Under the Medical Gaze
Facts and Fictions of Chronic Pain
This compelling account of the author's experience with a chronic pain disorder and subsequent interaction with the American health care system goes to the heart of the workings of power and culture in the biomedical domain. It is a medical whodunit full of mysterious misdiagnosis, subtle power plays, and shrewd detective work. Setting a new standard for the practice of autoethnography, Susan Greenhalgh presents a case study of her intense encounter with an enthusiastic young specialist who, through creative interpretation of the diagnostic criteria for a newly emerging chronic disease, became convinced she had a painful, essentially untreatable, lifelong muscle condition called fibromyalgia. Greenhalgh traces the ruinous effects of this diagnosis on her inner world, bodily health, and overall well-being. Under the Medical Gaze serves as a powerful illustration of medicine's power to create and inflict suffering, to define disease and the self, and to manage relationships and lives.
Greenhalgh ultimately learns that she had been misdiagnosed and begins the long process of undoing the physical and emotional damage brought about by her nearly catastrophic treatment. In considering how things could go so awry, she embarks on a cogent and powerful analysis of the sociopolitical sources of pain through feminist, cultural, and political understandings of the nature of medical discourse and practice in the United States. She develops fresh arguments about the power of medicine to medicalize our selves and lives, the seductions of medical science, and the deep, psychologically rooted difficulties women patients face in interactions with male physicians. In the end, Under the Medical Gaze goes beyond the critique of biomedicine to probe the social roots of chronic pain and therapeutic alternatives that rely on neither the body-cure of conventional medicine nor the mind-cure of some alternative medicines, but rather a broader set of strategies that address the sociopolitical sources of pain.
Greenhalgh, associate professor of anthropology at the University of California, Irvine, has written an autoethnography (autobiography analyzed through a cultural lens) of the eight months she spent as a patient ("patient S.," as she refers to herself) of "Dr. D.," a highly recommended rheumatologist, who diagnosed her chronic joint pain and sleeplessness as fibromyalgia, a relatively new and still not completely understood medical disorder, which, the author writes, claims more women than men as its victims. Based on the detailed diaries S. kept during her treatment under Dr. D., Greenhalgh describes how his regimen first relieved S.'s anxiety and then drove her into a severe depression. He prescribed an aggressive management plan with drugs that caused serious side effects, including fogginess, headaches and vision loss, and encouraged her to give up swimming, an exercise she greatly enjoyed. The author speculates at length about the role her female identity played in her willingness to accept the forceful and ultimately wrong advice of a male physician who was committed to the veracity of medical science. After a flirtation with alternative treatments, S. sought a second opinion from her original New York rheumatologist ("Dr. K."), a woman, who convinced her that she did not have fibromyalgia and recommended that she stop taking the previously prescribed medication. Afflicted with what was finally diagnosed as an arthritic condition, she is no longer heavily medicated or depressed. As a more straightforward medical memoir, this might have reached the wider audience of patients whom the author wants to reach. In its present form as a scholarly work of anthropology, though it raises provocative and controversial issues, it will mostly attract the attention of physicians and social scientists. Illus.