Lifestyle in Medicine . Abingdon : Routledge 2007 £21.99 xiii + 192pp . ISBN 978-0-415-53685-5 (pbk)and
A perhaps provocative suggestion: would it not be good if, sociologically, we could get rid of the word ‘lifestyles’? Like the other weasel word, ‘behaviour’– indeed, like much of sociological jargon – it has connotations in everyday speech that are confusing to non-sociologists and difficult to avoid. In the case of ‘lifestyles’, these include suggestions of consumption, fashion and superficiality, as well as moral overtones. Though most sociological definitions of lifestyle would mention some synergy of choice and chance, or agency and structure, the connotations of the word firmly favour choice.
This is not to say that the study of conventional ‘lifestyle’ factors, behaviours or ways of living – food, risk taking, exercise, sexual behaviour, alcohol consumption, self-treatment, smoking – is unimportant in the context of health. Each has its own interest and its own literature. But these topics are very different from each other and they are difficult to deal with as a coherent single category.
At the very beginning of this book ‘your [the reader's] lifestyle’ is defined as eating, smoking, drinking and physical activity: a bad start which does not in fact do the book justice. Persevere, however, and you find a thoughtful discussion of the history of the current medical use of the term lifestyle, and of the sociological critique of the medical approach as, amongst other problems, moralistic and discriminating, increasing the potential for surveillance and control, and associated with the commodification of the body and health.
The book is intended for students and academics of medical sociology and consists of six chapters. The first three discuss lifestyle as a medical explanatory model, shifts in sociological thinking about lifestyle, and the cultural critique of the medical approach. A fourth chapter turns to the history of the medical model, based on an interesting thematic analysis of formalised written medical and lay accounts over a thirty-year time period. This uncovers the history of the concept within epidemiology and public health texts, and analyses medical texts (used in the medical school of the University of Tasmania, the authors’ base). Added to this is an analysis of lay definitions in Australian popular culture, e.g. in self-help books, women's magazines and newspapers, asking: how do lay and medical understandings of lifestyle interact?
The fifth chapter offers original data from 20 interviews with doctors, combined with observation of doctor-patient consultations. This structure, with only a brief inclusion of empirical data, is slightly awkward – if this, why not an equivalent study of the patients’ understandings? However, the chapter is a good one, demonstrating the dual nature of the concept for doctors by showing both its benefits for them (allowing them to use everyday explanatory narratives, present disease as manageable, address the social as an ambiguous concept which can account for a wide range of situations) and its limitations (principally the inability to explain all disease). These are excellent interviews, thoughtfully analysed and giving clear evidence of the ‘complex, personalised, shifting and contingent nature of the doctors’ explanatory framework’.
The conclusion is interesting, suggesting that while many of the sociological claims about medical understandings of lifestyle are justified (for instance, as a universalistic but at the same time individualised concept of the social), sociology should also recognise the dynamic nature of medical understandings, their complexity and variation. The lay/medical divide was found to be blurred.
The book has a remarkably full bibliography. A minor complaint is that this is associated with what can be called the ‘current bun’ style of referencing: an unnecessary number of references spattering every page (excluding the data chapter) with an average nearing 20 references per page in some randomly chosen pages of the first two chapters. This is sometimes too staccato for comfortable reading, besides raising uneasy thoughts about medical models of ‘evidence’. However, some readers may find this very full referencing a useful feature, and the style is otherwise clear and fluent. The book ought to be useful to those in research or practice in health education, and in general practice, as well as sociologists in the field we have, for want of anything better, to call ‘lifestyles’.