Shweder Social Origins of Distress and Disease . Arthur Kleinman

Social Origins of Distress and Disease (henceforth Social Origins) is the most important book to be written in medical anthropology in a long time. The book is stimulating, passionate, sophisticated, balanced and theoretically up-to-date. It sets out an inspiring agenda for the anthropological study of suffering. It raises profound questions about psychic and physical pain, spiritual embodiment and somatization, and about the possibilities of cross-cultural understanding and translation of the subjective states of the "other." It entertains the view that forms of suffering vary across cultures and historical epochs. It advocates a holistic, dialectical, interactionist view of the interrelationships between mind-body-society-culture-nature. It advances a socio-political causal ontology of loss, defeat and social injustice for the explanation of suffering (angst and amines make room for oppression; ego isolation and neurotransmitters make room for adverse social conditions), inevitably leading the thoughtful reader to consider the range of causal ontologies or theodicies (bio-medical, moral, socio-political, interpersonal, psychological, etc.) that might get invoked, and are invoked in different regions of the world, to define the circumstances of suffering. In the context of a recent Current Anthropology treatment of Social Origins Kleinman (1986b: 508) has called on anthropologists to develop a "forceful cultural critique and a more complex anthropological alternative to the current paradigm of social epidemiology." Social Origins presents just such a cultural critique and complex alternative. Everyone should read it carefully and come to terms with its crafted complexity. One central theme in Social Origins is the evaluation of claims on behalf of neurasthenia and depression that they be designated illness experiences and/or disease entities. Like much of the book the exegesis is brilliant and complex, a stimulating and fluctuating evaluation by a master of dialectics and interactionism, trying in the name of the virtues of holism to do the best that can be done with that now famous, ambiguous, polysemous and shaggy distinction between illness and disease. In this review essay I hope to open a critical dialogue about the usefulness of the polysemous illness/disease distinction as an analytic tool in the crosscultural study of suffering. I have some doubts.