Health and Suffering in America analyzes how we came to see various forms of suffering as "mental illness," and argues that social and historical dynamics, not scientific discovery, gave us this notion. Robert Fancher argues that the beliefs of mental health professionals have less to do with science than with the professions' own values and ideologies. The image we have of mental health care hides vast realms of unexamined assumptions. In effect, the author maintains that "mental health" consists of mental health professionals' ideas about how people ought to live and act, not discoveries about human nature. The body of the book consists of detailed analyses and critiques of four infl uential American cultures of therapy: psychoanalysis, behaviorism, cognitive therapy, and biological therapy. Fancher emphasizes how heavily their concepts and methods are determined by their cultures rather than by empirical data. Furthermore, our notions of mental health are not scientifi c discoveries, but moral ideals. Yet mental health workers often fail to understand this. As a result, they misunderstand their own authority and, worse, fail to subject their moral ideals to appropriate moral and cultural criticism. The new introduction by the author explores how the rise of managed health care coalesces with insistence on parity for mental health problems, supported by continuing claims that mental health care is science-based.

"Health and Suffering in America analyzes how we came to see various forms of suffering as "mental illness," and argues that social and historical dynamics, not scientific discovery, gave us this notion. Robert Fancher argues that the beliefs of mental health professionals have less to do with science than with the professions' own values and ideologies. The image we have of mental health care hides vast realms of unexamined assumptions. In effect, the author maintains that "mental health" consists of mental health professionals' ideas about how people ought to live and act, not discoveries about human nature. The body of the book consists of detailed analyses and critiques of four infl uential American cultures of therapy: psychoanalysis, behaviorism, cognitive therapy, and biological therapy. Fancher emphasizes how heavily their concepts and methods are determined by their cultures rather than by empirical data. Furthermore, our notions of mental health are not scientifi c discoveries, but moral ideals. Yet mental health workers often fail to understand this. As a result, they misunderstand their own authority and, worse, fail to subject their moral ideals to appropriate moral and cultural criticism. The new introduction by the author explores how the rise of managed health care coalesces with insistence on parity for mental health problems, supported by continuing claims that mental health care is science-based."--Provided by publisher.

Service of the Engine is a common local Chichewa-English expression in the Malawian fishing village where the author did her fieldwork. It refers to the practice of taking various pills--known locally as Ciba--in order to prevent and cure diseases associated with sex. This study explores the sensitive interface between the use of pharmaceuticals, available through an extensive informal distribution system, and self-treatment of sex-related diseases. The author examines morally sensitive situations in which men and women opt for Ciba, and evaluates its efficacy, or effectiveness. The discussion not only covers physical and metaphorical aspects of efficacy, but also the possible social and moral effects of medication. It offers a fresh and empirically grounded perspective on the links between efficacy, sex-related diseases and moralities. Birgitte Bruun graduated from the Institute of Anthropology, University of Copenhagen, Denmark and is currently working with reproductive health projects for United Nations Population Fund (UNFPA) in Jakarta, Indonesia.

Health and Suffering in America analyzes how we came to see various forms of suffering as "mental illness," and argues that social and historical dynamics, not scientific discovery, gave us this notion. Robert Fancher argues that the beliefs of mental health professionals have less to do with science than with the professions' own values and ideologies. The image we have of mental health care hides vast realms of unexamined assumptions. In effect, the author maintains that "mental health" consists of mental health professionals' ideas about how people ought to live and act, not discoveries about human nature. The body of the book consists of detailed analyses and critiques of four influential American cultures of therapy: psychoanalysis, behaviorism, cognitive therapy, and biological therapy. Fancher emphasizes how heavily their concepts and methods are determined by their cultures rather than by empirical data. Furthermore, our notions of mental health are not scientific discoveries, but moral ideals. Yet mental health workers often fail to understand this. As a result, they misunderstand their own authority and, worse, fail to subject their moral ideals to appropriate moral and cultural criticism. The new introduction by the author explores how the rise of managed health care coalesces with insistence on parity for mental health problems, supported by continuing claims that mental health care is science-based.

On average, black Americans are sicker and die earlier than white Americans. Uncertain Suffering provides a richly nuanced examination of what this fact means for health care in the United States through the lens of sickle cell anemia, a disease that primarily affects blacks. In a wide ranging analysis that moves from individual patient cases to the compassionate yet distanced professionalism of health care specialists to the level of national policy, Carolyn Moxley Rouse uncovers the cultural assumptions that shape the quality and delivery of care for sickle cell patients. She reveals a clinical world fraught with uncertainties over how to treat black patients given resource limitations and ambivalence. Her book is a compelling look at the ways in which the politics of racism, attitudes toward pain and suffering, and the reliance on charity for healthcare services for the underclass can create disparities in the U.S. Instead of burdening hospitals and clinics with the task of ameliorating these disparities, Rouse argues that resources should be redirected to community-based health programs that reduce daily forms of physical and mental suffering.

Bondspeople who fled from slavery during and after the Civil War did not expect that their flight toward freedom would lead to sickness, disease, suffering, and death. But the war produced the largest biological crisis of the nineteenth century, and as historian Jim Downs reveals in this groundbreaking volume, it had deadly consequences for hundreds of thousands of freed people. In Sick from Freedom, Downs recovers the untold story of one of the bitterest ironies in American history--that the emancipation of the slaves, seen as one of the great turning points in U.S. history, had devastating consequences for innumerable freed people. Drawing on massive new research into the records of the Medical Division of the Freedmen's Bureau-a nascent national health system that cared for more than one million freed slaves-he shows how the collapse of the plantation economy released a plague of lethal diseases. With emancipation, African Americans seized the chance to move, migrating as never before. But in their journey to freedom, they also encountered yellow fever, smallpox, cholera, dysentery, malnutrition, and exposure. To address this crisis, the Medical Division hired more than 120 physicians, establishing some forty underfinanced and understaffed hospitals scattered throughout the South, largely in response to medical emergencies. Downs shows that the goal of the Medical Division was to promote a healthy workforce, an aim which often excluded a wide range of freedpeople, including women, the elderly, the physically disabled, and children. Downs concludes by tracing how the Reconstruction policy was then implemented in the American West, where it was disastrously applied to Native Americans. The widespread medical calamity sparked by emancipation is an overlooked episode of the Civil War and its aftermath, poignantly revealed in Sick from Freedom.

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.