Entropic Selves and the Persistence of Metaphor

Hegel said the ultimate tragedy is not the struggle of an easily recognized good against a clearly loathsome evil. Tragedy, he said, is the battle between two forces, both of which are good, a battle in which only one can win. Nature has woven that struggle into the superorganism.

~Howard Bloom, The Lucifer Principle

Emily Martin illustrates the post-modern tendency to support an image of the human body as a complex, open system where prevailing theories of immunology play into this thermodynamic metaphor. The body becomes just another system interwoven within other, larger systems, each subtly fluctuating and effecting the other. This matrix of inter-related bio-systems appears to obscure the notion of the "enemy" thus subverting the militant metaphor prevalently used to describe the human immune system during the Cold War years. It also appears to subvert the anthropocentric model used to describe health, illness, and immunity where humans either defeat the surge of pathogenic organisms embarking on their body, or they succumb to the "enemy." The open system perspective, however, does not necessarily ensure that the human being lies at the pinnacle of importance when it comes to the value of a subsystem within the global system. In fact, human bodies, as a subsystem are shown to hold no special importance in context to other parts of the system (125). The shift in the metaphor of the human body and the immune system, health and illness, appears to by typical of the "eroding of the identifiable self" in post-modern times (Gergen 7). Diseases like HIV/AIDS and cancer appear to evade scientific attempts at classification, understanding of etiology, as well as signify an internal collapse of the immune system or suggest that the body has turned against itself. The unsettling disease metaphors associated with HIV/AIDS and cancer depict the post-modern condition and the associated symbolic waning of a static, identifiable human condition, or an a priori sense of self. The many anomalies associated with the virus such as, individuals becoming infected and then testing negative for virus and remaining healthy with no subsequent test indicating seropositivity, or the fact that some individuals may be exposed to the virus but not become infected, appear to challenge established positivist notions of health and illness (Martin 128-129).

In the article Signifying the Pandemics: Metaphors of AIDS, Cancer, and Heart Disease, Meira Weiss discusses the cultural construction of these afflictions in relation to Twentieth Century modernist and post-modernist perspectives. Weiss describes, that unlike AIDS and cancer the metaphors associated with heart disease focus on the localized nature of the affliction and its relatively accessible understandings of its causes and courses. Heart disease has a very mechanistic connotation and its victims do not usually harbor the same stigma associated with AIDS and cancer. When asked to describe a patient with heart disease, respondents, comprised of nurses, physicians and students were noted to have illustrated a relatively healthy looking individual that could be viewed as making wrong life choices, but is usually presupposed to be a victim of an unavoidable inherited disease (469). In stark contrast, Weiss notes the response she received in asking individuals to illustrate their metaphors regarding AIDS.

AIDS means loss of self. I see no face, but a skull, with a screaming mouth, like Munch's picture. It reminds me of the pictures of holocaust victims. This is even more apparent in AIDS then it is in cancer. I can see the face, but it is hidden by many arrows all pointing at it (Weiss 466).

In this vivid metaphor one can observe the duality of AIDS as a disease that not only is the breakdown of the 'mechanics' of the immune system, but also a loss of control, a loss or degradation of self that reiterates the post-modern condition. Weiss depicts how individuals may often use metaphor to lessen the impact of the loss associated with AIDS and cancer. For instance, Weiss notes that Ronald Reagan was once asked about his cancer. Reagan replied, "I didn't have cancer. I had something inside of me that had cancer in it and it was removed" (Weiss 461). In this example, Weiss shows how the body insists on localizing a disease process to a particular region that may be either physically or symbolically excised.

Martin's elaboration on HIV/AIDS and associated metaphors truly depict a "war without borders" where the xenophobic-militant metaphor regarding the immune system is no longer applicable. In regards to HIV/AIDS, the lines between "self" and "non-self" become ever so difficult to determine. The notion of the body's triumph over its invading enemies becomes deluded, as one no longer views viruses as inherently 'bad' but rather just adapted to survive under the same processes and pressures of natural selection that governs all subsystems of the global system. In the field of Biotechnology, one observes the manipulation of viruses and their innate qualities and capabilities as being an asset to human disease prevention, treatment, and even aiding in the development of new cures. Disease agents, disarmed of their associated enemy- militia connotation, as well as their pathogenic quality, are often used in potential innovative treatments of diseases like cancer and HIV/AIDS. For example, HIV carries the enzyme for reverse transcription and is able to insert this enzyme into the genome of a healthy eukaryotic cell (host cell). Scientists and geneticists have realized that this perceived harmful characteristic may be used to insert "good"genes or genes that would benefit or combat the ill effects of a particular affliction.

Trends in globalization have facilitated the spread of a flexibility model in regards to the immune system, as well as the facilitated the spread of diseases like AIDS. Martin depicts the co-evolution of disease, disease metaphor, and social metaphor as being one not of coincidence but rather as symbolizing a shift in the prevailing world-view, one that transcends borders and is dictated by the culture of capitalism and the expansion of the world market.

Affliction, Metaphor, and the Body-Politic

In Flexible Bodies, Emily Martin illustrates the contextual use of metaphor to elucidate models of immunology, the body, illness, and the larger body-politic. She demonstrates the flexibility of these metaphors as agents used to uphold the idyllic social construct of the individual as a system within a larger system. In Part Two, Martin provides a concise historical overview of the malleable metaphors of the human immune system. The immune system is depicted as a castle equipped with fortifications that block the advancing enemy or pathogen. Martin proceeds to show how the metaphor of the immune system evolves along with the concept of the body-politic. She elaborates on the militant/xenophobic narrative that has outer as well as an internal arsenal of specialized white blood cells that identify and "attack" and invading organism. A preoccupation with hygiene and "barrier maintenance" moves aside for an immunity metaphor that portrays the internal mechanisms of the human machine.
Painting by Jacques Fabian Gautier D'Agoty (1717-1785)

The human body is scrutinized during the early-mid twentieth century and checked for efficiency. During the Fordist years, Martin illustrates how the private body entered the public realm. Maintenance and surveillance of the social body became imperative to the "moving assembly line organized for mass production" (30). It appears that during the mid-twentieth century the concept of ego, as illustrated by Sigmund Freud, and put to public relations use by Edward Bernays, provided the necessary component for maintenance of the social body without employing elaborate measures by the state. This mechanism may be referred to as ego nourishment or even narcissism. Checks, balances, and rewards for maintaining the body as a well-functioning unit, include the esteem and envy of others as well as certain societal entitlements. One is encouraged to seek the esteem of others to nourish the ego, which in turn encourages bodily optimization ultimately leading to the attunement of the social and political body. I am reminded of the statement made by R. D. Laing in the Politics of Experience, "What one is supposed to want, to live for, is 'gaining pleasure from the esteem of others.' If not, one is a psychopath" (40).

Martin acknowledges a shift in immunity metaphors that suggest a transition in the social order. She refers to "flexible specialization" as a term used by political economists to describe the change in production during the 1970s. She states, "multinational capital operates in a globally integrated environment: ideally, capital flows unimpeded across all borders, all points are connected by instantaneous communication and products are made as needed for the momentary and continuously changing market" (41). In other words, trends towards globalization requires optimized flexibility. Martin discusses the shift in the metaphor of immunity as slightly departing from the traditional militant/xenophobic model to one that favors homeostatic design and specialized flexibility. Scientific discovery appears to recapitulate the flexibility metaphor used in context to the social body. Or, likewise, the socio-political metaphor may recapitulate scientific discovery. Martin illustrates the scientific discovery of the flexible antibody as portrayed as a "galvanizing moment in the development of immunology" (92). She questions whether the biological model arose as a cause or as a result of the transition in the social body dynamic - from one characterized by specialization to one of a more flexible design (93). Martin illustrates how scientific objectivity is never divorced from socio-political ideology, though it makes painstaking claims at a complete excision. The sterile lab room is still muddied by culture and politics in spite of the elaborate efforts of the scientist.

In The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience, author Laurence J. Kirmayer illustrates the importance of language in giving meaning to bodily experience:

The body and its passions are viewed as disruptions to the flow of logical thought, as momentary aberrations or troublesome forms of deviance to be rationalized, contained, and controlled. Yet, in everyday life, bodily experience preempts our rational constructions. Through the pain and suffering that foreshadow its own mortality, the body drives us to seek meaning, to take our words as seriously as our deeds (325).

Kirmayer's statement illustrates that in the liminality of illness, embodied metaphor takes precedence over and in spite of rational biomedical assertions. Martin shows how metaphor shapes the perceptions of the body as inextricably linked to the larger body-politic. Political metaphors, like biological metaphors, forge the human imagination and give the impression of limitless freedom in a terrain that is ideologically pre-determined by language.

Bodily Transgressions and Post-Modern Magic

The mythical qualities of which we have been speaking are powers or produce power. What appeals most to the imagination is the ease with which the magician achieves his ends. He has the gift of conjuring up more things than any ordinary mortals can dream of. His words, his gestures, his glances, even his thoughts are forces in themselves. His own person emanates influences before which nature and men, spirits and gods must give way.

Marcel Mauss, A General Theory of Magic

In Twice Dead: Organ Transplants and the Reinvention of Death, Margaret Lock discusses the implications behind the establishment of death as an event (specific technical indicator(s) reporting the likelihood of the irreversible cessation of cerebral function) rather than a process, and the procurement of human organs. Lock reveals the socio-political and economic contexts in which the mere acceptance of organ transplants and "brain-death" in North American culture signifies embodied beliefs about nature, culture, the mind/body dichotomy, and even the concept of the soul or "personhood." Lock illustrates in detail the commodification process of the human body and its components, the point when the social duty of the attending physician lies not with his/her patients, but with the market value of that patient's organs and the protracted well-being of the future recipient. Lock points out incongruities that exist when one acknowledges the perfusing body of an individual legally defined as dead. She states, "In stark contrast to the half-hidden, pale, lifeless face of the brain-dead person, the interior of the body is colorful and alive" (20). Such incongruities fuel the debate on death as occurring upon the death of the brain when one can no longer observe death but rather is dependent on machines to state its occurrence. Lock indicates that defining death as an event rather than a process is central to the legality of organ procurement. If death is simply the point when the brain ceases to function, and this cessation is verifiable, then removal of vital organs such as the heart and liver would not be murder, under law.

As we have seen, conceptions of health and illness have been systematically re-worked and negotiated in order to support or resist cultural, social, political, and economic regimes. Lock depicts the contextual reframing of death in order to serve what may be deemed pragmatic and altruistic extensions of science. Defining death as the point when the brain ceases to function, is seemingly characteristic of the mind/body dichotomy that is prevalent in western cultures. To insist that brain-death signifies death of the person and attempting to export this notion into universal biomedical practice is seemingly intrusive and in violation of various familial and cultural milieus. Lock illustrates how the mind/body split associated with western culture recapitulates western philosophy (73). A look into the writings of Rene Descartes, the father of modern philosophy, provides insights as to the genealogy of the mind/body split in biomedicine and western culture as a whole. The following is a statement regarding Descartes theory on the pineal gland as being the seat of the sensus communis or soul. The statement is a succinct reiteration of Descartes's theory involving the pineal gland and the placement of the soul or "personhood" in the brain, by Jean Cousins, a defender of Descartes.

...one may observe a gland, called the pineal gland, which is situated like a centre in the middle of the ventricles, and which is the meeting point of threads coming from the external senses as if from the circumference; and because it is unique, supported by the choroid plexus and permanently inflated by the spirits which have been elaborated, it is only in this gland that the double appearances received by both the eyes and the ears can and must be united: "for there is one sense faculty, and one paramount sense organ." Aristotle was therefore mistaken when he located the common sense in the heart, the Arabs were mistaken when they located it in the anterior part of the brain, and the Metoposcopists were mistaken when they located it in the forehead and its wrinkles (Lockhorst 8).

In the article "The Ambiguity about Death in Japan: an Ethical Implication for organ procurement," author John Robert McConnell III asserts that Japanese religious and philosophical culture is influenced by Shinto, Taoism, Confucianism and Buddhism. He explains the effects that these belief systems have on the social perception of death and organ procurement. For instance, McConnell III illustrates the teachings of Confucianism and Taoism and how such belief structures infer that the "human body is a microcosm of the universe" (323). The integrity of the body after death is then perceived as essential to providing a "resting place for the soul." The notion of "brain death" is easily accepted within a culture that widely distinguishes from the mind and body, where the soul rests in the mind and mans the controls that maneuver the body. Within this mechanistic paradigm, with Judeo-Christian influences, organ procurement is justified as moral and pragmatic.

The rituals associated with death, Lock describes, can be associated with Turnerian liminality in that they represent the transition from one social order to another. The "performance," i.e. funeral procession, marks the transition between one's engagement within the social realm and one's cessation of all engagement. Death, thus, is a social and cultural process as much as it is a biological process or event. Lock takes notice of the protracted liminality of death and states, "the liminal period may commence before biological death sets in. It spans the ambiguous time of biological, spiritual, personal, and social transformations associated with dying and death" (198). The condition of "brain death" creates visual ambiguities that appear to greatly interfere with the necessary rite of passage that allows for the acceptance of one's passing and, further more, the re-establishment of social order, if only minutely. Lock demonstrates the peculiar nature in which North American and European cultures have been able to widely accept brain-death as symbolizing total death. She indicates that is is a typical assumption of the West to associate culture with the "other" and negate the cultural and religious traditions of the West. Lock does not then simply associate the limited acceptance and ambivalence regarding organ procurement and "brain-death" as being a peculiarity among the Japanese or a rejection of modernity by the "other." She asserts that organ procurement measures may provide relief to North American and European sensitivities in that the continuation of life via technology seems to "transcend the 'scandal' of biological death" (206). Lock reiterates Foucault's suggestion that death is perceived as a failure on the part of medical technology (203). This notion appears to portray the tragedy of death as transcending the personal and familial and framing death as a socio-political tragedy as well (203). I am reminded of the example stated in earlier in the book where Lock notes the reluctance of the medical community to disclose limitations in medical technology.

Hoffenberg is still shocked about a photograph showing Philip Blaiberg, the recipient of Haupt's heart, "swimming" at a Cape Town beach several months after surgery. He recalls that Blaiberg was never able to walk independently after surgery. For the photograph he had to be taken down to the water's edge in a wheelchair, carried into the ocean, photographed, and then hauled out again (85).

The quote by Marcel Mauss at the top of the page illustrates the relationship between Mauss's definition of magic and the culture of biomedicine. It appears as though the physician is not unlike a post-modern magician where notions of nature and man, spirits and gods are forced to give way to scientific rationalism and biomedical hegemony.

Dialysis Painting by Elisabeth Frauendorfer, PhD

http://www.magnussa.com/dialysis.JPG

Qigong, Biopolitics, and Psychosis

During the early morning, the urban parks in Chinese cities were utilized as "breathing spaces" or places where individuals could practice the healing and social qualities of qigong. The "breathing spaces" of the urban parks mirrored the symbolic "breathing space" that one carves out from the congesting politically-imposed order that manifests itself in all urban cities. Chen discusses the historical context in which post-Mao Zedong China created a high demand for these spaces (physically and spiritually) as a symbolic gesture at restoring individual control over the body as well as the pragmatic need for a system of healing in a time of the growing cost of healthcare. Chen states, "Cultivating qi on an individual basis involves transcending one's everyday thoughts and perceptions to facilitate opening up to a larger cosmological order via breathing" (8). The practice of qigong appears to be a liminal phenomena that is able to achieve a temporary state of transcendence from the imposition of the state while not subverting political notions. The following will attempt to show how, like the practices of Ayurvdeda described in Jean Langford's Fluent Bodies, qigong appears to be a malleable practice that circumvents attempts at essentialization and potential extraction as a viable method of healing. Furthermore, qigong practices, while providing a liminal space for temporary alleviation of the psychopathology of everyday life, do not attempt to subvert the state but rather, at times, appear to align with biopolitical conceptions of health and wellness. Medicalization and the pathologization of qigong deviance are used as instruments of the state to facilitate order and social control.

In Langford's Fluent Bodies, one observes how Ayurveda adapts within the political terrain of post-colonial India, and uses mimetic devices (i.e. parallel institutions) in order to gain political legitimacy as well as negates modernist assumptions of private/public conceptions of medicine, the mapping of medical concepts onto the human body, and the presumption of Ayurvedic practice as a static traditional discourse against the backdrop of scientific dynamism (19). Similar to the malleable practices of Ayruveda, Chen describes the reframing of qigong during various points of Chinese political history. For example, during the Maoist years of Cultural Revolution it was believed that beliefs in mixin or superstition and magic hindered China's progression towards modernization. The divorce of qigong from other related practices such as teyigongneng, was a strategic move that allowed for the continuation of qigong practices during the Cultural Revolution's campaigning against mysticism and spirituality (65). Qigong was able to survive campaigns aimed at destroying traditional practices by reframing itself as a strategy for health. From a biopolitical standpoint, this reframing upheld the ideals of the Maoist nation-state by developing and maintaining strong, able-bodied subjects. The post-revolutionary years, however, marked the transition to a market economy as well as the decline of state services assigned to healthcare. Individuals were pressed to maintain health in order to avoid costly medical services. Citizens were simultaneously discovering new independence through economic agency, as well as the permission to express spirituality and "oneness" with the cosmological order rather than simply with the state. Commercialization and the reframing of qigong as a marketable commodity shortly followed after the Mao Zedong era. Commercial zeal along with spiritual repression appeared to spawn qigong "fever," which in turn, threatened social order thus instigating further governmental involvement with qigong practices. Chen discusses the trend in political lampooning via the means of cartoons in the media (75). Political transgressions imposed on the body included the pathologization of qigong and deviation from qi run rampant.

One can view the taxonomic nature of psychiatry as being instrumental to the pathologization of certain maladaptive behaviors. Maladaption may include any behavior that does not uphold the sentiments and/or contribute to the economic progression of the nation-state. The Diagnostic and Statistical Manuel of mental illness must consistently be reviewed and modified in order to keep up with the changing political, cultural and social terrain in which individuals live. Homosexuality, for instance, was once considered a deviation that required psychiatric treatment. It appears that the emergence of culture-bound syndromes requires a more thorough look at the reification of psychiatry and mental illness in general. Schizophrenia has commonly been linked to spirituality and transcendental experience. The following is the account of a psychotic patient as recorded by Karl Jaspers:

Then came illumination. I fasted and so penetrated into the true nature of my seducers. They were pimps and deceivers of my dear personal self which seemed as much a thing of naught as they. A larger and more comprehensive self emerged and I could abandon the previous personality with its entire entourage. I saw this earlier personality could never enter transcendental realms. I felt as a result a terrible pain, like an annihilating blow, but I was rescued, the demons shriveled, vanished and perished. A new life began for me and from now on I felt different from other people (Laing 95).

The socio-cultural-contextual view of psychosis elucidates the concept of qigong deviation in a non-pathogenic way. R. D. Laing suggests that individuals in society are "pseudo-sane" or not truly sane in that we are living under conditions that promote false consciouses and uphold aquired cultural and social complexes in which individuals must learn to rationalize via the socialization process (35-37). These complexes, such as the industrial-millitary complex may be devastating to inner sensibilities and thus may hinder individual potentialities (36). Laing states:

Having at one and the same time lost our selves and developed the illusion that we are autonomous egos, we are expected to comply by inner consent with external constraints, to an almost unbelievable extent (47).

As mentioned previously, qigong practices provide a liminal space of transcendental healing, temporarily removed from state-imposed control over individual bodies, all while maintaining civil social structure that does not subvert the state apperatus. Constructions of qigong deviance, however, depict the penetration of the state, once again, into the personal lives of individuals. As commercialization of qigong along with spiritual repression of the Mao era promoted a feverish reception of yangsheng, or life cultivating acts, a sense of disorder that threatened state function was imagined and the consequent legitimization of qigong was used as a method of control and surveillance.

The Politics of Medicine: Post-colonialism and Science as Morality

The choice of syntax and vocabulary is a political act that defines and circumscribes the manner in which "facts" are to be experienced. Indeed, in a sense it goes further and even creates the facts that are studied.

R. D. Laing, The Politics of Experience

Jean Langford originally sets out to do a comparative analysis between modern biomedicine and traditional Ayurvedic practices and their incorporation in post-modern India. In Fluent Bodies, Langford discovers the complexities and ultimate refusal of Ayurvedic concepts to be enframed within a Western epistemological framework. Langford states, "my modern assumptions were reflected back to me through answers to my questions that resisted their epistemological thrust" (19). The unfolding of Langford's ethnography depicted a practice that appeared to trivialize such westernized conventions such as mapping medical concepts onto the human body, transcend the public/private dichotomy of biomedicine, and elude the modern perception of traditional "ethnomedicine" as relatively static against a dynamic scientific backdrop. Langford depicts patterns of Ayuvedic integration within the biomedical model as well as post-colonial resistance to the perceived hegemony of allopathy. Ayurveda appears to elude modernist tendencies towards compartmentalization and reification. Langford distinguishes her methodology as resisting the temptations to "police" the boundaries and demarcations of authentic Ayurveda. Rather she sets out to take a deeper gaze at the forces that create authenticity within Ayurveda. It appears that the reverberations of colonialism create a dynamic that attempts to incorporate biomedicine in order to achieve institutional clout in a post-colonial setting, while simultaneously attempting to ward off hegemonic devices of classification and control. Langford discovers ranges of this incorporation and resistance within the practices of Ayurveda that manifest themselves in the sentiments of their practitioners, whether it be a vaidya who received his credentials at a mimetic institution of Ayurvedic medicine or a rural Kaviraj who sells mixtures of boiled sugar and passes them off as "authentic" Ayurvedic pharmacopoeia (207).

It appears as though there is a state of ambivalence for the post-colonial consumer of healthcare. The consumer may perceive some value in biomedical approaches but may view procedures as invasive, dangerous, and even short-lived as many biomedical approaches are perceived as only riding the body of the undesired symptoms of affliction and not the source of the affliction. The healthcare market, consequently, has been forced to adapt to the needs of the ambivalent and multi-dimensional consumer in order to ensure its own economic survival. It appears as though many practitioners of Ayurveda are reluctantly subjected to packaging and essentializing Ayurveda, to the expectations of their customers, while simultaneously resisting the political categorization of Ayurveda by imperialist ideologies. Scientific rationalism, under the guise of objectivity, may be used as an agent of coercion to facilitate adherence to the dominating political doctrine of the occupation, or the ideological remnants and the institutional frameworks left behind by the occupation after independence. Collective experiences, observations, and practices are perceived as shaping the social and political terrain of a population. Langford, rather depicts how the social and political terrain of post-colonial India shapes the experiences, observations and practices of the population.

Under the guise of altruism, one can be reminded of countless examples where biomedicine has been used as a tool to uphold oppressive political doctrine. For instance, Nancy Rose Hunt discusses political campaigns in Zaire during the early 1900s, that were employed to encourage birth rate and to increase African infant survival rate. Mothers were given milk as well as medical knowledge regarding the health of their child. Missionaries worked tirelessly to circumvent traditional practices of birth spacing or post-partum abstinence. Birth spacing had been established in African cultures to ensure optimal care for the child, however, since Zaire experienced a morbidly low population during the years of early twentieth century colonialism, missionaries adapted strategies that would delineate from the traditional pattern. Interest in the medical well-being of Zaire's population proved to be one of "Imperial importance" (Hunt 289). Colonists were addressed by the president of an organization that emphasized healthcare for mothers and infants with the following statement: "Help us by all means in our ability to protect, to care for the child while educating indigenous mother, it is a duty. We need black labor....To protect the child in the Congo is a duty, not only of altruism, but of patriotism" (Hunt 289). One can observe how medicine quickly delineates from a pattern of objectivity to a politically motivated tactic that promotes the efficacy of establishing colonial dominance.

In the Politics of Experience R. D. Laing states, "The colonists not only mystify the natives....they have to mystify themselves." He continues, "We in Europe and North America are the colonists, and in order to sustain our amazing images of ourselves as God's gift to the vast majority of the starving human species, we have to interiorize our violence upon ourselves and our children and to employ the rhetoric of morality to describe this process" (36). It appears that scientific objectivity and biomedical expertise have become our post-modern rhetoric of morality and are used as gauges to measure the sophistication of culture. Langford's book shows how the fluid and adaptive quality of Ayurveda, both in practice and in theory, transcends and "spills over" all attempts at encapsulation.

Ritualistic Medicine: Science, Religion and Magic

...the romance and the beauty were all gone from the river. All the value any feature of it had for me now was the amount of usefulness it could furnish toward compassing the safe piloting of a steamboat. Since those days, I have pitied doctors from my heart. What does the lovely flush in a beauty's cheek mean to a doctor but a "break" that ripples above some deadly disease? Are not all her visible charms sown thick with what are to him the signs and symbols of hidden decay? Does he ever see her beauty at all, or doesn't he simply view her professionally, and comment upon her unwholesome condition all to himself? And doesn't he sometimes wonder whether he has gained most or lost most by learning his trade?

Mark Twain

The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science.

Albert Einstein


In A General Theory of Magic, Marcel Mauss attempts to distinguish the concept of magic as a social phenomenon that encompasses certain aspects of science, technology and religion, all the while, maintaining a distinct social system with its own definable terms. Mauss elaborates on the work of Sir James Frazer who classifies magic as a form of "pre-science" originating in "primitive societies"(15). Magic, according to Frazer, is the simplest, purest form of human scientific thought. The evolution of human thought appears to have sprung from the creative nature of the human mind and the attribution of creative mysticism to the totality of the natural world. "Immediately [man] endowed his universe with mysterious powers, of the kind he once arrogated to himself" (Mauss 17). Religion perhaps precipitated from the inevitable fallibility of humans. Since humans could not create in nature what they could create in their minds, humans may have created a third party, essentially gods, as a reason for their fallibility. The most recent event in Frazer's proposed genealogy of human thought involves human use of causality as a tool to collect and organize a posteriori knowledge into a systematic and reproducible form - namely science. Mauss goes about his objective of producing a distinct definition of magic by examining many systems of magic, beyond sympathetic rites such as contiguity and similarity, and formulating his essential elements of magic, the magician, magical rites or actions, and magical representations. Mauss explains magic in terms of collective phenomena similar, in this aspect, to religion. Magic, however, may be distinguished from religion in that its rituals serve technical objectives rather than serve to symbolize worship of a sacred notion. Magic, in this regard, does not contain a notion of the sacred, but rather serves as means to a desired end. Magic may involve the use of gods, demons, and religious icons within its practice, however, there is usually a technical objective. Mauss points out this objective as being a key similarity between magic and science. The following will briefly attempt to illustrate how, using Mauss's classification of magic, one may view systems of western biomedicine as "magical" when viewed through the lens of a differing embodied metaphor of illness than that of one governed by biomedical rationality.

Mauss asserts that magic has representations or laws that are governed by syllogistic logic and may be viewed as variations on the mechanisms used to distinguish science, namely experimental causality or a posteriori knowledge. The example I have chosen to elucidate the similarities between magic and western medicine, as viewed by an individual embodying a differing metaphor of illness than is typical in western society, is the procedure of hemodialysis. I spend much of my working week at a dialysis center for patients of various cultural backgrounds. Recently, I came across an article that sought to shed light on the seemingly irrational beliefs that are commonly expressed by dialysis patients. I personally identified with the article and was reminded of the qualities of magic as defined by Mauss. In the article, "The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience," Laurence J. Kirmayer discusses how the different metaphors for illness may formulate how one interprets and experiences illness. He shows how understandings of the mechanisms of these metaphors may assist in the elimination, or at least significantly decrease, the existing tensions between Western biomedical rationality and the individuals own attempts to rationalize their illness within their own cultural, social and personal ideology. Kirmayer succinctly illustrates the experiences of the hemodialysis patient:

"The patient witnesses his blood leaving his body and traveling through plastic tubing into the hidden depths of the dialysis machine. The machine has nervous habits: it blinks and twitches--shifting registers, clicks, and beeps mark the progress of blood through the machine. Once processed--transformed by the machine--the blood returns to the patient to be contained and hidden inside the body once more" (Kirmayer 328).




An individual is essentially "machine bound" as they are dependent on the dialysis machine to rid their bodies of toxins that would otherwise be ridden by healthy kidney function. Many patients have confessed their general distrust in their medical care and yet it is obligatory that they remain "machine-bound" for approximately four hours out of their day, three times a week. Some patients distrust is not necessarily unfounded as many had acquired kidney failure as a result of too much medication (usually Lithium, a salt prescribed in the treatment of bipolar disorder). Kirmayer tells the story of a dialysis patient called Mr. Y. Mr. Y is anemic and refuses to have a blood transfusion based on his belief that the blood of other individuals contains genetic material and thus will distort his personality (325). Mr. Y's physician has difficulty in viewing Mr. Y's presumption as anything other than irrational as it does not follow accordance with his/her biomedical explanatory model of illness.

Mauss describes the objectives of magical acts as either an attempt to expedite or create the occurrence of specific phenomena or to carry the involved objects out of a potentially dangerous state (76). Magic may be called an art of changing. The physician, like the magician is attempting to change the course of action of a particular occurrence, or in this scenario, attempts to deter death. Like the magician, the physician is distinguished from his/her colleagues by the specific procedures s/he performs (74).

Mauss extensively depicts how magic contains aspects of both technology, science and religion and yet remains its own separate social category. The above example depicts how traits of magic are similar to traits in western biomedicine. These similarities, however, seem to dissipate if one looks further into the principles causality and the variation of this principle associated with magic. For instance, Mauss describes science as based on knowledge acquired through repeated experiments, or a posteriori knowledge, whereas magic, like religion is based on belief, or a priori knowledge. When perceived through the eyes of an individual who does not possess an embodied metaphor of illness that is governed by the assumption of the superiority of rationality, the various technologies of medicine are seemingly inseparable from the rites of
magic.

Link to full-text essay by Mark Twain

http://grammar.about.com/od/60essays/a/twowaysessay.htm

Dislocation

Anne Fadiman tells the tragic story of Lia Lee, a Hmong child, who becomes the site of negotiation between two seemingly opposed worldviews or explanatory models of medicine. In her book, The Spirit Catches You and You Fall Down, Fadiman portrays the tragic circumstances involving grave cultural misunderstandings and misconceptions of two cultures, immigrant Hmong culture and American bio-medical culture. Lia’s parents attributed Lia’s illness as qaug dab peg, which is roughly translated to, “the spirit catches you and you fall down,” which is then temporalized into the western medical term - epilepsy. The author explains that Hmong culture generally regards one that exhibits symptoms of quag dab peg as potentially destined to become a tvix neeb, divine healer, or someone who can slip into the spiritual realm. Fadiman states, “Becoming a tvix neeb is not a choice; it is a vocation” (21). Lia’s illness did not improve in spite of the efforts of the American medical system. Her family was channeled through painful avenues of American bureaucracy that were ill equipped and seemingly inflexible to the task of handling culturally discordant metaphors of illness.

Fadiman’s book has captured and inspired readers both as an ethnography that contains all the elements of a tragic drama and as an effective portrayal of the urgent need for a culturally sensitive approach to Western medicine. The book has been used to facilitate discussions among medical anthropology students as well as students of biological medicine (Taylor 162). It has inspired models of “cultural competence” that have infiltrated Western hospitals. Author Janelle Taylor points out the complications associated with the “cultural competence” model and the reification of culture. In her writing, "The Story Catches You and You Fall Down: Tragedy, Ethnography and ‘Cultural Competence,’” Taylor defines culture as a dynamic ever-changing process rather than Fadiman’s reified, static view of Hmong culture. Fadiman states, “…the Hmong have responded to persecution and to pressures to assimilate by either fighting or migrating—a pattern that has been repeated so many times, in so many different eras and places, that it begins to seem almost a genetic trait, as inevitable in its recurrence as their straight hair of their short, sturdy stature ” (emphasis added, pg.13). She notes that the essentialization of Hmong culture, depicted in Fadiman’s book, should be viewed not as “solid lumps of congealed truth,” but rather as “invitations” to interpret relevant messages of meaning to the dynamic nature of culture, not static and by no means genetic (Taylor 179).

Fadiman provides historical accounts of Hmong involvement as American allies in the Vietnam War and the resulting migration of many people, including the Lees, from Laos to Thailand and eventually Merced, California. Upon finishing the book, one may begin to view similar themes of dislocation as contributing to the lack of comprehension between two cultural belief systems. The geographic and emotional dislocation of Hmong-American immigrants is juxtaposed with the American dislocation of the individual from society, the physical from the spiritual, and the mind from the body. Western biomedicine is compartmentalized and the individual becomes viewed as essentially dislocated from nature.

“..in Western cosmology humans have been exclusive possessors of a spirit, or a soul, or conscious intentionality, rendering other animate and inanimate aspects of the natural world spiritually dead or merely instinctual” (Henry 39).

The collectivism displayed and valued in Hmong culture clashes with the drive for individual autonomy and the individual versus society model that is observed in American culture. The metaphors used to describe illness vary cross-culturally and are often diametrically opposed, as in the case with American metaphors of illness and Hmong metaphors of illness. In the article, "Measles, Hmong, and Metaphor: Culture Change and Illness Management under Conditions of Immigration," Rebecca R. Henry, contrasts the “warfare” metaphor utilized in Western medicine with the Hmong metaphor of “harvesting crops” and the interrelation of the natural and spiritual worlds (34). The human immune system in Western terms is described as a militant counter-attack on invading organisms (33). The Hmong, however, tend to view the course of disease as cyclical, in tune with other environmental factors, such as season change, and as a natural process that needs to take its course (33-34). There, however, are human interventions that may expedite the course of nature. For example, in the treatment of measles, Henry points out that the Hmong view the presence of a rash as the “growth” or natural and necessary progression of the disease. The “growth” must be allowed to run its full course or else it runs the risk of lying dormant in the body inevitably causing illness later in life (38). Fever is explained in terms of the heat needed to allow for the progression of the disease, like how heat and sunlight are needed to facilitate plant growth (41-42). Henry indicates that Western approaches of treating fever with Tylenol actually compound the illness as it interferes with its natural course (42). Hmong belief systems regarding illness etiologies and treatments may be disregarded by Western medical practitioners due to language barriers and, consequently, misconstrued as medical non-compliance, as demonstrated in the case of the Lee’s.

Fadiman’s book appears to capture the social drama between the “collision” of differing views of health and illness and transcribes it into an aesthetic drama containing the pertinent elements of tragedy. I like to think of the book as a liminal piece that transcends the rigid classifications of reified culture and serves to provide a holistic interpretation of a patient as both a biological and cultural being, where prevailing science and cultural belief systems compliment each other, rather than remaining relatively mutually exclusive.