Professor Rivkin-Fish and Professor Thrailkill
24 January 2020
How does Kleinman distinguish “sickness” from both “illness” and “disease?” Why is it important to distinguish these terms?
Kleinman utilizes a matter-of-fact style tone as he begins his book by delineating between illness, sickness, and disease. Describing illness as “the lived experience of monitoring bodily processes,” he emphasizes the patient’s subjective evaluation of the condition and how the symptoms affect his or her life (Kleinman 4). In contrast, Kleinman defines disease as something which is crafted by physicians to make sense of chaotic illness stories. By transforming the stories of patients and their families into purely technical issues, this removes any agency the patient once held in their stories and places sole value on treating only the biological aspects of the condition. Kleinman uses the term “biological reductionism” to describe this narrowing of treatment that ignores the emotional and social repercussions of disorder (6). Lastly, Kleinman mentions another dimension of disorder, sickness, that recognizes diseases as influenced or instigated by economic and political influences. This definition serves to expand the category of disease across populations.
Kleinman wishes to categorize disorder in order to acknowledge the complexity of suffering, while condemning our current medical system for focusing only on the “technical quest for the control of symptoms” (9). Chronic illness is thus particularly devastating both for doctors, who feel powerless and ineffective in what they believe healing to be, and for patients, who realize the helplessness of the situation. Calling this reductionism an “oppressive iron cage,” Kleinman’s strong language speaks to the disastrous consequences of failing to acknowledge the significance of suffering (9). Instead, he advocates first acknowledging the patient’s illness story, and then offering psychosocial support to alleviate the disruptiveness of chronic illness. By witnessing the illness and not only the disease, he proposes that the situations which cause stress, and thus worsen the condition, can be improved in the process.
Kleinman, Arthur. “The Personal and Social Meanings of Illness.” The Illness Narratives: Suffering, Meaning, and the Human Condition, Basic Books, 1988, 31-55.
Word Count: 295