THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 11, Supplement 1, 2005, pp. S-67–S-75
© Mary Ann Liebert, Inc.
Diverse and Changing Perceptions of the Body:
Communicating Illness, Health, and Risk
in an Age of Medical Pluralism
RITA AGDAL, M.A.
ABSTRACT
There has been a marked increase in the use of complementary and alternative medicine (CAM) in the West
since the 1970s. However, biomedicine is still prevailing within public health services and health services covered
by private insurance. Different therapies, conventional and CAM, represent different perceptions of the
the body. Perceptions of the body are closely related to perceptions of illness, health, disease, and risk. The
cultural models of the body are related to social organization and the development of technologies. In a study
on spiritual healers and their clients in Norway, I found that clients adapted to a multitude of medical regimes
by processes of recognition through cognitive models, learning, and socialization. I describe five models that
are evident in communication between healers and clients; the model of the body as machine, plumbing system,
energetic, programmable, and as wireless network. People hold diverse perceptions of health, illness, body,
and risk, which influence attitudes and behavior. Changes in perceptions of body, health, and illness may be
one factor enforcing that CAM is increasingly becoming a first-line intervention. Health authorities meet this
challenge emphasizing the regulation of CAM to safeguard patients but could also choose to focus on what
clients define as their needs. The shift in cultural understandings of the body, and how people cope with this
diversity, ought to be an area for further investigation, as it may affect the choices citizens make and the legitimacy
of health authorities.
“The social body constrains the way the physical body is perceived. The physical
experience of the body, always modified by the social categories through which it is
known, sustains a particular view of society.”1
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INTRODUCTION
The use of complementary and alternative medicine
(CAM) is a widespread phenomenon. In a study where
different surveys on complementary and alternative medicine
in the United States is compared, it is estimated that
more than 1 in 3 U.S. adults have used CAM in the past
year.2 This number seems to have been stable from 1997 to
2002.2 Although it is difficult to calculate the development,
or the growth, as the definitions and methodology are not
consistent in different studies, the claim is that it is still increasing
in Europe. I have not been able to find studies stating
that the increase in Europe has stopped. One author
claims it is “the second biggest growth industry in Eu-
rope).”3
The diversity of therapies available is both related to a
revival of traditional treatments and new treatments spreading
globally aided by modern marketing. The revivals of traditional
treatments are in some societies also related to
poverty or lack of access to conventional medicine. This has,
for instance, been the case in Cuba, where government agencies
have encouraged the revival and research on traditional
herbal medicines. Use of CAM in the West is, however, generally
most widespread among those with higher annual inDepartment
of Social Anthropology, University of Bergen, Bergen, Norway.
comes. The popularity of alternative treatments among people
who may choose has been explained with reference to
the limitations of conventional medicine in what has been
called a “push factor,”4,5 and to qualities of CAM that makes
it popular, which may be seen as “pull factors.” The main
theme in this article is how the use of CAM is leading to
more diverse perceptions of the body. Perceptions of the
body are closely related to perceptions of illness, health, and
risk. This diversity of perceptions may, in turn, lead to
changes in preferences regarding treatment. It does also establish
patients as active participants who choose between
different treatments and therapies. The different perceptions
of the body that people hold affects what they think of as
relevant and meaningful in communication and what they
experience or consider as appropriate healing environments.
The human body is described and perceived differently
according to different medical perspectives.6 Medical perspectives
are linked to cultural webs of meaning and wider
cultural models of body and person. Cultural models are
complex and may be contradictory.7 I will present some cognitive
models which have been identified in communication
between clients and therapists and have a brief look at how
they are linked to a broader cultural model. My concern is
how cognitive models may work in communication as
clients meet different therapists, and neither the ontological
status of these models, nor the efficacy of the therapies.
Eventually, I will share some reflections on possible consequences
of the change toward diverse medical practices and
diversity of conceptual models for understanding body,
health, and healing.
In the cognitive models which will be presented, the body
is perceived as:
1. mechanical
2. plumbing system
3. energetic
4. computer
5. part of a wireless network
The conceptualizations related to different medical
regimes are bound to specific kinds of social organization
and culture. Different medical regimes represent different
discourses, which may be described as different frames of
understanding related to languages specific to each regime;
specific frames for reasoning and specific fields of practice.
There are no neutral or objective descriptions that simply
mirror the empirical body.6,8 The models presented here are
closely related to technologies and social organization of
Western culture. The biomedical perspective, still prevailing
within the education and health care systems, has been
criticized for providing too narrow a perspective, excluding
important facets of illness, disease, and healing.6,8 Other perspectives
offer different social constructions of the body,
and some of these discourses are compatible, while others
are not. The different descriptions may be more or less useful
and meaningful in specific situations, even though they
encompass contradictions.
Cultural perceptions of illness and disease
The existence of parallel ideas on the body, illness, and
health is not a new phenomenon. The increase in the use of
CAM in the West, and its growing legitimacy, has, however,
brought a broader multitude of medical expert voices
to people’s daily lives. There will always be a potential gap
between lived experience of illness and medical models classifying
diseases.9 This distinction must be acknowledged
when studying communication between patients and clinicians
to allow patients’ perspectives to be taken into account.
Although there has been an increase in the use of alternative
medicine in the West over the last few decades, there
have been few studies centred on how people cope with the
multitude of medical models they are confronted with. The
different medical models within this field represent diverse
perspectives on the body. During 1997 and 1999, I conducted
fieldwork among spiritual healers, excluding faith
healers (people who believe that the patient’s religious faith
is crucial to their ability to heal), and their clients in Norway,
which is described in the thesis submitted for the
cand.polit. degree.10 I focused on the construction of knowledge
and meaning in the interactions among healers and between
healers and clients within the frames of the welfare
state. I observed more than 100 treatments and conducted
semistructured in-depth interviews with some clients during
the course of their treatment and afterwards. By following
some of them in the course of a 2-year period, it was possible
to identify processes of transformation. The interviews
were audiotaped to allow further analysis of semantics. I
tried to avoid introducing new concepts related to health and
illness into the conversations, and the recordings made it
possible to check my input in retrospect. I was taken by surprise
by the clients’ ability to describe their conditions by
referring to a multitude of medical models, both conventional
as well as alternative. The majority of those who came
to see a spiritual healer had tried different kinds of alternative
treatment prior to this. I found that their descriptions of
the body referred to cognitive models identified by the social
anthropologists, Cecil Helman11,12 and Helle Johannessen,13
but also to other models.10 The empirical cases I
will refer to are samples from this fieldwork. These cases
are not presented as representative, but are presented to illustrate
processes of communication.
Metaphors, meaning, and cultural models
Language is not a neutral tool describing empirical realities
but is embedded with cultural meaning; it is a formative
principle which constitutes objects as much as it describes
them. The medical anthropologist Byron J. Good
puts it this way. “Learning the language of medicine consists
not of learning new words for the common-sense world,
AGDALS-68
but the reconstruction of a new world altogether.”6 Still, acknowledging
that words may correspond to definite physical
phenomena, language may be a considered representation
of cultural systems.7 Language is a conceptual system
built on metaphors,14 related to a larger cultural system,
rather than merely reflecting an empirical reality. According
to linguist George Lakoff and philosopher Mark Johnson,
metaphors are transferred from one area to another,
from a source to a target domain. “The essence of metaphor
is understanding and experiencing one kind of thing in terms
of another.”14 A classical example of how metaphorical
thought may shape everyday experience is argument perceived
as “war.” The use of “war” as metaphor will make
the opponents define each other and the situation accordingly;
they may strive to “attack” and “defend” arguments,
and even “shoot” or “wipe out” the other if they are “right
on target.”14 On the other hand, it is possible to perceive arguments
differently with other metaphors, like “dance,” implicitly
redefining the “opponents” as “partners.” In this way
“ . . . metaphors are pervasive in everyday life, not just in
language but in thought and action.”14 This does not imply
that empirical reality does not exist in itself. I neither suggest
that our concepts construct what we see as reality in
the sense that they overrule basic sensual experiences. But
concepts integral to our culture may serve as lenses, which
make us more aware of the things we expect to see than the
phenomena that are on the outskirts of the familiar or on the
fringe of our cultural system of meaning.
Sciences also rely on images and metaphors, and medical
theory refers both to literal objects and use metaphors.
To reason about relations between things, and to pursue abstract
or theoretical knowledge, we need metaphors.15 The
cognitive models which will be presented provide metaphors
and images that are “good to think with,” to paraphrase anthropologist
Claude Levi-Strauss. Metaphors and culturebound
conceptual systems, at the basis of cognitive models,
influence the way we perceive the body and thereby what
is considered specific knowledge and suitable interventions.
Cognitive models in alternative therapies
Living in diverse societies, people perceive the body in
multiple ways. As consumers use different kinds of medical
therapies, they do also meet therapists with different perspectives.
Even though users of alternative therapies don’t
know or understand the medical perspectives they meet
when they talk to alternative therapists, they may recognize
underlying cognitive models. As I observed interaction between
therapists and clients, and conducted interviews with
the clients afterwards, very few seemed concerned about the
therapists’ knowledge. I will argue that the apparent flow in
communication between healer and client is related to the
clients’ recognition of the underlying models, which they
know from other domains. The interaction with therapists
may lead to processes of learning and socialization into different
regimes of knowledge. The apparent silent acceptance
of the therapists’ models may lead to misunderstandings, but
the recognition of models, transferred from one domain to
another, sustains flow in interaction and communication.
Different cognitive models underlying communication
will be presented and illustrated with cases from my study.
The first four models presented—the “machine model,” the
“plumbing model,” the “energetic model,” and the “computer
model”—have been identified in earlier studies.12,13
The fifth model, where the body is seen as part of a “wireless
network,” is closely related to spiritual healing.10 Models
that serve as core models in one therapy may at the same
time be widely used in other therapies. There are a multitude
of models, but I will limit this presentation to five,
which represent coherent models and perceptions of the
body, illness, health, and risk.
1. The mechanical body
Conventional biomedicine is associated with a model of
the body as machine or a mechanical understanding concerned
with the physioanatomical body, which is well
known among the general public.10,16–18 This is not the only
model in modern biomedicine, but it serves as a core model.
The origin of biomedicine is often linked to the Cartesian
separation of the material body and the spirit. This meant
that the material body could be deconstructed and malfunctioning
parts seen independently healed or replaced. The image
of the body as mechanical had its final breakthrough
along with the industrial revolution. Following Lakoff and
Johnson,14,15 it can be argued that the acceptance of this
model is due to the familiarity of the machine model at that
time. The machine as cognitive model may have been transferred
from a source domain, the factory, to a new target
domain: medical treatment. The anthropologist Emily Martin16
takes the argument further and suggests that the body
is seen as a means of production. With reference to this
model, it is possible to talk about parts which are “worn
out,” which “break down” or “failures.” A person may be
“rusty” or need more “fuel.” In some cases, parts may be
replaced.
Martin performed a study interviewing more than 600
women16 as she focused on perceptions of body and health.
She found there was a gap between the descriptions of
processes in the female body offered by biomedical models
and the way women talked about their bodies and health
from the perspective of lived experience. She compared
these different modes of understanding and found that the
lived experiences provided meaning in their daily lives. The
gap between the perspectives within conventional medicine,
and the perspectives grounded in lived experience, led some
of the women into conflicts with representatives of the health
care system. Martin argues that the alternative perspectives
based on experience may represent resistance and challenge
and lead to questioning of biomedical discourses. She reCHANGING
PERCEPTIONS OF THE BODY S-69
gards the machine model as related to the Fordist model of
production. The Fordist model has had an important impact
on how people conceptualize the body. Martin also argues
that the idea of the body as a hierarchy of functions is related
to the hierarchical organization of society, where the
brain is perceived as the “director” of the bodily hierarchy.
The mechanical model has, however, met competition from
models central to CAM, which can be perceived as parallel
to recent technological development.
2. The plumbing model
The main characteristic of the “plumbing model” is the
focus on networks of circulation throughout the body, where
disease will occur if pipes are blocked.12 Helman describes
this model and finds that it is in use within biomedicine, although
not as a core model. This model is evident in a multitude
of therapies, but it is a core model of reflexology, the
most commonly used alternative therapy in Denmark.13,17
It has been pointed out that reflexology was developed at
the same time as the infrastructure was built to ensure a
steady flow of goods and information.13
The conversation between a healer and a client who
comes to see her for the first time may illustrate the use of
the “plumbing model”;
The healer: This is not just a headache.
The client: Isn’t it?
The healer: There is a blockage in your lower back.
The client: A blockage in my back? It is usually all
right.
The healer: I think it may be related to your headache.
The client: Tensions?
The healer: Sort of. A lot of energy is bound by that
blockage. It goes quite far back.
[The client falls silent.]
The healer refers to a “blockage in the lower back,” and it
could be a description of a blocked channel going through
the client’s lower back. Some might instantly get an image
of the spine as a channel, even though this is not mentioned.
The client is not familiar with the concept “blockage in the
back,” and says her back is “usually all right,” as if she
doubts the judgement. She asks about “tensions,” which may
refer to a mechanical model, and falls silent as the healer
refers to the “blockage” again. She does not seem to understand
the healer’s statement at this first visit, but in a conversation
we had a few weeks later, she mentions “a blockage”
as a possible reason for her headache. This seems to
be due to a process of acceptance and learning. As the client
is familiar with the “plumbing model,” as a cognitive model,
she may transfer it to a new domain: the body. The familiarity
of the model makes it is easier to accept the healer’s
opinion. Use of the plumbing model within CAM does not
necessarily imply a flow of a material substance, as in blood
vessels, but may, for instance, refer to a flow of energy or
information. The use of the plumbing model may, in some
therapies, be combined with a perception of the body as en-
ergetic.
3. The energetic body
In the “vitalistic” tradition, which was strong up until the
“machine model” had its breakthrough; health was dependent
on the “vital forces” a person or population possessed.
The energy, or the vital force, may be thought of as a principle
sustaining all that is alive, like the Indian “phrana” or
the Chinese “chi.” The physical body may be seen as surrounded
and permeated by energy. The body as machine
needs “energy” in the form of “fuel” to “burn,” but within
the energetic body, energy is more of an organizing principle.
To have a high or low “level of energy” may then be a
more profound matter. A spiritual healer explained that the
expression “out of shape” literally refers to the energy field
of somebody who is low in energy because the whole field
then gets an “unhealthy shape.”
Energy has been a central theme since the oil crises in
1973, and developing renewable sources for energy has been
seen as crucial to modern society. Since the 1970s the concern
about energy has become an issue related to personal
health in new ways. Generally, people talk of energy as
“electric,” as when they need “to recharge their batteries.”
In a Malaysian shopping center, I found bras, which
promised to increase the energy level of the client as the lining
supposedly was filled with “ceramic particles charged
with ions.” This is an echo of the more advanced theories
about the “electrical field of the human body.”19–21 Sophisticated
models intermingle with popular models, and flow
in communication is ensured. Energy is a central concept in
many alternative therapies, such as healing, acupuncture,
biopathy, and so forth but has many different meanings. The
Danish anthropologist Jette Jul Nielsen,22 who studied the
communication at a center where different therapists cooperated,
found that the term “energy” often led to misunderstandings
between the therapists. The term “energy” was
used in a diffuse way, which ensured a rather fragile con-
sensus.22
The clients of alternative therapies recognize the energy
model, although in popular versions. The following case illustrates
how a client agreed with the therapists’ use of the
terms “energy” and “field of energy.” I asked a client, after
his first visit to the healer, whether the healer’s terminology
was familiar to him or not. This is what he answered:
Alex: Well, yes, I might say so. But, well, it is all
quite logical. That an organism . . . well, yes, it boils
down to energy. And a source of electricity, or something,
will always be surrounded by an energy field.
So why should the human organism be different? I
think it is all logical. I do not think there is anything
mystical in it.
AGDALS-70
Alex refers to some of the words used by the healer: “field”
and “energy.” He accepts the concepts and thinks, as he says
“it is all logical.” But as I know the healer’s terminology
and observed the consultation, I realize that he does not understand
the terminology the same way as the healer. He is
referring to “energy” as electric energy and the “field” as
an “electric field.” Although nearly all clients immediately
accept the energy model, it usually rests on simple understandings
of “electricity,” and does not correspond with
CAM models. However, the familiarity of the conceptual
frame sustains flow in communication.
4. The body as computer
The image of the body as a computer has become widespread.12
The distinction between the genuinely human and
that which can be replaced by computer technology has become
blurred with cyborg-, nanotechnology, and artificial
intelligence. In some therapies, such as kinesiology, the
brain is perceived as software and the body as hardware.13
In kinesiology, as in different kinds of psychotherapy, such
as Neuro Linguistic Programming, therapists may speak of
“reprogramming.” Therapists may suggest replacing thought
patterns that affect the body and thereby bring health or illness.
The brain is conceptualized as software, with programes
or “patterns of thought,” which needs to be changed
when “things does not work,” as one client put it.
You have to be positive! You cannot let yourself be
dragged down by negative thoughts! You cannot just
accept the way you are, when things do not work. You
have to take the steering wheel and change the way
you think!
Some clients feel they get a powerful tool as they work
with affirmations and visualizations. There are a multitude
of books and recorded “guidings” in this genre, but one classic
is the international bestseller, “Heal your Body. The
Mental Causes for Physical Illness and the Metaphysical
Way to Overcome Them” by Louise Hay.23 In this classic,
a list of illnesses is presented in one column, next to a list
of corresponding thought patterns in a second column, and
a list of suggested affirmations to replace them in a third
column. These affirmations should be repeated as often possible
to be efficient. One of the first ailments alphabetically
listed by Hay is “abscesses.” According to Hay, abscesses
are a result of “Fermenting thoughts, over hurt, slights and
revenge,”23 which should be replaced by the following: “I
allow my thoughts to be free. The past is over. I am at
peace.”23 A quick search at Amazon.com (April 14, 2005)
showed that Louise Hay alone had more than 300 items in
this genre for sale through Amazon.
The idea of the body as computer can be related to the
idea of psychosomatic illness, which has become accepted
in some areas of conventional medicine. Self-help groups
for cancer patients, where the mental and emotional aspects
of illness are in focus, are now also, to some extent, organized
within the conventional health care system. How those
who take part in self-help groups may be engaged to alter
thoughts to gain health and well-being, is described in a
study by Leif I. Johansen.24 Although the focus on personal
experiences is generally still more prevalent within CAM
than in conventional therapies, such a focus is also evident
in a rather conventional book on nursing. The authors emphasize
that nurses should acknowledge the psychosomatic
and act as supportive advisers.25 In line with this, they
prompt nurses to encourage patients to conceptualize their
illness experience.
As illness is seen as psychosomatic, the subjective meaning
of illness may also receive more attention from therapists.
This process creates new dilemmas, as some patients
find it empowering, and others feel they are blamed for their
illness or that health advisers intrude on private areas.
5. The body as wireless network
Therapists applying spiritual healing or “chakra balancing”
generally perceive their work as adjusting or altering
the clients’ energy fields. Some healers also provide healing
over long distances, either by transferring energy or by
giving the client an object that contains the healing energy
(like catholic cloths of anointment or holy water). Some
healers touch their clients, as they practice “laying on of
hands,” and others do so mainly when they start or stop the
session. It is important to some unions of spiritual healers,
like the National Federation of Spiritual Healers in the U.K.
and the Norwegian Healers Union, to stress that they are not
faith healers in that they do not accept that the client’s religious
faith is important for healing to occur. Many of their
clients say they would not choose a “religious” healer. It is
difficult to estimate the use of spiritual healing, as it may
be difficult to distinguish from religious activities like
prayer, but the use and legitimacy seem to be increasing.
Therapies without “physical intervention” have gained popularity
at the same time as cell phones have become available
to the general public, and wireless networks have
become part of our daily activities. The first wireless communication
that came into most homes was the radio, where
the waves went through what was then described as “ether.”
The inner layer of the field of energy surrounding the physical
body is sometimes referred to as the body of “ether” by
spiritual healers.
Those who consult a spiritual healer sometimes express
surprise, as they feel the healers touch at the same time as
it is evident that the healer does not actually touch their physical
bodies. Boundaries between bodies may become blurred
during the treatment. I will illustrate this by presenting a
conversation between a healer and a client that took place
as the healer was standing behind the client with her hands
about 20 centimetres above the client’s head.
CHANGING PERCEPTIONS OF THE BODY S-71
Client: What is happening between us now? It is a
very scary feeling.
Healer: How do you mean scary?
Client: There is a kind of flow between us . . . and
warmth in my body. I have never experienced anything
like this. What is happening between us? It is
like . . . [She is gesticulating and looks at the healer
and then at the space between them]. Do I get your
energy now? It is moving through me. [Det går gjennom
meg].
Healer: I imagine that there is something that just
flows through me. Maybe you know that acupuncturists
see pain as blockages in the lines of energy? I am
just trying to improve the flow. When you are stressed,
it may disturb the flow and too little energy gets down
to your legs, it goes to your head. That is why we talk
about losing your foothold or your grounding.
This client is more verbal than many others, and both the
healer and the client talk about a “flow” going from the
healer to the client. “Flow of energy” refers both to the “body
as energetic” and the “plumbing model.” But in this case,
both healer and client acknowledge a “nonphysical” transference
from the healer to the client. The client is pointing
to “what is happening between them,” in a literal sense, looking
and pointing to the space between them. The borders between
clients and healers, or clients and others, do sometimes
become an explicit theme during the treatment.10 This
is due to experiences such as in the former case, where the
boundaries of the individual are no longer self-evident. The
boundaries of individuals are usually taken for granted in
Western late modernity. Spiritual healers may perceive relationships
as flows of energy between people, creating networks
of energy, which may be beneficial or harmful. Relations
are seen as energetic bonds and are evaluated with
reference to the origin or quality of the relation, the kind of
energy related to it, which may be described as high or low
in frequency, or just by referring to it in terms of pleasant
or unpleasant emotions. Some may release clients from old
bonds of energy if they perceive the energetic bonds as
restricting. The terms “old bonds” or “ties,” which are
metaphors in everyday use, may be recognized as a more
literal phenomenon to be considered in illness and health.
Both clients and healers I met could describe the bonds or
ties and how they had been transformed, cut, or released.
According to this model, individuals are perceived as part
of networks of energetic relations but may still influence
their position. They may choose to “cut the ties,” and be reconnected—or
they may transform—the relations that are
not beneficial to health.
Individual bodies in industrialized societies
The models presented are in frequent use in communication
and serve as core models in certain therapies. Although
the models are neither accurate, nor mirror the knowledge
of, the therapists, they provide common frames of reference
sustaining communication. Cognitive models like those presented
provide ways to perceive the body and interacts with
cultural models related to certain eras in technological and
social development of Western industrialized societies.13
The cognitive models interact with broader cultural themes,
like profound ideas on personhood, the individual, and social
relations. Cultural understandings of the person as an
individual is a feature of all the models presented.
The individualistic approach represented by the models
may become more evident in contrast to perceptions of body
and health as relational in more traditional societies. The idea
of the body as relational can, for instance, be found in Sanskrit
texts, where the body is seen as originating from the universe,
which it will return to after death. The spinal cord is
described as having been made from the axis of the earth,
body hair from shrubs, muscles from clay, tendons from
branches of vegetation, the intestines from the ocean, and so
on.26 In Bali, where such descriptions may be found among
Hindus and others, bodies are perceived as subtle instruments,
which reflect whether people are in balance with themselves
and their environment, including social relations.26 The health
of the society or the individual may also be seen as influenced
by relations reflected in parallel relations in the spirit world.
The concerns about the whereabouts in spiritual dimensions,
or a spirit world, are also central in African witchcraft, where
witches may harm others without conscious attempts. In most
traditional societies, illness and disease are perceived as relational,
rather than individual. The modern idea of individuals
shaping their own future and their own health are in contrast
to more collectivistic ideas and practices of traditional societies.
The models presented are in tune with the organizational
principles of industrialized societies. As individuals to
a greater extent may be able to leave particular social networks,
it may be easier to think of matters concerning bodies
and health as individual rather than relational.
The model in which the body is seen as part of a wireless
network is the only model described here which is open
to perceptions of illness as relational. Some spiritual healers
may talk about healing of relationships to improve health,
but this is rare. However, spiritual healers who cut or release
“energetic ties” or personal ties are common, and only
a few, in general, traditionally oriented healers, are opposed
to this practice. It seems as if the views of modern and traditional
healers are confronted when it comes to releasing
or cutting “energetic ties” versus healing relationships. Conscious
attempts to improve (physical) health through rituals
designed to heal relationships are rare in modern societies
but exist in many traditional societies.
The challenge of diversity
Users of CAM choose between therapies and perspectives
that make it possible to perceive the body from many facets.
AGDALS-72
Each model implies a particular focus on the body, on how
to maintain health, and on what kind of risks may lead to
illness and disease. As clients got accustomed to the healers’
perspectives, they described their bodies according to
different perceptions of body, illness, health, and risk. A
weakness in this study is that I am not able to say how clients
handle the diverse perceptions in different settings, as my
material is scarce when it comes to, for instance, hospital
settings. My material is limited, as it is mostly from observations
of treatments and interviews. It is not clear to what
extent clients may be able to synthesize the perspectives or
how different perspectives may be “compartmentalized” and
activated in different contexts, as Strauss7 has found with
other kinds of parallel cognitive models. It is, however, clear
that clients who had seen CAM therapists several times,
were more inclined to describe their body with reference to
the different models used by the practitioner,10 than those
who had no previous experiences with CAM. In some cases,
it was possible to identify and follow processes of internalization
as their descriptions of the body changed as they became
familiar with the perspectives of the therapists. In a
study of cancer patients who took part in different self-help
workshops, it is concluded that those who took part in selfhelp
groups over a period of time were most likely to be socialized
into distinct medical discourses.24 It has been found
that users of CAM do not tell practitioners of conventional
medicine that they use CAM.2 How people cope with their
diverse, and sometimes conflicting, perceptions in different
settings is an area where further investigation is needed.
Many clients find hope, meaning, and experience relief
among the multitude of models and practices. It has been
argued that CAM offers greater possibilities of establishing
meaning as therapists, in general, spend more time
with each client and focus on the person and her lifeworld,
rather than isolated symptoms.4,10,13,17,27 Patients who do
not get a biomedical diagnosis are often relieved when alternative
therapists accept their description of the illness
or give them an “alternative” diagnosis.10 The diversity
of therapeutic approaches represents different options for
clients who have a need to establish meaning regarding
their condition.
The models presented are pervasive as they are linked to
people’s basic bodily and existential experiences, as well as
to practical knowledge from other domains. Clients’ behavior
and perceptions of risk do also change along with their
acceptance of CAM and associated models. As a consequence,
perception of risk associated with conventional
medicine is opposed, and “new” kinds of risk come into focus.
It is, for instance, more likely that a client accustomed
to CAM will be skeptical towards conventional immunization
programs. Examples of risks in tune with the models
may be “lack of energy,” factors which influences the flow
or balance of energy, having the wrong “patterns of
thought,” or as one client put it: “there is something on my
heart chakra.”
CONCLUSIONS
As people have become familiar with CAM and associated
models, they may have several reasons to choose CAM
practitioners. A change in perceptions of the body may be
one reason why CAM is increasingly becoming a first-line
intervention. Several studies describe a shift in the behavior
of CAM users, as a growing number of clients do not
see an M.D. prior to a CAM practitioner.3,4,28 This is an interesting
shift as a visit to an M.D. is subsidized in the Nordic
countries and costs less than half the price compared to a
visit to a CAM practitioner. This shift is a result of clients’
experiences and perceptions of the both conventional medicine
and CAM. It is a trend that people develop diverse and
complex perceptions of body, illness, and disease and see
themselves as active participants searching for health, maneuvering
among different medical regimes. The shift toward
CAM as a first-line intervention may indicate that the
machine model is challenged as the dominating model.
The different cognitive models seem to make it possible
for people to have flexible understandings of the body, although
we do not know how flexible. Even if models are activated
in different contexts, some models may be more prevalent
than others—both as they refer to dominant cultural
models and on an individual level. What people experience
or consider appropriate healing environments is related to
their perspectives. Communication and trust are essential in
clinical settings, and there should be room for a client’s diverse
perceptions. Awareness of different perceptions of the
body may be crucial to enhance communication. If the client
who described her ailment as “something on the heart chakra”
were to be diagnosed with an infectious disease demanding
intensive care and isolation within a hospital unit, she might
disagree. In this case, different perceptions of disease may
lead to different opinions on whether antibiotics or “energetic
layout” will provide healing. It is an open question whether
the different perceptions and opinions can be bridged within
a new paradigm of integrative medicine.
Awareness of the qualitative and diverse differences in
perceptions of the body and the related communicative challenges
are key issues that must be handled in an integrative
model of medicine. Acceptance of cultural variations,
knowledge about CAM in general, and teaching of communicative
skills to all health practitioners are all elements
of how to accomplish this awareness. Many therapists do
strive to improve communication and mutual understanding,
but a more conscious effort is needed to acknowledge
clients’ diverse perceptions of illness. If, for instance, the
client’s body is treated according to the machine model,
needing maintenance, the patients are likely be more satisfied
if they share the idea. As users of CAM develop diverse,
sometimes sophisticated, perceptions of body and illness,
and change their roles as patients, it will influence what
they consider to be an appropriate or optimal healing environment
accordingly.
CHANGING PERCEPTIONS OF THE BODY S-73
We do not know enough about how people cope with the
multitude of models, but the model of the body as mechanical
is opposed by clients and practitioners who think of it
as too simple. The biomedical models have been criticized
from different groups during recent decades. As the process
of learning and socialization goes on, we might expect that
this trend will be reinforced. The users of CAM are generally
resourceful and well informed, and they see themselves
as active participants entitled to choose their preferred therapies.
Choosing CAM, which involves processes of learning
and socialization, sustains their perceptions of being active
participants entitled to choice. The more holistic
approaches to disease associated with CAM tend to support
the clients efforts to be recognized as active participants capable
of choosing to engage in processes improving or sustaining
health.
However, even though citizens’ perceptions of health are
changing and a large proportion choose to use alternative
medicine, public health policies are still dominated by one
model. The mechanical physioanatomic model has been a
core model in industrialized societies, but this seems to be
changing at the grass root level. Individuals take part in
processes transforming the conceptualization of the body,
health, and illness, but established institutions regulating and
financing health services appear rigid. There is a growing
gap between the diverse perceptions of citizens, their ideas
about rights to choose, and health policies currently based
on one model. Biomedical models have prevailed, with little
attention to differing explanatory models of health and
disease. An example illustrating this is that the public health
insurance (RTV) in Norway only acknowledges biomedical
diagnoses. Consumer rights movements and the holistic
health movement voice demands like rights to choose, availability,
funding, information, and research. Further neglect
of changes in citizens’ perceptions of the body, disease,
health, and risk, may affect the legitimacy of health authorities.
It is high time to explore and develop health care systems
embracing diversity and to enhance communication
and trust in multiplex societies.
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Address correspondence to:
Rita Agdal, M.A.
Fjellien 3
5019 Bergen
Norway
E-mail: ssara@rasmus.uib.no
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