Book reviews

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Sociology of Health & IllnessVolume 28, Issue 2 p. 252-260 Free Access Book reviews First published: 28 June 2008 https://doi.org/10.1111/j.1467-9566.2006.00491.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Roth, W. The Assault on Social Policy . New York : Columbia University Press , 2002 £33 (hbk), £15 (pbk) xi + 193pp . ISBN 0-231-12381-7 (pbk) . William Roth's book presents the case that the United States of America's social policy agenda and provision now serves the interests of American and global corporations instead of the ‘general will’. As such, it endeavours to provide a critique of these interests and their espousal of the merits and supremacy of the market, as well as the associated ‘naturalness’ of poverty and inequality. In so doing, Roth's text provides a useful introduction to US social policy for non-US students and other readers. What the book also usefully provides is a succinct critique of the market as a means of distributing goods. Roth sets out to examine social policy ‘in its various guises in both the public sector and the private sector’ (p. 22). As such, he takes a wider definition of social policy to that with which we are traditionally familiar in Britain. The text explores examples of social policy and then presents an argument for the origins and effects of power and politics. In so doing, Roth argues that social welfare provision has been attacked by the interests of corporations. However, even though ‘the welfare state as we have come to know it [in the USA] is diminishing, reasonable and decent politics and social policy are not dead . . . and thus it is my hope that [this account] will help the less powerful advance constructive and democratic changes in social policy’ (pp. 22–23). Thus Roth depicts a conflict between what he describes as the ‘haves and have nots’. It is this notion of the ‘haves and have-nots’ which is intriguing but also problematic. First, it would have been useful if he had said what he had meant by these two groupings earlier in the text. He does provide a definition in Chapter 3, that is a good third of the way into the book: In a capitalist economy, haves control capital and, through it, others [have-nots] who exchange their labor for income . . . Extreme have-nots are those who obtain income through the largess of the welfare state, charity, begging or theft. Have-nots must settle for fewer important resources such as health care and food . . . Increasingly, extreme have-nots are geographically isolated. Physically separating off the poor makes it more difficult to understand what it means to be poor (p. 49). From such a definition, it would seem that Roth is distinguishing between those with capital and, therefore, power and those without either of these. The ‘assault on social policy’ has, in his view, been conducted on behalf of the interests of the haves and to the detriment of the have-nots. This depiction of class groupings may well be too straightforward for some readers. Indeed, it arguably sets a tone for a generally over-simple analysis of what has happened to social welfare provision and what needs to be done as a consequence. In terms of the content of the book, Chapter 1 (Policy) provides a useful account of what policy is not. The chapter provides a useful exposition on the ‘myth’ and social construction of the market. There are illuminating insertions of theory to support the argument at times (see, for example, page 19). Chapter 2 (Corporations) goes on to provide a clear and straightforward explanation of market failure. Unlike many British-based social policy texts, it provides a quite detailed account of the complexities of the market. It advocates the democratic control of markets, not least with the impact of globalisation. Chapter 3 (Poverty) flows on nicely with a useful exposition of the downside of the ‘American Dream’, not least with the increase in poverty and the increasing income gap (pp. 48–49). Chapter 4 (Welfare) focuses on the political economy of welfare. Useful references are made to both Weber and Hobbes in this chapter. Chapters 5 through to 9 then focus respectively on disability, social security, health, children and ‘outsiders’. Again, these chapters are useful for a non-US audience wanting an introductory account of US social policy and political economy. In his concluding chapter, Chapter 10 (Democratic change), Roth argues that there are alternatives to the fallaciousness of corporate America and global capital which could allow for the reclaiming of the (welfare) state (see page 158), for example via ‘democratic socialism’, ‘market socialism’ or ‘civic democracy’ (p. 165). Ultimately, for Roth at least: The choice is not between socialism and markets. One can facilitate the other. A combination may make our expectations more realizable. Experience has taught us that the concentrations of power existing under capitalism grotesquely distort markets for the benefits of haves and to the detriment of have-nots. Market socialism is one appropriate vehicle for the realization of democratic change (p. 170). One is however left wondering how realistic this is, not least in the USA under the rule of George W. Bush and the continued hegemony of a neo-conservative social policy agenda. A recently published and useful account by Beland (2005) on the impact of the privatisation of social security in the US provides an indication of a signifiant task faced by opponents of the neo-conservative and corporate agenda. In terms of Roth's account, one is left wanting more on precisely what Roth (p. 171) envisages, as stated in the very last line of the book, could be done when ‘we consider, discuss and act on global governance and democracy’. Guy Daly Coventry University Reference Beland, D. (2005) History and Politics from the New Deal to the Privatization Debate, Kansas: University Press of Kansas. Mason, C. (Ed.) Journeys into Palliative Care: Roots and Reflections . London : Jessica Kingsley , 2002 , 192pp £l5.95 , ISBN 1-84310-030-4 (pbk) This collection of accounts from people who work in palliative care presents personal stories about the impact of palliative care on their lives. In this sense the book provides examples of ‘being reflective’ about this type of work and so is aimed at professionals from a range of disciplines who work in palliative care. The contributors to this exploration of the self in palliative care include the occupational disciplines of social work, medicine, research, training and development, sociology and nursing. The editor lays out the basic themes of the book in her first chapter, which include aspects of the professional self, healing, uncertainty, the ‘power of love’ and the use of stories. In order to show how personal experience can be used in professional life, Christina Mason asked the authors to answer two questions: what led you into the work and what has been the effect of this unique journey on the way you practice?’ She concludes with an overview of the use of self in ‘working with the (sic) dying’. I enjoyed reading this book and found the experience to be much more of a psychodynamic/psychotherapeutic good read than a sociological one, even though highlights of this book were in the openness with which the authors of these personal stories were able to account for the use of self in their work. Wanting much more sociological sense to be made of the themes, it is not surprising then that Gordon Riches’ story of the relationship between making sense of loss and bereavement following the death of children in his role as researcher and the effects of this work on his own identity, including the recognition that personal existence is not an infinite commodity, interested me most. This is not to deny the power of such accounts as Julia Franklin's ‘gift of serendipity’ and Kevin Yates’ account of the value of self exploration and his ability to move into management in the interests of improving the quality of palliative care. All of the stories show different forms of courage that are needed for practitioners to be able to recognise the role and engagement of the self in palliative care. However, while I think that many people would support the need for those who work in the field of death, dying and bereavement to be self-aware and reflective practitioners, I was left puzzled about what palliative care team members could take from this edited collection of reflections. This is partly because the editor places so much emphasis on the experiential dimensions of reflection, and the ‘irreconcilable tension between explanation and understanding’. Indeed, the accounts all echo this view. It seems to me there is no way to generalise from the individual self, as a practitioner in the art of supporting person-centred care to a unique dying person. Surely it is this individual uniqueness which is being both promoted and celebrated? Therefore, what can individual practitioners do with other people's accounts that contribute to their own understanding of self? It would have been useful for Christina Mason to have offered a rationale for how these can be used for this purpose and also a rationale for her choice of authors and perspectives. Finally, I did not find the book's relevance to the discipline of the sociology of health and illness immediately apparent, powerful as the disclosures were. Notwithstanding my concerns about the possibility of generalising beyond a banal claim that reflection is an essential feature of all practitioners who work with vulnerable people, it is the opposite of generalisation that this book sets out to claim. Perhaps the work is best located in the literature of practice supervision and person-centred therapy, where I think it will make a very useful contribution as a set of models of how to be a reflective practitioner. Carol Komaromy Open University Burns, W. Focus on Solutions – A Health Professional's Guide . London, Philadelphia : Whurr Publishers , 2005 £27.50 . ISBN 1-86156-479-1 Solution focused brief therapy (SFBT) as an approach is presented and explored within this text, the focus being on the application of an approach, or way of talking, for those working in healthcare settings. This is described as an attitude, rather than a technique. It is an extremely practical text, using a variety of case studies to explore how this way of working with service users could be used to advantage, and presents SFBT as an effective adjunct to therapy. With its focus on solutions rather than problems, the author illustrates how redefining questions can enable service users to achieve meaningful outcomes and therapists redefine a ‘difficult patient’. Although the approach is presented as a means to work with the individual client and it's focus is not specific to particular diagnositic groups or impairments, the case studies cited are set in the context of particular conditions, such as Parkinson's Disease or stroke and in relation to specific impairments e.g. dysarthria. Each chapter is well organised and written in an extremely accessible style. Different sections within chapters are summarised by useful ‘key points’ or ‘key questions’ which help direct thinking and could aid reflection. Chapters are presented in a logical order, each building on concepts already presented, exploring these in greater depth with detailed illustrations of how SFBT is applied. As such it gives clear guidance but is far from prescriptive, emphasising there is no one way to do it. The book is appropriately introduced, setting SFBT in context and in relation to the professional development and thinking of the author, who has an obvious commitment to this way of working with clients. Throughout the following chapters, reference is made to the working environment of the author and how the approach has been applied with individuals, groups, families and carers. The writing is theoretically informed and examines the interplay between biological, individual and social aspects of healthcare. The initial chapter introduces various themes which recur throughout subsequent chapters, where they are explored in greater depth and applied to specific cases. These include the move from medical models to health-oriented approaches, from reductionism to holism, the use of narratives, use of communication and language, client-centred practice, issues of power in therapeutic relationships, patient as expert, assessment and goal setting. As such it is packed with a range of concepts and ideas, all of which reflect current issues in healthcare. SFBT focuses principally on strengths and abilities, rather than disabilities, how strengths can be used to reduce the nature of the problem. It is portrayed as an approach which can empower the client to find their own solutions and promote self-efficacy. What is interesting is the clear application of concepts and theory which have been presented previously by other authors. For example, use of phenomenology and narratives, understanding of the patient in relation to the context of their lives, seeing therapy as a coherent ‘chapter’ in the life of the individual, imagining, building a meaningful future is central to the work of authors such as Mattingly (1998). Techniques used in narratives within the text reflect those of ‘motivational interviewing’ which aims to enable clients to find their own solutions. The approach of SFBT could be seen as a counselling technique, enabling those with long-term problems to redefine their lives and adjust to find meaning in the face of long-term disability. Although claims made are not overly supported by empirical evidence, SFBT does pull together strands of different theoretical frameworks to form a clear, not overly complicated way of talking with clients, which could enable clients to move thinking from a negative to a more positive way of conceptualising the future. However, with the drives towards evidence-based practice, more attention to empirical evidence might help substantiate claims made with regard to efficacy. Much of the evidence is anecdotal. In the concluding chapter there are references to empirical evidence, reviews of outcomes, results of control trials but maybe these sources of evidence could have been used more widely within individual chapters. Surprisingly, qualitative research is not mentioned, even though this methodology would appear to be relevant in exploring individual perspectives and meanings. Nevertheless, this text could inform many different disciplines working in healthcare concerned with issues of adjustment to disability, self-esteem and quality of life. Also, it may be of value to those involved in student training, as it presents an approach which integrates many of the values and beliefs, for example, holism, client-centredness, respect for each individual, empowerment, which are central to many professional philosophies. Anne Louise Conneeley Coventry University Reference Mattingly C. (1998) Healing, dramas and clinical plots. The narrative structure of experience. Cambridge. Cambridge University Press. Gray, A. and Harrison, S. (eds) Governing Medicine: Theory and Practice . Maidenhead : Open University Press , 2004 , x + 214pp £22.99 (pbk) ISBN 0-335-21435-5 , £65 (hbk) ISBN 0-335-21436-3 . Governing Medicine: Theory and Practice is an edited collection of essays addressing theoretical and practical dimensions of clinical governance. Contributors come from a broad spectrum of disciplines, including sociology, social policy, social work, clinical management and clinical practice. Throughout the book, many different issues are covered from varying perspectives, reflecting the fact that the implementation of clinical governance has had, and will have, a whole range of repercussions for healthcare users and providers. Editor Andrew Gray introduces the book by exploring the meaning of ‘clinical governance’. Introduced as a new system of managing the NHS in 1998, official definitions of clinical governance vary, but revolve around reducing risk and modernising healthcare, with quality assurance and evidence-based medicine as central tenets. The policy challenges medical professional autonomy, as external agencies (e.g. the National Institute for Clinical Excellence) are now empowered to set and monitor clinical standards. There has been little empirical research into these fundamental changes to healthcare delivery, and clinical governance still begs conceptual clarification, so the book sets out to explore the history and meaning of the concept and its practical implications. The book is divided into three parts. The first, Medicine, Autonomy and Governance, begins with a chapter by Rob Flynn, who suggests that Foucault's theory of governmentality and Courpasson's concept of ‘soft bureaucracy’ can elucidate the processes involved in clinical governance, in which practitioners are co-opted into carrying out self-surveillance and themselves come to legitimise the standardisation of performance. The next three chapters offer interesting historical perspectives. Michael Moran links changes in medical governance to the demise of a long-standing ‘club system’ of professional regulation, now anachronistic in a globally competitive economy. Stephan Watkins traces the historical relationship between the medical profession and the government, lamenting that the Labour Party now seems to be instigating a ‘Triple Way’ of NHS management, in which partnership is spurned. In Chapter 5, Stephen Harrison questions whether neo-bureaucratic healthcare, where, increasingly, protocols, guidelines and targets guide clinical decisions, is actually an improvement on the high professional autonomy of the ‘golden age of doctoring’. The final chapter in this section presents data on practitioners’ perspectives on clinical governance. Part 2 of the book deals with Evidence, Science and Medicine and includes an outstanding contribution by David Byrne, who argues convincingly that the veneration of the randomised control trial in evidence-based medicine is hopelessly flawed – such data can only ever provide probabilities of mono-causal relationships occurring in a population and are useless for making clinical decisions about an individual with a complex, contextualised illness. Two chapters in this section then critically examine the ontological basis of clinical governance, demonstrating that it assumes rationality in clinical decision-making, privileges rationality in policy-making, and therefore does not take account of the tacit knowledge drawn on daily by clinicians, nor the importance of emotion in the experiences of clinicians and patients. In another chapter, Maggie Mort and Colleagues aim similar critiques at the research and development of telemedicine, which, they argue, tends to ignore human agency and the heterogeneity of medical practice, and focuses on technological advances rather than medical benefits. Part 3 of the book, Realizing Clinical Governance, concerns practical ways in which clinical governance can be effectively implemented. Nancy Redfern and Jane Stewart posit that clinical governance policies will not translate into practice until they are embedded in the context and culture of everyday medical practice. Simultaneously, medical training needs to inculcate management skills which will allow practitioners to work within uncertainty and complexity. There is a chapter examining the human resource dimensions of clinical governance and another which recommends the restructuring of clinical governance along condition-treatment pathways rather than according to organisational issue. Stephen Harrison's final chapter sums up the book. The strength of Governing Medicine is its comprehensiveness; many substantive issues are dealt with from multiple perspectives. Theoretical and practical analyses of clinical governance are successfully interwoven throughout, with many chapters both deconstructing the concept and identifying practical issues impeding its implementation. The contributors raise more questions than they answer, and little is said about the impact this new mode of healthcare delivery has had, or is likely to have, on patients; yet this just highlights the need for more research in the area. As a sociologist, I found the first two parts of the book more interesting than the third, less critical, section. However, being alerted to the range of perspectives and stakeholders involved in clinical governance within the book is useful in itself. This multidisciplinary collection will provide thought-provoking reading for anyone interested in the theory and practice of the latest model of healthcare organisation. Caragh Brosnan University of Cambridge Hallowell, N., Lawton, J. and Gregory, S. (eds) ( 2005 ) Reflections on Research – the Realities of Doing Research in the Social Sciences . Maidenhead : Open University Press . xv + 156pp ISBN 0335 21309 X pbk McIntyre, L.J. ( 2005 ) Need to Know – Social Science Research Methods . Boston : McGraw Hill . xv + 303pp ISBN 0-7674-1317-2 pbk When it comes to learning about social research methods students have never had it so good. Scores of text books are currently available, few are bad and many are excellent. Sage Publications alone probably have more general methods textbooks in their catalogue than would have been available from all publishers together 20 years ago. This plethora of books is probably the outcome of a number of factors: the increase in the amount of university courses in the social sciences and humanities that include social research methods, faster and cheaper publishing processes and perhaps, more tendentiously, an overall increase in the number of people who teach methods and a growth in their repertoire of methods skills. Consequently, it is difficult both for the consumer of these texts to decide which to buy and, for the teacher of methods, which ones to recommend – though in the latter case it is increasingly their own text! The question of what should be in a general-methods textbook these days is harder than it was some years ago. On the one hand, the growth in the number of courses in which social research is taught requires a breadth of examples, disciplinary orientation and techniques, but on the other, many courses now demand much more of their students, particularly in data analysis. Virtually all graduate courses teach to the level of multivariate analysis (and some undergraduate ones) and many also require qualitative analysis techniques using NVivo, N5, etc. Should the text include only methodological underpinnings and design, or should it include analysis? How much statistics? Should it link to procedures in SPSS, or qualitative packages? Should it emphasise quantitative or qualitative methods? The risks in trying to include all or most of these things generate either very big and expensive books, superficiality or worse still a dry recipe book approach. In my view, a priority for an introductory methods book is to encourage students to develop a research imagination. Thus, a book such as Cathie Marsh's (1982) Survey Method (sadly long out of print) was short on many of the above components yet instilled that imagination and made you want to do research. The good news is that both of the books here are strong on research imagination and both have features that make them stand out from many of the standard works, though in a crowded market the extent to which their publishers will be able to convey these characteristics may be limited – but that's another story! They are, however, very different from each other. The McIntyre book initially looks and feels like so many other introductory texts (but initial appearances are deceptive), whereas the Hallowell et al. collection is a most unusual book. This latter could have been subtitled ‘Tales from the field’ for it is indeed a collection of travellers’ tales from the world of social research. It is not really a text book (though undoubtedly it will be marketed as such), though students and especially students in health-related fields would benefit enormously by reading this alongside a more standard text book. Forty-six contributors have written short autobiographical pieces on the research process across a wide range of issues including how one presents oneself as a researcher in the field, recruiting, respondents, ethics, being an outsider, working as a team member, dealing with the press and interviewing. Though inevitably autobiography raises issues of recall or self management, there is nevertheless bite and authenticity in all of the contributions. For the most part it is the world of research as it is, messy, uncertain, frustrating and rewarding. To give a flavour: Alice Lovell tells us about one of her first depth interviews where the respondent gave her tea, but locked the door on her and then confided in Alice that her neighbour was trying to poison her by putting ground glass in her tea! Laura Potts describes the conflict she felt between being a detached interviewer and her convictions as a feminist and political activist when interviewing people living in extremely impoverished circumstances. Elizabeth Ettorre recounts her experiences of conducting ‘expert interviews’. The usual power relationship (as famously described by Oakley 1984) was inverted with the respondent taking control. For Ettorre this was a learning experience and indeed, throughout these vignettes one gets the impression that the writer's experiences, however painful at the time, were valuable. This is such a positive message for new researchers faced with difficult interviews, non-response or worrying ethical decisions. Though this is a splendid book in so many ways it is marred a little by organisation and style. The editors admit it is light on examples from quantitative research and this is a pity. Contents are minimal and tell the reader very little. There are only six sections with enigmatic titles such as Research in Practice, Self, Others. These are more touchy, feely buzz words than useful descriptions of what the reader might find. Indeed on a re-reading to write this review I found it difficult to relocate the pieces I wished to refer to. Stylistically, it is mostly splendid, sometimes very humorous or poignant, but occasionally the start of a piece is trite or clichéd: ‘One bright morning in 1979. . . .’ or in the editorial introduction there is an imagined dialogue between the reader, complaining of another boring methods book and the editors who advise ‘Stop! Calm down and DO NOT PANIC’. Actually, it is style that is both a strength and an annoyance in the McIntyre book. Let's get the annoyance out of the way first. This is a book written for the US market, without any thought of anyone else reading it in the Anglophone world. In this book, students live in dorms, ‘fraternities’ or ‘sororities’ (whatever these last are!). Rush Limbaugh makes a cameo appearance (smoking a cigar?!), people vote in School Board elections. Apparently (p. 157) one's retirement options are ‘Regular IRA’ and ‘Roth IRA’. The in-your-face US style is off-putting enough to reject this text (unless of course you are in the US!), but that would be a pity, for in virtually every other way it is excellent. Indeed my earlier reference to Cathie Marsh was prompted by how good this book is in stimulating that research imagination. The other side to the very US style is its accessible language, clarity of explanation and the grounding of social research in some key rules of method and logic that apply across any investigative enterprise – characteristics unfortunately often missing in books published in the UK. The title is clever, for it implies both the importance of the need to know, but also the importance of knowledge on a need to know, as opposed to a superfluous, basis. Much of the contents list is pretty standard fare including chapters on survey methods, research design and qualitative methods, but there are also sections on ‘Working on the Internet’, Experiments and the Logic of enquiry. This latter chapter introduces researchers to deductive and inductive reasoning, logical fallacies and rules of evidence etc. These are rarely present in text books these days, but are just so useful to the enterprise of rigorous research. The examples and exercises are stimulating and where they are US-focused, could easily be adapted to non-US circumstances by a methods teacher. The chapter on sampling is a model of clarity, though frustratingly it never gets as far as telling the reader about sample size and how to calculate it – in my experience a key issue for new researchers. Indeed here, as in many places, it risks superficiality, but this is avoided by a constant emphasis on reflection and doing. Throughout there are Stop and Review sections that are problem orientated and other sections (Working Outside the Book) that encourage and help the new researcher to actually do research. A feature shared with the Hallowell et al. book is an attempt to inject researcher experience into the enterprise. This mostly consists of boxes entitled The Voice of Experience. These vary in kind from the nicely anecdotal story from George Homans about how he reasoned why the sea water in Maine is colder during an offshore wind (!) to a brief summary of how Gallup does its sampling. These are mostly pitched at the right level, though some are so short as to be almost enigmatic (e.g. the quote from Peter Berger on p. 224). These books left me feeling optimistic about social research. The McIntyre text is very much introductory, but it is both rigorous, and stimulates the all-important research imagination. The Hallowell et al. book reminds us that in the last couple of decades we have begun to reflect more carefully upon what we do and this, combined with rigour, is the best recipe for good research. Malcolm Williams University of Plymouth References Marsh, C. (1982) The Survey Method: the Contribution of Surveys to Sociological Excplanation. London: George Allen and Unwin. Oakley, A. (1981) Interviewing women: a contradiction in terms. In H. Roberts (Ed.) Doing Feminist Research. London: Routledge and Kegan Paul. Volume28, Issue2March 2006Pages 252-260 ReferencesRelatedInformation