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Good days, bad days
Sm. Sci. Med. Vol. 35, No. 7, pp. 949-950,
0277-9536/92 55.00 + 0.00 Pergamon Press Ltd
1992
Printed in Great Britain
BOOK
REVIEWS
necessitated by a chronic illness, Charmaz is traversing a well-worn landscape in the chronic illness literature. And yet, since such a discussion is requisite for a complete picture, this section of the book provides not only a good review but verification of Charmaz’ central premise, drawn from a variety of illnesses. The first two parts of the book thus set the stage for the final section, in which the relationship between illness, the self and time are more finely honed. Addressed are the ways that ill people structure and restructure the present when illness has made life uncertain. Charmaz then examines how ideas about the past influence the present and the futurefor example by creating bench marks or by defining certain events as turning points. And finally, she demonstrates how people come to treat the past, present or future as pivotal for organizing concepts of themselves. As Charmaz says in a footnote @. 280), “the melding of feeling and time into a reality, rather than the reality is what I wish to portray”and this she does, quite successfully. Throughout the book the author is not only respectful of other salient research on chronic illness but of significant lay accounts that have emerged in recent years to dramatize the illness experience. Classic sociological categories such as Roth’s “timemarkers” are successfully melded with those the author has discovered, such as “packaging an illness” and “developing a dialectical self”. Verbatim quotes and imagery such as “drifting and dragging time” should make the book of interest not only to sociologists and health professionals but to ill persons themselves, from whom, as Charmaz notes, the disease “process” usually remains elusive. As Conrad has pointed out in this journal [2], the growing body of research on chronic illness is finally rendering an important experienceof-illness framework (if not a comprehensive theory). Good Days, Bud Days makes a valuable contribution to this framework.
Good Days, Bad Days, by KATHY CHARMAZ. Rutgers University Press, New Brunswick, NJ. 311 pp. There is no better demonstration of the fit of method to subject matter than the harvest of qualitative literature extant on chronic illness. We have come a long way from the acceptance of the outsider perspective on ‘the sick role’ to an outpouring of studies presenting the insider perspective of the illness experience. Through open-ended interviews and close attention to the meanings people place upon their illnesses, a considerable body of credible research now documents the personal and social consequences of that dreaded sentence, “You’re going to have to learn to live with it.” So much so that one might legitimately ask: What else is left to discover? Kathy Charmaz in Good Days, Bad Days answers that question by delving deeper into the relationship between illness, the self and time. She points out that people with chronic illnesses provide mirrors of time and self for other adults, because time and even having a self become so problematic for them. In so doing, she is faithful to the Meadian/symbolic interaction tradition regarding the effect of time (memory and foresight) on identity. Earlier, Corbin and Strauss [l] examined the way in which three interrelated elements-(l) conceptions of the self, (2) conceptions that evolve over the course of biographical time and (3) conceptions that arise directly or indirectly through the bodymust work together to give structure and continuity to who one ‘is.’ Charmaz’ analysis of the experiences of people with serious chronic illnesses adds further depth to our understanding of the disruption of time and consequent disruption of self that occur as people try to accommodate their everyday lives in the face of a chronic illness. Charmaz’ insight comes from having talked to participants over a number of years (5-11) through both intensive interviews and informal conversations and from having obtained through previous research a heightened understanding of the effect of chronic illness on the self. Initially, she presents three ways that people experience chronic illness: as an interruption (looking for recovery, constructing ‘denial’, learning about chronicity); as an intrusion (a process of acceptance from which the book’s title derives); or by experiencing immersion (facing dependency, pulling into oneself and away from others, and slipping into illness routines). She analyzes how experiencing illness as interruption, intrusion, or immersion depends upon the person’s definitions of the experience and how different relationships to time flow from each of these ways of experiencing illness. When her attention focuses on the problems ill people face in talking about their condition and on the logistical problems of planning, organizing, pacing and juggling
Department of Social and Behavioral Sciences University of Call~ornia San Francisco U.S.A.
CAROLYN L. WIENER
REFERENCES 1. Corbin J. and Strauss A. Unending Work and Cure. Jossey-Bass, San Francisco, 1988. 2. Conrad P. Qualitative research on chronic illness: a commentary on method and conceptual development. Sot. Sci. Med. 30, 1257-1263, 1990.
Evaluating Health Services Effectiveness by A. ST LEGER, H. SCHNEIDEN and J. P. WALSWORTH-BELL. Open University Press, Milton Keynes, 1992. Paperback: f14.99; hardback: E35.00.
Health, I was not looking with joy to sitting and reading this one in detail. What a pleasant surprise. Not only was this text clear, user friendly and well written, it was actually interesting. It is clear that the authors have had experience in the evaluation field. Firstly, they seek to clarify words and concepts that other authors assume the reader should know. Secondly, they provide the reader with helpful hints about using the evaluation techniques which are described.
Having perused several books and articles of similar titles in my role as Course convener for the MSc. in International 949
0277-9536/92 55.00 + 0.00 Pergamon Press Ltd
1992
Printed in Great Britain
BOOK
REVIEWS
necessitated by a chronic illness, Charmaz is traversing a well-worn landscape in the chronic illness literature. And yet, since such a discussion is requisite for a complete picture, this section of the book provides not only a good review but verification of Charmaz’ central premise, drawn from a variety of illnesses. The first two parts of the book thus set the stage for the final section, in which the relationship between illness, the self and time are more finely honed. Addressed are the ways that ill people structure and restructure the present when illness has made life uncertain. Charmaz then examines how ideas about the past influence the present and the futurefor example by creating bench marks or by defining certain events as turning points. And finally, she demonstrates how people come to treat the past, present or future as pivotal for organizing concepts of themselves. As Charmaz says in a footnote @. 280), “the melding of feeling and time into a reality, rather than the reality is what I wish to portray”and this she does, quite successfully. Throughout the book the author is not only respectful of other salient research on chronic illness but of significant lay accounts that have emerged in recent years to dramatize the illness experience. Classic sociological categories such as Roth’s “timemarkers” are successfully melded with those the author has discovered, such as “packaging an illness” and “developing a dialectical self”. Verbatim quotes and imagery such as “drifting and dragging time” should make the book of interest not only to sociologists and health professionals but to ill persons themselves, from whom, as Charmaz notes, the disease “process” usually remains elusive. As Conrad has pointed out in this journal [2], the growing body of research on chronic illness is finally rendering an important experienceof-illness framework (if not a comprehensive theory). Good Days, Bud Days makes a valuable contribution to this framework.
Good Days, Bad Days, by KATHY CHARMAZ. Rutgers University Press, New Brunswick, NJ. 311 pp. There is no better demonstration of the fit of method to subject matter than the harvest of qualitative literature extant on chronic illness. We have come a long way from the acceptance of the outsider perspective on ‘the sick role’ to an outpouring of studies presenting the insider perspective of the illness experience. Through open-ended interviews and close attention to the meanings people place upon their illnesses, a considerable body of credible research now documents the personal and social consequences of that dreaded sentence, “You’re going to have to learn to live with it.” So much so that one might legitimately ask: What else is left to discover? Kathy Charmaz in Good Days, Bad Days answers that question by delving deeper into the relationship between illness, the self and time. She points out that people with chronic illnesses provide mirrors of time and self for other adults, because time and even having a self become so problematic for them. In so doing, she is faithful to the Meadian/symbolic interaction tradition regarding the effect of time (memory and foresight) on identity. Earlier, Corbin and Strauss [l] examined the way in which three interrelated elements-(l) conceptions of the self, (2) conceptions that evolve over the course of biographical time and (3) conceptions that arise directly or indirectly through the bodymust work together to give structure and continuity to who one ‘is.’ Charmaz’ analysis of the experiences of people with serious chronic illnesses adds further depth to our understanding of the disruption of time and consequent disruption of self that occur as people try to accommodate their everyday lives in the face of a chronic illness. Charmaz’ insight comes from having talked to participants over a number of years (5-11) through both intensive interviews and informal conversations and from having obtained through previous research a heightened understanding of the effect of chronic illness on the self. Initially, she presents three ways that people experience chronic illness: as an interruption (looking for recovery, constructing ‘denial’, learning about chronicity); as an intrusion (a process of acceptance from which the book’s title derives); or by experiencing immersion (facing dependency, pulling into oneself and away from others, and slipping into illness routines). She analyzes how experiencing illness as interruption, intrusion, or immersion depends upon the person’s definitions of the experience and how different relationships to time flow from each of these ways of experiencing illness. When her attention focuses on the problems ill people face in talking about their condition and on the logistical problems of planning, organizing, pacing and juggling
Department of Social and Behavioral Sciences University of Call~ornia San Francisco U.S.A.
CAROLYN L. WIENER
REFERENCES 1. Corbin J. and Strauss A. Unending Work and Cure. Jossey-Bass, San Francisco, 1988. 2. Conrad P. Qualitative research on chronic illness: a commentary on method and conceptual development. Sot. Sci. Med. 30, 1257-1263, 1990.
Evaluating Health Services Effectiveness by A. ST LEGER, H. SCHNEIDEN and J. P. WALSWORTH-BELL. Open University Press, Milton Keynes, 1992. Paperback: f14.99; hardback: E35.00.
Health, I was not looking with joy to sitting and reading this one in detail. What a pleasant surprise. Not only was this text clear, user friendly and well written, it was actually interesting. It is clear that the authors have had experience in the evaluation field. Firstly, they seek to clarify words and concepts that other authors assume the reader should know. Secondly, they provide the reader with helpful hints about using the evaluation techniques which are described.
Having perused several books and articles of similar titles in my role as Course convener for the MSc. in International 949