Book Book

Illness and Culture in the Postmodern Age

BMJ 2000; 320 doi: (Published 08 January 2000) Cite this as: BMJ 2000;320:125
  1. Iona Heath, general practitioner
  1. Kentish Town, London

    David B Morris

    University of California Press, £17.50, pp 360

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    ISBN 0 520 20869 2

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    The postmodern view of our world is simultaneously terrifying and liberating. By the start of this century, the great explanation of religion, promising perfection in an everlasting life after death, had given way to the big utopian political visions, which promised a perfect society in this life. Through the middle part of the century, these visions were inexorably corrupted into monstrous dystopias, and now, in our postmodern world, the resulting disillusion has fostered a deep distrust of all comprehensive explanations of, and solutions to, the human predicament. The notion of absolute truth has given way to an acceptance of multifaceted truths and the legitimacy of a range of approaches to the same problem. This challenge to the big explanations enriches our understanding but shakes our security. Patterns dissolve, leaving us bewildered and disorientated but with seemingly endless possibilities of creating new patterns and finding new truths and new ways of relating to the world, each other, and ourselves.

    The central thesis of David Morris's fascinating book is that illness is a mental, emotional, and bodily event constructed at the crossroads of biology and culture. He argues that, as our culture changes, so must our view of illness, and that the postmodern gaze introduces both new terrors and new freedoms into the arena of health and health care. Many of the terrors seem to arise from our undiminished yearning for perfection. The focus has simply shifted from society to the individual and from the soul to the body. Our obsession with the utopian body makes anorexia nervosa a quintessentially postmodern illness and, more broadly, fuels a fear of illness and disease that is out of all proportion to the unprecedented health and longevity enjoyed by those in the developed world. Biomedical science clings to the wreckage of an all embracing, essentially modernist explanation of the human experience of illness and disease, while simultaneously promising much more than it can deliver. If the explanation aspires to be comprehensive, it follows that death will come to be seen as a failure of science, and ultimately the desperate excesses of medical intervention drive the calls for legalised euthanasia.

    Biomedical research, with its insistent prioritisation of the methodologies of the randomised controlled trial and frequentist statistics, perpetuates the notion of absolute truth. But in a postmodern world all generalisations, all categories, and all classifications are open to challenge, and slowly this new perspective is infiltrating medicine. The doctor's claim to knowledge of objective fact is challenged by the immediacy of the patient's subjective experience. Insights from anthropology, sociology, philosophy, psychology, and poetry challenge the medical annexation of truth and profoundly alter our understanding. Each discipline uses words in a different way, and so each can contribute to reducing the dimension of suffering and pain that remains beyond language. Healing must always seek to give voice to suffering, and the greater the range of words and meanings we have at our disposal, the clearer the voice becomes.

    Morris eschews a conclusion as being incompatible with the open ended nature of the postmodern view, and a summarising book review may be a similarly suspect endeavour. Perhaps all I can say is that my view of the world, and my work within it, is more complex, and my life proportionately richer, for having read this book.


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