Each of the seven chapters in this short, quietly explosive book leads the reader further away from the details of constructions of identity, illness, and disability and into a thicket of new and disturbing questions about social and linguistic constructions of ailments and disabilities in general, particularly those that are not physically apparent. The book interweaves critical theories about time, memory, and the phenomenology of the body with accounts of and by persons with bodily ailments in order to ground a discussion of what we might mean when we say “disabled” or “abnormal.” I would like to see seminars across the disciplines, as well as in applied linguistics or sociolinguistics, using this text as a starting point for the kinds of reflective discussions of language that Ramanathan calls for.
Our linguistic constructs of “norm” and “normal,” which Ramanathan in Ch. 1 traces to the scientific rationalism of the mid 1800s, are maintained, for example, by formal policies around health insurance dictating coverage and funding for access such as wheelchair ramps, which in turn give rise to informal attitudes and ideologies about what is normal (4–5). What, then, is disabled? What are the differences between being a disabled person and a person with disabilities? There may be better questions to ask, given Ramanathan's trenchant comment that “viewing illness/disability in individualized ways runs the risk of framing it as personal bad luck, a risk that leans towards an orientation of charity” (6). Instead, looking at “societal views about ‘normalcy’” allows us to examine notions of equality and inclusion incorporated in “notions of ‘normal’ bodies” (6).
The next four chapters examine language used to construct cancer, diabetes, autism, partial hearing, and dementia. Ch. 2, on breast cancer, examines chemotherapy, amputation, and prosthesis, beginning with a discussion of gazes— “ways of seeing/interpreting/judging—that medical and societal discourses have perpetrated” (22). The breasts: are they separable from the woman? Do they become metonymic for the woman? The female or feminine aspect of the woman? If one breast is gone, is the woman a whole woman? The women whose autobiographical accounts that Ramanathan quotes are focused on narrating how they learned to recognize and to re-COG-nize (31; emphasis mine) their changed body, and to develop and redevelop personal agency as their changed selves. Part of their discussion is keyed to chemotherapy and to breast amputation (34): is reconstructive surgery or the wearing of a prosthetic a distortion of the self that first had two breasts and now has one? Ramanathan insists we look at our notions about “normal” and “attractive”: I hope readers will add a mental discussion of “natural.” If one is wearing a prosthetic breast sewn into a brassiere, a binding garment designed to make one look more attractive, is that breast natural? Or does it have to be sewn into the body to be natural? Or is the prosthetic nonnatural but the breast somehow natural again because it matches the other one? Because a breast is a body part that sticks out, that is seen one way by the surgeon's gaze, one way by a lover, one way by a baby, is it a separable body part that is reconstructed by each gaze? New questions grow steadily from those Ramanathan raises; this review can barely scratch the surface.
Ch. 3 focuses on autobiographical writings of persons who have Alzheimer's and also of their caregivers, looking at “contexts where the need to assemble selves through writing becomes both imperative and a crucial mode of survival…” As part of her own ongoing conversation about memory with Derrida's works (Ramanathan Reference Ramanathan2008), Ramanathan is concerned with looking at how one's scripted self shows traces not only of one's own leftover bits of memory and experience but also of the response and reflection from an Other. In this chapter, Ramanathan works with six diaries, some unpublished. She begins by considering how diary entries by persons with Alzheimer's reflect their grief at the loss of an ability to repeat what they could do or think or say before the disease so strongly affected their lives, and their effort to reassemble the new, constantly changing, self. Entries in diaries by caregivers show them attributing consciousness and intentions to their loved ones, “thus creating for them a sense of self” (55).
Diabetes and epilepsy, in Ch. 4, force writer and reader to confront a dilemma: Ramanathan notes the tension between dehumanizing medical discourses that emphasize “malfunctioning body parts” (60) and postmodern discourses of the malleable, performing body that she believes tend to over-romanticize it. To move between the horns of this dilemma, Ramanathan focuses on language around the experiencing of chronic ailments by the people with those ailments or conditions and by their partners. This chapter returns to the problem of how to define disability, cautioning readers that “‘disability experiences’ are not just constructs that emerge through language, but ones that construct as well” (65), as seen in an extended written discussion coordinated by Ramanathan between Jody, who has diabetes, and Sinfree, who has epilepsy (cf. Ramanathan & Makoni Reference Ramanathan and Makoni2008). As the writers share their first experiences, their fears, and some of their frustrations, they are able to move away from language labeling them as “a diabetic” or “an epileptic,” although they must still use medical language to name and discuss the conditions.
“Communication challenges” is the focus (and title) of Ch. 5, which looks at how we may read the behaviors of persons with autism and partial hearing, and raises questions about what constitutes “normal” hearing or “successful” communication, or comprehending another's communicative intentions. Ramanathan begins by asking how we can assume or ascribe intentionality to behaviors we may not understand. Drawing on the self-reflective writing of Mark Osteen about toileting and his autistic son, and the autobiographical account in which Shahla Mokhtarzade deals with her daughter's growing deafness, Ramanathan posits that from “a Bakhtinian-Vygotskian point of view, intentions might very well be part of inner speech” (92). Yet with whose intentions may we deal, she asks: those of the autistic son, the daughter losing her hearing, the agonized parent, or we who read?
Looking at serious, often invisible conditions or ailments and how people with those ailments struggle to make sense of themselves and their loved ones leads Ramanathan, in her last two chapters, to revisit previous sites in her own research and reflect on her previous efforts to make meaning. In Ch. 6, she reexamines tenets of applied sociolinguistics from her readings and rereadings over time of Derrida. In her earlier, doctoral research, she was “writing against scholarship that viewed human memories in purely mentalistic, cognitive terms, that characterized Alzheimer speech as being ‘meaningless’ and ‘incoherent’…”(101). What we readers discover with her is that she still espouses this stance; however, she would now oppose or “counter” the charge of incoherence in Alzheimer talk using a different argument—this one drawn from Derrida—to say that the emphasis on literal interpretation of language by clinicians omits the additional traces of meaning, the potential contexts offered by the speaker.
In Ch. 7, Ramanathan looks toward what applied linguistics research on critical ailments might include. She notes that the positioning of persons with ailments/disabilities is consonant with positioning for gender, ethnicity, race, and class (119): work on policy, medical classification, and racial disparities is called for, while at the same time, we must move beyond the language of medicine as being the sole language in which we discuss our realities, rooted in our bodies. It is to the body itself that Ramanathan turns, in a conclusion that both introduced her book and can, even must, introduce new interpretations and discourses. The body is important. The language around bodies and their breakdowns is important. We can move our thinking about bodies and breakdowns, perceptions and experiences to new critical planes, and by so doing, we receive “an education in cultural and social awareness” (124).
