in a dark place: how fibromyalgia avoids the physician’s gaze

7/31/2019 In a Dark Place: How Fibromyalgia Avoids the Physicians Gaze

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In a Dark Place: How Fibromyalgia Avoids the Physicians Gaze

By James Wallace Mischke


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____________, also known as the invisible syndrome, what is it and how does

it defeat the clinical gaze of the physician? What does this inability to see and thus treat

the disorder say about contemporary medical practice?

____________ is a chronic pain and fatigue syndrome that causes moderate to

severe pain localized around specific areas in the muscles and connective tissues such as

ligaments, tendons, and joints, as well as chronic persistent fatigue. This invisible

syndrome affects about 2% of the population, or roughly five million people, with the

majority of those afflicted overwhelmingly women.1

It has been often confused with or

considered a form of arthritis due to the amount of soreness and stiffness which the

patient has reported experiencing however no evidence connecting ____________ with

any of the causes of rheumatic disorders/diseases has ever been found.2

There are no

visible abnormalities or physical disfigurements that mark the sufferer. "[It] has been

called the invisible [syndrome] because you cant look at someone and tell if he or she

has [it]."3Not much is known about the disorder yet the condition has been written about

and identified as early as the 1800s. Between 1816 and 1824 a physician at the

University of Edinburgh, Dr. William Balfour, first fully described the syndrome and also

designated the eighteen tender points used to diagnose the illness.4There are no routine

laboratory tests or xrays that show abnormalities diagnostic of [the disorder]. A

physician's diagnosis of [the affliction] is based on taking a careful history and finding at

least 11 of the 18 characteristic tender points. Characteristic tender points cluster in

regions around the neck and shoulders, the upper chest wall, and the lower back. Because

additional symptoms often occur simultaneously with [the syndrome], further diagnostic


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studies may be needed to identify concomitant conditions. Frequently misdiagnosed, it is

often confused with myofascial pain syndrome, hypothyroidism, rheumatoid arthritis,

chronic fatigue syndrome, and systemic lupus erythematosus, any of which may occur

concomitantly with [the condition].5

So, the affliction, as yet, can-not be defined but is

instead interpreted and designated as a physical disorder/disease by its symptoms:

widespread body/muscle pain, an over stimulation of the pain processing centers of the

nervous system, chronic fatigue, and in addition is comorbid with psychological distress

disorders such as depression, anxiety, and post-traumatic stress disorder.6

To describe and begin to understand ____________ first let us examine the

disease/non-disease by analyzing its name Fibro/my/algia. The term itself is a

combination of Latin and Greek words which are a definition of its symptoms but not a

designation of classification of what it is such as diseases like arthritis or diabetes, for

example. The prefix Fibro is from the Latinfibra referring to fiber(s) or thefibrous

muscles of the body.7

The termfiber can also refer to the essential basic structure or

essence of a thing which in the connotation of the description of a syndrome that affects

the body is appropriate since the sufferer feels pain throughout their body, in every fiber

of their being, not just at a physical level but also at a mental and emotional level as

well...people with [this condition] dont just have ____________ [individuals] with

[the disorder] also have higher rates of psychiatric illness than the general population.8

Further inspection of the word fiber also alludes to a substance formed of fibers, or

able to be spun, woven, etc.9

such as cloth or paper. The pain and psychological angst

experienced by the afflicted individual is written across their face, upon their body, much

in the same way a text is written across a page and it is the disease(s) that serve as the


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text: the patient is only that through which the text can be read.10

The root my is Greek

in origin from the word myo ormus which means muscle.11

In English my is the

possessive form of the word self which defines the subjective element of the disease,

the self, the patient, the corporeal body of the individual which is comprised of living

tissue, of flesh ormusclefiber(s) that the prefix fibro pertains to. The suffix algia is

also of Greek origin denoting pain, from the [Greek] word algea.12

Algea offers further

connections of reference in its definition aside from pain, for in Greek mythology the

Algea were the spirits (demons) of pain and suffering (of both body and mind), grief,

sorrow and distress. They were the bringers of weeping and tears.

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The ____________

patient experiences physical pain, suffers from fatigue, feels grief because of the loss of

their health and mobility, sorrow over the effect of the condition on their lives, and is

distressed by the fact that there is little to no help for their disease/non-disease. So, what

can be inferred from the term as presented? ____________, then, literally means

fibrous-muscle-pain or pain in/of the fibrous muscles, on the other hand - whats in a

name? According to Michel Foucault, in his archaeology of the modern medical

institution The Birth of the Clinic, the gaze that traverses a sick body attains the truth

that it seeks only by passing through the dogmatic stage of the name, in which a double

truth is contained: the hidden, but already present truth of the disease and the enclosed

truth that is clearly deducible from the outcome and the means. So, it is not the gaze itself

that has the power of analysis and synthesis, but the synthetic truth of language, which is

added from the outsideIn this clinical method, in which the density of the perceived

hides only the imperious and laconic truth that names, it is a question not of examination,


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but of a deciphering.14

The name, then, itself is meaningless and is instead a listing of

the symptoms of the illness. It is not a classification of the disorder or a definition.

How does one define and categorize something that is unknown, that is invisible

to the eye, that can be only described in a subjective manner by those whom are afflicted

with the syndrome? ____________ is felt by the patient. Its symptoms are acute pain and

chronic fatigue, subjective states of being, of experience that can only be related to the

physician by the individual affected but not shown. There is no physical abnormality or

physiological trait inherit to the disorder that can yet be seen or detected by a physical

exam, in an X-ray, CAT scan, blood test, or in the cell under a microscope. How do you

quantify and describe something that can not be seen, can not be measured? The first

step is to measure whatever can be easily measured. This is ok as far as it goes. The

second step is to disregard that which can't be easily measured or to give it an arbitrary

quantitative value. This is artificial and misleading. The third step is to presume that what

can't be measured easily really isn't important. This is blindness. The fourth step is to say

that what can't be easily measured really doesn't exist. This is suicide.15

What then does

this suggest in regards to the syndrome? Since it can not be seen, can not be detected

aside from its symptoms, many within the medical community at first believed that there

was no disease or disorder present in the individual. In the article____________: Is

____________ Real? by Gina Shaw, Shaw cites the example of a neurologist and his

encounter with a patient presenting ____________ type symptoms. Like many of his

colleagues, John Kissel, M.D., used to think that [the illness] wasn't a real condition. Dr.

Kissel, a neurologist and the co-director of the MDA/ALS Center at Ohio State

University, thought it was a wastebasket diagnosis-a dumping ground for malingering,


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drug-seeking patients with unexplained pain, fatigue, and depression. Then he saw

patients that began to change his mind. He still remembers one woman in her 40s, a

professional trial attorney from Columbus, OH. She had developed debilitating fatigue

and horrible muscle pain and tenderness about a month after getting over a mild case of

the flu. After performing a number of tests, I went in to speak with her and mentioned

____________, Dr. Kissel recalls. She asked, 'What's that?' I said, 'You haven't heard of

[it]? People are talking about it all over the place.' She said to me, 'I work 14 hours a day

as a trial attorney-I don't do outside reading.' She wasn't depressed. She was still working.

But she had all the typical symptoms of [the disorder]. That was a formative experience

in my thinking about the condition.16

Dr. Kissels example illustrates a view held by

many in the medical establishment at the time.

Modern medicine is predicated on the gaze of the attending physician. The sense

of sight is central to medical theory and medical practice. Practitioners are looking when

they are taught anatomy, when they examine patients, when they diagnose illness, when

they operate and when they perform post-mortems.17

If it can not be seen, can not be

measured, categorized, classified, then (in the eyes of the physician and the clinic) there

is no disease present. The individual with ____________, however, is ill, is sick. All the

symptoms of a disease, a disorder, are present and can be related and described by the

patient. Physicians can see the affects of the disorder in the behavior of the afflicted

person, can see the loss of mobility, the pained expression on the face of the patient and

in their body language. The physician can hear or read the effects of the disease on the

patients daily life, how their actions are restricted, how certain aspects of life are

delineated due to the disorder, work is difficult or impossible, fatigue is chronic because


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the sufferers sleep is disturbed, weakness of the muscles persist as a result of lack of

healthy sleep and acute pain. Social interactions are strained because the individual with

the disease often does not feel well enough to engage in the normal social activities

previously enjoyed by them. The loss of productivity, of work and income, of normal

human interaction, this sense of loss is felt acutely by the sick person and leads to

depression, anxiety, and other stress related psychological disorders. doctors have

known for a long time that having [this illness] means that patients are at a higher risk for

other medical conditions many of them psychiatric.18

The patient with ____________ is sick, physically and psychologically, that much

is obvious. The symptoms of a disorder are present which signal the presence of a

disease. The symptom is the form in which the disease makes itself manifest in or on the

body. The sign (signaled event) is the way that which the disease is announced or

translated, what is happening in the body, what has happened, and what will happen. The

sign is also the textual or linguistic representation of the phenomenon, the linguistic

structure within which the disease is interpreted and thus subject to the diagnostic,

prognostic, and predictive gaze of the physician. The symptom + the sign = the disease.19

To the exhaustive presence of the disease in its symptoms corresponds the unobstructed

transparency of the pathological being with the syntax of a descriptive language: a

fundamental isomorphism of the structure of the disease and of the verbal form that

circumscribes itin clinical medicine, to be seen and to be spoken immediately

communicate the manifest truth of the diseaseThere is disease only in the element of

the visible and therefore stateable.20

However, in the individual with ____________, the

sign is absent or at the very least incomplete and lacking because the cause of the


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disorder and its mechanisms are, as yet, not known. Only the symptoms are visible to the

gaze of the physician. What is happening to the body of the patient, what has happened,

what will happen (outside the symptoms themselves) is unknown and thus can not be

stated. The patient then is sick and not sick, diseased/non-diseased, healthy and unhealthy

at the same time in the eyes of the physician and clinical medicine. They exist in a place

in space and time between healthy, for no disease can actually be detected, and unhealthy

because the symptoms of a disease are present and apparent. This state disrupts and

defeats the medical gaze of the doctor, circumvents the clinical investigative and

diagnostic prowess of contemporary medicine. According to philosopher and critical

theorist Jacques Derrida ____________, then, is an undecideable, caught in between the

oppositional states of healthy and unhealthy, either/or. The patient is both sick and not

sick. In the same regard, the individual with this disorder is neither diseased nor healthy

yet displays traits of both but can not be decided. Having both states, it has neither. It

(____________) belongs to a different order of things: in terms of [diseased] and [non-

diseased], it cannot be decidedThe terms [diseased] and [healthy] form a binary

opposition: a pair of contrasted terms, each of which depends on the other for its

meaning. There are many such oppositions , and theyre all governed by the distinction

either/or. If we accept this, it establishes conceptual order. Binary oppositions classify

and organize the objects, events, and relations of the world. They make decisions possible

and they govern thinking in everyday life, as well as philosophy, theory, and the sciences.

Undecideables disrupt this oppositional logic. They slip across both sides of an

opposition but dont properly fit either. They are more than the opposition can

allowthey show where classificatory order breaks down: they mark the limits of


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order.21

This limit of order which has been reached is the point at which the

physicians gaze can not penetrate the concealed truth of the disease/disorder. Unable to

see beyond the symptoms, the gaze is rendered impotent.

As stated previously, modern medicine is predicated on the gaze of the attending

physician. For the last two centuries the empirical method based on vision has been

rigorously developed and institutionalized. It has further been amplified and focused by

the development of technologies devoted to strengthening the sight of the physician, from

the introduction of the microscope, to the X-ray, and the CAT scan, to name a few. The

previous mode of primary sensory based medical examination and diagnosis has been

replaced by a greater dependence on these technologies which has resulted in a

diminished subjectivity in medicine and led to a more objective and standardized

application of medical knowledge in regards to the human body and disease. This has

allowed information to be more widely understood and communicable by the medical

community while at the same time This has produced important consequences for

medicine, including changes in the ways in which illness is perceived and understood by

the doctor; in the ability of patients to present and have analyzed the full range of

problems and requests they may have; and in the future standing of the physician and

medicine.22

____________ is a purely subjective syndrome, the physicians reliance on

the gaze and technology that reinforces the attending doctors sight has not allowed the

physician to see the disorder at work within the body of the patient nor the trigger, the

catalyst, which is the cause of the disease. All that is available is the individuals

biography, their personal history in regards to the disease/disorder, The patients story, a

medical biography, [is] a tapestry woven of events subjectively experienced. It contain(s)


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the patients feelings produced in the body by the illness, and the patients wants and

hopes.23

As a basis of insight, the patients story is of great importance in understanding

a disease that otherwise can not be quantified or measured using existing methods and

technology. However, as a foundation for scientific exploration and knowledge, the

individuals self report is not the ideal format of investigation because for doctors [it is]

often a biography of truths and half-truths, exaggeration and belittlement. It [is] for them

evidence they [cannot] usually verify.24

Unfortunately, there is not much else for the

physician to base their analysis on aside from a disparate gathering of random data and a

collection of as yet unproven theories.

One theory on the cause of____________ is that the body of the individual

afflicted with the syndrome is stuck in the flight or fight response. The body, due to

some form of infection or traumatic event, thinks it is under duress, in the presence of a

threatening stimulus, a part of the brain regulates the metabolic and autonomic functions

to prepare the muscles for any subsequent violent action, i.e. to either run away or fight.

Example of an autonomic reaction is the increased release of adrenaline in the body and

some of the physical manifestations include increased blood pressure and heart rate (as a

result of higher concentrations of adrenaline in the body).25

The body was not meant to

operate in this capacity for more than a few brief moments at a time and so the symptoms

experienced by the patient is the bodys reaction to an abnormal prolonged physical state.

Supportive evidence for this theory is lacking and unproven. A second theory is that there

is a chemical imbalance in the body, such as a serotonin, dopamine, or hormone

deficiency, which results in the patient developing the syndrome.26

There is no definitive

evidence to substantiate this hypothesis. Another theory put forth by neurological


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researchers working in conjunction with rheumatologists is the result of brain scans

showing abnormalities in blood in the brain (also called brain perfusion) of patients with

____________. Researchers took images of patients with the disorder using a technique

called single photon emission computed tomography (SPECT) and compared them with

individuals without the condition and found that patients with ____________ exhibited

brain perfusion abnormalities in comparison to the healthy participants. These

abnormalities corresponded with the severity of the disease. An increase in blood flow

was found in areas of the brain involved in sensing pain and a decrease was found within

an area thought to be involved in emotional responses to pain.

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This theory too has not

been proven, only documented, its correlation with the condition is dubious and

undecided. Is the abnormal blood perfusion in the brain the cause of the illness or another

symptom of the disease/non-disease? All the theories discussed can be broached this

same inquiry, are the phenomenon detected the cause of the disorder or just another

symptom of the syndrome? Is the prolonged flight or fight response, the chemical

imbalance, or the abnormal blood perfusion in the brain the trigger mechanism of the

condition, and if so, what causes these irregularities themselves? These are forms of the

undecideable nature of ____________ and offer nothing in regards to understanding the

disorder but more questions without answers. Without an answer, without being able to

decide what these signs point to and mean, there can be no knowledge gained and no

hope for a treatment or cure. This has not prevented physicians from attempting various

therapies nor deterred pharmaceutical manufacturers from marketing various drugs as a

treatment for ____________.


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Currently, treatments for the condition are as various as the symptoms of the

disorder itself. Most physicians agree though that since ____________ is a multi-faceted

syndrome, the best approach to treating the patient is with a varied therapy regimen

which includes life-style changes such as healthier eating and sleeping habits and a

reduction in environmental stressors, physical therapy, and medication to reduce pain,

alleviate depression and anxiety, and regulate restorative sleep patterns.28

The benefits of

any one of these treatments to the afflicted is debatable since the disorder is not fully

understood. It is unknown how or why any of these therapies improve the symptoms of

the patient. For example, there is no proof that better eating habits, improved sleep, or the

elimination of negative environmental factors benefit the individual with the disorder

aside from the increased over-all health of the individual. Even normal healthy people

could use more restful sleep, a better diet, and a reduction in pollutants in their lives. In

regards to physical therapy, there is little evidence besides the anecdotal that physical

therapy helps a patients symptoms. In a society where one third of the population is

over-weight, physical activity would benefit most Americans regardless of whether they

suffer from ____________ or not. Also, physical therapies such as massage or

acupuncture only offer a short respite from the symptoms themselves. Physical therapy

for the patient must also be carefully monitored so as not to aggravate the symptoms

further since it has been shown that physical activity can increase the muscle pain and

inflammation in the individual. Pharmaceuticals, particularly pain-killers (analgesics) and

anti-depressants, are also commonly prescribed to the ____________ patient. These

medications, although beneficial in the relief of pain and suffering, are not curative and

do nothing more than mask the symptoms of the disorder and come with their own inherit


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dangers. Pain-killers, especially narcotics, have many side-effects including and not

limited to constipation, respiratory depression, nausea, vomiting, drowsiness, dizziness,

weakness, dry mouth, confusion, difficulty urinating, and itching.29

Pain-killers can also

lead to dependence (addiction), result in liver and kidney damage, and have the potential

for over-dose and death. The side-effects for anti-depressants are similar and can also

include other possibly dangerous secondary effects. Take for example the now commonly

prescribed treatment for ____________ Milnacipran, in rare cases, certain other side

effects may occur with drugs like milnacipran, including: hypnoatremia (a lowering of

the level of sodium in the bloodstream), convulsions/seizures, excessive bruising or

bleeding, a lowering of the white blood cell count,sexual dysfunction, and serotonin

syndrome.30

Serotonin syndrome itself is a potentially fatal complication that can result

from taking anti-depressants like Milnacipran. Serotonin syndrome occurs when you

take medications that cause high levels of the chemical serotonin to accumulate in your

body. Serotonin syndrome can occur when you increase the dose of such a drug or add a

new drug to your regimen. Certain illicit drugs and dietary supplements are also

associated with serotonin syndrome. Serotonin is a chemical your body produces that's

needed for your nerve cells and brain to function. But too much serotonin causes

symptoms that can range from mild shivering and diarrhea to severe muscle

rigidity, fever and seizures. Severe serotonin syndrome can be fatal if not treated.31

In

addition, the benefits of treating the disorder with anti-depressants is deceptive.

____________ and depression share some similar symptoms such as fatigue, insomnia,

and body aches and pains. Depression is also a concomitant condition often

accompanying and a result of having the syndrome. When a person suffering from


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____________ is prescribed and takes anti-depressants, it relieves their depression and its

accompanying properties which the patient (and attending physician) misinterprets as

affecting an improvement in the symptoms of the disease. This is misleading and

prevents a true understanding of the syndrome by creating false connections between the

condition and the actions of the drug, leading the physician or researcher down a path

away from the true nature of the disease/disorder. How can one treat a disease/disorder

with drugs when the cause of and operative function of the disease/disorder is unknown?

Doctors prescribe medications for a condition they have very little insight in to and which

they have no idea how the drug acts upon the disease/disorder, this is irresponsible. This

is not to say that these various treatments do not provide some benefit to the patient for

any relief is a boon to the individual and can greatly improve their quality. However, the

physician and medical researcher must not be distracted or mislead by erroneous

associations between the effects of a therapy and/or drug on a disease that is of unknown

origin and action. These therapies are/can be a strain on the already limited resources

(physical, psychological, financial, and spiritual) of the patient and can lead to false hope

on the part of the afflicted and the physician.

The disease/non-disease ____________foils and defeats the clinical gaze of the

physician by thwarting any attempt at the detection of the mechanism of its cause within

the body by the investigative and analytical eye of the doctor. The technologies utilized

by the contemporary medical practioner serve only to augment the gaze but do not on

their own offer any insight into the syndrome itself. Since the disease can not be seen

(aside from its symptoms), can not be measured, quantified, described, nor explained then

hopes for a successful treatment or a cure are not possible. The current modes of


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investigation and analysis are not yielding positive results in knowing and understanding

the disorder, so then perhaps it would be best to start over from the beginning by

returning to a more subjective form of inquiry and an archeological based dissection of

the personal history of the patient. Hidden somewhere in the biography of the

____________ patient is the cause of the disease/disorder and once identified then the

gaze of the physician and its accompanying technologies can be focused upon it and yield

the answers that the patient and the physician so desperately desire.


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Notes

1. Centers for Disease Control and Prevention,Fibromyalgia,

http://www.cdc.gov/arthritis/basics/fibromyalgia.htm.

2. Sherron M. Stonecypher, Fibromyalgia Symptoms,Fibromyalgia:Resources for

Families, Lewis and Clark College, http://legacy.lclark.edu/~sherrons/symptoms.htm.

3. M. J. Pellegrino, The Fibromyalgia Supporter, (Columbus, Ohio: Anaden Publishing,

1997), 8.

4. Karen Lee Richards, History of Fibromyalgia, ChronicPainConnection.com, Health

Central, http://www.healthcentral.com/chronic-pain/fibromyalgia-287647-5.html.

5. D.L. Goldenberg, Controversies in Fibromyalgia and Myofascial Syndrome,

Evaluation and Treatment of Chronic Pain, ed., G.M. Arnoff, (Baltimore, Maryland: Williams

and Wilkins, 1992), quoted in Sherron M. Stonecypher, Fibromyalgia Symptoms,

Fibromyalgia: Resources for Families, Lewis and Clark College,

http://legacy.lclark.edu/~sherrons/symptoms.htm.

6. Dan Buskila, Comorbidity of Fibromyalgia and Psychiatric Disorders, Current Pain

and Headache Reports 11, no. 5 (2007): 333-338.

7. Fiber.Dictionary.com. Collins English Dictionary Complete and Unabridged 10th

Edition. Harper Collins. http://dictionary.reference.com/browse/fiber.

8. Generva Pittman, Fibromyalgia comes with a suicide risk: study,Reuters Health,

July 16, 2010, http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-

idUSTRE66F3JJ20100716.
http://www.cdc.gov/arthritis/basics/fibromyalgia.htmhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://www.healthcentral.com/chronic-pain/fibromyalgia-287647-5.htmlhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://dictionary.reference.com/browse/fiberhttp://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-idUSTRE66F3JJ20100716http://dictionary.reference.com/browse/fiberhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://www.healthcentral.com/chronic-pain/fibromyalgia-287647-5.htmlhttp://legacy.lclark.edu/~sherrons/symptoms.htmhttp://www.cdc.gov/arthritis/basics/fibromyalgia.htm


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9. Fiber. Dictionary.com. Collins English Dictionary Complete and Unabridged 10th


10. Michel Foucault, The Birth of the Clinic: An Archeology of Medical Perception (New

York: Vintage Books Edition, 1975), 59.

11. Fiber. Dictionary.com. Collins English Dictionary Complete and Unabridged 10th


12. Ibid.

13. Aaron J. Atsma, The Theoi Project: Greek Mythology,

http://www.theoi.com/Daimon/Algea.html.


York: Vintage Books Edition, 1975), 60.

15. Charles Handy, The Empty Raincoat, (New York: Hutchinson, 1994), as quoted in

The McNamara Fallacy, Wikipedia The Free Encyclopedia, Wikimedia Foundation Inc.,

http://en.wikipedia.org/wiki/McNamara_fallacy.

16. Gina Shaw, Fibromyalgia: Is Fibromyalgia Real?,Neurology Now, American

Academy of Neurology,

http://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&artic

le=00024&type=fulltext.

17. Ludmilla Jordanova, The Art and Science of Seeing in Medicine, inMedicine and

the five senses, ed. W.F. Bynum and Roy Porter (New York: Cambridge University Press, 1993),

122.
http://dictionary.reference.com/browse/fiberhttp://dictionary.reference.com/browse/fiberhttp://www.theoi.com/Daimon/Algea.htmlhttp://en.wikipedia.org/wiki/McNamara_fallacyhttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://journals.lww.com/neurologynow/pages/articleviewer.aspx?year=2009&issue=05050&article=00024&type=fulltexthttp://en.wikipedia.org/wiki/McNamara_fallacyhttp://www.theoi.com/Daimon/Algea.htmlhttp://dictionary.reference.com/browse/fiberhttp://dictionary.reference.com/browse/fiber


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18. Generva Pittman, Fibromyalgia comes with a suicide risk: study,Reuters Health,

July 16, 2010, http://www.reuters.com/article/2010/07/16/us-fibromyalgia-suicide-



York: Vintage Books Edition, 1975), 91-92.

20. Ibid., 95.

21. Jeff Collins and Bill Mayblin,Introducing Derrida (New York: Totem Books, 1996),

16-21.

22. Stanley J. Reiser, Technology and the use of the senses in twentieth century

medicine, inMedicine and the five senses, ed. W.F. Bynum and Roy Porter (New York:

Cambridge University Press, 1993), 262.

23. Ibid., 263.

24. Ibid., 263.

25. Biology Online,Fight or flight response, http://www.biology-

online.org/dictionary/Flight_or_fight_response.

26. WebMD,Fibromyalgia Guide,

http://www.webmd.com/fibromyalgia/guide/fibromyalgia-causes.

27. Caroline Wilbert, WebMD,Fibromyalgia a Real Disease, study shows,

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28. Sherron M. Stonecypher, Treatment of Fibromyalgia,Fibromyalgia: Resources for

Families, Lewis and Clark College, http://legacy.lclark.edu/~sherrons/treatment.htm.

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30. Forest Research Institute, Information and Consent Form, March 14, 2008, 6.

31. The Mayo Clinic Staff, Mayoclinic.com, Serotonin Syndrome: Definition,

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in a dark place: how fibromyalgia avoids the physician’s gaze

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