What do you make of the WHO definition of health and Singer/Baer/Long/Pavlotskis comment that it is somewhat utopian and akin to the notion of wellness associated with holistic health and

BOOK REVIEWS AT MAQ

Elisa J. Sobo Book Review Editor, Medical Anthropol- ogy Quarterly Department of Anthropology San Diego State University

How are books selected to be sent out for review at Medical Anthropology Quarterly? Books are sent out for review if they are sent in. If you have written or contributed to a book and would like to make sure that it gets reviewed in MAQ, please ask your publisher to send us a copy. All medical an- thropology books received are sent out for review.

Reviews are invited, not submitted. Po- tential reviewers are identified in a number of ways. We keep a file on hand of interested parties and their areas of expertise. We also may search for reviewers using AAA mem- ber profiles, Google, or the like (the Soci- ety for Medical Anthropology’s global di- rectory will also soon be searchable).

When we have confirmed a potential re- viewer’s familiarity with the topic covered by the candidate book, we issue an invita- tion. Invitations are issued pending confir- mation of availability to do the review in a timely fashion, and assurance that no con- flicts of interest exist. A conflict of interest, such as an ongoing friendship or a project- based relationship between the reviewer and the author, would negate the invitation. We rely on an honor system and assume that as- signments will be handled with intellectual integrity and respect for others.

Reviewers are tasked with the following requirements:

� Evaluate the item(s) in light of MAQ’s statement of purpose: To stimulate debate on and development of the ideas and methods in medical an-

thropology and to explore the rela- tionships of medical anthropology to health practice, the parent discipline of anthropology, and to other disci- plines concerned with human illness and wellness.

� Focus on the book’s purpose, key point(s), methods, and style.

� Address the book’s importance to the (sub)field, and its integration with rel- evant literature.

� Consider the book’s relevance for teaching at various levels.

� Consider both strengths and weak- nesses.

We are hopeful that the book reviews published in MAQ are helpful to our read- ers. If you have any questions or concerns, please contact the book review editor, Elisa J. Sobo, at [email protected] If you have a copy of your book sent to us, we will be more than happy to solicit a review.

BOOK REVIEWS

On the Game: Women and Sex Work. Sophie Day. London: Pluto Press, 2007, ix + 277 pp.

Yasmina Katsulis Arizona State University

On the Game: Women and Sex Work is largely based on life-history data collected between 1986 and 2000. It also relies, to some extent, on the author’s work in a GUM (genitourinary medicine, or STD) clinic, where she was able to identify re- search participants, observe clinic opera- tions, and access medical data. The choice of a health care setting as her primary

297

298 Medical Anthropology Quarterly

base of operations allowed Day to recruit both indoor (house) and outdoor (street) sex workers representing a diverse range of in- comes and backgrounds, and to maintain a stable and visible presence in a rapidly changing field setting for more than two decades.

Using thick description, Day delves into the personal lives, experiences, and stories shared with her, as both she, and her par- ticipants, grow older. Although life-history data were collected for several hundred sex workers over a 14-year period (354 for the first wave of data collection; 60 for the fi- nal wave), the sample itself is not described statistically. Thus, there are no easily identi- fiable sets of facts or statistics against which the reader may contextualize the core of the book, which concerns sex workers’ stories, the epithet of “public women,” methods by which sex workers keep activities, times, and places apart, the consequences of these divisions, and whether or not these divisions ever become reconciled.

Day’s study is unique in the literature on sex work because it provides both prospec- tive and retrospective accounts by the same women at different times of their life. To ac- complish this task, Day illustrates how work and business strategies differ over time, and how different visions of the past, present, and future relate to those strategies.

Although Day worked in a GUM clinic to recruit her informants, this is not an ac- counting of sexually transmitted infections among prostitutes. Day attends to more broadly defined occupational health issues such as labor conditions, mental illness, and quality of life, as well as issues related to sex- uality, identity making, and the body. Using personal storytelling and life-history narra- tives as a central theme, this book touches on important practical issues such as the shift in local working conditions as a result of the influx of sex workers from overseas; sex-worker activism(s); health and safety; police and client relationships; peer rela- tionships, social stratification, and knowl- edge exchange; consumption practices and bodily investments; infertility, pregnancy, and motherhood; sexualities and identity

politics; and differing ideologies of person- hood, work, and business. Day’s tone is bleak and hopeless at times, reflecting, no doubt, a frustration with the many unful- filled dreams and failed enterprises of some of her participants.

Day is careful not to impose her own nar- rative over the lives of those with whom she worked. Hers is not a tragic commen- tary about “victims” of prostitution. It is not a set of stories about good girls gone bad; nor is it a story of redemption or reha- bilitation. Although she provides space for those who construct a more typical career trajectory (e.g., a straightforward answer as to why they engaged in sex work, the goal they aspired to, and whether they met that goal), Day is also careful to contrast these narratives with those from participants who live in the moment, year after year, with no clear purpose or end in sight. It is this contrast that provokes Day to interrogate oral history as a method of inquiry. Why do we (as anthropologists) elicit life histories in the first place? What makes them com- pelling to our readers? More specifically, what kinds of developments or inevitabili- ties do we imagine for those we study? What can we tell ourselves about those who don’t fit our expectations?

The beauty of this book lies in its com- plexities. Although the first half of the book serves to report and clarify particular points about life “on the game,” the second half is woven with philosophical journeys that may seem to have, at times, no clear end point or destination. This lack of a clear sense of pur- pose or progression is likely intentional, fit- ting with the book’s central argument that life histories do not necessarily follow the expected path, and that some of the partic- ipants actively resisted a more conventional telling of their lives that would fit with read- ers’ expectations.

Of particular interest is Day’s framing of “workers,” who tend to be younger, ver- sus “businesswomen,” who tend to be older or more experienced. Although workers re- tain a constant orientation to the present, and see sex work simply as something they are doing right now, businesswomen look

Book Reviews 299

at sex work as a career, or as a part of a larger career development scheme. Busi- nesswomen differed from workers not only in terms of their future orientation (e.g., goal setting, cultivation of clients, invest- ments), but also in the way in which they constructed meaning out of their past. It was businesswomen who imposed a more coherent narrative of their accomplishments (or failures) through conventional story- telling techniques and expected biographi- cal norms (e.g., turning points). It is they who, in Day’s words, “responded to a gen- eral morality tale about the shape a lifetime should or might take, in which images of continuity, development and progress are important” (p. 242).

Also central to this work is the constant interplay of and tensions between public and private. For example, Day character- izes her participants as migrants, not nec- essarily in the literal sense, but because they move between two compartmentalized worlds (work and home) that, at least for some, become increasingly difficult to rein- tegrate over time. She also addresses such matters as sexual citizenship, and specifi- cally, the intrusion of the state and the pub- lic (e.g., the “general” public, public opin- ion, or public health) into such (seemingly) private matters as sex and the body, the im- pact of stigma and symbolic violence on the everyday experience of inhabiting a public body (being a “public woman,” “common woman,” or prostitute), and the process of fragmentation and compartmentalization required to survive such a landscape.

Are these pieces ever reintegrated into a single story of the self over time? Not always. And because, as Day notes, the pro- cess of differentiation and eventual reinte- gration is such a central theme in the life- history genre, we are left wondering what the goals of this mode of inquiry should be, and indeed what kinds of assumptions we make in asking our participants to impose an ordered telling of their lives in the first place. It is precisely this dilemma that Day struggles with in the latter half of her book.

Although substantial portions of the book are descriptive, concrete, and highly

readable, those areas focusing on Day’s in- terpretations and conceptual arguments are more challenging. The main arguments in the book are not laid out in a way that makes them easy to identify, and it is some- times difficult to ascertain what, if any, gen- eralities could be made based on the re- search (this may, in fact, be intentional on Day’s part). However, On the Game would be useful in graduate-level courses in an- thropology or gender studies, as well as a courses in research design, oral history, or qualitative methods. Anyone interested in sex-work research, more specifically, should find this book refreshing in its broad and comprehensive scope. Day is to be com- mended for her earnest refusal to impose any neat and tidy generalities about the so- cial organization of everyday life “on the game.”

Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. Andrew Lakoff. Cambridge: Cambridge University Press, 2005, x + 206 pp.

Michael Oldani Department of Sociology, Anthropology and Criminal Justice University of Wisconsin–Whitewater

With Pharmaceutical Reason, Andrew Lakoff has constructed an outstanding and important ethnography of experts, or, perhaps more accurately, of expertise. His work concerns psychiatry and psy- chiatric practices, specifically in Buenos Aires, Argentina, from the late 1990s to roughly 2003. Initially, what is most strik- ing about this work is that Lakoff man- ages to find a sociocultural setting where Freudian psychodynamics, in particular a Lacanian stream of psychoanalysis, remains dominant, or at least equal in terms of in- fluence, to the global form of biopsychia- try influenced by the Diagnostic and Sta- tistical Manual of Mental Disorders (fourth edition of the American Psychiatric Associa- tion 2000). He documents and analyzes the battle between these competing paradigms, in which the stakes are high both for experts

300 Medical Anthropology Quarterly

and their mentally ill patients (i.e., “the sub- jects”).

Lakoff uses the object of bipolar disor- der, specifically a French biotech company’s (Genset) quest to obtain blood samples of patients diagnosed with bipolar disorder for genetic sequencing, to explore what he describes as the “epistemic milieu” of the “Argentine mundo-psi”(p. 4)—a native term never fully explicated, but discussed at several points in the text in reference to Argentina’s unique cosmopolitan mixture and intellectual history of psychodynamic approaches to treating the mentally ill both in private and public health settings (e.g., p. 16–17). The problem Lakoff exposes in Argentina is that, depending on one’s psy- chiatric training and orientation, bipolar disorder exists as a collection of observ- able symptoms that present in patients who have a distinct genotype and are ready for pharmaceutical treatment (e.g., biopsychia- try), or that bipolar disorder is a “fiction” of biopsychiatry and patients must be re- cast (i.e., rediagnosed) through the prism of psychodynamics and enter into psychother- apy or analysis with or without the aid of psychotropic medication (e.g., Lacani- ans). Lakoff notes that, according to Tanya Luhrmann (Of Two Minds: The Growing Disorder in American Psychiatry, Knopf 2000), Freudian psychiatry in the United States was basically dead—or at the very least running a distant second when compet- ing (and compared) with global biopsychia- try. But in Arentine mundo-psi, Lakoff finds a site where these competing paradigms con- tinue to battle.

Lakoff is very successful in moving the reader through detailed ethnography and a sophisticated grasp of psychiatric history as well as critical theory, how these dueling paradigms require certain forms of “sub- jectivity” (or personhood) to function. He spent time talking with and interviewing psychiatrists and psychoanalysts as well as observing case presentations at several pub- lic hospitals. Specifically, his work at Hos- pital Romero on both the “women’s ward” (ch. 3, “The Lacan Ward”) and the “men’s ward” (e.g., the biopsychiatric ward) was

especially fascinating and at times quite disturbing. A psychology resident provides a concise description of the dilemma: “In this point the two discourses are incom- patible: in how to understand the subject. [Bio]Psychiatry thinks it knows and the pa- tient doesn’t, whereas psychoanalysis says the patient is the one who knows” (p. 85).

Lakoff, like Lacanians (and interpretive anthropologists alike), provides several case studies so that readers can clearly see the processes and discussions he observed in ac- tion (“thinking in cases,” p. 87). For ex- ample, on the women’s ward a Lacanian- trained resident presents to a mixed group of biopsychiatrists and psychoanalysts the case of a 53-year-old suicidal women who was hearing voices of “birds” telling her to “kill herself,” and a typical argument ensues. Some are skeptical about the “reality” of the hallucinations. Some think that the hal- lucinations tranquilize her fear—the delu- sion may be “restitution.” At the time, the patient would not talk to the resident and refused psychotherapeutic interventions. A (bio)psychiatric resident also working with the same patient felt her “silence” was a side effect of powerful antipsychotic med- ications: she was “neurolepticized.” After several weeks in the women’s ward there was little progress. The patient seemed “im- penetrable.”

However, the first resident had been able to construct a history through the woman’s case file of various traumatic events, includ- ing attempted rape, a troubled marriage, and her son’s departure for the Malvinas war. This resident presents her information to a senior Lacanian.

The senior Lacanian then tells the resi- dent that he is going to “make a hypothesis, to invent a meaning.” There must have been some kind of catastrophe, perhaps a bomb, leaving a hole—“an agujero.” An event, a moment: the three days of the 1955 Rev- olution of Liberty, in which people had to flee. The senior Lacanian explains that there was a saying in this period—“the birds are coming”—which referred to planes com- ing with bombs. “Something concrete hap- pened in the Real.”

Book Reviews 301

He then tells the resident that these “signs, hieroglyphics” (e.g., the suicide at- tempt) are not nothing. For the patient, killing herself would be the highest expres- sion of “staying put,” in the place with the “agujero, the hole.” The patient was there- fore unassociative, with no possibility for transference (key to Lacanian psychoana- lytic work). The senior Lacanian concludes: In psychoanalysis “one tries to bring the subject near the catastrophe, to the Real, whereas she is trying to flee the catastrophe” (p. 89). He proposes that the resident “con- struct a text with the patient.” The resident asks him if it will be possible to make a diag- nosis. He says: “What matters is the making of a historia.” Thus, the patient remains in the hospital, within an intertreatment (and epistemic) psychiatric limbo.

Lakoff skillfully presents an archaeol- ogy of how this current state and form of Argentine mundo-psi came to be. In partic- ular, the Argentine history of psychoanal- ysis and its current association and home within public (mental) health hospitals fas- cinates. In the 1940s psychoanalysis was re- served for the private treatment of neurosis of the educated classes. However, the polit- ical situation of Argentina in the 1950s and 1960s provided the right conditions for psy- choanalysis to enter the public hospital and salud mental was born—a progressive re- form movement for the treatment of mental health.

Some scholars and clinicians feel strongly that the Lacanians, through their inability to treat the psychotic, were creating a public health disaster in Argentina (i.e., large num- bers of patients being sedated and institu- tionalized). Nevertheless, followers of both psychiatric paradigms see themselves as pro- ponents of “social justice.” Lacanians in particular see themselves as fighting for “the human”—for subjectivity itself—preserving the depth of the subject (vs. treating the surface symptomatology through biopsy- chiatric means). Yet, through Lakoff’s ob- servations of mundo-psi realities and his critical interrogation of current global lit- erature regarding psychiatry, science, ne-

oliberal movements, and pharmaceutical sales practices, we come to see the short- comings and ethical quandaries of both paradigms.

Nevertheless, Lakoff leaves the reader with the sense that, with the current state of global capitalism and psychopharmaceu- tical marketing dominance, pharmaceutical reason may just win out. In fact, pharma- ceutical reason has evolved over time as (mental) illnesses gradually came to be de- fined in terms of that to which they respond (i.e., the drugs). Taken to its full extent, this reason has fueled the field of “phar- makogenetics.” In his final chapter, Lakoff shows the reader how the genetic sequenc- ing work of Genset (in collaboration with Jansen Pharmaceuticals) may erase the sub- ject altogether. Psychiatric categories will continue to be broken down in terms of “medication response,” so that neither La- canians nor biopsychiatrists will need to ask diagnostic questions like “Is it bipolar disor- der or schizophrenia?” But instead the clin- ician (or gene sequencer) will ask, “Is it a lithium or an olanzapine response profile?”

Lakoff’s work should be essential read- ing for graduate students of both medical anthropology and science and technology studies as well as critical pharmaceutical studies.

Upper-level undergraduate students will find portions of the text difficult without proper supplemental instruction. However, Lakoff has the ability to concisely and effec- tively explain complicated intellectual ter- rain (Lacan, Canguilhem, Deleuze, Rabi- now, Rose, etc.) because of the way he inter- weaves background theory (and discussion) with ethnographic observation. In short, he tells a compelling and important story of contemporary psychiatry and provides a model for future anthropological study.

Multiple Medical Realities: Patients and Healers in Biomedical, Alternative and Tra- ditional Medicine. Helle Johannessen and Imre Lázár, eds. New York: Berghahn Books, 2005 xiii + 202 pp.

302 Medical Anthropology Quarterly

Kaja Finkler Department of Anthropology University of North Carolina, Chapel Hill

This book makes a strong case for the im- portance of medical anthropology for the biomedical professions and exposes us to the work of our European colleagues on issues related to medical pluralism. It con- sists of an introduction by Johannessen, ten chapters dealing with alternative medical practices in various nations or regions, and an epilogue by the two editors. The major- ity of the chapters, and the ones that are most interesting, report on empirical stud- ies done in these venues, although several attempt to address theoretical issues. While the researchers take their cues from a very few U.S. medical anthropologists, the chap- ters for the most part reflect an unfamiliarity with the vigorous and extensive work that is being done in North America on medical pluralism and related topics. Consequently, for a U.S. anthropologist, many of the pieces seem to reinvent the wheel.

The introduction, which attempts to raise various trendy ideas, using unnecessary jar- gon, is a bit difficult to dig into. Standard poststructuralist analysis of the sort that has been discussed in the medical anthropolog- ical literature in the United States in past decades is advanced. However, the ethno- graphic studies make this book a worth- while read.

Two chapters drawing on materials from postcommunist Hungary are particularly in- teresting. In one, Buda et al. deal with the demographics and health status of alterna- tive medicine users in Hungry. The other, by Lázár, focuses on healers who are re- turning to what the author calls “ancient” Hungarian healing traditions; such healers (tâltos) were persecuted during the commu- nist period in the service of dialectical ma- terialism. In postcommunist Hungary, these practitioners have revived the old traditions that they now combine with contemporary spiritualist practices, Christian mysticism, contemporary educational materials, web pages, and videos. They integrate homeo-

pathy, acupuncture, osteopathy, hypno- sis, dowsing, and other such bioenergetics building layers on top of the ancient tradi- tions. It is noteworthy that, as in much of the world, people in Hungary seek alternative healers when biomedicine fails them. How- ever, Lázár notes that patients fail to give biomedicine a chance to do its work before turning to tâltos, who, according to the au- thor, bring back an enchanted world, espe- cially when the mechanistic laws of modern medicine fail to heal.

In another chapter, Frank and Stollberg seek to identify German medical doctors’ motives for practicing heterodox medicine, combining biomedicine with homeopathy, acupuncture, or Ayurveda. They found that heterodox physicians practicing homeo- pathy were usually disillusioned with biomedicine, as well as pharmaceuticals and their side effects. Those practicing Ayurveda normally have had some relation with In- dian culture. The authors could not pin down any one specific motive that pro- pelled physicians to practice acupuncture other than economic self-interest, because acupuncture is profitable. Acupuncture and homeopathy are accepted as legitimate heal- ing systems, and their treatments are re- imbursed by insurance companies. The demand for heterodox medicine is not con- sidered, but it may also influence physi- cians’ decisions. Yet one wonders how these heterodox physicians negotiate the different epistemologies entailed by disparate medi- cal systems.

A particularly good chapter by Barry claims that epistemological concerns seem to be irrelevant to physicians in London who integrate and recommend homeopathy in their practice. The author asserts that, whereas before patients were not concerned with issues of medical epistemologies, now even the practitioners seem to ignore the profound differences among alternative sys- tems’ understandings of how the body func- tions and the etiology of sickness. The au- thors do point out that those physicians who practice homeopathy tend to medical- ize it by focusing on the body, not on the

Book Reviews 303

social relations important in homeopathic medicine. It would be interesting to exam- ine whether biomedicine itself becomes re- shaped under the influence of such alterna- tive practices.

Knipper’s chapter is theoretically and methodologically sophisticated. It provides a cultural analysis of traditional medical beliefs by showing how in Ecuador intra- venous infusions become reinterpreted in terms of the people’s local beliefs about vi- tal forces. The author argues that to under- stand native meanings is to comprehend lo- cal responses to biomedicine. This is an old idea, but it is nicely laid out, using cultural and linguistic analysis. The author rightly concludes that clear distinctions cannot al- ways be made between local and Western medicine. Whereas indigenous perceptions of the body’s vital forces are not bone fide biomedical ideas, they can serve as tem- plates for people’s interpretation of biomed- ical practices. Knipper emphasizes that to make sense of “local domains of mean- ing” (p. 146), an inductive approach is necessary.

Sigfrid Grønseth studied Tamil refugees’ visits with biophysicians in Norway. These encounters generated confusion of personal identity among Tamils. The chapter pro- vides rich ethnographic detail, and it is es- pecially interesting when one considers how people from extreme southern parts of the globe respond to life in the extreme north- ern part of Norway. Placing her analysis in the broad context of Hinduism, Grønseth argues that the cultural notions the Tamils bring with them to Norway, including med- ical ideas that are part of their everyday life, cannot be separated from the person as biophysicians seem to demand. The chapter would have been strengthened had it em- phasized that the pains the Tamils are ex- periencing and present to the physicians are associated precisely with the precarious sit- uation in which they find themselves in the Arctic North.

Other chapters are less striking. For in- stance, a chapter on the concept of med- icalization, using infertility as its focus,

misuses the concept and is also repetitive. Another, on childbirth in South Asia, por- trays biomedicine as limited because it fo- cuses only on the body—a widely accepted notion in medical anthropology. The chap- ter’s critique of biomedicine and its related advocacy of a biocultural perspective in birthing are old hat. Similarly, a chapter on medical pluralism in Ghana covers little new ground.

Finally, there is a perplexing chapter on what the author considers mental illness in Chiapas. His aim is to show how the local population negotiates modern and various local traditions when a woman presents un- conventional behavior. He analyzes several different explanations of the woman’s be- havior, including a biomedical physician’s. But then he presents the failings of the physi- cian, critiquing the doctor’s unwillingness to accept the local explanation of the woman’s behavior and his insistence on treating her with medications. What is baffling here is why the author encouraged the woman to seek out a biophysician, whose approach he then criticizes. Was he unfamiliar with the biomedical model of treatment? He claims that in the final a

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.