Abstract
In this article, the author examines the undervaluation of caregiving—taken to be the day-to-day provision of material and emotional support necessary to enable life and alleviate suffering—in contemporary biomedical training and practice. Taking a crosscultural approach, the author highlights the institutional structures, practices and values that support an increasingly technocratic and bureaucratic model of care in biomedicine as it is organized in China and the United States. Drawing from personal experience as caregiver to his wife, who suffers from Alzheimer’s disease, as well as from ethnographic research into local moral experiences of illness, suffering and healing in varied contexts, the author shows that this biomedical model of care fails to attend to the basic, socially grounded conditions, needs and concerns of—that which matters most to—patients and their loved ones as they suffer, endure and confront the genuine existential reality of the human condition. The author concludes that caregiving, or recognizing and addressing those conditions, needs and concerns that shape suffering and illness experience, must be a central component of training and practice if clinicians are to realize a more humane, just, and ethical model of biomedicine. He points to the success of global health leaders who simultaneously address the local biological, socio-structural and cultural facets of suffering among the world’s poorest to illustrate what can be accomplished when biomedical practitioners implement the caregiving model.
Similar content being viewed by others
References
This essay builds on work by medical social scientists and humanists as well as critical theorists and practitioners of medicine. Cited references and other salient publications include:
Alterra, A. (2008). The caregiver: a life with Alzheimer’s. Ithaca: ILR.
Brandt, A., & Rozin, P. (Eds.). (1997). Morality and health. New York: Routledge.
Applewhite, J. (1986). Modernism and the imagination of ugliness. The Sewanee Review, 94(3), 418–439.
Biehl, J., Good, B., & Kleinman, A. (Eds.). (2007). Subjectivity. Berkeley: University of California.
Bourdieu, Pierre (Ed.). (1993). La Misére du Monde. Paris: Editions du Seuil.
Brombert, V. (1999). In praise of antiheroes. Chicago: University of Chicago.
Canguilhem, G. (1991). The normal and the pathological. New York: Zone.
Cassell, E. J. (1991). The nature of suffering and the goals of medicine. New York: Oxford University.
Coakley, S., & Shelemay, K. (Eds.). (2007). Pain and its transformations. Cambridge: Harvard University.
Dugger, C. (2003). Rural Haitians are vanguard in AIDS battle. New York Times, Nov. 29, Americas section.
Farmer, P. (2005). Pathologies of power. Berkeley: University of California.
Fei, W. (2010). Suicide. In Deep China, ed. Arthur Kleinman et al., submitted for publication.
Feng, X., Luo, B., & Zhang, H. J. (2008). Placing elderly patients in institutions in urban China. Research on Aging, 30(5), 543–571.
Good, B. (1994). Medicine, rationality and experience. Cambridge: Cambridge University.
Horwitz, A., & Wakefield, J. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. New York: Oxford University.
Joseph, A. E., & Phillips, D. R. (2004). Aging in rural China: impacts of increasing diversity in family and community resources. Journal of Cross-Cultural Gerontology, 14(2), 153–168.
Kim, J., et al. (Eds.). (2000). Dying for growth. Monroe: Common Courage.
Kleinman, A. (1980). Patients and healers in the context of culture. Berkeley: University of California.
Kleinman, A. (1988). The illness narratives. New York: Basic.
Kleinman, A. (2007). Today’s biomedicine and caregiving: Are they incompatible to the point of divorce? University of Leiden: Cleveringa Lecture, Nov. 26.
Kleinman, A. (1995). Writing at the margin: discourse between anthropology and medicine. Berkeley: University of California.
Kleinman, A. (2006). What really matters: living a moral life amidst uncertainty and danger. New York: Oxford University.
Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Medicine, 3(10), 1–4.
Kleinman, A., Das, V., & Lock, M. (Eds.). (1997). Social suffering. Berkeley: University of California.
Leininger, M. M. (1984). Care: The essence of nursing and health. Detroit: Wayne State University.
Leung, J. C. B. (2003). Family support for the elderly in China. In D. Cheal (Ed.), Family & gender issues (pp. 342–354). London: Routeledge.
Levine, C., & Murray, T. H. (2004). The cultures of caregiving: Conflict and common ground among families, health professionals, and policy makers. Baltimore: Johns Hopkins University.
Li, X., et al. (2006). Health indicators and geographic mobility among young rural-to-urban migrants in China. World Health and Population, 8(2), 5–21.
Lim, L. (2006). Stem-cell therapy in China draws foreign patients. Morning Edition. National Public Radio, March 8.
Lipkin, M. (1987). Care of patients: Perspectives and practices. New Haven: Yale University.
Lock, M. (1993). Encounters with aging. Berkeley: University of California.
Partners in Health. (2006). The PIH model of care—partnering with poor communities to combat disease and poverty. http://www.pih.org/what/PIHmodel.html.
Peabody, F. W. (1984). The care of the patient. Journal of the American Medical Association, 252, 813–18.
Petryna, A. (2007). Life exposed. Princeton: Princeton University.
Petryna, A., Lakoff, A., & Kleinman, A. (2006). Global pharmaceuticals. Durham: Duke University.
Roach, M. S. (1955). The human art of caring: a blueprint for the health professions. Ottawa: Canadian Hospitals Association. 1987.
Rogers, D. (1986). The early years: the medical world in which Walsh McDermott trained. Daedalus, 115(2), 1–18.
Rosenberg, C. (2007). Our present complaint: American medicine, then and now. Baltimore: Johns Hopkins University.
Saunders, J. (2000). The practice of clinical medicine as an art and as science. Journal of Medical Ethics: Medical Humanities, 26(18–22), 55.
Simon, L. (1998). Genuine reality: A life of William James. Chicago: University of Chicago.
Smith, C. (2001). Doctors worry as americans get organs from Chinese inmates. New York Times, November 8.
Spiro, H. et al, eds. (1993). Empathy and the practice of medicine. New Haven, CT: Yale University Press.
Talbott, J. E. (1997). Soldiers, psychiatrists, and combat trauma. Journal of Interdisciplinary History, 27(3), 437–454.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is a revised version of the Cleveringa Lecture I delivered at University of Leiden in November 2007.
Rights and permissions
About this article
Cite this article
Kleinman, A. Caregiving: Its Role in Medicine and Society in America and China. Ageing Int 35, 96–108 (2010). https://doi.org/10.1007/s12126-010-9054-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12126-010-9054-3