Kleinman- The Personal and Social Meanings of Illness – Healing in Ethnography and Literature

Reading Response 1: Examining “Illness Narratives”- Ch. 1

Brittany Swink

Professor Rivkin-Fish

Professor Thrailkill

ENGL 264-001

26 January 2020

Examining Chapter One of “Illness Narratives”

Upon reading the first passage, Arthur Kleinman immediately challenges our definition of what an illness is, and what defines a disease. Kleinman states how these terms are often used interchangeably, however, viewing the two through an anthropological lens allows one to realize the terms are quite different. Illness is described as an “innately human experience of symptoms and suffering” (Kleinman 3). The illness experience not only negatively or positively affects the patient, but it affects the family and loved ones of those who are suffering, as well. Kleinman’s definition emphasizes the importance of embracing the experience of illness by giving patients a voice via storytelling. The cultural and societal factors regarding illness shape how a patient experiences their suffering, and how the illness is an interruption within their story. Kleinmman further addresses disease as a pathological condition, which is diagnosed by a medical professional. This term focuses on what the underlying biological initiations of illness, or lack thereof. Disease does not incorporate the suffering of the patient via storytelling; the focus lies on the science behind the pathological condition causing the illness experience. Kleinman contrasts illness and disease with the term sickness, which is a social construct of the disease that has infested the patient’s body. These social constructs limit the ability of a patient to tell their story when living with stereotyped diseases, such as HIV/AIDS, which are automatically viewed in a different light- the disease overcomes the story of the patient.

References

Kleinman, Arthur. The Illness Narratives: Suffering, Healing, and the Human Condition. Basic Books, A Member of the Perseus Books Group, 2007.

First Reading Response (Kleinman, Illness Narratives) – Iris Kang

Kleinman’s Definition of “Illness”

As Kleinman states, illness refers to “the innately human experience of symptoms and suffering” (3). Examples of illness include the unique way in which an individual may cope after acquiring tinnitus, the family dynamic changes that occur due to a mother’s cancer diagnosis, or an athlete’s experienced impediment to success because of a torn ligament.

“Sickness,” “Illness,” and “Disease”

It is important to distinguish from “sickness,” “illness,” and “disease” because of the different meanings that each term carries and how they aid in understanding different perspectives of a condition. As Kleinman states, the term “disease” is viewed “only as an alteration in biological structure or functioning” (5). He uses this argument to convey the notion that disease is a “hard” way of viewing a disorder. Meanwhile, illness provides an understanding of a condition that is “always distinctive” (Kleinman 5), one that biological aspects cannot capture. In doing so, Kleinman creates a stark contrast between the coldness of “disease” and the immediateness yet intangibleness of “illness.” Lastly, Kleinman distinguishes “sickness” as understanding “a disorder in its generic sense across a population in relation to macrosocial forces” (Kleinman 6). In this way, Kleinman argues that a more communal and mutual aspect of a disorder is possible. By distinguishing these terms, Kleinman enables us to grasp the far-reaching experiences and implications of disorders—from the strictly detached to the most intimate.

The Meaning of “Materialist” in the Biological World

Kleinman refers to current medical training and healthcare as being engaged in a “radically materialist pursuit of the biological mechanism of disease” (9). He attempts to capture the “hardness” and narrow-focused view that results from viewing a condition as a “disease” rather than a more personal “illness” or societal “sickness.” Kleinman utilizes this metaphor to compare treating a disorder to achieving or gaining a “material,” ultimately leaving providers to fail at recognizing that rather than chasing more of an “item” (in this case a cure or explanation) they should seek to explore “the meanings of illness” (9) that transcend temporary success.

Reading Response 1

What are examples of Kleinman’s “illness” as subjective lived experience of a disorder?

Arthur Kleinman’s definition of “illness” is “how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability.” Illness problems arise from the disorder that cause disruptions in the sick person and their family member’s lives. Some examples Kleinman brings up when defining “illness” include headaches disrupting workflow, leading to feelings of frustration, or disfigurement leading to worsening body image and self esteem. These illness complaints are what the sick person brings up to their practitioner to help them cope and go back to a “normal” life.

Why is it important to distinguish “sickness” from both “illness” and “disease?”

Kleinman’s definition of “sickness” extrapolates the experiences a sick person and their family members goes through but across a macrosocial population. This distinction is important as the way a society perceives the sick person can shape the manner of how the sick person describes their complaints to their practitioner. The way a society views a disorder also alters the way practitioners view and interpret symptoms.

Kleinman refers to “radically materialist pursuit of the biological mechanism of disease” what does “materialist” mean here?

The context of “radically materialist pursuit of the biological mechanism of disease” refers to the faults of the post-modern practitioner with their desperate pursuit to understand the scientific mechanisms of disorders with their “disease” point of view. Materialist in this statement refers to how practitioners value and prioritize the biomedical view of disorders over the underlying “illness” complaints plaguing the sick person and their family.

Kleinman Question 2

Julia DiNicola

Professor Rivkin-Fish and Professor Thrailkill

ANTH 272

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

Materialism in the Body

Brooke ReBarker
Professor Rivkin-Fish and Professor Thrailkill
ENGL 264/ANTH 272
25 January 2020
Materialism in the Body
In Arthur Kleinman’s first chapter of The Illness Narratives: Suffering, Meaning, and the Human Condition, he refers to the Western biomedical process as a “radically materialist pursuit of the biological mechanism of disease” (Kleinman, 9). In this definition, ‘materialist’ is expressed as the desire and value for physical comfort and health in the body that clinicians prioritize when treating a patient. Kleinman argues that biomedicine focuses on the biological symptoms in the body rather than the psychological or social aspects that influence illness experiences that accompany disease. He defines the materialist view as believing “that symptoms are clues to disease, evidence of a ‘natural’ process, a physical entity to be discovered or uncovered…this is a way of thinking that fits better with the secure wisdom of physical science than with the nervous skepticism of the medical profession” (Kleinman, 17). He describes that physicians are searching for the biological problem that they have the potential to solve with medicine but this becomes challenging to understand in cases of chronic illness because there is no biological or material cure. He describes that this materialist view is problematic because it is excluding extremely important experiences of illness and it dehumanizes patients down to their diseases. In chronically ill patients, this materialist pursuit is devastating as physicians perceive themselves as unable to help in their suffering. He argues “the biomedical system replaces this allegedly ‘soft’, therefore devalued, psychosocial concern with meanings with the scientifically ‘hard’, therefore overvalued, technical quest for the control of symptoms” (Kleinman, 9). He describes that overlooking the psychosocial and only focusing on symptoms does not provide a proper understanding of each person’s specific illness experience. This value of material and scientific understandings of the body are essential for curing diseases but other healing beliefs and aspects of the psychosocial should also be incorporated into caring for the ill.

Sources
Kleinman, Arthur. “Meaning of Symptoms and Disorders”. The Illness Narratives: Suffering, Meaning, and the Human Condition. Basic Books, 1998, pp. 1-30.

First Reading Response: The Illness Narratives

Laurel Zeigler

Professors J. Thrailkill and M. Rivkin-Fish

ENGL 264

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.

Kleinman Reading Response

Will Chaiken

Professor M. Rivkin-Fish and J. Thrailkill

ANTH 272/ENGL 264

26 January 2020

Arthur Kleinman: The Meaning of Symptoms and Disorders

Arthur Kleinman attempts to distinguish the different meanings of symptoms and disorders as a way to expose the impersonal approach of healing by practitioners. His main distinction is between the subjective experience of “illness”, which “refers to how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability.” (Kleinman 3), and “disease”, which “is the problem from the practitioner’s perspective.” (Kleinman 6). The latter can be described as the purely biological deviation from “normalcy” that healers, in their many cross-cultural forms and practices, attempt to remedy. This view taken by healers can be seen as problematic. Kleinman states, “Illness problems are the principal difficulties that symptoms and disability create in our lives.” (Kleinman 4). Examples include the frustration involved with not being able to walk up the stairs, or the failure from the inability to focus on homework with pestering chronic aches and pains, or the anger in feeling that no one else knows the pain one feels. No two experiences of illness are the equivalent in the same way no two humans are equivalent in terms of biology and experience. The problem Kleinman seems to be highlighting is the accidental ignorance regarding the unique experience of “illness” from person to person. A practitioner might view multiple cases of epilepsy the same way or from the same lens without taking into account how the patient is actually experiencing the disorder. With the awareness of individuality regarding “illness”, healers could more appropriately interact with patients, attempt to understand their disorder in a more holistic sense, and provide better patient care altogether. Awareness of the fact could also sooth the patient when feelings of not being understood arise. Kleinman provides a valuable insight into the healer-patient relationship and possible ways to improve suffering by making this distinction and highlighting the subjective experience of “illness”.

Arthur Kleinman, Ch 1 “The Personal and Social Meanings of Illness,” in The Illness Narratives: Suffering, Meaning, and the Human Condition (Basic Books, 1988), 31-55.

Carpenter Response 1: Sickness in relation to “On Being a Cripple”

Kayley Carpenter

Reading Response 1

Julio Villa-Palomino

Prompt 2 (Kleinman and pg 1 of “On Being a Cripple”)

Word Count: 298

In The Illness Narratives, Arthur Kleinman distinguishes illness, disease, and sickness, as they pertain to suffering and healing. He describes illness as the “innately human experience of symptoms and suffering” (3). Contrastingly, he defines disease as “the problem from the practitioner’s perspective,” reminding readers that not every culture of healing believes in biomedicine, and their epistemologies are no less valid in defining disease within their cultural narrative (5). Sickness differs from both terms, as Kleinman defines sickness as “the understanding of a disorder in its generic sense across a population in relation to macrosocial…forces” (6). Kleinman’s specific use of a third term, sickness, emphasizes that, in many cases, sickness intensifies the illness experience more than the disease, or diagnosis, could. This concept regarding societal understanding and connotations of a particular disease is especially prevalent in Nancy Mairs’ essay, “On Being a Cripple.”

Mairs describes her multiple sclerosis diagnosis and self-label of “cripple.” She uses imagery to depict her illness experience, including her fall in a public restroom. On page 1, the audience is enlightened on her illness experience and suffering from her declining health. Mairs also explains how her disease fits into a larger societal understanding of people functioning as less-than the average, healthy person—this broader understanding and labeling of an illness within a culture is what Kleinman deems sickness. The societal understanding of disability is that “cripple” is a demeaning synonym for “handicapped,” “disabled,” or “differently abled.” Mairs vehemently dislikes the latter, as it glosses over her illness politely, so as not to offend her. Mairs claims this term fails to acknowledge her own personal suffering. Without acknowledging that sickness is the societal understanding of the disease diagnosis, society lacks the ability to truly absorb one’s suffering and oftentimes furthers the burden of one’s illness experience.

First Reading Response

It is important to differentiate between sickness, illness, and disease as they all carry very different connotations about the suffering, environment, and person. According to Kleinman, illness refers to the personal experience of suffering, the disease is what the doctor is trained to see as the problem, while sickness is how to understand a disorder from the individual case in relation to social factors. This is important because disease and illness are more focused on the individual, while sickness accounts for how the suffering exists in a social and environmental context. This also will carry significance for the healing methods. When the physician attempts to heal the disease, they are disregarding the relationships and context of the problem and effects. The example that Kleinman gives is of tuberculosis. While the disease is tuberculosis as named by the physician, and the illness is the physical and mental suffering that goes along with tuberculosis, the sickness refers to the larger range of what is affected. It accounts for the relationship of tuberculosis to low-income houses and malnutrition, where some demographics are more likely to be at risk for the disorder. This is significant when thinking about healing- it is not about fixing the biology of the illness, but looking at the scope of where problems arise and how to heal social burdens and relations. When a physician attempts to heal a disease biologically, they are concerned only with fixing the disease. This puts too much emphasis on the symptoms of the individual, and not enough on the meanings of the individual’s illness experience. By “materialistic pursuit” the physician is looking only for biomedical and medical ways of healing disease, not examining the wider scope of potential conflict or difficulty.

Kleinman, Arthur. The Illness Narratives: Suffering, Healing, and the Human Condition, Chapter 1. New York: Basic Books, 1988.