Toward a medicine of the imagination

New Literary History

Volumn 37, Issue 3, 2006, Pages 583-605

  Kirmayer, Laurence J ^a  

^a MCGILL UNIVERSITY   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 34250638520     PISSN: 00286087     EISSN: 1080661X     Source Type: Journal    
DOI: 10.1353/nlh.2006.0046     Document Type: Article

References (82)

1. Paracelsus, Selected Writings, ed. Jolande Székács Jacobi, trans. Norbert Guterman (Princeton, NJ: Princeton University Press, 1988), 44
2. See F. Solmsen, "Plato and the Concept of the Soul (Psyche): Some Historical Perspectives," Journal of the History of Ideas (1983): 355-67
3. D. B. Claus, Toward the Soul: An Inquiry into the Meaning of Yuch before Plato (New Haven, CT: Yale University Press, 1981)
4. William W. Fortenbaugh, Aristotle on Emotion: A Contribution to Philosophical Psychology, Rhetoric, Poetics, Politics, and Ethics (London: Duckworth, 1975)
5. Samuel S. Kottek, "The Seat of the Soul: Contribution to the History of Medieval Jewish Psychophysiology," Clio Medica 13, no. 3-4 (1978): 219-46
6. Laurence J. Kirmayer, "Mind and Body as Metaphors: Hidden Values in Biomedicine," in Biomedicine Examined, ed. M. Lock and D. Gordon (Dordrecht, Neth.: Kluwer, 1988), 57-92
7. On the universality of mind and body, see Michael Lambek, "Body and Mind in Mind, Body and Mind in Body: Some Anthropological Interventions in a Long Conversation," in Bodies and Persons: Comparative Perspectives from Africa and Melanesia, ed. Lambek and Anthony Strathern (New York: Cambridge University Press, 1998)
8. See Esther Fischer-Homberger, "On the Medical History of the Doctrine of Imagination," Psychological Medicine 9 (1979): 619-28
9. Walter Pagel, Paracelsus: An Introduction to Philosophical Medicine in the Era of the Renaissance, 2nd rev. ed. (Basel: Karger, 1982), 111
10. Paracelsus, Selected Writings, 75
11. Brian Vickers, "Analogy Versus Identity: The Rejection of Occult Symbolism, 1580-1680,"' in Occult and Scientific Mentalities in the Renaissance, ed.Vickers (Cambridge: Cambridge University Press, 1984), 95-163
12. Paracelsus, quoted in Oswei Temkin, "The Elusiveness of Paracelsus," Bulletin of the History of Medicine 26 (1952): 216
13. Vickers, "Analogy Versus Identity," 95-163
14. See Lorraine Daston, "Fear and Loathing of the Imagination in Science," Daedalus 127, no. 1 (1998): 73-96
15. See Robert Darnton, Mesmerism and the End of the Enlightenment in France (New York: Schocken Books, 1968)
16. and Alan Gauld, A History of Hypnotism (New York: Cambridge University Press, 1992)
17. Darnton, Mesmerism, 64
18. See Josephine Rohrs Hilgard, Personality and Hypnosis: A Study of Imaginative Involvement, 2nd ed. (Chicago: University of Chicago Press, 1979)
19. and S. J. Lynn and J. W. Rhue, "The Fantasy-Prone Person: Hypnosis, Imagination, and Creativity," Journal of Personality and Social Psychology 51, no. 2 (1986): 404-8
20. "The autonomy of fantasy is the soul's last refuge of dignity. "James Hillman, Re-Visioning Psychology (New York: Harper & Row, 1975), 39
21. For more on imaginai dialogues and the ontology of the imagination in Jungian psychology, see also Hillman, Archetypal Psychology: A Brief Account (Dallas, TX: Spring Publications, 1983)
22. Richard Avens, Imagination Is Reality: Western Nirvana in Jung, Hillman, Barfield and Cassirer (Irving, TX: Spring Publications, 1980)
23. and Barbara Hannah, Encounter with the Soul: Active Imagination as Developed by C. G. Jung (Santa Monica, CA: SIGO Press, 1981)
24. This rationalism is expressed by Marcia Angell, a former editor of the New England Journal of Medicine, when she refers to the placebo effect (incorrectly) as "the tendency of both doctors and patients to imagine a drug is working." (Angell, The Truth About the Drug Companies: How They Deceive Us and What to Do About It (New York: Random House, 2004), 94. This use of "imagine" implies that the placebo is not really effective; but placebos have physiological effects and really work, and, what is more, imagination may be a vehicle for therapeutic efficacy not just a source of misleading ideas. We might rephrase her statement to describe the placebo effect as "the tendency of the imagination to make a drug work," where imagination is conceived of in the broadest sense as the construction of possible worlds through image, thought, and language
25. Benedict Carey, "When Trust in Doctors Erodes, Other Treatments Fill the Void," New York Times, February 3, 2006, www.nytimes.com/2006/02/03/ health/03patient.html
26. P. M. Barnes, E. Powell-Griner, K. McFann, and R. L. Nahin, "Complementary and Alternative Medicine Use among Adults: United States, 2002," Advance Data no. 343 (2004): 1-19
27. However, there is no simple opposition between CAM and conventional medicine, since a growing number of biomedical practitioners also refer patients to CAM or often certain modalities themselves- In 2000, about 40 percent of general practitioners in the UK offered access to CAM (most commonly, referring patients to chiropractors or osteopaths for the treatment of chronic low back pain). See Andrew Vickers, "Complementary Medicine," British Medical Journal 321 (2000): 683-86
28. In Israel, complementary medicine has been integrated into multimodal primary care clinics, in part to attract and retain patients in a competitive environment, but this is no guarantee of satisfaction with services. See J. T. Shuval and N. Mizrachi, "Changing Boundaries: Modes of Coexistence of Alternative and Biomedicine," Qualitative Health Research 14, no. 5 (2004): 675-90
29. and J. Fadlon, "Unrest in Utopia: Israeli Patients' Dissatisfaction with Non-Conventional Medicine, " Social Science and Medicine 58, no. 12 (2004): 2421-29
30. See José A. Págán and Mark V. Pauly, "Access to Conventional Medical Care and the Use of Complementary and Alternative Medicine," Health Affairs 24, no. 1 (2005): 255-62
31. Barry L. Beyerstein, "Alternative Medicine and Common Errors of Reasoning," Academic Medicine 76, no. 3 (2001): 230-37
32. See Matthew Schneirov and Jonathan David Geczik, "Beyond the Culture Wars: The Politics of Alternative Healing," in The Politics of Healing: Histories of Alternative Medicine in Twentieth Century North America, ed. Robert D. Johnston (New York: Roudedge, 2004), 245-46
33. J. C. Whorton,"From Cultism to CAM: Alternative Medicine in the Twentieth Century," in The Politics of Healing, ed. Johnston, 287-305
34. Indeed, from mid-century until the 1960s, alternative medicine in the U.S. was largely the province of the Christian right, associated with mistrust of secular institutions and anti-Semitism. See Harry M. Collins and Trevor J. Pinch, Dr. Golem: How to Think About Medicine (Chicago: University of Chicago Press, 2005)
35. In response to a recent randomized clinical trial of intercessory prayer for people undergoing cardiac bypass operations, which found no benefit, physician Harold Koenig, Director of the Center for Spirituality, Theology and Health at the Duke University Medical Center, commented, "Science is not designed to study the supernatural." M. Ritter, "Healing Power of Prayer Debunked," The Gazette (Montreal), March 31, 2006
36. Ernest Gellner, Plough, Sword and Book: The Structure of Human History (Chicago: University of Chicago Press, 1988)
37. See Kirmayer, "The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience," Medical Anthropology Quarterly 6, no. 4 (1992): 323-46
38. See Martin H. Krieger, Doing Physics: How Physicists Take Hold of the World (Bloomington: Indiana University Press, 1992)
39. Alternative practitioners are sometimes portrayed as less motivated by commercial interests. Yet they must compete for clients and market their skills. A newspaper article described research on the beneficial effects of omega-3 fatty acids (found in fish oil) and quoted psychiatrist David Servan-Schreiber to the effect that, unlike the situation with antidepressant medications, no pharmaceutical company had a vested interest in promoting fish oil or inflating its claims for efficacy. "But you can't patent fish oil," Servan-Schreiber said about why alternative methods have been given little attention. "No one has an economic interest in making them widely available." Charlie Fidelman, "Lifting Depression the Natural Way," The Gazette (Montreal), January 12, 2006
40. In fact, the omega-3 market was valued at $195 million in 2004 and is expected to grow at an average rate of 8 percent to 2010. Dr. Servan-Schreiber himself is the author of a popular book on healing that promotes fish oil (The Instinct to Heal: Curing Stress, Anxiety, and Depression without Drugs and without Talk Therapy [Emmaus, PA: Rodale, 2004]) and a consultant to a company that sells omega-3 dietary supplements. His website, www.guerir.fr, ("heal stress, anxiety and depression without medications or psychoanalysis") offers a checklist of common somatic symptoms of stress and encourages readers to explore treatments including relaxation training, physical exercise, EMDR (Eye Movement Desensitization and Reprocessing, a therapy for trauma-related disorders), bright light therapy, acupuncture, emotional communication, and the use of omega-3 supplements
41. See Kirmayer, "Broken Narratives: Clinical Encounters and the Poetics of Illness Experience," in Narrative and the Cultural Construction of Illness and Healing, ed. Cheryl Mattingly and Linda C. Garro (Berkeley and Los Angeles: University of California Press, 2000), 153-80
42. See Ted J. Kaptchuk and D. M. Eisenberg, "The Persuasive Appeal of Alternative Medicine," Annals of Internal Medicine 129 (1998): 1061-65
43. For a discussion of the metaphor of nature in French understandings of health and illness, see Claudine Herzlich, Health and Illness, (London: Academic Press, 1973)
44. On the fantasy of omnipotence, see Robert Seidenberg, "Omnipotence, Denial, and Psychosomatic Medicine," Psychosomatic Medicine 25, no. 1 (1963): 31-36
45. On the other hand, psvchosomatic medicine still needs defending from arch reductionists who believe that psychological attitudes count for little in the face of the powerful biological processes of disease. See Redford Williams, N. Schneiderman, Arnold Relman, and Angell, "Resolved: Psychosocial Interventions Can Improve Clinical Outcomes in Organic Disease - Rebuttals and Closing Arguments," Psychosomatic Medicine 64, no. 4 (2002): 564-7
46. See Kirmayer, " Reflections on Embodiment," in Social and Cultural Lives of Immune Systems, ed. James Wilce (New York: Roudedge, 2003), 282-302
47. Kirmayer, "The Cultural Diversity of Healing: Meaning, Metaphor and Mechanism," British Medical Bulletin 69 (2004): 33-48
48. See Irving Kirsch, How Expectancies Shape Experience (Washington, DC: American Psychological Association, 1999)
49. See Anne Harrington, ed., The Placebo Effect: An Interdisciplinary Exploration (Cambridge, MA: Harvard University Press, 1997)
50. Kaptchuk, "The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?" Annals of Internal Medicine 136, no. 11 (2002): 817-25
51. and S. Stewart-Williams and J. Podd, "The Placebo Effect: Dissolving the Expectancy Versus Conditioning Debate," Psychological Bulletin 130, no. 2 (2004): 324-40
52. Daniel E. Moerman, Meaning, Medicine, and the "Placebo Effect" (New York: Cambridge University Press, 2002)
53. In his novel Plowing the Dark, Richard Powers paints a vivid portrait of these virtual worlds of imagination constructed through computer technology, in the interiority of a man progressively locked into his body by multiple sclerosis, and in books, whether read or remembered, as places of refuge to which one can escape. Powers, Phwing the Dark (New York: Farrar, Straus, and Giroux, 2000)
54. See Jerome D. Frank, "Psychotherapy as Rhetoric - Some Implications," Clinical Psychology: Science and Practice 2, no. 1 (1995): 90-93
55. and Arthur W. Frank, The Wounded Storyteller (Chicago: University of Chicago Press, 1995)
56. The recognition of the centrality of narrative in the experience of illness and the clinical encounter has led to a call for "narrative-based medicine" as a crucial complement to evidence-based medicine. See Trisha Greenhalgh, "Narrative Based Medicine in an Evidence Based World," British Medical Journal 318, no. 7179 (1999): 323-25
57. and Brian Hurwitz, Greenhalgh, and Vieda Skultans, Narrative Research in Health and Illness (Maiden, MA: BMJ Books, 2004)
58. James W. Pennebaker, ed., Emotion, Disclosure, and Health (Washington, DC: American Psychological Association, 1995)
59. Pennebaker and S. K. Beall, "Confronting a Traumatic Event: Toward Understanding of Inhibition and Disease, "Journal of Abnormal Psychology 95 (1986): 274-81
60. Pennebaker, "Confession, Inhibition and Disease," in Advances in Experimental Social Psychology, ed. L. Berkowitz (New York: Academic Press, 1989), 211-44
61. and Pennebaker, S. D. Barger, and J. Tiebout, "Disclosure of Traumas and Health among Holocaust Survivors," Psychosomatic Medicine 51, no. 5 (1989): 577-89
62. Pennebaker, Opening Up: The Healing Power of Confiding in Others (New York: William Morrow, 1990)
63. Pennebaker, "Writing About Emotional Experiences as a Therapeutic Process," Psychological Science 8, no. 3 (1997): 162-66
64. Pennebaker, T. J. Mayne, and M. E. Francis, "Linguistic Predictors of Adaptive Bereavement," Journal of Personality and Social Psychology 72, no. 4 (1997): 863-71
65. Pennebaker and J. D. Seagal, "Forming a Story: The Health Benefits of Narrative," Journal of Clinical Psychology 55, no. 10 (1999): 1243-54
66. M. A. Cohn, M. R. Mehl, and Pennebaker, "Linguistic Markers of Psychological Change Surrounding September 11, 2001," Psychological Science 15, no. 10 (2004): 687-93
67. Kirmayer, "Healing and the Invention of Metaphor: The Effectiveness of Symbols Revisited," Culture, Medicine and Psychiatry 17, no. 2 (1993): 161-95
68. George Lakoff and Mark Johnson, Metaphors We Live By (Chicago: University of Chicago Press, 1980)
69. Mark Johnson, The Body in the Mind: The Bodily Basis of Meaning, Imagination, and Reason (Chicago: University of Chicago Press, 1987)
70. See Cheryl Mattingly, "The Concept of Therapeutic 'Emplotment,'" Social Science and Medicine 38, no. 6 (1994): 811-22
71. See also, Michael Herzfeld, "Closure as Cure: Tropes in the Exploration of Bodily and Social Disorder," Current Anthropology 27, no. 2 (1986): 107-12
72. See Eve Sweetser, "Blended Spaces and Performativity," Cognitive Linguistics 11, no. 3-4 (2000): 305-33
73. See Kirmayer, "Broken Narratives," 153-80
74. See Byron J. Good, Medicine, Rationality, and Experience: An Anthropological Perspective (Cambridge: Cambridge University Press, 1994)
75. See Thomas J. Scheff, Catharsis in Healing, Ritual, and Drama (Berkeley and Los Angeles: University of California Press, 1979)
76. See Daniel Goleman, The Varieties of the Meditative Experience (New York: Irvington Publishers, 1977)
77. John F, Avedon, Fernand Meyer, N. D. Bolsokhoeva, K. M. Gerasimova, and T. S. Bradley, The Buddha's Art of Healing: Tibetan Paintings Rediscovered (New York: Rizzoli International Publications, 1998), 74-75
78. Raoul Birnbaum, The Healing Buddha (Boulder, CO: Shambhala, 1979), 107
79. Gershom Gerhard Scholem, Major Trends in Jewish Mysticism (New York: Schocken Books, 1961)
80. Betty Rojtman, Black Fire on While Fire: An Essay on Jewish Hermeneutics, from Midrash to Kabbalah (Berkeley and Los Angeles: University of California Press, 1998), 136
81. Moshe Idel, Absorbing Perfections: Kabbalah and Interpretation (New Haven, CT: Yale University Press, 2002), 76
82. Ciarán Benson, The Absorbed Self: Pragmatism, Psychology, and Aesthetic Experience (New York: Harvester Wheatsheaf, 1993)