CHAPTER 1: INTRODUCTION

By any count, the last thirty years in American culture have seen a significant rise the use of complementary and alternative medicine (see Eisenberg, et. al., 1993, 1998; for cross-cultural data, Buckle, 1994, Ernst, 1996, Fulder and Munro, 1985; Goldbeck-Wood, et. al., 1996; Fisher and Ward, 1994; Millar, 1997; Thomas, et. al., 1991; Verhoef, et. al., 1990, 1994).[1] Few patients in 1970 could have envisioned the wide variety of health alternative accorded patients at the turn of the millennium. Today, the number of alternatives presented the health consumer are vast—acupuncture, chiropractic, herbal therapies, meditation, homeopathy, naturopathy, megavitamins. All are offered as alternatives from, and complements to, the scientifically-based biomedicine which dominated the American medical scene for the majority of the twentieth century.

Consumers have greeted the emergence of such options with heavy demand. 33.8% of all Americans had used at least one unconventional therapy in 1990, when the first national survey to measure use of alternative medicine was conducted. By 1997, this same number had jumped to 42.1%. Nearly half (46.3%) of these users saw an alternative provider, while the rest used self-administered therapies. Extrapolation of survey data indicate that Americans made 629 million visits to alternative providers in 1997, a number which topped the total number of visits to all US primary care physicians in that year. Between 1990 and 1997, Americans increased spending on professional alternative services by 45.2%, totaling at least $21.2 billion in 1997, with at least $12.2 billion of that paid out-of-pocket, an amount which surpasses out-of-pocket expenses for all US hospitalizations in 1997 (Eisenberg, et al., 1993, 1998).

Americans spent another $6 billion on self-administered forms of alternative medicine in 1997, bringing the conservative estimate of total expenditures for all alternative therapies to $27 billion, which is comparable with the 1997 numbers for out-of-pocket expenditures for all US physician services. Use of alternative medicine was highest among adults between 35 and 49, among whom survey data estimates that one-half used at least one alternative therapy in 1997. Between 1990 and 1997, overall use of alternative medicine increased by 25%. Visits to alternative providers increased by approximately 47%, and the corresponding money spent on those visits increased by 45%, controlling for inflation (Eisenberg, et al., 1993, 1998). And to the extent that insurance coverage for alternative therapies expands in the future, past utilization patterns (Shekelle, et al., 1996) would predict further increases in the use of alternative medicine.

While similarly detailed survey data is regrettably unavailable pre-1990, we can deduce the sharp rise in use of alternative medicine in the 1970-1990 time frame through other measures. Take, for instance, the case of chiropractic. Long gone are the days of the first half of the twentieth century, when officials of the American Medical Association adopted the slogan, “Chiropractic must die,” and gave themselves ten years to accomplish the task. By 1974, they could be licensed in all 50 states, and in 1990, the Supreme Court found that the American Medical Association guilty of criminal conspiracy against chiropractics, thus giving the 60,000-70,000 American chiropractors professional standing vis-à-vis MD’s (Wardwell, 1994). This greater social acceptance of chiropractic surely lay behind the phenomenal growth in the number of providers, which twenty-five years earlier had numbered just 23,000 (White and Skipper, 1971). In 1950, there had been approximately 11,000 providers (Naegle, 1970).

In addition to increased supply and rise in demand, alternative medical practices have enjoyed a modicum of institutional success. In 1993, the National Institutes of Health established the Office of Alternative Medicine (OAM). By 1997, OAM’s budget had grown to $12 million. While comprising a minute portion of the NIH budget, the establishment of OAM marks the first official recognition of alternative medicine by any agency of the federal government. OAM has funded 42 independent studies since its inception, and has helped to create numerous centers for research on alternative medicine (Neimark, et. al., 1997). In addition to governmental recognition, alternative therapies have garnered some attention and recognition in mainstream medical education. 64% of US medical schools offer some form of coursework on alternative medicine (Wetzel, et al., 1998),[2] and at least 18 different insurance companies now cover alternative therapies (Daly, 1996). The best publicized of these, the Oxford Health Plan, has announced plans to create a network of 1,000 holistic providers for its customers (Neimark, et al., 1997).

In this study, I argue that the social significance of this movement is to be found, not so much in the substantive shifts between styles of medical practice represented by standard allopathic practice and alternative means, but in the particular form of American individualism which nourishes alternative medical practice and gives it sustenance. While there may indeed be significant substantive differences between the forms of medicine represented, respectively, by the MD and the alternative practitioner, the social sources which underlie patients’ attractions to each form of medicine are, I argue, what has driven the rising popularity of alternative medicine in recent years. Indeed, these different forms of healing have existed side-by-side in the West for at least two centuries. But the new societal recognition which alterative means have achieved in the past thirty years which is explainable only via an indepth investigation of the cultural trends which underlie patients’ seeking out of said methods of healing. I argue that many alternative health practices, predicated as they are on distinctly modern notions of self-improvement, self-actualization, and self-realization, are but one manifestation of a distinctive brand of expressive individualism (Bellah, et al., 1985). In my research, I found the logic by which Americans turn to alternative medicine to be deeply informed by a potent combination of four factors: a deep reverence for nature, a therapeutic ethic, a deep suspicion of authority, and an amorphously defined, organization-free form of religiosity. I refer to this quartet of social influences as organic individualism. Though related to expressive individualism, this brand of self-expression is distinct from Bellah’s expressive individualism in several important ways. For Bellah, et al., expressive individualism:

holds that each person has a unique core of feeling and intuition that should unfold or be expressed if individuality is to be realized. This core, though unique, is not necessarily alien to other persons or to nature. Under certain conditions, the expressive individualist may find it possible through intuitive feeling to “merge” with other persons, with nature, or with the cosmos as a whole. (1985:333-334)

Further, expressive inidividualism sees “cultivation and expression of the self, the exploration of its vast social and cosmic identities” (35) as the primary ends towards which human beings should strive. And, indeed, organic individualism is a type of expressive individualism. It shares with expressive individualism the central importance of nurturing of the self, of discovering its depths through self-exploration. Organic individualism, like expressive individualism, eschews the more pragmatic means-ends mindset of utilitarian individualism.

But where expressive individualism allows for the possibility of individuals merging with one another or with nature, organic individualism makes such experiences—especially aligning one’s self with nature—normative, mandatory. Where expressive individualism allows for the possibility that self-expression could occur within relatively traditional institutions and powerful organizations, organic individualism mandates that self-exploration and self-actualization take place outside the confines of traditional institutional authority, traditional organizational structure. Or again, where expressive individualism allows for at least the theoretical possibility that individual expression and deference to authority could co-exist, organic individualism makes clear that the two are wholly incompatible.

Organic individualism, in short, is “organic” in three important ways. First, it ties self-actualization and self-realization to nature, and purports to eschew synthetic, humanly constructed devices and substances. Too, it swears off the confines of traditional hierarchal social structures, traditionally powerful institutions, and sees organizational involvement as antithetical to self-actualization. The less institutionally bounded an activity, therefore, the more “real” (read organic) it is, and thus, the more it allows the individual to genuinely discover herself. Finally, organic individualism derives its name from its stress upon the place of the physical body in self-realization. Where expressive individualism allowed for the role of the physical body in the process of self-realization, organic individualism insists on its centrality.

The result, I argue, is a form of health-seeking behavior which makes American alternative medicine part search for cure, part search for leisure, and part search for identity. Ultimately, large numbers of people turn to alternative medicine because alternative medicine works. But what it means for a form of healing to “work” is culturally defined, and I argue here that when alternative medicine works, it is not only offering my respondents cures from disease and alleviation of suffering, but also an outlet for their distinctly natural, therapeutically-oriented, spiritually-informed definitions of their social worlds and themselves. But more on my argument later. First, to contextualize my contribution, a brief review of other social analyses of this recent upsurge in use of alternative health practices.

EARLY APPROACHES: THE MYTH OF DEVIANCE AND ITS LEGACY

What explanations have been given for this sudden upsurge in the use of alternative medicine in the late twentieth century? Early studies of alternative medicine tended to conceive of alternative health users and providers as Becker-like “outsiders” or as “wayward” Erikson-style deviants (Becker 1963, Erikson, 1966), drawn into alternative medicine out of either out of peculiar religious and metaphysical beliefs, simple curiosity, or a more complex anti-establishment sentiment (White and Skipper, 1971; Wardwell, 1958, 1979; Naegele, 1970; Wallis and Morely, 1976; Kronenfeld and Wasner, 1982). Though the alternative-medicine-as-deviance approach made empirical sense in an era when use of alternative medicine was all but unknown, its tendency to pathologize use both users and providers proved ultimately problematic. Still, the approach yielded two helpful foundations for contemporary scholars. First, the emphasis on metaphysical beliefs has carried through to a more informed contemporary focus on the varying religious commitments of alternative users. Second, the recognition that some use of alternative medicine arose out of anti-establishmentarian sentiments has caused many contemporary scholars to appropriately focus on the place of anti-scientific sentiment among alternative medical users. Although somewhat related, the two emphasize distinct characteristics of the alternative medical movement. While the former school of thought emphasized the ways in which alternative medicine functioned as an ideological community, the latter focused on alternative medicine’s role as a source of social change.

It is no surprise that a movement shaped by a quasi-spiritual understanding of human health should be populated by persons sympathetic to religion. This element of alternative medicine has been explored in some depth. Shupe (1988), reflecting a long tradition of sociological theory and research on secularization, notes that “from antiquity to modernity, the main trend has been one of separating the understanding of healing processes from the sacred” (see also Martineau, 1896, Berger, 1967). Significantly, however, he adds that “[in the] late 20^th century, there has been a retreat from this [trend].” Spiritually-based forms of healing, then, appear to have a curvilinear relationship to modernity—flourishing in pre-modern life, fading with the rise of biomedicine in the nineteenth and twentieth centuries, only to return to prominence under the conditions of “high modernity” (Giddens, 1990, 1991). Some (e.g., Goldstein, 1987) have focused on the religious experiences and attitudes of alternative practitioners, demonstrating that they are significantly more likely to have significant religious commitments than are their conventional counterparts. Users of alternative medicine are characterized by at least one scholar (Foltz, 1986) as comprising a new religious movement. Raymond (1982) sees the rise of alternative medicine as a reaction against mainstream allopathic medicine, which functions, she insists, as a “masculinist religion” which promotes “an ideology that life itself is a disease to be cured, or at best, prevented.” Raymond insists that “health must be viewed as the constant attempt to recreate a female environment that is self-defined on the boundary of an environment that is man-made.” Fuller hypothesizes that the rise in alternative medicine reveals a deep spiritual longing on the part of Americans which remains unfulfilled by conventional religion, insisting that:

. . . metaphysical healing systems are almost perfectly suited to the secular character of our age in that they provide experiential access to the sacred while neatly sidestepping modern disquietude concerning traditional religious authority. In this way, they initiate individuals otherwise quite at home in the modern world into a distinctively religious vision of the forces upon which health and happiness depend (1989:119-120)

There is evidence, then, that the new style of religious commitment characterized by Bellah (1985) and Rieff (1958) is at least part of the foundation of alternative medicine. These findings on the religious functions of alternative medicine prove to be important in my own analysis, and I will thus return to some of these same points later on in the study.

The other lasting legacy of the medicine-as-deviance approach is the literature which sees alternative medicine as a reaction against modern medicine, an institution which has defined itself in impersonal and overly scientific terms. This line of argumentation insists that the central import of the alternative medical movement, whatever its religious significance may be, lies in the fact that it is an antiscientific movement. Sociologists who take this approach see the rise in the use of non-biomedical forms of medicine in the last 35 years as a reaction against a scientifically-driven, technological, and impersonal society. For these scholars, alternative medicine thus serves as a form of resistance, a humanizing force in an increasingly Orwellian social context. Young (1980), for instance, insists that alternative medicine signifies a rise in the role of the patient in controlling medical knowledge. In a more sweeping analysis, Shupe (1988) situates the revival of alternative medicine in a Kuhnian framework, conceiving of the rise in alternative medicine as a paradigmatic shift in the practice of and demand for “practical scientific knowledge.” The rise in alternative medicine, for Shupe, serves as a sign of the limitations and inadequacies of biomedicine as a paradigm. Similarly, Gursoy (1996) maintains that the alternative medical movement serves as a reforming movement against the monolithic institutional orthodoxy of American biomedicine. Kurtz (1994) resonates with such sentiments, seeing the rise in alternative medicine as an example of the “growth of antiscience” in the latter part of the twentieth century. Like the medicine-as-religion literature, this literature contains many fruitful seeds which I bring to harvest in this study.

Both analyses have merit. Even a superficial review of the literature of the alternative medical movement would necessarily include both its religious functions and its antiscientific mood as central themes. The modern practice of alternative medicine is simultaneously religious in both substance and function, and it does indeed often position itself over and against scientifically-based biomedicine. But this only tells part of the story. Looked at in isolation, alternative medicine can appear to be a significant social trend for any of a number of reasons. But when we look at the movement within a slightly larger frame, one which takes into account the theoretical concerns of several broader fields of study, it becomes quickly evident that there are larger issues at stake. What might at first appear to be a simple study of a social movement proves to be much more—a window on the delicate balance between rationality, individual decision-making, and cultural influence.

LATER THEORY: RATIONALITY AND AUTHORITY

As the popularity of alternative medicine soared, and sociological scholarship charting it matured, scholars began to shy away from alternative-medicine-as-deviance notions, emphasizing the essentially rational nature of alternative health users. People used alternative medicine, it was argued, because they perceived that it was effective. Getting to this end, however, requires a bit of backtracking. Namely, it requires looking back at how medical sociologists viewed the process of individual decision-making before the emergence of alternative medicine. By the mid-1960’s, two models for understanding choices between medical options dominated sociological analyses. The Health Belief Model (Rosenstock, 1966) was formulated within the social psychology tradition, and focused primarily on the place of motivations, beliefs, and perceptions on patients’ health-related decision-making. The Sociobehavioral Model (Andersen, 1968) approached medical decisions by emphasizing the place of social structure in shaping actors’ choices concerning health care. Andersen focused first on access to and need for care, but also factored in “predisposing” attitudes, beliefs, and attributes which molded preferences for types of medical care. Each of these traditions borrowed insights from the other, and by the mid-1980’s, moved toward synthesis (Eraker, Kirscht, and Becker, 1984; Stoner, 1985).

Pescosolido notes that the most noteworthy trait of this synthesis was its reliance on the rational choice model of behavior, with the attendant implication that the patient was a “singular, insular individual” (1992:1112). Out of this critique, Pescosolido fashions what she what she terms “social organization strategy,” a more nuanced, sociologically-informed variant of rational choice theory. She fundamentally questions the central role which an individual’s “mental calculus” plays in earlier rational choice theory, saying that this approach causes social factors to be considered only post facto, ignoring the place of interaction as the engine of social action. She takes aim, too, at the ways in which rational action approaches remove social problems from social networks. She also decries the narrow focus of rational choice theory on single choices, saying that sociological analyses should rather focus on the series of actions in which single choices are embedded. Finally, she critiques the tendency of the rational action model to place undue reliance on a model of behavior so clearly modeled on economic behavior. In contrast, Pescosolido claims that her social organization strategy relies on an actor who is social and rational in an unconsciously pragmatic way, not in a consciously rational fashion. Her focus, then, is on the social actor in patterned interaction, making the social network the proper unit of analysis for decision-making. With respect to culture, Pescosolido simply states that, “Global macrovariables tapping context (time, place) represent different substantive and structural networks” (Pescosolido, 1992). In numerous empirical studies, Pescosolido applies social organization strategy to health-related choices in general (Pescosolido and Boyer, 1999; Pescosolido, Gardner, and Lubell, 1998; Pescosolido, Wright, Alegria, and Vera, 1998), and to alternative medicine in particular (Pescosolido, 1991).

Pescosolido’s articulation and application of a sociologically-informed version of rational choice theory represents a maturation in a certain approach to alternative medicine, a line of thinking which was itself an upgrade on the old deviance-centered approach. This shift in thought—from alternative medicine as radical to alternative medicine as rational—was necessary, understandable, and to a limited degree, correct. It was necessary and correct to the degree that it emphasized that users alternative medicine sought practical solutions to their perceived health needs. It was understandable because health issues seemed to lend themselves so well to the pleasure-maximizing, pain-minimizing tendencies of rational choice theory. Too, actor-centered, rational-choice approaches had long existed within medical utilization theory. Once alternative medicine graduated from its status as medical curiosity, and began to see more widespread use, it was simply a matter of time before such theories were applied to this new social movement. Among theorists, though, the tendency was to move too far in the rational-action direction, conceiving of users of alternative medicine as robotic, pleasure-maximizing, pain-minimizing creatures, living in rarified, rationally-charged air, void of cultural influences. Even Pescosolido’s theoretically sophisticated refinement of the rational choice model still clearly answers the “Why alternative medicine?” question through a markedly acultural model, one which fails to recognize the socially constructed nature of rationality itself.

MY CONTRIBUTION

My study, on the other hand, argues that rationality is not simply enacted in a social context. Indeed, who could argue that it is not? What even the most complex formulations of rational choice theory fail to recognize is that rationality itself is a social construction. More precisely, rational choice fails to recognize that rationality is a means-ends, cost-benefit calculation, and that the way in which people see costs and benefits, means and ends are deeply contingent upon myriad social factors. People who choose to attach themselves to powerful explosives, run into crowded public areas, and blow themselves to bits in order to kill scores of persons they view as “infidels” are operating rationally, as are government workers in the former Soviet Union who cling to their jobs even when salaries are paid weeks, if not months, late. The way in which such persons weigh costs and benefits, and the means and ends which they value are, indeed, very different from the way in which most middle-class Westerners operate. The cultural lens of each group deeply influences the ways in which individual social actors see costs, benefits, means and ends. So, to argue that a social actor is “rational” is to make far less profound claim than it might at first seem. Rational choice theory, while seeming to dignify the social actor by insisting that she is not an oversocialized “dupe” (see Wrong, 1961), unwittingly strips itself of sociological insight in the process.

Thus, rather than pursuing pointless further refinements in culturally-impoverished variants on rational choice theory, I pursue a fresh, relatively unexplored, culturally-rooted set of explanations for the rise of alternative medicine. Of course, I concur with rational choice advocates’ assertions that users of alternative medicine are not deviants. Indeed, survey research (Eisenberg, et. al., 1993, 1998) has demonstrated that nearly one-half of American adults use some form of alternative medicine annually. If alternative medicine users are not deviants, though, what are they?

Certain minority voices within the field of medical sociology may point us towards an answer to this question. Outside the mainstream rational choice theorizing, the most culturally-attuned approach was the “illness career” approach (Clausen and Yarrow, 1955; Aday, Anderson, and Fleming, 1980) which thought of sickness as a sequence of actions related to the resolution of a health problem. Emphasizing the different choices patients take in pursuing health, this approach used a complementary rather than competitive approach in understanding the uses of conventional and non-conventional forms of medicine. Different phases in the “career” were understood as “events” or “episodes.” Emanating as it did, however, from the grounded theory tradition, the “career” approach produced phenomenological descriptions which emphasized micro-, rather than macro- concerns. Much as with rational choice approaches, a larger concern for the cultural roots of the movement was all but absent. This study is undertaken partly as an attempt to rectify this oversight in the literature.

I argue that users of alternative medicine are mildly exaggerated representatives of certain trends within contemporary American culture. Specifically, I argue that alternative health users represent the effects of organic individualism within modern health-seeking behavior. Organic individualism, I contend, is an outgrowth of expressive individualism, most notably discussed by Bellah, et al. in their 1985 exploration of “individualism and commitment in American life.” There, the authors describe expressive individualism as a brand of individualism which posits that the “cultivation and expression of the self, the exploration of its vast social and cosmic identities” (Bellah, et al., 1985: 35) are the greatest ends toward which human beings can strive. Organic individualism, as I maintained earlier, goes beyond the confines of expressive individualism in three key areas: its insistence on the centrality of the physical body and of nature in the process of self-discovery, and in its contention that self-fulfillment necessarily occurs best outside institutional constraints. This perspective deeply influenced the ways in which my respondents think about symbolic authority structures. And these resulting ideas about authority caused them to think in certain ways about nature, the body, professions, and religion, which, in turn, prodded them towards alternative medicine.

My study, based on indepth interviews with contemporary users of CAM, focuses on the cultural meanings ascribed to CAM by its users. The assumption here is that medicine is not simply a practical tool which tries to bring about certain desired ends for its users. Medicine is a cultural system which patients use to construct meaning for their lives. In this study, I contend that the rise of CAM corresponds to changing ideas and visions of the self and authority in American society, which, while distinct, and somewhat new, are sociologically comprehensible, and sociologically significant. I explore whether the upsurge in alternative medical practices may be best understood as a form of individualism. Do social actors turn to alternative medicine primarily for pragmatic reasons, based on a hedonistic calculus which leads them to the conclusion that use of CAM will bring about less pain, or even increased pleasure? Such motivations for use of CAM might fairly be subsumed under rational choice models of behavior. Do people turn to alternative medicine primarily to more deeply express themselves, feeling that biomedicine is overly rationalized and overly bureaucratized? Do they feel that the scientistic biases of biomedicine leave little room for emotion and spirituality? Is their involvement in CAM based on a desire for richer, variegated experience in which social actors luxuriate in the sensual, living a life of strong feeling? These motivations underlie a type of individualism, one which prefers the “expressive” over the “utilitarian.”

METHODS

If culturally-shaped ideas about authority, rather than rationality, directs people to alternative medicine, how would we know it? Who would we need to talk to in order to ferret out the validity of such a claim? In short, what is the best way to answer the questions posed thus far?

I start here by asserting that answering such questions requires direct, indepth input from users of alternative medicine themselves. While survey data and historical study might help to give us a broader picture of the status of alternative medicine in contemporary culture, indepth interviews with users themselves help us to understand in some depth how users’ larger commitments, their worldviews, bring them to alternative medicine. Thus, I conducted interviews with sixty self-identified current users of alternative medicine. Because users have consistently been shown to be better-educated, financially better-off, and disproportionately middle-aged compared with non-users (Drivdahl and Misner, 1998; Eisenberg, et al., 1993, 1998; Kelner and Wellman, 1997; MacLennan et al., 1996; McGuire, 1988; Schar et al., 1994; Sharma, 1992; Shekelle et al., 1991, 1995; Vincent and Furnham, 1997), I attempted to draw my sample from this demographic, roughly speaking. Thus, I drew my sample from three different sites likely to be populated by such people—a federal government agency office in suburban Washington, DC, a large corporation based in suburban Baltimore, and the staff and faculty populations of a mid-sized university in the Richmond, Virginia area. From each site, I interviewed the first twenty people to respond, for a total of 60 interviews. The shortest interview conducted was 20 minutes long, and the longest ranged somewhere near three hours over two different sessions. Most, however, lasted somewhere between 60 and 90 minutes. In a handful of cases, I interviewed spouses of persons employed by the organization rather than employees themselves. At all three sites, I solicited requests for interviews in three ways: via corporate email notices, via informal private notices, and via traditional public notices, such as placards and posters distributed generally around the physical working environments of these three organizations. In these notices, I asked current users of alternative medicine to talk with me about their use of alternative health practices, estimating that interviews could last anywhere from 30 minutes to 2 hours. To ensure that I did not bias potential responses, I said nothing beyond this with respect to the content of the interviews.

For two reasons, I left “alternative medicine” undefined in these notices. The first rationale was ideological. I based my methodology on a grounded theory approach which privileged my respondents’ own definitions of what “alternative medicine” was, rather than constraing them by an a priori definition. My second reason for using an open definition was more practical. Simply stated, I wanted draw from as wide a range of modalities as possible. Though I originally considered limiting the forms of alternative medicine considered to allow for more indepth comparison between different approaches, I ultimately decided to cast as wide a net as possible in order to speak not simply to issues of, say, the differences between midwifery and yoga, but rather, to be able to speak more broadly about alternative medicine en toto. [3] To remain consistent with the survey data utilized here (Eisenberg, et al., 1993, 1998), I specified that to qualify as “current users,” potential interviewees must have used at least one alternative health practice in the previous year.

In the interviews, I pursued several different lines of inquiry.[4] After gathering general biographical and demographic information from my respondents, I pursued a set of questions intended to establish the conditions under which my interviewees first began to use alternative medicine. I probed to ascertain the role of symptoms, family and friends, dissatisfaction with conventional medicine, and their larger worldview played. I then asked several questions which attempted to gauge what my respondents thought of as the defining characteristics of alternative health practices themselves. Issues explored here included alternative medicine’s view of health and disease vis-à-vis “conventional” views of the same, the ways in which alternative medicine conceived of the role of the patient vis-à-vis health care providers, and the conditions under which respondents deemed alternative approaches to be appropriate and desirable. In a similar vein, I asked a number of questions to see whether my respondents shared a sense that alternative medical users as a group were distinct, whether there was a sense of “we”-ness among users of alternative medicine. I then connected these concerns to individual identity, asking my respondents to reflect on whether their use of alternative medicine said anything about them as a person, and conversely, whether their use of alternative medicine had influenced their larger worldview. If the topic had not arisen earlier—a rare occurrence, indeed—I asked my respondents about their religious sensibilities. Whether they considered themselves “non-religious,” “religious,” “spiritual,” or some combination of the three, I asked my interviewees whether their larger worldview connected in any clear way with their use of alternative medicine.

OUTLINE

The dissertation, then, is made up of three distinct sections. The present chapter along with the following one introduce the key themes I will visit and revisit throughout the study. More specifically, Chapter Two fleshes out more fully the central theoretical concern touched on only briefly here in the introduction—the inherent and obvious weaknesses of variants of rational choice theory in explaining use of alternative medicine and the strong prima facie evidence that rationality itself is socially constructed. I explore these weaknesses via an indepth case study of one of my respondents whose story, I argue, crystallizes many of the difficulties inherent in maintaining a rational choice view of human behavior. Her case also serves the purpose of foreshadowing some of the central themes visited in the second section of the dissertation.

The central section of the dissertation, then, is comprised of the three main substantive chapters which make up its heart. First, in Chapter Three, I explore the ways in which my respondents conceived of their relationships to health care professionals. I argue that my respondents’ attraction to alternative health care rests, in large part, on their desire for egalitarian relations with health care providers. They report that they are far more likely to find such relations with alternative providers than with conventional doctors. My respondents share a belief that “patient-directed health care” is good health care.

In Chapter Four, I probe the ways in which my respondents conceive of themselves in relation to their bodies, finding that my respondents generally share a common desire and claim a purported ability to control their bodies and their general state of health. Often, this was described as “being in touch with myself,” or “being in touch with my body.” Such physical intuition was important to my respondents because they tended to conceive of the body and of nature primarily in benevolent terms. Nature, here, is the form of symbolic authority they valorize. They thus preferred alternative medicine to conventional medicine because they saw the former as a benign augmentation to a powerful, natural, health-perpetuating system already possessed by the body. Biomedicine, on the other hand, cluttered this system by interjecting synthetically-produced processes and products, which often hindered the cooperative relationship between subject and body.

In Chapter Five, I look at the ways in which my respondents’ ultimate commitments, their worldviews, intersected with their use of alternative medicine. Open to the possibility, even probability, that alternative medicine’s soaring popularity could arise out of a thoroughgoing naturalism, I was struck by the extent to which my respondents connected their use of alternative medicine with quasi-religious commitments which were marked by a distinct blend of Eastern mysticism and reverence for nature. I surmise that such commitments arise, not out of some mystical emergence of a “New Age,” but precisely out of the ability of my respondents to thus have spiritually-charged experiences without having to commit themselves to a larger set of institutionalized religious organizations. I empirically flesh out Fuller’s hypothesis that alternative medicine “provides experiential access to the sacred while neatly sidestepping modern disquietude concerning traditional religious authority” (1989: 119-120).

In the final section of the study, Chapter Six, I conclude by drawing out larger social implications from these findings in five different areas. First, I argue that my respondents’ appetite for egalitarian relations with health care providers signals a “triumph of the therapeutic” in certain domains within the medical realm. Alternative health users crave relationships with health care providers that mirror their relationships with therapists. Such an arrangement allows subjects to identify their own end goals, rather than having goals imposed on them by health care providers. I contextualize this in the larger cultural setting by arguing that such sentiment perfectly mirrors “do it yourself” trends so pronounced in other arenas of social life. Second, I argue that the withdrawal from organizational involvement by many of my respondents, especially in the religious realm, signifies a further extension of what I call “organization-free spirituality.” I explore the social limitations of this form of religion, most notably its inability to serve as a basis of social solidarity or cohesion. Involvement in “organization-free spirituality” appears to be profoundly influenced by social location, I argue.

Third, I tease out the various meanings of my respondents’ reverence for nature and their contrasting suspicion of things synthetic. I locate their attitudes toward nature within modern, Western, romanticized urban and suburban attitudes toward nature, which see rural locales as locations for rest, relaxation, and recovery of the inner self. Their suspicion of scientific procedures and synthetically produced products is best understood through the notion which sees capitalism as exploiting both land and body as instruments of profit (Polanyi, 1980). In very real ways, my respondents’ suspicion of and resistance to synthetic products and procedures served as symbolic resistance to these capitalist drives.

Fourth, I place these findings regarding organic individualism within a larger body of work on expressive individualism. Certain forms of alternative medicine arise directly out of this cultural tradition wherein cultivation of the self is the primary goal. Meditation, modern forms of midwifery, and yoga, among others, served this purpose for many of my respondents, who valued expressive elements of health as much as they did more functional concerns. Finally, in light of these findings, I reevaluate Pescosolido’s version of rational action theory as an explanation for how social actors come to use alternative medicine. Her template conceives of culture as “network content,” reducible to the output of social ties within a network, asserting that “it may be that society is not a reality, sui generis” (1992: 1108). I find here that the cultural factors which cause my respondents to use alternative medicine are not reducible to such formulations. My respondents’ notions of “rationality” are all deeply influenced by a wide variety of deeply cultural factors, described here in detail.

In the end, I argue that alternative medicine is not only about “feeling well,” about “staying healthy.” Nor is it about rational actors acting to find optimal cures for their ills. On the macro level, it is not about the triumphant emergence of a non-scientific form of healing in a health care market long monopolized by science. Ultimately, the rise in alternative medicine is a story of Americans looking, not only for health, but for identity and meaning.

CHAPTER 2: REASON, AUTHORITY, AND ALTERNATIVE MEDICINE

The rational choice view of health care behavior argues that social actors adopt certain health-related attitudes and engage in particular health-seeking behaviors because it benefits them to do so. Longer life, decreased pain, and increased psychological well-being are among purported perks sought by social actors when they adopt these practices and attitudes. My research, however, indicates that while some version of this rationalistic “minimax”[5] calculus is present to some degree in most users of alternative medicine, it rarely serves as an unbending principle to guide behavior, and in some cases is all but entirely absent from considerations by the health-seeking social actor. Moreover, when this template is used by social actors seeking health, it guides behavior only in a modified form. Alternative medicine users, in other words, turn to alternative medicine’s many modalities for logical reasons, but the “logic” by which they turn to these practices is a logic which is a distinctly early twenty-first century American variety of “common sense.” That logic has been constructed within a distinctly individualistic and pragmatic cultural milieu, and is not a line of reasoning which those outside this cultural time and space would immediately recognize as “logic.”

Issues of authority are not part and parcel of medical interaction. Or so it would seem, especially if patients ostensibly choose alternative medicine for utilitarian reasons, as rational choice theory would lead us to believe. If rational choice theorists are correct, it would follow that patients would give utmost prominence to issues of pain and pleasure. We would expect, in other words, that patients would explain their choice of alternative medicine by underscoring the ways in which such treatment brings them gratification, while also emphasizing conventional medicine’s propensity to bring them pain.

Empirical study, however, does not bear out the expectations of rational choice advocates. Rather, my data provides powerful evidence that the “logic” which patients use to explain their use of alternative medicine is deeply influenced by cultural factors. Thus, when users of alternative medicine talk about their decision to use alternative medical methods, they sound, not like hyper-rationalistic philosophers, calculating means by which to minimize pain and maximize pleasure. Instead, they seem very much like people talking about participation in civil society, democracy, and vital moral issues of the day. This is not to deny that most social actors—save true masochists—make significant efforts to live life as pleasantly as possible. Rather, it is to say that notions of a “good life,” of pain and pleasure, of desirable ends and undesirable ends, are fabricated from social materials, and vary significantly depending upon time, place, and one’s place in social structure. This social foundation of reason was made clear throughout my respondent’s explanations for their use of alternative health practices. In this chapter, I pay special attention to the ways in which their understanding of authority colored the logic by which they chose alternative health practices.

Authority was salient for my respondents in three different areas: First and foremost, my interviewees indicated that they pursued alternative health options because it allowed them significant clout in medical decision-making. Especially prominent in their discussions of this issue was their status vis-à-vis health care providers. They invariably felt that they were afforded more power when using alternative methods than when using biomedical means. Second, my respondents’ responses revealed a certain concern with the ways in which they were able to maintain authority over themselves, or more specifically, over their bodies, through their health-related behaviors. In particular, my respondents indicated that that alternative health care gave them more of a sense of control over who they were, over their larger sense of identity. Under the thumb of biomedical practitioners, they were passive victims, awaiting the recommendation of an omnipotent professional. When they turned to alternative medicine, my respondents experienced a strong sense of agency, of decision-making power over their health and identity, more generally. Turning to mainstream medicine, for many users of alternative medicine, meant turning the definition of the self over to a physician, or in some cases, to the authority of synthetically produced drugs and the pharmaceutical corporations which produced them. Using alternative health practices, meanwhile, signified to them that they had control, both over decision-making processes and over their larger identity.

Third, while my respondents tended to tie their use of alternative medicine into a larger set of religious—or “spiritual,” as they would have it—beliefs, they were deeply suspicious of traditional religious organizations, namely because they tended to keep such tight rein over the individual. Though they saw larger connections between their worldviews and their choices regarding health, they preferred that these larger connections not be mediated through institutionally supported organizations. Put more simply, my respondents’ suspicions about modern medical organizations and professionals were mirrored by similar misgivings with regard to religious institutions, organizations, and anyone who wielded significant influence in such circles. Some respondents even made direct connections between the two realms.

I will explore these three interrelated sets of attitudes in Chapters Three and Four and Five, respectively. These explorations of the place of authority in the decision-making processes of my respondents will expose the weaknesses of the rational action approach to understanding health-seeking behavior. While seeking health is rational in some sense of the term, the rationale by which my respondents sought out health was clearly intertwined with a distinctly modern American understanding of authority relations between professionals and the clientele they serve. To set up this set of arguments in Chapters Three and Four, this chapter analyzes one case study which illustrates in some depth the cultural foundations of this tripartite notion of authority.

PHYSICIANS, PREGNANCY, POWER: JODI’S STORY

Soon after turning 40, Jodi Watson[6] decided that she wanted to have a baby. A brief marriage in her twenties had yielded no children, and for many years, Jodi had been content with her single, independent lifestyle. As she got older, however, she felt compelled to have a child of her own. Even before making serious attempts to get pregnant, though, Watson explored what types of health professionals she might use during her prospective pregnancy. Even before she conceived, she decided to use a midwife who worked alongside a practice of 4 doctors because, as she describes it, “I wanted a relationship with somebody . . . before [the pregnancy to] know what she was like. . . . And with my age, that I was nervous about not having any kind of underlying medical safety net, I guess, since there was much more potential for a problem.”

From discussions with a tight circle of female friends—many of whom had used midwives themselves, some even opting for home birth without immediate access to a doctor—Jodi had formed a clear picture of the differences between doctor-supervised and midwife-supervised pregnancies.

[With a midwife], from beginning to end, there’s not a high level of intervention. You’re still making the decisions as the woman. . . . The midwife is there to facilitate your process, as opposed to going into the hospital and being with a doctor where it’s their process. You’re just a part of their process. . . . And so this was mine, you know. And I felt really strongly about owning it and being mine. I wanted natural childbirth, and I wanted everything as safe as possible, but with as little interference as possible. I wanted to be calling the shots. I wanted informed decisions and that’s what . . . the midwife would be there for—to give information and help me make the decision. They were my decisions. And I thought that’s what a midwife would give me, whereas a doctor. . . Everyone I talked to said that I’d have less say-so if I used a doctor.

Eventually, Jodi found a midwife whom she came to know as “Deb.” The two quickly developed a good working relationship, as Jodi revealed in describing their initial exchanges:

A lot of doctors don’t come out and talk to you about their qualifications. They just assume that you know that they’re all-powerful and everything’s fine. . . . But Deb talked about that. She talked about her experience from beginning to end, how she got started in midwifery and the whole deal. And so that was real reassuring too. It wasn’t this battle for status that I sometimes feel you [have] with a doctor. And I have that relationship with doctors sometimes because I feel very much that part of my health care is my health, my control, my decision, not yours. I’m the one that’s important—not what you think. [But] there was none of that with Deb at all. You know, she’s said, “This is yours. I’m just here to help you.” So it’s a wholly different atmosphere than I’ve experienced with doctors. . . . I’d heard good things about Deb and [she] was just really supportive and, facilitating-- not controlling or patting on the head and telling me everything would be okay. . . . “You don’t know your body, I do!” You know, that kind of a thing.

These early interactions so impressed Jodi that she decided, in spite of her status as an “at risk” pregnancy, that she wanted to use Deb as her primary care giver, and that she would her exclusively for the birthing process, if at all possible.

When pressed further on her rationale for using a midwife in spite of her “at risk” pregnancy, Jodi returned time and time again to the same issue—control. Jodi clearly felt in selecting a health care professional that it was paramount that she, as patient, have as much decision-making power as possible, both during her pregnancy and her eventual delivery:

I wanted to be the one in control. I wanted it to be my process, not. . . When I see doctors often, I feel that I’m doing what they’re telling me to do. They’re doing what they think is best. And it just kind of gets away from the individual, and I really wanted to [run] the process. It was mine. [The relationship] is a partnership, and they’ll help me make decisions because they have part of the information, but I hold part of the information, too. I know my body; I know myself, and I know my wishes.

It was disappointing, then, when Jodi developed gestational diabetes and hypertension midway through her pregnancy. The resulting complications led Deb to turn Jodi over to several of her M.D. colleagues for closer medical observation and care. From this point on, Jodi was supervised exclusively by physicians, and her professional contact with Deb waned to nil. While recognizing the gravity of her condition, Jodi still experienced remorse at having to subject herself and her unborn child to the care of conventional doctors. Asked to describe her interactions with the supervising doctors, Jodi laments that her experience under their care was:

. . . [e]xactly what I feared. . . . I felt less in control. I demand from . . . most relationships . . . a lot of information. Either I get information that I want to discuss with them, or I expect them to give me information, but I want that. I don’t want just . . . them telling me, “Okay, here’s two pills. Take those three times a day. Don’t worry what they are. Just take the blue ones.” I’m not taking responsibility, you know, for myself and for what’s going on. And that’s the way I felt with them. And I felt that the changes were happening really quickly and I wasn’t getting enough information and it made the anxiety higher for me too, because then I would [be] driving home or something and I’d think, “Oh, what about this? What about that?” And so there was just like tons of unanswered stuff and it just felt always hurried, just not enough information, out of control. [Their approach was] exactly what I feared. Exactly what I feared.

Jodi shares numerous stories citing what she viewed as violations of her autonomy as a patient. Not least of these violations was one incident which occurred shortly after she was told that she had gestational diabetes:

[T]he . . . primary physician . . . I really didn’t like him at all, and had told them after he saw me that I wouldn’t see him anymore, that they were not to schedule anything. And, so I got real nervous that he might be the one to deliver my baby . . . I saw him after they had told me I had diabetes . . . and so I was trying to ask him questions. “What does this mean?” “What does it mean to my baby?” “I’ve read all these articles [about this] . . .” And so I was just, you know, saying all this stuff. And he said, “You really. . .” He stepped back, [and] had his hand on the doorknob to leave. He was behind me so I had to turn all the way around . . . and pull the curtain back [to] even see him, and of course, my ass was hanging out of that stupid hospital gown. . . . Now, [he said], the problem was that women in this day and age [had] too much information. It was just much better when women were ignorant and just popped these babies out without any questions. So you can well understand that he and I probably didn’t hit it off too well. I had some real problems with him. . . . And I was telling [my partner], “Sit down. Sit down. It’s okay. We won’t talk to him anymore.” Cuz [my partner] was . . . coming out of his chair, you know, saying, “What the hell’s wrong with this guy?”

Eventually, Jodi’s supervising physician decided to induce early labor. Deb, who had made a personal commitment to be at the birth despite her limited professional role, volunteered to induce the labor when the supervising doctor was held over in another surgery. The physician’s expectation was that Jodi’s labor, like that of most delivering mothers, would last for hours. Instead, it lasted for 28 minutes. As a result, Deb, rather than a doctor, oversaw the birth.

When asked, in retrospect, what her health care choices might reveal about her larger identity, Jodi returns again to the centrality of authority in interpersonal relationships, hypothesizing that “I guess that it says that I like to be in control, rather than being controlled!” Pausing briefly, she then adds:

But in my mind it also has to do with caring. I mean, I cared enough about my child to really do the best, even if there was discomfort for me. . . . I know I[‘ve] talked a lot about control, but the bottom line was it was control over the process because I thought it was the best process for my child. It wasn’t just some control freak thing! It wasn’t control just for the sake of control, but it was control because I thought it was the best thing to do, and so I really wanted that. I mean, I didn’t, you know, when they told me I was ill, I didn’t fight that. I went with it. I didn’t like it but because it was the best thing to do for my child, and that’s what I needed to do and that was the bottom line. Um. I wanted her to have . . . the best, and that’s what I tried to give her.

Pushed to describe the types of women who use midwives rather than conventional doctors, Jodi inevitably returns to the subject matter which has animated the majority of her account—control. Of such women she says:

They’re already in control of a lot of things in their life. [T]hey’re very much the people who are making decisions about their lives already. They’re strong, you know, very competent people, and having children was just really important to them, you know. I don’t think any of the women that I know [who used midwives] had accidental pregnancies.

And, in her own mind, Jodi is clearly one such woman. For her, a choice of a midwife signifies something far different from a rationally deduced, clinical choice among health care options. She even ties her choice to use a midwife to a larger set of religious commitments:

Because the spirituality that I practice is very feminine-based and mainstream medicine is very masculine to me. And I say that, in spite of the fact that my family doctor and OB-GYN are both women! What I mean, I guess, is that I think mainstream medicine very masculine in that it’s very invasive. For instance, rates for c-sections are so much higher if your primary caregiver is a conventional doctor than if the primary caregiver is a midwife. . . . The whole control thing—it’s what doctors are about—“Let’s intervene with this drug! Let’s do that procedure!” With my spirituality, and what I found with [my midwife] was that it was much more the natural cycle of things and letting things evolve—going with the flow. It’s very different from traditional medicine, just like I guess my spirituality is very different from organized religion. I guess that my approach is that we are all connected and we are a part of that flow, and of the cycle of life and to some degree, part of the underlying philosophy of this is that things happen for a reason. And it’s not that everything is predetermined, and you haven’t any choice, but kind of that there is a purpose for being here and you don’t want to mess around with too many things.

What exactly, though, is the symbolic significance of this choice? For Jodi, as for many of my other respondents, the significance of their use of alternative health practitioners revolved around issues of authority as they impacted the body, the relationship with a professional, and ultimately, one’s larger worldview.

JODI’S PERSPECTIVE, IN PERSPECTIVE

Jodi’s story is a compelling one. Viewed with a contemporary American middle-class lens, Jodi appears to be very much what we would expect from a modern consumer of professional services. She demands that she taken seriously. More than that, she demands a significant amount of clout in decision-making—as she insists, “[M]y health care is my health, my control, my decision, not yours. I’m the one that’s important—not [the doctor].” But if we strip away these uniquely modern assumptions, we begin to see how peculiar the profile and point of view of the modern American user of alternative medicine user is. Jodi, like my other respondents, scarcely noticed the uniquely modern and uniquely privileged perspective she brought to bear on her health care choices. It is precisely this veiled viewpoint, however, which makes the responses of this group so fascinating and worthy of sociological attention. Application of a sociological perspective to this decision-making process reveals that this pattern arises, not from nature, nor from some instinctively “rational” impulse; rather, it emerges out of a larger, modern, American expressive individualism which caused my respondents to view certain health-seeking behaviors and attitudes as preferable to others. Whether these behaviors and attitudes are actually more desirable, more rational, or more advantageous in some absolute sense is a question beyond the scope of this research. What is clear, though, is this: behaviors and attitudes of any kind are made to seem rational within certain social contexts, and could just as easily be made to seem irrational by different social forces. Jodi’s decisions reflect a certain set of shared social assumptions which were common among my respondents, assumptions which become clear only when one steps back from the immediate situation in which my interviewees find themselves.

Jodi insists that she sought out midwifery, not simply because she wanted control for the sake of control, but because she thought it best for her unborn child that she control the situation. As “natural” and “rational” as such a perspective might appear to modern Westerners, it is a perspective which would seem foreign to many others. This is where rational action theory’s approach to medical decision-making begins to fall apart, since logic and rationality are not only enacted in a social context, but are always defined by social context, as well. Desiring control of medical decision-making as a patient makes sense only because Jodi is part of a social context which frames information, choice, professional status, and identity, and religion in particular ways.

To place Jodi in context, we need juxtapose her attitudes and behaviors with others who have medically similar needs, but different social assets with which to meet those needs. For instance, consider how the women in each of these cases might view Jodi’s perspective on her prenatal health care:

-A pregnant woman illegally immigrates to the US from Latin America. She receives no professional prenatal care, and gives birth in her small, run-down apartment in East Los Angeles, with the help of a cousin who illegally immigrated to the US several years earlier. The woman cannot afford the costs of professional birth assistance. Even if she could afford professional medical help, she would avoid using it, for fear of being reported to authorities.

-A pregnant woman in a traditional Old-Order Amish community in Lancaster County, Pennsylvania receives standard Amish pre-natal care. She never visits a doctor, and gives birth in her home with the help of an Amish lay midwife who has attended hundreds of births in the community, but has never received any formal medical training.

-A woman in an American military hospital in the late 1970’s uses a nurse-midwife for giving birth because the midwife is the professional “on duty” when the woman goes into labor. Though she has used both doctors and midwives for prenatal care, she had no choice in the matter. As the wife of a military officer, her healthcare is provided by the US military, which indiscriminately staffed prenatal units of the time with midwives and doctors.

-Under Taliban rule in Afghanistan, a formerly prosperous middle-class woman gives birth at home with the help of female family members. Ruled by the fundamentalist Islamic sect from the time of their military coup in 1996 until their fall in December of 2001, women in Afghanistan were victims of much-publicized human rights offenses, including blockage of access to health care. Though the woman could have afforded to use an M.D. trained in the West in the pre-Taliban era, the Taliban did not allow her access to a male doctor, since they thought of such intimate contact between men and women not bound by marriage as an egregious sin. In the patriarchal society, women may practice medicine, but such highly-trained women are in short supply in many locales.

-A woman hired as a “nanny” to an affluent Western family living in modern Kenya gladly accepts an offer from the family to pay for the medical costs associated with her pregnancy. Prenatal care, labor, and the birthing process are all overseen by Western-trained doctors. The woman would have otherwise used traditional methods, which would include several female family members as midwives. These women would, of course, be lay midwives, never having received any formal medical training.

-A 14 year old medieval French peasant girl gives birth using female family members to help her through long, hard labor. For as long as anyone there can remember, this has been the only way women have ever given birth.

Taken together, these 6 cases help to give perspective on the socially, economically, and historically unique viewpoint with which Jodi and my other respondent approach their medical decision-making.

Sociologists have always placed great emphasis on the importance of symbols in social life, and we can better understand the importance of Jodi’s choice to use a midwife by understanding its symbolic place within Jodi’s world. In turn, we can better understand the symbolic place of midwifery in Jodi’s world by contrasting its place in her life with its place in the life of the hypothetical cases posited above. Imagine, for instance, the first case described above, that of the immigrant Latina who, of necessity, had only her sister attending to her during labor. What is the symbolic place of midwifery in her life? It seems reasonable to assert that for this disempowered immigrant woman and others like here, midwifery represents alienation from the American Dream she came north to pursue. Perhaps it is no different from the minimal assistance she would have received in her impoverished native land. Still, in a land of plenty, where illegal immigrants are routinely denied privileges afforded many other groups, lack of access to biomedical professionals becomes symbolic of a larger disenfranchisement.

What of the Amish woman and the medieval French peasant girl? Both use midwives out of tradition. It could scarcely occur to either that there might be some other way to manage pregnancy and the birthing process. Determining symbolic significance is thus slightly more difficult. How can a social practice which is understood as part of a seemingly inexorable way of life be said to have any symbolic significance whatsoever? But tradition itself, of course, holds its own form of significance for social actors who operate within it. So, we might well surmise that for the Old-Order Amish woman and her medieval French counterpart, midwifery holds the place of convention, of custom, in the social life which they share with their respective communities. Most members of traditional, pre-modern societies—which medieval France and Old Order Amish communities most certainly are—find convention reassuring. Or, said differently, such communities often find innovation disturbing. So, we might fairly assert that both women would probably have found the birthing assistance they received reassuring, even if it would have been impossible for them to imagine other options.

What about the American military wife? At a time when the idea was scarcely known in American middle-class circles, US military hospital utilized nurse-midwives extensively to staff their prenatal care units. Midwives also attended numerous births in this era. As is generally true in military hospitals, budgets were tight, and administrators turned to midwives primarily to help reduce operating costs. For the wife of an officer—many of whom bypass more lucrative careers in business and technical fields for the military profession—using a midwife could easily symbolize a second-class citizenship, or more positively, a patriotic sense of sacrifice. Such a woman might easily rationalize that if her husband left the military for something that would pay him his “market value,” she would have access to health care which would not oblige her to accept more “cost effective” solutions. Symbolically, this could occupy one of two positions. First, it could breed resentment, causing the woman and others like her to decry a nation which begrudges the families of those who fight its wars even the most “basic” of health care. In a more charitable mindset, it could symbolically remind the woman of the sacrificial life to which military personnel are called (and, by extension, the sacrifices to which military families are called). This, in turn, might foster feelings of patriotism, of the symbolic costs of serving country.

And so we could continue. For the Afghan woman, the Taliban-imposed medical restrictions might have symbolically represented simply another limitation within a larger misogynistic, patriarchal, social order. Were she a secularized Afghan woman who had a respectable status before the Taliban revolution, the necessity of a home birth unattended by any medical professional could be representative of the consequences of religious hatred and bigotry, and might portend for her the promise of a secularized, more moderate state free of such intolerance. For the Kenyan nanny, the symbolism of the Western doctor is that of a “better life,” one she could never had achieved outside association with an affluent Western family. Medical care by Western-trained doctors, to such an impoverished woman would symbolically be associated with elite status; conversely, the family-based midwife would symbolize traditionalism, but also the low status associated with that traditionalism.

Why, though, this exercise in symbolism? Surely, each of these women belongs to a different world than the one inhabited by Jodi. What could their disparate experiences possibly tell us about Jodi’s experience? More importantly, how can their experiences inform us about the cultural significance of American alternative medicine as it manifests itself in the early 21^st century? And what of “rational action,” the force which purportedly drives health-seeking behavior, according to dominant theoretical models?

The 6 women described here, to be sure, have radically different lives from the one Jodi lives. It is precisely this contrast, though, which allows us to see in more clear relief the cultural underpinnings of Jodi’s health-seeking attitudes and behaviors. In short, the cases described here make clear the symbolic meaning of midwifery for Jodi as a modern middle-class, professional American woman. First, these hypothetical cases make clear the amount of choice afforded Jodi as she contemplates how to monitor her pregnancy. Diverse as the women described above may be, they have one very visible thing in common: a lack of choice. Even in the early 21^st century, the thought that one could have control to the degree presumed by Jodi would strike most women in the world as a luxury. And clearly, if one considers Jodi’s historical antecedents, the notion of “choice” in managing the difficulties of pregnancy and childbirth would appear as utter nonsense. And yet, the presumption of multiple options in health care permeates Jodi’s account.

Moreover, these choices are laden with meaning. For Jodi, the fact that she can choose a health care provider ties directly into her assumption that she will have authority vis-à-vis those health care providers she chooses to consult. Most interesting in Jodi’s comments are those which she makes near the end of her interview, that in her “mind, [controlling her health care decisions] also [had] to do with caring. I mean, I cared enough about my child to really do the best. . . . It wasn’t control just for the sake of control, but it was control because I thought it was the best thing to do.”

And this—Jodi’s insistence that her desire to control health care decisions are altruistically-based—is precisely the point. Indeed, Jodi does think it best that she control her health care. Not only is it best for the individual as consumer to be able to choose from an array of health care services, according to Jodi. In her view, consumers—here, patients—should direct the provider. So, the self-interested actor will direct her own healthcare, rather than allowing a professional to supervise her care. This mirrors perfectly the “New Age Technoculture” so aptly described by Ross:

[H]olistic health practices are unequivocally in the business of reversing entropy [emphasis original]. In contrast to the paternalistic diktat of the health professional, holistic therapies have set up shop on the basis of faith in the body’s self-healing faculties. There, the health professional’s obscurantism is often replaced by an apparent voluntarism based on the assumption that ‘we are participating, however unconsciously, in the process of disease,’ and that ‘we can choose health instead’ (Ross, 1992: 531)

Only in light of this type of cultural logic could Jodi’s dictums regarding authority make sense. If the cultural logic to which one adheres says that the body can, indeed, reverse entropy, then it makes perfect sense to say that the patient should share authority with the medical care provider. If such is true, it may even make sense to give the patient authority over the physician. Notably, Jodi’s “condition”—pregnancy—is one which fits perfectly with this model of authority, since most pregnancies, left to themselves, tend to produce a successful outcomes—a healthy babies, and healthy, if exhausted, mothers. Whether this allocation of medical authority can or does hold for other conditions which do not fit this model—diseases such as cancer and heart disease, whose “natural” outcomes are often far less desirable—remains to be seen.

For Jodi, however, it is clear that this notion of self-supervised health care should not be limited to these more naturally occurring processes. Although, unlike some of my respondents, she consults MD’s for her more general health care, she does so in a fashion that gives her significant decision-making power:

I’m lucky that the doctor that I have I’ve known since he was in med-school when I worked in a hospital and so we have a really great relationship and we talk about everything. . . . We discuss . . . the different things he might prescribe for me and . . . he doesn’t just write you an antibiotic every time. We kind of talk about it, you know. “What do you think we can do here?” And so, I have that relationship with him where we make decisions together and he doesn’t always just, you know, hand me a prescription.

Clearly, whether consulting an alternative practitioner or a more conventional MD, Jodi values health care relationships in which she has authority. She consults biomedical professionals to the degree that they allow her authority.

When put beside the attitude one might imagine from the Kenyan woman hypothesized above, Jodi’s attitude stands out as clearly individualistic, if not somewhat monomaniacal and naïve. If, indeed, it is logical for the patient to make decisions, then what is the use of the medical professional? The Kenyan woman, we might imagine, would be thrilled at the prospect of receiving health care which is coveted throughout the developing world, where infant mortality rates run 6 times higher than they do in the West.[7] It would be reasonable to expect that women in these cases would be relieved to allow the Western-trained doctor—male or female—to make decisions about her well being that would, in their experience, normally be made by formally untrained female family members. The notion that a patient should employ a medical expert solely as a consultant to help make decisions would, to such a woman, be nonsensical. The training which professionals receive, and the decision-making ability which results from such training, is precisely their value. Or at least, so it would seem to many in the developing world.

Jodi, however, does not live in the developing world. She lives in a social and cultural milieu in which professionals are regularly consulted, but are commonly disparaged, as well. Make no mistake. Jodi is not simply advocating the pedestrian truism that good science—in this case, medicine—must be based on careful empirical observation. She is not simply saying that members of the medical professional need to listen closely to her symptomatic descriptions in order to formulate proper prognoses and diagnoses. She goes far beyond this, turning the conventional doctor-patient relationship on its head:

The midwife would be there to give me the information and help me make the decision, but they were my decisions. I feel very much that . . .my health care is my health, my control, my decision, not yours. I’m the one that’s important—not what you think. . . . I wanted to be the one in control. I wanted it to be my process. . . .[T]he midwife is there to facilitate your process, as opposed to going into the hospital and or being with a doctor where it’s their process. [emphases added]

Jodi, then, wants patient-directed medical care, and does not find such practice among conventional doctors. Midwifery, in Jodi’s mind, is a desirable medical option precisely because it is an island of patient-directed care in a market dominated by providers.

Can such a logic said to be rational, either in the more traditional, “instinctive” sense of the term used by the Health Belief Model (Rosenstock, 1966) and Sociobehavioral Model (Andersen, 1968), or in the more nuanced, sociologically-informed sense articulated by Pescosolido? Clearly, the former is easy enough to dismiss. To say that there is a clearly definable “logic” by which Jodi and her Amish, Afghani, and Kenyan counterparts decide to use one form of health care over another is problematic. First, of course, it assumes that there are choices from which the social actor has power to decide. Such an assumption makes some limited sense for affluent Westerners, but it immediately proves problematic once one moves into social contexts in which multiple medical options simply do not exist. Second, once one introduces a cross-cultural perspective, it quickly becomes obvious that definitions of pain and pleasure—or more desirable versus less desirable ends—are nowhere near identical as one surveys different contemporary cultures, much less different historical eras.

But what of Pescosolido’s social organization strategy, and its more socially-informed variation on rational choice theory? A more sustained, finely-tuned argument will be necessary to reveal the weaknesses of this argument, though, at its base, Pescosolido’s theory suffers from some of the same fundamental weaknesses as its simpler, rational-choice antecedents. What the foregoing exercise in cross-cultural case studies shows, if nothing else, is that the form of rationality exercised in any given cultural context depends heavily on a number of variables. First, it relies in no small part on what social actors define as costs and benefits. Jodie clearly sees the risk of losing autonomy in medical dealings as a cost, and the promise of self-directed health care as a benefit. What is recognized as rationality is dependent, too, on the ends valued by social actors and the means, the social apparatus with which they are equipped to reach those ends. Jodie may not explicitly articulate it here, but her desired ends are centrally organized around modern psychological definitions of self-actualization and self-discovery. And the means by which she tries to reach those ends are clearly contingent upon her placement as a middle-class professional woman in a twenty-first century, Western, post-industrial society. It should be amply evident by now that Jodie’s conception of costs and benefits, means and ends, is shared by none women in the six case studies here. In the next three chapters, I hope to clearly describe the various forms of symbolic authority which drew people like Jodie—my respondents—to alternative medicine, and, in that context, more fully develop my critique of rational-choice models of medical choice in particular, and human behavior more generally.

CHAPTER 3: WHO’S IN CHARGE HERE?

In the previous chapter, I talked about Jodi’s case in detail because she clearly and dramatically articulated attitudes which pervaded the sentiments of many of my respondents. Devotees of alternative medicine, it seems, keenly desire autonomy in their health-care decision-making, take exception with the authoritarian manner in which biomedical practitioners dictate their diagnoses, and, on the whole, value the degree of autonomy they are allowed to have vis-à-vis alternative health practitioners. Their reasoning usually followed a simple set of three principles. First, they explained to me either a pre-existing desire for autonomy in their health-care decisions, or a desire for autonomy which grew out of frustrating interactions with mainstream health care professionals. Second, respondents tended to follow up these narratives with assertions concerning the authority of the health-seeking actor, usually to the effect that, in certain circumstances, the patient should guide the patient-doctor relationship. Coupled with these assertions was a notion, either vague or explicit, of the role of health care provider, not so much as authoritative professional, but rather, as information-supplying advisor. Finally, these alternative medicine users reported that alternative health care providers conformed to these notions of health care far more than did mainstream health care providers. This combination of assertions together convinced me that part of the rationale of users of alternative medicine involved a notion of authority with respect to their health-care provider. In other words, alternative health users, like Jodi, desire self-directed health care in certain circumstances, and found such care more often in alternative venues than in mainstream venues. It was by this line of thinking that my respondents arrived in the office of an alternative health practitioner, rather than in a conventional “doctor’s office.” While this line of thinking is certainly understandable, and stood the test of “reason” in some sense of the term, it is clearly undergirded by numerous cultural assumptions, each of which I will discuss after looking in more detail at the responses of my interviewees on this topic.

SELF-RELIANCE AND WELL-BEING

The most prominent building block in the construction of the “self-supervised” health care logic held by my respondents was a belief that patients should take ultimate responsibility for their own health care. Whether explicitly stated or implied, this notion served as the foundation on which my respondents based the remainder of their health-seeking decisions. In its most basic form, this urge manifested itself in a basic utilitarian urge to take care of one’s self for pure practical and economic reasons. For Christine, a 55 year-old office secretary, the journey towards alternative health-maintenance practices started in early in her life, where frugality was encouraged by her farming parents:

We lived in the country. We went to town once a week. If you didn’t have it, then you did without. You learned to make a list and you learned all these things. . . . I learned a lot of basic things on the farm — responsibility and thriftiness, I guess. . . . [So], I don’t like to spend money on unnecessary expenses — doctors’ visits and things like that, so I’m always looking for ways to prevent [going]. How can I keep myself healthy? If I’m going to be off from work, I want to be well. I don’t want to be sick. If I miss school, I always had to make up. If I missed work, I always had it to make up. If I’m sick or I’m at home, I still got the work to do. So I don’t accomplish anything by being sick.

Christine is scarcely an archetypal “flower child,” nor is she a New Age devotee. The values she espouses could scarcely be considered revolutionary or anti-authoritarian. Her use of alternative medicine is not as extensive as it is for many of my respondents. She uses several herbs for health-maintenance purposes, and a few others for their curative powers. Through her encouragement, her husband has consulted an acupuncturist to treat chronic back pain. For most of her health-related problems, however, she does not hesitate to use pharmaceutical cures, nor to consult conventional doctors. And yet, at its core, her attitude towards her health is this: out of expediency, care should be as self-sufficient as possible. Though she represents perhaps the mildest affirmation of this principle among my respondents, the fundamental outlook is the same as that of Jodi—that the best health care is self-directed.

A more vigorous affirmation of this ethic came from Peter, a new father, who decided along with his then-pregnant wife that “they” should use a midwife for her pre-natal care.[8] Early in his wife’s pregnancy, Peter and his wife searched out possible alternatives for care, considering both doctor-based and midwife-based practices. After surveying numerous practices, they decided on a nurse-midwife.

The other places all had, we had advice that we geared up on that said, “Now, you have to make your wishes very specific, in writing, with the doctors and the hospital ahead of time, how you want it, otherwise you’re just going to get snow-plowed.” Here, suddenly, it was much more participatory. And you had much more frequent prenatal visits and you did you own blood pressure and recorded your own rates. . . . It was so appealing. We came away and said, “No contest. This is where [we want to receive our care]. Right here. Unanimous. And it was pretty much like that during the whole pregnancy. We felt very much [that this] was about the practice of educating ourselves.

Asked what it was, specifically, that drew him and his wife to the midwife-based practice, Peter responds:

It was their commitment to involving you in the birthing process and the care process.  It was an incorporation, and that’s what we were looking for, I guess. We weren’t really aware of it, but that struck a note with us.  We said, “Yes, this is good because we’re in charge.”  We were quite ready for that.  And all the other places, you weren’t in charge.  All the other places, you were a patient and you were following a regimen and you were following orders and this was a place where you got to call the shots and that was, that was real good.

Like Jodi, Peter and his wife conceived of the process of pregnancy and birthing as an essentially patient-guided process. He initially claims that he and his wife were looking for “an incorporation”—presumably, into decision-making. Soon, he makes clear that midwifery was attractive, not simply because he and his wife were “incorporated” into the decision-making process. In reality, its attraction lay in the fact that they were, in his mind, in charge of decision-making. This control over decision-making derives directly, in Peter’s mind, from “the practice of educating ourselves.” As we will see later, in the social world inhabited by users of alternative medicine, the expansion of knowledge by patients necessarily misplaces the direct supervisory power of the health care providers.

Amanda, a 23 year-old recent graduate of a prominent liberal-arts college in the Southeast, is decidedly more committed than either Peter or Christine in her dedication to alternative medicine. In fact, she has been so captivated by various alternative treatments that she has plans to become a homeopathic physician. She uses numerous herbs, both for health-maintenance and medicinal purposes, and uses homeopathic remedies for illness, as well. She lives what she calls a “natural” lifestyle: free of caffeine, alcohol, and of any pharmaceutically-produced medicines. She articulates her commitment to significant participation in her own health care primarily through her dreams for her future patients: “If I could teach someone to take [their health care] . . . into their own hands . . . . I think that’s amazing. I mean . . . it’s changed my life, I’d like to help someone else do the same thing.” Notably, Amanda’s ultimate aim as a future health care professional is not necessarily technical proficiency. She does not fantasize, as an aspiring surgeon might, about the dramatic ways in which she will save people near death due to injury or disease. Her ultimate dream is to teach her patients to take their health care “into their own hands.” Though she values biomedical procedures and medicines which help to solve acute problems, she finds that such post facto, expert-centered care is far too common, and precipitated by lack of preventative patient self-care. For Amanda, then, the foundation of good health care is self-care, which necessarily falls into the hands of the patient.

Amanda’s dreams of patient “ownership” of health care are more clearly spelled out more clearly by Allison, a 31 year-old business manager in a large East Coast city. She draws from Eastern sources in describing her ideal approach to health care:

I’m not sure where it is--it could be China--where you go to a doctor while you’re healthy and soon as you become sick, you fire that doctor because, obviously, he hasn’t helped you remain healthy, and the point of having a doctor is for preventative reasons. You know, he tells you what you should do to remain healthy . . . . And here, we go to a doctor when we’re sick, and want them to just magically solve this problem, but we don’t take any steps to try to remain healthy.

Allison provides a historical example, apocryphal though it may be, of a system in which authority figures were expected to help keep people healthy. She adapts this hierarchical model, however, only to fit it into an individualist social milieu. Allison is not envisioning a health care system in which powerful health care providers order the health maintenance of submissive patients. Rather, Allison uses the quasi-apocryphal story to advocate for individual responsibility for self-education, a notion with which Amanda would readily agree. Amanda’s wish for her future patients is as telling in what it says as it is for what it leaves unstated, since patients who take their health “into their own hands” are necessarily taking it “out of the hands” of someone else, namely their health care provider.

This displacement of authority is made most clear by the account of Paula, a 53 year-old accountant who began to lose faith in conventional medicine when her primary care physician concealed a diagnosis of uterine cancer from her:

I took to wearing leather pants, ‘cause I would start spontaneously bleeding.  I was seeing a doctor.  The doctor said me—I swear to God--“Paula, there is nothing wrong with you.  Let me take care of you.” Well after a couple, three years of this, it was getting worse.  And then one time, in this fancy restaurant, I started bleeding all of a sudden.  And I said, “Oh, cripe.  Tell the waitress you’ve got to move that chair.  There is something very wrong with me.”  And in changing doctors, I had to pick up a lab report from my old doctor to [take to] my new doctor.  And this lab report had stuff like “carcinogenic and hemorrhagic tissue,” and other words I didn’t exactly know, but I got the gist of.  And I looked them up and thought, “Oh, my God.”  And when I said to my old doctor, “Why didn’t you tell me,” his response was he didn’t want me to lose sleep.  He didn’t want to upset me.  It was his job to take care of it.  He just was kind of shocked, ‘cause I thought-- being a disclosure person[9]-- that the doctor communicates with the patient.  So right then, I think, began a shattering of traditional medicine.  This [was] not an equal partnership—the doctor was not taking care of me in the same way I would take care of me and this is me we’re looking at so . . . I think right then, I started looking for different things in a doctor.

Later, Paula decided to supplement her conventional cancer treatment, radiation therapy, with an alternative method—megadoses of vitamins A, C, and E.  I asked Paula if she discussed her decision to supplement her conventional cancer treatment with an alternative approach involving “megadoses” of certain vitamins with her primary care physician.  She responded:

I didn’t ask for the advice of my doctor.  My cancer doctor is a conventional person; he would have [discouraged it]. . . . My primary care physician would have probably thought I was a little peculiar to even suggest it.  The oncologist definitely would have thought I was peculiar. . . . But one thing I’m real clear on with my health--I have to have some serious input into the discussion of whatever is going to be done.

Paula’s account makes clear what Amanda’s story leaves unstated—that where the patient begins to take health care “into their own hands,” it necessarily displaces at least some of the authority of health care provider, and often reflects a loss of trust in conventional medicine.  For Paula, supplementing her doctor-ordered radiation treatments with self-regulated doses of vitamins serves symbolically as a way to assure herself that she is taking her health care, in the words of Amanda, “into her own hands.”  Clearly, Paula does not supplant the authority of her doctor en toto.  After all, she follows “doctor’s orders,” or biomedical protocol, here in the form of radiation therapy.  Still, she clearly challenges the authoritative position of the doctor via her self-regulated dosage of vitamins.  We hear this sentiment most clearly when she follows up her description of her vitamin-based regimen by emphatically declaring, “But one thing I’m real clear on with my health--I have to have some serious input into the discussion of whatever is going to be done.”  By concealing her “megadoses” from her doctor, Paula reserves a segment of decision-making power for herself.

So, for my respondents, there was a strong sense that they were ultimately responsible for their own health, and that the health services personnel—doctors or otherwise—were not. If we think back to several the hypothetical cases presented in Chapter 2—the Amish woman, the Latina immigrant woman, the Kenyan nanny—we begin to understand how peculiar this perspective is. This rise in patient ownership of health fits with the picture other sociologists have painted in analyzing the relationship between the modern American public and the professions which serve them. For instance, in studying parental participation in American public schooling, Lareau (1987) found modern American parents far more likely than their historical forbears to be actively involved in the education of their children, largely because of shifting social expectations concerning parental involvement. Indeed, she affirms that parental participation has always been a part of the American educational systems, but notes that historical notions of parental participation have varied significantly-- from nineteenth-century expectations that parents would provide shelter and food for teachers to the modern expectation that parents will be fully engaged in activities at home which further the cognitive development of their child. Similarly, it seems that the shape of patient participation in medical decision-making has morphed during different historical periods, depending upon myriad social factors—the status of those given the social designation “physician” or healer, notions about social distance between authority figures and less powerful members of society, gender relations, the distribution of education within a society, among others.

This self-reliant streak alone would not have been enough to lead my respondents to use alternative medicine. If left alone and taken to its logical conclusion, in fact, this tenet would lead us to expect that my respondents would never seek outside help, conventional or unconventional, for their healthcare. But this tenet was not left alone. It was supplemented by three other equally important beliefs, to which I now turn.

PATIENTS AND POWER

If health-seeking social actors are ultimately responsible for their own health care, then it logically follows that the patient will hold certain levels of authority over those who supply the health-related services which they seek.  And if patient self-reliance is the primary organizing principle of health care, then the role of the health-care provider will change dramatically.  No longer will health care providers be viewed as an all-powerful authority figures.  Rather, health-seeking actors will start to view them as advisors.  Paula hinted at this when she commented in the previous section that “the doctor was not taking care of me in the same way I would take care of me. . . . One thing I’m real clear on with my health--I have to have some serious input into the discussion of whatever is going to be done.”  Whatever reliance upon medical experts may be necessitated by Paula’s health problems, that dependence is mitigated by the willingness of health care professionals to seek health in the same way that she does.  None of my respondents asserted this principle as an unqualified axiom.  To a person, they would admit that medical personnel, conventional and alternative, have expertise which the patient lacks.  And certainly, they would say, there are certain situations in which patients must temporarily cede decision-making power to their provider.  Even with such exceptions, however, my respondents came back, time and again, to the assertion that the health-seeking actor must exercise ultimate decision-making authority over those who care for them.  Good health care, in their minds, conformed to this patient-centered model.  Bad health care, in contrast, clung to a decision-making hierarchy in which the health-care provider reigned supreme.

Paula further described her evolution from a provider-centered health care model to a more patient-centered model, saying that before her alienating experience with uterine cancer, she claims that she “had utter and complete blind faith in physicians.” After the series of events described earlier—the deceptive concealment of her diagnosis by her doctor, and subsequent success with alternative approaches to her cancer—she says that today, “And so I can’t trust my doctors. So as a general rule of thumb, I’ve gone from when I was 25 to hear what the doctor says is probably right, to now that I’m twice that old of, ‘Give me your recommendation, I’ll let you know...what we will be doing about this.’ It’s a completely different attitude about my alternatives.” In Paula’s economy of power between patient and physician, the patient is accorded ultimate decision-making power over the physician. “I’ll let you know . . . what we will be doing about this.” The statement, and the more general attitude pervasive among my respondents, turns conventional authority relations between patient and provider on its head, changing the health care provider into an advisor.

In some cases, this supremacy of the patient extended to the least likely of candidates. Jodi, whose case I explored in detail in Chapter Two, talked in some detail about her birthing process. When her attending physician was quickly called for surgery, and was thus unable to break Jodi’s water to start the birthing process, Deb, her highly-trusted and much-beloved midwife, did so instead. When labor pains intensified and became more frequent, Deb and Jodi both realized that the baby would be born quickly. Tension in the room shot up. Deb, however, was able to calm all involved with several quick breathing exercise, after which the midwife said to Jodi, “Oh, you know, I think, I think you can have this baby without the Pitocin.[10] . . . ‘This baby is really low. . . . I think she knows what’s going on.”

Jodi recounted to me that this brief interlude caused her to realize that she was not the only patient in the hospital that day. Indeed, she said, her unborn daughter was an equally important recipient of care. In other contexts, this aside might be taken metaphorically, and we might quickly dismiss it. But given Jodi’s larger insistence that health care providers should primarily facilitate the processes of their patients, a more measured analysis is necessary. When Jodi cites Bev’s insistent claim that the soon-to-be-born-child “knows what’s going on,” she is making a larger claim about the degree to which the natural instincts of an unborn child should be heeded by health providers who facilitate their birth. Indeed, it seems that both Bev and Jodi, in some measure, subscribe not only to a patient-directed birthing process, but to a fetus-directed process. A birthing process which conforms to the “knowledge” (which, in this case, might be more fairly labeled unconscious instincts) possessed by the unborn baby—with respect to what to do, when to do it, and how to do it—will invariably, in this view, be better off than a birthing process which fails to heed this fetal wisdom.

For some, this notion of patient-directed health care was not even limited to human subjects. While discussing psychic healing, one of my respondents told a story of consulting a medium to see whether she should have her gravely injured dog euthanized. She found the medium through a friend who had recently euthanized her own dog, which had suffered from congestive heart failure. According to the respondent, the friend felt that:

. . . maybe she didn’t do enough . . .and so she contacted Anita. . . . [a woman] who [could] communicate with animals, whether they’re alive or not. Anita contacted the dog, not knowing anything about it and told her said that the dog said that, “You know, it wasn’t your fault. You really helped keep me from drowning.” And in congestive heart failure, that’s what happens! You know, they’re filling up with fluid!

Based on the friend’s positive experiences, and the friend’s subsequent ability to come to peace with her decision to euthanize her dog, the respondent contacted the same medium. She wanted to know, from her dog, what she should do. In her words, “It needed to be [my dog’s] decision:”

[The medium] said, “He’s in a lot of pain.” And I said, “Yeah. He is.” I said, “He’s had a terrible accident and that’s, you know, what the dilemma is over.” She said, “I’m in a lot of pain.” And . . . the way she conveyed things, I knew it was my dog. She was right. I knew that it was him. . . . And she got this really sad sound of her voice and it started to kind of bothering me and I said, “I need to know what to do.” And she said that he wanted to fight, that he had a will to live. And I said, “I’m glad to hear that.” I said, “I want him to live, but does he understand . . . what they’re saying about him, that he may never walk, the quality of life?” And then she said, “Yes, he understands. He says, “He understands his prognosis.” And she says, “The doctors stand and talk in front of him, and he understands what they are saying about him.” And she said, “He says-- and I told her nothing about what had happened--he says that six months is bull. He’ll do it sooner than that and he’ll show them all.” And I said, “What’s in six months?” And she said, “The doctors said that you wouldn’t know for six months how much nerve damage would heal and he’s telling you he’ll do it sooner than that, and he’ll show you all. And I said, “Are you sure?” And she says, “That’s what I’m getting from him.”

For some, then, the logical conclusion of the primacy of the patient in medical decision-making is extended even to veterinary medicine. Though this was certainly not a common feature of the responses I received, in this context, it seems to be the reductio ad absurdum extension of the foundational assumptions inherent in this model of patient/health care provider relations. For indeed, if adult human patients are capable of deciding the best course of action, once given a diagnosis by a health care provider, why would such attributes be denied non-humans? If fetuses and pets— beings conventionally thought to have little conscious thought-- figure into the patient-centered logic of at least a few, then we can easily see how it becomes plausible to many to take the next step—to cast the health-care provider in an advisory, rather than authoritative, role.

DOCTORS AS CONSULTANTS

Leslie Towson, a computer network specialist with a small company on the Eastern seaboard, suffers from several chronic health problems. For most of her adult life, she has endured persistent back pain which has led her on a search for adequate pain-reduction approaches. At the same time, she has also suffered from irritable bowel syndrome, a digestive disorder which affects approximately one-fifth of women in the US at some point in their lives. On top of these, she has occasionally been subject to chronic headaches. For relief from the symptoms of each of these disorders, Leslie has turned to alternative medicine. Or, at least, in a sense, she has turned to alternative medicine. When asked what circumstances lead her to use alternative medical approaches, she says:

I try to judge for myself.  Like for years, I tried to take care of my back through alternative medicine, chiropractics, and yoga.  It didn’t work.  It just got...  Every episode got worse until I threw my back with a frisbee.  And then I realized, “Well, I need to have this assessed by a doctor!”  And after talking to him, I felt like I could make a good, informed decision.  In the case of something like headaches, stomach aches, I did go to see the doctor about the irritable bowel syndrome because it just was bad enough, that my sister said, “Linda, you better have it checked.  Don’t just think that, if you take Tums, maybe everything will be alright.  You might have cancer or something like that.”  I said, “Okay.”  Once I got the diagnosis from the doctor, then I looked to alternative medicine to figure out how could I treat it in a non-invasive manner where I’m not taking Tums or some crap like that, and find out what works for me.  In a way I would, I’d like to get the diagnosis from a medical doctor if I think I have a serious condition and whatever.  And then, figure out what they want to do and then see what alternatives there are.

Leslie’s responses here betrays a certain approach to medical expertise.  Leslie views her trips to the doctor as advisory visits, not as visits in which a professionally-trained expert mandates cures.  Her own preference for non-allopathic cures plays as large a role in her treatment as does the doctor’s diagnosis.  Though she recognizes the value of doctors—she consults with them in each case to ensure that she does not have a “serious condition,” after all—they play a largely advisory role in her approach to health, she prefers to use them an a advisory role.

Mary, a thirty-two year old English professor at a prominent East Coast liberal arts college who used a midwife for the birth of her son, seems to share Leslie’s perspective. When asked the role doctors play in her decision-making process about health care, she says:

I don’t avoid doctor’s advice. I’m not somebody who won’t go to the doctor when I feel sick, or am afraid to turn myself over to them or something like that. I do seek doctor’s advice, I think, as often or more often than other people. You know, I call my own doctor; I call my pediatrician and so on. But, I’m nervous about overmedication, so I do try to avoid using pharmaceutical products when possible. I try to remind myself when I go to the doctor that their advice represents the biomedical view-- nothing more, nothing less. And in some situations, I may want to take that approach, in other situations, I may not.

Where patients used to pay doctors to tell them what to do in a specific situation, it seems that Mary, among others, is now willing to pay doctors to tell them what they might do, should they, as patient, opt to take a biomedical approach in addressing their problem.

            Aislinn is a professional counselor and a new mother who knew very little about midwives before her first pregnancy.  Fully expecting to use conventional physicians for her prenatal care and labor process, she visited a doctor’s office early in her pregnancy, only to find that the office also employed four midwives.  Curious, she read materials on midwifery made available by the office.  She also pressed the office’s doctors and midwives to describe the working relationship between the two professions in their particular office.  Over time, she found that while she appreciated the medical “safety net” provided by doctors, she preferred the midwives’ general approach to care:

At first, I would request the doctor and would often get the midwife and midwife-in-training, and [the midwives] were so much more thorough in the questions that they asked.  They offered a lot of information that I found that physicians didn’t.  They would say, “Oh, well have you thought of this? Have you read this?  Let me recommend this or that.”  So I felt that I was leaving the appointments when I saw the midwife with more information and that caused me to read up on it.  They directed me in some of my preparation for childbirth.  I also felt that they were very open-minded about how I wanted to proceed.  I guess I was a little hesitant initially that I would end up with a practice where they would really push using a lot of drugs or not push them.  They were very open to saying that that decision was up to me, and provided me with the information.  So I felt good about that.  They trusted you to make decisions, but they were there as advisors.

Again, Aislinn makes clear that her preference for the midwives’ style of care rises largely out of their social relationship to her as the patient. In her mind, midwives offer information which doctors fail to volunteer, and this information empowers patients, enabling them to make their own decisions about proper health care.

From Aislinn’s account, it is clear that there is some re-socialization which first-time users of alternative medicine undergo during their early visits with providers. For Aislinn, the notion of patient responsibility for health and self-education were introduced by the midwives she consulted. Their suggestion of certain reading materials, promptings for childbirth preparation, and general encouragement of patient initiative together give new patients new definitions of patient-provider relations, and may, for many of them, plant more general ideas about the role of health care providers in the life of the patient.

“SNIP AWAY”: ALTERNATIVE PROVIDERS AS PATIENT ADVOCATES

            Having first fashioned a view of health care which made the patient ultimately responsible for their own health care, and having radically redefined the role of health care provider from authority figure to consultant, it was no surprise that my respondents utilized alternative health care when possible.  Why?  As I pored over their responses it became clear that they felt strongly that alternative practitioners were more likely to conform to their ideas about the authority relations between patients and health care providers.  Ultimately, they felt that while traditional doctors were likely to adhere to a model which saw the provider as an authority figure, and the patient as subject to that authority, alternative providers were more likely to think of their relationship to their patients in an egalitarian fashion.  For my respondents, rightful authority was accorded patients more often in alternative circles than in biomedical circles.  It was this congruence between my respondents’ definition of proper authority relations and the egalitarian approach of alternative medicine which led them to utilize alternative medicine in a variety of circumstances.

Mary, the English professor cited in the previous section, provides a good example of such thinking.  As a feminist, she has strong convictions about the proper relationship between a woman and her health care provider.  In her mind, the provider should, within reason, meet the patient’s wishes and desires, rather than imposing unwanted procedures and medication upon them.  It was this conviction about health care which led her to use a midwife rather than a conventional doctor for her prenatal care and for labor supervision.  She and her husband made very clear to the midwife certain preferences for care in their pregnancy.  First, she did not want to use pharmaceutical drugs, if at all possible.  Second, she did not want to have an episiotomy[11] during her labor process.  Both of these factors played a significant role in Mary’s decision-making process.  She shunned direct supervision by a doctor precisely because she wanted to avoid these two outcomes.  And during her pregnancies, when both decisions were challenged by circumstance, Mary had no hesitation in trusting her midwife’s advise, largely because she possessed a prior trust in the midwife to carry out her wishes as the patient.  First, her midwife advised her to go on prescription medication to avoid premature labor:

I was really trying to avoid [medication] for a long time, but eventually the midwife-- and, again, this one of those things where I knew the midwives knew I wanted to avoid medication.  I knew they were open to that and so when they said to me, “You really need to go on medication to avoid pre-term labor at this point,” I did it, and I thought that I trusted them at that point and I wasn’t even questioning them the way I question my current doctor when she’s telling me to take medications all the time.

Then, during the labor process, Mary’s midwife advised that Mary undergo an episiotomy:

I gave birth in Texas, and I don’t know if this just true in Texas or in general, but the rate of episiotomies with an OB-Gyn. is like 95 %, you know, and the midwives were something like 15% and I wanted to avoid [having an episiotomy].  I ended up having to have one because my labor went really long and I couldn’t get, you know. . .  They tried massage and other things and I couldn’t get the baby out, so I ended up having one anyway, but again at that point Nancy said to me, “You really need an episiotomy!”  I knew it was true.  I knew she’d really been working and working to help me have the baby without one.  When she said, “You’re not going to get this baby out without one!”  I knew it was true and I trusted her and I said, “Okay, snip away!”

Ironically, in spite of wanting to avoid both medication and an episiotomy, Mary eventually endured both, both at the urging of her midwife. But in this context, the outcomes—both of which one would have to describe as biomedical in orientation—are almost inconsequential. For while Mary eventually relented on these two counts, she was still able to control the larger decision-making process, something she doubts she would have been able to do had her primary health care provider been a doctor. While the outcomes here may well have been disappointing for Mary, the process was most certainly not. Mary’s autonomy was, in her mind, preserved, though one might reasonably wonder how acquiescent the midwife would have been if Mary had stubbornly resisted each of these suggestions. Though undesirable biomedical means were used in the end, they entered the picture only after Mary yielded. Patient primacy, in other words, won out. Too, we might note that the midwife here serves more as advisor than as supervisor. This is made most evident by Mary’s own testimony that she did not challenge her midwife “the way I question my current doctor.” To boot, when advised to submit to an episiotomy by the midwife, she “knew it was true,” that is, that she needed an episiotomy, and that “[the midwife] had been working to help . . . have the baby without one.” Mary challenges her doctor’s advise precisely because the MD is more likely to act as an authority figure than as peer advisor. The converse is true of the midwife, who is trusted because of her willingness to serve in a non-authoritarian manner, her willingness to uphold the personal preferences of her patient.

Aislinn, the professional counselor who consulted a midwife for healthcare during her pregnancy, spoke in similar terms when she talked about her post-natal care. In breast-feeding her daughter, Aislinn developed several infections, and consulted both a midwife and an MD concerning her problem.

I actually had some complications with nursing, but I went to the nurse midwife again. You can get an infections from nursing and it’s essentially high fever, feeling really awful, and it takes about 48 hours to run its course, and I had that three times in four months, and then I had an abscess develop and I had to have surgery, and so I had to be referred to a surgeon. So I did go back and see this nurse midwife get the referral for the surgery and, you know, I felt confident in the advice that she gave me. And then I had the surgery on the abscess, then I got my third case of the infection which is called [mastitis]. Dr. Royal was on call, and he said to me, you know, “You just need to quit nursing, you know. It’s been six months. You’ve given her a good start. You need to take care of yourself. This is ridiculous!” So, he said, “Stop nursing, and come back to see me in 2 weeks.” And when I went in I wouldn’t go see him, I saw the nurse midwife and she said, “Well, I can make a good case for you to stop and I can make a good case for you to stay on.” And she presented me with a good alternative, which was to stop nursing with the side that I had problems. It had never occurred to me that you could actually nurse a child just from one side. Um, and so, I expressed milk from the other side just because my husband and I thought it was important to do, and I still do nurse nine months later. So, I really credit her because, you know, I enjoy this and I had so many problems with nursing that, to me, this has been the payoff, the reward. It’s like, “Well, I had all those terrible infections and the surgery and all those appointments, you know, for 12 or 13 weeks. And then I had another infection, you know, and I felt like I didn’t get any of the benefits of the bonding of the mom. It was like, “I’m doing this ‘cause I think I’m supposed to and it’s what a good mom does, you know.” It was a hardship. But I’ve had the great payoff, you know. So I appreciate that. So I will always go back to this practice and ask for her, I think.

Aislinn says that she will return to the midwife rather than the doctor, for basic care, but why? Why does she avoid the doctor, while seeking out the midwife? Like Mary, Aislinn turns to an alternative health care provider because the alternative practitioner heeds the desire of the patient. What is paramount in Aislinn’s decision-making process? The desire which she and her husband have to continue nursing their child. How does Aislinn decide to heed the advice of her midwife, while spurning the recommendation of her doctor? By measuring each recommendation against her personal wishes. In sum, the midwives win out because they allow Aislinn decision-making power which enables her to continue breast-feeding. While doctors give orders, the midwives give suggestions.

But this generalization did not appear only when I talked to women who used midwives. Respondents with more serious ailments echoed this sentiment. Paula, the accounted who subjected her uterine cancer to both conventional and alternative remedies, talked pointedly about the differences between biomedically-based health practitioners and alternative providers:

My psychological well-being seems to be of more concern to [alternative practitioners] than it does to traditional MD’s. I’m an assertive person. But traditional doctors, they don’t listen to you, they don’t listen to me. It’s like they have a mindset, and it’s an accounting thing. Here’s the line, here’s the box and it has to fit in this little grid. Now the other folks, by virtue of being more flaky, more open, whatever, seem to be more open to a patient’s input. It’s like their remedy depends, to a great degree, upon the personality and preferences of the patient, not just their clinical symptoms. And stuff like alternative remedies, you tend to do them yourself, you have control over them rather than them having control over you. So I think it really is partly a control issue. . . . A more traditional doctor doesn’t care about my psychological well-being so much that he, as he does his legal liability and has checked the boxes off for this whatever—would he be found to be following the standard, acceptable procedures? It’s a rare doctor who says, “Well, you’re right. There are options here, or some different choices.” Or, “We don’t know exactly what the problem is.” Or acknowledge that there are other factors, other than the ones that they’ve recognized to put in the little grid that might play a part in your medical problem. I understand the legal liability [they assume], but they’ve got insurance for that. So pay the damned insurance premium, and let’s get on with the business of taking care of the patient. And your psychological need may be completely different from mine. You may need to be like held and patted on the head. I may need to get a kick in the ass, or whatever, but I think that doctors just kind of ignore that dynamic, and just stick with the technical diagnosis.

For Paula, as for Mary and Aislinn, the desirability of alternative health care comes precisely from the willingness of its practitioners to comport with her notions of proper care. And as I will show, those notions of proper care rise largely out of social sources.

SOURCES OF ANTI-AUTHORITARIANISM?

The foregoing logic makes clear how notions of patient responsibility, patient autonomy, and the resulting demotion of health-care provider to role of advisor lead patients to alternative health practices.  In the end, my respondents used alternative medicine because they felt that alternative practitioners encouraged them to take responsibility for their health, granted them significant autonomy in their interactions with them, and were willing to play an advisory, rather than authoritarian, role with respect to their patients.  In contrast, they asserted that conventional health care providers tended to diminish patient responsibility for health, keep authority for themselves, and diminish the authority of the patient.  In sum, alternative providers conformed to the notions my respondents held about good health care.  Not surprisingly, such notions were underpinned by several key facets of organic individualism.  Most centrally, my respondents’ ideas about good health care relied heavily on a therapeutic model of professional service.  For my respondents, health care providers, like good therapists, should listen closely to their patients to understand their desired ends.  They should not presume to foist their goals, their ideas of good health onto the patient.  Additionally, my respondents’ preference for self-directed health care relied on a certain suspicion of authority figures and authority structures.  While there is not space here to draw out the larger implications of the presence of these two key facets of organic individualism, it is important to note, for now, the centrality of these two themes within this chapter.

It is clear that my respondents felt that the nature of authority relations between themselves and health care providers was a key factor in their health care decisions. More precisely, they articulated an ethos which exalted the place of the patient in health-care relationships. Providers, though important for their expert knowledge, were not indispensable. They were valuable insofar as they provided patients the means with which to make their own decisions. Dictating ends in certain circumstances was verboten. Is this an inherently rational way to approach medical decision-making? Does it match the means-ends model proposed by rational action theorists, who insist that actors choose alternative medicine because it enables them to reach desirable ends? Do anti-authoritarian ideals help health-seeking actors to maximize “gain” and minimize “pain?” For my respondents, such a conception of authority in health-related decision making was clearly beneficial to them in some sense of the term. But it required a certain social lens to think as my respondents did. And the same lens which led to see health care providers as consultants led them to conceive of their bodies and their health in certain ways which I will explore in Chapter Four.

CHAPTER 4: SELF-HEALING AND SELF-IDENTITY

In the ancient Jewish songs of King David, the writer occasionally addresses himself in third person. “Why so downcast, o my soul?” he asks himself at one point. “Return, o my soul, to your rest,” he reminds himself at another. Mentally visualizing the self in a dualistic fashion in order to gain greater perspective on one’s circumstances was, indeed, not unknown in the ancient world. Religious and literary scholars speculate on the significance of this language, some saying that “my soul” was simply a way of denoting the “essential vitality” of human beings, others that the words refer to the “mental or psychological aspect of [human beings], their personalities, the seat of their feelings, desire, and will,” and still others suggesting that “my soul” acted as a literary device which provided an emotional manner in which to talk about the first person pronoun (Allen and Baigent, 1986: 584-585).

In many ways, the ancient Hebrew language used by David was substantially similar to the ways in which my respondents thought and talked about their relationships to their physical being. As we shall see later, one of my respondents even talked about his knee as though it had its own separate will, its own separate mind, one which warred with his “truer” self, and wreaked havoc on a unified sense of self. Though many respondents gave lip service to notions such as the “mind/body connection,” being “in tune” or “at one” with their bodies, the larger framework with which they spoke about their health-seeking behavior betrayed an underlying assumption that their bodies were separate entities-- things to be monitored, kept in check, and ultimately, controlled. Far from being synonymous with their self-identity, the body was often seen as something which caused dissonance in one’s sense of identity.

It was this mindset which allowed my respondents to think of their relationship to their body in hierarchical, authoritative terms. If the last chapter dealt with authority relations between patient and health care provider, this chapter deals with authority relations between my respondents and their bodies, the authority of the body over disease, suffering and pain, and alternative medicine’s purported ability to optimize that authority, and conventional medicine’s tendency to circumvent this authority relationship. The central ideas of these two chapters are not unrelated. Alternative health users are generally convinced that alternative medical practices give health-seeking agents greater control over their fate than do the practices of conventional medicine. Those who conceive of themselves in this fashion are not unlikely to transfer that perceived power to their own relationship to disease. If one controls one’s medical care, then it is surely not a large leap to envision controlling one’s own physical symptoms.

In this chapter, I explore the three different ways in which my respondents talked about this complex relationship. First, I note that they generally shared a common desire and claimed a purported ability to control their bodies and their general state of health. Often, this was described as “being in touch with myself,” or more specifically, “being in touch with my body.” This desire to maintain conscious mental (and sometimes psychic) contact with one’s physical being, and moreover, to maintain cognitive control over one’s corporal functions-- such as heart rate, transmission of pain signals, and healing processes--often exhibited two further characteristics. On the one hand, my respondents tended to think of their authority over their body in a decidedly non means-end fashion. In other words, control of one’s bodily operations was seen as an end in and of itself. On the other hand, my respondents were rather selective in choosing means by which to gain such control over their bodies. They preferred to draw on what they referred to as “natural” forms of pain-reduction as well as “natural” forms of fighting illness in augmenting their body’s ability to fight entropy.

Second, my respondents articulated an ideology which generally asserted the authority of the body and the individual over disease, illness and pain, specifically emphasizing the role of the mind in regulating this triumvirate. In contrast to the biomedical model, which thinks of cures primarily in terms of invasive procedures and biochemically-produced pharmaceutical products, alternative health enthusiasts think of the body as the primary curative agent. Consumers of alternative medicine assert that the human body is a self-regulating agent which, left to its own devices, under the control of a sufficiently enlightened subject, can fight off most disease and illness. Along with this conception of the human body, my respondents shared a conviction that conventional medicine often hampered the individual quest to control disease, illness and pain. How so? My respondents tended to hold in common a viewpoint that biomedicine made patients passive, and that many of its cures—especially those which depended heavily on pharmaceutics—were, in fact, counterproductive. For my respondents, phamaceutical cures were “unnatural” cures which dealt exclusively with symptoms, not underlying causes, and importantly for the present argument, diminished the individual actor’s authority over disease, illness, and pain. These pharmaceutical cures were to be contrasted, in their minds, with the “natural” cures—yoga, herbal remedies, drug-free labor processes--to be found within the broad parameters of alternative medicine. These “natural” cures worked because they harmonized with the instinctive healing capacities of nature. While biomedical methods, especially pharmaceuticals, subjected the individual agent to their authority, making them subject to a variety of undesirable and “unnatural” effects, alternative methods clearly empowered the individual.

It was understandable, then, that in the end, my respondents came to the conclusion that alternative medicine actually maximized the body’s self-healing capacity. Since its various modalities were perceived by my respondents to be simple augmentations of the essence of an already benevolent healing system supplied by the body, they were viewed very differently than the remedies offered by conventional medicine. Rather than muting the body’s self-regulating, self-healing process, these methods were thought to “naturally” amplify the body’s abilities. In situations where such methods could be called on to aid in seeking health, my respondents were more than happy to utilize these resources.

WHAT’S LOGIC GOT TO DO WITH IT?

Among other things, the previous chapter analyzed whether it was “rational” for my respondents to retain authority over their health care providers, to cast themselves as the ultimate deciding agent in their own health care. Ultimately, while I found that there was a certain rationale by which alternative medical users made their health-care decisions, this rationale failed to match the “minimax” calculus posited by rational action theory. Their rationale was more influenced by a modern American understanding of relations between patrons and professionals than they were by innate urges to minimize pain and maximize pleasure.

Again, it may seem on the surface that my respondents were, indeed, acting in exactly in the fashion predicted by rational action theorists. After all, if a patient is presented with a set of choices between healing methods, one of which they perceive to be counterproductive and the other of which they perceive to be beneficial, and they choose the latter option, are they not acting rationally? While it is difficult to argue that the desire to master one’s own body is not a near-universal desire, the responses I received indicated that when alternative medical patients speak of a general interest to be “in touch” and “in control” of their bodies, they spoke in a language which was more cultural than it was instinctual. As I will show, maintaining mastery of one’s physical faculties may be a universal desire, but users of various forms of alternative health draw from a uniquely American, uniquely modern vocabulary when they talk about maintaining authority over their own bodies. In the end, my respondents’ assertions of authority over disease, illness and pain revealed something about their conceptions of nature, their relationship to modern capitalism, and their ideas about the place of individual agency in social life. I will return to this issue after my analysis of my respondent’s ideas about their authoritative relationship to their bodies.

HEALTH-SEEKING AND THE BODY: STAYING IN TOUCH

To say that most cultures prize individual control over the body would be an understatement, indeed. Parents everywhere celebrate when their children finally overcome their bodies’ natural instinct to secrete waste at will. “Potty training,” as this event is referred to in America, is not only a graduation from an onerous task for parents, but a symbolic passage into a new level of development for children. Subsequent relapses in self-control, especially if they occur in public locales, such as the classroom, can prove extraordinarily embarrassing for the unfortunate pupil, who quickly becomes known as the student who “peed her pants.” Sports fans the world over cheer when athletes who have pushed their bodies past heretofore known limits in training accomplish impressive feats in competition. And nothing shocks these same fans more than seeing these same athletes in a state of decline, especially when their careers are cut short by a devastating injury, such as one which brings paralysis, or a quick-striking deadly disease. This desire for command of one’s body, it seems, extends even to the most private of venues, the bedroom, with modern magazines and even ancient sex manuals instructing men and women of varying sexual orientations how to achieve optimal sexual pleasure. In such publications, the path to sexual nirvana includes no small measure of physical discipline and control over the body’s sexual organs and functions. And at the end of life, one of the signs of the social death which often precedes physical death is the loss of control of one’s physical faculties. It may come innocently enough in middle age, with a “bum knee” or “trick hip,” but then give way to the failure of more basic physical functions in old age, such as loss of bladder control or involuntary drooling.

However universal this bodily “will to control” may be, its features are distinct from the sort of control which my respondents desired over their own bodies in two important respects. First, while the more universal desire for bodily control generally saw physical control as a means to an end (the physical discipline of the track star, for instance, was practiced in order to accomplish the elusive 4-minute mile), my respondents articulated a rationale which was markedly less means-ends oriented. For my respondents, bodily control and “intouchness” was a virtue in and of itself, irrespective of any prima facie evidence of benefits which such a practice might or might not yield. The second difference lay in the view which each perspective adopted towards natural and synthetic methods for the increased control of the body. While the more universal, instinctive approach appropriated any effective method which would optimize control of the body, my respondents tended to prize those techniques they deemed “natural,” as opposed to “synthetic” methods, which they regularly disparaged.

MEANS TO AN END?

Sandy, a forty something mother of four, works full-time as a recruiter for a medium-sized international development firm near Washington, D.C. In 1995, when her daughter was five, the family doctor discovered a serious problem during a routine check-up:

I took her for her regular checkup, and the doctor looked in her ear and said, “I see something. She needs to see Dr. Mary”-- the best ear specialist he knew. So I took her to see Dr. Mary, and indeed, there was a cyst growing in her eardrum. And, um, the characteristics of these types of cysts are that they grow, the growth begins inside the eardrum. It grows inward, not outward, and when you can finally see it outward, it’s already consumed much of the eardrum. So when you have it removed, often, there is severe hearing loss. So we were very worried about this. And we thought, “Well, we’ve got the best surgeon for her, Dr. Mary, though, so we have that covered.”

Soon, though, her deeply religious mother-in-law made a suggestion to Sandy, recommending that her daughter undergo reiki under the guidance of local Ursuline nuns:

And my mother-in-law said to me, “Okay, you have the surgery covered, but I have something else. It won’t hurt, and it might help.” And I’ve always been very skeptical about these things that can’t be proven, you know. And, and I said, “Okay, but she’s right, it won’t hurt. It will make her feel better and you always wants to please your mother-in-law when you can.” And so she told me about these Ursuline nuns who are in Washington. Yeah, and they have something called the Ursuline Counseling Service. And they do not represent themselves as healers in any way, shape, or form. They represent themselves as counselors. My mother-in-law briefed me before we went and she said, “This is not to cure the problem. This is just to have them prepare Natalya for her operation.” And she said, “And don’t say anything at all to them about you’re that they’re going to cure this because they don’t cure things, they say.” And I said, “Okay, fine.”

Though unconvinced, Sandy took her daughter to the nuns:

And when we got there, they put [Natalya] on this table, this soft thing, and they put this background music that was just very soft, soothing, and calming and they did this visualization exercise with her as they did reiki. And what they did reiki on her and the way they explained to me was that they were, you know, trying to give her, through the visualization, tools to make herself less afraid during surgery. So, they would say, “Here is your toe. Imagine you’ve got all the energy in the world in your toe. Now let’s take it and let’s move it to your elbow.” And, all these kind of things that little kids think are funny. And they asked her, “What’s your favorite color.” And she said, “Oh, it’s pink.” And they said, “Tell me some things that you like.” And she said, “I love stars” So they said, “Imagine a pink star and it’s right, you know, it’s right here in your head. Now, move it here, now move it there.” And so she was moving this pink star all over her body while they did this furious thing with their hands, although never touching her physically, but just over her, near her. And, um, once she was calm and at ease, they really started working on the area where the ear is. And they were, you know, taking out the bad energy and then replacing it with good energy, with their reiki. They spent maybe half and hour with her. And I watched this thinking, “Okay, well. It can’t hurt.”

What are we to make of Sandy’s experience with her daughter, her daughter’s ear, and reiki, an ancient Japanese Shinto practice, here appropriated by Catholic nuns? What about Sandy’s simultaneous reliance on surgery and alternative medical means? A logical starting point is the significance of this exercise in the eyes of the social actors involved. Over and over again, the main actors in Sandy’s narrative emphasize, then re-emphasize, that the point of reiki, or at least reiki as it is practiced here, is not healing itself. Sandy’s mother-in-law stresses, and then the nuns themselves reiterate this point. The point of the exercise, they insist, is preparation for surgery. In Sandy’s words, the nuns were providing tools to help Sandy’s daughter, so that she would be less afraid during the surgery itself. But what is the nature of this “preparation?” It is not a means-end logic, at least in the conventional sense of the term.[12] The control is not the direct control over the physical body itself, or even over the procedure which will alter the physical body. It is a “preparation” in the sense that it provides a scared young girl with a sense of agency in an otherwise uncontrollable situation. For indeed, the logic might go, if a girl can imagine herself to control a celestial body which jets back and forth over her body on command, it will not be a large leap for her to imagine controlling her own response to a painful and confusing medical procedure. Through reiki, the nuns provide, more than anything else, a sense of control, of agency. If reiki is a means to anything, it is not to direct healing, but to greater sense of agency as the individual.

The symbolic mechanisms by which my respondents appropriated meaning from their use of alternative medicine became even more clear in a brief snippet of an interview with a 20-year old college student Karol, who discovered that she had a form of muscular dystrophy called myodynia congenita as a teenager. She sought out numerous biomedical cures before finally turning to biofeedback.

My parents and I were looking into means of pain management. The drugs weren’t managing the pain. I needed some way myself to deal with the pain. Biofeedback had probably been brought up 6 months earlier, and at first I resisted it, but then I got to the point [where I thought], “You have to learn to cope with it. They’re going to say, ‘Accept it. It’s a very real thing. Let’s try these ways of helping you.’” And he said, you know, “We’re going to try it and we’ll try a few sessions and if it feels like it’s working for you, that’s great. If not, that’s fine.” And um, the second session, I changed the temperature in my hands and I thought, “This is right for me. Look. I can do something here.” And I think was physical proof in front of me that I could do something to control something in my body, and I thought, “If I can control that, clearly, there’s got to be some way for me to control my pain.”

Here, the means/ends aversion characteristic of my respondents is made most clear. By Karol’s own admission, changing the temperature in her hands had no direct effect over her migraine headaches. Karol’s volitional changing of her hands’ temperature serves symbolically, though, to represent the control which social agents can have over their physical faculties. But a direct means-ends logic is entirely absent here. Unlike the track star in this chapter’s introduction, Karol does not undertake specific preparatory physical activities specifically designed as a way to get to her specified goal. Alternative medicine, for Karol, provides a way of indirectly and symbolically reminding herself that she, indeed, possesses control over her faculties.

A traditional means/ends orientation is even more clearly eschewed by Matthew, a 50-year old retail manager who practices meditation. He describes an exercise whose primary objective is controlling one’s breathing:

You sit in a comfortable position. You place your hand on your thigh. And first, there’s a one minute pause in the tape and the woman on the tape tells you that you’re supposed to count your breath cycles, one inhale, one exhale counts as a cycle. And so I thought, “Okay,” and I did this and, you know, I’m relaxing my mind and everything and I’m just simply counting my breaths and I came up with 11. So then she says, “Now, put your hand on your thigh and as you inhale, raise your hand, as you exhale lower your hand slowly. Use your hand to control your breathing and do not physically attempt to slow down your breathing, but just mentally suggest to yourself that you want to slow it down. And do not deprive yourself of oxygen or air in anyway.” It’s just the idea going through your head that, “Hey, I want to breath more slowly.” And use your hand. It’s almost like working a bellows. And I tried this and my number of breaths turned out to be 8. So I thought, “Well, okay that’s kind of neat.” The next session, I tried it again and the first time I counted 8 breaths without doing the bellows thing. I thought, “Okay, well that’s neat. There’s a difference. I wonder what it’s like if I actually do try to slow it down.” Well, I did it and I just, I think it ended up being 2½. And I didn’t believe it. I must have spaced out or something, I didn’t count correctly or something so I rewound the tape tried it again. This time, it was 3½ . I tried it a couple more times. I was just trying the second minute. I thought, “well, maybe there’s something wrong here. Maybe something happened to the tape. I don’t’ know. This is just too absurd.” So I went back to the first minute and actually, did, you know, the exercise and still it was very consistent, about 3½ [cycles per] minute, eventually I got it down to 2 ½ [cycles per] minute, and that’s incredibly slow breathing and, um, I’ve talked to others who have said that they can control, you know, their body temperature and what have you. And I haven’t been able to do that, but . . . I guess what I’m getting at is that there are some physical aspects to it, as well, and meditation helps you to control these physical aspects. Now, I look back at the old Kung Fu movies where the guy was put in the box in desert heat, remains perfectly calm, and doesn’t break a sweat. I’m wondering, you know, maybe that’s a possibility.

When pushed to describe what end such breathing exercises might accomplish, Matthew bristles:

It’s not that kind of thing. I mean, I can’t deny that meditation puts me in a more relaxed state of mind, maybe even puts me in a mindset which makes me more considerate of others. And it probably lowers my blood pressure, too, now that I think about it. But that’s not why I do it. I mean, it’s kind of like what they used to say in Sunday School about joy—you couldn’t get it by pursing it. You can’t think of meditation as a way to get to some destination, because as soon as you start thinking of it that way, it becomes a tool. And that’s not what it’s about. Meditation is about just being and awareness of being. And that’s it. And good things may come out of that, but you can’t predict that, and if you do, you’ve missed the whole point. The point, if there is one, is to be. That’s it. I don’t mean to be contentious here, but the question kind of assumes a way of thinking that’s the opposite of meditation.

What is it about Matthew and my other respondents which make them so averse to a means-end logic? After all, their choice to use alternative forms of healthcare must emerge out of some idealized end, skeptics might contend. Clearly, part of their ideology comes out of the self-proclaimed purposes of the activities in which they are engaged. To take Matthew’s example, the various forms of meditation currently popular among alternative health enthusiasts emerged from a very specific set of Asian religious practices and ideas, all of which are avowedly less means-ends oriented than the Judeo-Christian tradition within Matthew situates himself. And yet, this ideology seems somehow less at home in a modern individualist capitalist means-end world which emerged out of Calvinist roots than it surely did in its initial Asian settings. Here, especially for Karol and Matthew, disavowing a means-end orientation is somehow a statement about the body, about the individual and their stance vis-à-vis their larger social world and ultimately, the larger universe. Perhaps they think of it as suggesting their stance vis-à-vis the larger capitalist economy. Perhaps it serves as a symbolic reaction against historical, traditional Western religious faith. What exactly this larger statement is remains to be seen until we glimpse the other elements of my patients’ relationships with their physical selves.

ADDICTED TO NATURE?

In trying to master their physical faculties, my respondents were nearly unanimous in their agreement that being “in touch” with their physical faculties included partial, or in some cases, complete, abstinence from synthetically-produced pharmaceutical cures. To the degree that others relied on synthetic cures, they were seen to be “out of touch,” or less than in control, of their physical faculties. In Chapter Five, I will develop more fully the ways in which users of alternative medicine conceive of the differences between “natural” and “synthetic” cures, and of their conception of nature more generally, but suffice it to say for now that alternative health users thought of people who unreflectively and habitually used pharmaceutical methods for health maintenance and health restoration as people who generally were “out of touch” with themselves, and had little control over their bodies as a result. Those, in contrast, who eschewed traditional pharamaceuticals, and maintained health (and restored health when ill) through what they termed “natural” means were seen as being “in touch” with themselves, and were thought to possess a certain level of control over their bodies which escaped the former group.

Ray is a young man of 27 who some might think of as a bit of a “drifter.” He was a heavy-drinking hockey player during his university years in Canada, when his highest goal was getting his BA, and following in his father’s footsteps in the family business. Shortly after college, however, through exposure to yoga, and reading of various Eastern religious texts, Ray decided that conventional Western suburban middle-class social life was not for him. A large part of his change in orientation included a shift towards a more “natural” lifestyle. For Ray, this included finding a job which would enable him to spend most of his waking hours outside, preferably in sparsely populated rural climes. Another element of this change included using what he thinks of as more “natural” forms of exercise, such as yoga, and bicycling and jogging, which enable him to “get out into nature,” in contrast with gymnasium-based exercises such as weightlifting and stationary aerobic exercise machines. The final element of Ray’s “natural” lifestyle includes an aversion to traditional Western medicine, especially to pharmaceutically produced products. Witness the following aside:

Let’s just say my girlfriend has a cold. She gets symptoms, you know-- “I can’t breathe.” “I can’t do this, that, or the other thing.” And she runs out and spends something like $25 on Sudafed and all these different things, and is in a completely different state of mind as a result. She really has no control over her mind or body anymore because of side effects of, you know, the 30 to 100 different chemicals they put in these small things. And we’re talking about people everywhere who have medicine cabinets full of this crap! And they rely on it. In some cases, they’re addicted! And these giant pharmaceuticals are laughing all the way to the bank.

For Ray, reliance on conventional biomedical means for short-term solutions is a sign, not of individual agency and power, but of individual weakness and dependency upon modern consumer culture, which enmeshed with corporate power. Symbolically, he sees the use of conventional medicine as a weakness of character. The control of the body is most clearly represented, for Ray as for many of my respondents by abstinence from pharmaceutical cures. The control of the body through biomedicine’s “artificial,” scientifically, and synthetically produced means is no control at all, according to this perspective. In Nietzschean terms, the ubermensch is not only the person who retains control of physical faculties, but the one who does so without the aid of modern biomedicine.

Amanda, the aspiring homeopath introduced in the previous chapter, talked at length about how she, as a perfectly healthy young woman, thinks about the role of “quick fix” biomedical approaches, I asked if and when she maintained health through the use of pharmaceuticals. Said Amanda:

I struggle with that decision. I mean I hate taking Tylenol and stuff like that. There are times when I get [menstrual] cramps from hell, and I’ll drink some chamomile tea. I mean there are ways to avoid drugs. I rarely, if ever, go to the doctor because I feel like my body’s going to take care of it, and I tend to trust my body’s own immune responses a lot. And I have a lot of books on natural medicine, so I refer to those. I hate antibiotics. That’s my biggest [reason] for trying to not go to the doctor—it’s because I want to avoid drugs, and they really don’t do anything else. Like I feel like every time I’ve ever been to an allopathic doctor, they talk to me for 5 minutes and then prescribe me some antibiotics, and I don’t want them. It depends on the situation. Like if I’m allowed to just hang out at home and be in pain and like allow for a little more time to pass before the remedy takes effect then, you know, I’ll do basic things like use a heating pad for cramps. If I have a headache, I’ll lie on the couch and relax. and there are situations where I can’t do that, you know. You don’t have time to make yourself a willow bark tea, or something like that for pain and you have to give in, and just pop the pill. So, in those situations, I’ll give in and take the pill, but I always hate doing it.

Pushed for a rationale for this “natural” approach to medicine, Amanda emphasizes the agency of the individual:

Well, I think it has something to do with the idea that I want to know what’s causing a problem. There were times when I was younger when I would have recurring yeast infections and I would want to know why. I mean, I don’t just want to treat it with Monistat, only to have it come back in six weeks. I want to know why I’m having them, so I would rather change the way I eat and see if that affects it. You know, if I take Acidophilus, or just eat yogurt, or you know, whatever it is. Another example--if I take Vitamin B6 on a regular basis, then I don’t get cramps, you know. Well, I know that works. I’m still slack about it sometimes, but I know that it works, so I’d rather do that and I’d rather not take the easy way out ‘cuz it’ll force me to change. Obviously, my body’s telling me something. I also think that there’s that element of the body/mind connection—I want to be aware of what my body is telling me and aware of how I can affect that through my actions and how I treat my body. And a lot of that, you know, I feel like a lot of things that I go through, whether it be anxiety or even the times where I probably could have clinically diagnosed as depressed, taking it into my own hands and going for walks or meditating or taking personal time has meant a world of difference. I think drugs are a bad idea, I guess, in a lot of cases. I think they’re overused. I don’t think they’re completely, bad, but. . . I love the idea that as a naturopathic physician, you can talk to a patient for an hour and find out that, “Oh, my gosh, this person has just gotten divorced. This is affecting this, this, and this in their lives and this is probably half the reason that they are having trouble with their health. And I think that makes sense. I think it’s ridiculous to talk to someone about a health issue, send them on their way with some drugs, and not address the fact that they could be suffering through troubles or transitions in their life. It’s a package deal. . We feel the way we do because of a million different influences in our lives and it’s not just physical. I definitely feel like [drugs] don’t allow you to take your health into your own hands and I think that one of the best ways of healing someone would be to teach them how to do it themselves. You know the old adage—“Give someone a fish, they’ll eat today. Teach someone to fish, they’ll eat the rest of their lives?” It’s like that.

For Amanda, as for Ray, abstinence from pharmaceutical healing means is a statement about the individual and a certain conception of what human beings essentially are, especially in relation to the natural world and science. Here, rather than being a means through which science can demonstrate its mastery over unruly nature, the individual becomes the conduit herself for conquering the natural world, here represented by physical imbalances and illnesses. In some senses, Amanda asserts a romanticist, anti-modern idea about the place of the individual in nature. Rather than relating to nature through science, or having science mitigate the detrimental effects of flawed nature or flawed bodies, the individual relates to nature directly. No longer is there a mediating agent between the individual and nature. Or, at least, so it seemed to my respondents. Whether it is possible for individuals in the modern world to relate so authentically to nature is a question open to significant debate. Much as Amanda and Ray might conceive of their health-seeking behavior as “natural” and authentic, they themselves can scarcely avoid the mediating organizations and institutions of the modern world. Indeed, most of Ray’s yoga sessions are held in the luxurious atmosphere of an exclusive Washington, DC health club. And Amanda’s herbal remedies are not only produced by corporations who someday hope to be as profitable as leading pharmaceuticals, but also rely in no small measure on active ingredients which are conspicuously drug-like in their behavior.

HEALTHCARE AS HINDRANCE

In the midst of a life filled with cuts, bruises, colds, flu, broken bones, chronic pain, and life-threatening illnesses, it is often easy to forget that, for the most part, the human body has an amazing ability to heal itself from injury and to fight off illness and disease. The “skinned” knee of the 7 year-old generally heals itself fully, without a scar, within weeks, if not days. And even the most severely broken of bones repair themselves within several months’ time. Only in the most immuno-compromised of people does a cold, or even the flu, not run its course within a matter of weeks. The evidence from my interview suggests that alternative medicine plays heavily upon this truism of human health, and that patients who turn to alternative methods have significant trust in the self-sustaining and self-repairing capacity of the human body. Wedded to this conviction was a critique of mainstream biomedicine. All too often, users of alternative health methods agreed, mainstream medicine mitigated said self-repairing capacities of the body. This benign instinct could, my respondents opined, be seen as an ally by physicians. Instead, at best it was ignored, and at worst, it was treated as an enemy. Worse, the interventionist, invasive, pharmaceutical orientation of biomedicine often muffled the finely-tuned mechanisms by which the body notified the health-seeking actor or pain and dysfunction.

Vincent is a Salvadoran-born New Yorker who works as an information technology consultant in the Washington, D.C. area. At age 23, he underwent open-heart surgery for abnormalities in his heart function. He had 2 more such surgeries before turning 30. In the meanwhile, Vincent learned several forms of meditation in conjunction with the martial arts training he did as part of his rehabilitative cardio-vascular workouts. The convergence of rehabilitation and meditation serendipitously supplied Victor with a mechanism through which to see his new health problem. Asked whether his experiences with meditation had influenced the way he viewed himself and the world around him, Vincent replies:

Meditation has given me the belief that, there’s really nothing I can’t do. It’s just given me an incredible amount of self-confidence, not just psychologically, but also confidence in my body and its ability to bounce back. Moments before my first surgery, it was the first time in my life, I couldn’t see the future. By that I mean [the thought that], “Tomorrow I’m going to get up, I’m going to eat breakfast.” But moments before that surgery, I couldn’t see that. I didn’t know. It was just a black hole in front of me. After two or three years, when I had the other two surgeries, they just became a nuisance. I thought, “This is irritating. I just want to get out of here!”

For a man who experienced three open-heart surgeries by the age of thirty, Vincent is a man brimming with confidence. Interestingly, his confidence lies, not in the skill of the doctors, nor in technology which has made open-heart surgeries a safe, common procedure for people in good health. His confidence does not lie even in some sense of providence, or even in fate. Through meditation, Vincent has developed confidence in himself, specifically in his body and its capacity to recuperate, even after his chest has been sawed in half, his blood has been recycled through an electronic pump, and one of his major organs has been severed and sewn back together. While the confidence that he would recover was well-founded (I, after all, found him the muscle-bound picture of health sitting across from me in a corporate conference room only 6 months after his most recent surgery), it is of particular sociological interest that the generally acknowledged resilience of the human body, here paired with the best technology biomedicine has to offer, is here turned into evidence of the sovereignty of the individual social actor to conquer whatever circumstances he might face. And what helps to position the social actor so favorably? In Vincent’s case, meditation. It is through this regular mental and religious exercise that he has gained confidence in the self and in the capacities of the human body, more generally.

“WORKING AGAINST NATURE”

Just as important as my respondents’ conviction that the human body was the ultimate self-healing organ was their conviction that modern biomedicine, all too often, interfered with this self-regulating and self-perpetuating propensity. While the first point concerns the nature of the physical body and the symbolic significance of entropy and renewal, respectively, the second point has to do with the manner in which a set of modern professions (MD’s and other biomedically-oriented vocations) and institutions (HMO’s, hospitals, etc.) interact with that socially constructed reality. The body’s modus operandi was to seek health, and root out illness, disease, and injury, my respondents insisted. Biomedicine’s modus operanidi, in contrast, was more ambiguous. Though its effective cures to acute problems were often lauded by my respondents, they were equally clear in criticizing the tendency of mainstream medicine to overmedicate to the point of dulling the natural healing instincts of the body.

Tammy, who began using herbs and practicing reiki for health-maintenance purposes during her college years, typifies the sentiment found among many of my respondents:

My mom is a complete hypochondriac, and so I used to go to the doctor all the time when I was a kid. Any time I would feel a sniffle, I was shuffled off to a doctor who would give me some antibiotics or something else. The stuff was supposed to make me feel better but it never did, you know. It never did. And, as a kid and even my first couple years in college, I was chronically ill. I was sick all the time with just little minor things--a cold, a stuffy nose, or something like that. And since I’ve started doing reiki and using herbs, in the last year, I haven’t been sick at all. I think it’s the mainly state of mind that I have now that I’ve started to view my health differently. Before, if I would get a stuffy nose, I would think, “Oh, my gosh. I’m getting sick.” And of course, I would get sick. And then, I’d either take some over-the-counter drugs or antibiotics, and it would just get worse. It just seems like a mindset that doctors kind of encourage. If I get a stuffy nose now, I think, “Oh, I have a stuffy nose.” I’m not sick though. My body will take care of it.

In some cases, my respondents had developed a more conscious, fully articulated critique of the medical profession’s inhibition of the innate healing abilities of the body. Consider Mary, the young English professor introduced in the previous chapter, and her description of how she decided to use a midwife for supervision of her pregnancy and delivery of her baby:

My longer-term reason for [using a midwife]? I don’t even know when, probably in some class in undergrad where women’s studies was my minor area, I’d been introduced to the history of childbirth in the US. And [I learned about] how it used to be very much in the hands of women and eventually became male-dominated and simultaneously, women started being highly medicated and laboring in more painful, less productive positions because it was easier for the doctor see. I thought I might be interested in trying to have a more woman-centered experience of childbirth. “Woman” isn’t even the right word, in some ways I mean, I don’t even know the right term for it, but several of my friends who had had female OB-GYNs who told me that they were, in fact, as bad or worse than male OB-GYNs in terms of being very distant, clinical, and hyper-professional. And so, um, it’s not even necessarily a male-female thing, but I wanted a more woman-centered, natural, commonsense experience to the birthing process. Where it was recognized that many so-called alternative approaches actually used the body’s tools and nature’s laws more efficiently than mainstream medicine did. So, all of those things made me initially start seeking out midwives.

Though Mary’s analysis begins as a feminist critique of modern medical practice, in the end, her complaints are as much practical as they are ideological. Modern medicine, she insists, ignores the cues given by the body and the self-evident laws of nature, cues which should serve as basic guidelines for good healthcare. The body has “tools,” just as nature has “laws.” And both, according to Mary, are routinely disregarded by doctors.

Mary’s feminist-informed standpoint finds a strange bedfellow in Paige’s fundamentalist Christian critique of mainstream American medicine. Paige, the home-maker wife of a US Air Force airman with 2 young children, and talked with me at length about her use of midwives during her 2 pregnancies, and of her current use of herbal and homeopathic remedies for various and sundry purposes, both for herself and her children. She insisted that her religious viewpoint informed every aspect of her life, which included her view of her body, and her health care choices. First, she articulated her core beliefs

Really, I’m a fundamentalist Christian. I believe that Jesus was sent here with the purpose to die to cover my sin and that by accepting that payment that He suffered for us on the cross that I have the gift of eternal life. I believe God created the earth. Actually, I believe in a literal 7-day creation and a young earth, and I believe that not strictly because it says that in the Bible, but because there is certain scientific evidence that points that direction, and that evidence is not consistent with the evolutionary model that I was taught.

Though such beliefs are not generally thought to be the typical worldview espoused by devotees of alternative medicine,[13] Paige contended that her use of alternative medicine issued directly from these conservative religious convictions.

I believe God made us. We’re fearfully and wonderfully make, it says in Psalms. And I feel if He built the body, He had a reason for the way he put it together and it makes sense to me to utilize practices that work with it, rather than working against it. I definitely like the alternative, less clinical approach to things, kind of letting nature take its course and working with it, rather than against it. . . . I feel like God created a beautiful earth and we’ve done a good job of destroying it. If he put us here to tend and to take care of it and I know He intended for us to use it. But I do think He wants us to respect what we’ve been given and, to try not to defy the laws of nature so much as to use them. You think flying defies the law of nature, but it doesn’t. You’re using air current—it lifts you in the air, you know. Flying uses what’s out there. And, um, I feel the same way about medicine, that there’s a time an when an M.D. is what’s needed. When I had tuberculosis, I needed an M.D. I needed to be on the high-powered stuff. But habitually being on the high-powered stuff, it’s just counterproductive. Basic medical care to me should not contradict what, the way that we’re created, and it seems like a lot of mainstream medicine commits exactly that sin. And in the process, it works against a lot of good things our bodies can naturally do on their own, the way God created them.

So, while my respondents were less than united in their worldviews, they were unified in their conviction that all too often, conventional medicine mitigated the innate ability of the human body to heal itself. Articulating a feminist perspective, Mary argues that good health care should not follow the demands of a gendered power structure, but should rather cohere with commonsensical, patient-centered principles. Applying her fundamentalist Christian convictions, Paige voices the view that healing systems should be congruent with providentially established principles of creation. Despite their significant ideological differences, the two share a common perspective which views the body as an efficient, principle-issuing entity and science as a oft-inefficient interloper in the healing process.

For many of my respondents, it was not only their own health care, but the health care of significant others which proved instructive in directing them towards a different model of health care. Take, for instance, recurring references in Amanda’s account to her grandmother’s failing health and the care which attended it:

My grandma [is] in a lot of pain on a regular basis. She’s suffering from shingles and she’s depressive. She has bowel issues bad enough that she’s had surgery on her colon and stuff like that. I mean she’s pretty much a wreck on a regular basis and it’s gotten worse over the years.

Later, she describes her frustrations with her grandmother’s treatment. Amanda’s worst fears with respect to the suppressive nature of biomedicine were embodied in the treatment her grandmother received:

[Homeopathy and naturopathy] just make so much more sense than regular medicine. My grandma is on so many drugs, and each one causes some other problem for her, and then she has to take a drug for the new problem. I don’t think people should have to live like that. If I could teach someone to take [their health care] . . . into their own hands . . . . I think that’s amazing. I mean . . . it’s changed my life, I’d like to help someone else do the same.”

Summing up her grandmother’s dilemma, Amanda declares:

My grandmother, she’s on so many medications. I mean, I really think it dulls her and it inhibits her ability to function and maintain her health, depending on which medication she’s on. I mean she’s on antidepressants and appetite-enhancing medicine, and all these things that interact and it just can’t be good for her overall health.

Amanda here crystallizes the sentiments of many of my respondents. In her mind, one of the very cornerstones of modern medicine—pharmaceutically-produced medicine—has become a stumbling block which inhibit the health of the patients they were intended to heal. Whether Amanda can empirically substantiate this claim, it is nonetheless real in the consequences it has for her health-related decision-making.

While I have thus far successfully avoided addressing the efficacy of biomedicine versus the efficacy of alternative medicine, it is necessary to briefly take up this peripheral topic here. Amanda’s claim here is that the pharmaceuticals which are so heavily relied upon in biomedicine actually worsen her grandmother’s health. Many of my other respondents made similar claims. While these claims are not completely without basis—clearly, many drugs do suppress symptoms without addressing causes of those symptoms-- but certainly, the larger truth about drugs and the biomedical establishment in the 20^th century is that it is precisely the effectiveness of these chemicals in rooting out disease, eliminating undesirable symptoms which has led to their prevalence. An implied part of the critique leveled by my respondents, however, is that these synthetically-produced products are all too effective, since they remove symptoms which might otherwise clue the sufferer in to some larger problem with their physical being. Like the leper who can feel no pain, and thus injures and re-injures herself unknowingly, those who rely too heavily on biomedicine dull the body’s receptors, and thus divert some of the most critical information the health-seeking actor could possibly obtain.

Users of alternative medicine have consistently been shown to be better-educated, financially better-off, and disproportionately likely to be middle-aged or young adults than non-users (Drivdahl and Misner, 1998; Eisenberg, et al., 1993, 1998; Kelner and Wellman, 1997; MacLennan et al., 1996; McGuire, 1988; Schar et al., 1994; Sharma, 1992; Shekelle et al., 1995, Shekelle and Brook, 1991; Vincent and Furnham, 1997). The established data on social class and well being establishes for us that overall health indicators are tied to class, so that members of the upper-middle class are far more likely than their poorer counterparts to enjoy high marks on all indicators of good health. And lifecycle sociologists clearly point to the correlation between certain health-related events and age, so that middle-aged persons are most likely to suffer from exactly the sorts of ailments alternative medicine purports to be the most successful in dealing with—reduction of chronic pain, reduction of psychological stress, health maintenance, options for natural childbirth. The traditional medical regimen of American childhood relies heavily on events thought to be best managed by biomedical means—from circumcision for boys to immunizations to broken bones. And while the aforementioned health troubles of middle age may grow in old age, they are inevitably overtaken by more serious conditions, sooner or later, conditions usually thought to be under the purview of biomedicine.

What does all of this have to do with my respondents’ claim that biomedicine suppresses the body’s naturally good, health-maintaining and healing tendencies? First, how does the class status of my respondents relate to such claims? If, indeed, my respondents generally enjoy a higher level of well-being than their working class and underclass counterparts, it would make sense that they would generally assume good health and access to biomedicine’s “quick fixes” when they need them. We would also expect them to feel a greater degree of agency over this area of their heath than would their less privileged counterparts. Feeling comfort and control over this area of their health, they might, as a result, be more likely to focus their health-seeking behavior on those symptoms over which they feel that they have no control. Their disenfranchised counterparts, in the meanwhile, simultaneously experiencing greater likelihood of acute and life-threatening health problems and lacking basic resources to deal with these problems, would first, lack a sense of agency and second, focus their health-seeking behavior on getting this “primary” health care. My respondents, in contrast, were largely able to assume that if they fell prey to a problem which would necessitate biomedical intervention, they would have easy access to such care. As a result, they feel that biomedicine suppresses the body’s healing ability largely because in the arena where they focus their conscious health-seeking behavior, this truism is comparatively plausible.

Theoretically, Cockerham, et al. (1998) help to shed light on our understanding of this middle-aged, middle-class approach to health which results in increased demand for alternative health approaches among this group. Synthesizing Simmel’s, Weber’s, Bourdieu’s, and Giddens’ varying theories on lifestyles, Cockerham, et. al. discuss health lifestyles, conceiving of them as “collective patterns of health-related behavior based on choices from options available to people according to their life chances.” Further, Cockerham, et al. specify that health lifestyles are:

a postmodern phenomenon most clearly visible in the culturally and economically empowered middle classes. . . In fact, the very idea of what constitutes contemporary health lifestyles has been triggered by changes in middle-class ways of living—especially the emerging perception of the necessity to exercise personal control over one’s health. [T]here is little empirical evidence that health lifestyles are simply a deliberate product of independent “postmodern” individuals within postmodern settings. Lifestyles are grounded in life chances that include age, gender, race, as well as the options those chances provide.

To the extent that my respondents tended to focus on health issues which substantiated their ability to “exercise personal control over [their] health,” it appeared to them that mainstream medicine simply got in the way of self-control.

COMMONSENSE MEDICINE

According to my respondents, conventional medical practices minimize the control social actors possess over disease and illness. Complementary and alternative health practices, in contrast, are seen as augmentations of an already efficient and benevolent health-maintaining capacity naturally possessed by the human body. Alternative medicine was seen as a means by which my respondents could amplify the natural proclivities of their bodies. In a sense, the assorted methods which fell under the rubric of “alternative medicine”—acupuncture, meditation, midwifery, biofeedback—were seen as “natural” lubricants which helped the powerful machinery of the body to function more effectively. Feminist Mary and fundamentalist Paige implied this type of model above, though their comments were directed more at the inefficiencies of biomedicine than they were at the health-enhancing capabilities of alternative health practices. I turn now to the task of describing and analyzing specifically what my respondents had to say about alternative medicine itself, especially focusing on what they said about its capacity to enhance their bodies’ natural health-seeking systems.

Readers will recall Jodi, whose experiences with midwifery introduced the previous chapter. In her search for adequate prenatal health care, Jodi concluded that midwifery offered her the most attractive health care options. In Chapter Three, I focused on the ways in which this lifestyle choice was influenced by socially shared notions of authority, especially focusing on Jodi’s ideas about proper relationships between health care providers and health-seeking actors. But Jodi’s choice arose out of other cultural assumptions held by many of my respondents. Most notably for our present purposes, Jodi’s reasoning reflected certain assumptions about the nature of the body and the character of health care, and how the two should interact with one another. Recall some of Jodi’s less-than-flattering characterizations of modern biomedical practice:

Everyone I talked to said that I’d have less say-so if I used a doctor. . . . The midwife is there to facilitate your process, as opposed to going into the hospital and or being with a doctor where it’s their process. You’re just a part of their process. . . . A lot of doctors don’t come out and talk to you about their qualifications. They just assume that you know that they’re all-powerful and everything’s fine. . . . When I see doctors often, I feel that I’m doing what they’re telling me to do. [The biomedical approach was] exactly what I feared. Exactly what I feared.

From these and various other similar comments in the previous chapter, Jodi made her view of her relationship to health care providers clear. In many ways, they were to play a subordinate role, to act as professionals, consulting Jodi in her quest for good health. It is no surprise, then, that in the midst of describing her most deeply held beliefs—a distinct mix of naturalism, feminism and 21^st century American individualism-- Jodi turns her ire towards the oft-misdirected interventionist proclivities of modern medicine:

Because the spirituality that I practice is very feminine-based and mainstream medicine is very masculine to me. And I say that, in spite of the fact that my family doctor and OB-GYN are both women! What I mean, I guess, is that I think mainstream medicine very masculine in that it’s very invasive. For instance, rates for c-sections are so much higher if your primary caregiver is a conventional doctor than if the primary caregiver is a midwife. . . . It’s like the more you fight something, the harder it is. And giving birth is kind of the same way, you know. It’s like, you know, you can go with the pain, you can move with it, you can learn how to mitigate these things yourself without IV’s and drugs that send you into la-la land. There are things you can do on your own. Laying flat on a table and not working with gravity is kind of no-brainer to me. I mean, it doesn’t make any sense! Being in a squatting position, sitting in a Jacuzzi, using massage, having somebody support you, you know, things like that make sense. I don’t think you have to be an Einstein to see how that probably works well and, um, and so it’s just that same rationale. Instead of fighting it, you can go with it. Mainstream medicine sometimes seems to kind of fight it, as opposed to, you know. . . . Yeah, labor hurts. It’s supposed to hurt! But if you pay attention to how the hurt develops and how things develop, that gives you clues as to what’s going on, and what you need to be doing and what to expect next and what stage you’re in. They’re all signals; they’re all things that you can learn from. And doctors don’t seem to want you to learn from the signals.

In making her case for a more “commonsense”-oriented set of medical practices, Jodi serves as a paradigmatic transition between the previous point and my present line of reasoning. While describing the manner in which conventional medicine wages war against pain, Jodi also notes the ways in which alternative medicine, here represented by the principles of midwifery, takes pain as a symbolic learning tool to divine the principles by which health care should be directed.

At its core, however, Jodi’s viewpoint and that shared by many other respondents was not simply a pragmatic dictum about rational forms of health care. To be sure, this made up a large portion of my respondents’ sentiment on this issue. More importantly, though, Jodi’s description here reveals why my respondents deemed it so important that health care be congruent with the mechanisms of the body. Jodi contends that:

It’s like the more you fight something, the harder it is. And giving birth is kind of the same way, you know. It’s like, you know, you can go with the pain, you can move with it . . . [L]abor is supposed to hurt! But if you pay attention to how the hurt develops and how things develop, that gives you clues as to what’s going on, and what you need to be doing and what to expect next and what stage you’re in. They’re all signals; they’re all things that you can learn from. And doctors don’t seem to want you to learn from the signals.

This notion-- that alternative medicine amplifies the natural healing tendencies of the body builds directly on a distinct cosmology. Namely, it builds on a view of the natural world which conceives of the cosmos as essentially good and of suffering as a gift in that good cosmos, insofar as that pain serves as a reliable source of information about solutions to the suffering of the individual. This way of thinking about human beings and healthcare contrasts radically with the Enlightenment notions on which biomedicine is based—that nature is something to be tamed, and that science is a tool which can aid to domesticate nature’s worst effects. In this view, pain, far from being a signal to be learned from, is conceived of as an enemy to be conquered, an undesirable element which should and can be rooted out through scientific means. Many alternative health treatments conceive of pain differently. Instead of being an enemy to be conquered, it is thought of as a necessary sign to point health-seeking actors towards a larger strategy for reaching their goals.

We should also note the shift in the role of the patient in this logic. Jodi contends that women giving birth should: “go with the pain,” “move with [the pain],” “learn how to mitigate these things [themselves],”should acquiesce to the fact that “labor is supposed to hurt,” while simultaneously “pay[ing] attention to how the hurt develops” and decoding “clues as to what’s going on,” “what you need to be doing,” “what to expect next,” and “what stage you’re in.” In sum, women in labor (and, by logical extension, all health-seeking actors) should realize that sensations of pain and discomfort are “all signals, things that you can learn from.” In Jodi’s mind, this is precisely why midwifery is such a desirable option—it optimizes the social actor’s ability to tune into these “signals,” and thus take advantage of the body’s health-perpetuating abilities.

While this approach to health is not entirely new, nor did it appear ex nihilo in the late twentieth century, there are elements of it which clearly emerge from a distinctly contemporary American, middle class perspective. Even if Joni’s hypothetical woman in labor were not already engaged in bringing new life into the world, she would still be enormously busy were she to follow Joni’s advice, even if only in part. Besides accepting the unpleasant truism that labor is “supposed to hurt,” Joni’s theoretical patient has 4 tasks at hand—“going” or “moving” with her pain, minimizing her labor pains through her own power, focusing her mental energy on the history of her pain, and finally, decoding various pieces of medical data in order to monitor her progress along a chronological continuum, about which, of course, she is presumptively already cognizant. While my respondents may be convinced that alternative health methods empower them by optimizing, rather than suppressing, their bodies’ benevolent healing powers, it appears that alternative medicine also keeps them extraordinarily busy monitoring details which were previously attended to by biomedical professionals. Whether these methods optimize the body’s capacity physically is unclear. Whether they are “rational” in the classic sense of the term is even less clear. One thing is are clear, however, about these methods: their plausibility as problem-solving schemes for individuals arises directly out of a certain social ideology which downplays the tension between individual social goals and a set of sometimes-hostile natural laws which would work against the purposes of the individual.

On the surface, Kevin Everly’s story of ligament replacement surgery on his knee does not stand out as an obvious candidate to further a discussion of the place of alternative health methods in my respondent’s sense of control over their bodies. A thirty-something consultant on water-use issues in the developing nations of Latin America, Kevin severely injured his knee in his mid-twenties. The knee was rebuilt with a “donor ligament” from another section of Kevin’s leg. Clearly, Kevin did not spurn the solutions biomedicine offers for acute pain, nor its methods for massive reconstruction of major body parts. But Kevin found that the procedure which he had undergone left him feeling powerless, and further, that his knee began to control him:

But . . . my knee started acting as a filter for my psyche about my body physically moving through space, like I would approach a stairwell and my knee would say, “Is that okay for you?” And then my brain could say “yes” or “no,” but it was like, I was no longer in control of my body. It was a really bizarre feeling, like I would start to do something like I naturally would and, and there was this sort of “on/off” regulating switch that came from my knee as to whether or not that was okay for me to do or not.

For Kevin, as for many of my respondents, long-term, sustainable control over one’s own body was paramount. In light of the inhibitions brought on by his major surgery, the question for Kevin was how he could regain a sense of control of agency over his body. What could he do to better integrate his body into a unified whole? At this point, he began to explore alternative approaches for rehabilitating his knee:

So, I started doing acupuncture and meditation to sort of, I don’t know if it was sort of psychic medicine, or if it in some way was bringing my knee up to a level where it no longer was so concerned. . . It’s almost like I’m anthropomorphizing my knee, but that’s how it felt. It was like an alternate psyche in my head! But it was like, after the surgery, I no longer had control of my body. It had control of me. . . . What I know is that [after acupuncture and meditation], I was no longer thinking with two heads, two minds, or two voices in my brain. My knee [became] part of me and it’s no longer an independent unit that makes decisions.

While a skilled surgeon reconstructed Kevin’s knee, it could be no more clear that, in Kevin’s mind, the self-help tools offered by meditation and the energy-focused technique of acupuncture reassembled his psyche and his sense of agency, of control over his body. While Jodi emphasized alternative medicine’s ability to draw on commonsense principles with respect to the physical body, Kevin highlights the sense in which alternative medicine optimizes health-seeking agents’ mental capacities to heal their own bodies. It is no surprise that Kevin “anthropomorphiz[es]” his knee. In his view, the characteristics which made alternative medicine such an effective tool in harnessing the body’s healing capacities were its psychic or mental characteristics. Efforts to restore the knee to its proper place within the functioning of the body are thus not cast in a “rehabilitation” model, as conventional medicine would classically have it. Instead, the process is seen as one in which two independent, warring minds vie for control over the agent’s will.

And if this struggle for health is, indeed, a battle, then it seems that the reconstructive surgery is a pyrrhic victory at best. For while it restores the mechanical functioning of the knee, it simultaneously undercuts the ability of the social actor to maintain a sense of bodily control. Without the surgery, there would be no mechanical functioning of the knee, but with it, there is a new struggle to maintain a sense of control over one’s health-related identity. Furthering the military analogy, acupuncture and meditation serve as key resources in this struggle, enabling the beleaguered health-seeking actor to quell an upstart renegade faction arising from his own unit.

Recall Karol, the young woman described above who suffered from a rare form of muscular dystrophy which resulted in migraines, but was able to gain control of her symptoms through biofeedback. In many ways, her various experiences synthesize the physical and psychic aspects of alternative medicine described by Jodi and Kevin, respectively. And in the end, she most clearly articulates what many of my respondents meant when they said that alternative medicine optimized their bodies’ health-seeking capacities. For Karol, it was the ability to change the temperature of her hands that assured her that she could maintain a certain level of control over her physical being. Symbolically, it served to ensure her that, in fact, she would be able to master the chronic pain which had plagued for most of her teenage years. Karol raves about the different ways in which acquaintances have established control over different major organs. Here, she emphasizes control over cardiac and digestive functions:

There [are] people are so good at biofeedback that they can control their heartbeat. The pace of their heart--they can change it totally, just by concentrating enough and breathing in certain ways. And I feel that [using] biofeedback put me so much in touch with my body, so in touch with the pain, and being able to think about that pain until it’s no longer really even there. . . . So you feel like there’s too much acid in your stomach? Most people would just reach for Pepto[-Bismol], right? Well, biofeedback encourages you just to think about [the acid] not being there. Think about your stomach moving in a different way, a more calming way. The control that your mind can have over your body is unbelievable.

Karol then contrasts alternative medicine’s agency-enhancing practices with the inhibiting procedures of biomedicine:

I mean, back when I was a kid and they tried all these different mainstream medical approaches to control my migraines, it just got to the point where my mom said, “Look what these medicines are doing to my child! Look at it. Look at her. It’s not going anywhere, and it’s only making her more miserable!” And so, it came to the point of having to try to do something new. So really, it was only through biofeedback that I was able to harness my pain.

If Jodi contends that alternative medicine’s agency-enhancing practices derive primarily from a patient-centered, nature-friendly commonsensical set of physical practices and Kevin argues that alternative health practices empower principally through their ability to restore a psychic sense of control, then Karol seems to simultaneously draw on and synthesize these two thematic strands. It is through biofeedback’s psychological methods that physical normality is restored.

CONCLUSION

In the end, most of my respondents were thoroughly convinced that for many medical conditions, they should rely as heavily as possible on the body’s self-healing mechanisms. Conceiving of mainstream and alternative medicine as they did—as working against and for this self-healing capacity, respectively—they tended to trust alternative means more readily than they did mainstream medical means. As I have shown, this line of reasoning not only requires a certain cultural lens; it also depends largely on what Cockerham et al. refer to as “health lifestyles” brought about by relative affluence and a certain good fortune in avoiding serious disease. Again, the way that my respondents made such health-related decisions seems reasonable enough. But is it a set of decisions guided by reason itself? I have hinted here that such a perspective with respect to the authority of the body over disease, injury, and simple entropy, depends on a larger set of cultural factors. Specifically here, it draws from several of the most fundamental themes of organic individualism. Three strands in particular stand out. Most obviously, organic individualism’s emphasis on the centrality of the physical body in the process of self-expression plays a large role here. Whether my respondents were getting “in touch” with their bodies or attempting to master them, the connection between body and self-identity was palpable. Also, the insistence of organic individualism on the central role of nature in self-actualization exerts its influence here. According to many of my respondents, it was precisely in nature or through natural means that connection with the physical body was most often realized. And both the emphasis on the body and the connection with nature were seen through a therapeutic lens, with my respondents always bringing the larger connection back to the psychological development of the self. I will draw these themes out more clearly after developing the final area in which my respondents’ ideas about authority influenced their use of alternative medicine—religion.

CH. 5: RELIGION[14] AND ALTERNATIVE MEDICINE

Imagine, for a moment, coming across the following news headlines in the international section of your local newspaper:

-“Upsurge in Nepalese Youth Keeping Kosher”

-“The Rosary: All the Rage Among New Dehli’s Secular Elite”

-“Tibetan Professionals Flock to Evangelical Faith Healers”

Now, juxtapose the surprise and disbelief such missives might cause against the more pedestrian reaction you might have reading the following banners in another section of the same newspaper, this time covering the domestic scene:

-“Yoga and Yuppies: ‘Oohm’ Goes the Subdivision”

-“Meditation on Main Street: Now And Zen”

-“Shamanism in the Suburbs: The Soul’s Journey Through the Cul-de-Sac”

While I imagine that the former set of headlines might cause incredulity among most of my readers, the latter would scarcely raise and eyebrow. Why? Well, of course, there are the empirical facts. There has been no recent, sudden demand for Jewish food products in the Himalayas, no increased demand for Catholic jewelry in the Indian subcontinent, no clamoring for conservative Protestant faith healers in the Chinese-controlled home of the exiled Dalai Lama. In the meanwhile, yoga, meditation, and other Eastern-inspired spiritual practices have skyrocketed in popularity in the West in the last 30 years.

Empirical reality, for the moment, however, is a bit distracting. By placing these sets of headlines side-by-side, what I intend is to do is to provoke thought about why the former set of affairs appears implausible to the modern reader, while the latter seems almost inevitable result of the march of history, of progress in American culture. This is the tale often told by the most the most vocal advocates of pluralism and multiculturalism. Shifts from old, Eurocentric, institutionalized forms of religion to ostensibly new, exotic, non-institutionalized forms of spirituality are welcomed, largely for what they tell us about the growing religious and cultural tolerance within our culture. That these practices have been lifted from their Eastern cultural and religious contexts and incorporated—sometimes wholesale, sometimes in part— into mainstream Western culture, all too often, is viewed unproblematically. Through some unspecified means, it is assumed, these practices arose ex nihilo out of the spiritually and ideologically fertile soil of the 1960’s, and found their way into the American living room. But, as my journalistic illustration suggests, the intersection of esoteric Eastern spiritual practices and mainstream American life is no more inevitable than the counterfactual reverse examples—Indians saying the rosary en masse, Nepalese mountain villages experiencing a kosher renaissance, Tibetans flocking to Bible-toting Fundamentalists for the restoration of physical and psychological health.

A complete historical analysis of this Eastward turn in American spirituality is beyond the scope of this study. Others (Wuthnow, 1988, 1994, 1998; Albanese, 1991; Eller, 1993, Heelas, 1996; Roof, 1993) have provided sufficient analysis in this direction, documenting the myriad causes behind this shift— increased Asian immigration to the US following liberalized immigration policies in 1965, war-induced attention to Southeast Asia in the 1960’s and 1970’s, the fascination of numerous high-profile musicians with Eastern thought, growing American disaffection with mainstream institutionalized religion, globalization, the increased reach of the global media, and growing cultural diversity and pluralism, among others.

In this chapter, I wish to analyze but one small component of this larger trend. For, within this study of alternative health behaviors, traditional mystic Asian practices are only part of the story. Of the 20 alternative health practices used by my respondents, four (reiki, acupuncture, yoga, shamanism) could fairly be characterized as practices at least somewhat influenced by mystical Eastern spirituality. At least three more (imagery, energy healing/therapeutic touch, telepathic communication/healing) have some affinity with Eastern religious conceptions. The remainder have their origins in different regions, different histories. What I found, however, was that many of my respondents linked their alternative health practices to a larger sense of spirituality, regardless of the origin of these practices—secular or religious, Eastern or Western. To be sure, among the 20 therapies I have investigated, the 7 listed above dominate the discussion of religiosity among my interviewees. But discussions on the remaining 13 therapies were by no means devoid of religiosity or spirituality. Whatever the case, my focus in discussing religion and spirituality was always how these practices—unabashedly esoteric or apologetically mundane—were appropriated by persons who think of these practices as part of a set of larger health-seeking behaviors, how this health-seeking behavior “turned” spiritual or religious in tone, and what the contours of the attending worldview and spirituality which emerged out of this interaction might be for this small, but growing, group of Americans.

Before continuing, I should make the limits of this chapter clearer, offering a few provisos. First, following from what I have just said, the likelihood of respondents to connect their alternative health practices to some form of spirituality or religiosity depended to some degree upon the type of alternative medicine which they used. While those respondents who used the seven “spiritually charged” therapies listed above almost inevitably talked about the religious and spiritual side of these practices, those whose interactions with alternative medicine came primarily through the other thirteen modalities were not as likely as the first group to see a connection between their sense of religiosity and their health-seeking behavior. Still, as will become quickly evident, the thirteen “secular” practices—including practices from midwifery to chiropractic—were certainly not free from religious associations on the part of my respondents.

Second, I should note that the direction of causality between the spiritual orientation I describe here and the use of alternative health practices is all but clear. In many cases, an interesting mix of pantheism and individual pragmatism led my respondents to a conception of an “open” universe which could not be simply reduced to naturalistic, scientistic, cause-and-effect explanatory schemes. At the same time, certain forms of alternative medicine seemed to have their own independent effect on my respondents’ conception of religion and of their own sense of, as they tended to describe it, “spirituality.” For most of my respondents, both directions of causation were evident. Clearly, the two sets of interactions were interwoven in a variety of complex ways, and some degree of Weberian elective affinity clearly came into play. My goal here is not to untangle this complicated “chicken and egg” question. Rather, it is to provide a detailed description of the religious claims which seemed to accompany the use of alternative medicine either as preexisting cause, or as product which emerged out these health practices themselves, or most likely, as a mixture of both.

Third, one might reasonably ask why, in the midst of a study of health-seeking behavior, I allow myself to be diverted to a topic so peripheral as religion. Surely, some might say, this is simply a digression into the current state of the “opiate of the masses”—that people who suffer and fear for their health will, in desperation, dignify their suffering by seeing it through a supernaturalist prism. Back pain, not to mention terminal cancer, may be more bearable if the sufferer can link it to some larger, more universal sense of significance. But this study deals with more than the issue of theodicy. Indeed, many of my respondents did link their physical trials and triumphs to larger, more universal rationales. But their discussion of religion and spirituality as it related to their health and body did far more than that, as I will show in this chapter.

CAROLINE, KICK-BOXING, AND CATHOLICISM

We have already seen that my respondent, in part, chose alternative medicine because it allowed them significant authority and latitude in their health-care decisions. In certain contexts, they resented the intrusive, authoritative role which conventional doctors assumed in relation to their patients. It should come as no surprise, then, that these same respondents carry similar anti-institutional attitudes over into the religious realm. Typical was Caroline, yoga and acupuncture devotee, who abandoned her Catholic upbringing in favor of a more Eastern, less institutionalized, form of spirituality. A 40 year-old freelance artist in Virginia, Caroline came to yoga in what she describes in conversion-like terms:

When I first moved here, I joined a gym and decided that I was going to get in shape. And so, I joined this particular gym here and it was okay. I was doing kick-boxing, using the Stairmaster, and all these Nautilus machines, too. I was just really getting into it for a workout. Then, I was walking home one day and I was thinking, “This is great. This is great.” And then I thought, “No, this really sucks.” It was so aggressive and I realized then and there that was way too aggressive for me and that the results actually really weren’t able to give me what I wanted—not just the body, but I was looking for this great life, and I thought I could find it in all those machines. But I knew that I wanted to get in tune with myself, not just have this “hard body,” you know. The gym was so fast and so much about these physical results that I just, I left the membership and everything. . . just walked away. . . . I just realized in that one walk home there I wouldn’t do it anymore, so, I decided to try yoga. It seemed so much more natural—it didn’t involve repeatedly doing unnatural things to your body on these glitzy $2000 machines with MTV blasting in your face—it was just you, the floor, and the group of people you were doing the poses with. And it’s the same workout, through the breathing and all that. But it’s just that there isn’t this sense of competition. There’s more of an inner peace, and a sense of going inside yourself, instead of just making your gut as flat as possible and your hips as narrow as possible so that everyone will look at you. And while there is still physical engagement of the body, it’s so much more soothing and calming. And there’s so much more connection to the Earth. I mean, it’s something you could do in the middle of the Serengeti. You couldn’t do that with a Stairmaster.

A self-described “lapsed Catholic” in graduate school and in the early years of her professional career, Caroline latched on to yoga’s worldview, which she found more satisfying than her past experiences with Catholicism:

For me, my experience in Catholicism was that it’s all about this sense of humility. And there is this particular view, where they’re always right and you’re always supposed to defer to God, to Mary, to the Church, the Pope, the Archbishop, the Bishop, the priests, the nuns, the altar boys, whoever. You’re always supposed to be repentant. And there was always this feeling that it was “up there,” and I was “down here.” This thing was “up there” and I was here to worship that thing. And with yoga, it isn’t that way at all. It’s not a Buddha, it isn’t Yahweh, it isn’t any of that. It’s that “it” is here—right here (pats chest, heart). And that you’re a part of this bigger thing, and you’re an active participant in this bigger thing. And you’re not constantly trying to reach it. I think for me, it’s not trying to reach this higher being, it’s coming to the realization that you’re a part of that. And with that, I think, comes responsibility. But it’s a responsibility you welcome and bring on yourself. I think I’m a much better person now than I was when I was in organized religion.

Caroline’s brief narrative provides a prism through which we can view my respondents’ connections between use of alternative medicine and their sense of religiosity. Her case is instructive insofar as it shows us five different things about alternative medicine and religious, each of which I will address in turn.

SEEKING GOD, SEEKING HEALTH

It is first significant that Caroline connects her use of alternative medicine directly with religious belief at all. Though health-seeking behavior and religious behavior might at first seem to be unrelated matters to the uninitiated, Caroline, along with many of my other respondents, made a clear connection between her religiosity and her use of alternative medical means.

Perhaps the best way to start exploring the somewhat improbable marriage of health seeking behavior and religious behavior is not to first look directly at the behavior itself, but to bring attention to the small number of respondents who found no connection between alternative medicine and religion. At times in social life, the best way to divine the governing norms and cultural assumptions of a particular social group is to find deviants whose convictions and behaviors bring into clear relief central social assumptions by questioning them. (See Erikson, 1966; Becker, 1963).

Take, for instance, Christine Golden. A well-educated 34 year-old professional who regularly uses a variety of herbal remedies, she has also participated in yoga sessions several times. For Christine, the herbal remedies stuck, while yoga sessions fell by the wayside. Why? Says Golden:

[S]ome of the things [in yoga] I find a little hokey. In principle, I don’t have a problem with the moves that you’re doing or even with meditation, you know, like they’ve done exercises in classes that are very [focused on] deep-breathing and focusing your center of energy and things like that. But then they start these chants and that’s where they lose me. I’m like, “Why are we chanting? What does that have to do with centering our mind and stretching and strengthening certain parts of [our] bod[ies]?” I guess I’m much more direct. Maybe as a runner, you know, you go out, you hit the pavement, you just go, and there’s nothing mystical about it.

Asked to amplify specifically what she finds attractive and unattractive about yoga, Christine replies:

I like the exercise itself, and the stretching, and the muscle control and things like that. I like that aspect of it, but not the spiritual side of it, or whatever this other thing is you’re supposed to experience when you do yoga. . . I [just] generally tend to be a little bit skeptical of a lot of that New Age-type stuff. I’m too grounded in science and that’s probably why I haven’t let myself get into the “ooohm”[15] shit. . . . I mean, here we are as twenty-first century people, exercising, doing yoga because of what modern science and modern medicine tell us about how it helps our overall health. And why add some hocus-pocus mumbo-jumbo shit about getting in touch with our energy to that science?

Or, again, listen to Amber, 24 year-old office manager, describe her experiences with yoga:

My most recent experience with yoga, we were doing the different poses, and doing the breathing and things like that, and then the instructor turned to breathing. And first it was, “Now, when you breathe, encapsulate your body and think about the air going into every pore, to every organ, every body part”-- stuff like that. That, I can do. But then it was like, “Take another breath and bring in the person that’s standing next to you.” You know, increasingly, it got bigger and bigger and the next breath, it was something like, “encapsulate the whole room” and then it was, “encapsulate the whole city,” then, “the whole state,” and stuff like that. And then, we were on to encapsulating the world and the universe, and stuff like that, so I just ignored her, and started doing my own mental exercises. At a certain point, it just becomes a little like, “I don’t know if I can encapsulate that many damned people at once.” I mean, yoga is such a good tool for mental and physical fitness, but so many of these folks are just “out there.”

Chiropractic similarly frustrates her:

And I see the same thing with my chiropractor. She’s moved away from manipulating my spine to putting her hands over me and trying to conduct her energy into my body and stuff like that. And that’s a little difficult for me to be able to believe. . . . I’m going there to have my spine manipulated and aligned, and she’s putting her hands over me and sending her energy to me? It’s not exactly what I’m paying her to do. . . I mean, it’s not all that different from those Christian faith healers you see on TV.

Reflecting on her frustrations with both health practices, she says:

It just seems that for all the good things in yoga and chiropractic, so many of these people go so far beyond reason. I can’t understand that, you know. It’s a little quirky, to say the least. You know—“encapsulating the universe,” “transferring energy”—both of those involve some kind of supernatural element, even if it’s at a very low level. And my frustration is that I don’t go to the chiropractic or to yoga to get evangelized. And that’s exactly what these people are doing.

Ann, a macrobiotics enthusiast, reiterated a similar point as she talked briefly about the various macrobiotic communes in which she had previously lived in California:

Within the communities where I’ve lived, there are still a lot of people who are just “out there.” Really “out there,” man—you know, swinging crystals back and forth, sensing your energy, messing with your aura when you’re not looking. Well, I’m just like, “Argh! Stop! Leave my aura alone! My aura is my business, dammit. I don’t care if you can see it or not. Just keep it to yourself! I’m here for my body and my health, not for some tripped-out hippie to tell me that Casper the Friendly Ghost is hovering over my shoulder.” And the problem in a lot of macrobiotic groups is that if you don’t see Casper, too, you’re considered to be the one who’s “out there.”

Ann, Amber, and Christine’s shared frustrations with the spiritualization of yoga, chiropractic, and macrobiotics serve as a good point of departure precisely because, in their frustration, these three women help us to see more clearly that the marriage of certain health practices with certain religious precepts, though common among my respondents, is neither inevitable nor commonsensical. This is a trio of hard-nosed naturalists who see their respective alternative health practices through a similar, categorically unbending, scientific lens. They find the imposition of religious language on these procedures detrimental insofar as such an imposition lessens the legitimacy of what they would otherwise view as an enlightened, helpful set of practices. They sense, additionally, that their experiences of these practices are discredited or discounted by others because they contravene social conventional, eschewing supernatural views of causation and intervention. Most importantly, for the purposes this chapter, they have a keen sense that social forces are acting upon them to modify their behavior. In the words of Ann, they recognize that socially speaking, they are deemed to be “out there.”

In my small sample, these women certainly were in the minority. Most of my respondents welcomed, to one degree or another, the religious element of alternative medicine, and many, in fact, used alternative health practices precisely because they offered a view of the body, health, disease, and ultimately of social life which holistically incorporated body and soul, mind and spirit.

What is it, then, that causes this sense of social stigma for this small group of skeptics? Simply put, it is the necessary connection which Caroline and many others like her make between their use of alternative medicine and religiosity. Indeed, for Caroline, yoga is every bit as much a functional religion as was the Roman Catholicism of her childhood. Where Christine and Amber desire a simple, commonsensical workout when they go to “do yoga,” Caroline is, in a very real way, “doing church” when she is “doing yoga.” It is a “social fact” in the truest Durkheimian sense of the term. If they are to engage in these health-related habits, they must at some point come to terms with the ideology which their contemporaries impose on these practices.

Several other brief vignettes of will help to form a more complete picture of how my respondents so routinely tied alternative medicine and spirituality together. After talking about her use of midwifery, Jodi Williams speaks more directly about her religious credo:

I guess that I think that there is a greater power that we can all access. How we live our life and the level of consciousness with which we live life is what affects how much we’re connected to that greater power, and the more connected you are to that power, the more you know, the more you’re aware, and so, the greater the flow, you know-- you’re “in the wave.” You’re not swimming upstream, you’re going with it and things are just more apparent to you as a result. If you recognize a lesson is coming and you go with the lesson, you learn a lot easier. You can fight it and fight it and fight it until, instead of getting these little nudges, you get that (hits fist to palm), “Hello!” You know, kind of a wake-up call. And a lot of ideas behind alternative medicine mesh with that—that idea of going with the flow, whereas a lot of mainstream medicine usually has something to do with going against the flow, almost begging for that rude wake-up call.

Like Caroline, Jodi sees her worldview and her health-related behaviors as part of a seamless whole. To be sure, Jodi’s creed represents a somewhat benign spirituality. As articulated here, the credo is vaguely New Age, vaguely pantheistic, perhaps even vaguely Deistic, though it is a Deism even Ben Franklin might have trouble recognizing. And yet, for all its blandness, this body-spirit connection is a very real and necessary one for many of my respondents, real enough to cause more agnostic souls to recoil at its supposed dogmatism. Amber goes to the extreme of labeling such behavior as a sort of proselytism, and Ann comically reminds her more religiously-oriented macrobiotics devotees that, “My aura is my business, dammit!”

Amanda, so strongly impressed by her experiences with various alternative health practices that she has considered becoming a homeopath, also expressed the typical sort of sentiment which elicited such strong feelings of alienation from Christine, Ann, and Amber:

I definitely feel like I have a relationship with a Creator-- God, the Creator, the universe, whatever. I don’t have one word I use. I definitely feel like I have a personal relationship with God. . . . I feel like God is everywhere, and in all of us, and we’re all part of that and it’s all just one energy, and that God is love. And I know that the idea of there being one energy has something to do with my approach to healing, and my appreciation for energy work—massage therapy, healing touch, reflexology, and some of the other forms of healing I’m interested in.

For Amanda, as for Jodi and Caroline, alternative medicine and religiosity are deeply woven together. To divorce certain practices from their attendant spiritual base would be as unnatural for many of my respondents as it would be for a conventional MD to begin thinking of open-heart surgery or antibiotics outside the biomedical, scientific worldview in which they are so deeply embedded. It was this necessary and palpable connection of two which was so off-putting to the those respondents who preferred to view health and the body in a more scientific, mechanistic fashion. And, as I argue, it is this sense of “outsidership” (Becker, 1963) which Amber, Ann, and Christine feel that points to the conclusion that there is, indeed, a shared sense of spirituality among my respondents.

EAST OF EDEN? THE FALL OF INSTITUTIONALIZED RELIGION

And so, religion and spirituality, it turns out, are intimately linked in many of my respondents’ ideas about the body and about what it means to seek health. What, though, are the broad contours of this spirituality? As I hinted in my introductory remarks, identifiably Eastern conceptions of spirituality and religion predominated among my respondents when they began to talk about the connections between their health care choices and their larger religious and spiritual commitments. Before exploring this topic indepth, though, I want to provide a brief picture of the few respondents who took special exception with this Eastern mysticism, so that I can then provide a clearer picture of precisely what it is that these “deviants” are deviating from.

If Christine, Amber and Ann represent the scientifically skeptical agnostic deviant, then Paige and Leslie-- the fundamentalist military wife and Catholic traditionalist whom I introduced in the last chapter represent a different brand of deviant. Like Christine and Anna, they resent the spiritual overtones found in certain alternative health practices. They, too, sense that the default worldview of these practices stands at odds with their own beliefs. Unlike Christine and Anna, neither Paige nor Leslie dismiss the spiritual currents within alternative medicine out of hand as inherently irrational. Indeed, they deem the spiritual language used by some alternative health practices extremely powerful, and express precious little doubt about the reality of such “spirits” and about supernatural theories of causation, more generally. At the same time, they reckon the spiritual forces posited by massage therapy, chiropractic, and yoga to be at least misguided, if not outright dangerous. On the grounds of their respective religious convictions, they take caution in their encounters with alternative medicine.

Witness Paige’s response when I asked her whether the religious undertones she noted among certain chiropractics and massage therapists caused dissonance for her as an evangelical Christian:

Massage therapists sometimes get into sensing forces and powers and things and I get a little bit leery when they start to [talk] about almost being a conduit of spiritual forces. I don’t want to be part of that. The actual act of massage therapy is wonderful, but I’m leery because a lot of times people that are in the alternative world tend to be out on the very fringes. . . They’re not in the same religious faith that I am, by any stretch of the imagination. . . . It’s more a brotherhood of mankind of concept. . . . I always walk into those sessions kind of watching what’s around me because when you’re in a position, especially in massage—I don’t want to say a “victim” position, but you’re . . .receiving whatever it is that they have to give. . . . and you want to be in a receptive mode, so that the therapy works, but you’re always on guard. You can’t relax.

Key here on two of Paige’s claims. First, her contention that “people in the alternative world tend to be out on the very fringes,” and are “not in the same religious faith that I am, by any stretch of the imagination.” Though she takes odds with its central tenets, Paige clearly recognizes the important fact that there is a shared sense of community among people within alternative medicine. Additionally, she notes that their sense of community is organized around what she deems a marginal set of religious beliefs and practices. Second, note Paige’s claim that she enters massage sessions in a quasi-victim position. This assertion assumes that the spiritual forces named by massage therapists are simultaneously real and nefarious.

Later, Paige explains why, despite these reservations, she continues to use a variety of different types of alternative medicines:

I believe God made us. We’re fearfully and wonderfully made, it says in Psalms. And I feel if He built the body, He had a reason for the way He put it together and it makes sense to me to utilize practices that work with it, rather than working against it. I definitely like the alternative, less clinical approach to things, kind of letting nature take its course and working with it, rather than against it. . . I do think [God] wants us to respect what we’ve been given and, to try not to defy the laws of nature so much as to use them. You think flying defies the law of nature, but it doesn’t. You’re using air current—it lifts you in the air, you know. Flying uses what’s out there. . . . So, yeah. I think that the Bible and my faith are some of the main things that made me critical of conventional doctors, and led me to consider using alternative medicine.

Leslie Towson, a Washington, D.C. computer network specialist, saw a similar connection between her upbringing in the Catholic Church and her openness to alternative health practices. Says Towson:

As a Catholic, you believe in miracles, and you have to believe in the supernatural to really have true faith. The miracle of the virgin birth, for instance, I truly believe that. I guess if you can believe in that, you can believe in other things as well, whether it’s something that seems impossible, or something that’s not yet proven by medical science.

The line of reasoning followed by Leslie and Paige seems reasonable enough. To the degree that both conventional religion and certain forms of alternative medicine rely on a supernaturalist cosmology, one might reasonably expect some sort of elective affinity between the two. In the previous section, Amber clearly lumped the two varieties of faith together-- her chiropractor was comparable to a TV faith healer, and she complained that both her chiropractor and fellow yoga practitioners proselytize in ways little different from certain conservative religious organizations. And Paige draws on a long contrarian tradition within American Evangelicalism to resist dominant social institutions. Indeed, had historical and social circumstances been different, the techniques which make up modern alternative medicine may well have been wedded with conservative, institutionalized Western religion.

But, of course, they have not. Commonsense arguments to the contrary notwithstanding, neither Leslie nor Paige represent the typical response I received from my respondents. For most, the thought of institutionalized, traditional, dogmatic Western religion leading one to alternative health practices would be laughable. Indeed, where my respondents thought of alternative medicine in religious or spiritual terms, they were nearly unanimous in their insistence that alternative medicine sprung, not from a organizationally-based or institutionally-based form of religion, but rather, from a private sense of “spirituality” which was ideologically and ritualistically similar to myriad forms of Eastern spirituality.

Here, we are again aided by Caroline in trying to get a sense of how my respondents wedded alternative health practices not simply with any set of religious codes, but with a discernibly Asian-informed spirituality with regular ease:

Through her description of the contrast between Catholicism and yoga, we learn that she has abandoned the conventional Western notion of God as one who stands outside the universe and is “wholly other.” Instead, Caroline has adopted a vaguely pantheistic worldview, though it is scarcely the pantheism of, say, organized Hinduism. This hybrid of Eastern spirituality and Western individualism, too, was typical. For nearly all my respondents, this Eastern religiosity was not tied to any particular religious community. Other than members of her health-club-based yoga class, of whom could Caroline name none personally, Caroline has no community of “believers” with whom she regularly assembles. The world is, indeed, for Caroline and others “construct[ed] somehow out of the self” (Bellah, et. al. 235) Instructively, the sole respondent who self-identified as belonging to a religious community—in this case, a neo-pagan wicca sect—confessed that, over time, she had become a “solitary practitioner” of wiccan rituals and meditation. Humorously, she added: “I generally do it all by myself. It’s less messy that way. You don’t have to deal with actual human beings.” The irony of pining for unity with the universe, while simultaneously shunning human community was not lost on her. One suspected that my respondents were attracted to Eastern religious and health practices precisely because, in the West, they are generally stripped of their institutional forms of authority. The traditions from which these practices spring—Zen meditation and yoga among others—indeed, can be traced back to organized, institutionalized forms of Asian religion, namely Buddhism and Hinduism. To be sure, these religions take on institutionalized, routinized forms in many regions, most visibly in the regions of the world in which they originated. Tell an Indian villager that Hinduism is a non-institutionalized, non-dogmatic, non-hierarchical faith, and she would surely laugh. But say “Zen Buddhism” or “yoga” to an Americans who use the first as a form of personal meditation or the second as a form of meditation and/or exercise, and they will most likely picture a solitary practice of self-exploration and self-definition. Many, indeed, first learn the practice in the physical presence of others, and some even continue to carry out these practices in small groups. But it is the ability to carry out these Eastern practices free of institutional and social obligation which make it so attractive for so many of my respondents.

I found the bias towards Eastern spirituality so strongly entrenched among my respondents that the very idea of conventional Western monotheists (i.e., Evangelicals, Mainstream Protestants, Catholics, Conservative Jews) practicing certain forms of alternative medicine was difficult for them to imagine. When I asked 35 year-old sales manager Toni how she would characterize people who meditated, she responded:

I think people have to be pretty open-minded to get into it. People who have this narrow, Western, Christian idea of the body as purely physical, of course, they’re not going to be looking towards alternative medicine or alternative therapies because the basic premise behind many alternative therapies is more Eastern-- it’s an integration of the mind, body, and the spirit in order to heal the body.

Challenging a respondent who responded similarly, I posited that a religious conventionalist or social conservative might be able to find benefit in meditation:

CH: Do you think someone could be a socially conservative, and get into meditation, or meditate and remain socially conservative? Or could a conservative, or even just mainstream Catholic or Protestant or Jew get into meditation?

MKB: That’s interesting. I don’t know. I suppose it could happen, but I highly doubt it. In my own experience and people I know that those who meditate generally follow a certain Buddhist meditation and for somebody in a Western context to go outside of that to try to find spirituality in another, you have to be a little open about it in the first place. So I don’t know. I certainly don’t think so. I can’t see my Catholic parents meditating. Or my fundamentalist next-door neighbors.

Though the linkage between alternative medicine and Eastern spirituality may, at first blush, appear commonsensical—a telling Bergerian “of course” statement—the association between the two is not nearly as inevitable as one might at first think. Using meditation as an example, there are two obvious factors which call this “commonsensical” relationship into question. First, there is an obvious and easily accessible mystical tradition within each of the three dominant American religious faiths, any of which could easily have been appropriated by my respondents. This practice is especially pronounced in Catholicism, where the monastic tradition is deeply entrenched. Though one may argue that this meditative tradition within Catholicism was generally ghettoized to the elite religious leaders, many of my ex-Catholic respondents volunteered that their openness to meditation may have been connected to their exposure to meditation within Catholicism. When pressed, however, they refused to draw direct connections between their current meditative practices and their Catholic upbringing. Given that the vast majority of my respondents were raised in one of these three dominant faiths, it is striking that almost none could conceive of a connection between their meditative practices and conventional, “institutionalized,” “organized” religion. Significantly, though I elicited respondents who had experiences with any “alternative health practice,” not one Protestant, Catholic or Jew came forward to tell me about the traditionally Western, religious meditative practices they used. Anecdotally, I can confirm that hotbeds of alternative health practices—New Age retreat centers, health food stores—are permeated by advertisements and flyers, not on how to tap the Catholic monastic tradition, but on various Eastern forms of meditation. Thus, the lack of response from “conventional” meditators was no accident—in the current American cultural contexts, when one speaks of “meditation” as part of “alternative medicine,” people unanimously think of Eastern forms of meditation. The second complicating factor here was the near chameleon-like flexibility of my respondents to utilize different forms of meditation, depending on the mode of meditation which suited them best, or to speak more sociologically, depending on the mechanism which was best suited to help them in their process of redefinition and reorganization of the self. Most named at least 3 or 4 forms of meditation they utilized on a regular basis, and these modalities could range significantly, from New Age to Buddhist to Hindu to Neo-Pagan rituals. In terms of worldview, one might say that my respondents were willing to prostitute themselves to the practices and rituals of various and sundry perspectives, granted that they furthered the development of the self. And yet, in spite of this pragmatism, my respondents could scarcely imagine turning to a Western Judeo-Christian meditation practice to achieve similar ends. Not only that, but they also had difficulty envisioning adherents of these faiths utilizing any form of meditation for their own ends. For them, the practice of the Catholic monk and the Buddhist monk were, literally and figuratively, worlds apart.

This disconnect bespeaks a profound, socially-constructed connection between alternative medicine and Eastern spirituality. How this connection became so entrenched is a subject for another study, but one might reasonably infer from the strength of this association in the minds of my respondents that the larger vocabulary on which they are drawing is that of anti-institutionalism. To the degree that Eastern religious disciplines in the US are divorced from institutionalized religion, they become a tool for the self. Stripping them from the more traditional forms of authority and accountability within which they were originally situated, they become tools for psychological development. Indeed, Wuthnow has written:

Over the centuries, spiritual discipline has been understood to have implications for how people lived in ordinary life. Devotional practice was meant to influence ordinary behavior by serving, in John Calvin’s words, as “a tutelage for our weakness,” thus providing regularity to one’s activities and periodic moments in which to entreat God for strength and to examine oneself. It was also the occasion for deepening one’s understanding of the divine rules of conduct set forth in religious texts, and it was a means of drawing close to the power and protection of God. . . . The part that has been retained is less concerned with the awesome power of God and more interested in satisfying our need to feel good about ourselves (1998: 105-106)

This is a point I will pursue in more detail in the fourth and final section of this chapter, but suffice it to say for now that the Eastern orientation of the spirituality practiced by many of my respondents had less to do with deep convictions regarding the validity of the Eastern conceptions of religious truth than it did to do with the relatively organization-free manner in which these religious traditions are practiced in the West.

MOTHER NATURE’S SON?

If the form of religiosity embraced by many of my respondents was markedly Eastern, it was also decidedly enamored with the natural world. Not only this, but many of my respondents tended to romanticize, if not revere, nature—or more properly, “Nature.” While Nature itself was not directly worshipped, the material universe played a central, guiding, standard-setting role for my respondents as they navigated their respective spiritual journeys. Clearly, a nature fixation on its own would not necessarily qualify as a spiritual or religious belief, my respondents tended to equate natural forms of healing with certain notions of healing “energy.” Often, they pitted “natural” forms of healing against mainstream medicine’s more synthetic cures, and unsurprisingly, “Nature” generally emerged triumphant.

In this sense, Caroline’s remarks foreshadowed the comments of my other respondents, as well. On leaving the gym with its Stairmasters and weight machines, recall Caroline’s comments: she realized that she could not find fulfillment in “all those machines.” Contrasting the equipment-guided exercise with yoga, she comments that, rather than “repeatedly doing unnatural things to [her] body on these shiny $2000 machines with MTV blasting in [her] face,” she wanted to “get in tune with [her]self.” Yoga, for her, was “so much more natural” than her previous exercise regimen, involving only the body, the ground, and the community of fellow yoga devotees, with an attendant inner peace, and a “sense of going inside [her]self.”

Caroline’s draws clear distinctions between 2 types of exercise. In her mind, there is first, the set of activities she engaged in during the kick-boxing class, on the exercise equipment, on the weight machines. This, in her mind, represented a synthetic form of exercise, represented most clearly in the gym’s expensive, shiny equipment, but most practically fleshed out in the unnatural contortions which said machines forced the body to do. It was this form of physical activity which “suck[ed],” according to Caroline. It was, in her words, “way too aggressive.” On the other side was yoga. For Caroline, yoga represented a mechanism for exploration of the self while also engaging in some form of activity which was recognizably exercise-like to Western eyes. Importantly though, for Caroline, yoga involves the use of no synthetically-produced equipment—“only you, the floor, and other people” are required, and as she noted later in our interview, once one learns yoga’s poses and routines, only the first two remain compulsory. One could theoretically do yoga “in the middle of the Serengeti,” says Caroline, a purported benefit not offered by industrially-produced, electronically-powered exercise equipment.

The desert language—the language of a solitary, pristine, unpopulated landscape, dominated primarily geographical features strikingly different from modern urban and suburban life—is no accident, and it was repeated numerous times, in various forms, by my respondents, whether in waxing romantic about a desert, a mountain, a secluded seaside beach, or most simply, a park in the midst of an otherwise populated and developed urban or suburban area. This sort of language was especially common for those respondents who used alternative health practices such as meditation or visualization which required high degrees of mental concentration, usually best done without numerous external distractions. Many of my city and suburb-dwelling respondents sought out isolated places “out in nature” in which to practice these disciplines. Whatever the amount of modern technology necessary to access the site, which often included pricey weather-resistant clothing, global positioning systems, sport utility vehicles, and a sizable amount of time and leisure, my respondents still tended conceived of nature in an unproblematic fashion, espousing a naturalist credo which few members of modern, industrial society could reliably and consistently uphold.

In any case, it was in this context that Caroline situated her use of yoga. Yoga was good because, unlike her gym workouts, it was “natural.” “Natural” practices, unsullied by modern machinery, served as a guide and reminder of the spirituality and order inherent in the universe. Exercise machines and kick-boxing, in contrast, necessarily distracted one’s focus and energy, and ultimately caused Caroline to act “too aggressive[ly]” in an otherwise benign and peaceful universe. It is in this context that historical and cross-cultural comparisons may be helpful in recognizing how peculiar Caroline and her cohorts’ perspective is. Western social philosophy, following Hobbes, classically conceived of nature as wild, in need of taming. To be sure, the earth’s raw materials were valuable resources, but nature qua nature was wild, dangerous, something to be tamed, hewn back. Sociologically speaking, such a view is roughly what one would expect in culture in nearly antecedents to post-industrial culture. This attitude is, however, manifestly ironic. The leisure-inducing fruits of industrialism are now assumed. Nature needs no longer be tamed, but rather explored as an extended playground for those who have most directly benefited from the industrial taming of said natural resources. Caroline’s cultural forebears fought back the land to yield subsistence crops and hunted animals for sustenance, waged war with wild woods to establish passable means of transportation, and risked life and limb to establish modern means of communication (the first TransAtlantic telegraph cable, for instance, did not lay itself). For Caroline and my other respondents, all of these—food, transportation, and communication—can be taken for granted. Nature is now the place one goes for leisure activity. It is a peaceful and kind to human endeavors, occasional blizzards, hurricanes, tornadoes, and earthquakes notwithstanding. It is this ideological matrix which is pressed upon health-related behavior. To the degree that a practice or remedy could be symbolically identified as “natural,” it was seen by my respondents, all other things being equal, as superior to its technologically manufactured counterpart.

Caroline’s distinction between these two forms of health-seeking behavior—“natural” and “synthetic”—finds its complement in the sentiments of many other respondents. Where Caroline’s romanticized notion of the natural world emanated from yoga, a health-maintaining practice, most of the people I talked with focused on post facto, health-restoring, practices. Leslie Towson claimed that:

. . . we have been provided with a way to take care of our bodies and our health that doesn’t necessarily require outside interference, where you can go into yourself and find what you need to make yourself better. I think that medicine often causes imbalances in your system where, yeah, you’re taking this for some sort of short-term relief, but what are the side-effects? And are they worth it? We just need to find what God has given us—whether it be in our bodies, in herbs, in natural procedures like massage.

Towson here articulates conceptions of nature and medicine not so different from Caroline’s conceptions of “synthetic” exercise versus “natural” exercise. On one side stood “Nature,” often incarnated in the alternative health practice(s) utilized by the respondent-- pristine, undefiled, unproblematic. Nature, in sum, was a benign force yearning to be drawn upon by ailing creatures in need of help. On the other side stood “Science,” or perhaps “Industry,” incarnated in modern mainstream medical practice. Where “Nature” was pristine, “Science” was soiled. Where “Nature” was benevolent, “Science” could sometimes be malevolent. While my respondents recognized the value of biomedical intervention in certain circumstances, in other situations, they viewed it with suspicion, thinking of it as modern political states think of the use of nuclear force—as a method of last resort. To be sure, they recognized that this “last resort” was often necessary—for broken bones, heart surgeries, and the like. But where biomedicine could be avoided, many preferred to do so. Conceiving of nature and science in the way that they did, it was difficult for them to imagine otherwise.[16]

Recall, for instance, Ray’s description of his girlfriend’s use of cold medicine from Chapter Four:

In Ray’s mind, using pharmaceutical methods where more “natural” methods are available is clearly a concession to industry and science. In his narrative, and in many others like it, he paints his girlfriend’s purchase of cold medicine as a betrayal of nature, and as a surrender. Ultimately, nature is a kinder master than its synthetic counterparts. Nature harmonizes with, even submits to, the will of the individual where pharmaceuticals force the self to submission to an alien, outside force.

How, then, did this inclination towards “natural” means, already explored to some degree in Chapter Four, become spiritualized? It was one thing for my respondents to say that they preferred “natural” over synthetic forms of healing. It is quite another to imbue that preference with spiritual language. We have already glimpsed bits of this logic from Leslie, who insisted that “we have been provided with a way to take care of our bodies . . . where you can go into yourself and find what you need to make yourself better.” It behooves us, she claims, to “find what God has given us—whether it be in our bodies, in herbs, in natural procedures like massage.” In a sense, “natural” forms of healing are considered spiritual because they are considered to be nearest to the earth, nearest to that undefiled, unnamed energy which my respondents invoked so often.

We get another glimpse of how the process might occur from Laura Fulgham who, early in her descriptions of her problems with colitis, made clear that conventional medicine was absolutely necessary in her case:

I never doubted that I needed the interventions of modern medicine at the time when I got as sick as I did. And it would have been suicidal for me to reject that. I needed to be on [blood thinning-medicine], I needed to have my colon taken out, you know, like I needed all these things and I feel that the doctors they had in Oregon saved my life. [They] saved my physical body.

Still, when she shifts to talking about interactions with her shaman, it was clear in her mind that the various biomedical procedures she had endured and medicines she had taken were spiritually detrimental:

My shaman, I guess, addressed the state of my soul in the wake of all that my physical body had been through. One thing she said was that I had this cobweb all around me, kind of like a cocoon and, she said normally she never sees the same thing twice on different people, but she had seen this before. So she asked her spirit guide what that was about. And they told her that people who had to take a lot of medications and drugs often have that. Their spirits have been trapped by medicines, or by being caged up in hospitals.

So, however necessary biomedical approaches may be from time to time, they inhibit and entrap the soul. Laura presents no fully-blown rationale for this claim, but she seems to imply that the cures offered by mainstream medicine are somehow not congruent with the body. This stands in stark with the shaman, whose desert retreat center, herbs, oils, water, and crystals, converge at a foundational level with the sorts of cures craved by the soul.

Jodi Williams, too, articulates a set of spiritual principles which see biomedical procedures and practices as spiritually constraining, insofar as they ignore “the natural cycle of things:”

Mainstream medicine “intervene[s],” “invade[s],” and generally “messes around” with a “natural flow” which, in her mind, is synonymous with spiritual order. One, of course, could argue that in certain situations—Jodi’s gestational diabetes and hypertension not least among them, “messing around with . . . things” is the most prudent course of action. Though many medical procedures are indeed unnatural, so too we might say, is good health. Entropy is natural. Biomedicine fights entropy. While Jodi, along with my other respondents, would recognize this truism, it seems that they see a detrimental after-effect from the short-term solutions offered by mainstream medicine. While this conception of “natural” means as congruent with a higher spiritual order may seem commonsensical to my middle-aged, relatively healthy respondents, it is clear that such a conception could arise only out of such a group whose day-to-day health needs rarely require the interventionist approach in which mainstream medicine specializes.

When I talked with Amanda, whose first experience with alternative medicine came through massage therapy, she made a clear connection between the natural inclinations of alternative health practices and the notion of “energy” which was raised so often by my respondents:

I would say for a lot a lot of the practitioners that I talk to, many of these methods are meditative for them. I know my massage therapist, I think, gets just as much out of giving massages as I do getting one. Because she gets very focused and focuses on the energy exchange between her and the person she’s working with. And as a recipient of massage therapy, I’ve found it to be very meditative, too.

Asked if the “energy” she experiences relates to her sense of spirituality, Amanda says:

I would say that the two definitely relate for me. When I’m experiencing healing touch—can you imagine energy flying into me from above? That’s what I experience. Because I feel like it’s all the same energy. We’re all part of that one energy that is God. You know, that’s what we are and it’s pretty much like love or light or god is flowing into me.

Then, contrasting that experience with her infrequent visits with her conventional doctor:

I honestly don’t sense any energy at all with allopathic doctors—what I sense is just the absence of energy. It’s not a spiritual experience at all.

So, even when the approaches of mainstream medicine did not strike my respondents as wholly detrimental to one’s spiritual status, it still failed to live up to their definitions of proper “holistic” health care. When Amanda says that her sporadic trips to mainstream physicians are “not spiritual experience[s] at all,” she clearly stakes out a definition of health and health care which necessarily incorporates both natural and spiritual elements as part of an authentic healing experience.

RELIGION AS SELF-IMPOSED RESPONSIBILITY

Caroline’s conclusion, then—“I think for me, [religion/spirituality] is not trying to reach this higher being, it’s coming to the realization that you’re a part of that. And with that, I think, comes responsibility. But it’s a responsibility you welcome and bring on yourself. I think I’m a much better person now than I was when I was in organized religion”—comes as no surprise. She is, indeed, not alone in this assertion. Many other respondents echoed similar sentiments, regarding institutionally-defined religion as a sometimes noble, but inevitably bankrupt effort. As a result, the Eastern-influenced, nature-revering practices which they employed were seen, not as rituals or disciplines within a larger institutional, hierarchically ordered faith, but as technologies for further development for the self. This anti-institutionalism and fully developed individualism were flip sides of the same coin, so I will take each in turn, spending more time on the second point than on the first.

In describing his religious upbringing and how it related to his current use of meditation, Kevin Everly states: “I’m culturally Jewish out of respect and deference for my ancestors and my lineage. It’s a rich cultural story. . . . In terms of the religion, I like the ethics, but I don’t like the religion itself. For me personally, the code is about as wacky as most organized religions.” When I probe deeper, asking what Kevin finds problematic with conventional Judaism, he responds:

I don’t think there’s much room for spirituality. I don’t think there’s room for people. I find that it’s very preachy and that the way that people are supposed to attain salvation or find connection with God is really “top-down.” I mean, if you read the Talmud, the Torah, or the Bible, and you get into it, the morality and ethics are excellent. But I find that the ways that you have to achieve what is deemed acceptable worship within the synagogue are constrained by all kinds of human social pressures that you get from your fellow members of the synagogue itself, so it becomes mired in human politics. In order to demonstrate that you’re doing the right thing to God, what you’re really doing is demonstrating your faith to other people. And that’s just not what I’m interested in doing. I’m interested in, instead of like God’s relationship to man, I want to have man’s relationship to God. Everybody should have their own way to do it. I do it through meditation and just getting out into nature, but I don’t know that many synagogues leave much room for that kind of individual expression.

Laura sounds similar themes with respect to the traditional Mennonite faith in which she was raised: “I never lost an appreciation for the values expressed in traditional Mennonite theology—simple lifestyle, pacifism—how can you argue with that kind of thing? I developed some disdain for the fact that Mennonite churches don’t embody that any more.”

Laura and Kevin here echo an American cultural story which is at least a generation old by now. While upwards of 90% of Americans report believing in some higher supernatural power, only half that number attend religious services weekly (Gallup, 1999). Americans “believe” in spades, but do not necessarily tie religious belief to involvement in institutionalized religious organizations, which raises interesting issues with respect to authority. For if institutions which have traditionally issued religious authority are now considered bankrupt and corrupt, it will inevitably appear that the individual is best served by freeing herself of institutional obligations. Giving up institutional forms of authority, however, means that the self is forever thrown back upon its own resources, a problematic social conundrum at best.

It then became not only plausible, but inevitable, that my respondents would view the various practices of alternative medicine as a means for self-development and self-expression. My respondents, in other words, became expressive individualists. They viewed the spiritually-oriented functions of alternative medicine as a means by which to express the self. As Bellah, et. al. have noted:

the tendency in American nature pantheism is to construct the world somehow out of the self. . . . [It] lacks a notion of nature from which any clear social norms could be derived. If the mystical quest is pursued far enough, it may take on new forms of self-discipline, committed practice, and community. . . . But more usually the languages of Eastern spirituality and American naturalistic pantheism are employed by people not connected with any particular religious practice or community (1985: 235).

Thus, the disciplines of meditation or yoga, the spiritual shepherding of the shaman, rather than being viewed as practices within a larger institution and system of authority, are viewed as technologies for further development of the individual psyche. The worldviews, institutions, and systems which originated these practices are ignored, with only those portions of the method which comported with an individually-defined notion of spirituality remaining. Where disciplines such as yoga and meditation and systems of domination such as shamanism may have been institutionally-imposed disciplines which imposed goals and ideological dogma upon individuals in other historical and cultural contexts, in the contemporary American setting, they are viewed very differently.

Caroline’s new-found belief that she is “part of” a higher universal energy roughly equivalent with God, and her subsequent claim that “with that comes [a] responsibility . . . [which] you welcome and bring on yourself” makes clear that she values self-imposed obligation over institutionally-imposed responsibility. Traditionally, social obligations have generally been brought onto the individual by institutions, but Caroline here purports that obligations are best brought on the self by the self. To be fair, traditional systems of social order do not oppose institutional obligation and self-development. In fact, it was generally thought that the self was best and most fully developed within the constraints and the supervision of institutions. My respondents deferred from this traditional formulation. For them, institutionally-imposed obligation countered the purposes of the individual. So, though my respondents conceived of certain forms of alternative medicine as essentially spiritual undertakings, they regularly turned these very activities into tools for the moral, psychological, or even social advancement of the self, most often using them as mechanisms for simple, pragmatic decision-making, or alternatively, for psychological analysis of the self.

The clearest example of this came from Melissa, the aforementioned wicca practitioner. She came to me to talk about her use of meditation. As was the case with nearly all of my meditation-using respondents, she utilized several different forms of meditation. As she began to describe her use of meditation, she described it as a “cleansing” process. When I probed further to find out what she meant for a practice to be “cleansing,” she said:

There are a lot of different stimuli that we take in every day and there are so many things that our minds focus on all at once. There are many different things that distract us from being at peace or feeling complete. And there are lots of negative energies out there that are forcing themselves on us. And meditation is way to sort of regain yourself and expunge all the different energies that try to overtake you.

When I ask her what kinds of energies she might try to rid herself of, her talk turns much more mundane and much less spiritually charged:

Well, I have a bad temper, and meditation is a way for me to control my feelings and try to understand them—“Why do I get so angry or have such a short patience with other people?” And it helps me to sort of train myself to calm down and step back and realize that whatever anger or frustrations I get from other people, I shouldn’t attach that to myself. I should just release that and mediation is really good for that.

Even more insightful was Melissa’s description of her use of what she simply described as a “candle meditation:”

You light a candle and focus on that candle, and every hour that goes by, every minute that goes by, that candle is not the same. Just as you yourself are not the same because, for instance, oxygen has been burnt out or the wick is shorter, or something has happened to it that makes it different. And by focusing on that candle you realize that you yourself are different; people around you are different. Not good or bad, it’s just the way it is. And you can apply that in theory to your life on a broader scale.

Asked when she might use this form of meditation, or for what purposes, Melanie responds:

It can be used in trying to solve a problem like, “Do I want to go to this grad school or that grad school? Should I say ‘yes’ to this guy who asked me out? What will the benefits be? Or what will the effects of it be?” There are so many different ways in which you can use meditation. It’s a tool; it’s how you use it that makes it what it is. I use it in some of my classes too. You can use it to try to logically solve a problem, or you can use it to basically sharpen your own mental ability or capability or spiritual abilities. Meditation is whatever you want it to be or need it to be. [Emphases added]

Meditation, then—as other forms of alternative medicine—is seen by many of my respondents as empty vessels, not as disciplines loaded with traditional religious baggage. To be sure, they often regard them as “spiritual,” but not in the same way that conventional Protestants, Catholics and Jews might regard regular Bible meditation, saying the rosary, or keeping kosher, respectively. Rather than being institutionally-mandated behaviors intended for a specific religious end, they are vessels which can, and often do, take on spiritual qualities, but if it is more advantageous to use them secularly, then my respondents had little hesitation in doing so.

It is ironically in Laura’s discussion about how the traditional Mennonite faith of her childhood informed her present shaman-influenced notions of spirituality that we get the clearest picture of the degree to which Eastern spiritual practices are turned into tools for self-improvement:

I think the main similarity is the idea that you could draw on a higher power to be better, that you overcome human limitations and can actually tap that higher source when you need it. Much like Christians believe in the Holy Spirit coming into you and being “born again.” I mean, in a lot of channeling, energies are almost like God inside of you. The question is-- are you listening? I remember the first time that I visited my shaman, she gave me a homework assignment. It was to go and make a list of all the things in my life that caused me sadness or that didn’t serve me, and then to do a release ceremony by burning that list. . . . And so, the question became, “Are you honoring your soul?” And growing up, that would have been couched in terms like – “What is God’s will for your life?” Now, the question is, “Well, what do I want from myself?” It doesn’t sound spiritual at first, but now that I understand that it’s listening to what your soul wants to come forward in your life and your higher purpose, it’s much easier for me to think in terms of “My soul has a plan for my life,” rather than, “Will I submit to the will of God?” And after all the crap with my colitis, I just feel like I did not take care of myself, I didn’t listen to my soul. You know, I allowed myself to have an absolutely insane work schedule, from one crisis to another over the course of a year and a half with almost no break, all because I didn’t listen to my soul.

Laura’s juxtaposition of traditional conservative Protestantism, shamanism, and channeling is both a fascinating and informative. Though perhaps unwittingly, she turns one of the most popular Evangelical mantras of the last fifty years—“God loves you and has a wonderful plan for your life”—on its head. The soul, a thinly disguised representation of the self, has a plan for Laura’s life. Rather than authority issuing from without, it originates from within. Shamanism and channeling, again, serve as empty vessels. The first task the shaman asks Laura to undertake is to identify those things which do not serve the self. Laura talks also about “honoring [one’s] soul,” “what [she] wants from [herself]”—these, for her replace higher religious authority. Rather than serving as an authority figure over the individual, or forcing the individual to submit to authority, shamanism, in its American incarnation, enthrones the self, thinly veiled as the soul, to the position of authority over its own mental, social, and religious journey.

It should come as no surprise, then, that though many of my respondents thought of alternative medicine in spiritual terms, this was a religiosity which could be “put on” and “taken off” with relative ease. Indeed, if alternative health practices are technologies for the self, then where their secularized cousins were more helpful, even the most spiritually-oriented of my respondents could quickly strip them of their religious baggage. Kevin Everly, for instance, when asked whether he viewed meditation as a spiritual practice, wavered:

I’d say it depends. At times it does and at times it doesn’t. It depends on what I’m thinking about, where I am. It’s contextual. It’s not specific to a religion or an art or a way of thought, but . . . It certainly has a spiritual quality when I’m feeling spiritual. If I’m meditating just to relax or to clear my mind, I mean, you can, I can use meditation both as sort of nuts and bolts tools in a kind of rationalistic, reductivist way, or I can use it as sort of liberation theology as a way to try and become greater one with sort of you know, the greater power. Or, whatever it is that’s out there. The great spirit, the great energy, the great something. There are times when I feel that connection, especially if I’m looking for it.

This is precisely what we would expect from an institution-less, organization-less form of religiosity. Where traditional faiths’ sacraments and rituals are religiously charged by definition, and ideally draw congregants more fully into organizational structure and organizational involvement, the rituals associated with the spirituality my respondents seemed to embrace could easily be turned into a tool, not for more intense ties to the group, but for the advancement of the self.

This follows Bellah, et. al.’s (1985) well-known finding of the pervasive individualist religion—dubbed “Sheilaism”-- among their respondents. “Sheila”’s original description of her own private religion:

I believe in God. I’m not a religious fanatic. I can’t remember the last time I went to church. My faith has carried me a long way. It’s Sheilaism. Just my own little voice. . . . It’s just try to love yourself and be gentle with yourself. You know, I guess, take care of each other. I think He would want us to take care of each other (221).

While Bellah, et al. first conceived of “Sheilaism” as a general model of religious commitment in an individualist society, in this chapter I have fleshed out what one variant, or in religious terms, sect or denomination of “Sheilaism” looks like. Among users of alternative medicine, individualist religion takes on a particularly Eastern, naturalist, and anti-organizational flavor.

CONCLUSION

These findings shed further light on the larger questions at hand—those of organic individualism and rationality. Again, we see the powerful effect which organic individualism’s emphasis on nature has, this time on the religious and spiritual practices of my respondents. The road to self-discovery, the road to good health, and in this case, the road to God, all go through nature. Also, we see the aversion of organic individualism to organizational structure. The form of spirituality I describe was attractive, as I argue, precisely because it allowed my respondents to remain aloof from the traditional institutional and organizational obligations traditionally brought on by religion. The cultivation and development of the self is the only remaining dogma. Adherence to a conventional set of religious beliefs and practices is all but absent. My respondents’ puzzled responses to my suggestion that a religious conventionalist could benefit from certain alternative health practices revealed, that indeed, the religious conventions of organic individualism, though murky, are clearly defined enough to exclude any dogma-wielding form of faith. Of course, hand in hand with this individualist faith is a deep suspicion of authority, especially religious authority. And more than one respondent saw the connection between the body and nature as somehow being central to one’s self-actualization, central ultimately to one’s spiritual quest.

If religion and faith are about the ultimate ends towards which one strives, then the question of rationality comes back into play once again, for as I have contended all along, speaking of rationality makes no sense without speaking of the means and ends, the perceptions and definitions of costs and benefits which accompany it. So, the findings here further underpin my critique of rational choice’s underdeveloped sociological vision. For if competing worldviews set radically different ends towards which its adherents should strive, then all the other components which make up rationality will surely be influenced, too. The default worldview of my respondents set certain ends as desirable—a reverence for nature, a deep commitment to self-development, the self-imposed nature of religious obligation—which, when set against more traditional forms of religious faith, causes a sea change in understanding what constitutes rational (and non-rational) decision-making.

CH. 6: CONCLUSION

So, what are we to make of all these accounts, accounts which range from pedestrian to exotic? Jodi’s contrasting tales of subordination at the hands of doctors versus the egalitarianism she experienced under the supervision of a midwife may point us to some understanding of how alternative health devotees relate to authority figures. Kevin’s anthropomorphization of his gimpy knee may help us glimpse how many of those who use alternative medicine think of their bodies, and how they see alternative health practices as augmentations to natural self-healing processes. And Caroline’s conversion from kick-boxing and weightlifting to yoga may point us towards a larger understanding of how my respondents framed their use of alternative medicine in spiritual terms, forging an individualistic faith from Eastern mysticism and a reverence for nature. But in the end, what are we left with? What do these various vignettes tell us about the larger cultural underpinnings of alternative medicine in modern America? And what about those nagging questions of individualism and rationality? In short, where do my findings fit into the larger picture?

At the outset of this study, I set out the dual purposes of demystifying the ostensible underlying “rationality” of medical choice by providing evidence that the “rationale” by which my respondents turned to alternative health practices was a logic embedded in the eminently cultural context of organic individualism. As I conclude, I hope to bring these loose strands together, restating my case in three key areas. First, I will draw together the main empirical findings here, summarizing what we learn from my respondents with respect to two key areas: the state of contemporary authority relations and contemporary convictions with respect to science and nature. In this first section, I will also draw out how my findings in these two areas fit into the larger cultural context. In a second section, I will connect these smaller themes into the larger picture of American individualism, particularly drawing attention to what my findings tell us about organic individualism and expressive individualism. Finally, I will make clear how these findings undercut current rational-choice-reliant strands of sociological explanations of what draws people to alternative medicine. In the end, I hope to make clear that “health-seeking” is never done in a cultural vacuum, but that at every step along the way, those who seek health seek culturally-defined ends through culturally-defined means.

(IL)LEGITIMATE AUTHORITY?

Clearly, at every point, this study has dealt directly with issues of authority. In Chapter 3, my respondents first revealed how, in certain circumstances, they preferred to consult health care providers with markedly egalitarian styles of interaction. Then, we heard in Chapter 4 how they thought about the body’s authority over disease and entropy. And Chapter 5 showed how little sway traditional Western religious authority had over most of my respondents, leaving a vacuum in which the self was left free to appropriate religious practices towards its own ends. Here, I will try to make clear the larger implications which my findings have in two key areas: First, I will situate my respondents’ reluctance to defer to health professionals within the larger decline in professional authority. I will then situate their aversion to institutional commitment and involvement within the larger cultural decline in institutional authority.

Clearly, numerous elements of this study point to a decrease in the status of professions. Conventional doctors fared especially badly in my respondents’ eyes. Alternative practitioners, professional or not, fared relatively well solely because they were more willing than others to comply with a patient-centered, patient-directed rationale. This decrease in professional authority, of course, has been widely explored by others scholars in recent years. But this decline is limited. Nearly all of my respondents responded “Of course!” when I asked them whether they would consult a conventional MD if they broke bones, had circulatory problems, had cancer, or faced any of a number of “serious” health problems. None of my respondents advocated do-it-yourself open-heart-surgery, and none reported setting their children’s broken bones. Doctors still hold significant amounts of professional authority in certain socially-defined and symptomatically-bounded situations. But with the increased demand for skills biomedicine has customarily lacked, traditional doctors have lost certain amounts of prestige which their profession once commanded. My research indicates that this lost prestige is the result of at least five different factors. First, my respondents reflect what seems to be an expanded Western definition of what constitutes “good health.” At the same time, biomedicine has shown itself ineffective in dealing with certain elements of this expanded definition of health, advances in biomedical practice aside. The expanded lay definition of good health has, third, has expanded lay knowledge and health-seeking initiative, as well. The continued swing up in life expectancy and a growing leisure culture, too, led to greater focus on smaller, less life-threatening health problems. And these are not the types of health problems with which biomedicine is best equipped to deal. Biomedical professionals thus lose status.

Nor is this shift limited only to those who use alternative medicine. Such challenges to medical authority are clearly the case, even among conventionalists. Numerous readers, especially Baby Boomers who have become increasingly involved in their parents’ health affairs as they have aged, know this from personal experience, exasperated as they often become at their parents’ refusal to challenge medical authority even when failing to do so may make grave differences in long-term health. Both survey and anecdotal evidence clearly point to the fact that Baby Boomers and members of Generation X challenge medical authority in ways that members of the Depression Generation did (and does) not. These facts bespeak a larger generational difference and attendant cultural shift towards decreased deference to medical authority.

Of course, there is the irony that many of my respondents were consulting professionals of their own (or at least specialists of their own) when they turned to alternative health practices. Nurse-midwives, chiropractors, acupuncturists, are all semi-autonomous profession-like in many ways. Massage therapists, homeopaths, and naturopaths, are also specialists in knowledge, and must all undergo significant, specialized training to ply their respective practices. Health store employees, shamans, reiki practitioners, yoga and meditation instructors all represent a lower level of formalized training, but again, purport to have a body of knowledge, a set of skills, or a connection with the spiritual universe which the lay population does not. In short, each type of alternative health provider purports to be some type of trained specialist, if not an out-and-out professional. Given their anti-authoritarian attitudes towards MD’s, it was curious, then, that many of my respondents gladly interacted with these professional and quasi-professional health care providers. As I noted earlier, though, their interaction with alternative providers was predicated on the fact that these knowledge workers were less authoritarian in their interactions than were doctors. So, the trend here may not be so much towards an anti-professionalism per se, but another instance of the “triumph of the therapeutic,” this time in the realm of patient/provider interaction. The health seeking agents I talked with may not so much resist authority or professionalism as they resist non-therapeutic forms of interaction within the patient-provider context. Alternative health users, it seems, value health care providers insofar as they can provide care which takes patient input seriously, at least for certain socially-defined procedures. And in these bounded areas, authority inevitably devolves to the self, so that to some degree, we see the rise of what I have called “patient-directed” health care.

Where should this “patient-directed” health care be situated vis-à-vis the larger culture? To be sure, such a trend did not arise ex nihilo. Nor can we assume that ideas about “patient-directed health care” stand alone, without impact on larger cultural issues. Here, I suggest several ways in which we might situate these findings, and make several suggestions on the ways in which a “patient-directed” ethos might itself influence the larger culture. The first and most obvious connection between these findings and the larger cultural context is to understand them with reference to the larger “McDonaldization” of American society. “Do it yourself” has ironically become a twenty-first century American mantra. Entire industries are built upon the ideal of “do-it-yourself” home repair and remodeling. Increasingly, we do our own banking and investing, whether at an ATM, at the computer screen, on the cell phone, or on the Palm Pilot. For leisure, we occasionally pick our own produce—in contrast with our forbears who did so because it was compulsory for survival. For the sake of expediency, numerous grocery store chains have even begun offering “self check-out,” a process wherein customers scan their own groceries over electric “eyes,” ringing up their own totals, and closing the transaction with a swipe of their credit or debit card, consulting store staff only for problematic or unusual transactions. “Do-it-yourself wills” instantly set one’s mind at ease, not only ensuring that one’s affairs are in order in case of sudden death, but that the process was moved along without outside help. The fast-growing home-schooling movement relies in no small measure on a conviction that the most effective education and socialization of children occurs outside the presence of educational experts, within the confines of the post-industrial family, usually under the supervision of a mother untrained in the rudiments of childhood development. In teaching a popular culture class, I, the puzzled, elder outsider to youth culture at age 30, learned that one of the most appealing elements of “hip-hop” culture for my undergraduate students was precisely the fact that “anyone [could] do it.” Similar assumptions lie behind the emergence in the last decade of several series of do-it-yourself books—the most prominent of which utilize the eye-grabbing mantra, “X for Dummies,” or in another case, “The Complete Idiot’s Guide to X.” “X,” of course, may be anything, from trigonometry to Tantric sex to the lesser volcanoes of the Greater Antilles. Modern American culture, it seems, is obsessed with instant knowledge, instant expertise, of morphing the “complete idiot” into the apparent instant expert, the 60-second ersatz “renaissance man.” This, too, is a simple extension of the “do it yourself” mentality. We have a cultural fascination with the specialized knowledge of “the expert,” and yet, we are also deeply suspicious of the hierarchical authority relations which traditional expert/non-expert divisions bring. We want to think of experts as being “just like us,” or more accurately, of ourselves as being “just like” the expert.

Of course, this is a distinctly modern, capitalist version of “do-it-yourself.” Considered historically and cross-culturally, modern Americans’ sense that they are “do[ing] it [themselves],” gaining instant, complete, practical knowledge—is suspect. In comparison with hunter-gatherers, horticultural, agrarian societies, even early industrial societies—not to mention the horticultural/agrarian/industrial hodge-podge collections which make up modern “developing” nations in which most people on the planet live today-- we very rarely “do” anything without the aid of significant supporting technology and infrastructure. In modern day America, “do it yourself” projects are generally leisure-time activities for the relatively affluent. The behaviors described above—home remodeling, long-term investments, leisurely gathering of produce—hardly qualify as subsistence-level tasks.

Modern alternative medicine as glimpsed through my respondents is deeply reflective of this cultural impulse. In a sense, many of the ailments treated by modern alternative medicine, in relative terms, are “leisure” forms of health. My respondents were generally not depending on alternative medicine as a first line of defense against a killer disease (as hundreds of thousands each year view heart bypass surgery, for instance), or as a form of emergency medicine in an acute situation which required rapid response for effective treatment (as might be the case with biomedical means of treating traumatic bleeding, for instance). Though their health concerns—migraine headaches, back pain, psychological well-being, emotionally satisfying birthing processes—were serious, they were the sorts of health concerns that become treatable and socially recognizable as problematic only in modern, developed economies. To the degree that my respondents experience certain health-related practices in this way, it is reasonable to surmise that they saw them through a similar “do-it-yourself” lens. As a result, they treated these health practices as domains in which they could have significant sway—could, in a very real sense “do it themselves”—rather than areas in which they were novices, dependent on the knowledge and authority of an all-knowing professional.

INSTITUTIONAL INDIFFERENCE?

The ways in which my respondents challenged authority was complemented by their hesitancy to commit themselves to institutionally-sanctioned organizations. That Americans have become increasingly wary of organizational commitment is a sociological truism. It has been especially well-documented in the religious realm, where an alliance between belief in God and ambivalence toward involvement in institutionally-sanctioned religious organizations has seemingly become the default religious status of many Americans. With the rise in health maintenance organizations in the last 30 years, meanwhile, it is nearly impossible for Americans to receive health care outside the confines of certain organizational structures. Still, even here, where they were most necessarily tied to organizational structures, my respondents showed a certain resistance to organizational involvement which pushed them to seek health care outside conventional, institutionally-defined boundaries. This trend is intimately related to the decline in deference to professionals, for the same professional consultation and organizational involvement are often inexorably intertwined. To the extent that my respondents challenged professional authority, they inevitably curtailed institutional and organizational involvement.

This recoiling from institutional and organization commitment was most evident in the religious realm. Time and again, my respondents echoed a familiar chorus—“I consider myself a spiritual person, but not a religious person.” As I followed up, teasing out the meaning of this mantra, it was clear that for most of my respondents, “I’m spiritual, but not religious” was a reiteration, a new formulation of this resistance to involvement in conventional religious organizations. Most, in fact, used this very vocabulary, decrying the shortcomings of “institutionalized,” “organized” religion. If, in the template of the previous section, conventional clergy could be seen as religious “professionals,” then their respective churches, temples, and mosques, and the members of their congregations, could be seen as the symbolic representation of “religion.” On the other side stood the anonymity of the gym-based yoga class, the isolation of individual meditation, the energy flows and self-discovery experienced during the $2,000 week-long getaway in the high desert with the shaman. These scenarios, and scores like them, represented “spirituality.” While my respondents eschewed the former, they embraced the latter. Why?

Part of the answer must lie in the analysis I offered in Chapter 4. To the degree that certain forms of alternative health practices are undergirded by a quasi-spiritual cosmology enacted in ritual practice in a community setting, they become a set of religious set of practices, functionally speaking. As practiced by my respondents, these religious practices are notably unbounded by conventional organizations in the West. Respondents are drawn toward Eastern-influenced, nature-revering forms of spirituality precisely because they are so rarely tied to organizational involvement in contemporary American culture. Such religious commitments are puzzling, at least. Critics would allege that, in fact, they do not involve “commitments” at all, but rather, a narcissistic set of practices whose only end is self-realization. While such assessments may act more as social criticism than as social analysis, they do raise important sociological questions. Do these organization-resistant forms of spirituality provide any basis for social cohesion? For social change? Are they a radical departure from previously known forms of religion?

In most cases, the forms of religious ritual practiced by my respondents were solitary in nature. The few cases where they were not practiced alone were instructive in and of themselves. Laura, the shaman-consulting young professional, spoke of her experience at a week-long, $2,000 retreat in the high desert of the Southwest. Even for members of the upper-middle class, such a prohibitively expensive price tag necessarily limits the frequency of such experiences, making them ephemeral, fleeting. And they comport with the shift reported by Wuthnow (1998) from a “dwelling” to a “seeking” form of spirituality, in which momentary, episodic religious experiences take precedence over formally structured forms of religion. Wuthnow seems to be speaking directly to the workaholism and professional overcommitment which led Laura to seek her shamanic experience in the first place when he says:

In one sense, the present interest in supernatural phenomena is difficult to reconcile with people’s everyday lives. These lives focus on the here and now. People are interested in things that work and that can be understood. . . . . Everyday life is fairly routine, a busy whirlwind of obligations that leaves little open time—or space—for the supernatural. . . . The routineness of everyday life, however, is precisely why current understandings of the supernatural fit so well with it. One experience of the supernatural will do. Just one. People can look back to the one moment when . . .they experienced something so unexplainable that it had to be proof of a reality beyond the present world. . . . Almost by definition, these experiences stand out because they are dramatic or exceptional. Moreover, these experiences not only reinforce belief that the supernatural exists but also convince people that the supernatural cannot in any way be understood and, therefore, it need not take much of their time. The supernatural remains a mysterious force, not something that is revealed in an authoritative text or institution. (134, emphases added)

As well as this describes the experiences of some of my respondents, yet other respondents had experiences which were far more ritualized and less episodic. Still, they shared with Laura’s experience a pronounced resistance to institutionalization. Consider Caroline’s gym-based yoga class and Matthew’s involvement in a short-lived, student meditation group, which both discussed and practiced meditation. Though both were regular activities, even by Caroline and Matthew’s admission, both also involved weak social ties, and tended to emphasize the utility of the experience for the individuals involved. Obligations were few, and hierarchical authority relations all but absent.

As for increasing criticism of health-related organizations, or “institutionalized medicine,” as some of my respondents referred to them, the stance here is somewhat ironic. Clearly, my respondents knew full-well that only certain types of alternative health care could be found in mainstream, HMO-dominated, biomedical practice, and that the acceptance of these forms of alternative medicine by medical insurance plans generally made these options more affordable for them as patients. Still, it was common for my respondents to argue that one of the problems with biomedical practice was precisely the bureaucratized, rationalized, form that it took on. Such bureaucratization and rationalization were clearly the objects of one respondents’ frustration when she talked about her experiences with doctors: “I think that natural medicine just pays more attention to the ‘whole picture,’ and so I think that they end up giving a lot more to you personally. [Doctors] are supposed to be healers. The idea of a healer, to me, shouldn’t be writing prescriptions. It just doesn’t fit my idea of healing.” The mainstream/alternative division thus becomes a divide between different Weberian forms of authority. While alternative practitioners evince signs of charismatic authority, traditional biomedical providers are thought of as bureaucrats, much as Weber’s “modern judge,” whom he likened to a “vending machine into which the pleadings are inserted, together with the fee, and which then disgorges the judgment together with the reasons, mechanically derived from the Code." Where Weber’s judge mechanically dispenses rulings and arguments, the conventional doctor, it seems, dispenses prescriptions and recommends . Speaking more broadly of this phenomena, Weber said:

The calculability of decision-making, and with it, its appropriateness for capitalism . . . [is] the more fully realized the more bureaucracy "depersonalizes" itself, i.e., the more completely it succeeds in achieving the exclusion of love, hatred, and every purely personal, especially irrational and incalculable, feeling from the execution of official tasks. In the place of the old-type ruler who is moved by sympathy, favor, grace, and gratitude, modern culture requires for its sustaining external apparatus the emotionally detached, and hence rigorously "professional" expert. (Weber, 1958: 365)

It is precisely this depersonalization, this indifference to sentiment, which my respondents challenged. Insofar as health care providers associated this kind of detachment with professionalism, my respondents avoided such providers. And in their minds such sentiment was most highly concentrated in modern, allopathically-based health care organizations.

This reticence to associate too closely with modern medical organizations even led one respondent to seriously consider giving birth in her own home, based on a similarly-fashioned critique of the modern hospital as the embodiment of such impersonality:

I think it was important to [some of my friends] that [labor and childbirth] was something that took place in their home and that they were surrounded by people that cared for and loved them, their family, extended family, children, husbands, or partners, or whatever. In their minds, the hospital was a place of sickness, and a place of stress. You don’t ever think about going into the hospital for something good. And so why go there to have the most miraculous thing that’s ever going to happen to you and the best thing that’s ever going to happen? Why go there, you know? So, I think that’s part of it. I like being home, you know. I have my big fluffy bed, and my big fluffy pillows, and I have all the people that love me standing around supporting me. If I go to the hospital, they only let one person and I gotta pick who that is. And then, you know, there are liability issues, insurance issues, all those things in the hospital. So they’re very, very structured and, um, and you ended up being completely disempowered. If my age hadn’t made me such a high-risk pregnancy, I definitely would’ve done the birth at home.

To the degree that one can receive health care outside the confines of bureaucratized health care systems, one should do so, in the minds of my respondents.

Thus, in this case, a retreat from organizational commitment stemmed from a desire to avoid the depersonalized care which seemed to be intertwined with the bureaucratic forms of such organizations. My respondents, it seems, were not convinced that depersonalization led to good health care. On the contrary, many clamored for more personalized attention. When pressed to cite the beneficial forms of care provided by midwifery not afforded by mainstream medicine, one respondent immediately cited two instances of the therapeutically-oriented, personally tailored form of care in which alternative medicine specialized. Told that she would have to deliver her baby several weeks early, she reacted strongly:

I started crying and saying, “I’m not ready. I’m not ready, you know. I’m not ready to be a mother. I can’t. I don’t know what to do.” And I was frantic. And [the midwife] talked to me. She had been on bed rest with her child and she had told me a lot of personal experience about what she had gone through and how much easier it was for me than when she had had her child ten years earlier when they had to hospitalize her and wouldn’t let her be at home on bed rest and how things had gotten better. And she started telling me, you know, “You already . . .”-- this was a really comforting thing--“You already are a mother, you know. For months you’ve been eating right, you know, avoiding all the things you’re not supposed to do. For six weeks you haven’t moved off of your futon to protect this child. You’ve already been caring for a child. Just now you’re going to do it in a different way. And you’re moving into a new stage of motherhood.” It was very calming at the time and she was, you know, hugging me and stroking my hair. And when I left that day, the other midwives, various other midwives were around the office and Brenda came out and said, “She’s gonna go. She’s gonna go on Saturday.” You know, and they all came over and were hugging us and saying “congratulations” and “Wait for my shift.” You know, and it was really a different experience than a typical kind of in and out medical experience. It was like having my own personalized cheerleading squad.

And later, when she was in actual labor:

My midwife stayed with me through probably six hours of labor. An OB-GYN comes in the last 20 minutes when the baby is going to make its appearance, and then scrubs up. And [the midwife] was really there, massaging and talking me through it, and she was very, very personable. She asked the baby’s name and while I was in the pushing stage, she got the nurse to [come in], and they were cheering for the baby by name because we already knew it was a boy, and had decided to name him Kirby. So, they were saying, “Come on out, Kirby!” [It was] a very personal, hands-on approach.

In the end, alternative medical practices appeared to my respondents to involve less organizationally-mandated, bureaucratically-organized procedures, and so they were glad to use them.

Still, it was very rare for my respondents to explicitly decry the organizational structure of conventional medicine in the same was that they did religion. “I believe in God, but I don’t like organized religion” had no parallel mantra on the medical side. What my respondents decried instead were the forms of interaction which emanated from the structure of modern medicine. They saw forms of interaction in alternative medicine forms which more closely approximated the therapeutic types of exchanges they saw as healthy, as beneficial.

What does this mean in the larger social context? There seems to be a certain tension in the sociological literature about Americans’ relationships vis-à-vis institutional and organizational commitment. We are a society of “joiners,” but we have certain suspicions about well-developed, socially prominent institutions. Much of modern political rhetoric with respect to “small government” presupposes that large, socially dominant institutions are inherently inefficient. Less institutionally-developed, less formally-organized domains of behavior are often framed as more “genuine” forms of human relation. Does this skepticism indicate that certain central institutions such as religion and medicine are losing their social centrality? Are organizations traditionally affiliated with these institutions in danger?

It is well documented, well-known in cross-cultural survey data that Americans, as a society, are “joiners.” This can be largely attributed to our general reluctance as a nation to necessarily tie individual citizens to certain institutions. We have no “state church.” Citizens are not automatically enrolled in a state-sponsored health care plan. And so, we as Americans, join organizations voluntarily. Still, certain areas seem organizationally and institutionally resistant. Some of this resistance seems to be influenced by social location. Liberals tend to eschew involvement in religion, and tend to be quicker to point out the shortcomings in bureaucratically-organized forms of health care and commerce. Conservatives, on the other hand, seem to be the first to balk at federal and state intrusion on areas of behavior which they view to be the purview of the traditional industrial and post-industrial family. So conservatives lobby for a minimalist government, and disproportionately withdraw their children from public schools, choosing to “home school” instead. And, though it would seem from my interviews that alternative medicine draws disproportionately from more liberal sectors of American culture, the growing numbers of liberals and conservatives who, for instance, keep their children from getting standard childhood immunizations should serve notice that the flight from biomedical dominance is bipartisan.

THE BODY AND NATURE

In the midst of conducting interviews for this study, I found myself at one point discussing the responses I had gathered on midwifery with a group of women, most of whom had small children, and so had experienced childbirth—some, multiple times—in the recent past. The discussion very quickly turned to the use of drugs during childbirth, focusing especially on anesthetizing drugs, such as those commonly administered during childbirth by conventional doctors through epidurals. Several women argued strongly that childbirth, the most “amazing” and “miraculous” experience a woman could have, should be experienced without the interjection of artificial substances and procedures. In other words, they thought that labor should be a “natural” process. Advocates of this position often drew on stories told them by their mothers and other older female relatives about the heavy drugging they experienced in giving birth during the 1960’s, and early 70’s and how their mothers could scarcely remember the moments after birth. It was at this point that the other side balked, arguing that “forgetting” the pain and hard work of labor was precisely the point. “The more drugs, the better,” one woman said dryly. “The less I felt, the happier I was.” Another poked fun at the advocates of natural childbirth, pointedly asking them if they would also promote “natural,” Novocain-free, removal of wisdom teeth. “‘Natural’ isn’t always better,” she added. “Death is a pretty ‘natural’ thing, but most people tend to think that it ain’t that grand.” One woman from the first group jokingly responded, “Yeah, maybe that’s kind of true. When I was on this awful pain-altered planet in the middle of labor, I did think once or twice that maybe experiencing childbirth ‘in all its glory’ wasn’t all it was cracked up to be.” Importantly, though, she added, “In the end, I was glad I did it without drugs, though.”

This discussion was precisely the sort of dialogue I reconstructed time and again as I pored over interview manuscripts. Why were my respondents so keen on “natural” solutions to health problems? What prompted their deep suspicions of synthetically-produced, scientifically-oriented approaches to health? While I touched on these issues in chapters three and four, here I wish to propose a broader framework in which to frame my respondents’ understandings of nature, medicine and science.

It is important to note that my respondents thought of the body itself, first and foremost, as a “natural” phenomenon. It was not generally conceived of in medical terms, nor as a site for scientific experimentation. Though my respondents recognized that it could be profitably seen through this lens, most resisted seeing it primarily in these terms. This makes sense of the sentiment expressed by Amanda above, that health care providers should be seen first and foremost as “healers,” not as prescription writers. If the body can best be understood in reductivistic, scientific terms, then, of course, Amanda is wrong. Under such a scenario, a scientific expert is precisely who should be examining the body and recommending cures. But if the body is thought of primarily as “part of nature,” then medical cures can be conceived of as foreign invaders whose means of health promotion are not symmetrical with the natural cures which the body craves. This makes sense also of Ray’s characterization of his girlfriend’s use of cold medicine putting her in a “completely different state of mind,” causing her to have “no control over her mind anymore.” This, recall, stands in contrast with his own more nature-oriented approach in similar situations—his drinking of fresh, organically-produced fruit juices and herbal teas, and his use of steam. For Ray, as for Amanda, the body is the example of unadulterated nature par excellence. It can be polluted by synthetic, counterproductive cures, or, in contrast, enhanced and purified by natural health practices.

This idea—of the body as a sacred repository, to be opposed to the corrupting influence of synthetically-produced cures—is best contextualized vis-à-vis Polyanian theory. Polyani (1980) posits that capitalism has 2 vehicles by which it generates profit—the body and land (or, more generally, natural resources). The body and the land, in short, are instruments of industry. My respondents, it seems, are recognizing this truth relative to both body and land, and in part, are symbolically resisting capitalist domination when they resist mainstream medicine. The trust my respondents put in “natural” things was a way of refusing to make their bodies the site of capitalist exploitation. Rob may as well have said that his girlfriend was no longer in control, but rather pharmaceutical companies were. Amanda may as well have said that doctors should be healers, not slaves to industry.

As a result, for my respondents, “natural” things were good things. In the context of health care issues, natural remedies were good remedies. For more traditional medically-minded Americans, this logic is difficult to understand, especially where synthetic cures would offer my respondents quick relief from symptoms. But my respondents doggedly insisted that natural approaches to health care allowed the expression of the primordial “true self.” This focus on self-expression clues us into the possible larger significance of the nature fixation among my respondents. So, though midwife-using advocates of natural childbirth might occasionally cite studies which indicated better APGAR test results for babies delivered without anesthetic drugs, when I pushed them for the primary reason they resisted drugs, they always returned to the central idea of “experiencing childbirth.” They did not want mind-altering, body-numbing drugs to deprive them of the genuine, joyously sobering experience of giving birth. And again, respondents across many different modalities expressed distaste for use of pharmaceuticals, even for common over-the-counter remedies, avoiding them when they could, claiming that such medicines dealt only with symptoms. It was also common for them to express fear that overuse would cause their bodies to build up a tolerance for such drugs, inevitably leading them to be ineffective. But in the end, all such arguments led to the same, inexorable conclusion: my respondents wanted to feel that they were “in charge” or “in control” of themselves, of their bodies. And they felt that natural cures afforded them such control. Easy mitigation of pain or other troublesome symptoms did not outweigh the desire for the experience qua experience.

I will more fully and explicitly address expressive individualism in the next section. For now, I simply want to draw out the tacit understandings held by my respondents with respect to nature and science. While nature was seen as a vessel which was friendly to self-expression, they saw science and nature as expressive-resistant vessels. In chapter 4, I detailed these attitudes in detail. Here, I would like to suggest several possible explanations for said attitudes. I have already suggested that my respondents’ attitudes towards natural remedies arose largely out of a modern, suburban romanticized view of nature which sees it primarily as a place of recreation, of self-discovery. Why does such a view predominate among my respondents, though?

It is precisely the routinized, bureaucratized nature of life in post-industrial societies which leaves so many yearning for pure “natural” experiences. Nature, in this context, connotes something wild, something which cannot necessarily be controlled or predicted. Something could go awry in natural childbirth, but at least the individual would have experienced something, and have maintained a feeling of control. But this yearning for natural cures is still kept in the context of modern, scientific life, so that the midwife-using woman using natural childbirth almost always has a doctor on call as a back-up, much as “Outward Bound” students in a fix will always have top-notch emergency back-up crews awaiting them, should they encounter injury or illness during their quest for self-discovery in Nature.

There is a clear irony here, of course. Very few, if any, of my respondents were self-subsistent in any sense of the term. They did not live in rural communes, nor did they grow their own crops, find their own herbs, concoct their own curative potions from natural resources. Insofar as they relied on herbs and vitamins, they relied largely on profitable corporations. The shamans they visited were profit-making health specialists who coordinated conferences in the mountains or in the desert much as cruise directors plan sea-bound trips for vacationing masses. And some of the specialists they visited—acupuncturists, chiropractors, and midwives—were actually registered professionals themselves, often parts of the same bureaucratically-organized health-related organizations which my respondents so regularly decried. And few of my respondents recognized the duplicitous character of the “nature”/”science” division which they constructed. The synthetic cures they disparaged contained many of the same active ingredients as their corresponding favorite “natural” cures. The only respondent to escape this paradox in some measure was Ann, who had spent some time in self-sustaining macrobiotic communities. For many of my respondents, however, the dualism to which they so regularly resorted could not hold up when exposed to scrutiny.

My respondents’ claims concerning the self-healing, self-sustaining nature of the body also proved problematic when put under scrutiny. As I asserted in Chapter 3, this general truism of health care is given a distinctly individualistic spin among alternative health enthusiasts. Where biomedical models conceive of the body’s self-healing ability as a mechanical factor to be factored in when constructing remedies for illness, my respondents tended to see the same as a larger symbolic statement about the preeminence of the individual. But, of course, these self-healing capacities have their limits. Discs degenerate. Artery-constricting plaque builds. Cancers grow. But these were not generally the types of problems for which my respondents sought out alternative health practices. On the contrary, they tended to call on the self-healing abilities of the body in areas where biomedicine has met with such little success. Biomedicine has no cure, nor significant prevention, for the most frequent infection in all age groups in the US, the common cold. Far more significantly, it does not deal well with chronic pain. By definition, it does not take into account most religious or psychological issues, and it has often tended to minimize patients’ input in the name of expediency. All of this, of course, comes with good reason. None of these forms of disease or pain has causes which biomedicine can readily pinpoint. My respondents, however, were generally seeking forms of well-being which emphasized the health-perpetuating tendencies of the body.

And when they were not allowing their bodies to heal themselves, they redefined pain, illness, and healing in such a manner that symptoms previously unlikely to be labeled problematic could be reframed as likely candidates for alternative medicine’s solutions. Put directly, they constructed new health problems. So, for instance, with serious medical complications during childbirth all but unknown, it now becomes “problematic” for women to feel psychologically stifled and overmedicated while giving birth. Medically qualified, customer-responsive, emotionally-attentive midwives emerge as the “solution.” Many other instances seem to point to the construction of new definitions of ill health, as well. When I pressed Tanya, an evidently healthy 22 year-old recent college graduate who used reiki on herself as a daily form of “healing” to explain what malady she might need healing for, she responded:

I mean . . . healing is basically just maintaining your body and allowing your body to fix itself in whatever ways it needs to. Anybody and everybody can benefit from some type of healing on some level [even if] they’re not physically sick at the moment.

This extremely pliable conception of healing is ingenious insofar as it allows nearly any form of personal malaise—physical, mental, spiritual, or otherwise—to be construed as an instance in which “healing” is necessary. It recalls Laura Fulgham’s use of a shaman for spiritual and mental healing after her use of various and sundry medical specialists to treat her colitis. For Laura, too, physical healing from her colitis was not enough: “I feel that the doctors . . . saved my life. Saved my physical body.” But, she added: “My shaman, I guess, addressed the state of my soul in the wake of all that my physical body had been through.” So, for Laura as for Tanya, this conception of suffering and healing relies in no small measure on the ideas they share about the disease and healing themselves. Only an affluent, leisure-oriented society—a culture which has seen its life expectancy increase by 50% in a century, thanks in no small measure to steady progress in medical technology and public health—could construct disease and cure in such a manner. It would seem, in some ways, that my respondents have taken the mental attention which previous generations might have paid to communicable disease, the perils of giving birth, and childhood disease, and redirected that energy toward health concerns which traditionally would have been considered less than dire. To a degree, my respondents pursued medicine as leisure, as a hobby.

This is roughly, of course, what we would expect in post-industrial societies. With serious communicable disease all but unknown, and with major scientific advances against major forms of illness and death, we would expect that for healthy middle-aged, middle class people, there might be greater focus on other forms of disease and pain, specifically those forms which occupy the statistical majority of our attention during our life span. To the degree that the majority of affluent moderns are able to live larger portions of their adult lives free of serious health concerns, modern life emphasizes the import of psychological well-being, and Americans doggedly believe in the myth that progress and hard work will always yield positive results, alternative medicine becomes a viable option.

PUTTING NATURE IN CONTEXT

How are we to contextualize these views of nature? As this study has emphasized time and again, nature, on the face of it, is far from benevolent. If Darwin is to be believed, nature is, in fact, ruthless, dealing death and extinction to the weak. Only the development of what modern, industrialized societies refer to as “infrastructure”— widespread, easy transportation, widespread electricity, indoor plumbing, and other urbanizing factors have made “nature” seem so accessible and tame on some level. It is thus curious that my respondents should hold such a view of nature. And given the many advances of scientific medicine in the last century, it is equally curious that my respondents should have so regularly expressed animosity towards “synthetic” forms of healing.

But these trends are far from sociologically baffling. This attitude towards nature is part of a larger social phenomena which I have explored only in part here. It makes sense in light of a number of other trends prevalent in the modern, affluent West. Think, for instance, of the trend among members of the affluent upper-middle class to seek out “organic” foodstuffs. Or, again, of the growing concern among Westerners (especially Western Europeans) about genetically altered food sources. In the same vein, many have railed against refining processes in the food industry, so that “Sugar in the Raw” has become a well-recognized brand name in coffee shops across the US. The “nature is better” myth is clearly alive and well among a significant affluent minority who can afford to allow moral qualms influence their choice of nutritional sources.

Think, also of “Outward Bound”— program wherein young people are encouraged to “discover themselves” through minimalist week-long camping excursions—and “Semester at Sea”—which offers much the same promise for the more nautically-oriented. Or, if one’s search for self-discovery is more religiously oriented, then the various religious rural retreat centers which dot the countryside can fill the need. Among various assumptions which attend these types of programs is the clear understanding that the process of “self-discovery” comes more easily in rural climes, in nature. These programs also draw heavily on essential beliefs about the nature of cities and suburbs as centers of social ills and “nature” as places unaffected, or at least less affected, by human failings. These ideas may not be new—they are at least as old as cities themselves—but their modern manifestations put special emphasis on the self-discovery which can take place in nature. If cities are centers of vice, then nature is the repository of innocence, Jonestown and Montana-bound Unabomber aside. As I noted earlier, this myth is rooted in a larger historical story of Americans’ migration from the country to the city, from a farm-based lifestyle to an urban lifestyle. Rather than being surrounded daily by the challenges of nature—crop-growing in oft-inhospitable climates, foxes who steal family chickens and the like, we now primarily live in relatively urban and suburban climes. The greatest challenge posed by “nature” in such settings is that of keeping a “good lawn,” keeping termites out of the woodwork, keeping wasps from taking up residence under the awning of the front porch. Primarily, nature became a place to recreate, a place drive through or fly over. It is in this contemporary context that we must locate my respondents’ views on nature.

The roots of such ideas about nature date at least from the founding of the Republic. John Winthrop, in a sense, thought of the New World as a good place to start a Christian community, not only because he would be free to express his particular brand of Protestantism unmolested, but also because he considered the shores of the New World to be natural and unspoiled. Such sentiment became even more pronounced in the Utopian societies founded throughout the 19^th century, not least in Robert Owen, Scottish industrialist who envisioned taking the best Europe had to offer—civic, industrial, and intellectual leaders he dubbed the “boatload of knowledge”—to the new world. This set of luminaries, wedded with the right architecture and the unspoiled garden of southern Indiana, would give him a chance to create utopia, he thought. While his community at New Harmony and others like it failed—Owen’s lasted barely five years—the idea lived on, and was appropriated by different groups at various junctures in the nation’s history. The already-mentioned “Outward Bound” and “Semester at Sea” were preceded by several decades by the “Back to the Earth” movement of the early 70’s which urged hippies of the day to trade in their suburban upbringing for a more authentic existence on organic farms.

This fascination with nature can be starkly contrasted against an eroding sense of trust in science, or at least a diminished faith in its irrevocable march toward progress. The nineteenth century’s untainted faith that science would usher in a Golden Age was very quickly undercut by the massive destruction and pointlessness of World War I. It was soon followed by the Holocaust, then at Hiroshima and Nagasaki, where it was all too obvious to us that the findings of science could just as easily bomb us back into the stone ages as they could bring us into a new, golden millennium. The Unabomber was rightly condemned for his terrorist means, but his anti-technology ideology resonated with many. As the new century dawns, the now-ritualistic protests which attend meetings of the World Trade Organization, International Monetary Fund, and G8 draw on no small amount of anti-technology rhetoric. Even as most Americans rely to some degree on science-based medicine, many of my respondents used standards for use of health promotion and restoration which were much more concerned with the proximity of the method to Nature, which was seen as an inherently benevolent healing source.

So, alternative medicine has become plausible due to certain changes in ideas about how patients should interact with health care providers. Additionally, it has gained recognition because of its ability to effectively convince patients that its providers and products are less adversely affected than their mainstream counterparts by the bureaucratization and institutionalization inherent in modern life. Alternative health practices have also gained credibility insofar as they have been able to tap powerful cultural ideals about the preferability of their “natural” methods over and against the “synthetic” methods put forth by mainstream medicine. But what do these three explanations tell us about our two larger questions—whether modern American use of alternative medicine stems from some primordial rationality, or in contrast, whether it might, more accurately be described as an outgrowth of various strands of American individualism? This question is probably best answered by first assessing the effect of expressive and organic individualism on my respondents, and then assessing how rational choice theory fares in light of my evidence.

ORGANIC AND EXPRESSIVE INDIVIDUALISM: HOW DO THEY FARE?

Suspicion of authority. An emphasis on the role of nature and the physical body in self-realization. An undercurrent of concern for things therapeutic. An amorphous form of spiritual belief. All the elements of organic individualism have manifested themselves here. But to what, if any, larger truths about individualism does the evidence here point?

Organic individualism holds in common with expressive individualism the ultimate goal of “cultivat[ing] and express[ing] the self and explor[ing] its vast social and cosmic identities” (Bellah, et al., 1985: 35). In Bellah, et al.’s rendering, this stands in contrast with utilitarian individualism, which “takes as given certain basic human appetites and fears . . . and sees human life as an effort by individuals to maximize their self-interest relative to these given ends” (1985: 336). The passion for self-discovery which organic individualism and expressive individualism share was everywhere evident among the responses I received in my interviews. Not least among these examples were the responses I received from respondents who used midwifery. Their responses serve as a good case study for our understanding of the larger social implications of organic and expressive individualism.

Certainly, for an outsider, it might be difficult to understand why relatively affluent American women would choose to use midwives when they have access to some of the best doctors in the world. But this choice can be tied to several larger issues. First, it is important to remember, given the American health care system, that choosing a midwife is still perceived as deviation from the norm, the norm being an MD-supervised process. Using a midwife in America symbolizes “taking charge” of the pregnancy and birthing process in a way that using a conventional doctor does not. Indeed, in the process of writing this conclusion, I spoke with a British friend with a 2 week-old newborn who wondered at the fact that in the US, midwives are not the default attending health care professional during labor, as they are in Britain. Second, it is crucial to realize that my respondents defined the birthing experience as more than a physiological or anatomical process. Defining the birthing experience in this way allows therapeutic meanings to increasingly be attributed to the experience.

These two factors, held together, explain much about how doing labor with a midwife attending became such a self-identifying statement for many of my respondents. Ultimately, what we see here is the therapeutic triumphing again, but this time, in the birthing process. What is the birthing process about? For millennia, of course, it has been about getting the baby, long-sequestered in the uterus, out into fresh air to live life. What else is it about, though? For much of the 20^th century in the West, it has been about getting the medical procedure right—whatever the cost. All other considerations—comfort, patient control, proximity of socially supportive friends and family during the process—were secondary, if not tertiary. Giving birth was a surgical procedure. And if it was surgery, then it was reasonable and proper to keep the father and other loved ones in a “waiting room.” It was proper to have bright lights, to readily use a variety of drugs to ease the process and to diminish the woman’s pain. It was appropriate, too, to err on the side of safety, giving more C-sections than necessary, since this, after all, is the sort of thing that modern biomedicine does best.

A number of social trends, however, over the last 25-30 years have led to the entry of the “therapeutic” into the delivery room. First, there were Lamaze classes, classes instructing expectant mothers how to breathe during labor, and in case they forgot, teaching fathers (and later, the non-pregnant partner) how to gently remind the woman in labor how to breathe. At the same time, there was the introduction of the husband (now, more generally, partner) into the birthing room. In the modern day, it is not uncommon for expectant parents to submit a “birth plan” to the hospital or birthing center, specifying their preferences in a number of care-related areas. This is, of course, medically nonsensical. For few other procedures, even ones where the subject is conscious, are socially supportive friends and family members allowed in the room in which the medical procedure occurs. In even fewer cases, are patients allowed to submit a “plan” to suggest to attending health care givers how they might proceed.

Now, with an increase in the number of home-based births, the use of home video recorders to capture births “live” on tape, and ever-increasing levels of graphic detail being shared in birth announcements, it seems that giving full attention to the unique experiences of each parent in the labor process has become a prominent part of “giving birth” in the modern day. It is seemingly tantamount that people have an experience to share, and then share it. While medical issues are still important, they are no longer the main defining discourse for many. To be sure, all of my respondents, and nearly all women who use midwives want the “safety net” of doctors in case of any complications. But now, women are equally concerned with the cultivation of personal experience during the pregnancy. Why else the concern of having the “full experience” of childbirth, with being “in charge” of the process, of having health care personnel who pay close attention to their patients’ preferences?

The choice of a midwife in this context is seen as a way of asserting the self, of allowing more of the “personality” of the parents to be expressed, not to be suppressed by modern capitalist bureaucracy. It seems that as middle-class members of the post-industrial world, with a good general level of health assured, and a doctor on call, my respondents assume, in most cases, that the medical details of the labor process will take care of themselves, as it were. In this context, expressive elements of giving birth become more salient.

This attitude permeates many other forms of alternative medicine, as well. Very few of my respondents had any problem answering the question, “What does your use of [“X” form of alternative medicine] say about you as an individual?” In its American manifestation, many forms alternative medicine express something about the individual. Other than its central role in midwifery, this tendency was most pronounced in modalities such as meditation, shamanism, massage therapy, yoga, and among herbal remedies. And what it communicated about people arose, most often, directly out of what I have referred to as the organic form of expressive individualism. Among those respondents who used midwifery, each of the four key elements of organic individualism was clearly present. First, there was the clear preference for “natural” health procedures over more synthetic form of medicine. The less modern medicine interfered with the labor, the more “authentic” the birthing process would be. Second, there is the clear suspicion of authority figures, especially if those authority figures are not closely attuned to the wishes and desires of their patients. There is clearly a focus on the physical body and its centrality in self-identity and self-actualization. And the fourth element—the reliance on therapeutic models of interaction—is so clearly present that I wish to talk about it in some depth here.

We see here that Bellah et al.’s (1985) identification of the therapist as the ideal type for all social interaction is especially salient. In many ways, my respondents valued alternative practitioners insofar as they comported with the model set forth by the therapist, who Bellah, et al. identify as “specialist[s] in mobilizing resources for effective action,” adding that “the resources are largely internal to the individual and the measure of effectiveness is the elusive criterion of satisfaction” (44). Further, they specify that:

For all its emotional . . . closeness . . . the therapeutic relationship is peculiarly distanced, circumscribed, and asymmetrical. The client almost always talks about himself and the therapist never does. The client pays a fee for professional services rendered, making it an economic exchange: the client’s money for the therapist’s time. The relationship is tightly regulated by . . . procedural rules that fix its fees, delimit its fifty-minute hours, and schedule its meetings, while precluding sexual behavior or such conventions of friendship as shared meals. The therapist’s authority seems to derive from psychological knowledge and clinical skill, not from moral values. The therapist is there not to judge, but to help clients become able to make their own judgements. The therapist is, nonetheless, even in not judging, a model for the client. This asymmetry encourages people to see the therapeutic relationship as a means to their own ends, not an end of which they are a part of an enduring set of practices that unifies the ends. . . . Compared to the practies members of a traditional family, church, or town share over a lifetime, the theapeutic relationship leaves us with relatively little to do together except communicate, and much less time in which to do it. In this, the therapeutic relationship resembles many other relationships in our complex, functionally differentiated society, particularly in professional and managerial life.” (122-123)

How is this different from the traditional patient/client relationship in medicine? After all, the traditional medical relationship, too, is a curious mix of “closeness” and “distance,” and is also circumscribed and asymmetrical. How else, for instance, could one describe a gynecological exam (see Henslin and Biggs, 1995) or a colonoscopy, other than “intimate?” And clearly, the traditional doctor/patient transaction was one-way. The patient did not inquire about the doctor’s health, while it was the obligation of the doctor to know the patient’s symptoms intimately. But the traditional medical relationship involved a “closeness” which was physical, not emotional and spiritual. One did not emerge from an appointment with a sense that the MD “knew” you personally. Their credentials permitted them special access to, among other things, body parts normally viewed and handled only by a sexually intimate partner. But such access did not parlay itself into personal knowledge. The patient did not enter the biomedical social transaction for expressive purposes. The notion that individual realization came only through the expression of individual feeling and/or intuition may have held sway in certain realms, but not in the medical realm. But for some of my respondents, and especially for certain forms of alternative medicine, this has changed. What, after all, is the trip to the shaman if not an attempt at self-discovery through a therapy-like relationship? My respondents wanted the opportunity to have a close relationship with their midwives, making sure that the midwife would “know me” and that I [would] “know them.” Among my respondents who used homeopathy, the idea that a health care provider would ask questions, not only about their physical symptoms, but about more personal details of their lives, their psychological and spiritual well-being was especially prized.

In short, when the therapeutic relationship becomes a dominant model of social interaction, social actors begin to see relations with many care-providers through that lens. Professionals are no longer authority figures in the traditional sense of the term. As Mary the English professor told me, “I try to remind myself that [doctors] represent the biomedical view. Nothing more and nothing less.” One turns, in other words, to the professional to see if the professional can assist the self towards certain ends. Professional medical care givers, at least in certain circumstances, do not mandate the ends. When the midwife told Mary that an episiotomy would be necessary, Mary gave in, but only because of the previously existing trust relationship in which she had clearly established certain ends as desirable, and not others. Jodie’s “I wanted it to be my process” mantra with respect to her pregnancy was echoed by many of my respondents. Of course, this logic clearly had its limits, as even my most alternatively-oriented respondents admitted that certain health conditions absolutely required biomedical attention. But even in these cases, could it be that my respondents would apply therapeutically-inspired assumptions there, too? More generally, it seems that whatever the form of individualism—organic or expressive—there is strong evidence here that the therapeutic has indeed gained increasing influence over how laypersons relate to professionals.

It seems that the findings here also speak, in a smaller way, to the extensive ways in which consumer culture has influenced heretofore non-commercial areas of social life. In a sense, the choices that my respondents made with respect to health cared communicated something about them in the same way that consumer choices purportedly communicate important pieces of information about social actors in other arenas. This mentality is so pervasive that Americans scarcely notice it. The idea, for instance, that a minivan “says” something about someone very different from the message conveyed by the person who owns a ’69 Volkswagen van is deeply embedded in such a consumer ideology. So, too, of course, is the idea that a “Deadhead” is different from a gangsta rap devotee, or that extra baggy jeans communicate something different from smartly trimmed khakis. In a Marxist perspective, this is simply the propaganda of the capitalist system, a way to convince consumers that their very identities are wedded with the industries run by the bourgeoisie. Whether contemporary consumerism indicates that we are nothing more than lackeys of the capitalist system or not, this is the reality of modern American culture. Personality is wedded to nearly every capitalist choice we make.

It makes sense, then, that such a trend would make itself known in medical realm in the late 20^th/early 21^st century. As health practices are organized by health-maintenance organizations and for-profit hospitals emerge, what we are seeing is the diversification of health care services. As consumers come to view these diverse medical options as products in a market, they soon begin to see these products saying something about who they are. This is especially true if, as I have argued, these practices take on the form of “medicine as leisure.” In peace-time, modern, affluent America, it is no surprise that “health care” is redefined and expanded so that it can become another consumer choice which helps to identify the individual. Saying that one “uses a midwife,” “sees an acupuncturist,” “meditates,” or “does yoga,” in other words, becomes another one of so many consumer choices which identifies the individual.

RATIONALITY’S FATE?

As each of these central empirical findings comes to light, and we inject the central question of rational choice theory—“Is X rational?”—the limits of such an approach quickly become evident. For instance, given my respondents’ deep suspicions of professional authority and their significant trust in their own judgement, several RAT-style questions arise: Is it rational to trust medical professionals? Is it rational, on the other hand, for lay persons with no formal training in healthcare issues to have so much trust in themselves? Or, again, with respect to organizational and institutional commitments, one might reasonably ask whether withdrawing from organized religions and institutionalized mainstream medicine makes for a better life. One might try to discern the prudence of an unquestioning faith in the benevolence of nature. And so forth. The potential questions multiply many times over.

A mere sampling of such questions, though, is sufficient to point out what is problematic about this way of framing use of alternative medicine, or any form of human behavior, for that matter. Most obviously, this approach begs the question of definition. What is rationality in the first place? Though sociologically sophisticated models of rational choice theory recognize a rationality which is network-embedded, social, pragmatic, and centered on social interaction, such paradigms still fail to recognize that rationality itself is socially constructed, ultimately a product of the varying ways in which societies produce different definitions of desirable ends, the means to get to those ends, and the relative value of different costs and benefits. So, if we ask if an action is “rational” in the context of this study, we are asking whether its characteristics conform to certain peculiarly American, modern cultural notions of what constitutes intellectual good sense. This, of course, would be very different from, say, what constitutes “logic” in the modern Islamic or Hindu world, not to mention any of a thousand historical exemplars.

Notions of rationality, in short, are profoundly shaped by culture. Though they are also influenced by network ties, they cannot be reduced to the same. Nor can any cultural product. Culture is not simply the outcome of a series of network interactions, a process reducible to rationally explainable processes. Culture is a set of symbols with a life of its own, a reality sui generis. Such a conception of culture is essential to sociology. Otherwise, culture is simply a series of psyches interacting, and the whole is no greater than the sum of its parts, which no matter what variant of RAT, still ends up being more minimax-driven psychology than sociology.

At the most basic level, all facets of health and healing are eminently cultural constructions. Think of the many layers of meaning which go into any definition of health and healing. First, any definition of health must first address the question of what, in essence, a human being is. If they are viewed naturalistically as organized conglomerations of cells, mammals whose distinctive characteristic is the development of abstract thought and enduring complex symbol systems whose basic goal is self-preservation, then a strictly biomedical model of health emerges. If, on the other hand, one thinks of human beings as many of my respondents did, then a very different model of health and health care emerges. Many of my respondents seemed to suggest that human beings were something very different—a species of being who could be better characterized as having distinct physical, mental, and spiritual components. If health-seeking agents have this model in mind when they pursue medical help, they will surely address questions of “rationality” differently. And this is only the proverbial tip of the iceberg. What is a body? What constitutes “good health?” What are the socially appropriate means of maintaining good health? Of restoring health when illness and injury strike? What is the social role of healers? What level of control should laypersons exert over health-related decisions? Do laypersons have “options” when it comes to health care, or is one system of healing so dominant, so structurally entrenched, that it is inaccurate to speak of health care “options” at all? What is the relative importance of health vis-à-vis other concerns within the culture? Credible, socially recognized answers to each of these questions underlie any health-related decision-making processes a scholar might wish to analyze.

So, to say that actors, or even “interactional events” as Pescosolido would have it, are rational, arational, or irrational is to misunderstand the nature of “rationality” itself. Since rationality is a constructed process, no matter the intellectual quibbles on the nature of the actor, the ultimate decision-making unit, decision-making process whereby that unit operates, the place of social structure in such processes, if one still conceives of “rationality” as a primary mover in the path to whatever health-related decision, it is still problematic because rationality is not “a” thing. It is a socially constructed series of ideas about what constitutes a “benefit,” what a “costs” are, what ends are desirable, and what reasonable means social may use to reach those ends. No matter how diluted by networks, affect, etc., Pescosolido’s SOS theory still relies on rationality as an instinctive, primordial urge. Simply making an implicit juxtaposition of the decision-making processes of my respondents with the decision-making processes of the traditional biomedical patient belies a problem with this way of thinking about medical utilization. Clearly, there are many decisions which my respondents make with respect to health that the archetypal biomedical patient would not—decision to forego pain killers, to use evidently less efficient “natural” methods over synthetic methods, to use a care provider who may not have quite the technical capacity, but is more therapeutic in their approach, less authoritarian in their manner—that reveal a culturally-grounded difference in notions of rationality. If one conceives of nature as essentially benign, then a certain decision-making logic follows with respect to natural vs. synthetic means. If, alternatively, one conceives of nature as the engine behind disease, entropy, and degeneration, then “rationality” will follow a very different course of events. If the cultural symbols drawn upon to decide between MD’s and midwives are decidedly therapeutic, then the ability of the provider to empathize and defer to individual desires will seem more “rational.” Under other social conditions, concerns with the vagaries of individual agency in the patient/provider relationship will flag, and emphasis on technical proficiency will increase—and definitions of “rationality” and resulting preferences for different types of providers will vary accordingly.

So, what might we suggest about the form of rationality which my respondents utilized? Two points are salient. First, we should note the prominent role of leisure in modern society and the ways in which it has shaped lay knowledge of facts pertaining to medicine and health. Indeed, entire segments of the publishing world are dedicated to producing health and medical information for lay persons interested in “informing themselves” about their health. Often, these publications publish recent scientific findings in language easily understood by non-medical experts. In such publications, there is also a heavy emphasis on preventive health practices, and on the place of individuals in preserving their own health. If the prominence of these materials represents some larger change in thinking about health and medicine, we can say at least a few things about how such a set of socially-sanctioned ideas would affect the seeming “rationality” of individual social actors. If Americans are increasingly being encouraged to believe that “taking ownership” of their own health yields better overall health, then blindly heeding professional authority will appear increasingly irrational, and resisting such authority will seem more and more plausible.[17] Health providers, professionals or not, who are willing to comport to the wishes of the individual will be seen as good health care providers. Consulting health-care providers such as Jodi’s—the OB-GYN who, when questioned by a concerned pregnant woman, muttered that “it was much better when women were ignorant and just popped these babies out without any questions”—will be increasingly seen as highly irrational. After all, “ignorantly . . . popping” anything out, by such a logic, is a highly undesirable end. Individual agency and control is highly prized. To the degree that certain alternative providers model themselves after therapists, their mode of relating to patients is preferable. The point of psychological therapy, after all, is to defer to individual ends. The therapist may have specialized knowledge, but that specialized knowledge is directed towards helping the self reach the ends it determines to be most important. In many cases, rationality may help to point many of my respondents to therapeutically-oriented, non-hierarchical forms of health care.

Second, larger conceptions of the natural and spiritual world will necessarily influence notions of types of health care which appear rational. Caroline’s declaration in the gym that “This sucks!” revealed a clear statement about desirable means and ends. That is, the logic by which she decided to forego certain health practices (electronic health machines and Nautilus weight machines) and pursue others rested squarely on the conviction that pursuing fitness through “synthetic” means was bad, doing so through natural means was good. Additionally, her “This sucks!” moment revealed the importance of therapeutic-inspired ends of establishing greater spiritual awareness of the self, as well. For Laura Fulgham, the need to address issues of the soul was clearly influenced by a combination of therapeutic ideas, Eastern spirituality, and the leisure society in which she lives. Under different social conditions, Laura’s dogged pursuit of spiritual wholeness might well be deemed silly and unnecessary.

FINAL WORD?

When I first came to study alternative medicine, I thought of my inquiry primarily as a study of the sociology of pain, an examination the various material and non-material “entropy-fighting” tools with which societies equipped their members. For the longest time, I was determined to work the pithy phrase “the sociology of pain” into my title. But, as with most initial impressions in research, this early framing of the facts eventually fell by the wayside. I increasingly found, as brainstorming turned to formal proposal turned to interviews turned to coding turned to writing, that while a pain-focused understanding of alternative medicine had certain merits, it missed what was most central about the recent upsurge in the popularity of alternative medicine in the US. Though various forms of physical pain—back spasms, migraine headaches, digestive problems—have led increasing numbers of Americans to use alternative medicine, this was only the tip of the proverbial iceberg. There were those who turned to alternative health practices out of more psychological forms of “pain.” Disorder in their personal lives lead some to meditation. Frequent international travelers used melatonin to help mitigate the effects of jet lag. And as strained as these psychological metaphors for pain may be, the metaphors became even more strained when I turned to other cases. Those who turned to midwifery for a greater sense of agency and control over their pregnancies—where did the pain factor fit into their decision to use alternative medicine?

As I contemplated these issues, juxtaposing them with the prevailing, rational choice-oriented, models for understanding the use of alternative medicine, I realized that the two issues were not unrelated. If one argued that the rise in use of alternative medicine was ultimately about pain, then the logic of rational choice advocates would appear to be unassailable. Whatever sociological adornments one may put on a rational choice framework, in the end, various social options are ultimately reduced to forms of “pain,” which are then contrasted with various forms of “gain.” How else could purportedly rational social actors decide which course of action to take when contemplated with various health-related choices? To be sure, what constitutes “pain” versus what constitutes “gain” varies from society to society, from era to era. But in the end, if alternative medicine was ultimately about pain, I would have to concede the clearly wrong-headed rational choice conception of some base rationality as the engine of human social action, of social change.

This mounting momentum caused me to realize that, indeed, the increased use of alternative medicine in the US was not borne simply out of some social shift in the definition of pain, though that was part of the story. More important were the ways in which Americans who used alternative medicine intertwined their health practices with their with their sense of identity. These were not simple pragmatic choices patterned to maximize personal benefit and minimize personal cost. These, in the end, were choices which bespoke a larger sense of identity, of belonging, not only to a particular social order, but to a certain cosmic order, as well. These particularly modern, particularly American ideas about self-identity originated in the ways in which my respondents thought about authority relations. They extended to the arena of the self’s relation to the body, and found their ultimate manifestation in the realm of religion, where ideas about the body, the self and an idealized social order harmonized together in a way that no rationalistic understanding of health-seeking behavior would never foresee. Perhaps this is because health-related behavior is always human behavior, and thus social behavior. And explanations of social behavior, in the end, must always return to those spaces between rational individual minds, where shared conceptions of the self, the body, the social order, and the cosmic order find their origins.

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[1] “Alternative medicine,” also known as “complementary medicine” or “holistic healing,” is, of course, itself a socially constructed category, broadly consisting of all health practices not encompassed by Western orthodox biomedical practice. Such a construction makes sense only in a social context in which biomedicine is institutionally dominant, powerful enough to blur significant distinctions between diverse non-medical forms of health promotion by labeling them all “non-scientific.” The “alternative” label also fails to capture the preventive, health-maintenance emphasis within many of the practices which fall under this rubric. While my study addresses and acknowledges the problematic nature of the “alternative medicine” label, in the end, I accept the category as currently socially defined, leaving the important task of discourse analysis and linguistic deconstruction to others.

[2] Among the courses reported, 68% were elective courses specifically on alternative medicine, 31% were parts of required courses, and 1% were part of an elective.

[3] Although I allowed my respondents to self-define “alternative medicine,” their conceptions rarely deviated from the list of therapies most Americans must think of when they think of alternative medicine. Among the 80 respondents, use of 20 different alternative health practices were reported: chiropractic, massage therapy, imagery, reiki, herbal remedies/supplements, megavitamin therapy, energy healing/therapeutic touch, rolfing, homeopathy, naturopathy, acupuncture, folk remedies, yoga, midwifery, macrobiotics, biofeedback, shamanism, reflexology, telepathic communication/healing.

[5] “Minimax” is a term which originated with 19^th century British utilitarian philosophers, such as John Stuart Mill and Jeremy Bentham, both of whom advocated the idea that human beings crafted their behavior to minimize pain and maximize pleasure.

[6] All names are changed to protect respondents’ privacy.

[7] Infant mortality rates in developing nations run at approximately 6.6%. In the West, these rates hover closer to 1.1%.

[8] In general, I interviewed only patients who received actual health care services, not socially supportive spouses, friends, family, etc. In this case, the woman who had actually given birth insisted that all of the decisions during her pregnancy were made in full agreement and cooperation with her husband. If I were to understand her decision-making process, she insisted, I would have to conduct a full interview with her husband. At her urging, I did so.

[9] Paula had explained earlier in the interview that, as an accountant, she advocated “full disclosure.” As the interview proceeded, it became clear that Paula expected this, not just in accounting, but from all professionals from whom she received services.

[10] Pitocin is an extremely common labor-inducing drug.

[11] An episiotomy is a procedure used to widen the birth canal during labor. A surgeon does so by making an incision upward from the top of the vaginal towards the navel.

[12] It is, of course, important to note that Sandy does engage in some level of means-end behavior when she sees to it that her daughter will have the best surgeon available and when she follows through with this surgery. My focus here, however, does not include all health-seeking behaviors of my respondents. Rather, my focus is the nature and significance of their health-seeking behavior as it relates to their use of alternative medicine.

[13] In the words of one of my respondents, “I’m basically your typical 21^st century hippie. Granola, tree-hugger, Mother Nature’s Son, New Age, whatever you want to call it. . . . And from my experience, that’s pretty typical among people who really get into herbs, natural food, and all that other alternative health stuff.”

[14] The vast majority of my respondents self-identified as “spiritual,” but not “religious” people. Though the difference may at first appear trivial, for my respondents the two were quite distinct. Religion was an empirically observable set of public behaviors and attitudes, usually acted out within the context of an organized institution, while spirituality represented more private convictions which generally resisted institutionalization.

[15] In the West, “oohm” is the best-known yoga chant. So widespread and well-known is it that numerous enterprising enthusiasts have marketed their yoga courses using the term. In my research, I even came across a yoga course for pregnant women called “Oohm Baby.”

[16] One probe I regularly used was to ask my respondents whether, if they knew two practices to be equally effective, one “synthetic” and one “natural,” which, if either, they would prefer. Unanimously, given equal effectiveness, they preferred the natural. Several responded by asking me, “Why would anyone want to use a drug when they could solve the problem naturally?”

[17] An anecdotal story which emerged as I was finishing this chapter clarifies how unique this perspective is. Living in Kiev, Ukraine, my wife and I had invited some of her work colleagues to dinner. As we offered decaffeinated coffee after work, several of my wife’s male colleagues shot puzzled looks our way. What followed was a fascinating discussion which revealed how little these Ukrainian men knew about the substances—caffeine, sugar, fat, fiber—which made up the food and beverages which they had unthinkingly consumed for years. Though there are varying degrees of such nutritional health knowledge in the West, a basic knowledge—that caffeine gives a “buzz” and can be addictive, that fat clogs arteries—is assumed. The ignorance and ambivalence which these Ukrainian men displayed would be viewed as irresponsible in the US.