Medical Explanation Research Articles

Reviewed by: The Cure Within: A History of Mind-Body Medicine Arthur W. Frank (bio) Anne Harrington. The Cure Within: A History of Mind-Body Medicine. New York: Norton, 2008. 336 pp. Hardcover. $25.95. Rarely does a movie plot hinge on a rhetorical phrase, but literacy has its outbreaks. In the recent film Stranger Than Fiction, a character has difficulty convincing people he is not crazy after he tells them he hears the voice of an author narrating a story in which he is the central character, and his life is the plot. He finally convinces a literature professor when he reports hearing the author say, “Little did he know . . . .” A phrase that does comparably heavy lifting in Anne Harrington’s book, The Cure Within: A History of Mind-Body Medicine, is “Were it not for . . . .” Harrington uses the phrase only once, on my reading, but the usage expresses Harrington’s working method and the contribution of this book as a model for the cultural study of illness. Harrington’s “Were it not for . . . ” occurs in her book’s penultimate chapter, when she is describing the sixth of six core narratives of mind-body medicine. She calls this narrative “eastward journeys.” A protagonist, who might be a pop star or a physician, makes a journey— often physical but sometimes spiritual—to the East (most often India or China), in order to experience, learn, and bring back some wisdom about healing that is then translated into professional clinical practice or into lay health practices. What gives these stories traction? Why are they immediately recognizable and believable? The answer is that the stories are located within narratives that have already established themselves. Here, finally, is Harrington’s full sentence, referring to an episode in the Healing and the Mind public television series narrated by Bill Moyers and aired in 1993. “Were it not for Bruce Lee and Star Wars, it is possible that ‘The Mystery of Chi’ would have met a much more uncomprehending or hostile reception” (224). Harrington, who is professor and chair of the History of Science program at Harvard, builds her history of mind-body medicine on progressions of “Were it not for . . . .” Were it not for earlier stories that establish a recognizable narrative, present stories would not readily find public acceptance. Each story is local and specific; narratives are generalizable templates that generate multiple stories. As Harrington puts it: . . . narratives provide us with tropes and plotlines that help us understand the larger import of specific stories we hear, read, or see in action. They also help us construct specific stories of our own—including ones about our own experience—that others can [End Page 103] recognize and affirm. We learn these narrative templates from our culture, not in the way we might formally learn the rules of grammar in school, but in the way we might unconsciously learn the rules of grammar at home—by being exposed to multiple individual examples of living stories that rely on them. (24–5) Harrington’s distinction between story and narrative—different as it might be from some literary uses of those terms—is crucial to her argument. I read Harrington as practicing a form of social constructionism, somewhere between what Ian Hacking calls historical constructionism—“[t]he least demanding grade of constructionism”—and ironic constructionism.1 Historical constructionism describes arguments in which, Hacking writes, “ . . . X is the contingent upshot of historical events. A historical constructionist could be quite noncommittal about whether X is good or bad. How does historical ‘social’ constructionism differ from history? Not much, a matter of attitude, perhaps.”2 Ironic constructionism notches up the stakes. X is not only contingent, as “the product of social history and forces,”3 but also X’s contingency is troubling because the dependability of X counts in the reliability and security of some group’s world making. As Hacking writes, X is “an inevitable part of the world or of our conceptual architecture,” and it is disorienting to realize that X “could have been quite different.”4 The health and illness of bodies are inevitable parts of our world, and so are medical explanations of disease and treatments. Readers of this...

Albrecht Durer (1471-1528) was perhaps the greatest exponent of the Northern European Renaissance, known for his painting, printmaking and engraving, and his books on perspective and anatomy. The son of a goldsmith, Durer was trained as a metalworker at a young age and applied the meticulous methods that he learned to his woodcuts and engravings, notably the Four Horsemen of his Apocalypse series (1498), and his Knight, Death and the Devil (1513). Following two visits to Venice, in 1494/1495 and 1505/1507, he became acquainted with Giovanni Bellini, whose influence is evident in the Madonna and Child (Figure 1). The athleticism of the Christ Child, the Virgin's pyramidal form, the sculpture-like modelling of the figures, and the contrast of Mary's dark blue robes against red drapes all recall Bellini's treatment of the same subject. Further analysis reveals the complexity of the panel's composition. The Madonna and Child adopts Netherlandish concepts of devotional images in portraying the corner of a room with a window open on a distant view. Jesus' squirming posture and the attention to surfaces and textures are typically German. The coat of arms in the lower left corner is that of the wealthy Nuremberg mercantile family of Haller von Hallerstein, patrons and friends of the artist.1 Figure 1 Madonna and Child C. 1496/1499; oil on panel, 52.4 × 42.2 cm; Samuel H Kress Collection, National Gallery of Art, Washington, DC, USA [In colour online.] In the painting, the Christ Child holds his apple in exactly the same position as Eve holds hers in Durer's engraving of Adam and Eve (Figure 2), implying that this is the forbidden fruit that brought disaster on humanity, which he has been born to redeem.2 Figure 2 Adam and Eve 1504; engraving, 25.2 × 19.4 cm, Staatliche Kunsthalle, Karlsruhe, Germany [In colour online.] There are alternative medical explanations for the abnormal posture. For example, the infant depicted in this painting may have suffered from Erb's palsy (a form of neonatal brachial plexopathy), the left upper limb being held in the typical ‘waiter's tip’ posture.3,4 There is internal rotation and pronation of the left upper limb with accentuation of the skin folds of the anterior axillary region, along with drooping of the left shoulder. Although Erb's palsy is a possibility, further differential diagnoses for this abnormal posture are worth entertaining, including amyoplasia congenita, anterior horn cell lesions, hereditary brachial plexus neuropathy and pseudoparalysis. Amyoplasia congenita, a form of arthrogryposis, is characterized by bilateral upper limb involvement along with congenital contractures and micro-gnathia. Central nervous system lesions of the anterior horn cells, such as congenital spinal atrophy and congenital varicella syndrome, present with generalized hypotonia, in contrast to the more common presentation of unilateral weakness or paralysis seen in brachial plexus injuries. Congenital varicella is also differentiated by the presence of skin scarring and finger amputations. Hereditary paediatric brachial plexus neuropathy is an autosomal dominant disorder that presents with shoulder and arm weakness, pain and atrophy. It is differentiated from brachial plexus injuries by its episodic nature and its tendency to present after the neonatal period, most often in the teenage years. Pseudoparalysis from a fractured clavicle or humerus causes limited movement, because of pain, and clinically can look like a neonatal brachial plexopathy. Indeed, on closer inspection of the painting (Figure 3), there is a lump (visible as a dark shadow) arising from the left clavicle of the child just above the Madonna's left thumb, consistent with a clavicular fracture. Pseudoparesis is therefore the most likely diagnosis for the abnormal left upper limb posture seen in the painting, although clavicular fractures can co-exist with neonatal brachial plexopathies in about 10% of neonates.5 Figure 3 Detail from Madonna and Child [In colour online.] On the whole, however, we prefer the metaphorical interpretation.

Medical Explanation Research Articles

Articles published on Medical Explanation

EuroGentest patient information leaflets: a free resource available in over 20 languages

« A Shadow behind the Heart » : l’Étranger au cœur de l’intime dans Pnin de Nabokov

Provider–patient interaction in rural Cameroon—How it relates to the patient's understanding of diagnosis and prescribed drugs, the patient's concept of illness, and access to therapy

Caesarean births increase

P01-297 Health-related quality of life in depressed patients: 6-month results from the French cohort of finder study

Significados do processo de adoecer: o que pensam cuidadoras principais de idosos portadores de câncer

Medical explanations and lay conceptions of disease and illness in doctor–patient interaction

Chronic abdominal pain: a psychological approach for the clinician

Trouble de l’identité et de l’intégrité corporelle : interrogations pathogéniques et enjeux éthiques autour d’une pathologie émergente

Sensitivity to electricity – Temporal changes in Austria

Medically unexplained presentations and quality of life: A study of a predominantly South Asian primary care population in England

Enlarged Vestibular Aqueduct in Pediatric SNHL

Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk

Surviving a Mine Explosion

Prevalence and Predictors of Deterioration of a Trustful Patient-Provider Relationship Among HIV-Infected Persons Treated With Antiretroviral Therapy

The Cure Within: A History of Mind-Body Medicine (review)

P.1.36 Caffeine exacerbates MDMA “Ecstasy”-induced hyperthermia: a role for dopamine D1 receptors

The diagnosis of art: Albrecht Dürer and the Christ Child's drooped shoulder

Why and How We Age, and Is That Process Modifiable?

Kirstie Blair, Victorian poetry and the culture of the heart, Oxford English Monographs, Oxford, Clarendon Press, 2006, pp. ix, 273, £50.00 (hardback 978-0-19-927394-2).

Lead the way for us

Editage

Paperpal

R Discovery

Mind the Graph

Medical Explanation Research Articles

Articles published on Medical Explanation

EuroGentest patient information leaflets: a free resource available in over 20 languages

« A Shadow behind the Heart » : l’Étranger au cœur de l’intime dans Pnin de Nabokov

Provider–patient interaction in rural Cameroon—How it relates to the patient's understanding of diagnosis and prescribed drugs, the patient's concept of illness, and access to therapy

Caesarean births increase

P01-297 Health-related quality of life in depressed patients: 6-month results from the French cohort of finder study

Significados do processo de adoecer: o que pensam cuidadoras principais de idosos portadores de câncer

Medical explanations and lay conceptions of disease and illness in doctor–patient interaction

Chronic abdominal pain: a psychological approach for the clinician

Trouble de l’identité et de l’intégrité corporelle : interrogations pathogéniques et enjeux éthiques autour d’une pathologie émergente

Sensitivity to electricity – Temporal changes in Austria

Medically unexplained presentations and quality of life: A study of a predominantly South Asian primary care population in England

Enlarged Vestibular Aqueduct in Pediatric SNHL

Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk

Surviving a Mine Explosion

Prevalence and Predictors of Deterioration of a Trustful Patient-Provider Relationship Among HIV-Infected Persons Treated With Antiretroviral Therapy

The Cure Within: A History of Mind-Body Medicine (review)

P.1.36 Caffeine exacerbates MDMA “Ecstasy”-induced hyperthermia: a role for dopamine D1 receptors

The diagnosis of art: Albrecht Dürer and the Christ Child's drooped shoulder

Why and How We Age, and Is That Process Modifiable?

Kirstie Blair, Victorian poetry and the culture of the heart, Oxford English Monographs, Oxford, Clarendon Press, 2006, pp. ix, 273, £50.00 (hardback 978-0-19-927394-2).