had resulted from deviant behavior. Moerman examines "placebo surgery" and some bimodal aspects of coronary bypass surgery, that is, "real" changes in function strongly aided by a placebo effect. He argues that even in demonstrated physiological change there is room for explanation provided by a metaphoric structure surrounding the medical event.
Significant pain, Kugelman notes, gets woven into complex narratives that reflect and influence how people explain, treat, and "make sense" of their suffering in the trajectory of their lives. The varied discourses of pain emphasize the need for its medical recognition, not only of its spiritual and emotional aspects, but the physical reality as experienced by the sufferer. Ng, Dimsdale, and colleagues present us with the results of their study, demonstrating that while there were no differences in the amount of narcotics self-administered (by patient), there were significant differences in the amount of narcotic prescribed by physicians among Asians, blacks, Hispanics, and whites. Their study would appear to indicate that pain is medically recognized and relegated to concepts about racial and ethnic attributes, at least in some medical contexts -- not, of course, what patients had in mind.
None of this is to suggest that the physiological consequences of medical treatment are not important; path 6 of Figure III.1, the central domain of biomedicine, is a fundamental one (see Part II of this book for detailed treatments of this path in non-Western medical traditions). It is to say that paths 1, 3, 5, and 7 -- that is, the conceptual consequences of sickness, diagnosis, and treatment -- and their interactions are extremely important in understanding and controlling sickness. An integrated biohuman medical paradigm requires that all of these relationships be understood simultaneously. And biohuman medicine requires that they all be controlled to optimize the healing process.
Lévi-Strauss C. 1967. Structural Anthropology. Garden City, N.Y: Doubleday.
Rappaport R. 1979. Ecology, Meaning, and Religion. Richmond, Calif.: North Atlantic Books.