The Social Medicine Reader, Second Edition, Duke University Press, 2005

Reviewed by Liat Ben-Moshe, Syracuse University

This manuscript is based on readings derived from a Medicine & Society course, taught to first year medical students at the University of North Carolina Chapel-Hill. Although primarily targeted towards future doctors and practitioners, this reader would be of interest to non-medical students and many of the readings can be used when teaching Disability Studies courses. Some sections would also be of interest to scholars in medical humanities, ethics and bioethics, social sciences as well as the general public.

Although the reader has three volumes I will focus in this review on volume II, "Social and Cultural Contributions to Health, Difference and Inequality", edited by Gail Handerson, Sue Estroff, Larry Churchill, Nancy King, Jonathan Oberlander and Roland Strauss.

The premise of the readings chosen for this volume stress that social context  (race/ethnicity, familial) is as important as somatic variables in understanding illness/disability and practicing medicine. This is an important assertion in an age of increased medicalization (Zola, 1991) in which medical discourse exerts power over other forms of knowledge (Foucault, 1965). The volume consists of empirical studies, first person narratives, short stories, policy analysis, philosophical contemplations, anthropological reflections and more.

The volume is comprised of three parts. Part I, "Defining and Experiencing Difference", would be of particular interest to Disability Studies scholars and students. By using first person narratives, scholarly and literary pieces, this section troubles the dis/ability binary. Zola offers a short (autobiographical?) story which could be titled "How to make love to a women more disabled then yourself", in which he deconstructs notions of dependence, the act of having intercourse, erotics and more. Both Mairs, in "On Being a Cripple," and Weaver, in "Finch the Spastic Speaks," offer complex narratives on life as a disabled (or crippled) body in an abelist world. They both also mention encounters with medical experts and professionals, although almost in passing. What these three narratives do best is personalize disability and humanize it for those who do not see themselves as disabled while deconstructing that binary simultaneously.

In the same section, Rapp also humanizes disability by offering narratives of parents who have children with Downs Syndrome. Her research details the way these parents navigate their way in medical webs, services, technologies and policing. Rapp offers a view familiar to parents of disabled children, that of parents in the role of activists, moving from pathologizing views of their children (often offered by medical personnel) to acceptance and love (also encouraged by some medical personnel). Finally in this section, Pernick poses historical questions on the power to define difference in the first place and how it takes effect. Pernick discusses eugenics in relation to aesthetic values, viewed through debates on representations of euthanasia in first part of the 20^th century.

Part II of this volume, Social Factors and Inequalities, focuses on the ways various forms of inequality (based on sex/gender, race/ethnicity, class, geographical location, nation and more) affect the incidence of and treatments for illnesses and disability. Lorber, for instance, discusses the connections of morbidity (rates of illness) and mortality to gender, especially when confounded with race and class. Smedley, Stith, and Nelson survey some possible reasons for lower quality health care received by ethnic and racial minorities, even when acquiring the same insurance and monetary resources and whites. Groopman, in a piece from the New Yorker, demonstrates connections between the pharmaceutical industry, medical research, and debates on "new found" diseases, by using male menopause as an example. Of interest to anthropologists, in particular, is Farmer's quintessential chapter on the social-economic causes of diseases that might manifest corporeally. By using his knowledge as anthropologist and a doctor working in a village in Haiti he reflects on the sins of both medicine (failing to discuss social factors as cures for illnesses) and classical anthropology (diagnosing oppression and economic exploitation as indigenous culture).

Of particular interest to critical thinkers and instructors are readings questioning the very categories from which inequality is derived. For instance, Soo-Jin Lee, Mountain and Koenig offer a comprehensive discussion on the history, present and possible future of racial categorization, especially in relation to health outcomes and new genetic research and technologies. The authors contemplate the disjuncture between science (which, for the most part, precludes the use of race as viable distinct biological categories) and policy goals (which aim at eliminating health disparities based on race). Bhopal and Donaldson question the appropriateness of "whiteness" and its related labels in medical research. Fausto-Sterling's article challenges sex/gender binaries and the necessity of gender reassignment surgery for people born intersex. Lastly, this section brings to the forefront a debate about the validity and necessity of racial profiling in medical treatment and research.

Part III of the volume, "Social Relationships and Sickness", is comprised of narratives and reflective pieces. It is the shortest section and perhaps the most partial and unchallenging section of this volume, although not uninteresting. In the same vein as the first section, personal narratives and stories put a face on illness (confounded with blackness, being poor and living in Chicago); a sibling of a person who is mentally ill; and being an unpaid family care giver to a person with multiple disabilities.

Although not reviewed here, the Social Medicine Reader is comprised of two other volumes, which can be obtained as separate books from Duke University Press. Volume I of the reader, "Patients, Doctors and Illness" has a section on end of life issues which would be particularly relevant to Disability Studies scholars and activists in view of recent debates of physician assisted suicide and the Schiavo case. Volume III, "Health Policy, Markets and Medicine", focuses on health care and insurance in the US as well as offering some international perspectives on the issue, and would be of particular interest to practitioners and advocates trying to understand and change the current health care system.

In conclusion, The Social Medicine Reader challenges traditional notions of disease, illness, and disability in relation to medicine and bioethics. Although not explicit, it troubles the false binary of a social versus medical model of disability. The field of medicine is shown by some readings to be rooted in the social, and medical encounters with disability are not seen as inherently unilateral or disempowering. In this regard, the fact that this manuscript originated from a course for medical students is encouraging itself. One can only hope future doctors and practitioners internalize the critical perspectives offered in the reader.

The large scope and all encompassing qualities of the reader are its major strength and also its weakness (the section dealing with familial connections to disability/illness was especially disappointing in this regard). The book provides good introductory texts on manufacturing, treating, interpreting, defining, ignoring and living with illness/ disability. For those looking for comprehensive accounts on any of these issues, you might want to look elsewhere, (for instance in the longer versions of some of the texts presented here) or use these readings and their bibliographies as entry points only. Nevertheless, this reader can thus provide a valuable teaching tool in Disability Studies, especially due to its interdisciplinary nature and the diverse, and often contradictory, perspectives it provides to its readership. In sum, The Social Medicine Reader is a timely and highly relevant collection of readings that is both intriguing and accessible to lay persons in the field. I would highly recommend this reader to anyone interested in the complex interplay of biology, culture, dis/ability, health, and medicine.

References:

Foucault, M. (1965) Madness and civilization; a history of insanity in the age of reason (New York, Pantheon Books).

Zola, I.K. (1991) The Medicalization of aging and disability, Advances in Medical Sociology, 2, pp. 299-315.