Arthur Frank

WHEN BODIES NEED VOICES 307
to the care of a physician. I understand this obligation of seelung medical care as a
narrative surrender and mark it as the central moment in modernist illness experience.
The ill person not only agrees to follow physical regimens that are prescribed;
she also agrees, tacitly but with no less implication, to tell her story in medical
(4
terms. How are you?" now requires that personal feeling be contextualized within
a secondhand medical report. The physician becomes the spokesperson for the
disease, and the ill person's stories come to depend heavily on repetition of what the
physician has said.
Times have come full circle from Bourdieu's North African informant when
we read of a patient whose running joke with his surgeon involves reporting his
symptoms in an overdone version of medical obscurity. For example, "If you will
diligently investigate the pilar projections rising sparsely from the vertext of my
cranial ossification, you will detect a macular callosity which may have malignant
potential."9 If modern medicine began when physicians asserted their authority as
scientists by imposing specialized language on their patients' experiences, the postmodern
divide is crossed when patients such as this one can mimic this language in
a send-up of medicine that is shared with the physician. But lay familiarity with
medical terms and techniques, even to the point of parody, is only one potential of
the postmodern experience of illness.
The postmodern experience of illness begins when ill people recognize that more
is involved in their experiences than the medical story can tell. The loss of a life's
map and destination are not medical symptoms, at least until some psychiatric
threshold is reached. The scope of modernist medicine4efined in practices
ranging from medical school curricula to billing categories--does not include helping
patients learn to think differently about their post-illness worlds and construct
new relationships to those worlds. Yet people like Judith Zaruches express a selfconscious
need to think differently.
Both the divide that was crossed from the premodern to the modern and that
from modern to postmodern involve issues of voice. The woman reported by
Bourdieu seems to perceive that medicine has taken away her voice: medicine assails
her with words she does not want to know and leaves her not knowing what. But
this woman does not perceive a need for what would now be called her own voice,
a personal voice telling what illness has imposed on her and seeking to define for
herself a new place in the world. What is distinct in postmodern times is people
feeling a need for a voice they can recognize as their own.
This sense of need for a personal voice depends on the availability of the
means-the rhetorical tools and cultural legitimacyfor expressing this voice.
Postmodern times are when the capacity for telling one's own story is reclaimed. Modernist
medicine hardly goes away: the postmodern claim to one's own voice is halting,
self-doubting, and often inarticulate, but such claims have enough currency for
illness to take on a different feel.
Voices tell stories. Stories are premodern; Bourdieu's informant suggests that
the coming of modern medicine took away a capacity for experiencing illness in her
folk's traditional stories. In the modern period the medical story has pride of place.
Other stories become, as non-medical healers are called, "alternative," meaning
secondary. The ~ostrnodern divide is crossed when people's own stories are no
10
longer told as secondary but have their own primary importance. Illness elicits