Portal de Periódicos da CAPES

Book reviews

2004; Wiley; Volume: 26; Issue: 5 Linguagem: Africâner

10.1111/j.0141-9889.2004.00410.x

1467-9566

Hip and Femur Fractures

Sociology of Health & IllnessVolume 26, Issue 5 p. 667-677 Free Access Book reviews First published: 29 July 2004 https://doi.org/10.1111/j.0141-9889.2004.00410.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Pain: Passion Compassion Sensibility . A Wellcome Trust Exhibition at the Science Museum, 13th February to 20th June 2004. http://www.wellcome.ac.uk/pain . Curator: Javier Moscoso . Catalogue (including a CD-ROM) ISBN: 1 841 29 050 5 . £2.00 In reviewing this exhibition and its accompanying catalogue (made up of a small glossy booklet containing a CD-ROM), you should be warned that you will not yourself be able to view the exhibits described. The exhibition, on view until June 20th at the Science Museum, is the fourth in a series of five put on by the Wellcome Trust. The catalogue material for this and the other exhibitions in the series is available through the Wellcome Trust website. The complex somatic, psychic and spiritual sensations and stimuli of the subjectivity of pain and the role of culture in producing its meaning have been staked out for sociological interest. The boundaries where scientific expertise, capitalist interests and everyday societal understandings converge are prime territory for medical sociological interpretations. Scientific medicine's promise of a pain-free existence, the widespread use of antibiotics, analgesics, general anaesthetics, tranquillisers and anti-depressants have arguably altered our relationship with pain and represent the triumph of medicine. Paradoxically, pain continues to indicate the failure of medicine: pain without detectable pathological cause (CFS, ME, RSI); pain unresponsive to medical intervention; the persistent and constant palliative and remedial (placebo) effect of inactive pharmaceuticals and sham-interventions all challenge medicine's own explanatory models. The curator of this exhibition, Javier Moscoso, teaches at the University of Murcia. He introduces the catalogue by stating ‘we all know pain’ and, more contentiously, that ‘the physical, psychological and social aspects of pain are universal’. This suggests that sociological insights will be central to this exhibition and I embarked on the short walk through three rooms in search of them. Three wooden chairs (dental, birthing, torture) face the doorway into the first matt black space (labelled ‘Passion’), which could be a furniture emporium, except for the jagged steel teeth on the upper arms of the third chair. The soundtrack of lamenting music also suggests this is not Habitat. Framed pictures (oil, lithograph, watercolour, etching) crowd the far wall beyond the light-shrouded cabinets showing the parallel forms of tortuous and therapeutic tools, with the proximate display of choke pear (poire d’angoisse), bronze Roman speculum and Indian curved amputation saw. It could be mistaken for a Top Shop accessory, but the iron wire penitent's belt (‘penitence enters the body without touching the bones . . . [to] . . . produce pain without causing disease’), is part of the depiction of the Christian preoccupation with redemptive suffering. The bright white space, labelled ‘Sensibility’, suggests religious interpretations of pain giving way to scientific intervention. The contents of my Grandmother's bathroom cabinet, wiped down and spaced out behind Perspex sheets, are displayed on one wall. Almost. (Wintergreen ointment, Germolene, – yes. Arnica – probably. Tooth of female ghoul – possibly. Human skull on carrier decorated with beads (Indonesian) – aaah, perhaps not.) Footage of a 1903 amputation, telephone-box adverts for sadistic sex services, the words of a chronic pain sufferer and a ‘Watch out! Here comes the science!’-style video-loop share this area. Reflective surfaces and grey walls mark the third space, labelled ‘Compassion’. Reactions to the pain of others are addressed with a giraffe trap, the videoed re-enactment of Milgram's notorious 1963 experiment on people's obedient administration of electric shocks and the suit of a matador fatally gored by a bull. Is this room more coherent? Or does the inclusion of less stuff reduce the curiosity-cave impression? The walk through this selection from the store-rooms of the Science Museum and the Wellcome Library was not unpleasant, which may be part of the problem. No pain, no gain. I got no visceral reaction. The only clenching of my innards came from catching sight of the crimson gash, gouged out of the otherwise unblemished wall, above head height. As I walked past the wound to read the label (Anish Kapoor, ‘The Healing of Saint Thomas’, 1989), its red-depth in the seamless white surroundings gave me a little lurch, an echo of the vulnerable, naked betrayal that pain can effect. This apart, the exhibition failed to move me, nor did it offer an analytic, organised insight; the sub-headings (salvation, truth, knowledge) did not aid interpretation of the collection of artefacts. The catalogue includes some material additional to the exhibition, such as talking heads on the pain of heartache, chronic pain clinic professionals and patients at St Thomas's. Perhaps the dozen short essays by academics, clinicians and journalists would supply the analysis that I wanted? The claim in the introductory essay (on the CD or website), to be working across disciplinary boundaries is hopeful, but is subsequently qualified as the more limited project of explaining one discipline's ideas beyond its own boundaries. Moscoso and Arnold (Head of Exhibitions at Wellcome) posit any lack of coherence as a lesson in ‘the nature of intellectual endeavour’. Another interpretation would be that, for want of skilled interpretation and bold editorial decisions, it is a collage rather than a synthesis on view. The exhibition and catalogue include much that is of interest in isolation (for instance, essays on the history of pain on the CD or website), but the central (and undeniable) tenet of the universality of pain impedes the impact of the project because it replaces any organising principle. Since pain touches everyone and every realm of life, nothing can be excluded and so an excess of connections and juxtapositions overwhelms the viewer. Patterns and peculiarities in the cultural place of pain are obscured rather than illuminated. While the ‘pain puzzles’ that have interested sociologists are hinted at, the sociological analysis of the influence of gender, class, ethnicity, sexuality and disability in the subjectivity of pain is largely absent. The lack of a critical approach to the role of medicine in shaping what constitutes the legitimate expression of, and reaction to, pain is an oversight. The parallel display of pharmaceutical, medically-sanctioned analgesics and alternatives such as Chinese herbs and Egyptian blue beads overlooks the authority, prestige and influence of scientific medical interpretations of pain which designate and police the legitimacy of various forms of suffering. Similarly, placing ancient birthing and torture tools side by side is naïve and ignores analyses of gendered power that explain the obvious similarities in form. The futile search for sociology's insights in this collection of artefacts, essays and video-clips underlined their worth, both for other disciplines and for a more popular understanding of pain. Hannah Bradby University of Warwick Timmermans, S. and Gabe, J. (eds) Partners in Health, Partners in Crime: Exploring the Boundaries of Criminology and Sociology of Health and Illness . Oxford: Blackwell Publishing , 2003 £16.99 (Pbk) vii + 188pp. ISBN 1-405-105399 This monograph explores various aspects of the borderland where contemporary jurisprudence and healthcare intersect. In Chapter 1 (Timmermans and Gabe) the editors set out their premise: that the juxtaposition between medical and legal concerns, respectively the eradication of disease or crime, may lead to a crisis of identity and a power struggle within the borderland, as each group attempts to redraw boundaries and colonise territory traditionally belonging to the other, creating new categories of patients or offenders. Or, conversely, bring about a ‘mixing of blood, land and resources’, resulting in the possible emergence of new third-way solutions to the issue of social control. Chapter 2 (Gomart) reconceptualises the legal-medical borderland issue of drug abuse and demonstrates how a clinic in Paris attempted to move beyond the traditional policy approach of abstinence from drug use, either in prison or a treatment programme, by developing a third-way approach based on using the addictive character of methadone to stabilize drug dependency. This ethnographic research explains how staff at the clinic encouraged the development of meaningful trusting relationships with users around a programme of ‘generous constraints’– a process of negotiating dosage and setting agreed targets with users. Chapter 3 (Timmermans) examines the borderland struggle between crime and medicine by discussing how organ-procurement organisations are attempting to assert their medical claim over forensic pathologists’medical-legal claim to corpses; a jurisdictional struggle is emerging between the need to carry out autopsies in cases of suspicious deaths and growing demand for transplantable organs and tissues. Patients who verbally threaten or physically attack their doctor clearly do not fit Parson's notion of the ‘sick’ role within doctor-patient relationships. Chapter 4 (Elston et al.) empirically addresses the question of how the general practitioner, who has become the victim of violence, deals with such patients, and considers whether state policy on healthcare-related violence is becoming more ‘zero-tolerant’ in its approach. The authors conclude that in policy terms such behaviour is increasingly criminalised, but that individual doctors reach decisions based on the circumstances and that these are far more complex than implied by a simple patient/offender dichotomy. The four remaining chapters deal with an issue which clearly highlights the contested nature of the borderland relationship between health and crime – the treatment, management and care of the mentally ill. In Chapter 5, the author (Armstrong) empirically shows that the de-institutionalisation of juvenile offenders in Massachusetts since the 1960s has resulted in a shift towards greater involvement from providers within the field of mental health. The emphasis since the 1980s has been on risk-management which is defined through fusing the retributive aims of criminal justice with the rehabilitative goals of mental health practice. Chapter 6 (Olstead) evaluates the role of the Canadian print media in perpetuating a negative relationship between mental illness and violent criminal behaviour. Through content analysis, the author persuasively argues that both criminal and medical definitions are used by the media to separate ‘us’ from the socially immoral and potentially dangerous ‘them’. This theme is continued in Chapter 7 (Manning), which illustrates how perceiving an interrelationship between mental illness and criminality can have powerful political implications. Here, the author discusses the UK government's role in redrawing the boundaries between mental health and crime by encouraging the development of a completely new sub-category of personality disorder: ‘dangerous and severe personality disorder’, resulting in the development of new specialist sites within the medical-legal borderland around treatment services in prisons. The book's concluding chapter (Reddy) discuses the emergence in the USA of a new legal defence strategy which uses the culture of the defendant as a means of determining their state of mind at the time of the offence. The author suggests that cultural values are being redefined as mitigating pathological conditions to assess diminished responsibility. This book invites us to start breaking down barriers dividing the two cultures of medicine and law enforcement. Each chapter provides a fascinating insight into the conjunction between health-crime boundaries, presents an interesting range of theories and research methodologies, and employs examples from Britain, Continental Europe, North America and Canada. After having started this demolition job, however, the editors appear to have packed up and gone home! What would have been interesting from the reader's point of view is a concluding chapter drawing together the editors’ own thoughts on how this new sociological/criminological outpost in the borderland between health and crime might be further developed. A minor point, which should not detract from what is an excellent monograph and an important starting point for anyone interested in exploring aspects of the dynamic interrelationship between criminology and medical sociology. Anthony Colombo School of Health and Social Sciences Coventry University Johansen, R.K. Listening in the Silence, Seeing in the Dark: Reconstructing Life after Brain Injury. . Berkeley: University of California Press , 2002 , £17.95 (pbk) 236pp ISBN 0-520-23114-7 This book, as the title suggests, is about the journey to recovery after traumatic brain injury. Written in the style of a narrative, portrayed sensitively through the eyes of a mother, this is the story of a young man, Erik, and his family. It describes the struggle to rebuild their lives, which are thrown into a world of turmoil and uncertainty when Erik sustains a severe traumatic brain injury following a road traffic accident. Through the story, which is compelling and at times disturbing, the experience of psychological and emotional trauma from the perspective of those affected unfolds. As such, it gives opportunities for deep insights into brain injury and the illness experience. The author, Erik's mother, a teacher of literature and narrative theory, writes in an informed manner, conveying the depths of emotion experienced through the course of the reconstruction of Erik's ‘self’. Theoretical and personal perspectives are interwoven throughout the text, which could inform the work of those involved in the rehabilitation of people with traumatic brain injury. This account is both moving and accessible, as such it may give comfort to others who might find themselves in a similar situation. The scene is set initially by Erik's mother who writes ‘this is a book I wish I would never have had the knowledge to write’. The reader is drawn into the experience as news of the accident reaches the family. The shock and enormity of the trauma are powerfully portrayed through a description of the ordeal to try to communicate with a foreign world of medical personnel, maintain contact with friends and family and learn to re-establish contact with their son. Grief, confusion, turmoil, denial and anger are among the range of emotions, which churn relentlessly during the initial chapters. Issues of power and powerlessness, feeling like interlopers in a strange and mistrusted land which is governed by hospital protocols and procedures, are more than adequately portrayed as Erik's parents wait for signs of recovery, which also brings further uncertainty. Through the turmoil the roles of the different medical institutions, medical personnel, therapists and others gradually unfold and interweave to play their part, alongside Erik's parents, in Erik's re-discovery of self and self-identity. Throughout, maternal and paternal love is evident, illustrated by extracts from family members’ diaries. Relationships within the family, the strength and influence of unconditional love on Erik's recovery are examined through this narrative. Erik's parents too are supported by ‘gifts’ of love, caring and prayers of friends and others as they begin the attempt to rebuild their own disrupted lifecourse. Compassion, love, prayer, sensitivity and understanding are common themes. Understanding of the self, selfhood, consciousness and conscious awareness become paramount as Erik emerges from coma. Analogies used enable the reader's ‘experience’. Erik's self is ‘like a house deserted’. The reconstruction is the ‘reconstruction of the self-house’, but the reconstruction is not without its difficulties, both for Erik and his family. The challenges involved in greater learning and growth, the balance between risk, impulsivity and self-determination, parental response and control, relinquishing control again, this time not to medical personnel but to Erik himself, all emerge as contributors to conflict and decision-making as issues of vulnerability are raised. The final chapter is a reflection on and a critical evaluation of events and experiences. Reflections on the needs of professional staff, the professionals’ view of the patient as a person, the role of families as well as of the patient and the effect of such factors on treatment itself gives interesting insights into one possible basis for practice. Service delivery and constraints are discussed in an ethical and moral context. Societal expectations, family roles, issues of control, desire, hope and vulnerability are all encompassed in a powerful social statement. Overall, it is a moving narrative of how family members survived and how the person with brain injury might be supported to rebuild his/her life. There is a wealth of literature relating to those affected by severe traumatic brain injury, the vast majority of which is written by specialists in the field of neurology. It is usually quantitative scientific ‘evidence’ which aims to support, test or prove hypothesizes or evaluate efficacy of treatment. Rarely are there qualitative accounts, which explore or convey the illness experience, seek to understand the perspective of those central to the picture, or consider self-reconstruction in the manner conveyed in this book. What a lot we could all learn from this unique text. Louise Conneeley School of Health and Social Sciences Coventry University Baker, M. (ed.) Modernising Cancer Services . Oxford: Radcliffe Medical Press , 2002 . 224pp £29.95 ISBN 1 85775 459 X (pbk) The NHS agenda on cancer has undergone a radical transformation since the publication of the Calman-Hine report in 1995. This report from the Expert Advisory Committee on Cancer Services suggested a dramatic reorganisation of cancer services in the UK as a response to the variation in treatment and access nationally and significantly poorer outcomes internationally. This was followed by the publication of the NHS Plan and the NHS Cancer Plan in 2000 and its follow up in 2001 all of which illustrate the far higher profile of cancer services within the NHS and in terms of the larger public health agenda. Despite these shifts in policy, there has been only limited reflection on the broader implications for both the NHS and existing cancer services of these changes. This book, with chapters ranging from What Cancer Patients Need to Information, Clinical Governance and Research, aims to describe ‘the changes which are required in services in order to implement the benefits that are aspired to in the Calman-Hine Report and subsequent national guidance’ (203) The fourteen chapters run the gamut of specific targeted discussions of the implication of the Report's recommendations for training and professional development (chapter 9) to the broad challenges to palliative care (chapter 12). The useful index provides one way of identifying and accessing relevant information. Despite the lack of any obvious coherence in the book there are some key themes that emerge. The need for co-ordinated work between voluntary groups and NHS organizations both in training and provision emerges quite forcefully and reinforces the policy pressure apparent in recent statements (DoH, The Expert Patient). The discussion of palliative care provides key statistics on the dominance of the voluntary sector in the funding and provision of hospice services (chapter 12). The limited availability of such services and lack of engagement with many primary care organisations is an issue which is also on the policy horizon but has had little direct response. Despite the appointment of cancer leads in all PCTs in 2001 there is still a lack of leadership and evidence of a lack of knowledge by GPs necessary to make timely referrals (chapters 7, 8). Yet, there is increasing pressure for greater primary care led cancer services, often managed by specialist nurses, in the areas of follow up often linked to greater commissioning responsibility (chapters 7, 8, 10, 11). The recent publication of evidence of physicians’ inaccuracy in survival predictions in terminally ill cancer patients (Glare et al., 2003) and the attempts to provide more effective predictive mortality models (Tekkis et al., 2003) suggests that this is an area of growing concern. However, this is a book to dip into rather than read from cover to cover. There is no introduction to the text nor a clear explanation for the rather strange structure. The chapters, many of which are interesting in themselves, have no broader coherence than many common references to the same policy documents and some are over reliant on bullet points rather than a more normal discursive format. The repetition is in itself symptomatic of one of the key flaws in the book; an almost complete absence of editorial input apart from, perhaps, the identification of contributing authors. There is little information for the reader about the authors apart from their titles and institutional affiliation. The editor, Mark Baker, is the Lead Clinician of the Yorkshire Cancer Network and all of the contributions appear to be from members of this Network, but this is a simply surmise on my part as the reader is never told why people were asked to contribute or how their experience relates to a national perspective on cancer services. The growing prominence of cancer networks provides opportunities for researchers and may also, as this book implies, generate useful reflections from a particular provider context. Jonathan Tritter Warwick University White, K. An Introduction to the Sociology of Health and Illness . 2002 London: Sage . xi + 196pp £50.00 ISBN 0 7619 6399 5 (hbk) £16.99 ISBN 0 7619 6400 2 (pbk) Barry, A-M. and Yuill, C. Understanding Health. A Sociological Introduction 2002 London: Sage . vii + 152 £60 ISBN 0 7619 7306 0 (hbk) £16.99 ISBN 0 7619 7307 9 (pbk) Naidoo, J. and Wills, J. (eds) Health Studies. An Introduction 2001. Basingstoke: Palgrave . xiv+329pp £19.99 ISBN 0 333 76008 5 (pbk) Research in and understanding of the area of health and illness today involves both academics and practitioners and crosses many an academic divide, with interdisciplinary collaboration and perspectives being the watchwords. Thus, it is perhaps not surprising to find a plethora of introductory texts aimed at the new entrants into this field. These three texts claim to introduce their readers to a sociological perspective from the first two and an interdisciplinary perspective from the third. Reviewing them together shows the range in form and content that introductory texts can take. Whilst there is evidence of common ground in parts of all three publications, I found the differences interesting and clear evidence of the need to dip into more than one text, even at an introductory level. White's An Introduction to the Sociology of Health and Illness starts with an introduction that sets out what he intends to cover in the book and how, and then develops his main argument that medical knowledge and practice cannot be properly understood without a social perspective. This is primarily seen through sociological eyes, although other disciplines, such as psychology and epidemiology, are addressed where the need arises. This book, of the three, is concerned the most with theoretical perspectives, and favours a social constructionist approach. It uses four theoretical perspectives to examine how views about health, illness and disease have been understood and have changed and developed over time. These are: political economy and Marxist approaches; Parsonian approaches; Foucauldian approaches and feminist approaches. These discourses are introduced in the introductory chapter and woven into the discussion that forms the basis of Chapters 2 to 4. The second chapter introduces the reader to the principles of social constructionism; the next chapter provides an historical perspective on how the relationship between medicine and sociology has developed, and chapter 4 elucidates upon how economic, political and social influences have influenced understanding and explaining disease. The next four chapters use each of the four theoretical perspectives to debate how particular ways of constructing society can be seen to predispose explanations of medicine's place and influence. Thus, Chapter 5 addresses material approaches to the sociology of health using Marxist analyses of capitalism as a starting point for a discussion of the relationship between medical knowledge and health inequalities. Chapter 6 uses Parson's notion of the sick role as a starting point for discussing the relationship between health and illness and social cohesion. Chapter 7 takes the debate further through the use of Foucault's analysis of the medical professions, drawing the debate away from economics and the social order and towards an understanding of health and illness through embodiment and power. The next chapter uses feminist debates as the pivot to show how medical knowledge is influenced by beliefs about gender and so influences how medicine is practiced, especially in relation to women. Chapter 9 focuses on race and ethnicity and, whilst first drawing attention to the dubious nature of notions and definitions of ‘race’ and ‘ethnicity’, draws effectively upon the abuses perpetrated through such notions across the Western world, including the author's home country. This book covers a lot of ground and in some depth for an introductory volume, but succeeds because the arguments are conveyed in clear, simple terms and by using examples that are usefully illustrative. There were times when I found it was a little repetitious, but thought that this might be necessary for an introductory text intended to get across complicated concepts and arguments not necessarily amenable to the reader new to the area. This may also be the reason, on a few occasions, for some rather simplistic assertions that seem to ignore the complexity of the debate. Nevertheless, the book is lively, fluent and engaging, offering an enthusiastic introduction to the background, history and main theoretical debates underpinning current medical sociology. A glance though the extensive bibliography reveals a comprehensive and eclectic source of publications and includes all the classic works I would expect to find there and would want someone new to the sociology of health and illness to be exposed to, as well as specific references appearing at the end of each chapter as recommended reading. Presumably as an attempt to help the reader through the text, each chapter includes a series of boxes in which text has been enclosed, as well as a summary. These boxes do not really work very well, especially in comparison to the other two books being reviewed here. My complaint is that the aim of the boxes is not clear, with some seemingly acting as an introduction to the chapter (but not always even when appearing at the beginning of the chapter), others seemingly as a summary of the section (but not all sections have summaries), whilst others seem to be examples/vignettes intended to illustrate a debate, although not all examples are contained within boxes. There is no explanation for how the boxes were to be used and, had this been accomplished in the introduction or a preface, more attention might have been given to their content. Certainly, the use of boxes and summaries can be very useful to break down the detail and intricacy of the topics to help the reader through the volume, especially in an introductory text intended for people new to the field, and so it is unfortunate that this has not been the case here. Barry and Yuill's book