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Book Review Whiplash and Other Useful Illnesses. Andrew Malleson. Montreal, McGill-Queen's University Press: 2002, 532 pages. $49.95 Cdn. "Whiplash" hangs like an imprecation over North America, and much but not all of Europe. It conjures the image of relentless neck pain consequent to even a minor rear-end motor vehicle accident. That anyone might suffer this fate is deeply embedded in the common wisdom. It is institutionalized by an insurance industry that offers to indemnify us, by the regulators who mandated headrests in personal automobiles, and by a medical establishment that countenanced a certifying acronym, WAD (whiplash associated disorder). Whiplash takes its place among the many untested "truths" that we are wont to accept as part of our social order; whiplash is a social construction. Unlike most social constructions, whiplash was born to be contentious. That is fortunate. If social constructions are not recognized and challenged, they become creeds. Controversy unmasks their weaknesses and fuels advances in knowledge. To exist, whiplash must be indemnified. To qualify for indemnity, others must agree that the patient is a victim of a personal injury that is deemed consequent to the wrongful action of another. That is why the driver whose vehicle is rear ended is at risk for whiplash; the driver whose vehicle commits the rear ending is not, in spite of the first law of thermodynamics. If the driver whose vehicle is rear ended can convince all who question the veracity of symptoms, the victim is entitled to payment of medical care and compensation for loss of income if not compromise in joie de vivre. That is no mean task if whiplash is present in the absence of damage. There are people paid as believers and as doubters at every twist and turn in the indemnity process. Andrew Malleson is a doubter, unabashedly and unwaveringly so. He is also a keen observer of all aspects of this contest. He is a student of the relevant literatures. And he is an outstanding wordsmith. This monograph is a treat to read. It is a gauntlet for any or all the believers to pick up. It is a model for the way conytroversy can be marshaled to dissect a social construction. And it is successful in demonstrating the sophistical nature of the whiplash construction. I would recommend this book for all physicians who see their primary responsibility as educators of their patients, and for anyone else who feels at risk for medicalization by "whiplash" and its kindred labels. NORTIN M. HADLER, MD, FACP, FACR, FACOEM, Professor of Medicine and Microbiology/Immunology, University of North Carolina, Chapel Hill, NC, USA. |