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BOOK REVIEWS AT MAQ

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

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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

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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

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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

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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.”

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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.

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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

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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 analysis the patient suffered because of confusing explanations of her ex- istential problems. Yet, he seems to have contributed to this confusion by his own actions.

In the epilogue, the argument is made against an essentialist model of illness. But again, this is an argument that has been made for many decades. More disconcert- ing, the authors state that anthropologists take Western scientific epistemologies as the “true concept of reality” (p. 185). Al- though indeed there may be some medical anthropologists who do so, many have ques- tioned and critiqued scientific and medical “truths.” Nonetheless, the epilogue argues correctly that people do not think in mutu- ally exclusive categories but in many differ- ent modes.

Although some chapters may have their shortcomings, most of the chapters— especially the ethnographic case studies— are worth reading. They will be of interest

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to students, especially those who are not yet too familiar with the anthropological lit- erature on biomedicine’s relationship with other healing modalities.

Transforming Emotions with Chinese Medicine: An Ethnographic Account from Contemporary China. Yanhua Zhang. Al- bany: State University of New York Press, 2007, xiv + 191 pp.

Judith Farquhar Department of Anthropology University of Chicago

Anyone who has conducted research on traditional Chinese medicine is aware of the Frequently Asked Questions: Is Chinese medicine effective? What is its spiritual mes- sage? How does Chinese medicine under- stand and treat psychological disorders? Of these, the third is perhaps the hardest to an- swer.

Yanhua Zhang’s new book splendidly solves the problem. In the process of metic- ulously explaining what emotions mean and why they matter in the therapeutic and discursive world of Chinese medicine, she also addresses, very usefully, a number of broader questions in medical, cultural, and linguistic anthropology.

It is tempting, when trying to explain why “psychology” and even “the emotions” are not a simple or obvious topic for Chinese medical experts, to overstress the “holism” of the field. One can insist that Chinese medicine (or classical metaphysics, aesthet- ics, etc.) makes no distinction between mind and body, spirit and flesh, suggesting that the entire “Western” tradition of coping with emotional disorders is a foreign im- position. Such a strategy, however, makes too facile an East–West contrast and smacks of Orientalism. A reduction of human life to holistic principles like “the harmony of heaven and man” or the “interconnection of all the body’s organs” risks losing touch with a great deal of Chinese thinking about the most subtle aspects of human experi- ence. In fact, Chinese medicine can tell us

much about the relationships between vital processes and experiences of insight, pas- sion, and thought.

In appreciation of the foregoing, Zhang is very careful to avoid metaphysical overgen- eralizations, providing instead a nuanced exploration of modern Chinese emotional life as it takes form in the clinics of tradi- tional Chinese doctors. She conveys an un- derstanding of the particularity of a Chinese world of experience while offering a fecund vocabulary for experience. Her discussion of the word jingshen, usually translated as “spirit,” for example, leads us to an under- standing of both its components as referring first to vitality, so the compound concept helps us understand a “Chinese conceptu- alization of life.” Observable qualities of a person such as responsiveness, a good mem- ory, an interest in others, and willingness to talk all contribute to a clinical sense of healthy jingshen. A Chinese medical vision invites us to see “spirit” as “spiritedness,” not as an essence or a magical vapor but as a refined form of vital activity. By shifting the terms in which we imagine embodied human experience itself, this book reveals much about the practical relations among discourse, knowledge, embodiment, and experience.

Zhang bases her ethnography on careful study of training and professional discourse in contemporary Chinese medicine, on a thorough understanding of Chinese moder- nity in all its hybrid complexity, and on sys- tematic field research in clinics of Chinese medicine. Chapter 1 introduces the ambi- tions of the book by orienting the project in relation to recent medical anthropology, anthropology of embodiment, and Chinese studies. Chapter 2 provides historical back- ground for understanding contemporary Chinese medicine. Although the chapter is too brief to incorporate all the valuable find- ings by recent historians of 19th- and 20th- century medicine in China, in it Zhang does succeed in showing some of the complex- ity and internal differences in the field that only came to be organized and called “Chi- nese medicine” (zhongyi) during the last 100 years. She also provides an interesting

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discussion of the kind of knowledge that is translated as medical “theory” (lilun).

Chapter 3 grapples with keywords of Chinese medicine related to embodiment. Zhang’s sensitive approach to interpret- ing the “semantic networks” of terms like shenti (body–person), xin (heart–mind) and nao (brain), tong (flowing and connect- ing), du (position, moderation), and he (har- mony) is essential for understanding the ethnographic findings of this study. This chapter and chapters 4 (on qingzhi, the emotions) and 7 (conversation analysis of clinical encounters) demonstrate magnifi- cently the contribution a linguistic anthro- pology can make to medical anthropology and embodiment studies. Zhang, writing as both linguist and as native speaker, shows how ordinary usage of language produces culture-specific objects that take on consid- erable importance in everyday life and ex- perience. Her elucidation of these objects or terms goes beyond the task of translation. It poses for Anglophone readers a world of novel causes and effects (esp. evident in ch. 6, where Zhang discusses stagnation), and it shows us fresh terrains and temporalities. Zhang’s research proves that the nature of both the self and its environment are up for negotiation in the clinical encounter. This is, of course, true of many kinds of heal- ing relationships, but medical anthropology has not always addressed the productivity of clinical work at such a deep level as Zhang reveals in this book.

Throughout Transforming Emotions with Chinese Medicine, Zhang illustrates her findings about Chinese medicine with case vignettes drawn from her work in clinics. As traces of troubled lives and examples of therapeutic strategies, these stories render the abstruse principles of Chinese medicine and the methods of its practitioners much more accessible to outsiders. The relationships between com- mon sense, mundane practice, and medical theory are not always easy to reveal; in doing so with well-chosen examples, Zhang has unpretentiously shown that China’s great tradition, in all its philosophical com-

plexity, still speaks in everyday embodied experience.

Some of the material Zhang analyzes is quite technical, and for some readers her presentation of the deeper ideas in Chinese medicine will be slow going. Errors in some tables and other evidence of the publisher’s copyediting laxity may aggravate the read- ing process. Careful attention to Zhang’s rigorous and accurate translation and com- mentary is very much warranted, however. It would be a great pity if Transforming Emotions with Chinese Medicine were only read by the small community of Chinese medicine scholars. The book has much to teach medical and cultural anthropology; it is a study that begs for analysis in class- rooms. This is a very courageous book, in- sisting on the uniqueness, power, and rele- vance of a Chinese medical approach to the passions. It repays careful reading, whether readers have anthropological, historical, or personal ends.

Gender, Race, Class, and Health: Intersec- tional Approaches. Amy J. Schulz and Leith Mullings, eds. San Francisco: Jossey-Bass, 2007. xx + 423 pp.

Janis Faye Hutchinson Department of Anthropology University of Houston–University Park

Anthropologists often discuss the impor- tance of interdisciplinary collaboration. However, interaction between disciplines, let alone within anthropology, seldom oc- curs. This edited volume is an exception. Here, we have a set of articles that pro- vide perspectives of social science and public health to address a single and pressing issue: health disparities.

Often, edited volumes lack coherence. Certain key points, however, hold these articles together. First, all of the chapters examine race, gender, and class as social relationships that generate health inequal- ities. Second, authors in each chapter exam- ine the historical and social context in which knowledge is shaped and illness, health, and

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inequality are understood. Third, the au- thors examine the ways that institutions structure health care and access based on race, class, and gender. Last, the authors consider how to reduce or eliminate inequal- ities in health outcomes. With these themes running through each chapter, this edited book is a cohesive collection of articles on health inequality.

The approach used by all of these re- searchers, whether from public health or the social sciences, is intersectional theory. With roots in feminist scholarship, especially black womanist research, intersectional the- ory examines dimensions of race, class, gen- der, and sexuality in terms of differential power and social relations. Intersectional feminism, according to Lynn Weber, “inter- rogates the institutionally structured power relations shaping the process of knowl- edge production itself, the social inequali- ties of health, and the relation between the two” (p. 30). This edited volume does not belittle the importance of the biomedical model but argus that examination of alter- native paradigms in conjunction with the dominant model can generate new knowl- edge and contribute to shaping policy about health disparities.

In the introduction, Schulz and Mullings state the goals of the book: to understand how gender, race, and class interact to pro- duce differences in health, illness, and well- being. The editors hope to create critical dialogue between public health and social scientists that can bridge the gap between theory and practice and inform efforts to eliminate social inequalities that drive dis- parities in health.

The second section deals with the pro- duction of knowledge. Weber compares the biomedical and intersectional frameworks stressing the importance of collaboration. Weber acknowledges that the power imbal- ance between the two traditions must be addressed. In this chapter, it is also argued that “outsiders-within” such as women of color can make important scholarly contri- butions to understanding the intersection of gender, race, and class. In all of the chapters it is stressed that race, gender, and class are

not just additive but are “mutually constitu- tive.” In the same section, Martin provides a case study of the intersectional approach using mood disorders. She interrogates di- agnosis of mood disorders among racial groups at different points in time and il- lustrates how diagnoses changed over time. Last, Daniels and Schultz examine the con- struction of whiteness in interpreting racial disparities and the implications of this con- cept for eradicating health inequalities. In particular, they investigate racial differences in health due to differences in social envi- ronments rather than differences in innate characteristics of groups.

The third section is entitled “The Social Context of Health and Illness.” Here, au- thors provide case studies of health within particular social and historical contexts. For instance, Jackson and Williams examine “the Intersectional Paradox” by which the black middle class are better off economi- cally but just as sick as blacks in the lower class. The authors focus on resources and power differentials because black middle- class status does not entail the resources and power expected for that group. Caldwell et al. examine identity theory and psycho- logical well-being where experiences with discrimination are associated with lowered self-esteem. The epidemiological paradox of good health in Latinas is also examined; it is shown that once the data is disaggregated, Latinas do not have improved health. Zam- brana and Dill argue that the ways groups are depicted in society and the expectations associated with these depictions are impor- tant in health status. Instead of personal characteristics, these authors focus on ac- cess to social capital or social resources. Brown’s discussion of immigrants shows how they were marginalized in the most haz- ardous jobs. Although language and culture differences are used in biomedical models as barriers, these authors locate barriers within historical and local settings.

“Structuring Health Care,” the fourth section, examines access to quality health care. In particular, authors in this section focus on structural racism and the privileg- ing of some groups while access to resources

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is denied to others. Geiger examines the quality, intensity, and comprehensiveness of medical care for people of color. He dis- cusses bias, a pseudonym for racism, in health care among physicians, nurses, and other health providers. In particular, the clinical encounter is examined as the focal point for “bias.” In similar fashion, Mwaria suggests that prejudgments by physicians based on race, gender, and class may lead to assumptions about patients’ ability to un- derstand or follow protocols. Although it is often stated that people of color are un- willing to participate in clinical trials, she found that patients of color valued the op- portunity to participate in such trials. Gate- keeping by physicians, however, plays a ma- jor role in maintaining differential access to clinical trials by gender, class, and race. An- glin probes how gender, race, and class dif- ferentially impact health because of differ- ential diagnosis, treatment, and illness for breast cancer. She argues that the national breast cancer movement is not as effective as it could be because it does not incorporate those with less access to quality health care, including advanced technological medicine (i.e., women of color), into the movement. Again, the focus is on structural racism op- erating within or through the intersections of race, gender, and class.

The last section deals with “Resistance, Disruption, and Transformations” of health inequalities based on race, class and gen- der. Although certain experiences may ex- acerbate health problems, others reduce the negative health effects of inequalities. So- cial movements such as the women’s health care movement are examined. Mullings, for instance, discusses the activism of Harlem residents to improve the quality of health in their community. Mullings examines as- pects of life that are not usually directly discussed in connection to poor health. She uses the “Sojourner Paradox” as a frame; this conceptual frame draws atten- tion to the responsibilities that black women must perform while experiencing racial and gender oppression. The Sojourner Paradox addresses the structural constraints that im- pact health as well as strategies for resis-

tance and transformations. Mullings also notes that a consequence of being a black woman is an unstable class status. In other words, “race dilutes the protection of class” (p. 363).

Interventions were also addressed in this section. For instance, using a case study of the social context of HIV infection among young men of color, Schulz et al. show that race, gender, and class are linked by struc- tures that enforce differential access to re- sources such as decent housing, and that racist residential and employment policies and symbolic representations such as me- dia portrayals of young men of color influ- ence mobilization and policy affecting their health. Through activism, communities in Los Angeles and New York City illustrate factors that maintain inequality. Moreover, mobilization and activation in these neigh- borhoods prevented health-damaging facili- ties from being developed. Morgen’s com- plementary chapter examines the role of grassroots activists in keeping health dis- parities in the forefront. Using movement- grounded and intersectional theories, she focuses on the importance of women of color activists in interrogating race, gender, and class as mutually constitutive and in- tertwined rather than simply additive. With the Institute of Medicine’s report on racial disparity (a biomedical perspective) and the National Black Women’s Health Project’s report, which uses an intersectional ap- proach, she argues “that women of color went beyond the discourse of ‘rights’ to show how capitalist social relations effec- tively prevent the poor from exercising fun- damental rights” (p. 400). Morgen notes that women of color were the primary ones to nurture the intersectional approach. They had no choice. If health issues of women of color are subsumed under ei- ther women or minority, they become marginalized and invisible.

This volume moves the focus of scholar- ship on health disparities from personal be- havior to structural constraints and social justice. Although the intersectional ap- proach is rooted in the principles of social justice, this does not oppose or conflict

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with the positivist biomedical model. To- gether, both approaches, biomedical and intersectional, can provide a more robust critique of health disparities. Weber states that the intersectional approach emerged to promote an explicit social justice agenda “countering the dominant-culture institu- tions that reinforce and reproduce health and other social inequalities” (p. 45). So- cial justice is the backdrop for intersectional theory and there is no apology. Rather, it is argued that this approach can bridge the gap between the academy and social action.

This edited volume will be a valuable resource for professionals in health-related fields and for those interested in inter- sectional approaches to social issues. It could be used in upper-level undergraduate courses in medical anthropology or medical sociology as well as graduate courses in the social sciences and public health.

Introducing Medical Anthropology: A Dis- cipline in Action. Merrill Singer and Hans Baer. Lanham, MD: AltaMira Press, 2007, v + 246 pp.

Priscilla Song Yale University

This concise new volume by veteran text- book authors Merrill Singer and Hans Baer provides an engaging introduction to the discipline by focusing on what medical an- thropologists do. The emphasis on practice guides both the purpose and style of the book in productive directions. Intended for undergraduates with no prior exposure to the field, the book aims to convince read- ers that “medical anthropology is not an ivory-tower discipline insulated from the off-campus realities of human illness, suf- fering, and death” (p. 9). They make a compelling case for why medical anthropol- ogy matters by presenting concrete exam- ples of how practitioners actively address health problems in diverse settings through- out the world. Their tone is accordingly pragmatic rather than philosophical, fore-

grounding empirical research and applied contributions over abstract theory.

The authors begin their overview of the discipline by introducing readers to ac- tual cases of medical anthropologists in action, an expository technique they utilize throughout the book. In answering the ques- tion “Why have a medical anthropology?” the introductory chapter also provides a brief history of the field’s emergence within the parent discipline of anthropology and situates the field in relation to other health- related disciplines. The next two chapters give readers a grounding in the founda- tional methods and core issues of the dis- cipline, utilizing the case study approach to explore research design (ch. 2) and concepts (ch. 3), medical anthropologists employ to understand health-related activities and ill- ness experience. The book then shifts to a systems-level analysis of disease and heal- ing by situating medical beliefs and prac- tices in their wider social contexts, first com- paring various ethnomedical systems among nomadic foraging, pastoral, and chiefdom societies (ch. 4) and then discussing medical pluralism in complex societies (ch. 5). The final two chapters examine health problems from a critical perspective, focusing on the structural causes of health inequalities (ch. 6) and the negative health consequences of environmental degradation (ch. 7).

Although previous textbooks coauthored by Singer and Baer have emphasized a politicoeconomic approach to understand- ing health problems, here the two aim to present a more general overview of med- ical anthropology. They thus explore the cultural construction of illness and dis- ease, reviewing meaning-centered concepts such as stigmatization, illness narratives, and embodiment. They also address bio- cultural approaches, outlining an evolution- ary model of ethnomedical systems and as- sessing key features of the medical ecology model. As long-standing proponents of crit- ical medical anthropology, however, Singer and Baer continue to place their emphasis on a world-systems perspective that links health and suffering to wider structures of

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power and inequalities. Their critical analy- sis ultimately blames global capitalism for a wide range of health injustices, and the book concludes with a radical call to replace the current world order. Although the authors seek to galvanize readers into “pragmatic solidarity with a broad coalition of progres- sive people” to create a “healthy planet for both humanity and ecosystem” (p. 207), their sweeping prescription for change at the global structural level may ultimately dissuade new learners about their own and medical anthropologists’ abilities to make a significant difference. This contrasts with the bulk of the book, which documents the many productive ways in which anthropol- ogists address health problems in diverse locales.

This book would be a good primary text in survey courses that seek to introduce stu- dents to a broad range of work in med- ical anthropology. Singer and Baer con- dense an impressive array of book-length monographs and journal articles into short case studies ranging from a few paragraphs to several pages. The authors showcase projects as diverse as preventing dengue transmission in Malaysian communities and increasing breast cancer screening among African American women in Arkansas, to investigating medical pluralism in rural Bo- livia, studying the indigenous use of medic- inal plants in a Madagascan village, and understanding the culture of surgeons in a Canadian hospital. The result is a slim and portable paperback volume that offers students and instructors a sampling of the eclectic variety of projects in which medical anthropologists engage.

No book is without limitations. The book’s usefulness as a primer for students who are new to the discipline is some- what offset by its lack of learning aids such as chapter summaries and review ques- tions. Instead of a comprehensive glossary or boldface terms, each chapter elaborates a few concepts in boxes separated from the main text (e.g., bioculturalism, community- based organizations, ethnography, and capitalism). Also, although the black- and-white photographs provide important

visual context for readers, the generic “artist depictions” scattered throughout the book reduce complex biosocial phenomena to overly simplistic line drawings that fail to do justice to captions such as “snorting co- caine,” “mother nursing infant,” and “dia- betic injecting dose of insulin.”

The book’s emphasis on case studies might be a pedagogical challenge for in- structors who want to provide a more sys- tematic overview of specific topics and con- cepts in medical anthropology. Important concepts tend to get buried within or scat- tered among various case studies, when they would be more productively considered as overarching principles tying together vari- ous examples.

The book’s vivid case examples from around the world can enrich students’ ap- preciation for the diverse range of work en- compassed by medical anthropology. But in skipping from one continent to the next, often within a single paragraph, the book runs the danger of reinforcing a problematic view of the world as a mosaic of bounded cultures. In their account of folk under- standings of health and illness, for exam- ple, Singer and Baer describe how concep- tions of good health differ among the James Bay Cree in subarctic Canada, the !Kung San of the Kalahari Desert, the Tongans of Polynesia, and the Han of China (p. 69). This breathtaking coverage inadvertently contributes to a reified understanding of cul- ture as an immutable property of internally homogenous groups that map neatly onto distinct geographical locales.

Furthermore, the book misses impor- tant opportunities to explore the prob- lematic uses of culture in clinical settings. The section on “culturally competent care” (pp. 162–165) portrays this as a posi- tive development that helps produce better health outcomes for ethnic minority groups. Despite the brief acknowledgment that cul- tural issues must be addressed for all people, the substantive focus on the health dispari- ties of ethnic minority groups relegates cul- ture to the domain of the Other. As crit- ical medical anthropologists, the authors do an excellent job of demonstrating that

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social and medical systems are neither ho- mogenous nor bounded but instead shaped internally and externally by power relations and socioeconomic inequalities. Yet I would have liked to see more sustained and reflex- ive engagement with the meanings and uses of culture, particularly in a textbook that may serve as students’ first (or only) en- counter with anthropology.

Despite these qualifications, the book’s digest format and affordable price make it a welcome addition to introductory syllabi

in an age of escalating textbook prices and capricious online resources. By condens- ing dozens of research reports, community- based interventions, and policy initiatives into short case studies, Singer and Baer effectively introduce readers to the broad range of projects in which medical an- thropologists participate. Their distinctive focus on practical action offers an engag- ing way to persuade students that study- ing medical anthropology is a meaningful endeavor.