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Social History of Medicine 1999 12(3):407-435; doi:10.1093/shm/12.3.407
© 1999 by Society for the Social History of Medicine
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Discussion Point

Rhetoric and the Social Construction of Sickness and Healing

DAVID HARLEY*

* Department of History 219 O'Shaughnessy Hall University of Notre Dame Notre Dame, IN 46556, USA. E-mail: David.N.Harley{at}nd.edu

An important element in recent science studies has been the analysis of the social rhetoric involved in the construction of disciplines and knowledge. An explicit use of rhetorical and semiotic frames of reference would illuminate many aspects of the history of medicine and could provide a unifying framework for the field. Medical theories were always intended for use and therefore had to be plausible in the eyes of patients. The interpretation of signs and the construction of explanations lie at the heart of diagnosis, therapy and prognosis. These are usually interactive processes and the efficacy of medical interventions therefore depends upon meaning, narrative and persuasion. Since mental processes are not rigidly separated from bodily functions, trust and expectation have physiological effects that are required for successful healing in all cultures at all times. The conduct of patients and practitioners always turns on the expectation of cure and the establishment of confidence. The efficacy of rhetoric was more readily recognized by practitioners in the past than it has been by social historians of medicine. Once mind–body dualism has been discarded, it can be seen that historians are not studying the context of healing but its very heart.

Keywords: historiography of science; historiography of medicine; social construction; rhetoric; semiotics; disease ontology; psychosomatic disease; culture-bound disease; mind–body dualism; patient–practitioner relations; the placebo effect; non-specific healing


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