by Arthur Kleinman, 314 pp, $40, ISBN 0-520-20099-3, Berkeley, Calif, University of California Press, 1995.
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Writing at the Margin is primarily a collection of revisions of recently published articles, some coauthored, by a distinguished medical anthropologist-psychiatrist. This review will describe only those sections that are relevant to medicine.
While medicine is universal in human societies, healing customs and traditions vary widely both among and within societies. According to Kleinman, biomedicine does not accept this multiplicity of healing systems but maintains a "single-minded approach to illness and care," with an almost total emphasis on the physical aspects of disease. To biomedicine "the psychological, social, and moral are only so many superficial layers of epiphenomenal cover that disguise the bedrock of truth, the ultimately natural substance in pathology and therapy."
While the biomedical approach has advantages, it fails to incorporate "the patient's experience of suffering," to utilize the "charismatic powers of the healer-patient relationship" or to take advantage of "the therapeutic powers within patients, denying efficacy to
Rothstein WG. Writing at the Margin: Discourse Between Anthropology and Medicine. JAMA. 1996;275(24):1934-1935. doi:10.1001/jama.1996.03530480076048