As much as has been written about allopathic hegemony silencing and replacing others’ viewpoints and voices in daily clinical encounters, one is impressed by the resistance with which individual patients counter the truth claims of allopathic medicine. The cognitive frames or schemas with which patients think about their illness and choose modes of redress are the basis of their engagement with medicine, and determine to what extent they will allow allopathic hegemonization of their bodies. If the tropes, metaphors, or messages implicit in medicine's expectations for how a patient is supposed to behave are not consonant with those that give meaning and identity to the patient himself or herself, allopathic therapy is bound to fail. It will either be avoided by the patient, or, as David Perusek shows in this issue, it will be a source of frustration as it challenges patients’ own ideas of what and how to be in the world. The concept of “medical pluralism” should be expanded to include the cognitive schemas or “key concepts” that patients use to construct meaning and chart a course of behavior through an illness that is consonant with how they think about themselves and relate socially, politically, and economically with others.
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