Originally appeared
in the Boston Globe
http://www.boston.com/news/globe/ideas/articles/2006/07/23/qa_with_arthur_kleinman/
By Harvey Blume
"AFTER ALL THESE YEARS of being a psychiatrist, and
anthropologist, what have you learned that's useful for living?" That's
the question Arthur Kleinman, a professor of anthropology at Harvard and a
former chair of the department, challenged himself to address in his new,
plainspoken, and engaging book, "What Really Matters: Living a Moral Life
Amidst Uncertainty and Danger" (Oxford).
Kleinman, now 65 years old and still, despite the often
somber tone of the book, hale and hearty, has had an influential career as a
psychiatrist, teacher, researcher, and writer. His book "The Illness
Narratives: Suffering, Healing and the Human Condition" (1988), now
standard fare in medical curriculums, is a defining text of medical
anthropology, a field that uses anthropological methods to study the social and
cultural elements of disease.
In "The Illness Narratives" Kleinman insists that
it isn't enough for physicians to master the relevant biology, especially when
treating chronic illness. Chronic diseases, he wrote, "by definition
cannot be cured," and to effect even "modest improvement," a
doctor must appreciate the psychological and social components of the ailment.
It is in part due to Kleinman's efforts that the idea of healing--alongside the
more traditional notion of curing--has gained a foothold in the medical
establishment.
The new book broadens the scope of Kleinman's earlier work
by asking the same kinds of questions about human life as a whole that he had
previously asked about illness per se. Given that most of us are bound to
experience, "some kind of health catastrophe near the close of our lives,
if not sooner," what, he asks, makes for a good life, a meaningful life?
To find answers, Kleinman mines his own experience and that of eight other
people--a disparate group that includes a New York City sanitation worker, an
Israeli kibbutznik, and an English psychologist who treated soldiers
shell-shocked during World War I. What he values in these cases is people's
efforts to act ethically in the midst of suffering and adversity.
When I met with Kleinman in his office at Harvard's William
James Hall, I opined that "What Really Matters" was obviously not
written with the youth market in mind.
KLEINMAN: You have to be of a certain age, to travel through
dark periods. I've spent my whole career working on suffering, so it's not that
I'm unfamiliar with it. And I've had some diseases--asthma, for example,
hypertension--but they never affected me the way my wife's neuro-degenerative
disease, which has ruined her vision, affected me. The book was written during
a stage of my life that was--that is--difficult.
IDEAS: The book is in some ways a critique of language,
isn't it? You make a point of trying to clear the air of the medical language
that obscures what you see as the basic realities of human life.
KLEINMAN: There are key psychiatric disorders like
schizophrenia and depression, but I'm very concerned about people who have
ordinary unhappiness, or have experienced a catastrophe, or just bad luck, and
are renamed depressed or having an anxiety disorder. That's happening in a big
way right now. I'm concerned about taking ordinary life, stripping it of its
moral content, and making it over into a disease.
IDEAS: Are you still a practicing psychiatrist?
KLEINMAN: I stopped practicing about six years ago. But I
had 25 years of practice and saw thousands of cases. I saw many people in
psychotherapy and also used psychopharmacology. It's precisely because I
believe in the seriousness of mental illness that I've been concerned about
medicalization, remaking the normal into the abnormal.
IDEAS: Why is this happening?
KLEINMAN: There's a hyping not just of psychiatry, but all
of medicine. This has come out of the medical-industrial complex, and the need
to get medicine the resources and support it needs, for research, among other
things. I'm all for medical research--but not the hyping. The other day I
received a solicitation from a medical foundation, and was surprised by the
first sentence, which said: "Imagine a world free of disease." That's
inhuman! There can't be a world free of disease. Disease is part of what life is
about.
By the time you get to be my age, in the middle of your
seventh decade, you're going to realize that just about every family is going
to deal with a social or health catastrophe. That's not something people have
been prepared for. It's grim. But the grimness is made over by religion,
aesthetics, ethics, into something that makes life meaningful.
IDEAS: One of the key figures in the book is Winthrop Cohen,
a hero of World War II in the Pacific, who came to you in his 60s, some years
ago, and was depressed. But didn't you, when you looked over your notes more
recently, conclude that by calling him depressed you were missing something
essential?
KLEINMAN: I missed the moral statement. Here was a decorated
solder, who had, in his own words, been turned into a killer, committing
several atrocities. The worst was that he'd killed an unarmed Japanese doctor
who had been treating Japanese wounded. Think of how hard it is for a guy who's
been treated as a hero to say, "I killed a doctor up close, who looked in
my eyes, and made me feel I was a real killer." There are some things you
can't say.
The rest of his life was an encounter with that atrocity, a
constant attempt to deal with it, and finally, a kind of giving up. That
produced a very severe clinical depression. But the clinical depression was in
the context of the tragedy. And maybe the illness, the fact that he really did
become depressed, allowed him to speak.
IDEAS: You stress the importance of ethics to meaningful
life--the need to resist local norms, go against the flow. But whether you're
writing about Winthrop Cohen, or a survivor of the Chinese Cultural Revolution,
or a humanitarian worker in Africa, or telling your own story, what comes out
is how hard it is be ethical, how many gray areas there are.
KLEINMAN: The best most of us, me included, can do, is less
than heroic. Most of us are caught in situations in our work, in our
institutions, maybe even in our families, where part of us is a collaborator.
Periodically, we make a decision to stand up for something. How do we do that?
I don't have the answers. I'm just saying that in looking at people over the
course of my life I'm astonished to see that most of us try to build this
ethical part of our lives.
DEAS: How important is guilt to ethical behavior?
KLEINMAN: It is important to the moral imagination. It makes
us unpack ourselves, be critical of ourselves, and begin to step out of
ourselves. It helps us imagine what it would be like to be in the other
person's shoes.
IDEAS: Can you give me an example of ethical behavior from
your own life?
KLEINMAN: I'll never forget this. I was sent by the NIH to a
medical research unit in Taiwan during the Vietnam War. I was odd man out
because I was from the NIH. The worst the captain who ran the place could do to
me was send me back to Bethesda, Maryland. Navy doctors could be sent to the
boonies in Vietnam with a Marine battalion. So no one ever spoke up, except for
me.
We had a neurosurgeon who was comparing the Korean War to
Vietnam, and said: "We've made incredible gains in neurosurgery. Today we
can keep a soldier alive who's got half a brain." I remember him saying
that, exactly. So I raised my hand and said, "Well, maybe preventive
medicine would be better." Everyone looked at me. If I was a Navy
physician, I wouldn't have said that.
Harvey Blume is a writer based in Cambridge.
No comments:
Post a Comment