Diagnosis Narratives and the Healing Ritual in Western Medicine

Book Title: Diagnosis Narratives and the Healing Ritual in Western Medicine

Book Author: James P. Meza

Publication Information: New York, Routledge, 2019, 258 pp., $140, hardcover

Anthropology meets medicine in cultural anthropologist and family physician James P. Meza’s treatise, Diagnosis Narratives and the Healing Ritual in Western Medicine. Through the pages of this tome, Meza, an educator and clinician, attempts to tackle the research question, “What is healing?”

The book reads as a qualitative research study and is divided into sections accordingly. The beginning chapters of the work define the study question and methods. Later chapters go on to detail the author’s theoretical framework; this is interspersed with various narratives describing the author’s observations of interactions (eg, physician patient, physician-physician, physician-staff, etc) and conclusions resulting from these observations. Reader beware: there is potential to become lost in a whirlwind of anthropologic jargon. Students of anthropology will perhaps find this section clarifying, but the novice reader should be prepared to externally define the unfamiliar terminology.

An initially identifiable shortcoming of the book is that the intended audience is not explicitly mentioned until the final chapters of the work. Furthermore, the question arises as to the generalizability of the author’s findings to multiple clinical settings, since the study takes place in a urology and an oncology practice. For example, the author notes spatial cognition (reviewing images) was more essential than verbal elements (conversation with the patient; p 65), and that doctors decided the diagnostic narrative (plan) before even seeing the patient based on these (p 75). Perhaps this is true for a particular subspecialty but likely does not apply to most primary care patient encounters. The author notes these practices were selected for methodology purposes but does not go on to further explain just what this means.

In the quest to define healing, there is first an attempt to define “doctor.” The author surmises during his initial field work, “the doctor" is actually a group of people working in a highly coordinated fashion toward a unified goal: patient care” (p 57). As I find this supposition philosophically flawed, I found this to be an unfortunate frame for the remainder of the work. In ensuing chapters, the author identifies two prominent narratives. The purveyor of the diagnostic narrative (etiology of disease [p 108]) is identified as the physician while the illness narrative (recounting a life story [p 113]) belongs to the patient. The author concludes that the input of the patient is actually unnecessary to make a diagnosis (p 77), again a supposition I find to be not particularly applicable to primary care.

After establishing the diagnostic narrative, the author goes on to explore the “universality of ritual healing.” The middle of the book finally began to capture my attention—through its exploration of the idea of the ritual across cultures. Ritual theory notes that a healing ritual must have a “socially sanctioned healing agent, a sufferer who seeks relief, and a healing relationship” (p 116). The interaction of the healer and the sufferer is, therefore, necessary for the ritual of healing to take place, and indeed, this makes sense when considering the nature of the physician-patient relationship. He then goes on to identify the trigger for the initiation of the healing ritual ie “the existential threat of disease and death” (p 130). Thereafter, the survival of the healing ritual is noted to be predicated upon cultural replication, ie, the socially sanctioned leech (doctor) teaches the apprentice (students and residents), noting this represents what appears to be a “ritual within a ritual” (medical training occurring concurrently alongside the healing ritual; p 136).

By the end of the book, I finally realized that this work is primarily aimed at the anthropologist rather than the clinician. Through this study, the author attempts to reframe current perception of the Western healing ritual. He notes that anthropologic work on this topic to date creates observation and sampling bias and also fails to address important topics such as the doctor as healer, the existence of suffering due to the human condition, and the collaborative (rather than competitive) nature of the doctor-patient relationship.

If you are searching for an anthropological treatise that explores the theoretical foundation of the Western healing ritual, then look no further. However, if you are looking for some light reading describing the healing relationship, this book is probably not for you. At $140, this slim volume is probably best used as an anthropologic reference rather than as a part of your personal library.