Intelligent cells and the body as conversation: the democratic rhetoric of mindbody medicine.

• Author: Darwin, Thomas J.

Despite our familiarity with our bodies, they are essentially mysterious. Very few of us understand in any detail how the body actually functions beyond very general, popularized knowledge of physiology and anatomy. Medical professionals confront this mystery from the very outset of their training. Medical training is grounded in teaching students how to see and interpret a body that supports many possible interpretations, many of them conflicting (Good, 71). Understanding of the body, whether by the general "lay" person or the expert, must be constituted from language, images, and concepts that are culturally bound. As a result, articulations of the body carry traces of the cultural and social relationships in which a given body exists. Even when a "picture" of the body is accurate, that does not necessarily deny the discursive nature of explanations of the body. Bodies consistently take on the features and functions of their social and cultural circumstances (Kirmayer 59; Scheper-Hughes and Lock 7). Because the body can be made to fit the form of so many situations, it becomes a very powerful argumentative tool. As an undeniable part of our experience, the body provides the basis of powerful metaphorical arguments (Grosz 88-91). In those instances where the body can be shown to function according to and thus exemplify social structures, those structures become more natural and valid (Martin 121).

The indeterminacy of the body and it's ability to naturalize social and cultural agendas makes the body an intense site of social contestation (Turner 15-18). This is particularly true in healing and medicine, where so much is at stake. The way a body is articulated in a given paradigm of healing has direct entailments for the treatment of patients. Paradigms that are mechanistic and reductive marginalize subjective aspects of illness in favor of the aspects that are empirically available. Because they are grounded in material science, these paradigms have a tremendous cultural persuasiveness. Their limitations arise, however, when they confront paradigms of healing that feature the subjective and experiential nature of illness, as does mindbody medicine. In either case, a paradigm of medicine or healing must ground itself in a coherent rhetoric of the body which explains how the body works, what the nature of disease is, and thus how best to care for the body. At stake in a paradigm's ability to articulate and advocate its account of the body is trust in that paradigm, as well as vast financial and cultural resources.

Among the most culturally compelling and argumentatively rich paradigms of healing is mindbody medicine. As this paper details, it advocates a much more active role for patients in their own healing by offering an alternative physiology in which the body is a fully integrated communication network. Mindbody medicine's argument for an alternative physiology is grounded in a series of conceptual metaphors which recasts our understanding of cells and the relationships among those cells. Using the conceptual metaphor of a "body-mind," mindbody medicine collapses the physiological hierarchy that grounds both physiology and biomedical practice. Arguing against the notion that most cells in the body passively follow orders from higher control centers, mindbody medicine metaphorically recasts the body as a cellular democracy in which all cells participate by virtue of inherent intelligence and constant communication with each other. Because it has the cultural legitimacy of being grounded in scientific research, mindbody medicine provides a powerful argument for patients having primary agency in deliberation over their own health and healing. Most radically, mindbody medicine implies that the body itself becomes an agent in its own heeding, acquiring a voice by virtue of the fact that its symptoms and processes are directly subject to and directly influence the thoughts and feelings of the person.

Because mindbody medicine's argument is grounded in the way it articulates and explains the body, this paper analyzes three aspects of the rhetoric by which it advocates its position. First, it analyzes how mindbody medicine interprets cells as intelligent and thereby autonomous. Second, it explains in detail the central conceptual metaphor of the body as a cellular conversation, succinctly captured in the neologism of the "bodymind." It shows how the metaphor of conversation is evident not only in how mindbody medicine explains the physiology of the body, but also in how it explains disease. Finally, it shows how mindbody therapies themselves enact the cooperative and democratic relationship which mindbody medicine finds in the body and advocates between physicians and patients. The analysis is framed by an overview of the democratic agenda of mindbody medicine itself, and how it has increased its legitimacy by grounding itself in scientific research. In analyzing the rhetoric of mindbody medicine, this paper focuses on the metaphors and conceptual themes by which mindbody medicine advocates its position for a larger public comprised of all those who deliberate about health and medicine, whether privately or on a large scale. It analyzes a very rich discourse that is brought to bear on the body in order to make sense of and keep the body healthy. Because the body supports many discursive interpretations, the rhetoric of the body is more than a metaphorical overlay. The metaphors enable us to "see" how the body might actually be functioning. Mindbody medicine articulates and advocates a view of the body that implies that the body itself is an agent. By even making it plausible to think of the body itself as an agent, the rhetoric of mindbody medicine about the body in effect becomes a rhetoric of the body and by the body.

Throughout the paper, I use the term "democratic" in the generic sense of a political system in which individuals participate in the process of deliberation over collective policies. It is premised on the notion that each individual has certain rights and powers of self-determination, though these powers are tempered by competing needs of the community. Democracy encompasses a tension between the power of an individual to do what he or she wills and pleases, and the needs of the greater collective. Democracy in the sense I am using it implies that the members of a democratic community have the intelligence to govern themselves. The most prominent expression of this intelligence lies in collective public discourse by which members of the democracy deliberate over and negotiate policy. Whether a direct participatory democracy or a representative democracy, well developed modes of public communication are essential to its functioning and survival. And although the concept of the public has many shades of meaning, the sense of the public used in this paper is of the body of individuals who deliberate together to decide collective policy issues, and do so utilizing generally available arguments and lines of discourse.

MINDBODY MEDICINE AND EMPOWERING PATIENTS

Mindbody medicine is the most popular form of alternative medicine in the United States. The most extensive and widely cited study of the use of alternative medicine showed in 1993 that over a third of all Americans use some form of alternative medical therapy, often in conjunction with biomedical therapies (Eisenberg et.al.). Their reasons range from exhausting possibilities for treating terminal and chronic illnesses to simple frustration with what they perceive to be the cold and inhuman nature of biomedicine. Still others have become convinced that alternative medicine simply has a better understanding of how the body works, and therefore holds out better promise of healing the body. Proponents of the alternatives do not deny the effectiveness of biomedicine in surgical techniques and fighting infections, for example, but they find the biomedical paradigm too limited at best, and dangerous at worst. Since 1993 there has been tremendous growth in the number of books, articles, magazines, websites, and television programs all providing and advocating alternatives to biomedicine. Among the best known advocates of mindbody medicine are Andrew Weil, Deepak Chopra, Larry Dossey, Herbert Benson, Joan Borysenko, and Bill Moyers, to name a few.

Mindbody medicine's popularity has derived in large part from its advocacy of the view that physicians and patients are equal partners in the process of healing and that patients have autonomy and responsibility for overcoming illness and maintaining health. Mindbody medicine's growing legitimacy has derived from its ability to show scientifically that patients' subjective interpretations of their bodies and illnesses have direct physiological and etiological effects. Mindbody medicine presents the body in a way that the body becomes a heuristic for effective healing relationships. In effect, the body advocates a view of how best to maintain health and treat illness.

Two of mindbody medicine's most prominent advocates are Deepak Chopra and Candace Pert. Chopra, a medical doctor, has provided the most well developed popular advocacy of mindbody medicine over the last two decades. Chopra's books, tapes, seminars, and wellness centers put him in a position equaled perhaps only by Andrew Weil as a leading advocate of mindbody medicine. While Chopra has popularized mindbody medicine, Candace Pert's work exemplifies its grounding in scientific research. Pert's discoveries of how peptides and receptors constitute the body's internal communication network exemplify the ways that scientific research on the relationship between mind and body in health and illness have given mindbody medicine a legitimacy it could not hope to enjoy otherwise. As researchers and advocates, Chopra and Pert have lead an argumentative and rhetorical process by which the public has created alternatives to biomedicine and used...