Sociology of Health and Illness Book Prize

Winner 2007

The BSA Medical Sociology Group is pleased to announce the winner of the Sociology of Health and Illness book of the year prize, 2007 which was awarded at the groups Annual General Meeting (7th September, Adelphi Hotel, Liverpool).

Stefan Timmermans (2006). Postmortem. How Medical Examiners Explain Suspicious Deaths. (University of Chicago Press, 2006).

Nominated by Professor Jonathan Gabe

This excellent book investigates how medical examiners do their work, and their connections to groups they usually serve: the criminal justice system, the medical establishment, bereaved family members and public health interests. Based on a three-year study of a single examiner's office in the USA (serving a population of more than a million) Timmermans traces how medical examiners remain near the bottom of the medical hierarchy, finding it difficult to attract new practitioners and governmental resources. They are also wary of their critics: grief struck families wishing to avoid the stigma of death by suicide certification, distraught parents that could be charged with crimes of child abuse, and public ridicule if their autopsy findings are found to be deficient in criminal investigations, leading its practitioners to take a conservative stance. Now the profession confronts new challenges as organ and procurement organisations seek to compromise its tradition roles.

Timmermans' book stands out for a number of reasons. First it took considerable courage to venture into a place that few sociologists would dream to tread to undertake sociological observations: the autopsy room of a medical examiner's office, where he observed more than 200 autopsies over a three year period. In our death-denying culture, observing death and the sights and odours that those who perform death-work experience daily at such close quarters took a steely determination.

Second, Timmermans makes a good case for what he calls a 'medical sociology of practice' - a sociology that privileges what pathologists actually do rather than what they say they do. Using this approach has enabled him to reconstitute the 'network of their work' in a nuanced way. And it has also highlighted how the substantive content of medicine is shaped by policies, relationships and other structural elements.

Third, and finally, Timmermans makes an important contribution to the sociology of the professions. He shows how the work of medical examiners can be understood in terms of both professional and cultural authority, and argues for an analysis which takes a middle path between Light's countervailing powers with its focus on the larger organisational context, and Freidson's privileging of the autonomy of the workplace. Timmermans shows that in the case of medical examiners the distinction between the workplace and the broader organisational arena is untenable. In order to maintain forensic authority medical examiners are required to consider the interests and needs of various external parties while investigating death, but the work itself determines the extent of third party involvement.

In sum Timmermans has produced an insightful and conceptually astute analysis, which has made a major contribution to our understanding of both the everyday work of the medical examiner and their status as members of a medical profession whose power is being challenged.