IMPROVISATION AND AUTHORITY IN ILLNESS MEANING

Using the example of psychosomatic diagnosis, I argue that the clinica l context has unique epistemological constraints that limit the certai nty of diagnosis and so make meaning indeterminate for sufferer and he aler. As a result, forms of clinical truth are borrowed from the thera peutic context to create and authorize meanings for ambiguous or ill-d efined conditions and inchoate suffering. Diagnostic interpretation is concerned with classification and legitimation through the production of authoritative truth. In contrast, therapeutic interpretation is fu ndamentally concerned with the pragmatic problem of ''how to continue' ' and hence, with the improvisation of meaning. These different ends g ive rise to tensions and contradictions in psychosomatic theory and pr actice. While authority is necessary to provide a structure on which v ariations of meaning can be improvised, authoritative meanings may als o restrict the possibilities for invention by clinician and patient. T he goal of patient and physician is to create enough certainty to dimi nish the threat of the inchoate while preserving enough ambiguity to a llow for fresh improvisation. Accounts of illness meaning must recogni ze the interdependence of normative rigidity and metaphoric invention.