The Renewal of Generosity: Illness, Medicine, and How to Live
Although one might expect a book about generosity in medicine to involve a discussion of charity in health care, Arthur W. Frank engages the reader as a person who might alternatively be a patient or a physician. The Renewal of Generosity is about a seldom-discussed virtue; its subtitle, Illness, Medicine, and How to Live, defines its context and intent. The book offers no recipes or rules for living but engages the reader in a set of exercises that draw on a wide range of writers to show how generosity and gratitude are central features of any ethically sound practice of medicine. This reflection is starkly honest and never pedantic or condescending. Not only is it rich with both clinical and psychological detail, but it is filled with sensitive portraits of the complexities of meaning involved in the care of patients. Frank's mode of presentation is dialogue, which is more than a literary or sociological technique. It serves a methodologically effective function of engaging the reader in a project about the complexity and importance of generosity as a way of living with others. Although dialogue is the central theme, Frank clearly shows that verbal communication is just one form of the complex interactions that define what caregiving involves. Dialogue emerges in the empty space between two people. This empty space is an essential condition that medicine, with its technical and scientific mastery, cannot erase. Dealing with this condition demands an imaginative response that far exceeds the typical themes in common treatments of communication between physicians and patients. Frank rightly understands that communication gains its importance not in achieving a technical mastery, such as accurate conveyance of information, but in educating one to face difference, frailty, and limitation. Through a rich telling of stories and reflection on them, Frank conducts a complex symphony of ideas about medicine with writing from a wide range of authors that models how readers might enact and experience the complex, subtle meaning of generosity and gratitude in their own practices. Anchored in the context of contemporary medicine, this book is more about how one ought to live when facing the limits of action, communication, and understanding than it is about any topical issue. Through open engagement with another human being, generosity and the sometimes frightful situations that call it forth are revealed not only in complex clinical situations and actions (including avoidances), but also in the acts of speech that make up and surround caregiving relationships. Although it is accurate to say that this book is about communication, it is communication at a level that is seldom broached in the most common technical discussions. As Frank sees it, the world of physician and patient is not so much silent or filled with complex messages between sender and receiver as it is full of a nearly unspeakable meaningfulness that can help us to learn how to be better caregivers and how to live with others. Frank more often shows, rather than tells us, what must be done. He is not content to capture or express multifaceted acts of kindness or compassion but, rather, shows in dialogue how to live better. It is accurate to say that this book is brilliant, but its light shines more with subtle twinkles than with dazzling flashes of insight about the meaning and the value of generosity and gratitude in medicine. Physicians should rush to read this book, and I hope that patients will join them, because their partnership is unavoidable.George J. Agich, Ph.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.--This text refers to theHardcoveredition.