ENCOUNTERS WITH LIVE BLOOD ANALYSIS: AN ANTHROPOLOCICAL PERSPECTIVE ON AN ALTERNATIVE HEALTH PRACTICE

George Alexander Hadjipavlou B.S.. University of Arizona. 1 996

THESIS SUBMITTED iN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS

in the Department of Sociology and Anthropology

G George Alexander Hadjipavlou 1999 SIMON FRASER UNIVERSITY May 1999

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ABSTRACT This research takes the alternative health practice of live blood analysis (LBA) as a site of inquiry into the relationship between medical pluralism and the construction o f medical reality in the context of individual lives. It is primarily concemed with how people approach and use alternative medical knowledge. and how they locate themselves in relation to the dominant system o f biomedicine. Data were collected through an ethnographie approach combining participant-observation in the office of a live blood

analyst with in-depth interviews with clients and practitioners. Chapter One interrogates the assumption common to critics of alternative health practices that patients' irrationality or lack of scientific literacy are suitable explanations for their use. The concept of pragmatic skepticism is explored as a more appropriate way to characterize how people approach practices such as LBA. Chapter Two examines how clients draw on LBA as a resource to develop medical definitions for experiences of bodily dis-ease. Particular attention is paid to the complicated relationship such definitions bear to the institutional authority o f biomedicine. Chapter Three employs a Bakhtinian theory o f language to explore how biomedical discourse is brought into dialogue with the practice o f LBA. and to demonstrate the shortcomings of an empiricist approach to medical language in this context. Finally. 1 consider implications this research holds for the evaluation o f alternative health practices.

[BJy subjugated knowledges one should understand something else. something which in a sense is altogether different. narnel y. a whole set of knowledges that have been disqualified as inadequate to their task or insufficiently elaborated: naive knowledges. located low down on the hierarchy. below the required level of cognition or scientificity. 1 also believe that it is through the re-emergence of these low-ranking knowledges. these unqualified. even directly disqualified knowledges. . . that criticism performs its work.

Michel Foucault

But as if a magic lantern threw the nerves in patterns on a screen: Would it have been worth while If one. settling a pillow or throwing off a shawi. And turning toward the window would Say: 'That is not it at all. That is not what 1 meant. at all." T.S. Et iot, The Love Song of J. Aijkd Przrfrock

Acknowledgements

1 am deeply gratefül to Stacy Pigg for having been a wonderful. inspiring supervisor. and to Maegen Giltrow, Tara Tudor and Russ Westhaver for their inexhaustible support and encouragement.

Yeast and bactena in Peter's blood ....................................................... 70 The limitations of an empiricist view of LBA .......................................... 74 Parasites: 1 suspected it .................................................................... 82 Grapeseeds: Basically the concept of parasites hasn't clicked ....................... 86 Antibiotics and Rachel's yeast ............................................................ 88 Candida as idiom .......................................................................... -90 I guess 1 have a parasite or two .......................................................... -92 Conclusion ....................................................................................... 95 Appendix Appendix Appendix Appendix Re ferences Cited...............................................................................

vii

106

Introduction: Encounters with Live Blood Analysis in the Context of Medical Pluralism and Medical Reality

This thesis addresses the intersection of two social processes that define the current cultural context in which rnedicine-of whatever variety-is

practiced in our society.'

The first process entails an increasing medicat pluralism. This is evident in the vast proliferation of alternative medical practices. A recent study in the US. for example. indicates that the use of alternative medicine is widespread. having increased from 33.8% in 1990 to 32.1 % in 1997 (Eisenberg et al. 1998). The second process defines itself in opposition to medical pluralism. It is the process through which biomedicine exercises its socially privileged position as the final ar'oiter of medical r d i t y . This is evident. for

instance. in the current efforts to scienti fically evaluate alternative medicine in a way that refutes medical pluralism as a social fact.' There is biomedicine. and there are questionable alternatives.

Although my most relevant description of Placé. below. is of what is ultimately my field site. I must. here. not only locate my field site. but my broader field of inquiry. My fieldwork took place in Vancouver and the surrounding Lower Mainland. At the same rime. many of the sources of my scholarly citations are from the U S . I take my research field to be indicative of broader trends in North Arnerican society. However. 1 must also concede that products of my inquiry will not necessarily be generalizeable to such a broad definition of "our society." For instance. surveys have show a greater use of alternative health practices on the West Coast of North Amerïca (e.g.. Eisenberg et al. 1993). Moreover. in any discussion surrounding mcdical rcality. tire must recognize chat this reality is panially shaped by the state defined health-care s>.stemsin which individuals esist. I use .'medical" in the broadcst sense to refer to al1 knowledge and practice related to the definition. treatment and prevention of illness in the body. as well as to the interpretation of health.

'

\Vhile it would be tempting to think o f medical pluralism in industnal societies as referring only to the immense array of medical practices located outside the institutional apparatus of biomedicine. this would be a mistake. Medical pluralism encompasses biomedicine. More precisely. despite insisting on keeping itself distinct. biomedicine necessarily contributes to the social logic of medical pluralism. It does so. first. by being variously absorbed into non-biomedical spaces. and. second. by being itself plural.' Interestinçly. Iiowever. public attention to the evaluation of alternative medicine obscures a more careful consideration of biomedicine's relationship to medical pluralism.

In an article on "Syncretisrn in Ayurveda." Charles Leslie provides the followincg analytic snapshot of medical pluralism in India. Indians commonly assume that illness arises from a concatenation of events. s o that it is reasonable to consult different specialists for the sarne illness if it seems intractable. They expect different interpretations under these circumstances. and to pursue different remedies concurrently or in sequence. This may look inconsistent to an outside observer. and cosmopolitan medical practitioners disapprove of this "shopping around" because it ignores their claim to exclusive authority to diagnose and treat illnesses. The more pluralistic medical systems are. the greater autonomy laypeople have to interpret their own illnesses and to make choices about how to combine the ideas and advice o f different specialists. ( 1992203)

The situation Leslie describes speaks. albeit across great distances. to accounts 1 heard whilc doing fieldwork on medical pluralism not in India. but in Vancouver. It points to

various aspects of the relationship between medical pluralisrn and the formulation o f medical reality as an active process in the context of individual lives. Leslie concludes his discussion by stating. "The structural reasons that medical pluralism is a prominent

' This thesis addresses the first of these two assenions-that is. how biomedicine is absorbed into nonbiomedical spaces. For a discussion of biomedicine's pluralism. sce Kleinrnan (1995). Berg and Mol ( i 998).

feature of health care throughout the world are that biomedicine. like Ayurveda and every other therapeutic system. fails to help many patients. Every system generates discontent with its limitations and a search for alternative therapies" (1 992205). The rising tide of alternative medicine is intimately related to different ways of understanding and esperiencing illness. of inhabitinç Our bodies and investing them with meaning. In short. of constructing medical realities. Here 1 investipate the nature of the construction of individual medical reaiities. Or. rather. since medical pluralism is intricately comected to the construction of medical reaiity. 1 investigate how the nature of medical pluralism is made meaningful. In this way I understand medical pluralism as more than just the immense assortment of practices that dot Our cultural landscape. It is an ongoing process. an unfinished social web of relations through which people act and

think and speak about their bodily States of dis-ease. Medical pluralism arises from and eives rise to -'diverse interpretive practices through which illness realities are constmcted.

C

authorized and contested" (Good 19945). There is a tendency in the social science research on alternative medicine to emphasize how it is socially distinct from biomedicine. In her espansive study of ritual healing in suburban America. for example. Meredith McGuire argues that bbbiomedicine and alternative healing systems operate within totally different paradigms of health. illness. and healing" (19885). This tendency is especially evident in research that pursues understandings of alternative medicine as a cultural phenomenon or social movement (e-g.. Schneirov and Geczik 1996). with associated analyses of clients in ternis of their distinct worldviews. beliefs. or ideofogies (e.g.. Furnham and Forey 1994: MacCormack 1991 ; Astin 1998: Douglas 1994). WhiIe such studies offer important 3

insights into how certain ideas are integral in shaping Our medically plural landscape-for instance. notions of holism-it

is my impression that they suggest a too-divided ïiew of

things. It is in this way that McGuire speaks of the use of alternative health practices as "typicaily involv[ing] a rorally dgferenr definition of medical reality" (1 9885. emphasis added). While the research 1 present here deals specifically with how people draw on alternative health practices to formulate definitions of their own medical realities. it also shows how biomedicine and alternative practices interpenetrate these realities.

In this study 1 use live blood analysis (LBA) as a site at which to explore some of the complexities conceming how non-esperts encounter and engage alternative medical knowledge." 1 am specifically interested in the process through which the knowledge and practice of LBA become incorporated into (or dismissed from) the very local contest of people's bodily concerns and their associated repertoire of health practices. From the outset 1 should state that I am not particularly interested in live blood analysis itselfneither in its theoretical content nor in its practitioners. And 1 am neither interested in defending nor debunking the knowledge claims of this arguably minute health practice

Medical anthropologists and sociologists who have studied alternative health practices include Sharma homeopathic knowledge: Hess ( 1996) on alternative cancer therapies; Baer ( 1996) on chiropractic; and Csordas (1994a) on charismatic healing. A recent collection edited by Sarah Budd and Ursula Sharma (1994) is organized around the theme of the therapeutic relationship between patients and healers. and it features contributions by both sociologists and practitioners. Another collection edited by Cant and Sharma ( 1 996) addresses the nature of alternative medical knowledge in terms of broader debates about the role of knowleage in society. paying particular attention to questions that surround legitimacy and espertisc. Furin (1997) has exarnined sociocultural influences. panicularly A[DS activisrn, on the use of alternative therapies by gay men living with AIDS. For a review of disparate approaches in the social scicnccs that address medical pluralisrn, see Baer (1995). ( 1 996) on

tucked away beneath the (misleadingly) encompassing rubric of alternative medicine.' Settling the question of legitimacy-that biomedical rationality-is

is institutional legitimacy that relies on

simply irrelevant here. To invoke Geertz (1 973). we c m say

that I did not study live blood analysis: 1 studied in and around the office of a live blood anal yst. In the first chapter 1 address the v e y attitudes which initially drew my attention to iive blood analysis as a site where the boundaries of science in medical practice were at

once being questioned. drawn and blurred. Ct-itics of alternative health practices commonly invoke explmations for the increasing use of alternative medicine which dcscribe clients as scientifically iiliterate or irrational. Drawing on my field work surrounding live blood analysis 1 suggest and explore the notion o f pragmatic skepticism as a way to more appropriately characterize how people approach their encounters with

this practice. 1 endeavor to reveal and describe an esisting and perpetual process of evaluation which people bring to everyday encounters with LBA. This is. then. ais0 a description of how the question of validity is settled in the Iaboratory of individual bodies. Anthropologists of medicine and science have raised objection to a view of people

Wliile I use the term .*alternativemedicine" throughout this thesis. 1 do so ivith some reservations. It is my impression that ive can speak meaningfuliy about "alternative medicine" to a point. It is quite obvious. for instance. that alternative practices are alternative to diffcrent degrees. We simply cannot speak of chiropractic and live blood analysis in the same breath. The t e m "alternative medicinc" also suggests a coherence. or a self-conscious orgnization of medical practices. While many practiccs and practitioners and clients may share certain values. usually glossed by notions of holism. together they certainIy do not comprise a "system" of any sort. Practices are located at different distances from biomedicine. and the institutional legitimacy it confers; they are not located as a unified. alternative system. Finally. it is also important to recognize that practices are ofien alternative because of border crossings. Ayurveda is ccrtainly not "alternative" in India. just as Traditional Chinese Medicine is obviously not alternative in China. Despite these caveats. however, 1 use alternative rnedicine because it corresponds to the language of my infamants. For a discussion of the tenn. see Wardwell ( 1 994).

in society as passive. reconsidering the relationship of non-experts to the knowledge o f science and biomedicine. In Flexible Bodies. for example. Emily Martin "assume[s] as a starting point that seeing science as an active agent in a culture that passively acquiesces does not provide an adequately complex view o f how scientific knowledge operates in a social world" (1 994:7). Her organizing premise joins with a vast score of science studies research showing how the pervasive cultural image that scientific knowledge is pristinely produced in laboratories-socidly

impregnable fortresses of sorts-and

and uncertain degrees passively diffuses out into society-as citadel wall-is

to very timited

if through cracks in the

long due for disassemb~y.~ Martin's major contribution to this

disassembly h a been to elaborately demonstrate that Our conception-knowledge. images. metaphors-of the immune system is neither determined by scientists and physicians. nor fixed within their purview. Rather. it is a dynarnic. emergent cultural complex of ideas and practices which spans a multiplicity of social spaces. According to Martin. Our conception of the immune system has been actively constituted through a continual interplay between scientists and people on the Street. both of whom help shape and are shaped by similar social. cultural and historical processes. In a sirnilar vein. Rayna Rapp ( 1 988) has examined how the knowledge of biomedical genetics is opened

:O

active reinterpretation as its meanings and potential application are evaluated by pregnant women vis-à-vis their specific social. cultural and economic contexts. And Joseph Dumit. concemed with the digital images of PET scans. speaks of '-objective-self fashioning" to draw critical attention to "how we take facts about ourselves-about

'' Sec also Heath ( 1 997). Clarke and Monitini ( 1 993) and Haraway (1997): Martin (1997) provides a succinct but highly insightful review.

our

bodies. minds. capacities, traits. States. limitations. propensities. etc-that

we have read.

heard. or othenvise encountered in the world. and incorporate them into Our lives" ( 1 99739). Passive reception of scientific or medical knowledge is simply an untenable.

aIbeit sticky. presumption. In the second chapter 1 look at how clients activeiy engage live blood analysishow they draw on it as a resource. incorporate or reject its insights-to

further develop

and address their specific health concerns. The ofi-noted observation that clients of

alternative medicine don't usually disclose their non-biomedical practices to their physicians (apparently because of existing problems in doctor-patient communication) becomes a foi1 against which 1 explore other analytic possibilities. 1 take heed o f Sharma's suggestion that --[i]t is by contextualizing alternative medicine in t e m s of the agency of the patient that anthropologists can make their most distinctive contribution to its study" ( 1 993: 18). At the root of rny anthropological reflections. then. is the question.

Wl~atdoes the undetermined (i1)legitimacy of live blood analysis enable? 1 posit that engagements with such practices as LBA may participate in a process of alternative practitioner assisted self-medicalization in which bodily complaints are transforrned into provisional medical conditions. 1 also look at how engagements with live blood analysis

ma). help clients strategize for biomedical resources while subverting various aspects of its authority. Further. the ethnographic excerpts presented in the second chapter illustrate the complesity involved in the ways clients simultaneously draw on alternative heal th practices and locate themselves in relation to biomedicine. While previous writings on alternative health tend to highlight its oppositional stance toward biomedicine (e.g.. 7

Schneirov and Geczik 1996). this chapter demonstrates how alternative practices c m be utilized as points of entry into the biomedical apparatus. Perhaps one way to consider this fmding is to draw a distinction between the practice of biomedicine and the '-biomedical model" on one hand, and its resources and knowledge on the other. By specifically emphasizing ahemative medicine's relationship to the biomedical model and not biomedicine. author and social critic David Morris puts the matter well: [Tlhe concept o f alternative medicine aptly ilhstrates what postrnodem theory calls the logic o f the supplement.. .an indigestible lefi-over generated through the binary thinking endemic to Western rationalism: a residue in excess of what the biomedical model can accommodate or explain.. ..[Tlhe supplement in effect undermines the opposition on which biomedicine has established its superiority.. . Alternative medicine is neither a rival capable of fully supplanting biomedicine nor a collection of optional therapies perfectly consistent with business as usual in the health-care industry: it is an approach to illness that implicitly and uneasily calls into question the adequacy of the biomedical model. (1 998:70) While 1 agree with Moms's analysis. it is important to keep in mind that alternative medicine exists in terms of people's interpretive activities. That is. it is not alternative medicine itself that potentially undermines the biomedical model. but how people variously approach and interact with its my-iad practices. His allusion to the logic of the supplement captures something of the additive. sequential process through which medical realities are constmcted. It is a process that. for clients of live blood analysis at least. remains culturally tethered to biomedicine.

In the third chapter 1 draw on Bakhtin's theory of language to explore how biomedicine is brought into dialogue with the practice of live blood analysis. I consider how in the mouths and ears of clients and practitioners. medically relevant words are evoked with new accents. ofien imbued with simultaneous and contradictory meanings and intentions. The possibility of a neat. singular medical reality is thus implicitly called

into question. A significant theoretical concem in this chapter is to demonstrate the shortcomings of an empiricist approach to medical language in understanding thé verbalconceptual activities of live blood analysis clients. Broadly conceived. this research casts light on the process through which medical knowledge-biomedical

or alternative or of whatever designation-becomes

"local

knowledge" in the Geertzian sense. That is. "local not just as to place. time. class. and variety of issue. but as to accent-vernacular

characterizations of what happens

connected to vemacular imaginings of what can" (Geertz l983:2 15). In this way my analytic interest is aligned with other approaches in medical anthropology that have sought to restore medical significance to how individuals esperience and give meaning to illness. and the steps they take to rid themselves of it. In Arthur Kleinman's terms. 1 endeavor to situate live biood analysis in people's "local moral wor1ds"-"the niicrocontests of daily life-' in which the reaIity of illness is constituted intersubjectively (1995:123).

Methods

I did not have a specific hypothesis in mind when 1 began my research on LBA. A whirl of possibilities about how people engaged with this ostensibly hybrid practice that

absorbed scientific instruments and language into nonscientific spaces invited inquiry. 1 tvondered. for instance: In what sort of medical discourse did communication and miscommunication between clients and practitioners and rnicroscopic images of biood take place? What understandings did clients pursue through LBA? What meanings of hcalth and illness were negotiated in these encounters? How did people conceive of LBA 9

in the broader context of their health related practices? Assuming that gullibility and scientific illiteracy are unacceptable esplmations for its use. how else could we approach the question of how such a practice becomes a viable option? Geertz suggests that anthropoiogy is an effort "[tlo tum from trying to cxplain social phenomena by weaving them into grand textures of cause and effect to uying to esplain them by placing them in local frarnes of awareness" (1 983:6). Towards this end. the methodological toolbox 1 brought to bear on these questions consisted of fieldwork based on participant-observation. combined with ethnographic interviews. 1 am cognizant that these two methodoiogical procedures produce very different kinds of qualitative data-a

function. no doubt. of the special social interactions that shape them.

So while this section is intended as a nuts-and-bolts rendering of my research methods, it

is also occasion to elucidate some qualities that both broadened and limited my analysis in ways which may not be apparent. 1 think of the participant-observation portion of this research as comprised of two parts. one a broader frame for the other. The first part began in the fa11 of 1997 when 1

encountered live blood analysis in the morning paper. It consisted of keeping a close watch over the health sections in the local papers (two articles followed). navigating throuçh (a steadily increasing number of) relevant web-sites. and speaking with people at health food and book stores. Further. in the mindset of an ethnographer. 1 attended a local wellncss show where I spent most of my time around three booths devoted to live blood analysis. casually conversing with clients and practitioners. 1 also had my blood analyzed by one of the five analysts and attended relevant lectures. one of which was delivered by a semi-famous naturopath who developed training courses in LBA. In short. my 10

ethnographie field was both modestly multi-sited and open ended. a "concerted traipsing" (Martin 1994) in the realms of alternative health. Within this field we can locate my p r i m q site for participant-observation: the office of a local live blood analyst. Over the course of two months I attended 23 consultations in Emily's office.' 1 kvould usually approach clients in a small waiting room. when they first arrived for their appointments. 1 introduced myself as an MA student in anthropology. briefly outlining my research interests and how their participation would fit in. Clients would then read

over a description of the research objectives and procedures that were relevant to their participation: if they elected to have me sit in through their consultations. clients signed a f o m acknowledging infonned consent. Clients who felt that they would potentially be interested in participating in an in-depth interview provided me with their phone numbers. In addition. 1 usually had the opportunity to briefly interview clients about how they came to know about live blood analysis. and about what heaIth concems they were hopinç to address (see Appendix A). Following Our brief meeting in the waiting room. w e would proceed to Emily's office. (In two instances when clients were under the age of

eighteen. their parents agreed to a short-roughly

twenty minute-interview

in the

waiting room while their adolescent children began their con~ultations.~) By sitting in during consultations 1 was interested not in explaining ivhy people use this particular alternative health practice but how they do so-how they interact with the analyst: how they interface with images of their bodily interiors: how they represent themselves in relation to their health concerns. etc.

' Throughout the test 1 have used pseudonyms to ensure confidentialil. 1 did not have approval fiorn the universin, ethics board to include legal minors in my research.

By participant-observation 1 do not imply that 1 was an unobtmsive observer. My presence durinç the consultations could hardly be overlooked. 1 participated in several senses. Consultations were almost always conversational and interactive. bringing into their scope al1 manner of subjects. however distant from discussions of blood cells. The feel of the consultations was such that my presence could quite easily be absorbed: 1 bscame a third or fourth or fifth interlocutor. hardly neutral or passive. Clients would

both solicit my views and question me about my esperiences with the practice. 1 rrisponded candidly in these exchanges. Clients would also frequently look at me during consultations as if to çauge what sorts of reaction images of their blood. or different aspects of the analysis. elicited. With pen in hand and notebook on lap. 1 would ofien ask clients questions during othenvise quiet interludes-for

instance. when Emily prepared slides or fiddled with her

microscope. Both Ernily and her clients often joked about what. exactly. I could be n-riting down: if my note taking seemed to make clients feei uncornfortable. 1 would simply stop for the remainder of that consultation. Eight of the consultations wcre taperecorded. with permission from the clients and the analyst,

I conducted ten interviews with clirnts and practitioners. ail of whom signed consent foms. The interviews spanned from approsimately one to nearly three hours; a11 Save one were tape-recorded (with permission). Of the seven interviews with live blood analysis clients. sis took place in people's homes. and one was conducted at the client's office: of the three interviews with practitioners. one took place at the analyst's office and two were in coffee shops. Interviewees were not selected randomly; of the clients. al1 but one were people from the consultations 1 attended who expressed interest in being 12

interviewed (volunteered). Further. given scheduling constraints. 1 tned to recruit the most diverse-with

regard to socio-cultural background or health circumstance-cases

possible for such a small subset of clients. I have provided segments of conversation from al1 of these interviews to illustrate how diverse such a small group of LBA users can be. and to show how such diverse viewpoints shape and inform m!; analysis.

These interviews were open-ended. exploring clients' and practitioners' esperiences with LBA. My initial objective kvas to draw on clients' and practitioners' reflections on their experiences to open discussion on how they situated LBA in the broader context of their health practices. Respondents often had to discuss issues which. al though familiar to different degrees. may not have been explicitly thought out or voiced before. For instance. asking someone if they "could relate to the images s/he saw" invited rcsponses that although previously experienced. had also remained largely below the threshold of con~ciousnessfor most. Respondents often took time to reflect on. reshape or even disregard my questions. and nearly a1ways diverged ont0 themes they identitied as relevant to their specific health circumstances. 1 do not view the data gathered from my interviews as simply the collection of

views elicited by relatively innocent proddings. Rather. they are perhaps better thought of

as siiiiated conversations or uncertain dialogical productions-a

collective example of a

stmggle (Marcus 1996) to represent thoughts. mine and my interlocutors'. that were difficult to pin-down. ofien complicated and sometimes contradictory. These difficulties. liowever. were almost always telling of the cultural intricacies present when

WC

speak

about medical knowledge related to the rising tide of alternative medicine. Panly to capture something of the texture of these exchanges. but mostly to bnng the views and 13

voices o f the people with whom I interacted into focus. 1 have presented long quotations. As Downey and Dumit note. "[presenting long quotations] maximizes the estent to which informants 'speak for themselves' in the text and allows multiple. personal. heterogeneous perspectives to potentially work against objectifjing the group represented" (1997:14). Given my concern to dislodge the implicit category of the domestic savage tumed client o f alternative medicine. which. 1 argue. f o m s the basis of a rather tenacious tendency in biomedical discourse on the use of alternative medicine (see Chapter One. below). this is an apt strategy. As a final note on methodolom 1 should add that 1 have attempted to fashion a discursive space in which the views and voices o f nonesperts and the experts who write about them may be rendered simultaneously visible. speaking against. or alongside. each other. As Lock and Kaufert note. "One strength of anthropological analyses is the elicitation of subjective accounts as told by informants which can then be justaposed with other versions o f reality" (1998: 16).

Some Background to LBA

The following is a rough outline of the practice of live blood analysis. sirnply intended to familiarize the uninitiated. Since there is considerable variation as to how live blood s n a l ~ s i sis practiced, 1 should underscore that i have elected to sketch a n outline of live blood analysis that is specifically grounded in rny experiences as a participant-observer with a single analyst. Therefore my account may not be an accurate general representation of the practice. Some factors that affect this variation include: prac t i tioners ' di fferent health backgrounds-some

are nutri tionists o r herbologists. some

iridologists. others have no previous training. etc-some 14

practitioners only observe "live

blood" while others view a "dry sample" as well, and there is small selection of training programs and courses that Vary according to duration and depth of training, analytic orientation, choice of microscope. etc. Consultations were scheduled by telephone appointment. lasted around an hour and cost approsirnately seventy dollars. Never during the two and a half months that 1 visited Emily's office did anyone just drop in. As I conceptualize them. Emily's consultations comprised five parts: an introductory interview; a two-part viewing and analysis of the live sarnple which focused first on red blood cells and then on white blood cells; a viewing and analysis of the dried sarnple: suggestions and overview. For first-time clients. each session began with a brief (approxirnately 10 minute) interview in which Emily inquired into general factors that could affect the composition or appearance of a client's btood-specifically

age and use of medication or nutritional

supplements. She would also ask women clients about their menstrual cycles. Unless clients volunteered symptoms-that any-Emily

is. if they elected to reveal whether or not they had

usually did not ask. Nor did she question clients as to whether they had been

previously diagnosed with any medical conditions. What was revealed about a client's health during the first ten minutes of the consultation depended on what clients chose to disclose: niost remained relatively restrained until later in the session. Also during this time clients would ofien inquire into Emil y's "background' or "training." asking for rsplanations or greater clarification regarding the analytic procedure. At the end of the introductory interview. Emily would puncture clients' fingers using a picking dcïice designed for diabetics to test blood-sugar levels-a

relatively painless process. The live

sample consisted of a single drop of blood placed under a microscope slide to be viewed 15

imrnediately. The dry sarnple consisted of a sequence o f drops. produced by repeatedly pressing clients' fingers across the slide. and then leaving them to dry while the live blood was analyzed. Placed beneath a phase-contrast microscope and projected ont0 a monitor. client and analyst watched live red blood cells move across the screen. Of the 15 first-time clients whose consultations 1 attended. none had previous knowlrdge of what their -'blood oct~rciiij? looked like." Most were surprised that it was blue and not red; many joked

about being "blue-blooded." Instructed by clients' comments. 1 conceptualize this ponion of the consultation as an interactive science lesson. Dave. who when first faced with the

image of his blood exclaimed. T h a t ' s me?! [That's you.] No way!" captured this sentiment when he remarked. "This reminds me of science in the eighth grade: going to the pond." As live blood cells floated by. Emily identified different structures-red

cells. neutrophils. platelets. plaque. etc-and

blood

provided clients with brief descriptions of

their significance and function. My understanding of this portion of the consultation is

that Emily would look at the shape. number. colour and distribution of red blood cells as

a way to assess general levels of health. specifically with reference to nutrition. liver function. presence of allergens. protein absorption. and hormonal imbalance. Further. while viewing the live sarnple Emily was also able to detect the presence and relative

concentration of yeast (which emerged as small. opaque. cream-cotored blobs) and parasites (which appeared as black. squirmy. tubular shapes). The second component of the live blood portion involved watching white blood cclls lumber sIowly about. Based on the relative number. size. and activity of clifferent kinds of white blood cells. Emily was able to make inferences about immune system 16

activity. The live blood portion of the consultation ended with Emily providing clients with a printout of an image that captured a salient element of the analysis-a plaque. a parasite or yeast-intended

shard of

to remind and motivate clients to address related

health issues (See Appendix B). The analysis of the dned blood. also called the HLB (Heitan-LeGarde-Bradford) test after the researchers who invented it. is based on the premise that each drop could be meaningfully considered as a rnicroscopic representation of major parts of the body.

9

Roughly. the drops are analyzed in four parts. as if vertical and horizontal axes transect the body. Specific locations within each of the four sections correspond to different organs and body parts. Near the center of the drop. for instance. is where one's "boweIs would show up." Further. Emily analyzed a sequence of drops as different interpretive features would be revealed between them. (When clients expressed disbelief concerning the logic underIying the analysis of the dried sample. Emily would playfully submit that it was "the magic-voodoo crystal-bal 1 part of the session .'-) Salient interpret ive features seemed to be: the darkness and elaboration o f the "fibrinogen netting" (protein clotting factor). white perforations that represented the lymph. and the shading and color of the sample more generally. Emily seemed to primarily use the dry sample to discuss stress. iymphatic blockage. metal toxicity. bowel irritation. protein assimilation. and "indicators" of pathogenic processes that were often in a very early stage of development (See Appcndis C). The dry sample \vas also used t o further test the results from the live sample.

'' For a discussion of the HLB test see Bradford and Allen (1997). 17

At the end of the consultation Ernily would make '-suggestions" to clients about how to address a specific condition or irnprove their health more generally. Some esamples include: colon hydrotherapy. lymphatic drainage massage, removai of denta1

fillings- different forms of exercise. foods to eat or avoid. vitamins. supplements and

enzymes. Clients were also &en different information sheets that related to their health concerns (e-cg..a f o m about liver function. the effects of coffee. or proper food combining) as well as an overview of the most significant aspects of the consultation (See Appendis D).

Chapter 1 The Body Laboratory: Pragmatic Skepticism and Empirical Evaluation at the Site of the Body

[Hlow 1 became involved with alternative medicine: My mom and dad died from cancer.. ..I was terrified.. ..Once 1 bought a book on alternative medicine. And then 1 bought another book. And another book. And another book. And now 1 have library [of] books. 1 have to understand my body.. . the chemistry of my body. You see. 1 have book that talks about things starting from Ievel of elements. metals in the body-potassium and chloride and calcium. .. and sodium.. . and what they do.. ..I want to learn about things on that level. On al1 leveIs. 1 bought two books on boweis. 1 look for things that will work on me. [Her attention is drawn again to the screen. She tums and points at a white blood cell. slowly lurnbering across.] What is this? --Nastasha Medicine remains. despite al1 the talk of scientific medicine. essentially an empiricai process in which one does what works. --R.C. Lewontin, The Docrrine ofDN4

Whatever connotations the label '-alternative medicine" may evoke. we can hardly deny that the innumerable practices and ideas associateci with it have permeated into everyday Me.' We can suggest. as Mary Douglas has. that alternative medicine will be a "permaiient feature of our cultural landscape" ( 1994:40). And then there is science.

1

The most recent statistics indicate that "4 out of 10 Americans use some f o m of alternative medicine" ( J A M A 1998: 1640). Millar (1997) has s h o w that the parallel figure for Canadians aged 15 and over is 1596.

Whether we take an essentialist or a constructivist tack. emphasize its unity or argue its diversity. we cannot speak of science without an awareness of its cultural force. its presence. as it were. throughout Our cultural landscape.

' A curious coupling of

sentiments has it that alternative medicine and science are categorically different. and so to endure the former must be reconciled with the principles of the latter. Curious. too. is the notion that the preirulence of alternative medicine can be accounted for by the inadequats scientific literacy of the inhabitants of the very same cultural landscape where the presence of science is everywhere felt. Embedded in such aspersions about scientific iIliteracy and. simultaneously it would seem. serving as both its cause and effect. is a distrust of science. a "prevalent flight from science and reason-• (Yankauer 1995:135). Several months ago. for instance. in an expression of displeasure and impatience

ivith what they see as a too-tolerant attitude on the part of the scientific medical communi ty. the editors of the i C é \ r v England Jorrrrtczi oj-:\kclicine argued that an antiscience sentiment is in fact one of alternative medicine's defining features. They wote: "It is time for the scientific cornmunit): to stop giving alternative medicine a free ride-' as

"alternative medicine distinguishes itself by an ideology that largely ignores biological mechanisms. disparages modem science. and relies on what are purported to be ancient practices and natural remedies" (Angel and Kassirer 1998:81O).

'

An essentialist view of science considen iü privileçed social position as a consequence of the distinct cpistemology (e.g.. the experimental method) that governs its knowledge production practices. Const~ctivistsof whatever stripe tend to maintain a view of science as a social process that is shaped by (and participates in the shaping of) forces of culture. politics. and gender. Thus. its knowledge claims can neither be creditcd with unexamined notions of objectivity or neutnlity. nor self-evidently granted a privileged position in the representation of reality. This is an admittedly cnss account of these approaches: for more detai lcd and delicate renderings see Rouse ( 1992). Gieryn ( 1995). Hess ( 1997).

lrony is sometimes invoked at this stage to capture the mood of the more enlightened when they face this annoying observation. As the .VEJ&l editors remark. "hrow. with the increased interest in alternative medicine. we see a reversion to irrational approaches to medical practice. even while scientific medicine is making some o f its more dramatic advances" (Ange11 and Kassirer 1998:840). And. from another editorial. this time from the Canadim Jolrrnal of Public Heulrh. we are reminded that [t]he fringes of medicine have always attracced more than their share o f these

poseurs. but it is ironic that at a time when medical science has never had s o much to offer. nonscientific therapies are clearly gaining in popularity. (Beyerstein 1997:149) Picking up momentum. the author goes on to sum things up: The willingness of many to accept the claims of dubious health providers must. in large part. be blarned on the low level of scientific literacy in the public at large.. ..[T]he average citizen o f the industrialized world is shockingly ignorant when it comes to even the rudiments o f science. The profit-driven media do little to alleviate this state of affairs and. in fact. their fondness for pseudoscience ofien worsens the problem. (Beyerstein 1997:149) 1 would suggest that these editorials are ostensible examples of how scientific

discourse constructs-to

invoke Jean Lave's phrase-"the

savagery of the domestic

mind." That is. people in society are cast as the "inferior other": irrational. scientifically illiterate and incompetent in the "good thinking'. associated with scientists and physicians (Lave 1996; Claeson et al. 1996). As Lave notes. this imagined conception of nonscientists is basic to the constitution of the "scientific mind." an image developed in dialectical tension to that of the inferior other. As should be evident in the editorials above. such a conception is also basic to how power is exercised in the demarcation o f

boundaries-now

science. now non-science. now knowledge. now belief. now legitimate.

now illegitimate-making

it seem only natural that these boundaries exist and. what is

more. that the. are dnwn and maintained by certain people (scientists) and not others (nonscientists). To speak of alternative health practices as unscientific and irrational is implicitly and self-evidently to position biornedicine and physicians as rational and ~ c i e n t i f i c .This ~ is one way that the g-boundary-work"of biomedicine gets done. The ethnographic origins of the present study offer an apt illustration: In Louis Althusser's terms 1 was "interpellatedu into the discourse and practice of

iive blood analysis over moming coffee. while reading the health section of the I.Nncozci.er Sun.

esample-a

Like the individual turned subject by-to

use Althusser's famous

policeman "hail ing. 'Hey. you there! "' ( 1 981:48). my interpellation

happened at the hail of a headline: "Blood testing rad alarms experts." As I read. 1 became alamed at how the '.experts" were able to dismiss the knowledge claims of a practice with which they were vaguely acquainted. variously asserting how it "had no b a i s in science." and. more significantly. how they-and them-inanaged

the article that represented

to convey an image of the "pub1 ic" as "gulli ble" ( Fayerrnan 1997).

' Yet the self-evident juxtaposition of biomedicine with alternative medicine to render thern on other sides of the great sciencehon-science divide should be a q ~ h i n gbut self-evident. I am often reminded of Charles Lcslie's efforts to clariQ for medical anthropologists a more appropriate designation for biomedicine. Over a decade ago. Leslie suggested the term -'cosmopolitan medicine" as a synonym for biomedicine. intrnded to connote "that the ideology and institutional forms of biornedicine are part of the capitalkt world-system" (Lcslic and Young 19926). Especiaily significant to my present concern is that in selecting an appropriate tcrm \vith which to "identiS the dominant medical tradition of the industrial societies." Leslie rejected the term "scientific medicine" on two grounds: clinical work necessarily includes much by way of inference, intuition. and judgement that is clearly medical but cannot reasonably be labeled scicncc: "science," like the term "Western," implies a greater degree of homogeneity than this medical systern can justifiably claim. (Leslie and Young: 19926) In addition. the nonscientific quatities of biomedicine are also noted from within the medical establishment. The editor of the Brirish ,\,ledical Joilrr7al. for instance. has observed that only "about 15% of [biomedical] intcrvcntions are supponed by scientific evidence." He goes on to explain that "this is panly because only 196 of the articles in medical joumals are scientifically sound and partly because many of the treatrnents have never been assessed at all" (Dossey 1998: 1 8).

Perhaps most alarming, however. is how familiar this image felt. how easy it was to imagine the difference between the productive activity of scientists and the passive acquiescence of everyday dullards. Given the recent clarnor about the scientific evaluation of alternative rnedi~ine.~ taken together with scientific or biomedical research and commentaries that reinforce an image of the lay people who use alternative medicine as irrational. scientifically illiterate and. of course. gdlible. we would do well to wonder about the poIitical consequences involved when the legitimacy of alternative practices is apparently to be defined by science. and science is defined as beyond the purview of passive lay persons. Does this help ensure. for instance. that lay persons are kept out of efforts to evaluate alternative medical practices? How would biomedicine's cultural authority be restmctured if people were conceptualized differently. Say as active participants in the evaluation of medical practices and their associated knowledges?

My thinking in this chapter draws and builds on research by Emily Martin ( 1993) and Jean Lave (1996) which interrogates the common construction of lay persons as scicntifically illiterate. Through their inquiries into the role of the immune system in American culture. Martin and her students have s h o w that. when no longer restricted by a --narrowly technocratic" definition of scientific literacy. it is easy to see how "people are

highly literate in the diverse social. political. moral. and metaphysical aspects of such matters as health and illness." and how they approach or use "facts" in relation to their

Sec. for instance. Marshall ( 1994). Manvick (1995). Vogel (1997) for accounts of the controversy and debate surrounding the recently conceivcd Office of Alternative Medicine (OAM) at the National lnstitute of Health (WH) and its efforts to fund and promote scientitic research on the eficacy of alternative medical practices in the United States.

b-particularlocal circumstances" (Claeson et al. 1996: 102- 1 14).

' Working in similar

conceptual terrain. Lave has showm that contrary to the mathematical ineptitude witten into the irrational mind of the inferior other (or: how cognitive science characterizes the mental abilities of lay people). "just plain folks" are particularly adept at mathematical reasoning and problem solving in the multiple contexts of their daily lives. Further. Lave draws considerable attention to how "'sciences' of the rational suppress the recognition of the political character and consequences of their assumptions and activities" ( 1996: 100). Thus the juxtaposition of scienti fic and non-scienti fic thought functions to reinforce the iiegemonic role of science while it maintains a cuIturaI m-yth o f inescapable difference (Nader 1 996). Here i want to take issue with the common assumption that how people in society encounter and engage medical knowledge is necessarily incommensurable with ways of knowing and engaging which are generally thoupht of as scientific. 1 am not trying to substitute the myth of the rational. value-aximizing individual (certainly that myth already esists: see. for instance. Good (1994) for a compelling critique) for the myth of the domestic savage. Rather. 1 am trying to bring a different analytic lens to bear. if only to illustrate tendencies which are usually overlooked or omitted in conversations about people's use of alternative medicine. A move away from a facile rationaVirrationa1 dichotomy may permit a more realistic view of how people make decisions about what medical knowledge they incorporate into or dismiss from the very local contexts of their bodies.

For another recent reassessment of scientific litency that addresses similar issues. sec Turney ( 1996) and Gregory and Miller ( 1 9%).

24

During my fieldwork on live blood analysis 1 was frequently stmck by how people's encounters with the practice were often shaped by an approach which I came to understand in terms of a productive coupling of pragmatism and skepticism that guided an embodied evaluative sensibility. 6 1 say pragmatism to capture the considerable attention paid to the exigencies and esperiences of one's own body: that is. people seemed less concerned with whether something "worked" on abstract. universal grounds. and more concerned with whether it worked for them given how they expenenced their bodies at a particular moment in time. at the intersection of specific social circumstances.

Skepticism denotes an attitude. a posture toward encounters with new knowledge. We c m say that people approached the practice o f live blood analysis with the question: Why should this-when

there is so much out there-work

for me? Further. 1 Say that

skepticism and pragmatism are productively coupled because it is my impression that they set parameters for each other: a pragmatic approach toward knowledge curtails the estent o f skepticism while skepticism limits the scope of pragmatism. And so instead o f invoking gullibiIity-that thought!-as

inevitable symptom o f nonscienti fic

a general posture to describe how nonesperts. muddled as we are with

ceaseless waves of medical information. encounter different alternative practices. 1 want to suggest that if in fact such a general posture exists. pragmatic skepticism may be a more appropriate designation. This suggestion is o f course grounded in my fieldwork on LBA: whether it holds in other quarters of alternative medicine is a question for further

empirical research-though

my sense is that it does.

~ l i i panially s echoes Lock and Kaufert's (1998) characterimion o f women's "dominant mode o f response" to medical technologies and rnedicalization as "ambivalence coupled with pragmatism."

In the ethnographic segments below 1 illustrate and explore how the posture of pragrnatic skepticism is made manifest. How is it that clients who enter a practice like LBA may do so without the slightest inkling of what to expect (One woman queried. "Will I pet a peek??') yet quickly develop interpretive criteria with which to evaluate the

effectiveness of the practice? The excerpts 1 present are taken from interviews and participant-observationl and they range from how people verbally revealed their approaches to me in an interview setting to how they embodied those approaches while engaginp with the practice itself. To bring my suggestion of pragmatic skepticism in Iine ~vitha broader conception of scientific literacy. 1 want to draw brief attention to something obvious before tuming to the ethnographic sections. Skepticism is commonly associated with science. In fact. we can Say that it is fundamental to science and to a scientific attitude (method) toward apprehending the world. This is. of course. glaringly apparent to anyone who has taken an introductot)? science course-a

primary social site where idealized accounts of science are rendered.

Robert Merton. the famous sociologist of science who endeavored to demarcate science according to essentialist criteria. identified (organized) skepticism as one of the four '*moral noms" that are "held to be binding to the man of science" (Gieryn 1996398-99). We would do well to wonder if the skepticism embodied and esercised by clients of

alternative health is not also a dernonstration of scientific literacy. a scientific habit of mind. as it were. Or. perhaps we could conceive of skepticism as a cultural resource drawn upon by scientists and nonscientists alike.

I try to be my own doctorfl become my own guinea pig Nastasha is a robust, older Russian woman whose skeptical approach takes several forms. Urhen she encounters a health practice that seems to be of use to her. she begins by doing research. "First," she says.

"

1 always read." During Our interview. Nastasha showed me

"her library" of health related books. most of which were shelved above her washing niachine. Nastasha emphasizes logic: not only must things stand to reason. but she must also be able to test that reason. Nastasha did live blood analysis to gain insights into her health--especially with regard to her emotional concems which. she felt. were made physically manifest in terms of a "pH balance [that] is out of order." interestingly. however. she later revealed that LSA was the second of three tests. each of which kvas used to test the results of the others. We returned to this topic at various points during

Our two-hour interview. The escerpt below relates to an account of her vieus on the popular diet book. Eur Riglrr For- Yottr. Type. tvhich argues that blood types set limitations on the sorts of food

one can effectively digest. Nastasha first provided a set of empirical exarnplcs (taken tiom her own experiences as well as from the experiences of those for whom she cooks)

to demonstrate how the author's claims held together and. as well. to voice her skepticism about how the book was "denied" by certain "alternative and conventional" doctors during a certain television program. Nastasha was upset because not only did their views contradict her own experiences with the book-"And

1 find a lot of sense there and logic.

and they made laughing stock of that bookoo-but also becausc their strategy in dcnouncing its value was not scientific. but social.

He said, "Oh. We've heard about diets before."-so those rnay not be exactly the kvords [he] said. but the meaning is: "So what? It's another diet." What he did was-who wants to hear about diet? [forcefully] Now diet is a dirty word. Everybody understands no one diet works. If this book was about diet w-ho the hell would buy it? This book is about ...[how] food which is bad for you in your body will fonn agglunative protein which will stick to your blood.. .. They don't want people to read the book. get healthy and not come to them. And because what 1 try to do. 1 try to be my own doctor. And in my opinion every person has to be his own doctor. What 1 want to explain by that if you're interested? George: Oh yes! [nodding] Yes. Yes. Nastasha: My idea is. because every person knows himself better than doctors. wliy. how 1 react to that o r to this or to that. 1 become my o w n guinea pig. 1 test al1 information 1 obtain 1 test on myself. What works for me 1 leave. what doesn't work for me goes away. For example. 1 have flu three. four times a year. and 1 suffer very much. it will go to bronchitis [waving her hands] and so on. so on. so on. S o 1 have information about colonics. 1 have information about fluorescence tea. so 1 start using fluorescence tea. 1 start using colonics m y own way. 1 invented a little bit the way I do colonics. And it-s working for me! 1 stopped having flu like three. four times. already 1 don't have tlu. Whatever works for me. 1 keep it, Now. whatever information 1 have. 1 try-it works: 1 leave. But now with this new condition in my life. this acidity. it's pH. it's not working. But al1 medicine, every medicine-okay. sorry. but books or whatever says that saliva have to be alkaline. Even my saliva is acid. It means my body is very much disturbed. And. 1 tried to find the solution of what to do with that. So, 1 read a lot of books and 1 had information. Muscle testing: okay. what i s al1 about? Because 1 want to understand my body. what is going on in my body. 1 want to understand myself. So 1 went to muscle testing. The muscle testing explained to me that a11 t h e 4 didn't understand that. now 1 understand!-that a11 the problems 1 have. it came from emotional stress. So 1 have to deal with emotional stress. So. they explained to me how. and 1 incorporated this in my life. how to deal with emotional stress. Second t e s t 4 decided 1 will make three test-second test was blood test. So. she contïrrned only what the first test said: that because of the stress. my blood cells. this is not normal. this is not normal. I have to pay attention to gastro-intestinal tract. So. she confirmed what the first test said. so. after that 1 decided to d o the third test. which 1 also did three or four years ago. This test was ... what's the word? ... Vega test. Vega test [allergy test] shows everything what is w o n g on the body and what is not wrong on the body. So Vega confirmed for me what 1 leamed before. So. now the picture is clear for me.

To my mind Nastasha offers a wonderful illustration o f how pragmatic skepticism is cmbodied-one which also offers a rather remarkable contrast to the image of the

scientifically illiterate domestic savage. Instead of a bumbling. irrational alternative health user. we have a woman whose enormous resourcefulness is continually tested on her body: she remains unconvinced until she has tested whatever information she obtains. Her pragmatic approach to medical knowledge leads her to develop her "own way" of

doing colonies. always maintaining that what works for her need not work for anyone else. At the end of our interview. Nastasha reiterated her approach to rnedicd

knowledge. this time emphasizing that she not only uses her body to physically test the results o f certain practices but that she also tests underlying "ideas." 1 should Say that I felt more than a trifle pleased when she went on to offer her own. rather optimistic. assessment of the scientific literacy of just plain fol ks.

1 told you. I mentioned that I am a guinea pig for myself. I try that. it work with me. if it works-if there is an idea [emphasis]. 1 use an idea. and it works with me. 1 don't want to know how it works with orher people because we're al1 d~ferenr. Again. what works with me. will not work for you. Why should 1 bother if it doesn't work with me?! It works with me right !.. ..Now people. 1 think. so sophisticated, and so knowledgeable-not all of them. but some. You cannot fool. you cannot now sel1 water on the Street and say that this is elisir of your life. It doesn't work ...well. it doesn't work with people anymore like what happened in 130 years ago. It doesn't happen. People are edma~ed.People have some knowledge. If 1 wanted. for example. if you would eat leaves from a tree and it would make you young and whatever. 1 will think this people crazy. 1 won? even bother. because there is no logic to that. and everything have to be logical. i'm a very logical person. Where there is no logic 1 will not accept. 1 accept things where there is a logic. And if there is a logic 1 wiIl like to try.

My body tells me Sarah and Peter are a retired older couple who reside in a farming community outside of Vancouver. Like Nastasha. Sarah uses multiple tests to evaluate changes in her condition and to assess the results of each test. While she sees her "specialist" every few weeks. she plays the results of her doctor's examination against iridology. live blood analysis. muscle testing. and a device that measures her breath output in cubic centirneters. Most importantly. she plays the results of al1 of these tests against her own body. Sarah characterizes each of her tests as "just another help in the right direction." without placing too much stock in any of them. Though her specialist presumes her chronic respiratory condition to be associated with an infection. thus prescribing antibiotics. Sarah seems to only partially accept her diagnosis. (She explains that she has been "doing a lot of readinç and testing for allergies.") When 1 asked Sarah. '-How do you think about the antibiotics?" she exclaimed. -'I hate them. I hate taking them ...but 1 have no choice. absolutely no choice." Although 1 first took her response to mean that she felt it incumbent to comply with her doctor's orders. she and her husband later revealed that this kvas not actuaIly the case. Sarah and Peter esplained that she continued taking antibiotics

because they had "proven" their usefulness on "that little instrument" which she used to measure her breath output. Sarah added that she felt better for a short time following each regimen. Still skeptical of the antibiotics. however. she used Iive blood analysis to further test their effects. while also continuing to search for an underlying cause to her condition. (Although she often alluded to her respiratory problem as due to an -'infection." it was aiso clear that she was skeptical as to whether the etiology of that infection was best explained by bacteria. She supplemented her antibiotics with 30

acidophilus--or "good bacteria." As well. she h e w that "parasites" played a role (the main reason she used LBA was to check up on the parasites) but she also suspected that

there may be something else responsible for the parasites.) Throughout Our interview. Sarah ofien contradicted her husband. insisting that it was not the different tests she used but her "body [that] told" her if something worked. For instance. tvhen 1 asked Sarah

whether she used live blood analysis to monitor what \vas going on tvith her health. she cut me off mid sentence and declared. "NO. My body tells me:'

She accepted its

usefulness because it "tvent hand in hand with her" bodily experiences. Sarah persistently pushed whatever tests she did to the periphery of her evaluative consciousness. Living the past four years with a chronic respiratory infection that kept the specialists "absolutelp baftled" had taught Sarah to be cautious about giving too much heed to know-ledge gleaned from ony medical practice. always evaluating whatever howledge she

encountered by listening to what her body told her.

The whole connection

Many clients mentioned that there was nothing that marked LBA off from any other practice they may have done. In other words. there was nothing specific to choosing LBA as opposed to anything else. The following is Giota's account of her outlook when she first engaged LBA which. she mentions. "could have been anything at that point. [as she] wasn't completely invested in [live] blood analysis itself." Giota's discussion raises some interesting questions. Like Nastasha and Sarah. Giota uses her body as grounds on whicl-i to evaluate her esperiences. emphasizing the persona1 subjectivity that resides behind notions of validity. Yet what is especially interesting in the excerpt below is 3l

Giota's awareness of the intricate connectivity that allows for an esperience to be "valid." As her evaluative impulse skims the different surfaces of her experiences. she raises questions about the comple'city that is simultaneously drawn on and obfuscated as one decides. simply. that "something works for me." In addition to the palpably physical. the empiricai envelope of evaluation encompasses emotional. metaphysical. and idiosyncratic elements that are ofien rendered ineffable. As an art history student. for instance. Giota is not surprised that a significant therapeutic component to live blood analysis is her

--connection" to images of her own bodily interior. There's so many different routes you can take! Blood analysis is not the only way to go in terrns of alternative medicine.. .And to be quite honest with you when 1 first-1 went in there a little reluctantly. 1 wasn't in any kind of financial position to invest al1 this money in doing al1 this stuff. A n d 4 wouldn't say I'm an estremely skepticaI person. but 1 have some skepticism in terms o f 4 don't take it and just think. "This is going to be it. this is going to be rny savior." So 1 do kind of wait it out to see what are the effects-like. what am I feeling? As opposed to what I'm supposed to be feeling? So I went in there just like. "I'm just going to go do it and see what happens and what she suggests.-'. .. 1 didn't go in to Emily thinking she was going to give me al1 the answers. or that 1 was going to come out and she's going to tell me al1 this stuff to do. and 1 \vas going to be al1 better. 1 didnmthave that clear focus that "this is going to be my esperience." It was really almost like walking very slowly through something. and just taking it as it cornes. analyzing. taking one step further. and going further with everything that 1 had done.. .. It could have been anything at that point. 1 wasn't completely invested in blood analysis itself. but 1 think afierwards ... the images for me. really got me. 1 think that was the thing that really got me-and there was a lot of other things that 1 can't ... even if 1 could mention. George: What do you mean? Giota: Just little things! Afier a while. like 1 said. Emily and 1 were kind of working on it iogether. and 1 like that symbiotic relationship. that you have. With Stephanie [health store proprietor/pharmacist]-she doesn't have this auihority position necessarily. but she has this knowledge that she has that she's willing to pass on to you. And you go in there and you ask questions. and she tells you "Wcll this works well." and she's done a lot of it her self-almost a sense of community. Did 1 Say this before? 1 don't knotv.. . George: Something similarGiota: Yeah. well there is that-you don3 want to be alienated. And 1 think

that's actually a good word .... You know 1 hadn't really thought about this: you don't want to be alienated from your own body because 1 think that's what a traditional blood test does. 1 feel really alienated from the whole process. Because 1 don't know what's going on. 1 don't know what they do. 1 don3 know how they come to the conclusions. Most of the time they don3 even fi\-e \.ou what conclusions they've come up with. They just tell you. "You don3 have this." and. "Everything seems normal"-that's the one 1 usually get: " E v e l h i n g seems normal." And 1 don't know what to do from information like that. because if you're physically not feeling weil. and they're telling you. "Everything seems normal." then where do you go from there?' And 1 find that whole connection that you have-not only with yourself-you tend to feel more whole. and 'ou tend to have this connection with food and every-thing that you bnng into your body-like there's a connection that's taking place? There's just a whole other understanding 1 think of eating and how you function and knowing that when you're not feeling that well it could be this. And having that awareness. higher level awareness that 1 don't think you have when you're doing some of the other stuff.. .. Because. through my own stuff. through my own reading. whether it's personal. 1just find things are so interconnected. It's not r e d f y about whether you have cancer. or whether you have this. or whether you have that. there's so many di fferent factors to any ailment that you have.. .

Giota's insistence that a decontextualized evaluation of L B A a view from nowhere. as it were-would

bear tittle nieaning or relevance for her takes an interesting turn as we

' Giota's remarks about not feeling "alienated or "disconnected" from the images of her blood touches on some intriguing issues. Like Giota. other clients felt a sense of enjoyment and empowerment from having access to. and a sense of control over, images of their blood. How they interfaced with such images can be understood as an irnplicit critique of biomedica1 imaging practices. Knowledge about their health concerns \vas not just imparted to them in its finished form. fised and separated fiom the images. but clients were also sirnultaneously esposed to the interpretive practices involved in producing such knowledge and. what is morc, csperienced the images themselves as knowledge (e-g.. a visual understanding of blood composition). Although 1 have no esplicit data to support this clairn, I ivould suggest that scientific images in ihe contest of live blood analysis functioned to "open-up" the interpretative practices of biomedical practitioners and scientists that oficn go unquestioned-or at least unnoticed as inferpretive practices per se. As Anna or Sarah or Giota pondered over their own blood images. comparins them to Emily's manual as they questioned and challenged her on her interpretations. they seem to have developed a metaundcrstanding of the range of possibilities intrinsic to interpretative practiccs involved in undcrstanding medical images. This offers a stark contrat to how the "interpretive possibilities" of medical images are csactly what "makes it imperative" for physicians "to close offtheir potential meanings and downplay their ambiguities" (Trcichler and Cartwright 1992:s). And as Martin has noted "the main thrust of the pictures in sciencc is to clinch an argument by revealing visual evidence of ~vhatone is clairning" ( 1 996: 18). We would do well to wonder if a tacit understanding that opposes this closing off of the interpretative possibilities of scientific images is not itself a fonn of scientific literacy.

broach the subject of science. For Giota. an evaluation of live blood analysis cannot simply be limited to live blood analysis in and of itself. George: So what do you think about efforts to evaluate these practices from outside criteria? A scientific evaIuation of these practices. How would you respond to that? Giota: For me that's really problematic. because 1 don't see how you can actually do that. because 1 see how my experience is so specific to me. The blood analysis in itself. probably wasn't 100% of it. There was al1 this other stuff. and I'm sure this has had a lot of impact in terms of how 1 looked at other things. But. 1 d o i t have a clear picture. I think it would be really. really hard. but it's not really about validating scientifically or not. In our society 1 think what happens is that we want scientific data to prove to u s - e v e n though 1 think some of us are quite skeptical about scientific data that cornes out that says. "This is good for you this is not good for you and you should be taking this." I mean. you hear this on the news al1 the time. One year it's fiber.. .one year it's.. .you know. How do you determine? They take this group of people. and they do this test. whether it's a prolonged test. a short test or whatever. And through a group of people they detennine if something is good and not good. or something you shouid be taking.. .and it changes consistently.. .. This whole thing that we try to exclude sornething. and Say. T h i s is good because of these reasons." And 1 don't think with something like [LBA] that o u can actually determine whether it is or not. Because 1 think what she does. she does a lot more than just look at the screen. 1 mean. there is obviously science involved in terms of what she knows. and in terms of the herbs and al1 these chemicals that are supposed to work for you or not work for you. But. 1 think that there's a lot more going on there. in ternis of her analysis-this is my perception anyway-that she just doesn't determine necessarily what she sees on the screen. And she doesn't disconnect 'ou. even though you might feel a little bit alien to it. she doesn't discomect you from what she sees. She sees you there as a person who has these esperiences. as well as this other thing that she sees about you. which is your blood. right? So 1 think that there's a lot more involved in there. And 1 think that that's really. really hard to cive scientific proof-and I'm not even sure if ever I would actuaI1y say I wouldn't do anything because some scientist said that this is not vaiid. 1 mean. 1 probably wouldn't listen to it. 1 probably would prefer to find out on my own. George: So. for you. coming back to the question of validity-it's something that has to be tested on your own body. Giota: Yeah. and that's what 1 was saying earlier. in terms of-and 1 think [Emily] realizes it too. 1 think Stephanie realizes it. Because 1 know Stephanie used to work as pharmacist before that. And 1 know one of the things she used to hate is the people coming in and saying. "This is what 1 feel." and she goes. "You just give them a pill. and you just send them on their way." and she used to hate that. And this is a more interactive way of approaching.. .that something might no[ work for you. It's not "This is it. this has to work for you." C

At the end of our interview, Giota offered an interesting take on her skepticismgrounding it in speci fic social circumstances she especially identifies with li fe in Vancouver. Understanding the popularity of alternative medicine in Vancouver as --trendy." Giota explains that the current visible interest in such practices not only made her more skeptical about the practices themselves. but. as well. about her ideas and attitude toward biomedicine. Significant here is that her body is also the empirical test of her skepticism. [Jlust the whole notion of alternative health is like: a lot of people are turning in that direction. and then you wonder. just being one of them. and then. the feelings you feel toward the medical profession. are they based on your own persona1 experiences? George: Or is it "trendy" [a word she used previously] t o Giota: Yeah. exactly. Or is it that you're just becoming one of them that's criticizing. and you're rebelling against that and going to something that's totally the opposite. George: So how did you reconcile those feelings? Giota: 1 think it's that 1 experienced the difference. And I think it's through that. I f you esperience the difference. then the only conclusion 1 corne to is it works for rire. And it's good because it does work for me. And then there is no conflict anymore. It's like it doesn't matter if it's trendy. it doesn't matter if millions of people are doing it. it doesn't matter hou- many people are invalidating the medical system. this really works for me. and that's good enough. right?

Skepticism as rhetorical strategy?

My own consultation shed some unexpected light on the issue of pragmatic skepticism. First. a tield-note written the evening afier 1 had my blood analyzed: 1 was aghast. today. when 1 saw rny blood up on the screen. 1 had seen enough cases by then-a good 7 or so-to know that 1 had seen far better looking blood. 1 had. li ke other repeat clients. developed a certain sophistication about what blood looks like. 1 did not need Emily to point out the dumping. the irregular shaped celIs. blobs of opaque white stuff that I have grown accustomed to calling candida, deposits of arterial plaque. and-this is still a strange admission-a

parasite wriggling around and burnping into suspended red blood cells. The main concern had to do with an inability to effectively digest and absorb protein. And so 1 have. despite whatever skeptical perspective I seem to undeniably maintain. taken the viewing to heart. My blood corresponded well to how 1 thought about my health of late: poor eating habits. internalized stress. fatigue. and so on.. . Despite a growing curiosity about the appearance of my blood. 1 initiated my consultation more or less as another cornponent to rny field-work. (Clients ofien asked. -'Have you had yours done?" to which 1 could only respond by telling them about the quick 1 O-minute analysis I had at a health exhibit. For one thing. 1 was looking fonvard to having something more substantive to share.) What is interesting to me is that 1 initially chalked up my skepticism as part of my role as a social scientist and. what is more. wondered whether the change in Emily's tone-she detached than usual-was

seemed more resewed and

simply due to an assumption that 1 would not buy in to what

she had to say. (As an aside. 1 should add that two weeks following my consultation with Emily I w n t to see my family physician about feeling run down and because of consistently encounterinp blood in my stool. Following blood and urine tests 1 was told that -ever)~hingwas normal." except for the "protcin in my urine" which indicated that 1 "may not be absorbing protein effectively.") It was uhen 1 retumed the following week

that I beçan to become more aware that not only did just about everyone eshibit varying degrces of skepticism. but Emily's detached manner of imparting her knowledge as if to a curious skeptic was a fairly consistent rhetorical position. Indecd. Emily seemed to expect clients to initiate their consultations with a skeptical cast of mind. Ernily's rhetorical position. as 1 cal1 it. will be illustrated in practice when we look at Dave's consultation below. Here 1 want to present a segment from our interview which partly reff ects lier awareness of clients' skeptical outlooks. Emily's rhetorical position of

imparting information as if to a curious skeptic is consistent with how therapeutic relationships of alternative medicine purport to keep control in the hands o f the client George: So what do you expect o f your clients when they come in? Emily: It varies. It varies by the age o f the clients and their attitude. I e'tpect. when someone's come in to an alternative practice. for them to be pr-ocrctive about their health care. but that's not always the case. I expect people to be rrenerally interested and not too overly speculative.. . George: What do you mean by overly speculative? Emily: 1 mean for people to come in here almost as if they want to debunk the whole thing.. .. And when 1 get that sort o f a vibe from someone on the phone. 1 tell them right away that this is not something where I'm going to try to diagnose you with any particular disease. It's not a diagnostic tool in that respect. It's for prevention. and 1 don3 really care what disease you may have. quotelunquote. this or that. but what lead to it. And that's what I'm going to address. So. that's the important rhing. C

Although Emily says "too overly speculative." given the remainder of the exchange. it is safe to assume that she means "overly skeptical." Significant here is how she characterizes her practice as designed "for prevention." Emily frequently drrecrs conditions before they have reached the stage when thcy would be diagnosable in biomedical terms. So when she tells a client that s/he has "indicators" of a certain condition. and then she and her client proceed to speak about that condition as if the client has the condition and not just the "indicators." client and analyst have. in Bakthin's terms. placed a different "accent" on the word that signifies the condition. Analogous to how a word sounds differently when it is spoken with a new or different stress or emphasis. 1 use "accent" here to refer to how a word takes on new meanings and intentions: how it becomes '-bathed in different iight" (Bakthin 1981 :420). For exarnple. when Emily toid Ralph that he had thyroid indicators and later they referred to tliis as '-hyperthyroidism." we can say that they were speaking about a latent condition. one ~vhichmay or may not ever correspond to the hyperthyroidism of biomedicine. To talk

about hyperthyroidism in this way is to simuItaneously relocate it on a health continuum (rather than as a discrete disease category). and in a sense to offer RaIph the possibility of -'treatinga. it (stress reduction. supplements. etc.) before it develops into something less easy to manage. 1 would suggest that the skepticism Emily anticipates is closely associated with the re-accenting that takes place in her office. Clients' skepticism directs and limits the degree of acceptable re-accentuation. 1 read her remark about expecting

prospective clients to be "interested and not overly speculative" to mean that she espects her clients to accept that the meanings and intentions she ascribes to her analysis are not easily comparable with the diagnostic criteria of biomedicine-"overly

speculative"

clients would "want to debunk" what she does based on those critena.

Rebecca's own double blind test

Clients were sometimes explicit about their skepticism as they proclaimed themselves skeptics at the door. and entered to see if there \vas any value whatsoever to this practice \vit11 ivhich they were somehow recently acquainted. It Las not uncornmon that esplici t

articuIations of skepticism were wrapped up in vernacular evaluations of live blood anal>.sisas science. The moment Ralph burst into the office he inquired. escitedly. -'What's the science behind it. behind the machine?" And looking over at the microscope sct-up continued. "1s that the machine right there or is that just a microscope?" Like Ralpli. many clients seemed to assess whether the practice of LBA warranted the designation "science." and the legitimacy and symbolic capital it implies. We can say that the way "science" was deployed or evoked in these exchanges speaks to what Gieryn ( 1995) has

considered as the "boundary-work" of '-people in societyq'-that is. how non38

experts participate in the episodic and contextually contingent construction of the boundaries of science by articulating a distinction between what counts as science and

Consultations that began on this note were characterized by just how much a client would accept or continue to be skeptical about. drawing fine lines as to what parts of live blood analysis were valid. and which parts were not. An interesting example is

Rebeccn. a 53-year-old woman whose initially austere presence made us al1 a little uncomfortable. as she seerned unwilling to reveal why. in fact. she was there. Dressed completely in black with the exception of a silver crucifk that dangied prominently on her chest. Rebecca introduced herself as "a total nonbeliever" and. tuming to indicate her

husband who walked in behind her. said. "And he's a total skeptic." Though she saw a chiropractor regularly and supplemented her diet with pills made from dehydrated. pulverized vegetables. she repeatedly reminded us that it was "her first time for this sort of thing." Rebecca's consultation was punctuated with skeptical glances between husband and wife and seemingly ceaseless interjections about the logic underlying Emily's

insights. At the end of the session. Rebecca debriefed me on pan of the method

underlying her skepticism.

Tliere is a lot of tom-foolery and quackery going on and this could have tumed out to be one of them. But it wasn't.. . I'm a skeptic. What 1 didn't tell you is that Father Brooks [the person who recommended this to her] tofd me that [he] went to two analysts. [They were] consistent. they picked up the sarne three things.. .that was my own double blind test. There. [laughs]

What is significant in this account is neither that Rebecca declares herself a skepticthough that she wants to be considered one speaks to the sort o f relationship she is interested in establishing with the analyst-nor

whether slie really did a -'double blind"

test. Rather. Rebecca reminds us that perceptions of alternative practices as quackery and of the people who generally use them as somehow gullible are not by any stretch of the imagination limited to scientists or doctors. Her symbolic use of scientific discourse-

"my own double blind tesi"-coupled witli the manner by which she revealsd her visws. suggests that she imagined herself to be distinct from Emily's other clients. She. unlike et-eryoneelse. was skeptical and scientific.

How do you know the top from the bottom?

Consultations were frequently rnarked with moments of skeptical interrogation about Iiow. esactly. Emily knew what she knew. This is especially true o f the second segment of the consultation when. from dried drops of blood. she was able to glean insight into the

irregularities o f different organs. as well as "indicaiors" of such things as stress. toxicity. auto-immunity. and allergies. "The first few drops." Emily ofien esplained. '-would show Iymph nodes. Later the bowels start to show up." Clients would ofien not only challenge Emily's insights-as

part o f a more subtle process of negotiation-but

they would also

challenge the underlying logic to the sample. Rarely did anyone just passively acquiesce wlien s h e was confronted with an approach to understanding her or his body that did not scern to make sense. Here I present an excerpt from Dave's consultation to illustrate how clients' evaluative impulses surfaced during the course of the analysis.

Prior to his consultation. Dave had been "out in the bush" for several weeks. hunting. This was his first experience with live blood analysis. Emily: This white spot here is your low intestine. Dave: How do you know that? [More emphatically] Does it always dry Iike that? Emily: Yup. As long as you leave it alone. Dave: How did they figure that out? Emily: Trial and error. [She says some more but 1 miss it] Dave jumps to his feet and afier muttering something about how LBA was "just like reflexology and iridology" he exclaims. T h i s is crazy!" He seems simultaneously puzzled and pleased. As Emily continues to talk about the '-bowel indicators" present in t h e dry sample and magni fied on the screen. how they are "not very strong." Dave returns to his chair. covers his mouth with his hand and stares inquisitively at the monitor. Moments later he points his finger to the darkly shaded segment of an othenvise white and red screen and. apparently disregarding Emily's previous comment about how the bowel indicators were not strong. he asks. quite seriously. "It's pronounced there. isn't it? This is my bowels. isn't it?" The consultation continues. Emily's analysis of his dry sample essentially focuses on '-stress" and his Aymphatic system." Dave has also continued to intempt her. retuming again and again to the theme of symmetry to which he seems to have latched on: he is apparently quite concerned as to how Ernily can teIl how his body is represented on a drop of blood-how it is that right is right. bottom is bottom. etc. He also asked repeatedly. as if testing EmiIy. "You don't see anything else there?" Emily seems untroubled by his interruptions. As the consultation draws to a close. Dave requests a copy of his dried sample-a picture. [Emily has already given hirn a picture of his "live blood." a standard part of her analysis to remind clients of the major themes they have discussed with hcr. She doesn't usually give out pictures of the dried sample.] Emily says that it isn't a problem. but that she will have to charge him two more dollars. Dave esplains that he wants to see how '-it shows up [relative] to the chart" that shows Iiow his drop corresponds to his organs. He now holds up his picture. stares down at the manual and begins to analyze his o\vn blood. moving his eyes back and forth between the manual. the screen and his picture. Pointing at the picture he mutters. '-Imtation in bowels. here." Sliding his finger to another point. "This is the lymphatic. Stress." Emily asks him more questions about his being tired. about liow he is sleeping. He responds briskly. retuminp again to the theme of symmetry. Dave: How do you h o w the top from the bottom? Emily: [looks at photo] This is the top-Dave: How is it on the TV screen? Emily: Esactly the same as on the picture.

Dave: [shakes his head] So we got some lyrnphatic and we got some colon. And you said hormonal imbalance. 1 was quite surprised when Dave's skepticism started to surface: until Emily began the

analysis of the dried sample. he had seemed rather nonchalant about the whole thing. 1 tind se\reral features of this eschange especially striking. The first is how Dave seemed

to become fixated on how syrnmetry was preserved in the analysis of the dried sample. As 1 watched him in the consultation 1 began to realize that he was strategically using this as a way to question the validity of Emily's analysis. trying as best h e could to catch her

making a mistake-afain

and again he asked Emily to veritj which side of his sample

\vas right or left or up or down and then demonstrate how that corresponded between screen. manual and picture. Also interesting is that despite what Emily identified as relevant in the analysis. Dave. aware of his own health concems and of what he had pemsed in the "photo-cornparison manual" on her desk. would persistently voice his own interpretation of the sample. For instance. "This is colon. isn't it?" In this way he simultaneously tested her facility with the technique. while remaining skeptical about the validity of its knowledge daims. Also worth noting is that despite Dave-s reactions. Emilfs rhetorical position remained consistent: she was simply imparting information. A superficial interpretation of Dave's consultation would suggest that he was only trying

to ensure that he understood what Emily was telIing him. However. 1 tend to think that he was esercising his pragmatic skepticism. questioning both the validity and relevance of live blood analysis in the context of his own health concerns.

A sideward glance at power

Sliot through the ethnographie passages above is an emphasis on the individual as the locus of control or decision-making. as well as an emphasis on the singularity of his or her health context. Meredith McGuire (1 988) uses the tenn '-flexible self' to capture the resourcefulness and versatility of alternative health clients as they choose from a vast range of possible options in their pursuits of better health (Kelner and Wellman 1997). People's sense of control over their bodies and health is. directly or indirectly. and to \variable degrees of awareness. voiced in critical contrast to how the (bio)medical encounter strips individuals of their sense of agency. transforming thern into purienrs who arc intended to be passive and pliable in the hands of their physicians, And while 1 have presented this material in a vaguely similar vein. partly to sketch a general posture of people-s encounters with live blood analysis that counters the people-as-gullible-passivevcssrls view of things. my account runs the risk of painting pragmatic skepticism a little too optimistically. perhaps even ceiebrating it as a desirable cultural value of sorts, more or less congruent with my informants. self-descriptions. Yet considering pragmatic skepticism as a genuine expression of agency may be a little hasty. Some parsing is in order. Drawing on Foucault's notions of "biopower" and "govemrnentail ity." as weli as on Gidden's account of "reflexive resources." Nettleton (1 997) argues that power-in Foucauldian sense-is

the

effectively exercised becausc people are able to actively respond

to diffcrcnt forms of medical knowledge. A sense of individualized control in which we kcl free to evaluate. reject. or incorporate ideas and practices about health is fundamental to a process in which the effects of power are internalized. "Self-govemance implies an 43

ongoing project whereby we are continuously assessing informatior. and expertise in relation to our selves" (Nettleton 19972 18). We c m conceive of the pragmatic skepticism exercised by clients of live blood analysis as an element or condition of this self-governance. As Giddens has pointed out. the "self today is for everyone a retlesive project.. .carried on arnid a profusion of refisive resolrrces: therapy and sel f-help manuals of al1 kinds. television programmes and magazine articles" (Nettleton 19972 18).

In the following chapter we will consider how live blood analysis is employed as a reflesive resource through which such meanings and understandings are made possible. often against the institutional authority of biomedicine. To my mind the posture of pragmatic skepticism 1 have been elaborating f o m s the philosophical grounds on which clients are prepared to use LBA to pursue-or participate in the production o f d i f f e r e n t accents on medical language they associate with their bodiIy concerns.

Chapter 2 Behveen Patients and Agents: Live Blood Analysis a s Resource

A recent spate o f articles and editorials in biomedical journals have noted that patients

don' t usuaIIy tell their doctors about the alternative heahh practices they use (e.g. .Murray and Rubel 1 9 9 2 Eisenberg et al. 1993: Campion 1993: Eisenberg 1997). Typical to these sorts of conjectures is the ascription o f a numerical value which. in this case. tums out to be around 70% (e.g.. Campion 1993). Further. the observation that people aren't telling

their physicians about their alternative practices is not without its didactic purpose: it apparently brings home a message about the problems in doctor-patient communication. and. as well. about how doctors may be collectively unaware of the pt-ewlence of alternative medicine. In a national study published in the Neiv EnglundJortrnçrl of :L/L.dicinc-one which seems to have set something of a precedent for research and commentaries on these matters-Eisenberg

et al. assert that

this observation suggests a deficiency in the c u r e n t patient-doctor relations. Perhaps this lack of communication derives from medical doctors' mistaken assumptions that their patients do not routinely use unconventional therapies.. .. This failure to communicate is not in the best interest of the patients, since the use of unconventional therapy. especially ifit is totally unsupervised. ma- be harmful. ( 1993252) The author o f the editorial accompanying this article attempts to chri@ and recommend solutions to these problems of doctor-patient communication which. he suggests. lie at

the very heart of the "public's expensive romance with unconventional medicine" (Campion 1993283 j. Ironically. while he dismisses most alternative practices as "probably quackery" and '-patently unscientific." with "accompanying theories [that] are silly." he admonishes his fellow physicians to '-resist the immediate temptation to condemn. since that simply cuts off further communication" ( 1 993282-3). Doctors are apparently to exercise their authority delicately-to

humor patients. Without diminishing

the breadth of his insights. his suggestions can be reduced to an appeal for the dinical equivalent of better bedside manners intended to ensure the appropriate combination of trust and surveillance. Improve doctor-patient communication. so the logic goes. and not only will patients reveal what the devil they're up to with these other practices. but they soon enough limit-given

the appropriate attention and advice--or even discontinue

their use. lmplied here is the idea that an improved communication which enables --frank discussion.. .about alternative medicine" (Murray and Rubel l992:63) is to the patient's benefit. Afier all. it is in keeping with common sense that the increased use of alternative medicine is "in part a matter of disillusionment with the ofien humed and impersonal care delivered by conventional physicians" (Angel and Kassirer IW8:84O). Admittedly. 1 am rendering a mildly skewed and caricatured account of these views. There are certainly good reasons why physicians and their patients should be in dialogue about alternative practices (Eisenberg 1997). One reason. for instance. is that mising certain herbal treatments with prescription medication may have adverse effects. And yet it is difficult to overlook that such dialogues inevitably authorize physicians' power and. as Michael Taussig (1992 [1980]) pointed out long ago. augment their capacity as forceful agents of social control. Given the way perceptions of the medical 46

profession have changed over the last few years as critiques of biomedicine-in forrn and to whatever degree of sophistication-are

whatever

no longer the stuff of critically

minded social scientists. but also the stuff of everyday conversations. Taussig's critique may appear less relevant than it once was. It would be foolish. however. to overlook its significance. How puiknrs who use live blood analysis position themselves against the institutional authority of biomedicine is deeply related to how they employ this prrictice as a resource. And eshortations for physicians to speak with patients about their alternative practices-many

have even stressed its inclusion into the patient history-can be read as

a strategy to address the diminishing hegernony of biomedicine. especially as it is made

manifest in the social significance of physicians. In this chapter I want to draw on my research on live blood analysis to consider what else may in fact be going on when people don't speak to their doctors about the alternative practices they use. First. 1 present a brief segment from my interview with Rachel as ethnographie background to my starting premise that problems in doctorpatient communication. as ubiquitous as they seem to be. may have less to do with why people do not usually broach the subject of their non-biomedical practices than one would

espect. I then draw on rny experiences with several live blood analysis clients to postulate three elements that may underlie these nondisclosures. The first of these elements concerns what \hie c m cal1 everyday understandings of physicians and their medical knowledge as socially situated. That is. clients seemed to view physicians as pan of a socially distinct knowledge tradition. with its own normative codes and Iimitations. to be considered and evaluated against the relativizing plurality of non-biomedical health practices. The second and third elements are related through my tentative theorizing on 47

alternative practitioner assisted self-medicalization; they respectively address the issues of strategizing for biomedical resources. and the elaboration of provisional "diagnoses" for symptoms that fa11 below the threshold of biomedical signs of disease. 1 contend that it is because LBA does not bear the legitimizing imprint of biomedicine that it becomes.

for sonie clients at least. a valuable resource through which to reflect on their bodiIy complaints.

1 would stick to the alternative practices and change doctors It was during an interview with Rachel. a sixty-three year old woman who works as a

house cleaner. that began to realize how the question of telling one's doctor about the use of alternative medical practices was far more comples and nuanced than 1 had previously imagined. Following breast reduction surgery Rachel suffered from a prolonged infection for which she had been on and off mtibiotics for almost a year. Her li1.e bIood consultation with Emily kvas intended to show her what was "going on with her infection." and why she "was so tired that she could sleep 18 hours a day." Rachel had her blood analyzed by an iridologist in Winnipeg seven yars ago and since then has had three more consultations. During our interview she ofien espressed enthusiasm about her esperiences. repeatedly emphasizing how much she enjoyed the "depth" of the analysis and how she was '-really fascinated" with the process of "seeing her blood like that." (Indeed she thought 1 \vas "very lucky" to be able to sit in on so many consultations.) Many of these remarks were followed by comments about doctors-how

they "don't go

in depth like that9*-and. more significantly. about her ow-n doctor whom she sees regularly. This prompted me ro ask. "So did you tell your doctor about it [LBA]?"

Rachel: 1 have been thinking that over.. .the other girl that lives here and 1 went and took her daughter [Amanda] to see Emily and she had hers done three weeks ago, 1 guess. And [when] she mentioned [LBA] to her doctor. her doctor flew off the handle at her. George: [timidly] In what way? Rachel: [takes a sharp tone] You're so stupid. you're wasting your money. there's not such a thing as candida. Ahh, she'd corne home from the doctor in tears. he \vas so mad at her. George: And what did she think. how did she work it out in terms of. you know. what she had learned at LBA and how that compared with what the doctor saw? Rachel: She doesn't believe in doctors now. George: Because of the way he responded? Rachel: Yes. because of the way he responded and it was shomn to her. You know. she sat in Emily's office and saw it for herself. And then a doctor turns and tells her she doesn't have it. [raises her voice] that there's no such thing as candida.. .well 1 had it myself? Amanda's reaction-or at least Rachel's representation. anyway-

seems to be less

related to the way the doctor treated her. how he berated her for her ignorant credulity. and more related to how he. in the process. revealed his ignorance. It is somewhat striking that an encounter which ended in tears and outrage becomes muted a s a social comrnentary by unconsciously shifting attention from a professional relationship in n-hich one person imposes strict sanctions on the reali ty of another's experiences. to a discrepancy in the degree of shared knowIedge. 1 am reminded here of Taussig's ( 1992) characterization of the medical encounter as a "combat zone of disputes over power and o\?erdefinitions of illness" ( 1992:99). The fight over the reality of candida is lost in the doctor's office but won elsewhere: Rachel and Amanda apparently have no doubts about whether candida is really real. Afier having continued on a number of issues that related to candida and live blood analysis. Rachel again returned to the issue of telling her doctor: Doctors prescribe antibiotics but they d o i t prescribe anything to help your system afier it's stripped. And, ah, so this is one more reason that i'm going to approach

my doctor and see what he. what he really has to say.. . And then. 1-11 probably change doctors! George: So you think that how he will respond will help you make a decision about hirn. but not about the alternative practices you use? Rachel: [confidently] 1 would stick to the alternative practices and change doctors. George: So your wony then is not that. you know. he will reprimand you like your friend's doctor did. but somehow what he-s going to do is going to break your trust in him. orRachel: No! No. 1 don't think it would break the t r u s t 4 have a lot o f trust in him: he's a very outspoken person: 1 c m talk to him about anything and everythingwhich 1 found great for me-uhm. 1 would just like to know his opinion on it too. And. uhm. he could believe in it just as rnuch as 1do.. .Well. I'd really have to have a big talk with him-he takes time with you. uhrn. where most doctors you're in and out o f the office.. .he takes time and explains things to o u . he'll even write it down in case he thinks you'll forget. George: The thing is you like your doctor and you don't want to have to change doctorsRachel: 1 don't want to have IO change doctors: there is reasons a person has to go to a doctor. Rachel is certainly not "disillusioned'? with her doctor. Nor does she see a problem in the way they communicate-in

fact. it is exactly because he communicates so effectively

witli her that she is apprehensive about speaking with him about live blood analysis. Convinced of the efficacy of live blood analysis. shr is worried that her doctor's inability to relate to it. to allow his interactions with her to be informed by the analysis. will somehow rupture their relationship. (It is worth noting that in Rachet's ideal vision o f our health care-system. she grants doctors a central role: '-1 think doctors should work with live blood analysts. they should send their reports in to doctors. ..they should al1 be u-orking together.") Yet Rachel would rather "stick to" live blood analysis than keep secing a doctor whom she seems to hold in high regard. Neither the dialogue above nor the rest o f my interview with Rachel allows me to understand esactly why this is the

case-why

her doctor's not "believing" in live blood analysis would be grounds on which

to replace him. A tenuous hypothesis may be that an inability to accept LBA may

simultaneously signal to Rachel a rejection of the way she has corne to understand her o \ i body-both

biologically (e.g.. her cellular conception of blood that allows insight

into her physical well being) and socially (e-g.. her practices to experience and funher that well being. for instance. "lymphatic drainage massages-)-with

which she is unwilling to

part.

But will conventional doctor tell you that? No. Why? He doesn't know. At first. when the subject of people's esperiences with doctors was broached in conversations-especially

when such conversations hinged on critique-[

expected

accounts that spoke to poweriknowledge inequalities and how they were made manifest in such contexts as the patient-doctor interview. 1 was certainly surprised when I realized that people instead often demonstrated what seemed to be an awareness of the power esercised not by but on physicians. Through exchanges that ofien took on playful. mocking tones--especial!y when these exchanges occurred during consultations-people expressed a view of doctors as held captive. socially and intellectually. in what Arthur Kleinman refers to as biomedicine's "iron cage of technical rationality" ( 1995:33). Many considered doctors to be limited-stunted.

ewn-as

a result of medical school. As Emily

often said to enthusiastically concurring clients. "Doctors just don't know about this [substi tute: health: nutrition; candida: LBA]. If they weren't taught it in medical school. we11 that's it!" My sense is that the ione of such remarks is especially significant. That thcy resonated playfully. usually untainted with bittemess. as they fiequently occasioncd rt shared laugh between al1 of us (the analyst. her clients and me) speaks to the location of

doctors in a small bit of the social imagination. I don't mean to suggest that "disillusionment" (or bittemess) with biomedical doctors is not an issue: 1 only want to suggest that it has been too often foregrounded at the expense of other intellectual and

Many of the people with whom 1 interacted felt that part of the reason they could not speak with doctors about their alternative practices

riras

not that they feared reprimand

or that they would be treated as foolish. but that doctors would simply not --get it"-or rather. they cozrld nor get it. For exampie. a view ofien voiced was that doctors had only learned to think a certain way. that when it came to issues about health and how to pursue or protect it. they were unsuitable candidates from whom to seek advice. Unlike Rachel who seriously deiiberated over talking to her doctor about live blood analysis. others simply did not see the relevance. In one informant's words. doctors were unable "to stray fiom the four corners of their paradigm" (Mau). In another's *-therewas no point." '-they just do their own thing." and besides. they were just "a very small piece of [the puzzle]"

(Sarah). Nastasha. the robust older Rüssian woman from whom we heard in the first chaptcr. became especially animated when she articulated her views on doctors: For example. right now 1 will go to conventional doctor in my condition. He will make a test. like x-ray of stomach because 1 am compIaining of digestion and this and that. And then he will give me the bunch of pills. Or. for esample if 1 have carpal tunnel syndrome. 1 went to the doctor's they make me bracelet. and give advice. So. conventional medicine. it deals with ... how do I say? ... it deals with the part of body. It doesn't deal with the whole body. it doesn't deal why the hell the heart is sick. how the hell the ear is sick or leg or liver. Why it is sick? Simply it is sick. You have arthritis? Go on take Advil. take aspirin. go take

'

A recent study in JllA.I.4 reports: [a] centra1 finding is that users of alternative hcalth care are no more dissatisfied or distrustful of the conventional medicine than nonusers" (Astin 1998: 1532). The centralit? of this flnding. of course. is that it contradicts the common-sense vietvs on the popularity of alternative medicine. (This statistic does not include the 4.4% of those who used alternative mcdicinc and had no dealings with biomedicine.) "

painkillers.. .We don't know where arthritis came from. go on painkillers. Like my boss. he is a doctor. he went to doctor. he has arthritis. they say use painlriller and live with that. Alternative medicine knows that arthritis came through that place. through your mouth [she is refemng to her previously stated view of bodily health as related to dietary and environmental factors]. but will conventional doctor tell you that? No. Why? He doesn't know. Why he doesn't know? Nobody taught him. Because I'm a housekeeper. looking after doctor. and 1 know their mentality. 1 know-he was a professor. he was the best pediatrician in the city-but he knows ZERO! Absolutely zero about vitamins. about nutrition. about everything. I have to fight with him for his health. because anything 1 suggest healthy he says. "Forget it. A l i this is BS! Al1 this is BS!" And 1 have to fight for his health because 1 know so much and he knows so little. And we are fighting but sometimes he gives up his position ... this is not what you asked me .... George: This is a good example though. Nastasha: Yeah. Yeah. Alternative rnedicine ... You know how much I achieved with hirn? He had cramps and ... and he would fight back. Finally he gave up. In two weeks or three weeks his cramp's gone. Hah hah! So he gave up his position.. .. So. I know what conventional medicine knows. and 1 know that they know zero about proper life maintenance.

Nastasha begins with a commonplace critique of how biomedicine reduces bodily complaints to a specific organ dysfunction. attending to parts not the whole. treating s\mptoms and not causes. She moves easily from h>.pothetical scenarios in which she provides a possible symptom and a physician's response she anticipates. There is no mystery. What is more interesting. however. is how she situates doctors as circumscribed nithin a specific knowledge space. To help her "doctor." in this case her employer. the pcrson whose house she cleans. she must first dislodge him from his "position." His very medical knowledge, the b a i s for his authoritative dismissals of her practice~-~:41l this is BS!'*-also

keeps him from feeling well. This curious doctorhouse cleaner stmggle over

knowledge raises some interesting questions about who has the right to assen what counts as real medical knowledge.

This question is again raised in the following passage when Giota critically assesses what sort of knowledge is missing from the "medical profession." For Giota. doctors are not only located because o f their medical knowledge. but they. like that medical knowfedge. are located in a particular social-history. Something to consider here is that she partially associates her awareness with her experiences with live blood analysis. Her experiences with LBA become a platform on which to elevate and critically consider broader social. cultural and politicaI concerns about medical knowledge relevant to her body.

It goes back to al1 the social changes that have happened for women in terms of how their health is being affected. Fifty years ago. women were not dying of h e m attacks. Now they are. I honestly don't believe that that profession has caught up with al 1 the social changes that have happened. And 1 think if you' re going to take an active role in society. then you should be able to take an active role in terms of your health. and make those kinds o f changes. And 1 think it spills into so man) other areas. because. what has happened - probably al1 stuff that 1 had been thinking about in the process. but just doing that [LBA]. and feeling so empowered by having done that. 1 started to look around me and see how many other things that 1 didn't want. In terms of al1 these other constructions - like you have to work nine-to-five. you have to work so niany hours. and if you d o i t do that.. .and if you're not married at 3 5 with three kids. then there's something wrong with you. And that had already been there. my criticisms around those social issues. but it just really magnified 1 think. al1 the '-normal" range that goes across the board.. . And there's a lot of power in that actually. because then you do have the choice.. .. George: So do you think that your experiences with [live blood analysis] helped you recognizeGiota: 1 think. on a different level. yeah. Especially being Greek. 1 mean. my parents grew up in a village. They looked at doctors and teachers like they were gods [Iaughs]. 1 remember rny grandmother one time. there was this architect coming over and she goes, "Sikothite [Stand up]" [laughs]. It kvas absolutely amazinç! Because for me it just articulated what die thought-she was enarnoured with the whole aspect-you know. that somebody had gone to university and they knew al1 this stuff and they knew how to read.. . And 1 don3 believe that. and part of actually doing an MA. it kind of destroys a lot of your illusions in terms of what's considered the authority. and what's considered "you don't know nothing." which 1 think is basically what you're trying to Say is that -

we do know a lot. Maybe my not having read the textbooks on alternative medicine. 1 may not know al1 the herbs. but 1 have a sense of what's right for me. and 1 think that's valid. 1 think that's really valid. Social. cultural and gender issues become narrative threads in Giota's account of medical knowledge. Interestingly. live blood analysis becomes another moment in this narrative. Because of the way she situates doctors and biomedical knowledge. Giota establishes limitations on their reIevance to her bodily experiences. What is more. she expresses an awareness of the scientific literacy people possess and exercise when she simply informs me of part of my o w research agenda-"which

say-[

1 think is basically what you're trying to

] we do know a lot." Giota's "sense of what's right" for her is fundarnentally

about what sorts of knowledge she pursues and privileges. In this way. not only is the authority of physicians diminished. but for Giota. as for other clients of live blood analysis. the question of whether they should tell their physician about it is simply irrelevant. Giota's mention of graduate school as a space in which she further develops her --criticisms around those social issues." criticisms which inevitably examine the place of physicians and biomedicine as a social issue. is significant to this discussion. An often noted demographic description of '-users of alternative medicine" is their increased formal education. As a very recent national study published in the Journal of the Arnericran ,\ledicrii.4ssociofionreported: *-educationemerged as the 1 sociodemographic variable

that predicted use of alternative medicine" (Astin 1998:155 1 ). In addition. 50% of those interviewed with graduate degrees reported use of alternative medicine (Astin 1998; see also Blais et al. 1997; Eisenberg et al. 1993). What is perhaps more interesting than the findings themselves is the way they are often interpreted. especiallytvhen such

interpretations try to reconcile increased education with a view that explains the popularity of alternative medicine in ternis of the public's woeful lack of scientific literacy. For example. the author of the editorial with which 1 began the previous chapter does not seem the least bit troubled by statistics indicating significantly higher education for those who accept alternative practices. Indeed. he speculates that while "clients of alternative medicine tend to have more years of education than nonusers. it is stiH a safe bet that they are not better infonned about basic science" (Beyerstein 1997: 149): they are still "shockingly ignorant" (1997: 149). He concludes his indictment of our general scientific illiteracy with some more demeaning remarks: when consumers have not the foggiest idea of how bacteria. vinises. carcinogens. oncogenes. and toxins wreak havoc on bodily tissues. then shark cartilage. healing cqstals. and pulverized tiger penis seems more magical than the latest breakthrough from the biochemistry laboratory (Beyerstein 1997:1 50). 1 would suggest that a more productive interpretation of these findings may Iead us to

consider how they are linked. as we witnessed in Giota's case. to a view of al1 medical knowledçe as socially and historically situated. as well as to a wiiliugmss to question and actively engage that knowledge. (That increased education can be so easily dismissed with an assertion saying little more than people have simply attended the w o n g classes. should give anyone pause.) Further. if there was a feature shared by ail of the people with whom 1 interacted. it was that they read estensively. if not voraciously. about health matters that concerned them directly. 1 have already illustrated how the concept of pragmatic skepticism addresses the inadequacy of tactically resorting to conventional formulations of scientific (i1)literacy in order to explain people's acceptance of certain practices. I will let this discussion corne to a temporary close with an escerpt from rny

interview with Max, a fifty-year-old man who holds an MA in hospital administration and ~ v h onow works as a "light and sound" therapist. Max's off-the-cuff rernarks hit on a number of pertinent concerns. It is especially interesting to me that not only does he address current efforts to change doctor-patient communication (those efforts discussed in medical journals and. as well. in modifications recently initiated in medical school curricula) but he cynically recounts these events as if they have already occurred.' [Wlhat I don't think mybody is really doing is appreciating that complernent-; medicine really stems from an increasing educational Ievel on the part of the population such that they can ask the doctor for reasoning that goes into the doctor's decision. And because they are not getting good answers. or because there are now competing theories. as we evolve. you know. things are starting to open up and we are now-freedom of information. I mean is infecting al1 disciplines-we are now able to ask.. .not my mothsr' generation perhaps. but certainly my generation. you h o w . George: What aboutMm: And doctors aren't keeping up. George: Keeping up withMax: With this new.. .this new socioiogical trend to be questioned. 1 think what a lot of them are doing [is] just adopting a reaily sofi bedside manner. but still eiving you the same bad reasoning. And people are being emotionally sucked in by the.. .increased interpersonal capability of the physician. but it's still the same bad reasoning that they are applying to the diagnostic or.. .treatment process.

C

Alternative practitioner assisted self-medicalization MedicaIization in the traditional sense is usually invoked in discussions about how the niedical profession or biornedicine is a primary institution of social control which has historically maintained a privileçed position --overthe social construction of bodily reality" (Illich 1986)~.Recent efforts to revisit rnedicalization from broader. if not

For an interesting account of how medical students perceive curricular changes thai involve alternative medicine see Shetal (1998). ' Sse Zola ( 1972).

divergent. perspectives bring into relief the inadequacy of "an account limited to the medical profession and the state" because, for one thing, it presupposes or takes for granted the existence of docile bodies (Lock and Kaufert 1998:1 7- 19). in a similar vein. Lupton ( 1997) tries to bring the traditional conception of medicalization. which shr sees as upholding a view of power as primarily repressive. in line with a Foucauldian perspective o f disciplinary power which highlights its productive aspects (we will r e t m ta

this again below). Especially reievant to my present concems is an essay by Mark

Nichter (1998) which examines "self-initiated medicalization as [an] expression of agency." He reminds us that: Medicalization is not just the prerogative of the medical (psychological and medico-legal) profession and it is engaged for reasons other than social control. It is embraced by people for a variety of reasons. The medicalization of disorder m a i be self-initiated. engaged prior to medical confirmation or contrary to the opinion o f doctors. Health-care seeking ma' be undertaken to Isgitimize and vaIidate a sick role already assumed and enacted. ( 1 998:327) Nichter goes on to provide a detailed case study of Joan. a 60-year-old woman who creatively appropriates and exercises medical knowledge in a complicated and often trying trajectory o f self-initiated medicalization. in which she endeavors to have the knowledge and technology of biomedicine bend to her will. Joan's is a quest for mcdicalization-and

the simultaneous legitimation that comes with it-"on

her own

terms" (Nichter 1998% 1 ).

In this and the next section. 1 draw and diverge from Nichter's account of selfinitiated medicalization. In keeping with the theme of this chapter. part of my intention is to add yet another layer of complexity to what may be going on when patients d o i t tell their physicians about the alternative practices they use. Here. then. I explore what 1 have

corne to think of as alternative practitioner assisted self-medicalization. (Without comprornising rny meaning. there seems to be no way around this cumbersome phrase.) This section addresses how people use Iive blood analysis as a tool with which to more effectively access biomedical resources (not dissirnilar to Joan). while the nest section explores how alternative practitioners may assist in a process of self-medicalization that remains apart from establishment medicine. Echoing a point raised in the first chapter. whether we consider self-medicalization as a genuine expression of agency (as in Nichter's case study of Joan). an empowered stance of a pragmatic actor. or as a more insidious manifestation of disciplinary power exercised at the site of individual bodies. remains unsettled--or at least contextually contingent. Without knowledge of the persona1 intricacies of my informants' lives 1 cannot say whether self-medicalization in the context of Iive blood analysis was. for them. genuinely empowering. Clearly. it would be fooihardy to pursue such a complicated analysis based on an hour of

intenliewing or observation.

Anna's fibroids and Patricia's chronic fatigue: self-medicalization and biomedical rcsources Descriptions of strategies about how to get doctors to do what they were supposed to be doing-if

only they knew better-add

an interesting feature to conversations about why

people won't disciose some of the alternative practices they engage. To request a certain diagnostic technique-an

ultrasound or full blood work. for instance-on the basis of an

alternative health practitioner's assessment is risky. Clients and practitioners fear having

that request more forcefully denied or invalidated. Excerpts from two different consultations capture different aspects of this scenario. Anna. a 40-year-old German woman. pursued an ultrasound because of what she learned during a LBA consultation. Convinced of what she had '-seen"-the dimension corroborated her suspicions-she

visual

.'forced" her doctor to do the diagnostic test

she and Emily identified as necessary. For Emily, this was a special triumph. recounted in rny presence more than once. It was during a short segment of Anna's consultation

(her fourth visit this year) that 1 began to think more carefully about these issues. Anna: ...even though I went the traditional way with the medical doctor blood test and whatever ... Like [doctors] always tell you. "You're fine. you're fine. you're fine." 1 had fibroids [benign turnor in the uterine wall]. which they didn't find. I practically had to force them to let me go and have an ultrasound done. Because 1 wanted to investigate what's behind the.. . [motions with her hands] George: So how did you find out about the fibroid? Anna: Through Emily! 1 carneEmily: She's one of my ... 1 tell people al1 the time. 1 Say: --Don3go for a physical esam! Make them do the ultrasound now!" Anna: The doctor. she said. "Oh you're fine. you're fine." there were some irregularities. and so 1 can't be that fine. And so it kept on coming up .... George: Oh you mean in the live bloodAnna: In the live blood. And so 1 said. '-This is it." So the doctor that 1 usually see was on holidays. and somebody was filling in for her. So I practically said to her. "Listen: something's \\Tong here and I want an ultra-sound." And so. I did go. Emily: And she did tell the doctor that she'd been for blood analysis. and the doctor went. *'Humph." Anna: Yeah. Because the doctor said -.I don't believe in that." and I said -'welI. we will see." And then 1 came back [to &etresults] and 1 said. "Well. 1 don't know now. maybe you should give it more thouçht in the future, because very obviously [lauçhing] there is something to it!" Emily: It was terrific to have someone go who made sure they told the doctor afienvards. It was great. George: So what brings you here today? Anna: 1 have to see if 1 still have candida. 1 need to h o w where my stress level is. and last time 1 was here 1 had inflamed liver. pancreas. and spleen or something? 1s that right? Emily: Spleen. liver.. .and lymphatic sites of blockages.

Not altogether clear in the passage above is that Anna told the doctor about live blood analysis only afier getting a referral for ultra-sound. AM^ was convinced of the facticity of her bodily dis-ease: she went to see Emily-as \\as present-with

she did in the consultation in which 1

already well shaped ideas about what was the matter.

Anna uses different words to medicalize her persistent feeling of stress and tiredness. "Candidao' and "lymphatic blockage" (she came into the consultation that day just afier having had a "lymphatic drainage massage") are real medical concerns which allow her to naturalize-locate

within her body-e?iperiences of dis-ease that are also

social. It has been some time since she was last employed: her partner lives in Germany and she seems to have complicated feeling about his visits-she

repeatedly joked that she

has to "come in right away" to have her blood analyzed afier he leaves. Live blood analysis becomes a way for Anna to further devslop and negotiate her self-medicalization and. what is more. allows her to access hospital resources that will add legitimacy (and trratment) to that medicalization. She "practically forced them to have an ultrasound done" because she already knew ahead of time that her bodily experiences were accounted for by a medical condition.

Patricia. a hair-dresser in her middle thirties. went to see Emily because of an '-eye irritation. a two month rash that was now clearing up." She had been '.to the doctor several times" and had been given antibiotics for her eye infection. She added. '-The eye thing brought me here but 1 was also interested in Lvhat else could be going on-you know. with my health. 1 also have some emotional things going on." She also mentioned

fccling tired frequently. During the consultation. Emily observed "autoimmune

indicators" in Patricia's sarnple that "matched up" to Epstein-Barr Virus. This did not come as much of a surprise to Patricia. She recounts her experiences with her close friend and roommate for seven years who was recently diagnosed with chronic fatigue syndrome. Looking at Emily's "diagnostic" manual. she wonders. "Could this be arthritis and not Epstein-Barr? Suzy [room-mate] is so womed that it's contagious--chronic fat igue-fLbromyalgia.

too-she's had it for seven years." The conversation between

them takes an interesting turn as they take up the "problem [of being] properly diagnosed" and "getting legitirnate." A pressing concern for Patricia is that she wants to becorne pregnant and is unclear as to how she should be thinking about recent incidences in her life that have forced her to think more about such things as chronic fatigue. Emily suggests that she "see a doctor for a urine test and a full blood work-up. especially for white blood ce11 count.. .[if only] to rule out lupus." Patricia rernarks that she "would just like someone other than a doctor to be doctor." and the exchange continues: Patricia: [Apprehensively] Should 1 tell him why 1 want to have this done? Emily: Tell him what you want. That you have a rash. That you had some alternative health stuff done. [They look at each other for a moment; as if anticipating Patricia's question. Emily adds:] You can tell them that you had live blood analysis done. 1 don't mind. Just be prepared for them to go [she wags her head from side to side and makes propelier sounds from her lips] "Bpmprrr." and dismiss it. But p u should convince them to have it d o n e - e v e n if you have to tell them that you're pregnant, Whilc Patricia. like AM^ above. uses live blood analysis as a tool with which to pursue her self-medicalization. the texture of her pursuit differs significantly. Anna demands that she be properly (legitimately) diagnosed and treated for fibroids. Yet for Patricia. her self-medicalization bears an uneasy relationship to biomedicine.

1 presented Patricia's consultation witb Emily to illustrate the uncertainty

surrounding disclosure about alternative practices to physicians in light of the ofien tacit understanding that such disclosiires may prevent patients frorn accessing the resources they need. However. it is Patricia's provisional diagnosis-and diffèrent webs of social signification-that

irs entanglement in

requires delicate attention. As a backdrop to

my interpretation 1 present a fieldnote entry that gnawed at me for some time. When Emily stcggested to Patncia that she had "indications of auto-immune disorders." that her "dried sample" matched up with a photograph in the LBA manual for "Epstein-Barr Virus." I felt an uncomfortable pang in my stornach. 1 dissociated myself from the conversation by remaining silent. And so as not to reveal my discomfort. 1 lowered my eyes to the tip o f my noticeably agitated pen. Why did I feel this discomfort? Was it a muted awareness that Emily (perhaps) had violated some kind o f medical code. in the line o f practicing rnedicine without a license or something o f that ilk? Had my own epistemological predilections about bodily knowledge kicked in in such a way as to invoke distrust? Was this mild paranoia about the complicity of being there? What? As I drove home from Emily's office. I began to understand that rny feeIings in her office [only reflected] my ow-n susceptibility to the hegemony of biomedical science and its lasting legal imprints. This susceptibility made me miss what was. in the final instance. far more central to my crop o f concerns. Emily's clients willfully signed a consent form which explicitly stated her status as a non-rnedical practitioner-a point Emily often belabored-but they still sought out. encouraged. denianded. even. that Emily tell them whatever she could.. .

From the moment clients sign a consent form ucknol~*ledging that ErniIy is no, u rl~edical

simuitaneousIy acknowledge that what she says can be considered non-legitimate at any tum. While the ostensible purpose of the consent form is to demonstrate that Emily has not deceived her clients into thinking she is a doctor. it is also a necessary precondition

for the esperience of medical knowledge in the conteltt o f live blood analysis a s

provisional: clients can easily reject it or reshape it into a more contestually meaningful forrn. Emily cannot speak with the authoritative and reifying voice of biomedicine.

I am reminded here of Bakhtin's description of certain kinds of (internally persuasive) discourses that "can be fundamentally and organically fused with the image of a speaking person"-for

instance ethical discourse fùsed with the image of a preacher.

or philosophical discourse with that of a wise man (198 1 : 347). By extension. 1 would consider media1 discourse-however

fractured and polyrnorphous-to

be fused ~ i t the h

image of a doctor. To invoke medical discourse is. more or less. to invoke an image of a doctor as a speaking person. I suspect that while clients speak with Emily as ij'she were a physician-albeit

a more conversationally accessible one-they

simultaneously

esperience her -'assessment" as that of a non-physician, without any imprint o f legitimacy and authority. While Patricia entered the consultation with words like "chronic fatigue syndrome" and "fybromyaIgia" at the tip of her tongue. and her experiences with LBA enabled her to further develop a medical vocabulary through which to describe what she \vas esperiencing. she certainly did not leave thinking she had chronic fatigue syndrome

in the biomedical sense of the phrase. That is. she \vas aware that what Emily called -'Epstein-Barr-' were "indicators" which. like Ralph's hyperthyroidism. did not necessarily correspond to Epstein-Barr or chronic fatigue." 1 would also suggest that for Patricia. the category of chronic fatigue remained malleable. of undetermined elaboration and legitimacy. without the rigid imprint of biomedical authority. (Indeed. she even

'' The goinç wisdom in biomedical discourse is chat there is linle evidence CO support the causal link bct\vecn Epstein-Barr Virus and Chronic Fatigue Syndrome (Merck Manual of~Cfedicallnforntarion 1997).

participated in choosing which "diagnostic'' photograph best matched her blood sampleT o u l d this be arthritis and not Epstein-Barr?") And yet a significant aspect of this selfmedicalization is the interplay with establishment medicine. and flination with the sort of legitimation that may earn someone a disability pension. Simultaneously attracted and repulsed by the possibility of havinç conditions diagnosed by alternative medical practitioners aIso legitimated by physicians. the question of telling one's doctor is not necessarily about good bedside manners and open-mindedness: it is also about what is at stake when the pGwer over one's self-medicalization is wested away from the individual by the medical establishment. For Pairicia. control over her self-medicalization must also be negotiated with the desire to access biomedical resources.

Below the threshold of signs

Emily ofien contrasts what she does to what "a medical doctor would do." Something to consider here is that for a lot of people. the symptoms they esperience faIl below the threshold of what medical doctors are trained to deteci as signs. Patricia's eye infection and Anna's early detection of fibroids illustrate this point. During my consultation with Ernily we spoke about being tired-about Of

my feeling tired and the persistent esperience

tN-ecl for which people seek her advice. "Well if you ever went to a medical doctor

they'd jusi go. "Oh you're fine. Go home. If you're tired have a nap." Tired. at the intersection of the individual's felt experience and LBA becomes a medical concern. Sometvhere between the acceptable level of everyday tiredness and the dubious diagnostic category of chronic fatigue. the tired which 1 speak of here is a tired that forms the stuff of self-medicalization. It is shaped out of a bodily experience that somcthing is 65

awry which refuses to be mollified by a physician's non-diagnosis. "Nothing to wony about. You're fine." In a brief interview with Pascal. the father of a sixteen year old client. he explains that they went to see Emily because their physician would not properly medicalize his son's fatigue. George: So what sort of problem brought you here today-for your son 1 mean? Pascal: We went to a normal doctor because my son is [always] tired. His energy is low. The doctor-specialist said he has '-the yuppie flu!" Can you believe that!? 1 thought. --What kind of thing is that?" George: The Yuppie flu? That soundsPascal: Yeah I didn't think he would be much help afier that. My son told him he was "full of farts." and he said. -'that's because you're fuI1 of beans." [tosses his hands in the air] Doctors! And I'm supposed to think that he will help us?

Like Pascal. Giota. voices her awareness that doctors are unable to handle vague bodily cornplaints such as feeling run down or sluggish. She talks about her encounters with LBA as "a much more gentle way of accessing" her bodily h o w l e d g e that slie was unwe:Il. She understood that these experiences were very closely related to her father's

death . When 1 asked her to "tell me about what brought her to LBA'. she responded: 1 think on some IeveI it was really. really abstract. It was just under this umbrella like. T m not feeling that great. I'm not feeling as well as 1 want to be feeling." 1 didn't have as much energ?/ as 1 thought 1 should. 1 was working out. but I still felt a little sluggish. It was al1 of those things that I find really hard to relate to a doctor. To identifq. and also to relate to doctors. Because 1 don't think it's very easy for them to actually be able to pinpoint conditions like that because okay. T m not feeling that well" or T m tiredo*-it could be so man' di fferent things from a medical perspective. And 1 think what happened with Ernily is she was able to see specifically: "Okay. there's too much protein in your blood. so that's going to thicken the blood. so the circulation's going to go a lot slower." And there was some candida which of course is going to have effects in terms of energy levels and how you feel generally. and digestive system-that was another big issue." Like. she could tell how well my digestion was actually working in that it wasn't coming up to par. And 1 think that sort of stuff. which has a lot to do with diet. it doesn't have to do with taking a pill and everything's going to be alright. It has to do more with changes that are long term. Does that answer your question?

George: Yeah.. .so what brought you in there was s o n o f the lasting experience of being tiredGiota: Yeah. specifically. yeah. And a lot o f it had to do with my emotional state at that point too. and 1 know a lot of it had to d o with stress. And 1 really wasn-t sure how much of it was physical either. And it just seemed like an easy way to kind o f access it without being like. "Oh. there's something really seriously il1 about me." It wasn't anything like that. 1 \vas very. very conscious that 1 was under stress at that point-I was very depressed cause my dad had died. and there was a tot o f factors going on. And it just feh a much more gentle way of accessing al1 this stuff. George: Did you see a doctor around that time too? Giota: No. I didn't. Actually after we were involved with doctors for a while with rny dad. 1 actually haven't seen doctors after that. So 1 mean 1 just haven't really bothered.. .. But in the past 1 have gone to the msdical profession. -'I'm not feeling well, I'm feeling tired." that sort o f stuff. I never really got any help on that sort o f thing. And 1 don't know even if they can. George: Like if it's within their domain? Giota: Yeah. yeah. And wtiat's reaIIy interesting actually for me kvas. Emily was able to see that there's some thyroid indicators. And 1 said to her-because 1 know she has suggested to other clients. "Maybe you should go to the doctor and get this checked out. or have this blood test." And 1 asked her if 1 should go see a doctor. and she said. -'Weil you cortld .. . but you're probably within the normal range. but maybe you're probably at either end o f the range. so they probably wouldn't see it as problematic." And I thought that was real1y interesting. because there's a lot o f times-and this is what we were talking about with the blood tests - you're in this range which they assume to be normal. but that doesn't necessarily mean that you're feeling well or that you are normal. it just means that their data. their ideas. their perceptions of what is normaI. then you fit in rhew. Giota's use o f LBA as a way to ascribe medical significance to symptoms that faIl below the threshold o f biomedically recognized signs is esplicitly articulated in this passage. 1 ivould suggest that her remark about how live blood analysis enabled her to conceptualize her bodily dis-ease "without being like. 'Oh. there's something realIy seriously il1 about

me.'" speaks to the sense of control she is able to exercise over her self-medicalization. While Giota repeatedly emphasizes the social contest o f her experience of dis-ease-her father's recent death. her dissertation. an awareness o f social mores she identifies with being a single woman in her mid-thirties-it

becornes transformed into a medical

cornplaint to be addressed through a candida cleanse. a variety of dietary proscriptions. vitamins. supplements. and exercise. Giota identifies her experiences with live blood analysis. especially the transformation of her vague but persistent experience of *'net feeling well'. into a concrete biological etiology. as -'really empowering." It is worth noting that despite only making a brief allusion to '-candidagoabove. the scope of Giota's health concerns were condensed into the word candida. Both Giota-on the telephone prior to our meeting-and

Emily explained to me that candida was the main reason for

her last three appointments with live blood analysis.

A second sideward glance at power

Is LB.4 a site of -'resistance." an effort to evade or deflect Foucault's elaboration of the '-medical gaze" and the disciplinary power esercised through its objecti@ing. dissecting ocularity? Are the bodies that enter into such sectors of alternative medicine as LBA "rebellious and 'anarchic' bodies-bodies

that refuse to conforrn (or submit) to

presumably universal categories and concepts of diseases. distress. and medical efficacy" (Lock and Schepher-Hughes 1996:43)? This. of course, would be an interpretation mors or less congruent with practitioners and clients who identiQ their medical activities as

part of a more collective protest against biomedicine (Cant and Sharma 1996). as it would with the voices of doctors in editorials and clinic corridors who think of the proliferation of alternative medicine as a threat to be quelled or a source of change to be cautiously welcomed. Among whatever else could be wrong with it. one of the problems with this line of thinking is that it juxtaposes biomedicine and alternative medicine in such a way that we 68

are often I& with a lasting illusion of categorical c o n t r a t and separation-a

divided.

two-systems view of things. 1 understand the relationship between alternative medicine and biomedicine as a complex mixture of critique and compticity. characterized by an ongoing verbal-conceptual trafficking. While this is not the place to elaborate such an understanding. 1 do want to emphasize that it is necessary to think of biomedicine and alternative health as sharing certain core cuitural values that center on the remarkable moral significance of health as an individual responsibility. -4s Robert Crawford. among numerous others. has noted. "The emphasis o n individual responsibility for health mystifies the social production of disease and undermines demands for rights and entitlements to medical care-' (1984:75). Ironically. whiie we can say that the process of aIternative self-medicalization associated with LBA is ostensibly an effort to address one's right and entitlement to medical care. it also risks participating in a process of mystification that relentlessly situates social dis-ease at the site of highly individualized bodies. And while many of the accounts 1 have presented above c m be heard as direct or indirect critiques of the (bio)medical rnodel. they. like the practice of live blood analysis. seem to estend biomedical hegemony while simuttaneously attempting to subvert it. We can sa?. for instance. that both clients and practitioners submit to "biomedicine's

hermeneutics" (Good 1994)-the

interpretive practice of mapping signs and symptoms

ont0 specific categories of illness-while of physicians.

continually contrasting their activities to those

Chapter 3

Of Parasites, Candida and Antibiotics: A Dialogical View on Live Blood Analysis

At the doctor things stay as arthritis. This is more than arthritis. Arthritis is more than arthritis. --Janet, LBA client Candida usually infects the skin and mucous membranes. such as the lining of the mouth and vagina. Rarely. it invades the deeper tissues as well as the blood. causing life-threatening systemic candidiasis. --ibfwck !bfanzml of Medical Informurion

Etreryone has a little candida in their blood. That's normal. --Rachel. house-keeper. LBA client

m ] o living word relates to its object in a sing~tturway: between the word and its object. between the word and the speaking subject. there exists an elastic environment of other. al ien words about the sarne object. the same theme.. ..[T]here are no "neutraI" words and forms-words and forms that c m belonç to "no one". .. Al1 words have the "taste" of a profession. a genre. a tendency. a Party. the day and hour. Each word tastes of the context and contests in which it has lived its socially charged life: al1 words and forms are populated by intentions. Contestual overtones (generic. tendentious. individualistic) are inevitable in the word. --Bakhtin 198 1 9 7 6 : 293

Yeast and bacteria in Peter's blood

Emily: [Watching the monitor; pointing] Nice T-ce11 here. perfect. Another w-hite blood ce11 there. [Very surprised] You've got yeast! You didn't have this before. [Pointing] There's candida there. Peter: [Subdued] Wow.

-

Emily: And there's sorne bacteria in your blood-1 wonder if it's going to be related if. if we're going to see something in your bowels in the dry sample. Peter: Could that be that bread: every morning 1 have a slice o f Sour dough andEmily: 1s it homemade sourdough? Peter: You better believe it it's home made and it isSarah: [Has been silent for some time] But there's not much yeast in that. darling. With the sourdough you get less yeast. And 1 don't think one slice a day is going to d o it. Emily: Yeah. 1 d o n 3 think so either. Peter: Hah. Emily: Now yeast could be related to your. your digestive health in general though: you're not breaking things dowm well. Your stomach aciditySarah: I told you to take somc o f that digestive enzyme Iast time and you didn't. Emily: Your stomach acidity also helps kill foreign matter that enters your body through your foods and things and your water. Your acid is your first "antibiotic" in your body. it kills a lot of stuff so if that's not really there as much. 1 mean your protein digestion looks really good. but there might be fats and sugars and that may feed stuff like this [indicates candida on the screen]. Peter: 1 see. Sarah: What about butter? Emily: [Tentatively] Nooh. That's an animal oil and our bodies really respond to that right away-it's the vegetable oils-I'd rather see someone use butter than margarinePeter: I've been eating raw. raw vegetables a lot: cucumbers. broccoli. cauli flou-er. mushrooms.. . Emily: Yeah I'm sure your getting a lot of good enzymes if you guys have your ow-n garden. Peter: That was interesting. that yeastEmily: Yup and it wasn't there before. [Pointing with her pen] You c m see the big mycelial root coming out o f it. here. Peter: Okay. Emily: That's how they l e t through the intestinal wall. Peter: 1s that right? Emily: They root through it. Sarah: You shouid go on acidophilus. too. Emity: Every night before you go to bed. Pop a couple of acidophilus. ..[Has been looking at the screen a s she speaks] You d o n 3 have any plaque. realIy. or anything like that. Peter: [Assenive] No. now 1 d o i t see an. plaque there. do 1. Emily: No you d o n 3 have any fats in your blood to a great degree. You're going to be just finePeter: That's the beans [Emily laughs. Peter goes on to recount his different morning eating rituals in which beans figure prominently. He also mentions that he has '-had 60% of his stomach removed."]

Emily: Oh here's a nice B-cell. It's a ce11 that helps fight things off with antibodies. Peter: [Subdued] Wow. Emily: Good white blood cells. Peter: Aha. Emily: Nice and healthyPeter: Aha. Emily: Nice and big. but [switches tone: nith mild emphasis] yeast everytvhere Peter. You have more than Sarah. Peter: Yeah 1 saw that. [Alluding to Sarah's session which he attended.] Acidophilus is thatSarah: That's why I've been taking four a day-because of being on those antibiotics. They kilt al1 of your good bacteria. and of course you build up that yeast. Peter: The candida-that is interesting because the last couple of weks 1 have been couçhing up a little bit of mucous before doing yoga-and afier doing yoga of course. it's completely stopped. But I know that there was something there that wasn't right. Emily: There's quite a bit of bacteria in your blood. too. Sarah: What would cause that: well water? Peter: Not enough garlic.. .[Laughter: Peter eats roasted garlic every moming to "boost his immune system"] Emily: Well bacteria. we can breathe it in-it depends on what kind of bacteria it is-the thing is though you shouldn't really have any in your blood. [In Sara-s consultation Emily had highlighted that a minimal presence of candida and parasites was normal.] As far as bacteria goes your blood should be pretty aseptic. A doctor would argue that if you had bacteria in your blood you're pretty much going to die [parodyingl-"Your're on your death bed. you-re in the hospital. on IV and stuff." They don3 recognize the progression.. .of the number of bacteriayou're introduced to it. your body fights it for a bit. it either wins or loses. right. So. you're right now being introduced to bacteria that weren't in your blood before. They might have gotten into the body through the digestive system. it's just beginning to weaken a bit and is more porous and things are able to get through so you're getting yeast and bacteria through the biood. Sarah: And raw hamburgers. Emily: Raw hamburgers?!! Sarah: He loves it. Peter: Tartar. Oh delicious. Emily: Hamburger? 1 though that \vas steak. Pcter: Oh it is steak. shoulders. ground shoulders. Okay. sometime she puts in some French onion soup.. . Emily: Peter: I'm ail for al1 the things you do. but 1 don't know about this raw meat thing, 1 d o i t know about that. [laughtcr] Peter: Well I'm seventy and I've done it since I'm six years old. George: Six or sixty?

Peter: Six. George: Six. Emily: Well 1 suppose it's not killing you. Peter: No. not after this much. And when she comes down with that nice ground roast-ground shoulder f laughter] ... Emily: Well al1 I'm going to Say is that you don't have the digestive tract of a s i s year old anymore.. .better ease up a little bitPeter: The truth comes out in the end! Emily: [Laughingl you can't hide anything from me. Peter. Peter: Okay. No more raw hamburger. From two cloves of garlic 1-11 go to four cloves.. .. --What is really at issue in the increasing number of people visiting alternative practitioners." w ~ i t e sEmily Martin. "is not medical fraud or charlatans but the incompatibility between biomedicine's view of the body and the immune system and the ~ e i e ~ of v s many nonmedical people. Alternative practices offer a place where the comples systems thinking that so cornmonly accompanies how people talk about the immune system can meet an enthusiastic response. a response thar is u b k ro subordinaie biomedicine by incorporming ir" ( 1 994:90. emphasis added). The vignette above offers us a window ont0 how biomedicine is subordinated through its incorporation. and yet. as we \vil1 explore more carefully below. how this is not a neat incorporation-an

of packaged ideas or practices o r images-but

inclusion

one that induces an intermingling of

meanings and words. Parodying a physician. Emily incorporates the voice o f biomedicine into the consultation. Her remarks about the presence of bacteria. as well as

of candida and parasites. are made in opposition to and in dialogue with an imagined voice of biomedicine. This is a dialogue in which Sarah and Peter participate- indeed one in which we al1 participate to different degrees and to different degrees of awareness.

The limitation of an empiricist view of LBA We have become saturated with medical language and medical images. Magazines. radio

programs. the internet. a plethora of health practices and practitioners.. .everything d o m to our everyday conversations conspire in this saturation. Martin ( 1 994. 1996) has considered saturation as the immense diffusion of concepts and images through which our culturally attuned understandings o f our bodies and our health have become inextricably tied to notions of the immune system. As a participant-observer in the office o f a live blood analyst 1 became acuteiy aware of the central significance o f the immune system in understandings o f health. "My immune system is down." -*I need to Cet my immune system in line again." "I want to see what's going on with my immune system." were rcmarks s o common that they seemed to be lifted out of a cultural script. 1 was often reminded of Martin's discussion o f her encounters kvith alternative health practitioners ~vhiletracking the immune system through innumerable nooks in American culture. in a-hich she suggests that "[tlhe immune system serves as an entirely compatible link. a seamless weld. really. between biomedicine and alternative therapies" ( l994:84). Live blood analysis seems. arnong its more nutrition oriented functions-I the link between nutrition and immunity is certainly well developed-a

hasten to add that way for people to

access concrete images of their immune systems which may otherwise remain a more abstract. versatile metaphor or idiom through which to talk about one's heaIth. To see the immune system at work is. in the context o f live blood analysis. to see the presence and activity o f white blood cells. and. as well. entities implicated in one way or another to its

proper functioning-parasites.

fungus, bacteria. But now we have slipped from the

scientifically acceptable and real (knowledge of the immune system in t e m s of white blood cells) to the scientifically discredited and cooked-up (beliefs about the presence of candida and parasites in the blood of apparently healthy. ambulatov humans). Or have \ve?

Does knowledge of the real make beliefs of the faIse go away? Concrete packages of understanding displacing or substituting other concrete packages of (less desirable)

understanding? This at least is a way of approaching the problem of what medical or scientific facts people know and don't know consistent with a narrowly empiricist view of medical language that privileges biomedical rationality. Such a view presupposes the existence of an objective. medical reality that precedes interpretation. Within this medical reality words directly relate to objects: appropriate diagnostic terms correspond to discrete disease entities (Good 1994). Medical words used the right way. demonstrate knowledge of that reality. Medical words used the wrong way. demonstrate a lack or misuse of knowledge. or reveal beliefs about something which is not real. Let us glirnpse at this pervasive ordering of reality at work on live blood analysis and its clients:

In a recent article in The Ct'csrem Jowncri of Muficine which takes issue with -'unproven questionable cancer therapies." live blood analysis is discussed in a section intended to farniliarize its readers with '.bogus and unscientific laboratory investigations." whose "proponents are ofien slick promoters who use plausible scientific jargon. operate high-tech modem facilities. and boast walls of diplomas" (Brigdcn 1 995 3). Speaking to a biomedical audience. the author does not have to go into any depth as to why analysts'

claims do not hold up-we

are apparently clspected to nod in acknowiedgement that what 75

is folried is also erroneous. From an (affected) objective distance, dismissal is quick and easy: --This analysis is touted as being able to demonstrate the activity or inactivity of the immune system. the presence of live fungi or bacterial f o m s in the blood. parasites. cq~stallinestructures such as arterial plaque. and other bodily imbalances" (Brigden 1995:8). Implied here. 1 would suggest. is the juxtaposition between clients' and

practitionen' bdiefS. and the anticipated reader's kno~~ledgr. That alternative medical practitioners unjustly avail themselves of scientific rnedical language so as to mystify and dupe their clients is an accusation rather commonplace to biomedical discourse. In an article that maintains a view of alternative medicine as deeply associated-if

not interchangeable-with

quackery. the authors. both

mernbers of "The Council for Scientific Medicine" assert that "today's promoters wear the cloak of science. They use scientiiic terms and quote (or misquote) scientific references" (Jarvis and Bailett 19933.' The logic underlying these sons of assessments entails a strict division between scientific knowledge and people's beliefs.

In his critique of the empiricist approach in the medical social sciences. Byron Good demonstrates how "belief typically marks the boundaries between lay or popular rnedical culture and scientific knowledge" (199439). and how the juxtaposition between the iwo-explicitly

or implicitly-is

enmeshed in relations of power and authority.

Further. what is interesting (and challenged) in light of the ethnographie sections that follow is that the boundaries between these two categories are somehow maintained as

1

The Councii for Scientific Medicine has recently launched a journal, The Scicnrifîc Review of .-llrernari~:r :\ledicine. backed by a srnattering of Nobel Iaureates, and devoted "entirely to the scientific. rational evaluation of unconventional health claims" (Wadman 1997:775).

mutually exclusive-apparently.

if you have scientific knowledge about candida then you

~vouldnot believe that you could see it in your blood. In the context of live blood analysis. with its "strange mixing of science and pseudoscience." as one critic put it (Lowe11 1986). another layer to this juxtaposition is added: scienti fic language is appropriated to convey nonscientific beliefs. The following passage gleaned from The

Georgia Struighi. a Vancouver newspaper that is both free and easily accessible. brings this issue to the fore. Obviously intended to debunk LBA by showing how rnisguided beliefs dissolve under the light of real medical knowledge. the author muses: Concerned about yeast and the possibility of (gasp!) parasites in my blood. 1 asked Buskard [professor of hematology at the University of British Columbia] to give me his opinion. -'It wasn't yeast." he said. 3t.s very, very rare to see an organism in the blood. If you see an organism in the biood. that person is very ill. They won't be walking in off the Street in good health looking for an analysis."(Wilson 1998)

The now belief. now knowledge formulation is comically evident in a pathologist's \\.ebsite intended as a -'Guide to Alternative Medicine." He concludes his section on tive blood analysis with a rather incredible exhortation: "if you are involved in 'live blood analysis.' I understand how you got the mistaken impression that you're looking at undiscovered disease agents. and 1 ask you to stop deceiving yourself and the public" (Friedlander 1998). Sympathy, power and bad faith are al1 wrapped up in a simple assertion about how words do not correspond to their objects: "These structures j ust

we know about aren't parasites-or if they are. we're going to have to rethink e v e ~ h i n g

chernistry, physics. and the basics of biology" (Friedlander 1998).' It is ironic that the author inadvertently touches on a significant issue. one that is illustrated again and again in the ethnographic passages below: for some people it is the necessity to rethink what the? know that moves them to place a different accent on such words as parasites or candida. That is, most clients are well aware of how such entities as candida and parasites are defined in the official. biomedical discourse. as they are simultaneously aware that such definitions are ofien incongruent with. or unconvincing in light of. their own bodily experiences. In the context of live blood analysis become re-accented in such a way as to sirnultaneously develop congruence with people's lived experience while remaining linguistically tethered to their (biomedical) discursive origins. To Say that scientific language is simply appropriated and employed toward whatever purposes. rrreatly obscures more intricate processes at work when people speak and know medical

b

knowledge in such contexts as live blood analysis. What 1 want to show in this chapter is that the way people speak and know medical language is far more compiicated than an empiricist view of language would allow. Whether to debunk or to celebrate. when we set out to describe people's usually tluid conceptions of their bodies and health-conceptions that are aiways being contested and reshaped by the very fact of existing in a sociaI world-in

terms of beliefs or

1

- The manner by which doctors' views on LBA discredit the analyst's ability to see an "objective rea1ity"that is. to sce what is actually there, in the blood, and not sirnply an artifact of their technical incornpetence and sketchy. un-scientific reasoning-calls to mind Evans-Pritchard's famous account of Zande autopsy. lt is an inevitable conclusion fiom Zande descriptions of witchcraft that it is not an objective reality. The physiological condition which is said to be ihe seat of witchcrafi, and which I believe to be nothing more than food passing through the small intestine. is an objective condition, but the qualities they attribute to it and the rest of their beliefs about it are mystical. Witches, as Azande conceive rhern. cannot esist. (Evans- Pritchard. cited in Good 1994: 1 1 - 12).

knowledge. we also inadvertently rei@ them into concrete. bounded objects. Much of the biomedical and social science Iiterature on alternative medicine 1 have encountered tends to focus on descriptions of practitioner and clients' beliefs-knowledge purpose is evaluative-that

claims. if the

sets them apart fiom biomedicine. This. of course. is

especially evident in the excerpts cited above. What 1 am a r g ~ i n ghere is not so much that this separation does not exist. but that it is constantly traversed in such a way that a neat account of words as bounded objects holding specific rneanings. to be understood or misunderstood. is inadequate. Indeed. these ongoing traversals through rnedical spaces seem to "trail debris of meaning" (Smith 1998). Returning again to the theme of saturation with which 1 began this discussion. 1 want to move from thinking about how ive are saturated by medical images and language to how medical language is saturated with meanings and intentions. and how we participate in its saturation. In the first chapter 1 alluded to Bakhtin's notion of re-accenting to describe how certain medical words are used to indicate conditions before they have taken a form recognizable to biomedical criteria. In the second chapter we witnessed how clients incorporate alternative medical knowledge in a process of self-medicalization. drawing on live blood analysis as one of many resources through w-hich to transform and conceptualize their health complaints into self-managed medical problsms. And yet while it should be clear by now that the people 1 have been wrïting about reshape and evaluate medical knowledge in the very local contexts in which they construct their daily [ives. we have yet to carefully attend to the relationship of medical knowledge to medical Ianguage.

Medical knowledge is not stored in vials or textbooks o r hard-drives o r doctors' heads. always in the form o f tightly packaged facts. Bakhtin ( 1 98 1 ) provides us with a w q - of thinking about (medical) utterances that does not limit analysis to a simplistic.

reifying conception o f what people know or don't know. His image o f language as a dynamic struggle of centrifuga1 and centripetal forces offers a compelling approach-a guiding image. perhaps-through

which to better understand how medicaI discourse

csists in a social world-especially in people's mouths and ears. Bakhtin's insistence on not treating the word as "a dead material object" but as "lh-ing" ( 1 98 1 :4 1la-9)

ways

fraught with meanings and intentions. entangled in ongoing yet incomplete processes of re-accentuation. is especially instructive. By drawing on Bakthin's insights on "Discourse in the Novel." we can meaningfully consider how clients of iive blood analysis can have hyperthyroidism which is less than hyperthyroidism. and arthritis which is more than arthritis. Or how such words as candida and parasites may exist simultaneously on two contradictory conceptual planes. Inspired by Bakhtin. over the course of this research 1 have taken to thinking about biomedicine as casting itself in the image of a unitary language set in opposition to the heteroglossia that marks our everyday conversations about our bodies. health and illness. as well as the heteroglot conceptions of alternative medicine. To be clear: 1 am not suggesting that biomedicine is a u n i t q language but rather that it posits itself as a unitary language (Bakhtin 198 1 :270).' It is in the guise of a unitary language that biomedicine

' M y consideration o f biomedicine as a unitary language resonatcs with Paul Unschuld's claim "that the n~onotheismof the Western medical tradition has had a determinate effect on biomedicine" (Kieinman 199527). Drawing on Unschuld. Kleinman goes on to note. '-Alternatives may persist in the poputar culturc or ar the professional fringe. but they are esecrated as false beliefs by the profession as a whole, not unlike the accusation o f heresy in the Western religious tradition" (199527).

atternpts to author a singular. universal view of medical reaiity. Further. as it pursues a unitary conception of itself by opposing the social and medical heteroglossia in which it is awash. biomedicine makes itself known as an authoritative discourse. In Bakhtin's words. "Authoritative discourse pennits no play ~vithits borders. no gradua1 and flexible transitions. no spontaneously creative stylizing variants on it. It enters our verbal consciousness as a compact and indivisible mass" ( 198 1 :343).

Implicit in authoritative discourse. then. is a necessarily reified and

dialogically inert conception of words-as-objects. In light of the previous section. 1 would argue that this conception of words is (falsely) applied to understandings o f how (medical) words are voiced by people in Society (a view of language that goes hand-inglove with assertions of "belief' and "knowledge" as durable. bounded categories). What

is more. when biomedical language enters into non-biomedical contexts its subjection to

linguistically "centrifuga1 forces" becomes apparent. In other words. biomedicine is brought into dialogue with the medical pluralism it opposes. One way to think about live blood analysis, then. is as one of the many sites that operate as "dialogizing backdrops" to the image of biomedicine as a unitary language. Words moving in and out of such contexts are opened up to new meanings. new viewpoints: they are relativized. de-privileged (Bakhtin 198 1 :400). We can say that live blood analysis is among the endless number of social contexts that are "capable of attracting.. .words and forms into their orbit by means of their own characteristic intentions and accents*' (Bakhtin 198 1 290). And as we witnessed in the ethnographie section above. these ne\: accents and intentions are evoked in dialogical tension with

biomedicine. with its imagined voice. Re-accentuation, however. is necessarily

many words stubbomly resist. others remain alien. sound foreign in the mouth of the one who appropriated them and who now speaks them[. ..] Language is not a neutral medium that passes freely and easily into the private property of the the intentions of speaker3 intentions: it is populated-overpopulated-with others. Expropriating it. forcing it to submit to one's own intentions and accents. is a difficult and complicated process. (Bakhtin 1981 294) It is precisely because re-accentuation is incompletr-that

displace an old one-that

a new accent does not fully

we c m speak meaningfully about certain words as '-double-

voiced." or "intemaily dialogized." It is my contention that clients of live blood analysis esperience such words as "candida" (Cmdida alhicans).parasites. or even antibiotics as double-voiced. simultaneously aware of the agitated relation between the biomedical and non-biomedical viewpoints embedded within their permeable ~vord-shells.

Parasites: 1 suspected it

l-iaving only attended four consultations. 1 was a little surprised. if not perturbcd. \\.ben Samantha. a thirty-four year old hospital nurse. came in to have her blood analyzed.

My response was due in part to the fact that she kvas a nurse. and. in part because she was the first to read carefully over my consent f o m . twice questioning me on how 1 was going to "ensure confidentiality." Sarnantha was open about how she did not want knowledge of her doing live blood analysis to make it back to her "colleagues at work." 1 was not open about my nervous curiosity of what obstacles her medical knowledge would potentially pose to the analysis.

At first cautious and reserved in her responses to Emily's comments. Samantha later revealed that she was specifically concemed about the possibility that her previous travels abroad (she would be leaving the follow-ing week for another trip) had lefi traces in her blood-that

is. parasites. Two points beg highlighting: Sarnantha only mentions

this . ~ o n c e m "afier Emily has identified a parasite in her sample. and. as the escerpt below intimates. she is well versed on the "official" medical discourse on parasites. As soon as Emily. albeit a little cautiously. mentions that the squirrny. bIack tubuiar thing on the screen is a parasite. Samantha esclaims. "1 suspected it." Samantha: I was realIy sick after my last trip. Went on three courses of antibiotics.. .[she explains that she bas been sick several times following travels abroad] and once it was a form of amoeba they weren't even sure about. Emily: People wonder why 1 don't tell them what parasite it is...[emphatically] when there's rhortsunds of species. Samantha: Yeah andEmily: And in a visual test like this it's virtually impossibleSamantha: Actually I've studied parasites-they fascinate me. Emily: Oh really? Sarnantha: Yeah it doesn't bother me [motioning towards the screen]. Emily: Another clientSamantha: That's the reason 1 suspected 1 hadEmily: Has discovered a web site that has photographs of parasites Samantha: Oh really? O.k.. 1 used to teach a littte-basic health care stuff. We'd use pictures. you know: this is the classic giardia case. This is the classic amoebae. Emily: Yeah.. . Sarnantha: [Tosses her hands up and laughs] And then one of rny friends said that she had some parasites in her blood. (AI1 of our eyes move back to the monitor.] The presence of parasites in Samantha's blood worked as a conversational ice-breaker: from the moment we al1 acknowledçed their presence. she became more animated. more at ease to speak about things she "knows." This dialogue is shaped out of a certain confusion and uncertainty. fractured by interruptions that anticipate implied meanings rather than overt statements. and yet it provides a glimpse into the intemal dialogism of

the word. As Samantha shitis fiom representing herself as a clinical instructor to the nonclinical realm of her everyday life. the word parasite becomes (incompletely) re-accented. Her laughter signals this shifi. As a clinical instructor-she esplicitly-she

later reveals this more

"knows" that parasites '-shouldn't" be present in her blood. Yet as she

faces the screen. she "knows" that what she sees is a parasite. Indeed. this is what she --suspected." The word parasite. in Bakthin's terms. is shor rhrolïgh rvirh meunings und iiiieniions from the previous contexts where it has livsd its .sociuff~* c-hurgrdIV&-from

her esperiences in the hospital. in nursing school, as a clinical instmctor. conversations ~vithher friends. in the office of a live blood anaiyst. These previous contexts inhabit the n.ord. T o my mind. it is the effort to deal with this saturation neatly-a destined to confusion-which

project no doubt

makes the dialogue above so uncertain. Moreover. the

\vord "parasite" is given a certain accent by the analyst. one that stands in opposition to

the accent it takes on in biomedical contests. The re-accentuation of parasites in the contest of live blood analysis is hard to miss when Emily remarks. "the parasites doctors are trained to identify correspond to specific diseases.. .what we see in the blood are

parasites. but they rnay have nothing to d o with a specific disease state." As both speakers seem to be aware of this they are also both uncertain of the response to expect from one other-that

is, each is uncertain o f the distance (or proximity) they can presume

the other is located relative to the dual accents of the word "parasite." Just as Samantha used live blood analysis as a way to test her "suspicions" about the meaning of parasites in the context o f her body. Lian. a 23-year-old woman on her way to Iridia. announced to us in the presence of her openly skeptical boyfricnd: "1 suspected the yeast. 1 suspected parasites and bacteria. 1 suspected my Iiver." Like 84

Samantha, what Lian suspects is the possibility of a very different viewpoint on her body. Havinp "read a lot about candida and parasites." she. too. expresses awareness about how these words are otherwise accented. ffiowing that the meanings of parasites and candida she has corne to learn and accept through her esperiences at health food stores are typically dismissed by --traditional doctors." she opted for [ive blood analysis over a ~ o o sarnple" l (the other possible option she had identified). That Lian and her boyfriend wsre aware of simultaneous and contradictory accents becarne even more apparent whenever he awkwardly uttered the words "candida" or "parasite." inevitably affising at the end of each a resonant question mark-an

open invitation to an argument which. with

the esception of an occasional exchange of quiuical glances. did not take place.

Grapeseeds: Basically the concept of parasites hasn't clicked

Sarah has a chronic respiratory condition over which "the specialists are abso lutely baffled"; she describes herself as 'ljust going down hiIl." ofien unable to get out of bed. .4lthough both Sarah and her husband. Peter. have incorporated [ive blood analysis into their repertoire of health practices-analogously. e>.e check-her

as Sarah put it. to a general

health concerns are clearly the main reason they travel for over an hour to

have their blood images analyzed. She explains that three years ago she came to the

conclusion that parasites were responsible for her condition: How 1 discovered it myself is. we were in for a test in Vancouver. and 1 happened to walk across the Street and saw this vitamin store. and my eyes just went to this parasite cleanse. And prior to that 1 could actually lay in bed and hear them. eating my stomach out and feel the movement in there. So of course when 1 saw that parasite cleanse and 1 read it. it just sort of clicked.

Peter describes this r n o r n e n t 4 r rather, the moment Sarah took him back to the vitamin store-as

when the "green light went on." A week later. afier having done some

"background reading." they returned to the vitamin store and spoke with "the proprietor ~ v h obasically understood exactly what [Sarah] was going through." The second tirne things "just clicked" was when they encountered an ad for [ive blood analysis in Comrnon GI-ultncl.an alternative health magazine issued monthly. For Sarah and Peter. live blood

analysis was a way to visualize Sarah's parasites. 1 happened to be sitting in on their third consultation-the

one in which Emily did not Bnd anp parasites. "none whatsoever in

[Sarah's blood ample].^ When Sarah. smiling with pleasure. exclaimed. '-Hear that?!." Peter responded approvingly. "Yes. It's true. If there were any we could see them

moving around like little sea horses." Peter's serene conception of parasites as little sea horses is. strangely. at odds with Sarah's disturbing experiences with them. and with the symbolic proportions with which they are later imbued. As the material and symbolic dimensions of parasites are brought into uncom fortably comic tension. the following passage. taken from an interview with Sarah (while Peter moved about the kitchen). raises sonie interesting concerns about the struggle to re-accentuate parasites. Because 1 had saved some in a little jar. and 1 had actually taken them out of my stools and put them in this jar in water had taken thern to my doctor.. .. George: So you were actually able toSarah: Oh yeah they were actually a good sized grape seed and you could actually see their head and the Little feet and everything on them. And when I took them to my doctor. of course they were dead at that tirne because I'd been taking my cleanse and what not. and he just looked at them and said. "You've been eating rrapes." and 1 asked him to have them tested but of course maybe it didn't corne back as positive because 1 was - because they were already dead. If I had taken a live stool sarnple then it would have been a different story. George: What did he mean when he said. "You've been eating grapes?" Sarah: That's esactly what they looked Iike George: Oh. so he thought they were grape secds? C

Sarah: Yup. but they were in there by the hundreds. George: [in obvious jest] Had you been eating grapes? Sarah: [very serious] No. Of course not. George: So. did you tell him thatSarah: Yes. But doctors don't-they just don't even recognize it. Peter: The concept of parasites. it basically hasn't clicked. They think of it as absoIutely not questionable.. .. The dialogue between Sarah and her doctor-or at least Sarah's reprrsentation of itspeaks to how biomedicine posits itself as a unitary language. resisting dialogization. Here. this is taken to a comic extreme as the doctor. intent on maintainine a definition of parasites faithful to biomedical discourse-that

is. of a rnedical reality pemissible

through that discourse-discredits Sarah's sample as '-grape seeds." Sarah's physician sees only that Sarah has naively interpreted the grapes she did not eat as parasites! (Despite intending it humorously. my own question about grapes is more than a little embarrassing.) Interestingly. however. Sarah appropriates "grape seeds" to describe her parasites. transforming her physician's dismissal into a simile. and adding yet another layer to her conception of parasites. Peter's last remark (which actually precedes the dialogue below) begs analysis. First. it echoes Bakhtin's point mentioned above about how authoritative discourse allo~vsno play with its border. Peter is aware that Sarah's physician denies the reality of lier medical condition. When he says. "They think of it as absolutely not questionable." he is addressing the possibility that Sarah's medical reality may not only be discrepant

with the one her physician formulates. but that it may in fact be a more accurate rendering of her bodily experiences. Second. for Peter. it is biomedicine which is not literate in its reading of parasites. That parasites is a double-voiced word. and concentrated within it

w-e can

find (at least) "two voices. two world views. two languages." (Bakhtin 1981:325)

becomes apparent here. 1 think of this exchange as making explicit a dialogue that is already embedded in the word itself. And the sarne thing with the candida. Two years ago 1 was in the hospital right at this time of ycar. and 1 had this bad bacterial infection in my lungs. and he phoned me up afier taking this stool sarnple and he told me that 1 had this infection that 1 Iiad to go on antibiotics right away. And I said. "Well. what's antibiotics going to do to my candida etc?" And he just said. .'I don't recognize candida. Penod." George: The doctor said that? Sarah: Yes. Exactly. George: So how did you figure that out? 1 mean. those competing ideas - how did you deal with them? Sarah: Well. 1 had no choice at that time but to go on antibiotics. But at the same tirne 1 kept on taking my acidophilus because the antibiotics kill al1 the good bacteria in your system. So I continued taking my antibiotics. and 1 ended up in hospital because 1 lost my voice. and my lungs were just about shutting me down. And so 1 was in there ten days. fifieen days or something.. . George: Acidophilus is theSarah: The good bacteria. George: So it's a way of cleansing? Sarah: No. it's a way of keeping your bacterial level good in your body George: And so how does that help with the candida? Sarah: Weil it kills the yeast. and candida is yeast of course. So it kills the yeast mind you. 1 think 1 was on other medication for that too at the time. And of course no products with yeast in. 1 went to rice cakes and 1 went to pastas that kvere naturai.

Antibiotics and Rachel's yeast 1 introduced Rachel in the previous chapter to consider her protracted hesitation over

speaking to her doctor about live blood analysis. Rachel developed an iatrogenic infection following breast reduction surgery. and she has been on and off antibiotics for alrnost a year. The following excerpt is from her consultation. geared. in her mind. to %nd out what is going on with her infection..' as well as with her '-low iron" and the unintended effects of her antibiotic regimens. Her sister. Alice. and her mother. Julie.

whose consultation preceded hers. accompanied her in the consultation. As an aside I should mention that this excerpt captures something of the general texture of most exchanges: it shows how people initiate consultations with specific concems in mind and how they (as well as those who accompany them) usually participate actively in the consultation process.

Emily places the slide under the microscope and. as she peers through the eyepiece. continues to speak casually with Julie. Alice and Rachel. As soon as the image emerges on the screen. Rachel seems pleased as she exclaims. Look. That looks perfect: they're al1 individual. Look at the bright centers! Julie: What about the yeast? Rachel: Well everyone has some yeast in thern. Emily: Well. there's a platelet and they usually grow near them. Rachet: Tell me its better Emily. Emily: There is an indication of low iron. Rachel: Still? 1 should tell you I had an operation in Febmary and 1 got an infection-from the hospital. Emily: Were you on antibiotics? Rachel: [with emphasis] Mega-antibiotics. up untiI July. Julie: [has been peering at the screen during this eschange] There's a scavengerAlice: [has been exarnining the chart of the digestive tract. now interjects] What about topical antibiotics? Rachel: Yeah, some of those too. [she adds. parentheticalIy] I had a breast reduction.. . Emily: When I said low iron and you said still? Were you previously diagnosed? Rachel: In JuIy-Natalie [an iridologist in Winnipeg who uses LBA] said 1 had no iron! The conversation between thern takes several turns before Rachel says. summarily.

-'Those antibiotics sure strip yah. don't they." to which Emily replies. "Increased candida growth is ofien associated with antibiotics." The tveb of moaningful relations between antibiotics. the "growth of fungal forrns" or candida. beside platelets-resulting

in "platelet aggregation." and "having low energy" or "feeling fatigued" was ofien evokec!

in the context of live blood analysis. This web of relations seems inextricable from '-antibiotics," It became more apparent to me during Our interview that. for Rachel. '-antibiotics'.

simultaneously holds different meanings. Echoing her remarks in the consultation. she mentions that '-antibiotics are fine. But they strip your system. Doctors prescribe antibiotics but they don't prescribe anything to help your system after it's stripped." While she is aware that antibiotics are intended to rid her of infection-a

view she

maintains despite the fact that her infection lasted eight months. and which she describes as having "spread to different levelsm-like Sarah. she is also aware that they "kill the eood bacteria" and promote the growth of candida. More than that. while Rachel

C

esperiences the presence of candida in her body-'-1

had been feeling lousy.. . e v e v time 1

burped 1 could taste yeast in my mouth. just like fuzzy yeast. heh"-she

is also cognizant

that. according to doctors. "there's no such thing as candida."

Candida as idiom Emily articulates her understanding of the different viewpoints on candida in the following way: "1 always tell people that candida-candidiasis-is

part of a progression.

We catch things before the disease state [with emphasis]. I hear about doctors going off about how people wouldn't be walking around if they had candidiasis. but that's because for them you either have it or you don't. They d o n 3 recognize it as a progression:'

What

is more. Emily. like a growing number of alternative health practitioners (see. for instance. the enormous number of related websites) identities candida as implicated in a

..

number o f conditions-~gchronic fatigue. PMS. irritable mood. anxiety. depression.. .. The envelope of its meaning is extended to include a broad range of possibilities.

To speak about candida as a real entity. there. as it were. in the blood. is also to speak about a particular worldview. a way o f knowing the body. over-run with social and moral overtones. When Anna asks Emily. "What about candida?" She replies.

-- .4nna!

1

swear to god. you must be the source of candida for the rest of the world or something ."

HOM'can you still have candida? And 1 know you. 1 know how good you are." The moral overtones in EmiIy's response are difficult to miss. To have candida. among other things. is to be a certain type of person. While candida signals a certain worldview. it sirnultaneously signals something about how you inhabit that worldview. This cornes out esplicitly when Cathy. a politician fiom the Yukon territories who had her blood analyzed to

-'sec

about her candida problem and about the bacteria in her blood associated with

well-tvater." speaks of her visit to Vancouver: "1 see e v e ~ h i n here. g [It's] such a tempting place. 1 don2 generally drink coffee. but here. mochas-mmm.

1 love

mochas-everything the yeast thrives on. 1 had yeast really bad before. around ninety." The association with yeast and all things decadent is also especially evident in what 1

often heard referred to as "The three Cs of the candida diet: coffee. cheese. and chocolate." Further. while these moral overtones are closely associated with a view o f health as individual responsibility. "candida" may also be considered to contain a certain social

" Overstaternents o f this sort serve a rhetorical function. as they g o to curious and impossible estremes"you're body is just not able to digest this" or "1 had no iron. Such remarks seem to neither be spokcn nor listened to literally; they are intended to draw attention in such a way that their very estremes imply an -'as if' quality not only to the objects in question-iron. digestion. etc-but to the whole manner of spcaking about them.

and political commentary. As Emily states. in an interesting twist. "We're led to believe ttiat i t's normal to have candida in the blood and be roralldvhealthy ...but I'm a linle skeptical about that. Have we degenerated that much? 1 mean. like our environrnentthe food we eat. toxins. pollution.. ." Heard in this way candida can be conceived o f as a relatively muted 3diom of distress" (Nichter 198 1 ). a way to express anxieties and frustrations and powerlessness over an encompassing social order. 1 Say muted because while candida may very well be a condition of the times (alluded to by one alternative heaIth practitioner i met as an "invisible epidemic") rife with metaphorical significance. in the context of people's bodies it is attended to as a primarily physical entity-it

is

medicalized. And as we have seen above. what is most often emphasized about candida is the individual iifestyle which promotes its progression. rather than the social order in which such a lifestyle is made possible. Thus while feelings of malaise and fatigue connected to candida remain explicitly associated with culturally prominent notions about liealth as self-responsibiiity. they simultaneously contain a political message about the social world in which such feelings have become so prevalent.

I guess everyone has a parasite o r two Bill's was the last consultation 1 attended and. more significantly. the one that made it impossible for me to overlook the re-accentuation of parasites in the context of live blood analysis. His animated responses and charged inquisitiveness that punctuated a consultation othewise characterized by careful note-taking remain vivid in my imagination. As he pursues insights into "a problem with his testes" which his doctor has been unable to remedy. Bill actively and openly engages Emily-as 92

well as an imagined

conception of his physician-in

dialogue. Whereas Sarnantha' s consultation set me

thinking about the dialogical quality of medically associated words in the context of live blood analysis. Bill got me thinking about how meanings from previous contexts stick to words in such a way as to elicit embodied responses that resist or de@ re-accentuation. In other words. while Emily maintains a re-accentuation of parasites as relatively normalpresent in -'every living thing"-Bill

cannot overcome his. or rather. Our. more common

conception of parasites as dangerous and detrimental to their host. There is an evident interplay here between the dual accents and intentions contained within the word parasite. The intention of the word parasite in the context of live blood analysis cm. on one Ievel. be understood as its (and so Bill's) -'directionality toward the objecta (Bakhtin 1981 :277 )-the black. squirmy thing on the screen. On another level. the word indexes a scale: it refers to a normal state of the blood as popu!ated with live oqanisms (a viewpoint on the body that is openly and vehemently rejected by biomedical commentators) which. when escalated. becomes a medical problem. ln this sense. we can think of the inlenrions of the word parasite in LBA to be linked. as Good (1994) has pointed out. to structures of authority. The re-accentuation of parasites in this context not only directs the listener to the black-squirrny thing on the screen. it also directs him away from the authority of biomedicine. When a parasite appears on the screen. Emily tells Bill

Look sou have a little friend in here. Bill: A parasite? Oh shit! [He is beaming: h r looks alarmed and simultaneousl~~ pleased or excited] Emily: Well every living thing has parasites. Parasites have parasites for al1 we h o w . This is just a really healthy specimen. [Black. tubular. squirmy e n t i h gyrates against a background of different hues of blue.] Bill: If there was a whole bunch. you would see it?

Emily: [while speaking, she scans the sample: we depart from the site o f the parasite as different locations o n the sample flash through the screen] There are cases when you see them eveyvhere--eveqwhere you look in the sample. Bill: . . . parasites in chicken. Fish. too. now. What the hell am 1 supposed to eat?! Emily: [reassuringly] You have white blood cells that kill parasites.. . Bill: [seems a little molli fied] 1 guess everyone has a parasite o r two. You can't get around that can you? Emily's remark about how we have white blood cells that kill parasites-a often raised in the presence of parasites-highlights

point that was

that there is nothing unusual about

their presence. Bill even begins to speak of parasites as if he holds a similar conception

('.I guess everyone has a parasite o r two.. ."). but when the parasite appears on the screen again. he raises his Pen. jumps to his feet. and begins to stab the screen repeatedly. After a few strokes he settles back in his chair and says. 1 just want to kill that iittle bastard. 1 eat garlic too. Garlic: It's supposed to kill those little mugaroos. [1 laugh. Emily l o o k at him. smiling. 1 wonder if she is nemous. if she has seen people d o this before. if this is not such an uncommon response when faced with one's parasite.]

Conclusion

Like the clients of live blood analysis whose voices have been represented here. n ~ y concems in the foregoing pages have been with "the artisan task of seeing broad principles in parochial facts" (Geertz 1983:167). 1 have tried. in my own way. to make

sense of the complex process through which people variously incorporate the practice and knowledge of live blood analysis into the feli reality of their daily lives. My attention has not been toward epistemology but toward esperirnce-toward

encounters and

engagements and the language through which they are mediated. Are Bill's parasites real? Does candida esist in the blood? Is live blood analysis

legitimate? lnstead of pursuing answers to such questions 1 have tned to make them more difficult to ask. arguing that if their underlying premises remain unexarnined they necessarily obfuscate more than illuminate. impose sharp limits rather than broaden Our understandings of health and illness and the bodies in which such constructs corne to be. Thus 1 have not evaluated the reality of candida or parasites or the insights of live blood analysis rrgair~sfthe "pIaceless principle[s]" (Geertz 1983:2 18) of science or biomedicine. Nor do 1 see a need to.

A view of reality as self-evident. faithfùlly reflected through science or

biomedicine. is. to my mind at least, insufficient-if

not erroneous. Byron Good puts the

matter well: Reality.. .is not that which precedes interpretation. It is rather that which resides amidst the interactions or relationships among the physical body. the lived body. and the interpretive activities of the sufferer. healers. and others in the social world. Medical knowledge. whether that of bench researchers. ciinicians. health workers in an urban community. specialists of Tibetan meditation. or Brazilian Indian sharnans. is knowledge of distinctive aspects of reality mediated by symbolic forms and interpretative practices. Each depends on a form of correspondence between language and the ernpirical world. where the "empirical tvorld" refers to that which is found within human experience. However. as Hilary Putnam argues in his discussions of varieties of realisrn.. .the problem we face is no, ivherher [here is a correspondence belireen hngtruge und the entpiricul ic.orld. but that there are too muny COI-respondences. ( 1994:1 76. e mphas is added) And so it goes with medical language. We can say that many of the clients of live blood

analysis we encountered above are aware of the too-many correspondences between the empirical world o f their bodily experiences and the (medical) language through which it is mediated. We can also say that the posture of pragmatic skepticism and the process of

self'4nitiated medicalization 1 have described are. like clients' esperiences. entangled in these correspondences, We can Say. as well. that it is precisely with respect to such entanglements that a Bakhtinian listening to medical utterances may allow for an appropriately complex (and contestualized) account of how people simultaneously inhabit different medical worlds. It is my contention that the universalism of biomedicine's (theoretical) body must be understood as always in relational tension with the (empirical) bodies that people

inhabit-bodies

that are inextricably enmeshed in and constituted through ongoing social.

cultural and historical processes. This perspective informs my commitment to a view that

medical care must be rendered in the felt (physical and intellectual) reality of people's lives. Biomedicine, in rny opinion. rnust make itself receptive to ideas and understandings and experiences that fa11 outside its theoretical purview. I would like to imagine an encounter between a doctor and her patient in which the latter's concems over candida can be meaningfully discussed-not

simply humored. dismissed or execrated as

bcliefi best kept out of the way of real medical care. Having been esposed to the ways

people productively interact with their candida-as organizing idiom-1

a concrete tùngal form or as an

would. in keeping with the perspective 1 have espoused throughout

this paper. suggest that whether candida in the blood exists in abstract. theoretical tenns is less interesting than how it exists in the contexts of people's lives. Following phenomenology-mindeci medical anthropologists we could. for esample. frame investigation of the positive effects of alternative medical practices commonly dismissed as placeboes (because they-according

to biomedical

representations-do not seem to be biologically based) by critically considering the relationship between their enzbociinzerzr to healing (e-g.. Csordas 1 994b: Jackson 1 996). Or instead of dismissing stories about people's esperiences with LBA as anecdotal. we

could think about how such practices are situated in narratives in a way that cntically engages the relationship between the construction of narratives and the experience of healing (e-g.. Good 1994: Morris 1998). Further. as we have witnessed in the ethnographie sections. how people meaningfully incorporate live blood analysis into their lives is far more complicated than simply using the practice in a way that directly corresponds to how practitioners intend it to be used. While the extent and manner in which LBA has participated in the 97

construction of clients' rnedical realities is remarkably varied. none of the clients with whom I interacted seemed to passively accept its insights. This holds. 1 think. serious implications for how such practices are evaluated. The argument 1 want to make here is simple: if we focus evaluative efforts on the practice and iis howledge claims. we inevitably fail to adequately understand the central issue of how such practices as LBA esist in a social world. And what is more. we fail to understand how evaluative efforts themselves-and

their related biornedical kno\vIedge-e.uist in the very same social

n-orld. Evaluation has not been the focus of this study no[ because 1 wish to deny its obvious importance. and no1 because 1 fail to see the relevance of applying biomedical knowledge to interpret nonbiomedical practices. Rather. it stems from my belief that the usefulness of medical practices need not make biomedical sense. Albeit highly conk~incing.biomedicine produces representations of medical reality. representations that are fraught with moral. cultural and political sinificance. It does not offer special access to things as they are. To evaluate the therapeutic or diagnostic efficacy of alternative pracrices against biomedicine is to evaluate how well such practices match up to biornedical representations-not

how well they match up to the empirical world.'

1 am thus suspicious of current evaluative efforts that conflate legitimacy with

(scicntifically deterrnined) efficacy. Who benefits when alternative practices are. in fact. legitirnated and included into what Leslie and Young cal1 biomedicine's -'armamentarium" (1992: l ) ? Should evaluative efforts not be more refined so that

' Sec Good ( 1994).

leçitimacy and efficacy can be handled as separate issues? Are there not reasons why we need medical practices that help us formulate versions of medical reality that are discrepant to those of biomedicine? Finally. should we not pay serious attention to why. how and to whom the evaluation of alternative health practices such as LBA matters? These are questions that impinge on broader humanistic issues about autonomy and

freedom. about the need. perhaps. for biomedicine to seriously reconceptualize the Patient. What 1 am suggesting here is not an argument for unrestrained medical rclativism. Medical reality. however constructed. is always subject to "constraints and resistances inherent" in the empirical world (Good 1994). Of this there is little doubt. What 1 am arguing. though, is for the need to recognize the importance of the relationship between people's interpretive activities-how

they give meaning and order to illness-

and their medically plural landscape. Open-endedness and contradiction seem inestricable to experiences of illness and healing. Perhaps. we can even Say that an awareness of other versions of medicat reality is integral to healing. A discussion of medical pluralism in Sri Lanka offers an interesting lesson.

[I]n the context of Sri Lankan medical pluralism. the prognosis for patients diagnosed as schizophrenic is more optirnistic than in the West. where schizophrenia is seen as incurable. [Amarasingham] suggests that schizophrenia in Sri Lanka may be healed because each medical system diagnoses the patient3 illness differently. In effect. the disease disappears because it has no consistent definition. Strangeiy. it seems that in a society with plural medical traditions. the lack of a single meaning expressed by al1 of them together. accounts for their culturally satis@ing quality and sometimes even for the healing of the patient. (Trawick 1992:134).

This research is situated at an interesting moment in the context of my own life. Midway into witing this paper 1 began interviewing at different medical schools in Canada and the US. By way of conclusion. 1 want to mention how this research was brought into their orbit. .4salient element in these interviews is the injunction-splicit

or othenvise-to

justi- the worth of one's past activities. Having endured 1 1 interviews. 1 was ofien asked-interrogated.

rather-on the point of my research. Unlike the more structured.

question-and-answer shape these interviews took on. eschanges about my research teetered on the genuinely conversational. providing a forum for my interviewers to espress. what. exactly, they felt this business of alternative medicine was al1 about. What follow arc excerpts taken from two interviews with physicians. the first surprisingly arnicable. the second rernarkably adversarial.' Interview +/9: It sounds to me that this live blood analysis uses science to appear legitimatethey make themselves seem scientific ...But really it's more like faith healing or anythinç like that. It's important not to discredit that people feel better when they go to a faith healer.. . But does that mean that there's a verifiable basis for it? In Ireland. for instance. if you're the seventh son of a seventh son thcn people will corne to see you because of your healing powers. 1 don't think things are much different here-with regard to alternative medicine.

Interview #7: [After presenting a rather tortuous account of my research that more or less covered the gist of the foregoing pages. 1 couldn-t help but ask:] So have you heard of live blood analysis? Interviewer: Yes. actualty. 1 have. p o d d i n g his head. srniIes.1 George: So what do you think of it?

' Given the social situation, note-taking was obviously impossible. The escerpts 1 present herc were reconstructed from memory following the interviews. AIthough they may not be esactly right. they are at the ve? least close approximations of the exchanges that took place.

Interviewer: It's obviously garbage. Nonsense. If you want my opinion 1 dont know why anyone would waste their time studying it. So what's your hypothesis? How are you furthering knowledge? Are you trying to find out why intelligent people do things liiie that? Why do intelligent people do things like colonics? 1s that what you're trying to find out? George: I'm actually more interested in why we ask questions like that. Interviewer: We have a family fnend who does colonics. She's a very bright wornan and 1 can't figure out why she does it. She seems to swear by it. Now. why do you suppose that is? How would your research help me understand this?

if kve remain stubbornly attached to the idea that biomedicine has an epistemologically

privileged right to the representation o f a singular. ultimate medical reality. we may. unfortunately. never be able to answer such questions.

Appendix A

List of Clients' Consultations ~ t t e n d e d *

Name

Age

n of visits

'Occupation'

Nancy Sally Miranda Ralph

housework masseuse dancer writerfactor

Dave

outdoorsman/studying film anist Iives on a farm

Gai1 ColIin

Julie Rachel Lian

married to Collin retired medical technician graphics designer Reiche instmctor buyer pharmaceutical Company housework housecleaner han,OS out

Nastasha Sarah

housekeeper grandtnother

Peter Stacy Cathy Patricia Anna Bill

retired framer student poiitician hairdresser between work maintenance

Grace Rebecca Nick Joleen Jackie

~Mostsalient concerns candiddarthritis low energyi "liver"/candida osteoporosis/meta~tosicity "hyperthyroidism"/headaches~ stress/allergies tiredhormona1 indicators tired-"Iistless"1 "seriously fatigued"! "ovenctive immune systern"1antibiotics low energy chronic pain tired/immune system parasi tes candidallow energy probiems with digestion candida/antibiotics/fatigue probterns with digestiodparasites debilitating menstrual cramps emotional stress chronic respiratory condition/ parasites/ antibiotics immune system/candida candida/imrnune systemifatigue chronic fatigue candidaffatigue "problem with testes'.

AI1 of the information in this table is derived frorn clients' cornments during the consultation. The salient concems I list are nor the indicators identified by the analyst, but more or less the clients* reasons for having live blood analysis perfonned.

Appendix B

Author's "Live Blood Sample"

Appendix C Author's "Dry Blood Samplew

Appendix D Overview of Live Blood Analysis consultation*

Indications from live analysis: Liver-poor protein digestion/assimiIation Low WBC #s Arterial plaque Low levef candida overgrowth Indications of food/environrnental sensitivities

Indications from HLB analysis:

Stress Lymphatic congestion/blocked nodes MiId metal toxicity Liver inflammation

Suggestions:

Candida diet (especially no chocolate. cheese or caffeine) Garlic tablets for cholesterol & immune support Greens drink for digestion. nutrition & detoxifying the liver

Save for identi@ing information about the office of the analyst and a legal disclaimer at the bottom of the form. tliis is a accurate replication of the review sheet 1 received at the end of my consultation.

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