BOOK REVIEWS

Toxic Exposures: Contested Illnesses and debated. In particular, activists call for re-
the Environmental Health Movement. Phil search into environmental factors; but such
Brown. New York: Columbia University explorations threaten to undermine power-
Press, 2007, ix + 337 pp. ful political and economic interests. Unsur-
prisingly, each illness has spawned an orga-
Melissa Checker nized, well-connected grassroots movement.
Queen’s College–City University of New For Brown, these environmental health
York movements are in a unique position to trans-
form the field of epidemiology, as well as
In 1998 and 2000, respectively, two films, environmental policy. Not only do these
Erin Brockovitch and A Civil Action, be- movements use community-based research
came box-office hits for their gripping por- to connect environmental causes to partic-
trayals of everyday, working-class commu- ular illnesses, but they also strive to es-
nity members’ attempts to trace recurring tablish political and scientific alliances and
local illnesses to nearby factories. Based to raise public awareness. In so doing,
on real events, the films depict commu- they encourage civic challenges to scientific
nity members’ battles against factory at- authority.
torneys; as the former painstakingly edu- Brown bases his arguments on what he
cate themselves about toxins, gather and describes as “multi-sited ethnography.” In
map epidemiological data, and build their other words, he interviewed a total of
cases, the latter go to great lengths to deny 96 activists, researchers, and government
wrongdoing. officials, examined policy-related govern-
For three decades, environmental sociol- ment documents and organizational mate-
ogist Phil Brown has pioneered the study of rials from each organization, and he con-
such efforts. In fact, in the 1980s Brown re- ducted participant observation with various
searched and participated in the Woburn, organizations in a total of 42 locations (p.
MA, case on which A Civil Action is 40). Notably, Brown collaborated with ac-
based. That research formed the basis of tivists in each of the movements, to varying
Brown’s 1990 No Safe Place: Toxic Waste, degrees.
Leukemia, and Community Action (coau- These collaborations gave Brown close
thored with Edwin Mikkelson). No Safe access to movement participants. As a re-
Place quickly became a landmark book sult, he offers details on how activists, them-
for its detailed exploration of popular epi- selves, conceptualize their movements. For
demiology or grassroots efforts to chal- example, Brown focuses on how environ-
lenge dominant epidemiological paradigms mental justice groups frame asthma as an
through community-generated research. issue of racial and economic injustice (black
Brown’s latest work broadens his ini- and poor children are up to 20% more
tial investigations by focusing on three likely to have asthma than white children,
diseases—asthma, breast cancer, and Gulf and mortality rates from asthma are much
War–related conditions. Brown terms these higher for blacks than for whites [p. 101]).
conditions “contested illnesses” in the Similarly, breast cancer activists define their
book’s title because their causes are hotly movement in terms of gender equity. Brown

70
 Book Reviews 71

also includes long quotes from activists about, and defenses against, such censure
that provide insights into the emotional shapes their activism.
components of their activism. For, as Brown At the same time, Brown does an excel-
aptly points out, one of the distinguish- lent job of highlighting certain of the cul-
ing (and limiting) features of environmental tural components of health-related activism.
health movements is that frequently either For example, he argues that the ideological
activists themselves or their immediate fam- differences among veterans, breast cancer
ily members are ill. activists and asthma activists explain vari-
Yet, in general, Brown’s prosaic style be- ances in their successes. Whereas breast can-
lies the emotionally charged movements he cer activists hold the women’s movement as
describes. In particular, despite the many a reference point, and asthma activists refer
hours of participant observation he con- to a civil rights movement legacy, military
ducted, he neglects to offer any ethno- training often hamstrings veterans from di-
graphic detail. For example he does not de- rectly challenging authority.
scribe the social and cultural dynamics of Indeed, Brown’s first five chapters, in
organizational gatherings, or the context- which he describes and compares the three
specific life stories of individuals he in- movements, are his strongest; they present
terviewed. As a result, the prose lacks his most insightful findings. Further explor-
the warmth and pathos that its subject ing the reasons for the movements’ achieve-
warrants. ments, for instance, Brown shows that
Although he does not discuss his writ- asthma activists’ success in publicly con-
ing style, it is possible that Brown may necting asthma and the environment rests
have made a conscious choice to write on several factors. First, they have estab-
in a removed, scientific voice to immu- lished strong scientific evidence that par-
nize himself against accusations of subjec- ticulate matter and certain allergens trig-
tivity, or to ensure that activists’ claims ger asthma attacks, and second, they have
were taken seriously. If so, he is using aca- found many academic and medical allies.
demic conventions to challenge dominant Conversely, very little attention is paid
medical paradigms. This potentially para- to breast cancer’s environmental causes be-
doxical strategy of working within one sys- cause activists have not established strong
tem to subvert another is common to many scientific evidence of environmental causa-
social movements, but it is especially per- tion, nor have they found many experts will-
tinent for environmental health movement ing to explore that causation. At the same
activists who must dispute science with sci- time, breast cancer has received ample pub-
ence if they are to gain any credibility for licity because of the disease’s high morbid-
their cause. Here again, Brown misses an ity and mortality rates, which, for the most
opportunity to enrich his ethnography: how part, cut across class and race lines.
do activists themselves explain this conun- Gulf War veterans have had the least suc-
drum, and how do they overcome it? cess in winning public attention because
A second distinguishing feature of con- they have few allies, weak scientific evi-
tested illnesses is that they are often blamed dence, and have not achieved widespread
on the victim. For instance, low-income public awareness of their cause. Moreover,
asthma sufferers are told that their house- and perhaps most significantly, Brown’s
holds are dirty and roach infested; women data powerfully demonstrates the various
with breast cancer (and no family history of ways in which the Department of Defense
it) are told they eat too much fat, or they routinely discredits the claims of Gulf War
bear children at too late an age; and veter- illness activists.
ans with Gulf War–related illnesses are told With instances of asthma, breast can-
that they have post-traumatic stress disor- cer, and Gulf War–related illnesses on the
der. Yet, here again Brown misses an oppor- rise, along with concerns about our environ-
tunity to delve into how activists’ feelings ment, Toxic Exposures is important work
72 Medical Anthropology Quarterly

for undergraduate and graduate students, health. Specifically, the study investigates
as well as for laypeople. It would make a the role of structural factors in precipitat-
particularly good text for courses concern- ing migration and examines the effects of
ing medical anthropology, social move- gendered power dynamics within the family
ments, community organizing, and environ- and minority status in the workplace, across
mental anthropology. gender, class, and ethnic statuses.
In sum, the book provides alternative, One of the most interesting questions this
in-depth, and well-researched perspectives study asks is about the effects of migra-
on widespread and significant contempo- tion history—in particular how the deci-
rary illnesses that threaten to remain public sion to migrate was made and who made
health issues for generations to come. Al- it—on mental health. This question is one
though Brown might be overly optimistic that has not been well studied in anthropol-
about the degree to which environmen- ogy or cross-cultural psychiatry. Attempts
tal health movements are currently alter- to relate the massively disruptive experience
ing dominant scientific paradigms, his work of migration and its complex aftermath of
actually makes that change more likely. transnational experience to mental health is
That is, studying, highlighting, and publi- indeed a worthwhile endeavor, and the lit-
cizing the growth of environmental move- erature on the mental health of nonrefugee
ments, as Brown does so elegantly, can only immigrants in general retains some major
serve to hasten the destiny he proposes for gaps. For instance, many pressing questions
them. remain regarding issues like the apparent
underutilization of mental health services by
Mental Health among Taiwanese Ameri- first- and second-generation Asian and His-
cans: Gender, Immigration, and Transna- panic Americans. In this respect, this study
tional Struggles. Chien-Juh Gu. New York: has the potential to make important con-
LFB Scholarly Publishing, 2006, vii + 305 tributions to the literature. However, while
pp. it succeeds as a solid, empirical examina-
tion of Taiwanese American experience, in-
Rebecca Seligman cluding structural and personal motivations
Northwestern University for migration and sources of stress in fam-
ily and work life, it is less successful in its
This book aims to illuminate the role of treatment of mental health issues. Although
structural factors and immigration expe- the author’s stated intent is to contextual-
rience in the mental health of Taiwanese ize Asian American emotional life, in fact,
Americans. The study on which the book there is very little discussion of, or empiri-
is based attempts to address important gaps cal evidence regarding, mental or emotional
in the literature on Asian American mental distress. A further review of the book’s con-
health through qualitative examination of tent will serve to illustrate.
migration and social relations in the context After introducing her research questions,
of macrolevel structural factors. The au- rationale, and theoretical orientations in
thor takes a “structurative approach” (pp. the first chapter, Chien-Juh Gu devotes the
5, 48, 53–55), attempting to demonstrate next two chapters to review of the liter-
how the mental distress of first- and second- ature and elaboration of her theoretical
generation Taiwanese Americans is pro- approach and conceptual framework. She
duced through the imposition of power on reviews and critiques some of the medical
individuals. The author also sets out to ex- sociology literature on mental health, so-
amine the role of transnational experience, cial psychology studies dealing with family,
and the effects of conflicts and ambiva- gender relations, and employment, immi-
lence inherent in such experience (“emo- gration studies, political economy of health,
tional transnationalism,” pp. 5, 46–47,164– feminist standpoint theory, and theories of
165, 256), on Taiwanese American mental transnationalism. Unfortunately, she fails to
 Book Reviews 73

adequately address and incorporate the lit- conclusion and attributes to demographic
erature on cross-cultural psychiatry. For in- trends resulting in, of all things, a genuine
stance, while nodding to the importance of lack of lower-class Taiwanese Americans
cultural differences in the experience, inter- among whom to do research.
pretation, and labeling of distress, the book Nevertheless, this empirically grounded
fails to satisfactorily characterize Taiwanese book exposes many interesting dynamics
American ethnopsychology. A related prob- surrounding migration, family tensions, and
lem, and one of the major shortcomings of the relationships of Taiwanese men and
the book, is in the approach to the defini- women to their work. The last four chapters
tion and identification of mental health is- are devoted to the description and analysis
sues. The author appropriately argues that of these findings, and although their presen-
use of diagnostic instruments and psychi- tation mainly in the form of simple descrip-
atric nosology within culturally diverse pop- tive statistics tends toward the dry, these
ulations is fraught. She uses the general term are the most revealing and compelling chap-
“mental distress” throughout the book to ters of the book. Gu reports, for instance,
label all forms of emotional and psycholog- that for most middle-class Taiwanese Amer-
ical dysphoria, arguing that by doing so she icans, permanent settlement was not a con-
is better able to take into account people’s scious decision but the de facto result of
subjective experiences and interpretations. studying in the United States and finding
The validity of this approach, however, is a good job after graduation. For the few
undermined by the nagging questions it ex- lower-class Taiwanese in her study, how-
poses, and that the author leaves unad- ever, permanent settlement was a conscious,
dressed, about how we identify distress and effortful choice motivated by the desire to
distinguish what is truly burdensome and provide better educational opportunities to
disruptive. Gu ignores this problem, tak- their children.
ing mental distress among Taiwanese Amer- Other intriguing findings involve differ-
icans as a given and making no attempt to ences between first- and second-generation
differentiate between, for instance, chronic Taiwanese Americans concerning identity
depression and minor frustrations. issues and perceptions of racial discrim-
A further elaboration of Taiwanese ethno- ination. Although struggles over identity
psychology and an exploration of the social were much more prevalent among second-
meanings of emotional distress, along with generation informants, perceptions of racial
the implications of idioms like “worries,” discrimination were largely confined to the
“frustrations,” and “hardships” (pp. 49, first generation. Hence, second-generation
152, 238) would have gone a long way to- Taiwanese Americans struggled to ac-
ward addressing these problems. Similarly, commodate conflicting cultural imperatives
fewer statistics about the relative demo- within their sense of identity, whereas first-
graphics of various Asian groups within the generation informants were prone to make
United States, and more background about attributions about racial discrimination re-
the cultural meaning systems, social struc- lated to their identities as outsiders. For
tures, and political histories of Taiwanese first-generation men in particular, culture
immigrants, would have better contextual- was both a real and imagined barrier to
ized the results of this exploratory study. economic achievement and social integra-
In addition, although the attempt to link tion. As Gu puts it, these individuals are
structural factors to the production of stress “othered” by those around them, but also
and impaired mental health among immi- “other” themselves (p. 247). Data from
grants is an important ambition, it is ham- Gu’s study frequently do the work of sub-
pered in this particular study by the fact that stantiating ideas and hypotheses that are un-
Gu’s sample is overwhelmingly middle class surprising but nevertheless important to see
and relatively privileged, a fact that she ac- empirically supported. For instance, Gu’s
knowledges in the limitations section of her study demonstrates that intergenerational
74 Medical Anthropology Quarterly

clashes over “cultural values” (pp. 197– age stress” (p. 5). She finds that although
204) are a common and significant source the U.S. public is not experiencing more
of stress for both parents and children. stress than in previous generations, there is
Thus, this book is at its best when it sticks greater awareness of stress in the medical
most closely to analysis and interpretation literature—so much so that three out of four
of study results and presentation of details Americans are reported as having chronic
from the often rich ethnographic interviews stress, the management of which is a $15
Gu conducted. As a study of the experi- billion industry.
ence of Taiwanese Americans, their trans- Hanna defines stress and its several
national and intergenerational conflicts, and causes, making the case that stress does lead
family and gender dynamics, this book is to serious illness. Many of the larger cor-
worthwhile reading for scholars from so- porations acknowledge this by paying for
ciology and anthropology, especially those stress-reduction programs for their employ-
with interests in immigration and Asian ees. Stress is something that Hanna says
American studies. For instance, it would be needs to be addressed more in our society. In
well suited to both advanced undergradu- her research she found that coping mecha-
ate and graduate courses in Asian Ameri- nisms for stress include talking with friends,
can studies, the sociology of family, and im- drinking, eating, exercising, joining a reli-
migration studies. It will be less satisfying gious or support group, or becoming vio-
to students of cross-cultural psychiatry for lent. Alternatively, some people have turned
its treatment of Taiwanese American mental to dance as the solution.
health. Hanna states that dance has many unique
characteristics. For one, it entails a mind–
Dancing for Health: Conquering and Pre- body connection, wherein one needs to
venting Stress (Rev. edition). Judith Lynne memorize patterns of steps in addition to
Hanna. Lanham, MD, AltaMira Press, engaging in nonverbal communication or
2006, vii + 264 pp. “the bodily sending and receiving of mes-
sages” (p. 186). There is also a social aspect
Luci Fernandez that promotes self-esteem. Dance has been
Eastern Carolina University used throughout the ages to heal the indi-
vidual as well as the community. Hanna ar-
This work, originally published in 1988, of- gues that dance as opposed to other forms
fers a cross-cultural analysis of dance and of exercise is more effective at reducing
the many objectives that it serves. For the stress because dance is exercise with “dis-
purposes of this book, dance is understood tinct physical dimensions, affective patterns,
as an innovative method for dealing with and non-verbal language communication”
stress. The tragic events of 9/11 and the (p. 14). She states “to dance is to be human”
years that followed led the author, Judith (p. 14), pointing out that as part of our
Lynne Hanna, to revise her original work human history cave paintings and artifacts
for this 2006 publication. She felt that it with images of dance have been document-
was important to offer something to people ing dance since antiquity. Our ancestors
who are looking for ways to find solace. have used dance as a means of celebra-
Dancing for health is a topic that Hanna tion, to pass down cultural heritage, for reli-
is an expert on as she has explored this topic gious purposes, to enforce social bonds, and
for more than 20 years as an anthropologist to release energy and express oneself: even
and as a dancer. This unique perspective al- when dance was repressed it persisted and
lows Hanna not only to observe others but continued.
also to give experiential accounts of dancing Dance is a storytelling form of workout
as a therapeutic modality. As Hanna puts that offers spontaneity, fantasy, and creativ-
it, “dance is a language-like form of hu- ity. It allows the individual to work through
man culture that helps individuals to man- difficulties creatively and processually.
 Book Reviews 75

Movement therapy has been used his- pology such as alternative healing modal-
torically and cross-culturally to alleviate ities or dance and performing arts. It is
symptoms of stress, whether because of suitable for graduate students and under-
abrupt changes, trauma, invasions, wars, graduates along with the general public.
acute diseases, or chronic illnesses. Hanna It is engaging, well written, contemporary,
gives the example of the American Ghost and relevant. It certainly should extend to
Dance, practiced in response to white po- a wider audience than just students to in-
litical and economic domination. This rit- clude anyone who is interested in dance,
ual aims to effect change through hastened health, or education, as well as the arts and
world renewal. Hanna states that dance or humanities.
movement therapy also marks important
milestones in people’s lives such as birth, Skin: A Natural History. Nina G. Jablon-
marriage, and death, citing the Ubakala so- ski. Berkeley: University of California Press,
ciety’s dance plays. These rituals are carried 2006, ix + 266 pp.
out as a form of indoctrination regarding an
individual’s place in society, group support, Bernhard Fink
and self-worth. University of Goettingen, Germany
The book offers a fresh perspective into
finding solutions to the problems associ- The physical appearance of the human body
ated with stress, which can compromise our and its signaling qualities in social en-
overall health and quality of life. Hanna counters has been a topic of investigation
presents dance as a healing art that works for various research disciplines in recent
as a process of renewal for the mind, body, years. Evolutionary psychology, for exam-
and spirit. She argues that our popular cul- ple, puts physical appearance into the con-
ture increasingly glorifies competitive dance text of mate selection and suggests that
in television series like Dancing with the certain morphological characteristics indi-
Stars, and that salsa and cha cha have cate an individual’s “quality” (in terms of
found their way to nearly every corner of health and reproductive success). Hence, it
the earth. She claims, that more and more is thought that humans have evolved to
people have begun to explore the world of view certain features such as left–right sym-
dance and are experiencing its social and metry or certain sexually dimorphic traits
health benefits. She argues that, as many as attractive because they are displayed by
people in the United States express a dislike healthy individuals. One feature that has
for the stresses of a postindustrial society, received comparably little attention in this
some have turned to dance. They experience context is human skin.
dance as a “pristine human-sentient phe- It is true that recently research has em-
nomenon, a basic form of expression and phasized the signaling value of skin condi-
communication, and an ennobling way of tion in human sexual selection because of
thinking, feeling, and moving that is under its dependency on the environmental condi-
the individual’s own control” (p. 78). Prac- tions to which individuals are exposed, and
tically, dance as a form of exercise has be- to age-related changes. However, this line
come a widespread practice as an expres- of argument requires a profound knowl-
sion of community, as a means of exercise, edge of the biological and cultural history
to cope with a negative self-image, or as a of human skin. Alas, much of our knowl-
way to manage stress. Additionally, it has edge about the human integument stems
been shown to boost the immune system to from dermatological or cosmetic sciences.
ward off disease. It engages people from all In this regard, Skin: A Natural History is
walks of life and in all age categories. a timely and important anthropological ac-
This book is appropriate for courses that count of the body’s largest and most visible
address topics in cultural anthropology, organ. The book discusses skin’s visual vari-
medical anthropology, and applied anthro- ation primarily in the context of natural and
76 Medical Anthropology Quarterly

sexual selection, but it does not fail to to be considered in interaction with the en-
make the reader sensitive to its other func- vironment, and examinations of this inter-
tions, as for other social and communication action will probably challenge present and
goals. future generations of researchers. It is quite
The human skin is a bewildering reser- unfortunate that prejudice and stigmatiza-
voir of information about an individual. tion fog human interpretations of skin color,
Skin color and topography cues reflect our but the book teaches us in a comprehen-
emotions and health and can be altered in sive way that color-based prejudices are not
various ways. Although most people prob- in accord with a modern anthropological
ably think of skin color in terms of related perspective.
“racial” issues first, the author does not. She In comparison to the extensive discus-
takes the reader on a carefully substantiated sion of the evolution of human skin col-
evolutionary journey through the develop- oration, the discussion of other important
ment of skin pigmentation and its biologi- functions of the skin is relatively brief, al-
cal variation. According to Jablonski, vari- though still sufficiently detailed to provide a
ation in skin color is adaptive and related to relatively complete picture of how humans
the regulation of ultraviolet (UV) radiation and nonhuman animals communicate with
penetration. Skin color is examined as a bi- and through their skin. Humans like other
ological trait, which has evolved in response primates are sensitive to touch, and, with
to geographical (latitude) and environmen- reference to Ashley Montagu’s book Touch-
tal (radiation) conditions. As such, it is ar- ing, the reader is reminded of the social and
gued that any fitness-related link with the psychological significance of this sensual ex-
evolution of skin color, such as the differ- perience. Given the regulatory functions of
ential production of vitamin D, has been in touch in terms of communicating friend-
response to natural selection because of sun ship and hostility, the author notes that, in
exposure and matters of thermoregulation. many social contexts today, touch is dis-
However, this pattern may not be as sim- couraged although still needed for wellbe-
ple as it appears at first sight, and the book ing and health. The skin is a highly sensual
is quick to make clear that skin phenotypes organ, which mirrors emotions and is also
may have changed several times in human intimately involved in sexual activity.
evolution. The expression of skin pigmen- Thus, the visual appearance of the skin,
tation in response to UV radiation seems its present and permanent state, comprises
to be linked to the movement of groups unique information about an individual.
of early hominids, and dark and light skin Moreover, if we only consider age-related
may have evolved more than once in the changes of skin, including photo damage be-
course of modern human development. Skin cause of cumulative UV exposure and a loss
color, therefore, is a highly adaptive feature, of hygroscopicity and hydration, but also
and, like any highly variable trait, not espe- clinical issues, it can be regarded as an in-
cially useful in classifying people into ge- dividual canvas of human life history. It is
netically distinct groups. Thus, the author’s the overarching aim of the book to make
account on the evolution of skin color puts the reader sensitive to this diversity, and to
racial categorization and the determination convince the reader that at least from an an-
of phylogenetic relationships among human thropological perspective, a lot of the skin’s
groups, just on the basis of skin color, into “secrets” remain to be investigated.
absurdity. In fact, it is admitted that genetic Skin, however, conveys more than just
basis of human skin coloration is still not evolutionary history, physiological condi-
very well understood as most of the genetic tion, or emotional states, as like no other
investigations have until now concentrated organ its appearance can be deliberately al-
on understanding the action of a polymor- tered, through modifications such as tat-
phic gene involved in melanin production toos, piercing, or cosmetics. The book
(MC1R). However, any genetic action has touches such forms of body art and
 Book Reviews 77

alteration at its very end and emphasizes the primer for intellectual foxes. His argument,
significance of a thorough understanding of intended more for epidemiologists and pop-
skin biology for making sense of any mode ulation health specialists than anthropolo-
of skin decoration, rejuvenation, or healing. gists (likely members of the choir to which
Skin: A Natural History will be useful pri- he is preaching, on this point at least), is that
marily for undergraduate students of bio- the exceptions and anomalies to general the-
logical and cultural anthropology, although ories about health and disease are, because
graduate students of related science disci- they point to importance of particular con-
plines may find this book a valuable addi- texts, where the real intellectual work is to
tion to their reading list on racial issues and be done.
identity. It is a comprehensive and informa- With the term context, Kunitz is refer-
tive account on human skin with most of its ring to two things. The first has to do with
focus on aspects of natural and sexual se- the importance of understanding the histor-
lection of the evolution of skin coloration. ical, social, and cultural processes by and
However, it does acknowledge the various through which groups of people come to
other functions of skin and may thus be- both produce and experience distinct epi-
come a valuable reference not only for stu- demiologic regimes. Understanding the pat-
dents and researchers in anthropology, but terns of population health in the U.S. South,
also for dermatologists, cultural scientists, for example, a region to which Kunitz di-
and cosmetic scientists. We can look for- rects frequent attention, depends on not
ward to upcoming research or future ac- only appreciating the epidemiological sig-
counts on skin that will likely be inspired nificance of a political economy character-
by this text. ized by rural agrarian development and a
long history of slavery, but also on anal-
The Health of Populations: General Theo- ysis of the cultural traditions brought by
ries and Particular Realities. Stephen J. Ku- those who settled this region. The second
nitz. New York: Oxford University Press, aspect of context that Kunitz is concerned
2007, viii + 286 pp. with is the important contribution made
by the political regime, especially the in-
Craig Janes vestments by government in public health,
Simon Fraser University health care, and supportive social services
more generally.
Kunitz observes in the preface to this fine Kunitz’s argument is as much conceptual
and critical work that scholars of the so- and historical as it is methodological. Partly
cial determinants of health tend to sort as a way to explain the genealogies of those
themselves into two camps. Invoking Isa- master narratives that intellectual hedge-
iah Berlin’s essay on intellectual and artistic hogs have come to depend on, for example
personalities (1953), Kunitz finds that these that levels of income inequality are invari-
scholars can be characterized as “hedge- ably linked to mortality rates, he provides
hogs,” who stubbornly hold on to overar- an insightful analysis of the history of mod-
ching generalizations about health and so- ern public health. This useful history ex-
ciety regardless of evidence to the contrary, pands on earlier works that have focused on
or as “foxes,” who note, and indeed em- the social and political origins, and implica-
brace, the many exceptions to such over- tions, of different theories of disease cau-
arching generalizations. These latter schol- sation, leading the reader to consider the
ars take as a starting point the assumption implications of another revolution: the in-
that it is impossible to link everywhere and dustrial revolution in England (and the
under all conditions things such as social origins of industrial capitalism more gen-
capital, stress, income inequality, or global- erally), which provoked debates over the
ization to population health. Kunitz would health-related costs and benefits of eco-
agree. Indeed, this book may be seen as a nomic growth.
78 Medical Anthropology Quarterly

On the optimistic side of this debate, Although the argument that context mat-
scholars argue that rising standards of living ters will not be particularly illuminating to
have yielded benefits to public health that most medical anthropologists, the manner
far outweigh the costs. On the pessimistic and logic of the argument as set forth in this
side are those who argue that industrial text is instructive. The book is character-
development and globalization have dis- ized by careful causal analysis, showcasing
rupted traditional social ties, leading to a how the logic of epidemiology, when care-
breakdown of communities and a dissi- fully and critically applied, can yield surpris-
pation of social cohesion, and ill-health. ing results. Kunitz’ careful analysis and cri-
Kunitz doesn’t come down cleanly on ei- tique of the famous Roseto, Pennsylvania,
ther side of this debate but demonstrates study of social cohesion and cardiovascu-
that in the absence of considering so- lar health among Italian immigrants (Bruhn
cial, political, and historical context, both and Wolf 1979), much celebrated by those
sides of the argument are flawed. Indus- who link social factors to health, is exem-
trial capitalism is not everywhere the same, plary in this regard. In this sense the book
nor are the political regimes that may, or is a nice primer of epidemiologic thought,
may not, blunt the negative consequences particularly as this thought has been de-
of laissez-faire industrial growth and ployed in the study of the social determi-
development. nants of health. There is even the occasional
Kunitz argues, for example, that in the excursus into finer points of method, some
U.S. South, where political institutions were central to basic epidemiology, for example
dominated by and for the benefit of a white the important distinction to be drawn be-
elite, poor whites and African Americans tween relative and population attributable
“were set against one another . . . [result- risk, and some more arcane and esoteric, for
ing in] low levels of support for education example spatial autocorrelation and bias in
and health care . . . high levels of income in- ecological study designs.
equality . . . high levels of distrust . . . and Although the book is written in a clear
worse mortality rates than in other regions” and accessible way, it will be most use-
(p. 134). Lack of political investment in ser- ful for those who have had some expo-
vices, combined with social and economic sure to the fundamental concepts and meth-
inequity, contributed to high rates of mor- ods of epidemiology. There is much here
tality. Pushing this line of argument a bit fur- that is useful to graduate students, teach-
ther, Kunitz argues, with persuasive logic, ers, and researchers who are interested in
that the association between social capital critiques of the more common assumptions
and mortality is “the result of a common regarding the links between social factors
cause, the failure of local and state govern- and processes and patterns of population
ments to deal equitably with all their cit- health. Those interested in the intellectual
izens and to provide the services that are history of social epidemiology and public
the raison d’être of governments at this level health will find the book especially infor-
(p. 134).” mative. Although the conclusions drawn in
Extending this argument to other settings, the book will not be particularly startling
Kunitz rejects the findings of population to medical anthropologists, who by virtue
health scholars who argue for the primacy of their training and experience are likely
of public health over organized medical care to be more attuned to the health conse-
in determining population health outcomes. quences of local social, cultural, and histor-
Instead, he makes a compelling case for the ical processes, many will find the framing of
importance of investment in clinical health these arguments, intended as they are for a
care systems to increase life expectancy and broader public health audience, to be use-
reduce mortality. Here his careful compar- ful. To those working in public health and
isons between the United States and Canada who must occasionally tangle with intellec-
are particularly instructive. tual hedgehogs, this book is invaluable.
 Book Reviews 79

References Cited It may help to think of the

experience of displacement and its
Berlin, Isaiah negative memories as being like a
1953 The Hedgehog and the Fox. New splinter of iron which has been
York: Simon and Schuster. trapped inside the now-healed flesh
Bruhn, John G., and Stewart Wolf and causes no difficulty until
1979 The Roseto Story: An Anatomy of inadvertently pressed, when there
Health. Norman: University of Okla- will [be] sharp reactive pain. It
homa Press. would seem to be the case that as
time goes by, more and more
Iron in the Soul: Displacement, Liveli- refugees spend more and more time
hood and Health in Cyprus. Peter Loizos. with their refugee identity “switched
New York: Berghahn Books 2008, xxiv + off.” If something happens to
210 pp. “switch it on” then the sense of
grievance returns to the surface in
Lisa Modenos full strength—the iron is still in both
University of Massachusetts, Amherst the heart and soul. [p. 186]

Peter Loizos’s latest book strives to If Loizos had written this book imme-
“build bridges with economic history and diately after his community had been dis-
medicine” (p. 1) with anthropological per- placed, he most likely would have come
spectives on the relationships between the up with a different metaphor. However,
experiences of and meanings behind dis- the book looks back over four decades
placement, physical health, and emotional and in particular explores the health and
health. Well known for various contribu- well-being of some of the villagers at least
tions to anthropology including scholarship 30 years after displacement. The author is
on ethnographic and qualitative methods, intrigued with how they dealt with and ex-
and visual anthropological scholarship that perienced displacement and “in many ways
has explored ethnographic film and photog- transcended it” (p. 3). And it is in the tran-
raphy, Peter Loizos is also known for his scendence that Loizos finds the most com-
work in Cyprus. Beginning with his PhD pelling questions about refugees, displace-
research in the 1960s in the village of Ar- ment, experience, and health (both physical
gaki, Cyprus, Loizos has continuously re- and emotional).
turned to his research community as a pro- Loizos does not look to his research
fessional anthropologist, as a friend, and as community as a microcosm that reflects
kin; including returning after 1974 when all refugee experiences. Instead, his com-
his community was scattered throughout munity is seen as a specific case study
the south of Cyprus as a result of the con- on displacement that illuminates the var-
flicts on the island that forced them to flee ious and complex ways that refugees can
their village. Those same villagers remain and have experienced displacement. He
refugees today, and this book takes Loizos’s interweaves analyses of economics, his-
40 years of experiences and insights and tory, politics, social relationships, famil-
explores how his research community has ial communities, medicine, psychology, and
coped with and experienced displacement: even religion into the fray of how and
physically, mentally, emotionally, and why some refugees transcend their displace-
socially. ment physically and emotionally, whereas
The title of the book, Iron in the others are destroyed by it. The particu-
Soul, comes from a metaphor Loizos uses lar case of the Argaki refugees that Loizos
in regard to displacement, specifically for describes offers interesting critiques of the
those refugees who have been displaced for many medical, political, and social scientific
decades. assumptions about displacement that often
80 Medical Anthropology Quarterly

essentialize refugee experience and disre- group of people from an anthropological

gard the particulars of context, meaning, perspective.
and experience. And it does so by combin- Beyond the academy, the book also offers
ing theoretical, empirical, and ethnographic important insights into refugee experiences
data. that policy makers and medical profession-
The book is written in accessible language als rarely have access to. As Loizos right-
and would be a great addition to an intro- fully asserts, “[t]here will alas, be no short-
ductory medical anthropology course. Its age of refugees and failing states” (p. 115)
emphasis on ethnography and the insight in the future, and the insights gained from
that can be gained through long-term ethno- an anthropological investigation could help
graphic research also makes the book an im- future policies and treatment.
portant addition to any level ethnography In all, the book offers more questions
course. than answers. The questions according to
The book is broken down into chapters Loizos are offered with the purpose of
that Loizos explains are both chronologi- helping us to reconceptualize our under-
cal and thematic. Each chapter also includes standings of displacement and of the po-
ethnographic vignettes, interviews, and rich tential role an anthropological perspective
descriptive accounts of the various stages, may have on future research, as well as
experiences of, and complex meanings as- policy geared toward refugees. For the
sociated with displacement by the Argaki Argaki refugees in particular, a complex
villagers. Although some readers might have combination of support has helped them
expected or wanted more quantitative data transcend their life-altering experience of
and analyses (only one chapter is truly ded- displacement. Being internally displaced
icated to quantitative analysis), I appreci- peoples (which is their official international
ated the qualitative and ethnographic na- status, although within public and private
ture of each chapter. One of the final chap- discourses in Cyprus they are “refugees”),
ters, “In Their Own Words,” consists of and having state-sponsored support (hous-
an assortment of commentaries written by ing, free health care, economic support),
Greek Cypriots themselves: some are po- communal support (linguistic, religious, and
ems, some are published works, and oth- social), and family cohesion despite the
ers are diary excerpts. Loizos explains the dissipation of a physical village, have all
rationale for such a chapter stating that worked in tandem to help the Argaki
“the reader can have . . . a more direct, less refugees overcome their displacement in nu-
mediated contact with some of the people merous ways. Through ethnographic under-
this book is about” (p. 171). Yet, Loizos’s standing, life histories, and anthropological
longevity and relationship with the villagers, inquiries, these complex relationships be-
his sensitivity, and understanding of their come clear. In the end a more collaborative
lives and experiences somehow makes the inquiry into refugee health and well-being
reader feel that the book might not be much between anthropology and the life sciences
different if written by the villagers them- is encouraged by Loizos and is encouraging.
selves. And for anthropologists interested
in teaching ethnography to their students,
particularly the shifting practices of ethnog- References Cited
raphers who are dedicated to long-term re-
search and returning to their research sites, Loizos, Peter
this book along with Loizos’s two other 1975 The Greek Gift: Politics in a
major publications on the Argaki villagers Cypriot Village. Oxford: Blackwell.
(1975, 1981) would be a powerful trinity 1981 The Heart Grown Bitter: A Chron-
of anthropological work, offering in-depth icle of Cypriot War Refugees. Cam-
and longitudinal knowledge about a specific bridge: Cambridge University Press.
 Book Reviews 81

Deaf in Japan: Signing and the Politics of abled an unusual form of personal and mass
Identity. Karen Nakamura. Ithaca: Cornell organizational identity politics to emerge”
University Press, 2006, xx + 226 pp. (p. 2).
The unusualness of the Japanese situation
Jan-Kåre Breivik is a continual theme throughout the book, in
University of Bergen, Norway particular as related to the Japanese minor-
ity politics—or rather lack of such. To be a
Deaf in Japan is a well-written and solid Japanese person has been and still is strongly
contribution to the anthropological litera- connected to the ability to use the verbal
ture on deafness, disability, minority issues, Japanese language (p. 183). The space for
and language. It is especially an important minority politics is thereby quite limited,
book within medical anthropology because and within this space JFD has therefore
it introduces new and nuanced perspec- stressed that Japanese Sign Language is a
tives on a group that is mainly approached version of the majority language rather than
through a medical gaze and a phonocen- a separate language in its own right. This
tric rehabilitation lens. Within Deaf Studies, is of course a highly contested standpoint.
where deaf people as sign language users are In contrast to the U.S. (and other Western
basically understood as linguistic and cul- countries’) situation, the national deaf fed-
tural minority groups, the contrast to medi- eration (here JFD) has chosen (or maybe
cal models or disability frameworks already has been forced to choose?) an integrationist
is prominent. Within this subdiscipline, deaf strategy.
refers to the medical–audiological condition To substantiate this, Nakamura places
and Deaf to the cultural minority position of Japanese d/Deaf people within the wider
sign language users. Nakamura, who does contexts of Japanese history, politics, and
not subscribe to this political correctness, culture through comparisons with some of
still provides an interesting contribution to the other Japanese minorities and social
this subfield. First of all, she highlights a dif- movements. She gives several accounts of
ferent national context for d/Deaf identity “how the deaf community has been able to
politics and thus contributes to a more nu- achieve important political gains and posi-
anced picture than the universalistic “global tive social acceptance when other minorities
Deafhood” literature. Even though d/Deaf have not” (p. xviii). This is, however, just a
people around the globe share some com- part of the picture, and if this had been her
mon concerns and challenges, they differ in final conclusion, I would have objected to it
relation to context (national policies, ma- for being too biased and for not taking into
jority culture, gender, age, etc.). In grap- account the negative and problematic out-
pling with this, Nakamura demonstrates comes of such a strategy. Nakamura con-
both sensitive ethnographic skills, with solid tinues, however, writing that the assimila-
contextual awareness, and theoretical bril- tion strategy certainly has some drawbacks.
liance, which makes this book a must read And one of her guiding questions through-
for any anthropologist or social scientist. out the book is: what do signing people do
Nakamura’s 14 months of fieldwork in- in a postwar Japanese society where being
cludes work within the Japanese Federa- a linguistic minority historically has been
tion of the Deaf (JFD), where she had ac- more difficult than being a disabled mem-
cess to archives and discussions with and ber of the majority community?
among JFD leaders and staff. Most impor- The answer is far from clear cut. As there
tant, though, Nakamura includes interviews are “many ways to be deaf” (p. 192), signing
with d/Deaf women from three different people do different things with their present
generations. These contextually sensitive re- concerns and challenges. Here the conflict
ports give empirical strength to her thesis perspective enters the scene, and it is ba-
that “the social and institutional history sically presented as a generational conflict,
of postwar deaf communities in Japan en- which for the younger generation draws
82 Medical Anthropology Quarterly

on the U.S.-style transnational influence on ily) of the lives of d/Deaf people in Japan,
deaf empowerment. Much of Nakamura’s there are, however, still some more parts
work is therefore devoted to exploration of of the picture missing. In my Norwegian
the political differences between the older work, I found that d/Deaf identity for-
Japanese Federation of the Deaf and more mation cannot do without a transnational
recent groups, like DeafPro, that promote a and a translocal reference, beyond territo-
more ethnic separatist agenda. rial fixedness and national sentiments. We
Not only do d/Deaf groups have to strug- simply cannot take for granted how iden-
gle against the wider hearing society and tities are constructed. It must be explored
institutions. They also struggle against one through different ethnographical practices,
another about the nature of deafness, deaf and through a thorough questioning of
identity, and sign language. With Naka- taken-for-granted aspects of how social life
mura’s sensitive use of historical cases and and cultural traditions are created, sus-
snapshot views from her fieldwork and in- tained, and renewed.
depth interviews, we can better understand This should hold for the situation in
how these identity-related questions work in Japan as well, but in Nakamura’s Deaf in
the everyday lives of deaf people. Through Japan the transnational scope only partly
her description Nakamura manages to con- exists. Nakamura shows how some dis-
textualize her discussions and she grasps courses go beyond national borders and in-
most of the important complexity of the fluence being d/Deaf in Japan. But in addi-
subject matter. She insists on trying to un- tion, d/Deaf Japanese people do travel and
derstand and render her informants as they attend transnational events (such as Deaf-
“are” and not as subjects that can be framed lympics and World Congresses). Even
and put into static models. though I understand and accept Naka-
This is not, however, an easy and safe mura’s main focus on and conclusions re-
task. Nakamura discusses quite nicely issues lated to the particularities of being d/Deaf
of ethnographic representation and its con- within a Japanese context, I still won-
sequences, especially in fields of contesta- der: How and to what extent are Japanese
tion such as this one certainly is. She also d/Deaf lives influenced by translocal and
anticipates possible critiques of her work transnational practices?
from more outspoken defenders of ethnic My critique of Nakamura’s work is how-
Deafhood and “pure” sign language. Born ever mainly positive. This book is a valuable
in Japan, raised in the United States, Naka- inspiration for cross-cultural studies of deaf-
mura is well acquainted with the tension be- ness, language policies, social movements,
tween the different notions of d/Deafness, minorities, and identity politics. It should
and she frequently contrasts the Japanese be useful in teaching at different levels and
context with the U.S. and other western na- fields such as Deaf Studies, Asian Studies,
tional contexts. She does not, however, take and both general and medical anthropol-
a strong stance in favor of one notion of ogy courses. It is an inspiring read and a
d/Deafness at the expense of the other— trigger for thought and discussion. It leaves
even though she is a little more positive to- this reader with new understanding, but also
ward the JFD policy than the DeafPro posi- with a few new questions. That’s a mark of
tion. This may relate to her internship with good work and excellent writing.
JFD, her preconceptions, or maybe the lim-
ited variation of experiences exposed in the The Cambridge Handbook of Sociocultural
life story accounts she presents. Out of the Psychology. J. Valsiner and A. Rosa, eds.
five life stories, none of them come from New York: Cambridge University Press,
men or from families where sign language 2007, xvii + 929 pp.
was the common language.
In Nakamura’s solid contextualization Rebecca J. Lester
(historically, nationally, and contemporar- Washington University in St. Louis
 Book Reviews 83

The Cambridge Handbook of Sociocultural within these contexts. Part V—From Society
Psychology is a remarkable compilation of to the Person through Culture—develops
state-of-the-art writings on culture and psy- the theme of how sociocultural activities
chology from an international contingent of “are the cradle for the constitution of the
scholars. Its editors, Jaan Valsiner of Clark person” (p. 15). Part VI—From Social Cul-
University and Alberto Rosa of the Univer- ture to Personal Culture—engages social
sidad Autónoma de Madrid, offer this vol- theories of dialogics and reciprocity in the
ume as a sort of formal “coming out” of cultural development of persons. And, fi-
a field of inquiry that self-consciously in- nally, Part VII—Making Sense of the Past
tegrates theoretical and methodological ap- for the Future—takes up the theme of mem-
proaches from anthropology, psychology, ory (collective and personal) and the ways
sociology, history and the humanities, and in which memory is entangled with cultural
social sciences more generally. The editors semiotics. All sections have something to say
locate the newness of the field of “socio- to the medical anthropologist reader regard-
cultural psychology” (vs., e.g., psychologi- ing social and cultural elaborations of bio-
cal anthropology or cultural psychology) in logical processes and lived bodily engage-
the degree to which its scholars integrate ments with social and cultural worlds.
cutting-edge developments in human biol- This volume is an excellent resource for
ogy and physiology with attention to so- scholars looking for a solid and multilayered
cial and cultural influences. In this sense, orientation to emerging research on topics
sociocultural psychology adopts a largely related the human psychological function-
ecological view of such issues as memory, ing and well-being (or not) in social context.
cognition, self-perception, interpersonal dy- It is also a rich source of readings for ad-
namics, and cultural forms—all of which are vanced undergraduate or graduate courses
crucial to human well-being. in medical anthropology, particularly those
This hefty volume provides a compre- dealing with the anthropology of suffering,
hensive overview of current work in so- altered states of consciousness, psychiatric
ciocultural psychology and does so in a distress, or biocultural approaches to heal-
thoughtful and accessible manner. The col- ing. A great strength of the book is that it
lection comprises 34 essays organized into is “profoundly international, with a slightly
seven sections, preceded by a clear and Mediterranean accent” (p. 2), bringing a
concise introduction. Part I—Psyche, Soci- much-needed internationalist correction to
ety, and Culture—explores interdisciplinary U.S. psychological anthropology and cul-
forays into questions of psychology and tural psychology.
culture and considers the methodological At the same time, I would have liked to
and theoretical concerns that have informed have seen the editors more explicitly engage
these engagements. Part II—From Nature prevailing U.S. trends of scholarship in the
to Culture—examines biological bases of introduction to make the case more clearly
human behavior and the ways in which for what is new about “sociocultural psy-
sociocultural theories can inform models chology.” After reading the Handbook, I
of human biological history. Part III— was not persuaded that this is a new intel-
From Orientation to Meaning—considers lectual endeavor at all. It seems to me that
the constitution of meaning via percep- the interdisciplinary investigation of culture
tual processes and the elaboration of these and psychology across multiple layers of
processes within sociocultural worlds. Part analysis, drawing on emerging biomedical
IV—Symbolic Resources for the Constitu- knowledge, is, and has been, part and parcel
tion of Experience—builds on the essays of both psychological anthropology and cul-
in Part III to attend to institutional pro- tural psychology for decades. Although the
ductions of meanings and the ways in Handbook stands as a substantial contribu-
which these meanings are variously incorpo- tion to these fields (and, indeed, its scholar-
rated, contested, or rejected by individuals ship is of the highest caliber) as a collection,
84 Medical Anthropology Quarterly

it does not seem to break fundamentally new lectual ambition and rigorous scholarship,
disciplinary or conceptual ground. The Cambridge Handbook of Sociocultural
I did, however, find this book provoca- Psychology can serve as both a model and
tive in a different way. I have been immersed an interlocutor for such an enterprise.
in the fields of psychological anthropology
and cultural psychology for over 15 years Reference Cited
and have read voraciously in these and re-
lated fields. Yet many of the authors in this Schwartz, Theodore, Geoffrey M. White,
volume were unfamiliar to me. This left and Catherine A. Lutz, eds.
me wondering about the disconnections be- 1992 New Directions in Psychologi-
tween U.S. anthropologists and our Euro- cal Anthropology. New York: Cam-
pean, Asian, African, and Latin American bridge University Press.
colleagues. I know from being involved in
the Society for Psychological Anthropology Wayward Women: Sexuality and Agency
and the Society for the Anthropology of Re- in a New Guinea Society. Holly Wardlow.
ligion that in recent years there have been Berkeley: University of California Press,
concerted efforts to build better connections 2006, xi + 284 pp.
between U.S. and non-U.S. professional or-
ganizations and to encourage international Mary Bicker
scholars to present their work at our con- San Diego State University
ferences. The same is true of the Society for
Medical Anthropology (SMA). This Hand- Holly Wardlow addresses gender and
book is a concrete example of why such agency among Huli women of the Southern
reaching out is so essential to the continued Highland Province of Papua New Guinea
health of our discipline. with engaging clarity. For the past 50-plus
It also drives home the need for psycho- years, both for better and worse, ethnogra-
logical anthropology in the United States phers have been enthralled with the societies
to get in gear. Some of the very best of Papua New Guinea. Many have focused
work in contemporary anthropology comes research on substance theories, women’s
from psychological anthropologists, many pollution, and proscriptions on sexual in-
of whom are SMA members. Broader dis- teraction because of men’s fear of substance
ciplinary interests in such things as subjec- pollution. Wardlow addresses changes that
tivity, gender, religious belief, postcolonial are occurring within the Huli social struc-
dynamics, politics, ethnicity, human rights, ture because of modernization and global-
and institutional cultures (to name just a ization. She does so to explain how and why
few) often draw on the theories and methods some Huli women can and do reject previ-
of psychological anthropology, even when ously accepted forms of Huli sexuality and
they explicitly deny doing so. Yet it has gender relations.
been 16 years since we have collectively pro- Working within a practice theory frame-
duced anything approaching a “state of the work, Wardlow draws on 50 Huli women’s
field” volume (Schwartz et al. 1992). Al- life stories (including 18 from self-identified
though one might speculate about the intel- pasinja meri), local hospital and court
lectual, disciplinary, and institutional rea- records, and participant observation to
sons for this silence, the fact remains that paint a portrait of Huli women as strug-
it is a real problem in our field in terms of gling to make sense of the changes oc-
internal cohesion and productive dialogue curring within the structure of bridewealth
with other scholars in anthropology and be- as a result of modernization. In craft-
yond. We clearly have the creativity, energy, ing her exposition, Wardlow focuses on
and talent in our subdiscipline to contribute pasinja meri—literally, passenger women.
meaningfully to the field as a whole. It is Passenger women are women who leave
long past time we do so. In both its intel- their husbands or family and engage in
 Book Reviews 85

extramarital sex. Although it is not neces- a woman’s productive capacities from a

sary and may not occur initially, the ex- relationship.
change of money for sex often follows entry Within the system of male dominance ex-
into the pasinja meri role. Although such ex- ists what Wardlow sees as a gendered social
changes suggest that pasinja meri are pros- contract. Women’s reproductive capacities
titutes, Wardlow argues that categorization and personhood are bound to men. Men
as prostitute does not fully explain the life are, in turn, responsible for teaching women
choices of passenger women. To explicate proper conduct and, in the event of breach
this differentiation, Wardlow first addresses of conduct on the women, of upholding the
the concepts of social reproduction, person- women’s reputation. For example, in the
hood, agency, and bridewealth that encap- case of rape, a man is responsible to demand
sulate the topics of gender and sexuality in compensation for theft of the woman’s sex-
Melanesia. She then brings these issues to- ual capacity from the rapist. Although her
gether to show how they are changing in supporting arguments are persuasive, it is
the face of modernity and becoming the reasonable to question whether the Huli
cultural backdrop for a new expression of themselves see patterns of gender interac-
agency among women as well as the increas- tion in such a structured and defined way
ing epidemic of HIV/AIDS and other sexu- and make decisions based on an explicit un-
ally transmitted diseases. derstanding of such a social contract.
Personhood among the Huli, as among Notwithstanding, guiding reputation-
most Melanesians, is constructed through related transactions of compensation and
the relationships that encompass said per- payment is the system of bridewealth. In-
son. Lacking an exaggerated conception deed, this system may be the touchstone
of individual ownership, the Huli cast a for all of Huli culture; it certainly is for
woman’s reproductive capacities as belong- gender-related ideas and activities. Ward-
ing socially and physically to the fam- low states that “bridewealth is what makes
ily or clan as a whole. Wali ore, real or women wali ore . . . [and] the bridewealth
good women, should be “under the legs system, for all its current permutations and
of men,” their personhood and relation- ambiguities, is central to the construction
ships included. Wardlow points out that of female identity and the reproduction of
women’s agency is bound to their bodily society” (p. 133). Bridewealth is about rela-
capacities and is “fenced in” or “encom- tionships and connectivity; it facilitates al-
passed” by spheres of men’s agency. Women liances between clans and thus supports the
who transgress spatiomoral boundaries are essential flow of substance, and so of per-
literally said to be “jumping the fence.” sonhood. Women view their decisions and
Yet, Huli women have found means to un- very identity in terms of their bridewealth.
dercut male dominance in expressing what With this understanding of Huli corpo-
Wardlow refers to as “negative agency.” Es- rality and connectivity, it stands to rea-
sentially, it is the capacity of an individ- son that increasing individualism owing
ual to engage in willful acts of subversion; to modernity would change the structures
for example, a wife may “forget” that her and processes of society. And individu-
husband asked for his favorite shirt to be alism, says Wardlow, has increased. She
washed before he goes to town, thus de- cites three factors related to modernity that
laying his trip and ability to conduct busi- have supported this change: Christianity,
ness until she has washed it. Some women commodity consumption, and wage labor
may take negative agency as far as self- (p. 21). Christianity encourages individu-
inflicted violence, for example by cutting off als to “own” their own faith, making it a
their own fingers to protest accusations of personal rather than corporate experience.
adultery. The ultimate expression of nega- Commodity consumption and wage labor
tive agency is suicide, which fully removes introduce capitalism and monetization of
86 Medical Anthropology Quarterly

society, which in turn cause the monetiza- as rape, or feelings of betrayal and anger at
tion of the bridewealth system and female husbands or kin. Although anger is usually
agency. directed at male kin, it is not uncommon for
In the newly cash-based economy, some pasinja meri to resent lack of support from
anthropologists of Melanesia are concerned female kin, whether in advocating male-
that Huli women are being commoditized dominant ideals or in receiving portions
by the preferential use of money over pigs in of compensation payment without consid-
bridewealth payment. Indeed, the demand eration of the victim. Female kin may in-
for cash among rural populations is leading deed be reluctant to support other women
the majority of men ages 20 to 39 to out- who have been ill treated, especially those
migrate as wage laborers in mines and port who transgress accepted sociocultural roles,
cities. Increasing absence of husbands and because association may taint their own
male kin upset the flow of social instruction reputations.
and authority. Many Huli to whom Ward- Regarding the distinction between pas-
low spoke blame increases in rape, crime, inja meri and prostitutes, Wardlow argues
and family disputes (which Wardlow care- that although in many ways fulfilling the
fully documented with archival research) on role of prostitute, pasinja meri can be seen as
the fact that men are not around to fence in a separate category because they exchange
women. sex for money not predominantly for eco-
This is where the pasinja meri lifestyle nomic security but more as a decisive act of
comes in. Many pasinja meri point di- negative agency against the male-dominated
rectly to an incident in which a husband sphere that surrounds them. Wardlow ac-
or male kin member broke the social con- knowledges the economic factors that af-
tract as pushing them into exchanging sex fect pasinja meri’s decisions, but she asserts
for money. Because the man (or men) did that “to the extent that these factors can
not fulfill his (their) social obligations to the be disentangled, it was emotion, not eco-
woman, she decides that they are undeserv- nomics, that first impelled them to engage in
ing of her reproductive capacities and hence extramarital, monetized sexual exchanges”
she uses them for personal gain instead. By (p. 139).
doing so, passenger women effectively steal Pasinja meri exist as an example of gen-
what would otherwise be rightfully pos- dered expression of negative agency in re-
sessed by a man because of bridewealth. sponse to the changes brought on by moder-
Here, Wardlow claims to diverge from nity. In the book’s conclusion, Wardlow
“conventional academic wisdom” regard- briefly links this ethnographic data the
ing motivation of prostitution, by asserting spread of HIV/AIDS in the area. With
that Huli passenger women do not turn to HIV/AIDS prevalence steadily increasing
prostitution in response to economic depri- across Papua New Guinea, knowledge re-
vation. With only a vague and unreferenced garding the agency and gender tensions
review of what the extant literatures shows, faced by the Huli as modernization en-
readers new to the topic are left unable to croaches will be useful to medical anthro-
judge this assertion. Still, Wardlow’s coun- pologists, government officials, and public
terargument is compelling, especially when health personnel aiming to stem the epi-
contextualized against the Huli’s traditional demic. Having said that, although the con-
worldview and social structures as Wardlow clusion is informative and relevant to the
has described them. It is the desire to re- unique nature of the HIV/AIDS epidemic in
pudiate kin, usually men, that fosters their Papua New Guinea, it does not fit with the
involvement in this lifestyle. flow of the book and is mildly jarring to
Thirteen of the 18 self-identified pasinja transition into.
meri that Wardlow interviewed started ex- Through not only the content but also
changing sex for money as a direct result the structure of her writing, Wardlow
of incidents of male-initiated violence, such encourages readers to understand Huli
 Book Reviews 87

bridewealth, gender issues, sexuality, and Because of this, I can easily recommend this
agency as intertwined. Although this en- book to both nonanthropologists and an-
ables the reader to fully grasp the ethno- thropology students at any level. Although
logical richness of the pasinja meri phe- best fit for a reader with basic understanding
nomenon, and its relevance in the context of of the concepts discussed and some facility
modernization and the spread of HIV/AIDS, in reading this type of multilayered ethnog-
it also makes for challenging reading and raphy, any reader could pick up the book
will foster in less advanced readers confu- and follow Wardlow’s discussion of the con-
sion regarding what the book’s take-home cepts while losing only some of her deeper
message may be. More clarity in terms of ideas or analytic connections. The book is
the book’s structure would have been help- relevant not only as an ethnography of Huli
ful in making its ultimate objectives more gender and sexuality in the face of moder-
obvious. nity, or as a study of agency, but also as a
Notwithstanding, Wardlow’s writing it- contextual backdrop for the study of sexu-
self is clear and captivating at every turn, ally transmitted diseases and HIV/AIDS in
alternately witty and thought provoking. Melanesia.