1930 Book Reviews

It is hoped that this approach will not end with Young’s tragic death in 1981 and that other medical anthropologists will follow his lead in exploring this aspect of health care. Perhaps further studies of this kind may provide the impetus needed to improve health care access through change in public policy. This book is germane not only to anthropology but perhaps more importantly to health planners and physicians working both in this country and in the developing world. This study challenged many of rnQ beliefs (as a physician working in a cross-cultural practice) about treatment choice and the role of Western medical systems in communities such as Pichatarefios.

Alaska Native Hospital Kotzebue, AK, U.S.A.

KATHLEEN TOOMEY

The ~ennlng of Huntan Suffering, edited by FLAVIAN DOUGHERTY. C. P. Human Sciences Press, New York, 1982. 349 pp. $29.95

If the opening sentence in the Introduction to this book is correct that “mankind’s most common, most persistent, and most puzzling problem is suffering”, then most medical textbooks are seriously deficient. As Eric Cassell has observed, these texts have much to say about disease and pain, but almost nothing about suffering. As a result, the profound human concerns of patients who encounter helplessness, limitation, hopelessness and anguish elude the earnest attentiveness of medical professionals trained to deal with disease, but not with suffering. There is ample evidence, from patient satisfaction surveys, memoirs of illness and personal accounts of medical training, that this lack of attention to suffering leaves many people isolated, frightened and angry even when they are being plied with the very best that modem medicine has to offer for their conditions.

It would appear from this that medical professionals would benefit from increased exposure to the analysis of human suffering-its manifestations, meanings and the resources with which people came to grips with it. These are the principal themes of The Meaning of Human Su#ering. Yet from the standpoint of a medical audience, this book is only partially successful in broadening our understandings of human suffering. The book is heavy going. While theologians and philosophers may find in it much food for thought and learned disquisitions, only portions of the book will be accessible and clearly meaning- ful to most clinicians.

The book is a collection of papers that were presented to “The First International, Ecumenical Congress on the Meaning of Human SuITering”, held in April, 1979 at the University of Notre Dame. Although most of the authors insist, within their first paragraph or two, that discussions of suffering in the abstract, separated from the messy details of actual human experience, miss the mark, much of this volume is very abstract indeed. Essavs bv John Bowker. Stanislas Breton and Carroll Stuhlmueller,-rich in scholarly detail, address philosophical and theological issues that require a speciahst’s training and enthusiasms.

At the other end of the spectrum, and of the book, are essays focusing on socio-political oppression in Latin America (by Joel Gajardo-Velasquez) and in the experience of blacks in the United States (by Henry Young). These essays place the notion of ‘suffering’ in a broader political and historical context, in contrast to more clinical perspeo tives on death and grief presented by Wayne Oates.

Each of these essays is concerned with the relationships between the human experience of suffering and the doc- trines of Catholic and Protestant theology. Readers.who either do not share or who are unfamiliar with the

presuppositions, historical variations and doctrinal contro- versies of Christian theology must be prepared to work hard in these chapters.

The two most compelling chapters of the book stand at its center. These are essays by Arthur McGill and Robert Jay Lifton. McGill argues that we live in “the age of technology and anesthetics”; i.e. technology has given us the expectation that we should be able to abolish suffering. Suffering we cannot abolish we seek to dull through drugs or isolation of the sufferer from the rest of the population. Suffering, McGill claims, is elevated to God-like status. Where suffering exists, human values are thought to perish. We only feel truly human when we are free of suITering. The walls we erect to protect ourselves from suffering-& metaphorical walls of withdrawal and detachment or the literal walls of asylums, hospitals and warehouses for the infirm or aged-are the real sources of evil and inhumanity. McGill argues. But we who hide behind them do not see this; we see instead only the dying dream of an existence free of all suffering. McGill contrasts this perspective with the Passion of Christ, in which vulnerability and sharing of suffering emerge as alternative human postures. In this view, suffering is not the primary evil. Rather, evil resides most of all in the human flight from suffering that destroys mutuality, empathy and responsibility.

Lifton extends McGill’s discussion of walls against suffering into the psychological realm with his analysis of ‘psychic numbing’ as the basic human response to over- whelming suffering and the threat of death. Numbing as both deadening in itself and necessary protection from the overload of existence in a nuclear age presents a dilemma for professionals, in particular. They are charged with entering sensitively into the sufferings of others, and yet must try to emerge with their competence, optimism and humor intact. Both the essays by McGill and Lifton are written with grace, compassion and concrete appreciation for the sufferings of real people. Though their writings have made these discussions available elsewhere, these chapters deserve close attention.

This volume has no central organizing theme. The conference leaders were pleased to draw Catholic and Protestant theologians (and one Jewish psychiatrist) into sustained dialogue. From their point of view, this ecumen- ism itself is a singular achievement. Readers without this theological agenda will be left to work their way through complex philosophical and theological matters, to glean greater appreciation for the existential and humanistic dimensions of pain, suffering and death than is customarily provided by social, political or medical treatises.

Institute for the Medical Humanities DAVID BARNARD The University of Texas Medical Branch Galveston, TX, U.S.A.

Tke Sick Citadel. TIE American Academic Medical Center and llte Public I&eat, by IRVING J. LEWIS and CECIL G. SHEPS. Delgeschlager, Gunn & Hain, Cambridge, MA, 1983. 263 pp. 525.00

This is an important book. Under the right political economic circumstances, namely, with an assumption of power by socialist-oriented social democrats, it could become the new Flexner Report. I will not hold my breath for this to happen, given the present political climate of the U.S.A. But in the meantime, this book can serve as an alternative yardstick against which both health policy makers and planners as well as social science observers of the U.S.A. health system can compare what is actually happening with what might have been.