Many argue that we live in society permitting medical care overuse, one of a “Might Help, Can’t Hurt” mindset towards medication and medical procedures. Headaches warrant hospital visits, a bruised arm needs a splint, etc. A recent article in The Atlantic discusses what they call a current “epidemic of unnecessary and unhelpful treatments.” The article states, “Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver.”
For example, many patients with knee problems want, even demand, that they receive an arthroscopic partial meniscectomy, or APM. APM has recently become one of the most popular surgeries nationwide, despite the fact that it is often referred to as a “sham surgery” and is as effective on average as physical therapy alone. “According to interviews with surgeons,” writes David Epstein, “Many patients they see want, or even demand, to be operated upon and will simply shop around until they find a willing doctor.”
Perhaps Claude Levi-Strauss can provide an explanation for this phenomenon. In “The Effectiveness of Symbols,” Levi-Strauss explains the power of convention and symbol in medical procedures. He discusses a birthing ritual in which a shaman talks their patient through the birthing process in terms of an ancient song involving monsters and a plethora of magical elements. Levi-Strauss’ main argument here is that the song evokes a psychological response which allows his patient to relax. Once relaxed the childbirth goes easier. Specifically the myth works on the imagination to produce a psychological and physiological response; “the song constitutes a psychological manipulation of the sick organ and it is precisely from this manipulation that a cure is expected” (192). The incoherent and arbitrary pains of the patient’s situation are put into a comprehensible and meaningful framework that the patient can deal with. Therefore myth is a concrete interpretation or representation for a more abstract concept.
Modern medicine is a current example of this system of meaning. While the vast majority of medical procedures are scientifically proven as effective, plenty of placebo-based treatments also exist (one notable example is the treatment of warts). Like the shaman’s ritual, these treatments find their effectiveness from the patient’s belief in this system of meaning. Similarly, as noted above, many people seek unnecessary medical procedures based on their faith in and dependence on medical treatment itself, and we can see examples of this practice in the areas of weight loss and mental illness.
The National Institute of Diabetes and Digestive and Kidney Diseases report that about 70% of the US population is either overweight or obese. This number is rising. The system of meaning regarding weight loss that Americans live under is that of diet and exercise. Psychology Today referred to this as the “obesity myth.”
Diet and exercise have mixed results in overall effectiveness. Some say bariatric surgery or medication is the only solution others say psychotherapy and meditation is the answer. The New York Times published an article arguing that diet is more efficacious in weight loss than exercise. However, exercise magazines suggest that exercise is as important as diet. There are mixed results on validity of every claim. Nothing is the absolute ‘answer’ to the obesity problem. A Harvard doctor even cited over 59 types of obesity. The subjectivity of weight loss creates a fundamental problem in the system of meaning. What force or action can we subscribe to if the accepted solutions are subjective?
In the United States, there is also the myth that “money” can solve any problem. The combination of the myths surrounding weight loss and the broader cultural myth of the efficacy of money gives rise to weight loss programs that creatively combine the different methods in an attractive structure. The data behind the individual methods doesn’t matter. The social view of these programs is the importance. On the sites of these weight loss programs are pages and pages of testimonials; there is the illusion of social consensus.
So, how can all of these programs and methods have efficacy? Every method has positive testimonials and reviews. The subscription to these subjective methods can be attributed to mythology. Myths, according to Levi-Strauss “confront the student with a situation which at first sight appears contradictory. On the one hand it would seem that in the course of a myth anything is likely to happen. There is no logic, no continuity” (208). There is a problem that contradicts the system of meaning. So, the bricoleur pieces and constructs a resolution to that contradiction using the system of meaning itself. We can see direct parallels between the Levi-Strauss’ myths and weight loss programs.
Programs like Jenny Craig combine the bundles of relationships provided by the system of meaning to resolve the contradiction in that system. Jenny Craig is not cost-free, so it utilizes the myth of the efficacy of money. It is also a comprehensive program that includes both diet and exercise and psychological motivation to solve the individual’s obesity.
The comprehensive programs point to interesting facets of modern American mythos. Jenny Craig bricolages the different relationships of exercise and weight loss, diet and weight loss, motivation and weight loss, and the efficacy of money to convince people of the validity of the program. The testimonials and the website and reviews online have many positive reviews as well. This exemplifies the Levi-Straussian view of myths, “The true constituent units of a myth are not the isolated relations but the bundles of such relations, and it is only as bundles that these relations can be put to use and combined so as to produce a meaning” (Strauss, 211). None of the methods have individual efficacy, as does the program as a whole. Jenny Craig is just one example of modern businesses using the modern American mythos and system of meaning to promote and sell a product.
Jenny Craig “understands” because she is able to use the Levi-Straussian bundles of relationships to create an efficacious system.
Modern systems of meaning related to disease and its diagnosis and treatment are not limited only to physical aspects of the individual’s body, but are extended to emotional aspects as well in the realm of mental health. The New York Times recently published an article titled “Is a Teen Depressed, or Just Moody?” The author of the article, a pediatrician, advises that “it’s important for parents to be aware of the risks, both for children who are already struggling with mental health issues, and for those who may not yet have given their feelings a name.” This quote reveals a lot about the way modern American society views mental illness. This is a society which subscribes to a system of meaning that recognizes that individuals experience different “feelings” and that certain feelings are normal and to be expected while certain feelings are out of the ordinary and worthy of being “given a name.”
The article acknowledges that there exists a degree of murkiness in the distinction between feelings considered to be normal and feelings that constitute a medical condition that necessitates treatment. This fact can be seen from the title of the article. While some teens are “depressed” and therefore in need of treatment, some teens who experience similar feelings are simply “moody” and do not need treatment. The title suggests not only that it is difficult to distinguish between the two, but that it is vital to distinguish between the two, because feelings worthy of being given a name necessitate certain steps that must be taken in service of treatment. The article quotes a doctor who laments that “a lot of children and adolescents have psychiatric problems that are not recognized by parents and they go untreated as a result.”
Within this framework, it is held as important that certain emotions be recognized and given a name. And once these feelings are given a name, certain practices (perhaps rituals?) are prescribed. The article says that once parents have recognized that their teen is depressed, the next step is usually to “bring your child to a counselor or psychiatrist.” Once again, similarly to how Levi-Strauss describes it, the effectiveness of these practices requires the patient’s subscription to certain systems of meaning. The patient must first believe that there is such a thing as depression and that certain feelings are normal and certain feelings are abnormal and constitute a condition worthy of being treated. Second, they must believe that this treatment – often not a physical medicine but a ritual practice, such as talking to a psychiatrist – is an effective way of treating this condition.