Book Review
Bodies at Risk: An Ethnography of Heart Disease
Elizabeth E Wheatley
ISBN: 978-0-754643-07-4; 2006; 135 pages; Ashgate Publishing;
Angela Cushing
Honorary Research Advisor, School of Nursing & Midwifery, University of Queensland, Ipswich Campus, Ipswich QLD
Wheatley, a medical sociologist, offers a refreshing approach to heart disease research - the qualitative strategy of ethnography. Historically, cardiac investigations have stemmed mostly from a quantitative bio-medical paradigm, with heart disease separated from co-morbidities and a gender focus on men's experiences. Wheatley stipulates that the only selection criterion for the 20 participants in this study was the existence of a heart condition, and underpins the data analysis with the theoretical concepts of Giddens and Foucault.
Chapters 2 and 3 explicate the relevance of Giddens' notion of re-skilling in a risk culture following cardiac dysfunction. Illuminated is the interpretive effort by participants in analysing embodiment leading to a raised awareness of emotional and bodily limitations. Flow-on benefits for participants were an understanding of the inevitability of on-going social negotiations at the micro-political level of clinical practices of power and persuasion; and the ability to recognize what constitutes 'acceptable risk.'
Chapters 4, 5 and 6 extend Foucault's thesis of the 'clinical gaze', visibility, knowledge and power. Demonstrated is the transformation in the practice of surveillance medicine from a period when the focus was mainly on the ill person's body to that of today's practice where medicine's vision is panoptic - lifestyles and human health are also under observation.
Undertaking an ethnography signals commitment to the long social process of fieldwork. Wheatley experienced two years in the field which allowed interaction with the patients during different periods of their illness. Methods employed were participant observation, one-to-one interviews and focus groups, and excerpts from the transcriptions are integrated in-text. There are a few omissions. Wheatley does not indicate how the data were analysed nor is there any detail about research ethics, informed consent or patient confidentiality. On page 1, Chapter 1 it is footnoted that permission was obtained to approach patients.
As heart disease is a major cause of death in our society, Wheatley's ethnography has much to commend it. Nurse researchers, allied health researchers and clinical practitioners in the field of cardiology familiar with qualitative strategies as a means to capture the collective subjectiveness of the human illness/health experience and its social ramifications, will find this book a key study.
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