Valuable studies of medicine and health, Bronwyn Dalley

A Healthy Country: Essays on the Social History of Medicine in New Zealand
Linda Bryder (ed),
Bridget Williams Books, Wellington, 1991, $29.95

A Question of Adoption
Anne Else,
Bridget Williams Books, Wellington, 1991, $29.95

Selfish Generations? The Ageing of New Zealand’s Welfare State
David Thomson,
Bridget Williams Books, Wellington, 1991, $29.95

This attractive-looking trio of books adds to the expanding body of social history. Their subjects, for New Zealand at least, are relatively new fields of study. Considering the accelerated changes to all sections of the welfare state, including the provision of health care and access to adoption information, their publication is crucial.

A Healthy Country serves as a useful introduction to aspects of the social history of medicine and health care. The contributions focus on four main areas, specifically the consolidation of the health professions, the institutional medical environment, aspects of public health, and issues central to women’s health. Although presented as discrete issues, the topics are interrelated. The process of the medicalisation of maternity services, for example, the core of Charlotte Parkes’s chapter, sits firmly within the context of the rise of the health professions and the development of the hospital system, discussed by Michael Belgrave and Derek Dow. Linda Bryder’s introduction to the collection fails to draw together the commonalities of all the essays, and what is an opportunity to comment on themes beyond ‘imperial strategy’ or the ‘self-help’ ethos, remains untapped. Indeed, what emerged from this collection is a theme of increasing professional and official control over medical care coincidental with an expansion in the role of the state.

Although Bryder argues that ‘like medicine itself, medical history is no longer solely the preserve of doctors’, the emphasis of the majority of the essays is history ‘from above’, examining the organisation or activities of health professionals or groups. The recipients of health care remain largely invisible. Waltraud Ernst’s exploration of the major themes in Pakeha psychiatry points to the need to include a discussion of patients to provide a more complete impression of medicine. Issues raised by Tennant, Brookes and Parkes provide an indication of the possibilities of this, and no doubt future work will focus more intensively on this area. As a basis for ongoing research, and evidence of an increasing interest in aspects of New Zealand’s medical history, the collection is an important source for the general and specialist reader alike.

Anne Else’s discussion of the rise and decline of adoption in New Zealand from the 1940s combines the perceptions of officials and subjects involved throughout all stages of the process. A Question of Adoption examines closed stranger adoption, where the identities of the birth and adoptive parties remain unknown to each other. Else’s book emerges at a time of growing interest in this issue, particularly on an international scale, as illustrated by the recent publication of Vivien Pullar’s Romanian Babies, Robbery or Rescue? (Daphne Brasell Associates Press, Wellington, 1991), a subject which Else discusses in her final chapter.

Else attempts to lift the veil from around adoption and show it ‘for what it was ‑ a social experiment with unknown and uninvestigated outcomes’. She demonstrates how, in the face of social pressures and the actions of adoption organisations, single women were often unable to make a free and informed decision to hand over their children. Else suggests that adoption was presented as being in the interests of the children concerned, but in fact, centred on adult needs, often to the detriment of the birth mothers. Although Else argues this forcefully, showing the varied degree of official assessment of those wishing to adopt children, for example, her conclusions are not convincing. The implicit assumption that closed stranger adoption was a process in which the birth mothers were always the victims is not sustainable from the information provided. Important factors such as age, religion or socio-economic background played some part in a woman’s ‘choice’ to give up her child, and in official responses to the birth mother. Housing, employment opportunities, wages and child-care, and the changes in these during the period, would have affected individual and organisational actions. In the absence of a more detailed analysis of these circumstances, Else’s argument is contentious. For those interested in the process of adoption as such, A Question of Adoption is a valuable source, but for others looking to place this in its wider social context or discern a uniqueness about the New Zealand process, the work provides few pointers.

Of the three books, David Thomson’s Selfish Generations? is of the greatest moment and of the widest appeal, published in the wake of pivotal changes to New Zealand’s welfare state. Thomson’s thesis is that the welfare state has operated in the interests of one generation, that born between 1920 and 1945and he examines the various ways this ‘selfish generation’ has maximised its benefits, breaching the unwritten welfare contract between them in the process. Later ones in particular have paid, and will continue to inject, greater financial resources into the maintenance of the welfare state than earlier ones, and will reap fewer of its benefits. Thomson is careful to point out that this process is integral to welfare states ‑ and in this respect New Zealand is not alone – and is not a deliberate plot to disadvantage one generation in favour of another.

Thomson’s argument is persuasive, as he sets up and then rejects alternative interpretations for the actions of the welfare state. The suggestion that ‘the first welfare generation has remained the only welfare generation’ is not always obvious from the examples given, for it appears that such a definition could be extended to include those born up until the mid-1950s as well. The ‘crude and yet deliberate’ focus on generation to the exclusion of other social processes does leave crucial avenues unexplored, and Thomson’s brief forays into the differing effects of the political ageing of the welfare state on women and Maori give an indication of the directions in which further analysis could lead. As a frank and detailed study of changing social policy and priorities, this work is a major contribution to New Zealand historiography.

 

Bronwyn Dalley is in the History Department at the University of Otago. She is completing her PhD thesis on women’s imprisonment and has interests in women’s crime and punishment.

 

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Posted in Health, History, Non-fiction, Review and Sociology
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