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Kleinman's main interest is the withering of trust in the medical profession caused
by an ignorance of the patient's illness narrative. From a perspective of medical
anthropology, the right twist of Sadegh-Zadeh of understanding disease from the
patient would need further deepening in terms of the significance of the illness nar-
rative for the healing process.
6.5
Disease and Power - Concluding Remarks
with Michel Foucault
At the end of this paper, I will take a last twist and read the
Handbook
in the light of
the historical, even archeological, account of Michel Foucault. Rather than seeing
modern medicine as the result of a humanitarian progress, Foucault is seeing in it
yet another means of control. His
Birth of the Clinic
([3], 1973) is analyzing the
ways power is exerted in clinical practice - power in terms of control and knowl-
edge. The patients in hospitals are not only cared for; their examination is also a
method of control, which establishes a power structure. The physician's judgment
is creating truths and setting a norm. The constant observation further creates a hi-
erarchical structure; the patient becoming the object of the physicians manipulation.
The suffering individual in the hospital setting is thus transformed in an object of
knowledge; a transformation also making the patient one case among many to be
medically treated but also controlled.
This Foucaultian perspective has well become part of academic knowledge. As
arguable as it might be, it can help counteract academic naïveté of a too idealis-
tic construction of the medical profession. Power and control (as exerted through
medicine) are not part of the conceptual framework of the
Handbook
. The belief
in the analytic tools of the physician, if correctly applied, leaves possible concerns
about the power dimension of the generated knowledge unmentioned. Although
there is partial mention of the wider clinical setting - the importance of family
members of the patient and the staff of the physician in the framing of the clinical
encounter - the physician's task is described “as if” it took place outside the reg-
ular interaction of society. This ideal construction of the clinical encounter allows
putting medicine next to charity and beyond the systemic dynamics in the health care
sector and real-world constraints. Such an ideal construction has its benefits but also
its costs. On the benefits side, it allows for a clear grasp of the concepts involved;
on the cost side, however, it leaves out important aspects of the clinical encounter.
These aspects of control and the intertwinement of knowledge/power are not merely
external to modern Western medicine, but part of its conceptual framework. The
generation of knowledge as well as the increasing professional differentiation is an
inherent part of modern medicine. The clinical view unveiled by Foucault points to
the same one-sidedness of the Handbook as Kleinman's concern about inadequate
care due to an overly focus on the category of diseases.
The
Handbook
tends to
strengthen this disease orientation of modern medicine.
Defending Sadegh-Zadeh's approach one might rightly point out at the different
vantage points but also different scope and interests from Kleinman and Foucault;
