Illness Narratives : Suffering, Healing, and the Human Condition (9781541674608) by Kleinman Arthur

Author:Kleinman, Arthur [KLEINMAN, MD, ARTHUR]
Language: eng
Format: epub
Publisher: Hachette Book Group USA
Published: 2020-10-13T00:00:00+00:00

Dr. Richards also sent a terse note for a consultation to the dietician, which read: “39 year old Black woman with poorly controlled hypertension who does not comply with low salt diet. Please help plan 2 gram sodium diet, and explain to her again relationship of salt intake to her disease and that she must stop eating high salt foods and cooking with salt.”

Interpretation

The case that materializes in the written record seems quite different from the sick woman who speaks in the transcript. Melissa Flowers is reduced to her hypertension, her noncompliance with the medical regimen, her early signs of heart failure, and her medications. Gone from the record is Melissa Flowers as a sick person under great social pressure, worried and demoralized by difficult family problems (see Dressler 1985). Those problems are a reflection of the social breakdown, violence, and inadequate resources and limited life chances of the United States’s black underclass. But while we might not expect Dr. Richards to include those social sources of Mrs. Flowers’s multiple misfortunes in the medical record, it is deplorable that he fails to include her life problems, including the multiple family difficulties, the prolonged grief reaction, and the psychological effects of her troubled social environment. (Indeed, I believe a case can be made for describing social sources of illness in order to specify the social changes needed to prevent and treat such life distress.) But then again these are concerns that Dr. Richards either failed to follow up on with specific questions or actually stopped Mrs. Flowers from elaborating. That is to say, Dr. Richards permits Mrs. Flowers to speak about her disease but not about her illness. Physical complaints are authorized, but psychological or social ones are not. The diagnosis is, in fact, a systematic distortion of the interview: only facts that relate to the disease and its treatment are sought, allowed to emerge, and heard. The human suffering that is so much a part of this chronic illness is met with silence and seemingly denied.

Cultural issues are allowed to slip by, one after another, in a way that would be regarded as sheer clinical incompetence if the issues were biological. Mrs. Flowers uses the terms “pressure” and “high blood,” which refer to folk illnesses in lower-class black American society (see Nations et al. 1985). These concepts help explain what Dr. Richards labels noncompliance; for example, high blood, a folk condition believed to result from blood rising into the head, is thought to cause headaches and is treated (“lowered,” “thinned,” “cut”) with pickle juice. If Dr. Richards were to attend to this alternative belief system, he would have a more accurate understanding of Mrs. Flowers’s behavior and would also have an opportunity to explain the biomedical view and negotiate with Mrs. Flowers to change potentially dangerous behavior. When Mrs. Flowers uses the word pressure she is drawing on holistic concepts that relate social and psychological pressures to blood pressure. Biomedical theory acknowledges a role of stress in hypertension grudgingly and

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