Professors J. Thrailkill and M. Rivkin-Fish
26 January 2020
First Reading Response: The Illness Narratives
In the first chapter of Kleinman’s The Illness Narratives, Kleinman sees an opportunity to clarify his point by distinguishing illness from disease and sickness. Kleinman’s discussion of these three terms offers us insight into how the Western world views illness, disease, and sickness, and allows us to explore alternative ways of thinking. Klienman also discusses how the Western view of illness and disease can be damaging to both patient and physician.
Why distinguish illness from disease and sickness? In Kleinman’s view, these are very different things. While illness represents the actual feelings of the ill and those around them, disease is the label given to the physical symptoms by the physician. Sickness, meanwhile, refers to how the society at large views both illness and disease. For example, a chronically ill person may see their disorder as an inescapable fact of life, something to be managed, like the weather. This is illness. Meanwhile, under the disease model, a doctor might see the same disorder as a particularly frustrating problem to be solved. And as sickness, the society at large may regard the disorder as a rare occurrence that elicits sympathy but not much fear.
Under all the disease and sickness models, and sometimes the illness model, the West regards the body as separate from the mind. A sick person may grow frustrated that their body is a useless vessel for housing their otherwise healthy mind. However, there is a growing body of evidence that links the way people think about their disorders with overall physical health. As Kleinman states, “By now a very substantial body of findings indicates that psychological and social factors are often the determinants of the swing towards amplification,” or exacerbation of a health problem. This regard for body as separate from mind is part of what Kleinman calls a “radically materialist pursuit of the biological mechanism of disease.” Here, “materialist” refers to the ignorance of the mind’s role in treating the body. Physicians focus only on physical wellness, on the material self, and ignore the immaterial, which may equally if not more affect the person’s health.
Kleinman urges his readers to consider how they interact with illness in their own lives, and to rethink how their societies structure ideas of sickness. After all, not long ago, homosexuality was regarded as a disease even though those “affected” were, for the most part, perfectly healthy otherwise. Autism is still regarded as a disease, even though those with the disorder do not, overall, desire a cure. We need to rethink matters of illness, sickness, and disease not just in our own lives but in the lives of others, and physicians in particular must start to pay attention to the whole health of their patients. Only then can we create a truly well society.