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Book Review   |    
Evolution of Sickness and Healing
David J. Lynn, M.D.
Psychiatric Services 1998; doi:
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by Horacio Fàbrega, Jr., M.D.; Berkeley, University of California Press, 1997, 382 pages, $45

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Any prospective reader should keep clearly in mind what this book aims to accomplish. It is best described by the author, a professor of psychiatry and anthropology, in the ninth chapter: "to provide a frame of reference and a methodology for conceptualizing the evolution of medicine." Later he acknowledges, "The evolution of sickness and healing has been handled with main emphasis given to the hypothetical conduct of key participants in this enterprise."

Note that this is social science theory—not a historical narrative or series of vignettes, nor a historical analysis—and it is indeed very hypothetical in its treatment of issues. As such, it will be of much more interest to social scientists than to practitioners, historians, or other academicians.

Most valuable is a central idea: that the best way to consider the evolution of sickness and healing is to treat these two aspects of human experience as inextricably linked. Social and biological evolution can then be seen as continuously shaping and reshaping this pair. The author deals with six levels of "prototypical social organizations," from family-level and village-level societies to postmodern societies. I found the hypothetical discussions in these categories disappointing; more specific illustrations of actual practices, relationships, concepts, and activities encountered in the societies would have been more interesting and also more convincing. The author makes many references to sociological and anthropological studies of particular societies, but without excerpting details. Only a reader who already has command of these sources will know how to consider them.

Some passages resist comprehension. Consider this one: "The psychosomatic/somatopsychic capacity to medicalize conditions of distress and suffering in different ways and with different emphases may be held to reside in the way members of a society have come to operationalize, using cultural knowledge, the biologically innate information that leads to the formation and expression of the SH adaptation." Or, "Political economic factors have seductively seized on existential imperatives devolving from the curing/elimination emphasis that biomedicine has itself derived from the SH adaptation."

An additional weakness throughout Evolution of Sickness and Healing occurs when the author proposes theoretical generalizations and postulates without describing or discussing alternatives and without suggesting further studies that might validate his proposals.

Anyone interested in social science theory will find this book relevant and will be stimulated to debate the pros and cons of the author's ideas, but other readers may not find that the substantial effort required to read it will be adequately rewarded.

Dr. Lynn is director of psychiatric residency training at St. Francis Medical Center in Pittsburgh.

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