This interesting and enlightening book frames medical humanities in a way that proves to be very helpful to readers. In particular, author Sander Gilman provides an historical account of a number of medical values and reveals how cultural and medical assumptions can elide and confuse our understanding of issues such as posture and pain. Illness and Image would serve as a great pedagogical tool both in terms of what medical humanities has to offer medicine and bioethics and in terms of often-overlooked medical issues whose representations have changed over time and from culture to culture.

Gilman’s introduction gives a helpful definition and discursive explanation for the relationship between medical humanities and the health sciences. The field is multidisciplinary in its probing of some of the fundamental questions about what constitutes health and illness. He focuses on representations and ways of seeing that have the potential to contest and shift our theory and practice of some important issues in health sciences. Gilman shows how this field opens up an appreciation for how the generation of knowledge is always historically and culturally situated. “Knowing the approach by which you interpret what you see,’ Gilman writes, ‘makes you a better diagnostician, and learning those theories of interpretation meansstudying the medical humanities as a physician in training or indeed as a potential patient’ (Gilman xiii). Thus, studying medical humanities is integral to becoming a good physician, nurse, social worker, and psychologist–while not denigrating the richness of health sciences in their own right.

The bulk of Gilman’s book is an analysis of nine case studies: male circumcision; face transplantation; posture; obesity; pain; madness; self-harming; scientific racism and genetic research; and meanings of death. Each chapter illustrates central questions in medicine such as what is normal, what is healthy, and what it means to be human. I will only discuss a few of these chapters in this review. The chapter on face transplantation, for example, raises the question of what it means to have an authentic face and to what degree our face is ‘who we are.’Themes of this chapter include what it means to have a ‘normal’ nose instead of a ‘Jewish’ one–an issue tied to body aesthetics but also to questions of character–and the experience of passing and why it has been viewed as necessary by members of oppressed groups.

I found the chapter on posture to be particularly fascinating given that I had never thought about it in an historical and cultural context. Gilman gives a clear overview of changing ideas about posture over time and shows how ideas about the healthy individual are tied to a military stance whose roots are ancient but persistent. ‘Good’ posture is seen to be associated with health and humanness, and ‘bad’ posture with disability–in particular, Gilman notes, with respect to Jews. He includes a discussion of ways that values about good Chinese posture have changed due to globalization and its Western influence. Interestingly, his analysis of posture illustrates how good posture is not only considered the standard of health and humanness but is also the signifier and literal pathway to citizenship. Race and class differences thus are integrally tied to postural interpretations of what it means to be human. Gilman mentions gender as well (particularly with respect to corsets and foot-binding) but I wish he had connected it with the other issues he raised. Instructors might wish to supplement this chapter withAnn Cahill’s article ‘A phenomenology of fear: The threat of rape and feminine bodily comportment’ (Cahill 2001).

The chapter, Obesity across cultures, prompts readers to delve more deeply, and from a different angle, at assumed universal and timeless concepts such as the body, the self, and the nation state. It may be surprising that a health concept such as obesity, which has gained so much attention in the U.S. recently in the campaign against fat, would bring us to painful ethical practices of colonialism and expansionism, but Gilman does just this, and in a persuasive way. This chapter draws on differences between U.S. meanings of Body Mass Index (BMI)in the U.S. and in China to facilitate our understanding of deep prejudices and biases in cultural differences. Such assumptions are deeply embedded in values and aims in health sciences, but it takes an analysis of representations in order fully to appreciate their effects.

Another chapter I call attention to is on genes and race. In this chapter, Gilman gives a short history of racialization and eugenics, illustrating his points with the racialization of Jews and ‘scientific’ claims of a Jewish gene. The 21^st century emphasis on genetic research in order to explain illness–and why some groups of people seem more or less vulnerable to particular illnesses or even endowed with valued traits–raises the question of whether a ‘new’ old eugenics is at hand. His discussion of the historical change from talking about Jews as a race to Jews as bearing a ‘genetic’ marker, is crucial in understanding how language can work to disguise old wolves dressed up in newly-fashioned sheep’s clothing. However, this chapter left me wanting more: I would have liked him to say more about Middle Easterners, indigenous populations, and Hispanics, and I wished for a discussion of the broader relation between 21^st century genetics and ‘post’-colonialism. A supplemental article for instructors would be María Lugones’ ‘Heterosexualism and the modern/colonial system’ (Lugones 2007).

Because of theoretical literature and argumentation that may prove daunting to undergraduates, I see this book primarily as a text for graduate students. But it may still take some filling in by instructors about concepts that Gilman does not explain, like ‘neoliberalism’ and ‘entangled geneologies.’ Instructors might also want to provide links to additional imagery that would illustrate visually the arguments presented in the book. Finally, each chapter has a set of questions at the end; I found these a bit simplistic given the depth of material in the book; I wish Gilman had really pushed the limits of our representational thinking and ontological commitments by the questions he offered. That said, this is a great book, and I would recommend it for graduate courses in bioethics, medical humanities, and electives for residents.

References

Cahill, Ann. 2001. Rethinking Rape. Ithaca: Cornell University Press,145-166.

Lugones, María. 2007. Heterosexualism and the modern/colonial system. Hypatia 22(1): 186-209.

© 2015 Nancy Nyquist Potter

Nancy Nyquist Potter is the author of Mapping the Edges and the In-Between: A Critical Analysis of Borderline Personality Disorder (Oxford University Press, 2009). Look for her book The Virtue of Defiance and Psychiatric Engagement  in 2016 (Oxford University Press.)