ABSTRACT
Armstrong has chartered the gradual emergency of the figure of the thinking, feeling patient within medical discourse - patient-centred medicine, or medical holism. Drawing on our current and past research in a range of medical settings - cleft-palate clinics and diabetic clinics, assessments for tonsillectomy in ENT clinics, forensic pathology, AZT treatment for HIV positive patients, oncology clinics and paediatric cardiology clinics, and therapeutic communities - we seek to sketch a general overview of holism by reference to, and comparison of, particular discursive practices. We note how the patient is constituted in such discourses, how a particular version of reality is elicited, marked and asserted. We show how far patient-centred medicine has penetrated, even, paradoxically, into forensic pathology, a specialism without patients. However, we also illustrate the unevenness of its penetration within specialisms, and indicate the particular kinds of conditions and patient-career stages where the patient is most likely to be constituted in terms of this new discourse. This constitution can involve two strategies of power: an “incitement to speak”, where patients’ “essential” character may remain enigmatic to practitioners; or an active remoulding of patients’ subjectivity, using material derived from that incitement. Finally, we note the assonance of the medical query “How do you feel?” with a wider cultural movement associating truth or authenticity with the revelation of inner experience, what Tom Wolfe called the “Let’s Talk about Me” movement.
