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METAPHYSICIANS :

APPLIED KINESIOLOGY, CHIROPRACTIC AND HEALING

BY
Jonathan Wilson Bolton

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Anthropology

19?7

ABSTRACT
METAPHYSICIANS : APPLIED KINESIOLOGY, CHIROPRACTIC AND HEALING
BY

Jonathan Wilson Bolton

Chiropractic is the most successful "deviant" medical system
in the united States. It is, however, a profession divided by
internecine squabbles between conservative "straights" and
eclectic "mixers." At the mixer extreme is a relatively new
approach to diagnosis call applied kinesiology, which posits a
necessary and direct relationship between .muscle strength and
body function. AK claims to be a multi-disciplinary approach to
healing and as an institution it is not located within
chiropractic. Nonetheless, AK cannot be understood apart from
chiropractic.

This thesis is an ethnography of a single chiropractor who
considers himself an applied kinesiologist. Since he does not
practice in a vacuum but within two traditions I first present
historical and institutional analyses of chiropractic and AK. I
then describe his clinic, present a profile of his patients, and
focus on the healer-patient encounter. I consider the healing
encounter as ritual, suspending all questions of technical
efficacy and dwelling on its performative and communicative

aspects.

ACKNOWLEDGEMENTS

I would like to thank Dr. and Mrs. William Farrago who
opened up their clinic and their office-lives to me. I hope that
in reading this study they find themselves more "biographied"
than transmogrified and that they will not find reason to echo
another's criticism that "the more anthropologists tell us about
the United States, the less we believe what they say about
Samoam" :rt is always difficult to read another's dispassionate
account of what one is passionate about. I hope it becomes
obvious that I am not out to inflate or discredit Dr. Farrago's
practices, applied kinesiology or chiropractic. What I have
tried to achieve is beyond mere reportage. I have tried to
locate the individual in the general and to subject arguments to
critical analysis. Quite possibly I have been the most critical
observer Dr. Farrago has encountered--most of his patients want
to believe he can help--and it must be made clear that the same
suspicious posture must be sustained when examining all health
care systems, especially orthodox allopathic medicine. Having
known him for about four years I consider Dr. Farrago an
unusually dedicated and honorable man, certainly more so than
many other healers I have encountered in the last ten years.

I would also like to thank the members of my advisory
committee--Professor Harry Raulet, Professor Judy Pugh, Professor
Charles Morrison. and Professor’ Robert. McKinley-~who for four
years have guided me in my defection from natural science to
social science. I would particularly like to express my
gratitude to Dr. Raulet who was most generous in his opinions at
the critical early stages and has been my cicerone throughout.

Finally, I would like to thank Dr. George Goodheart for

providing me with information on applied kinesiology and his
assistance in setting things straight for me.

iii

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Appendix A

Appendix B

Bibliography

TABLE OF CONTENTS

Introduction

A History of Chiropractic and Applied
Kinesiology

Intitutional Analysis of Chiropractic
and Applied Kinesiology

2.1 Signification
2.2 Legitimation
2.3 Domination

An Ethnography of Dr. Farrago's Practice

Dr. Farrago

Patient Profile

The Clinic

Dr. Farrago's Performance

Routine Visit

Communication

The Relationship Between Dr. Farrago
and his Patients

wwwwwww
\JO‘U'il-‘WNF"

Conclusion

Associations Between Muscles, Glands, Organs
and Vertebrae in Applied Kinesiology

A Transcript of Dialogue Between Dr.
Farrago and Mrs. Clara Dobson

iv

16

35

45
63
88

97
98
110
116
121
130

144
154

161

166

167

176

Table

Table

Table

Table

LIST OF TABLES

Patient Residence Distribution

Distribution of Patients by Sex per
Age Group

Actual and Adjusted Ratios of Patient
Visits by Sex per Age Group

Dr. Farrago's Weekly Working Schedule

109

110

111

118

INTRODUCTION

In every culture, illness is a rupture in the routine of
every day life--it represents a loss of trust in one's body and
forces a tacit acknowledgement of an ignorance of our flesh which
"surrounds us with its own decisions" (Larkin 1964:39). That the
body's logic is incoherent is realized most forcefully during
illness; any subsequent action on the part of the sick person or
family member is predicated on a suspended trust in the body. In
the wake of illness--or in its anticipation--we appeal to
authorities we believe are able to interpret the body's logic and
rewrite 11» The healer becomes the mediator between a hidden,
alien, disordered order within us and the public, everyday world
we live in. Within a space, usually circumscribed and sacred,
which ‘the healer' manipulates or' merely occupies, the healer
directs his, and the patient's, attention on the disorder. The
healer may then take the patient along or leave him/her behind as
he/she enters the disorder, tries to comprehend it, and reorder

it. This is a study of the healing space constructed and

2
occupied by Dr. William Farragol a healer who considers himself
an applied kinesiologist, but who is licensed and trained in
chiropractic.

The separation between Dr. Farrago's self-identity as an
applied kinesiologist and his public identity as a chiropractor
reflects applied kinesiology's nebulous status as a healing
system. At its most modest claim, applied kinesiology is a
system of diagnosis which uses the body's muscles to indicate
body dysfunction and thus it is considered by adherents to be a
technique of potential use to all healers. However, applied
kinesiology was developed by a chiropractor, most of its concepts
and explanations are based in chiropractic theory, and it
continues to attract mostly chiropractors. Applied kinesiology
is taught as an elective at several chiropractic schools.
Applied kinesiology, then, is a body of techniques and principles
closely related to chiropractic. In many ways it is an extension
of the views held by a majority of chiropractors. It can not be
understood apart from chiropractic but it should not be
considered coterminous with or a sub-discipline of chiropractic.
AK has a professional body, the International College of Applied
Kinesiology, which is external to chiropractic's professional
organizations. Ak is also taught and practiced by non-

chiropractors.

 

1I have changed all personal names where appropriate. I
refer to Dr. Farrago not solely out of courtesy but because in
the United States chiropractors are Doctors of Chiropractic (D.C.)

3

It was not until I was well into my research that I realized
Dr. Farrago was not legally recognized as an applied
kinesiologist and that applied kinesiology is not an autonomous
medical system. As I became aware of its relationship to
chiropractic I was forced to refocus my study to locate Dr.
Farrago within the history, social structure and tenets of
chiropractic.

I first met Dr. Farrago in 1983. My father had for some
time invited me to accompany him on Thursday mornings when he had
breakfast with some healers, including a close friend of his, Dr.
Andersen, an orthodontic surgeon, who were experimenting with a
novel,and he believed, efficacious approach to healing. After
breakfast they would adjourn to Dr. Farrago's nearby office where
they would test each other and try out new techniques. When I
finally accompanied my father, I met Dr. Farrago and two or three
other regulars. After breakfast, we went to his clinic where I
watched and listened as the four of them diagnosed and treated my
father. They had him lie down, turn over, bend his legs, lift
his arms, and so on as they tested him for this and that. They
explained what they were doing but what they were saying sounded
preposterous. They spoke of energy meridians, neurovascular
reflexes, TMJ's, and raw adrenals. I realized then it is not
just Azande or Ndembu "medicine" that requires explication and
that there was something to Aldous Huxley's dictum "anthropology,

like charity, should begin at home." (1955:11)

4

I kept up a loose communication with Dr. Farrago for the
next two years. I had told him of my intention to study some
aspect of applied kinesiology for a masters thesis and he was
enthusiastic. He told. me applied. kinesiology needed. to ‘be
studied by an unbiased outsider and he was confident it would
prove itself under such impartial scrutiny. He provided me with
textbooks and waited patiently for me to lay the foundation for
my study.

In the spring of 1986 I took a leave of absence from
Michigan State University to observe Dr. Farrago in his clinic.
I had originally intended to study a number of applied
kinesiologists in the area but I had to narrow my focus for two
main reasons. The first was that I soon discovered there is no
such thing as an applied kinesiologist. What I had thought was
an autonomous healing tradition. was in fact only' a nascent
ensemble of diagnostic techniques connected by a loose philosophy
and a single diagnostic methodology: manual muscle testing. The
only qualification needed to become trained in applied
kinesiology is a license to practice some sort of medicine (e.g.,
chiropractic, osteopathy, allopathy, or dentistry). It turned
out to be impossible to separate Dr. Farrago as an applied
kinesiologist from Dr. Farrago as a chiropractor. ‘I had to study
chiropractors who use AK, or dentists who use AK. Since applied
kinesiology developed out of chiropractic, and still has organic
roots to it, I decided to limit my study to a chiropractor using

applied kinesiology.

5

The second limitation in my fieldwork was logistical. I had
a full—time job as an orderly in a Lansing hospital, some eighty
miles from Dr. Farrago's office. I was able to re-arrange my
schedule such that I could spend every other week observing Dr.
Farrago. This allowed me to observe the weekly nature of the
office but it effectively halved the time available to spend in
Detroit. I could observe a few healers superficially or a single
healer more intensively. Since I had already established a
rapport with Dr. Farrago, I decided on the latter. I would
observe his office and then try to compare his views with those
of other chiropractors trained and untrained in applied
kinesiology along certain dimensions such as conservatism-
eclecticism in approach, enthusiasm in committment to applied
kinesiology, and so on.

Precedents for relying on the insights and practices of a
single informant may be found in the works of Turner
(1967:131-150) and Cowie and Roebuck (1975). The latter is an
ethnography of a single chiropractor's clinic and in many ways,
this study may be considered an extension of their work.

The limitations of such a narrow focus are both obvious and
subtle. The informant's idiosyncracies may go unnoticed and the
researcher may extrapolate too far. The informant might be so
"immersed" in his/her culture that he/she cannot separate him or
herself to offer the researcher insights into the culture, or
alternately, the informant might be so "analytical" that he or

she gives only commentary (Barrett 1984:37). Obviously, life

6
history influences-~perhaps determines--points of view; the
privileged informant will offer a markedly different analysis of
his or her society to that offered by the disenfranchised. And
not inconsequential is a preference in the literature, and in
policy debates, for the statistically sound study over the
"interpretive" study.

However, there are advantages of relying principally on the
opinions and practices of a single informant, but I must admit I
would not have explored them had not the lords of limit imposed
themselves.

First, and in general, if the researcher concentrates his
or her observations on a single informant, in time, he or she is
able to effect a change in the type of explanations offered:
from outsider oriented discourse to a discourse of familiarity
(Bourdieu 1977:18) . Bourdieu describes the latter as leaving
unsaid all that goes without saying, and the former as excluding
direct references to jparticular cases. Both. discourses, as
explanations, are removed from the actual practices and amount to
ideological statements. The shift, only ever partial, never
complete, exposes the observer to levels of ideology, which would
remain unnoticed in a broad and shallow survey.

Second, and more relevant to this study, I am a member, by
adoption, of Dr. Farrago's society, and thus I am not totally
ingenuous of its "practical discourse" (Giddens 1979:73). I am
able to discern dominant ideology from subordinate ideologies and

as such, I might be able to help turn the tide of criticism of

7
anthropological practice such as DeVoto's: "the :more
anthropologists write about the United States, the less we
believe what they say about Samoa" (Geertz 1983:9). We must hone
our analytical skills at home, where the "natives" we study are
better able to respond and criticize them.

Third, there is no typical chiropractor. As will be
discussed later, there is little consensus between chiropractors
as to what chiropractic is or on how and what they should do as
chiropractors. Opinions range from the conservative
"super-straights," who advocate spinal adjustment for all
complaints regardless of their symptoms, to the eclectic mixers,
who do everything but prescribe drugs and perform surgery. Too
narrow a focus on an individual chiropractor might not make this
lack of consesus evident (e.g. Cowie & Roebuck), but an in-depth,
narrowly focused study would also reveal why chiropractors have
been unable to unify.

Ultimately any study which focuses on a single practitioner
must explore the contexts--historical, economic, cultural--within
which he or she practices. The way in which the individual as a
knowledgeable, reflexive agent constructs his or her reality must
be connected to the acknowledged and unacknowledged conditions,
and consequences, intended and unintended, of his or her actions.
The form of this thesis reflects an attempt to place the
individual chiropractor--applied kinesiologist within a
historical, socio-economic context of chiropractic and AK as

institutions.

8

I have entitled their study "metaphysicians" to make issue
of the equivocal status of chiropractic and its practitioners.
On the one hand, they present themselves, and are regarded by
some, as meta-physicians, i.e. as practitioners of a higher
medicine examining the first causes of illness. They do not
justify themselves by statistics or scientific .method but by
their patients' testimonies. On the other hand, others, including
the dominant allopaths,2 consider them as metaphysicians in the
pejorative sense as dabblers in "occult or magical lore," (Oxford
English Dictionary), as quacks beyond the pale of science and
morals.

The opposing points of view push to the fore questions of
the nature and use of science, ideology, definitions of healing
and medicine. All have political implications, and I shall
examine them as such. They are items in the argument over
allopathy's hegemony and the possibility of change. Ivan Illich,
a critic of industrialization, has stated, "Society has
transferred to physicians the exclusive right to determine what
constitutes sickness, who is or might become sick, and what shall

be done to such people." (1976:6) I shall not examine whether or

 

2 Hereafter I shall refer to orthodox medicine as allopathy.
It is a term first coined by Hahnemann, the founder of
homeopathy. It seems preferable to other terms in use, e.g.
scientific medicine, western medicine, cosmopolitan medicine and
biomedicine which rely on dichotomies between science-anti-
science, high-low, developed and underdeveloped, all of which are
not suitable for this study since both chiropractic and allopathy
draw upon "science," neither have a monopoly on the use of
biological sciences, and both are western and cosmopolitan forms
of medicine.

9
not allopathy is entitled to the hegemony it enjoys. I shall
instead examine to what extent chiropractic and AK are real
alternatives and to what extent they are subject to similar
“prejudices"3 (Howard 1982:147-8) and have similar consequences
to allopathic medicine.

Originally, Dr. Farrago welcomed my interest in AK as a
subject of sociological study because he believed .AK ‘would
benefit from academic attention. He believed it would prove
itself under scrutiny and would be vindicated as a viable
alternative to allopathy. However, in this study I have not
tried to answer the immediate, difficult-simple questions--I am
not qualified--such as "Does it work?" I have chosen to operate
on certain assumptions and within certain boundaries that Dr.
Farrago and others might take issue with. This is a sociological
study and so leaves unasked questions of efficacy, ethical
dimensions of deviant medicine, or the truth value of his
statements. I will not slice through. the Gordian. Knot of
chiropractic and AK; perhaps I shall add a few more.

Despite Canute-like caveats, this thesis remains a political
article. Simply by studying a "deviant practice" I am violating
orthodox ideology which insists that they are of no real
importance and if we ignore them they will go away and everybody
will be better off. This is obviously not the case, there will

always be heretics. But it was the excitement of finding this

 

3 I use prejudice here not in the negative sense but in the
way Gadamer uses it ti refer' to the temporal and cultural
situation of practice and interpretation (Howard 1982:149-154).

lO

message--one that I had been taught as a pre-medical student and
lived as an orderly in a large hospital--subverted and inverted
by healers in my back yard that led me to consider studying first
AK and then chiropractic for a graduate thesis. To disturb the
tranquil formula "science equals truth" is apostasy, an act of
intellectual and political violence. Yet I was meeting
people-~middle-class Americans--who were offering translations of
the body's logic, apparently validated by science, which were
alien to my training in anatomy and physiology. I found their
statements incredible, but as St. Augustine wrote: "If the thing
believed is incredible, it also is incredible that the incredible
should have been so believed." In this thesis, I shall not try to
explain why these people believe. their heresies--such questions
are beyond the capacity of social science. I shall examine what
makes them heresies and how heretical they really are. I shall
also examine their use in contexts of healing.

Studying heresy is both exciting as a political act, and-
potentially dangerous: one might actually start to believe the
heresies one is studying. More than one member of my advisory
committee expressed their concern that I might be displaying
signs of conversion. Their words of caution betray some of the
tacit assumptions of anthropological fieldwork that need to be
made explicit.

As social scientists, we too often claim to be the less
deceived: "experts beyond experience" (Eliot 1948c). As

anthropologists we pride ourselves on limiting the physical

ll

distance between ourselves as researchers and our "objects" of
study, but we retain our faith in and reliance upon varieties of
"objective" distance, a derivative of Bullough's "psychical
distance," (1912, in Dickie and Sclafani, eds. ‘l977:758ff).
This is of course unavoidable: anthropological perception is
really apperception--we "make something" of the apparent chaos we
encounter. The implications of this distance for our studies of
"belief" must be unpacked.

It is generally thought that our’ distance from others'
beliefs allows us to remain uncommitted: we can either consider
them useful or as a species of false consciousness. Our models
impose boundaries containing labeled beliefs but excluding whole
domains of reality or possibility. In studying religion, for
example, we ignore the long-shot that God or gods appear as
avatars, or even exist. Geertz writes:

Whatever role divine intervention may or may not play

in the creation of faith-~and it is not the business of

the scientist to pronounce upon such matters one way or“

the other--it is primarily at least, out of the context

of concrete acts of religious observance that religious

conviction emergences on the human plane. (1973:113)

As scientists, then, we must reduce and ground beliefs. But do
we believe them? Can we? Some beliefs are so alien that we
struggle to understand them. But if we can understand them--as
we can if they are "domestic" beliefs--what are our options?

From where do we make our statements?

There are four possible directions from which to approach,

and leave, a subject: I believe, I don't believe, I disbelieve,

12

and I don't disbelieve. Philip Larkin has asked, "And what
remains when disbelief has gone?" (1958:28-9). Having spoken
with enough patients who each claimed Dr. Farrago is the only who
has been able to help them, I cannot disbelieve that he is in one
way or another healing or allowing the patients to heal. In
looking at what he is doing I focus on the nature and production
of the technical knowledge he draws on and how he uses it in his
performance. I bracket out from consideration whether or not his
treatments have the direct effects he. promises, and. when I
consider the scientific status of chiropractic or AK knowledge,
or any other treatment modality he may use, I do not assume that
if it isn't "scientific" then it is not either valid or
efficacious. As Levi-Strauss, borrowing from Simpson, has
cautioned, "since scientific explanation is always the discovery
of an 'arrangement,' any attempt of this type, even one inspired
by non-scientific principles, can. hit. on 'true ‘arrangements."
(1966:12)

The posture I have tried to maintain throughout this thesis
is on the one hand that I do not disbelieve that he helps, even
heals, his patients, but on the other hand, I do not necessarily
believe it is for the reasons Dr. Farrago gives. Not that I
believe he is lying but apparent inconsistencies in his practices
add to the probability that his translation of the body's logic
is not entirely faithful. This is of course a belief, here made

explicit, and subject to criticism and correction. The important

l3
thing is that it is presented up front and does not lurk unseen
between the lines.

At the end of the thesis, caveats hopefully unviolated, it
will be evident that I have resolved little or nothing. I will
have left unasked questions of efficacy and other looming
questions relevant to the "consumer." I will have only placed in
context and dissected the statements and actions of a single
practitioner.of an obscure approach to healing, observed during a
brief period of time.

Besides being an article submitted in partial fulfillment of
the requirements for another academic degree--its exchange
value--what possible value might such a parochial topic have--its
use value? I will try to answer this more adequately in the
conclusion and for now only suggest that it might serve as a
foil: in it might be seen how our medicine uses science, how
individual practitioners draw upon traditions and are subject to
"prejudices." As a foil Dr. Farago may be considered a reflector
of some of our society's dominant and subordinate ideologies. In
his practices, some of the contradictions of our medical system
might be resolved or repeated. This is part of the value of
interpolating from the obvious, unearthing the implicit and
dwelling on the mundane. If changes are to be made in our
"medical system" in anything but a haphazard manner the
distortions in the taken-for-granted, especially those deep
enough to be reproduced in both orthodox and deviant ideologies,

must be brought to light.

14

If such are the ultimate questions to be examined, they can
only be approached as they arise in specific occasions. In this
thesis, I shall invert the famous hermeneutic circle, that is, in
order to examine the whole, I must first locate it and describe
it by parts; only then can I reconstruct the whole.

In chapter one I shall present a brief history of
chiropractic and applied kinesiology. In chapter two, I shall
first examine the concept of medical system and then consider
chiropractic and AK as institutions by bracketing out social
integration on the level of the face-to-face encounter, focusing
instead on system integration, i.e. relations between
chiropractic and AK as medical systems and other medical systems
and institutions. I shall heuristically separate three
dimensions of analysis: signification, or chiropractic's and
AK's bodies of concepts and technical knowledge; legitimation,
the processes whereby chiropractic, at least, has become
recognized as a healing profession by the state and at least
publically by the "medical community,"4; and domination, or the
resources available to chiropractic and AK to set the conditions
of their existence as institutions. In reality the three
dimensions are linked as in the case of the ideological use of

signification to legitimate domination.

 

4 I use this phrase as a fiction, that is as a convenience
aware that such a community does not exist. Similarly when I
write chiropractic, AK, and the medical community, I do not
assume that they are corporate groups, but categories.
Technically, these terms should be in quotation marks but for
purposes of style I shall leave them unaccentuated.

15

Chapter three, is an ethnography of the practice and
practices of a single healer who is legally recognized as a
chiropractor but who uses AK and considers himself an applied
kinesiologist. First, I present a biographical profile, then a
description of his patients and his office. I then describe and
analyze the performative and communicative aspects of the
doctor-patient encounter, and the ways in which Dr. Farrago's
practice is similar to those of allopaths.

Finally, in chapter four, I try to tag some of the more
obvious connections between Dr. Farrago's practice and
chiropractic and applied kinesiology generally to reveal to what
extent Dr. Farrago contributes to the circumstances of his

practices.

CHAPTER ONE

A HISTORY OF CHIROPRACTIC AND APPLIED

KINESIOLOGY

There are very few non-partisan studies of chiropractic's
history. Most accounts portray Daniel David (D.D.) Palmer and
his son, Bartlett Joshua (B.J.) as avatars, or as the re-
discoverers of an ancient method of healing: and their disciples,
many jailed for practicing medicine without a license, as martyrs
to a benighted orthodoxy. Such accounts gloss over charges of
piracy, charlatanry and patricide, but they do offer insight into
the process of legitimation and tendentious history. This brief
outline of chiropractic's history, is drawn from partisan
accounts varying only in their enthusiasm.1

Born- in Canada, D.D. Palmer, "The Discoverer," was at
various times an itinerant tradesman, a school teacher and a
magnetic healer throughout the mid-west, before he came to

Davenport, Iowa in 1885. At this time allopathic medicine did

 

1 Russell Gibbons' articles are the least partial I have
read and I have relied on them heavily. However, he writes from
within chiropractic and remains largely uncritical in his
analyses. Other sources I have drawn on in this chapter are Bach
1968: Haldeman and Hamerich 1973; Lomax 1973: Null 1986; Shryock
1966; Starr 1982; Wilk 1973: and an unattributed article in the
ICA Review, March-April 1986,

16

17

not enjoy the prestige or success it does today. Medical
education and practice followed no regular pattern. Medical
schools awarded degrees with little or no formal training, often
after a brief apprenticeship to a practicing physician. The
advances then being made in Europe in neurology, physiology,
anatomy and pathology, only very slowly reached the medical
schools in the American interior, if at all. There was no
professional control and no licensure. The absence of
standardized medical education and colleagues control is
significant because D.D.-and B.J. Palmer and their disciples are
often portrayed as doing battle with a behemoth medical
oligarchy. It wasn't until the early part of the twentieth
century when allopathy, with new licensure laws, and through
changes in the by-laws of medical societies, requiring members of
the American Medical Association and state medical societies to
be members of local medical societies, and through educational
reform was finally able to offer a united front against
unlicensed practitioners and irregulars.

Earlier in the nineteenth century, allopaths had been fought
to a draw by homeopaths and eclectics. Homeopathy, eclectic
medicine, Thompsonian botanic. societies and other brands of
irregulars protested what they considered the unnecessary abuses
of "heroic medicine," which included purging and bleeding.
Homeopathy, founded by Samuel Hahnemann, a German physician,
considered disease a matter of the spirit, resulting from a

suppressed "itch" (psora) . Treatments involved administering

l8

tiny amounts of drugs which produced similar symptoms to those
presented by the patient" Homeopathy’ became 'popular,
particularly among the middle-class, and homeopathic medical
schools were founded throughout the country. In 1875 the faculty
of the University of Michigan medical school was required by law
to be equally represented regular or allopathic and homeopathic
(Starr 1982:100). There was a rapprochement though largely for
non-medical reasons: regulars were able to quiet their loudest
and most successful critics and with the homeopaths' support they
would be able to! gather enough support for licensing laws.
Recognition of homeopathy by allopaths and its assimilation into
orthodoxy created a schism in homeopathy. Purists, opposed to
what they saw as a Faustian bargain, formed the International
Hahnemann Association and struggled to keep homeopathy free from
allopathy. The efforts of the "super-straight" chiropractors
today echo this struggle to remain distinct from mixers who, they
believe, are caught in the sway of allopathic ideology. Like the
homeopathic purists, they are a minority.

By 1885, the first and second waves of protest against the‘
so-called. heroic medicine had largely’ broken up. Allopathy
absorbed many of its .critics and underwent a counter-
reformation. Some, like homeopathy, once they had become
legitimate, failed to keep pace with the advances of allopathy
and slid into disfavor and disuse. Allopathy's incipient

organization was to consolidate and by 1920 it was able to mount

19
a more unified offensive against the third wave of dissent,
including chiropractic, osteopathy, and Christian Science.

Chiropractic's "myth of origin" describes how on the
eighteenth of September, 1885, in Davenport, Iowa, D.D. Palmer
disovered a displaced vertebra (fourth dorsal) in Harvey Lillard,
the janitor of D.D.'s office building, who had only partial
hearing. When D.D. pushed against the vertebra it gave with a
loud snap and Mr. Lillard's hearing was restored. A little later
D.D. was examining a man with heart disease and he discovered a
similar displaced vertebra. He pushed on it and again he heard
it snap and the patient reported relief. From these events, D.D.
constructed a theory of healing and disease. Health, he argued,
depended on body "tone," which was the manifestation of "nerve
energy." If there is too much or too little nerve energy, there
was disease. Displaced vertebrae could interrupt the flow of
nerve energy and allow disease. D.D. and his followers claim he
rediscovered and improved a lost art of healing. Spinal
manipulation had been practiced "from Toltecs to Incas, to
Tahiti" (Wilk 1973:17), but D.D. claimed to be the first to do it
scientifically, by using the spinal processes as levers.

Numerous criticism have been made of this account not least
of which claims that D.D.'s discovery was in fact piracy.
Critics, usually osteopaths, have argued he stole the ideas and
techniques essential to chiropractic from Andrew Taylor Still,
the founder of osteopathy, who lived in Kirksville, Missouri down

river from Davenport. Indeed both men advocated spinal

20

manipulation as a principal, if not the principal, therapeutic
technique. There is evidence that D.D. had in fact been Still's
house-guest, though this was vigorously denied by D.D. '5 son,
B.J. The two methods of healing are not the same, however,in
theory or practice, as was attested in court not long after
D.D. 's "discovery." Osteopaths have never limited their
treatments to a single technique (i.e. spinal adjustment), and
blood flow was considered by Still to be primary to nerve flow.
Nevertheless, the similarity in philosophy and techniques points
to the problems associated with assigning the origins to any
movement, - revolution or dispute. Foucault writes ". . .all
manifest discourse is secretly based on an 'already
said'...Everything that is formulated in discourse was already
articulated in the semi-silence that precedes it..." (1972:25).

Concepts of nerve energy and spinal irritation were popular
among allopaths until the latter part of the nineteenth century
(Schiller 1971:250-266). The spine was considered the center for
many functions and "irritations," detectable by tenderness or
pressure over the vertebrae, could provoke mania, vertigo,
amblyopia, nervous or fevers, cough, dyspnoea, pleuritis, colic,
vomiting, disorders of menstruation, hysteria, asthma, and
diabetes" (Lomax 1975:152). At that time the nervous system was
the only known control over body functions and discoveries of
reflex action were creating excitement (Haldeman and Hammerich
1973:57-64) . These and other contemporary concepts in one form

or another were adopted by both Still and Palmer. As I shall

21
describe later, both movements grew by bricolage, i.e. by
eclectic addition (Levi-Strauss 1966:16ff).

D.D. Palmer founded his first school--Palmer School and
Cure--in Davenport in 1897. Between 1897 and 1902, he graduated
only fifteen students. Of these fifteen a third were physicians,
though the significance of this fact is difficult to establish
given the state of allopathic medicine at the time. .

Between 1902 and 1906, D.D. travelled and proselytized. He
established a second school in Portland, Oregon. He was also
charged, convicted, and imprisoned for practicing medicine
without a license. In 1906, he sold his interests in the
Davenport college to his son B.J. and left again to preach his
message. In 1910, he published his massive "The Chiropractors
Adjustor"--the second textbook on chiropractic, the first was
written by 3.3. and was published in 1905--in which he reminded
all, including his son, that he was the "discoverer" of
chiropractic.

B.J. Palmer, the self-styled "developer" and "maximumED
leader of chiropractic," was a shrewd businessman and
administrator. Under his leadership, the Palmer School of
Chiropractic flourished. By 1912, enrollment had reached 500.
He acquired new buildings, expanded its faculty, and assembled
what investigators from the AMA's Council on Medical Education
and Hospitals would describe as "without a doubt the best
collection of human spines in existence" (J.A.M.A. 1928

(99):1733-8). Gibbons has called B.J. the "last great

22

entrepreneur of folk medicine in the United States.. .He was
Elbert Hubbard, Titus Oakes (sic), Baron Munchausen, and P.T.
Barnum, all rolled into one" (1980:8,10).

B.J. was the inheritor of his father's charisma. Accounts
lionize him, even at an early age:

B.J. at the time of his father's discovery of

chiropractic in 1895, was a boy of 13. Even at this

age, he showed signs of precocious and charismatic

wonders. His mind was photographic, his insight

uncanny, his confidence in himself, his destiny almost

Galenic...flamboyant and fearless, he grasped in one

flash of his trigger-mind, the hunch that D.D.'s

discovery had world-shaking implications. (Bach

1968:98)
He was described as wearing his hair long, flowing over his
shoulders, invariably attired in a white linen suit, and long,
black silk tie hanging halfway to his waist (Gibbons 1980:40).

As 'maximum leader' he maintained tight control of P.S.C.
"Jealously watching over the ideological flare which he
maintained he alone was to keep" (Gibbons 1980:10). He was one
of the first to effectively use radio--he owned the first radio
station West of the Mississippi, where many years later, Ronald
Reagan was to work as a broadcaster. B.J. published tracts
defining his "Pure, Straight and Unadulterated" chiropractic and
attacking apostates and detractors. The faithful could even send
away for life-size busts or a series of eight portraits "in
various thought poses" (Gibbons 1980:11).

It was in large part B.J.'s dogmatic intransigence that led

to a series of desertions among P.S.C.'s faculty and students.

There was dissent among chiropractors during D.D.'s tenure as

23
leader, but it was during B.J's tenure that the divisions which
separate chiropractors today became institutionalized.

The first schism. occurred in 1906 when John. Howard, a
faculty’ member' at P.S.C., resigned after B.J. showed little
interest in acquiring cadavers for his anatomy class. Claiming
lineage from D.D. Howard formed his own school, National College,
which 2 years later, moved to Chicago, then the "plague spot of
medical education in the country" (Gibbons 1981:237) . Howard
remained president of National College until 1916. Under the
later guidance of William Schultz and Arthur Foster, both M.D.s,
graduates of Rush. Medical School and 'University of Illinois
Medical School respectively, National continued to teach a more
moderate chiropractic than B.J.'s "pure, straight and
unadulterated chiropractic." Probably under the influence of
allopathic instructors-administrators, National became the Mecca
for a mixer chiropractic, eschewing the one cause-one cure
message of the more conservative straights. Dr. Farrago, the
focus of this study, graduated from National in 1966: his views
are consonant with mixer philosophy associated with that school.

The second mutiny at P.S.C. followed opposition to B.J.'s use
of X-rays, or "spinography" as he called it, when, in 1910, on a
prearranged signal, half of the class stood up and walked out.
They established a rival school which later moved to Pittsburgh.
Ironically, a few years later this rival school claimed the first

X-ray views of a spine in an upright position (Gibbons 1981:237).

24
Since then x-rays have become a standard item in the
chiropractor's armamentarium.

The third major dispute within chiropractic followed B.J.'s
"The Hour Has Struck" speech' in August, 1924, which was
remembered by one observer as "the hour that nearly rimracked and
slaughtered and destroyed chiropractic" (Gibbons 1980:12) . At
this lecture, B.J. introduced the neurocalometer which he claimed
was a heat seeking device able to locate subluxations. "No
chiropractor can practice chiropractic without a neurocalometer,"
he said. "No chiropractor can render an efficient, competent, or
honest service without the NCM" (Gibbons 1980:12). The speech
was followed by mass denunciations and marked the end of B.J.'s
tenure as maximum leader in all but a titular sense.

By 1920, there were chiropractic schools in Chicago, St.
Louis, Oklahoma City, Los Angeles, New York, Oregon, and Texas.
Each school varied in its adherence to B.J. 's PSU chiropractic
and developed its own philosophy and championed certain
techniques (Haldeman and. Hammerich 1973). .Although. recently
there have been attempts to coordinate curricula through the
Council on Chiropractic Education, there are unaffiliated
colleges, and chiropractors remain uncommitted on even a
definition of chiropractic. One common denominator between all
modern chiropractors, however, is a shift from legitimacy derived
from D.D. and B.J.'s charismatic authority to a rational-legal

authority, as will be disscussed later.

25

Chiropractic's recent history is one of a continuing
struggle for recognition from the state, insurance companies, and
allopathy. This struggle, described in chapter two, was fought
mainly by the professional bodies of chiropractic: the American
Chiropractic Association (ACA), representing approximately 17,000
"mixer" chiropractors and the International Chiropractic
Association (ICA) , representing approximately 5,300 "straight"
chiropractors. These organizations are represented at the state
level by affiliated bodies: in Michigan, the Michigan State
Chiropractic Association (ACA affiliate) claiming almost 500
members and the Chiropractic Council (ICA affiliate) claiming 75
members. There are also non-aligned bodies such as Michigan
Fellowship of Straight Chiropractors (75-90 members),
Chiropractic Physicians (25-30 members), the Union of
Chiropractic Physicians (approximately 15 physicians), which
fight for special interests, e.g. super-straights.

The predecessor of today's ACA was founded in Cedar Rapids,
Iowa in 1905. It comprised American School alumni. The UCA, the
Universal Chiropractic Association, was founded a year later in
Davenport, Iowa and mainly consisted Palmer School graduates.
The latter advocated "hands only" and claimed chiropractic to be
distinct from allopathy and osteopathy. They pejoratively
labelled members of the ACA mixers because they mixed

chiropractic with other treatment techniques.2 The first ACA

 

2 The differences have been encoded in different terms and
phrases: chiropractic physicians/chiropractors, spinal
manipulation/spinal adjustment and diagnosis/analysis. The

26

dissolved, but in 1922 another ACA was founded embracing protest
schools and opponents of B.J. Palmer. In the early to
mid-twenties, the UCA considered admitting graduates of "mixer"
schools. As a result, B.J. Palmer resigned as the UCA's
secretary-treasurer and the officers were moved from Davenport to
LaCrosse, Wisconsin. In 1926, the predecessor of today's
ICA--The Chiropractic Health Bureau--was founded. It served as a
"protective association" for straights. Its constitution
declared its purpose:

The organization shall aim. by research, publicity,

-combative and defensive legislation, lawful legal

protection, cooperation in every legitimate and ethical

way, to promote and advance the philosophy, science,

and Art of Chiropractic and have the unhampered right

and opportunity of obtaining the services of

chiropractors of unquestionable standing and

ability..." (ICA Review 1986).

In 1932, the CH3 established a publicity department and a
supporting CHB Layman's Division, with chapters modelled on
fraternal lodges. Chapter members paid dues and helped spread
the word about chiropractic. By 1936, there were 56 chapters in
various cities.

In 1930, the UCA, and ACA. merged to form the National
Chiropractic Association. The NCA maintained its opposition to
the conservative ethos of the CHB. At the 1939 Annual meeting of
the NCA, heads of the chiropractic colleges formed the Allied

Chiropractic Education Institutions as a consolidated front

against the "Palmerized" CHB. In 1941, the CH3 slightly modified

‘

latter terms are used by straights and are attempts to purge
Chiropractic of allopathic influences.

27
its position on chiropractic and changed its name to the
International Chiropractic Association.

From the 1930s to the 19508, chiropractic made some advances
but it was also challenged more vigorously by allopathy. By
1943, forty-three states had some type of licensing provisions
for chiropractors. But as a way of curbing the growth of
chiropractic and other unorthodox movements, the medical
community lobbied for Basic Science laws which would require
allopaths, osteopaths, chiropractors, and naturopaths to pass an
examination in basic sciences. Michigan adopted the law in 1937.
The effect throughout the nation was dramatic. In Washington,
746 chiropractors were licensed before the enactment of the Basic
Science Laws: during the twelve years after the law was
instituted 27 licenses were issued.

Through the 19508 and 19603, there were fewer prosecutions
for practicing medicine without a license. In the 1950s the
professional bodies began to retain lobbyists or legislative
consultants, who were largely responsible for much of the
recognition subsequently won by chiropractic from the state and
the medical community. Among these coups was inclusion in the
Universal Military Training and Service Act of 1951, which
exempted chiropractors from the draft, and inclusion in a limited
number of policies from the Aetna Insurance Company in 1960. By
1962, 2.5 million trade union members benefits included coverage

for chiropractic treatment.

28

In the 19603 and 19703, the ICA and the ACA--the NCA changed
its name in 1963--tried to reach an accord, and managed to
temporarily lay aside differences to present a united front in
the wake of chiropractic's initial exclusion from Medicare
reimbursement programs.

Chiropractic's eventual inclusion under Medicare was one of
the four major advances in the 19703. Along with the Wilk law
suit, the NINCDS conference, certification by the Department of
Health, Education and Welfare of the ACA's Council on
Chiropractic Education as the accrediting agency for chiropractic
colleges and inclusion under' Medicare reimbursement progress
signalled acceptance of chiropractic as an established health
profession (Wardwell 1980:31).

Perhaps the most far-reaching in its effects was the lawsuit
filed by Chester Wilk and four other chiropractors in Illinois,
on October 12, 1976 against the American Medical Association, the
American Academy of Orthopedic Surgeons, the American College of
Physicians, the American College of Radiology, the American
College of Surgeons, the American Hospital Association, the Joint
Commission on Accreditation of Hospitals and the Illinois State
Medical Society charging they had conspired to contain and
eliminate chiropractic, thus violating sections 1 and 2 of the
Sherman Anti-trust Act.

Two defendants--the American Osteopathic Association and the
American Academy of Physical Medicine and Rehabilitation--3ettled

before the December 1980 trial. The settlements included

29

statements to the effect that there were no ethical impediments
to full professional cooperation between osteopaths, members of
the AAPMR and chiropractors. In addition, the AMA's House of
Delegates reversed its long standing prohibition against allowing
its members to accept "transfer" patients from chiropractors, and
later revised its position on chiropractors as members of an
"unscientific cult."

The trial went to court in late 1980, and in early 1981 the
jury returned a not-guilty verdict. The decision was immediately
appealed and in September, 1983, a U.S. Court of Appeals
overturned the verdict. The retrial is still pending but in 1985
another defendant, the Illinois State Medical Society, settled
agreeing to pay each plaintiff $35,000 and to issue a statement
declaring there was to be no impediments to full professional
association and cooperation between chiropractors and members of
the Illinois State Medical Society.

After the Wilk suit was filed, the ICA circulated copies of
the suit to attorney generals throughout the country asking them
to consider the charges in light of artificial increase in health
care costs“ .As a result, similar suits were filed in
Philadelphia, New York, and Michigan. The Philadelphia case was
dropped after the AMA agreed to revise its position on
Chiropractic. In the New York case one of the defendants--the
American Hospital Association--reached a settlement including an

agreement that it would not prevent affiliated hospitals from

30
granting hospital privileges to chiropractors. The Michigan case
is still pending a court date.

Whatever the final decisions, chiropractors have won major
concessions from the "medical community." It is now recognized
as a healing ,profession by the state, by most insurance
companies, and at least officially by some medical and hospital
associations. However, it will be a long time before practicing
physicians recognize chiropractors as partners in healing.

Chiropractic faces a new challenge in the growth of health
maintenance organizations (HMO's) and. preferred provider
organizations (PPO's) , in which enrolled patients must select
from a stable of physicians. In order for an. HMO to be
reimbursed by Medicare it must offer all of the services normally
covered by Medicare, but if more than one category of
practitioner is qualified to provide a certain service, the HMO
may select the practitioner. Thus, practitioners who practice
spinal manipulation therapy other than chiropractors (e.g.
osteopaths, physiatrists or orthopedic surgeons) may be retained
by* an. HMO thereby excluding chiropractors from *the nation's
fastest growing insurance program. As the president of the ICA
has written "this trend can be devastating to our profession"
(Pedigo 1986:8-9) . How chiropractors handle this new challenge
remains to be seen. One thing is for certain: it will require

unification and standardization.

31

The history of applied kinesiology is quite short and by
contrast uneventful. In 1964, Dr. George Goodheart, a Detroit
based practicing chiropractor and 1939 graduate of National
College, observed that most muscle spasm is not primary but
secondary to muscle weakness. Research revealed that muscle
weakness resulted primarily from a disruption in motorneuronal
facilitation and was an indicator of body dysfunctions:
Particular disease states were associated with specific muscle
weakness patterns. Muscle testing allowed the diagnostician to
read the body's language, to divine the relationship between the
viscera and the muscles.

A3 with chiropractic, the origin of AK precedes the occasion
in 1964 when Dr. Goodheart treated a young man complaining of
chronic shoulder-pain. By accident, Dr. Goodheart palpated and
rubbed several nodules at the muscle's insertion the rib cage
which "released" the muscle and restored full movement to the
young man's shoulder. The similarity of this account to a
chiropractic's charter myth is intriguing.

This incident, however accidental, -was not simple
serendipity, and can only be understood by exploring the "already
said,".i.e. the conditions that allowed it to happen.

Muscle testing and most of the body of knowledge which
comprises "the ever-expanding compendium of knowledge known as
applied kinesiology" (Goodheart and Schmitt) were drawn from
extant sources. For example, muscle testing was borrowed from

Kendall & Kendall (1949); neurolymphatic reflexes from Chapman:

32

neuromuscular reflexes from Bennett and energy meridians from
traditional acupuncture. Some discoveries such as therapy
location (1973) and body-into-distortion technique grew from the
research conducted from within applied kinesiology, notably the
work of Dr. Goodheart, the research director of the ICAK, but
these are based on prior knowledge intrisic or extrinsic to AK.

AK is taught only to qualified and licensed health
professionals (e.g. chiropractors, osteopathic, allopathic and
dentists) in courses consisting of a series of weekend seminars.
Tapes, research bulletins, and a series of texts, are also
available. The attendance of the seminars is comprised
predominantly of chiropractors but there is a significant number
of dentists and a minority of osteopaths and allopaths. It is
claimed of AK by its adherents that it may be benefit all healers
of whatever ilk. As Dr. Goodheart explained to me, the ACA was
willing to incorporate AK as an independent council, but on the
condition that it be taught only to chiropractors. Apparently,
this was not acceptable to the International College of Applied
Kinesiology (ICAK). The AK's organizational body was founded in
1973 and conceives of AK as an interdisciplinary approach to
healing. Dr. Goodheart foresees a closer relationship between AK
and dentistry in the future based on the crucial role of the
temporomandibular joint in body functions.

AK is now taught in at least eight chiropractic schools as
an elective, but it is not considered mainstream chiropractic.

Dr. Ronald Grant, of the ACA National Office, told me that the

33
ACA considers AK to be overly enthusiastic in its promises.
Before it would be embraced by the ACA, he said, AK would have to
prove or modify its claims.

There have been offshoots from AK. Behavioral Kinesiology
is headed by John Diamond, M.D., a psychiatrist: Clinical
Kinesiology headed by Allan Beardall; Educational Kinesiology;
and Neurological Organization Technique, headed by Carl Ferraro.
All retain some of the basic tenets of AK and muscle testing as a
principle diagnostic method, but each either extrapolates from AK
or limits its focus to specific applications, for example,
Neurological Organization Technique studies dyslexia and
educational kinesiology studies confusion in the learning
processes.

Touch for Health was founded by Drs. Goodheart, Stoakes and
Thie, the founding chairman of the ICAK, but is now referred to
by Dr. Goodheart as his bastard child. Touch for Health is
dedicated to the promotion of AK techniques and philosophy among
lay people for family care and self-use. Dr. Goodheart and Dr.
Farrago and others I met during my research felt that Touch for
Health had exceeded its original promise by teaching individuals
who then sold their services as health care practitioners. They
believed Touch for Health instructors were not adequately trained
in the basic sciences to understand either its principles or when
and if it should be applied. These individuals, it was felt,
were injurious to AK's struggle for recognition and

legitimization. One Touch for Health instructor I met, however,

34
disputed these views as akin. to the arrogance displayed. by
allopaths and typical of practitioners interested more in self
gain than patient care. The differences between the two camps
are more political and economic than theoretical.

To date, Dr. Goodheart estimates eight to ten thousand
health professionals have been trained in AK, including over
eight hundred dentists, practicing .in the U.S., Canada,
Australia, Japan, France and Great Britain.

AK's future remains uncertain. Whether it is bought back
into the chiropractic fold, or becomes an autonomous medical
system, or fades away remains to be seen. In certain respects,
it is a revitalization movement within chiropractic, in others it
represents an extreme example of eclectic, mixer practice. It's
catholicity might convince chiropractors trained in AK that there
is no need to compromise with allopaths. Ironically, this is a
typically straight argument and may subvert attempts to organize
chiropractic to forestall future marginalization. However, for

the moment it cannot be considered apart from chiropractic.

CHAPTER TWO

INSTITUTIONAL ANALYSIS OF CHIROPRACTIC AND

APPLIED KINESIOLOGY

A glance at any telephone directory or health store bulletin
board reveals a bewildering variety of orthodox and heterodox
healers promising all manner of cures for all manner of
afflictions. A conservative list would include osteopaths and
chiropractors, chief among deviants, homeopaths, naturopaths,
rolfers, herbalists and polarity therapists.

This profusion is not a recent phenomenon. In the middle of
the sixteenth century, Montaigne wrote of disputes between
practitioners over the nature of disease:

Herophilus lodges the original cause of all disease in

the humours: Erasistratus, in the blood of the

arteries: Asclepiades, in the invisible atoms of the

pores: Alcmaeon, in the exuberance or defect of our
bodily strength: Diocles, in the inequality of the
elements of which the body is composed, and in the
quality of the air we breathe; Strato, in the
abundance, crudity, and corruption of the nourishment

we take; and Hippocrates lodges it in the spirits.

(1952:371)

Nor is it a result of specialization, as Herodotus reports was
the case in Egypt,

"where medicine is practiced among them on a plan of

separation, each physician treats a single disorder,

and no more. Thus the country swarms with medical

practitioners, some undertaking to cure diseases of the
eye, others of the hand, others again of the teeth,

35

36

others of the intestines, and some those which are not
local. (Synopticon 1952:118)

Although there is a great degree of specialization within
allopathy--which has not gone uncriticized--there are many
different non-allopathic general translations of the body's logic
available. For example, different variations of spinal
manipulation are offered by chiropractors, osteopaths,
physiatrists, or physical therapists, and orthopedic surgeons.
All offer’ different explanations for slightly’ different
techniques, but claim similar results: relief from discomfort,
though some go further, particularly chiropractors, who claim to
heal general body dysfunction by adjusting the spine.

Such a profusion of translations of the body's logic has
been termed medical pluralism in the anthropological literature,
but the phrase reveals nothing about the relations that exist
between the translations. Janzen has described a complementary
medical pluralism in lower Zaire, in which sufferers routinely
consult all "translations," which enjoy more or less equal status
(1978:222, et passim). In other societies, the relations between.
translations are less complementary than hierarchical. There are
divisions between official and unofficial, high land low,
indigenous and cosmopolitan, professional and folk. medicines
(Leslie 1976). In the United States, Wardwell has distinguished
limited practitioners, marginal practitioners, and quasi-
practitioners from the orthodox allopathic medical profession.
(1972:250-273; 1976:61-73) Limited. jpractitioners ‘usually

specialize in specific regions of the body and may or may not be

37

part of the allopathic medical "team" (e.g., optometrists,
dentists, podiatristsg clinical. .psychologists). Marginal
practitioners do not limit their treatments to particular parts
of the body, but treat the whole body. However, their
translations of the body's logic and their methods of diagnosis
and treatment differ from orthodoxy and they have been forced to
practice more ‘or less in the shadows (e.g. chiropractor,
naturopaths, rolfers, naturopaths) . Quasi-practitioners is a
"garbage-can" category containing all those who "use methods that
have not been or cannot be empirically validated" (1972:263),
including faith healers, clergymen, Christian Scientists,
astrologists, and curanderas. This typology is useful. By
locating approaches to healing along three axes
(orthodox-unorthodox, general-particular, and
consistent-inconsistent with scientific method), Wardwell offers
a topographical map of medical systems. But this typology tends
to make real distinctions that in reality are blurred. What is
also needed is a stratigraphic map which reveals common concepts,
practices, and relations between practitioners.

The latter is usually analyzed by introducing the concept of
an overarching medical system of one sort or another. However,
while the denotation of "system" varies by author, the
connotation remains fairly constantly that of mechanical or
biological organization (i.e. organismal cell or the body as a
system of systems). The relationship of the parts (i.e. healing

systems and other institutions) to the whole is studied, assuming

38
changes in one order will cause changes in the other. This model
is implicit in the works of Hendrickson, Parsons and other
functionalist authors and reappears in Kleinman's works.

In all of these models the medical system is a homeostatic
device for maintaining an acceptable level of health to allow
society to function. Kleinman's health care system, ostensibly a
cultural system on the order of Geertz's models of art, religion,
common-sense, and ideology as cultural systems (1973: 1983), is
divided into three sectors (professional, folk, and popular) and
into sub-sectors and so on down to basic structural components
(1980:44) . "The relationships between (these) component parts
form the system and guide the activities of its components "
(34) . The health care system has an internal structure and is
influenced by external forces. Each health care system
"performs" certain "core clinical functions" and so the system
itself, not just the healer, heals (72).

As valuable as much of 'Kleinman's work is, his concept of
health care systems has some serious flaws and reiterates many of
the shortcomings of earlier, functionalist models. Consistent
with science's preoccupation with systems, he proposes the health
care system to be a totality within a larger totality. Like a
physiological system, the health care system has a structure, it
reacts to external "forces," and performs certain vital
functions. As appealing as this model might be for
cross-cultural comparisons it must be scrutinized more carefully.

What are the limits of the health care system? Kleinman

39

suggests they are geographical, but how do you separate one
health care system's boundaries from another? And what happens
at the interstices? In the United States, is the Detroit health
care system merely a subsystem of the larger American health care
system? On the other hand, they might be considered behavioral
systems. According to Kleinman it is the relationship of all
health care activities that defines the health care system. What
is a health care activity? Actions (or thoughts) designed to
fight or ward off disease or affliction, before and after illness
strikes? If so, then its domain is extremely broad and far too
unwieldy to allow the cross-cultural comparison claimed for it.
Furthermore, the sectors, if distinguished by the formal nature
of their knowledge, are by no means easily divided, especially
between the folk and popular sectors. As one divides sectors
into sub-sectors and so on, where does one find the basic unit of
the health care system? At the face-to-face encounter? At the
level of the prescription or the spell?

I suggest that Kleinman's comparison between the health care
system and language and kinship as cultural systems is at best
misleading. The promise of a medical system ‘which. can. be
isolated and compared. is more elusive than. Kleinman's model
suggests. it: might be argued that the days of such totalizing,

meta-models are over.1 Instead, the term medical system might be

 

1 The notion of a medical system itself might be pernicious.
Medicine has long been one of the West's dominant categories of
knowledge, along with law and theology. Even though its
epistemological domain is less inclusive than in the Middle Ages,
it may still be too discriminating, or too catholic, for

4O

reserved for single institutions, e.g. osteopathy, allopathy, or
chiropractic (Press 1980:46-7) . But even this perpetuates the
metaphor of medical systems as pseudo-biological species
occupying' different. ecological niches. JNonetheless, I shall
tentatively adopt Press's basic definition of medical system as

a patterned, interrelated body of values and deliberate

practices, governed by a single paradigm of the

meaning, identification, prevention, and treatment of

sickness (1980:46-47).
I object, however, to his bastardization of "paradigm."
Medicine of any type, even allopathy, is at best. a quasi-
discipline, since it develops not by internal theoretical
gestalts but according to external social needs. It might draw
on disciplines that are "governed by a single paradigm," like
physiology or anatomy but it itself is not one (Kuhn 1970:19).
The definition might be rewritten as "the adherence to a single
discourse." I shall examine the nature of discourse later.

As this thesis will demonstrate, chiropractic, ‘ and

especially applied kinesiology, is hardly unified by a universal

 

transposition onto other cultures. For example, western concepts ,
of medicine dismiss the relation of morality to causality, i.e.
it dismisses as irrelevant questions like "why me?" relegating
them to the equally circumscribed domains of religion or
philosophy. Kleinman implicitly commits this error by
distinguishing between religion and health .care as cultural
systems.

2 I shall for the meantime follow the conventional
definition of disease as a physiological disturbance, illness as
the existential manifestation of desease, and sickness as a
generic term enveloping both illness and disease. It must be
noted, however, that this distinction has philosophical flaws in
its implied separation of body and mind, and inimical
consequences (see Taussig 1980).

41

consensus on the nature and. premise of its techniques-~some
chiropractors have more in common with allopaths than other
chiropractors. By avoiding totalizing' schemes and. reserving
'medical system' for individual traditions, am. I in effect
returning to a.taxonomy, like that offered by Wardwell? To the
extent that I minimize the rigidity of the boundaries between
medical systems and search for common grounds, I minimize the
risk of reproducing such simple taxonomies. The notion of
system, then, should be sufficiently loose to appreciate this
lack of consensus.

Giddens provides an appropriate model of social systems and
hence medical systems for use here (1979, 1984). Social systems
are best conceived as "reproduced relations between actors or
collectivities, organized as regular social practices."
(1984:25; 1979:65-81) They exist in space and time, but draw
upon rules and resources which have no real existence in
themselves, only as properties of social systems. In drawing on
rules and resources to produce social action, individuals or
collectivities reproduce the properties of the social system.
Giddens refers to this as the duality of structure.
Institutions are regular social practices. which. are embedded
broadly and deeply in time and space.

By considering social systems as patterns of practices it is
possible to escape the metaphors of discrete social systems on
the order of biological systems. The task of sociology becomes

the elucidation of rules and resources drawn upon in the

42
interaction of collectivities or individuals, and not the
labeling of pseudo-physiological sub-systems whose "functions"
are to satisfy the "needs" of the whole. The whole is dissolved
and structure is dereified and seen not as concrete limits to
action but as continually reproduced conditions for and
consequences of action.

Two levels of interaction might be distinguished: that of
social integration, or the interaction and interdependence
between copresent individuals; and system integration, or the
interdependence of absent individuals or collectivities. System
integration is in large part a function of social integration but
it is not merely social integration writ large. In this chapter,
I shall examine system integration within chiropractic and
between chiropractic and other medical systems and institutions.
In the following chapter, I shall explore the social integration
between the doctor and patient. In the conclusion, I shall tag
salient linkages, but it must be realized that my focus on the
relationship between the doctor and patient is largely confined
to the geographic setting of the clinic and to the communication
of technical knowledge. The largest part of the "link" between
the two "levels" is through. practical, unexamined and 'tacit
knowledge: technical knowledge is only a minor point of
connection.

In this chapter I shall examine the structural properties of
Chiropractic and AK as social systems viz signification (i.e.

Chiropractic as discourse, its interpretive schemes, their bodies

43

of concepts and concepts of body): legitimation (i.e. the manner
in which chiropractic and AK are sustained as legitimate orders)
and domination (i.e. the allocative and authoritative resources
that are be drawn on to defend and advance chiropractic and AK as
social systems). In chapter three, I shall not dissect the
interaction so explicitly into tripartite divisions, but implicit
are the analogous dimensions of communication, power, and
sanction.

Giddens' model of social systems seems more useful than
others in the literature. It avoids the parts-whole notion of
social system and by defining the social system as a pattern of
relations between actors or collectivities it avoids a
structure-event dualism. Finally, the analytical separation
between institutional analysis, involving system integration, and
analysis of conduct in the face-to-face encounter, i.e. social
integration, is linked through the modalities of structuration
and the duality of structure, thereby avoiding a disconnected
macro-micro model. This model, then is a necessary corrective to
the taxonomic models offered by wardwell (1972), Leslie (1976),
Kleinman (1980:1978), Dunn (1976), Press (1980) and others.

With these correctives in place it might be worthwhile to
define chiropractic and applied kinesiology by inserting them
back into Wardwell's taxonomy. Chiropractors are marginal
healers, who claim to treat the whole body. They eschew--and are
legally prohibited from prescribing--drugs and invasive surgical

Procedures. Chiropractors range from "purists" or "straights" to

44

"broadscope chiropractors" or "mixers" (Gibbons l980:4).
Straights limit their treatment techniques to spinal adjustment,
while mixers, in addition to spinal adjustment, advocate the use
of :many other ‘techniques such as soft tissue 'manipulations,
nutritional therapy. diathermy, etc. The dichotomy between
straights and mixers, however, is misleading because
chiropractors are not either one or the other but fit somewhere
on a continuum between the two poles. The distinguishing
characteristics of chiropractors then, are as "natural" healers
who, having been certified as doctors of chiropractic, practice
spinal adjustment as one of their primary, if not the primary,
therapeutic techniques. According to Wardwell's taxonomy, they
are unorthodox, professional healers whose practices have not
been scientifically certified, and who may limit their treatments
to a single part of the body (i.e. the spine) but who claim for
them general functional effects. What I am calling chiropractic
comprises those trained as a chiropractic school, licensed as a
Doctor of Chiropractic, and who practice a method of healing in
which spinal adjustment .is a central technique. It also
comprises the professional organizations which exist to promote
what they consider the interests of practicing chiropractors.

Applied kinesiology is not a medical system per se. There
are no applied kinesiologists, only health care professionals who
use applied kinesiology. There are, however, Touch for Health
instructors who are lay practitioners who teach and practice a

fOrm of AK, and who, like chiropractors, practice as unorthodox,

01

b1

45
marginal, healers using’ an ‘unverified. body of knowledge and
techniques to heal the whole body.

Applied kinesiology comprises those trained in the knowledge
or techniques that are taught as AK, AK's professional
organization, the International College of Applied Kinesiology
(ICAK). AK is far less of an isolatable entity, and may not yet
be considered a medical system. It is a set of techniques and
principles used by diverse medical practitioners, who by and
large do not consider themselves applied kinesiologists. But it
is also an organization with a body of concepts struggling for
legitimacy.

It must be realized that in comparing chiropractic and AK
one would be comparing apples and oranges. They are not
equivalent. However, both may be analyzed on the level of system
integration as social institutions, i.e. as reproduced relations
extending through space and time. The three dimensional
institutional analysis I will perform on chiropractic may also be
performed on AK, but because of its equivocal status as an
incipient medical system and its limited extension in time and
space, it will reveal fewer and more tenuous structural

jproperties than those of chiropractic's.

- S n
In this section, I shall examine first the nature of

<flluiropractic's stock of knowledge and the body of concepts

46
central to applied kinesiology, which Dr. Farrago both draws on
and contributes to. I will begin by considering chiropractic as
a discourse, then I shall discuss how its knowledge is produced
and how it is used.

In social science "discourse" has become a fortuitous
homonym; it signifies» both dialogue Ibetween individuals, and
unities of statements and the rules that allow such statements to
be uttered (Foucault 1972:44). According to the latter°
definition, the statements of a practitioner, presupposes a
discursive formation, in this case chiropractic or AK. The rules
by which statements are made are "anterior" and impenetrable to
the speaker (Jay 1984:523). Chiropractic qua discourse, then, is
not just an assemblage of facts, it is the rules by which
statements are ‘made, concepts are realised and. knowledge is
produced.

A discourse delimits how and what statements are made, but
it is not merely an abstraction, it is realised in practice,
which is "embodied in technical processes, in institutions, in
patterns of general behavior, in forms for ‘transmission and
diffusion, and in pedagogical forms which, at once, impose and
:maintain them." (Foucault 1977:200)

Discourse cannot be separated from action. There is a
dialectic between discursive practices which "form" knowledge
(I?oucault 1972:83) and its use in action (i.e. to manipulate or

CCintrol). The dialectic is not usually considered by the agent.

Thus far I have assumed that chiropractic may be considered a

{'0

C4

Vi

47
discourse, but this cannot be casually assumed: it might be part
of a larger discourse. This question is not easily answered. In
many ways chiropractic duplicates many of the hallmarks of the
dominant allopathic medicine. For example, in its abstraction
the patient's body from the patient and his or her environment;
its hierarchical relationship between doctor and patient; its
concepts of anatomy, physiology, pathology: but in sdme important
ways it differs. For example, the provenance of illness is not
external but internal to the patient's body: and the central role
afforded the spine in health and illness. In addition,
chiropractic is characterized by a lack of consensus on the
definition of chiropractic and until recently a lack of
standardization among chiropractic schools.3 However, beneath
the differences there are regularities: all chiropractors have
been educated at one of only 17 chiropractic schools in the U.S.;
all claim as an apical ancestor D.D. Palmer, if not B.J.; all are
opposed though in varying degrees, to drugs and invasive surgery:
all practice spinal adjustment as a primary, if not the only,
treatment technique, and all resent allopathic hegemony. Even
the differences between mixers and straights over the use of
extra-spinal manipulation and adjunct therapies, amount to.
disputes between conservative and liberal readings of the same
text. That chiropractic might be considered a discourse, and not

a variation on allopathic discourse, is illustrated by its

‘

3 It should not be imagined that allopathy is characterized
In? a consensus on its techniques and procedures (Katz 1984:90-93
et passim).

48
distinctive approach to spinal manipulation vis-a-vis osteopaths,
physiatrists, and orthopedic surgeons.

If I consider chiropractic a discourse can I do the same for
AK, or is it a variation of chiropractic discourse? This
question is more difficult to settle. On the one hand, AK is not
mutually exclusive of allopathy, chiropractic or even dentistry.
It is one of the many diagnostic techniques found within
chiropractic and it is taught as an elective at some chiropractic
colleges. On the other hand, it is advertized as an
interdisciplinary approach to healing, and is in many ways
external to chiropractic. It has its own professional
organization: it draws on concepts and techniques to some extent
alien to chiropractic and incorporates them within AK's
conceptual framework according to tacit rules; and new knowledge
is being produced by Dr. Goodheart and others.4 If AK is
considered a discursive practice, then it offers an interesting
case of application of one discourse to other discourses as ‘
chiropractors, dentists and others use it in their practices.

Dr. Goodheart told me he believed AK "explained"
chiropractic, suggesting not an intersection between discourses
but an enclosure of one discourse by another, not unlike Kuhn's
new paradigm explaining an old inadequate paradigm. I am willing

to tentatively consider AK as an incipient discourse. It may be

‘

4 As I shall discuss later, AK knowledge is produced by
Practicing clinicians who send in papers either to satisfy the
requirements for Diplomats status or from the sense of discovery.
The point is it is not produced by professional producer-
re searchers, nor according to "scientific method."

49
that AK has only just passed what Foucault has called the
"threshold of positivity,...the moment at which a discursive
practice achieves individuality and autonomy, (and) the moment at
which a single system for the formation of statements is put into
operation" and is developing towards the "threshold of
epistemologization," when in the operation of a discursive
formation, "a group of statements is articulated, claims to
validate...norms of verification and coherence, and. when it
exercises a dominant function over knowledge...." (Foucault
1972:186-7) It will remain to be seen whether AK reaches the
"threshold of scientificity," when statements comply with certain
laws for the construction of propositions and the epistemological

framework obeys a number of formal criteria.

According to chiropractic's "Big Idea," (Keating 1986) the
body is a naturally balanced, "intelligent" being. Balance is
maintained largely by the nervous system, through reflexes and
autonomic control.5 The body is considered an intelligent being.
capable of monitoring changes and responding intelligently.
Modern chiropractic, following biological and physiological
theory, terms this balance homeostasis. In doing so, modern

chiropractors are distancing themselves from earlier theories of

5 Chiropractic_was 'discovered' prior to the discoveries of
the effects of the endocrine system. Ever since, hormonal
Gontrol has by and large been ignored in chiropractic, emphasis
be ing placed instead on the relationship between structure and function.

50
innate and educated intelligence promulgated mostly by B.J.
Palmer. (1920)

Briefly, B.J. argued that "nothing in or above this earth
'just happens'" (107): all things occur as the result of
universal laws, which are not reducible to the laws of chemistry
and physics (120). All life is the expression of this universal
intelligence: it is the source of all energy. The universal
intelligence is realized in individuals as the innate
intelligence, which is the life within the body, and like the
universal intelligence, it is perfect. Its expression, however,
may be distorted by' obstructions in. the cyclic jpathways of
communication with the body (i.e. the nervous system). The
innate intelligence expresses "herself" through two media: the
educated mind and the innate mind. The innate mind
controls all actions of the body in an intelligent manner not as
blind laws or the result of laws of chemical affinity, but as
reasoning, logical intelligence (125) . The innate mind exists
before the physical body and exists after it. It is unlimited,
intuitive, instructive and immortal. The educated mind begins at
birth and ends at death. It receives impressions through the
five senses, through which it understands its external
environment, and it gains knowledge by reasoning. The educated
mind, however, must receive impulses from the innate mind before
there can be any expression. The educated mind is never perfect,
which implies the innate intelligence can never be perfectly

realized. The control of the body by the innate mind can be

51
compromised by vertebral subluxations which produce pressure on
the nerves and interfere with their "carrying capacity,"
resulting in too much or too little nerve energy reaching the
organs and possibly disease. Adjustments of subluxations allows
the innate to more properly express itself in the body (137).

B.J.'s formulation of the body's organization is an
extension of his father's and has undergone many revisions. Few
now adhere to it in its original form, but the Big Idea retains
most of the elements of his argument, often under different
labels. For example, innate intelligence is analogous to
homeostasis; the essential emphasis on the relationship between
structure and function is retained: healing is believed to
consist in releasing the body from structural constraints to
allow the body to return itself to a balanced state: and there
still seems to be a widespread belief that nothing happens
without a reason, and that every structure exists for a function.
Thus there is no such thing as an accident: afflictions always
have a cause and a reason. These hallmark beliefs of the Big
Idea, are also intrinsic to AK.

AK canon, as written in Walther's multi-volume text Applied
W (1980), describes the body as an organized and
integrated whole. When the body's balance is upset, "the body
heals. itself...in a sure, sensible, practical, reasonable
manner." Disease is a disruption of the body's organization and
results in a shift from the optimum function for the individual

organism. Health depends upon a balance between structural,

52
chemical, and mental factors: the triad of health. A state of
health is a state of balance: all the body's structures must be
working in concert according to uninterrupted neurological
signals. Dr. Goodheart describes disease as a rock beat
disrupting a symphony performance. AK tries to get the noise
out.

The body's organization is controlled primarily by the
nervous system and secondly by the endocrine system. The nervous
system controls the strengthening and weakening of muscles. The
manual muscle test, the principal diagnostic technique of AK,
evaluates this control. The body's organization is partly innate
and partly acquired. For example the dichotomy in cerebral
function is innate, and. the development of the body's form
through life is acquired.

When the body's balance is disrupted it will be indicated by
a pattern of muscle weakness. AK claims as one of its major
achievements to have discovered an association between specific
muscle weakness and specific organ or gland involvement, that is,
when an organ or gland is in a state of dysfunction, there is
always a specific muscle or muscle group that will be weak. The
basis for the association is not understood but hypotheses
attribute it to the connection between the complex interworking
of the body's control mechanisms, and its energy patterns. It is
suggested that, in addition to organs and glands "causing" muscle

weakness, weak muscles may "cause" organ or gland dysfunction.

53

Four types of reflex are held to Ibe involved in. this
relationship: somatosomatic, somatovisceral, viscerosomatic, and
visceral-visceral reflexes. AK recognizes certain constellations
of reflexes mapped by earlier researchers: neurolymphatic
reflexes are associated with lymphatic drainage. When active,
they’ harden into BB-like nodules. iMassaging’ these reflexes
increases lymphatic drainage and has been shown by Goodheart to
strengthen associated muscles. Likewise, neurovascular reflexes
found on the hand have been found to affect the vascularity of
different organs, and have been correlated with specific organs
and muscles. Massaging these reflexes, is said to increase blood
flow to the associated organs and increase muscle strength.

The second major achievement claimed of AK is the use of
muscle testing to evaluate muscle weakness and hence body
function. Muscle weakness can be caused by a disruption in any
body system. On the chemical side of the triad of health, it may
result from nutritional deficit, poisons or allergens. On the
structural side, AK considers five interrelated factors in
analyzing muscle weakness resulting from possible vertebral
involvement viz nerve, blood and lymph flow, cerebro-spinal
respiration,6 and acupuncture or body energy meridians. The five

factors are held to be interrelated by their common structural

 

5 cerebro-spinal respiration is a hypothesis which proposes
that the cranium expands and contracts, and the sacrum tucks
inward rhythmically as cerebrospinal fluid is pumped along the
spinal canal into the cerebral ventricals and out again (See
Upledger 1983). The hypothesis has found support among some
chiropractors and is taught in some osteopathic schools,
including Michigan State University.

54

association with the intervertebral foramina (IVF), the point of
entry and exit for spinal nerves to and from the spinal canal.
According to Walther, a nerve, a blood vessel, and a lymph vessel
runs through each IVF; cerebrospinal fluid escapes through the
lymphatic capillaries; and acupuncture meridians touch each IVF
(1976:14). A disruption in any of these factors affects the
others and may influence the ability of a muscle or muscles to
resist against a force such as that applied in muscle testing.

Other structural assemblies considered to have adverse
affects on the body if distorted include the pelvis, which can
lead to headaches, neck pain, visual disturbances, pains at the
first rib, head, etc., and the base of the cranium.

AK has correlated muscle groups with organs and glands (see
Appendix A). Testing these muscles is believed to test the
condition of the associated organ or gland.

The manual muscle test is the hallmark diagnostic technique
of AK. It was borrowed from existing knowledge and modified.
The test is said to measure muscle strength or more properly, the
ability of a muscle to resist a force applied to it. In the
exam, the doctor will have the patient assume a position or
maintain a limb in a .certain posture as he pushes or pulls
against it. If the ‘muscle can *withstand the force--always
subjectively measured and compared to the strength and size of
the patient--it is considered to indicate either that a specific
gland or organ is functioning correctly or that the body as a

whole is balanced. Should the muscle weaken it is inferred that

55

a specific region or structure, or the body generally is
dysfunctional. Some muscles are correlated with certain organs
and glands, others may be used as general indicators. Certain
conditions must be met for the muscle test to be valid: the
doctor must not either mentally or physically try to overcome the
muscle, the patient must not be taking any medications that might
interfere with the test, and there must not be any other
disruptions.7 The muscle test 'is used by Dr. Farrago for all
manner of diagnoses. In addition to testing the state of organs
or glands, he would use it to determine whether the body was in
need of particular substance. He would also use it to ask the
body questions such as "is this dental plate disrupting body
function?", and he claimed when combined with other tests it
could reveal whether a person was lying. I am not sure if it is
used similarly by other healers.

I shall not attempt a more in-depth description of AK's
concept of body. It is sufficient to give an idea of the
distance between AK and dominant allopathic concepts of body and
the proximity to chiropractic. I shall briefly describe AK
concepts of disease and. methods of diagnosis and treatment.-
Finally, I shall consider the claims made by chiropractic and AK

to be sciences.

 

7 When I first started observing Dr. Farrago with patients
he used a crystal to help with diagnoses. He explained that it
focused energy' which either added or subtracted. body energy
depending on which way it was pointed. Later on, I noticed he
was no longer using the crystal. He told me he stopped because
he found it was distorting the results of the muscle test.

56

Disease results from an imbalance in any one or combination
of sides of the triad of health. A factor affecting only one
side of the triad of health will, if untreated, eventually affect
all sides. Disease is essentially the imbalance and
disorganization of the body; it implies a less than optimal
functioning. Most disease is functional: only in advanced stages
does it become pathological. AK and chiropractic argues that
allopathy is constrained by its methodology. MD's, they argue,
are unable to detect early disease, the patient must wait until
he or she has advanced stages of disease before the M.D. can be
of any-help. The practitioner trained in chiropractic or AK, on
the other hand, is able to detect early stages of disease and
prevent it from worsening.

Disorganization, i.e, disease, may be the result of trauma
or failure to develop. Either results in improper signalling
(i.e. usually neurological but may include endocrine
communications) or energy imbalance throughout the body. Often,
if the disorganization is great enough such that the body cannot
immediately return itself to a balanced state, and treatment is
not forthcoming, back-up mechanisms or compensations will allow
continued, if compromised, function. These compensations are
often responsible for the Ibody "masking" the true cause of

illness from the clinician. The mechanisms by which the body

 

8 see Eco on non-human communication (1979:8,32-38)

57
compensates for disorganization is unknown, and again, AK
postulates it is related to body energy patterns.9

I shall not attempt to list AK's inventory of therapeutic
techniques: it is large and ever-expanding. I shall simply
categorize them. It should be noted that AK, strictly speaking,
is a diagnostic, not a therapeutic, technique. However, AK canon
suggests suitable techniques for specific conditions 'once a
diagnosis has been made. Individual healers mix these techniques
with. others, chiropractic, osteopathic, dental, or any’ of a
thousand therapeutic techniques.

All of AK's techniques are. non-invasive and. non-
pharmaceutical. However, in practice nutritional supplements and
other substances are prescribed as analogs to pharmaceuticals.
AK claims treatments should "release" the body to allow it to
organize and return itself to a balanced state; or alternately
educate it, if it has been compromised or distorted for a long
period of time.

The basic therapeutic techniques described in AK texts are
manipulation of the spins, the cranium, the extremities, massage
of trigger points, neurolymphatic, neuromuscular and other
reflexes: prostheses (e.g. splints for feet or the jaws);

nutritional supplements: and treatments designed to balance the

 

9 Energy seems to "fill" the body. It enters the body,
courses along meridians and leaves. If a region is out of
balance its energy pattern is altered and there might be too much
or too little. One treatment I witnessed included taping a BB to
a patient's shoulder. The BB is supposed to act as an antenna
attracting extra-body energy to fill the patient up. Energy
might also be blocked by a subluxation for example.

58
energy flow of the body. As the variety of these regimens
suggest, AK, if it is to be considered within the purview of
chiropractic, represents an extreme on the mixed-straight

continuum.

In this section I shall consider the claims made by
chiropractic and AK to be sciences. The relationship between
medicine and science, especially in our culture, is nebulous but
usually expected to exist. Medicine is often considered, and
sold as, science incarnate, as the clearest instance of science
serving man. Yet, the relationship has not always been so
intimate, nor has science always been so valued as it is today
(Shryock 1966:71-89). Today, science confers upon a product or a
occupation qualities of control, precision, parsimony, in a word
trustworthiness. It is understandable, then, why occupations
that rely on trust, such as healing, would strive hard to present
themselves as "scientific." But as I have described clinical
medicine is not a science,

Not only because it does not comply with the formal

criteria, or attain the level of rigour expected of

physics, chemistry, or even physiology; but also
because it involves a scarcely organized mass of
empirical observations, or controlled experiments and
results, therapeutic prescriptions, and institutional

regulations. (Foucault 1972:181)

Like technology and law, and unlike sciences such as anatomy,

geology, physics, etc., medicine's raison d'etre is social need

external to the problems of the discipline (Kuhn 1962:19).

59

It is a truism that medicine lives under a diarchy of art
and science. But what this metaphor means is not always clear.
It is often used when expectations of a scientific medicine fall
short or it may indicate the essential tension between
codifiable, technical knowledge and non-codifiable, tacit
appreciation of the social conditions of illness. Whatever it
may ordinarily mean it is too ambiguous to be useful in
understanding the scientific quotient of medicine--allopathic or
chiropractic.

It might be worthwhile to consider science as a form of
knowledge produced according to certain, usually tacit but
codifiable rules. It has already been mentioned that medicine,
and chiropractic, cannot be considered a science because of its
attention to external social needs and not to inconsistencies or
contradictions revealed within its models. I have established
that chiropractic and AK might be considered discourses and they
have formalized their knowledge but to different degrees.
Neither, however, can be considered to have reached the threshold
of scientificity, when statements "comply with certain laws for
the construction of propositions" (Foucault 1972:87) . In both
chiropractic and AK, statements are not. made from ‘within a
framework of formal, self-conscious rules. Chiropractors have
been of a long-standing opinion that there is no need to
constrain one's statements and practices to those permissable by
scientific principles (Keating 1986:73). Chiropractors are being

asked to change this opinion, but as, I shall explain, mostly for

60
reasons other than the growth-according-to-science ethos of true
disciplines.

More so than. allopathic :medicine, chiropractic fails 'to
produce or evaluate its knowledge according to codifiable rules.
Unlike allopathy, most of whose knowledge, basic and clinical, is
produced in universities, in laboratories and research clinics
and in hospitals by professional researchers or at least by
clinicians subscribing to the same rules of verification,
chiropractic's knowledge is produced almost exclusively in
private clinics by private practitioners largely unrestarained by
the rules of "scientific method" (Keating 1986). The two
different centers of knowledge production and modes of production
are reminiscent of the opposition between the rational or
dogmatic school and the empiric schools of medicine in ancient
Greece. The latter rejected the former's reliance upon rational
principles and advocated empirical observations (Major
1954:150-1). Of course such a distinction is simplistic, but it
does put into black and white the tendencies of each mode of
production of knowledge, and it forces into relief the lack of
standardization in chiropractic's production of knowledge.

Thus far I have established that chiropractic knowledge is
not produced according to, or evaluated by a strict body of
rules, so in form it is even more exclusive of science than
allopathic knowledge. But knowledge may be considered in a
different way: its use. Knowledge may be considered scientific,

or at least technical, if it is generated and evaluated out of an

61
active interest in prediction and control. Habermas considers
knowledge scientific if it is produced by communities of
interacting individuals who operate upon and perceive reality,
not idly and contemplatively, but in terms of particular
instrumental manipulative and predictive interests (Barnes
1977:12-13). Therefore, to the degree that chiropractic and AK
produce knowledge to better control and manipulate body
dysfunction, they’ may' be considered. as bodies of scientific
knowledge.10 However, as Barnes explains, "knowledge grows under
the impulse of two great interests, an overt interest in
prediction, manipulation and control, and a covert interest in
rationalization and persuasion" (1977:38). The latter impulse
may be termed ideologically determined knowledge, i.e. knowledge
or beliefs that are "created, sustained. or accepted. in the
particular form that they have only because they were related to
social interests" (Barnes 1972:27). It is very difficult to
establish whatever knowledge is instrumentalky or ideologically
determined, but whenever knowledge is ideologically determined
(i.e. used to remote or’ sustain. an interest) it is 'usually
disguised as such: it is legitimized. While theoretical
contradictions may indicate the ideological functioning of
knowledge, attempts to mitigate them do not necessarily imply any

lessened ideological role. Foucault explains, "The role of

 

10 It should be noted that science as form, as was discussed
above, remains the most efficient method of developing
instrumental knowledge, and to the extent that chiropractic fails
to produce its knowledge by the "scientific method" it will be
less efficient in producing generalized useful knowledge.

62

ideology does not diminish as rigor increases error is
dissipated" (1972:186).

The question remains: what proportion of chiropractic and
AK as knowledge is instrumental and what proportion ideological?
Joseph Keating's article "The Practitioner's Role in the Science
of Chiropractic" (1986) offers a window into the process of
ideology. In it he argues that it is time that chiropractors not
just accept the "Big Idea" on faith, they need to explore whether
.or not their clinical attitudes actually work. It has long been
argued that chiropractors have "empirical" proof that their
treatments work because their patients get better, and that all
research (i.e. science) must do is to "explain" why. Scientific
explanations would give credence to already "proven" techniques
and vindicate chiropractic as a profession. Much research has
been done towards these ends. This is an example of the
ideological use of science, i.e. to legitimize extent practices
and interests. It is of interest that the central techniques of
chiropractic have changed little since 1900, when science and
medicine were not considered to be in a necessary relationship.
However, since then the relationship has become more intimate and
chiropractic has tried to arrange a marriage between its tenets
and science, and like most arranged marriages it is for social
reasons. Rather than being used to verify and increase its
instrumental efficacy, it is to legitimate a relatively constant

body of techniques.

63

In conclusion, it is difficult to determine the status of
chiropractic, not as a science-wit cannot be anymore a science
than allopathy can-~but as quasi-discipline.‘using' science ‘to
improve its ability to heal patients. I have shown how science
used to maintain and improve chiropractic's standing as a healing
profession.

The same is true of AK's use of science. It's mode of
production of knowledge is essentially the same as
chiropractic's, but with one important and revealing difference:
Dr. Goodheart informed me that all of the knowledge "on the
books" before 1983 is now' considered orthodox: all research
results submitted after 1983 must be verified by one measure or
another. This declaration of validity by fiat is illustrative of
a lack of adherence to the rules of verification implicit in
normal scientific evaluation of information. Thus to the extent
that AK is claimed to be a science it is for ideological rather

instrumental reasons.

2.; ngitimation,
Every group or order justifies itself and what it considers

truth in one way or another. Justifications range from simply.
listing the groups activities to explaining the necessity for the
group's existence. The virtuosos of justification, or
legitimation, in American society are public relations officers.
In this section I shall analyze chiropractic's and AK's struggle

for recognition and legitimation on the level of system

64
integration. I shall examine aspects of legitimation in the
practitioner's performance on the level of social integration in
the next chapter.

As institutions, chiropractic and AK must justify and
explain itself to its praCtitioners--current and prospective; to
the public--patients and prospective patients: to the state: to
other institutions (e.g. insurance companies, labor unions,
hospitals): and to other medical systems. As with other
institutions, chiropractic's justification serves as a boundary
marker.

AK justifies itself with at least four major arguments: AK
is a new translation of the body's logic that allows the skilled
practitioners to ask the body questions and to understand its
responses; it relies on the patient's "participation not
cooperation," thus "restoring the soul and heart to what then
becomes the cold in inhuman practices of much of today's
medicine"; it is the only therapeutic system able to evaluate all
three sides of the triad of health and thus is useful for all
medical systems; it explains chiropractic, bringing all of
chiropractic's therapeutic techniques together. These four
explanations, or promises: AK as a cipher for the body's code;
.AK treatment of patients as individuals, AK's potential benefit
for all medical systems, and AK as chiropractic's hope for
IJnification are offered as AK's raison d'etre.

Chiropractic offers similar justifications. It claims to do

good and do no harm, consistent with the Hippocratic oath, by

65
eschewing "drugs" and invasive surgical procedures; it works with
nature not against it; and it can be a portal of entry to the
allopathic medical community.

Implicit in AK's and chiropractic's "explanations" are
claims to be sciences. No matter how science is defined its
authority derives from its production of knowledge according to
rational, "legal" rules, and not tradition or the charisma of a
leader (Weber 1947:328). Historically, the predominant basis of‘
chiropractic's legitimization has shifted from the charismatic
authority of its founder to rational-legal authority of
chiropractic as a clinical "science." It began as a protest
against and an alternative to the "heroism" of allopathic
medicine, as conceived first by D. D. Palmer and then his son
B.J.,and while it may still be a protest and alternative to
allopathy's continued "heroism," it is no longer defended on the
grounds of the wisdom of its two founders. In Weber's terms, the
Palmers' charisma has been routinized; the direction this
routinization has taken may have been in large part due to the
early influence of allopaths--from within (e.g., the A
administrations of Howard, Schultz and Foster at National
College) and from without (e.g., in their continued criticism of
chiropractors as quacks and medical pariahs).

According to Weber's model of legitimation, recognition
ordinarily follows legitimation (i.e. the grounding of beliefs in
authority). But the process may be reversed.

When the organization of the corporate group undergoes a
process of progressive rationalization, it is readily possible

66

that, instead of recognition being treated as a consequence of
legitimacy, it is treated as the basis of legitimacy, legitimacy
that is, becomes democratic. (Weber 1947:386)

Put a little differently, Weber is arguing that l) legitimacy is
the necessary condition for recognition and 2) recognition is a
sufficient condition for legitimacy. Chiropractic's struggle for
acceptance as a medical system may be considered a dialectic
between recognition and legitimization. The first moment of this
dialectic corresponds to legitimation derived from popular
recognition and the second, recognition as a consequence of
legitimacy.

The first moment represents chiropractic's recognition as a
result of popular legitimation. At least four related dimensions
to this movement may be isolated: chiropractic's anti-orthodox
posture and a lack of uniform consensus on the validity of
allopathy's dominance: a correspondence between chiropractic
principles and patient's world views: and a general recognition
of chiropractors as "back doctors."

Chiropractic attracts some jpeople merely' by' standing' in
opposition to allopathic hegemony, regardless of what it
practices or preaches. Dolby has described the medical systems,
organized and unorganized, in the shadows of orthodoxy as
comprising the "cultic milieu" (Dolby 1978:25). He describes an
"ideology of seekership" according to which people, unimpressed
or disenchanted with the dominant ideology will look elsewhere
for satisfaction of their needs. Often they will consult a

series of practitioners from different medical systems. As the

67

most prominent marginal medical systems, chiropractic attracts a
number of "seekers," who are aware to varying degrees of what
chiropractic promises. If chiropractic is not the first to be
"tried," then the apparent similarity of its principles to those
of other medical systems in the cultic milieu (e.g. the
importance of a balanced life, the role. of energy’ in Zbody
functions as natural healing), will tempt the seeker who has
tried other approaches to health to try it sooner or later.

Chiropractic is also attractive to some for its apparent
opposition to the image of allopaths as high priests of high-tech
medicine. In contrast, they are seen as old-time, caring doctors
interested in their patients as people as cases. The
chiropractor-patient relationship is felt by many to be less
threatening and more egalitarian than their relationships with
their 11133.11 This may in part be due to the general
characteristics of chiropractic practitioners: most are white
males drawn from the middle-lower-middle class, and not educated
out of the working class or lower middle class world views also
held by their patients, though this is changing as chiropractic
professionalizes.

.Another instance of chiropractic benefitting from its
opposition to orthodoxy is its fortuitous participation in the

holistic health movement which was part of the larger ecological

 

11 Plato noted a distinction between the way doctors treat a
slave, the free but poor, and the free and rich (The Republic,
Book III). It might be argued that the differential treatment of
patients continues today, but I do not have the data at hand to
assert it.

68
movement of the 19603 and 19703 and its long standing opposition
to surgery and drugs. Its advocacy of a balanced life style was
consistent with the movement's general ideology.

Implicit in chiropractic's success as a marginal medical
system is the absence of a universal consensus regarding
allopathy's claims for dominance. Michael Mann has described how
social cohesion in liberal democracies is not the result of a
universal value consensus through society but more from a
consensus among society's dominant classes and the absence of any
consensus among lower classes which keeps them compliant
(1970:373-395). It may well be that allopathy's dominance is
maintained by the ruling classes, for' which science is the
dominant ideology and its relationship with medicine is
considered the sine qua non. This is not to say that science is
not considered necessary for effective medicine among the lower
classes, but there seems not to be the consensus that there is
among the ruling classes. Among the lower classes, issues other
than the scientism of the methodology are considered more
important (Wolinsky and. Steiber 1982:765: Riley 1980). The
absence of any consensus among the lower classes means also that
allopathy is not the "high" medicine of the society's elite
opposed by a "low" medicine of the masses as it is in some
cultures. The consquences of chiropractic's "scientization" for
its lower class patients remains to be seen, but it may be
hypothesized that it is at least in part an effort to legimitate

itself in the eyes of the society's dominant institutions, which

69
place great stock in scientific ‘verification (e.g. insurance
agencies, allopathy, the media).

A second and related dimension to chiropractic's recognition
as a medical system is its congruence with the world views of its
patients. McCorkle has described how chiropractic tenets and
treatment is appealing to "the objective-minded, 'practical
Iowans,'" who looks for a quick, cheap, mechanical no-fuss cure
(1961:22) . By now, chiropractic has spread far beyond Iowa;
whether or not its popularity derives from a similar appeal
remains to be established. In my study of a single
practitioner's clinic near Detroit there did seem to be a
preference among patients for the quick, inexpensive and
mechanical cure over the expensive, other high-tech diagnostic
and therapeutic regimen offered by allopathy, but I did not study
this in any depth.

A final dimension to the first moment of the dialectic is a
recognition of chiropractors as "back specialists" or
pejoratively as "back crackers." Almost certainly patients who
consult chiropractors, also consult allopaths, and make decisions
as to which one to consult for what conditions (Riley 1980:117).
Where there is overlap between services offered, chiropractors
may be consulted for a second opinion, especially if the allopath
has recommended surgery or an expensive therapeutic regimen.

The first moment of the dialectic--legitimacy as a
consequence of popular recognition--is by definition democratic.

The advances of second moment--recognition as a consequence of

7O

legitimacy--have been won largely by chiropractic's professional
bodies and have been accompanied by a differential preservation
of chiropractic's history, according to the values of the
dominant institutions of the society. The more metaphysical
arguments of D. D. and B. J. Palmer and early chiropractors have
been quietly forgotten and newer explanations couched in
scientific terms and concepts for the same practices have been
brought to the fore. Events along the second moment of the
dialectic brought chiropractic under the protection of elites and
beyond. The four dimensions to this movement that I shall
examine are chiropractic's protection from elites: its
scientization: its professionalization; and its victories in the
law courts. The dimensions are inseparable and contribute to the
overall dialectic of chiropractic's development.

Despite its lack of scientific verification, chiropractic
has enjoyed federal governmental recognition. since 1951 ‘when
chiropractors and chiropractic students were exempted from the
draft by the Universal Military Training and Service Act (ICA
Review, March/April 1986:16). Since then chiropractic has been
included under most federal insurance and health legislations,
including the Elder Care Bill (1961), the Comprehensive Health
Planning Act (1966), H.R.l., the social security amendments
(1973), and the Federal Employee Compensation Act (1974). In
addition, since 1974, all fifty states have recognized and
license chiropractors as health care professionals. Recognition

on the federal and state level has come in the face of concerted

71

attempts by the A.M.A. to "contain and eliminate" chiropractic
(Pedigo, 1986:8-9: Null, 1985). Through paid retainers, letter
writing' campaigns, and contributions to election funds,
chiropractic bodies have managed to secure the protection and
sponsorship of powerful elites. In light of allopathy's
hegemony, the absence of any scientific verification and its
exclusion from the nation's universities, this protection has
been essential for chiropractic's survival.12 Cobb recounts how
Daniel J. Flood's, the subcommittee of the House Appropriations
Committee hearings in 1971, riposted to the statement made by
Roger' Egeberg, M.D., the .Assistant Secretary for' Health and
Scientific Affairs, to the effect that there was no scientific
basis for chiropractic therapy.

The fact remains that the mail that the members are getting,
and speak to me about, in the last year or two, because of my
position as chairman of the subcommittee is very heavy. They all
say to me, and mail I have received is from patients--these are
mostly form letters, they are from patients who say they have
been relieved of this pain or suffering or whatever it was.
(Cobb 1977:18)

Politicians recognize that popular demand is easily translated
into political pressure, and in 1974 chiropractic was included
under Medicare.

Another instance of sponsorship by political elites is the
National Institute of Neurological and Communicative Disorders

and Stroke (NINCDS) conference on the research status of spinal

manipulative therapy in 1975. The conference grew out of an

 

12 See Baer 1984 for an account of osteopathy's struggle for
recognition in Britain and its similar reliance upon the support
of elites.

72

order from Senator Warren Magnuson, chairman of the
Appropriations Committee for the Department of Health, Education,
and welfare, to the NINCDS to allocate two million dollars for
research related to spinal manipulation. Senator Magnuson had
been involved with chiropractic since 1949, and had been a member
of the layman's organization of the CHB. He had often lobbied on
chiropractic's behalf and as committee chairman was able to offer
chiropractic a chance to. confront its critics in a respected
forum. The NINCDS Director of Extramural Research was Murray
Goldman, D.O. He coordinated the conference and edited the
monograph containing the papers presented (1975). As an
osteopathic physician it has been argued, Goldman was more
open-minded about chiropractic and less likely to succumb to
pressure from the AMA to focus on chiropractic as a profession
and not on spinal manipulation as a healing technique (Holder
1974:922-3: Null 19853passim). The conference was inconclusive on
the mechanics of spinal manipulation, but it was conceded that it
could relieve suffering in some patients (West 1975:267-8).
Chiropractic, at least, was not thrown out of court.

Appeals to political elites have often followed partisan
lines. For example, the Michigan Chiropractic‘ Council (an
affiliate of the ICA) has been accused by the Michigan State
Chiropractic Association, an affiliate of the ACA, of imposing
anti-mixer legislation and too narrow' a definition. of
chiropractic secured largely through a campaign contribution to

then state governor, William Milliken. Other instances of

73

protection of chiropractic by elites might be cited, but for
purposes of this thesis, it is enough to demonstrate that
protection and hence recognition by the state is often based on
popular legitimation which is converted into legitimation
vis-a-vis the state and dominant institutions. Chiropractic has
benefitted from such protection and has attained a certain degree
of legitimacy in the eyes of the dominant powers despite an
absence of scientific verification.

AK has by-passed the need for state or federal recognition
by limiting those who may learn its techniques and principles to
those already licensed to diagnose and treat patients. There is
no need for independent licensure and at this stage no need for
protection from the elite, since it is not an entity likely to
attract the attention of regulatory agencies.

Another dimension to the second moment of the dialectic, is
the scientization of chiropractic. In the section on
signification I discussed some of the difficulties involved in
defining science. I also introduced the notion of ideologically
determined knowledge, which serves to maintain, advance or defend
the social interests of a social system, rather than increase its
ability to manipulate or control the real world (i.e.
instrumental or technical knowledge). Here I shall examine the

scientization of chiropractic as an ideological use of science.13

 

13 The same analysis of allopathy would be both possible and
profitable (see Comaroff n.d.).

74

In its early history, there was no need to couple
chiropractic tenets to scientific principles. Basic science was
only beginning to be valued as a source of technological
innovation (Shryock 1966:71-893162). Chiropractic canon as
written by B. J. Palmer and J. H. Craven (1920) drew on
contemporary scientific concepts, such as the reflex cycle, and
adjusted them to suit their needs. Their models of physiology
are filled with analogies of electricity, dynamos, currents, and
circuits, but they constructed their theories not by research
from within a paradigm, but by bricolage, i.e. the assembling of
heterogenous and preformed concepts into a useful whole, but one
not marked by internal consistency, nor one born from within a
system of concepts (Levi-Strauss 1966:6-22).14 As I noted, only
relatively recently has science been considered the essential
condition for "instrumental" healing. The necessity of this
relationship is evident from the report prepared for the first
hearing on chiropractic's inclusion under Medicare, in 1968:

Chiropractic theory and practice are not based upon the

body of basic knowledge related to health, disease, and

health care that has been ‘widely accepted by the

scientific community. (Holden 1974:923)
Largely as a result of the predominance of these sentiments,
chiropractic was not included under Medicare. Not until
chiropractic's professional bodies had come together and written
a white paper defending the "science of chiropractic," did

chiropractic win inclusion in 1972.

 

14 I shall discuss more fully the concept of bricolage in
chapter three.

75

Incidents such as these brought home the necessity of at
least appearing to be scientifically grounded: of revealing "the
sciences underlying the art of (chiropractic) healing" (Gibbons
1981:238).ls This, however, is tendentious science-~production
of knowledge not for greater instrumental control but in defense
of chiropractic as a social interest. The hows and whys of the
Big Idea have been studied but not whether it actually works
(Keating 1986).

In 1974, the U.S. Office of Education authorized the Council
on Chiropractic Education (CCE) of the .ACA. to establish an
accreditation committee for chiropractic colleges. One of the
directives of the CCE was to upgrade and standardize chiropractic
education. The CCE established requirements for admission into
chiropractic school which included at least. two ‘years
"pre-chiropractic" university level education in the basic
sciences. It was hoped that formal training in ‘the basic
sciences would produce a new breed of chiropractors conversant in
scientific terms and concepts. The requirements for entry
suggested an incipient meritocracy, a necessary condition for
chiropractic to professionalize. It might also be imagined that
the requirements would facilitate chiropractic's entry into the

universities which has so far not'happened.l6

 

15 See Wright 1978 for an account of the role of capitalism
and science in medicine's 'success.'

16 Null reports how the AMA brought pressure to bear on
colleges and universities which considered forming institutional
ties with chiropractic schools resulting in the offers being
rescinded (1986:31).

76

The push to scientize is revealed in Haldeman's call for "a
rational approach to the theory and practice of chiropractic"
(Haldeman 1980:ix). Symposia have examined the neurophysiology
of chiropractic adjustment, the pathology of subluxations and
other aspects of chiropractic theory and practice. More and more
chiropractic is being "explained" in scientific terms. To the
extent that chiropractic is "scientized" it will undermine
allopathy's long-standing opposition on the grounds that
chiropractic is unscientific and would, in effect, force
allopathy to recognize it. However, this seems a long way off;
simply saying does not make it so.

Similarly, AK claims to be a "science," but as I explained
in the previous section, it's arbitrary definition of orthodoxy
betrays the absences of any real "scientization." In addition,
Dr. Goodheart, Research Director of the ICAK, told me he is not
overly interested in producing knowledge according to the
guidelines of "scientific ‘method," His method. of discovery
follows a pattern something like this: when he finds
correlations between. two factors he figures out. a causative
relationship by narrowing the possibilities by a process akin to
the philosophical method reductio ad absurdum. Once he has
settled on a possible relationship he informs his colleagues and
asks them to see if they obtain similar results. If they do the
relationship becomes AK knowledge. This mode of production is
not that ordinarily associated with science. Claims to be a

science then must be considered spurious and ideologically

77
determined. But again, it is not so necessary that AK ground its
authority to rational-legal principles since it is riding on the
recognition. and legitimacy’ of other' professions, for’ now' at
least.

A third dimension to this moment is chiropractic's struggle
to professionalize. Chiropractic's professional bodies have
existed, in one form or another, since 1905, and chiropractors
have managed to present themselves and be accepted as "doctors of
chiropractic," but chiropractic's professionalization has only
been partially successful and rests on a low degree of
standardization, the necessary condition for full
professionalization.

Professional status is highly valued in our society. In
addition to those occupations traditionally considered
professions--"paradigm professions" (Moline 1986:502)--such as
medicine, law and theology, other occupations are claiming
professional status (e.g. nurses, plumbers, hair stylists,
managers). Doubtless, there is an honorific sense to the label,
but probably more essential is the claim to autonomy made by
professionals and the right to decide when to do what. When
achieved, this autonomy' allows the occupation to escape the
capricious and fragile protection by elites, the fickle nature of
popular discontent with orthodoxy or the fashion of the cultic
milieu. Professionals can set their own rules, because they are

considered knowledgeable and trustworthy.

78

In our society, trustworthiness seems to be a function of
standardization. Products are standardized--even food products.
The irregular is suspicious. Professionalism requires
standardization along three axes: cognitive, ethical and
normative standardization (Starr 1982:15). The three dimensions
correspond to the conditions and consequences of a standardized
production of practitioners (Larson 1977:14 et passim).

To the extent that it is standardized, a professional can
demand trust not appeal for it. In economic terms
professionalization corresponds to a process of market control in
which producers of special services seek to constitute and
dominate a market for their expertise (Larson 1977:xvi).

Professionalization is a process which requires increasing _
control over the production of its practitioners. But
professionalization is often considered a threshold: you are
either a professional or not. Thus occupations that are
professionalizing will often project the image that they are
already a bona fide profession. Cobb and Leslie refer to those
occupations that are not professionalized but claim to be as
spurious professions (Cobb 1977:11; Leslie 1972:54). However,
since professionalization is a process and there is no point at
which an occupation suddenly becomes a profession, their models
make too much of the "paradigm professions" of medicine, law, and
theology. They become ideal types or measures for professions.
Those that are not and claim to be such professions are

considered spurious. But to label professions spurious or

79
genuine implies a threshold of professionalization that does not
exist. It seems more reasonable to locate occupations along the
dimensions of standardization--cognitive, ethical and normative--
to better appreciate the distance between real and ideal, than
measuring all occupations against paradigm or archetypal
professions.

In many ways chiropractic appears to be standardized. Very
real divisions within chiropractic are not publicized.
Chiropractors do not advertize as straights or mixers; if there
are adjectives in their advertisements, such as "Life
Chiropractic," they are not understood as political statements by
the public.” And chiropractors are united against allopathic
hegemonyu .All chiropractors clainl professional descent from
D.D., if not B.J. Third, the jprofessional bodies have on
occasion come together when the future of chiropractic was at
stake. Fourth, chiropractors are considered trained, licensed
health professionals, implying some sort of meritocratic control
over who becomes a chiropractor. Finally, until recently most
chiropractors-looked the same: mostly middle-aged white men.

Despite chiropractic's apparent standardization, the
production of its practitioners is less standardized than
chiropractic's apologists might claim. The consequences include
the inability to organize and push for greater legitimacy. The

successes that have been won for chiropractic have been won

 

17 consider the message sent by the following denominations:
The Reorganized Church of Jesus Christ of Latter Day Saints,
Evangelical Orthodox Church,and the Nondenominational Church.

80
largely by the professional bodies not through the organization
of individual practitioners.

The primary condition for, and consequence of, the
standardized production of practitioners is cognitive unity, i.e.
a standard body of knowledge consisting of what is known, what
has been "proven," what others believe they believe and stock
replies. This stock of knowledge is to be organized and taught
through. formal ‘training. Professions stress. codifiable
knowledge, that is concepts and rules that can be taught as
opposed to indeterminate knowledge-~which cannot be taught, only
learned by percept (Larson 1977:41-2).

As knowledge becomes more and more formalized it appears
more 'objective,' more abstract, and less tinged by sectional or
self-interest. A dichotomy separates fact and value, items and
context (Taussig 1980). The formalization of knowledge also
necessitates a class of educators whose job is to produce average
students conversant in the knowledge necessary to function as
professionals. On the other side of the diploma, the students
begin to feel that the knowledge they are learning is special
knowledge, superior to that possessed by outsiders (Larson
1977:47). A chasm opens between those who are possessed of
truth, and an ignorant laity. The student-professionals begin to
believe that they are qualified and entitled to make decisions on
behalf of others.

Chiropractic has no standard stock of knowledge. Since 1974

there has been a core-curriculum at those chiropractic schools

. 81

accredited by the CCE. But as of 1978 there were only seven
accredited chiropractic schools and ten schools either not
accredited (7) or awaiting accreditation (3) (Wardwell 1980:30).

Chiropractic has formalized some of its knowledge. As I
described earlier, there are now entry requirements for
chiropractic schools, at least those by the CCE, including at
least two years education in the basic sciences. This
requirement introduces the students to basic - scientific
principles of thought. In chiropractic school, students are
taught basic and applied sciences, including anatomy, physiology,

microbiology--often from the same textbooks used by allopathic.
and osteopathic medical students. They are shown how
chiropractic knowledge is to be resolved with science and
allopathic knowledge. In its effects on the student chiropractic
education is similar to allopathic and osteopathic education in
the separation it creates between the professional and the lay
person. This phenomenon might be considered mimicry or spurious
cognitive standardization. Like allopathy, chiropractic draws on
the formalized knowledge of scientific ‘disciplines, and like
allopathy it considers itself to be a science of healing, but
unlike allopathy there is no accepted body of central tenants nor
any evidence to prove that chiropractic works. Theory follows
practice in chiropractic to a far greater degree than in
allopathy. The use, then, of the formalized knowledge of
scientific disciplines in the education of chiropractors is

another instance of the ideological use of knowledge: knowledge

82
used not for greater instrumental control or research into the
efficacy of chiropractic, but in this case to instill
chiropractic students with the message that chiropractic is
scientific, and to establish the necessary distance between them
as future professionals and their patients.

The second condition, and desired consequence, of the
standardized production of chiropractor is a normative accord
between practitioners. Like cognitive unity, normative accord is
largely developed through formal training in which neophytes are
inculcated in the behavior expected of a. chiropractor. More
importantly for the definition of a professional, the student is
taught never to impugn the profession. C. Everett Hughes defined
quacks as practitioners who please their customers but not their
colleagues (Starr 1982:23). Professionalization is partly
achieved through normative indoctrination and colleague control.
Of course, indoctrination is never sufficient: it must be
reinforced by the threat of sanctions. In' W, A. J.
Cronin described the opprobrium suffered by a physician who is
stricken off the register as similar to that suffered by the
ex-communicated priest. Normative control is essential if the
profession is to project a focused image, but more importantly,
without normative control the profession will not be able to set
the conditions for its practice. It will remain subject to the
laws of the market, and will not be able to rewrite them.

Overall, chiropractic has not been very successful at

policing itself. There is no system of sanctions, and

83

chiropractors seem to show little hesitation in criticizing each
other; Despite ad. hoc rapprochements between the political
bodies, the average practitioner still maintains his
entrepreneurial individuality. Chiropractic students are
inculcated in the behavior expected of them; they are taught the
need for unity, but once they leave school they tend to establish
their own private practices. In many ways they are prepared for
this at school where they are taught the skills needed for a
successful, private practice. They are taught that they really
don't need the support of other chiropractors for a successful
practice. Unlike allopathic physicians, chiropractors will
rarely refer a patient to another chiropractor, and it is not
always easy to refer patients to allopaths (Peters 1986:134).
The chiropractor is a free agent. Furthermore, the student is
aware of doctrinal differences between the chiropractic he or she
was taught and that taught at other schools. When he or she goes
into practice, then prejudices are maintained.

The political bodies make appeals to the profession,
explaining that if chiropractors "cannot stop the
self-destructive wasting of (their) precious funds and energy or
internal battles, chiropractic ‘will become history."
’Practitioners are admonished to "look for solutions together as a
profession" (Pedigo 1986:9). Despite these warnings,
chiropractic remains a profession remains divided.

Adherence to established ethical guidelines, the third

condition and consequence of professionalization is closely

84
connected to normative accord. Codes of ethics make explicit the
duties and obligations of the practitioner and often include the
responsibilities of the patient. They are variously promises or
contracts.

The Hippocratic Oath is the prototypical code of ethics. It
enjoins the physician is to serve the patient with disinterested
dedication: he or she is to do what is in the best interest of
the patient and above all, do no harm (Katz 1984:93).
Chiropractic codes of ethics are very similar in form and content
to the Hippocratic Oath (Langone 1982:62-4).

Ethical codes are part of the secondary socialization of the
professional student. They are a crystallization of the
profession's promise: they are vows of dedication. But codes of
ethics are more than vows, they are political manifestos, and
Faustian contracts. As well as serving as guides for conduct
with patients or clients, codes of ethics can become
justifications for opposing other groups. Groups considered in
violation of one's code of ethics, especially if they pose a
threat, may justifiably (i.e. ethically) become targets of
machinations.

Chiropractors have been effectively denied hospital
privileges in part. because the .JCAH--the. Joint Commision of
Accreditation of Hospitals, a powerful hospital accreditation
committee affiliated with the AMA--denies accreditation to those
hospitals not abiding by the AMA code of ethics, which until

recently prohibited professional association with non-scientific

85
healers including chiropractors. Chiropractic, on the other
hand, has not been able to oppose other medical systems on the
basis of its code of ethics largely because it does not possess
the sanctions to back up any ethical opposition.

A second way in which ethics are used is as justification
for control of the patient by the practitioner. Codes of ethics
are the tacit conditions of a contract between patient and
doctor. The codes are not just restricting, they are enabling
for the practitioner, at least. A lecturer at Palmer College of
Chiropractic, Virgil Strang writes:

The chiropractor should ask what is best for the

patient's health not what is best for the chiropractor.

Not what is best for the chiropractor's corporation.

Not even what is best for the patient's pocketbook for

just as it is unethical to perform a clinical service

simply for perceiving gain, it is likewise unethical to

not perform a prudent service solely because the

patient might look disfavorably at the additional cost.

(1985:123)

Ethics, then, can be used to support the professional's claim to
know what's best for the client. They are not just guidelines to
conduct: they are part of image-maintenance;18 they are
political articles and tacit contracts allowing professional
control over their wards.

In summary, as a dimension in the overall conversion of
popular legitimacy into official recognition, the second moment

in the dialectic of chiropractic's legitimation, chiropractic's

professionalization has been only partially successful.

 

13 cf. "Lawyers Reflect on Professional Image and Ethics," in
The Christian Science Monitor, February 5, 1987, page 25.

86

Standardization of the production of practitioners has been
hampered by the lack of a standard, agreed-upon stock of
knowledge and by political divisions. Nonetheless chiropractic's
professionalization has included a formalization of education,
which together with the partially successful inculcation of norms
of behavior, produces chiropractors who maintain the requisite
distance from their patients central to. the definition of a
professional. These advances aside, chiropractic's
professionalization is successful to the extent that it controls
the medical market and produces chiropractors able to demand
trust. By this criterion, chiropractic's professionalization has
been only partially successful vis-a-vis allopathy and
osteopathy, but far more successful than the myriad other
translations of the body's logic in the cultic milieu.

The fourth and final dimension to the second dialectic is
the recognition forced from allopathy and other members of the
"medical community" in the law courts. As I described earlier,
the Wilk case and similar law suits, have forced, at least
publically, the AMA and. various affiliated and unaffiliated
medical societies to reconsider their positions on chiropractic.
The AMA has since dismantled its Committee on Quackery, whose
main objective, it is contended, was the containment and
elimination of chiropractic. Some of the defendants have made
public statements to the effect that there are no ethical
impediments to professional relationships between their members

and chiropractors. These public declarations of recognition have

87

undeniably conferred a degree of legitimacy on chiropractic
despite its lack of scientific verification--a central issue in
allopathic opposition. Chiropractic may have won this battle--a
major one to be sure--but it is still at war. The average
practicing allopath is unreserved in his or her opinions on
chiropractors, and allopathic opposition will likely continue but
at a less public level. The fight for inclusion under HMO's and
PPO's is likely to be the decisive battle and quite possibly this
too will be decided in court.

In conclusion, chiropractic's struggle for legitimacy may be
seen as a dialectic of two processes: legitimacy as a
consequence of recognition and recognition as a consequence of
legitimation. The first moment is essentially democratic; the
second implies recognition is only granted. when claims for
legitimacy are grounded in authority; in this case science. But
as I have demonstrated, this requirement may be circumvented.

The successes of the first moment were generally won on the
level of day-to-day encounters between chiropractors and
patients. I have attributed them to chiropractic's anti-orthodox
posture, a lack of consensus on allopathy's claim to hegemony, a
correspondence between chiropractic tenets and patients' world
views and a perception of chiropractors as "back doctors."

The second moment has been fought largely by the
chiropractic's professional bodies. Legitimation on the popular
fronts has been converted into demands for recognition by the

state and other institutions, including the "medical community."

88

These demands were made in Congress and in court, and both have
been successful. But the protection of elites is capricious and
popular discontent with orthodoxy undependable. If chiropractic
is to become autonomous, it must professionalize, which requires
a standardization of the education of chiropractors. The
conditions, and consequences of standardization are cognitive,
normative and ethical unity, and are most effectively realized
through formal education. Recognizing this the Council on
Chiropractic Education has accredited only those schools that
have standardized their curricula. This and other measures have
been partially successful in standardizing chiropractic education
but chiropractors have not been able to establish controls over
each other. Chiropractors are still unable to demand the trust
of their patients and are more interested in pleasing their
patients than their colleagues.

The major advances ~made in chiropractic's quest for
legitimacy aside, it is yet to be recognized by the average
allopath, the average osteopath, or even the average person in‘
the street. By all accounts, this recognition will be a long

time coming.

The third dimension in this institutional analysis of
chiropractic and AK is that of domination. By domination, I mean
the ability of a social or medical system to determine the

conditions of its existence and, pace Larson, not necessarily the

89
struggle for control of the market. Domination corresponds to
power on the level of social integration.

Chiropractic is the largest unorthodox medical system in the
United States. As I have described, it has fought for and won a
certain degree of legitimacy vis-a-vis other institutions,
including the "medical community." To achieve and maintain this
recognition chiropractic has drawn on and recreated structures of
domination which fall into two main categories: allocative
resources and authoritative resources (Giddens 1984:33). I will
discuss these shortly.

Domination or sectional interests are usually concealed as
such. Giddens lists three ways in which domination is
"explained" or justified (1984:193-4). The connection to
legitimation is obvious.

First, sectional interests are represented as universal
interests. The most famous example of this the statement is
"What's good for G.M. is good for America." Likewise,
chiropractic and AK both explicitly state the health of the
patient is what matters, and so does allopathy when it publically
opposes chiropracts. As Iarson notes, the need for health care
is salient, universal, and boundless. To the extent that
chiropractic and AK contribute to the care of the patient, its
practitioners claim they are justified in their existence, and
fees.

A second way in which domination is concealed is by the

denial or transmutation of contradictions inherent in the group's

90

practices. As I shall describe in chapter three, in many ways
chiropractic duplicates the contradictions intrinsic to allopathy
and professionalized medicine generally. Central to the
definition of a profession is its demand for trust based on the
claim that it is dedicated to service; that it is not motivated
by self-interest but by the patient's interest. The reality, of
course, is that medicine in American society is a business;
health is a commodity. The medical market is not free and hence
not democratizing: it is regulated and exclusionary (Larson
1977). Furthermore, chiropractic reproduces the dichotomy
between "objective" fact and "subjective" value. Chiropractors
as professionals concern themselves with facts, consistent with
their formal school training in determinate, technical facts.
Taussig has revealed how this dichotomy pervades medical thought
and how it serves to control the patient (1980).

A third way in which domination is concealed is by
"naturalizing" the status quo. It is claimed by dominant groups
that the present state is both natural and inevitable, that
social evolution has reached its apogee, and any changes that
need to be made are merely fine tuning. This is the argument
offered by allopathy, but chiropractic is a marginal medical
system, until recently completely' shut out from. the medical
establishment. It had no interest in maintaining the status quo.
However, it has achieved some degree of legitimacy as it is the
most successful of the "deviant" medical systems in America, thus

it has a stake in the current state of medicine. Most

91

chiropractors (i.e. most of the mixer majority) would like to be
part of the medical establishment, not dismantlers of it. They
are reformists not revolutionaries. Revolutionaries might put
their current state of relative domination at risk.
Chiropractic's statements about the state of medicine and the
allopathic orthodoxy, then, are ambiguous: they are critical of
the seating arrangement not the occasion of the feast.

Chiropractic's interests are sustained through its
capability to draw upon structures of domination in the form of
allocative and authoritative resources (Giddens 1984:33-4).
Allocative resources are non-human and authoritative are human
resources. A resource of one order' may' be converted into
another. For example money, an allocative resource, may be
converted into the legislative assistance of a lobbyist, an
authoritative resource. In the past chiropractic has organized
popular support in the form of layman's associations modelled on
the fraternal lodges of the day. More recently, chiropractic
bodies have retained "legislative counsel" to lobby for ‘the
attention of lawmakers, and lawyers to present chiropractic's
case in court. Both have been successful. The individual
chiropractor, however, has few authoritative resources to draw
on. Unlike the allopath, the chiropractor's order is not
considered valid by the army of health care workers in the
medical community (e.g. nurses, lab and x-ray technicians,
orderlies, respiratory therapists, social workers, pharmacists)

(Austin 1975:14-5). The range of his power extends to his or her

92

office staff. Many chiropractors have informal or social
relationships with allopaths or osteopaths in the area and are
able to refer patients to them if the patient is too sick for
chiropractic care or for diagnostic tests. Chiropractors are,
however, able to excuse a worker on medical grounds, if the
complaint is associated with the back. Finally, the chiropractor
may be able to draw upon minor authoritative resources, such as
WAICA (Wives of the ICA) .

Allocative resources include payment for services, inclusion
under health care benefit packages, limited access to a few
hospitals, and product endorsements. In 1978, chiropractors
generated $1.3 billion dollars of which most was paid by third-
party insurers. Medicare alone paid over 30 million dollars.
The average gross income for chiropractors in 1979 was 50,000
dollars: if those practices making less than 10,000 dollars and
more than 200,000 dollars are excluded the average was $63,000
dollars (Langone 1982:38,47). Chiropractic care is covered by
most major insurance companies, often because chiropractic care
is cheaper than analogous treatment under allopaths. Coverage is
also included under federal employees' health plans, labor union
health plans, and a pilot study has been initiated for veterans'
benefits.

In addition, the two national chiropractic bodies have
received payments and royalties for endorsements of mattresses:
$1.1 million dollars to the ACA for Springwall Mattress Company,

and $300,000 dollars to the ICA from King Coil Spinal Guard

93
Mattress Company. The payments went into research investigating
the scientific basis for chiropractic techniques.

Finally, largely as a result of the Wilk suit--the American
Hospital Association was one of the defendants who settled out of
court--chiropractors have begun to receive hospital privileges.
In hospitals in Detroit (New Center Hospital) and St. Louis
(Lindell Hospital) chiropractors have access to hospital services
including diagnostic services. At Lindell Hospital, there is
even an ICA recognized residency program. Given the economic
crises hospitals now find themselves in chiropractors might
provide a new source of income. Chiropractors might be able to
help relieve the pain of bed-ridden patients and term
pregnancies, and they would receive new recognition and status,
but there is a risk that under controlled scrutiny the Big Idea
might be statistically disproven, which would be the coup de
grace for chiropractic's recognition from the medical community.
Whether this occurs remains to be seen.

In this section, domination was considered the ability to
set the conditions of a group's existence. Domination is
inseparable from legitimation and the ideological aspects of
signification. Structures of domination are rules and resources
drawn upon, converted and reproduced in system integration, as
institutions pursue their interests and the interests of their
members. I distinguished allocative and authoritative resources
and listed some of those available to the professional bodies and

the individual practitioner.

94

Significant among the authoritative resources not generally
drawn are referrals between chiropractors. Certainly they occur
but nowhere near to the extent as among allopaths and osteopaths.
This is due in large part to the nature of chiropractic technical
knowledge. There is little specialization within chiropractic:
most consider themselves general practitioners. But it is also
due to the absence of an intra-professional ethic by which one
chiropractor would not impugn another in front of a patient.
This absence of colleague control may, in the future, result in
the denial of access to such potential allocative resources as
HMOs and PPOs. ‘

Significant among allocative resources not drawn on by
chiropractors is technology. It might be argued that technology
is not necessary given chiropractic's reluctance to subject its
theories to 'objective', reproducible 'tests 'usually' requiring
technological means of analysis. This reluctance combined with
chiropractic's tendency to reupholster old techniques with new
theories and its exclusion from the technological centers keeps
chiropractic fairly technology free.

Applied kinesiology is not an autonomous medical system, but
it does have a professional body, the ICAK, which is dedicated to
the advancement and dissemination of AK. It is a nascent and not
widely recognized institution, but its attempts to set the
conditions of its existence have already resulted in AK being
offered as an elective course at least eight chiropractic

schools. AK, however, is not limited to chiropractic students,

95
it is taught to any interested and already licensed health care
practitioner. It is attempting to develop a broad base of
support.

Compared to chiropractic's, AK's resources are slight. Its
allocative resources include funds awarded for' research. into
topics of relevance to AK. I know of six projects supported in
part by grants from the ICAK, all to chiropractors. Like
chiropractic, AK is technology poor. Dr. Goodheart, the Research
Director of the ICAK, has an odd collection of equipment in his
office with which he collects data, though as I described earlier
not in accordance with the rough guidelines of the scientific
method. The equipment is also used to educate patients and for
seminars.

AK's authoritative resources are also minimal. Because AK
is not a medical system per se and there are no certified applied
kinesiologists there is no visible supply of advocates. Dr.
Goodheart brings a certain degree of legitimacy' which
practitioners my draw on. He was selected to represent
chiropractic on the United States Olympic Committee, and is quite
well known within chiropractic circles. All in all AK has few
resources to draw on and considering this it is remarkable that

it has become as established as it has.

In this chapter, I have examined chiropractic and applied
kinesiology on the level of system integration. I have offered a

model of medical system, based on the works of Giddens, which

96
seems more adequate than those offered in the medical
anthropological literature. I have considered chiropractic a
medical system, but AK is best seen as an incipient medical
system, with little organization or standardization of
practitioners. I have analyzed both systems along three axes
which are only analytically separable, in reality one implies the
other two. signification refers to the nature, production and
use of knowledge in chiropractic and AK. Legitimation refers to
the processes by which chiropractic has been recognized as a
health care profession. I described the dialectic between
legitimation and recognition. Domination refers to the manner in
which both systems sustain themselves as such by drawing on
allocative and authoritative resources. These three dimensions
are structural properties of chiropractic and AK as medical-
social systems. They are not the social systems themselves but
the rules and resources which individual actors and
collectivities use and re-create in their practices. In the next
chapter I shall shift from an institutional analysis of system
integration to the level of social integration between copresent
actors. This should not be seen as a quantum leap between macro-

and micro-levels of analysis but more a change in focus.

CHAPTER THREE

AN ETHNOGRAPHY OF DR. FARRAGO'S PRACTICE

So far I have analyzed chiropractic as an institution. I
have bracketed out the practice of chiropractic in clinics and
concentrated on examining chiropractic as a discourse, and as a
legitimizing and professionalizing occupation capable of drawing
on resources to maintain and further the interests of its
practitioners. Similarly, I have described applied kinesiology
as discourse but not as a medical system. AK is a body of
concepts and techniques and it has a professional organization,
but there is no group of practitioners who consider themselves or
are licensed as applied kinesiologists.

To study chiropractic and AK as institutions, I invoked the
notion of fiction. I put into suspension the disunity of
chiropractic and the calculus of individual differences between
practitioners of chiropractic and considered chiropractic as a
medical system. In this section I shall dismantle that fiction
as I examine the practice of a single practitioner.

Juxtaposing an analysis of the general and a study of the
particular emphasizes the contrast between the collage of fragile
and fractured beliefs of individual practitioners and the
canonical texts and positions of the professional bodies.
Alternately, the juxtaposition contextualizes the idiosyncratic.

97

98
It suggests links between the profession and the professional,
practice and precept, the social system and structural
properties. But it is not enough to juxtapose and suggest: the
levels of analysis must be reconnected and the links tagged.
This is the purpose of the social sciences, but it is a tall
order. In this thesis, I shall first juxtapose the two levels,
and in the last chapter indicate a few of the more obvious
connections between Dr. Farrago's practice and chiropractic and

AK as institutions.

3.]. 2:, Farragg.
In many Dr. Farrago is typical of the older school of

chiropractic. His education at National College predates the
reforms of the CCE and chiropractic's relatively recent
accelerated professionalization. In 1979, Dr. Farrago was
forty-five, which at the time was the average age for practicing
chiropractors. Since 1979, the average age has not kept up with
Dr. Farrago as more younger people are becoming chiropractors.
He is also white. In 1979, over 96 percent of chiropractors were
male and over 99 percent were white. These statistics have'
changed slightly as 10 percent of recent graduating chiropractic
students are female (Langone 1982:47-8) . Despite‘these trends
Dr. Farrago is in many ways typical of practicing chiropractors.
However, in one important way, he is among the minority: less
than 21 percent of chiropractors continue their education with

post-graduate courses (Langone 1982:48). Dr. Farrago has studied

99
and practiced applied kinesiology for seven years. He has taken
the series of seminars almost three times and his command of the
concepts is impressive.

Dr. Farrago grew up in Pine Lake where he still lives and
practices. It is a small town of 3,000. Dr. Farrago told me it
has changed very little since his youth. After high school, he
joined the army, was trained as a demolitions specialist and sent
to Korea. After his tour of duty, he was sent to back
Washington, D.C., where he armed Nike missiles. In 1955, he was
discharged and with some Army buddies he "pipelined" in Maryland
for about a year. He returned to Pine Lake for a short while but
returned to Maryland. For the next two years or so he worked on
a pipelines in Maryland, Louisiana, Texas and Venezuela, but in
1958 he suffered a back injury and was forced to return to Pine
Lake to convalesce. At that time his father was being treated by
a chiropractor and Dr. Farrago would drive him to the clinic.
The chiropractor took on a partner, a young, recent chiropractic
school graduate. He and Dr. Farrago became friends, and he
talked him into applying for admission to National College.1 At
that time, there were no basic science requirements for admission
and Dr. Farrago was accepted.

Dr. Farrago enrolled at National in 1960, and graduated in

January 1966--he did not go to school during the summers and so

 

1 National College of Chiropractic is the second largest
chiropractic school and the capital of mixer chiropractic. Over
eighteen percent of the nation's chiropractors graduated from
National.

100

his education took longer than the normal four years. After
graduation he served a six month internship in a clinic in
Chicago affiliated with National College. In June, 1966, Dr.
Farrago returned to Michigan and joined the practice of another
chiropractor. He practiced with this chiropractor until 1973
when he established a private practice in Pine Lake. He has
remained in the same building since 1973.

Dr. Farrago practiced basic mixer chiropractic2 for about
twelve years before he attended his first AK seminar. He has on
occasion mentioned how AK saved his faith in chiropractic. He
was becoming disenchanted with what he was beginning to consider
the artless, hit-or-miss techniques of chiropractic.

Dr. Farrago tells of how he first learned about AK from a
"detail man" (a salesman) for a nutritional supplement company.
Dr. Farrago bought a book here and there, and studied it and
tried it, but he found it too complicated and it took too much
time to learn. A little later he was at a demonstration for a
plethysmograph--an instrument that measures peripheral blood
circulation--and the demonstrator asked for volunteers. A
chiropractor from a nearby city who Dr. Farrago knew went up and
was diagnosed. Four or five chiropractors then went up to treat
him but the machine recorded no changes. Then Gary Sacks, a
chiropractor from Gaylord, Michigan, trained in AK went up and

challenged the cervical spine and adjusted it; challenged an

 

2 I have already established that there is no standard
chiropractic. Here I mean Dr. Farrago used chiropractic
techniques taught him at National College.

101

anteriority--D4 he thinks it was--and adjusted that. He then sat
the volunteer up and put the machine back on and he was normal,
just like that. "Bang! That's when I became an AK-man, right
there. I said, 'That's it, I've seen enough. No matter what it
costs, I'm going to do it.‘ And I did it; and it's been a lot of
struggle and a lot of aggravation and frustration but I've come
out on top. I'm getting fairly decent at it and my practice
mirrors that."

Dr. Farrago's tale of conversion, or better rejuvenation
since he did not renounce chiropractic, is not equalled by many
who have taken the AK seminars with whom I have spoken. Most see
AK as another diagnostic tool in their armamentarium. Indeed, on
occasion Dr. Farrago has said as much, while on others he argues
for an independent status for' applied kinesiologists in the
future.

Dr. Farrago considers himself an "AK man." He wears a small
gold badge with AK in block capitals on his collar. However, he
is not involved in its political. structure of AK preferring to
remain a private practitioner. Although he has more than enough
continuing education credits to become a Diplomate3 and although

he believes he would like to teach, he is hesitant about applying

 

3 Diplomates are the teachers of AK. In order to become a
Diplomate on must have completed 300 hours of education in AK
principles, have submitted two research papers, have practiced AK
for three years and pass a written and practical exam. Once a
Diplomate, one must attend the two national ICAK business
meetings a year, submit a research paper a year.

102
because of the additional responsibilities to the ICAK. He
considers himself a healer, not a politician.

There are only eighty or so Diplomates of AK (Goodheart,
personal communication) and there is very little if any cohesion
between most of the practitioners trained in AK. Dr. Farrago's
Thursday morning sessions are the only instance, I have heard of,
of AK-trained practitioners regularly meeting to discuss new
techniques or problems they may have encountered. The absence of
any necessary relationships between practitioners is one way in
which AK might be considered analogous to magic in Durkheim's
opposition between magic and religion (1965:57-63). As opposed
to Church members, magicians may form societies between
themselves but these associations are 1) not indispensible to
their practice and 2) are restricted to practitioners. Magicians
are in the main free agents with a clientele not a flock. A
Church on the other hand, is a community of believers. According
to the analogy allopathy would be to the Church as chiropractic
and AK are to magic. Allopathy is not just a fraternity of
physicians, although it is in part, it is also the accepted form
of medicine in our society. It is upheld by powerful
institutions, pharmaceutical companies, social workers, the state
and the insurance companies to name a few. Commercials exhort us
to have faith in our doctors: "He knows what's best for you."
To be an unbeliever is to be a heretic. The chiropractor and
especially the "AK-man" is an dissenter, perhaps an apostate,

twice a heretic. He operates by himself beyond the ken of

103
science. Typical of magicians, "even in regard to his colleagues
(Dr. Farrago) always keeps his personal independence" (Hubert &
Mauss quoted in Durkheim 1965:60).

Dr. Farrago's independence is evident in his feelings toward
other healers. He considers the ability to heal to be a gift:
some people can heal by having lunch with a person, others can't
heal even with the most expensive technology at their disposal.
The ability to heal is not possessed by all chiropractors, nor
are all allopaths incapable of healing. There are bad
chiropractors and good allopaths, but even good allopaths, in
most instances, are handicapped by their approach.

Dr. Farrago divides medical systems into natural and
non-natural (i.e. surgical and pharmaceutical healing).' In most
cases, the latter is too much too late. Its diagnostic methods
are such that it can only discern the pathological from the
normal: they are ‘unable to ‘detect the functional "dis-ease"
before it becomes organic or pathological. The natural
approaches to healing, including chiropractic and AK, 1) are
often able to detect the early presence of "dis-ease" and correct
it, 2) may be preventive, and 3) work with the body, not against
it.

Dr. Farrago seems to regard the allopathic profession as
something like a rogue elephant: big enough to do anything it
pleases but considering the damage it does to people it ought to
be restrained. Its monopoly is largely due to its claims to be a

science, but Dr. Farrago points out that when cornered in a law

104
court allopaths claim medicine to be an art. He considers
allopathy's arrogance unwarranted in light of his waiting room
filled with refugees.

At his mildest, Dr. Farrago considers allopaths to be
theoretically misguided and beholden to other interests, such as
pharmaceutical and insurance companies. Like other chiropractors
I have met, Dr. Farrago cites the germ theory as allopathy's
achilles heel. If bacteria are agents of disease, he asks, why
don't the body's resident flora and fauna continually infect and
ultimately kill it? He argues that the healthy body is resistant
to these potential pathogens, only when it is compromised through
stress, poor nutrition or vertebral subluxation will it succumb.
Etiology then must distinguish between predisposing and causative
factors. Disease is not initially the result of an external
"attack" but of an internal disorganization. Chiropractic,
especially when combined with AK, allows the healer to find the
first causes of disease.

As poorly as he considers most allopaths, Dr. Farrago
reserves his harshest invectives for straight chiropractors. He
refers to them, among other things, as quacks. He accuses them
of vitiating chiropractic by pushing for, and getting, a law
defining the scope of chiropractic practice which has hamstringed
mixers such as himself. According to the Michigan law,
chiropractors may not make differential diagnoses, they may only
adjust vertebrae. As a result, most of Dr. Farrago's practices

are illegal. He considers straights fanatics, "cracking backs,

105
jumping up and down yelling 'chiropractic gets sick people well,’
and running to the next (patient)." In addition to immoderation
he accuses them of being motivated more by greed than by service
to the ill--a change made by most healers against .most other
healers indicating the importance of a service ethic in medicine.
Sardonically, he has said

I envy them in a way, ... it's a lot easier than having

to think for a living. And I just ain't made that way,

I just can't do that. I have no other explanations. I

prefer to see people get better ...."

Next on his list of disreputables are those chiropractors
who have attended AK seminars but who use it solely to boost
their income or who use it in a fixed, unreflective manner
unaware of AK's subtleties. He calls these "straight AK-men."
He also considers the Touch for Health movement contrary to the
good of AK. He echoes Dr. Goodheart's accusation that instead of
teaching AK for self- or family use, Touch for Health instructors
are setting themselves up as professional healers, arguing they
have not had the proper training in the basic sciences to qualify
them to use AK. They make outrageous claims, he says, which
hurts all bona fide practitioners who use AK.

Mixers, he will tell you, whether or not they practice AK,
are the only true chiropractors. They are not. blinded. by
fanaticism and are sensitive enough to refer patients who are too
ill for them to treat. Differential diagnosis is essential for
effective treatment and AK allows the chiropractor to be sure he
is treating the correct thing and that his treatment did or
didn't effect a change.

106

Dr. Farrago holds osteopaths in a certain degree of respect.
In some ways he is envious of their greater access to resources
such as laboratory and radiological tests. In others, he
considers osteopathy to have entered a Faustian bargain with
allopathy: the price for greater legitimacy has been the
renouncement of its distinctive and to a large part efficacious
principles. Dr. Farrago is able to refer patients to the local
osteopathic Ihospital for' radiological exams through. his
friendship with one of the radiologists. This and other informal
ties allow Dr. Farrago limited access to medical services but he
enjoys no official recognition or privileges.

He enjoys the strongest professional relationships with area
.dentists and dental surgeons. For one reason or another dentists
are attracted to AK as a method of diagnosis and as a way to link
dental architecture to the rest of the body.4 As I mentioned
earlier, Dr. Goodheart foresees a closer relationship between AK
and dentistry in the future. The three most regular members of
Dr. Farrago's Thursday morning sessions are dentists or dental
surgeons. All three refer patients, usually those with jaw or

general health problems, to Dr. Farrago.

 

4 The role of the temporomandibular joint (TMJ) in AK and
dentistry is one nexus. Another reason for the attraction might
be dentistry's astounding success and consequent underutilization
of dentists. A newspaper article recently reported that
dentistry is perhaps the only’ profession that has been so
successful as to put itself out of a job. AK provides a way for
dentistry to become involved with general health, and hence a new
market. In addition, there is a popular perception that dentists
are frustrated physicians; AK would provide a way to satisfy this
frustration.

107

As for other medical systems or medical discourses, such as
homeopathy, naturopathy, iridology and rolfing, Dr. Farrago is
rarely completely sceptical, but he quickly points out their
limitations. None are complete in themselves: all require AK to
be sure their techniques are indicated.

Listening to Dr. Farrago, the observer will notice an
eclecticism in his arguments and explanations. Dr. Farrago's
education at National College was divided into the principles of
basic science (e.g. anatomy and physiology) and those of
chiropractic clinical practice. His training in the basic
sciences is evident in his mastery of the body's musculature. He
also retains knowledge of physiology, but on the gross level. At
the time of his application chiropractic schools did not require
a foundation in biology and chemistry particularly organic
chemistry and biochemistry. As a consequence, Dr. Farrago's
explanations of physiology while made in the vocabulary of
science are often. made ‘without. a. deep understanding“ of its
complexities. This is not to say that Dr. Farrago practices
beyond science--many of the research articles he reads are
written by research scientists--but that his explanations are
those of a bricoleur rather than a scientist.

By bricoleur, I refer to Ievi-Strauss's famous distinction
between the engineer-scientist and the bricoleur-handyman. The
bricoleur approaches problems with a heterogeneous set of tools
not constructed for the job at hand nor from within a seamless

system of concepts (i.e. a paradigm), but consisting of fragments

108

of previous events. Unlike the scientist who creates events by
means of structures, or systems of knowledge, the bricoleur
creates structures by means of events (Levi-Strauss 1966:22) .
Put a little differently, Dr. Farrago approaches his patients'
problems with a body of knowledge that is continually
metamorphosing, as he adds to it fragments of knowledge he picks
up from here and there, from seminars or from accidental
"discoveries" in his office.5 In the short time I observed him,
he discovered, toyed with, embraced or rejected at least four new
healing techniques or clinical conditions: healing crystals,
biochemical salts, systemic yeast or candida infection and
body-into-distortion technique. He is quick to point out that
some of these are not "official AK." Some were borrowed from
other healing systems (e.g. biochemical salts are used by
homeopaths) , others he learned of from other sources (e.g.
nutritional supply companies have discovered, produced and
marketed an anti-yeast agents based on research conducted by Oran
Truss, M.D.; crystals are found in many approaches to healing
within the cultic milieu).

AK's body of knowledge as a whole grows largely by
bricolage. Individual healers like Dr. Farrago trained in AK
submit results of their independent research to the ICAK where as
was described earlier it is tested, and verified or not. Of

course, clinical medicine in many instances does the same but

¥

5 See Allan Young (1983:203-219) for a study of the ways in
which new facts are incorporated into pre-existing interpretive
sotzhemes.

109
research is usually borrowed from the work of members of
scientific disciplines (anatomy, physiology, microbiology, etc.)
who produce their knowledge according to what is generally known
as the scientific method. The AK and chiropractic mode of
production of medical knowledge is clinic centered and quite
different. Information is produced based on fragments of events
and not from within a bounded discourse. What may not be claimed
in AK is far less than in allopathy. Of course, while AK--and
chiropractic--may grow by bricolage it is presented to the
student as a systematic and collected set of concepts and
statements. To the student it looks like a "structure" and it is
the base from which the healer practices and to which he appends
future discoveries (i.e. the stuff of experience). Dr. Farrago
then is an educated bricoleur. His "structure" (i.e. his
interpretive scheme) is not entirely self-constructed, nor is it
conceptually consistent like the engineer-scientist's. The large
part of his "base" is the knowledge taught to him in chiropractic
school and at AK seminars, but a significant portion of his
technical knowledge has been constructed by bricolage. In regard
to this unscientific mode of production of knowledge I reinvoke
the caveat lodged in the introduction: inasmuch as explanation
is the discovering of an "arrangement," any attempt to explain,
even those produced in a non-scientific fashion, might hit upon
‘the truth (Levi-Strauss 1966:12). Science, though, has proved to
3be the most powerful and economical way to obtain knowledge about

the natural world (i.e. at discovering "arrangements") . Of

110
course this begs the question of the relation of science to

medicine, as Illich writes

3. O

Dr. Farrago lives and has practiced for feurteen years in
Pine Lake, where he grew up. Pine Lake is a small (population of
3,000) almost entirely white (96.5%) community. It is located in
Highland County, one of the most affluent counties in the nation,
comprised. largely of the bedroom. communities of the Detroit
metropolitan area. Of the 59 communities in Highland County,
Pine Lake is one of the smallest and least affluent.6

Pine Lake is next to Canton, the largest city in Highland
County with a total population of 92,100 (Canton city has a
population of 76,715 and is approximately 60 percent white, and
40 percent black; Canton township has a population of 15,388 and
is approximately 90 percent white and 10 percent black).
Highland County is 92 percent white, Canton contains almost two
thirds of the county's black population. Given this it might be
expected that Dr. Farrago would have a significant number of
black patients, instead he almost has none.

I conducted a rough survey of Dr. Farrago's patients by

looking at the sheets filled out by the patients on their first

6 According to the 1983 census reports, the average
residential dwelling unit in Pine Lake sold for $28,400, well
below the average .for Highland County of $71,200. Pine Lake
iranked 56 out of 59 in terms of property values.

111

visit. I recorded sex, age, marital status, town of residence,
number of visits, date of first visit, and reference if any. The
sample size was 208, but was adjusted depending on whether the
patient filled out all relevant data. I do not know the total
population of patients but estimate it to Ibe upwards of a
thousand, though this is a wild guess.

From this survey, I was able to roughly plot the residence
patterns of Dr. Farrago's visits listed in table 1.

Table 1. Patient residence distribution (in miles from Dr.
Farrago's office)
Distance in miles Percentage of patients
0 - 2 15%
2 - 7 50%
7 - 10 12%
10 - 15 7%
15 - l7 2%
>17 (within Detroit SMSA) 11%
>17 (beyond Detroit SMSA) 3%

The great majority, 77 percent, live within ten miles of his
office. It is probably significant that such a large proportion
of Dr. Farrago's patients come from within the immediate area
given the relative ease of transportation. .

The area is well served by medical practitioners. There are
three large hospitalsin Canton and many more within a short
drive. There is a large population of allopaths and osteopaths

so it is not the case that Dr. Farrago's patients come to him

112
because there is no other alternative.7 Also, there are a great
number of chiropractors in the area: one within two miles of Dr.
Farrago's office, 31 from two to seven miles away, 17 from seven
to ten miles away and 10 from ten to fifteen miles away.8 Thus
Dr. Farrago's patients do not come solely because there are no
other chiropractors around. His practice is quite successful,
but I would need more statistical information from other
practices to determine just how successful he is compared to
other area chiropractors. I suspect, though, he is most
successful, i.e. has more and more regular patients, than most.
Other patterns are discernable from the survey and are
listed in tables 2, 3, and 4. Table 2 describes the distribution

of patients by sex and age bracket.

Age Bracket Males Females Total
0 - 4 50.0% (1) 50.0% (1) 1.0% (2)
5 - 14 45.5% (4) 55.5% (5) 4.3% (9)
15 - 24 56.2% (9) 43.8% (7) 7.7% (16)
25 - 34 39.0% (16) 61.0% (25) 19.7% (41)
35 - 44 55.5% (24) 45.5% (20) 21.2% (44)
45 - 54 33.3% (12) 66.7% (24) 17.3% (36)
55 - 64 37.1% (10) 62.9% (17) 13.0% (27)
> 65 48.5% (16) 51.5% (17) 15.9% (33)

 

7 It has been argued that chiropractors might be filling the
family practitioner niche opened by osteopathy's increasing
specialization. However, in the Canton area there is no shortage
of allopathic and osteopathic practitioners.

8 According to the Michigan State Chiropractic Association,
of the 192 chiropractors practicing in Highland County, almost a
third (60) live within fifteen miles of Dr. Farrago's office.

113

It reveals a fairly even distribution by sex overall--56 percent
are female--but there are fairly wide deviations by age
bracket-~from 43.8% female in the 15-24 year old age bracket to
66.7% female in the 45-54 bracket. The distribution also reveals
that the majority of Dr. Farrago's patients (58.2%) are between
25 and 54 years--the working years. A correlation :may’ be
hypothesized between the predominance of patients in these age
brackets and work-related musculoskeletal injuries, though I do
not have the data to substantiate it. If this is indeed the case
it may be that Dr. Farrago's patients consider him a specialist
for back and muscle injuries, going to other kinds of
practitioners for other' complaints especially for ‘their
childrens' complaints.

Table 3 describes the actual and adjusted ratios of patient

visits by sex per age group.

Age bracket Male:Female ratio (raw) (adjusted)
0 - 4 6 : 1 1:1
5 - 14 l : 2 1:1
15 - 24 1 : 1.3 (no need to adjust)
25 - 34 1.3 : 1 (no need to adjust)
35 - 44 1.5 : 1 1.2 : 1
45 - 54 2.6 : 1 1.1 : 1
55 - 64 2 : 1 1.2 : 1
> 65 1.8 : 1 1.2 : l

The raw values show a great variation between the sexes and age
groups. However, if those patients who have made an

extraordinary number of visits to Dr. Farrago (from 65 to 271)

114
are excluded the ratio of visits by sex per age bracket levels
out to nearly 1:1.

A graph of the frequency of visits per patient would show a
hyperbolic curve revealing that while a few patients see Dr.
Farrago a great number of times, most make less than twenty
visits. The median is 43.8 visits while the average is 16.3
visits.

The marital statuses of Dr. Farrago's are as_ follows:
approximateiy 70 percent are married, 20 percent are single, 5
percent widowed and 5 percent divorced. This distribution
suggests that patients drawn to Dr. Farrago as a chiropractor are
not older widows looking for some physical attention, as I heard
one allopath claim.

Of those who listed a person who referred them to Dr.
Farrago 60 percent listed friends, 24 percent listed .family
members, 10 percent other health professionals (4 percent
chiropractors, 5 percent dentists, and 1 percent allopaths) , 2
percent health food stores and 4 percent others, including a
local newspaper article and Dr. Farrago's yellow pages listing).

Dr. Farrago is fully aware of the sources of his patients.
He considers it remarkable to get a patient out of the phone book
and a miracle if they come back more than once: "I don't keep
those patients because they're looking for a crack in the back,
for a cheap price usually." This does not mean that he just
waits for patients to come in. While he does not employ the

practice building tactics that other chiropractors have taken to,

115

he has an advertisement in the yellow pages, which incidentally
advertises, Dr. Farrago as a chiropractor and specialist in AK.
He has also hit upon the idea of writing his "prescriptions" for
those substances he does not sell on the back of his business
cards and sending the patient to the health food store. He
explained that since the mark-up of the items is often so small
it makes better business sense to send the patients to the health
food stores which might in turn refer some patients to him.

Returning to the profile of Dr. Farrago's patients, certain
conclusions might be drawn. Most of his patients come from
within a fifteen mile radius of his office and are referred by
friends or family members. Most patients are married and of
working age. There is an overall equal representation by sex,
whereas certain age brackets show a disparity. Noticeably absent
in this survey is data on occupation, education and income. Such
information would be valuable if more difficult to obtain, and
since some of the hypotheses offered in this thesis rely on
questions of class, its absence marks a significant hole in my
research. _ My general impression of the patients I met is that
most are high school graduates but with little or no college
education. Many are working housewives, most are blue collar.
These impressions are unsubstantiated and drawn from a relatively
small sample of patients. They might, however, be correlated
with and supported by the residence patterns described earlier:
most patients live within ten to fifteen miles of Dr. Farrago's

office in working class communities.

116

3.3 T

Dr. Farrago's office is on the main thoroughfare to Canton,
a busy four lane road flanked by small businesses, fast-food
restaurants and convenience stores. The office is inconspicuous,
squat one-level building surrounded by the parking lots of three
businesses. The building is modest and too small for Dr. Farrago
and although he would like to move the low monthly rent, now $650
a month, among other things, has kept him there for fourteen
years.

I will describe the clinic's geography since it will be
relevant later when I examine the healing’ process, and Dr.
Farrago's performance as a healer. The patient enters the clinic
through a door facing the road into a carpeted, windowed waiting
room. The patient checks in at the receptionist's window and
sits in one of the chairs along three walls. The receptionist is
Mrs. Farrago, the doctor's wife, and she chats with the patients
until the doctor is ready for them.

The waiting room is the largest and best lit space in the
office. There is a low table, well-stocked with popular magazines
in the middle of the rectangular room. In one corner there is a
rack of pamphlets on various topics of chiropractic health care.
Next to the rack there is a bottled water dispenser. On the
walls and around the receptionist's window there are plaques and
maxims summarizing chiropractic and AK philosophy. There are

also some office plants here and there. Audible in the waiting

117
room and throughout the clinic is lulling, innocuous music, which
smothers all but the loudest outside noises.

Mrs. Farrago sits at her desk looking out the receptionist's
window. From her desk she can talk with the patients as she
files, types, and so on. On the wall behind her, fully visible
from the waiting room, are Dr. Farrago's diplomas and
certificates. Her "office" is very small--more an alcove--and
filled by filing cabinets, shelves, her desk and chair,
typewriter, and other office equipment. From her desk, Mrs.
Farrago can keep an eye on the waiting room and can slip back to
inform her husband that a patient is ready or when he is getting
backed up.

From the doorway separating the waiting room and the rest of
the clinic one corridor leads straight ahead the other dog-legs
right then left. Both corridors are dark and narrow. The first,
about thirty feet long, leads past the receptionist's alcove, and
the major exam room, past Dr. Farrago's office and ends at a
toilet. The other leads past the minor exam room, past
closed-off storage rooms to a room which contains an old x-ray
machine, two metal x-ray tables and an alcove from where Dr.
Farrago controls the machine.

The major exam room is adjacent to the receptionist's area
and the music and Mrs. Farrago's typing or conversation are
audible through the walls. The room is square and quite
small--approximately 15' x 15'. It has windows but they are

covered, making the room feel internal and sequestered. On the

118

panelled walls are anatomical charts and diagrams, photocopied
from an AK manual, but which Dr. Farrago rarely consults. The
thigh-high, homemade adjustment table--more a bed than the usual
chiropractic adjustment table-~13 in the center and at a diagonal
to the room. Around the walls, on one side of the room there is
an office chair, an old chest-like adjustment table above which
is an x-ray light panel and above that to one corner a small
chalk board and a section of connected vertebrae occasionally
used for demonstration. On the other side of the room, there is
a table and a rack filled with little containers of substances
used in tongue-testing. There is also a 24"x4"x18" myomatic
machine which emits variable frequency electrical impulses and is
used to treat various conditions. In the corner there are
various small boxes and objects (e.g. blood pressure cuff,
triangular adjustment blocks, tongue depressors, a roll of paper
towels).

The other exam room is smaller and _spartan by comparison.
In the center is a standard break-away chiropractic table. Along
one wall there is an anti-gravity suspension frame, which I have
never seen Dr. Farrago use, an office chair, and along the other
wall a few containers. Dr. Farrago usually treats patients in the
major exam room, using the minor room only when he was backed up
then Mrs. Farrago would put the patient "on deck" in the
available exam room.

The clinic may be divided into "front regions," where Dr.

and Mrs. Farrago attempt to foster certain impressions and

119

suppress others, and "back regions," where they relax and where
these impressions may be contravened (Goffman 1959:106-140). In
Dr. Farrago's clinic, the front regions tend to be tidy, well lit
and commodious while the back regions tend to be cluttered, dark
and generally small. The two narrow and dark corridors connect
the front and back regions. The principal front regions are the
waiting room. and the exam rooms; the back regions are Dr.
Farrago's office, his bathroom, storage rooms. Some regions,
like the public bathroom and the x-ray room are ambiguous: open
but not usually seen. The difference between the regions can be
stark. The waiting room under the eye and care of Mrs. Farrago
is very tidy. The magazines remain in rows, the office plants
are healthy and the carpet is clean. In contrast, little effort
is spent on cleaning the back regions. Dr. Farrago's office is
extremely cluttered and the major exam room only slightly less
so, but as a result of constant ‘use. I *will discuss the
manipulation of geography in Dr. Farrago's performance later.

Mrs. Farrago schedules Dr. Farrago's appointments. She will
not schedule more than 125 a week and averages in the 70's.
During the four weeks that I counted patient visits the numbers
ranged from 62 to 84 visits per week, the average being 77. Dr.
Farrago has told me that this volume remains fairly constant
throughout the year.

Dr. Farrago works approximately thirty hours a week. Table
1 lists hours worked and number of patients seen per day for a

four-week period.

120

Table 4. Dr. Farrago's weekly work schedule.

Day figurs worked Patients seen per week
1 2 3 i
Mon. 9 am - 12 am 19 20 18 18
2 pm - 7 pm
Tues. 9 am - 12 am 8 8 7 5
Wed. 9 am - 12 am 25 24 20 12

2 pm - 7 pm

Thur. office closed
"morning session"

Fri. 9 am - 12 am 24 24 24 13
2 pm - 7 pm

Sat. ' 9 am - 12:30 am 8 6 10 4

Sun. Closed

Dr. Farrago spends an average of twenty-five minutes with
each patient. He charges a basic fee of $23. He acknowledges
that this is more than most chiropractors charge.9 To this basic
fee are often added additional charges for nutritional
supplements, X-rays, etc. bringing the average charge per visit
to between $28 and $35. Most of Dr. Farrago's patients are
covered by third party insurers.

Dr. Farrago told me he would make over a hundred thousand
dollars by the end of 1986. Considering he pays only $800 a year

for malpractice insurance per year,10 and since his wife works as

 

9 The F.A.C.T.S. study of 1979 lists an average basic fee of
$13.69 (Langone 1982:42) . The average today is between $15 and $20.

-10 allopaths and osteopaths, depending on their specialty,
pay upwards of thirty to sixty thousand. dollars a gyear in
malpractice insurance premiums.

121
his receptionist he does not have to pay for office help, this

represents a considerable income.

3. 0' Pa 0 c

In this section I shall describe that part of Dr. Farrago's
behavior seen by his patients, i.e. his performance. Goffman has
called the front that part of the performance which regularly
functions to define the situation for those who observe it. The
front is "the expressive equipment of a standard kind
intentionally or unwittingly employed by the individual during
his performance" (Goffman 1959:22). In his performance, Dr.
Farrago will try to foster certain impressions in the patient and
suppress others. It shall examine how and which impressions are
fostered and which are suppressed. This analysis of performance
must be considered as inseparable from that of communication
which will follow, for as Marshall McLuhan realized the medium is
part of the message.

I have already described the geography of Dr. Farrago's
clinic and its front and back regions. Performances occur in the
front regions. Back regions provide an escape from patients
where Dr. Farrago may relax in his role as healer. It was in the
back regions where Dr. Farrago would express his opinions of
patients who minutes before he had been treating as valued
patients. One he called a Mama's boy and a "a pain in the ...,"
another he explained had been from one healer to another and was

particularly distrustful; he would have to be particularly

122

careful of what he said with her. Such back-stage comments are
typical of all performers and are mild compared to those I have
heard in hospitals.11 That he does "go back" and will "explain"
patients emphasizes his performance as a front. This is no great
revelation, as Goffman notes and everybody knows, a front region
implies a .back region, but it does undermine claims made by
healers, including Dr. Farrago, to always maintain professional
decorum. In the harshest of terms, it amounts to a violation of
the trust professionals try so hard to cultivate in the front
regions.

Trustworthiness is in fact the essential image Dr. Farrago
tries to foster. As I described earlier, the principal claim of
a professional is that he or she should be the one to decide when
and how his or her services are needed. Such a claims rests on
trust. Well established professionals can demand trust, others
must appeal for it. Much of Dr. Farrago's performance--at least

its verbal dimension--amounts to just such an appeal.

The performance setting helps set the tone for the
doctor-patient encounter. The office's mise en scene is
unmistakably that of a clinic. The waiting room with its rows of.
magazines, its pamphlets and maxims on the walls accelerate the

shift of the person to a patient that began on the drive to the

 

11 See George and Dundes 1978 for a study on "the Gomer, a
Figure of American Hospital Folk Speech" in which they examine
how and why hospital workers label the old and chronically ill
Gomers.

123
office. The registration book becomes a Rubicon. The doctor's
diplomas and certificates, clearly visible behind the
receptionist, vouch for the doctor's training, even before his
entrance.

Mrs. Farrago assists in preparing the patient for the
doctor's performance. Probably because she is the doctor's wife,
Mrs. Farrago does not dress in nurse's uniforms and defer so
obsequiously to the doctor's authority as do many receptionists
and office workers in other clinics. She does, however, refer to
her husband as Doctor Farrago in the presence of others thereby
reinforcing his image. It is Mrs. Farrago who escorts the
patients into the exam room, and if the patient is female she may
have her change into a patient's gown, thereby shifting the
person further into the patient role.

The exam rooms are dominated by the exam table, not unlike
an altar. The major exam room is cluttered with arcane objects:
an array of little bottles filled with tablets, a partial spine,
a blood-pressure cuff, a black box with knobs and dials all
bespeaking an ownership of highly technical knowledge. By the
time the patient meets Dr. Farrago he or she has been prepared
and more than likely has become the patient.

In analyzing an individual's performance Goffman offers a
distinction between appearance and manner (1959:24). Appearance
refers to those stimuli that inform the observer of the
performer's social status; manner refers to those stimuli that

.infomm the observer of the role the performer expects to play.

124
We expect a consistency between the two. We expect that a
lawyer, priest or doctor will look the part. Inconsistencies
introduce contradictions into the performance and might put the
role categories into question and perhaps undermine the
performer's actions and statements.

There is an inconsistency between Dr. Farrago's appearance
and manner, but the effect is equivocal. Dr. Farrago acts like a
doctor. He is authoritative, and there is never any doubt that
he is in control of the situation. Yet despite his short white
coat he often doesn't look like a doctor, at least not like the
more sartorially conscious majority. This incongruity certainly
doesn't bother him. Typical of heretics he criticizes orthodoxy
for its misplaced priorities, Dr. Farrago considers well heeled
physicians to be correspondingly less interested in getting his
or her patients well healed. It might be that his patients
appreciate his no-nonsense approach to healing, as McCorkle found
to be the case among rural Iowans (1961). It may well be that
the white coat is enough to justify his manner. '

The trust that Dr. Farrago seeks to instill in his patients
on a rational level derives from two claims: that he is sincere
and that he is capable, i.e. knowledgeable and skilled. Of
course, trust is sought on non-rational grounds and. I will
di3¢uss some of ,those later. As I described earlier,
professionalization is an attempt by an occupation to in effect
say that so and so is sincere and capable because he is a member

of this profession: if he wasn't he would not have been allowed

125
in. Whatever the empirical evidence against this argument, it is
one that is widely accepted. Thus to the extent that
chiropractic is professionalized and chiropractors are considered
professionals, Dr. Farrago as a chiropractor will benefit, but to
the extent that it is derided he will have to rely on other
arguments. It is significant then, that Dr. Farrago's claims are
not usually explicitly grounded in chiropractic's prestige as a
profession and more often on his personal characteristics as a
healer or the limits of other healers. His ties to chiropractic
and its "cultural authority" (Starr 1982:13-15) are implied in
his right to be addressed as "Doctor," the diplomas and
certificates on the wall, his license to practice and advertise
as a health care professional, and his access to public and
private insurance funds. However, to the extent that
chiropractors are considered by his patients to be pseudo-doctors
he must assert himself to be a bona fide doctor. Some patients
are more sceptical than others and require more exertion on his
part, but he knows that generally he is not the first to be
consulted, and the fact they are in his exam room tells him they
have not been satisfied with orthodox physicians at least for the
problem at hand. Also, he is aware that the patient was probably
referred to him by a friend or family member and that they are
already half converted or are at least open-minded, so although
he has very little time in which to justify himself and the
patient's trust--about twenty-five minutes--he is not so hard

pressed as might be imagined.

126

Just as reproductive success is not measured in how many
children one has but how‘ many grandchildren, Dr. Farrago's
success is not reflected in how many patients he sees but in how
many patients he sees for the second or third time and in how
many referrals he gets from satisfied patients. The patient
survey indicates that most of Dr. Farrago's patients (84%) were
indeed referred by friends or family members. However, as the
graph of frequency of visits per patient shows the greatest
number of patients make fewer than six visits. As Larson has
pointed out for allopaths, a different set of arguments, usually
non-logical, are used to keep patients coming back to the clinic
than got them there in the first place (1977:22). Two hypotheses
may be offered to explain the hyperbolic decline in the number of
visits made per person: Dr. Farrago is getting most of his
patients better and quickly or his arguments for keeping them as
patients are not as effective as those made by friends and family
members to get them to first go. I leave these hypotheses
unexamined.

The arguments that are employed by Dr. Farrago to support
this claims to be trustworthy are of two kinds: disparaging of
other healers or medical systems, and self-laudatory statements.
It is perhaps too much to say he has a stock of standard
arguments, but I have heard the same anecdotes or observations
offered to several different patients. His arguments of course
differ with each patient. The newer patient is more likely to

require a full barrage than the regular who will be less

127
sceptical and more easily retained. Appendix B is a transcript
of an encounter between Dr. Farrago and Mrs. Dobson, a regular
patient, and it reveals some of the many arguments used to defend
his practice.

Dr. Farrago will often criticize what he sees as the
shortcomings, or dangers, of allopathy. He Ihas said. to a
.patient,

The longer I practice applied kinesiology, and become

more knowledgeable in physiology and whatever, the more

I question the medical approach in many instances. Now

in acute emergencies no problem, absolutely ... But for

chronic problems, the everyday illnesses, and don't-

feel-goods, medicine is really a failure. It really

is. And that's why I shine, and yet for shining they
call me a quack.

In” an

encounter with Mrs. Dobson, ~Dr. Farrago criticizes allopathic
treatment, especially its use of drug therapy, on a number of
counts: for causing her drug (cortisone) dependency (line 150);
for causing her intestinal irritation (line 184): for obscuring
the patient's real problem with medication (line 261); and for
exaggerations intrinsic to medical advice (line 285). Allopathy
is characterized as providing short-term remedies but with
harmful long-term effects: the longer the patient is under
medical care often the harder it is for Dr. Farrago to treat the
initial condition and the longer a cure will take. At one point,
Dr. Farrago advises Mrs. Dobson against consenting to a series of

allergy shots suggested by an allopathic physician (line 173).

128

Dr. Farrago feels secure enough to challenge orthodox advice and
simultaneousLy to offer his services as the better choice. On
other occasions, Dr. Farrago will suggest that other healers are
not motivated by the patient's interest but by pecuniary gain.
In summary, the arguments used by Dr. Farrago to criticize other
healers as being untrustworthy, impugn their sincerity and/or
their capability’ to heal, questioning' their theoretical
foundation or their technical ability.

Arguments made by Dr. Farrago in support of his claims to
trustworthiness are of a different order. Two main arguments are
made: his practice is informed by two valid bodies of
knowledge--chiropractic and AK: and his experience. The effect
of two other factors--his use of scientific language and the
manual muscle testing--will be examined in a later section on the
communicative aspects of Dr. Farrago's performance.

The principal impression that Dr. Farrago tries to convey is
that while others may be insincere and/or incompetent he is
neither. To this end he might mention how he studied medicine,
albeit chiropractic medicine for six years (line 118),.how he
still attends seminars on the weekends, and keeps up on the state
of the art. He has done his time, he argues, and deserves to be
considered a professional. The certificates and diplomas on the
wall attest to this. Implicit in these claims is the argument
that Dr. Farrago is guided by an "objective" facts and
concepts--chiefly AK--and not by vague and random impressions.

"Objective" knowledge, as I noted in the previous chapter,

129
appears to be natural truth not affected by special interests or
the potentially dubious interests of the practitioner.

The second major pillar to Dr. Farrago's claim for trust is
his experience as a healer. Dr. Farrago reiterates orthodox
ideology by claiming healing to be an art and a science.
Experience is taken to be synonymous for the art quotient. Many
of Dr. Farrago's explanations rest upon what in his experience he
has found to be the case (line 33). As Katz has noted,
explanations based on experience can only be arbitrarily accepted
or arbitrarily rejected (1984:124). They are not logical
statements whose truth value can be discussed, they can only be
accepted on faith. Regardless, they often act as catalysts for
the acceptance of other explicitly made claims or perhaps more
importantly in the ordering of inchoate feelings, following the
manual muscle test, as will be discussed later.

Finally, the way in which Dr. Farrago states his arguments,
has a lot to do with their acceptance by patients. He will often
phrase them in "scientese," that is using fragments of the
vocabularies of chiropractic, AK, physiology and anatomy to
explain his actions. I will discuss the importance of this too
later.

As these arguments suggest, the necessity of inspiring trust
in patients, what has been called the faith that heals is not
lost on Dr. Farrago. For each patient he employs a different
strategy to foster an impression of trustworthiness. In addition

to the immediate necessity for trust, Dr. Farrago is also aware

130
that the patient who trusts his physician is less likely to file
suit than the patient who doesn't. Given the current litigious
climate this is no small consideration. In this section I have
examined the verbal, mostly logical arguments ‘underlying’ Dr.
Farrago's claim to trust. Once I have outlined a *typical
encounter I shall return to the non-verbal and the non-logical
levels of communication immanent in the encounter between Dr.

Farrago and his patients.

3.5 Egutine Vigi;

It must first be realized that there can be no routine or
typical visit. Like the ideal type, a routine visit is an
abstraction emphasizing the regular over the irregular. In this
section I shall describe the episodes which may be analytically
distilled from any encounter.

Before. proceedingy a brief ‘word about terminology.
Throughout this thesis I have labeled the situated interaction
between doctor and patient an encounter. The unfortunate
connotations of this word--as a confrontation between

adversaries12 or a romantic interlude--are unavoidable in light

of the paucity of suitable synonyms. 'Meeting, " 'rencounter,'
'joining,' 'palaver,' 'conference,' all miss the sense of the
interaction between doctor and patient. Of any perhaps

consultation seems closest but while it accurately connotes the

 

12 Friedson. has described. the encounter as a "clash of
perspectives." The encounters I witnessed were less of a clash
than a stand-off.

131

sense of petition that patients arrive with, encounter accurately
describes the initial distrust between the parties, which Dr.
Farrago must overcome. Also, to call the face-to-face
interaction between doctor and patient an encounter is consistent
with Goffman's typology of interactions, according to which an
encounter is a unit of focused interaction between two or more
copresent individuals (Goffman 1963:17-24; Giddens 1984:70-73).

I have already described how the patient enters, registers
and waits in the waiting room, and how he or she is escorted into
an exam room wait for Dr. Farrago. The visit continues as Dr.
Farrago enters the exam room, closes the door and greets the
patient who is sitting either on the exam table or in the office
chair in the corner. The patient may be alone or accompanied by
another. Not wasting much time, Dr. Farrago will ask "what's
up?" This is a clue-in question which allows the patient to
explain why he or she came. If the patient is new, Dr. Farrago
will take a brief history and explain how the encounter will
proceed. At this point, he will also make his first pitches for
trust, but as the dialogue transcript (Appendix A) reveals, these
appeals continue throughout the encounter, though they are most
concentrated in the first half. Dr. Farrago once told me that
his initial explanations of what he is going to do sets the stage
for the series of muscle tests that are to follow. He places
great faith in the muscle test and believes it is really the
unexpected weakening arm that convinces patients that he knows

what he is talking about. As he explains, and as the patient

132
probably read on the plaques on the waiting room walls, "body
language never lies."

During the first half of the exam, there is usually a fairly
constant exchange of information, symptoms, news, and opinions.
Depending upon the patient and how well Dr. Farrago knows him or
her, he might ask about home-life, work and other apparently
unrelated topics, often gleaning clinically relevant impressions
from the patient's responses.

When I witnessed encounters, Dr. Farrago would often explain
over the patient to me what he was doing and what he was finding.
Obviously, my presence affected his performance, but how much I'm
not sure. He did tell me that often he will perform a soliloquy,
telling the patient what he was doing as he does it. My
presence, he said, allowed him to achieve the same effect though
indirectly.

Occasionally, in his exam Dr. Farrago will ask questions
like "Does this hurt?" or "Does this happen when ....?" Often it
seemed to me that he knew the question's answer and that the
answer was not so-important as the impression that he knew where
he was going. For example, he asked one patient "Do your
shoulders get tired after a day in front of the computer?"

The exam usually begins with general scanning diagnostic

methods such as temperosphenoidal (T-S) line palpatation,13

 

‘13 Palpation of the T-S line, a C-shaped line on the sides
of the head, reveals nodes if certain regions are dysfunctional
or if there is a vertebral subluxation.

133

vertebral challenge}4 and postural analysis.:L5 Dr. Farrago
might also check the state of key regions such as the small
intestine, the hypothalamus and the temporomandibular joint
(TMJ) . Consonant with AK methods, Dr. Farrago pays little
attention to the patient's descriptions of his or her symptoms as
they may be misleading reflections of the real problem. AK
claims to enable the practitioner to ask the patient's body
directly, thereby circumventing the need to take detailed medical
histories. The general scanning tests indicates foci of body
dysfunction. Dr. Farrago then tests each focus to determine the
primary system involved, e.g. nutritional, lymphatic, vascular,
neurological, meridian, cranial-respiratory, allergy, and
emotional systems. Once he isolates the cause of the dysfunction
he treats it and retests the involved area to make sure his
treatment was effective. The encounter as a whole is divisible
into separate episodes, each episode in turn consists of three
procedures: testing for involvement or diagnosis, treatment of
region, and retesting to check whether or not the treatment was
effective.

Testing for involvement usually involves a muscle test in

which the integrity of a structure, gland or organ is checked by

 

14 Vertebral challenge allows the practitioner to test the
integrity of the spinal column by pressing against each vertebra
with one hand while pushing or pulling against a flexed limb. If
the limb weakens it indicates the presence of a subluxation at
the vertebra under the first hand.

15 Postural analysis checks the symmetry of the body, face,
legs, etc. Asymmetry indicates structural imbalance and hence
compromised body function.

134

testing the strength of an associated muscle or a general
indicator muscle. Other techniques may be combined with the
muscle test, e.g. therapy localization which reveals whether an
area is involved but not why. The muscle test allows Dr. Farrago
to ask the patient's body yes-no questions much like Azande
oracles (Evans-Pritchard 1976), and like Azande oracles there are
certain necessary conditions for the muscle test to reveal valid
results.

Testing for involvement, or put more conventionally
diagnosis, is complicated by Dr. Farrago's curious assertion that
anything can be caused by anything. As I understand it, he means
by this that changes in body function are the result of
structural, chemical or mental imbalances. If these imbalances
are left untreated for long the body erects compensations so that
it can continue to function, but less efficiently. Each
compensation determines how the next imbalance or insult will be
manifested. Thus each. body, with its different. history of
compensations and structural distortions will react differently
to any given noxious condition. The body becomes a complex of
jerry-rigged compensations. Carried to the extreme, this
argument is untenable. There could be no syndromes, no
significance to symptoms, no access to physiology: the signified
is separated from its conventional signifier. The manual muscle

test would reveal nothing. Clearly, Dr. Farrago does not carry

135
this argument to its logical conclusion and this has implications
for the nature of his knowledge base as ideology.16

Dr. Farrago uses many treatment techniques: most are found
in chiropractic and AK-tests, some he has "discovered" himself
through bricolage. Five categories of therapeutic techniques may
be distinguished: skeletal adjustment--e.g. vertebrae, cranial
bones, pelvis and limbs: soft tissue massage--manual or' by
machine,e.g. the myomatic or a machine he calls a laser:
substances taken orally-~e.g. nutritional supplements, anti-yeast
substances, biochemical salts; splints--for 'feet, jaw; and
home-care advice. All but the latter are usually tested after
they have been administered to make certain they have had the
desired effect.

The end of each episode ostensibly marks .either the
elimination of a focus of dysfunction or the dismantling of a
compensation. Treatment, Dr. Farrago explains, releases the body
from its constriction and allows it to return to a balanced
state, unless it is prevented from doing so by a "deeper" fault
or compensation, requiring another episode of testing, treating
and retesting. The encounter and the healing process generally,
is analogous to an archaeological excavation: each episode

represents a new layer, hidden by the previous layer and usually

 

15 Trent Schroyer has defined ideology as those belief
systems which can maintain their legitimacy despite the fact that
they could not be validated if subjected to rational discourse
(Held 1980:256). See the section on signification in chapter 2
for a discussion of AK and chiropractic as ideologically
determined knowledge.

136

obscuring a deeper layer and ultimately the primordial injury or
imbalance. Treatment corresponds to a search for the cause of
the cause of the cause Since the body is continually
subject to insults--birth is cited as one of the most
traumatic--the structure of compensations will likely be
extensive and complex. It seems unlikely that Dr. Farrago could
ever rid the patient of distortions and return him or her to a
balanced state. He claims, however, that he has completely
healed a few patients, but most he reestablishes a compensation
which might have slipped, and at least frees them of pain.

The test-treat-retest episodes continue to the end of the
encounter.

In the latter part of the encounter, conversation tends to
drop off as Dr. Farrago concentrates on the matter at hand and
the patient is changing positions, rolling over, pushing, pulling
in response to Dr. Farrago's orders.

The encounter ends rather abruptly, with Dr. Farrago simply
saying something like "up and at 'em young girl!" or "O.K., we're
done. See you in a week." He might offer a brief summary of
what he has found. He will give the patient parting
instructions, including what nutritional supplement to take if
needed-~and almost every patient is found to require something or
other--when and how much, things to avoid and things to do. He
will also mention that the patient should return in a week or two
to make sure the adjustments he made have held or to continue

"digging" until he reaches the principal cause of the patient's

137

discomfort. At the end of the encounter, he may consent to
simply crack a back or rub a sore spot. Such last request suggest
that all has not been healed. At the end of one encounter a
patient asked Dr. Farrago to rub a point on his back. I asked
what the significance of this spot was and Dr. Farrago replied it
was just a sore spot. This response illustrates a contradiction
between his contention that every symptom has significance and
the temporal restrictions of the healing encounter.

Throughout the encounter there is little doubt that Dr.
Farrago is in charge. He maintains his distance as the healer,
even when long-term patients feel comfortable calling him Bill or
BilLy. He guides the conversation, introducing new topics here
and there which the patient responds to. He walks around the
table, has the patients stand, sit, lie prone or supine. The
whole exam, but particularly the latter half is punctuated by
orders to "resist as he pushes or pulls against one body part or
another.

The encounter might be divided into phases but they would
not be so easily isolated as Coulehan suggests (1985:370-374).
Coulehan divided the chiropractic encounter into four movements:
acceptance and validation, during which the patient accepts the
legitimacy of the chiropractor, who in turn validates the
patient's suffering; expectations and explanations, during which
the chiropractor explains, usually in mechanical terms, the
patient's illness to him or her; the clinical action-~during

which the chiropractor focuses his or her attention on the

138

complaint; and the engaging plan, during which the chiropractor
explains what the patient should do after the encounter,
including exercise or dietary regimes and making another
appointment. Similar aspects are found in Dr. Farrago's
performance but they are not so easily identified. For example,
Dr. Farrago continues throughout the encounter to ask for
acceptance not just as a prologue to action, and the clinical
action begins with the first test-treat-retest episode.

Thus far I have considered the doctor-patient encounter as a
performance. II have described the explicit claims made by Dr.
Farrago for trust. These claims, together with other tacit
stimuli sent by Dr. Farrago, may be seen as attempts to satisfy
the conditions for a performative speech act so that his words
will "do something" (Austin 1975:14). Here I shall briefly
examine whether this healing procedure might usefully be
considered a ritual, or if to do so would be obfuscation.

Considering the encounter between Dr. Farrago and his
patients a ritual would immediately force comparisons between it
and other, more alien healing procedures already labeled rituals.
It would also force a reappraisal of the tacitly accepted notion
that "rituals" are performed by "natives."

Certainly, similarities may be drawn between the way Dr.
Farrago does things and the way other healers have been described

to do things, however, the bases for these similarities must be

139
exposed. It seems anthropology'sl7 raison d'etre as a science is
to examine and emphasize the similarities among cultures.
However, to achieve this end, anthropology relies on what Needham
has called polythetic notions: classes of phenomena having no
more in common than a "family resemblance," e.g. ritual,
sacrifice, shaman, and medical system (Sperber 1985:24).
Interpreting what he or she finds in the field, the
anthropologist gathers a set of scattered representations
organized, and synthesized, through interpretive schemes
consisting of a complex of polythetic notions. These schemes may
be hierarchical: one category subsuming a class of others. Thus
anthropologists have created, and use, pseudo-objective
categories from interpretations of . scattered (native)
representations into which they fit heterogeneous phenomena.
"Healing" is one such example, often being subsumed by more

catholic categories such as "religion," "magic," and "science."18

It has been argued by Winch (1958) and others that as

products of our culture these categories are inappropriate for

 

17 There is a greater distance between anthropology and
ethnology than is generally acknowledged (Sperber 1985:9-34), but
in this paper I conjoin them under the generic term
'anthropology.'

18 A noticeable shift has occurred in the literature in the
epistemological content of medicine from "religion" and "magic"
to either "science" or "health care systems." Kleinman has
implicitly separated "religion" and "medicine" considering both
to be "cultural systems," objectifying the categories still more.
This shift is a reflection of, or’ at least. parallels, the
separation in our culture between "science" and "religion," and
the rescue of medicine from the latter.

140
the study of other cultures. While Winch's argument ultimately
would disallow conversation between individuals, even of the same
culture, it has some merit. Certainly, care must be exercised
when using such categories. It is with a lack of commitment
then that I suggest that the encounters between Dr. Farrago and
his patients might be briefly considered as ritual.

"Ritual," like "medical system," lacks any accepted
denotation. Its connotations usually emphasize the formal,
collective, unifying, sacred. and. non-technical "activity"with
reference to beliefs in mystical beings or powers" (Turner
1967:19: 1968:269). To others it connotes the repetitive,
celebration of form over substance.19 In contrast to these
definitions the doctor-patient encounter is generally considered
private, secular, technical, and separating, as the patient is
exempted from social obligations. Despite the presence of some
elements usually considered ritualistic, e.g. repetition, some
degree of formality and the recognition of an adept, it seems
inappropriate to call the encounter a ritual. However, I shall
follow' Leach's distinction. between ritual and technical
components of action (1954:10-14), taking technical components to
be those which effect changes in the patient according to the
laws of biology, chemistry and physics (Rappaport 1979:175-6):

and ritual to be that component of action which changes the

 

19 Authors emphasizing the former connotation include Turner
(l967,l969,l981): Leach (1954): Moore and Myerhoff (1977): Evans-
Pritchard (1976) :. Rappaport (1979): and the latter connotation
Douglas (1982).

141
patient by other means. The latter implies communication and I
shall examine the communicative dimensions to the encounter
between Dr. Farrago and his patients in the next section. Here I
shall describe how the structure of the encounter effects changes
in the patient.

Implicit in any definition of ritual is the premise that the
medium is part of the message. In the encounter between Dr.
Farrago and his patients at least four structural elements may be
distinguished: its formality, its spatial constriction--already
discussed, its time-binding effect and its episodic structure.
All three contribute to the transformation of the patient during
the encounter.

The encounters between Dr. Farrago and his patients are not
marked by an invariant sequence of events. There are no
mandatory exchanges typical of what Rappaport has called
liturgical orders (1979:175). Nonetheless, they are not
informal. There is a recognition by both sides that the
relationship is hierarchical; that the patient occupies a
dependent status. Almost all his. patients referred to Dr.
Farrago as "Doctor." The newer' patients were usually politely
reticent, while the older patients might be more garrulous they
always remained within the bounds of their status. Costumes
signify the formality of the encounter. Dr. Farrago wears a

short white doctor's coat zippered closed and a tie.20 If

 

20 Dr. Farrago's white coat is ironic since in the medical
community a short white coat is a symbol of student or
subordinate status.

142
female the patient might be asked to put on a patient's gown, if
male to remove his shirt. The opposition of bare:clothed is a
formal expression of the opposition between the petitioner:expert
and the subordinate: dominate roles.

The formality of the encounter together with its spatial
confinement, described earlier, "fixes" the patient. He or she
is constrained allowing Dr. Farrago to manipulate his or her
body. This is analogous to the control exercised over the
patient--"Like a patient etherised upon a table" (Eliot 1948a)--
allowing the doctor to readjust the body's physiological
"parameters." It may be that ritual control of the person as a
patient is necessary’ to healing, beyond the ceteris paribus
requirement for technical action.

The encounter also binds the patient's inchoate feelings of
discomfort to an external measure of time, giving it an
"official" history and a future, the conditions for the
conversion of illness into disease. From the encounter the
temporal life telescopes in ever larger segments away for the
present, in the past and into the future. the history of the
disease begins with the patient's first appointment. Before then
the illness existed in mythical time. Since then Dr. Farrago has
got closer and closer to uncovering the initial cause of the
problem, the visits telescoping in on the present encounter.
During the encounter, the future of the disease is mapped and its
eradication assured. Disease is grafted onto time allowing its

limits to be more clearly perceived by the patient.

143

The third salient aspect of the encounter is its episodic
structure. Beyond the initial scans, the encounter is really a
series of discrete diagnosis-treatment-check episodes as each
fault or compensation is discovered and dismissed one by one.

Rappaport's distinction between analogic and digital
processes (1979:184) is useful in analyzing the episodic nature
of the encounter. Disease is analogic, that is it changes in
continuous, imperceptible gradations. Dr. Farrago traces a
disease's career from its predisposing factors to its actual
cause to its effects, first functional and then organic or
pathological. Compensations, too, are gradually constructed. AK
treatment, on the other hand, is digital: it advances in
discontinuous stages or steps. Each episode of treatment is
another step. A3 stereo enthusiasts are aware, digitalization of
sound--by nature analogic--increases the clarity of distinction
between sounds. Likewise, digitalization of healing, forces the
patient to consider that changes are being effected. Often the
end of an episode is indicated by the loud snap as Dr. Farrago
adjusts a vertebral subluxation.21 Not only does the
segmentation of the encounter force the patient to recognize that
Dr. Farrago is doing something, but the tacit message of each
episode is the same: "I found something wrong but now I have
fixed it." If this message is transmitted enough times it will

impress itself upon the patient, despite surrounding noise and

 

21 See Needham (1967) and McKinley (n.d.) on the role of
percussion in effecting shifts between ritual phases.

144

interruptions in transmission. The message is a property of the
structure of the event. The order it imposes upon one the chaos
of illness is a result of the redundancy of the episodic
structure as each episode reduces the possibility that the
message will be misinterpreted.22

In summary, I have examined the encounter between Dr.
Farrago and his patients as ritual. I have looked at how
the encounter as a structured event mighteffect changes in the
patient through non-technical means, that is, for reasons other
than those explicable in terms of biology, chemistry or physics.
I identified four dimensions to the encounter which might effect
changes in the patient:spatial confinement, which I examined in a
previous section: the time-binding of disease: the formality of
the occasion: and its episodic structures. In these ways, and
probably others, the medium or structure of the encounter is part
of its message. In the next section I shall examine the skeins

of communication between the participants of the encounter.

3.6 Communication

Umberto Eco has made a useful distinction between
communication--"the passage of a signal (not necessarily a sign)
from a source (through a transmitter, along a channel) to a
destination"--and signification--implying a system of codes by

which something' presented to the sensation of the addressee

 

22 See Arnheim (1971) for a discussion of the relationship
between order, structure and information in art.

145

stands for something else (1976:8). The distinction is
essentially between process and rules. A major advantage of this
model is that it is not subject to the limitations of other
theories and communication which require both source and receiver
to be human (e.g. Leach 1976). According to this model
symptoms23 and other stimuli not intentionally sent by humans may
be considered as communication if they are considered meaningful
by the interpreter, that is, if they may be "plugged into" a
code. I shall examine this further when I discuss the manual
muscle test.

As I noted earlier, the encounter between Dr. Farrago and
his patients is one of co-presence: the participants are engaged
in a face-to-face exchange in which both continuously monitor
their own conduct and ‘that of the other, ‘making continuous
adjustments, questioning, responding, using and abiding by norms,
invoking sanctions, and so cum. Communication is constant, even
during the yawning silences when Dr. Farrago is testing muscles
both parties sustain the encounter as such.

The stimuli by which the participants orient themselves are
interpreted as meaningful only through signification systems, or
what Sahlins calls conceptual schemes or codes (1976:55-125).

Earlier, I mentioned two codes by which Dr. Farrago's conduct

 

23 In allopathic medicine, "symptoms" usually refer to those
indicators of illness expressed by the patient and "signs" to
those indicators which are detectable by another person (MacBryde
and Blacklow 1970:l). However, due to the inflated use of "sign"
in the social science literature, I shall use "symptom" to refer
to both sign and symptom.

146

might be interpreted: manner, including "kinesics," "proxemics,"
and "etiquette," and appearance, including "costume" (Eco
1976:9-14): Sahlins 1976:179-204: Goffman 1959:24). Other codes
immanent in the counter are language, including everyday language
or vernacular: formalized languages including organic chemistry
and biochemistry: medical semiotics as codified, conventional
connections between symptoms and conditions (e.g. AK,
chiropractic, osteopathy, allopathy, homeopathy, acupuncture,
reflexology). In the following pages, I shall examine some of
the many skeins of communication between Dr. Farrago and his
patients. Since the manual muscle test is the most significant
code in the encounter, and the hallmark of AK, I shall analyze it
in the greatest detail.

Verbal communication between Dr. Farrago and his patients is
discontinuous. There are relatively long periods of time (5-20
seconds) when no word is spoken. During these periods Dr.
Farrago is testing the various muscles, communicating with the
patient's body. These periods suggest there are three planes or
movements of communication occurring simultaneously: between Dr.
Farrago and the patient as a person. between Dr. Farrago and the
patient's body, and between the patient and his or her body.
This communication triad takes into consideration the
contradiction between the person as a body and the person having
a body. Western medicine is body-oriented and it might be argued
that communication between doctor and patient is simply foreplay

to allow the doctor to "fix" and get at the patient's body.

147
Certainly in the encounters between Dr. Farrago and his patients'
verbal communication was secondary to non-verbal, kinesthetic
communication. The former was used to explain the latter.

As I have described, much of the conversation between Dr.
Farrago and his patients serves to establish him as a sincere and
capable healer. However, Dr. Farrago's statements do more than
characterize him as trustworthy and explain by the non-verbal
communication, they also effect changes themselves.

Fernandez (1986) has suggested that words, specifically
metaphors, effect changes in individuals by moving them in what
he calls "quality space." The predication of metaphors onto
inchoate subjects (i.e. pronouns) moves them along certain
dimensions. Dr. Farrago's statements move his patients from weak
to strong, from constrained to free, from bent to straight. This
movement is particularly evident after a muscle test when Dr.
Farrago will. point out to the patient "See how strong you are
now!" As I shall discuss, Dr. Farrago's healing is metonymic,
and akin to sympathetic magic: by curing a part--getting the
muscle to strengthen--he cures the whole. Strength becomes the
dominant metaphor of the encounter.

Another aspect of the verbal communication of the encounter,
is what I call the mystificatory effect of Dr. Farrago's
statements. Often, in response to a question, Dr. Farrago will
slip into medicalese ‘using fragments of the ‘vocabularies of
microbiology, chemistry, anatomy, physiology, AK, chiropractic
and allopathy. There is usually little chance that the patient

148

understands exactly what is being said. However, his medicalese
is not considered by his patients mumbo-jumbo (Tambiah 1968:180).
They are able to recognize words here and there from television
commercials and magazine advertisements. They recognize it as a
sacred language: one which although non-sensical to them, appears
to enable Dr. Farrago to translate the body's logic and to see
what's wrong. The use of medicalese is more mystificatory than
explanatory, and the mystification is inflationary. For example,
Dr. Farrago may "explain" the patient's body to the patient in
arcane terms, which the patient will grasp in fragments.24 It
may be that they come to him not caring what he tells them just
so long as he fixes what's wrong. However, when they try to
explain what he did for them to others, they will likely do so
using fragments of Dr. Farrago's explanation, and since the great
majority of Dr. Farrago's patients are referred to him by
previous patients, it is conceivable that they come to his
office, anticipating similar explanations. In a sense, they are
pre-converted. The cycle of mystification then extends beyond
the clinic and contributes to Dr. Farrago's reputation as a
knowledgeable healer and to his continued successful practice.

As the above discussion indicates, it must not be imagined
that verbal communication between Dr. Farrago and his patients is

always formal, logical and transparent. Dr. Farrago may,

 

24 see Young (1983) for an analysis of the way in which new
knowledge is added to old knowledge. His analysis is important
in that it undermines Kleinman's and Good's use of cognitive
structures to describe Explanatory Models.

149
wittingly or unwittingly, obfuscate, he may convince the patient
to trust him not on the strength of the logic of his argument but
on the strengflh of his character. The verbal dimension to the
communication. between Dr. Farrago and. his patients is
discontinuous and secondary to other channels. It is used by Dr.
Farrago mainly to disarm the patient's suspicion and to make sure

he or she doesn't miss the significance of the muscle test.

Non-verbal communication between co-present individuals
includes the continuous monitoring of conduct by codes of
proxemics, gestures, costume, manner, etc. Non-verbal
communication provides the continuous communicative axis of the
encounter. The most salient non-verbal dimension of
communication in the encounter between Dr. Farrago and his
patients is kinesthetic communication, specifically the manual
muscle test.

Kinesthetics might not generally be considered communication
since bodily sensations are not usually interpreted through a
code. However, much work in birthing has questioned whether
parturition is experienced differently in different cultures and
how much this has to do with body position, i.e. kinesthesis, and
cultural expectations. Kinesthesis is also synesthetic, that is,
it elicits sensations of a different order. For example,
allowing one's head to rest in Dr. Farrago's hands, knowing he is
going to quickly twist it until the neck snaps induces many

feelings in the patient, including that of handing the keys over,

150
of letting go, and apprehension. The snap is synesthetic: you
hear the feeling.

The manual muscle test is communication. It is the means by
which Dr. Farrago asks the body questions and interprets its
replies. Even though the source--the patient's body--is not
intentionally sending signals, signs are interpreted as messages
by the doctor, through a code, i.e. the body of concepts of AK
which considers a mmscle's ability to resist a force applied to
it to be an index of the state of the body as a whole. But as
Bakhtin realized, the sign, and hence the code, is not neutral or
self-evident, but a focus of struggle and contradiction (Eagleton
1983:117). What adherents of AK take to be an index of body
function-~i.e. a weak muscle is causally connected to compromised
body function--is considered by its critics to be a symbol of
body function--i.e. a weak muscle is symbolic of but not
necessarily connected to a compromised body, or put a little
differently, they admit that a compromised body is a sufficient
condition for muscle weakness but not a necessary condition. The
code is by nature political, its validity is defended on the
grounds that it was produced according to rules of science and
its validation by experience. I have already shown how the first
claim is groundless and the second claim beyond examination, but
it would be naive to believe that beliefs crumble in the absence
of rational verification (Held 1980:256). Other factors sustain

the code as was discussed in chapter 2.

151

Dr. Farrago has great faith in the manual muscle test. He
told me that while patients may be sceptical of what he tells
them but he believes they recognize what their body tells them
through the manual muscle test. I have seen patients, after
their arm or leg went limp say "I didn't know I was so weak," or
"what does that mean?" They clearly are impressed. by' the
weakening muscle: "signs are taken for wonders" (Eliot 1948b).
The ability to resist against a force applied by Dr. Farrago
seems to be clearly associated in a physical, non-verbal
vernacular with ideas of strength, power, health, the ability to
work, resistance, vigour, etc. When Dr. Farrago can demonstrate
by retesting the previously weak muscle that after the treatment
it is now strong the patient is forced to consider that something
has happened, a change has occured and health, strength and
vigour have returned. It may be that, as Rappaport suggests,
states such as health or illness, without tangible or definite
boundaries, in order to be communicated require dramatic or at
least substantial signs, such as the muscle test (1979:181).

The effectiveness of such signs on the non-verbal plane of
communication has been discussed by Levi-Strauss:

Speech, no matter how symbolic it might be still (can)

not penetrate beyond the consciousness and..,(the

healer) can reach deeply buried complexes only through

acts. ._

(Shamanistic and psychotherapeutic healing) may at one

time involve a manipulation of ideas and, at another

time, a manipulation of organs. But the basic

condition remains that the manipulation must be carried

out through symbols, that is, through meaningful

equivalents of things meant which belong to another
order of reality (1963:200).

152

Dr. Farrago's manipulation of symbols in many cases
corresponds to homeopathic and contagious magic, the two species
of sympathetic magic isolated by Frazer. Homeopathic magic is
based on the "Laonf Similarity," or the association of ideas by
similarity: and contagious magic on the "Law of Contact or
Contagion," or the association of ideas by contiguity (Evans-
Pritchard 1981:132). ‘Van Gennup described contagious rites as
those "based on a belief that natural or acquired characteristics
are material and transmissable (either through physical contact
or over a distance): and sympathetic, here homeopathic, rites as
those "based on belief in reciprocal action of like on like,...of
the container and the contained, or the part and the whole,..."
(1960:4-7). The distinction was echoed by Jacobson who opposed
metaphoric and metonymic association as analogous to homeopathic
and contagious magic (Leach 1976:29).

Dr. Farrago uses the manual muscle test to diagnose body
function. By testing muscle strength he believes he is testing
the body. The muscle becomes a metonym, or more properly a
synedoche, for the body, in a relationship between a part and the
whole. ILf he strengthens the muscle he believes he strengthens
the whole. He takes the relationship between muscle strength and
body function to be indexical, i.e. associated in a cause and
effect relationship. According to Leach, but in a different
terminology, this is the essential error of magic: mistaking what

is indexical for what is symbolic (1976:31).

153

Other treatments used. by Dr. Farrago may' be considered
contagious magic, reiterating van Gennup's definition, in which
natural or acquired characteristics are believed to be
transmissable either accross space or by physical contact. For
example, on occasion Dr. Farrago will have a mother hold her sick
child and he will test her to diagnose the child. He explains
that the child's energy patterns travel through the mother and
are detectable by testing the parent. I also witnessed the Dr.
Farrago use this procedure to diagnose racing horses. In other
instances of contagious magic, Dr. Farrago will have the patient
hold an object, e.g. a dental plate or a substance thought to be
causing a reaction, while he tests the body to see how it
responds. If it weakens it is noxious, if not it is inert.

As Ievi-Strauss described in the quote above, manipulation
of symbols, such as that practiced by Dr. Farrago, is intrinsic
to shamanistic and psychotherapeutic healing, and probably all
healing. It implies a triad of communication between the doctor,
the patient as a social entity and the patient's body. Symbolic
manipulation involves all three and is largely responsible for
the changes experienced by the patient in the encounter.

It is my contention ‘that the non-verbal dimensions of this
communication between Dr. Farrago and his patients are the more
motive elements of the encounter: if a patient is changed--and
all patients leave the encounter in a different state than they
entered--it is largely due to the non-verbal communication,

particularly through kinesthetic communication. In this

154
chapter, I have discussed the general pattern of the encounter,
how the structure itself might effect changes in the patient, and
the kinds of messages sent by the doctor and received by the
patient on various planes and along different channels. I have
described some of the explicit claims made by Dr. Farrago for
trust, and some of the tacit messages sent by him regarding the
patient's body. At the end of this chapter, I shall examine some
of the implicit statements in his arguments and actions, and
consider just how far his practices are from those of the medical

orthodoxy, and how he perpetuates the system within which he

practices.

 

A3 I mentioned earlier, Dr. Farrago does not have a
congregation or a flock, but a clientele. His patients do not
form a moral community of believers, as might be argued for
allopathic patients who adhere to the messages they are bombarded
with daily to believe in scientific medicine. His relationships
are accidental and transient (Durkheim 1915:60).

Like all healers, Dr. Farrago sees his share of "suppliants,
'iadmirers, doubting Thomases, paranoics and pests" (Cooke
1986:144). Some come to him regularly, some once or twice. Some
patients he can swear at, some swear with, some he can swear with

if he apologizes, and some he is most proper with. With all he

155
tries to retain control through ‘verbal and non-verbal
communication.

The asymmetry of power intrinsic to every social encounter
is certainly evident between Dr. Farrago and his patient but not
to the degree as between many allopaths and their patients. Dr.
Farrago tries to maintain a professional, authoritative distance,
even when his regular patients refer to him as Bill or Billy.25
He is aware that his authority is tenuous. Unlike allopaths and
osteopaths, Dr. Farrago has few sanctions at hand to control the
patient with aside from personal charisma. If a patient is not
"complying" he does not have a retinue of nurses to convince the
patient that the doctor knows best, nor does the threat of going
against medical advice carry the weight it does in the allopathic
sector, and Dr. Farrago does not have the legal right to treat
patients against their wills. Dr. Farrago is aware, too, that he
is probably not the first professional consulted and that once
the patient considers seeing an unorthodox healer he or she is
confronted by a bewildering variety of healers: he is just one of
many. Dr. Farrago's authority is tenuous and the dialectic of
control is less one sided than between an allopath and his or her
patients.

Within this dialectic of control Dr. Farrago acts as a
mediator. He mediates between the patient and his or her body.

He explains the body in vernacular or in ostensibly unrefracted

 

25 The disproportionate number of lines spoken by Dr.
Farrago ( to ) illustrates one way in which he maintains
control.

156
medicalese. He reveals the disease and before he dispatches it
he forces the patient to confront it as a named entity. Through
the muscle test he shows the effect of silent disruptions within
the body so dramatically ‘that the jpatient cannot deny' that
something is going on. And once he treats the body he shows the
patient the change in such a way that he or she can not deny it.

He is the mediator between the patient and others, including
family members and workers. He is a gatekeeper validating
temporary exit visas from home or work responsibilities. Often
patients will be accompanied by a family member to whom Dr.
Farrago will direct part of his performance. The family members
will be impressed with the fact that his or her spouse, child or
sibling is ill--ill enough to pay for treatment--and should be
treated accordingly.

Dr. Farrago also mediates between the patient and other
healers. He will "explain" what other healers might have told
the patient. Of course, the translations are usually biased and
adduced as instances of allopathic, or chiropractic,
mismanagement. By explaining others away, Dr. Farrago
simultaneously’ distances himself from them so ‘that the only
possibility for a cure lies with him.

He also mediates between the patient and the media. The
patient might hear or read of a new wonder cure for this or that
and will ask Dr. Farrago if he has heard of it. He will usually

explain it away arguing that if it isn't included in AK it

157
probably isn't as good as it sounds. I shall examine some of the
implications of Dr. Farrago's role as mediator shortly.

Throughout the encounter, many of Dr. Farrago's statements
resound with the ideology of the disenfranchised. He voices his
resentment at being labeled a quack: he lists ways in which he is
the victim of the prejudice of the orthodoxy, including his
exclusion from hospitals, and the unexamined scorn his diagnoses
are met with from allopaths. He thus appears to understand the
plight of the common-man, or woman, and the ennui he or she feels
in the work place and the home: the sense of no exit. Dr.
Farrago doesn't seem to offer the same subtle messages of "you'll
be O.K. if you go back to work" that the orthodox physician often
transmits (Waitzkin 1984). But however much Dr. Farrago appears
the David to allopathy's Goliath he borrows much from the
dominant allopathic ideology and contributes to the maintenance
of the system he so vocally challenges. '

An archaeology of the implicit (Taussig 1980) in his
performance reveals how Dr. Farrago duplicates many of the
practices that have led to what Illich calls the medicalization
of life (1976). The last fifty years have seen a tremendous
expansion in the purview of allopathic medicine. The
acceleration of allopathy's hegemony is no doubt in part due to
its ‘vital partnership ‘with. bio-technology’ and. the scientific
disciplines, and it is also in large part due to its ability to
capitalize on its "cultural authority" (Starr 1982). The

benefits of this monopolization of health care have been widely

158

publicized, and probably overstated. As more and more
aberrations, bodily and social, become clinical conditions,
allopathy makes more and more promises which become harder and
harder to keep. In the wake of broken promises there are always
more practitioners willing to make even more extravagant

promises, all of which are based on the same premise: health or
alternately relief from disease is a commodity (Illich 1976:34).
Patients become consumers who learn to conceive of their
illnesses in a pastiche of pidgin medicalese. They begin to
think that there is no need to suffer, that medical science, in'
one form or another, can eradicate the pain if it can't exscind
the cause. There is a collective mentality that is looking for
the quick-fix cure which is preventing people from dealing with
human weakness, ugliness and. deviations from. the norm. in a
personal and autonomous manner. As Illich has noted, "cultures
(traditionally) make pain tolerable by interpreting its
necessity. Only pain perceived as curable is intolerable".
(1976:133). If medicine could live up to its can-do promise,
handing over responsibility for illness to a professional, who
knows the "facts", might be more satisfactory. But as Comaroff
has pointed out the promise of medicine is ambiguous (1979:1981).
Illness reduced to facts, abstracted from social context, and
dismissing as irrelevant questions of morality (Why me?) is not
satisfactory. The medicalization of life has resulted in the
eclipse of man's social being by his natural state (Comaroff

1981:368). There is no alternative but to accept on faith what

159

the professional says often in opaque terms. In the majority of
cases there is little to gain to offset the acquiescence of
responsibility for handing over one's body--most people hand over
their bodies more readily than they would the keys to their cars.
More often than not they are rewarded with palliatives or
anodynes, or nothing. Even if one does not accept Illich's
thesis that medicalization is producing sickness (1976:33,116, et
passim), it is undeniable that many, many people too readily hand
over responsibility for their illness and receive at most
nothing. When approached form this angle anything that Dr.
Farrago does might be helpful, but in many ways he is both an
accessory to and a beneficiary of the medicalization of life.

:Perhaps the most salient similarity between Dr. Farrago and
allopaths is his reduction of all illness to physiology. He
explains that there is a reason for everything, all he has to do
is find it,;‘36 but instead of looking for the sources of most
complaints in the social context and in social relations he looks
for them in the body. The body is not considered the reflection
or mediator of social contexts but as a disconnected unity. He
explains that if he can cure the patient's body he or she will
then be able to handle the stresses of daily life. The person is
abstracted from both his or her body and his or her social

context. In this sense Dr. Farrago does the allopaths one

 

25 This argument falls under Levi-Strauss's definition of
magic as "a complete and all embracing determinism," rather than
science which distinguishes between levels and realms of
causation (1966:11).

160
better, who at least concede the need for social workers,
community health projects, etc. so long as they are under medical
control.

Also, laying aside questions of efficacy and questions of
cost to the patient, the assumption that illness can usually be
treated with tablets echoes allopathic practice. Dr. Farrago
prescribes one pill or another for almost every patient. Whether
or not they are always indicated, I cannot tell, but as Comaroff
has shown for allopaths, physicians will often prescribe
unnecessary medications to satisfy their patients that they are
doing something (n.d.). Whatever the case, the pill prescribed
by Dr. Farrago whether it is a nutritional supplement, an anti-
yeast agent, or raw and desiccated organs is analogous to the
silver bullet therapy of the allopath, and it might be argued in
many’ cases equally' off ‘target, leaving' the social causes. of

sickness untreated.

CHAPTER FOUR

CON CLUS ION

It has been my intention to show through the form of this
thesis that Dr. Farrago does not practice within a vacuum. As a
chiropractor, and even an "AK man," he practices within a
tradition. He may construct his knowledge by bricolage but his
foundations--chiropractic and AK--are the result of historical
conditions. To maintain the terminology used throughout this
paper, he draws upon their bodies of knowledge, their legitimacy
and their resources. Theses rules and resources provide the
conditions of his practice and like all conditions they are both
restricting and enabling. He is allowed to practice as a doctor
because chiropractors have been recognised as doctors in the
past, and he has trained and been licensed as a chiropractor as
the diplomas on his office wall certify. But he is also limited
in what he may do as a doctor. He is prevented by law and
popular opinion from performing surgery even if he wanted to. He
may not claim or do too much but he must do certain things,
including acting like a doctor. These conditions, for the most
part unacknowledged, exist before and throughout the encounter.

Likewise the consequences of his action as a chiropractor,
many unintended, extend beyond the immediate encounter. I have
already mentioned the medicalization of life and the cycle of

mystification as consequences of Dr. Farrago's practices. By

161

162
being such an ardent champion of AK other consequences will
follow from his actions, including the continuity of AK as a
feature on the topographical map of medical systems, a continued
lack of consensus between chiropractors and an inability to unify
despite differences, a decreased probability that chiropractic
will limit itself to conditions related to the musculoskeletal
system and hence be incorporated within the "medical community,"
and remain in continued opposition to allopathy. From his
association with other healers, especially those practicing
unorthodox medicine, he will maintain his ties with and
contribute to the existence of the cultic milieu. Consequences
such as these are linked to the conditions of his action through
what Giddens calls the duality of structure. It is through this
link that it becomes possible to see how Dr. Farrago contributes
to the conditions of his practices.

The limits of this study should be made explicit before
drawing final conclusions about Dr. Farrago's practices. It will
have been obvious that my analysis looked only at the doctor's
performance and left unexamined the patient's performance, why
they came to Dr. Farrago, whether or not they were satisfied, to
what extent there was any negotiation between the perspectives
and so on. Needless to say a more balanced study would have
examined these questions. In effect I have committed the
greatest error an ethnographer can: I have spoken for the
patient. I have not restricted my analysis to the locutionary

act--the act of saying something, e.g. "he said..."--and the

163

illocutionary act--the performance of an act by saying something,
e.g. "he argued or suggested..."--, which given my quasi-native's
understanding of mid-western american cultural and linguistic
conventions is defensible, but I have also strayed into the realm
of the perlocutionary act--the results of saying something, e.g.
"be convinced me that..."--(Austin 1975:94-109). However, it
might be argued that had the lords of limit not prevailed and I
had been able to interview more patients I would not have
received explanations of what had transpired in the encounter
only another set of interpretations. I would have been able to
produce a richer and more solid ethnography, but I'm not sure it
would have strengthened my analysis of the encounter as ritual
and communication.

Throughout I have taken for granted that the patient is
changed by the encounter; I have jput into suspension. the
possibility that Dr. Farrago's treatments are effective in and of
themselves for reasons having to do with the biological, chemical
and physical effects of his ministrations--no doubt this will be
criticized by Dr. Farrago and other practitioners of AK and
chiropractic--and considered the ritualistic aspects of the
encounter. I have offered hypotheses as to how changes might be
effected in the patient, looking first at the structural
dimension of the encounter and then its performative and
communicative dimensions. Essentially, I have assumed the
perlocutionary effect and, using linguistic and cultural

convention, examined the locutionary act to see how it occurred.

164
Of course this analysis can only go so far: it stops at the point
where the patient wants to believe, or not. These questions
would have been better examined had I talked with more patients.

Given these weaknesses in my research, what might finally be
said about Dr. Farrago's practice and practices? How might he be
a foil for larger issues of healing as I asserted. in the
introduction? The question that forces its way to the front is
whether as a chiropractor, Dr. Farrago is a chirosophist, a
master of sleight of hand. The question is densely packed and
defies a yes/no verdict. If he is a chirosophist does that
invalidate the testimonials of patients who claim he is the only
one who has been able to help? For what it's worth, I do not
believe Dr. Farrago is a charlatan. I think he believes in what
he's doing. Medicine, for him seems not primarily a means to
financial security, a distraction or a status trip. Like all
heretics he is fervent in his belief that the orthodoxy is not
justified in its domination, though as I have explained he is not
a revolutionary. He borrows fragments and the form of the
dominant ideology and the consequences of his practice are
medicalizing.

If he is more of a bricloleur than a scientist or even an
allopath, and if he uses science ideologically and if he gets
people better, what might A be said of the relationship between
science and medicine? Is it a necessary or sufficient
relationship, or neither? There has been a continuous dialogue

in Western thought between those who judge medicine to be

165

efficacious or not based on the internal consistency of a
practitioner's argument (i.e. the rationalists), and those who in
defense of their practices adduce instances of healing. Clearly
both arguments may be ideologies (Bourdieu 1977:18). The point
is that by pointing out 'inconsistencies in Dr. Farrago's
arguments, by citing instances of magic in his practices and the
absence of a scientific mode of production of the knowledge he
uses, I am not invalidating or' attempting to discredit. his
efforts at healing for as Illich (1976) puts it,

Technical intervention in the physical and biochemical
make-up of the patient or his environment is not, and
never has been, the sole function of medical
institutions. . .magic or healing through ceremonies is
clearly one of the important traditional functions of
medicine...(107)

Most healing is a traditional way of consoling, caring,
and comforting people while they heal, and most sick-
care a form of tolerance extended to the afflicted.
The ideology promoted by the contemporary cosmopolitan
medical enterprises runs counter' to ‘these functions
(131).

APPENDICES

APPENDIX A

ASSOCIATIONS BETWEEN MUSCLES, GLANDS AND VERTEBRAE

Gluteus Maximus

Sacrospinalis
Quadratus Lumborum
Abdominalis

Psoas

Iliacus

Gluteus Medius

Adductors

Tensor Fascia Lata
Sartorius

Gracilis
Hamstrings
Quadriceps
Piriformis

Gastrocnemius
Soleus

Popliteus
Peronius

Mid- Trapezius
Serratus Anticus
Rhomboids
Latissimus Dorsi
Supraspinatus
Teres Major
Teres Minor
Infraspinatus
Subscapularis
Anterior Deltoid
Triceps Brachii
Anconeus

Biceps Brachii
Neck flexors
Upper Trapezius

Neck extensors

*List incomplete

IN APPLIED KINESIOLOGY

reproductive glands
prostate gland
broad ligament
bladder
appendix
duodenum

kidney

kidney
iliocecal valve
uterus

seminal vesicles
climateric
colon

adrenal

adrenal

rectum

small intestine
uterus

seminal vesicles
adrenals
adrenals

gall bladder
bladder

spleen

lungs

stomach
pancreas

brain

spine

thyroid

thyroid

heart

lungs

pancreas
pancreas
stomach

sinuses

eye

ear

sinuses

166

lumbar 3

lumbar 2

thoracic 11 & 12

lumbar 5

lumbar 4
thoracic 9
thoracic 9
lumbar 1
thoracic 10
sacral region

thoracic 4

\l

thoracic
thoracic 3

thoracic 6

N

thoracic
thoracic 3

APPENDIX B

A TRANSCRIPT OF DIALOGUE BETWEEN DR. FARRAGO AND MRS. CLARA IXDBSON

Dr. Farrago entered slightly ahead of me and asked Mrs. Dobson if she
minded that‘be in the room as he treated her. He explained that Iwas a
graduate student at Michigan State University and was interested in doing
my thesis on Applied Kinesiology. She said she did not mind and I

entered the room.

(d = doctor: p = patient: and m = myself)

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Well Clara what brings you here today?

Well doctor I have a pain in my side.

Where abouts is it?

It's all in the side

Did you hear what she said there? She said it's all on

that side.

Which side?

She said it's all on the left side. Resist as hard as

you can. See how she goes weak when I challenge the

hyoid?

I'm weak all over,too. If it was anything-else but

this [the visit] I'd still be in bed.

resist as hard as you can. So generally speaking, people who
have all of their symptoms on one side have a hyoid involvement .
0k. lay on your back, Clara!

They were going to me [the hospital] where does your head hurt?
I said all over.

yeah. .
It felt like it was going to explode. I've had them before

but they generally go away if I lay on my
(unintelligible) . . .

Yeah. What hospital did you go to?

St. Jo's [Saint Joseph's, an extremely large hospital
nearby] Nothing helped it. It started at about four
o'clock in the afternoon. I think I went to sleep about
twelve woke up at two thirty. Oh boy It never stopped. I
still. . . They gave me a shot that would last eight hours.
They gave it to me at three 30. I feel like I've been on
a drunk.

Dr. Farrago turns on and applies the myomatic machine

to Clara's neck] Many times it's been my experience in
Applied Kinesiology that I'll treat a patient and

they'll say "Jeeze, you made me worse." And in a

sense, I suppose is true, but what it usually is is

I've uncovered the real problem. And what I treated
before is a compensation. So then you're well on your

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way to recovery because then you ' re dealing with what
should be dealt with.

Right. So the next step would be

Well the next step is to cure whatever you find and

that is usually the real problem the patient has been
hibiting or feeling. 'Cause sometimes it seems as

though you do things and I've gotten many strange looks
from patients who question that I 'm even connected with
the patient's problem, they think.

When did I have my last treatment? Tuesday?

Tuesday, yeah.

Tuesday, for the first time in what since December
fifteenth my bladder hasn't hurt. But then on

Wednesday I cleaned the carpeting. And the bladder

pain came back.

Well what you're doing there though, Clara, I think

we're right and I think they're right in saying that

the bladder problem is from the back. And when you do
that with that degenerated disc, especially if you're

on your feet alot and you tend to bend. And I think

that what that does is to aggravate everything, you

know. There's something you can't get away from,

really.

Well probably my golf game is shot, shot to hell, huh?
Well one never knows, I wouldn't advise you to give it up
without a st. toggle. And knowing you I don't think you would
anyway.

Well golfing is easier than, I don't think there's
anything harder that's as hard as cleaning carpet.

Golfing isn't so bad, because it's not constant and

it 's not cor“ ..:etely bending. True, you twist when you
swing and st"... fthat's true, but then you walk quite a ways and
you can walk that out you know what we've got to do in that
instance is to keep you balanced and to keep you straight get
out any twists and any torques out of you.

yeah, I've got that brace.

Yeah you can wear your brace.

Well I'm sure that I'm not cleaning any more carpeting, I know
that. Hewy, it used to hurt me ten years ago, so.

0.x. Clara can you straighten your legs out?

You can take my shoes off if you want.

Well. Turn over on you stomach. So what did they give you?
just a tranquilizer, or what?

Well they gave me a shot

of what?

of what?

yeah

I don't know. I didn't ask them. They said it was to
relax me. Oh it was partly for nausea too I was throwing up.
Oh that spine hurts so badly.

she has many episodes on going to the hospital on an
emergency basis became of her severe asthma.

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Is that what happened last night?
Apparently what happened yesterday was she just went numb on
one side. And you really. . .
. this armstill isnumb, not numb numb, you knowwhat I

mean?

It aches.

Yeah it just feels strange—it just aches.

She has, you can't really call it a transient ischemic

attack because it's not transient and yet it's not a

stroke either because there is no neurological deficit

and there's no no uh classic signs of stroke or

anything which by now should be developing. So what

you got to say is it's a reflex problem from something

out of place, or the hyoid or whatever. Generally,

when the hyoid goes out of place like that it will pull
something out in the neck and I don't know why I stuck

that under your shoulder I meant to stick it under

your hip, and by the way Clara I do know the difference
between your shoulder and your hip. I studied that for

six years.

Let's face it you can't chew gum and walk ..

[laughs]

so she's never had a stroke before?

No. You've never had a stroke before

No

No really, if we could just wave our magic fingers and get rid
of the asthmatic problem and get her off all the medications
that she's taking as a result of the asthmatic problem, she
would probably do very well

Yeah, if it weren't for a bad back.

Yeah, but you see that would even do better because if you were
off the cortisone you'd lose weight and you know you'd generally
be bet" er off and that would have a positive effect on your back
too , you lmow. And she's always got tenderness over this right
sacroiliac. And that's adrenal. The sacroiliac is always
involved with the adrenal gland and that's the cortisone .

And so no matter what else I find that's always there. And as
long as the situation remains as it is then that's going to be
there, because of all the cortisone she takes.

Is there an applied kinesiological technique for

[treating] asthma?

Not specifically. There are things you treat which is the
adrenal system, 'cause asthma is an adrenal disease. And I have
some rather good results with asthma. I 've got one patient in
particular who is doing extremely well, and he's been a chronic
asthmatic for years and I'm treating primarily his adrenals and
his lungs and what the problem with this. young lady is that she
has been on the cortisone for so long that she's dependent,
she's cortisone dependent I'm sure. And barring some major
healing miracle, which I don't know how to administer so to
speak, she'll probably be on it the rest of her life.

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“'PP'PEL'PEL 've- '0

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170

There's nothing you can do to override the cortisone , its too
strong?

Well, when you go back into physiology, it says if you

don't use it you lose it, so what has happened is she's

used cortisone so long her adrenals have atrophied.

Even in the standard approach to adrenal therapy with

. cortisone when they take the patient off and they just had it on

for two weeks, or three weeks, or a month they take the patient
off slowly, to allow the adrenal glands to regain their
function.

Right, it decreases the adrenal gland. They want me to go have
tests again and start having shots .

what kind of shots?

Oh, the ones that, oh that's sore, oh what ever you're
allergic to

allergy shots?

oh yeah, yeah, that's sore.

well, I'm not impressed with allergy shots

I don't know hat to do. They never helped me before

Well, I wouldn't do it Clara.

I really don't know hat to do.

If I can get your stomach soothed down enough to be

able to handle nutrition, I can handle your

allergies. But the key to the whole thing is to get

your stomach and intestines so that they're not so

damn hypersensitive. She's probably a good case for a
Rolaids advertisement, you know. because. . .

Riopan, and everything else

Yeah, I imagine she pretty well lives on those things
because of the intestinal irritation and inflammation
created by the medication she's taking because they are
pretty rough on the old intestine .

should you give her stuff for that? Trophins?

Well I've got her trying to take enterophic, which is a
small intestine concentrate . With the idea that eventually that
will help heal the inflammation in the intestine, because that's
what I'm finding. I'm not finding too much [of a] stomach
problem, but that may be there. It may be covered up by the
intestines. And when I can get those two things normally
functioning then I want to start aiming towards her allergies
and indirectly, then, towards her adrenals.

Yeah, I just get to feel good when they put me on that
dammit, HES, which that tears you apart.

What's HES?

It's a, a, oh heck what is it. It's what they give you

when you've got a cold.

An antihistamine?

Huh?

Not an antihistamine?

No, it's a what is it, I can't think straight...

It's a nonsteroidal antiinflammatory?

No, what is it that they make molds out of? You know?

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Penicillin?

Yeah, it's that kind of thing...

antibiotic?

Yeah, it an antibiotic

Well that was a long way around.

It's an antibiotic, Yes. It's one that I can't take.
How's this feel?

Move your finger, Yeah right there it's really sore,
right there

Would you pick her up on an allergic response to an
antibiotic?

If I put it on the patient's tongue it would
immediately go weak.

That hurts so good, it feels good.

Lie on your back!

What were you doing when you had this numbness on one
side?

You mean. . .

was it yesterday?

It just came along with the headache, but the day
before I had cleaned the carpet and when I got up
yesterday morning I got a headache, and it felt worse and got
worse all day long.

I just want you to relax. I'm just putting this machine
here.

What's the difference between doing that [using the
myomatic machine] and rubbing it manually?

Iess painful and this is more effective more rapidly.
When I get this way [lying prone] too my hands go like
this [?]

yeah. [period of silence while the laser is aimed at
her back] How's that now?

better. .
You ought to sit with an ice pack right on here, Clara. Is it
tender there?

It doesn't hurt as bad as it did a few minutes ago.
Yes, now up right in there it's really painful.

Right there?

Oh, right there! How come it hurts the other side from
where I had the problem?

Well, the problem doesn't necessarily show up on the
side involvement, due [to] a lot of different types of
factors. It could be on one side the problem and the pain could
be on the other, or vice versa, or on the same side or
whatever.

Well, I don't hurt on the left side, I just don't know.
Uh, huh.
When I got up at eight o'clock this morning I felt just
like I'd had a stroke. Of course, I don't know what a
stroke is like I've never had one before. Bit I didn't
lose anything, you know what I mean. I can lift, I can
walk, but it just seems just... the numbness there.

9'?

.9"?

9".“

172

You know it's interesting in a case like this trying to

decide how much of the patient ' 5 total problem is

medication induced. As opposed to just the patient's

problem, you know.

I'm a drug addict, let's face it. They didn't do anything for
me at that hospital but give me that shot, but that was a
blessing because boy I'll tell you I was throwing up and my head
was, when I coughed it felt just like it was going to explode,
you know.

Now, I've seen patients like that before, who... the classic
example is that patient who goes into in mid July or August,
rakeshisyardorheryardordoes somethingoutinthesunfor
some period of time and then gets dizzy, light headed and
numb, vomits, disoriented. The characteristic I've found on
those people is they're on a salt free diet. And what I've
found kinesiologically is they don't have enough sodium. And
if you build your sodium level back up your alright. I 've
found by experience, I've found a lot of those types of attacks.
How do you test for sodium?

You use the nutritional circuit for the adrenals. Is that
better now there Clara?

Uh huh.

Now again, it's like every other medical proposition, they carry
the damn thing entirely too far when they say don't eat salt,
because if some people who are slat dependent they have to have
it. Everybody has to have a certain amount of sodium, and so,
but they make it, they say your going to get hardening of the
arteries if you eat salt. 'Ihat's not true. Now you may get
high blood pressure from water retention and if you have
arteriosclerosis then you may rupture and have a stroke, so I'm
not saying that there is no such thing where the patient should
not eat salt, you know, but it's been my experience, and I've
had to argue with a few patients and their doctors, that. . .

Oh, I've got a cramp...

Now, there's another thing, when you test a patient, you test
their hamstrings and tend to cramp, that usually because of a
calcium deficiency but the calcium deficiency is not calcium
it's hydrochloric acid. 'Iheir stomach and their intestines
aren't acidic enough to absorb calcium properly, and the
treatment HCl , but I know that if I put this lady on HCl she is
going to have a lot more stomach trouble, because her stomach is
so damn sensitive now it is pathetic. Turn over on your back!
So it's kind of damned if you do and damned if you don't. O.K.
now, just drop your knee over, resist as hard as you can.
Apparently, because she's on cortisone her adrenals, her body is
accepting the cortisone so that it's just like she's got normal
adrenals which she doesn't. What I'm going to do here is test
the nutritional circuit for the adrenal gland. Drop your knee
over, resist. And yet she goes weak, so that tells me
regardless of the mrtisone, her adrenals still aren't
functioning right so if that's true then it's probably
nutritional and it's probably based on her symptomatology:

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9'9 9'? M

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9'?

9"?

P"?

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173

salt. So what I would do is put a little salt on her tongue.
Stick out your tongue! Just enough to let her' body taste it and
identify it. then I would retest the nutritional circuit. See
how strong that is? There is no way. Yeah this is the alarm
point for the circulation sex meridian, which the adrenal is
on, and, this is the neurolymphatic. So what I've got to tell
you.C1ara, is you've got to increase your sodium intake. See
her geographic tongue. And.this is due to a great extent to

years of medication.

Oh, oh that hurts.

I'd like to see you increase your sodium intake a little.
well, that means I decrease the potassium.

Yeah, essentially.

You mean if I'm drinking a lot of orange juice and stuff
In the case of low sodium, the worst thing you could. do, I
think, is to take more potassium. I've seen patients retain
water from.having not enough sodium.

I have been retaining water. See if you can see [she shows
her calf and ankle where the short sockrstocking has left an
imprint in her skin].

my wife, bless her, is the one that pointed this out to
cause, this has been three or four years ago, she did

that she went out and worked like hell in the garden

and just collapsed practically. .And I got to think

about it and she was retaining water. .And so I started

to examine her and that's what I found: she needed more
sodium, so put her on more salt and on soda scorb is

what it was. She started getting the darndest uresis

you ever seen. She started.letting go of water like it
was going out of style.

When you put her on sodium? That's surprising.

well no when you think about it because if the body
doesn't have enough sodium it will retain.water trying

to retain sodium. How's that now?

It still hurts.

And so the point is, in applied kinesiology you find a

lot of paradoxical things that are, as opposed to the
standard medical mental rigidity of approach, you know?
[Dr. Farrago is rubbing a point just cranial to the solar
plexus] and by treating that what are you trying to do?
I'm just trying to relieve that sore spot she's got

there, I'm.not using it for any other particular thing,
She's just got a tremendously tender spot there that
I'mljust trying to relieve some of the pain of.

Is there anything I can do there?

Yeah, just rub it. You can put an ice pack on it. I'd
like to see you with an ice pack on your sacroiliac

joint on this side [left]. O.K. Clara, try to increase

your salt...

do you think.my neck is O.K.?

Oh, I didn't check it did I? Resist as hard.as you
can! [Dr. Farrago tests for neck flexion and extension

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8- 88:00-

174

while Clara lies on her back] Stick your tongue out to
the right. Resist hard to the left. O.K. Up and 'at
'em young lady. Hang in there. that numbness should
just kind of slowly clear up. And this came on you all

at once?

No. . .

Did it kind of creep up on you?

I woke up with it yesterday morning. I woke up I had a
headache, and you know, I thought I had slept on it but
as the day went on it got worse and worse. I never got
to where I couldn't use it. It just ached, it ached
like a toothache, and this whole side did. ..

Now that's another thing.

I think that's why they gave me the EKG at the
hospital. Hell I've heard of people who have had EKG's
who walk out of the door and drop dead.

I saw that happen one time

I don't want to hear it [laughs]

That's a strange thing, Yeah but your heart's supposed
to be normal, you know.

I 've seen then pronounced dead and they 've still got
their EKG waves, because of the chemicals, the
dopamine.

Nothing near [?] produced the pain in your arm?
Areyouaskingme? NoIthinkitwasall fromtheneck.
All righty. See how you do. Get back in here this week.
I've made an appointment for 'mesday, but if I don't feel good
on Monday I'm coming over.

O.K. , alright. You have a good day, Clara.

BIBLIOGRAPHY

BIBLImRAH-IY

ARNHEDI, Ruiolph,
1971 mtropyarriArt. AnFssayonDisorder. Berkeley:
university of California.

AUSTIN, J.L.
1975 How To Do Things With Words. 2nd. edition.
J.O.Urmson and M.Sbisa (eds.) Cambridge,
Massadmssetts : Harvard University Press.

BAG-I, Marcus
1968 The Chiropractic Story. Ios Angeles : De Vorss.

BAER, Hans
1984 The Drive For Professionalization in British
Osteopathy. Social Science and Medicine 19(7) 717-
725

BARNES,Barry
1977 IrrterestsandtheerthofKnowledge. Boston:
RoutledgeandKeganPaul.

BARREIT, R. ‘
1984 Oilture and Conduct: An Excursion in Anthropology.
Belmont, California : Wadsworth mblishing Co.

EIJRDIEU, Pierre
1977 Outline of a Theory of Practice. New York :
Cambridge University Press.

HJL‘IIIJQ-I, E.
1912 "Psychical Distance" as a Factor in Art and an
Aesthetic Principle. in Aesthetics: A Critical
Anthology. (eds.) G. Dickie and R.J. Sclafani.
New York : St. Martin's Press 1977.

176

177

KUCKIEMEN OOBB,.Ann

1977

Pluralistic Legitimation of an Alternative
Therapeutic System: The Case of Chiropractic.
Medical Anthropology 4 : 1—23.

CDMARDFF) Jean

1979

1981

1983

n.d.

The Symbolic Constitution of Western Medical
Mledge. unpublished paper.

Ambiguity and the Search for Meaning: Childhood
IeikeniaintheModernClinical Context. Social
Science and Medicine 158: 115-123.

Defective-mess of Symbols or the Symbols of
Defectiveness? 01 Cultural Analysis of Medical
System. culture, Medicine and Psychiatry

7 : 3-20.

A Bitter P111 to Swallow: Placebo Therapy in

COOKE,4Alistair

1986

000mm, (LL.

1985

'Ihe Patient Has the Floor. New York : Alfred
Knopf.

Adjustment, The Hands arri Healing. oilture,
Medicine and Psychiatry 3 : 353-382.

CDWIE, J. and.RGEBUCK, L.

1975

DOLBY, RmeA.

1978

DaIGIAS,Mary

1982

DUNN, Fred,
1976

An Ethnography of a Chiropractic Clinic:
Definitions of a Deviant Situation. New York : The
Free Press.

Reflections on Deviant Science. in On the Margins
of Science: The Social Ccmstruction of Rejected
Knowledge. (ed.) R. Wallis Sociological Review
Monograph No. 27. Keele : University of Keele.

Natural Symbols: Explorations in Cosmology. New
York : Pantheon Books.

Traditional Asian Medicine and Cosmoplitan Medicine
as Adaptive Systems. in Asian Medical Systers: A
Oamparative Study (ed.) C. Leslie Berkeley :
University of California.

 

178

IIIRKHEIM, Emile
1915 'me Elementary Forms of the Religious Life. New
York : The Free Press.

EAGIEIW, Terry . . .
1983 Literary Theory. An Introduction. Mimeapolis :
the University of Mirmesota Press.

Em, Umberto
1976 A Theory of Semiotics. Bloomington : Indiana
University Press.

ELIOT, T.S.
1948a "Ioveson; of J. Alfred Prufrock." Selected Poems.
Harmondsworth, Middlesex : Penguin Books.
1948b "Geronticm" Selected Poems. Harmonisworth,
Middlesex : Penguin Books.
1948c "Whispers of Immortality." Selected Poems.
Harmaidsmrth, Middlesex : Penguin Books.

EWSNS-IRI'IU-IARD, E.E. .
1976 Witchcraft, Oracles and Magic Among the Azande.
Oxford: Clarendon Press.

1981 A History of Anthropological Thought. New York :
Basic Books, Inc.

FERNANDEZ, James
1986 Ptarsuasions and Performances. The Play of Tropes
in Culture. Bloamington : Indiana University
Press.

W, Michel
1972 The Arctaeology of Knowledge. New York : Pantheon
Books.

1977 Ianguage, Canter-Memory, Practice. Ithaca :
Cornell University Press.

GEERI‘Z, Clifford
1973 The Interpretation of Cultures. New York : Basic
Books, Inc.
1983 Local Knowledge. New York : Basic Books, Inc.

GEORGE, V. and m, A.
1978 The Gamer: A Figure of American Hospital Folk
Speech. Jamal of American Folklore Jan-March
91(359) : 568-581.

179

GIBBJNS, Russell

1980 The Evolution of Chiropractic: Medial and Social
ProtestinAmerioa. inModernDevelopnents inthe
Principles and Practice of Chiropractic. ( ed.)
Scott Haldeman. New York : Appleton, Oentury,
Crofts.

1981 nysician-Chiropractors: Medical Presence in the
Evolution of Chiropractic. Bulletin of the History
of Medicine 55(2) : 233-245. '

GIMNS, Anthony
1979 Central Problems in Social Theory. Berkeley :

University of California Press.
1984 The Constitution of Society. Berkeley :
University of California Press.

GOFFMAN, Erving
1959 'Ihe Presentation of Self in Everyday Life. Gardei
City : Doubleday arr! 00., Inc.
1963 Behavior in Public Places. New York : The Free
Press.

GOIIMAN, M. (ed.)
1975 The Research Status of Spinal Manipulative

Therapy. NINCIB Monograph No. 15. DEW
Publication No. (NIH) 76-998.

GOOIHEARI', George and SCHMIDT, Walter
n.d. unpublished paper.

HALDEMAN, Scott
1980 Modern Developments in the Principles and Practice
of chiropractic. (ed). Nev York : Appleton,
century Crofts.

HAIDEMAN, Scott and mm, Karin
1973 The Evolution of Neurology and the Concept of
Chiropractic. American Chiropractic Association
Journal of Chiropractic August 57-64 .

HELD, David
1980 Introduction to Critical Theory : Horkheimer to
Habermas. Berkeley : university of California
Press.

180

man, R.J.
1982 Three Faces of Hermeneutics. An Introduction to
Oarrent Theories of Understanding. Berkeley :
University of (alifornia Press.

HUIU-HNS, R.M. (editorin-ohief)
1952 Syrbprtioon. Great Ideas of the Western World. Vol
II, (micago : Bicyclopaedia Britannica, Inc.

WY, Aldous
1934 Beyond the Merique Bay: A Traveller's Jamal.
Harmfimrth, Middlesex : Penguin Boole.

IIIICH, I.
1976 Medical Nemesis. The Ebcprcpriation of Health. Nev
York : Bartram Boole.

W, F.
1980 Arrogance. Nev England Jairnal of Medicine Dec.
25, 1980 : 1507-1511.

JANZEN, J .M.
1978 The Qiest for Therapy: Medical Pluralism in Lower
Zaire. Berkeley: University of California Press.

JAY, Martin
1984 mismardTotality. 'meAdverturesofaOonoept
fran Inkacs to Habermas. Berkeley: University of
(alifornia Press.

KAT‘Z, Jay
1984 The Silent World of Doctor and Patient. Nev York :
The Free Press.

KEAT'ING, J. et a1.
1986 The Practitioner's Role in the Science of
Chiropractic. Internatiaal Reviev of
Chiropractic, IQ Review Marcia-April: 73-80.

KENDALL, F.P. and KENDALL, H.O.
1949 Miscles: Testing and Function. Baltimore :
Williams and Wilkirs.

181

FIEINMRN,7Arthur

1978

1980

I<UHN,Thamas
1970

mm, Jon
1986

IANGONE, J}
1982

OonoeptsandaModel fortheOalparisonofMedical
SystemsasCulturalSystems. SocialScienoeand
Medicine 12 : 85-93.

PatientsandHealers intheOontextof Culture. An
Ebcploration of the Borderland between Anthropology,
Medicine and Psychiatry. Berkeley : University of
California Press.

The Structure of Scieitific Revolutions. 2nd
edition. Chicago : The University of Chicago
Press.

Professionals and Professies: A Philosophical
Examinatiai of an Ideal. Social Science and
Medicine 22(5) : 501-8.

Chiropractors: A (brewer's Guide. Reading, Mass.
: Addism Wesley.

rARmIN, Philip

1958

1964

"Cimrch Gomg' " in The Less Deoeived. The Marvel
Press.

"Ignorance" in The Whitsun Weddings“ . Boston:
Faber and Faber.

LARSON, Magali Sarfati

1977

IEEACH, Edmund

1954

1976

The Rise of Professionalism. Berkeley : University
of California Press.

Political Systems of Highland Birma. Boston :
Beacm Press.

mlture and Oatmmicatiai: The Logic by which
Symbols are connected. New York : Cambridge
University Press.

LESLIE, Charles

1972

The Professionalization of Ayurvedic and Urani
Medicine. in Medical Men and their Work, (eds.) E.
Friedson andJ. Iorber. Chicago : Aldine and
Atherton. 39-54.

182

1976 Asian Medical Systems (ed. ). Berkel : Universi
of California Press. ey ty
LEVI-STRAUSS, Clawe
1963 fluctural Arthropology. Nev York: Basic Books,
1966 The Savage Mind. Chicago: The University of
diicago Press.
W, E.
1975 Manipulative Therapy: A Historical Perspective from
AncieitTi'metothelbdernEra. inNINCIB
Monograph No. 15. : 11-17.
Mam, .8111 W, R. (eis. )
1970C Sigrs and Symptars: Applied Pathologic Physiology
and Clinical Interpretaticns. 5th edition.
Philadellbia : J.B. Lippinoott Oo.
W, T. ,
1961 Chiropractic: A Deviant Theory of Disease and
Treatment in Oonterporary Western Culture. Human
Organization 20(Spring) : 20-23.
McKtNlEY, Rdoert
n.d. Dimming in Social Reality : Same Reflections on
mrcussion and Transition. Impublished paper,
MAJOR, R.
1954 A History of Medicine. Vol. I. Springfield,

Illinois : Charles Thames.

MANN, Michael

1970

The Social Cohesion of Liberal Denocracracy. in
Classes, Power, and Conflict. eds. A. Giddens and
D. Held. Berkeley : University of California
Press. 1982 : 373-395.

de mam, M.

1952

The Essays of Montaigne. Translated by Charles
Ootton. micago : Encyclopedia Britannica, Inc.

MERE, S.F. and MYERIDFF, B.

1977

Introduction: Secular Religion: Forms and Meanings
in Secular Ritual. in Secular Ritual. (eds.) S.
Moore and B. Myerhoff. Assen, the Netherlands :
Van Gorcum : 3-24.

183

mm, Rodney
1967 Parcussion and Transition. Man II : 606-14.

NULL,13.
1986 Medical Gebcide. in IQ Reviev March-April 42(2)

PALMER, B.J.
1920 The Philosqby of Chiropractic. 6th edition.
mveport, Iava : The Palmer School of Chiropractic
Press.

FEIEGO,1M.
1986 President's Message. in IQ Reviev larch-April
42(2) : 8-9.

memes, E.
1986 my Won't Doctors Help the Patients I Can't?
Medical Eoonamiae July 14 : 134.

PRESS, I.
1980 Problems in the Definitim and Classification of
Medical Systets. Social Science and Medicine 148
: 45-57.

‘RAPPAPORT,IROY
1979 Ecology, Meaning and Religion. Richmond,
California : North Atlantic Boole.

RIIEY, J.R.
1980 Cliert Choicss Among Osteopaths and Ordinary
Physicians in a Michigan Oanmmity. Social Science
and Medicine 148 :111-120.

SAHIINS,IMarShall
1976 Culuire and Practical Reason. Chicago: The
University of Chicago Press.

SOLDIER, Francis
1971 Spiral Irritation and Osteopathy. Bulletin of the
History of Medicine 45(3) : 250-266.

SHRYOCK, 12.11.

1966 Medicine in America. Historical Essays . Baltimore
: Johns Hopkins Press.

184

SPEREER, D. .
1985 m Anthropological Knowledge. New York : Cambridge
University Press.

STARR, Paul . .
1982 The Social Transformation of American mdicme.

NevYork : Basic Boole, Inc. .

smmuums,‘Vixgdi.
1984 Essertial Principles of Chiropractic. Davenport,
Iava : Palmer School of Chiropractic Press.

MIN-I, Stanley
1968 The Magical Power of Words. Man. ms. 3 : 175-206.

TAUSSIG, Midael
1980 Reification and the Oonsciaisness of the Patie'rt.
Social Science and Medicine 14B : 3-13.

TURNER, Victor

1967 The Forest of symbols. Aspects of Ndembu Ritual.
Ithaca : Cornell University Press.

1969 The Ritual Process. Structure and Anti-structure.
Chicago : Aldine Biblishing O0.

1981 The Drums of Affliction. A Study of the Religiais
ProoessesAmongtheNderbuonambia. Ithaca:
Cornell University Press.

UPIEIIEER, Jd‘m
1983 Craniosacral Therapy. Chicago : Eastland Press.

VAN GENNUP, Arnold,
1960 The Rites of Passage. translated by M. Vizedam and
G. foee. Chicago : The University of Chicago
Press.

WTZKIN, H.
1984 'Ihe Micropolitics of Medicine: A Contextual
Aralysis. Internatioral Jamal of Health Services
14(3) : 339-378.

185

WEBER, David
1976 Applied Kinesiology: The Advanced Approach to
c. Colorado: Systems D. C.
1980 Applied Kinesiology. Vols. I, II. Colorado :
Systems D.C.
1982 unpublished letter.

WARDIELL, Walter

1972 Limited, Margiral and Quasi-Practitioners. in
Hardback of Medical Sociology. eds. H. Freetan, S.
Levine and L. Reeder. Englevccd Cliffs, N. J. :
250-273.

1976 Orthodox and Urorthodox Practitioners: Changing
Relationships and the Future Status of
Chiropracto . inMarginal Medicine. eds. R.
Wallis and P. Morley. New York: The Free Press:
61-73.

1980 The Present and Future Role of the Chiropractor.
in Modern Develqments in the Principles and
Practice of Chiropractic. ed. S. Haldeman. New
York : Appleton, Century, Crofts : 25-41.

WEBER, Max
1947 The Theory of Social and Econanic Organization.
ed. T. Parsons. NevYork : TheFreePress.

WEST, H.G.
1975 Jr.(hairman's Summary: What the Clinical Sciences
Tell Us Abait Manipulative Therapy. NINCIB
Monograph No. 15. ed M. Goldman. : 267-8.

WILK, Chester
1973 Chiropractic Speaks Out: A Reply to Medical
Propaganda, Bigotry and Ignorance. Park Ridge,
Ill. : Wilk Publishing Co.

WINCH, Peter
1958 The Idea of a Social Science and Its Relation to
Philosophy. Nev York : Humanities Press.

wormsxy, F. am STEIBER, S.
1982 Salient Issues in Choosing a Nev Doctor. Social
- Science and Medicine 16 : 759-767.

 

186

WRIGH‘, Peter
1978 A Study in the Iegitimisation of Knowledge: The
'Success' of Medicine and the 'Failure' of
Astrology. in On the Margins of Scieoe: The
Social Construction of Rejected Knavledge. (ed.) R.
Wallis. Sociological Review Monograph No. 27.
Reels : University of Keele : 85-101.

YCXJNG, Alan

1983 Rethinking Ideology. Interratioral Jourral of
Health Services 13(2) : 203-219.

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