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COMMUNITY HEALTH STUDIES VOLUME V, NUMBER 2, 1981 more than an introduction to techniques in most Allen J. Enelow and Scott N. Swishergdentiewing areas of medicine. This process clearly becomes and Patient Care counter-productive when the vehicle for all the (Edn.2 Oxford University Press, 1979) factual knowledge and technical expertise, the doctor - patient relationship, is itself reduced to From an informed, non-medical point of view just another specialised technique. it is often difficult to be constructively critical The most useful application of a technique about medical education. It seems relatively easy approach is demonstrated in the chapter on the to go on endlessly about what is wrong, but not so problem-oriented medical record. The easy to go about the task of doing it better. This juxtaposition of a conventional and a problem - book by Enelow and Swisher is the sort of text that oriented approach clearly shows the value of a would be used to introduce medical students to what many consider the most important aspect of more useful technique when it is applied to a practical problem like medical records. doctoring, the care and maintenance of the doctor - The negative consequences of a technical patient relationship. Given that it is a second approach are seen at their worst in the chapter on edition - updated from 1972 - it must be quite emotional and behavioural responses to illness and widely used. Its contents covers a wide area, to the interviewer. It is little more than a catalogue introducing the reader to the nature of medical of common cultural stereotypes of problem information, basic interviewing and data- patients. Using a simplified form of psychoanalytic gathering, specialised areas like dentistry, children jargon, the authors describe the paranoid, and families, handling emotions, medical records seductive, angry, or overtalkative patient and and planning treatment. suggest ways for the doctor to avoid being While the book provides a brief coverage of a wide range of topics, quite important areas are embarrassed by them. Armed with such powerful missing completely. We search in vain for any tools for understanding, the new doctor will discussion of health education and how an quickly learn to locate all the problems inside the interview can be used as its vehicle. There is not patient where they belong. There is little chance the problems of effective even a mention in the index of that favourite medical preoccupation, compliance, and no interviewing will be seen in the social relationship serious discussion of how to encourage a more of patient to doctor. Even more remote will be any recognition of a wider network of social active and participatory patient role. relationships that include both the doctor and the It might be said that there is little point in trying to turn medical students into sociologists, patient. This book will doubtless continue to be used but it is equally unrealistic to ignore the large amount of critical thinking and solid research that as a respected medical text. This will be primarily because it covers an important and problematic has been done on the doctor - patient relationship. area in such a way that it fails to raise the important This book leaves the reader with the impression issues. As such it further reinforces an already that there is little to understand beyond a few widespread medical myopia. It effectively obscures techniques. A lot of areas are covered, but not in beyond recognition the fact that relationships are such a way as to give the beginning interviewer any critical understanding of this essential part of socially produced, and, by extension limits the clinical practice. awareness of how disease is socially produced. For The problem with this book is not so much the those medical teachers who have yet themselves to content, or the lack of it, but the way in which come to grips with a critical awareness of the role interviewing is treated as just another medical of medicine it is a safe book to recommend. technique. To a certain extent medical Alan Owen, specialisation and the “weight of knowledge” that Council Street Project. Bondi Junction Community Health Centre. is imposed on students, crams out any chance of N.S. W. VOLUME V. NUMBER 2. 1981 174 COMMUNITY HEALTH STUDIES P.M. Strong: The Ceremonial Order of the practical problems: as Strong pithily observes, “to Chic - Parents, Doctors and Medical notice that the dog did not bark in the night is often Bureaucracies. (Routledge & Kegan Paul a most difficult task and one that is even harder to London 1979) prove unless one can display all of one’s data“. In general he handles the problem well, though the This study is important for all persons presentofion of one of his major conclusions, connected with the delivery of health care in a concerning the “idealization” of staff and formal institutional setting. It will also be of patients’/parents’ character, veers towards the considerable interest to microsociologists and oversimplified summaries of “patient-doctor others interested in empirical field research. attitudes” which, amongst other things, his work is Strong’s sophisticated analysis is marked by an an attempt to transcend. Hence what is intended as extreme density of observation and style which an illustration of structure-by-avoidance: qualitative sociologists may interpret as richness “What parents were actually like; whether they but which other, including health professionals really loved a child or not; the degree of and those more familiar with “snap” research competence with which they cared for it; the methodology, may find frustrating and tedious. responsibility which they themselves might bear Fortunately, much useful questioning might be for a child’s condition - none of these things stimulated by simply dipping into the substantive were at issue, at least on the surface” chapters at random. appears misleadingly, later on that very page, as a This book is based on three years’ direct matter of positive and concrete belief observation of 1020 consultations between doctors “Every mother, just because she was a mother, and parents concerning their children, in various was an ideal mother ... likewise, every mother made an ideal (childrens’) representative ... (principally hospital) settings in Scotland, and on I00 similar outpatients’consultations in the United honest, intelligent, reliable and impartial”. Many readers will question, from experience, the States of America. Strong is concerned not with universality of any such ascription. Strong the well worn (in his view worn-out) paths of “the sick role” or “the doctor-patient relationship” as acknowledges that contradictory results are furnished by other United Kingdom studies and seen in one-sided cognitive approaches but with the ceremonial form of the encounter itself; that is that structural variables may hold the key to this. Strong’s other inductivelyderived features of the ways in which it is ritually structured and his “bureaucratic role format” concern firm clothed by its’ participants. In this he is conceptually indebted to Erving Goffman, while medical control, an emphasis on service, a his methodology combines elements of analytic combination of both politeness and impersonality, induction with the “constant comparative method” and an emphasis on collegial rather than individual of Glaser and Strauss, being concerned first with medical expertise. Rather than take these as given, the generation of observations, categories and he explores how they might be illuminated by hypotheses, rather than exclusively with identifiable social/ historical factors. In addition to the familiar themes of the “medical dominance” hypot hesis-testing. literature, he notes the effects of the cohesion and Strong finds that the ceremonial order of uniformity of clientele, the amount of available occasions was remarkably invariant; the number time and the extent to which competition between of institutionalized “r formats” was severely doctors is encouraged or restricted. In his final limited and one, which he calls the bureaucratic, discussion of policy implications, he briefly was found - though not exclusively - in every type considers the implications of this for the existing of setting observed, for most of the time. (Other orthodoxies of manpower-population ratios, role formats are designated as charity, clinical and though unfortunately this tilt at sacred cows private). Present readers may object that, given the remains a side-swipe. His historical explanation of research setting, this finding merely states the obvious. In fact, however, Strong’s own the pervasiveness of bourgeois medical gentility in interactional perspective on the “bureaucratic terms of the “direct political management” exerted format’’ is quite distinct from conventional by the community through the State remains organization-theory treatments of bureaucracy as speculative and unconvincing. Finally, a comment concerning the a structure per se. His locus of observation is that relationship of Strong’s eventual findings to the very “obviousness” of encounters: their taken-for- more familiar sociological literature on granted and unwritten rules. Hence he is bureaucracy. For Strong, as for Goffman, particularly concerned with those interactional “situated roles” are not derived axiomatically from rules which do not become visible until they must the theorists’s consideration of systemic be broken; which are embodied not in the way properties, but are empirically observed to emerge certain matters are observed so much as in the way from repeated “runs” of a situation. Yet the they are ruled out as “irrelevant” to the encounter upshot, that a routinized solution such as the (itself a potent strategy for medical control). bureaucratic role format “diminishes uncertainty, This focus presents both methodological and COMMUNITY HEALTH STUDIES 175 VOLUME V, NUMBER 2, 1981 cuts out initial skirmishing, avoids trouble and a medical career are persuasively portrayed. The enables a rapid concentration on the task at hand” statistical evidence of the relatively high physical precisely mirrors the classic work of Weber. and psychiatric morbidity among doctors is known Structuralists may therefore query whether it is to many, but the casual factors underlying these worth their while pushing through an sobering statistics are not often depicted as clearly interactionist thicket in order to reach what they and trenchantly as in this book. A concluding “already know”. The answer must be that the chapter entitled “The Wounded Healer” is written detour is worth it for the richness of the view. with sensitivity and wisdom. The paradigm of the Richard Keam, psychotherapeutic transaction is offered as a step Department of Social Sciences toward resolution of the problems created for both Royal Melbourne Institute, doctor and patient by perpetuation of a of Technology. dominance/ submission interaction pattern during a medical career. While the content of the book is oriented somewhat more toward hospital than community Glyn Bennet: Patients and fheir Doctors. (Bailliere practice, the issues raised are universal and the TyndaU London, 1979) book can be commended both to mdical students and to medical graduates in all settings, and would This book, which is subtitled, “The Journey also be useful reading for nonmedical health Through Medical Care”, is addressed particularly professionals and administrators concerned with to medical students and doctors, and the author’s health care. intention is to identify and describe the personal or C.G. Barrow, psychological conflicts inherent both in Department of Psychiatry, patienthood and in the role of medical University of Adelaide. practitioner. There is due acknowledgement to the covert, but pervasive, psychological influence exerted on both by the climate and structure of the Norman Klein (ed.): Culture, curers & institutions in which doctors and patients interact. contagion. (Chandler & Sharp California 1979) These themes are effectively elaborated by examples from personal experience in a variety of This collection focuses on perceptions of clinical roles, and from anecdote, and are health and medicine. It consists of sarticles supported by extensive references. previously published in professional journals, A major theme regarding the patients’ books and magazines which range from the experiences is that the subjective aspects are academic to the popular; from the humorous to the relatively, but significantly neglected during the cautionary. Articles were selected according to sociocultural and environmental criteria. Klein course through medical care, and that there are adverse practical consequences to such omission. uses a cultural relativist approach and comparative Examples are taken from the initial diagnostic method to design an edition for interdisciplinary consultation, adaptation to coping with a complex consumption. Each of the five, extensive sections is and bewildering staff system, reactions to physical prefaced with explanations of the concepts (such as illness, preparation for surgery, post-operative culture, cultural relativism, ethnocentrism and care, the management of pain, and adaptation to race) illustrated by the assembled articles. The first fatal illness. While agreeing that it is necessaryand section concentrates on the notion of contagion as salutary to bring these perennial matters to the not only biological in origin but also organic, attention of all persons involved in patient care, social and ritual; the second section examines some this reviewer would have liked to have seen further ecological parameters of health; the third looks at comment on the effects of efforts to tackle such relationships between practitioners, and medical problems which have been made in the past few practitioners and patients; the fourth covers health decades. Perhaps it is asking a little too much, but care in a pluralistic society; and the final section it would have been useful to have included explores scientific, folk and primitive health belief reference to whether such initiatives as changes in systems. undergraduate curricula regarding behavioural In the current stream of publications in sciences, community medicine and psychiatric medical anthropology/sociology/ psychology, teaching, and through such developments at the and social/ community/ preventive medicine, these postgraduate level as multidisciplinary medical- 246 pages emerge as noteworthy. An easily-read psychiatric liaison programs, have been shown to style and pertinence without pretension make for influence the problems described. favourable comparison between this and other The section of the book concerned with the more scholastic collections. Klein also avoids the character style and personality conflicts of those tendency of interdisciplinary publications to be taking up a medical career, is of particular interest. fragmentary failures. He demonstrates complexity The danger to both doctor and patient of a gradual yet reveals discernible patterns and the need to assumption of arrogance, power and pride during maintain perspective in cultural diversity. He VOLUME V, NUMBER 2, 1981 176 COMMUNITY HEALTH STUDJES achieves this by careful structuring of the book as a The volume under review is not above whole and within each section. For example in the criticism on these grounds. We owe a great deal to ecological part, the first two articles (Levin, the editor for his numerous monographs and contributions to the literature. However, there Fleetwood) describe environmental contamination, followed by Desowitz’s illustration must be a limit to the number of times some of his work, for example his figures on morbidity in an of how changing an ecosystem can cause disease average general practice, are reproduced in and Mathews et a1 on cultural influence on disease different publications. Many readers might almost epidemiology. The section is concluded with know this material by heart. Rosenbaum’s article which raises the question of how far do we go in the future. This is an ambitious book, which deals with There is something here for everyone and many aspects of the philosophy and practice of everything for some. Klein attempts to positively Primary Care in six sections. These are Health, analyse health as a social construct rather than Disease and Care (3 papers by different authors), health as the absence of disease and illness. The Systems and Patterns (6), Work of Primary Care result .shows two symptoms of present thinking. (6), Common Diseases (6), Education (4), and Consumers and Patients (4). To deal with all these Firstly, there is inclusion of non-health, because that is where most literature “is at”, secondly, a subjects in more than a superficial way is a formidable task, even in five hundred pages, and large proportion has psychiatric orientation, one wonders whether the attempt has been because in this discipline there has been much completely successful. There is an overall lack of querying of disease etiology and treatment balance, perhaps due partly to the fact that the methodology. However, there is sensitive papers range in length from 5 to 37 pages. By presentation of material. The article on including contributions by authors from the maltreatment of women by the medical profession United Kingdom, Europe, United States, is written by a male doctor (Nolen). Thomas Szasz Australia and New Zealand, a real attempt has is humanized by an interview with Ballad. It is a been made to present a world view. Most of the relief to find some closet ritual among the Western authors are from the medical profession, although male of our species (Oring). For some insomniacs, the other health disciplines are represented. other titillations are by Miner, Roth, Tao-Kim- Some of the papers are very good indeed and Hai and Haley - but don’t count on going to sleep, merit brief reference here. Barry Reedy discusses you might muse for some time. Teamwork in Primary Care very objectively and The real value of this book is its potential as a freely acknowledges the difficulties in achieving teaching manual for introductory social science effective team function. He deplores the courses and nursing and medical programs. The segregation of education in most systems of health articles should generate discussion. There is good care, which militates against effective referencing and referral to further reading, communication between various health workers. although indexing is nonexistent. His bibliography is excellent. David Metcalfe, in From the first article on our own society to the his long article on Undergraduate Teaching in last on how to fail as a therapist, this collection General Practice, gives a pragmatic account of the inverts our gaze and isolates our perceptions of United Kingdom experience of introducing others’ ideas about health and health care. It is a general practitioners into the Universities and book to remind those who already know and to jolt outlines some of the hazards faced by those setting those who don’t know about people and health. up new Departments of this type. These hazards Robyn Mobbs, are obviously not unique to the United Kingdom. Department of Anthropology & Sociology, He claims that “When a medical school decides to University of Queensland. incorporate general practice teaching in its curriculum it is best to assume, perhaps cynically, but at any rate until proved otherwise, that it is John Fry (ed.): Primpry Care. Heinemann doing so for cosmetic reasons rather than to gain Medical Books, London. 1980) well thought-out, needs-related, objectives”. He is During the last few years there appears to concerned that some Universities have had good teaching programs established by enthusiastic have been a frantic attempt to establish a general practitioners at a minimum cost, and respectable body of lilterature dealing with having achieved this have been unwilling to primary care, family medicine and general increase the investment of resources for further practice, fields which previously had been largely development. He poses sixteen pertinent questions neglected. Naturally enough, this has led to the that should be asked by a general practitioner with production of books which vary greatly in quality. academic aspirations before he applies for Some of them are marked by a great deal of appointment. repetitiveness, while those that contain There are papers from both sides of the contributions from a number of authors often have Atlantic on the important question of standards of a curate’s egg quality. VOLUME V, NUMBER 2, 1981 COMMUNITY HEALTH STUDIES 177 practitioner is frequently broken when a patient prescribing by primary care physicians. Carol enters a hospital because treatment is provided by Buck and Ian McWhinney, in a joint paper on a consultant specialist. How the British general assessment of quality, remind us that the quality of practitioner became separated from hospital medical practice depends heavily on human factors practice between 191 1 and 1968 is the main focus of which cannot be measured easily; chief among this book. these are the morale of physicians and other health Honigsbaum contends that separation workers and the relationship between them and their patients. They relate the current malpractice commenced with friendly society ”club” practice in crisis in the United States to the weakening of the late-nineteenth and early-twentieth century. human relationships which has accompanied the Doctors employed by the clubs were paid a fixed fragmentation and mechanization of medical care. capitation fee for each member on their panel of patients. By providing general practitioners with a A prescription for ensuring that the same thing secure income, friendly societies removed the does not happen in our society is contained in a perceptive short paper on Care and Management incentive for doctors to provide hospital services in competition with consultants. This division was by Maurice Wood, who stresses the difference between “care” and “cure”, the need for the reinforced with the passing of the National Insurance Act 1911 which extended the panel “holistic” approach in primary care, and the increasing problems of overcare and iatrogenesis. system to employed members of the working class. There was no major attempt to improve It is pleasing to note that he recognizes the general practitioners’ access until the Dawson importance of the primary physician’s role as Report, in May 1920, sought to achieve it by the advocate for the patient. He sums this up as establishment of health centres or “collective follows:- “The awareness that the physician will surgeries”. Each health centre would contain function as a friend who will interpret and monitor the decisions and interventions of the unknown consulting rooms, diagnostic facilities, local authority clinics and between 16 and 32 beds in sub-specialist to the best advantage of the patient is small local clinics and about 100 beds in larger a security beyond compare”. He goes on to plead regional centres where consultants would work for primary medicine training programs to develop with general practitioners. Dawson believed that training environments, curricula, and learning collective surgeries would unite the profession and situations which will engender appropriate lead to an improvement in the quality of medical attitudes of concern and interest without which care. However, the response to the Dawson Report effective primary care and management is was poor: general practitioners did not want to impossible. The reviewer believes that if teachers in primary care at the undergraduate level are work with consultants and for financial and ideological reasons, the Ministry of Health did not successful in inculcating these desirable attitudes, their impact on the medical course will be of great want to build health centres. The Ministry significance and certainly out of proportion to the preferred to broaden the role of the general modest amount of curriculum time they are practitioner in the community by extending the allotted. panel system to the wives and children of insured In spite of the earlier reservations, a broad persons. The final blow to the concept of collective spectrum of readers should find much of interest surgeries came in 1948 when Bevan introduced a and value in this very well produced book. It will be salaried health service which limited general a valuable addition to the literature on the practitioners’ access to hospital facilities. philosophy and the future of primary care and a The cost of extending the number of people very convenient source of material for the receiving national health services, according to increasing number of teachers in the field. Honigsbaum, was the foregoing of possible improvements in the quality of care which would J. G. P. Ryan, Deparimeni of Community Practice, have arisen from the establishment of health centres. In the end, he contends that the British Universii.v of Queensland public tended to regard the general practitioner in the hospital as a potential menace throughout the fifties and sixties. Frank Honigsbnum: The Division in British 7he Division in British Medicine is one of the Medicine. (Kognn Page London, 1979) most comprehensive accounts of the means by which the profession made use of the developing 7he Division in Briiish Medicine is written on public service to widen the gulf that existed the premise that “the aim of every medical system between consultants and general practitioners. It ought to be to provide continuity throughout - no outlines the major health policies promoted matter where the patient receives care.” In the throughout the period and documents the main American health care system, the author argues characters involved in developing medical policies, continuity of care is maintained because the including Dawson, Bevan, Hastings, Brackenbury, physician treating a patient has access to hospital Morant and Newman. The book is one of the few facilities. In Britain, continuity of care by a general VOLUME V, NUMBER 2, 1981 178 COMMUNITY HEALTH STUDIES behaviour etc.) and of the dilemmas involved in a to give prominence to the role of medical decision to prescribe at all in up to one-third of organisations outside the British Medical consultations, the proportion estimated by a Association, including the Medical Practitioners number of investigators to be principally psycho- Union, the Socialist Medical Association, the social in origin. This book contributes much (in State (later National) Medical Service Association places) to a more precise understanding of the and the Medical Policy Association. In some ways, social-psychological and interpersonal factors that the author’s pre-occupation with these mediate the prescribing relationship. associations is often at the expense of discussions The eleven commissioned papers in the book on the role of the B.M.A. One is left with some review past work and document original material uncertainty about the relative power and role of on prescribing behaviour. They cover ground that the B.M.A. compared with other medical ranges from macrosocial issues of the associations. consequences of a medicated society, to Honigsbaum believes that the general microsocial analyses of the prescribing ritual as a practitioner was indifferent to the need to secure social encounter in the Goffman sense. Three access to hospital facilities. The factors which he papers are concerned with the old, yet perennial, calls to account for this supposed “indifference” chestnut of psychotropic drugs. That by Lennard are shortage in the supply of doctors, the role of the and Cooperstock does little to refine or develop panel system in limiting competition, the their earlier historic analyses dating back to the increasing specialisation of medicine and general early 1970s. Their points about mystification of practitioner opposition to municipal control of social problems into medical diagnoses and the proposed health centres. However this very consequent socially conservative role that catalogue might be read as positive reasons for medicine latently adopts, are nonetheless as general practitioners’ acceptance of the status quo, rather than pointing to an indifference on their important now as they ever were. Six of the papers are by staff of the Medical part. Sociology Research Centre at the University of The main weakness of the book lies in the Swansea. They provide an impressive example of assumption on which it is based. Honigsbaum’s how a team working on different facets of a assumptions that general practitioners should have problem can apportion their research to emerge access to hospital beds and that the extension of with what is undoubtedly a product incomparably coverage under the national health services was at more penetrating than the various isolated pieces the expense of quality of care are never fully of research done by individuals working off their developed. He does not demonstrate sufficiently own bats. how the adoption of the Dawson plan would have There is an interesting chapter on the resulted in continuity of care and a better quality of prescribing of the now withdrawn beta blocker, service. Some may argue that the role of the practolol (Eraldin) by a sample of GPs who were general practitioner should be firmly based on assessed in terms ofjob satisfaction and autonomy, community and preventive medicine rather than which revealed a positive correlation between low hospital practice. A history of British medicine job satisfaction and high practolol prescribing. based on this premise would probably see the Smith contributes a piece on the interprofessional separation of the profession in a different light. relationship between doctors and pharmacists, and Given the current debate on the role of the doctor gives some tangible suggestions on their future co- in the community, however, this book is a timely ordination, forecasting a much more decisive role addition to the debate. for the pharmacist. Tony S. Pensabene. The main criticism that ought to be made is Australian Institute of not so much concerned with what is in the Multirultural Affairs. collection, as with what is not. The book is 570 Bourke St., avowedly preoccupied with the doctor as the main Melbourne. Vic. 5000. determinant of prescribing, a position that makes a great deal of cQmmon sense. But the doctor as a prescriber of quasi-solutions to social malaise, R.Mapes (ed.): Prescribing Practice and Drug oppression and alienation is as historically recent a Usage. (Croom Helm, London. 1980) phenomenon as the psychotropic drugs that are the end point in these prescribing situations. In the few There may still be a few doctors who believe in places where some authors attempt to locate the a total medical account of drug prescribing, doctor and his prescribing dilemmas in historico- whereby any given script can be explained solely in political perspective, rather simplistic views terms of a basic symptoms-diagnosis-prescription emerge. Melville for example, in a piece on repeat model. All but the most self-mystified must now be prescriptions which is excellent within the attitude very aware of both the non-rational factors which zssessment parameters set for it, dismisses often influence their prescribing (lack of critiques of drug company promotions as the appropriate pharmacological knowledge; patient “railings of anti-capitalists”. Nowhere is there any COMMUNITY HEALTH STUDIES 179 VOLUME V, NUMBER 2, 1981 appreciation of the doctor's prescribing dilemmas book or challenge the accuracy of the material. as the individual, or nuts and bolts, expression of Indeed, several contributions are in themselves the need of medicine under capitalism to offer valuable, especially to those unfamiliar with the solutions in commodity form compatible with authors' other published work. Smith, Wesson & economic growth. The constraints against the Linda provide what for Australians is a timely humanistic, counselling type solutions to reminder (full of practical tips) about the patterns inappropriate prescribing advocated by some of illness seen in the wake of barbiturate and authors in the book are, instead, viewed as sedative abuse. The paper by Kripper on altered characteristics of individuals amenable to possible states of consciousness has a rather nostalgic air change through individual-oriented solutions such for the more cynical drug-using public of the as medical education reform. The book does not eighties. Cherubin's discussion of three methods of seriously consider any radical critique of estimating the mortality rate from drug use is of medicine's role in mass society, which would interest, though the feasibility of using some of include an understanding of the complex these indicators may be likened to looking for a relationship between drug companies, the needle in a haystack, given Australia's lower structurallydetermined range of responses to population densities and the desperate state of our presenting "illness" realistically available to a data collection in this field. Einstein's own essay doctor and patients' definitions of their problems "Treating the Drug Abuser" gives a valuable grid as medical. for thinking about the array of treatment The book must, however, be unreservedly modalities available. recommended to anyone involved in medical For United States field workers in drug abuse education as both a reference and "ideas" book for clinics, the book does have a fair amount of useful future research. material but differences in the Australian idiom Simon Chapman, make the lists of drug terminology, for example, Department of Preventive less useful than they might be, while some of the and Social Medicine. writing is not attractive. "Personal chemistry University of Sydney challenges" or "intervention agents" are not phrases likely to endear themselves to the Australian reader. In all, the Australian field worker still lacks a "practical resource book" as a S. Einstein (4.): Drugs in Relation to the Drug guide to safe and sensible management. User. (Pergamon Press New York 1980) Andrea Mant, Department of Community Medicine, 'This collection of papers on various aspects of University of Sydney diagnosis, management and philosophy about drug misuse comes mainly from a number of well- known United States clinicians or medical scientists. The editor, from the Institute for the Study of Drug Misuse, wrote an excellent book David Robinson (ed): Alcohol Problems: "Beyond Drugs" in which the underlying thesis was Reviews, Research and Recommendations. that drug misuse was part and parcel of our (Macmillan London 1979) adaptation to the chemical environment. He sees this collection as a "resource book", but it is not The problems arising from the excessive consumption of alcohol are being recognised obvious, after reading the contributions, for whom it is to be a resource. increasingly as something which can and should be The interested "lay" reader (non-medico, or tackled. In response to this awareness, David nondrug worker) is likely to find the book too Robinson had edited a book of interest to many technical, while the scientist or professional may professional groups, "about alcohol, its use, well feel it is too "basic" and rather out-of-date. associated problems and certain recommendations about how these might more realistically be Few if any of the references postdate 1974,.yet exciting developments have taken place in a approached than they tend to be at the moment". On each of seven topics (Drinking and Social number of areas since then, not the least being the discovery that the body produces and uses its own Life, Alcohol Problems and Alcoholism, Teenage Drinking, Women and Alcohol, Alcohol and morphine-like substances, the endorphins and Work, Drinking and Driving, Prevention and enkephalins. Public Health) four readings have been included. Even the editor himself seems to have had In a number of Sections there are two readings some difficulties convincing his proposed authors with a similar theme, for example, the two papers of the value of the exercise, as he tells us several in the Drinking and Driving Section dealing with authors let him down nor was he able to get overseas authors as he had intended. the effect on traffic safety of lowering the legal This criticism is not to imply that I disagree drinking age. A more purposeful editing would with the broad-minded sentiments expressed in the have avoided such duplication in the interests of VOLUME V, NUMBER 2, 1981 180 COMMUNITY HEALTH STUDIES is to indicate factors which promote health, rather embracing a wider range of material. Noteworthy than those which cause specific diseases. omissions were sections on Minority Groups, The book begins with data on disease Treatment or Rehabilitation and Preventive incidence in large populations, showing that by Education. Some reference is made to education in International Classification of Diseases criteria, a the Section on Teenage Drinking but, given the majority of people in the population appear to “Recommendations” component of the subtitle have one or more diseases most of the time. Data and the widespread belief in our community that from the United States of America predominate, more education will solve all problems, the reader with some reference to Bridges-Webb’s work in should have been provided with a Section on the Australia. Antonovsky goes on to present a health topic. easejdisease continuum as an alternative to the One is left with some feeling of despair after traditional health or disease dichotomy; then, reading the book. Apart from lobbying politicians drawing on the work of Selye and others, he argues to reduce the availability of alcohol by restrictions that “tension” is salutory. Stress, defined as the in liquor licensing laws, little reference is made to result of the organism not being able to handle means whereby individuals may assist in reducing tension adequately. is nresented as a significant the use and abuse of alcohol - an action which they factor destructive to health. In discussing tension will undoubtedly be motivated to do after reading management, Antonovsky emphasises of the many and varied problems arising from the “generalised resitance resources” (factors that can excessive consumption of alcohol. In this respect, be identified in a range of domains from the and especially for Australian health and welfare physical and biochemical to the interpersonal and workers seeking to obtain some knowledge on a macro-sociolcultural) with examples of how topic not usually covered in professional education resistance resources can be basic to good health in courses, there was a need for the inclusion of some ad v.e r se or ga n i s m ic en vi r o n m e n t a 1 and action papers. circumstances. The new is not necessarily better, but given the Antonovsky then introduces a key concept, substantial increase in alcohol-related research the sense of coherence, during the past few years the antiquity of some of “ .... a global orientation that expresses the the readings is a little surprising. Over half of the extent to which one has a pervasive, enduring papers had a first publication date of 1974 or through dynamic feeling of confidence that earlier, while only three papers were published in one’s internal and external environments are 1976 or later. Not surprisingly therefore, the predictable, and that there is a high Editor’s claim that the book brings together a set of probability that things will work out as wellas readings which are not readily accessible to most can reasonably be expected” people is correct. Librarians might order a copy His own research has suggested that this “sense of now: the publisher does not hold stocks in coherence” is characteristic of people who, in a Australia so there is likely to be a three-to-four- variety of cultural settings and under adverse month delay in delivery. circumstances, are not negatively affected by Ian Smith, stress. Chapter 7 develops the salutogenic model of W.A. Alcohol and Drug Authority health, involving a detailed systematisation of the 25 Richardson St.. reciprocal interactions between sociocultural and West Perth. W.A. 6005 historical contexts, resistance resources, life experiences the sense of coherence and endogenic and exogenic stressors. I‘he tinal chapter deals Aaron Antonovsky: HeaIth, Stress and Copmg with implications for an improved health care (Jossey-Bass San Francisco 1980) system. This chapter is disappointing. It is mainly physician-oriented, and deals with health care Stress management is a popular member of largely in terms of the traditional organisation of the set of panaceas being offered to the public as Western medicine, but does contain some part of the current vogue for health promotion. worthwhile insights. Individual misbehaviours and biophysical This book does not provide facile answers to concomitants of lifestyle that seem to increase the the puzzle of the origins of good health. It is future probability of disease, identified by studies detailed and scholarly, and evidence to support of large populations, provide much of the scientific Antonovsky’s speculations and generalisations is rationale for the work of health promoters. well selected and competently presented. Antonovsky argues that, while such work is Empirical data, descriptions of social phenomena important, the study of diseases will not inform us and case studies are often interwoven to support adequately about the origins of health. The core of his contentions. As the author states, a great deal this book is an exposition of the “salutogenic” of future research will be necessary to validate the model of health, which is contrasted with the model that he has developed. It is a book worth pathogenic model that continues to dominate grappling with for the data presented on disease health care and health research. Antonovsky’s aim COMMUNITY HEALTH STUDIES 181 VOLUME V, NUMBER 2, 1981 and health, for its coverage of important empiricM nature of the problems under discussion, or with research, and for the framework within which the possibility that those who accept the reality of Antonovsky integrates a wide range of mental illness (or health), may be engaging in a information and theory. It is a timely contrast to political rather than scientific exercise. the plethora of enthusiastic treatises loosely based It is disappointing that only one of the on epidemiology, nutrition, biomedicine and psychologist contributors draws a distinction behavioural science which preach the adoption of between clinical psychologists as applied scientists, individualistic healthy lifestyles. Antonovsky engaging in what Kuhn calls normal science, and entices us some distance alonga path that may lead psychiatrists as electric technologists. This to an empirical base and a set of concepts helpful in important distinction between the two groups understanding the origins of good health in its accounts for the many changes in the social context. conceptualization and modification of problem Neville Owen, behaviour over the last two decades. 1 can only Foundation for Multi- Disciplinary Education in hope that the tenor of the articles by psychologists Community Health. does not mean they have been seduced from their Royal Adelaide Hospital. mother science by the attractions of a professional model. I suspect that this is the case, as a similar trend is evident within clinical psychology in Thomas A. Williams and James H. Johnson Australia. Behaviourism for example. has become (eds.): Mental Health in the 21st Century. Australia. Behaviourism for example. has become (Lexington Books Massachusetts 1979) a pantechnicon word describing not only the an empirical science of behaviour, but also the The book consists of a number of papers from eclectic procedures of mentalistically-inclined invited contributors, each of whom attempts to clinicians (cognitive behaviourists!). extrapolate from current mental health practices My main criticism of the book then, is that it is to the behaviour of clinicians twenty years hence - difficult to understand for whom it was written. or, more accurately, up to, rather than after, the The paucity of data makes it of little value to a beginning of the next century. health planner or scientificallyminded clinician. A major problem in predicting future events is The emphasis on ideological and professional that our conceptual framework is conditioned by issues in many chapters may be of interest to some past experience. We tend to conceive of the future psychologists and psychiatrists but is most likely to as the same, only better (or worse). Thus science reinforce their prejudices. The book’s great virtue fiction writers often set their plot within a social is its uncluttered style enabling easy assimilation organization not radically different from that of and evaluation of the subject matter. the present with a recognizably derivative Donald A. Sandford, technology. Whilst there is excellent clinical Hillcrest Hospiral, evidence to suggest past behaviour is indeed the A delaide best predictor of future behaviour, it may also be true that, within a society where there is a rapid social and technological change, there is an inverse relationship between time and accuracy of Connie Peck and Meredith Wallace judgement. If such is the case, a virtue of this book Problems in Pain. Proceedjnds of the first National is that its predictions are confined to a twenty year Australia New Zealand Conference on Pain. interval. (Pergamon Press New York, 1980) This is not a book concerned with data. The focus is primarily on professional and inter- This book reflects the current rapid upsurge of professional ideological issues and how these will interest in pain, its determinants and alleviation. In influence service delivery. It is indicative of current very few areas of research and applied endeavour status-relationships within the mental health area are so many different disciplines and that all chapters in the book are written by methodologies represented. Many of the major psychiatrists or psychologists. Contributions from advances in the study of pain are a direct social workers, mental health nurses and other consequence of this multidisciplinary approach. mental health professionals are conspicuously Several of the papers presented here demonstrate absent. According to their training, different this point forcibly. authors suggest different scenarios for the year The text is divided into sections dealing with 2000: the psychiatrists emphasize the biological experimental studies, the assessment of pain, bases for behaviour and the role of psychologists in diagnostic and intervention procedures and a evaluation; the psychologists acknowledge their section on selected clinical problems. A final role in evaluation but give primacy to socio- section containing a single paper presents the cultural factors in the development and educational objectives of a course on pain control maintenance of unacceptable behaviour. Sadly, for physiotherapists. One would hope that further neither group comes to grips with the metaphorical discussion will develop on this topic for other VOLUME V, NUMBER 2, 1981 COMMUNITY HEALTH STUDIES 182 stress innoculation, relaxation and biofeedback, to health professionals including medical students. the more pharmacologically and surgically based In the experimental section there are several procedures. useful reviews in addition to the empirical studies. This text is well worth acquiring for those who The introductory chapter provides an account of have an interest in pain. It contains up-to-date the spinal mechanisms and enkephalins. A studies, some of which confound popular beliefs. hypothesis based upon a Lurian analysis of frontal The problems of proceedings from conferences are lobe function suggests that an interaction takes not completely avoided in this text however. There place between the frontal lobes and the basal are papers which are wholly clinical and represent ganglia in the modulation of pain. an opinion rather than presenting data. Reviews of Following a short review of central mechanisms, there are a series of experimental current states of knowledge can tend to be so condensed as to appear superficial. Where this did papers which examine the inter-relationships between stress and the endorphins. There are occur, there were at least excellent references noted for the serious reader. important implications for the hypothesised Overall this book is an important addition to a mechanisms of hypnotic analgesia in so far as growing literature and can be recommended stress appears to play a significant part in the highly, especially at the reasonable price. action of the endorphins and hypnosis very little. Presumably there will be further conferences and The section on assessment contains a some space will be given to headaches which must discussion of a variety of stimuli that can be used in compete with low back pain for popularity. pain research. The methodologies used for M.M. Wood assessing pain responses included signal detection School of Social Sciences analysis, magnitude estimation and a projective The Flinders University of South Australia test. The latter requires the respondent to rate a series of visually-presented scenes containing noxious stimulation to an arm. The reviewer hopes that potential respondents had the option of not R. Farmer and S. Hirsch (4s.): The Suicide being exposed to the more gruesome stimuli! An Syndrome. (Croom Helm London, 1980) excellent review of the experimental methods is included with a useful discussion of experimental The Suicide Syndrome. Could this be the versus clinical pain. The point is made that next best seller in the genre of Alistair McLean or experimental pain lacks the implications for the Frederick Forsyth? No doubt the editors are person that clinical pain has. The use of aluopens as relying on the title to boost sales, as a bland title, noxious stimuli is presented. A study of such as “The proceedings of a conference on intradermal or intramuscular pain by these agents selected aspects of suicide and attempted suicide indicated that whilst the site of the administration held at Charing Cross Hospital Medical School in was reflected in the pain profile, concentration of October 1978” would attract less attention. Such a chemical played a significant role. A series of title would, in fact, be more accurate for this papers, both experimental and clinical, used a collection of papers does not present a cohesive visual scale to indicate severity of pain. The view of suicidal behaviour (indeed, that may not be authors found no evidence to support the common possible!). Rather, it presents, in five parts, belief that pain tolerance was related to personality contemporary issues of concern in the field of or response style. suicidal behaviour: Suicidal behaviour in different Social and clinical factors also received groups; The role of events in suicidal behaviour; attention. Thus pain reporting can be seen both as Diagnosis and prediction of outcome; Assessment a feature of a maladaptive behaviour (illness - who should do it?; and The management of behaviour) and as a consequence of compensable survivors. injury. It could be argued that these may not be The increase in suicide rate of women and the dissimilar. Both could be seen as disorders of young is an interesting contemporary communication. phenomenon and Sainsbury and his colleagues Several papers deal with low back pain, one of have produced challenging data on the role of the the most prevalent problems in modern industrial changing status of women, increasing anomie, and society; the reader can obtain useful information socioeconomic factors, and their relation to the from the hypothesised neural mechanisms to varying suicide rate. The papers of most pertinence current methods of treatment. The latter are to the practising health professional will extensive, ranging from surgery to acupuncture. undoubtedly be those dealing with the assessment Finally, a group of papers deal with specific and management of persons who have attempted treatments and pain management problems. Such suicide. There is a good cover of recent British diverse sources as labour pain, post herpetic studies which have questioned the traditional neuralgia and pain due to pelvic carcinoma are practise of all patients being psychiatrically presented. The methods of control include those assessed. These are valuable contributions, but which are frankly psychological, for example, following their initial publication, caution in the COMMUNITY HEALTH STUDIES VOLUME V, NUMBER 2, 1981 183 interpretation of their data was suggested in There is no ready-made solution to this subsequent correspondence columns, and such a complex problem, and the contributions included balance has not been included in the book. in this book make no bones about it. The Other shortcomings are that this book is traditional approach, cost-benefit analysis, is confined to British and a few Continental studies. criticised heavily and whilst no final solution is Furthermore, no attempt has been made to presented (as there is none), a successful effort is reconcile apparently conflicting views, Thus the made to develop new approaches which overcome alleged “impulsive” nature of suicide attempts is the most serious shortcomings of the cost-benefit noted in the introduction (p. 15), by Farmer (p.36) approach. and Gibbons (p.237). but Ettlinger (p. 171) states Under the cost-benefit approach, the discount “Suicidal acts are mostly not impulsive”. There is rate to calculate the present value of future benefits evidence that people who attempt suicide have has to be chosen subjectively, which allows elevated “life events scores” over a period of time, manipulation. The value of elderly women and particularly in the month before the suicide persons in minority groups are understated attempt, and it is possible that the word because of their expected lower productivity due to “impulsive” may simply be another in the long list the lack of long-term career opportunities. The of pejorative terms so frequently applied to these young are undervalued because of the discount subjects. rate applied to future gains in production. The question must be asked, to whom in this The possibility of assessing the health status of book addressed? It is not priced for the general a community is explored in the first section of the reader. For the specialist, surprised that so many book. If health status could be monitored, then an papers which have already been published in evaluation of the impact of health programs could similar form (and followed by debate in become a reality. Mushkin and Dunlop provide a correspondence columns) could be put together valuable review of the literature on alternative with so little acknowledgement of their original measures of health status with respect to their appearance (a footnote appears to only one paper), public policy usefulness. The predictable this book will not be necessary, even though it conclusion is that the choice of the appropriate would stimulate discussion among those measure depends on the specific resource- concerned with suicidal behaviour. allocation decision. The construction of indicators necessitates Robert Goldney. value judgements. However the question of Department of Psychiatry. valuing health and health benefits is addressed in a University of Adelaide. more direct, open way in the second section of this book. Again, various common approaches are reviewed, with the conclusion that they all have weaknesses, and therefore no accurate dollar value Selma T. Mushkin and David W. Dunlop (ed.): can be placed on a life saved. However, some of the Ht-akh; What Is It Worth? Measures of Health most promising approaches are explored further. Benefits. (Pergamon Press New York, 1979) These are approaches based on the concept of using “consumer willingness to pay” as a measure Health expenditure has increased of perceived health benefits of programs and substantially in many countries over recent services. Whilst this approach could in some ways decades and policy makers have to question how be seen as the medical profession “passing the eflective this expenditure and its allocation has buck” to the average man on the street, it been. Statistics from the United States of America nevertheless appeals because of the underlying suggest that only a slight reduction in death rates democratic principles on which it rests. has been achieved and there is no clear causal The third section of the book deals with relationship between progress in medicine and “Returns to Biomedical Investments”, containing science and the reduction in death rates. Disability a paper addressing the question of prevention or rates have in tact increased cure in the area of cancer research. A topic of This disheartening situation is the starting particular relevance to Australia today. point for Health: What Is It Worth?-The editors Finally, the question of health resource first try to redefine the objectives of modern allocation is addressed. One of the contributors medicine, arguing that “the aim of applied concludes that because of the lack of allocation biomedical research appears to be to treat and methodologies, the political process is the only control those chronic diseases.” Of course it is not feasible way of making difficult resource decisions. easy to measure the effectiveness of health (Note that the contributor is not a politician programs with these objectives. Death rates would himself, which gives his statement some have been easy to establish and monitor but they credibility). The use of health status indicators, are not an adequate measure of the success of consumers’ willingness to pay, and intellectual modem medicine so we have to look for other, development (as an indicator of the health status of more appropriate measurements. VOLUME V, NUMBER 2. 1981 COMMUNITY HEALTH STUDIES children) is explored in contributions dealing with classical epidemiological approach to disease practical applications. investigation. Some are simple descriptions of The reader who looks for a definite answer to measures of incidence and prevalence of disease in the question "Health: What Is It Worth?" will be a particular community, industry or age group. disappointed. However, this is not a criticism of The Australian contributions by Hobbs, Hetzel the book, merely an acknowledgement that there is and McIntosh describe the demography of the no definite answer to this question and may never elderly in Western Australia, student mental health be one. The book provides an excellent overview in Victoria, thyroid disease in Tasmania and on the most common approaches to this complex Papua New Guinea and childhood accidents in area, critically exposing much of the work that has New South Wales. The paper by da Motta from been done in the past, which has possibly led to Portugal, which presents a summary indicator of misleading policy decisions, pursuing the most health status to assist in regional planning, is of promising directions and covering the theoretical particular interest. The indicator makes use of nine framework as well as experiences in the practical components, including maternal mortality rate, application. The book can be highlyrecommended infant mortality rate, one-to-four years mortality as a "state-of-the-art" review. rate, respiratory tuberculosis mortality rate, P.E Steidl, gastroenteritis mortality rate, infectious and Department of Commerce, parasitic disease mortality rate, pneumonia University of A&h&. mortality rate, percentage of deliveries without health assistance and percentage of deaths without medical certificaton. An index of this kind has been found useful in comparing Portugese regions W.W.Holl.nd, 1. Ipscn & J. Ko6trzeuski (ab.): in respect to their need for health service inputs. Measurement of Levels of If& (W.H.O. A paper of perhaps greater applicability to Copenhagen, 1979) Australia's current needs is that by Jones et. al., describing an approach to the assessment of long- In recent years, the International term care. These workers have tried to develop Epidemiological Association has sponsored a methods for quantifying changes in patient status number of symposia and publications aimed at whilst they are receiving institutional care. They clarifying the potential contribution of have used a functional specification to grade epidemiologists to health service planning and disability and report that the approach has been evaluation. This latest symposium yielded 56 both feasible and practicable. There are papers contributions, predominantly from the United describing measurement of physician attendances, Kingdom, and United States of America and myocardial infarction, the natural history of Europe, in three sections entitkd "Purposes and chronic bronchitis, mental retardation, abortion Concepts", "Measures" and "Applications". It surveillance, hospital stay and sickness absence bears all the marks of a book planned by a following inguinal herniorrhaphy, to name but a committee. few. My initial enthusiasm waned as I struggled Undoubtedly, this book has a place on the through the ponderous, repetitivejargon of Parts 1 bookshelves of "Politicians, policy makers, and 2 in which twenty different authors with varied planners, administrators, managers, voluntary perspectives, preconceptions and enthusiasms bodies, pressure groups and consumers in the field attempt in vain to establish a disciplinary of health related measurements, demonstrating organization and a conceptual framework for the what measurements are available and how they are polyglot offerings which follow in later chapters. or could be used". Its value lies in its diversity and That being said, this book has valuefor allwhoare the disparate ideas it brings to the notion of wrestling with the problems of evaluation of measurement and health care. I cannot Australasian health services. The book's usefulness recommend it as enjoyable reading, but as a source results from the very fragmented bits and pieces book for ideas and perspectives on measurement, which the framework unsuccessfully tries to tie Part 3 has much to offer. together. Mowbray's chapter on "Planning, R.M. Douglas, Allocation and Monitoring" has a series of useful Department of Community Medicine. tables, including a series of questions which can be University of Adelaide. used to obtain measures of outcome. There is also a chapter on information contained in a district profile in the United Kingdom and a series of "norms" used in the British National Health Service, together with a discussion of the way these "norms" are weighted. As Holland points out in his introduction to Part 3, many of the applications of health measurement described are examples of. the VOLUME V, NUMBER 2, 1981 COMMUNITY HEALTH STUDIES R.F. Morton and J.R. Hebel: “Thestudy Guide P.M. Tatchell (ed.): Economics und Health - to Epidcmiolo~ and Biostutistics” (University Proceedings of the first Austrdim Conference of Park Press Baltimore 1979) Heulth Economists. (Health Research Project Technical Paper No. 3, Australian National This is an excellent little book. It covers, inan University, Canberra, 1980) interesting and concise manner, the major components of contemporary epidemiology. It has A convention of health economists is likely to chapters dealing with mortality, incidence and generate as much, if not more, jargon as any other prevalence, risk, variability, probability and specialist meeting. Although this report is, in parts. various kinds of retrospective and prospective heavy going it is a useful reference work on an studies, both experimental and nonexperimental important and growing aspect of health policy. A and some elementary biostatistics. set of six papers, mostly by well-known I have had the pleasure of watching Morton contributors to the Australian health economics teach medical students in Baltimore where he is debate, together with associated discussant very well accepted and made the subject comments, make up the content. interesting. This book represents a substantial The first two papers, by Dixon and Palmer development in material which he and Hebel use in respectively, cover the theoretical issues related to their educational program. universality and selectively in economic policy and From an educational point of view it is the interacting and conflicting political and thoroughly reputable. At the beginning of the economic forces which provide the policy setting book and the beginning of each chapter for the funding of health services. Palmer puts the behavioural objectives are identified which give the problem succinctly in the “theory of unbalanced reader a clear idea of what he/she is likely to be political interests” which ensure that “the most able to do at the end of the chapter, having read it effective strategy for containing costs is the least and worked through the various examples which likely to be implemented”. are provided. Webb analyses the sources of hospital costs I have used the book at an international increases in Victoria and the varying mix of clinical epidemiology workshop for non- quantitative and qualitative factors. He concludes epidemiologically trained clinicians, where it was a that increasing admission rates, with the associated most useful resource document. I have not, costs of a higher turnover, are more important however, worked through all the examples and am factors than the actual cost per patient day. not aware, therefore, of minor or major errors in Scotton reviews the available data on medical the problems or their solutions although none were manpower for Australia and appears to concur brought to my attention by my workshop with the view that “Australia has reached a colleagues. situation of surplus medical manpower both in In essence, it is a simple, clear introduction to economic terms and relative to the level required to epidemiology and biostatistics which could find a provide an “appropiate or ‘acceptable’ standard place in many medical curricula, either those which of medical care”. Policy options for controlling the seek to develop these skills independently through undesirable cost and other consequences appear to didactic teaching or in an integrated mode through offer little prospect of success. problem-solving. The book has sufficient A long paper by Richardson comprehensively versatility to be used in either context and it has my analyses Medibank data for the demand/supply enthusiastic endorsement. relationship for doctor services in Australia. Stephen Leeder, Regrettably, it appears to present few definite Department of Community Medicine, conclusions, at least to a non-specialist reviewer. University of Newcastle The final paper by Culyer discusses health care models of externality, a concept which remains undefined and unclear. Culyer’s perspective seemed to promote rigorous criticism from discussant Wallace. Carol D. Harvey and Howard M. Bahrr The In summary, therefore, this is a useful report Sunshine Widows. (Lexington Books Mass., 1980) on an important issue but likely to be a struggle for The study of adaptation to sudden those without a knowledge of the language of bereavement by women widowed in a mining economics. accident might seem marginal to community Laurence Malcolm health interests but useful analogies could be Health Planning & Research Unit, drawn from this book by people studying stress- Christchurch, N. 2. related illness or the problems of ageing. The chapters on morale, loneliness and adjustment in social networks would all repay reflection by health researchers. N. H. VOLUME V, NUMBER 2, 1981 COMMUNITY HEALTH STUDIES
Australian and New Zealand Journal of Public Health – Wiley
Published: Jun 1, 1981
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