody claims that being born without a resistance to, say, measles is some sort of defect. Classical musicians (and lawyers, and other people prone to stage anxiety or fright) aren't somehow ill- the medication (performance enhancing, quite literally) is an augmentation, not a correction. Medical marijuana is frequently attacked as being a roundabout way to treat the various conditions for which it is prescribed- that is, more chemically and tissue-level specific treatments are available, why use such a general substance? The ritalin question has been done to death, but even proponents admit there is no chemical or physical lesion detectable that "explains" ADD. And its interesting to note that ritalin (and adderall, and provigil) are acquiring a cachet outside the medical sphere as performance-enhancers for adults in intellectually strenuous environments.
Defenders of all of these practices are also quick to compare them to the standard western narrative- perhaps the lesion responsible for ADD isn't detectable yet, but surely it exists beyond the threshold of our technology? Is stage fright classifiable as a disease? But even the staunchest opponents of "allopathic" medicine (perhaps especially the staunch opponents) are quick to equate the schematic non-conformity of these practices with moral error and suspicion.
Not that there aren't reasons to be uncomfortable with, say, mass-dosing ritalin to eight-year-olds on weekdays only, but the reason has nothing to do with whether or not ADD is a "legitimate disease." Arguments about medical (or any other kind of) marijuana aren't really about what works "best" in treating the specific malfunctions of diseases. And vaccines... hoo boy, vaccines. (That chain email about swine flu vaccine causing smallpox or whatever- just look up the name of the author and google her other works, okay? SKETCHball city!)
There are other particularities about the western model. For instance, the disease is always personal, and the cure is always personal as well. The question doctors seek to answer is not "where did this disease come from?" but "why this person, at this time, in this way?" To say, as an unnamed (seriously, even Lori Alvord doesn't name the guy) Navajo elder told CDC epidemiologists that victims of hantavirus had died from "too much rain" is simply too far outside the western paradigm. We accept that these diseases are out there and strike all the time, and concern ourselves with how each individual can be made safer, or cured.
In certain cases we accept that the person causing the trouble and the person getting sick might not be the same. What we don't accept is that there not be a direct, physical connection to explain the causality. The physical connection has to involve the individual who gets sick. For instance, if I burn lots of coal, and you in the downwind county get pancreatic cancer, okay, we accept that you breathed the heavy metals in the soot and fumes (I'm making this up- I don't know about pancreatic cancer and coal.) If I yell at my kids, and a stranger two blocks away gets pancreatic cancer, we don't accept that. If I do coke and stop going to church, and my great-grandchildren starve mysteriously, we don't accept a connection. Other cultures have.
Social questions are also viewed in the same language and schemata as individual health. We accept that there are social causes for illness- breast cancer, or obesity, are generally accepted to follow social trends- but we assume that here again there is an error at the root of the problem. There is something unnatural in the world, and only by eliminating it and returning to an innate order of things will the symptoms (youth violence, diabetes) be repaired or prevented.
Let me be clear- this is not a "western medicine sucks" essay. It isn't even an "herbal medicine isn't as great as crimethincers claim it is" essay. There are a lot of reasons to appreciate the western model of illness, disease, health, and medicine. But there are problems too. One of these, which relates back to alternative medicine, is the problem of the ideal.
If diseases are explained by erroneous or malfunctioning parts of a whole, social or bodily, then a "perfect" or uninjured body or society must be our birthright. In fact, goes the narrative, you would have this body if you weren't sick. In the narrowly-defined medical field this pops up as an obsession with testing, with locating minute lesions or chemical variations which indicate an as-yet-unexperienced but nevertheless Wrong and Bad disease, possibly one that will kill you if you don't correct it now. If you don't get ovarian testing push-pieces from the NYT forwarded to you by your mother, well, your family is different from mine!
In the broadly-defined medical field, though, this belief in the platonic ideal body, the "who would you be if you'd never been hurt," gives rise to a panoply of guilt-inducing narratives of the fall from grace, personal irresponsibility, or the inadequacy of one's stewardship of one's life, and of course a nation full of rebirthing, detoxification, healing, "natural diets" and other remedies that purport to return you to your innocence. I find this completely at odds with the very concept of being alive- you don't remain untouched, and you weren't perfect to begin with, and there's no such thing as perfection, and everybody is always different and the only appropriate answer to the question "who would you be if you'd never been hurt?" is a dumbfounded stare. But the damage it does to people's hearts, especially people who try, over and over again, to regain (or attain) some form of perfection and "fail" is tragic.
The social manifestations of this are, to me, the most disturbing of all. If we accept, with some trepidation, that there is a social lesion underlying every social disease, does this create, as it does with the individual body, the idea that somewhere out there is a pure, uncorrupted, disease free human society? What are we doing wrong? How can we get there? This is the scariest question of all, to me. While I have a great deal of respect for those cultures (hey look, Navajos again) that have maintained a particular way of life as a spiritual form of health, and I wish I could get into that further, I am frightened of a world that uses the idea of health to reject the inherent heterodoxy of people and their self-organizations. I mean for one thing, if you were to take a numerical poll, Americans would believe social health had something to do with that jesus guy. Yikes.
At the same time, though, I really don't want this to be a hater piece. We can't imagine social cures because we admit we can't agree on (or, if you get us drunk, we admit we can't even conceive of) a lesion-less society. That would be utopia, in the old school Thomas More sense, and even utopians don't buy that shit off the dock any more. Still, its possible to imagine a vision of health care in which non-lesional interventions that do people good- beta blocked violinists, artists on psychedelics, et al- are accepted and developed, and a similar vision is applied to the world, to the idea of "living right" and to the idea of "how we should be." That is, I don't want to see actual human suffering attributed to the specific malfunctions in a social body, but I would like to see some development of methods by which societies can start to work better, even if in diverse ways. That is, improvement without guilt.
I've somewhat lost the thread of my own post here. Take it away, commenters!
So the story about the hantavirus: I get my "official" data from The Scalpel and the Silver Bear but I'd heard other versions of this elsewhere. When a few people in their early twenties suddenly died of a mysterious virulent illness (one shortly after an unrelated surgery) in the Four Corners reservation, the CDC mobilized and sent researchers to track down what looked like a pretty scary outbreak. At one point somebody asked a Navajo singer what was going on, and the singer told him there was too much rain. He also showed the CDC epidemiologist a photograph of an old sand painting with a mouse in the corner and said that mice were involved. At the time he was dismissed, because he was answering a different question. The singer understood that people died, but didn't accept that the disease should be around in circulation. The CDC understood that the disease existed but didn't accept that these young people should have died of it. As it turned out, the disease was hantavirus, spread by dried mouse urine. The mice had moved indoors into people's homes and trailers, after reproducing like crazy when an unusually wet year created a temporary surplus of pinon nuts, and then going hungry when the nut harvest ended.
I'm not going to get into the discussion of Navajo vs. Diné. When I was there and trying to learn the language (ha! that was a laugh!) everybody, white or native, said Navajo. Yes, I know what nabeehu means and I can even tell you what language its a word in. I'm just going by what was said at the time.
I also want to steer clear of the idea that there's something "better" about Navajo, or any other indigenous, medical practice. You can't say better or worse- the terms of evaluation are embedded in the system itself. I only use it as an example because I'm able to say a few smart things about it and its very different from what I learned in school.
|Date:||Август 26, 2009 11:40 am|| |
Along exactly the lines of the last several paragraphs of your essay was a two-part Ideas series by the CBC and Alan Cassels, called "You are Pre-Diseased
". And by purest serendipity, both episodes (1 2
) happen to be up on the Ideas Podcast
for the next week or two!
Going to go download now.
|Date:||Август 27, 2009 08:27 am|| |
If you like that one, I should note there was another three-part Ideas series from last year by Jill Eisen called "Sick People or Sick Societies?" looking at the "social determinants" of health, which I was reminded of a few times in the first half of the essay too. That one doesn't seem to be available at the website, but happily, I saved it
when it was. She also did another three-parter a year or two earlier called "The Heart of the Matter
" investigating the myths and realities around heart disease.
Is it any wonder that Ideas
is my favorite radio show ever?
Are you a canadian or soemthing?
By the way I'm listening to these one at a time at work, and absolutely loving them. I envy the entire nation of Canadia.
|Date:||Сентябрь 24, 2009 04:08 pm|| |
Hey, glad you enjoyed them. :) In case you aren't checking regularly, there's another interesting batch of podcast eps at the above-mentioned link this week whose topics seem to dovetail with each other (and this blog posting again) in interesting ways.
And if you /really/ want something to listen to, I could toss a DVD of Ideas 'back-issues' your way too (I've been saving them for awhile now). Just email or LJ-note me with where to send it. :)
"Arguments about medical (or any other kind of) marijuana aren't really about what works "best" in treating the specific malfunctions of diseases."
As someone who has worked for a medical marijuana advocacy group, I'd have to disagree. Marijuana is often a mild remedy for chronic pain, and it increases the appetite of those going through chemo, and quite a lot of patients will say that it's a rare medication that doesn't create other, nastier side effects. If you're saying that marijuana doesn't CURE anything, that makes sense. But it does address a wide variety of medical problems.
I say that as somebody who does not smoke and finds the drug to be not that pleasant. I have no hat in the ring for medicinal marijuana, except that through my former job I've talked to so many people whose lives would be miserable without it. They're often shut-ins with chronic pain, and pot happens to be the single respite they have from an otherwise miserable life. And it doesn't completely incapacitate them as other meds might.
Also its (generally) pleasant, pro-social, easy to use, and even when not restricted to purely therapeutic use the side effects are widely acceptable in cultural terms. And "it makes you okay with being bored or boring" is hardly a terrible side effect in the first place. There are plenty of other appetite stimulants or god knows pain-control agents, as well as anti-anxietals or ocular pressure medications, which are much more carefully "targeted" towards the underlying issue associated with the listed disease. My point is that marijuana is a very general, non-specific substance that doesn't fit the "fix the problem, leave the rest alone" model of health care. Atl all. And I don't smoke either (hell, I don't even drink) but not only do I support medical marijuana, I'm still waiting for a convincing argument against non-medical marijuana. Another topic, I guess.
>improvement without guilt.
Improvement with guilt definitely doesn't work. All the things I would want to improve on become too much a part of my identity if I feel guilty about them.
>if you were to take a numerical poll, Americans would believe social health had something to do with that jesus guy. Yikes.
The scary thing to me is how many different Jesuses there seem to be: buddy Jesus, wrathful Jesus, pinko Jesus, sacrificial Jesus, baby Jesus...I guess as the personification of a healty society, he'd need a lot of different personalities to meet all of America's conflicting ideals.
Yes, that always makes me wonder too. I see the 9-12's of the world affirm a "christian nation" as a point of unity and wonder exactly how unified that would really make them in the end. Then again, I'm neither christian nor a theologian, and I would be most uncomfortable if all public debates had to be held in the language of any religion no matter how diverse and permissive its terms were. I wouldn't even want to see a unitarian "plan for social health." Well, neither would unitarians, I'd bet.
I wouldn't even want to see a unitarian "plan for social health."
Oh, G-d/Gods/Formless Divine, quick, somebody get the big wooden question marks and a can of gasoline.
Anne, I would buy a book you wrote, if you were gonna write one, and I'd get all my friends to buy it too. Especially if it were an expanded, easy to follow criticism of medical theory and practice at the end of the age of cheap oil.
Ha! Writing books, especially non-fiction books, isn't about whether you can write interesting stuff or not. Its about, well, a lot of self-selling, credentials, connections, stuff I'm not good at. Besides, I don't need to write a book. I write a blog. :)
Actually, if you said "Anne, you need an editor" I'd be inclined to agree, and that factor is why most books are better than most blogs. I've worked as an editor (for a newspaper) and have no illusions about the "natural brilliance" of unedited text. Maybe if I get a sudden burst of self-esteem I'll go talk to a friend of mine who does write books...