<i>Contesting Illness: Processes and Practices</i>‐ Edited by Moss, P. and Teghtsoonian, K

P. Moss and K. Teghtsoonian (eds) Contesting Illness: Processes and Practices. Toronto : University of Toronto Press , 2008 £22.50 (pbk) viii + 347pp . ISBN 978-0-8020-9512-1 This eclectic collection of seventeen provocative and challenging essays adds to the burgeoning literature concerning the ways in which power relations constitute people's experiences and interpretations of illness or disability in industrialised Western societies. The term ‘contesting illness’ in the title is used both to describe illnesses which are ‘dismissed as illegitimate . . . by researchers, health practitioners and policy-makers operating within conventional paradigms of knowledge’ (p. 7), and also the contestation taking place in relation to the social construction of illness. Contestation is framed as a specific dimension of power and the contributors aim to explore the intersections between power and illness. The volume is refreshing and innovative in its multi-disciplinary approach. Its contributors come from a variety of cognate backgrounds – including sociology and anthropology, policy, law, psychology and nursing – proffering a multiplicity of lenses on various contestations of illness or disability. Moreover, examples are drawn from various health care systems throughout the world, including Sweden, Ireland, Australasia, Canada and the United States, which, in addition to providing interesting cross-cultural comparisons, also makes clear the link between interpretation of illness and disability and local politics. Each chapter, which explores illness contestation in relation to a particular illness or disability experience, presents a theoretical argument, which is supported and brought to life with qualitative research. The essays are arranged sequentially under three broad themes reflecting different areas of contestation: authority, bodies and context. The theme of authority concerns elements of contestation with both political authority, for example, Prince (Chapter 2) and the authority of biomedical knowledge (Orsini, Chapter 6). The chapters clustered under ‘bodies’ provide fascinating explorations of the tension between the material (bodily experience of symptoms) and discursive (diagnostic contradictions) nature of bodies in relation to particular illnesses; demonstrating that ill bodies are constituted by and constitutive of social relations. For example, Ussher (Chapter 10) explores women's bodily experiences of their pre-menstrual phase and the contradictions surrounding the pathologising of these experiences. Finally, the chapters grouped under ‘context’ are concerned with the ways in which illness experience is shaped and articulated through various aspects of social relations including ethnicity, class and gender. This is exemplified by Gremillion's (Chapter 12) analysis of the influence of ‘race’ and class on the diagnosis and treatment of eating disorders. The contestation in question usually centres on the ways in which ill or disabled bodies are defined, that is, the diagnosis. Contestation may arise from biomedicine's rejection of the layperson's diagnosis in such cases as Chronic Fatigue Syndrome (Bulow, Chapter 7) and Myalgic Encephalomyelitis (Moss, Chapter 9); or conversely the layperson's rejection of their biomedical diagnosis, exemplified by Angus's (Chapter 5) discussion of people diagnosed as being ‘at risk’ of coronary heart disease. The collection of contested illnesses also contains some surprising inclusions, such as breast cancer diagnosis and treatment. Purkis and van Mossell (Chapter 8), drawing on historical research and women's current experiences of breast cancer, demonstrate the ways in which both the diagnosis and treatment are open to contestation between patients and professionals. The chapters are underpinned by a variety of critical theoretical perspectives, providing a robust critique of biomedical knowledge in various areas. In particular, many of the chapters draw on Foucault's critical theories concerning the medical gaze, discipline and surveillance to problematise biomedicine's implicit assumptions. However, this critique slips into less helpful polemic in parts, setting up biomedicine –‘medical experts and their allies’ (p. 17) – and women in opposition, with demonising generalisations about medicine. For example, Potts's (Chapter 14) otherwise excellent analysis of diagnosis and treatment of female sexual dysfunction appears to present what I suggest is a false dichotomy of those who endorse bio-physiological explanations for sexual difficulties – the ‘authoritative medical model’– versus those who argue for a more holistic understanding of sexuality. This dichotomy discredits the knowledge and (holistic) understanding of health professionals in relation to female sexual dysfunction and also disregards the reality that physical problems do often influence sexual function. Overall, notwithstanding my concerns regarding the tendency towards polemic, the authors have achieved their aim of presenting a critically informed exploration of the intersections between power and illness. This collection is an important contribution to the field, providing information, clarity and originality; enabling readers to engage with the nature of contested illness. This text would be beneficial to undergraduate and postgraduate students, researchers and academics in the fields of medical sociology, medicine, nursing, policy and health and social care. It would also be valuable for practitioners in these fields.

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