THE ILLNESS NARRATIVES
Suffering, Healing and the Human Condition
Arthur Kleinman, M.D.
New York: Basic Books, 1988
284 pp. $19.95
THE SECOND MEDICAL REVOLUTION
From Biomedicine to Infomedicine
Laurence Foss and Kenneth Rothenberg
Boston: Shambhala, 1987
335 pp. $29.95
An exchange of views that continues to resonate two decades later took place in 1968 at a New York Academy of Sciences conference on the "Psychophysiological Aspects of Cancer." In the wrap-up discussion of the endocrine, immune and nervous systems, Dr. Harley Shands stood up to say that the "symbolic system," the thoughts and feelings of a human being, must be accorded full consideration as well.
To which Dr. Jonas Salk responded: "All right, then, how are you going to get that symbolic system to make cancer?"
To which Dr. Shands replied: "Isn't that just the point?"
Yes, that is just the point: Can the mind (the symbolic system) bring about disease ("make cancer")? In the twenty years since that exchange of views, there have been increasing challenges to the narrowness of the biomedical model, which insists that the only relevant messages are those that can be read by sophisticated technologies. Messages that cannot be so quantified--the psychological and sociological influences on our well being--have tended to fall by the wayside, to be picked up by various alternative therapies that themselves rise and fall in popularity.
Two recently published books, written from far-differing vantage points, take up the issue of medical messages. Although neither book has received much in the way of general review or commentary, both deserve a wide reading.
The first, Arthur Kleinman's The Illness Narratives: Suffering, Healing and the Human Condition, focuses on the problem of chronic illness. Whereas modern medicine has scored its greatest triumphs (and earned its reputation) in the battle against acute infectious diseases, the chronic illness are troublesome precisely because there is no quick fix, magic wand, or potent pill to banish their miseries. Chronic back pain, headaches, asthma, high blood pressure, heart disease, even cancer, and now AIDS--the list of ongoing sufferings in the twentieth century is truly prodigious.
Kleinman wrote The Illness Narratives to explain to patients, their families, and their practitioners what he has learned from a career devoted to the study of the psychological and social aspects of chronic illness. "I write," he says, "because I wish to popularize a technical literature that would be of great practical values for those who must live with, make sense of, and care for chronic illness." The perspective that Kleinman brings to medical care is that of the social scientists who recently have reformulated the concepts of illness and disease and therefore of the
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