Ideas about Illness: An Intellectual and Political History of Medical Sociology by Ute GerhardtReview by: Cecilia BenoitThe Canadian Journal of Sociology / Cahiers canadiens de sociologie, Vol. 16, No. 2 (Spring,1991), pp. 227-229Published by: Canadian Journal of SociologyStable URL: http://www.jstor.org/stable/3341283 .

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to legitimize the normalization of poverty and dependency within the framework of welfare state ideology. Moreover, it fails to theorize the administration of the expanding therapeutic-welfarist enterprise; to account for its predominantly working-class, ethnic, and female "clientele"; or to explain how the classifica- tion and treatment of individual subjects has contributed to wider processes of individualization through which power, gender, class, ethnic, race, and sexual relations are depoliticized and rendered inert as categories of emancipatory praxis.

In sum, Governing the Soul inspires an ambivalent response. This volume is a dramatic illustration of Foucauldian genealogical and discursive analysis at its very best and worst. It is an indispensable resource, and might well become the most influential study to date on the twentieth-century history of the psychological discipline. At the same time, the book's abandonment of socio-critique - and its privileging of language over life (see Palmer, 1989) - become its most

limiting features. Still in the final analysis, its liabilities notwithstanding, Rose's work will undoubtedly be used as the foundation for new assignments in the history of psychological powers and practices - assignments that will locate this history in broader social, political, and ideological context, taking seriously the conditions under which these new strategies and techniques were discovered and shaped.

References Garland, David

1985 Punishment and Welfare: A History of Penal Strategies. Aldershot UK: Gower. Palmer, Bryan

1989 Descent Into Discourse: The Reification of Language and the Writing of Social History. Philadelphia PA: Temple University Press.

Rose, Nikolas 1979 "The psychological complex: mental measurement and social administration." Ideology

and Consciousness 5: 5-68. 1985 The Psychological Complex: Psychology, Politics and Society in England, 1869-1939.

London: Routledge and Kegan Paul.

Simon Fraser University Mimi Ajzenstadt Robert Menzies

Ute Gerhardt, Ideas About Illness: An Intellectual and Political History of Medical Sociology. London: MacMillan; New York: New York University Press, 1989, 425 pp., $35.00 US cloth, $11.95 US paper.

Medical sociology is the largest section of the American Sociological Association and a respected field of study in Canada and in most European countries. It has, nevertheless, often been viewed with skepticism by the medical profession and, until recently, even by mainstream sociology. Many physicians reject the

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to legitimize the normalization of poverty and dependency within the framework of welfare state ideology. Moreover, it fails to theorize the administration of the expanding therapeutic-welfarist enterprise; to account for its predominantly working-class, ethnic, and female "clientele"; or to explain how the classifica- tion and treatment of individual subjects has contributed to wider processes of individualization through which power, gender, class, ethnic, race, and sexual relations are depoliticized and rendered inert as categories of emancipatory praxis.

In sum, Governing the Soul inspires an ambivalent response. This volume is a dramatic illustration of Foucauldian genealogical and discursive analysis at its very best and worst. It is an indispensable resource, and might well become the most influential study to date on the twentieth-century history of the psychological discipline. At the same time, the book's abandonment of socio-critique - and its privileging of language over life (see Palmer, 1989) - become its most

limiting features. Still in the final analysis, its liabilities notwithstanding, Rose's work will undoubtedly be used as the foundation for new assignments in the history of psychological powers and practices - assignments that will locate this history in broader social, political, and ideological context, taking seriously the conditions under which these new strategies and techniques were discovered and shaped.

References Garland, David

1985 Punishment and Welfare: A History of Penal Strategies. Aldershot UK: Gower. Palmer, Bryan

1989 Descent Into Discourse: The Reification of Language and the Writing of Social History. Philadelphia PA: Temple University Press.

Rose, Nikolas 1979 "The psychological complex: mental measurement and social administration." Ideology

and Consciousness 5: 5-68. 1985 The Psychological Complex: Psychology, Politics and Society in England, 1869-1939.

London: Routledge and Kegan Paul.

Simon Fraser University Mimi Ajzenstadt Robert Menzies

Ute Gerhardt, Ideas About Illness: An Intellectual and Political History of Medical Sociology. London: MacMillan; New York: New York University Press, 1989, 425 pp., $35.00 US cloth, $11.95 US paper.

Medical sociology is the largest section of the American Sociological Association and a respected field of study in Canada and in most European countries. It has, nevertheless, often been viewed with skepticism by the medical profession and, until recently, even by mainstream sociology. Many physicians reject the

227

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iconoclastic ideas espoused by medical sociologists concerning the non-biologi- cal origins of human illness, and mainstream sociologists in the recent past tended to view those of their colleagues researching medically related issues as junior partners in the sociological enterprise.

Uta Gerhardt's Ideas About Illness provides convincing evidence that such criticism is unwarranted. Classical sociological thought, she shows, focused

mainly on issues of social organization and structure, but overlooked the significance of the problem of illness. Such a narrow understanding of the complex workings of human society was even typical of the founders of sociology. Recognition of the relevance of physical and mental health to societal maintenance and reproduction first emerged, in Western societies, as a topic of sociological inquiry in the 1930s - a period also marked by thge growing impact of science and technology. Only in the post-World War Two period, however, did social scientists begin to take seriously the central role played by medicine in alleviating sickness at the individual level as well as, by way of controlled institutional change, in promoting general social health. Gerhardt observes that "[t]he connection between the political issues of the day and the medical perspective occasionally surfaced in the early 1940s, but it was not until the end of the Second World War - after knowledge of the holocaust had become widespread - that the question arose: can any member of a society be acknowledged as normal and sane if the society, simply by functioning, seems to rely on members who are far from normal and sane?" (pp. xvi-xvii). Illness now emerged as a core issue of sociological concern and medical sociology was granted recognition by mainstream sociology.

With a considerable degree of success Gerhardt manages to select from the voluminous medical sociology literature of the past forty years those materials that have contributed major ideas about illness to sociological theory. The book is divided into four sections, each devoted to the four different theoretical

paradigms - structural functionalism, symbolic interactionism, phenomenol- ogy, and the conflict theory approach. Together these paradigms comprise the totality of theoretical developments in medical sociology. Except for phenom- enology, the paradigms are subdivided by the author in order to highlight subtle lines of explication. What emerges from this systematic format are quite different definitions of illness, its causality, and treatment.

Each of the four sections discusses the theoretical breakthroughs concerning sociological approaches to illness achieved by contributors to the paradigms under review: structural functionalism's concept of the "sick role" and its related view of medicine as a legitimate "institution of social control"; symbolic interactionism's notion of the patient as "underdog" and of society and its repressive institutions as the major cause of ill-health; phenomenology's view of illness as "trouble" resulting from misunderstandings and communication gaps that break down "trust" in medical authority; conflict theory's conception of

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illness as "loss," or due to a combination of "medical dominance/resource deprivation."

But Ideas About Illness goes far beyond an analysis of paradigms and their contributions to sociological thought. Gerhardt concludes each section of her book with a valuable discussion of some of the blindspots of the different sociological approaches to illness. While all claim to have overcome the theo- retical lacunae of their predecessors, no single conceptualization in fact has emerged as all-encompassing. This lingering theoretical disunity within medical sociology, with each paradigm displaying key differences in orientation and mission, may not be as damaging to the field as it first appears; Gerhardt argues that the paradigmatic divisions in medical sociology are quite in line with the state of theory in general sociology:

medical sociology is not a subdiscipline unconnected with general theory's problems. In particular, that the issue of social order looms large in matters of deviance seems to put medical sociology more in the front line of general sociological reasoning than has hitherto been widely recognized. The

political driving force behind its intellectual history is what ties medical sociology to, and makes it an important part of, mainstream sociological thought. (p. 354)

Despite the undeniable scope and depth of Ideas AboutIllness, some medical

sociologists will undoubtedly take exception to Gerhardt's decision to place their own work alongside writings that espouse very different views concerning the causes and treatment of illness. To mention just one example, advocates of the "loss model" who encourage self-help and lay support in alleviating illness are included under the conflict theory paradigm with Marxist medical sociologists who employ a "domination-deprivation" model that favours structural, even revolutionary change. More importantly, while the book systematically describes the major theoretical developments in medical sociology, it makes little effort to link medical sociology with the emerging field of health sociology. Are these identical subspecialties or are there important differences between them, indica- tive of a paradigmatic shift now underway in sociology's theoretical reflections on illness? Recent attempts by health sociologists to broaden the scope of medical sociology by focusing on comparative and historical perspectives in

researching illness are, after all, at least in part a response to the failure of medical

sociology to explain the extraordinary cultural diversity of care givers and healing practices in other times and at other places. An additional chapter on cultural "ideas about illness" might have enriched Uta Gerhardt's outstanding book and secured for it a privileged place among the major texts of moder

sociology.

University of Victoria Cecilia Benoit

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