school-based samples (do early leavers maintain their sports involvement in the face of`competing' interests?), and the fact that some writers have claimed that youths are de¯ectedfrom physical activities by the e�ects of adult organization, rather than the loss of interest inthe activities themselves. Further, while the attempts at the theoretical modelling ofparticipation are to be applaudedÐand the chapter is indeed a good coverage of existingideas and extends theseÐthe fact that a process model is developed without some reference tothe views of Rutter (1996) on processes and mechanisms in a wider socialization perspectiveseems an important omission.In summing up my views on this text, it may be useful to record my wishes towards

restructuring. Firstly, I would have liked to see more European references, given the book'sinitial claims. If Scanlan and Greendorfer are regarded as important names, Fasting (1987) andother European researchers' work is also worthy of mention. Second, in a book that is based ona painstaking methodology of collaborating with young people, I was disappointed to ®nd thatnowhere in the text did `the voice of youth' sound out directly to provide some insights into theirperspective. Third, when I came with anticipation to the last chapter, hoping for an overallinterpretation or a further (universal) development and/or application of the proposed model(Chapter 9) or a more theoretical and less parochial analysis of sports policy (Chapter 10),instead all I found was a technical report of the research project, much of which I already knewfrom previous chapters. I would have preferred to read this as part of the appendices.However, I appreciate the di�culties the authors of this book have faced in translating a

large research endeavour into a reasonably focused book. Therefore I recommend this text toanyone wishing to explore young people's involvement in sport. As a sports writer mightcomment about a soccer game: ``It was a hard fought match with a good opening period,though there were, at times, some ``gaps'' in defence and in mid®eld. The excitement built up asthe game progressed. After a series of powerful, inventive attacks the game ®zzled out a little.Bringing on some European strikers could have enhanced the team's play. Nevertheless, manyspectators (i.e. readers) will enjoy the team's e�orts throughout'.

LEO HENDRY

Centre for Educational ResearchDepartment of Sociology, University of Aberdeen,

Aberdeen AB24 3QY, UK

REFERENCES

Fasting, K. (1987) `Youth sport: too boringÐrestrictiveÐcompetitive? 12th ICSSPESport and Leisure and 10th Trim and Fitness Congress Seminar, pp. 56±63, NIF (NorwegianConfederation of Sports), Oslo.

Rutter, M. (1996) `Stress research', in R. J. Haggerty, L. R. Sherrod, W. Garnegy andM. Rutter (eds), Stress, Risk and Resilience in Children and Adolescents, CambridgeUniversity Press, Cambridge.

Leo Hendry is Professor of Education at the University of Aberdeen and Professor in Psychology at theNorwegian University of Science and Technology, Trondheim. He is co-author (with J. C. Coleman) ofThe Nature of Adolescence (1990, Routledge, New York and London). His latest book (with D. Sanders) isNew Perspectives on Disa�ection (1997, Cassell, London).

The Greatest Bene®t to Mankind: A Medical History of Humanity fromAntiquity to the Present

PORTER, R. (1997).Harper Collins, London: pp. 831. £24.99 ISBN 0-002-15173-1 (hardback).

In this weighty book, Roy Porter, Professor of the Social History of Medicine at the WellcomeInstitute for the History of Medicine, suggests that Western medicine has become trapped by its

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own success in dealing with acute and infectious disease. This success may have led to theexpectations of both the public and the medical profession being raised almost to the point of afantasy that death can be inde®nitely avoided. On the ®nal page of the book, Porter commentsthat, although extending life may be feasible, it may be a degraded, neglected life due toresources getting over-stretched and politics growing meaner. Porter concludes that medicinemust change direction and rede®ne its limits if it is to truly meet the population's needs. Themessage of the book, overall, that we need to search for new ways to conceptualize, provideand evaluate health care, is in accord with the knowledge, beliefs and aspirations of muchof community psychology. We should be alert, at this time of political change, for ways to buildon this.The book begins with medicine before science. Descriptions of the short lives and painful

deaths experienced by most people throughout most of history and the gruesome nature ofmany treatments reminds us that there never was a golden age of health for all. Porternotes, ironically, that judging by our life expectancy, we are now healthier than we have everbeen, yet we are increasingly dissatis®ed with doctors and worried and preoccupied by ourhealth. However, according to Porter's own descriptions, many in the past must have beenpermanently worried about their own and their families' health too, and I was not convincedthat we are really more worried nowadays. Moreover, length of life is not the only criterion ofhealth. By broader standards, perhaps we are not living healthier lives.Porter draws clear links between methods of treatment for illness and socially-based con-

ceptual models of the meaning and signi®cance of life. He is respectful of healing traditions,emphasizing that throughout much of history, magic, religion and medicine have coalesced fortherapeutic ends. Yet, a substantial part of the book is a history of doctoring. Nurses receivean honourable mention but there is scant regard to other mainstream professions. There is adanger that this book may simply con®rm the public prejudice that medicine is mainly aboutdoctors and what they do. Despite its apparently radical message, it does not look to otherplayers in the health scene for clues as to how the required change in direction may comeabout.Most of the book deals in a factual, descriptive, way with scienti®c medicine, incorporating

absorbing anecdotes and extracts from a huge range of sources: archival records; personalaccounts; diaries and letters. Porter believes that engagement with detail is essential if we are tounderstand the powerful meaning of medicine. These central chapters illuminate the way inwhich the real, but limited, technical successes of scienti®c medicine may have led to a neglectof less glamorous preventive health care and to increasing emphasis on attempts to curewithout recourse to care, personal understanding or coping. There is no need to question themeaning, signi®cance and impact of illness when scienti®c rationality leads to the positivistconclusion that all can be explained and treated by reduction to biology, chemistry andphysics.For community psychologists, the pivotal section of the book is the middle chapter on

public medicine. Here, the links between social measures and improved health are clearlydocumented, with a clear implication that we must not neglect preventive aspects of healthcare. Porter is convinced that historical evidence con®rms that improvements in health havebeen largely due to the public health movement.Parallels between the nineteenth century and now are marked. Social inequalities continue to

bedevil our social structures, underpin much ill-health and still require social agitation andpublic action to enforce equitable and decent living standards. There is also a growingsuspicion of the limitations of science, demonstrated, for example, through the alternativehealth movement which was signi®cant in the nineteenth century, which saw the start ofhomeopathy, and which is now growing apace in the West. Porter describes alternative practiceas governed by a concern with empowerment, explanations, understanding and a sense ofwholeness. He contrasts the thinking of most traditional approaches to life and healing,characterized by understanding the relationship of human beings to the wider cosmos, withthat of scienti®c medicine, which he sees as based in a culture preoccupied with the individualself and his/her body.The ®nal chapters deal with the historical relationships between state, society and public and

individual health. It is good to see these issues expressed so cogently for public attention. In hischallenging ®nal chapter, Porter urges us to resist the temptation, fuelled by the pressures of

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powerful vested commercial and professional interests, to fall into the trap of trying to saveand enhance our own lives, perhaps through over-emphasizing cure relative to prevention andcare, at the expense of the well-being of society and the world as a whole. Our aspirations, hesays, are literally costing us the earth while rendering our lives empty and meaningless.Porter does not suggest any speci®c ways forward. I would argue that policy makers,

researchers and clinicians should listen attentively to the voices of those who use health careservices. We may discover that people's criteria for e�ective health care include not onlysymptom relief and cure but also understanding and explanations, humane and respectful careand empowerment through self-help. This may help us to rede®ne our limits and bring issues ofsocial power and social support into clearer focus, moving us away from an over-individualizedmedical system.This book is a tour de force: learned yet enjoyably accessible. Community psychologists

should read it to remind ourselves of our humble place in the wide scheme of social and healthcare but also for the historical support it gives to the view that, while valuing and respectingthe signi®cance of each person's life, it is at the level of social rather than individual changethat we have the greatest hope of improving the lot of mankind.Finally, two reservations about the book's title: what about womankind, and shouldn't

there be a question mark after ``The Greatest Bene®t to Mankind''?

ANNIE MITCHELL

Clinial and Community PsychologyUniversity of Exeter, UK

Annie Mitchell is Lecturer and Clinical tutor for the Doctorate in Clinical and CommunityPsychology at the University of Exeter and has a particular interest in user views of healthservice provision. She is co-author (with M. Cormack) of The Therapeutic Relationship inComplementary Health Care (1998, Churchill Livingstone, Edinburgh).

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