Abstract
The topic addressed by Chronic Illness, Vulnerability and Social Work is the everyday lived experience of ongoing ill-health through the specific lens of autoimmune conditions, such as lupus, multiple sclerosis, rheumatoid arthritis, and scleroderma. In sociology and anthropology alike, pathological and non-pathological bodies have for long assumed greater significance. While this can also be found in other cognate sciences more broadly, as Price and Walker illustrate, this assumed significance is not as commonly found in the school of social work and care, where the embodied experience of health, illness, and disease has been far less engaged with. In redressing this disciplinary (im)balance, this volume, which is based not only on the testimony of several interviewees but also on the authors’ own direct experience of ill-health, provides a nuanced contribution to a research area previously left well-nigh untouched.
Overall, the book is of noteworthy linear coherence and is clearly structured into eight formal chapters, which all purposefully foreground the voices of people living with autoimmune conditions. After introducing the content of the book more broadly, in chapter one, Price and Walker outline the history of autoimmunity while deliberating on the biomedical and philosophical perspectives that reinforce the concept and its paradoxical nature. As the authors contend, autoimmunity is a pathogenic state where the self ‘creates the physical and existential conditions for illness’ (p. 7) rather than to protect it ‘self’ from disease. That is, how the body ends up ‘at war with itself’ (p. 11), to employ a much-used military analogue. Further on, in Chapter 2, we get to follow the authors’ exploration of the lengthy and intricate process of procuring a diagnosis of an autoimmune condition, a journey which is characterised by extended uncertainty in waiting for a ‘legitimate illness identity’ (p. 8) to be disclosed. In this chapter, Price and Walker exhibit the challenges that may come with autoimmunity (to patients and practitioners alike) and they suggest that, instead of being centred around a diagnostic moment, the uncertain journey for people with autoimmune conditions takes the shape of what they term ‘diagnostic vertigo’ (p. 31). The following chapters centre on placing the voices and experiences of people living with autoimmunity in the limelight. The reader is introduced to, for instance, the subsequent impact from relationships with clinicians, and other health professionals, in peoples’ everyday realities of living in a chronic state where ‘there is nothing more to be done’ (Chapter 3), and the often neglected context where the experience of chronic illness more broadly has been framed, such as how autoimmune conditions, in this case, may come to effect and change roles and responsibilities within families and other intimate relationships (Chapter 7).
In the eighth and final chapter, which foregrounds several of the volume’s most central arguments, the authors assert the importance and role of ‘chronic illness and the physical body in social work practice’ (p. 9). They contend that their respondents ‘never encountered or even thought of’ (p. 134) acquiring the service or expertise of a social worker in the course of coping with an autoimmune condition. As shown, the autoimmune body ends up in a contradictory place. Despite being central in the everyday social work practice, due to the nature and vulnerabilities of autoimmunity, the body turns invisible and thus absent from day-to-day intervention. However, while Price and Walker conclude the book by putting applied perspectives in the limelight, and furthermore ‘suggest ways which the social work profession might more profitably engage with the issues … highlighted’ (p. 9), as made transparent in the introduction, they do acknowledge that this work is ‘not a handbook for practice’ (p. 9). Instead, it aims to provide a setting for interdisciplinary conversations (theoretical and applied, respectively) to take place, and discuss the autoimmune experience as the ‘existential conundrum’ it has come to present itself as. Explicitly, as chronic conditions may come to introduce shifting roles, identities and responsibilities to peoples’ everyday lives and struggles, in the end, what does it mean and how does it feel to live with ongoing sickness and a day-to-day grind of illness?
In conclusion, Chronic Illness, Vulnerability and Social Work is an innovative and ground-breaking volume that enters and engages in a wide range of debates surrounding not only social vulnerability, independence, and resistance, but also with central concerns of the social work and care profession as such. Moreover, it is worth underlining that this contribution more broadly is indisputably enriched by the fact that the authors, Price and Walker, provide the reader with their personal and direct experiences of living with autoimmune conditions. While it is not a ‘memoir or a personal account’ (p. 3) per se, given their own experiences, Price and Walker are ‘inevitably and explicitly written into and refracted through both the narratives of [their] respondents and the theoretical frameworks [used] to explicate and analyse them’ (p. 3) – which definitely lends the content of the book considerable levels of depth and acumen. Apart from sociology, anthropology, and other cognate social sciences, this volume will certainly be of interest to scholars, students, or practitioners in the fields of social work, disability studies, nursing, and medicine.
