The Comfort of People

Daniel Miller, Cambridge: Polity Press, 2017, ISBN 978-1-5095-2432-7, 226 pp., Pb: £15.99/€18.72.

Part of the series To See Ourselves as Others See Us: Reviews of Anthropological Works by Non-Anthropologists

Reviewed by Denise Turner

In his introduction to The Comfort of People, Daniel Miller states: ‘This is a book about people’s lives not their deaths’ (1). Given that the book is a study of the social worlds of hospice patients, at first it is difficult to understand this statement. However, it is not long before the book’s warm and accessible tone, together with its vibrant depictions of people living with terminal diagnoses, delivers what Miller promises. This is a book about death which celebrates life and thereby avoids the mawkish portrayals that so often accompany similar accounts of death or dying.

Each of the 18 chapters, or ‘stories’ as the book dubs them, focuses on a different individual and their methods for creating social connections, drawing from fieldwork in a prosperous and largely White-British community. As the book progresses, common themes emerge which highlight the significance of ‘Englishness’ (9) in both community and individual relationships together with the impact of a declining social circle in later life.

Throughout the book, Miller argues for an understanding of ‘polymedia’ (13), a term which attempts to capture the proliferation of contemporary communication channels together with the ways in which they can achieve particular outcomes. As a term, poly-media eschews trite populist condemnations of modern communication channels in favour of a much more sophisticated analysis. What is distinctive about Miller’s analysis is the positivity which surrounds it, especially when it comes to social media. At a time when concerns about data storage are causing users to delete their social media accounts, Miller argues that this ‘social media’ is enabling people to forge and maintain relationships in innovative and beneficial ways (20).

Throughout the book, these beneficial ways are emphasised, for example, in the description of Sarah, whose newly acquired Facebook account allows her to share the progress of her disease widely, thereby avoiding the potential pitfalls of constantly repeating distressing information. In a different story, Emma’s iPad is a ‘bloody miracle’ in navigating her terminal illness (105).

Veronica’s story, by contrast, is characterised by the difficulties of communication at end of life. Having spent her entire career working for the National Health Service, Veronica feels let down by a lack of support from senior colleagues. This is compounded by both her husband and son, who find it difficult to talk openly about her cancer.

Similar problems with communication are developed in later stories, where issues of isolation, predominantly amongst men, are highlighted. Robin’s story in particular demonstrates how commercial relationships, such as those with a hairdresser or gardener, may become the only significant social relationships at end of life.

Themes from all the stories are progressed within the penultimate chapter as distinctive discussions on the role of friendship and the problem of ‘Englishness’ (199).

The final chapter captures key findings from Miller’s fieldwork in a series of pragmatic recommendations, beginning with a plea for ‘a necessary assault on the cult of … confidentiality’ (214), which Miller argues harms patients by forcing them to constantly repeat distressing prognoses.

Miller’s final recommendations all suggest ways of integrating new media within hospice services, ranging from establishing a digital buddy scheme to an e-listening/ consultation service and, ambitiously, the creation of a patient charter for new media use. Having worked within the hospice sector, I recognise the wisdom of Miller’s recommendations, which match the modern hospice movement’s drive to modernise in order to prevail. Additionally, whilst many research studies remain abstruse, drawing from my academic experience I can unhesitatingly recommend this accessible, practical book as a valuable exemplar of academic impact within the ‘real world’.

How Development Projects Persist: Everyday Negotiations with Guatemalan NGOs

Erin Beck, Durham, NC: Duke University Press, 2017, ISBN 978-0-8223-6378-1, 266pp., Pb: $25.95.

Reviewed by Bronwen Gillespie

How Development Projects Persist offers a detailed ethnographic account of two microfinance organisations in Guatemala: Namaste and Fraternity. By focusing on people – the people who receive loans, the people who offer them, and the people whose vision led to the organisations in the first place – Beck provides a rich portrayal of how development takes place. She shows how human agency makes gaps between policy, practice and outcome inevitable.

The book starts with a brief but very useful summary of the critical literature, introducing Beck’s agent-based approach to theorising development. Chapter Two sets out the Guatemalan context with a historical overview of development interventions and a special focus on the growth of the microcredit sector. Beck then concentrates on her in-depth case studies, examining NGOs’ organisational models and the on-the-ground reactions of the Guatemalan women involved. The book closes by summarising the conceptual contributions made through focusing on the socially constructed nature of development interventions.

Her presentation of two microfinance projects makes for very interesting reading. The contrast between a foreign business-style model in which providing loans is the central aim and a grassroots initiative using microcredit as a means to attract women for personal empowerment activities invites the reader to question assumptions regarding the legitimacy of certain types of projects or development goals. Careful analysis of the practices behind discourse shows how women react to development workers whose own visions and goals shape how projects actually unfold.

Beck’s ethnographic fieldwork, which traces policy and its implementation over time, allows her to make a strong case for putting people first and foremost in theorising development. We are shown that despite shifting trends development practice is shaped by individual actors (policy-wise and on the ground) perhaps much more than is admitted outright or understood by those working in or studying the field. She makes crucial points about the persistence of certain modes of work and project styles, describing how the unspoken desire for organisational survival can lead to programme continuity, despite little evidence that participants experience enduring changes in their circumstances. While organisations often assume that they play a central role in transforming people’s lives, for those involved projects may appear fleeting or underwhelming in the face of multiple other influences, actors and strategies.

At times, the ethnographer in me wanted to hear even more from women in order to reflect further on Beck’s suggestion that researchers examine what sort of agency certain development relationships constrain and enable, and for whom (212). While Fraternity openly aimed for transformative action to empower political voice, Namaste had a narrower business-oriented focus, often requiring decision-makers to wear blinders regarding possible structural factors limiting women’s economic futures. Although Beck makes it clear that her work does not aim to judge which development model is ‘best’, I would welcome further comment on how these development approaches limit or empower women’s agency in light of the structural constraints within which they struggle to meet their own goals.

Beck’s book is a useful development studies text for interested students and academics, with relevance far beyond Latin America. Its value lies in the good summary of critical viewpoints (Chapter One) and the clear illustration of how explicit goals can be diluted in everyday practice by multiple actors (Chapters Four and Six). It is also highly relevant for development practitioners as a reminder to learn from staff on the ground and be aware of the complex circumstances and biases within which they are immersed. Beck has made a lasting contribution to the field of development studies in theorising development as a social interaction while also raising important issues for policy and practice. Her book is a call to contemplate, assess and study development not simply according to the goals of policymakers and organisations, but according to the larger vision and life goals of the people that interventions hope to serve.

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Contributor Notes

Denise Turner has a PhD in Social Work and currently works as a Senior Lecturer in Social Work wthin higher education. As a Registered Social Worker, Denise has worked within a hospital emergency department and a hospice, as well as with children and families. Her teaching and research interests include narrative; social networking and digital innovation; grief; child death; and family transitions. Linking her ostensibly disparate research interests is an interest in the disruptions created by loss, change and transitions at either the personal or cultural level. Email: d.turner@londonmet.ac.uk

Bronwen Gillespie has a PhD in Social Anthropology from the University of Sussex, and specialises in development and global health. Her ethnographic work explores women’s agency in reaction to public services in the rural Peruvian Andes, and examines concepts of reproductive governance and social inclusion. She currently works as an independent re-searcher and development consultant, and has done so most recently on a maternal and child health research project in Guatemala. Email: gillespiebronwen@yahoo.es

Anthropology in Action

Journal for Applied Anthropology in Policy and Practice

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