Lerman, S., Ostrach, B. and Singer, M. (eds) Foundations of Biosocial Health: Stigma and Illness Interactions. London: Lexington. 2017. 244pp £77 (hbk) ISBN 978–1498552110

This book is one of two edited volumes which contribute both theoretically and empirically to the growing body of literature about the syndemics of stigma. In their definition, the editors describe syndemics as the ‘multiple detrimental interconnections that occur among co-present or clustered diseases and other health-related conditions in a population and the social and socioenvironmental factors that promote and enhance negative effects produced by disease interaction’ (p. ix). From the outset, the editors underline the importance of Goffman in the development of stigma syndemics, recognising that ‘[a]s a health and social science concept, stigma has a fifty-year history that first gained attention with Erving Goffman's seminal work’ (p. vii). One of the key strengths of this particular text is its international appeal. Chapters include fieldwork undertaken in Canada, Kenya, Puerto Rico and the USA. In tying this diverse subject together, the editors offer a unifying research question which is carried throughout all eight chapters: ‘how and through what mechanisms does social stigmatisation play a role in increasing the likelihood that specific diseases will cluster in a population and produce or worsen the conditions for harmful disease synergy?’ (p. xi) In content this volume is clear and thematically coherent; the early chapters cover broad ground, with topics including drug use, substance abuse, violence and suicide among Aboriginal people, depression and obesity, and homeless women’s experiences of various forms of abuse and mental illness. In the first chapter, Singer and Ziegler examine how the intertwined pathways and clustering of existing marginalised groups intensify stigma interactions. In analysing poverty, illness, drug use, violence and injury among minority ethnic and working-class communities, the authors argue that communities endure a stigma magnification that creates the impression of ‘ghettoisation’ in certain areas (p. 11). In chapter two, McKinley builds on the previous theme of poverty in minority ethnic communities, with a focus on Aboriginal youth in Ontario in Canada. McKinley's data, derived from ethnographic fieldwork, demonstrates that numerous causes fuel the syndemic: the education system, access to food, the collapse of community support and the long-lasting influence of colonialism – of which remnants still exist in the Canadian Constitution – all contribute ‘to an institutional system of discrimination which promote(s) the biological pathways of syndemic interaction’ (p. 40). Chapters three and four move the focus of the volume onto the intersections of obesity and depression stigma. Lerman's research suggests that Puerto Rico's status as a US colony exacerbates the structural factors that inhibit health and wellbeing. Importantly, Lerman identifies systematic oversights that could be addressed; for example, the employment of mental health specialists in diabetes clinics could improve the outcome of people affected by both depression and obesity. In chapter five, Marcus and Singer concentrate on the numerous and complex layers of stigma that affect the lives of homeless women. They theorise that the women's lives are experienced through themes such as loss, abuse, mental health issues and the breakdown of their families. The authors argue that all these factors create drivers that adversely affect the pathways taken by these women. The final three chapters focus on the stigma syndemics among communities affected by HIV. Drawing on qualitative interviews with people in Kenya, Pfeiffer et al. observe that there has been a shift towards a focus on mental health ramifications among those infected with HIV/AIDS. In part, this is due to medication that can conceal or halt the advance of the illness. People living with HIV/AIDS were likely to be affected by isolation from their social and familial networks, fuelling depression and other mental health disorders. Emard's chapter moves on to consider biomedical moralities, whereby people who are HIV-positive are judged to be ‘good’ or ‘bad’ patients, depending upon their adherence to prescribed medications and healthy behaviour. The author examines how risky behaviour can cast people who are HIV-positive out of both HIV communities and the wider society. In the final chapter of this volume, Gideonse shows that stigma serves a function: that of othering. Gideonse argues that Western culture, for example, ‘needs homophobia as a way to define itself; to know what is “normal, rational, and acceptable”’ (italics in original, p. 208). In summarising his arguments, Gideonse suggests that the only way we could address this syndemic is to fight the cultural logic and structures that support them. Overall, the authors are to be congratulated on their international perspective, addressing the diversity of backgrounds in communities affected by HIV/AIDS. However, although the volume is theoretically coherent, its format and structure could have been improved. For example, as HIV/AIDS is given a substantial focus during the last three chapters, it would have worth signposting this shift more explicitly. Alternatively, there is perhaps a case to be made that the volume is over-reliant in its use of the topic of HIV/AIDS to drive the theoretical position forward, possibly to the detriment of other topics of enquiry that may have demonstrated the robust claims of stigma syndemics as a worthwhile avenue of theoretical exploration. Likewise, the broad demographical scope of this book has its own drawbacks. For example, given the embodied focus of the topics covered, I was surprised to see a lack of engagement with feminist theory. This was especially evident in the chapter on stigma interactions among homeless women. Indeed, with the global reach of the topics included in this volume, intersectional feminist perspectives which consider class, race, sexuality and ability would have strengthened the chapters by providing a more compelling argument for the development of this theory. However, these are minor considerations to an otherwise pioneering piece of scholarship. This volume makes a persuasive case for the expansion of research into this area. This book would be of particular interest to those familiar with the theoretical traditions on which it is founded. With its substantial theoretical content, this text would be most useful to scholars and postgraduate students who are interested in research that focuses on the intersections of contemporary social theory, health and illness and medical sociology. I eagerly await the next instalment in this volume.

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