How to Speak Postmodern: Medicine, Illness, and Cultural Change

Article excerpt

There are lots of sons of bitches out there.

William Carlos Williams[1]

Postmodern, a term as indispensable as it is vague and irritating, serves here to designate the period commencing about 1950, after the heyday of modernism and the end of World War II. What comes after modernism is, chronologically, post modern, but of course modernist ideas and programs do not simply drop away. The postmodern era is an uneasy amalgam of past and future, with vintage movies just one click away from MTV, and theorists disagree mightily about how to characterize its diverse cultural trends and intellectual conflicts.[2] There is general agreement, however, on four basic traits that have a direct bearing on health care. First, the postmodern era coincides with the rise of late consumer capitalism: a shift from steel-and-concrete industrial production to electronic, managed, service-and-information economies, where businesses must continuously stimulate desire for products that consumers never knew they wanted, from automatic garage door openers to cell phones. Health care too is aggressively marketed as a product, and (one sign of successful marketing) the percentage of the U.S. economy devoted to health care since 1950 has soared.[3] Second, postmodern thinkers regard all knowledge as historically situated and culturally inflected, so that we stand deprived of an outside, wholly objective, God's-eye view of Truth. Even the most accurate science does not supply pure facts, knowledge in a vacuum, but reflects time-bound distinctive political and social desires, expressed in medicine through practices as specific to postmodern life as in vitro fertilization or the search for an HIV vaccine. Third, experience for postmodern thinkers is always mediated by organized discourses that amount to systems of representation. Along with individual genes and biological processes, it is collective social discourses and codes (including the ultra-powerful discourses of medicine) that help shape human health and illness. Fourth, discourses and social codes assume material form in stories, so that narratives provide a complex lens into the cultures and discourses that (as much as individual authors) produce them.

The power of cultural codes and discourses to shape the experience of health and illness has helped launch an innovative postmodern study of narrative in medicine. Narrative in fact now serves as a significant measure of medical change. For example, sociologist Arthur W. Frank has shown how control over the representation of illness is shifting in the postmodern era from doctors to patients.[4] Modernism, we might say, located the truth of illness in the doctor's story: an objectivist, scientific, biomedical account that regularly assigned medicine a heroic role in the progressive, worldwide struggle against disease.[5] The invention of sulfa drugs and the elimination of smallpox are key episodes in this authorized narrative. By contrast, the postmodern narrative of illness increasingly tells the patient's story. Almost each weekly best-seller list contains a memoir of illness, while Internet chat rooms and listservs provide an unregulated and previously unimagined space where patients converse with patients in the absence of doctors. These formal and informal patient narratives range widely in their representations of illness, from nightmare tales of loss to edifying parables of triumph over adversity, but they consistently provide something other than an authoritative, scientific, biomedical account. Numerous signs point to the reformulation of postmodern medical discourse. The recent arrival of managed care in America has reframed even the basic story of who pays whom how much for what, much as the narrative of doctor-patient relations has been recast as actual or potential courtroom drama. The challenge implicit in these significant changes is to understand our postmodern moment in ways that illuminate the current experience of illness. …