The Renewal of Generosity: Illness, Medicine, and How to Live contemplates the phenomenon of generosity as it is realized in the stories of physicians and patients.  For Arthur Frank, generosity is grounded in the willingness of people to give themselves over to dialogical processes of communication wherein participants best realize themselves through relational engagement: generous, dialogical communication leads to a renewal and realization of human being. Health care systems today tend to impede communicative generosity, however, and the result is a de-humanization and de-moralization of both physicians and patients.  As a remedy, Frank proposes, first, that we re-figure our conceptualization of the physician-patient relationship—from the economic or business metaphor of “provider” and “client,” we should turn to the metaphorical conceptualization of “host” and “guest,” which clearly has implications for manner of treatment and communication that occurs in the relationship.  In addition, Frank turns to and thinks with stories of physicians and stories of the ill to reflect on the ways that generosity is realized.  Drawing on the wisdom of the striking philosophical triumvirate of Marcus Aurelius (Stoicism), Mikhail Bakhtin (Dialogism), and Emmanuel Levinas  to amplify the reflections emerging from the physician and patient stories, Frank ultimately proposes “exercises” for training to generate a vivifying generosity within the medical profession, which can in turn lead to a re-humanization and re-moralization for physicians, improved care for patients, and enhanced flourishing for all.


In my view, this book is a generous demonstration of mentorship that I am delighted to include as a dimension of the professional identity formation I seek to promote in my medical students.  By means of rich and moving stories, Frank shares with his readers a deep concern over communicative inadequacies rampant in medicine, as well as his concern over the de-humanizing, de-moralizing impact of these inadequacies. His approach is to construct a “reflecting team”—a persona composed of Marcus Aurelius, Mikhail Bakhtin, and Emmanuel Levinas—which he names the “Dialogical Stoic.” From this persona, he draws philosophical and literary insight in order to read well and think with stories of physicians and patients, discern the generosity demonstrated in those stories, and discover, through them, a way out of the debilitating tunnel we’ve created for ourselves.  In the process of our shared reflection, we also encounter one of the more appropriately sophisticated and helpful accounts of empathy that I’ve come across.  This and the culminating “exercises” for “training” in the development of generosity are invaluable for the project of professional identity formation, in my view—as is the generous mentorship, overall, of Arthur Frank in his offering of this book.


University of Chicago Press

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