De la responsibilidad individual a la culpabilización de la víctima: El papel del paciente en la prevención de la enfermedad (review)

Luis Monteil and Isabel Porras, eds. De la responsibilidad individual a la culpabilización de la víctima: El papel del paciente en la prevención de la enfermedad. Colección Actas. Madrid: Doce Calles, 1998. 343 pp. $30.00 (paperbound).

This volume, the result of a broad-based effort by an interdisciplinary group of Spanish scholars centered around the Medical School at the Universidad Complutense in Madrid, takes as its goal the examination of the "role conferred upon the patient in the prevention of illness in contemporary Western culture" (p. 11). While for the most part it is limited in scope to Spain and Western Europe, the editors and contributors largely fulfill their promise, providing scholars with a collection of fascinating essays on topics ranging from early views on dental hygiene and water cures to medico-legal judgments of juvenile delinquents to the representation of AIDS in contemporary Spain. Taken as a whole, most of the authors are primarily concerned with the discursive aspects of medicine in determining the patient's responsibility for individual and social health.

The topic is viewed through a broad lens, both chronologically and topically. The book is organized into six parts: the first two groups of articles examine the concept of "prevention" in both early modern and modern Europe (primarily Spain and Germany) for its social and political significance; the third part examines medical theories of responsibility and blame, primarily in their nineteenth-century context; parts four and five explore various aspects of social and legal responsibility for disease; and the final section looks at the contours of recently pathologized conditions such as smoking and menopause.

While it is difficult to choose any particular essay in this uniformly excellent collection, a number do deserve special mention. Juan Antonio Rodríguez-Sánchez highlights the complicated issues raised in the intermingling of science and religion in his look at the reception and influence of the ideas of German healer Sebastian Kneipp in Spain. Ramón Castejón Bolea sheds light on the growing significance of Spanish legal medicine in the campaigns against venereal disease in the nineteenth and twentieth centuries. Rosa Ballester and Emilio Balaguer's article on the role of medical experts in schools and the courts in disciplining the seemingly pathological behavior of underage subjects provides an enlightening look at an often overlooked subject. These essays--and most of the others--will be especially useful to scholars exploring similar questions in the United States, Latin America, and other parts of the world. Taken collectively, they not only provide comparative perspectives and new ideas for future research, but many also consciously build linkages between past and present constructions of medical responsibility.

This otherwise excellent volume is marred by some flaws, however. Inconsistencies in citation style and bibliographies may annoy some readers. On a more substantive note, the collection would have benefited from a stronger gender component. Isidoro Bruna Catalán and Maria Teresa Merino Rodríguez's commendable exploration of continuities in the stigmatization of menopause stands alone in its appreciation of the ways in which physicians and society at large hold men and women to different standards of responsibility for illness. To that end, additional examinations of mental illness or even rape would have significantly rounded out this collective effort.

While historians of medicine will welcome this close examination of Spanish medical discourse on the pathological subject, patient responsibility, the role of "life style," and other seeming choices in disease, the book's reach will undoubtedly be limited by its publication in Spanish. This is a shame, because it is a volume that deserves to be read by a wider audience of scholars.

Julia E. Rodriguez
University of New Hampshire

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