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Day, S. and Ward, H. (eds), Sex Work, Mobility and Health in Europe.
Engelhardt, H.T. and Cherry, M.J. (eds), Allocating Scarce Medical Resources: Roman Catholic Perspectives.
Luke, H., Medical Education and Sociology of Medical Habitus: ‘It's not about the Stethoscope!’.
Borsay, A., Disability and Social Policy in Britain Since 1750.
Bolton, S.C., Emotion Management in the Workplace
Clark, D. and Wright, M., Transitions in End of Life Care: Hospice and related developments in Eastern Europe and Central Asia
De Vries, R.A., A Pleasing Birth. Midwives and Maternity Care in the Netherlands
Hawkes, G. and Scott, J. (eds), Perspectives in Human Sexuality.
Sex Work, Mobility and Health in Europe . London : Kegan Paul , 2004 £65 (hbk) 281pp . ISBN 0-7103-0942-2 and (eds)
Prostitution is one subject that is virtually guaranteed to excite comment and controversy. It is one of those issues that everyone has a view on, and rarely are these neutral. On the whole, debates on prostitution tend to fall into two diametrically opposed camps. There are the abolitionists, who see it as a scourge and as perpetrating violence to women, and on the other side of the divide are those activists, often working within the trade, whose efforts are directed at legitimating sex work and with it, winning worker rights. On this side too are those who are pragmatic about the trade, often working within a health-related paradigm concerned largely with reducing the sexual health and other dangers to those working within it. This book falls in the latter category of representing the position of what might loosely be described as activists and pragmatists.
The book is divided into four categories; histories; mobility and migration; health; and policy. The first section charts four perspectives on recent histories of sex worker movements and inter-relatedly the changing responses of many European governments to prostitution, particularly in the context of new anxieties over illegal migrant labour and sex trafficking. All four chapters are testimony to the continuing struggles for legitimacy in the face of entrenched opposition, particularly in the anti-trafficking campaign, and disorganisation within the sex work movement itself. This stems in part, at least, from the deep-seated reluctance of many prostitutes to engage openly in efforts to ‘normalise’ work that is so deeply stigmatising.
Given the prominence of the anti trafficking debate the following section on migration would have been strengthened greatly by the addition of some head-on engagement with the issues. The chapter on mobility in the Netherlands by van der Helm, whilst illuminating, does not really do the work of a more overarching, authoritative view. The chapter by Agustin, which has a refreshingly different take on women who migrate for work, admitting of a plurality of reasons for doing so, moves away from dominant stereotypes of migrant women as doomed to victimhood by representing them as resourceful adventurers.
The third section on health aims to extend the dominant remit beyond sexual health to the other threats to health often associated with sex work Kinnell considers the prevalence and meaning of sexual violence to women in the trade and the difficulties in reducing this, given the stigmatising label of ‘prostitute’. Day and Ward discuss stigma and its effects on prostitute health over two chapters. I was fascinated by the notion of charting its long-term effects on women but was rather disappointed by its sketchiness as a schema; the case study approach and lack of data undermined the argument greatly.
Policy issues in Europe inform the last section which brings together the preceding themes. These range from the legal situation in Sweden where prostitution is seen as violence to women, to the legal situation in the Netherlands, which defines prostitution as work, but only for nationals or legal migrants. The editors link these legal changes to debates on national identity and immigration, particularly in light of changes to the European Union. In concluding, Priscilla Alexander, the Grande Dame of the prostitution rights movement, is gloomy that change can be effected given these conditions; this tightening of the borders, and the continued ascendancy of the moral argument against women selling sex. One has the sense of everything changing but everything staying the same, given that, at core, there is no greater acceptance of the sale of sex, probably among the general public and certainly not as enacted in law.
The prostitution rights movement is driven by people who are passionate to change the deep-seated inequities and injustices faced by men and women who work in the sex trade. This passion is mirrored in this book, by those reflecting on their work in the sex trade; to the academics and practitioners who reflect on the political, economic and social conditions of its existence in various parts of Europe. It is, to my mind, however a collection that is short on substantive or closely analysed debate, which is a significant weakness. Nevertheless, as a text on the current state of the debate from one side of the divide, it really illuminates just how highly contested the territory is.
Marina Barnard University of Glasgow
Allocating Scarce Medical Resources: Roman Catholic Perspectives . Washington DC : Georgetown University Press , 2002 £29.75 (pbk) x+331pp . ISBN 0-87840-882-7 and (eds)
‘My God!’ might well be the exclamation health workers in intensive care units (ICUs) utter on reading this book. In some it might be a declaration of faith; in most, I suspect, frustration. It is an appropriate epithet in two senses. A collection of eminent Roman Catholic theologians, moral philosophers and medical practitioners might well provoke exasperation by being unable to commit to any definite position or final answer, but when they meet on several occasions over three years to discuss Roman Catholic teachings and their implications for medical practice in ICUs, God enters a fair amount. I pity the medical worker in an ICU who tries to discern either what God says about their practice in biblical scriptures that are culturally embedded in an entirely different sort of world or what this group of contributors discern as God's practice for ICU workers today. Perhaps we ought to pity the patients more if moral philosophers or theologians were ever to try to resolve the dilemmas of modern medical practice. A simple answer is not what you get from them. This is hardly surprising when the issues are so complex. But if the efforts of these contributors are intended to engage with the real world dilemmas of modern medical workers in ICUs, medical staff at least expect some definitiveness, some sort of guidelines for practice and policy, some sort of answer. None comes.
The issues that the contributors address are very timely. Several high-profile cases in Britain and the United States have highlighted the disagreement there can be amongst relatives, and between them and doctors and lawyers, over the care of brain-dead patients. The retrenchment and narrowing of the welfare state has introduced rationing in medical care and financial limits on access to medical treatment. The monetary costs involved in saving life are as much a factor as the quality of the life in decisions about medical care. Various medical treatments are being increasingly approached as ethical matters, such as abortion and assisted dying. Advances in medical science have delayed the on-set of death well beyond what was considered God's appointed time when the Bible was written two millennia ago, and death is now an ethical and legal moment as much as a medical one. The law intervenes in medicine to a greater extent than ever before. Paradoxically, so does religion, at least in the United States, where these authors are based. One of the ironies of the tradition of the separation of church and state in the United States is that religious enlightenment is taken to be defence of the right to believe and to have these beliefs count in public life. An increasing number of people expect their religious beliefs to matter in the public square and have all the assurance of the self-righteous to impose them on others, including medical practitioners. The alignment of conservative evangelicalism with conservative Catholicism in the United States has far-reaching implications and healthcare workers, as much as teachers of evolution theory, risk the wrath of the newly empowered and emboldened religious Right. Medicine is thus a new battleground for moral conflicts, with some protagonists thinking they literally have God on their side and for whom no defeat can be countenanced without challenging their very religiosity.
The editors of this volume have thus broached very important issues when asking contributors to reflect on whether Roman Catholicism offers moral precepts that can and should limit access to critical care – precepts that are over and above, or separate from, any secular set of moral precepts. Contributor after contributor lays out the dilemmas very well, to the point of irritating repetitiveness, and, for the most part, they come to no conclusion at all, or to different conclusions, depending on whether they are medical practitioners, responsible for delivering care in life and death settings, or wordsmiths from seminaries and universities who can spin fine-sounding arguments immune from the realities of ICUs. My complaint is not about the importance of the issues, but the relativism of the answers. As the first editor remarks in the Introduction, the question of what Christianity offers as moral guidance in the use of scarce medical resources, especially in critical care, ‘remains without a unanimous answer’ (p. 16). So many interminable pages later the reader is in no different a place. The only non-relativist answer to that question is the moral principle that medicine be left to medics.
John D. Brewer University of Aberdeen
Medical Education and Sociology of Medical Habitus: ‘It's not about the Stethoscope!’ . Dordrecht : Springer , 2003 £60 (hbk) xiv + 178pp . ISBN 1-4020-1238-1
The sociology of medical education emerged almost 50 years ago, with a debate over the influence of professional values and student culture in the training of medical students. Robert Merton and colleagues emphasised the former, while Howard Becker's team argued for the latter. It is now generally agreed that both factors are significant, and that these founding studies were both correct in their general premise: medical training consists of learning more than the formal curriculum. Drawing on the work of Pierre Bourdieu, Haida Luke takes this further by conceptualising medical training as the formation of a ‘medical habitus’. Her study focuses on junior house officers (JHOs) – doctors in the first two years after medical school – who, during this fundamental transition period, typically feel stressed, isolated, overworked, undervalued and sometimes even suicidal. Luke looks at what happens at the interface between undergraduate training and full professional status, as JHOs go from being ‘clinical doctors’ (i.e. technically qualified) to ‘social doctors’ with a ‘feel for the game’ of medicine. She argues that the problems JHOs experience arise from a ‘cultural gap’ between the neophytes and the role they are expected to play in their new job, which gradually diminishes as they learn to walk, talk and think like doctors.
In the tradition of medical education ethnographies, Luke observed and interviewed 13 JHOs at one Australian hospital over 12 months, also using video to record interactions in the field. The JHOs were preoccupied with: learning what was expected of them in their job; impressing their superiors; and, getting onto the specialty training programme of their choice. Following Bourdieu, Luke proposes that these rewards are forms of cultural capital which JHOs are able to access only by developing a medical habitus – that is, by acquiring the set of dispositions needed to practice successfully, behave and look like ‘a doctor’. Luke documents this process, showing that JHOs gradually learn (in their own words) to ‘play the game’ of medicine. For example, her interviewees told her that being at the bottom of the hierarchy, they had to ‘suck up’ to the right people, to be compliant and ‘likeable’. They learned which consultants represented valuable social capital and how to use cultural capital to access it, e.g. one JHO planned to read up on the cricket results so he could discuss them with the surgeon he wanted to impress.
One of the most interesting aspects of Luke's study which comes out through her use of the habitus concept is the embodied nature of the medical habitus. The JHOs quickly began to dress conservatively and even started to mimic the posture and voice of the registrars. They learned where to stand and how to conduct themselves on ward rounds, when to pick up charts and who to hand them to. At the end of the year, the JHOs reflected on how these behaviours had become natural for them and how much more confident they were in the doctor role. Thus, the habitus explains ‘how professions succeed in reproducing themselves in the form of durable dispositions in people’ (p. 52).
The sociology of medical education has often not been clearly differentiated from the psychological study of how attitudes, values and roles are learned in medicine. Luke places medical education squarely back into the domain of sociology by using the habitus to show how individual practices are shaped by, and reproduce, social structure and power relations. Luke's medical ‘habitus’, however, is a somewhat reductionist and overly-conscious interpretation of what Bourdieu conceptualised as an all-pervasive, structuring worldview. For example, she suggests that JHOs revert to being ‘individuals again’ after hours (p. 147), as though the habitus were merely a work role. Meanwhile, Simon Sinclair's (1997) earlier (less fully-developed) discussion of the medical habitus goes unacknowledged.
The book has a number of serious shortcomings. Inadequate proofreading has left some passages incoherent, many sections unfocused and the reference list incomplete. With all the hallmarks of a PhD thesis, this work might have been published more appropriately as a series of articles. Data are not presented until almost halfway through and there is a lot of repetition.
Nevertheless, I am convinced that there is more to medical training than either top-down socialisation or peer enculturation, and the medical habitus is certainly a useful concept which has not been fully explored before. While I would not recommend this book as a teaching aid, it should appeal to researchers interested in the old question of how the medical profession succeeds in reproducing itself.
Caragh Brosnan University of Cambridge
Disability and Social Policy in Britain Since 1750 . Basingstoke : Palgrave Macmillan, 2005 £16.99 (pbk) 306pp. ISBN 0-333-91255-1
Historical explorations of disability in a sociological context have been both neglected and oversimplified. Where historical references to disability have been made, these have failed to account for the heterogeneity and complexity of disabled people's experiences. It is this discrepancy that Borsay seeks to overcome in Disability and Social Policy in Britain Since 1750. By placing her analysis within a historical context, Borsay offers us a valuable resource. Moreover, in locating her account within a social model of disability, Borsay moves beyond factual explanations, making for an exciting and stimulating read.
Through the use of visual, literary and oral sources, Borsay outlines the challenge of modernity and ensuing hierarchical social relations in the development of disability policy since 1750. Engagement with concepts such as economic rationality, power, resistance and oppression allows the reader to understand further, the context in which social policy was made in the 18th and 19th centuries, and the subsequent legacy which remains evident in contemporary society. The book is of relevance to those seeking to gain a better understanding of disability issues and will be of interest to disabled people, practitioners and students as well as academics in the fields of disability, social policy, health, and sociology more generally.
The complexities and implications of social policies are presented in two parts. Part one explores institutional living in workhouses, hospitals, asylums and schools while part two examines community living in the domains of work, financial relief and community care. Social policy relating to institutional living in the l8th and 19th centuries, built upon the initial developments of the voluntary and commercial sectors in establishing workhouses and other institutions. Schools, workhouses and hospitals emphasised their humanitarian role in ‘looking after’ disabled people. Such declarations were, however, underpinned by a desire to equip, as far as possible, disabled people for economic independence and self-help, such was the emphasis on economic rationality and normality. Hospitals and asylums sought to ‘cure’ those with the most potential and rehabilitate those most likely to succeed in the economic domain.
In her analysis of institutional and community living, Borsay examines how, contrary to popular belief, some disabled people did have positive experiences. In the main however, social policy sought to reinforce dominant hegemonies of normality, against which disabled people were measured. Workhouses for example, were held up as a humiliating example of what could happen to those who did not subscribe to state desires of economic fulfilment.
The direction of social policy has undergone change from the 18th century. The insight which this book provides suggests that changes in social policy may be cosmetic rather than substantive. Policies such as the 1944 Employment Act conferred the right to employment, but these were not enforced and the marginalisation of disabled people remained static. Access to services and benefits were undermined by reliance on means testing and stigmatising connotations.
The latter part of the book explores how social policy in relation to disability has developed in the late 20th century under the auspices of Thatcherism and New Labour. While apparent progress has been made in the form of the Disability Discrimination Act (1995) and various social policies, the extent to which these represent significant development is being questioned.
Disability and Social Policy recognises that, although disabled people have a shared history and a shared experience of marginalisation, experiences differ between individuals with different types of impairments. The author clearly locates the ‘problem’ of disability as firmly embedded in society rather than the ‘impaired’ individual. Individuals were (and are) disabled not by their impairment, but via socialised notions of normality. Such norms, outside which disabled people are perceived to fall, manifest themselves in economic, political and cultural structures, including education and welfare. In her final analysis, Borsay brings a reflective element to the text. The author is under no illusions about the potential pitfalls of her role as a ‘non-disabled’ writer and describes herself as a ‘positional’ observer rather than an organic one.
This text is a welcome addition to the fold, and a ‘must read’ for those with an interest in the roots of the marginalisation and exclusion of disabled people in contemporary society.
Bronagh Byrne Queen's University of Belfast
Emotion Management in the Workplace Basingstoke : Palgrave Macmillan , 2005 £24.99 (pbk) 190pp . ISBN 0-333-99017-X
The role that emotion plays in our understanding of management, organisations and the workplace has become a distinct, important and valid area of study. Despite this, there are comparatively few texts dealing with such matters. This book adds to the expanding series of texts within the Management, Work and Organisations Series published by Palgrave with which many readers will be familiar. As the title suggests Sharon Bolton's book concerns itself with emotion management in the workplace. She takes a critical perspective encouraging the reader to look beyond what she calls ‘the emotional labour bandwagon’ (p. 53): that is the popularisation and adoption of the term ‘emotional labour’ beyond its original definition. Bolton also criticises other simplistic descriptive phrases concerning emotion which she accuses serve to confuse rather than inform debate. This text aims to go beyond simple description and looks to contribute to debate by providing a greater synthesis of emotion management and the world of work and introduces a ‘typology of workplace emotion’ (p. 89).
When looking through the contents page of books such as this I tend to turn right to the chapter or subsection that appeals to me to be the most interesting or attractive and as such I dip into and out of the book as time and interest permit. With this book, however, I quickly realised such a strategy was a mistake as so many of the chapters cross reference one another and refer to previous arguments and discussion. This is not a dip-into-and-out-of book but is one that should be read chronologically. Chapter 1 is where readers should therefore begin. In this chapter Bolton paints the background and justification of her text and ends it with a useful overview of subsequent chapters.
Each chapter begins with a brief outline of the focus of the chapter, where Bolton explains what she will and more importantly what she will not be considering. This ensures that the reader is aware of any implicit assumptions and intended omissions from her analysis. It is in essence a book of two parts, the first three chapters following the introductory chapter (Chapters 2, 3 and 4) offer an analysis of the study of emotion in the workplace, acknowledging and critiquing the contributions of many key studies and workers in the area. In concluding Chapter 3 Bolton argues that if organisations are seen to have a culture then they can also be seen to have emotions, and that new ways of conceptualising emotionality in organisations are required.
These chapters represent a useful analysis of the literature on emotion and organisations; they also form a prelude to the latter half of the book (Chapters 5, 6 and 7) in which the author reveals the main motivation for her writing. Here she proposes a ‘typology of workplace emotion’ and aims to clarify and add to the current debate about emotion and organisations by making organisational emotionality more understandable and meaningful. Using ‘Labour Process Analysis’ and Goffman's work on the ‘Presentation of Self’ the typology acknowledges that the employee is an important and skilled social actor. To support this assertion the remaining chapters of the book explore organisational feeling rules surrounding emotion management: prescriptive and pecuniary. Within this, there is also a consideration of those aspects of emotion management not dictated by organisations but which are embedded within social interaction (presentational and philanthropic emotion management).
I found it hard to be critical of this book as I found myself agreeing with and nodding as I read many of the challenges that the author levels at the assumption that emotion-management skills of employees are there to be commercialised by employers, and that the distinctions between the commercial and intimate have become obscured or irrelevant. Indeed, this concern seems to be one of the prime stimuli for writing her book. For readers unfamiliar with some of the concepts such as ‘Labour Process Analysis’ or the ‘Presentation of Self’ then this book may pose some problems. For the book's primary target audience, however, this terminology should pose no issue. Primarily aimed at the organisational studies or personnel management student, this book also undoubtedly offers much to other students with an interest in emotion and organisations, including those in the field of the sociology of health and illness, and would be of benefit to them. It is in general a very readable text and helps to fill a critical gap in the literature and current market. At 199 pages in its entirety, the book is comparatively succinct, made up of eight well-balanced chapters providing a useful and accessible account in which the author systematically outlines the key concepts and issues regarding emotion management in the workplace.
The final chapter (8) titled ‘Mixed feelings’ brings together the arguments presented previously and concludes as you might expect that emotion work is skilled work that can have an important effect in an organisation's success or otherwise and, in terms of emotion, organisations are mixed. As such ‘there can be no [absolute] conclusions just more questions’ perhaps a fitting end to a book that sets out not to answer the questions about emotion in the workplace but to add to the debate, an aim I believe it achieves.
Kevin Hugill Coventry University and University of Central Lancashire
Transitions in End of Life Care: Hospice and related developments in Eastern Europe and Central Asia , Buckingham : Open University Press , 2003 ISBN 0 - 335 - 21286 - 7 . and
I was grateful for the opportunity to review this book, since I have always been impressed by the quality of David Clark's writing and work in palliative care. The subject matter for this book makes it an ambitious undertaking which covers a diverse and complex area of palliative care provision in Eastern Europe and Central Asia. Over half of the book is devoted to individual reports on palliative care across these 28 countries, but as well as providing an analysis of palliative and hospice-care developments, these reports include geographic, demographic and economic profiles. The review of these data collected in 2001 will provide a sound evidence base for future evaluation, and this is one of the author's stated aims of the book. For example, at the time of the data collection, only seven out of the 15 countries of Eastern Europe provided paediatric palliative care services, and the authors argue for the need to develop core standards and to measure the outcomes of the needs for all dying children. The second half of the book is devoted to good examples of palliative care provision. The book concludes with an examination of the key themes, most of which are resource-based issues, including opioid availability, medical aid, equipment and materials, external partnerships and the ‘culture of care’.
Part of the context of this review is the social and economic reforms and transition from communism to more market-based healthcare systems. There are many qualifications of terminology and language that need to be taken into account when reading this book and which the authors lay out in their introduction.
The comparisons between countries follow the same structure and include innovations, current provision, special issues and palliative care providers. This makes comparison between countries relatively straightforward. The book moves on to present five beacon reports from four countries and these case studies from Hungary, Poland, Romania and Russia capture palliative care examples of excellence. The authors selected these reports for their historical significance, clinical ‘excellence’, personal impact on policy, education, research and academic links. The book concludes with specific recommendations that these beacons should be used as the means to extend and disseminate good practice to develop more beacons of palliative care.
It is interesting to note how much the hospice movement in the UK has been associated with pioneers and the extent to which its uneven development has been more likely to be based on the presence of charismatic leaders than on the need for palliative care provision. The authors make claims about the pioneering value of the development of hospice and palliative care in the regions of Eastern Europe and Central Asia. Certainly, the coherence of palliative care into a strategic group of pioneers, which they have noted, suggests a more collaborative style of growth and one with the capacity to satisfy palliative care need more than provision. The authors also highlight the significance of partnership, and throughout my reading, especially the examples of beacons of palliative care, I recognised that not only is the success of palliative care provision dependent upon a relationship of holistic care, but so too is its development.
I have two concerns about possible omissions in this study, both of which might be unreasonable, given the authors’ stated aims of the book. First, it would have been good for the authors to have presented a more sociological analysis which could have included a view on the direction of palliative care and its continued (exclusive) focus on cancer in adults. Second, and related to this, I would have welcomed a critique of the existing palliative care provision, alongside existing services. This more epidemiological mapping and analysis, could have contributed to the planning of future provision.
Having argued from two apparently contradictory positions that this book is both ambitious and limited, I need to applaud the enormous task that must have been involved in collecting and presenting these data. Furthermore, this book is not merely an exercise in the mapping of palliative care provision in Eastern Europe and Central Asia, it contains many stories, some of which are tantalisingly brief and some almost evangelical in style. It is these stories which make the book such an engaging read and much more than the presentation of a set of comparative data, useful as that might be.
Carol Komaromy Open University
A Pleasing Birth. Midwives and Maternity Care in the Netherlands , Philadelphia : Temple University Press 2004 £13.33 pbk ISBN 1-59213-103-4 . .
Who cares about birth in the Netherlands? Around 30 per cent women still give birth at home in the Netherlands and are encouraged to do so. Unlike every other country in Western Europe and North America, where around two per cent of women do. This book asks why is the Dutch way of birthing children so different, and explores this ‘exceptional case’ within worldwide maternity systems to understand the wider relationship between health policy, health systems and culture.
The book goes on to ask what is the place of maternity care in the larger healthcare system? How is government policy on healthcare made? How does the political system influence healthcare? Who pays for healthcare? Who profits from services? Finally, and most interestingly, what elements of Dutch culture, for example ideas about the body, about gender and families) influence the particular healthcare system?
The book sets the stage for two stories of Dutch maternity care. The first is about the Dutch way of giving birth, the second is an account of how health systems operate. Raymond de Vries argues that the best way to learn about the operation of complex health systems is to look at a small slice of healthcare in one country. Thus, the study of maternity care is of interest to scholars of health policy because, unlike other medical specialities, the influence of culture and society is not masked by widespread uniformity in technology and practice.
Raymond de Vries is well placed to write such a book. As he points out in his personal reflections at the beginning of the book, very few people have the opportunity to spend time in another country and conduct research in the language of that country. The insights that this brings are fascinating and one begins to understand how much cultural meaning and understanding is ‘lost in translation’. One example is that women in the Netherlands do not ‘have’ babies, they ‘get’ babies. Thus signifying a child is regarded more as a gift than a possession.
Part 1 starts out by exploring what makes a ‘pleasing’ birth, and the specific features that make Dutch birth different from the rest of Europe and the USA, which is the main point of comparison. Part 2, tells the story of how Dutch maternity care avoided the technological imperative by looking at the unique features of Dutch society, i.e. the health insurance system, the health policy process, educational and professional institutions, and political arrangements. Part 3 asks why the Dutch, unlike their neighbours, created and maintain midwife-assisted birth at home. By looking at the critical role of cultural ideas and values, a sociology of obstetric science analyses how structure and culture have been used both to support and criticize Dutch obstetrics, and introduces the notion of a ‘cultured science’, i.e. one that is thoroughly embedded in its host culture. Part 4 explains how health systems have been formed and reformed and the relationship between Dutch obstetrics, Dutch medicine and society.
This book is of interest to those who are interested in birthing and reproduction and maternity issues. However, it is also of interest to those scholars of health systems and health policy, as through the lens of maternity care in the Netherlands it explores where and how such systems come into being, are maintained and changed. Thus, it provides a greater understanding for those who wish to influence and change health policy. It would be fascinating to see if a similar analysis of a different facet of Dutch health policy would arrive at the same conclusions regarding the role of culture. The reference point is the role of culture in American health systems. Again a similar analysis reveals the role of culture in USA health systems and policy and begins to explain why some attempts to change policy have failed.
The book provides a greater understanding of the Dutch maternity system. This is important for those who look to the Netherlands as a blueprint for maternity care in their own countries. For example, jurisdictional boundaries between midwives, obstetricians and family doctors are enshrined in state provision informed by notions of efficiency and equity, rather than women's choice about who delivers her care. There is a danger that by focusing on the exceptional case of Dutch maternity care, the rather more mundane is invisible. I would welcome greater exploration of the views and experiences of the health professionals and women who work and give birth in the tertiary hospital sector, where 70 per cent of women receive their care.
This work aims to challenge widely accepted academic views about the way health systems develop and operate. It forces us to revise knowledge that health policy and medical sociology takes for granted, and suggests a new way of thinking about health policy that draws on political science, sociology and anthropology in a way that is elegant and readable.
Jane Sandall King's College London
Perspectives in Human Sexuality . Oxford : Oxford University Press , 2005 £28.99 (pbk) 344pp . ISBN 019551701-6 and (eds)
Sexuality textbooks have often focused solely on those sexualities deemed ‘non-normative’ or, in other words, non-heterosexual. Perspectives in Human Sexuality, with its ‘pluralistic philosophy’ and framework of problematisation evades this pitfall and evidences the diversity of sexuality issues which, in a postmodern world, provoke re-examination and further theoretical exploration. Ross Morrow points out within the text that ‘as their research interests change, as new theoretical perspectives open up new questions and lines of enquiry, and as society and culture itself changes, sociologists will have important new issues to explore and analyse’ (p. 188), a point of view which is clearly subscribed to by those who have contributed to this edited collection.
The key themes of this Australia- and New Zealand-based text are the organisation and regulation of sexuality within society. The introduction, consisting of two chapters, affords valuable background information that works to acquaint the reader with the basics of the intersections of sexuality with society and theory. There follow more detailed investigations of particular aspects of sexuality research such as gay cultures in Australia, young people and the social organisation of sex, homophobia, and pornography.
Allanah Ryan's chapter on the regulation of sexuality in the name of public health, Ross Morrow's ‘sexual dysfunction and sex therapy,’ and Allison Kirkman's discussion of ageing and sexuality are likely to be of particular interest to readers of Sociology of Health and Illness. These analyses of health-related sexuality issues are each based on a notion of the medicalisation of sexuality as a form of social control and normalisation. Medicalisation is theorised as setting up a ‘norm’ against which other sexualities are evaluated: this ‘norm’ being heterosexuality, and in particular male heterosexuality.
Allanah Ryan (Chapter 12) points out that particular sub-populations are classified as posing a health threat to others, and are expected to regulate themselves accordingly. ‘Value-laden positions are taken on the right and proper ordering of sexual and gendered bodies’ (p. 207), for example the control of prostitutes via the Contagious Diseases Act of 1864 and the pressure placed upon gay men to self-regulate in relation to AIDS. This can also be seen in the regulation of transsexual identities through medicine and psychiatry. Hence, the medicalisation of sexuality, and also gender, can be seen to influence the identities of those within the affected groups. In a similar vein, Morrow (Chapter 11) discusses the classification of certain conditions as sexual dysfunctions. These are defined in comparison to ‘normal’ sexual response and functioning, with such departures from the ‘norm’ often being regarded as illnesses, and therefore becoming likely objects of therapeutic intervention.
Sexuality has become a major area of study within many academic disciplines and this multidisciplinary text brings together many of these perspectives, examining them through a critical lens, with an underlying recognition of the influence of heteronormativity's production, maintenance and legitimation. Heteronormativity, the presumption that heterosexuality is the only viable sexuality, leads academics to study only those outside this ‘norm’, whereas in this book there is also examination of other aspects of sexuality, such as ageing, ethnicity and prostitution. There is a movement towards challenging heteronormativity, and in this way Perspectives in Human Sexuality goes further than many other sexuality textbooks.
Particularly welcome are discussions of the fluidity of sexuality, the intersections of sexuality with other aspects of identity, and the resulting complexity of studying sexuality: aspects that are often overlooked. Notwithstanding the inclusion of many often-marginalised aspects of sexuality, it is unfortunate that asexuality and polyamory have not been incorporated as newly-emerging areas of interest within the field of sexuality studies.
Despite this book being aimed at undergraduate students, it is an extremely useful overview of the study of sexuality, which is also likely to be of value to Masters and PhD students, and to those within academia who just wish to learn more about the field of sexuality studies. Especially helpful are the glossary, extensive bibliography, additional reading, discussion questions, and an overview of the key thinkers in sexology, which make this textbook particularly suitable for undergraduate modules.
Tam Sanger Queen's University of Belfast