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Good Days, Bad Days: The Self in Chronic Illness and Time.

With Good Days, Bad Days, Kathy Charmaz confirms her position as one of the preeminent scholars of the experience of illness. Charmaz adopts a social constructionist perspective to examine how individuals structure their lives and maintain a sense of self when faced with chronic illness. This book differs from previous works in this area both in the wealth of detail it provides about how chronically ill people manage their day-to-day lives and in its fascinating discussion of the interplay of time and the self. For this book, Charmaz conducted 115 interviews with fifty-five people. Almost half were interviewed more than once, and sixteen were followed for at least five years. The book is rich with quotes from these interviews. Recognizing that interactions with doctors and hospitals represent only a small portion of the experience of illness, Charmaz interviewed most of her respondents outside of medical settings and included in her sample people who avoid as well as those who use medical care. The sample included men and women from diverse classes and ethnic backgrounds, although all were white. In Part 1, Charmaz identifies three ways of experiencing illness: as interruption, as intrusion, and as immersion. Those who believe that they will recover or at least will achieve a physical plateau can define their illness as an interruption, a "time out" from their usual life that does not warrant a change in their sense of self or future. Once illness becomes intrusive, however, maintaining the self becomes more difficult. Some respond by welcoming their illness and building their lives and selves around it, while others work to keep their illness invisible and separate from their sense of self. Most commonly, however, individuals learn to tolerate and to reconcile themselves to the current impact illness has on their lives but ignore the potential for greater future impact. By so doing they can retain at least some of their former self. This becomes increasingly difficult, however, as the effects of the illness broaden. Eventually, individuals can find themselves immersed in illness, losing their sense of self in what seems like endless, undifferentiated time. The two chapters in Part Il discuss everyday problems of living with illness. The first chapter explores how chronically ill people use concealment and disclosure to protect themselves, making decisions about when, how, and what to disclose. The second chapter discusses how individuals learn to organize and simplify their lives and to juggle and pace tasks so that they can remain in control and protect their sense of being independent, worthwhile adults. In Part 111, Charmaz extends her discussion of the relationship between time and the self among chronically ill people. Here she presents an engrossing analysis of how individuals structure and think about time, and how these "time structures" and "time perspectives" affect their sense of self. She contrasts, for example, those who can live their life one day at a time with those who must simply exist day to day. She also explores how and why chronically ill people focus on the past, present, or future, and the impact of this for the self. Charmaz concludes the book with a brief discussion of the policy implications of her findings. Like many observers, she notes that our health care system is oriented toward treating illness rather than maintaining health. Yet to retain control over their lives and thus their sense of self, chronically ill persons need access not only to crisis care but to a broad range of continuing rehabilitative services as well as social and economic supports. Thus she concludes that the emphasis on treatment probably affects chronically ill persons as much as if not more than healthy persons. The few weaknesses of this book are extensions of its strengths. First, Charmaz's desire to stay close to her respondents' experiences and let them speak in their own words led her to edit the quotes only minimally. As a result, they are sometimes hard to follow. Second, earlier writings in this area tended to look only at the interactions between chronically ill persons and health care practitioners, not recognizing that even chronically ill persons spend most of their time in the world beyond the hospital and clinic. In her efforts to avoid this pitfall, Charmaz largely has ignored the impact of health care workers on how chronically ill persons understand and manage their illnesses and their lives. Third, in focusing on the lives of individuals with such microscopic clarity, Charmaz gives her readers little sense of the broader context in which these individuals live. Thus, for example, she discusses how individuals hide their illnesses to avoid stigma, but provides no discussion of the social context in which illness becomes stigmatized. Similarly, she describes a woman who puts off major surgery because her lover fears he will be repulsed by her scars, but does not discuss the obvious role that gender and power play in this situation.

Despite these minor flaws, the book remains an invaluable contribution to the literature on the experience of illness.

Rose Weitz is a professor of sociology at Arizona State University, Tempe.
COPYRIGHT 1993 Hastings Center
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Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Author:Weitz, Rose
Publication:The Hastings Center Report
Article Type:Book Review
Date:Sep 1, 1993
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