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Writing at the Margin: Discourse between Anthropology and Medicine by Arthur Kleinman (Berkeley: University of California Press, 1995), 314 pp., $40
Arthur Kleinman is professor of anthropology at Harvard University and chair of social medicine at Harvard Medical School. More than perhaps any other single figure, his work over the past two decades has helped to define the connection between anthropology and medical care. His first major work, Patients and Healers in the Context of Culture, was published in 1979. Since then, Kleinman has produced dozens of influential papers and authored, edited, or coedited some fifteen additional books. Much of this work has centered on health care practices in China, which continues to serve as a site of his fieldwork on patient/provider interactions and, arising out of this observational material, as a basis for theorizing on the complex relationship among clinical, cultural, and social/institutional processes.
Writing at the Margin is a kind of summa of Kleinman's impressive intellectual career. The first chapter provides a quite personal essay in which the author reviews elements of continuity and change in his orientation to the medical anthropology field. It is a fascinating and unusual introspection (whose tone reminded me of some of the thoughtful autobiographical writings of Robert Coles and the late Erik Erikson, no other socially attuned Harvard professors). Interestingly, over time, Kleinman finds himself becoming much more wary of "explanatory models" of patient and practitioner behavior, more engaged by richly individualistic case studies that convey the "lived experience" of illness and healing, and more inclined to explore the linkage between microclinical problems and macropolitical forces. In the remainder of the book are seven essays based more or less closely on writings Kleinman has published over the past five years, a lengthy review of the recent ethnographic literature in medical anthropology, and a bibliographic appendix of Kleinman's scholarly opus since the early 1970s.
Kleinman's general stance is that medical anthropology lies at the boundary between the humanities and the social sciences; psychiatric concerns occupy a peripheral place within biomedicine; and cross-cultural analysis intrinsically demands a perspective that can transcend (while taking most seriously) the mainstream values of any particular society. In all of these respects, as his title suggests, Kleinman finds his field to be "marginal," without...