The elementary forms of the medical life: sacred and profane in biomedical cosmology.

Abstract

This thesis examines the place of metaphor in biomedical knowledge about two major public health problems: cancer and coronary heart disease (CHD). Specifically, it considers why cancer is constituted by biomedicine in obviously metaphorical concepts that are also highly pejorative. Conversely, the metaphorical dimension of the biomedical knowledge concerning CHD is less obvious and less negative in its connotations. This thesis posits that the difference in linguistic styles associated with cancer and CHD can be accounted for by whether knowledge about them confirms or challenges the knowledge and value system of modernity. Cancer, as construed by biomedicine, appears to confound some important tenets of the epistemology and knowledge of modernity. In particular, it confounds the idea that the body is a machine and that nature is an inert order obeying objective laws. It thus suggests that the universe, including that of bodies, is not entirely subject to rational understanding and control. Women having irrational bodies and an affinity with unruly nature are primary sites for cancer. It is therefore hardly surprising that cancer's metaphors express a fear that order based on masculine rational agency is fragile. By contrast, biomedical knowledge about CHD appears to confirm key aspects of modernist knowledge. Specifically, it suggests that the (masculine) body can be understood as a machine that exists as part of a wider domain of nature that is inert and is fuelled by objective laws. Unlike cancer, which is depicted as mysterious and arcane, CHD is presented as an ailment with causes that are well understood and treatment that is effective, thus affirming the truth of rationality and technology. Coronary heart disease is construed overwhelmingly as a disease affecting men exercising their capacity for rational agency, free from the 'dictates' of an irrational body. Coronary heart disease is depicted as a disruption of supply and demand rather than as a threat to social order itself. In Durkheimian terms, sacred things can be pure and beneficent or they can take impure and threatening forms. Cancer expresses the impure, threatening dimension of sacredness in exposing threats to the knowledge and order of modernity. Conversely, coronary heart disease is profane, in those terms, since it offers apparent confirmation of the knowledge and order of modernity. Cancer makes us aware of deeply held values by making us conscious of threats to them but the knowledge of CHD is so congruent with the knowledge system of modernity, that it does not provoke us to examine that framework; it merely affirms our routine and mundane view of the world. These findings suggest that biomedicine can be regarded as a secular religion because it acts as a cosmology. Knowledge of the body and its ailments is set within a wider conceptual framework and value system recognizing and naming sources of order and danger. This further suggests that while biomedicine may be rightly regarded as a technical and instrumental body of knowledge, it is nevertheless fuelled by and intertwined with deeply held values and convictions that are beyond the domain of rationality. The unexamined, a-rational elements of biomedicine have been virtually ignored within public health and explain some of its limitations in defining and responding to familiar public health problems.