- What Really Matters: Living a Moral Life Amidst Uncertainty and Danger
Arthur Kleinman has been pre-eminent in advancing the mutual relevance of medicine and social science since his 1980 book, Patients and Healers in the Context of Culture. Kleinman's strategic use of his Harvard positions in both social medicine and anthropology and his editorial work, notably the 1997 Social Suffering collaboration with Veena Das and Margaret Lock, have created an agenda for suffering as a social-scientific research topic. In What Really Matters Kleinman refines the writing style that made his 1988 book, The Illness Narratives, so widely accessible and influential. What Really Matters is a capstone work not only because it distills the core of Kleinman's thoughts about lives, morality, and suffering but also because the book's autobiographical aspects show the integration of Kleinman's own life with his scholarship.
Each of the book's chapters presents what might be called a literary oral history—not literal transcriptions but artful re-creations from clinical notes and memory—of the words and stories of six people whom Kleinman has known either as patients, research participants, or personal mentors. A seventh life history is about the physician and anthropologist W. H. R. Rivers, who is best known for having treated poet Siegfried Sassoon during World War I. Rivers had a distinguished research career as a neurologist, and his ethnographic fieldwork was influential in shaping British anthropology. His story stands out from the others because Kleinman did not know him personally, yet Rivers's life and commitments provide the gravitational center to the moral [End Page 564] lessons of the other chapters. Rivers is Kleinman's idealized alter ego for his life project: "remaking the self as moral and political agent" (213) through a variety of scholarly interventions.
In most books intended for sales beyond academic readership, the subtitle is a marketing device. Kleinman's subtitle is a perfectly concise description of what his book offers: stories of how people live moral lives amid the uncertainties and dangers of war, disease, and both third-world and first-world inequalities. However useful Kleinman's analytic ideas are, what counts is how close his stories take us to lives lived in "gray zones where the separation between acts that sustain a moral life and inhuman ones that destroy it is thin" (17). The dangers faced in these lives at first seem extreme, but increasingly the reader realizes how often life is that dangerous.
The characters in Kleinman's stories are impaired by different combinations of illness and traumatic injury—more significantly the latter—and face moral crises of how to respond to a world that inflicts such injuries. In The Illness Narratives and his writing since, Kleinman has insisted on the word moral, which most social scientists would prefer to bypass. Life is necessarily moral, for Kleinman, because humans act based on what they realize matters—what really matters—in conditions of danger. The stories are suspenseful because the protagonist is often surprised at what does matter. One story tells of a Chinese physician, Dr. Yan, whose life and family were destroyed during the Cultural Revolution. When political times change, Yan regains influence and is encouraged by his colleagues to send the physician who denounced him to the distant provinces, where, Yan knows, the harsh conditions of life will kill his adversary. Yet at the moment when Yan must speak, he proposes instead that all the physicians rotate through the rural practice so that no one suffers unduly.
Kleinman refuses the sentimental version of this story as a moral victory of forgiveness over retribution. The physician who is not sent away continues to undermine the career of the man who chose to spare him, and that contributes to Yan's eventual emigration to the United States. Looking back on his life, Yan perceives his actions as a defeat. "And yet," Kleinman writes, "his own defeat . . . signifies for me the survival of aspiration for something finer and better that remoralizes the...