Book Review

Sickness and Healing: An anthropological perspective

N Engl J Med 1995; 332:1722-1723June 22, 1995

Article

Sickness and Healing: An anthropological perspective
By Robert A. Hahn. 325 pp. New Haven, Conn., Yale University Press, 1995. $30. ISBN: 0-300-06088-2

Sickness and Healing is a book with a mission. Robert Hahn, an epidemiologist and anthropologist, intends to persuade his readers of the importance of incorporating an anthropologic perspective into the practice of biomedicine. Through theoretical discussions and practical examples, the author argues for the inclusion of sociocultural phenomena in medical epistemology and practice as a means of redressing the exclusion of patients' emotional experiences, social circumstances, and cultural influence.

The book includes a broad array of relevant topics and discussions. Information and analyses of specific theoretical debates are presented as compact subsections within larger sections. This format lends itself to the teaching of a comprehensive, if not in-depth, course on medical anthropology appropriate for medical students and other medical care providers. There are discussions of topics such as the definition of sickness, “culture-bound syndromes,” infant mortality rates, and physicians' experiences as patients. The author proposes that “anthropological” medicine be practiced instead of biomedicine in its present form.

Hahn takes on the anthropologic notion of “culture-bound syndromes,” illnesses that have no discernible physiologic source. He argues for the independent existence of socioculturally caused sickness by suggesting that the causes of all sickness are both biologic and cultural. Therefore, all illness is culture-bound. A valuable section on the effect of sociocultural influences on low birth weight emphasizes the contribution that anthropology can make to this perplexing sociomedical problem.

To argue further for integrating the patient's personal experience into medical practice, Hahn includes a chapter on physicians' responses to their own illnesses and how they came to recognize the importance of individual experience in treatment. Hahn thereby underscores his view that the patient's subjective experiences should be incorporated into medical practice and theory.

Hahn's attempt to reconcile the theoretical foundations of anthropology and epidemiology seems somewhat forced. He suggests that the two disciplines, conventionally viewed as starting from opposing premises — epidemiology is seen as objective and anthropology as subjective — in fact cover common ground. Despite differences in the problems under study, the sources of data, and methods, Hahn insists that the logic of the two disciplines is similar. He cites the formulation of hypotheses by anthropologists and recognition of contextual influences on sickness by epidemiologists as central similarities. Ultimately, Hahn's argument seems unnecessary. Surely, anthropology and epidemiology might profit from integration and a broadening of method and practice without the need to posit similarities of logic where there appear to be none.

Having argued for a similarity in the logic of anthropology and epidemiology, Hahn proceeds to analyze low birth weight among African Americans, using both epidemiologic and anthropologic perspectives. This choice is a good one. It illustrates what each of the two disciplines contributes to our understanding of a complex and disturbing problem, and it serves as a powerful means of expressing the benefits of looking at sickness and healing from both sociocultural and biomedical perspectives.

To further his argument for integration, Hahn suggests that anthropology is almost exclusively founded on investigations of subjective states. He thus omits important aspects of medical anthropology, many of which include what he would term objective factors. On the other hand, he fails to make sufficiently clear the fact that epidemiology is not a laboratory science and does not lay claim to determining causation, but rather describes associations between outcomes and posited causes, thereby suggesting but not proving causation.

Anitra Pivnick, Ph.D.
Montefiore Medical Center–Albert Einstein College of Medicine, New York, NY 10467