Rhetoric and the social construction of sickness and healing

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