Rheumatology Advance Access originally published online on February 28, 2003
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Rheumatology 2003; 42: 507-515
© 2003 British Society for Rheumatology
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Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting
Department of Military Forensic and Social Psychiatry, PO Box 3003, 3800 DA Amersfoort and
1 Department of Rheumatology, Hospital Medisch Spectrum Twente and Department of Communication Studies, Faculty of Philosophy and Social Sciences, University of Twente, Enschede, The Netherlands
Objectives. Fibromyalgia has always attracted controversy. Wolfe states that fibromyalgia will always exist regardless of the name given to the syndrome. Hadler describes fibromyalgia as a form of illness behaviour escalated by labelling. However, we believe that fibromyalgia, as other functional somatic syndromes, is not waiting below the surface until it becomes manifest by labelling.
Methods. We developed our hypothesis on the relationship between a specific social setting (called the therapeutic domain) and fibromyalgia using empirical philosophical arguments based on Foucault and Hacking. A therapeutic domain is a real and heterogeneous medical domain in which people, their thoughts and practices, and medical technology in any form coexist and communicate. In this domain blood is aspirated, radiographs are taken and classification criteria are made and applied. It is a domain where patient and therapist have initiated a relationship, which is influenced by the media and political pressure. This results in a looping effect where classification criteria and images give structure to perceptions and form the description for human behaviour; the person thus diagnosed (!) constantly has to grow into the conformity of these classification criteria, which also have to be constantly revised. The fibromyalgia concept becomes manifest in an individual as non-specific aches and pains along with other features.
Results. In other times and settings this resulted in analogue syndromes like railway spine, telegraph wrists, neurocirculatory asthenia or perhaps repetitive strain injury. In the application of American College of Rheumatology fibromyalgia classification criteria, labels and medical technology it is possible that invisible experiences manifest themselves in a therapeutic domain. It is not only a phenotype induced by the physician, but in this domain a certain power creates reality making the ‘disease’ become manifest.
Conclusion. The only certainty in fibromyalgia is that it is still being diagnosed. For prevention and treatment of fibromyalgia, doctors as well as politicians and media have to start by fundamentally changing the therapeutic domain. In such a renewed setting, fibromyalgia cannot become manifest in an individual and thus fibromyalgia syndrome can no longer exist. A firm public message that symptoms can be psychological in origin to prevent their spread, as Wessely recently stated in the comparable case of mass psychogenic illness, is only a part of the answer.
KEY WORDS: Fibromyalgia, Functional somatic syndromes, Therapeutic domain, Doctor–patient relationship, Medical technology, Representation of diseases, Philosophy of fibromyalgia.
Correspondence to: J. J. Rasker, University of Twente, Faculty of Philosophy and Social Sciences, PO Box 217, 7500 AE Enschede, The Netherlands. E-mail: j.j.rasker{at}wmw.utwente.nl
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  C. V. Caballero-Uribe The fibromyalgia problem. A Latin American point of view Rheumatology, October 1, 2004; 43(10): 1311 - 1313. [Full Text] [PDF]
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I. Hazemeijer and J. J. Rasker The fibromyalgia problem. A Latin American point of view: reply Rheumatology, October 1, 2004; 43(10): 1313 - 1314. [Full Text] [PDF]
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I. Hazemeijer and J. J. Rasker Reply Rheumatology, February 1, 2004; 43(2): 257 - 259. [Full Text] [PDF]
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I. Hazemeijer and J. J. Rasker Reply Rheumatology, January 1, 2004; 43(1): 113 - 113. [Full Text] [PDF]
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