BOOK REVIEWS
Gillian Bendelow
Health, Emotion and the Body
Polity Press, 2009 £ 15.99 (pbk)
(ISBN 9780745636443) 224pp
Gillian Bendelow’s latest book comes as an attempt to critically re-evaluate prevailing contemporary Western biomedicine and to develop a new integrated model of health and illness. Although medicine suffers from the lack of a conceptual framework with which to link up different levels of understanding relating to health (from genes to physiology, psychology, family, community, and society), and although nowadays the medical limitations of healing are perhaps more self-evident then ever, people still cherish a hope about medicine’s future miraculous development. Yet it seems that medicine’s precise failure to comprehend the new situation has forced laymen to set out towards a new practical understanding of health and illness in the sphere of alternative/complementary medical practice. Without any doubt, the findings provided by sociologists like Bendelow can build a strong, stable, and constructivist bridge between positivist scientific knowledge of medicine on the one side, and lived individual experience of health and illness on the other.
In the introductory chapter of her book, Bendelow makes a short, illustrative, yet highly elucidative review of existing models of health and illness. In contrast to the predominating biomedical model, Bendelow sets up an integrative model of health and illness. A paradigm shift in models evidently reveals a need for transformation from a mechanistic to a holistic understanding and practising of health and illness. While the old Cartesian dualism between the mind and the body still exists, the paradigm shift shows more faith in the interaction between the mind and the body than in the reduction of the mind to the physical conditions of the body. Above all, the social integration of an individual is emphasised as an important element for maintaining good health or for healing illness. Another difference is that the integrative model focuses on long-term health conditions to avoid risk, instead of on acute illness.
The second chapter debates conditions for a mind/body/society model of stress. According to Bendelow, the concept of stress is essential for the construction of any new health model. Not only does the biological level count, but the social level is important as well. Of course, to Bendelow, the social aspect comes first and the biological second, as emotions are culturally relative (the author refers to Goffman’s ‘deep acting,’ Hochschild’s ‘emotional work,’ and Peter Freund’s ‘dramaturgical stress’). Stress, than, is a state ‘of coping with a perceived, real or imagined threat to one’s physical, mental, spiritual or emotional wellbeing, resulting in a series of physiological responses and adaptations’ (49).
As a consequence, the third chapter is about the inability of modern medical science to accept the above-defined mind-body relationship, culminating in medically unexplainable symptoms (like chronic pain, fatigue syndrome, and so on). Due to the fact that such medical conditions can be highly contested and cannot be clearly defined in medical terms, a space is created for their manipulation by different social trends and beliefs. Even medicine is not ‘immune’ to this and to commercialising trauma, misery, and, most of all, human madness.
This leads us to the next chapter of Bendelow’s book. Besides a desire to reveal the scientific logic beneath the surface of unexplained phenomena, medicine develops several responses to emotional and psychological distress based on physical and chemical interventions in the body. Yet, modern medicine is falling short in this attempt, which is most evident in the increase of pharma-scepticism, the phenomenon of laymen rejecting pharmaceutical and technical interventions. People who confront terminal or chronic health conditions swerve to complementary medicine or to alternative healing systems, for they are frequently deeply disappointed by the limitations of modern medicine.
As a consequence, the penultimate chapter is devoted to the review of various dilemmas, contradictions, and problems that accompany the use of alternative/complementary approaches to healing. Despite the fact that the effects of alternative/complementary medicine are often either unknown or incapable of being proven by rational scientific examination patients may feel temporary physical/emotional relief, although this could simply be due to individual suggestibility. Although visiting an alternative doctor or spiritual healer can be pretty expensive and thus inaccessible for many people, it has nevertheless increased over the past years, especially amongst the middle class.
One particular reason for the growing interest in alternative/complementary medical practice is the application of new communication technologies, above all the Internet, which people use to look for information and advice about their health and illness. The relationship between patients and doctors, once in favour of the latter, has significantly changed as the doctors are no longer the only ones who possess medical knowledge and licence to intervene in someone’s body. Although some therapists are perhaps nothing more than fancy charlatans exploiting others’ suffering, their chances are good as long as doctors keep on forgetting that not only the physical body of an individual is subject to healing, but the mind (i.e. emotions and cognitions) is also an important element during the process of healing.
Bendelow’s book Emotion, Health and the Body is an excellent study of the dilemmas concerning health and illness that people are facing in everyday life. Due to the ‘over-medicalisation’ of human life and a reductionist understanding of the mind-body connection, medicine focuses solely on the body. However, the human need for adequate information and the individual’s longing for emotional stability are still unjustifiably neglected. On top of that, modern society ‘nurtures’ the cult of individualism, which prevents us from maintaining a proper social contextualisation of health and illness. Thus, the true value of Bendelow’s book lies in her stressing the importance of a close relationship between the mind and body. Within the social context, the emotional as well as the physical health of an individual contribute to their being a member of our modern community.
Peter Morrall
The Trouble with Therapy: Sociology and Psychotherapy
Open University Press 2008 £21.99 (pbk)
(ISBN 978-0335218752) 272 pp
From the outset Peter Morrall declares that, probably due to his prolonged exposure to sociology, he is a trouble-maker. More than this, he is an angry trouble-maker; angry because ‘the physical world is deteriorating, global society is in disarray, and humanity debased’ (5), and yet whilst psychotherapy (along with sociology) is in the position to understand and repair society and individual lives, it is instead dysfunctional, arrogant, selfish, abusive, infectious, insane, and deceitful. The substantive chapters are titled accordingly, except the first chapter (‘Enlightenment’), which is an overview of four key sociological frameworks (structuralism, interactionism, constructionism, and realism) and their application in understanding therapy. In order to illustrate the arguments made in the book, throughout the author refers to the story of ‘Heather’, a pathologically insecure and troubled woman with a ‘Jekyll and Hyde’ character who has had extensive experience with therapy.
Chapter two, ‘Dysfunctional’, provides a brief overview of the main types of therapy and how they are (dis)organised under various national and international umbrellas, arguing that therapy is filled with confusion and rivalry, and that choosing a therapist is a lottery. Chapter three, ‘Arrogant’, focuses on the scientisation of therapy and the questionable credibility this brings with it. Chapter four, ‘Selfish’, argues that therapy focuses too much on the self, ignores social context, and is overflowing with sexuality, by dealing with problems of sexual abuse, performance, and perversions, for example. Chapter five, ‘Abusive’, considers issues of power and control. Chapter six, ‘Infectious’, looks at the spread of therapy culture, and issues of professionalisation and medicalisation. Chapter seven, ‘Insane’, argues that therapy is uninformed when it comes to the topic of madness, and is in turn a mad business itself. The last of the substantive chapters, chapter eight, ‘Deceitful’, is concerned with the (misguided) goal of happiness.
Morrall draws on an eclectic range of mostly theoretical material from psychology, psychiatry, philosophy, media sources, official agencies, as well as sociology, to cover this broad terrain. Although many of the arguments presented in this book are not new, it is useful to have them brought together under one sustained critique with ample reference to their theoretical context. For example, chapter three contains an overview of the sociology of science, covering the themes of positivism, scientific medicine, legitimacy, efficacy, and how these apply to therapy. Chapter four talks of the sexualisation of society, repression and oppression, gender-bending, and historical accounts of sexuality, before going on to consider sex and therapy. The result is that the author’s arguments are generally well-contextualised, mostly in terms of theory, but also in terms of social changes and changing practice, which makes the book interesting and accessible to read.
The use of Heather’s story is in some respects analogous to her ‘Jekyll and Hyde’ character. On the one hand, it makes the book more interesting to read; on the other, it is possible to argue that Morrall puts too much weight on the experiences of one person. It raises the question of what arguments would have been made if the story of someone who had had positive experiences with therapy had been used instead. Similarly, although the book is entitled The Trouble with Therapy, and the reader should therefore rightfully expect a critique,many of the arguments made seem overly one-sided. For example, in chapter eight Morrall discusses the happiness industry, which he contends has commodified happiness and promotes it as the ultimate goal in life. He argues that those deemed to be happy, however, are ‘really ill-informed or idiots, or both’, given the mess that global society is in (189). He argues that the happiness industry is fuelled by positive psychology (e.g. self-help programmes), which is something therapists collaborate in. There are two issues here. The first is that very little mention of therapy is actually made; the focus is on positive psychology, and therefore it seems that the two are somewhat conflated. The second, and related issue, is that therapy is more concerned with alleviating the suffering of those who are not as happy as the norm, or even positively distressed, as opposed to inducing a universal state of Nirvana. Here and elsewhere, there seems to be very little concession that in some cases therapy alleviates misery and suffering.
That said, this book is a critique rather than an appraisal, and so the bigger problem is that despite the author stating that he positions himself on the sceptical as opposed to cynical side of trouble-making, it is difficult to come away from the book with the impression that he holds his position throughout. At one point he presents the view that therapy is like prostitution, except that prostitutes are more sincere than therapists (211). Elsewhere he states that ‘the therapeutic enterprise is spreading plague-like across Western society and is rapidly contaminating the rest of global society’ (145). Overall, the tone of the book is mostly one of contempt for therapy, and seems in places to verge on the polemical, which might put off readers who would otherwise learn of the valid criticisms that are presented. The result might be less rather than more collaboration between sociology and therapy, which runs counter to Morrall’s statement that his critique ‘has the express aim of informing psychotherapy practice...’. Although they are thin on the ground and appear mostly as almost a footnote at the end of the book, Morrall does offer some suggestions as to how this aim might be achieved, by focusing more on social factors in therapy, recognising the limitations of scientific evidence, and training therapists with sociological knowledge, for example.
In sum, this book presents a broad range of well-contextualised sociological criticisms of therapy, and will be useful for readers who wish to gain background knowledge of them, as long as they are aware of the sometimes cynical nature of the text and often one-sided nature of the arguments made. What the reader makes of the book, of course, will depend to a large extent on their appraisal of therapy prior to reading it; it will undoubtedly find favour with those who are already mostly against therapy, and provoke interest in those who are already mostly for it. In my view, it is a pity that the author offers little positive sociological analysis of therapy. Given that we already more or less know what the trouble with therapy is, a book offering more suggestions for how we might overcome these problems would have been welcome. With that said, what is presented here is a critique, and in that respect it includes a number of interesting arguments, and should serve as a useful point of reference. Hopefully its value in encouraging debate is not compromised by its sometimes polemical tone.
Martin Seeleib-Kaiser (ed.)
Welfare State Transformations: Comparative Perspectives
Palgrave Macmillan 2008 £50.00 (hbk)
(ISBN 9780230205789) 280pp
Since the welfare state’s proclaimed crisis due to the end of the ‘trente glorieuses’, many reforms have taken place across OECD countries to address the problems of rising unemployment, ageing populations and shrinking budgets. Much political and academic debate has revolved around the questions of if and how the state should retrench from its responsibility for social security by privatising certain social risks such as old-age, poverty, sickness or unemployment. Whilst path-dependent analysis suggested a stickiness of institutions, others pointed to the possible privatisation of risks according to ‘neo-liberalist’ ideas.
Instead of discussing whether or not the state should privatise social protection, the main concern of the book edited by Seeleib-Kaiser is to explore whether the public domain has actually surrendered silently to ‘neo-liberalist’ ideas of welfare or whether the changes in the public-private mix of welfare provision could instead be conceptualised as a transformation of the welfare state itself.
In the first theoretical chapter the analytical framework is developed. Suggesting a departure from conventional concepts of public social policy, Seeleib-Kaiser introduces the concept of welfare systems which takes into account the fact that the boundaries between the terms ‘private’ and ‘public’ are blurred since public social services do not necessarily equate to state services. Hence, private arrangements tightly regulated by the state do not fall outside the public domain of welfare provision. In order to gain a comprehensive understanding of possible welfare state transformations with regard to shifts from public to private social security, three different modes of policy intervention are analysed in the book: financing, provision and regulation of social policies. Furthermore, discourse, institutions and outcomes are set out as analytical dimensions.
The book is then structured in three parts in order to address the question of whether change varies in its extent and contents among policy areas and countries. Part I of the book presents empirical studies, across different policy areas, of different advanced industrial countries such as Denmark, the United Kingdom, Southern and Central European states, and Japan. The second chapter, written by Martin Powell, analyses the change of the public-private mix in the United Kingdom across healthcare, pensions, elderly and family care. Showing how the pattern of change varies across services and over time, he discusses the decline of direct state provision and the increase in regulation and governance of social services. In the third chapter, Jørgen Goul Andersen inquires about a possible retrenchment of the Danish welfare state and analyses changes across unemployment, pension and other welfare policies such as healthcare, elderly care and education. The following chapter by Ana Guillén and Maria Petmesidou exposes the common traits of reform challenges to Southern European countries and changes in the public-private mix of social policy due to the catch-up process in welfare provision. The transformations of the welfare state in Central and Eastern European countries are the focus of the fifth chapter by Martin Potůček. He analyses how democratisation, the establishment of the market economy and accession to the European Union have led to a broad variety of approaches to welfare provision in these countries. The first part is concluded by a chapter on the Japanese welfare state in which Roger Goodman shows how Japan’s cultural heritage has led to a distinct pattern of welfare provision and thus to a distinct public-private mix after reforms.
Part II of the book provides cross-sectional analyses of different key policies. In the seventh chapter Paul Bridgen and Traute Meyer analyse the shift from state run pension systems to multi-pillar systems and its impact on the social inclusion of different social categories of retired citizens. The changing public-private mix in OECD healthcare systems with respect to financing, expenditure, service provision and regulatory structures is scrutinised in chapter 8 by Heinz Rothgang et.al. They show how systems move towards hybrid forms of healthcare systems due to contrary trends in reform measures. In the following chapter on unemployment policies Daniel Clegg focuses on institutional arrangements, looking at whether signs of state retrenchment can be found. Chapter 10 by Peter A. Kemp and chapter 11 deal with the changing notion of work and its recommodification, incapacity, and new social risks such as the balance between working and family life respectively.
Part III presents the conclusions. These are introduced by John Clarke’s chapter on the complexity of welfare formations and the possibility of multiple rather than one-dimensional transformations of the welfare state. Chapter 13 by Seeleib-Kaiser summarises and discusses the results that point away from a simple privatisation of social policies to complex processes of refocusing state responsibility in welfare provision.
Seeleib-Kaiser’s book represents an outstanding contribution to the literature on welfare state reforms, retrenchment and recommodification. By dissecting with sharp analytical precision the blurred terms of ‘public’ and ‘private’ responsibility in social policy, the authors show that the welfare state is neither as path-dependent nor as radically privatised as had been expected by some scholars. The different chapters expose the ways in which the state sometimes has to intervene more to do less and that changes in one state and across policies can represent contradictory trends. The variation between quantitative and qualitative methodological approaches, and between country comparisons across different policies on the one hand and cross-sectional analyses on the other, will provide the reader with rich information on the welfare state and inspiration for further research into different social policies and systems.
Anne Llewellyn, Lorraine Agu, and David Mercer
Sociology for Social Workers
Polity Press 2008 £18.99 (pbk)(ISBN 0745636985)
264pp
‘Sociology for Social Workers’ offers an introduction to the discipline of sociology for social work students. To engage their intended audience, Llewellyn and her colleagues demonstrate the relevance of sociology to the practice of social work throughout the text. The authors first provide a prologue that describes the sociology discipline, key sociological themes, and both classical and contemporary theories. Next, the authors discuss broad social and structural factors, that should be of interest to social work students, in sociological terms—social class, inequality, crime and deviance. The remainder of the book consists of chapters that offer a sociological perspective on providing social work services to individuals in accordance with their achieved or ascribed statuses.
In the first part of the book, the authors introduce the reader to fundamental sociological themes. In so doing, they discuss the development of, and define the social work profession from a sociological perspective. Ostensibly, the authors took this approach to establish a framework for the remainder of the book. Perhaps appropriately, portions of this section are reminiscent of Mills’ first chapter of The Sociological Imagination (1959). In this chapter, entitled ‘The Promise’, Mills put forward the notion that there is a reflexive connection between ‘public issues’ and ‘private problems’. Throughout this section, Llewellyn and her colleagues present examples that highlight the interconnectedness of the individual and the group. In the chapter that follows, the authors continue their discussion of key sociological themes by situating them in a theoretical context. Each of the broad theoretical orientations is discussed: structural theories, social action theories and critical theories.
In the section that follows, Llewellyn and colleagues define and discuss social class, inequality, crime and deviance. These factors are discussed in terms of their general influence on the shaping of British society as a whole as well as their influence on individuals and their actions. The authors emphasise that social workers should understand the theoretical perspectives related to social stratification. Moreover, Llewellyn and colleagues describe the role of power in perpetuating the structure and processes whereby group membership (e.g., race or ethnicity, gender, age, etc.) determines life chances by facilitating or limiting access to resources. This discussion provides a good segue into the remaining chapters in the book, which discuss several achieved and ascribed statuses as they relate to their influence on the field of social work as well as key issues for work with various vulnerable and/or marginalised populations.
This textbook would be useful as a companion text in a social problems or introductory human behaviour in the social environment course.
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