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Feminist Interventions in Biomedical Discourse: An Analysis of the Rhetoric of Integrative Medicine

Posted on: Thursday, 28 April 2005, 03:00 CDT

The growing integrative health care community has produced a rhetorical text stressing personal empowerment, egalitarian relationships, and medical knowledge based on one's bodily experiences. This article examines the rhetoric of best-selling books and PBS documentaries promoting integrative medicine. A metaphor analysis of the rhetoric suggests that integrative medical practitioners perform a feminist intervention in biomedical discourse having the potential to significantly alter health care practices in the U.S.

Medical discourse is a contested, open-ended text, fraught with competing rhetorics and systems of meaning. Patterns of discourse in medical practice, for instance, may disempower women, especially during times of crisis (Birke, 2000). Some, however, may empower women as participants in their own health care and enable their informed decisions about appropriate treatment. Because feminist rhetorical critics scrutinize discourse that creates and sustains injustices inherent in social structures, they have the potential to reveal this kind of variation in the symbolic construction of illness.

Women are the primary consumers of health care because they live longer than men, their reproductive system typically requires medical intervention, and they are more likely to care for others' health (Boston Women's Health Book Collective [BWHBC], 1998; Lorber, 1997; Nettleton, 1995; Weisman, 1998). Feminist activists and theorists maintain that despite women's disproportionate use, Western medical establishments suffer communicative and psychological shortcomings, and therefore fail to provide satisfactory care to women (BWHBC, 1998; Fisher, 1994; Lorber, 1997; Northrup, 1994, 2001). The women's health movement gained visibility in the 1970s with the publication of the book Our Bodies, Ourselves (BWHBC, 1971). This movement criticized the inaccessibility of medical discourse and emphasized the need for straightforward medical knowledge about the female body and women's empowerment over their own health care. As a result, many women turned to complementary and alternative medicine (CAM) because of increased personal attention from doctors, the perception of patient empowerment, and a sense of participative decision making in determining healing approaches (Astin, 1998; Lupton, 1994; Nahin, 1999; Scott, 1998a). Recently, The Journal of the American Medical Association reported that CAM therapy use was more common among women (49%) than men (38%) (Eisenberg, et al., 1998). Other recent research has found similar patterns of CAM usage among women and men (Astin, 1998; Barnes, Powell-Griner, McFann, & Nahin, 2004).

Practitioners of CAM, also called integrative medicine, are typically M.D.s, trained at traditional medical universities, who have integrated alternative medical modalities (e.g. acupuncture, meditation, homeopathy) into their practice. This approach to medicine is seen as a health care option that addresses and overcomes the communicative and psychological weaknesses of traditional Western medicine (BWHBC, 1998; Northrup, 1994, 2001). The rhetoric used in traditional Western medicine is typically identified as biomedical discourse. Biomedicine is defined by Columbia University medical professor Daniel Eskinazi (1998) as medical practice that focuses on the "molecular, physiological and pathological mechanisms believed to form the basis of biological processes" (p. 1622). Biomedicine generally places an emphasis on interventions that treat biological pathologies as opposed to preventing illness or creating the conditions of health.

Critics of the biomedical model characterize it as overly mechanistic and maintain that biomedical practitioners view the body as an object to be repaired (Scott, 1998b; Weitz, 2001). This view, critics claim, results in a mind/body dualism and physical reductionism that overlooks psychological and social causes of illness (Birke, 2000; Lupton, 1994; Nettleton, 1995; Rios & Simpson, 1998). Additionally, biomedical practitioners have been perceived as overly paternalistic, especially with female patients (Beisecker & Beisecker, 1993; Richter, et al., 2001). Furthermore, many patients of CAM maintain that biomedical practice places the creation and maintenance of health in the hands of the physician while integrative medicine generally transfers agency over personal health to the individual (Goldner, 2004; Hughes, 2004; Reismann, 1994).

CAM's potentially emancipatory symbolic constructions of illness merit the attention of feminist rhetorical scholars. In this article I describe how CAM rhetoric creates an alternative discourse that establishes symbolic ground for a more egalitarian health care practice. I explore how CAM health care practitioners use metaphors to challenge existing patterns of power and oppression prevalent in the Western medical tradition. This alternative medical rhetoric constitutes a feminist intervention into biomedical discourse.

My first order of business is to identify the primary metaphors and their constituent vehicles that CAM practitioners use to animate their medical discourse. The texts I examine are accessible to a wide range of women; hence they have a pronounced capacity for popularizing integrative medicine, thereby empowering women to seek out integrative medical services. Although a myriad of texts address women's health and integrative medicine, the present analysis considers 11 texts chosen according to the following criteria: written by CAM practitioners,1 published in the past twenty years, achieved best-selling status, and focused on integrative medicine and women's health. Applying these criteria yields a sample whose ideas circulate among a large number of women. Additionally, I chose books by both male and female practitioners in an effort to ensure that the medical metaphors were used by authors of both sexes. The following books comprise the sample: The BWHBC's (1992; 1998) The New Our Bodies, Ourselves; Christiane Northrup's (1994; 2001) Women's Bodies Women's Wisdom and The Wisdom of Menopause; Bradley J. Wilcox, D. Craig Wilcox, and Makoto Suzuki's (2001) The Okinawa Program; Andrew Weil's (1995) Spontaneous Healing; and Dean Ornish's (1991; 1998) Eat More Weigh Less and Love and Survival: The Scientific Basis for the Healing Power of Intimacy. The sample also includes three widely available PBS videos focusing on the alternative practice of Christiane Northrup (1998), Andrew Weil (1996), and Dean Ornish (1998).

The primary rhetorical tactic employed in the above texts was the consistent use of metaphor that served to structure medical practices and relationships. Feminist critic Susan Sherwin (2001) states that each selection of a metaphor in medical discourse "suggest[s] different strategies for research and therapy and promotes different ways of thinking about those who are infected and those who are at risk of infection. Each can be seen to lead to significant material consequences that should be evaluated in terms of effectiveness, efficiency and so on" (p. 353). To determine the potential "material consequences" of metaphor use in CAM rhetoric, I first identified the recurring metaphors found in the texts. After sorting the metaphors into clusters according to similar meanings and patterns of use, I analyzed these clusters to observe their underlying values about medicine and suggested medical practices. This paper reports on this analysis and explains the primary finding that the meaning created through these metaphor clusters performs a feminist intervention into biomedical discourse, having the potential to significantly alter health care practices in the U.S.

Metaphors in Medical Discourse

The study of metaphor in rhetoric has a long and rich history. In On Rhetoric, Aristotle (trans. 1991) defines metaphor as a decorative feature of language, stating that it has "clarity and sweetness and strangeness" (3:2:8). But he finds no other function for metaphor beyond the stylistic and provides guidelines for appropriate usage. Cicero (trans. 1942) also conceives of metaphor as a linguistic device with a primarily ornamental function, although he believes that effective use of metaphor has the potential to clarify meaning. He states that metaphor conveys "some degree of brilliance to the style" (p. 156). This stylistic perspective dominated the treatment of metaphor until the twentieth century when metaphoric criticism within rhetorical studies conceptualized metaphor as a symbolic force with the ability to constitute meaning, prescribe action, and organize attitudes about a particular subject (Black, 1962; Burke, 1969; Lakoff & Johnson, 1980; Leff, 1983; Osborn & Ehniger, 1962; Richards, 1965). I.A. Richards (1965), the theorist perhaps most responsible for advancing the role of metaphor as a system of meaning, maintains that our very "[t]hought is metaphoric, and proceeds by comparison, and the metaphors of language derive therefrom" (p. 94). In this expanded view, metaphors have the power to move beyond symbolism and influence the concepts that ultimately structure daily practices. Metaphor acts as a central vehicle in the transmission and meaning of culture.

Kenneth Burke (1984) finds that metaphor crea\tes perspective by incongruity, which is defined as a symbolic ability to dislodge meaning from a set orientation, or way of viewing the world. Burke (1984) maintains that the metaphor's vehicle exemplifies "relationships between objects which our customary rational vocabulary has ignored" (p. 90). In this manner, metaphor has the capability to act as a symbolic agent of change that results in what Stephen Daniel (1990) calls a "dynamic tension [in] a text" (p. 26). This tension results in a shift in meaning as the vehicle offers new insight to the meaning of the tenor.

George Lakoff and Mark Johnson (1980) describe the role that metaphor plays in cultural practice:

[E]very experience takes place within a vast background of cultural presuppositions. It can be misleading, therefore, to speak of direct physical experience as though there were some core of immediate experience which we then 'interpret' in terms of our conceptual system. . . . It would be more correct to say that all experience is cultural through and through, that we experience our 'world' in such a way that our culture is already present in every experience itself. (p. 57)

Metaphors, acting as linguistic containers of culture, inform our attitudes and behaviors vis--vis health care. They influence how doctors practice medicine, how patients respond to illness, how medical personnel respond to patients, and how the ill person and the health care provider form a relationship.

Integrative medical discourse that is written for a lay audience typically relies on what Lakoff and Johnson (1980) describe as structural metaphors, "cases where one concept is metaphorically structured in terms of another" (p. 14). Structural metaphors focus on a particular aspect of reality while hiding others. Consequently, these metaphors have the capability to privilege certain medical practices. The theory behind structural metaphors derives from Max Black's (1962) interaction view based around metaphor as "a system of associated commonplaces" from which we manufacture meaning about a particular practice (p. 40). The system of associated commonplaces refers to the characteristics we associate with the vehicle of the metaphor. We then apply these characteristics to the tenor and produce commonplaces of meaning. Thus, if the metaphor "the body is a battleground" describes illness, then medical treatment of the body receives the hermeneutic elements of a battleground. Medical care becomes a military intervention, a combat theater marked by attack, invasion, and mortal struggle. The practice of health care, in turn, becomes war-like: germs need conquering, viruses require a counter-offensive.

The use of structural metaphors in medical discourse forms the primary assumptions that guide our understanding of illness. Susan Sontag (1990) offers an opposing view in Illness as Metaphor stating, "illness is not a metaphor . . . the most truthful way of regarding illness-and the healthiest way of being ill-is one most purified of, most resistant to, metaphoric thinking" (p. 3). This position does not leave room for the possibility that illness is always a culturally constructed social text that can draw upon positive symbols as often as it can turn to metaphors of invasion, destruction, and decay (e.g., invasion metaphors associated with cancer). She did recant this position in her later work AIDS and Its Metaphors, stating that "one cannot think without metaphors. But that does not mean that there aren't some metaphors we might well abstain from or try to retire" (1990, p. 93). Here, she acknowledges that while it is an impossibility to erase metaphor from our thinking about illness, it is essential to choose metaphors that facilitate healing, optimism, and the acceptance of the ill patient.

Sociologist Deborah Lupton (1994) acknowledges the frequent use of metaphor in the medical context and notes that they are "commonly used in ideological struggles around a contested site of meaning" (p. 44). However, no scholars to date have explored the competing metaphors offered by CAM rhetoric as I do in this paper. Philosopher Susan Sherwin (2001) maintains that it is necessary to explore the use of metaphor in health care because of its power to influence medical practice. Ultimately, Sherwin (2001 ) maintains, the critic of biomedical rhetoric can

challenge the established metaphors that govern the various practices in each area of medicine and . . . [observe] the competitive co-existence of different interpretive models . . . [for] recognizing the distinct practical implications of each can help us to appreciate the possibility and significance of pursuing alternative ways of conceiving of other subjects of medical concern and intervention. (p. 345)

My aim in this paper is to examine the "different interpretive models" offered by the rhetoric of CAM practitioners.

In the case of CAM medical discourse, metaphor shifts to a feminist terrain. The metaphors construct a set of relationships between patients and health care providers based on partnership, personal empowerment, collaboration, and mutual respect. Additionally, in CAM discourse illness is viewed in a different light. The metaphors situate illness in a complex construction of biology, culture, interpersonal relationships, lifestyle choices, and spiritual practices, thereby creating a holistic approach to understanding the health maintenance of the body. This significantly alters the conception of health care produced by the rhetorical leaders of Western medicine such as The New England Journal of Medicine, The Journal of the American Medical Association, and The Lancet. This is not to say that the familiar representatives of CAM practitioners (Dean Ornish, Andrew Weil, and Christiane Northrup) do not publish in these journals; they do. But, in a true integrative fashion, they also address the general public by producing best selling books, videotapes, newsletters, and web sites that invite individuals to participate in the healing process.

Feminist Analysis of Medical Discourse

The feminist critique of biomedical discourse has gained significant ground since the women's health movement of the 1960s and 1970s. This movement was catalyzed by the legal battle over a woman's right to choose and quickly spread to include a variety of other health care-related topics (Lay, 2003; Loustaunau & Sobo, 1997). Specifically, Carol Weisman (1998) maintains that "the medical profession was perceived as treating women in a condescending manner, withholding information, overusing surgery and risky drugs and devices, medicalizing women's reproductive functions, and reinforcing sexual stereotypes" (p. 72). Movement activists demystified medical knowledge concerning women's body with publications like Our Bodies, Ourselves (BWHBC, 1971) in an effort to empower women to make educated choices. Additionally, Weisman (1998) describes that activists created alternative health care sites that put '"women's culture' back into health care" (p. 74). These sites included abortion and women's health care clinics that used both traditional and nontraditional medical personnel, including midwives and homeopathic practitioners (Lay, 2003). More recently, activism in the women's health movement has moved into organizational groups such as the American Medical Women's Association, which functions at the national and international levels addressing policy health care issues of concern to women such as reproductive health, affirmative action, managed care, and violence against women. Sheryl Ruzek (1999) writes in her article about the history of the women's health movement that "[t]he success of the . . . movement is reflected in the extent to which mainstream organizations and institutions, particularly federal agencies, have incorporated or adopted core ideas and created new opportunities for women's health advocates" (p. 1481). For instance, in 1990, after pressure from grassroots women's health groups and the passage of the Women's Health Equity Act, the National Institute of Health (NIH) established the Office of Research on Women's Health, charged with increasing women's representation in study populations (Ruzek, 1999).

Feminist theory has kept pace with this activism and a large body of literature now addresses the biomedical model as it pertains to women's access to and quality of health care. Typically, this research falls into four general categories: the overmedicalization of women's bodies and reproductive capacity (Farquhar, 1996; Lay, 2003; Lorber, 1997; Morgan, 1998; Nettleton, 1995; Ruzek, 1999; Sherwin, 1992; Weitz, 2001); the power dynamics of doctor-patient interactions (Ballard-Reisch, 1990; Birke, 2000; Candib, 1988, 1995; Ellingson & Buzzanell, 1999; Ehrenreich & English, 1973, 1978; Scott, 1998a); the epistemological foundation of medicine and standpoint epistemology as it relates to women's understanding of their bodies (Ellingson, 2000; Hayden, 1997; Haraway, 1991; Morgan, 1998; Morris, 1998; Ruzek, 1999; Sherwin, 1998); and equity of representation in medical research (Coffins & Leiman, 1996; Ruzek, 1999; Sherwin, 1992; Weisman, 1998).

Some research in the communication discipline has contributed to the feminist analysis of health care by exploring the growing area of integrative medical discourse (Ellingson, 2000; Hayden, 1997, 2001). Sara Hayden (1997) analyzes five editions of the BWHBC's Our Bodies, Ourselves and finds that their rhetoric is characterized by the "feminine style" (i.e., personal in tone, use of inductive reasoning, reliance on identification). She describes how the authors encourage women to understand their bodies through personal bodily experience. This in turn legitimizes a "body-centered" way of knowing in women's health care. Hayden's findings offer a solid starting point for analyzing the rhetoric of CAM practitioners; however, to be truly beneficial to our field, we nee\d analysis of a variety of texts that reach a diverse audience. This essay expands on Hayden's analytical foundation by examining a broader array of texts written by both men and women and published for the popular press.

Laura Ellingson (2000) examines best-selling author Bernie Siegel's rhetoric of self-healing using a feminist framework and standpoint epistemology in her analysis. She argues that while Siegel's rhetoric assumes a feminine style, the standpoint from which he writes is that of a privileged white male, which renders him incapable of reaching out to marginalized women and women of color. Ellingson maintains that this "makes Siegel's text problematic for some (particularly those in less powerful groups such as women, racial and ethnic minorities, and homosexuals) who want to apply Siegel's techniques to their lives" (p. 87). I disagree with this position and find that it narrowly defines the experiences of women, racial and ethnic minorities, and homosexuals. Standpoint epistemology has been criticized for its essentializing potential, assuming that the experiences of members of a marginalized group are similar due to their oppression (Hekman, 1997; Walby, 2001). Feminist critic Susan Hekman ( 1997) points out that "[t]he nature of their oppression is not obvious to all women; it is only through feminist analysis that the feminist standpoint can be articulated" (p. 346). While Siegel is indeed a product of the ruling class of privileged white males, he advances a critique of Western medical practice that offers a feminist analysis, thereby articulating a feminist standpoint. He describes a perspective and understanding of health and illness that is quite different from the Western medical model typically associated with privileged white males. Ellingson does acknowledge that some integrative practitioners such as Andrew Weil and Christiane Northrup, two medical rhetors included in my analysis, reflect the "diverse positions and needs of readers" (p. 86). However, it can be argued, following Ellingson's logic that Andrew Weil, a white, male M.D. educated at Harvard University, also comes from the standpoint of privilege. Weil is able to reach beyond this standpoint and out into an alternative way of knowing about health care and the body that articulates a feminist standpoint.

In addition to analyzing the rhetoric of alternative health care found in Our Bodies, Ourselves, Sara Hayden (2001) also examines traditional biomedical discourse found in two sex education texts used in high school curricula. She describes how this rhetoric operates as a discourse of power, "normalizing" and "disciplining" the body as it relates to sexual practice. She concludes that these texts "participate in a body of discourse through which bio-power is perpetuated" (p. 33). Her findings are consistent with feminist critiques of biomedical discourse and uphold the CAM criticisms of Western medicine examined in this paper.

The following analysis adds to this body of literature in communication that analyzes the rhetoric of alternative medicine in a number of ways. First, it advances Hayden's (1997; 2001) analysis of feminist theorizing and the use of feminine style in health care rhetoric. I show how the strategic use of metaphors is a rhetorical strategy that draws from the feminine style to offer an alternative health care rhetoric that validates women's personal experience with their bodies and encourages relationships of equality between women and their health care providers. Second, I contribute to feminist theorizing about biomedical discourse by examining how CAM practitioners characterize biomedical discourse through the use of metaphor, and in the process, intervene in the dominant medical model. Finally, I contribute to feminist rhetorical theory with an analysis of how metaphor can advance feminist thought concerning health care practices. I make these contributions by examining three primary metaphors (war, god/priest, and machine) used by CAM practitioners to debunk the biomedical model's conception of illness and craft their own conception within an integrative model.

The key method used by CAM practitioners to promote their practice is the raising and dismantling of biomedical discourse's straw man metaphors. Using straw man metaphors, CAM practitioners misrepresent biomedical discourse in a variety of ways, such as paraphrasing in carefully chosen words, oversimplifying, or extending the argument beyond its original bounds (Darner, 1987). The rhetorical metaphors used by the CAM practitioners examined in this analysis are not supported with evidence from biomedical texts. They function as anecdotal representations based primarily on the integrative practitioners' and their patients' experience with traditional medical institutions. Typically, straw man metaphors are considered to be fallacious arguments, but in this case, CAM practitioners reclaim this fallacy as a rhetorical tool used in their efforts to critique biomedical discourse. Integrative practitioners use straw man metaphors to link a masculine system of associated commonplaces to the purported rhetoric of traditional medicine, framing the practice of Western medicine in a negative light as overly hierarchical, invasive, and aggressive. At the same time, integrative practitioners offer an alternative discourse that characterizes their practice as a more feminine, nurturing, and empowering approach to health care. What is unusual about this use of the straw man metaphor is the fact that such arguments are typically characterized as divisive rhetorical techniques of our dominant culture. However, the CAM practitioners use this technique to affect a feminist intervention in the biomedical discourse of our dominant culture. In a sense they "use the master's tools" to affect change.

While not all integrative practitioners are overtly feminist,2 they do have a connection to feminism and health care. My analysis indicates that the primary method used in the rhetoric of CAM medicine involves paraphrasing masculine and military metaphors, giving the impression that they dominate biomedical discourse and thereby control traditional medical practice. Other critics have made similar arguments concerning the use of masculine and military metaphors in biomedical discourse (Birke, 2000; Loustaunau & Sobo, 1997; Lupton, 1994; Martin, 1999; Nettleton, 1995; Sherwin, 2001). For instance, CAM practitioners argue that traditional medicine adorns the rhetoric of illness with war imagery and depicts doctors as heroic warriors entering into battle with an external enemy such as a germ or tumor. CAM practitioners take what may be customarily seen as an appropriate metaphor (disease as the enemy - with a heroic doctor saving the body) and attach to it a negative connotation (doctors fight our health battles for us, taking away our power). These straw man metaphors function to persuade readers that alternative medical practices are often preferable to traditional Western medicine.

Straw-Man Metaphors

From War to Gift

Susan Sontag (1990) writes that:

[M]ilitary metaphors have more and more come to infuse all aspects of the description of the medical situation. Disease is seen as an invasion of alien organisms, to which the body responds by its own military operations, such as the mobilizing of immunological 'defenses,' and medicine is 'aggressive,' as in the language of most chemotherapies. (p. 97)

While few would dispute Sontag's claim that metaphors of war exist in medical discourse, integrative practitioners suggest that war is the overriding metaphor governing the symbolic territory of allopathic medicine. Similarly, feminist scholars of the biomedical model have found a prevalence of military metaphors in traditional medical discourse (Birke, 2000; Lupton, 1994; Martin, 1999; Sherwin, 2001). Critic Emily Martin (1999) in her analysis of the rhetoric of reproductive technologies identifies a preponderance of military metaphors that advance an "imagery of aggressive immuno-warfare against the foreign foe" (p. 99). CAM practitioners stress that a Western approach to medicine views illness as the enemy and health care practitioners as the soldiers fighting to save the victim. For example, Northrup (1994) describes the war metaphor as follows:

Military metaphors run rampant through the language of Western medical care. The disease or tumor is 'the enemy,' to be eliminated at all costs. . . . Even the immune system . . . is described in militaristic terms, with its 'killer' t-cells. (pp. 7-8)

In her PBS special, Northrup (1998) offers a humorous example of the war metaphor in medical discourse in the title of an article found in a journal of gynecology, "Induction of Labor in the 90s- Conquering the Unfavorable Cervix." She states that in this case, traditional practitioners approach the female reproductive system in a warlike stance. "We're going to go in there and wipe that out- cut, burn, destroy."

Dean Ornish (1998b) contends that his medical training gave him the wrong approach to treating symptoms of pain. He states that he was not trained to view pain as a messenger, as he believes health care practitioners should. Rather, he believes he was trained to view pain as an enemy-something that needed to be expunged at all costs. According to Ornish, if you eliminate pain, you eliminate a valuable source of information, a key to understanding and treating illness.

Andrew Weil (1996) also criticizes mainstream medicine for its overuse of the war metaphor, maintaining that allopathic doctors take the view that illness is the enemy, "we fight it, we wage war." He believes that pharmaceutical medicine is the weapon of choice in the battle against illness. Weil argues that the discovery of antibiotics fueled the war-like approach to medicine because it produced "great victories against infectious disease and the development of weapons a\gainst them" (p. 4). However, he finds that this overuse of antibiotics has produced a dangerous situation wherein the drugs create a disturbing growth in microbial resistance to drugs. He describes this cautionary tale using the same war metaphors that he critiques as follows, "Weapons are dangerous. They may backfire, causing injury to the user, and they may also stimulate greater aggression on the part of the enemy" (p. 5).

Northrup (1998), Weil (1995), and Ornish (1998b) describe Western medical discourse, and subsequent practice, as one that is guided by the military metaphor. From their characterization, one might expect that a medical textbook would read like a Tom Clancy novel. However, they rarely provide specific evidence from allopathic texts that support the claim that these metaphors are consistently used. Rather, they primarily draw upon anecdotal evidence and case studies gathered from patients they have treated in their practices. When the straw man is used as an argumentative tactic, it is, essentially, a misrepresentation of another's statements. The value in creating this straw man use of metaphor is that integrative practitioners can depict, without textual support, that the guiding symbols of biomedicine are disempowering and can be harmful. When integrative medical rhetoric similarly implies the damaging effects of the military metaphors, it opens up a rhetorical space that offers a more personally empowering symbolic grounding than standard medical practice. The negative war metaphors, and practices that follow, can be replaced with a new set of symbolic devices that favor integrative practice.

CAM practitioners replace the straw man metaphor of war, where illness is the enemy, with a metaphor of "message" or "gift," where illness is a communicative force that tells the patient what is wrong in his or her life. The gift is the message itself. Andrew Weil (1995) states that his successful patients look back and regard their illness as a gift because it signaled the importance of living differently. The message often identifies behavioral patterns that are producing negative effects on the body and the mind. For example, heart disease might be a message that one's life is too full of stress, that the body is not being properly exercised, and that one's spiritual peace is in jeopardy. The message is a gift from the body to the mind-telling the individual that she must improve her health, and ultimately, the quality of her life.

Northrup relies on the communication model to describe the process by which illness functions as a message. She believes that the mind operates throughout the body as a transmitter of messages to the vital organs. Northrup (1994) advances the idea that the mind exists throughout the body:

Our body organs communicate directly with the brain and vice versa, through chemical messengers known as neuropeptides. These neuropeptides pass messages between nerve cells; neuropeptide receptor molecules then receive messages that are triggered to be released by emotions and thoughts. (p. 29)

This physiological description compares the bodily processes to the human communication process, thus, constructing a model of communication between the body and the mind. She contends that it is essential for individuals to pay attention to these physiological messages.

In her most recent best-seller, The Wisdom of Menopause, Northrup (2001) states that menopause functions as a gift for women in that it often results in a "wake-up call" for women because of its ability to give them "clarity of vision and increasing intolerance for injustice and inequity" experienced by women in their earlier years (p. 19). Speaking from her years of practice as a gynecologist and her personal experience, Northrup describes menopause as a time when hormones provide "an opportunity to see, once and for all, what we need to change in order to live honestly, fully, and healthfully in the second half of our lives" (p. 19),

Dean Ornish also relies on the metaphor of illness as a message but because his practice is specifically in cardiology, he relates the communication model to the heart. He believes that the heart speaks volumes and states that when he opens the heart up anatomically he then tries to open the heart up metaphorically. Ornish (1998b) states, "Humans need contact, love and intimacy, without it they are far more likely to succumb to illnesses like heart disease and cancer." Ornish (1998b) is concerned that traditional medicine's emphasis on eradicating pain will ultimately kill the messenger.

There are lots of ways to numb pain in our culture - but pain isn't the problem, it's the messenger. If you numb pain it's like clipping the wires in your fire alarm because the noise bothers you. The noise goes away but the fire rages on.

He believes there is a transformative value in pain in that it gets our attention and motivates us to begin making life changes. Ornish (1998a) does not celebrate pain but rather asks his patients to find the reason behind the pain. "Not that we should seek out pain, but the pain is there for a reason. It says 'Hey! Listen up! Pay attention! . . . Pain is a messenger. Pain is information" (p. 15). He continues on, stating that those patients who view their heart disease as a messenger believe that while their physical heart might be scarred

their emotional and spiritual hearts may open in ways that transform the joy and meaning in their lives . . . without having experienced a major traumatic event like that, it would have been unlikely for these other changes in their lives to have occurred. Their suffering got their attention. (p. 16)

The CAM practitioners' replacement of straw man military metaphors with the gift or message metaphor performs a symbolic function that communicates an intervention in biomedical discourse. The gift/message metaphor as it is contextualized in CAM rhetoric is an improvement over the symbolic atmosphere created by the use of the straw man military metaphors. By immediately replacing the violent military metaphors used to describe traditional medicine with the gift/message metaphor used to depict integrative medical practice, the prospective patient sees a healthy alternative to the traditional biomedical model. The gift/message metaphor allows the patient to embrace the illness as part of her body and find a reason for its presence in the body, to convey a message. Accepting this rhetoric, and the integrative practice it describes, can produce a psychological shift in one's attitude toward her illness. Ultimately, it could contribute to a healthier healing experience as the patient begins to work with the perceived gift/message associated with the illness. Such a shift could contribute to a more positive feeling about one's capacity to heal.

From Doctor as God to Doctor as Partner

Integrative practitioners, like participants in the women's health movement, seek to empower their patients by de-emphasizing the doctor's role in recovery and stressing the patient's responsibility in the process of wellness. They maintain that biomedical practitioners place too much emphasis upon the role that the doctor plays in recovery, thereby creating a god-like or priest- like status for physicians. Prior to the formation of the medical establishment,3 women were seen as the primary source of health care and most of this care took place within the home. Health care was primarily perceived as women's work that did not require professional training (BWHBC, 1998; Ehrenreich & English, 1973, 1978; Lay, 2003; Loustaunau & Sobo, 1997; Starr, 1982). It was not until the Industrial Revolution and the professionalization of medicine in the latter half of the nineteenth century that health care moved into the public sphere and was taken over by a male establishment. During this time, the image of health care was transformed into a highly complex scientific endeavor requiring expert intervention. Patients were taught to view the doctor as the best source of knowledge about their body and as the person most capable of translating relevant scientific research published in medical journals. Consequently, this created a relationship of dependence between a doctor and his patient.

In her PBS special, Northrup (1998) states that "In medicine you are trained to be the higher power of your patient." However, she finds this to be an ultimately defeating role for any doctor because the patient then does not believe that she has agency in the recovery process. The patient believes that only the doctor can cure her. Northrup (1994) states:

We have been taught the myth of the medical gods - that doctors know more than we do about our bodies, that the expert holds the cure. . . . Doctors are authority figures for some women, right up there with their husbands and priests. (p. 9)

Arguing from individual rather than scientific observation, she finds that the doctor as god metaphor reflects the highly patriarchal and hierarchical medical model. She contends that it is natural for the medical establishment to follow the patriarchal model because it is the determining organizational framework for most of our institutions. She finds that this masculine approach to medical care is most harmful for women in that they tend to become highly passive in the context of a paternalistic relationship with a doctor. This passive position results in an "addiction" to the dictates of doctors when it comes to care of the body. The BWHBC (1998) advances a similar critique of the patriarchal nature of the doctor-patient relationship, stating that it produces a perception of the patient as a child:

There may always be something about the 'laying on of hands' that calls up the child in us and makes us feel dependent, especially when pain and fear are present. Some physicians deliberately work to increase this natural phenomenon into a special kind of dependency in whic\h the patient turns to the physician in a child-like way for guidance. (p. 685)

Ornish (1998b) also contends that there is an unequal relationship established between the doctor and patient under the biomedical model, stating that there is an "Aztec priest quality to heart surgeons - cutting open someone's chest and exposing [the] beating heart." He believes that patients desire freedom and control over their bodies but do not get this from traditional medical practitioners. He asserts that "[d]octor's orders are like God telling Eve to not eat the apple-it only produces tension. Patients need to take responsibility for their own care and make wise choices." Weil offers a similar critique of the hierarchical positioning of doctors. He finds that doctors "hex" the healing process because of their incredulity in the human body's capacity to maintain wellness. Weil (1996) argues that the allopathic practitioner is like a "priest of technological medicine sitting in his temple" announcing the verdict of an illness. He likens such priestly behavior to casting a spell in shamanistic healing.

Once the straw-man metaphor of doctor as god has been developed, these CAM practitioners describe a more egalitarian relationship to take its place. They believe the role of integrative health care providers is to work with the patient, empowering him or her to seek healing in the body. They find that when it comes to illness, the patient knows her body best and this intuitive knowledge of the body should be honored in both the healing and dying process. The negative characterization of the medical authority operating in highly hierarchical structures makes the egalitarian approach far more appealing to the audience of integrative medical discourse.

The BWHBC is perhaps most outspoken on the transformation of the doctor-patient relationship from one of authoritarianism to one of equality and partnership. The authors of Our Bodies, Ourselves (BWHBC, 1998) maintain that the hierarchical nature of the doctor- patient relationship is one of the primary mechanisms through which "medicine has achieved social control over women's lives" (p. 685). They do not offer an alternative metaphor to the doctor as god or priest; rather, they describe a partnering relationship based on mutual respect and understanding. The authors state that "[i]deally, you should come away from every encounter feeling more confident in your ability to promote healing in yourself (p. 104). The authors of Our Bodies, Ourselves (BWHBC, 1992) describe a relationship based on "feminine" values and skills, including the qualities of "nurturance, empathy, caring, sensitive listening, encouraging others to take care of themselves, [and] collaboration" (p. 664). This statement reflects Sara Hayden's (1997) earlier findings that the BWHBC is characterized by the feminine style.

According to the BWHBC (1998), the patient's role in this egalitarian partnership is one of empowerment and responsibility to "take charge of your own health care" and "get informed" (p. 686). In this view, the patient becomes an equal partner in the search for the cure to her illness. The BWHBC (1998) states, "Our stories are crucial for correct diagnosis as well as for choice of treatment options, and we need to insist that our providers listen to them and act upon them" (p. 685). Additionally, informed consent and informed decision-making are central parts of this relationship. Our Bodies, Ourselves (BWHBC, 1998) includes the essay "Our Rights as Patients" which outlines the specific, legal rights a patient should expect in the medical setting, including, most significantly, "the right to control what happens to your body, to decide about your treatment" (Annas, p. 713). Additionally, the BWHBC (1992) provides personal testimony describing the ideal doctor-patient relationship:

Friends now marvel at my close relationship with my current doctor and my ability to talk back, question and disagree with him and his colleagues. He respects me and trusts me to tell him what is going on, and I in turn trust him to listen, make suggestions and consult with me before any action is taken. (p. 659)

Christiane Northrup also emphasizes the importance of women's central participation in the healing process. Northrup (2001) states that in her medical practice she seeks to empower women by "giv[ing] them a safe place in which to tell their personal stories so that they could discover new, more health-enhancing ways of living their lives" (p. 13). She encourages women to "reclaim" authority over the health care of their bodies and devotes a whole chapter to the identification of an alternative to the hierarchal doctor-patient relationship. Speaking from her own physical experience, Northrup (1994) states, "I've found it enormously empowering to realize that no scientific study can explain exactly how and why my own particular body acts the way it does. Only our connection with our own inner guidance and our emotions are reliable in the end" (p. 12). She encourages women to establish a "working partnership" with a "health care team" (1998). Here, she unpacks the paternal nature of the doctorpatient relationship, shifting to an association of equality and collaboration. She maintains that a doctor's communication skills are of utmost importance as their "words" are a great source of power. Northrup (1994) states, "The cloak of the shaman rests on [the doctors'] shoulders whether they realize it or not. Their words have the power to heal or to destroy" (p. 544). She offers an interesting assessment of the doctor's power over a patient while at the same time, encouraging women to acknowledge their own power in the relationship, the power to carefully select an appropriate doctor-partner and to ultimately choose which treatment works best. Northrup (1994) describes her own approach to working with patients as follows, "I'm very willing to work in partnership with them, sharing my expertise along with their faith" (p. 546).

Andrew Weil encourages patients to be active participants in their health care and harness their agency in the healing process. Like Northrup, Weil (1995) suggests that patients establish a healing partnership with health care professionals, finding a practitioner who "believes in you and in your ability to heal yourself, someone who empowers you in your search" (p. 250). He believes that a major role for the patient to assume is that of information gatherer, "ask questions, read books and articles, go to libraries, write to authors, ask friends and neighbors for ideas, and travel to meet with practitioners who seem promising" (p. 249). Here, he identifies a network of health care sources that a patient can consult beyond the biomedical community. He establishes a foundation for a system of care that creates a broader base of support than in medical science, thereby acknowledging and legitimizing the informal health care network that was a foundation of health care in the past and is encouraged by women's health groups. However, he warns that those patients that do seek help and information outside of the biomedical community will often be chastised for their difficult and noncompliant behavior.

CAM practitioners seek to replace the hierarchical nature of the biomedical model doctor-patient relationship with a relationship based upon feminist characteristics of cooperation, respect, and empowerment (Cavalcanti de Aguiar, 1998; Scott, 1998a). As stated earlier, the women's health movement and feminist critics have long argued for women's need to have empowerment over their bodies, especially during illness. Empowerment in the context of health care requires that women gain access to a variety of medical opinions and that they are able to make decisions about their treatment. Additionally, empowerment requires that women are treated as equals in the health care process, receiving validation for their opinions about treatment. The relationship that integrative practitioners describe meets this requirement, and in the process, offers a preferred alternative for women who view the biomedical model as disempowering.

Deus Ex Machina: From Body as Machine to Body in Balance

The seventeenth century introduction of modern medicine brought with it a belief in the mind-body split. Inspired by the writings of French philosopher Rene Descartes, medical practitioners viewed the body in a mechanistic model-the body as machine-and disconnected the body from the mind. In the process, the body came to be viewed as a machine that could, for example, be manipulated in the same manner that a technician repairs a clock. In her analysis of the contemporary biomedical model, feminist critic Sarah Nettleton (1995) states that this mind-body split continues to characterize the biomedical approach, stating that in this view "the body can be repaired like a machine; thus medicine adopts a mechanical metaphor presuming that doctors can act like engineers to mend that which is dysfunctioning" (p. 3). Other critics have identified the prevalence of the machine metaphor, stating that it results in an over reliance on technology to treat isolated parts of the body instead of examining the whole patient (Cavalcanti de Aguiar, 1998; Farquhar, 1996; Lupton, 1994; Martin, 1999; Osherson & AmaraSingham, 1981; Scheper-Hughes & Lock, 1987; Stein, 1990; Turner, 1984; Weitz, 2001). As feminist critic Emily Martin (1999) describes, this machine metaphor "depicts a body of the machine age . . . engaged in orderly assembly-line production on a rigid time schedule, divided into parts, each with a separate function" (p. 99). Osherson and AmaraSingham (1981) maintain that this conception of the body as machine ultimately results in the body being "reduced to component parts, there is no more to the 'whole' and we can exclude considerations of 'spirit' and 'psyche'" (p. 238).

CAM practitioners confirm this c\ritique, claiming that what is lost in this view of the body as machine is the mind and the role it plays in healing. Northrup (1994) maintains that

[o]ur culture and its addictive medical system believe that technology and testing will save us, that it is possible to control and quantify every variable, and that if we just had more data from more studies, we'd be able to improve our health, cure diseases, and live happily ever after. (pp. 9-10)

But she finds this reliance on technology to be lacking in that it misses a crucial piece of the puzzle-the role that the mind and emotions play in both health and illness. Northrup (1994) states, "Thoughts and emotions are mediated via the immune, endocrine, and nervous systems. They are biochemical events" (p. 23). When health care practitioners ignore thoughts and emotions and focus only on the structure of the body, they miss out on a major determinant of health and wellness-positive emotion. Weil also finds that this mechanistic model completely ignores the role of the mind in the healing process. He contends that because Western science is so focused on the material, Western health care providers tend to ignore any factor that cannot be touched, measured, or seen.

Ornish (1998b) asserts that the body as machine metaphor privileges the over reliance on technology in healing, which ultimately results in over medicalization and over treatment of patients. He maintains that the best "advances" in medicine are often as simple as lifestyle choices. He contends that a positive approach to care of the self will produce a healing patient but the body as machine does not acknowledge this "technology" of the mind. Ornish's work as a cardiologist led him to view the "body as machine" metaphor as an impediment to creating cardiac health. He believes that the common practice of bypass surgery is an example of the problem with so much of the biomedical model. Ornish (1998b) states that it was "like mopping up the floor around a sink that's overflowing without turning off the faucet."

Ultimately for Ornish, bypass surgery does not treat the underlying cause of heart disease because it is the quick fix approach; it is a quick cure that will not last. Ornish (1998a) finds that "efforts to contain medical costs that do not address the more fundamental lifestyle choices that determine why people become sick-rather than literally or figuratively bypassing them- inevitably result in painful choices" (p. 20). He argues that nothing in medicine is more powerful than the healing power of love and intimacy but allopathic medical practitioners believe only in what can be measured. Because doctors cannot measure love and intimacy they ignore it as a viable area of inquiry; they say it is touchy feely stuff. However, he believes that humans are emotional creatures and this cannot be ignored in the science of medicine. This is not to say that he would ignore the role of the body in the healing process. Rather, Ornish (1998a) asserts that medical research needs to acknowledge the inseparable connection between the mind and the body in scientific inquiry.

The heart is a pump that needs to be addressed on a physical level, but our hearts are more than just pumps. A true physician is more than just a plumber, technician, or mechanic. We also have an emotional heart, a psychological heart, and a spiritual heart, (p. 11)

Similarly, the BWHBC (1998) contend that the biomedical model's emphasis on the "body as machine" results in the medicalization of normal life events (e.g., giving birth, menopause) and an over reliance on technological solutions.

Because physicians are trained to look for problems and to respond with interventions like drugs, surgery and medical devices, we are often led to see our normal life events as full of potential problems and to accept [technological] interventions when they aren't necessary. (pp. 684-685)

They state that this medicalization, brought on by increased reliance on the technological fix, has severe material consequences, such as unnecessary hysterectomies and radical mastectomies.

Like the other two straw man metaphors, integrative practitioners posit that the body as machine metaphor dominates biomedical science. In so doing, they create a rhetorical space for this negative metaphor to be replaced with a positive metaphor, the balance metaphor. The balance, or gyroscope, metaphor is used to construct an image of the body as a system that integrates mind and body, searching for holistic approaches to maintaining wellness. Sociologists Deborah Lupton (1994) notes that alternative therapies "seek to recast the imagery of the body and disease . . . as 'natural,' as self-regulating and part of a wider ecological balance, with the words 'balance,' 'harmony,' 'regulate,' 'spirit,' and 'energy,' prevailing" (p. 128). The emphasis in this symbolic field is on preventive health care and the power of the individual to make positive choices that promote healing. These choices always include an engagement of the mind in the recovery process and a realization of one's relationship with the surrounding environment.

Yield and overcome;

Bend and be straight;

Empty the self and be full;

Wear out and be new.

Therefore the ancients say,

"Yield and overcome."

Be whole,

And all things will come to you.

(from the Tao Te Ching, as cited in Wilcox, Wilcox, & Suzuki, 2001, p. 179)

The above spiritual passage offers a clear illustration of the balance metaphor. This metaphor serves to counter the deus ex machina metaphor which structures a mechanistic and atomistic conception of the body. Andrew Weil describes this balance metaphor as one that acknowledges the natural condition of the body. Weil (1996) equates health to a "spinning gyroscope or a child's toy with a weighted bottom-the center keeps the balance." He goes on to extend this metaphor, likening the healing process to homeostasis:

The body follows the process of homeostasis, the same place. The body seeks a place for equilibrium. If you take a drug this disrupts the equilibrium. When the drug wears off, the problem is worse than before.

Weil (1996) believes that ultimately, "Health is the condition of perfect balance, when all systems run smoothly and energy circulates freely." Weil (1995) defines the word "healing" as "making whole . . . that is restoring integrity and balance" (p. 6). This idea of "restoring" health is important in integrative medical discourse for it supports the idea that the patient is always capable of returning to his or her natural state of wellness.

The BWHBC (1992) identifies bodily balance as one of the key assumptions of alternative medicine.

[W]e are healthy when our body/mind/spirit exist in a dynamically balanced state of well-being. Though we are physically made up of cells, tissues, organs, and so on, no parts of us can be understood as isolated entities; all interconnected, they are harmoniously related. (p. 80)

The authors of Our Bodies, Ourselves (BWHBC, 1998) suggest that women practice holistic health care practices such as meditation, yoga, and tai chi that quiet the mind and "renew the balance of body/ mind/spirit" (p. 108). While they describe the ultimate health benefits of these practices, slowing heart beat, lowering blood pressure, decreasing muscle tension, and decreasing the release of stress hormones, their primary purpose in urging women to turn to these health care practices is to bring the whole body into balance with the mind and spirit.

Similarly Wilcox, Wilcox, and Suzuki, authors of The Okinawa Program, rely heavily on the balance metaphor. They draw upon a variety of metaphoric vehicles from Taoism, the ancient religion practiced by many Asian cultures and becoming increasingly popular in the United States. For example, Wilcox, Wilcox, and Suzuki (2001) use the principle of yin and yang to describe the sympathetic (yin) and parasympathetic (yang) nervous system, stating that "[e]ach system works in tandem with the other, balancing and counterbalancing, matching the moves of the other in an intricate dance of opposites" (p. 242). The Taoist principal of yin represents everything dark, hidden, passive, receptive, cool, soft, and feminine while yang represents everything clear, bright, hot, illuminated, active, aggressive, controlling, hard, and massive. Yin and yang symbolize the complete system of opposites that constructs our world. Taoists believe that everything in our world is really a balance of yin and yang.

The Okinawa Program also stresses the principle of "chi" or life energy that promotes a balanced life in every aspect (spiritual, physical, psychological). Wilcox, Wilcox, and Suzuki (2001) laud the Okinawans for their "balanced lifestyle that is in tune with nature's way" (p. 7). Another example of the balance metaphor cluster can be found in the yuimaru vehicle as it applies to interpersonal relationships and one's state of health. Yuimaru refers to reciprocity-coming from the ancient Okinawan work-sharing practices-what you sow, you shall reap. In this ancient practice, all villagers helped with planting and harvesting crops in an interdependent relationship that was necessary for the survival of the culture. Wilcox, Wilcox, and Suzuki (2001) suggest that individuals practice the idea of yuimaru in their own relationships- what you give, you will receive-for their "studies and other significant research show that [it] not only help[s] to extend our lives but also seemfs] to offer protection from illness" (p. 8).

Like the message/gift metaphor, the gyroscope/balance metaphor creates a union between the mind and the body. This metaphor also extends the body into its surroundings, claiming that one's health is connected to the homeostasis one can maintain in her environment. The manner in which one handles stress, interpersonal relationships, even exposure to the news, becomes a way of maintaining a healthy balance in the \world. These metaphors function to create a symbolic connection between the mind and the body. According to this rhetoric, the body should no longer be disassociated from the workings of the mind; rather, the body should be seen as a channel of communication to the mind, urging individuals to examine the way they live their life and to change harmful behaviors, ways of thinking, and unhealthy relationships. This metaphoric shift is a direct challenge to the Cartesian mind/body split that separates bodily functions from emotional and cognitive systems. These CAM practitioners, like feminist critics of the biomedical model, argue that by disconnecting the body and the mind, we have overlooked a crucial source of information about personal illness and health and have fallen prey to the biomedical tendency to atomize the body into constituent parts.

Implications for Feminist Health Care: Shifting Metaphors, Shifting Relationships

This project explores the feminist texts of medicine used by integrative practitioners as they attempt structural transformation of the practices of mainstream medicine. I describe a rhetorical strategy consisting of identifying a series of straw man metaphors that CAM practitioners claim dominate the biomedical model. I illustrate how the metaphors of war, doctor as God or priest, and the body as machine are depicted as overly patriarchal and result in a negative symbolic influence on traditional medical practice.

While most of this rhetoric is not specifically identified with the feminist health movement, it does advance a social text that corresponds with the rhetoric of the women's health movement. Integrative practitioners purport that traditional medical practitioners use metaphors that are aggressive, paternal, and unemotional, all traits associated with masculinity (Bem, 1976; 1993). They maintain that the supposed use of these metaphors results in a patriarchal and hierarchical system of medicine that privileges a particular culture of medicine through regulation and institutionalization.

This integrative social text of illness operates as a feminist rhetoric in the health care movement. CAM practitioners critique the dominating elements of the biomedical model found not only in the priest-like status of physicians but also in the sacred nature of the scientific-technical model of modern medicine. In this manner, integrative rhetoric functions as a feminist intervention to the biomedical model. Through the use of straw man metaphors, CAM practitioners recontextualize the meaning behind the metaphors commonly associated with the biomedical model. They function as what Condit et al. (2002) describe as "conceptually structuring" metaphors that serve to impact the "way in which a particular set of topics are constituted within a given ideology, worldview, episteme, or discourse" (p. 321). When the straw man metaphors are replaced with metaphors characterizing CAM practice, they function to alter perception through Burke's (1984) notion of perspective by incongruity. The straw man metaphors are more familiar orientations to how we view medical practice. Popular discourse reflects the common belief that doctors "fight" our illness through technological (machine-like) means. When these straw man metaphors are compared to the replacement metaphors and symbols of CAM rhetoric, these meanings are dislodged and placed in a negative light. In other words, a person shifts her perspective on a medical practice because she is faced with an intervening symbol that causes her to think differently about her illness and her relationship with her health care providers and mainstream medical institutions. This juxtaposition of medical metaphors favors CAM philosophy and the potential patient sees that her illness is not an enemy that alienates her from her body but a gift that can help her make necessary changes in her lifestyle. The potential patient sees that she does not have to accept every suggestion made by her doctor but can work with health care providers to determine the best treatment for the illness.

These conceptual interventions have the potential to restructure medical experiences by creating a liberatory health practice. As individuals are persuaded by the metaphor clusters and begin to engage in integrative health practices, they begin to inhabit an embodied discourse. In other words, they perform the act of integrative health care. Their bodily practices become the sites of systemic intervention.

There are three primary symbolic "feminist interventions" that can be found in integrative medical discourse: 1) Feminization of Medicine, 2) Bodily Site of Contestation, and 3) The Body as a Project. First, Feminization of Medicine occurs through the rhetoric of the integrative approach, which suggests the need for a more "feminine" view of medical practice. It acknowledges the legitimacy of the private sphere in health care and it develops relationships of equality among health care professionals and between patients and health care providers. The rhetoric of integrative medicine also creates a significant place for the role of emotions in health maintenance. Downplayed in the biomedical model, emotions play a central role in the rhetoric of integrative medicine as practitioners suggest the patient pay attention to emotions as a source of information or "communication" about what is going on with his or her body. Additionally, CAM rhetoric encourages reintroducing medical treatment back into the private sphere of the home and lived experience. Because the patient plays a larger role in the maintenance of health and in the healing process, she relies less on formalized institutions, such as hospitals and corporate medical offices. These metaphors reinvision relationships among patients, health-care practitioners, and illness and in the process, realign relations of power.

Bodily Site of Contestation: Those who have joined the health movement seek to dismantle the monopoly that traditional Western medicine has on American medical p

Source: Women's Studies in Communication

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