Wheatley, E. E. Bodies at Risk. An Ethnography of Heart Disease . 2006 Aldershot : Ashgate . 148pp £45.00 ISBN 0754643077 (hbk) Cardiovascular diseases are the main causes of death in the modern world, with 17 million deaths annually according to the World Health Organisation. Of these, some 7 million result from coronary heart disease (CHD), largely as a result of acute myocardial infarction. While deaths appear to be falling (a welcome trend seen in the UK and elsewhere in recent decades), the global burden of CHD is increasing as a result of lifestyle changes, increasing urbanisation, and longer life expectancy. An estimated 83 per cent of future increases in CHD mortality will be seen in developing countries. The impact of CHD on individuals has been well explored and there is an abundant literature in the biomedical press. This book examines the experiences of having heart disease with no exclusion criteria: people qualified as participants if they had a cardiac condition irrespective of age, gender, or co-morbidities. The author worked in a heart centre in a voluntary capacity and met patients at various stages of their ‘cardiac journey’, complemented by periods of internship in cardiac rehabilitation clinics. Observational data were combined with findings from formal interviews undertaken both in the acute setting and following discharge from hospital. Throughout its six chapters the book provides insights into how patients managed the bodily and emotional sequelae of heart disease, exploring the concept of an individual ‘reskilling’ as a form of coping, and how this is a continuous process in the struggle to reclaim what may have been lost after an acute event. Social negotiations and interactional dilemmas, alongside physical efforts, are seen as central to recovery. Study participants understood the importance of taking measures (such as physical exercise and smoking cessation) to reducing the risk of a further heart attack but most (in the author's word) ‘fell short’ in one way or another in their efforts. While eliminating risk was not entirely possible, ongoing negotiation helped most at least to come to terms with the changes required. Market-based rehabilitation services were seen to individualise disease prevention and fitness efforts, but messages about risk were not consistent and coherent but rather contradictory and shifting. Advice from health professionals for patients simply to ‘manage’ stress, however well-intentioned, were seen as insufficient, and more socially progressive approaches were required. Styles of reskilling, from an ‘ethic of exactitude’ through resignation, playfulness, evasion, objection to experimentation, are discussed: patients tended to move between these categories over the course of their illness, and were enabled rather than repressed by clinical routines and regimens. Rehabilitation has emerged as a profitable enterprise in the United States, expanding to provide for those ‘at risk’ as well as those who have suffered an acute event. Although I am unfamiliar with the methodology used in the research and much of the literature cited (I work principally within a biomedical model) I found this an interesting and stimulating read, and there was much in the transcripts of patient experiences that rings true both from personal observation as a practitioner and from the UK literature on recovery from bypass surgery, for example. Health care in the United States is of course very different from that provided by our much criticised (but actually highly rated and much more equitable) NHS, but there are important insights here for those planning, commissioning and delivering cardiac rehabilitation services in the era of choice and responsiveness. This book would be of value not just to the academic but to the cardiac rehabilitation team.
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Sep 13, 2023
Julia Burdick-Will + 2
Open Access