The Soul of Care: The Moral Education of a Husband and a Doctor - Hardcover

Kleinman, Arthur

Hardcover

ISBN 10: 0525559329 ISBN 13: 9780525559320

Publisher: Viking, 2019

Synopsis

A moving memoir and an extraordinary love story that shows how an expert physician became a family caregiver and learned why care is so central to all our lives and yet is at risk in today's world.

When Dr. Arthur Kleinman, an eminent Harvard psychiatrist and social anthropologist, began caring for his wife, Joan, after she was diagnosed with early-onset Alzheimer's disease, he found just how far the act of caregiving extended beyond the boundaries of medicine. In The Soul of Care: The Moral Education of a Husband and a Doctor, Kleinman delivers a deeply humane and inspiring story of his life in medicine and his marriage to Joan, and he describes the practical, emotional and moral aspects of caretaking. He also writes about the problems our society faces as medical technology advances and the cost of health care soars but caring for patients no longer seems important.

Caregiving is long, hard, unglamorous work--at moments joyous, more often tedious, sometimes agonizing, but it is always rich in meaning. In the face of our current political indifference and the challenge to the health care system, he emphasizes how we must ask uncomfortable questions of ourselves, and of our doctors. To give care, to be "present" for someone who needs us, and to feel and show kindness are deep emotional and moral experiences, enactments of our core values. The practice of caregiving teaches us what is most important in life, and reveals the very heart of what it is to be human.

About this title

About the Author:

Arthur Kleinman, MD, is one of the most renowned and influential scholars and writers on psychiatry, anthropology, global health, and cultural issues in medicine. Educated at Stanford University and Stanford Medical School, he has taught at Harvard for over forty years. He is currently professor of psychiatry and of medical anthropology at Harvard Medical School and Esther and Sidney Rabb Professor of Anthropology in Harvard's Faculty of Arts and Sciences. Having spent decades doing field research in China and Taiwan, he is also a leading expert on East Asia, and was the Victor and William Fung Director of Harvard's Asia Center from 2008 to 2016. He is also the author of The Illness Narratives: Suffering, Healing, and the Human Condition, now widely taught in medical schools. He is a member of the National Academy of Medicine and of the American Academy of Arts and Sciences.

Excerpt. © Reprinted by permission. All rights reserved.:

One

Not much in my youth signaled a future of caregiving.

I never knew my biological father, Nathan Spier. Even as I write his name, I am unable to conjure a face or even a shadow. My mother, Marcia, ran away from him and from a marriage she couldn't tolerate, taking me with her, when I was one. I didn't know his full name or anything else about him until I was in my twenties, and even then, the subject remained radioactive enough in my family that I made no serious effort to find him. The mystery of my origins would haunt much of my young life. My own mother was unable to talk to me about my biological father and his family until she was in her sixties, and even then, she insisted that I should never meet him. A real estate developer, called the King of Bensonhurst as I later learned, he and his family had been involved in a scandal concerning illegal influence on the courts that resulted in the suicide of a judge. And to this day, that is all I permitted myself to know.

I grew up in a well-to-do Jewish family, in an economically and culturally mixed Brooklyn neighborhood. Our household, at least initially, consisted of my mother, my maternal grandparents, and me. My mother was a vivacious redhead (dyed) who loved the high life filled with nights out on the town, which she balanced with volunteer work in hospitals and for Jewish advocacy groups. She had the means to hire nurses and maids to look after me and, later, my brother. When she realized that I had played hooky from Hebrew school for several weeks, she assured me that I would indeed learn enough Hebrew to achieve my bar mitzvah, because she would not be denied the privilege of throwing a big party, as was expected in her circle. She made it clear throughout my childhood that I was to become a physician or a professor, or some other high-status professional whose intellectual achievements would add a patina of class and respectability to the family's financial success.

My mother was also high-strung and volatile. I never doubted her love, but at the same time, I found her emotionally untrustworthy. When my half brother came along, I never felt sure if her concern for me was as great as her worry about him. I sensed that she and the rest of the family saw me as more self-sufficient and able to look after myself. My stepfather would prove to be almost as much of a party animal as my mother, and their friendship networks included all kinds of colorful and sometimes slightly shady characters.

My mother was one of four daughters, but her father's clear favorite. It was for this reason that we lived with my grandparents. My grandfather, a proudly secular Jew of Russian background, had built a prosperous soap company and amassed real estate holdings. His business prospered in the 1930s and early '40s but went into precipitous decline in the postwar years.

My grandfather was, I imagine, typical for his times, but would seem totally out of place in the second decade of the twenty-first century. He was formal, distant, and authoritarian. He didn't express his love in words but in deeds, protecting and often defending me when neighbors and shopkeepers objected to my delinquent behavior. I remember one Saturday morning, when the Lubavitcher Rebbe, Menachem Mendel Schneerson, a monumental figure in the Hasidic Jewish community who had recently moved next door, took away the basketball I was dribbling and told me not to play on the Sabbath. It was my grandfather who retrieved my basketball from the Rebbe and admonished me to play with it outside every Saturday from then on. He was at the very center of the family-a loving paterfamilias-and he carried as an almost sacred duty the responsibility for our financial and social security. I admired my grandfather, and always felt secure under his protective wing but never felt emotionally close to him.

In contrast to my high-living mother, my grandmother was old-world, a poorly educated, superstitious, and increasingly paranoid matriarch who never left the house and who occasionally whispered to me that I came from an even richer family. Her mysterious mutterings only further confused and disturbed me, since she would stubbornly refuse to elaborate, no matter how hard I questioned her.

These older generations saw me as a willful, headstrong little boy, naturally resistant to authority. In the family's folklore, these traits were forged at birth, when I emerged from the birth canal with the umbilical cord wrapped tightly around my neck, blue and struggling to breathe. In their eyes, I was born a fighter, and it's fair to say that I did little to dissuade them from that notion as I grew up.

In 1943, when I was two years old, my mother absconded with me to Miami, so as to thwart my biological father, who was trying to use legal means to compel our return. (Apparently, Florida did not recognize New York State's marriage laws then.) For a while we lived across from a hostel for army and navy officers, several of whom took an interest in my mother. I remember asking each one plaintively but with hope, "Are you my father?" Perhaps this sense of loss and longing contributed more to my aggressive willfulness than any birth trauma I might have experienced. At any rate, my behavior got bad enough that my frustrated kindergarten teacher insisted my mother remove me from the classroom. "He only does things his own way," she complained.

My mother met the man who would become my stepfather during that brief sojourn in Florida. Peter Kleinman had played professional basketball and was a minor celebrity in his day. He was good-looking, friendly and charming, and admired by many. I admired him, too, when I was young. As I grew older, though, I could see that my grandfather regarded him as a failure in business and in his law practice, and with good reason. I think even my mother, who loved her new husband, came to share this view. I could feel my stepfather's love and concern for me-he was the man I saw as my dad-but I understood and accepted that he loved my brother, his natural son, more. Peter Kleinman would adopt me when I was twelve, changing my name from Arthur Spier (pronounced "Spear") to Arthur Kleinman, so that it felt as if I was starting out anew.

In the decade after my grandfather's death in 1958, during which time my stepfather stopped working, he and my mother together spent her entire inheritance. I didn't feel the loss of the family's financial security as deeply as the resentment, embarrassment, and maybe even shame over the irresponsibility of my parents, who had put the family-meaning my brother and me-second. This was quite the opposite of the example set by my grandfather.

My kindergarten teacher wasn't completely wrong about me. I remember an episode from around that same time, when I angrily informed my mother I was running away from home. When my mother opened the door I had so dramatically slammed on the way out, she found me sitting on the steps. I couldn't go any further, I explained, because I was not allowed to cross the street on my own! Clearly, there was something in my nature, even at this early time, which acted as a natural brake on my impulsiveness. I could be difficult, but I knew there were rules and directives that needed to be followed. And I was not so foolhardy as to do something that would cause me to injure myself. This fundamental awareness would keep me out of trouble time and again during my childhood, or at least it helped keep that trouble to a mostly manageable level.

Back in Brooklyn, I attended a public school four blocks from our house. Our Crown Heights neighborhood was a mainly Jewish enclave surrounded by Irish and Italian communities, where apartment blocks thrust their dark brick facades from between brighter rows of sturdy single-family houses. In the street, we boys played stickball or punchball, bought vanilla or chocolate cones from the ice cream truck, shot marbles, flipped coins, watched the girls play hopscotch, experimented with cigarettes, and fought with one another to see who was the toughest. Nobody bothered to hide their racism or anti-Semitism in the 1940s and early '50s, and I got into many fights on the streets outside our little enclave on account of being Jewish and unwilling, to a point anyway, to back down. But there must have been more than this at stake for me because I fought with Jewish boys too.

My life on the street from 1944 to 1953 contrasted sharply with the cushy existence at home, where we had a cook and a housekeeper and I never had so much as a chore to do. I was given to understand that I would always be financially secure and that the family would always take care of me-not exactly the best message to encourage my sense of responsibility and stewardship. I treated myself from childhood on with a carelessness that was surely compounded by my mother's distraction with a new marriage that had produced a new child. I neglected my health, as did most kids then, I suppose, and have suffered the consequences ever since, with dental problems, asthma, melanoma, and other ailments.

My neighborhood friends came from hardworking ethnic families, and most were not well off like mine. I spent my childhood with these tough working-class kids, instinctively understanding that the best way to survive the bullies and the street fighters was to become one of them. I learned to take care of myself, teasing, hassling, and abusing other kids just for the sport of it. I was becoming not just tough, but hard.

And yet that same instinct that kept me from crossing the street when I wanted to run away from home must have also tempered the worst of my behavior toward others. It was partly a nascent awareness of the need for self-protective boundaries, but also an awakening sense of the emotional and moral responsibilities of relationships. Around age ten or eleven, when girls started to come into focus, I developed a childhood crush on one in particular. But the conventions of courtship entirely escaped me. I think I must have believed that I had the right to help myself to whatever captured my fancy. At the end of the school day as we all left to walk home, I asked her if I could carry her books. It never occurred to me that I might be rebuffed, and when she said "No!" I impulsively grabbed the books and ran away. It took only a few moments to recognize I had done something shameful and for a hopeful suitor terminally unhelpful, so I returned her books with a burning feeling in my face and chest.

At the same age, an older boy in the playground tried to wrench my brand-new basketball from my hands. When I refused to let go, he banged my head repeatedly against the steel pole that supported the hoop. My head was bleeding, but I refused to cry in front of him or the other kids who had gathered around, or beg for the ball back. I ran home believing my dignity was still intact but bearing the wounds of battle. I wasn't angry about the injustice done to me; I was just burning for revenge. I would show I would not be trifled with or cowed. I would strike back. I had watched and learned. But all I had really learned is what every bully knows: you pick fights with those you can defeat and humiliate.

I came to the cynical understanding that beneath its orderly and proper exterior, it is a violent world without justice or goodness. I learned another brutal lesson, also not compatible with caregiving, in a fight with another aggressive boy who lived on the block. Following a minute of grappling and hitting, I locked my arms around his head and squeezed as hard as I could. He started to cry and begged me to stop. So I released my hold, only to have him crush my neck with a hammerlock that was so tight I couldn't breathe. I gave up, and he celebrated his victory by laughing at me. It would take me a long time to unlearn the lesson this particular beating taught me: to resist empathizing with my enemies, to take no pity, no mercy.

Every now and then, though, the light found its way through a crack in my armor. One summer when I was eleven or twelve, I had gone to a summer camp in upstate New York, where I joined with the other more rugged campers in making fun of a small, bespectacled boy who avoided sports and always carried a book around. But his surprising response to our teasing-arguing that he was becoming serious about intellectual matters-was so passionate, so mature, and yet carried lightly with a self-deprecating humor that I felt a respect and even admiration for him. This boy was also caring. When I got hit in the head with a softball pitch, he ran over to see if I was all right. I knew I liked him and what he stood for, which was so very different from the rest of my experience. I couldn't recall having felt that way before, except for the tough kids whose coarse behavior I emulated. I remember wondering if there might be a way to be like him and also still be myself. This was one of the first times in my life that I actually began to see that there was a part of me that wasn't being cultivated at all, and perhaps was even being stifled by my hard shell.

Yet even on those tough streets occasionally there was evidence that friends had your back, at least when you were threatened by "outsiders," such as kids from other neighborhoods, older kids who belonged to rival gangs, or the police. I remember a time when everybody knew about a big gang fight among high schoolers that was to take place in a park near my school. I was very excited and planned to go. Two of my friends prevented me from going, insisting that if I got involved, even as an observer, I was likely to get into more serious trouble. At a nearby movie theater for a Saturday matinee, a fight started several rows behind where I was sitting with friends. I started out of my seat to take a closer look at the action, but one of my classmates abruptly pulled me back by the collar of my jacket, saying, "Come on, they have knives. We are getting out of here!" Could we call these school chums and street friends a social network that functioned as a caring circle? If I had used words like these with them I doubtless would have been laughed at and ridiculed. But there was a kind of incipient care among us that held fast despite the otherwise brutal atmosphere of carelessness and violence. We shared a local world, and knew it, and we were learning how to care for one another.

About this edition

• Publisher: Viking
• Publication date: 2019
• ISBN 10: 0525559329
• ISBN 13: 9780525559320
• Binding: Hardcover
• Number of pages: 272