Book Review -- The Paradox of Hope: Journeys through a Clinical Borderland

This book is not about breast cancer. But it may be of interest to those who are exploring the discourse of hope that dominates biomedicine and the broader cultural landscape oriented to survivorship.

The Paradox of Hope by Cheryl Mattingly intimately explores the experiences of African American families who are caring for children with a variety of severe and chronic health problems and disabilities. The book is based on a multidisciplinary ethnographic study that took place from 1997 to 2009 across three primary sites in Los Angeles and involved more than forty families (of which, more than half were followed for ten years). Bearing witness to their crises as they navigate the medical system within the context of the multicultural urban hospital, Mattingly analyzes hope not only as an existential problem, but as a culturally and structurally situated practice that involves deep contemplation about what it means to have a good life and be a good person in the wake of suffering.

The book begins in the lobby of a clinic, a borderland of its own, a space of the “not-yet” where transient encounters bring patients, families, and strangers together in a permeable and seemingly endless state of anticipation, suspense, and uncertainty. It is a place of disquiet where wounds and humanity become visible, and harrowing circumstances and dramatic moments have the capacity to foster ties among people who would typically occupy very different spheres. It is a space where hope springs–not as an eternal belief but as an individual practice and ongoing conversation shaped by personal choices, relationships, interactions, the health care system, and the broader culture.

To acknowledge hope as a paradox, to recognize the realities of anguish, despair, and grief—is to give voice to the vicissitudes of life itself. Yet, The Paradox of Hope carefully documents and theorizes the complexity of everyday life as deeply rooted in the social and structural, with particular attention to race and class divides. It demonstrates that the effects of poverty are strong in limiting access to good health care and contributing to health disparities; that urban healthcare facilities are often underfunded, poorly staffed, and overcrowded; and that when health care professionals do not share race or class backgrounds with their patients and their families, miscommunications and “othering” may contribute to an erosion of trust in the midst of intense and risky medical situations. This scholarly book beautifully walks the reader through narrative practices, clinical settings, family dramas, and the mundane events that make up the territory of suffering.

A version of this book review was published in 2012 by Contemporary Sociology.


The Paradox of Hope: Journeys through a Clinical Borderland, by Cheryl Mattingly. University of California Press, 2010. 288pp. ISBN: 978-0520267350. 


Breast Cancer Consortium founder Gayle Sulik is a social science researcher and writer affiliated with the University at Albany (SUNY) Department of Women’s Studies. With expertise in medical sociology and interdisciplinary community research, her scholarship has focused on medical consumerism, technology, cancer survivorship, health policy, and specifically the culture and industry of breast cancer. She is author of Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health (Oxford, 2011) as well numerous articles, essays, and book chapters on health and medicine.

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