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© 2006 The Author. Journal compilation© 2006 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

some dictionaries which compromisecomplexity for pragmatic expediency, thisbook is much more nuanced in conveyingthe subtleties which underpin their use.

There are no obvious inadequaciesevident in this book. Given its pre-defined remit, any criticism aboutdeficiencies may be misplaced. A couplemay nevertheless be noteworthy. There isno explicit section on how classical andcontemporary sociological theory haveshaped medical sociology or how theoryitself has shaped the empirical and meth-odological evolution of the disciplineitself. To some extent, each entry alreadysucceeds in doing this by drawing ontheoretical traditions and influences. Buta separate section might have satisfiedthose readers seeking a much more explicitdiscussion of how certain concepts haveemerged from, been shaped by, andanchored within, predisposing theoreti-cal traditions. Finally, each entry endswith a list of references referred to in thetext and this is helpful for further reading.The book might be enhanced if therewere an independent, but necessarilyselective bibliographical essay of majorbooks and papers, which authors feelhave defined the field of medical sociol-ogy. This would serve to complement thereferences at the end of each essay. Itwould also enable the reader to surveythe broader landscape of medical sociol-ogy and pursue additional reading.

Rampaul ChambaINNOGEN and Development Policy and

Practice Open University

Shilling, C.

The Body and Social Theory

(2nd Edition) London: Sage, 2003. £60ISBN 0-7619-4284-X (hbk) £19.99 ISBN0-7619-4285-8 (pbk) x + 238pp.

The second edition of this now-classictheoretical textbook has been published

10 years after the first one (which itselfwas re-printed no less than seven times –a testament either to the popularity of thebook or the scepticism of the publishersas to its value!). The overall numericaldifference between the two editions isjust six pages, but this hides the morecomplex work undertaken by the authorfor the second edition. Whilst most chapterscover the same material, this is in slightlycondensed form so as to enable the additionof a foreword and a 33-page afterwordwithout significantly adding to the costof publication. In this afterword, Shillingreviews ‘some of the major themes ofthis study in the light of developments inthe sociology of the body . . .’ (p. 16).

The over-riding value of the text lies inthe way Shilling appraises many tradi-tional and modern sociological theoriesof the body: Douglas, Foucault andGoffman on the socially-constructedbody; Bourdieu and Elias on the body asa capitalist or civilising resource; and –perhaps most interestingly – variousapproaches to the body, self-identity anddeath, including Berger, Turner, Baumanand Giddens. Each of these approachesis summarised, analysed and criticised ina relatively accessible way which stimu-lates the thought processes. Althoughprimary sources are always preferable,the reality of financial constraint dictatesour access to such treasures; Shilling’swork as a secondary resource is animportant contribution.

I have made use of the first edition invarious ways in most of my assortedwork – on disability, identity, junk mail,naturism, the lifecourse, public transportand community profiling – since themid-1990s. Yet the term ‘inform’ is cru-cial here because Shilling’s review – firstor second edition – could be defined asneither a ‘last word’ nor a ‘first word’ onthe subject of the body. It is, as Shillinghimself notes, a ‘contribution’ to what is,in my view, one of the most significantdebates in the history of sociology: that

378 Book Reviews

© 2006 The Author. Journal compilation © 2006 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

of the body as the ‘irreducible source ofsociety’, the ‘corporeal basis on whichidentities and social relations are consol-idated and changed’ (p. 210).

For me, Shilling’s work actually raisesmore empirically-based sociologicalquestions than any solutions offered.Many of my personal and theoreticalinterests lie, for example, in single-issuepolitics and political campaigning. So Iask the question: how does a sociologyof the body explain the power andattractiveness of massed bodies as ‘singlevoice’: peace vigils or rallies, as in Ireland,Spain, Eastern Europe and the UnitedKingdom; the well-known activities ofmembers of Greenpeace, or those offer-ing their bodies as ‘human shields’ as aprotest against war?

Secondly, and perhaps more relevantto this journal, there is the theoreticalproblem of ‘fragmented bodies’. How, forexample, does a sociology of the bodyexplain the current medical fad regard-ing infant feeding in the UK (whereexcellent formula alternatives and cleanwater exist in abundance)? We have movedwell beyond the ‘breast is best’ syndrometo – arguably – emotional abuse of women,who are effectively bullied by medicaland nursing professionals (through alack of reasoned alternative information)into breast-feeding their babies. Thisattitude towards women’s breasts seemsto represent a return to the ‘naturalisticbody’ or alternatively a view of the bodyas a ‘capitalistic resource’, and flies in theface of the language of choice implied inthe ‘socially constructed body’ theories.Yet it is not the body that is abused, butthe mind within that body.

Again, in terms of ‘fragmented bodies’,how does a sociology of the body beginto explain the willingness to donate one’sbody parts or fluids (

e.g.

kidneys, eggs,sperm, blood) whilst still alive? And howdo we begin to analyse and reconcile thedifferences between, on the one hand,the distress caused by hospitals with-

holding body parts from already-deadbabies and children (thereby resulting,sometimes many years later, in a secondfuneral ritual for the same body), and,on the other hand, the removal of body-parts from clinically, but not function-ally, dead carriers of donor cards? Thesetwo empirical examples illustrate some-thing of the complexity of trying todefine both ‘body’ and ‘life’.

A further issue for theorising ‘fragmentedbodies’ lies in self-harm, and ultimatelyin the willing ending of embodiment.Despite Shilling’s perceptive commentson embodiment, identity and theory inthe afterword of the second edition, weseem little nearer to understanding orexplaining suicide sociologically than wewere when Durkheim attempted hisquantitative analysis a century ago. Suchembodied action, of course, has takenon new and chilling importance with theincreasing number of suicide bombers,who not only kill or maim others butscatter their own body parts over a widearea. Indeed, such empirical examplestend to highlight the fact that most, ifnot all, current and past sociologicalapproaches to the body are embedded ina naturalistic philosophy of desire forcontinuing embodiment (life). And hereinlies, for me, the problematisation ofShilling’s work. The very fact that any ofthese questions can be partially – but onlypartially – explained by a number of dif-ferent approaches, all of which are to someextent mutually exclusive – highlights theambiguity of theoretical approaches tothe body that fail fully to account for themind as

part of

that body. The classicworks of Alfred Schutz on phenomenol-ogy taught us to be sceptical of attemptsto categorise the mind of another. Hewrote from within his era – with a phil-osophical split of mind and body. Howdo we develop a sociology of the bodythat engages, not in a mindless body, nora mind-body split but in an

embodied

relationship between body and mind?

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© 2006 The Author. Journal compilation© 2006 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd

Reference

Schutz, A. (1967) (originally published1932) The Phenomenology of theSocial World. Chicago: North WesternUniversity Press

Gillian ReynoldsCoventry University

Armstrong, E.A.

Conceiving Risk, Bear-ing Responsibility: Fetal Alcohol Syn-drome and the Diagnosis of MoralDisorder

. Baltimore: The John HopkinsUniversity Press, 2003. £32 (hbk) xiii +277pp. ISBN 0-8018-7345-2

This book is an interesting and informa-tive exploration of the construction ofFetal Alcohol Syndrome (FAS) as amajor social problem within the US. Itcombines an historical overview, epide-miological data, and qualitative inter-viewing to show clearly how moral valuesaffect medical and policy pronouncements.Armstrong clearly demonstrates the cur-rent construction of FAS to be deeplyflawed, and the effects of alcohol on thedeveloping foetus are still poorly under-stood, yet she never denies that the con-dition of FAS exists. Instead, she directsattention to the way that the medical/moral discourses are intimately connectedto social class and racism, leading to thoseat the margins of US society being dis-proportionately diagnosed and the stig-matisation of their mothers as failures.

The book begins by tracing the historyof the ‘problem’ of drinking duringpregnancy. It briefly touches on ancientwritings which focused on drunkennessat the time of conception as potentiallyproducing ‘misshapen’ children (p. 25),moving through time to the emergenceof alcohol as a serious social problem, andto the growth of the prohibition move-ment. As Armstrong points out, in theearly discussions, male drinking was also

thought to be problematic for the devel-oping foetus. However, whilst alcoholwas considered to be detrimental duringpregnancy, FAS as a diagnosable condi-tion was named in 1973 in an article inthe

Lancet.

Ironically, at the same timealcohol was recognised by the medicalprofession as a treatment for threatenedpreterm labour, and medical textbookswere still discussing the intravenousadministration of ethanol into the 1980s.Indeed, for a time in the mid-20

th

cen-tury, medicine seems to have disregardedor forgotten earlier concerns on the effectof alcohol on the developing foetus.

Following the history of FAS in themedical literature, the book moves on tothe interviews with 30 doctors, and inparticular considers how doctors learnabout and diagnose FAS. Currently, thereare four criteria set out to be met: evidenceof maternal drinking; a distinct patternof facial abnormalities; growth retardation;and neurodevelopment abnormalities.As Armstrong shows, however, doctorsoften applied these criteria differently.So, for some, the birth of ‘funny lookingkids’ (p. 117) led to investigation of theother criteria, whereas, for others, devel-opment or behaviour problems were moresalient. Many of the doctors recognisedthe uncertainty of diagnosis, and somereported that they had never or rarelyseen it. This contrasts sharply with medicaland media claims that drinking in pre-gnancy is a major health problem. Theredoes however appear to be a growingwillingness of other doctors to expand thediagnosis as a number of related conditions,such as ‘partial FAS’ or ‘fetal alcohol effect’,have emerged. Moreover, the diagnosticcriteria are complicated by patient ageand ethnicity. Small babies may growand certain populations, such as NativeAmericans, may be over-diagnosed astheir facial characteristics may be per-ceived as within the diagnostic criteria.

Armstrong’s strong evidence clearlyshows how the current demonisation of