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Book Review
Communicating Health and Illness
Richard Gwyn
ISBN: 0-7619647-5-4 2002 182 pages Sage Publications, London
Bethne Hart
School of Humanities, University of Newcastle, Central Coast Campus, NSW
Richard Gwyn indicates that this book has evolved through his teaching of health communication to undergraduate students at Cardiff University. This is evident through the organisation of the text as it firstly presents foundation theory, and follows with theoretical analysis and conceptual applications to various concerns and domains of practice within health, illness and medicine. A stated primary goal of Communicating Health and Illness is to encourage and enable students and the health professions to respond critically to the adoption and pursuit of normative discourses on health, illness and the practice of medicine. The book brings an interdisciplinary approach to the broad field of health communication, drawing on sociology, anthropology, psychology and cultural studies, with central attention to the concept of discourse.
Each of the six main chapters focuses upon themes that Gwyn considers to be fundamental to understandings of communication surrounding health, illness, medical practice, and health care relations. The first chapter begins with a summary of conceptualisations of health and illness, arguing that discourses of the body and of medicine work together to construct ideas about the now highly medicalized body. The chapter includes valuable summaries of Foucauldian approaches to the body, and of Goffman's theoretical contributions to understanding the presentation of self, interactions, and stigmatised illness, and Frank's typology of bodies as a meta-narrative. With these summaries of theoretical approaches, Gwyn also gives brief indications of the critical evaluations that other theorists have given to these theoretical foundations. Following this the concept of discourse and approaches to its analysis are presented, drawing distinctions between conversation analysis, critical discourse analysis, and ethnographic discourse analysis. This chapter clearly illustrates that the human body and its illnesses are a result of discursive processes as well as being biological realities.
The second chapter presents sociological studies of 'lay' representations as sources of knowledge about health and illness, locating these within a discussion of the privileging of biomedical accounts. He summarises studies of health beliefs, and meanings of aging and death. These are followed by an exploration of methodological issues arising from such studies, emphasising both research process and context. Two poststructuralist studies draw out particular perspectives on diversity and subjectivity within experiences and accounts of health and illness. Gwyn demonstrates his research method and narrative analysis through an extract of a research interview. This chapter clearly establishes and illustrates illness as social phenomenon, and the discursive organisation of 'lay' narratives about illness.
The following chapters apply a discourse analysis perspective. Firstly, there is a focus on the clinical context of health and medicine, emphasising power relations between doctors and patients, with an overview of the significant contributions to knowledge and analysis of this from medical sociology. Models of 'shared decision making' that seek to democratise professional and institutional relations are presented with an interesting analysis of the emerging nurse practitioner role which may hold potential for shifting power relations, but may also continue to reflect inequalities of class, gender and race. This is followed by a chapter exploring media representations of health, illness and the practice of medicine. Gwyn critically analyses examples from documentaries, health information programs, the media reporting of health 'scares' and technological 'miracles', television dramas and mainstream film. He argues that the discursive formulation of issues is central to our understanding and our responses to them. The next focus in this book is on the various significant theoretical contributions to the study of metaphor, with the intention of extending the understanding of discourse. It explores medical metaphors, metaphor across cultures, the use of metaphor in accounts of chronic illness and recovery, and the increasing presence of symbolic and political action as metaphor to challenge the stigmatising of illness. This material highlights the importance of metaphor within experiences of illness and practices of health care, and challenges the tendency in positivist health science approaches to minimise this importance. The following chapter considers illness narratives from the fields of sociology, sociolinguistics and semiotics. There is a useful presentation here of narrative as a resource for the health practitioner, as it facilitates diagnostic processes, therapeutic goals, patient education and health research. In the concluding chapter, the central arguments of each chapter are highlighted, with an emphasis on the study of discourses in order to understand more fully health, illness and the social body.
This is clearly not a text book on communication skills for the health professions, nor is it a textbook on skills in discourse analysis. It is a valuable resource for theory and research relevant to discourses on health, illness and medicine. Knowledge gained from this text would certainly inform and strengthen awareness of normative discourses, enable critical analysis of these, and substantially promote reflexivity. The book would also inform researchers about the processes and outcomes of discourse analysis and its importance to understanding crucial elements within health and health care arenas. On this broad basis, it is highly relevant to students from a variety of social science disciplines, and to all students of the health professions. It would also be a source of information and guidance for students in postgraduate research and health profession programs. Some readers may find parts of it off-putting and inaccessible because of the denseness of the text. However, those who are seeking summaries of theoretical perspectives and research studies will locate them readily. The concept of discourse remains central throughout all chapters. However, some readers who are new to sociological theories may lose their way amidst the various levels to which discourse analysis is applied.
Overall, the title of the book does not fully capture the depth and richness of its contents, particularly in its presentation of foundational social theory and its application to social analysis. It is really about much more than health communication, and traverses far more broadly than just communication processes and contexts. It encompasses issues and practices often highly problematic within health promotion, professional ethics, media analysis, health research, and health policy. Those teaching and researching within health sociology will find themselves in familiar territory. Its value to Australian sociology is only slightly limited by some examples that are arising from other and different cultural and health care settings. Communicating Health and Illness is an important book for health sociology and health care, primarily through its transdisciplinary focus as it brings together a range of theoretical perspectives and levels of analysis.
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