For those intending to read up on the now burgeoning field of social and cultural studies related to ‘the body’ but who have lacked the time or were put off by the seemingly impenetrable text and heavily theorised nature of these writings, waiting has been astute. Here, in a slim, well-written volume, Julia Twigg has provided both a synopsis of two decades of research literature and a well-argued advocacy of the case for paying much closer attention to the body. Twigg argues that both health-care and social-care are essentially concerned with managing problems that arise from physical failings of the body. But the very centrality of the body for this work has paradoxically led to it being overlooked as a focus for social research and policy analysis. She points out that the dominant account of the body has been that of medicine and the biological sciences, which focus on disease, ageing and disability and associated social problems, and sees them as arising from pathology and individual physiology. In seeking to provide an alternative, socially-informed perspective, social researchers have consistently avoided the body, focusing instead on questions of social structure, and in so doing giving priority to analyses that address the political-economic interests involved, social inequality and the characteristics of administrative and financial systems. This situation is replicated at other levels of the system. For example, the dominant profession in the field of social care (at least in Britian), Twigg claims, has been social work, whose boundaries and interests are drawn in social terms to distinguish them from the medical and nursing professions. The ‘New Public Management’ approach to the administration of services, with its fetish for objective measurement, similarly adds to this avoidance of the corporeal. Consequently, policy making is a disembodied world informed by abstracted, neutral research. Focusing on the body can help remedy this, Twigg argues, as it ‘helps to make the rationalistic world of policy making more concrete, more earthy, more rooted in the realities in which it aims to deal’ (p. 173).

The development of the field of the sociology of the body owes much to the recent work of social theorists, in particular Bryan Turner and Michel Foucault. The basis of the new interest in the body from a generation of social researchers builds on this, reflecting the cultural turn in sociology and the rise of theoretical perspectives such as post-modernism and post-structuralism. Twigg provides a useful and critical introduction to this largely theoretical work in the opening chapters. While her concise discussion of these perspectives provides valuable background to the origins and conceptual underpinning of the material in the remainder of the book, these sections are the most complex and difficult to comprehend. This arises in part from the author's attempt to summarise complex and often contradictory theoretical positions in a few pages, and in part from the critical approach she takes to post-modernism and post-structuralism. Although the effects of discipline and control of the body have been emphasised in a number of seminal accounts, the emphasis on theory and discourse in much of this work, she argues, resulted in its own disembodied and abstract perspective. The approach of critical realism, which she praises as ‘increasingly influential’, is seen as offering a way through the dilemmas of mind/body dualism that have plagued scholars since Descartes. Her approach in the remainder of the book broadly follows this perspective. She argues that we are living beings that can be described at one level in biological terms, but that our bodies are in turn ‘interpreted, mediated and in part constituted’ through cultural and social processes. The introduction concludes with a discussion of cultural accounts of bodily difference expressed in social inequality, race and sexuality, the latter drawing heavily on queer theory. Cultural research on these topics is clearly summarised and made accessible to a broader readership.

The most interesting parts of the book for me were the later chapters which deal with several substantive topics from the perspective of the body: ageing, disability, medicine and health-care, obesity and eating disorders, home care, social-care provision as body-work, and the body and public space. In considering each of these topics, it is possible to advance arguments concerning the social construction of difference and to criticise and go beyond biologically reductionist accounts. An excellent summary of these arguments is presented in the chapters on old age and disability, which recognise that the underpinnings of both ageism and of anti-ageing are socially constructed and not biologically determined. But the real strength of Twigg's approach is that she does not simply leave these arguments uncontested. Instead she points to the need to acknowledge the reality of underlying physiological processes such as ageing. The disabilities and chronic illnesses that are so common in deep old age, for example, cannot be dismissed as just another cultural construction, any more than disability at earlier ages can be explained purely in terms of social ascriptions. Twigg hints at several points of the need to develop more comprehensive and complex theories that can bring together cultural critiques with embodied realism. Although she is unable to take the reader that further step, she lays the foundations out clearly.

Throughout the book, Twigg points to the ways in which research on the body has ‘destabilised’ comfortable normative assumptions about health and social care. She is also convincing in showing us how interesting and invigorating such analyses can be. I was left wanting to seek out a number of the studies summarised to read more. But there is little evidence that such analyses have so far reshaped policy or changed the operation of health-care or social-care services in productive ways. To those who pursue the approach she advocates, this is the challenge that remains. But it is a challenge that we can confront now with much greater confidence. Like other publications by the author, the book is a treat to read and is destined to be essential reading for students and anyone else with a serious interest in advancing our understanding of the operation of social care and health services.