Michael Stein is a professor of medicine, and the author of four novels (This Room Is Yours, The Lynching Tree, The White Life, and Probabilities). As a physician and as a writer, his goal in this book is to provide "the story of sickness as experienced by the patient" (14). The individual patient and her unique yet familiar story: Joanna with her unexplainable pain, Luke with his suspicious looking bump in the forehead, Leila with the post-surgical scar in her neck, Charlie with his advancing HIV disease. The narrative of Richard, the author's brother-in-law, weaves together the other four in this compelling and informative essay.

The concept of disease is not a simple one. Some authors have described it as a triad comprising "disease", "illness", and "sickness". The terms of this triad reflect professional, personal, and social perspectives and concern biological, phenomenological, and behavioral phenomena respectively. In this sense, the subtitle "how we experience illness" speaks of the concept of disease as perceived by the ill person, the subjective experience of the individual patient. Modern medicine has often forgotten this concept of "illness", focusing instead in the professional perspective of disease, and postmodernist critique has often focused on "sickness" (as in the early work by Foucault, who challenged the modern use of the terms "mad" and "mentally ill" as synonyms). Only after the rise of bioethics and the patient's rights movements in the 1970s, the critique of modern medicine has been directed at its ignorance of the patient's own conception of health. The work of Arthur Frank and others has given rise to a sort of "narrative bioethics", which brings about an epistemic and normative primacy of the concept of illness.

So what is illness? According to this book, illness is experienced by the patient as four complex feelings, namely: betrayal, terror, loneliness, and loss. "Betrayed by his own body, the terrified patient has lost the thread of the narrative of his life" (91), and the doctor's most difficult job is to help him recover or reinvent his story. Stein does not provide magic solutions, or a false sense that betrayal, terror, loneliness and loss can always be overcome. His final advice is to "pay attention" (220), something that writers and doctors must always be good at.

Stein aptly uses fine examples from contemporary literature, from fellow writers such as Lorrie Moore or Philip Roth, but does not provide the references of the works he quotes. After all, this is not an academic or scholarly book; it rather belongs to the genre of creative nonfiction, in the sense that it tells true stories but makes ample use of literary devices. But it is a little annoying to read sentences such as "sickness, it occurred to me, is a foreign kingdom" (10) without acknowledging Susan Sontag, who began with that very image her famous book on "illness as metaphor", two masterly essays which Stein quotes from later on (122-123). Still, this absence of critical apparatus might help keeping the tone of the book popular and accessible to a wide audience. This is important, since The Lonely Patient is a valuable book for healthcare professionals, but its main value lies somewhere else. With its technical skill, sympathetic perspective and easy reading, it will provide help and comfort to those patients who are betrayed, terrified, lonely, and lost–a group that, sooner or later, we all might eventually join.

© 2007 Antonio Casado da Rocha

Antonio Casado da Rocha is a researcher in bioethics at the University of the Basque Country, Spain.

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