This beautifully documented book was written in response to the House Joint Committee on Human Rights 2006-2007 call for a better understanding of hospital culture and its consequences. Its focus is on how things are actually done in hospital wards and with what impact.

Eight chapters develop this theme. We are introduced to the concept of cultures of care and ward life; we are helped to see ‘invisibilities’ – the needs and often pragmatic capacities of people with dementia, their embodied intelligence and the ‘logic’ of their praxis. We follow the bedside practices of recognising and attributing ‘dementia’ to patients in the wards and then examine the tension between, on the one hand, wanting to provide person-centred care with its often-slower pace required when caring for people with dementia versus, on the other hand, ward timetables, normative expectations (including notions of what things ‘ought’ to look like in a ‘neat tidy ward’), pressures, frustration and stress for care staff, linked to cultures of compliance. And we see how communication between care staff and patients living with dementia proceeds, with what kinds of consequences, including the use of containment, restriction and restraint. The undergirding theme, developed in the final chapter, is that identities emerge in ecological contexts and with consequences for the social distribution of problems in living – and therefore human rights.

For us, researchers currently focused on community music therapy in care homes and hospices and asking the question how, why and with what logics people ‘care for music’; even in extremis, this book highlighted three important, interrelated topics. First, self-preservation: How, within totalising institutions, do individuals engage in make-do, impromptu and improvised strategies as part of the routine care of self? Walking, for example, can be understood as an adaptive behaviour, a response to the sense of a restricted environment. To – literally – exercise freedom (of movement) is thus potentially to restore a sense of embodied agency. Is it any wonder that people like to move, even when movement involves risk (people with dementia, but also rock climbers)?

Second, communication and cognition manifest themselves in multiple formats, extending beyond linguistic matters. However, even when people ostensibly ‘share’ language, there may be no isomorphism between speaker and hearer. The ethnography of speech has long-highlighted the importance of local vocabularies and ‘indigenous’ speech practices and speech communities. We know that not all participants in hospital will be fluent in institutional parlance. And when people cannot employ linguistic communicative forms, they may nonetheless engage in embodied communicative strategies that exhibit practical logic. The ethnographer is often able to follow this logic because, in addition to methodological training, she/he has something hospital staff do not have – time. And it is time – or rather slow and gentle enquiry (being with) – that can reveal what at first glance seems to be lacking. Conversely, it is time pressure that prevents perception of people’s personal logics and communicative acts, exacerbating the perception of people as ‘problematic’. The result is exclusion from entry into the category of ‘having’ capability and/or capacity.

That exclusion plays into the third theme, namely the vicious circle set in motion when logics of practice are rendered invisible. Doing things, so to speak, differently – in non-verbal or ‘strange’ verbal ways – can then be allowed to serve as ‘evidence’ of pathology, and justification for compliance cultures within local ecologies. The authors describe, in ways that are redolent of Goffman, the oracular reasoning processes that lead to patients living with dementia being ignored, and to forms of symbolic violence. In response, these people/patients can be seen to retreat in on themselves or become distressed, behaviours that are then interpreted as further ‘evidence’ of disability rather than as, ‘a normal response to an abnormal world’ (p. 141). Thus, the hospital culture itself can be seen to produce or enhance the insignia of ‘the wrong sort of patient’, ‘highly dependent’, ‘cognitively impaired’ and in ways that ensure these labels are adherent.

This is a starkly beautiful book (the field note passages are often harrowing) and one that everyone should read. It highlights politics of identity. It shows how identities take shape and are allocated within institutional and organisational ecologies. It reminds us that many of the taken-for-granted assumptions about difference are, at least in part, of our own social, technical, material, aesthetic, economic and political making. And it reminds us that difficult identities and attributions may be reversed if we are willing to adapt the materials, practices, resource allocations and aesthetic preferences through which we enact the realities that are our lives.

这本记录精美的书是为了响应众议院人权联合委员会 2006-2007 呼吁更好地了解医院文化及其后果而编写的。它的重点是在医院病房中如何实际完成工作以及产生什么影响。

八章发展了这个主题。我们介绍了护理和病房生活文化的概念；我们有助于看到“隐形”——痴呆症患者的需求和通常的实用能力、他们的具身智力和他们实践的“逻辑”。我们遵循床边实践，识别病房中的患者并将其归因于“痴呆症”，然后检查一方面希望提供以人为本的护理，但在护理痴呆症患者时所需的速度通常较慢，这两者之间存在紧张关系。另一方面，病房时间表、规范期望（包括“整洁的病房”中“应该”是什么样子的概念）、压力、挫折和护理人员的压力，与合规文化相关。我们看到护理人员和痴呆症患者之间的沟通是如何进行的，带有什么样的后果，包括使用遏制、限制和约束。在最后一章中发展的基础主题是，身份出现在生态环境中，并对生活中问题的社会分布产生影响——因此也对人权产生影响。

对我们而言，研究人员目前专注于疗养院和收容所的社区音乐治疗，并询问人们如何、为什么以及以何种逻辑“关心音乐”；即使在极端情况下，本书也强调了三个重要的、相互关联的主题。第一，自我保护：在总体制度中，个人如何将凑合、即兴和即兴的策略作为日常自我护理的一部分？例如，步行可以被理解为一种适应性行为，一种对受限环境感的反应。因此，从字面上看，行使（运动）自由可能会恢复一种体现代理的感觉。难怪人们喜欢移动，即使移动涉及风险（痴呆症患者，还有攀岩者）？

其次，交流和认知以多种形式表现出来，超越了语言问题。然而，即使人们表面上“共享”语言，说话者和听者之间也可能没有同构。语言民族志长期以来一直强调当地词汇和“土著”语言实践和语言社区的重要性。我们知道，并非所有医院参与者都能流利使用机构用语。当人们无法使用语言交际形式时，他们仍然可以采用表现出实际逻辑的具身交际策略。民族志学家通常能够遵循这个逻辑，因为除了方法论培训之外，她/他还有一些医院工作人员没有的东西——时间. 正是时间——或者更确切地说是缓慢而温和的询问（与他人在一起）——可以揭示乍一看似乎缺乏的东西。相反，正是时间压力阻碍了人们对个人逻辑和交流行为的感知，加剧了人们对“有问题”的感知。结果是被排除在“具有”能力和/或能力类别之外。

这种排斥在第三个主题中发挥作用，即当实践逻辑变得不可见时，恶性循环就开始了。可以说，以不同的方式做事——以非语言或“奇怪”的语言方式——然后可以作为病理的“证据”，以及当地生态中合规文化的理由。作者以让人想起戈夫曼的方式描述了导致痴呆症患者被忽视的神谕推理过程，以及象征性暴力的形式。作为回应，可以看到这些人/患者退缩或变得痛苦，然后将这些行为解释为残疾的进一步“证据”，而不是“对异常世界的正常反应”（第 141 页）。因此，

这是一本非常漂亮的书（田野笔记段落通常令人痛苦），每个人都应该阅读。它突出了身份政治。它展示了身份如何在制度和组织生态中形成和分配。它提醒我们，许多关于差异的理所当然的假设，至少部分来自我们自己的社会、技术、物质、美学、经济和政治决策。它提醒我们，如果我们愿意调整材料、实践、资源分配和审美偏好，通过这些材料、实践、资源分配和审美偏好来实现我们生活的现实，那么困难的身份和归因可能会被逆转。