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Illness Narratives

Illness Narratives. Suffering, Meaning, Experience. Kleinman - T he Illness Narratives. “ It is more important to know what sort of person has a disease than to know what sort of disease a person has.” ---Hippocrates BA, Stanford U, MD Stanford MA Social Anthropology, Harvard

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Illness Narratives

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  1. Illness Narratives Suffering, Meaning, Experience

  2. Kleinman- The Illness Narratives • “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” ---Hippocrates • BA, Stanford U, MD Stanford • MA Social Anthropology, Harvard • Psychiatry- Mass General Hospital

  3. Fields • Medical anthropology • Cultural psychiatry • Global health • Social medicine • Medical humanities • Research in China since 1978 • Somatization- mental distress expressed as somatized distress (i.e. as a bodily ailment) than as psychological distress by Chinese or East Asian patients.

  4. Illness Narratives • Interpreting the illness experience is a neglected art • Chronic Illness: “The way of the specialist diagnostician, which is not to credit the patient’s subjective account until it can be quantified and therefore rendered more ‘objective,’ can make a shambles of the care of the chronically ill.” • “The illness narrative is a story the patient tells, and significant others retell, to give coherence to the distinctive events and long-term course of suffering”

  5. Why is this important? • Illness- patient experience, meaning • Chronic pain, suffering- remakes the world • Experience of body- how live with and respond to symptoms • Body expresses distress • Disease- practitioner’s view of the illness • Sickness-problem at the population level • “Physicians are not taught that biological processes are known only through socially constructed categories that constrain experience as much as does disordered physiology” . . . • Translating Illness to disease- much is lost • Relationship between patient and practitioner is impoverished, leads away from effective therapy

  6. Healing/Curing • Healing– addresses illness “Coming to terms with” • Curing- addresses disease • Cure may occur without healing; • Healing may occur without cure. • Cure separates body from soul; • Healing embraces the whole. • Cure categorizes; healing individualizes.

  7. Kleinman- What makes a good doctor? • Does not simply treat disease, but treat sick people- relationship with person • “Empathic witnessing” • Building an illness narrative (equal partnership) • Modeling courage • Sanctioning suffering

  8. Narrative Medicine • Columbia School of Medicine: • MA in “Narrative Medicine”

  9. Nancy Scheper-Hughes • Very different context • Critical of Kleinman (185): “Here I am trying to recuperate and politicize the uses of the body and the secret language of the organs that play such a large part in the lives of many anthropological ‘subjects.’”

  10. Nancy Scheper-Hughes

  11. On being a critical medical anthropologist . . . . • “ . . . public anthropology doesn’t only mean making things more readily available to the layman, let’s say. To me it means like making things public that are private. Making invisible things into public issues, making visible secrets that empower some and disempower others who are not privy to the information. So I think that part of being a critical anthropologist is getting to the underside of things, the dimensions of social and political life that people cannot ordinarily see.”

  12. Marx and Gramsci • Marx- “False consciousness” • "Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people.“ • Antonio Gramsci- student of Marx • Hegemony- to explain why proletariat did not revolt

  13. Hegemony • “The taken for granted, naturalized practices that command any cultural field, empowering without appearing to do so, seeming to transcend historical time and human agency.” • Explains: HOW control is achieved NOT through force, but through CONSENT • Ideas of the ruling class come to be seen as normal, natural • Renders existing social relationships as natural, “commonsense”

  14. Medicalization • The process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. • Seen as a form of social control in which medical authority expands into domains of everyday existence • Examples: “hyperkinesis”, menstruation, pregnancy, mental illness

  15. Scheper-Hughes-Medicalization • Looking at expansion, process and effects of “medicalization” in an area where it is happening for the first time (196) • Looking at cultural forms as “Webs of mystification” • “Nervoso”- Form of suffering derived from class relations defined as illness and brought under the authority of the medical profession and the state • A technical medical problem rather than a political, economic, social problem • Public is made docile, reliant on the medical profession to cope with life in their society

  16. Who is to blame? • No agent, unconscious processes of power • NOT a “conspiratorial plot by doctors and pharmacists” • Hegemony- Transformation of everyday knowledge and practice about the body

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