Med Anthropol Q. 1997 Sep; 11(3): 352-74.

Discourse, power, and the diagnosis of weakness: encountering practitioners in Bangladesh.

Wilce JM.

Department of Anthropology, Northern Arizona University.

The author's experiences as a "patient" of nonbiomedical practitioners, and an examination of Bangladeshis encounters with practitioners (daktars [biomedical doctors], herbalists, exorcists, and diviners), reveal the interactive means by which the diagnosis of durbalata (weakness) is constructed. In the cases presented, facing power in the person of the practitioner means losing face. I argue that discursive phenomena above and below the lexical level are responsible. The phenomena described--(1) interruption or dismissal of the patient's words by practitioner and others present during the clinical encounter, (2) divinatory routines that assign the durbalata label to women, and (3) one patient's use of "creaky" voice quality in a strictly "popular sector" (domestic) encounter--are nonreferential but socially significant semiotic processes that operate, for the most part, beneath the level of discursive awareness. These encounters and their outcomes have more to do with social reproduction than with any unambiguously effective therapeutic outcome.