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Under the Medical Gaze: Facts and Fictions of Chronic Pain

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Susan Greenhalgh has written a fascinating account of how the process of medical diagnosis and treatment can go horribly astray despite the best intentions of both the doctor and the patient. Greenhalgh had suffered for years from a painful arthritic condition. Upon moving to California she found her condition getting much worse. Unsatisfied with the care she was getting from the local rheumatologist, care that addressed the flare-ups of pain but not the cause of the pain, she sought help from a rheumatologist some distance away who had been recommended to her by a friend. At her first visit, this rheumatologist then misdiagnosed her with fibromyalgia, among other conditions. The treatments he then recommended caused side effects, which mimicked fibromyalgia and compounded his initial misdiagnosis. He treated the side effects that included severe headaches, neck and back pain, cognitive difficulties, vision problems and severe depression, as further evidence of fibromyalgia. The result was that Greenhalgh became increasingly sick, with her life and livelihood placed in jeopardy. Her book is an account of the 8 disastrous months she spent in this rheumatologist's care, until she finally realized that she needed to seek another opinion.

During her time in treatment she had taken scrupulous notes of all her visits and telephone calls with the doctor as well as the progress of her symptoms. She took these notes to understand and track her treatment, not with the intention of writing a book. They simply reflect the lifelong habits of a conscientious anthropologist. Her book uses these notes as the basis of a careful analysis of the assumptions underlying medical diagnosis, and how these assumptions, along with the rhetoric and practices of medicine, can have disastrous results, especially when applied to chronic pain conditions, rather then acute illnesses. Her analysis, far from simply criticizing the doctor for a combination of misdiagnosis and a disinclination to really hear what she was saying about how she was feeling, also critically analyzes her own role in the relationship. Both she and the doctor were active partners in creating a doctor patient relationship, which worked against the best interests of the patient (and the best interests of the doctor, assuming his intention truly was to help). In becoming aware of how the doctor patient relationship can work against the best interest of patients, patients and doctors can potentially both become active participants in creating doctor patient partnerships that honor the complementary knowledge that doctors and patients can bring to medical encounters. Such doctor patient relationships are counter to the medical discourse, which is the discourse of science, in which the doctor is all knowing and the patient the quiet recipient of that knowledge. Doctors and patients are both socialized to accept this hierarchy of all knowing doctor and all believing patient and both doctor and patient must become aware of the assumptions underpinning that relationship if a more successful model of diagnosis and treatment is to gain hold.

Greenhalgh's title "Under the Medical Gaze" comes from Foucault's analysis of the discourses of western medicine. Such analyses do not result in a simple to read book, but Greenhalgh does an admirable job of eliminating much of the jargon that usually accompanies such analyses. This book is well worth the effort of a careful read, for it goes well beyond describing unsuccessful medical treatment to gaze at what can underlie such medical misses.

Excuse me?? Where are the Facts and Fictions of Chronic Pain? As a sufferer of chronic back pain I thought that this book would provide me with some new options for treatment and pain control. Judging from the excerpts that I read all it is is a story of scaterbrained woman who can't figure out if a medical doctor is doing her any good?? Please - are there really people out there that are really this stupid?

For those of us suffering with chronic pain there is almost no treatment we won't try or book we won't read. This book, however, was a total waste of time. Instead of calling it "Under the Medical Gaze" she should have titled it "A Whiner's Guide to Complaining as an Art Form". No wonder the author didn't experience much sympathy from the medical profession. This is 2001! Take charge of directing your own health care and pain management. If something doesn't work for you, move on! After a hostile reading of this book, I had to increase my ibuprofen intake just to cover an additional headache instead of the usual chronic pain of fibromyalgia. Boo Hiss!