Book Review

The Straight Path: A Story of Healing and Transformation in Fiji

N Engl J Med 1994; 330:1764June 16, 1994

Article

The Straight Path: A Story of Healing and Transformation in Fiji
By Richard Katz. 413 pp., illustrated. Reading, Mass., Addison-Wesley, 1993. $27.95. ISBN: 0-201-60867-7

“An important work combining psychology and anthropology, The Straight Path will be of profound interest to all those concerned with the essential nature of healing.” Given the current concern with health care and its costs, this dust-jacket endorsement appeals to all our hopes. But what is delivered against the promise?

Because I am a research scientist rather than a clinician, I cannot state with complete assurance what others might consider the essential nature of healing to be. Nonetheless, high on my own list of standards for any contemplated course of action -- experimental design, surgery, medication, counseling, or whatever -- would be the demonstrated efficacy of the indicated treatment rather than the mere interest of the subject matter. By extension, for the audience of a medical journal, the appropriate question should not be merely whether this book is entertaining, but whether physicians can find anything in it that would be applicable to their practices. To those who share my utilitarian premise, the central message in this review is straightforward: in the main, no.

The primary reason for the disappointing difference between promise and delivery is that the standards of clinical medicine and scientific research are not those of ethnography. Ethnography is the description of a culture or a subsystem of a culture, usually written by an anthropologist from the standpoint of a participant-observer. The Straight Path provides an ethnographic examination of the traditional portion of Fiji's health care system within two contexts. The first is Fijian social structure, particularly its traditional ceremonies, religious beliefs, and values; it was within this cultural setting that gaunisala dodonu, “the straight path” of Fijian spiritual healing, was studied by the author. The second context is the entire medical system in Fiji, which includes clinics equipped with basic first-aid items to manage infections, burns, wounds, and broken bones, as well as hospitals in major cities where detailed diagnoses and major surgery are undertaken.

As these two overlapping systems are described, it becomes clear that the author is sympathetic toward traditional Fijian spiritual healing and critical of Western medicine. These attitudes are apparent in one case study, the threads of which are woven through about 25 pages. The subject is Joeli, a young man whose problem evidently began with a bruised back from a fall while he was carrying coconuts in the bush. Joeli is first given aspirin and the recommendation of bed rest by a medical doctor, then massage and an emetic by a Fijian spiritual healer, then massage and medicine three more times specifically for vakatevoro (literally, “from the work of the devil”). Towels sufficiently hot to blister his legs are applied by his parents, a public healing ceremony is held by his father, and the diagnosis is changed by the traditional healer to vakavanua (violation of a sacred taboo). Finally, Joeli undergoes surgery in a hospital to remove a precancerous tumor exerting pressure on his spinal cord and thereby gains relief. Yet the author refers to “the failure of Western medical help” and laments the patient's isolation and loneliness in the hospital. Examples of this sort add a new dimension to the concept of the double standard.

The author has devoted much time to his subject and is evidently sincere and well intentioned. I also believe that he is wrong in both his diagnosis (that in industrialized societies health and development are deteriorating) and in his prescription (that if accepted by Western physicians, “the straight path is a dynamic healing system that can bring about effective social change”). To the extent that the straight path encourages physicians to be supportive and aware of their patients' emotional needs, it is unexceptionable and unexceptional. But if this message is embedded in a matrix that gives us no objective standards for a reliable differential diagnosis between vakatevoro and vakavanua, its acceptance outside Fiji is likely to be slow.

Robert B. Eckhardt, Ph.D.
Pennsylvania State University, University Park, PA 16802