- Email: [email protected]
Women, health, and healing
Women's Studies International Forum, Vol. 19, No. 3, pp. 339--341, 1996 Copyright © 1996 Elsevier Science Ltd Printed in the USA. All rights reserved 0277-5395/96 $15.00 + .00
Pergamon
SSDI 0277-5395(95)00091-7
REVIEW ARTICLE W O M E N , HEALTH, AND HEALING
WOMENANDThE HEALTh CARE Im~us'rRv:.A s Umm~aatv RELATIONSHIP.9, by Peggy Foster, 218 pages. Open University Press, Buckingham. Philadelphia, 1995. WOMEN AND HEALTIt: FEM~IST PERSPECTIVES,edited by Sue Wilkinson and Celia Kitzinger, 209 pages. Taylor and Francis, London 1994.
At a recent conference in Bristol, England, academics and health professionals came together to review the current state of research on gender and women's health, l The conference reflected a growing interest in gender issues amongst mainstream health care providers. This article reviews two recent books that contribute to the debate, highlighting implications for the promotion of women's health at the broadest level.
GENDER, HEALTH, AND RESEARCH The task of promoting women's health is constrained by a lack of knowledge both about the underlying causes of illness and the effects of medical interventions on women. This lack of knowledge is apparent in both the medical and social literature. Lesley Doyal (1995, pp. 17-18) draws attention to the practice of extrapolating onto women research findings based on exclusively male samples. As a result of this practice, women's experience of common diseases remains unexplored, whilst the impact of many accepted medical procedures on women is simply unknown. Social research has also tended to marginalize or exclude women in a number of ways highlighted by the contributors to Women and Health: Feminist perspectives, edited by Sue Wilkinson and Celia Kitzinger. This book uses a lifecycle approach and draws on multidiseiplinary research into women's health issues ranging from sexuality to the experience of widowhood. In her chapter, "Surviving by Smoking," Hilary Graham demonstrates that crucial information is lost through the use of conventional survey techniques of data collection. These techniques generally position women in relation to heterosexual relationships of cohabitation and marriage, rendering the lives of women outside of these arrangements invisible. Similarly, Elizabeth Ettore exposes the distorted view of gender presented in traditional research on substance use, which has tended to focus on men, failing to address wider social arenas affecting women, such as poverty and family health.
Health researchers face the key tasks of addressing patterns of diversity, and exploring differences between women as well as common experiences. Feminists have been increasingly criticized for constructing "universal" demands from the experiences of a small minority of women (Aziz, 1992). For example, relatively little attention has been paid to the health experiences of Black women, with researchers too often focusing on "exotic" diseases and not addressing the concerns of minority ethnic women, themselves (Douglas, 1995). The stated intention of the editors of Women and Health is to encourage contributors to "weave considerations of difference throughout their chapters" (p. 2), rather than addressing separate constituencies. Most of the authors do, indeed, write with reference to "differences" between women, although empirically grounded explorations of these issues are not always given space, and assumptions about women's collective experience are not always problematised. The contributors to this collection draw largely from British perspectives, the exception being Lesley Doyal who provides a framework for looking at the health effects of waged work in different geographical locations. Despite wide disparities, she finds a common pattern of occupational segregation whereby women continue to be concentrated in the lowest paid and lowest status jobs in most countries. This analysis, which takes into account variations in income, domestic circumstances and job characteristics, provides a crucial underpinning for explorations of the relationships between gender, social conditions, and patterns of mortality and morbidity.
GENDER AND HEALTH PROMOTION Research into social and material conditions is also important in relation to lifestyle factors associated with health. Traditional health promotion strategies have failed to address the links between poverty and lifestyle, particularly in relation to women who are often the targets of health promotion messages (Daykin & Naidoo, 1995). Hilary Graham's chapter in Women and Health highlights the consolidation in recent years of cigarette smoking among lone mothers in Britain. This trend has occurred at the same time as the relative material and social position of this group has deteriorated (Marsh & MacKay, 1994). According to Graham, smoking helps women to manage the contradictory pressures that structure their lives: "It provides a way of keeping going when women have little going for them" (p. 103). This argument suggests that successful health promotion strategies must be based on an understanding of the 339
340
Review Article
gendered social context of health related behaviours. This is far from the current approach favoured by policymakers in the United Kingdom, which, as Graham points out, attempts, "to change what people do rather than the circumstances in which they live" (pp. 105-106). Some of the contributions to this volume offer positive strategies for promoting women's health. For example, Elizabeth Ettore suggests that health promotion should build on the insights of feminist perspectives that interpret women's use of drugs as attempts to establish autonomy. This requires a recognition of the significance of the pursuit of pleasure for women; and whilst not advocating substance abuse, health promotion needs to be able to offer a means of moving toward something and not just away from danger. This notion of health promotion as social agency is echoed in Rachel Thompson and Janet Holland's exploration of the sexual careers of young heterosexual women. The authors paint a depressing, but familiar, picture of the ways in which girls' first negotiations of sex are constrained by the cultural pressures of romantic discourse as well as by gendered power relations. However, a small number of the young women in their sample do appear to have overcome these limitations in order to explore and privilege their own sexual needs. This strategy of taking control is seen by Thompson and Holland as enabling safe sexual practices to develop as well as challenging the dominant constructions of heterosexuality that disadvantage girls and women. Unfortunately, the authors find that this positive health promotion message has yet to be taken on board within mainstream health education and family planning. WOMEN
AND MEDICINE
Interactions between the many social influences on health and illness represent one of the major concerns of health researchers and activists. The organization and impact of health services upon different groups of women has also received attention. Some of the contributions to Wilkinson and Kitzinger's book question the ability of medicine, which continues to be dominated by the values of a white male elite, to address women's needs adequately. Several examples of the masculinist bias of medicine emerge from these accounts. For example, Pat Spallone, writing on the ethics of new reproductive technologies (NRTs), highlights the way in which the uniquely female experience of pregnancy has been ignored. According to Spallone, the official debate has centred around the protection of embryos, and has neglected to consider the possible adverse effects of fertility treatment on women. Medicine is seen here as a form of patriarchal social control; the author draws attention to the desire articulated by members of the medical and scientific community to link the use of NRTs with the preservation of the heterosexual nuclear family. This masculinist ethos is also demonstrated in Wilkinson and Kitzinger's chapter on breast cancer. The analysis of the medical literature presented reveals what the authors term a "page 3" mentality in which breasts are emphasized as sources of male sexual pleasure. The concern of doctors to "normalize" women after surgery by ensuring that sexual intercourse with male partners takes place is highlighted, along with the routine use of words like disfigurement to describe postmastectomy patients. The same literature rarely focuses on alternative issues which might be of concern to women patients, such as breast feeding or explaining the loss of a breast to a child.
Given these characteristics of modem medical practice, it is not surprising that the benefits of health care interventions for women have been questioned. The notion of iatrogenie (doctor-made) disease informs the main thesis of "Women and the Health Care Industry" by Peggy Foster. Here it is claimed that British feminists have been more reluctant than their North American counterparts to attack the exploitative nature of health care, focusing instead on issues of service delivery and on doctors' attitudes towards patients. State ownership and control of the National Health Service has obscured the workings of commercial and other vested interests which nevertheless, she argues, exert a powerful and negative influence on women's health. Foster builds on Illich's (1975) critique, in which westem scientific medicine was seen as a major threat to health, to suggest that: "Much contemporary health care, including health promotion activities, is intrinsically more harmful to women than beneficial; whether or not it is delivered in a patronizing or sexist manner" (pp. 5-6). Foster argues that the benefits of modem medicine are seen as oversold and the harmful effects understated. Further, women's ability to make rational choices in health care is constrained, either because doctors are unaware of the risks attached to many forms of medical treatment, or because they assume that their female patients will not be able to cope with the information concerning possible risks. Foster is prepared for the fact that students may only read the conclusion of her book. If they do, they will miss out on a wealth of detailed evidence and powerful argument about the physical and social harm caused by many accepted medical practices. Whilst consumer pressures and demands for outcome evaluation have limited the use of some ineffective procedures, Foster shows how technological developments have led to increased medicalisation and control, particularly in relation to reproductive health and maternity care. Foster's account of the impact of NRTs is particularly disturbing. Although NRTs offer "choices" to relatively well-off women, these carry significant social costs. For example, rather than childlessness being accepted as inevitable and natural for some women, Foster suggests that the cult of motherhood has been reinforced and the childlessness of infertile women stigmatised as "giving up." Attention is drawn to the eugenicist assumptions that have influenced the use of NRTs has well as the potentially exploitative effects of practices such as surrogacy on poor and third world women. Foster's thesis is most convincing in areas where serious threats to physical health and negative social effects of medical technology can be demonstrated. The question remains, however, of whether medical technologies are inherently harmful, or whether iatrogenesis is a result of their inappropriate and, more broadly, undemocratic use. Foster's argument is most challenging in relation to strategies for the prevention of HIV and AIDS. These are seen as having placed too much emphasis on the role of the HIV virus as opposed to social factors in the aetiology of AIDS. Poor women are identified as being at greatest risk from the disease, for which they also receive the worst treatment. Many health promotion workers would agree that poverty is an important issue, although few would accept that a focus on poverty obviates the need to prevent HIV transmission occuring in the first place. According to Foster, safe sex campaigns have benefited health professionals at the expense of women. These campaigns are seen as alarmist, and likely to "create a whole
Review Article
new range of female anxieties and inhibitions in relation to sex" (p. 172). Unfortunately, empirical evidence to support this predicition is not provided. Although the argument usefully draws attention to the potential for increased surveillance through health promotion, it underestimates the radical potential of sexual health work to challenge dominant and oppressive notions of sexuality and sexual pleasure (Wilton, 1995).
REFORMING MEDICINE Foster does not argue for a complete rejection of modem medicine. Rather, she argues for limitations on its use and for a reversal of priorities away from interventionism towards simple, woman-controlled measures. In addition, income redistribution and support for women's caring roles are advocated. Foster does not, however, sanction calls for greater equality of access to health services, arguing that this would simply extend the harm done to already oppressed groups. It is difficult to find wholehearted support for this argument. Whilst differential access to health services cannot in itself explain inequalities in health (Townsend, Davidson, & Whitehead, 1988), it is important not to ignore the medical needs of marginalized groups, nor to overlook the contribution that doctors can make to improvements in social and living conditions. Together, these two books point to the need for improvements in knowledge and increased effectiveness of health care as well as a broadening of the social basis of medicine. Meg Stacey, writing in Women and Health, describes the ways in which the General Medical Council is constrained by its historical identity as "an English gentleman's club." She sees this legacy as limiting the ability of the medical profession to respond positively to current trends toward managerialism and consumerism in health care. Conventional medicine has also been challenged by the growth of alternative and complimentary therapies, as those who can afford to choose are exploring a widening range of healing options in Britain, Europe, and North America (Saks, 1994). The philosophies that underpin self health and alternative therapies available to women are explored in Wilkinson and Kitzinger's chapter on breast cancer in Women and Health. These are seen as promoting a victim-blaming message of individual responsibility for causing and curing cancer as well as offering a "spurious illusion of power over illness" (p. 133). Whilst reliance on such therapies clearly has its dangers, the growing support for alternative approaches highlights some of the gaps within conventional medicine. Evidence suggests that users of alternative medicines in the United Kingdom do so, not just because of conventional medicine's perceived inability to cure many illnesses, but because the "cures" offered are not always acceptable to the patient (Sharma, 1990). Further, conventional medicine is seen as failing to cope with the social and experiential aspects of illness (Sharma, p. 132). Hence, some alternative
341
therapies offer a powerful challenge to the basic premises of scientific medicine, such as the Cartesian separation of mind and body. This particular challenge is important for women who, as Ellen M. Goudsmit demonstrates in her contribution to Women and Health, have often been discredited and disadvantaged by the psychologisation of illness. However, as Saks (1994, p. 100) concludes, the ability of m a i n s t r e a m health services to fully incorporate nonorthodox paradigms is questionable given the continued dominance of the orthodox medical profession. NORMA DAYKIN UNIVERSITYOF THE WEST OF ENGLAND
ENDNOTE 1. This conference, entitled Researching women, gender and health was held at the University of the West of England, Bristol, on the 17th July, 1995.
REFERENCES Aziz, Razia. (1992). F e m i n i s m and the challenge of racism: Deviance or difference? In Helen Crowley & Susan Himmelweit (Eds.), Knowing women: Feminism and knowledge (pp. 291-305). Cambridge: Polity Press. Daykin, Norma, & Naidoo, Jennie. (1995). Feminist critiques of health promotion. In Robin Bunton, Sarah Nettleton, Roger Burrows. The sociology of health promotion: Critical analyses of consumption, lifestyle and risk. London: Routledge. Douglas, Jenny. (1995, June 17). Researching Black women's health. Paper presented at conference Researching women, gender and health, University of the West of England, Bristol. Doyal, Lesley. (1995). What makes women sick? Gender and the political economy of health. London: Macmillan. Illich, Ivan. (1975). Medical nemesis: The expropriation of health. London: Marion Boyars. Marsh, Alan, & McKay, Stephen. (1994). Poor smokers. London: Policy Studies Institute. Saks, Mike. (1994). The alternatives to medicine. In Jonathan Gabe, David Kelleher, & Gareth Williams rEds.), Challenging medicine. London: Routledge. Sharma, Ursula. (1990). U s i n g alternative therapies: Marginal medicine and central concerns. In Pamela Abbott & Geoff Payne (Eds.), New directions in the sociology o f health. London: Falmer Press. Townsend, Peter, Davidson, Nick, & Whitehead, Margaret. (I 988). Inequalities in health: The Black report/the health divide. London: Penguin. Wilton, Tamsin. (! 995, July). Safety in pornatopia: Desire, pleasure and safer sex education. Paper presented at conference HIV and AIDS: Social issues: Social theory into practice, MacQuarie University, Sidney.
Pergamon
SSDI 0277-5395(95)00091-7
REVIEW ARTICLE W O M E N , HEALTH, AND HEALING
WOMENANDThE HEALTh CARE Im~us'rRv:.A s Umm~aatv RELATIONSHIP.9, by Peggy Foster, 218 pages. Open University Press, Buckingham. Philadelphia, 1995. WOMEN AND HEALTIt: FEM~IST PERSPECTIVES,edited by Sue Wilkinson and Celia Kitzinger, 209 pages. Taylor and Francis, London 1994.
At a recent conference in Bristol, England, academics and health professionals came together to review the current state of research on gender and women's health, l The conference reflected a growing interest in gender issues amongst mainstream health care providers. This article reviews two recent books that contribute to the debate, highlighting implications for the promotion of women's health at the broadest level.
GENDER, HEALTH, AND RESEARCH The task of promoting women's health is constrained by a lack of knowledge both about the underlying causes of illness and the effects of medical interventions on women. This lack of knowledge is apparent in both the medical and social literature. Lesley Doyal (1995, pp. 17-18) draws attention to the practice of extrapolating onto women research findings based on exclusively male samples. As a result of this practice, women's experience of common diseases remains unexplored, whilst the impact of many accepted medical procedures on women is simply unknown. Social research has also tended to marginalize or exclude women in a number of ways highlighted by the contributors to Women and Health: Feminist perspectives, edited by Sue Wilkinson and Celia Kitzinger. This book uses a lifecycle approach and draws on multidiseiplinary research into women's health issues ranging from sexuality to the experience of widowhood. In her chapter, "Surviving by Smoking," Hilary Graham demonstrates that crucial information is lost through the use of conventional survey techniques of data collection. These techniques generally position women in relation to heterosexual relationships of cohabitation and marriage, rendering the lives of women outside of these arrangements invisible. Similarly, Elizabeth Ettore exposes the distorted view of gender presented in traditional research on substance use, which has tended to focus on men, failing to address wider social arenas affecting women, such as poverty and family health.
Health researchers face the key tasks of addressing patterns of diversity, and exploring differences between women as well as common experiences. Feminists have been increasingly criticized for constructing "universal" demands from the experiences of a small minority of women (Aziz, 1992). For example, relatively little attention has been paid to the health experiences of Black women, with researchers too often focusing on "exotic" diseases and not addressing the concerns of minority ethnic women, themselves (Douglas, 1995). The stated intention of the editors of Women and Health is to encourage contributors to "weave considerations of difference throughout their chapters" (p. 2), rather than addressing separate constituencies. Most of the authors do, indeed, write with reference to "differences" between women, although empirically grounded explorations of these issues are not always given space, and assumptions about women's collective experience are not always problematised. The contributors to this collection draw largely from British perspectives, the exception being Lesley Doyal who provides a framework for looking at the health effects of waged work in different geographical locations. Despite wide disparities, she finds a common pattern of occupational segregation whereby women continue to be concentrated in the lowest paid and lowest status jobs in most countries. This analysis, which takes into account variations in income, domestic circumstances and job characteristics, provides a crucial underpinning for explorations of the relationships between gender, social conditions, and patterns of mortality and morbidity.
GENDER AND HEALTH PROMOTION Research into social and material conditions is also important in relation to lifestyle factors associated with health. Traditional health promotion strategies have failed to address the links between poverty and lifestyle, particularly in relation to women who are often the targets of health promotion messages (Daykin & Naidoo, 1995). Hilary Graham's chapter in Women and Health highlights the consolidation in recent years of cigarette smoking among lone mothers in Britain. This trend has occurred at the same time as the relative material and social position of this group has deteriorated (Marsh & MacKay, 1994). According to Graham, smoking helps women to manage the contradictory pressures that structure their lives: "It provides a way of keeping going when women have little going for them" (p. 103). This argument suggests that successful health promotion strategies must be based on an understanding of the 339
340
Review Article
gendered social context of health related behaviours. This is far from the current approach favoured by policymakers in the United Kingdom, which, as Graham points out, attempts, "to change what people do rather than the circumstances in which they live" (pp. 105-106). Some of the contributions to this volume offer positive strategies for promoting women's health. For example, Elizabeth Ettore suggests that health promotion should build on the insights of feminist perspectives that interpret women's use of drugs as attempts to establish autonomy. This requires a recognition of the significance of the pursuit of pleasure for women; and whilst not advocating substance abuse, health promotion needs to be able to offer a means of moving toward something and not just away from danger. This notion of health promotion as social agency is echoed in Rachel Thompson and Janet Holland's exploration of the sexual careers of young heterosexual women. The authors paint a depressing, but familiar, picture of the ways in which girls' first negotiations of sex are constrained by the cultural pressures of romantic discourse as well as by gendered power relations. However, a small number of the young women in their sample do appear to have overcome these limitations in order to explore and privilege their own sexual needs. This strategy of taking control is seen by Thompson and Holland as enabling safe sexual practices to develop as well as challenging the dominant constructions of heterosexuality that disadvantage girls and women. Unfortunately, the authors find that this positive health promotion message has yet to be taken on board within mainstream health education and family planning. WOMEN
AND MEDICINE
Interactions between the many social influences on health and illness represent one of the major concerns of health researchers and activists. The organization and impact of health services upon different groups of women has also received attention. Some of the contributions to Wilkinson and Kitzinger's book question the ability of medicine, which continues to be dominated by the values of a white male elite, to address women's needs adequately. Several examples of the masculinist bias of medicine emerge from these accounts. For example, Pat Spallone, writing on the ethics of new reproductive technologies (NRTs), highlights the way in which the uniquely female experience of pregnancy has been ignored. According to Spallone, the official debate has centred around the protection of embryos, and has neglected to consider the possible adverse effects of fertility treatment on women. Medicine is seen here as a form of patriarchal social control; the author draws attention to the desire articulated by members of the medical and scientific community to link the use of NRTs with the preservation of the heterosexual nuclear family. This masculinist ethos is also demonstrated in Wilkinson and Kitzinger's chapter on breast cancer. The analysis of the medical literature presented reveals what the authors term a "page 3" mentality in which breasts are emphasized as sources of male sexual pleasure. The concern of doctors to "normalize" women after surgery by ensuring that sexual intercourse with male partners takes place is highlighted, along with the routine use of words like disfigurement to describe postmastectomy patients. The same literature rarely focuses on alternative issues which might be of concern to women patients, such as breast feeding or explaining the loss of a breast to a child.
Given these characteristics of modem medical practice, it is not surprising that the benefits of health care interventions for women have been questioned. The notion of iatrogenie (doctor-made) disease informs the main thesis of "Women and the Health Care Industry" by Peggy Foster. Here it is claimed that British feminists have been more reluctant than their North American counterparts to attack the exploitative nature of health care, focusing instead on issues of service delivery and on doctors' attitudes towards patients. State ownership and control of the National Health Service has obscured the workings of commercial and other vested interests which nevertheless, she argues, exert a powerful and negative influence on women's health. Foster builds on Illich's (1975) critique, in which westem scientific medicine was seen as a major threat to health, to suggest that: "Much contemporary health care, including health promotion activities, is intrinsically more harmful to women than beneficial; whether or not it is delivered in a patronizing or sexist manner" (pp. 5-6). Foster argues that the benefits of modem medicine are seen as oversold and the harmful effects understated. Further, women's ability to make rational choices in health care is constrained, either because doctors are unaware of the risks attached to many forms of medical treatment, or because they assume that their female patients will not be able to cope with the information concerning possible risks. Foster is prepared for the fact that students may only read the conclusion of her book. If they do, they will miss out on a wealth of detailed evidence and powerful argument about the physical and social harm caused by many accepted medical practices. Whilst consumer pressures and demands for outcome evaluation have limited the use of some ineffective procedures, Foster shows how technological developments have led to increased medicalisation and control, particularly in relation to reproductive health and maternity care. Foster's account of the impact of NRTs is particularly disturbing. Although NRTs offer "choices" to relatively well-off women, these carry significant social costs. For example, rather than childlessness being accepted as inevitable and natural for some women, Foster suggests that the cult of motherhood has been reinforced and the childlessness of infertile women stigmatised as "giving up." Attention is drawn to the eugenicist assumptions that have influenced the use of NRTs has well as the potentially exploitative effects of practices such as surrogacy on poor and third world women. Foster's thesis is most convincing in areas where serious threats to physical health and negative social effects of medical technology can be demonstrated. The question remains, however, of whether medical technologies are inherently harmful, or whether iatrogenesis is a result of their inappropriate and, more broadly, undemocratic use. Foster's argument is most challenging in relation to strategies for the prevention of HIV and AIDS. These are seen as having placed too much emphasis on the role of the HIV virus as opposed to social factors in the aetiology of AIDS. Poor women are identified as being at greatest risk from the disease, for which they also receive the worst treatment. Many health promotion workers would agree that poverty is an important issue, although few would accept that a focus on poverty obviates the need to prevent HIV transmission occuring in the first place. According to Foster, safe sex campaigns have benefited health professionals at the expense of women. These campaigns are seen as alarmist, and likely to "create a whole
Review Article
new range of female anxieties and inhibitions in relation to sex" (p. 172). Unfortunately, empirical evidence to support this predicition is not provided. Although the argument usefully draws attention to the potential for increased surveillance through health promotion, it underestimates the radical potential of sexual health work to challenge dominant and oppressive notions of sexuality and sexual pleasure (Wilton, 1995).
REFORMING MEDICINE Foster does not argue for a complete rejection of modem medicine. Rather, she argues for limitations on its use and for a reversal of priorities away from interventionism towards simple, woman-controlled measures. In addition, income redistribution and support for women's caring roles are advocated. Foster does not, however, sanction calls for greater equality of access to health services, arguing that this would simply extend the harm done to already oppressed groups. It is difficult to find wholehearted support for this argument. Whilst differential access to health services cannot in itself explain inequalities in health (Townsend, Davidson, & Whitehead, 1988), it is important not to ignore the medical needs of marginalized groups, nor to overlook the contribution that doctors can make to improvements in social and living conditions. Together, these two books point to the need for improvements in knowledge and increased effectiveness of health care as well as a broadening of the social basis of medicine. Meg Stacey, writing in Women and Health, describes the ways in which the General Medical Council is constrained by its historical identity as "an English gentleman's club." She sees this legacy as limiting the ability of the medical profession to respond positively to current trends toward managerialism and consumerism in health care. Conventional medicine has also been challenged by the growth of alternative and complimentary therapies, as those who can afford to choose are exploring a widening range of healing options in Britain, Europe, and North America (Saks, 1994). The philosophies that underpin self health and alternative therapies available to women are explored in Wilkinson and Kitzinger's chapter on breast cancer in Women and Health. These are seen as promoting a victim-blaming message of individual responsibility for causing and curing cancer as well as offering a "spurious illusion of power over illness" (p. 133). Whilst reliance on such therapies clearly has its dangers, the growing support for alternative approaches highlights some of the gaps within conventional medicine. Evidence suggests that users of alternative medicines in the United Kingdom do so, not just because of conventional medicine's perceived inability to cure many illnesses, but because the "cures" offered are not always acceptable to the patient (Sharma, 1990). Further, conventional medicine is seen as failing to cope with the social and experiential aspects of illness (Sharma, p. 132). Hence, some alternative
341
therapies offer a powerful challenge to the basic premises of scientific medicine, such as the Cartesian separation of mind and body. This particular challenge is important for women who, as Ellen M. Goudsmit demonstrates in her contribution to Women and Health, have often been discredited and disadvantaged by the psychologisation of illness. However, as Saks (1994, p. 100) concludes, the ability of m a i n s t r e a m health services to fully incorporate nonorthodox paradigms is questionable given the continued dominance of the orthodox medical profession. NORMA DAYKIN UNIVERSITYOF THE WEST OF ENGLAND
ENDNOTE 1. This conference, entitled Researching women, gender and health was held at the University of the West of England, Bristol, on the 17th July, 1995.
REFERENCES Aziz, Razia. (1992). F e m i n i s m and the challenge of racism: Deviance or difference? In Helen Crowley & Susan Himmelweit (Eds.), Knowing women: Feminism and knowledge (pp. 291-305). Cambridge: Polity Press. Daykin, Norma, & Naidoo, Jennie. (1995). Feminist critiques of health promotion. In Robin Bunton, Sarah Nettleton, Roger Burrows. The sociology of health promotion: Critical analyses of consumption, lifestyle and risk. London: Routledge. Douglas, Jenny. (1995, June 17). Researching Black women's health. Paper presented at conference Researching women, gender and health, University of the West of England, Bristol. Doyal, Lesley. (1995). What makes women sick? Gender and the political economy of health. London: Macmillan. Illich, Ivan. (1975). Medical nemesis: The expropriation of health. London: Marion Boyars. Marsh, Alan, & McKay, Stephen. (1994). Poor smokers. London: Policy Studies Institute. Saks, Mike. (1994). The alternatives to medicine. In Jonathan Gabe, David Kelleher, & Gareth Williams rEds.), Challenging medicine. London: Routledge. Sharma, Ursula. (1990). U s i n g alternative therapies: Marginal medicine and central concerns. In Pamela Abbott & Geoff Payne (Eds.), New directions in the sociology o f health. London: Falmer Press. Townsend, Peter, Davidson, Nick, & Whitehead, Margaret. (I 988). Inequalities in health: The Black report/the health divide. London: Penguin. Wilton, Tamsin. (! 995, July). Safety in pornatopia: Desire, pleasure and safer sex education. Paper presented at conference HIV and AIDS: Social issues: Social theory into practice, MacQuarie University, Sidney.