Book reviews / Social Science & Medicine 56 (2003) 1369–1371
and development. We need this kind of thinking to grasp where sex is taking globalization, and where market forces are driving or hindering sexual change. This is a wonderfully clear reckoning of some of these trends. Dennis Altman has written a timely and necessary book on a topic that cannot be ignored.
Chris Beyrer Departments of Epidemiology and International Health Johns Hopkins Bloomberg School of Public Health John Hopkins University 615 N Wolfe Street, Baltimore, MD 21205, USA E-mail address: [email protected]
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La vida en la adversidad: el signiﬁcado de la salud y la ! en la pobreza reproduccion Roberto Castro, Centro Regional de Investigaciones Multidisiplinarias, UNAM, Cuernavaca, Morelos, 2000, 541pp., paperback In this remarkable study, Dr. Roberto Castro, professor at the National Autonomous University of Mexico’s Regional Center for Multidisciplinary Research, seeks to uncover the logical connections between the traditional customs and beliefs of rural Mexicans regarding disease and good health and their subjective experience of both illness and wellness, as well as reproduction and contraception. Based on systematic empirical research that surveyed residents of the village of Ocuituco, Morelos, a rural community of 3200 just 55 miles southeast of Mexico City, Castro explores the way in which his subjects combine the elements of the discourse of modern medicine with their traditional knowledge and practices. Even more telling, he frames his study in such a way as to reveal how this synthesis of modern and traditional, of ‘‘science’’ and ‘‘beliefs’’, is shaped by the objective reality in which these villagers live. What, he asks, is the worldview that underlies the Ocuitucans’ experience of pain and other physical symptoms? And how is this worldview connected to their socioeconomic condition? While other social scientists have explored the articulation of modern and traditional concepts of health in the Mexican countryside, Castro takes the discussion much further when he proposes, as his central hypothesis, that the way in which the people of Ocuituco give meaning to health and reproduction springs not only from traditional beliefs tempered by modern medical concepts, but is also inﬂuenced by their economic condition and the dominant gender relations that characterize their world. In this study Castro goes beyond the effort simply to show which traditional concepts survive and continue to shape rural Mexicans’ thinking about health and disease. Rather, his survey provides the basis for him to argue that the immediate social reality of these people plays a large part in the formulation of their ideas about health and reproduction issues. Castro’s goal is not merely to document that
Ocuitucans are poor or that the women are subordinate and oppressed, but rather that these very aspects of their lives profoundly inﬂuence their views on health and reproduction. Having formulated the problem in his introduction, Castro next provides a critical review of the anthropological and sociological literature on the subjective experience of health, disease and reproduction. This exercise is nothing less than encyclopedic, running 115 pages of text and covering every signiﬁcant debate on these issues, particularly the questions of structure and agency that have been highlighted in the Marxistfeminist approaches. While Castro suggests that the non-specialist may want to skip the entire exercise, there is no question that, surveying as he does, the contributions of scholars writing principally in English, with this chapter alone, Castro will have provided those who read Spanish with an invaluable resource. With his conceptual vocabulary thus deﬁned, Castro goes on to detail the theoretical and methodological approach he uses in his project, ‘‘a perspective that presupposes that actors function as agents with the capacity to interpret their circumstances and adapt themselves accordinglyyat the same time that they are inserted in a social order that molds them’’ (p. 147). Accordingly, he identiﬁes three levels of links between social conditions and the subjective experience of health and reproduction: the sociodemographic context of Ocuituco which he explores in vivid ethnographic detail while providing graphic breakdowns of the population by age, sex, occupation, employment and literacy levels, fertility rates and access to potable water, electricity, and other basic social services; the subjects’ vision of the world or ‘‘common sense understanding’’ of their daily life as a factor that mediates their subjective experience; and, ﬁnally the subjective experience as such. To explore these three levels, Castro provides a thorough description of the sociodemographic context of Ocuituco based on a survey conducted over the years from 1988 to 1992. He also examines the elements of the common sense understanding of its people, through indepth interviews with 79 informants: 35 women, 26 men, and the 18 men and women whom he sought out as key informants.
Book reviews / Social Science & Medicine 56 (2003) 1369–1371
Having established these links, he provides an analysis of the meaning that individuals give to the general notion of ‘‘health’’ as well as the causes that, from their perspective, explain the occurrence of disease. In this framework Castro is also able to explain the subjective experience of Ocuitucans with traditional illnesses like ! susto (fright) and perdida de la sombra (loss of ones shadow, or inner being) and ca!ıda de la mollera (an infants’ illness that manifests as diarrhea, dehydration and a cranial depression). In the ﬁnal chapters, Castro focuses on the subjective experiences of sexuality of both his male and female informants, and the ways in which these people seek attention for the health problems that they suffer. He concludes with an analysis of his ﬁndings and an examination of the degree to which the Ocuituco data may be generalized to other cases. What emerges from this mountain of quantitative and qualitative data is a portrait of people who share a view of themselves as victims, a clear self-perception of their place at the bottom of the heap and a permanent sense of uncertainty expressed in the inclination to view the unexpected as normal, an orientation toward the present, a profound sense of the precariousness of life, and a corresponding disinclination to complete projects. Castro also ﬁnds that both men and women have internalized the rules of gender inequality and hold negative views of themselves in relationship to what they perceive as a rapidly changing social environment. In
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this context Castro identiﬁes an inexorable trend toward ‘‘medicalization’’ in which the discourse of modern medicine—that is, the very health care to which Ocuitucans have only insecure access—overwhelms traditional understandings of health and disease. In his appendices, Castro provides us with the interview questions he asked, precise details on the coding of responses, the variables of his census, more than 30 pages of bibliography and an index of both themes and names. To be sure, in a study this long, thorough, and systematic, the reader is bound to ﬁnd a certain amount of repetition. However, overall, the work is a stunning achievement. Through the interviews it gives voice to marginalized rural Mexicans. At the same time it speaks to policy makers who may be insufﬁciently attentive to the fact that, yes, living in poverty makes a difference, that a life of misery shapes the attitudes of the poor. Speciﬁcally material deprivation conditions the way in which they think about their bodies and their health and the way in which they are likely to receive policies designed to bring to them the miracles of modern medicine. Judith Adler Hellman Social Science Division York University Toronto Ontario M3J 1P3, Canada E-mail address: [email protected]