The Goddess in the Mirror: An Anthropology of Beauty. Tulasi Srinivas. Duke University Press. 2025.

What does beauty and the many forms of labour, consumption and culture that surround it, look like in contemporary Bangalore (Bengaluru)? Tulasi Srinivas’s The Goddess in the Mirror is an ethnographic study of contemporary Indian beauty parlours in the capital city of the state of Karnataka, India. The beauty parlours located in every corner of contemporary urban India may initially seem like unlikely sites for political anthropology. But Srinivas’s detailed account of the moral, political and emotional worlds that sustain the beauty parlour begs to differ. Through vivid descriptions of bodies, relations, and myths, Srinivas adroitly demonstrates how the pursuit of beauty is deeply intertwined with gender, religion, and power in urban India. 

Beauty parlours have emerged as crucial sites for understanding contemporary urban life as spaces where gender, labour, consumption, and cultural transformation meet, yet few ethnographies have captured their complexity. Srinivas thus makes an original and worthwhile intervention with this work. Her scholarly background in anthropology of religion and ethics permeates the work. Each chapter explores a theme corresponding to an aspect of the goddess and a facet of beauty culture, providing the book with a conceptual symmetry. Srinivas’s analysis of beauty is deeply feminist, while also expanding feminist discourse by including perspectives beyond the heteronormative frame. This book challenges both Western feminist discourses on beauty, which are mostly centred on cisgender heterosexual women’s experiences and South Asian feminist scholarship on embodiment and public space. Both of those traditions have tended to overlook queer and transgender experiences in discussions of beauty, labour, and aspiration.  

Ethnographic approaches and urban context 

The book is immersive, seamlessly blending theory and case studies and a multi-sited ethnographic approach of participant observation and in-depth interviews at beauty parlours around Bangalore. Encompassing upscale boutiques to modest neighbourhood salons, the client base of these beauty parlours is wide, serving women from different classes and castes from middle-class housewives to working-class migrants and queer communities. This enables Srinivas to capture the heterogeneity of the beauty industry. 

The work situates intimate salon interactions within the broader context of Bangalore’s post-1990s urban transformation, during which the beauty services sector exploded

Crucially, the work situates these intimate salon interactions within the broader context of Bangalore’s post-1990s urban transformation, during which it emerged as a global tech hub. During the same period, the beauty services sector exploded, and by the end of the 1990s, the “personal care” market was booming. In this neoliberal urban milieu and capitalist expansion, when beauty work became a new labour niche, Srinivas’s ethnography stays attentive to everyday life and interpersonal relationships in the salon. She documents the intimate ties between beauticians and their clients, and how the salon becomes a microcosm of Bangalore’s social contrasts and connections.  

Her fieldwork combines traditional observation with a knack for narrative. For example, Srinivas describes sitting with beauticians as they styled hair or threaded eyebrows, and interweaves these descriptions with stories of film stars, Hindu goddesses, and personal hopes. She acknowledges the unstable power dynamics between the researcher and subjects in the salon setting, as well as the challenge of representing intimate, embodied experiences without exploiting them. Srinivas’s reflexivity about her own positionality as a researcher and as an Indian-American anthropologist returning to Bangalore strengthens the ethnography. She occasionally appears in the narrative, which humanises the account, renders her presence and learning process transparent. 

Beauty as a social, moral and political project

A central contribution of this book is its reconceptualisation of beauty as a richly layered social project. Srinivas notes that the concept of beauty has long been a central ethical category in South Asian cosmology. She illuminates how the abundance of beauty signifies auspiciousness, moral virtue and order, while ugliness in myth signals evil, chaos, or the asura (demonic) realm. This cultural association of beauty with goodness means that women’s appearances are never politically neutral.  

Clients and beauticians often reference Hindu myths in their daily salon conversations. These stories serve as models for women to interpret their lives and desires.

Srinivas argues that women in Bangalore’s salons practice ethical self-fashioning. As they seek smoother skin or more radiant faces, they also shape their “ethical subjectivities” through storytelling and ritual practice. For example, clients and beauticians often reference Hindu myths in their daily salon conversations. These stories serve as models for women to interpret their lives and desires. Beauty is a political resource, a way for women to navigate recognition as an intersubjective acknowledgement of one’s social standing and worth, as well as respectability and opportunities within the prevalent power dynamics.  

Rather than romanticise beauty, Srinivas outlines its complexity. It is not entirely empowering or oppressive, but a constantly evolving arena of negotiation. This perspective counters the Western feminist discourse that attempts to place beauty within binaries; they either view beauty solely as a patriarchal trap or they see it as a form of liberation. Within this context, Srinivas portrays beauty as part of everyday politics involving ethics and feelings. 

Myth, narrative and embodiment 

Salons of Bangalore are revealed as storied spaces where women often recount Hindu epics and legends alongside Bollywood plots and personal anecdotes, through which they process their realities. A beautician might compare a client’s predicament with a scene from the Mahabharata, or a group of clients collectively riff on the beauty contests of celestial apsaras. Such storytelling, Srinivas argues, functions much like Scheherazade’s One Thousand and One Nights (an endless story technique that is ultimately survivalist)She suggests that Bangalorean women sustain hope and community through shared mythic references. This perspective resonates with current anthropological interest in affect and futurity in neoliberal societies, as Srinivas aligns with scholars like Arjun Appadurai and Lauren Berlant who view narrative and imagination as essential tools for managing uncertain futures. 

Srinivas does not side with scholars (such as Talal Asad and Johannes Fabian) who argue that myth is “passé” in contemporary anthropology, a mere reflection of something else. In fact, in her fieldwork, she observes how myth provides a vocabulary of embodiment and emotion that bridges the personal and the cosmic. Srinivas’s writing excels in conveying the sensory and affective dimensions of this process. 

Caste and labour politics of beauty 

Srinivas also illuminates macro-political issues through grounded, everyday encounters, analysing the caste and class dynamics underlying India’s beauty culture. She delves into the politics of skin colour and caste to argue how fair skin – coded as savarna (upper-caste) and upper-class – remains a premium beauty ideal in India. Srinivas powerfully juxtaposes the myth of Draupadi with Mahasweta Devi’s subaltern story of Dopdi. Through this retelling, she exposes how social violence against darker-skinned women persists in contemporary India, albeit in new guises. She shows how caste inequalities are both reinforced and contested in everyday beauty work. 

A book that will resonate with scholars of gender and labour, urban anthropology, South Asian studies, and anyone interested in how everyday practices become sites of political struggle

Labour and economic exploitation form another critical thread of her work, as Bangalore’s beauty workers are often young women from the northeastern states or from marginalised caste backgrounds. Srinivas analytically links personal narratives of loneliness of migration and vulnerability to abuse, and a constant negotiation of belonging to wider political-economic structures. She argues that beauty labour is political labour in the sense of who gets to occupy urban spaces, whose bodies are considered desirable or polluting and how global capitalist forces intersect with ancient inequities of caste.  

One potential limitation of the work stems from its analytical breadth. Srinivas sets out to combine mythology, economics, sensory ethnography, and political critique all in one volume, resulting in certain topics being touched upon but not followed explored in depth. Similarly, the detours into Sanskrit aesthetics and epic myths might overwhelm readers unfamiliar with these references and can occasionally lead to an idealised interpretation of its role. 

That said, this is a valuable and nuanced book that will resonate with scholars of gender and labour, urban anthropology, South Asian studies, and anyone interested in how everyday practices become sites of political struggle. In terms of disciplinary impact, The Goddess in the Mirror may well become a touchstone for integrating aesthetic and affective dimensions into analyses of power.

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Care Poverty and Unmet Needs: Inequalities in Theory and Practice. Teppo Kroger, Nicola Brimblecombe, Ricardo Rodrigues and Kirstein Rummer. Policy Press. 2025. 

 A growing number of unmet needs 

Comparing the social care crisis to the climate emergency, as the editors of Care Poverty and Unmet Needs: Inequalities in Theory and Practice do at the outset, might seem hyperbolic, but it is not. Increased life expectancy and a decrease in global birth rates has raised the ratio of those in need of support. Meanwhile, developed welfare states rely heavily on migrant labour from the Global South, exacerbating the issue of care inequalities in those countries. Recognising the impact of unsustainable care systems on care outcomes, theorised as “unmet needs”, the contributors propose “care poverty” as an analytical framework encompassing the structural, political and societal causes of care deprivation. The book offers theoretical and methodological tools for measuring care poverty, grounded in case studies from across the Global North, which offer empirical evidence on the prevalence and key determinants of unmet needs. The combination of the two exposes the giving and receiving of care as highly gendered and entangled with an individual’s socioeconomic status.

Kirstein Rummery reviews feminist theory which argues that to ‘free’ women from unpaid ‘informal care’ (given by an individual’s familial and social network), the distribution of care ought to be the responsibility of the state.

The gendered nature of care 

The intersection of gender and care is first taken up in chapter two. Kirstein Rummery reviews feminist theory which argues that to “free” women from unpaid “informal care” (given by an individual’s familial and social network), the distribution of care ought to be the responsibility of the state. She compares such scholarship with the standpoint of disabled scholars and activists “who have fought long and hard to free themselves from the oppression, paternalism and segregation associated with state care” (17). Rummery concludes that if we reframe care poverty to be as politically charged as material poverty, care may be considered as a social right and therefore a public concern. However, this view is contested in proceeding chapters where gaps in “formal care” provision (state or market-based) are identified as being met by informal care given predominately by female relatives. 

As a past Direct Payment recipient myself, I can testify that having a choice over who provided my care and when, and being able to pay my PAs well, was an empowering, ethically sound experience.

There is a middle ground between formal and informal care which arguably mitigates the gendered devaluation of caregiving. The Self-directed Support system or “Direct Payment” provides disabled people with a budget with which to organise and manage their own care, and enables service-users to pay their carers or personal assistants (PAs) a higher rate. It therefore opposes the profit-driven model offered by market-based providers. However, Rummery contends that as the care recipient takes on the responsibilities of the employer, for the state, the initiative is a “cost containment measure, rather than embracing the ideological emancipation of those who need care” (20-21). This is an area of the text where lived experience may have been instructive: as a past Direct Payment recipient myself, I can testify that having a choice over who provided my care and when, and being able to pay my PAs well, was an empowering, ethically sound experience. 

Care poverty in developed welfare states 

Systemic underfunding across state-provided care is felt both in the availability and continuity of care. The book illustrates this reality through empirical insights on care poverty, including those shown to persist in developed welfare states. In chapter twelve, Petra Ulmanen examines structural inadequacies in Sweden’s community care sector through the notion of “managerial care […] a family caregiving task involving handling contacts with health and social care services in order to make them meet the care needs at hand” (172). This chapter offers some welcome lived experience accounts. Participant interviews evidence “managerial care” as being not only entangled with gender norms, but also social class and socio-economic status: “cultural and social capital possessed by service users in terms of education, networks, skills and resources” (173) enabled relatives to better navigate the system.  

Assisted dying as an existential threat 

Of some concern is the centring of the emotional and physical labour experienced by caregivers. Although the authors are reflecting data on care that is theorised as a “burden”, this term is arguably problematic. Here, the concept of care poverty appears to diverge from sociological understandings of material poverty which recognise the ways in which those experiencing poverty can be stigmatised and shamed by public institutions and cultural attitudes. Indeed, disabled activists are vigilant to the implications of stigmatising rhetoric. For example, the political signalling surrounding cuts to disability benefits in the UK, which has undertones of eugenics, has mobilised disabled individuals and activists to campaign against assisted dying legislation. Despite Kroger et al’s analogy between the social care crisis and climate change, they do not attend to the “existential threat” of assisted dying to disabled people, who fear they may be pressured into ending their lives as either a cost-saving measure to society or their families. 

Care as a universal social right

That end-of-life decisions may be influenced by financial concerns is potentially a crude definition of care poverty. Nevertheless, the authors’ synthesis of their theoretical, empirical and policy analysis shows how care poverty increases the risk of interdependence between care recipients and their carers, particularly when systemic issues leave both parties emotionally and financially vulnerable. The editors do advocate for care to be recognised as a universal social right, to address the privileging of care to those with either the funds to pay for it or the educational and class advantages to fight for it. To achieve this, Kroger et al argue that welfare states must reinvigorate welfare policies to ensure that they not only meet the continuing challenge an aging society presents, but do so in a way that enshrines basic human rights of dignity and respect. However, one can’t help but question where the political will to do so will come from. In the UK, successive governments have implemented increasingly stringent means testing measures which separate social care from a free-at-point-of-need NHS, and across the Global North, political policy continues to lean to the right which opposes social democracy. 

A solid methodological foundation by which to advance research in this field by introducing ways to mobilise the concept of care poverty.

As the editors themselves conclude, the book raises more questions than it answers, and is therefore offered as a “blueprint” (198) for further scholarly research. However, they do construct a solid methodological foundation by which to advance research in this field by introducing ways to mobilise the concept of care poverty. Among these is the need to involve individuals with lived experience in further research through a combination of survey and qualitative methods, and to employ tools which distinguish subjective perceptions of unmet needs from objectively defined measurement of need. The book is a valuable resource for scholars, students and practitioners in the fields of health, social care, social policy, economics and public health research. It further offers insightful and interesting contributions to feminist theory in particular, and provoked this reader to reflect on her own experiences of care and caregiving, before seeking out related research from the Global South. 

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Beliefism: How to Stop Hating the People We Disagree With. Paul Dolan. The Bridge Street Press. 2025.

The age of polarisation

In the past decade the phenomenon of polarisation – the tendency for differences in opinions to become more extreme – has affected societies regardless of their level of economic, political or technological development.  It has resulted in dysfunctional governments, fractured societies, and citizens’ weakened trust in the state. Amid these dangerous implications, scholars and policymakers have proposed ways to mitigate polarisation by bridging divides and building a consensus on contentious policy questions, including immigration reforms and climate-change policies, that sharply divide the public.

His project is not about reducing polarisation in views. Instead, Dolan addresses a specific form of polarisation that is characterised by hostility or negative emotions induced by differences in views – what he terms ‘beliefism’.

In Beliefism: How to Stop Hating People You Disagree With, behavioural scientist Paul Dolan sets himself apart from such efforts, emphasising that his project is not about reducing polarisation in views. Instead, Dolan addresses a specific form of polarisation that is characterised by hostility or negative emotions induced by differences in views – what he terms “beliefism”. But Dolan argues that people can suffer extreme positions without mutual disdain. He invites readers to shift their perspective from what people believe to how they feel about those who hold different beliefs. This focus on affect, rather than substantive disagreement, distinguishes Dolan’s contribution from more conventional approaches to polarisation.

Mitigating feelings of hostility, not the views themselves

Dolan’s contention that we can reduce feelings of hostility without changing the extremity of beliefs has an underlying assumption: extremity of views does not constitute a necessary condition for affective polarisation. This perspective considers that ideological polarisation (policy disagreement) and affective polarisation (emotional hostility) are separate phenomena and are not interlinked. This assumption is important because agreeing or disagreeing with it would point to divergent interventions to mitigate affective polarisation. Dolan adopts the view that affective polarisation is primarily driven by group identity ratherthan substantive policy differences.

However, this assumption is non-trivial and not uncontroversial. Evidence indicates that ideological polarisation significantly contributes to affective polarisation. Experimental research suggests that the description of political candidates as moderate or extreme influences voters’ emotions towards candidates. In addition, recent work has found that people care more about substantive policy positions than partisan loyalty when the two come into conflict. With the rise of extreme positions, policy differences become more pronounced and moralised. Individuals perceive higher stakes and formulate affective evaluations, which transform disagreements into moral boundaries of right and wrong.

Ways to foster cross-belief interaction and empathy

Dolan’s assumption about the origins of affective polarisation informs his framework for reducing emotional hostility. He proposes increasing tolerance towards opposing viewpoints through micro-level interventions, instead of taking steps to influence the media environment and elite polarisation that could directly affect policy differences. He encourages individuals to consider situational factors when evaluating others, to learn from their mistakes, to highlight commonalities, to support their positions with compelling evidence, to manage their emotional responses to disagreement, to ensure the diversity of experience in decision-making, and to spend time with people who hold opposing beliefs. These strategies – underpinned with evidence from behavioural studies about their efficacy – aim to increase cross-belief interaction and empathy. However, Dolan does not consider environmental barriers, such as algorithmic bubbles created by personalized content feeds and highly polarized elite rhetoric, which may make it difficult for individuals to apply these behavioural changes.

Democratic institutions and polarisation

While highlighting the role of situational factors in relation to policy issues, Dolan argues that the legitimacy of the policymaking process can help reduce beliefism. As he puts it, “If the processes in the environment are legitimate, then we expect to see less beliefism. […] In liberal democracies, most people appreciate that competing beliefs are put to the test at the ballot box” (80). Importantly, Dolan’s point is not about how democratic institutions may help narrow policy differences, but about their capacity to make opposing positions more acceptable. This reflects an optimistic view of the relationship between democratic practices and affective polarisation. The Brexit referendum in the UK was a democratic exercise, yet the vote deepened social and territorial fractures.

Dolan’s reliance on reason and evidence as remedies for beliefism also warrants scrutiny. He suggests that encouraging rational engagement with facts can soften hostility. Yet research in cognitive psychology and political communication consistently demonstrates that people rarely change their minds in response to new information.  When individuals are invested in their beliefs due to their extremity, they engage in motivated reasoning, accepting information that aligns with their group and discounting or distrusting information that does not.

The limits of empathy in persuading certain groups

In environments of extreme positions, evidence from the “other side” is not merely rejected; it is viewed with suspicion. For example, the policy differences on mandating COVID-19 vaccine led to personal insults against scientists in attempts to discredit the scientific evidence. Thus, Dolan’s emphasis on rational discourse underestimates the power of cognition driven by policy positions. And the widening of policy differences due to extreme positions is likely to enhance the use of motivated reasoning in interpreting information and evaluating evidence.

For individuals or groups whose identities are marginalised or historically devalued, engaging with opposing beliefs can entail significant psychological and social costs, especially when the other side’s viewpoint may deny their basic rights or humanity.

Moreover, Dolan’s appeal to empathy and perspective-taking, while commendable, contains an implicit asymmetry. The act of borrowing the other side’s perspective assumes that all parties enter dialogue on a relatively equal footing. Yet for individuals or groups whose identities are marginalised or historically devalued, engaging with opposing beliefs can entail significant psychological and social costs, especially when the other side’s viewpoint may deny their basic rights or humanity. Asking such individuals to empathise with hostile perspectives carries the risk of reinforcing inequities under the guise of civility. In such cases, appeals to tolerance are not neutral and instead place a disproportionate burden on those already compelled to defend their dignity or existence. This tension brings to view the limits of behavioural prescriptions: empathy and engagement, though valuable, cannot substitute for justice or equality in social relations.

The optimism underlying Dolan’s approach underestimates the extent to which affective responses may be rooted in ideological disagreements that have widened by social media algorithms, income inequality, and elite polarisation. Social media platforms, driven by the motive of increasing user engagement, promote extremist content. Further, research suggests that rising income inequality contributes to the uptake of extreme positions by political parties. While acknowledging the role of the “digital realm” in triggering emotional responses, Dolan urges individuals to manage emotional responses while leaving the online environment intact. However, without addressing the media environment that fuels polarisation and narrowing socio-economic disparities, efforts to cultivate civility would risk treating the symptoms rather than the sources of animosity. To achieve the goal of reducing beliefism, we must pair behavioural insights with institutional reforms that influence incentives for media platforms in promoting partisanship, and that help to reduce economic inequality.

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Behavioural Economics and Policy for Pandemics: Insights from Responses to COVID-19. Joan Costa-Font and Matteo M. Galizzi (eds.). Cambridge University Press. 2024.

Pandemics as revealing tipping points 

The editors of Behavioural Economics and Policy for Pandemics, Joan Costa-Font and Matteo Galizzi, start with a loaded statement: pandemics don’t just strain systems, they “can be seen as tipping points because they can radically affect the whole host of human behaviours”. One declarative line, and we’re pitched from lab psychology into a world of emptied streets and contested mask mandates. Does the 22-chapter collection cash the metaphor’s cheque? Mostly, though the spread and synthesis of topics and regions covered is somewhat uneven. 

Chapter Two sets out a three-part manifesto: people differ; the policies meant to budge them must differ; only randomised trials separate hunch from truth. The claim ripples through Part I. Loewenstein and Kinnane’s climate-change parallel notes that rapid adaptation can soothe or sedate, “a double-edged sword” that pacifies publics while dulling urgency (open-access chapter). Guenther et al. comb 70+ studies on risk tolerance and find no global post-COVID shift, just the hardy perennial of men scoring higher than women (their chapter; for the gender gap, see this pre-COVID meta-review summary of 150 studies: “Gender differences in perceived risk of COVID-19”, which recaps the classic meta-analysis). Cerutti stalks the risk-compensation spectre (“Put a mask on and people will crowd closer”) and finds “hardly any evidence” it mattered, which is consistent with a multi-country study finding no risk-compensation from mask use in public places (Nature Human Behaviour paper). Hodges, writing on advance-care planning, drops the bluntest statistic in the book: only about four per cent of adults in England had a living will as COVID hit (peer-reviewed evidence with the figure in context). Together these chapters hammer home that the idea of a typical decision-maker or “representative agent” died of COVID-induced irrelevance. 

Heroic volunteers, herd-immunity politics and experts under scrutiny 

Chapters seven to ten swivel from lab bias to policy appetite. A crisp primer on human-challenge trials (Adams-Phipps et al.) underlines that altruism, not hazard pay, lured thousands to volunteer. Banerjee’s 19-country panel becomes a mood seismograph: support for lockdowns shoots up as ICU beds fill, ebbs as case curves flatten. The swings suggest pandemic politics runs on perceived danger, not intrinsic love or loathing of state muscle. 

Brody, Saccardo and Dai ground that insight in vaccine roll-outs. In Sweden, a $24 incentive nudged fence-sitters; in a low-trust US county, the same carrot rotted on the stick. Kourtidis et al. then chart the blow-back: dietary relapse, doom-scroll insomnia, upticks in intimate-partner violence. These shifts didn’t just tag along quietly – they revealed how behaviour-altering policies ripple beyond their target. Behavioural aftershocks, the authors argue, are the next pandemic – subtle, cumulative shifts in everyday habits that trail crisis response long after the emergency fades. The section’s lesson is blunt: behaviour nudges work, until they meet a population shaped by different priors that is – different baseline beliefs, assumptions, and expectations about risk, authority, and health, different histories, different reservoirs of trust. 

Part I’s final trio flips the telescope. Adam Oliver fires a caution shot: behavioural scientists “strayed beyond their lane” when they prescribed blanket lockdowns on fragmentary evidence. Matteo Galizzi completes the pirouette, listing the cognitive potholes that tripped policy elites: hindsight bias – the illusion that events were obvious all along – anchoring on flu seasonality, the “herd-effect fallacy” that treats viral spread as pathogen physics, not human networks. The reflexive turn is the volume’s best surprise: behavioural economics is willing to put its own discipline under the microscope. 

Mind over mortality and the imperative of trust 

Part II zones in on clinics, kitchens and WhatsApp groups. Prieto and Vall-Castelló mine Spanish survey panels: women’s anxiety surged more than men’s, and routine GP visits fell off a cliff. Banko-Ferran’s US work echoes the race-class scars. Then Costa-Font and Vilaplana flip the script again: in high-mortality regions, lockdowns actually soothed nerves, proof that decisive action can feel like a life raft. The paradox unsettles the oversimplification that lockdowns were universally bad for mental health. 

Countries with thick layers of civic trust like Finland and Denmark saw steadier compliance and quicker rebounds. In contrast, low-trust settings fought policy fatigue and conspiracy churn.

Chapter 18 tackles the thorny topic of equity, mapping what it calls the “ethnic-minority vector” of vaccine hesitancy. The authors attributing successes to instances where messages came from community doctors, not distant ministries. Connolly and Srivastava track the tele-health surge, an accidental shift that may stick, provided designers remember that default log-ins beat glossy features. Costa-Font, Asaria and Mossialos then dissect regulatory over-caution: drawing conclusions from the AstraZeneca clot scare, they argue that “vaccine authorisation should not be held hostage by the ghost of one-in-a-million events.” 

Rudisill and Harrison’s cross-national trust audit builds on the case for the trust imperative. Countries with thick layers of civic trust like Finland and Denmark saw steadier compliance and quicker rebounds. In contrast, low-trust settings fought policy fatigue and conspiracy churn. They offer a neat aphorism to contain the pandemic’s chaos that health ministers would do well to remember: “Pandemics run on the fuel of trust.”

Both wide-ranging and deep in its coverage, the book has many strengths. The editors let messy data breathe, null or negative results aren’t swept aside, but interrogated. The global authorship pulls diverse levers, from Spanish mental-health surveys to Bayesian risk dashboards for human-challenge trials. And concrete blueprints abound: Ireland’s Behavioural Change Sub-Group (which ran a weekly survey and tweaked policy in response to the results), the four-branch decision tree, proposed by Brody, Saccardo and Dai, for matching vaccine nudges to hesitancy type, and a checklist proposed by Costa-Font, Asaria, and Mossialos for defusing rare-event bias before it snowballs into policy paralysis. 

The pandemic forced behavioural economics out of conference rooms and into cabinet briefings. Behavioural Economics and Policy for Pandemics captures that collision: its triumphs, blind spots and growing pains.

The book does have some shortcomings: Despite a handful of Brazilian and Indian datasets, the volume’s gravity field is firmly Global North. Africa is a footnote, Latin America darts in and out. Several chapters rely on lean samples: quick-fire online surveys, and convenience panels that wobble under close methodological weight. And the editors’ own promise of an “integrated” behavioural-policy synthesis is undercut by sectioning: mental-health shocks live in a silo, digital-health momentum in another, climate lessons in a third. A punchy cross-chapter conclusion could have stitched those fabrics tighter and extrapolated broader lessons. 

Why behavioural and social science matters 

The pandemic forced behavioural economics out of conference rooms and into cabinet briefings. Behavioural Economics and Policy for Pandemics captures that collision: its triumphs, blind spots and growing pains. Read it for the Irish case study that shows how fast evidence can cycle into public messaging; for the Swedish-versus-US vaccination contrast that eviscerates “one-size” evangelism; and for the regulatory post-mortem that reminds us: fear of tiny probabilities can cost real lives. 

Health-department strategists drafting the next outbreak plan, economists weary of monoculture models, social scientists hunting mixed results, not miracle cures and journalists chasing fresh angles on the next trust shock will all find it a worthwhile read. This is a reference book, dense with tables, footnotes and acronyms, so it won’t appeal to those seeking a page-turning narrative or a universal prescription. Yet in the welter of pandemic post-mortems, it carries a rare humility: the authors keep admitting what they don’t know. And as contributor Adam Oliver reminds us, “scientific expertise – even social-scientific expertise – is located within very specific domains.” This is a point worth remembering before the next virus outruns our certainties.

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Longevity Hubs: Regional Innovation for Global Aging. Joseph F. Coughlin and Luke Yoquinto (eds.). The MIT Press. 2024.

“One very telling measure of a country’s well-being is how its residents live as they grow older.” – Alyaa AlMulla, Longevity Hubs.

The age of longevity 

We are living in a period described by the United Nations as a “longevity revolution”, with projections showing one in six people in the world being over the age of 65 by 2050. As this future unfolds before us, researchers, policy makers, and innovators are hard at work to prepare for the economic impacts and opportunities that a fast ageing population presents. In Longevity Hubs: Regional Innovation for Global Aging, editors Joseph F. Coughlin and Luke Yoquinto set out to define and identify “longevity hubs”, or geographic hotspots with a relatively high level of innovation activity specifically aimed at older populations. 

The book is a two-part compilation of short essays authored by executives and CEOs from healthcare companies, assisted living centres, financial and investment firms, thinktanks, nonprofits, market research institutes, a medical billing software company, a VR start-up, and a self-driving vehicles start-up. In addition to the editors’ contributions, there are also pieces by academics from gerontology, architecture, neuroscience, and computer sciences.  

[The editors] propose the idea of a spectrum in which some longevity hubs excel at inventing scalable, exportable age-friendly or age-focused products and services, some excel at providing top-level quality of life to local ageing populations, and some excel at both.

The first part includes 32 essays that were originally published as opinion pieces by The Boston Globe in collaboration with the MIT AgeLab in 2021 and 2022 as part of a series called The Longevity Hub. Coughlin, the Founder and Director of the MIT AgeLab, and Yoquinto, a research associate at the MIT Age Lab, describe the book as partly being a permanent home for these works. The second part of the book contains nine additional essays from innovators around the world who each make a case for their region to be classified as a longevity hub. 

Emerging longevity hubs 

In the preface and introduction, Coughlin and Yoquinto pose questions about the conditions under which longevity hubs emerge, what keeps hubs going, how market knowledge flows between hubs, and who longevity hubs truly serve. To begin exploring the longevity hub concept, they sought to avoid predetermined definitions, citing their method of selecting “cities and regions by a simple criterion: their reputation as disproportionate hot spots of innovation for ageing has reached our ears” (xvi). In this way, the nine essays arguing for longevity hub status come from Dubai, Louisville, Japan, Milan, Newcastle, São Paulo, Tel Aviv, eastern Thailand, and the “Aging 2.0 global ecosystem” (a worldwide chapter-based network of cities and regions that organise conferences, maintain a startup database, and publish reports on age-related innovation). Analysing these submissions, as well as interviews they conducted with the authors, Coughlin and Yoquinto present a preliminary typology for focusing the definition of and making sense of a longevity hub. 

Contrasting approaches to age-centric innovation 

They propose the idea of a spectrum in which some longevity hubs excel at inventing scalable, exportable age-friendly or age-focused products and services, some excel at providing top-level quality of life to local ageing populations, and some excel at both. Each of the nine locations they evaluated are charted in the book according to their level of global aims, local aims, global input, and local input. They observed, for example, that their homebase Boston appears to have more global aims and inputs, whereas the Japanese sites and São Paulo have largely local aims and inputs.  

Additionally, their typology considers variables such as the number of relevant industries involved in age-centric innovation, if the innovation activities were more grassroots or top down, and the level of government support. Dubai, for example, has relatively few relevant industries, a hugely top-down approach, and a high level of government support. Founder of the UAE’s Longevity Think Tank Alyaa AlMulla describes in Chapter 12 how the government has placed a huge focus on providing high quality health care services and investing in healthcare research, real estate, and technology. By contrast São Paulo has relatively many industries, an entirely grassroots approach, and minimal government support. In Chapter 17, Layla Vallias, cofounder of the Data8 longevity economics research institute, explains that Brazil has a multitude of local business initiatives focused on the silver economy related to not just elderly care and care management, but also engagement and purpose, lifestyle, mobility and movement, mental health, and financial health. The editors hope that these regional analyses and initial explorations of the longevity hub concept will serve as a useful foundation for future research into the geography of age-related innovation.  

Scope and limitations 

Following the research set out by Coughlin and Yoquinto, the common thread running through the patchwork of essays is the authors’ shared interest in the “silver economy”. Also known as the ageing market, the term refers to the multi-sector market segment of products and services which are especially designed for ageing populations. The essays in Longevity Hubs reveal a wide range of thinkers and experts working to support their ageing customers to enjoy the best possible life quality for as long as possible through new and adapted age-friendly products and services. Examples from the book include intergenerational learning facilities, “mobility as a service” solutions, autonomous vehicles, management software for caregiving facilities, daily wellness rewards-based programmes, and community-centred living facilities. 

On the whole, this book is rather off balance. The 32 opinion pieces from The Boston Globe which occupy more than half of the book overshadow and fail to meaningfully connect with the broader theoretical concept of a longevity hub. This could be due to the fact that the book is not representing one cohesive study on longevity hubs but is rather a compilation of reflections from various figures working across the silver economy. The focus on global regions comes through in the second part of the book by nature of the geographically varied essays (though what constitutes a region could be better defined). 

In terms of advancing the development of products and services for older populations, the idea of longevity hubs may offer a useful framework to policymakers and those investing money and resources into age-related innovation.

In terms of advancing the development of products and services for older populations, the idea of longevity hubs may offer a useful framework to policymakers and those investing money and resources into age-related innovation. Further studies on the concept of longevity hubs may be relevant to business and economics researchers interested in innovation hubs. 

Longevity Hubs does not set out to deeply contribute to any research field per se, although academic readers will find interesting the initial typology presented in the introduction. This book will be primarily of interest to entrepreneurs, innovators, and policymakers who are developing and supporting technologies and solutions for local and global ageing populations.

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Menstrual Myth Busting: The Case of the Hormonal Female. Sally King. Policy Press. 2025.

The next time somebody describes a woman’s mood, behaviour, symptom, or condition as “hormonal” I strongly suggest you ask, “which hormone?” and “which study demonstrated a causal link?”.

Contrary to popular (and even medical) opinion, female prevalent health conditions are not caused by the “female” sex hormones. For instance, no direct causal link between either oestrogen or progesterone has ever been demonstrated in relation to PMS (Premenstrual Syndrome), PMDD (Premenstrual Dysphoric Disorder), morning sickness, peri-natal depression, or most peri-menopausal symptoms (in fact, oestrogen appears to protect our health and may contribute to cis women’s longer average life spans). Importantly, there is also no significant difference in circulating female sex hormone levels between those who experience debilitating symptoms during these key reproductive events and the majority of us who do not.

What is more, alternative evidence-based factors in women’s health are typically absent from medical and lay discourses on these topics (e.g., inflammation, iron deficiency/anaemia, underlying health conditions, poor social support, trauma experiences, and poverty).

Of course, the word “hormonal” also exists as a minimising/undermining euphemism for a woman’s mood or behaviour, especially if it challenges established gender norms. Indeed, as others have previously argued, the “hormonal female” is simply the contemporary iteration of the “hysterical female” gender stereotype. It perpetuates the biological-essentialist myth used over the past few centuries to justify gender inequalities in education, health, work, pay, political agency, and leadership.

So how and why do such widespread “hormonal” discourses (and associated gender myths) persist in the face of so much contradictory data?

This is what I try to demonstrate in my new book, “Menstrual Myth Busting: The Case of the Hormonal Female”. The book uses the example of PMS, to reveal the way in which gender and racial myths limit medical knowledge and practice regarding women’s health.

The first chapter provides a short primer in menstrual physiology beyond its hormonal coordination, to enable readers to engage with the rest of the book. You will learn all sorts of things that we should have been taught at (med) school but were not. For instance, why we menstruate given that 98 per cent of mammals do not, the abortifacient (not pro-pregnancy) function of periods, and the inflammatory nature of healthy reproductive processes.

I argue that the reason why we are not taught this stuff is largely due to pro-natalist influences within society and, thus, within science, too. Crucially, however, if all we are taught is that “the female (reproductive) body is hormonal” [in apparent unfounded contrast to male bodies], it’s little wonder that damaging gender myths continue to impact our health and lives.

Until we are taught more comprehensive reproductive physiology, including established sex differences in immune system function (to help us survive pregnancy), I fear we are destined to keep on getting it wrong.

The second chapter is a comprehensive summary of the biomedical and critical feminist literature on menstrual health and medicine. It focuses on the medical preoccupation of “blaming femininity itself” for the female prevalence of certain symptoms and health conditions. Taking a symptom-based approach also allows me to make an original argument about the unintentional perpetuation of gender myths in both literatures, as being partly due to a lack of (known) alternative physiological explanations. First, the womb was perceived as being the main/only physiological difference between the binary sexes, now it is our reproductive hormones… Until we are taught more comprehensive reproductive physiology, including established sex differences in immune system function (to help us survive pregnancy), I fear we are destined to keep on getting it wrong.

The second part of the book is based on my doctoral research, which compared expert (biomedical and critical feminist) and lay descriptions of PMS with the available population data regarding cyclic symptoms. The idea being that if participant descriptions did not match the available data, they must have been influenced by something else (i.e., unscientific discourses).

Chapter three outlines my research questions and the Critical Realist Discourse Analysis methodology applied to the interview data. This information is probably of most interest to fellow researchers, but it is also crucial to ‘show the working” when sharing findings that may challenge personal and professional beliefs.

The shocking discovery that even gynaecologists (let alone students, teachers, GPs and research scientists outside of fertility/menstrual health) are not taught healthy menstrual physiology beyond its hormonal coordination, is ultimately what prompted me to write this book.

Chapters four to seven outline the four main discursive themes identified in my PMS study. Each theme is described and supported by some fantastic participant quotes and the implications are summarised in a handy ‘so what?” section at the end of each chapter.

In short, the themes are “Mind over matter- the psychologisation of premenstrual changes”; “snatch 22 – premenstrual changes as simultaneously ‘normal’ and ‘debilitatin’g”; “The Curse-femininity as debility”; and “Black Box; the unknown/mysterious female reproductive body”. It was this last theme that prompted me to review the menstrual physiology content of several of the top medical textbooks available in the UK. The shocking discovery that even gynaecologists (let alone students, teachers, GPs and research scientists outside of fertility/menstrual health) are not taught healthy menstrual physiology beyond its hormonal coordination, is ultimately what prompted me to write this book.

We need to systematically improve reproductive health literacy, for all, right now.

The final chapter offers a short conclusion but is really more of a call to action. It explains how the four discursive themes identified overlap with three core gender stereotypes more than the available empirical evidence regarding cyclic symptoms. The “all in her mind”, “femininity as debility” and “mysterious female (reproductive) body” tropes combine to (unintentionally) reproduce the myth of the “hormonal/hysterical female” in expert and lay descriptions of PMS.

This is why we need to systematically improve reproductive health literacy, for all, right now. If not, I fear female patients, especially those who are also subject to compounding racist myths and misconceptions, will continue to face disbelief in, and the inadequate treatment of, their physical and emotional pain for centuries to come.

This post gives the views of the authors, not the position of the LSE Review of Books blog, or of the London School of Economics and Political Science.

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Sociality: Social Rights and Human Welfare (2nd Edition). Hartley Dean. Routledge. 2025.

Social rights and welfare have long been pivotal topics in both public policy and academic discourse. Over recent decades, governments worldwide have grappled with balancing the ideals of universal welfare with the economic and political constraints that shape their adoption. Scholarship in this area has evolved to reflect these tensions, offering critical insights into the shifting paradigms of social justice and human rights. Within this broader context, the concept of sociality has emerged as a vital lens through which to understand the interplay between individual needs, community responsibilities, and systemic structures. Sociality underscores the interconnectedness of human lives, emphasising that the pursuit of welfare is inherently tied to the social fabric that binds communities together. y

A new edition of Hartley Dean’s 2015 Sociality: Social Rights and Welfare presents a significant contribution to this field, expanding on his previous work while introducing a revised theoretical framework centred around the concept of sociality. Dean, an Emeritus Professor renowned for his scholarship in social policy, brings a unique perspective to this 10th-anniversary revision. It builds on the original’s core themes, introducing reorganised chapters and a fresh theoretical lens. Moreover, it presents a new narrative that further develops and applies his alternative theory of social rights – one grounded in the realities of human sociality. 

This revision incorporates a broader philosophical exploration of the link between human need, rights, and citizenship, providing a framework for critical social policy analysis.

Dean’s work (including the above and other notable publications, Dependency Culture (1992) co-authored with Peter Taylor-Gooby and Social Policy, 2006, 2009, and 2012) engages with a broader scholarly conversation that includes notable figures like T.H. Marshall, whose foundational theories on citizenship and welfare rights remain influential, and Nancy Fraser, known for her work on social justice and redistribution. These scholars, among others, provide critical context for understanding the evolution of welfare policies and rights-based approaches. 

The book is divided into two parts: the first, titled “Established Theories of Social Rights” (19), establishes theoretical foundations of social rights, and the second, “Social Rights in Practice” (109), focuses on their practical application. Dean’s central thesis proposes that sociality, “the ways in which humans attend to each other’s welfare” (1) is essential to understanding social rights as human constructs designed to meet fundamental needs and promote collective welfare. This revision incorporates a broader philosophical exploration of the link between human need, rights, and citizenship, providing a framework for critical social policy analysis. Dean attests that “developing the concept of sociality does help us to explain the relationship between social rights and human welfare in a ‘real world’ context” (xviii). 

In the preface and Chapter One, Dean introduces sociality as a defining characteristic of the human species. He argues that social rights, such as the right to work, education, shelter, are human inventions intended to guarantee essential welfare requirements. The clarity of this opening chapter sets the stage for subsequent discussions by defining sociality and emphasising its relationship to social rights. Dean suggests that “developing the concept of sociality does help us to explain the relationship between social rights and human welfare in a ‘real world’ context.” (xviii). 

The privatisation of public services, such as healthcare and education, has increasingly tied access to social rights to market-driven efficiency and performance metrics.

Chapter Two delves into social rights as a component of citizenship within democratic welfare-capitalist states. Dean emphasises the constructed nature of social rights, noting that they arise from negotiated compromises between class interests rather than purely theoretical principles. He highlights the paradox of modern social rights, which, while originally designed to empower individuals independently of market forces, now often serve to integrate individuals into market participation, even within the public sector. For example, workfare programs, such as the UK’s Universal Credit system, link social benefits to employment-seeking activities, compelling recipients to engage in the labour market rather than providing unconditional support. Similarly, the privatisation of public services, such as healthcare and education, has increasingly tied access to social rights to market-driven efficiency and performance metrics. Dean’s critique that administrative power is more technical than political makes a significant contribution to debates on neoliberal welfare policies. 

Chapter Three, focusing on human needs and human rights, emphasises that social rights are inherently relational, emerging from micro-level human encounters. Dean effectively critiques debates surrounding absolute versus relative need, arguing that such distinctions can obscure the broader purpose of social rights: articulating and addressing human needs. My own background in human rights studies made this chapter particularly engaging, as it was less theoretically dense than expected, yet conceptually rich. 

Dean’s integration of human rights doctrine, scholarly literature, real-world examples, and cross-cultural comparisons provides a grounded perspective on the theoretical debates.

Dean’s critique deepens in Chapter Six, where he questions whether social rights genuinely advance equality or instead reinforce existing power structures. While his analysis primarily engages with the UK Welfare State, he also considers broader international contexts. He challenges the assumption that the Welfare State has been a linear progression toward universal social rights, instead suggesting it has evolved as a tool of state control and capital dominance. In this light, he critiques policies such as means-tested benefits and conditional welfare schemes, arguing that they often serve to discipline recipients rather than empower them. His provocative analysis invites critical reflection on the limitations of welfare policies and their role in maintaining social hierarchies. 

The second part of the book shifts its focus to the practical applications of social rights. Chapter Seven, which explores rights to human services, is particularly impactful, breaking down key areas such as education, healthcare, and housing. Dean’s integration of human rights doctrine, scholarly literature, real-world examples, and cross-cultural comparisons provides a grounded perspective on the theoretical debates. For instance, he discusses the contrast between the UK’s National Health Service (NHS) and the US healthcare system, highlighting how universal healthcare models can promote social rights more effectively than market-driven approaches. Additionally, his use of boxed information summaries throughout the chapters offers useful supplementary notes that enhance the book’s accessibility to a wider audience. 

The final chapters offer a global perspective on social rights, with Chapter Nine presenting examples from Europe, Asia, Africa, and the Americas, while Chapter Eleven explores the mechanisms of redress available when social rights are violated and considers the various levels at which redress might be sought. These include access to justice, international mechanisms such as the ICESCR of 1966, and national courts, with Dean synthesising: “Social rights, however, are the rights of everyday life, and it is in the ordinary courts that they are likely most frequently to surface.” For instance, when governments fail to provide adequate housing, legal action can be taken under domestic human rights law, as seen in landmark cases like Grootboom v. South Africa (2000), where the Constitutional Court ruled that the state must take reasonable measures to fulfil the right to housing. Dean emphasises the need for effective enforcement and critiques the procedural barriers that often inhibit meaningful redress, such as overly complex administrative mechanisms. 

Dean’s work challenges conventional narratives of welfare state development and offers a thought-provoking framework for rethinking the relationship between social rights and human welfare

While Dean’s writing is academically rigorous, this edition is more accessible than previous works, balancing theoretical depth with practical insights. His discussion of sociality as both an ethical foundation and a policy tool contributes a fresh lens to the literature on social rights. However, while Chapter Six offers a sharp critique of welfare policies, it could have been strengthened by a deeper discussion of alternative policy solutions, bridging the gap between critique and reform. 

Overall, Sociality: Social Rights and Welfare is a substantial contribution to social policy scholarship. Dean’s work challenges conventional narratives of welfare state development and offers a thought-provoking framework for rethinking the relationship between social rights and human welfare. It will be of particular interest to scholars of social policy, human rights, and public administration, as well as policymakers and students seeking a comprehensive understanding of social rights theory and practice. 

Note: This review gives the views of the author, not the position of the LSE Review of Books blog, or of the London School of Economics and Political Science.

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Policing Patients: Treatment and Surveillance on the Frontlines of the Opioid Crisis. Elizabeth Chiarello. Princeton University Press. 2024.

The cover of Policing Patients shows row after row of little white pills with a rogue CCTV camera occupying one of the spots. In its diagnosis of an unending opioid crisis, the book outlines the promise made by this visual sleight of hand: sociologist Elizabeth Chiarello argues that healthcare professionals have swapped care out for a kind of carceral surveillance. Surveillance is, we know, both a popular metaphor and practice. The depth of her data and its comprehensive coverage of how US pharmacists, physicians, and police all now rely on prescription drug monitoring programmes (PDMPs) are breath-taking. But is the exchange Chiarello describes really happening? I found myself reading Policing Patients with the wrong kind of vigilant attention.  

Pharmacists can refuse to fulfil scripts if they think someone is drug-seeking or if the script is fraudulent. That said, that’s a difficult call to make about a person and a document you’ve never seen before.

Years of research on pharmacists who deny opioid prescriptions to patients drew Chiarello’s attention to the quiet roll-out of prescription drug monitoring programmes (PDMPs). She set out to understand pharmacists’ often overlooked role in patient care and their fierce commitment to precision. She thought that contraceptive provision would be pharmacists’ biggest headache. Through a decade of hundreds interviews across eight states, she realised instead that it was patient addiction. Chiarello documented how, as a response to the opioid crisis, PDMPs had changed pharmacists’ relationship to prescription-holders. She points out how overprescription of opioids for chronic pain and other illnesses initially created the opioid crisis, by encouraging addiction among patients. That cause, however, has given clinicians the false impression that just reducing the prescription rate for opioids will end the crisis.   

This emphasis on enforcement appears in how pharmacists fill prescriptions. As care providers, pharmacists can refuse to fulfil scripts if they think someone is drug-seeking or if the script is fraudulent. That said, that’s a difficult call to make about a person and a document you’ve never seen before. PDMPs, which monitor how and with whom patients seek to fulfil prescriptions, make the confusing question “Is this person a patient or an addict?” seem simple. PDMP data does not make a case alone, but they direct eyes towards patterns. They help healthcare workers determine what “looks suspicious,” which saves them time and doubt in their labour process. And with the prod of federal funding, PDMPs are now used across all kinds of law enforcement agencies and medical providers.  

The history of patient discipline and professional control by doctors goes a long way to explain how compatible surveillance practices are with medical care. 

Chiarello believes PDMPs have made medical workers surveil patients more – bringing law enforcement approaches into healthcare. Key to her argument is her concept of “Trojan Horse technologies”: PDMPs “usher enforcement logics into healthcare. Physicians and pharmacists who use them begin to accept policing patients as a core task, though they do not consider their actions policing.” According to her logic, because PDMPs were first used by law enforcement, they are infused with that profession’s values and practices.  

Making patient behaviours more visible to healthcare workers does encourage scrutiny. But how Chiarello frames this practice is questionable. Throughout Policing Patients, she proposes a disciplinary alliance between sociologists and historians – better able to understand the subtle effects of new technologies than policymakers – to improve healthcare for patients. But her Trojan Horse model ignores a basic concepts in the history of technology: “interpretive flexibility.” As historians looked closer at how technologies are made and spread, they realised just how estranged new adoptions are from old uses. Often, the way a technology is used strays far from its intended design.  

Patients themselves are conspicuously absent from this study. 

In a recent history of medical mediation technologies The Doctor Who Wasn’t There, Jeremy A. Greene shows how medical adoption of the telephone in the 20th century became a means to tether doctors to patient care, even as they experimented with telephones as a tool for diagnosis. I don’t think, however, that the inventors and promoters of the telephone had the proletariansation of medical doctors in mind at all. Rather, Greene suggests, the common use of a technology is determined by the conditions where it is used, an extension of professional authority coupled with a loss of control of the conditions of their labour. The history of patient discipline and professional control by doctors goes a long way to explain how compatible surveillance practices are with medical care. 

Patients themselves are conspicuously absent from this study. Chiarello claims the unhelped patients and addicts in the opioid crisis are central to her book, but we barely hear from them. She points out that increased surveillance of prescriptions can, on the one hand, deny pain medication from people suffering from chronic pain who need it and, on the other, prevent addicts from receiving the addiction treatment they actually need. Denying a prescription is a simple way for healthcare providers to make pain or addiction treatment another person’s problem. But the extended harm that could occur in either case, hinted at in a handful of patient narratives, is beyond the scope of Chiarello’s study.  

If we return and try to extend Chiarello’s Trojan Horse metaphor, things get confused. The Trojan Horse was a deliberate attempt at sabotage. Nowhere in Policing Patients is that clear. Police officers themselves didn’t build the software of PDMPs (or if they did, that history is not present). Nor did they force healthcare providers to adopt them. These professions have been tied together by the technology itself and their shared need to deal with the law, without legal training. PDMPs remove the requirements of legal interpretation from their work – this is the backbite of Lawrence Lessig’s “Code is Law.”  

In the last decade of “techlash,” academics have become comfortable in calling tech solutions what they are – crude profit-seeking tools that appear to solve complex social problems. Policing Patients is another example of this style of critique. Rather than suggesting an end to PDMPs or a change in professional standards, Chiarello wraps up her writing with a series of harm-reduction interventions that would actually begin to end the opioid crisis, like increasing funding for addiction treatment and the provisions and training for the overdose medication naloxone. But there’s a deeper problem.  

Chiarello ends Policing Patients by reminding us to always look a gift horse in the mouth. What if we do? The tale of the Trojan Horse is a compelling warning about false gifts. For PDMPs and techno-utopian tools writ large, the Trojan Horse metaphor implies volition on the part of its promoters, and it requires a gullible populace. What if, rather, and as seems often to be the case, we are well warned, but the potential boons seem too great to ignore? What if we feel wise in ignoring any naysayers? New technologies will continue to produce disastrous social effects until we find ways to put them under more scrutiny before we put them into use.   

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Menopause Transitions and the Workplace: Theorizing Transitions, Responsibilities and Interventions. Vanessa Beck and Jo Brewis (eds.). Bristol University Press. 2024.

How does menopause impact women’s ability to work, and how does work impact their experience of menopause? A recent title in Bristol University Press’s “Rethinking Work, Ageing and Retirement” series, Menopause Transitions and the Workplace, considers these question within the UK context. Edited by Professor Vanessa Beck, University of Bristol, and Professor Jo Brewis, Open University Business School, the book compiles the experiences of menopausal employees and offers critiques of the ways in which menopause is pathologised and stigmatised. Guided by interdisciplinary theoretical frameworks including sociology, workplace studies, feminist theory, and policy analysis, the volume makes an essential empirical contribution to the growing discourse on menopause transitions in the workplace. Engaging with the existing academic literature, by Butler, Steffan, and others, this book contributes to the scholarly discourse on workplace inclusion and gender equality and challenges the norms of secrecy and inadequate accommodations around menopause in the workplace. 

Vanessa Beck draws attention to how trade unions can be instrumental in advocating for and educating on menopause-inclusive policies in workspaces 

Menopause is a biopsychosocial process, marked by the cessation of menstruation (among cisgender women, transgender men, intersex and non-binary individuals) between 45-50 years age group. Its symptoms, different for each person, can include hot flushes, mood swings, and cognitive challenges. Such symptoms can significantly impact employees’ ability to continue working. The editors frame menopause as a condition that, though often medicalised, is shaped by several social, cultural, and environmental factors. 

Throughout the volume, the authors critique the biomedical model of menopause, which has traditionally promoted Hormone Replacement Therapy (HRT) as the primary solution. Karen Throsby and Celia Roberts promote alternative treatments and support systems beyond HRT that consider the social contexts of menopausal individuals. They suggest unifying workplace policies for all bodies that undergo menopause, including those who identify as LGBTQI+, have disabilities, experience premature menopause or have not gone through childbirth.  A subsequent chapter by Carol Atkinson, Catrina Page, and Jo Duberley advocate menopause-inclusive work environments. They discuss the barriers and stigma manifested as embarrassment, shame, taboo, and ridicule surrounding menopause that necessitates training line managers to support menopausal employees. This chapter draws from UK survey data and focuses on the roles of organisations and employers in normalising menopause-related discussions at work. The authors call for “substantial cultural change” in this matter.

Myriad workplace interventions […] have improved conditions for menopausal workers […] manager training and employer awareness, flexible working hours and virtual work access, organisational shifts, reciprocating feedback, and creating space for open discussions

Following that, Jane Parry’s chapter reveals the mismatch between organisational policies and real-life menopausal experiences. She depicts how menopause can induce women to think of quitting their jobs because their employers failed to address their specific adequately. Parry outlines the role of flexible working arrangements and systematic integration of menopause policies into human resources management practices to build more supportive work environments for menopausal employees. Similarly, Vanessa Beck draws attention to how trade unions can be instrumental in advocating for and educating on menopause-inclusive policies in workspaces. She indicates that trade unions are responsible for amplifying conversations regarding menopause between management and employees and enhancing working conditions. 

The subsequent chapter by Jo Brewis elaborates on how spatial justice is asserted in workplaces,  analysing empirical data through Philippopoulos-Mihalopoulos’ concept of spatial justice. This concept comprehends the corporeal negotiations and the conflicts between humans sharing the same physical space. The chapter depicts how menopause-induced hot flushes may conflict with temperature control policies in shared workspaces and posits that organisational interventions and individual empathy can mitigate the limitations of shared physical spaces. 

The book also discusses the capacity of male allyship in ameliorating the challenges of menopause for women. For their chapter, authors Gavin Jack, Hannah Bardett and Kathleen Riach interviewed six young men who recently completed or are about to finish their university degrees, and their mothers. Their findings suggest that these young men have a broad understanding of, and empathy for, menopause, and they feel committed to challenging the prevalent gender inequalities. 

The volume highlights myriad workplace interventions that have improved conditions for menopausal workers, especially in small- to medium-sized businesses. These include manager training and employer awareness, flexible working hours and virtual work access, organisational shifts, reciprocating feedback, and creating space for open discussions. These initiatives enhance productivity at work, especially for doubly marginalised menopausal individuals, like those who are LGBTQI+ or people with a disability. UK legislation, including the Equality Act 2010, protects menopausal employees from age and sex-related discrimination. The book aligns with the contributions of American sociologist Shelly J. Correll whose scholarship identifies gender discrimination in workplaces and proposes the need for academic research that promotes awareness and inclusive organisational policies. By discussing the proactive menopause awareness policies in workspaces, the present volume reinforces Correll’s contributions. 

Emphasising the understudied domain of menopause in the workspace, this book paves a path for future research interventions on workplace inclusion.

One limitation of the book is its confinement to the UK. Its scope could be broadened by exploring the experience of menopause for women in workplaces in other parts of the world, and how different social and cultural contexts impact them. Another criticism is that the book promotes flexible working arrangements without exploring the feasibility of such practices, which would be more difficult to implement in industries like manufacturing, construction, mining and others. Discussing the issues of menopausal individuals in the manufacturing sector and employees in remote work emerges as another research gap. Knowing the ground-level challenges in implementing the authors’ recommendations would also be interesting.  

Despite these criticisms, this volume is an important study that bridges the gap between academic research on menopause and practical strategies for supporting menopausal employees. The book frames menopause as a health concern and a matter of workplace equity by incorporating multiple perspectives, from trade unions to male allyship. It reinforces theoretical constructs like intersectionality, health issues, gender dimensions and workplace regulations. Emphasising the understudied domain of menopause in the workspace, this book paves a path for future research interventions on workplace inclusion. It will serve as a guide for scholars, employers, policymakers, human resource management professionals and union leaders in advancing gender-inclusive work environments. 

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

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Depletion: The Human Costs of Caring. Shirin M. Rai. Oxford University Press. 2024.

“Reproduction of life doesn’t just happen–it is laboured over, in different contexts and with differential resources, unequally.” So states Shirin Rai in the introduction to Depletion: The Human Costs of Caring, a sophisticated and thought-provoking analysis of the political economy of paid and unpaid care (2). Worldwide, the invisibility of this reproduction is mainly shouldered by women and “yet we rely on this work every day and know that without this work we will not survive–as a global population, culture and community” (2). The inequalities of reproductive work have been vocalised time and time again by feminists including Tithi Bhattacharya’s Social Reproduction Theory (2017), Nancy Fraser’s “Can society be commodities all the way down?” (2014), Servants of Globalization by Rhacel Salazar Parreñas (2015) and “Portraits of Women’s Paid Domestic-Care Labour” by Grover, Chambers and Jeffrey (2018), to give a few examples. It is a lonely and isolating battle, with scholarship on care often appearing as the last item of a conference schedule or a singular book chapter. Feminists continue to advocate for an inclusive agenda of care and social reproduction to be duly recognised as “work” in national budgets, policy and GDG. Few studies have captured the costs of social reproduction and their anticipatory harms in such a comprehensive and nuanced manner as this new book. 

Conceptualising the toll that care takes 

So, what is depletion? Rai invokes the term to explicate how the unequal distribution of social reproduction manifests harm to those who care for others (eg. mental and physical health, loss of career, personal safety, everyday structural violence, environmental damage etc.). Usually, caring for others is imagined as a rewarding, safe experience, its difficulties outweighed by its benefits. Rai courageously turns this narrative on its head, centring the harm caused through care work in its current form in the book’s four compelling argument. The first of these holds that an unequal system of social reproduction, which we are experiencing, leads to depletion and affects everyone engaged in social reproduction. Secondly, she argues that the reversal of harm requires seismic changes, not just mitigatory strategies. While mitigation, is the most prominent strategy of reversing depletion, it remains individualised and connects the worlds of paid and unpaid work in fundamentally unequal ways. Thirdly, she claims that besides human life, planetary care is a key factor in the vision of a good life for all and not just selected populations and countries. Finally, she makes the case that harm is embedded in locations and long histories of inequalities, such as gender, race, class, colonialism and slavery.  

Rai’s contribution is thus to conceptualise depletion as affecting a broad spectrum of stakeholders: individuals, communities, households and the environment. This novel framing of depletion is striking and is polygonal, convincingly capturing the tensions between unpaid and paid work.  

Depletion in context 

Conveying the multifaceted, painful and hidden labours of those who perform care is not an easy task. Rai achieves this through a meticulous mixed-methods approach combining participant observation, photographic portraits and interview narratives (a Feminist Everyday Observation Tool approach) that capture everyday forms of depletion through a fine-grained analysis. Crucially, Rai’s insightful conceptual framework eschews narrow area-specific, adult-specific and a class-specific analytical lens; her subjects and locations constitute the multiple, intersectional, intergenerational and overlapping, as well as different landscapes and of poverty and violence. Depletion is drawn out through a series of case studies demonstrating what it can look like in different contexts around different the world. There are chapters on children taking on unpaid caring responsibilities for their parents and grandparents in Coventry (UK) at the peril of their own childhoods, women in India leading different classed lives yet having to heavily negotiate non-state caring resources, and a South African Amadiba community resisting the violent onslaught of a mining company taking over their land. The picture painted across these contexts is one of hardship and struggle, of marginalised people contending with the harms inflicted on them by unequal systems.

The book showcases the energy, compassion and solidarity shared between communities around the world as they mobilise to overturn depletion and build more sustainable and just structures of care

The urgent task of reversing depletion 

Situating her work in the domain of feminist political economy, Rai’s deployment of temporality and spatiality foregrounds social reproduction as part of a continuum that should be valued consistently. This is in contrast to the sense of a momentary slippage that the COVID-19 pandemic prompted: governments newly found and arguably short-lived recognition of care work (embodied in “clap for our carers”) as essential work, worthy of gratitude and resources. It is important to remember that care and social reproduction has a rich history of enquiry and feminist agendas well before the pandemic. Rai draws on this broader social and scholarly context throughout the book, which makes for a text that is highly accessible to readers, opening the door for wide audiences such as students, anthropologists, sociologists, historians, policy makers, economists, gender and development studies, counsellors and activists, who will all surely benefit from Rai’s refined analysis. This is a remarkable achievement and an innovative way to foreground the inequalities of social reproductive labour, care economies and planetary harm and its human costs. More than that, the book showcases the energy, compassion and solidarity shared between communities around the world as they mobilise to overturn depletion and build more sustainable and just structures of care. 

Rai therefore concludes that there is hope, despite the scale of the task of reversing depletion. It may require a revolution as it slips down the list of governments’ priorities as the COVID crisis slips into the rear-view mirror. The book is a compelling call to action, urging us to mobilise against depletion and the deep-seated structural inequalities though which it operates. Above all, the book offers readers new theoretical directions, concrete visions and the momentum for a transformational feminist politics of care. 

Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.

Read an article by author Shirin Rai about the book’s research on the LSE Inequalities Blog.

Image: Eric Johnson Photography on Shutterstock.

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The post Depletion: The Human Costs of Caring – review first appeared on LSE Review of Books.