[Writing at the Margins: Discourse between Anthropology & Medicine]

By Kleinman, Arthur; DiGiacomo, Susan M. | Anthropologica, January 1, 1996 | Go to article overview

[Writing at the Margins: Discourse between Anthropology & Medicine]


Kleinman, Arthur, DiGiacomo, Susan M., Anthropologica


With the exception of the introduction and the final section, both written expressly for this volume, the essays collected here are chapters and articles published elsewhere over the past five years, sometimes in collaboration with others, and reworked stylistically and analytically to form a critical mass of work around two intellectual projects. The first of these, a cultural critique of biomedicine, prepares the ground for the second: theorizing the experience of suffering as interpersonal and social in nature. The marginality Kleinman invokes in the book's title is a space of "vital liminality" (p. 3) where change is likeliest to begin. This book marks a change in Kleinman's engagement with both psychiatry and anthropology that was foreshadowed in The Illness Narratives (Basic Books, 1988) but was constrained by the book's reliance on the "patient's explanatory model of illness" paradigm. These newer essays have a welcome incisiveness that derives the sharpness of its edge from a willingness to advocate, with feminist theorists, "a way of acting that simultaneously engages the power of context and the context of power" (p. 66). The three chapters of Part One, "The Culture of Biomedicine," critically examine what Kleinman calls the "deep cultural processes" (p. 16) that make biomedicine an effective technical-rational strategy and at the same time limit its effectiveness as a response to human problems. Biomedicine and bioethics, Kleinman argues in Chapters 2 and 3 respectively, privilege a very Western and late-capitalist understanding of illness as an individual experience that lends itself easily to regulation by market forces and the state. Even international public health, with its population- and community-based orientation, is conscripted by its reliance on the concept of "objective" measurement (critiqued in Chapter 4) into the service of the political and economic interests of states and international institutions such as the World Bank, oriented as they are to "science-based" development (p.

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