"Your time or mine?" An anthropological view of the tragic temporal contradictions of biomedical practice

Abstract

The symbolic construction and use of time in health care is examined both in relation to social control of patients and to the power/powers accorded to and claimed by physicians. After reviewing classical medical sociology approaches of Zerubavel and Roth, it is suggested that an anthropological approach using concepts of disease, illness, and sickness and especially the last make it possible to produce a more adequate analysis. The cultural performance of sickness is seen in a framework of power, space, and time, and comparisons drawn between preindustrial and industrial patterns of healing (including Hahn's detailed ethnographic account of the practice of an internist in the United States). It is argued that medicine as it is at present practiced in industrial society inevitably requires health workers and especially physicians to distance themselves in time from the experience of their patients by taking the present-tense account of perceived illness (the history), which they initially share, and translating it into timeless, almost disembodied, disease. The physicians' special position in relation to time makes symbolically possible their control not only over patients' access to space and use of time but also over patients' autonomy in controlling the body and its boundaries. Finally, it is proposed that, although the contradiction arises from the theory and practice of biomedicine itself, the ability of health workers to overcome it is related to the extent to which the exercise of power within medicine reinforces (or is reinforced by) the ideology of the society in which it operates.