Tuesday, July 3, 2007

Book Review: The Spirit Catches You and You Fall Down

a) Problem #1
I have a problem with the line of argument that shows how sterile and clinical (in the sense of cold and unfriendly) modern medicine is in contrast to the wonders and amazing sensitivities of tribal medicine. Though she is not over aggressive about it (which I appreciated), Anne Fadiman returns to this again and again. <>

I have two main problems with this line of argument.

The first problem is that the comparisons are completely unfair. In one system the person gets good medical care and poor social experience, and in the other system the person gets a great social experience and NO medical care. Attributing an illness to a cave dwelling spirit is not medicine. <> So there is no way to compare the two experiences. Just because both deliverers are called "healers" does not make them actually comparable.

Secondly, it would be nice if someone could design a new system where doctors and other care givers spend much more time with their patients. But in fact there is a system like that and we live in it today. Any doctor could spend as much time as she wants with each patient. But where would that time come from? Already every resident, GP, and specialist out there works his or her guts out to treat as many people as possible and there are tens of millions of people who get no care at all. Have you ever had to see a specialist and waited nervously behind a massive waiting lists for months? And then waited again to get a treatment? Would you triple that wait time if you got triple the face time when you were finally seen? What decision would you make if you were the doctor?

Don't get me wrong, it's a nice book, and it's nicely written. Anne Fadiman bends over backwards to showcase the dedication of the doctors and the roadblocks thrown in their way by the parents.

b) Problem #2
But my other real problem with the book is that so far (p 60) there isn't a story, just a setup. The girl comes in, the doctors try to treat her, the parents thwart. OK, after 60 pages of that what next? Do I have to read 300 pages? I already get it.

c) Appeal
I think part of the appeal of the book is that it is a window into what we all want to see: a glimpse of the pre-industrialized society. Usually you think of the deep bush in Africa, or some polynesian island that has never been discovered or mapped. And in fact here we get a titilating glimpse into a society where a woman will bear 14 children and deliver them herself silently so as not to wake the sleeping children in her one room hut. Where people talk about spirits and ghosts without self consciousness. Where death is so prevelant that nobody mourns the passing of their own children. And then to transpose them directly into the most advanced society ever seen on earth, well, that's just amazing.