The Nature of Suffering underscores the change that is taking place in medicine from a basic concern with disease to a greater focus on the sick person. Cassell centers his discussion on the problem of suffering because, he says, its recognition and relief are a test of the adequacy of any system of medicine. He describes what suffering is and its relationship to the sick bodies do not suffer, people do. An exclusive concern with scientific knowledge of the body and disease, therefore, impedes an understanding of suffering and diminishes the care of the suffering patient. The growing criticism that medicine is not sufficiently humanistic does not go deep enough to provide a basis for a new understanding of medicine. New concepts in medicine must have their basis in its history and in the development of ideas about disease and treatment. Cassell uses many stories about patients to demonstrate that, despite the current dominance of science and technology, there can be no diagnosis, search for the cause of the patient's disease, prognostication, or treatment without consideration of the individual sick person. Recent trends in medicine and society, Cassell believes, show that it is time for the sick person to be not merely an important concern for physicians but the central focus of medicine. He addresses the exciting problems involved in such a shift. In this new medicine, doctors would have to know the person as well as they know the disease. What are persons, however, and how are doctors to comprehend them? The kinds of knowledge involved are varied, including values and aesthetics as well as science. In the process of knowing the experience of patient and doctor move to center stage. He believes that the exploration of the person will engage medicine in the 21st century just as understanding the body has occupied the last hundred years.
This book raises some vital points about the important of physicians treating people rather than just their bodies or the diseases they have, and interesting philosophical discussions of suffering. The summary of the history of medicine and of medical philosophy is also excellent, and there are lots of patient stories that make it clear the author is a dedicated and caring physician. But not all of the author’s philosophical discussions are well explained, he seems to particularly disagree with the approaches of psychologists to making medical decisions, and he takes some little digs at people opposed to abortion and assisted suicide that didn’t really seem warranted by the rest of the discussions in which they appeared. Also, the writing — or more so, the copy editing — was surprisingly sloppy in a couple of chapters. So it was a good and thought-provoking book, with lots of good suggestions for further reading, but it wasn’t as great as the recommendation I’d gotten had suggested.
This book articulates important and enduring concepts for the practice of medicine. Most of all, it challenges the "either/or" paradigm in which the science of medicine roundly trumps the art of medicine by offering a robust defense of a "both/and" paradigm with the patient at the center of practice. It reminds clinicians of the noble goals with which we entered medicine, and enriches our understanding of what those goals mean.
Although Cassell illustrates his analysis with lots of stories, at times it is quite thick with abstract concepts. Nonetheless, he states them clearly and provides ample opportunity to digest them. I have read few better discussions of personhood, the threat of illness to personhood, the difference between illness and disease, and why medicine should aim above all to treat illness, promote function, and relieve suffering.
The two central issues in the book that I would like to discuss and expand upon are: his view of PERSON rather than the mind/body dualism we see too often and his view of meaning which is central to how he views suffering. An outstanding book.