This paper introduces the notion of plausibility as a decisive condition for the acceptance by groups in society of fundamental ideas concerning the nature of illness.

Plausibility, it is argued, helps to explain both transition from one system of fundamental ideas to another in history, and coexistence of different such systems in a single civilization. Hence this paper challenges an interpretation of medicine prevalent, especially in medical anthropology, since the 1940s, when Erwin Ackerknecht introduced the idea of medicine as an integrated aspect of a society's or community's culture.

Because early research focused on small-scale communities where a majority, if not all, of the members adhered to one world view and experienced one and the same existential environment, medicine came to be identified as a cultural system representative of entire communities and, later, societies. Hence we speak of Chinese medicine as if there were one system of therapeutic ideas and practices representative of China as a whole. The fact is that even though medicine is indeed a cultural system, it is representative only of the culture developed by people sharing identical environments and experiences. That is, if within one civilization different groups coexist in different existential realities entailing different notions of what causes crisis and how to maintain harmony, then these groups will believe in different systems of ideas concerning the generation, treatment, and prevention of illness. Such systems of ideas are therefore always metaphorical reflections of a real social environment or ideas are therefore always metaphorical reflections of a real social environment or of one aspired to.

It is not truth(Wahrheit) that leads to an acceptance of basic therapeutic ideas but plausibility (Wahrschein).

Pain has important biomedical socioanthropological, semiotic, and other facets. In this contribution pain and the experssion of pain are looked at from the perspective of evolutionary biology, utilizing, among others, cross-cultural data from field work in Melanesia.

No other being cares for sick and suffering conspecifics in the way humans do. Notwithstanding aggression and neglect, common in all cultures, human societies can be characterized as empathic, comforting, and promoting the health and well-being of their members. One important stimulus triggering this caring response in others is the expression of pain. The nonverbal channel of communication, particularly certain universal — i.e., culture-independent facial expressions, gestures, and body postures, convey much of the message from the painstricken person to the group.

These behaviors signal the person's physical and psychical pain, sadness, grief, and despair in ways very similar to the signs given by infants and small children: the body loses tonus and sinks or drops to the ground, the gestures are those of helplessness. Pain and grief may be so strong that control is lost not only over the body's posture but also over the mind's awareness. In such cases the afflicted person may carry out actions endangering himself or others. In general, these behavior patterns resemble those of infants in situations of distress and danger, and it is not surprising that the response of the members of the group is basically parental: taking care, assisting and consoling.

Perceptive and behavioral patterns which developed in the course of avian and mammalian phylogeny to serve the well-being of the young have proven, as was shown by Eibl-Eibesfeldt (1989), to be powerful building blocks for actions in other spheres of human interaction. Love is one such field, the reactions to a conspecific suffering pain is another.

The study of pain in a historical context requires a consideration of the cultural context in which pain is sensed and expressed. This paper examines attitudes toward physical pain in the later Middle Ages in Europe from several standpoints: theology, law, and medicine. During the later Middle Ages attitudes toward pain shifted from rejection and a demand for impassivity as a mark of status to a conscious attempt to sense, express, and inflict as much pain as possible. Pain became a positive force, a useful tool for reaching a variety of truths. While this attitude stemmed from the religious wish to identify with Christ's passion, it permeated and affected all spheres of cultural expression and investigation. Late permeated and affected all spheres of cultural expression and investigation. Late medieval medicine accepted pain, trying to relieve it only when it became dangerous to the patient. Given the existence of analgesic medicines at the time, this attitude is comprehensible only within the cultural context of the period.

In this paper I try to analyze the fate of a new medical model that was developed in the thirteenth and fourteenth centuries in European Latin society, particularly in the southern parts of Latin Europe. This model won the approval of the communities in which it was developed as part of an incipient network of medical care and attention. The new healer (Christian and male )that emerged from this model, whether physician or surgeon, based his practice on his knowledge of Aristotelian natural philosophy. He was an intellectual and a social product fashioned and supported by traditional and new urban leader groups, whether civil or ecclesiastic, Christian or Jewish. Health and healers were considered part of the urban social organization both in large cities and in smaller towns.

Full social acceptance of this new model was achieved only after heated debate. In practice, the new way of conceiving of medicine did not begin to become socially accepted outside intellectual circles until the new healer was able to offer specific solutions for the maintenance or restoration of health, both at an individual and at a collective level, and according to the criteria and feelings of the leader groups of the society of that time.

Progress in research allows us to identify nene factors, at least, that were involed in the construction of these novelties in late medieval Latin society.

By the beginning of the fourteenth century, medicine had acquired a cultural role in addition to its traditional functions as a therapeutic art. Medical subject matter infiltrated the religious discourse via the new thirteenth-century encyclopedic literature. Preachers came to employ in their moral analogies a wider range of medical topics, using sophisticated medical examples and citations attributed to recognized medical authorities. These developments coincided with the growing prestige of medicine as an academic discipline.

Medicine is only a cultural system of its own. It also performs specific roles in the broader culture of society at large. This article examines the role of medical arguments in the critique of“enthusiasm” on the eve of the Enlightenment. The enthusiasts, who claimed to prophesy and to have direct divine inspiration, were increasingly see in the seventeenth century as melancholics. With the decline of humoral medicine, however, the account of melancholic disturbances – including enthusiasm – that was offered tended to be chemical, mechanistic, and clearly corpuscular. Protestant ministers, in adopting such an account of enthusiasm, also adopted a strict distinction between the realm of the mind (to which true prophecy belonged) and that of the body (in which they located the phenomena of enthusiasm). Such a distinctions served in turn to demarcate more specifically the limits between the clerical and medical professions. Yet in relegating the treatment of enthusiasts to the physicians, rather than seeing the enthusiasts as heretics, the ministers stood in danger of relying too much on a secular profession and secular arguments, thus paving the way to a more general secularization of the ideological basis of the social order.

One disconcerting aspect of the role of culture in shaping human suffering is the gap between the explanatory models of therapists and patients in multicultural settings. This gap is particularly noted in working with Jewish ultra–Orthodox psychiatric patients whose idioms of distress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic efficacy that this incompatibility may pose, we propose a culturally sensitive therapy based on strategic principles that focus on the patient's mythic world and religious idioms of distress as the kernel of therapeutic interventions. Using one case of post–traumatic stress disorder (PTSD) as illustration, we seek to show how the religious symbols through which the patient's distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self–reconstruction.

American eugenics developed out of a cultural tradition independent of medicine. However, the eugenicist Harry Hamilton Laughlin and some legal experts involved in eugenic practice in the United States used medical language in discussing and evaluating enforced eugenic sterilizations. They built on medicine as a model for healing, while at the same time playing down medicine's concern with its traditional client: the individual patient. Laughlin's attitude toward medicine was ambivalent because he wanted expert eugenicists, rather than medical experts, to control eugenic practice. In contrast, legal experts saw eugenics as an integral part of medicine, though one expert challenged basing the judicial system on eugenically minded medicine. All in all, the medicalization of American eugenics involved expanding the scope of medicine to include the mutilation of individuals for the benefit of society. The judicial system was medicalized in that an expanded medicine became the basis of legislation in the thirty states that permitted eugenic sterilizations

Eugenics is the paradigmatic case of the conflict between biology and medicine over social influence. Commenting on as essay by Debora Kamrat–Lang(1995), the paper reconstructs the historical roots of eugenics as a form of preventive medicine. A comparision between the development of some crucial aspects of eugenics between Germany and the United States reveals that the prevalence of the value placed on the individual over hereditary health of a population ultimately determined the outcome of the conflict but collective concepts may be revived by new biological knowledge

Patients suffering from advanced, incurable cancer often receive from their doctors proposals to enroll in a clinical trial of an experimental therapy. Experimental therapies are increasingly perceived not as a highly problematic approach but as a near-standard way to deal with incurable cancer. There are, however, important differences in the diffusion of these therapies in Western countries. The large diffusion of experimental therapies for malignant disease in the United States contrasts with the much more restricted diffusion of these therapies in the United Kingdom. The difference between the two reflects differences in the organization of health care in these countries and distinct patterns of the professionalization of medical oncology in America and in Britain. The high density and great autonomy of medical oncologists in the United States encourages there the diffusion of experimental therapies (regarded by some as expensive and inefficient); the lower density of these specialists in the United Kingdom and their task as consultants and not primary caregivers, favors the choice of more conservative (for some, too conservative) treatments. Theoretically, the decision as to whether patients suffering from advanced, incurable cancer will be steered toward an experimental therapy or toward palliative care depends on the values and beliefs of these patients and their physicians. In practice, however, such choice does not depend exclusively on the individual' cultural background and ethical values, but is also strongly affected by the — culturally conditioned — Professional and institutional structure of medicine

This paper describes the way in which a simple device, the pregnancy wheel, has been used by the medical profession to impose a new way of measuring and experiencing pregnancy.The change involves counting in weeks instead of counting in months and it is gradually replacing a commonsensical method that had deep physiological and cultural roots. In contrast, the medical methodology of counting forty weeks is more complicated and lacks direct connections to the events of pregnancy

In the encounter between the doctor and the pregnant woman the pregnancy wheel has a variety of uses, among them determinations of the age and estimated size of the fetus.It plays an additional role, however, in the medicalization of pregnancy by providing the doctor with privileged information. It also influences modes of thinking through the way in which it deals with the question of the beginning of pregnancy, a question that has clear moral implications

The paper is divided into the two parts. In the first, I examine the relations among molecular biology, gene technology, and medicine as some aspect of the consequences of these relations with respect to the human genome project of the consequences of these relations with respect to the human genome project. I argue that the prevailing momentum of early molecular biology resided in argue that the prevailing momentum of relay molecular biology resided in crating the technical means for an extracellular representation of intracellular configurations. Assuch, its medical impact was rather limited. With the advent of recombinant DNA technology is based on the prospects of an intracellular representation of extracellular projects—the “rewriting” of life. Its medical impact is potentially unlimited. In the second part, I question the very opposition between nature and culture that implicitly underlies the notion of medicine as a “cultural system.” I argue that both on a macroscopic level (global ecological changes) and on a microscopic level (genetic engineering), the “natural” and the “social” are no longer to be seen as ontologically different.

In its uncanny oscillation between retrospection and foresight, between description and proclamation, and between assertion and hesitation, this essay translates an uneasiness that I have not been able to overcome while writing it. The essay conveys the tangled views of a hybrid author who himself cannot but oscillate between the perspectives of an actor in the field of molecular biology, a participant in the field of science studies, and a citizen

The status of the person is analyzed as represented by the life sciences under the influence of modern physico–chemical and molecular biology.

At the same time the linguistic structure of reality as seen through formalized scientific discourse is not that of a language, but rather that of operational symbolisms, so that the judeo–Greek tradition of Verb as creating and Logos as procreating — which is probably at the origin of the surprising confidence in the possibility of dominating nature through words and formulae — could be suc–cessful only through the depersonalization of language.

Notwithstanding appearances, the phenomena of structural and functional self–organization do not really change this situation.

In this context the question of the status of the person and of the intentional subject has to be dealt with pragmatically, giving up the notion of a unified scientific theory that would take into consideration at the same time the experi–mental sciences (physics, chemistry, biology and “objective” human) and the human sciences as linking subjectivity and intentionality.