The Social Construction of Fibromyalgia "With so many people in so much pain, how could fibro myalgia not be a disease?" (Groopman 3) This question regarding the "condition of persistent muscle pain throughout the body, pain that is often accompanied by severe fatigue, insomnia, diarrhea and abdominal bloating, bladder irritation, and headache," now known as fibro myalgia raises some rather interesting yet complicated issues in today's health care field such as: What criteria must be met in order for a symptom or a set of symptoms, as is the case here, to be classified as an illness or a disorder? What does the term illness itself mean? What makes up the concept of health? In this paper, I attempt to tackle these questions by examining the process of the social construction, the, and the medical uncertainties surrounding fibro myalgia. I will first discuss the process of social construction, or the development of a condition as a disorder, also discussing who the key actors in the process are and how everyone involved in the process is affected. Second, I will analyze the process of, or how a set of symptoms comes to be known as a disorder, complete with treatment and all, of fibro myalgia over the years. Third, I Mohamed 2 will look at the medical uncertainties, or doubts about knowledge and treatment, regarding fibro myalgia.

Last, I will discuss the possible explanations that have been given to explain fibro myalgia in patients by physicians who are opposed to the disorder. The term fibro myalgia was introduced in 1990, and since then almost six million Americans, ninety per cent of them being women, have been diagnosed as living with the disorder. Physicians are not sure of the exact cause of the illness, but many of the cases are reported immediately after a traumatic event (Groopman 3). Another puzzling issue here is the absence of any muscular inflammation in the complaining patient or the presence of any abnormal laboratory test results or X-rays.

So is it possible for six million patients to be "fooling" physicians? You might have another illness of your own requiring another one of these papers if you " re even considering that absurd idea! Let us begin by defining illness and health. "Modern medicine is based on and dominated by concepts, methods, and principles of the biological sciences... The dominant model of disease today... assumes disease to be fully accounted for by deviations from the norm of measurable biological (somatic) variables" (Mishler 153).

"Health, in a positive sense, consists in the capacity of the organism to maintain a balance in which it may be reasonably free of undue pain, discomfort, disability or limitation of action" (Mishler 154). Because of our modern definition and perception of illness or disease, some physicians may ignore patients' claims of having fibro myalgia, or may even dismiss the patients as "crazy" and refer them to psychiatrists, since this is their only logical explanation for a patient complaining of pains who shows no biological dysfunctions Mohamed 3 through physical and / or laboratory exams. However, "the presence of measurable 'deviations from normal biological functioning' is only one of the conditions for illness, certainly not a necessary and sufficient condition" (Mishler 159). Fortunately, some physicians look further into the conditions, performing more detailed experiments with the patients to attempt to understand what exactly is going on. The process of social construction consists of a few main steps. First, is the acknowledgement by the patient or a group of patients, or even an organization that there is an abnormal condition and feelings of illness.

Next are the decisions that must be made in order to diagnose the illness, but who makes these decisions? "Physicians have been granted by society the right to define criteria of sickness, to determine appropriate modes of treatment and management... ." (Mishler 164). Physicians are not the only ones involved, however. The patients also have a huge role since they usually have deep desires to legitimize their symptoms by an explanation, as well as pharmaceutical companies who will market new drugs to try to treat symptoms patients are complaining of. The media also plays a substantial role in the social construction of illness by sending messages regarding what's normal vs. abnormal.

Physicians, however play a fairly larger role than anyone else in the process, taking a set of symptoms and trying to match them to a known disorder, thus diagnosing the patient with that disease. They possess a substantial amount of power in constructing illnesses. When the set of symptoms is a new set though, the process of begins. "Medical ization consists of defining a problem in medical terms... a sociocultural process that may or may not involve the medical profession... occurs when a Mohamed 4 medical frame or definition has been applied to understand or manage a problem" (Brown 105).

Fibromyalgia has come to be medical ized over the years, mainly started by Dr. Frederick Wolfe, director of the Arthritis Cancer Research Foundation. In recent years, uncertainty in the knowledge of medicine and disorders has caused doubts in patients, as well as physician's minds, regarding issues of dealing with disorders. Many physicians are perplexed by fibro myalgia and are rather confused on how to deal with these millions of patients since they have no reasonable explanations to account for the symptoms the patients are experiencing (Brown 267).

On the other hand, the patients don't know who to believe and constantly seek explanations for their symptoms. If the patient had an explanation, at least maybe they could rest more assured knowing that there is treatment for their problems, rather than just being told that they are "crazy" or that "it's all in their heads" (Brown 271). The dilemma involved in the social construction of illnesses in society, such as this one, lies in the question of which way to go. Should the physicians consistently search for explanations and treatments for fibro myalgia, or should they attempt to explain the symptoms these patients are having in terms of other ways? Dr.

Wolfe and a group of twenty formed a set of diagnostic criteria, where if patients felt pain at eleven of eighteen designated points on the body where muscles and tendons meet, than they would be diagnosed with the disorder. This would be the beginning of the social construction, which would lead to more research, since they would now have something to work with. Physicians who went the other way, had many explanations, a few of which I will discuss. Dr. Thomas Bohr, a neurologist at Loma Linda University School of Mohamed 5 Medicine "cites data showing that a third of healthy people at any one time will have aches and pains in their muscles, and a fifth will report significant fatigue" (Groopman 4). Could these patients be overreacting about their symptoms? You could argue this if you point out the fact that ninety per cent of fibro myalgia patients are women.

Could these patients be "hypochondriacs," excessively preoccupied with their health? (Groopman 4). Could males also have these pains, but manage to just ignore them? "Women are more likely to attend to minor symptoms than men are, for a variety of reasons, among them familiarity with the health care system through reproductive needs. Men are encouraged from childhood to be stoical or masculine... and are not likely to see a doctor for non-serious health problems" (Brown 43). These physicians also argue that patients become trapped in beliefs that they have an illness, allowing the beliefs to affect them psychologically, worsening their symptoms as a result of stress and depression.

The social construction of fibro myalgia is a quite complicated issue and requires much research. Social constructions are not always this difficult, but the general two paths seem to always be there: Should physicians a set of symptoms into a disorder or disease, and attempt to treat the illness, or should they attempt to figure out the underlying causes of the symptoms and try not to something which doesn't need? Both arguments about fibro myalgia are strong, and both are backed up by valid claims, although each does have its positive and negative aspects. The social construction of illnesses in the medical field is an extremely assiduous task and requires years of dedication, time and research before final decisions are made. They must be made carefully, since they will affect millions and millions of people.