Category: Reading Response

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

Reading Response #1 – Into the Water

Khalilah Taylor

Professor Rivkin-Fish & Professor Thrailkill

ANTH 272

26 January 2020

Reading Response #1: Into the Water

“Into the Water – The Clinical Clerkships” by Katharine Treadway and Neal Chatterjee at first seemed to be an article simply discussing the lack of empathy physicians and other medical professionals possess. However, after analyzing the article and considering the alternating perspectives, tones, and shared experiences between the clinician (Katharine) and a medical student (Neal)the true symbolism of water and its connotations are made apparent.

As this article starts off, the narrator, Neal, puts readers in the perspective of a medical student during his first day of surgical clerkship. Placing us in the unnatural hospital setting and his shared uneasiness when residents discussed tragic events in a comedic manner with his readers, helps us understand the warped emotional connection between physicians and patients. Such degradation is made clear through the anecdote of the fish in the water. Because the fish experience water every day, the water has become more normalized as the residents in this environment have become more desensitized. It’s not that Neal on his first day is experiencing abnormal feelings but rather, everyone else has become unphased by the reality of the medical world. Katherine shares, in a complementary viewpoint, that the neglect physicians show their students is what makes the students numb.

These parallel perspectives reveal how we, as humans, tend to disconnect from our true emotions and feelings in order to get through the harder parts of our lives and by doing so in silence, we encourage others to do the same. The pragmatic and philosophical tone presented in this text helps us understand that acknowledging the presence of water is of true importance. Along with acknowledging,  addressing exactly how we deal with the events that cause heightened emotions is a solution that is presented in order to prevent denormalization of numbness in both the medical field and life as a whole.

Work cited

Treadway, Katharine, and Neal Chatterjee. Into the Water — The Clinical Clerkships. The New England Journal of Medicine, 31 Mar. 2011

Reading Response 1: Mairs “My Life as a Cripple”

From the beginning of her story, Nancy Mairs dives straight into a controversial discussion of the effects of euphemisms to sugar-coat harsh realities. On page one, she notes that “Some realities do not obey the dictates of language.” In saying this, Mairs sets the tone of her narrative while simultaneously, presenting to the audience a common issue faced in today’s society. Often, it is believed that prescribing harsh situations with words that have a more positive connotation allows for an easier integration into society and softens the blow of the hardship. Yet, Mairs makes it clear that while terms such as “handicapped” or “differently abled” may seem less offensive, they inherently suggest a sense of hopelessness and deliberate disadvantage, which is not always the case (Mairs 1). Moreover, the use of such terminology may not always allow for an easier integration into society. In fact, words like “differently abled” creates the sense of a common normality threshold, one that categorizes people such as Mairs as different from the standard norm. As a result, it furthers the divide within communities as people are now being seen as different than their peers.

Intertwined in her scope of unraveling the hidden truths embedded in euphemisms, Mairs touches on a similar argument of Arthur Frank. In chapter 3 of “The Wounded Storyteller”, Frank mentions the idea that many [North Americans] often glaze over instances where their lives have gone wrong (Frank 63). Yet, Frank mentions that what makes a good illness story is the narrator’s ability to explicitly state the true reality of a situation regardless of what people want to hear. Respectively, Mairs represents a good illness story by opting to choose to be described using the term “crippled”. By choosing to embody a word with a negative connotation, Mairs shows that she is actively ignoring the prettifying of her condition, and instead presenting it as it is: a jarring life altering illness that will not define her. Her ability to stand by the word “crippled” in light of her diagnosis not only gives the readers a better understanding of her situation, but also strengthens their respect for her for being honest about the terrifying experiences faced by multiple sclerosis patients. Evidently, Mairs’s way of representing herself and her illness story allows her to reach into the audience and call them to be witnesses to her narrative.

Mairs, Nancy. “On Being a Cripple.” University of Arizona Press, 1986, 1-10.

Frank, Arthur W. “The Wounded Storyteller: Body, Illness, and Ethics.” University of Chicago Press, 1997

Reading Response #1 – Omesi

The experience of illness and injury in Berger’s A Fortunate Man reflects a state of panic and confusion inherent in emergency treatment as seen in the fallen tree event.  The scene begins in media res as characters and setting are largely unknown, the only exception being a bystander named Harry.  The repeated usage of ‘He’ as a stand-in for characters exemplified a state of strangeness to the viewpoint, as though it were merely an example of the immaterial whirlwind of healthcare in a setting where a doctor is poorly equipped to treat their patients and merely serves as an “accomplice of disaster” ( Berger and Mohr 19), unable to take any direct role in healing.

              Nonetheless, the doctor is imagined as a powerful force, capable of bringing understanding and giving an injured man “the courage to be quieter” (Berger and Mohr 18).  Nearby characters look to the doctor for understanding, as the doctor insists that the injured man will not lose his leg while others had previously merely accepted this loss, showcasing a struggle between modern and premodern medical forces in a setting without a large biomedical influence.  Yet, the image of a man waving behind mist provides powerful imagery to this scene, in both direct imagery and its relation to “trying to wipe clean a vast steamed-up window” (Berger and Mohr 17).  In both cases, the individual attempts to compete with immaterial natural forces of mist and steam, concealing and providing confusion.  Although temporary relief may be found as the mist and fog is cleared up, neither case will provide permanent improvement.  Healthcare in this unknown rural area will continue to stagnate, the area will once more be covered with mist, and the ‘vast window’ will once more fog up. This state of confusion and ambiguity thus gives symbolic meaning to the falling of the tree, showcasing typical emergency treatment in this medically isolated countryside.

Reference:

Berger, John and Jean Mohr. A fortunate Man: Story of a Country Doctor. Random House, 1967.

Arthur Frank : The Wounded Storyteller Chapter 3 – Illness as a Call for Stories

On page 56, there is a paragraph that talks about how telling stories, specifically a self-story, is a means to “reaffirm” relationships with oneself (who is experiencing illness/suffering from disease) and the listener. Within this paragraph the phrase “reaffirm” or a variation of it comes up seven times. As I was reading this idea of reaffirming connections to others and to the self leads me to believe that the self is always doubting or at stake of being lost. There is a constant battle to keep a connection to the self or others. There is a consuming quality of an illness to take over identities and networks of people. The prefix “re-” means once more or with return to a previous state. In our case reaffirm means to affirm once more and/or that the state of affirmation was lost but now has been restored. Disease is causing constant disruptions to life that need to be addressed on a repeated basis.

This passage parallels a the following paragraphs on interruptions caused by disease on a ill person’s life. There is a repetition of the word “interruption”. I find repetitions very obvious to see but hard to understand.

In order to understand all the jargon and terms we have related to narratives and storytellers themselves, we must have some understanding of their day-to-day lived experiences. Through the repetition of “reaffirm” and “interruption”, we are experiencing the constant questioning and constant stop-and-go nature. The mood seems frantic and distressed. When someone is constantly trying to gain affirmation, there is a nagging and an anxiety of losing something integral. Through repetition, Frank is allowing us to understand (to a superficial extent) the frequent occurrences that an ill person is experiencing. I found myself taking not, and in a sense pausing by means of interruption, each time I came to the word “reaffirm” or “interruption”.

Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. University of Chicago Press, 1997.

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.

Kleinman – Subjectivity of Illness

“Illness” is a subjective lived experience since every person experiences disease differently. The concept is subject to cultural orientations and can often vary by outcome. In Kleinman’s terms, “there are normal ways of being ill (ways that our society regards as appropriate as well as anomalous ways,” (5 Kleinman). Here, Kleinman elicits the idea that society has the ability to dictate how to be ill, hence affecting the illness experience. For example, it is socially acceptable in the United States for someone who has the flu to stay home and get well. Perhaps the person may receive get well cards or comfort from loved ones to alleviate their suffering. Contrarily, if the same person was part of a society that did not pamper a sick person when he/she had the flu, then the person may feel more suffering. The same experience of the flu a person can be completely different depending of environment.

Kleinman cites the illness experience to be subject to outcome. Kleinman illustrates three examples: an adolescent quadriplegic who requires life assist constantly, a business executive who suffers from asthma only known to his wife and children, and a young woman who has been demoralized by breast cancer surgery to the extent where she feels that her metastasis is an omen of her demise (5 Kleinman). Though all three cases experience illness, the adolescent quadriplegic feels that his vital functions are under constant threat, the business executive suffers from the maintenance of separating his work, where his illness is virtually invisible, and home, where he is impaired greatly, and the young woman interprets her symptoms as a death sentence. Due to the nature of disease, illness is experienced differently in all three cases. Kleinman’s definition of subjectivity relates to variation.

“On Being a Cripple” – Mairs Reading Response

Nancy Mairs, in “On Being a Cripple” writes in a complexly optimistic tone about her diagnosis, MS, while retaining a framework of realism. She expresses her preference from the get-go: to be called a “cripple” instead of any other politically correct semantic iteration. Her reasoning is as follows; “And I refuse to participate in the degeneration of the language to the extent that I deny that I have lost anything in the course of this calamitous disease; I refuse to pretend that the only differences between you and me are the various ordinary ones that distinguish any one person from another.” In this explanation, one begins to grasp one of the most important parts of living with chronic disease, being the inability and refusal to erase experiences. Mairs is unapologetically acknowledging her losses, and the weight of those losses.

Her autobiographical essay elegantly, though not-so-delicately, expresses the changes of body, mind, and lifestyle that all accompany a chronic disease; these include an inability to see friends on outings, play piano, dress herself for style instead of comfort, and other. The lack of subtlety in language about the symptoms and pain of MS work towards acceptance and even appreciation of the diagnosis at times. To me, it was striking how she was able to so honestly discuss the losses she has endured, and it seems important to recognize one’s past in order to appreciate her present and disregard the future. While she has lost the ability to do many things, she has also gained good, bad, and different. It feels almost like Frank’s chaos narrative, in which she recognizes all the sides of her symptoms and lifestyle without trying to return to her life before. She writes beautifully about the appreciation she has for new activities in her life that fulfill her, including humor and gentleness towards others. She also discusses the intense pressure to please and self-consciousness that partners itself with her diagnosis. And lastly, she notes the ways in which she can still enjoy herself in activities that perhaps are just slightly different now; she still loves to cook even though she makes a mess, and she can play bridge with her friends but has to lay the cards on the table and trust that others won’t peek.

I truly believe that her outlook on life is beautiful and poetic. She finds the light in small things, while acknowledging that it is okay for things to be dark sometimes too. It is with this complexity that she expresses a truly unique and inspiring account of living with an equally complex diagnosis.

Reading Response to Berger’s A Fortunate Man

Charlotte Grush 

Julio Villa-Palomino

ANTH 272

January 26th, 2020

While reading Henry Berger’s A Fortunate Man, I noticed the majority of the piece regarding the man crushed under a tree was neither really focused on the injured man or the doctor, it was focused around the other woodmen who were present at the scene. Though the woodmen provide the context of the accident to the doctor, they way they view the doctor plays a much more important role in the narrative. For example, near the beginning they view the doctor as an important figure who can help save their friend and his arrival is referred to as an advent. Further along in the story the doctor is described as an accomplice and they seem to lose faith in the doctor. In fact, the last sentence states “But every time they noticed the place they questioned whether the doctor could be right” ( Berger and Mohr 19). There was also a shift in the way the other woodmen viewed the man trapped under the tree. The woodmen originally viewed the man as someone who needed help but as you read further they seem to view the man as someone who brought this injury upon himself. The woodmen had very little sympathy for this man the longer the doctor worked on him and even started placing blame on the injured man. The focus on the woodmen in the story shows how illness is not something just between the doctor and patient, it is something experienced by everyone around them. 

 

Works cited

 

Berger, John, and Jean Mohr. A Fortunate Man: The Story of a Country Doctor. Vintage Books, 1997.