This collection takes as its starting point the need to raise the healthcare profession's awareness of difference, in all its forms. A special issue of the journal Literature and Medicine, it attempts to "explore the complex ways in which notions of disease, disability, and difference are intimately related and in which bodies marked by particular gender, racial, disability, sexuality, and ethnic identities experience disease in specific ways" (p.vii).  Similar endeavours have been launched by social science disciplines; this collection, according to the editors, takes a more humanities-based approach.

The humanities are very broadly represented here, which adds to the richness of the collection and is also its chief drawback. Section 1, Dis-ability, begins with an interesting essay by Tobin Siebers on forms of masquerade employed, consciously or otherwise, by people with impairments. These aren't always what one would predict: in addition to the well characterised practice of "passing" (as able bodied), Siebers also discusses the more unfamiliar one in which people "disguise one kind of disability with another or display their disability by exaggerating it", in order to receive necessary services or accommodations, for example. Siebers analyses these and other behaviours using the idea of masquerade but also tries to move away from seeing masquerade as a "way to manage the stigma of social difference" to "stories about the politics of this strategy".

Susan Squiers' next chapter on Zen meditation and disability offers a different insight the experience of difference. She usefully questions the possibility of transcending the variant body by means of rejecting of embodiment, arguing rather for an "oscillating affiliation" with disability identity in the course of encounter with the "imperfect, disabled, physically and/or mentally limited aspects of our embodied selves" that are universal to human experience. Next, Sander L Gilman takes a more historical approach to another form of physical variation in Fat as disability: the case of the Jews. This is a dense but frustratingly short and, in my view, under-argued attempt to trace the connection between Jewish identity and what Gilman identifies as "the potential for disease and decay associated with the modern body of the fat male". He argues that the "something" about Jewish identity that was perceived (by non-Jews) as different and abnormal continues to be expressed in the conceptualisation of the Jewish body as at especial risk of obesity.

An unusual feature of this book is that each of the three sections ends with a short response to what has gone before. In section 1 this is by Thomas W Laqueur, whose criticism is primarily that the evidence and argument given, especially in the papers by Siebers and Squiers, are inadequate for the claims that are made, which reading between the lines he finds symptomatic of the "large ambitions" of disability studies in general.

The second section is on Dis-sexuality. (And at the risk of sounding petty, I felt I was forced to work harder than I wanted to — harder than I would have bothered, in fact, if I'd been a reader rather than a reviewer — to get past this irritating and unexplained neologism.) It starts with Sue Sun Yom's highly focused unpacking of an anti-venereal disease military health education film of the Vietnam era, in which she diagnoses a "potentially unwitting complicity of preventive health education" in supporting ethnic and sexual stereotypes. Next come two contributions taking up the theme of HIV/AIDS. In the first, Gregory Tomso discusses the "emerging phenomena of barebacking and bugchasing", defined respectively as the practices of unprotected anal sex and of unprotected anal sex with the intention of becoming infected with HIV. Tomso turns discourse analysis on popular and scientific texts that discuss these behaviours, finding that "the link between gay male sex and death is as strong today as ever" (p.102), but also noting hidden concerns for ethical and social normativity that structure the "attempt to comprehend behaviors and desires that, at the moment, exceed our powers of understanding and explanation" (p.108). Next Lisa Diedrich takes on a reading of Paul Monette's writing on the AIDS crisis. In this interesting chapter she draws on psychoanalytic models of the function of witness and testimony, to illuminate the "personal and political transformations" engendered by Monette's witnessing of his lover's and his own illness and (impending) death, and also by the acts of witness of his readers. Sidonie Smith's response at the end of this section is to place sexuality and dis-sexuality within an understanding of the "international regime of human rights", reminding us of the need "to attend to the ways in which particular stories…become intelligible at specific historical moments, and how the narrator is always situated within webs of powerrelations that allow certain people to tell their stories while silencing others" (p. 133).

The final section on Dis-embodiment contains two thoughtful, substantial historical essays. The first is Steven Rachman's account of the medical illustrations of the nineteenth century Cantonese painter Lam Qua, produced for the medical missionary Rev Dr Peter Parker between 1836 and 1852. While recognising the colonial and medical power that gave Parker "unprecented access to the Chinese body of all ages and classes, male and female" (p. 142), Rachman argues that Parker and Lam Qua shared a unexpected commonality of task, working under pressure and against time, so that "cutting and painting find their ultimate equivalency in these images and in the lives and cases of the individuals they represent" (p.154).  Robert I Goler then tells the strange story of Dr George Dedlow, a fictional quadrupal amputee who "experienced" the spiritualist-induced reappearance of his amputated limbs. However bizarre the account (and that it was widely held to be nonfiction at the time), Goler suggests that it became a powerful contemporary symbol of thespiritual restoration needed for the health of the wounded post-Civil War United States. The final essay, by David A Kirby, brings us up to date with a reading of the science fiction film GATTACA. Conventionally GATTACA is taken as an intelligent and nuanced critique of genetic determinism. Kirby however finds that this critique has a major flaw in that it misses the "clear analogy between the genetic determinism faced by genetically unmodified people" in the film and "racial discrimination faced by minorities in contemporary American society" (p. 187). Joel Howell's response at the end of this section notes the disparity of the individual contributions but finds (or tries to find) a coherence in a shared concern with the tension between the purity of theory and the messiness of practice, and — perhaps less obviously — with the subjective nature of the gaze, which he finds in Lam Qua's subjects (and the gaze of these subjects), the technological gaze onto the wounded of the civil war, and the "race-blind, gender-blind" but genome-obsessed gaze of the world of GATTACA.

I don't usually review a book by listing the chapters and their contents, but in this case it is unavoidable because of the huge diversity of topic across the contributions. This is the drawback I alluded to at the start. A special edition of a journal, and particularly one that consciously draws on such a span of approaches, from personal account to history to image and film analysis, simply cannot be expected to show the same kind of argument development as an edited collection. Still, the book's lack of coherence is no less frustrating for being understandable. Any reader will have a hard job seeing what exactly holds all these pieces together. Of course, no editor is under any obligation to give the reader an easy ride. In this cas, though, it seems likely to antagonise the editors' desire to reach those members of the healthcare professions in need of the qualities of imagination and the inner resources to confront the unexpected. No nurse or doctor I know would have the time or energy to work their way through these papers, to get the message the editors obviously want them to. What's needed is a much less subtle path through the woods — a clearer and more solid introduction, and a more consistent editorial lead throughout. Although the idea of having responses by different authors to end each section seems a good one in principle, in this particular case it means there is a lack of the necessary broader overview to lead us through the text.

But what this collection does succeed in doing is whetting the appetite for more on topics raised in isolated chapters, and most of the authors manage to point the reader in the direction of further sources. Many readers will undoubtedly find different chapters catalyse further thinking and exploration, and in this the editors have certainly achieved part of their goal. It's just frustrating that I feel it will be mostly the already converted — the nonpractitioner academics and not the working healthcare professionals — who take the bait offered here.

© 2006 Jackie Leach Scully

Jackie Leach Scully, Ph.D., School of Geography, Politics and Sociology, Newcastle University, United Kingdom

Categories: Philosophical, Ethics