The third speaker: The body as interlocutor in conventional, complementary, and integrative medicine encounters
DOI:
https://doi.org/10.1558/cam.32577Keywords:
agency, biomedicine, body, clinical encounters, complementary/alternative medicine, micro-interactionAbstract
This paper examines talk about the body in interactions between patients and their complementary/ alternative providers (CAM), integrative physicians (IM), or conventional physicians. In an analysis of 603 consultations, we focus on instances where the body is spoken of in agentive terms. We thus examine particular micro-interactive moments where the body is constituted as an agent that speaks, responds, and otherwise acts in ways that direct the flow of conversation or the medical decision-making process. With this data, we demonstrate how body-as-agent metaphors in the clinical encounter underscore the communicative agency of providers and position the body as an interlocutor or ‘third speaker’ in conversation with the patient and provider. We further note that we found only limited differences in the ways body-as-agent metaphors were used by CAM/IM and conventional providers. Rather than arguing that such differences demonstrate a fundamental divide between CAM/IM and conventional approaches, we therefore suggest that these kinds of supportive body-as-agent talk exist as opportunities for all providers to support patients in taking a more active stance in managing their relationship with their body.References
Agha, A. (2007) Language and Social Relations. Cambridge: Cambridge University Press.
Ahearn, L. M. (2001) Language and agency. Annual Review of Anthropology 30: 109–137. https://doi.org/10.1146/annurev.anthro.30.1.109
Arroliga, A. C., Newman, S., Longworth. D. L. and Stoller, J. K. (2002) Metaphorical medicine: Using metaphors to enhance communication with patients who have pulmonary disease. Annals of Internal Medicine 137 (5/1): 376–379. https://doi.org/10.7326/0003-4819-137-5_Part_1-200209030-00037
Austin, J. L. (1961) Philosophical Papers. Oxford: Oxford University Press.
Barcan, R. (2011) Complementary and Alternative Medicine: Bodies, Therapies, Senses. Oxford and New York: Berg
Barry, M. J. and Edgman-Levitan, S. (2012) Shared decision-making – pinnacle of patient-centered care. New England Journal of Medicine 366 (9): 780–781. https://doi.org/10.1056/NEJMp1109283
Becker, G. (1994) Metaphor in disrupted lives: Infertility and cultural constructions of continuity. Medical Anthropology Quarterly 8 (4): 383–410. https://doi.org/10.1525/maq.1994.8.4.02a00040
Charon, R. (2005) Narrative medicine: Attention, representation, affiliation. Narrative 13 (3): 261–270. https://doi.org/10.1353/nar.2005.0017
Chen, A. T. (2015) Body-as-information: Learning to listen to the body in the context of chronic illness. Proceedings of the Association for Information Science and Technology 52 (1): 1–4. https://doi.org/10.1002/pra2.2015.145052010085
Cloninger, C. R. and Cloninger, K. M. (2011) Person-centered therapeutics. International Journal of Person Centered Medicine 1 (1): 43–52. https://doi.org/10.5750/ijpcm.v1i1.21
Duranti, A. (2004) Agency in language. In A. Duranti (ed.) Companion to Linguistic Anthropology, 451–473. Malden, MA: Blackwell.
Ellis-Hill, C. S., Payne, S. and Wardoe, C. (2000) Self-body split: Issues of identity in physical recovery following a stroke. Disability and Rehabilitation 22 (16): 725–733. https://doi.org/10.1080/09638280050191990
Fingerson, L. (2005) Agency and the body in adolescent menstrual talk. Childhood 12 (1): 91–110. https://doi.org/10.1177/0907568205049894
Goldstein, M. (1999) Alternative Health Care: Medicine, Miracle, or Mirage? Philadelphia: Temple University Press.
Good, B. and Delvecchio-Good, M. J. (1993) Learning medicine: The constructing of medical knowledge at Harvard Medical School. In S. Lindenbaum and M. Lock (eds) Knowledge, Power, and Practice, 81–107. Berkeley: University of California Press.
Goodwin, C. (2000) Action and embodiment within situated human interaction. Journal of Pragmatics 32: 1489–1522. https://doi.org/10.1016/S0378-2166(99)00096-X
Heath, C. (2006) Body work: The collaborative production of the clinical object. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Providers and Patients, 185–213. Cambridge: Cambridge University Press.
Katz, M. (2000) Constructing the ‘good patient’ in conventional and unconventional medical settings: Roles, relationships and information transfer. In J. Jacobs Kronenfeld (ed.) Health, Illness, and Use of Care: The Impact of Social Factors. Research in Sociology of Healthcare 18: 183–206. Bingley, UK: Emerald Group.
Kirmayer, L. J. (1992) The body’s insistence on meaning: Metaphor as presentation and representation in illness experience. Medical Anthropology Quarterly 6 (4): 323–346. https://doi.org/10.1525/maq.1992.6.4.02a00020
Kleinman, A. (1988) The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.
Kovecses, Z. (2005) Metaphor in Culture: Universality and Variation. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511614408
Lakoff, G. and Johnson, M. (1980) Metaphors We Live By. Chicago: University of Chicago Press.
Leder, D. (1990) The Absent Body. Chicago: University of Chicago Press.
Oths, K. (1994) Communication in a chiropractic clinic: How a D.C. treats his patients. Culture, Medicine, and Psychiatry 18 (1): 83–113. https://doi.org/10.1007/BF01384878
Periyakoil, V. S. (2008) Using metaphors in medicine. Journal of Palliative Medicine 11 (6): 842–844. https://doi.org/10.1089/jpm.2008.9885
Ross, A. I. (2012) The Anthropology of Alternative Medicine. London and New York: Berg.
Scarry, E. (1985) The Body in Pain. Oxford: Oxford University Press.
Sinclair, S. (1997) Making Doctors: An Institutional Apprenticeship. Oxford and New York: Berg.
Tarn, D. M., Karlamangla, A., Coulter, I. D., Paterniti, D. A., Knox, L., Khang, P. S., Hui, K. K. and Wenger, N. S. (2015) A cross-sectional study of provider and patient characteristics associated with outpatient disclosures of dietary supplement use. Patient Education and Counseling 98 (7): 830–836. https://doi.org/10.1016/j.pec.2015.03.020
van Manen, M. (1998) Modalities of body experience in illness and health. Qualitative Health Research 8 (1): 7–24. https://doi.org/10.1177/104973239800800102
Ahearn, L. M. (2001) Language and agency. Annual Review of Anthropology 30: 109–137. https://doi.org/10.1146/annurev.anthro.30.1.109
Arroliga, A. C., Newman, S., Longworth. D. L. and Stoller, J. K. (2002) Metaphorical medicine: Using metaphors to enhance communication with patients who have pulmonary disease. Annals of Internal Medicine 137 (5/1): 376–379. https://doi.org/10.7326/0003-4819-137-5_Part_1-200209030-00037
Austin, J. L. (1961) Philosophical Papers. Oxford: Oxford University Press.
Barcan, R. (2011) Complementary and Alternative Medicine: Bodies, Therapies, Senses. Oxford and New York: Berg
Barry, M. J. and Edgman-Levitan, S. (2012) Shared decision-making – pinnacle of patient-centered care. New England Journal of Medicine 366 (9): 780–781. https://doi.org/10.1056/NEJMp1109283
Becker, G. (1994) Metaphor in disrupted lives: Infertility and cultural constructions of continuity. Medical Anthropology Quarterly 8 (4): 383–410. https://doi.org/10.1525/maq.1994.8.4.02a00040
Charon, R. (2005) Narrative medicine: Attention, representation, affiliation. Narrative 13 (3): 261–270. https://doi.org/10.1353/nar.2005.0017
Chen, A. T. (2015) Body-as-information: Learning to listen to the body in the context of chronic illness. Proceedings of the Association for Information Science and Technology 52 (1): 1–4. https://doi.org/10.1002/pra2.2015.145052010085
Cloninger, C. R. and Cloninger, K. M. (2011) Person-centered therapeutics. International Journal of Person Centered Medicine 1 (1): 43–52. https://doi.org/10.5750/ijpcm.v1i1.21
Duranti, A. (2004) Agency in language. In A. Duranti (ed.) Companion to Linguistic Anthropology, 451–473. Malden, MA: Blackwell.
Ellis-Hill, C. S., Payne, S. and Wardoe, C. (2000) Self-body split: Issues of identity in physical recovery following a stroke. Disability and Rehabilitation 22 (16): 725–733. https://doi.org/10.1080/09638280050191990
Fingerson, L. (2005) Agency and the body in adolescent menstrual talk. Childhood 12 (1): 91–110. https://doi.org/10.1177/0907568205049894
Goldstein, M. (1999) Alternative Health Care: Medicine, Miracle, or Mirage? Philadelphia: Temple University Press.
Good, B. and Delvecchio-Good, M. J. (1993) Learning medicine: The constructing of medical knowledge at Harvard Medical School. In S. Lindenbaum and M. Lock (eds) Knowledge, Power, and Practice, 81–107. Berkeley: University of California Press.
Goodwin, C. (2000) Action and embodiment within situated human interaction. Journal of Pragmatics 32: 1489–1522. https://doi.org/10.1016/S0378-2166(99)00096-X
Heath, C. (2006) Body work: The collaborative production of the clinical object. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Providers and Patients, 185–213. Cambridge: Cambridge University Press.
Katz, M. (2000) Constructing the ‘good patient’ in conventional and unconventional medical settings: Roles, relationships and information transfer. In J. Jacobs Kronenfeld (ed.) Health, Illness, and Use of Care: The Impact of Social Factors. Research in Sociology of Healthcare 18: 183–206. Bingley, UK: Emerald Group.
Kirmayer, L. J. (1992) The body’s insistence on meaning: Metaphor as presentation and representation in illness experience. Medical Anthropology Quarterly 6 (4): 323–346. https://doi.org/10.1525/maq.1992.6.4.02a00020
Kleinman, A. (1988) The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.
Kovecses, Z. (2005) Metaphor in Culture: Universality and Variation. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511614408
Lakoff, G. and Johnson, M. (1980) Metaphors We Live By. Chicago: University of Chicago Press.
Leder, D. (1990) The Absent Body. Chicago: University of Chicago Press.
Oths, K. (1994) Communication in a chiropractic clinic: How a D.C. treats his patients. Culture, Medicine, and Psychiatry 18 (1): 83–113. https://doi.org/10.1007/BF01384878
Periyakoil, V. S. (2008) Using metaphors in medicine. Journal of Palliative Medicine 11 (6): 842–844. https://doi.org/10.1089/jpm.2008.9885
Ross, A. I. (2012) The Anthropology of Alternative Medicine. London and New York: Berg.
Scarry, E. (1985) The Body in Pain. Oxford: Oxford University Press.
Sinclair, S. (1997) Making Doctors: An Institutional Apprenticeship. Oxford and New York: Berg.
Tarn, D. M., Karlamangla, A., Coulter, I. D., Paterniti, D. A., Knox, L., Khang, P. S., Hui, K. K. and Wenger, N. S. (2015) A cross-sectional study of provider and patient characteristics associated with outpatient disclosures of dietary supplement use. Patient Education and Counseling 98 (7): 830–836. https://doi.org/10.1016/j.pec.2015.03.020
van Manen, M. (1998) Modalities of body experience in illness and health. Qualitative Health Research 8 (1): 7–24. https://doi.org/10.1177/104973239800800102
Published
2018-10-26
Issue
Section
Articles
License
copyright Equinox Publishing Ltd.
How to Cite
Pritzker, S. E., Guzman, J., Hui, K.-K., & Tarn, D. (2018). The third speaker: The body as interlocutor in conventional, complementary, and integrative medicine encounters. Communication and Medicine, 14(3), 256-267. https://doi.org/10.1558/cam.32577
