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Transcript of In a Dark Place: How Fibromyalgia Avoids the Physician’s Gaze
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In a Dark Place: How Fibromyalgia Avoids the Physicians Gaze
By James Wallace Mischke
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____________, also known as the invisible syndrome, what is it and how does
it defeat the clinical gaze of the physician? What does this inability to see and thus treat
the disorder say about contemporary medical practice?
____________ is a chronic pain and fatigue syndrome that causes moderate to
severe pain localized around specific areas in the muscles and connective tissues such as
ligaments, tendons, and joints, as well as chronic persistent fatigue. This invisible
syndrome affects about 2% of the population, or roughly five million people, with the
majority of those afflicted overwhelmingly women.1
It has been often confused with or
considered a form of arthritis due to the amount of soreness and stiffness which the
patient has reported experiencing however no evidence connecting ____________ with
any of the causes of rheumatic disorders/diseases has ever been found.2
There are no
visible abnormalities or physical disfigurements that mark the sufferer. "[It] has been
called the invisible [syndrome] because you cant look at someone and tell if he or she
has [it]."3Not much is known about the disorder yet the condition has been written about
and identified as early as the 1800s. Between 1816 and 1824 a physician at the
University of Edinburgh, Dr. William Balfour, first fully described the syndrome and also
designated the eighteen tender points used to diagnose the illness.4There are no routine
laboratory tests or xrays that show abnormalities diagnostic of [the disorder]. A
physician's diagnosis of [the affliction] is based on taking a careful history and finding at
least 11 of the 18 characteristic tender points. Characteristic tender points cluster in
regions around the neck and shoulders, the upper chest wall, and the lower back. Because
additional symptoms often occur simultaneously with [the syndrome], further diagnostic
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studies may be needed to identify concomitant conditions. Frequently misdiagnosed, it is
often confused with myofascial pain syndrome, hypothyroidism, rheumatoid arthritis,
chronic fatigue syndrome, and systemic lupus erythematosus, any of which may occur
concomitantly with [the condition].5
So, the affliction, as yet, can-not be defined but is
instead interpreted and designated as a physical disorder/disease by its symptoms:
widespread body/muscle pain, an over stimulation of the pain processing centers of the
nervous system, chronic fatigue, and in addition is comorbid with psychological distress
disorders such as depression, anxiety, and post-traumatic stress disorder.6
To describe and begin to understand ____________ first let us examine the
disease/non-disease by analyzing its name Fibro/my/algia. The term itself is a
combination of Latin and Greek words which are a definition of its symptoms but not a
designation of classification of what it is such as diseases like arthritis or diabetes, for
example. The prefix Fibro is from the Latinfibra referring to fiber(s) or thefibrous
muscles of the body.7
The termfiber can also refer to the essential basic structure or
essence of a thing which in the connotation of the description of a syndrome that affects
the body is appropriate since the sufferer feels pain throughout their body, in every fiber
of their being, not just at a physical level but also at a mental and emotional level as
well...people with [this condition] dont just have ____________ [individuals] with
[the disorder] also have higher rates of psychiatric illness than the general population.8
Further inspection of the word fiber also alludes to a substance formed of fibers, or
able to be spun, woven, etc.9
such as cloth or paper. The pain and psychological angst
experienced by the afflicted individual is written across their face, upon their body, much
in the same way a text is written across a page and it is the disease(s) that serve as the
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text: the patient is only that through which the text can be read.10
The root my is Greek
in origin from the word myo ormus which means muscle.11
In English my is the
possessive form of the word self which defines the subjective element of the disease,
the self, the patient, the corporeal body of the individual which is comprised of living
tissue, of flesh ormusclefiber(s) that the prefix fibro pertains to. The suffix algia is
also of Greek origin denoting pain, from the [Greek] word algea.12
Algea offers further
connections of reference in its definition aside from pain, for in Greek mythology the
Algea were the spirits (demons) of pain and suffering (of both body and mind), grief,
sorrow and distress. They were the bringers of weeping and tears.
13
The ____________
patient experiences physical pain, suffers from fatigue, feels grief because of the loss of
their health and mobility, sorrow over the effect of the condition on their lives, and is
distressed by the fact that there is little to no help for their disease/non-disease. So, what
can be inferred from the term as presented? ____________, then, literally means
fibrous-muscle-pain or pain in/of the fibrous muscles, on the other hand - whats in a
name? According to Michel Foucault, in his archaeology of the modern medical
institution The Birth of the Clinic, the gaze that traverses a sick body attains the truth
that it seeks only by passing through the dogmatic stage of the name, in which a double
truth is contained: the hidden, but already present truth of the disease and the enclosed
truth that is clearly deducible from the outcome and the means. So, it is not the gaze itself
that has the power of analysis and synthesis, but the synthetic truth of language, which is
added from the outsideIn this clinical method, in which the density of the perceived
hides only the imperious and laconic truth that names, it is a question not of examination,
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but of a deciphering.14
The name, then, itself is meaningless and is instead a listing of
the symptoms of the illness. It is not a classification of the disorder or a definition.
How does one define and categorize something that is unknown, that is invisible
to the eye, that can be only described in a subjective manner by those whom are afflicted
with the syndrome? ____________ is felt by the patient. Its symptoms are acute pain and
chronic fatigue, subjective states of being, of experience that can only be related to the
physician by the individual affected but not shown. There is no physical abnormality or
physiological trait inherit to the disorder that can yet be seen or detected by a physical
exam, in an X-ray, CAT scan, blood test, or in the cell under a microscope. How do you
quantify and describe something that can not be seen, can not be measured? The first
step is to measure whatever can be easily measured. This is ok as far as it goes. The
second step is to disregard that which can't be easily measured or to give it an arbitrary
quantitative value. This is artificial and misleading. The third step is to presume that what
can't be measured easily really isn't important. This is blindness. The fourth step is to say
that what can't be easily measured really doesn't exist. This is suicide.15
What then does
this suggest in regards to the syndrome? Since it can not be seen, can not be detected
aside from its symptoms, many within the medical community at first believed that there
was no disease or disorder present in the individual. In the article____________: Is
____________ Real? by Gina Shaw, Shaw cites the example of a neurologist and his
encounter with a patient presenting ____________ type symptoms. Like many of his
colleagues, John Kissel, M.D., used to think that [the illness] wasn't a real condition. Dr.
Kissel, a neurologist and the co-director of the MDA/ALS Center at Ohio State
University, thought it was a wastebasket diagnosis-a dumping ground for malingering,
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drug-seeking patients with unexplained pain, fatigue, and depression. Then he saw
patients that began to change his mind. He still remembers one woman in her 40s, a
professional trial attorney from Columbus, OH. She had developed debilitating fatigue
and horrible muscle pain and tenderness about a month after getting over a mild case of
the flu. After performing a number of tests, I went in to speak with her and mentioned
____________, Dr. Kissel recalls. She asked, 'What's that?' I said, 'You haven't heard of
[it]? People are talking about it all over the place.' She said to me, 'I work 14 hours a day
as a trial attorney-I don't do outside reading.' She wasn't depressed. She was still working.
But she had all the typical symptoms of [the disorder]. That was a formative experience
in my thinking about the condition.16
Dr. Kissels example illustrates a view held by
many in the medical establishment at the time.
Modern medicine is predicated on the gaze of the attending physician. The sense
of sight is central to medical theory and medical practice. Practitioners are looking when
they are taught anatomy, when they examine patients, when they diagnose illness, when
they operate and when they perform post-mortems.17
If it can not be seen, can not be
measured, categorized, classified, then (in the eyes of the physician and the clinic) there
is no disease present. The individual with ____________, however, is ill, is sick. All the
symptoms of a disease, a disorder, are present and can be related and described by the
patient. Physicians can see the affects of the disorder in the behavior of the afflicted
person, can see the loss of mobility, the pained expression on the face of the patient and
in their body language. The physician can hear or read the effects of the disease on the
patients daily life, how their actions are restricted, how certain aspects of life are
delineated due to the disorder, work is difficult or impossible, fatigue is chronic because
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the sufferers sleep is disturbed, weakness of the muscles persist as a result of lack of
healthy sleep and acute pain. Social interactions are strained because the individual with
the disease often does not feel well enough to engage in the normal social activities
previously enjoyed by them. The loss of productivity, of work and income, of normal
human interaction, this sense of loss is felt acutely by the sick person and leads to
depression, anxiety, and other stress related psychological disorders. doctors have
known for a long time that having [this illness] means that patients are at a higher risk for
other medical conditions many of them psychiatric.18
The patient with ____________ is sick, physically and psychologically, that much
is obvious. The symptoms of a disorder are present which signal the presence of a
disease. The symptom is the form in which the disease makes itself manifest in or on the
body. The sign (signaled event) is the way that which the disease is announced or
translated, what is happening in the body, what has happened, and what will happen. The
sign is also the textual or linguistic representation of the phenomenon, the linguistic
structure within which the disease is interpreted and thus subject to the diagnostic,
prognostic, and predictive gaze of the physician. The symptom + the sign = the disease.19
To the exhaustive presence of the disease in its symptoms corresponds the unobstructed
transparency of the pathological being with the syntax of a descriptive language: a
fundamental isomorphism of the structure of the disease and of the verbal form that
circumscribes itin clinical medicine, to be seen and to be spoken immediately
communicate the manifest truth of the diseaseThere is disease only in the element of
the visible and therefore stateable.20
However, in the individual with ____________, the
sign is absent or at the very least incomplete and lacking because the cause of the
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disorder and its mechanisms are, as yet, not known. Only the symptoms are visible to the
gaze of the physician. What is happening to the body of the patient, what has happened,
what will happen (outside the symptoms themselves) is unknown and thus can not be
stated. The patient then is sick and not sick, diseased/non-diseased, healthy and unhealthy
at the same time in the eyes of the physician and clinical medicine. They exist in a place
in space and time between healthy, for no disease can actually be detected, and unhealthy
because the symptoms of a disease are present and apparent. This state disrupts and
defeats the medical gaze of the doctor, circumvents the clinical investigative and
diagnostic prowess of contemporary medicine. According to philosopher and critical
theorist Jacques Derrida ____________, then, is an undecideable, caught in between the
oppositional states of healthy and unhealthy, either/or. The patient is both sick and not
sick. In the same regard, the individual with this disorder is neither diseased nor healthy
yet displays traits of both but can not be decided. Having both states, it has neither. It
(____________) belongs to a different order of things: in terms of [diseased] and [non-
diseased], it cannot be decidedThe terms [diseased] and [healthy] form a binary
opposition: a pair of contrasted terms, each of which depends on the other for its
meaning. There are many such oppositions , and theyre all governed by the distinction
either/or. If we accept this, it establishes conceptual order. Binary oppositions classify
and organize the objects, events, and relations of the world. They make decisions possible
and they govern thinking in everyday life, as well as philosophy, theory, and the sciences.
Undecideables disrupt this oppositional logic. They slip across both sides of an
opposition but dont properly fit either. They are more than the opposition can
allowthey show where classificatory order breaks down: they mark the limits of
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order.21
This limit of order which has been reached is the point at which the
physicians gaze can not penetrate the concealed truth of the disease/disorder. Unable to
see beyond the symptoms, the gaze is rendered impotent.
As stated previously, modern medicine is predicated on the gaze of the attending
physician. For the last two centuries the empirical method based on vision has been
rigorously developed and institutionalized. It has further been amplified and focused by
the development of technologies devoted to strengthening the sight of the physician, from
the introduction of the microscope, to the X-ray, and the CAT scan, to name a few. The
previous mode of primary sensory based medical examination and diagnosis has been
replaced by a greater dependence on these technologies which has resulted in a
diminished subjectivity in medicine and led to a more objective and standardized
application of medical knowledge in regards to the human body and disease. This has
allowed information to be more widely understood and communicable by the medical
community while at the same time This has produced important consequences for
medicine, including changes in the ways in which illness is perceived and understood by
the doctor; in the ability of patients to present and have analyzed the full range of
problems and requests they may have; and in the future standing of the physician and
medicine.22
____________ is a purely subjective syndrome, the physicians reliance on
the gaze and technology that reinforces the attending doctors sight has not allowed the
physician to see the disorder at work within the body of the patient nor the trigger, the
catalyst, which is the cause of the disease. All that is available is the individuals
biography, their personal history in regards to the disease/disorder, The patients story, a
medical biography, [is] a tapestry woven of events subjectively experienced. It contain(s)
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the patients feelings produced in the body by the illness, and the patients wants and
hopes.23
As a basis of insight, the patients story is of great importance in understanding
a disease that otherwise can not be quantified or measured using existing methods and
technology. However, as a foundation for scientific exploration and knowledge, the
individuals self report is not the ideal format of investigation because for doctors [it is]
often a biography of truths and half-truths, exaggeration and belittlement. It [is] for them
evidence they [cannot] usually verify.24
Unfortunately, there is not much else for the
physician to base their analysis on aside from a disparate gathering of random data and a
collection of as yet unproven theories.
One theory on the cause of____________ is that the body of the individual
afflicted with the syndrome is stuck in the flight or fight response. The body, due to
some form of infection or traumatic event, thinks it is under duress, in the presence of a
threatening stimulus, a part of the brain regulates the metabolic and autonomic functions
to prepare the muscles for any subsequent violent action, i.e. to either run away or fight.
Example of an autonomic reaction is the increased release of adrenaline in the body and
some of the physical manifestations include increased blood pressure and heart rate (as a
result of higher concentrations of adrenaline in the body).25
The body was not meant to
operate in this capacity for more than a few brief moments at a time and so the symptoms
experienced by the patient is the bodys reaction to an abnormal prolonged physical state.
Supportive evidence for this theory is lacking and unproven. A second theory is that there
is a chemical imbalance in the body, such as a serotonin, dopamine, or hormone
deficiency, which results in the patient developing the syndrome.26
There is no definitive
evidence to substantiate this hypothesis. Another theory put forth by neurological
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researchers working in conjunction with rheumatologists is the result of brain scans
showing abnormalities in blood in the brain (also called brain perfusion) of patients with
____________. Researchers took images of patients with the disorder using a technique
called single photon emission computed tomography (SPECT) and compared them with
individuals without the condition and found that patients with ____________ exhibited
brain perfusion abnormalities in comparison to the healthy participants. These
abnormalities corresponded with the severity of the disease. An increase in blood flow
was found in areas of the brain involved in sensing pain and a decrease was found within
an area thought to be involved in emotional responses to pain.
27
This theory too has not
been proven, only documented, its correlation with the condition is dubious and
undecided. Is the abnormal blood perfusion in the brain the cause of the illness or another
symptom of the disease/non-disease? All the theories discussed can be broached this
same inquiry, are the phenomenon detected the cause of the disorder or just another
symptom of the syndrome? Is the prolonged flight or fight response, the chemical
imbalance, or the abnormal blood perfusion in the brain the trigger mechanism of the
condition, and if so, what causes these irregularities themselves? These are forms of the
undecideable nature of ____________ and offer nothing in regards to understanding the
disorder but more questions without answers. Without an answer, without being able to
decide what these signs point to and mean, there can be no knowledge gained and no
hope for a treatment or cure. This has not prevented physicians from attempting various
therapies nor deterred pharmaceutical manufacturers from marketing various drugs as a
treatment for ____________.
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Currently, treatments for the condition are as various as the symptoms of the
disorder itself. Most physicians agree though that since ____________ is a multi-faceted
syndrome, the best approach to treating the patient is with a varied therapy regimen
which includes life-style changes such as healthier eating and sleeping habits and a
reduction in environmental stressors, physical therapy, and medication to reduce pain,
alleviate depression and anxiety, and regulate restorative sleep patterns.28
The benefits of
any one of these treatments to the afflicted is debatable since the disorder is not fully
understood. It is unknown how or why any of these therapies improve the symptoms of
the patient. For example, there is no proof that better eating habits, improved sleep, or the
elimination of negative environmental factors benefit the individual with the disorder
aside from the increased over-all health of the individual. Even normal healthy people
could use more restful sleep, a better diet, and a reduction in pollutants in their lives. In
regards to physical therapy, there is little evidence besides the anecdotal that physical
therapy helps a patients symptoms. In a society where one third of the population is
over-weight, physical activity would benefit most Americans regardless of whether they
suffer from ____________ or not. Also, physical therapies such as massage or
acupuncture only offer a short respite from the symptoms themselves. Physical therapy
for the patient must also be carefully monitored so as not to aggravate the symptoms
further since it has been shown that physical activity can increase the muscle pain and
inflammation in the individual. Pharmaceuticals, particularly pain-killers (analgesics) and
anti-depressants, are also commonly prescribed to the ____________ patient. These
medications, although beneficial in the relief of pain and suffering, are not curative and
do nothing more than mask the symptoms of the disorder and come with their own inherit
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dangers. Pain-killers, especially narcotics, have many side-effects including and not
limited to constipation, respiratory depression, nausea, vomiting, drowsiness, dizziness,
weakness, dry mouth, confusion, difficulty urinating, and itching.29
Pain-killers can also
lead to dependence (addiction), result in liver and kidney damage, and have the potential
for over-dose and death. The side-effects for anti-depressants are similar and can also
include other possibly dangerous secondary effects. Take for example the now commonly
prescribed treatment for ____________ Milnacipran, in rare cases, certain other side
effects may occur with drugs like milnacipran, including: hypnoatremia (a lowering of
the level of sodium in the bloodstream), convulsions/seizures, excessive bruising or
bleeding, a lowering of the white blood cell count,sexual dysfunction, and serotonin
syndrome.30
Serotonin syndrome itself is a potentially fatal complication that can result
from taking anti-depressants like Milnacipran. Serotonin syndrome occurs when you
take medications that cause high levels of the chemical serotonin to accumulate in your
body. Serotonin syndrome can occur when you increase the dose of such a drug or add a
new drug to your regimen. Certain illicit drugs and dietary supplements are also
associated with serotonin syndrome. Serotonin is a chemical your body produces that's
needed for your nerve cells and brain to function. But too much serotonin causes
symptoms that can range from mild shivering and diarrhea to severe muscle
rigidity, fever and seizures. Severe serotonin syndrome can be fatal if not treated.31
In
addition, the benefits of treating the disorder with anti-depressants is deceptive.
____________ and depression share some similar symptoms such as fatigue, insomnia,
and body aches and pains. Depression is also a concomitant condition often
accompanying and a result of having the syndrome. When a person suffering from
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____________ is prescribed and takes anti-depressants, it relieves their depression and its
accompanying properties which the patient (and attending physician) misinterprets as
affecting an improvement in the symptoms of the disease. This is misleading and
prevents a true understanding of the syndrome by creating false connections between the
condition and the actions of the drug, leading the physician or researcher down a path
away from the true nature of the disease/disorder. How can one treat a disease/disorder
with drugs when the cause of and operative function of the disease/disorder is unknown?
Doctors prescribe medications for a condition they have very little insight in to and which
they have no idea how the drug acts upon the disease/disorder, this is irresponsible. This
is not to say that these various treatments do not provide some benefit to the patient for
any relief is a boon to the individual and can greatly improve their quality. However, the
physician and medical researcher must not be distracted or mislead by erroneous
associations between the effects of a therapy and/or drug on a disease that is of unknown
origin and action. These therapies are/can be a strain on the already limited resources
(physical, psychological, financial, and spiritual) of the patient and can lead to false hope
on the part of the afflicted and the physician.
The disease/non-disease ____________foils and defeats the clinical gaze of the
physician by thwarting any attempt at the detection of the mechanism of its cause within
the body by the investigative and analytical eye of the doctor. The technologies utilized
by the contemporary medical practioner serve only to augment the gaze but do not on
their own offer any insight into the syndrome itself. Since the disease can not be seen
(aside from its symptoms), can not be measured, quantified, described, nor explained then
hopes for a successful treatment or a cure are not possible. The current modes of
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investigation and analysis are not yielding positive results in knowing and understanding
the disorder, so then perhaps it would be best to start over from the beginning by
returning to a more subjective form of inquiry and an archeological based dissection of
the personal history of the patient. Hidden somewhere in the biography of the
____________ patient is the cause of the disease/disorder and once identified then the
gaze of the physician and its accompanying technologies can be focused upon it and yield
the answers that the patient and the physician so desperately desire.
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Notes
1. Centers for Disease Control and Prevention,Fibromyalgia,
http://www.cdc.gov/arthritis/basics/fibromyalgia.htm.
2. Sherron M. Stonecypher, Fibromyalgia Symptoms,Fibromyalgia:Resources for
Families, Lewis and Clark College, http://legacy.lclark.edu/~sherrons/symptoms.htm.
3. M. J. Pellegrino, The Fibromyalgia Supporter, (Columbus, Ohio: Anaden Publishing,
1997), 8.
4. Karen Lee Richards, History of Fibromyalgia, ChronicPainConnection.com, Health
Central, http://www.healthcentral.com/chronic-pain/fibromyalgia-287647-5.html.
5. D.L. Goldenberg, Controversies in Fibromyalgia and Myofascial Syndrome,
Evaluation and Treatment of Chronic Pain, ed., G.M. Arnoff, (Baltimore, Maryland: Williams
and Wilkins, 1992), quoted in Sherron M. Stonecypher, Fibromyalgia Symptoms,
Fibromyalgia: Resources for Families, Lewis and Clark College,
http://legacy.lclark.edu/~sherrons/symptoms.htm.
6. Dan Buskila, Comorbidity of Fibromyalgia and Psychiatric Disorders, Current Pain
and Headache Reports 11, no. 5 (2007): 333-338.
7. Fiber.Dictionary.com. Collins English Dictionary Complete and Unabridged 10th
Edition. Harper Collins. http://dictionary.reference.com/browse/fiber.
8. Generva Pittman, Fibromyalgia comes with a suicide risk: study,Reuters Health,
July 16, 2010, http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-
idUSTRE66F3JJ20100716.
http://www.cdc.gov/arthritis/basics/fibromyalgia.htmhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://www.healthcentral.com/chronic-pain/fibromyalgia-287647-5.htmlhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://dictionary.reference.com/browse/fiberhttp://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://dictionary.reference.com/browse/fiberhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://www.healthcentral.com/chronic-pain/fibromyalgia-287647-5.htmlhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://www.cdc.gov/arthritis/basics/fibromyalgia.htm -
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9. Fiber. Dictionary.com. Collins English Dictionary Complete and Unabridged 10th
Edition. Harper Collins. http://dictionary.reference.com/browse/fiber.
10. Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perception (New
York: Vintage Books Edition, 1975), 59.
11. Fiber. Dictionary.com. Collins English Dictionary Complete and Unabridged 10th
Edition. Harper Collins. http://dictionary.reference.com/browse/fiber.
12. Ibid.
13. Aaron J. Atsma, The Theoi Project: Greek Mythology,
http://www.theoi.com/Daimon/Algea.html.
14. Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perception (New
York: Vintage Books Edition, 1975), 60.
15. Charles Handy, The Empty Raincoat, (New York: Hutchinson, 1994), as quoted in
The McNamara Fallacy, Wikipedia The Free Encyclopedia, Wikimedia Foundation Inc.,
http://en.wikipedia.org/wiki/McNamara_fallacy.
16. Gina Shaw, Fibromyalgia: Is Fibromyalgia Real?,Neurology Now, American
Academy of Neurology,
http://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&artic
le=00024&type=fulltext.
17. Ludmilla Jordanova, The Art and Science of Seeing in Medicine, inMedicine and
the five senses, ed. W.F. Bynum and Roy Porter (New York: Cambridge University Press, 1993),
122.
http://dictionary.reference.com/browse/fiberhttp://dictionary.reference.com/browse/fiberhttp://www.theoi.com/Daimon/Algea.htmlhttp://en.wikipedia.org/wiki/McNamara_fallacyhttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://en.wikipedia.org/wiki/McNamara_fallacyhttp://www.theoi.com/Daimon/Algea.htmlhttp://dictionary.reference.com/browse/fiberhttp://dictionary.reference.com/browse/fiber -
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18. Generva Pittman, Fibromyalgia comes with a suicide risk: study,Reuters Health,
July 16, 2010, http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-
idUSTRE66F3JJ20100716.
19. Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perception (New
York: Vintage Books Edition, 1975), 91-92.
20. Ibid., 95.
21. Jeff Collins and Bill Mayblin,Introducing Derrida (New York: Totem Books, 1996),
16-21.
22. Stanley J. Reiser, Technology and the use of the senses in twentieth century
medicine, inMedicine and the five senses, ed. W.F. Bynum and Roy Porter (New York:
Cambridge University Press, 1993), 262.
23. Ibid., 263.
24. Ibid., 263.
25. Biology Online,Fight or flight response, http://www.biology-
online.org/dictionary/Flight_or_fight_response.
26. WebMD,Fibromyalgia Guide,
http://www.webmd.com/fibromyalgia/guide/fibromyalgia-causes.
27. Caroline Wilbert, WebMD,Fibromyalgia a Real Disease, study shows,
http://www.webmd.com/fibromyalgia/guide/fibromyalgia-causes.
http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.biology-online.org/dictionary/Flight_or_fight_responsehttp://www.biology-online.org/dictionary/Flight_or_fight_responsehttp://www.webmd.com/fibromyalgia/guide/fibromyalgia-causeshttp://www.webmd.com/fibromyalgia/guide/fibromyalgia-causeshttp://www.webmd.com/fibromyalgia/guide/fibromyalgia-causeshttp://www.webmd.com/fibromyalgia/guide/fibromyalgia-causeshttp://www.biology-online.org/dictionary/Flight_or_fight_responsehttp://www.biology-online.org/dictionary/Flight_or_fight_responsehttp://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716 -
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28. Sherron M. Stonecypher, Treatment of Fibromyalgia,Fibromyalgia: Resources for
Families, Lewis and Clark College, http://legacy.lclark.edu/~sherrons/treatment.htm.
29. Health.com., Tips for Managing the Side-Effects of Narcotic Painkillers,
http://www.health.com/health/condition-article/0,,20189463,00.html.
30. Forest Research Institute, Information and Consent Form, March 14, 2008, 6.
31. The Mayo Clinic Staff, Mayoclinic.com, Serotonin Syndrome: Definition,
http://www.mayoclinic.com/health/serotonin-syndrome/DS00860.
http://legacy.lclark.edu/~sherrons/treatment.htmhttp://www.health.com/health/condition-article/0%2C%2C20189463%2C00.htmlhttp://www.health.com/health/condition-article/0%2C%2C20189463%2C00.htmlhttp://legacy.lclark.edu/~sherrons/treatment.htm -
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