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The social and cultural legitimation of complementary and alternative medicine in cancer care : an ethnography Fryer, Margaret L.


This dissertation explores the question of how the legitimacy of different approaches to healing is socially and culturally constructed. Questions about the legitimacy of what has come to be called "Complementary and Alternative Medicine" or CAM have come to the forefront of both health policy and public discourses as the popularity of these non-biomedical approaches to healing has grown. The dissertation used an ethnographic approach to explore the complex issues related to the legitimation of CAM. This interdisciplinary research focused on the field of cancer treatment since a significant proportion of cancer patients use both conventional and unconventional treatments and since treatment decisions have important consequences. Fieldwork was undertaken in the Lower Mainland area of British Columbia over a period of three years. A total of 45 in-depth individual interviews were done with 17 cancer patients, six oncologists, three nurses who specialize in cancer care, and 11 professionals involved in CAM, including practitioners of traditional Chinese medicine, naturopathy, chiropractic, healing touch, and psychospiritual counseling. Eight people participated in more than one interview. A focus group with seven cancer patients was done to supplement the interviews. Participant-observation was done in a variety of relevant settings including a committee considering how to integrate CAM with conventional medicine, a healing group for patients, and public lectures, conferences, and events. Textual material from public media was analyzed. The dissertation uses the results of the fieldwork, particularly the experiences of patients, to formulate a model that elucidates the processes whereby emerging cultural models are linked with personal experience to form situated meanings about legitimacy that take root through social practices. The dissertation argues that underneath the growing use of CAM lie important changes in the way people are thinking about the nature of the body, the nature of health and healing, and relationships between patients and health care providers. In addition, the use of CAM is associated with the adoption of epistemologies that undermine the hegemony of scientific rationality. The implications of these findings for health care policy, practice, and research are discussed.

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