Jonathan Cole. Massachusetts Institute of Technology, 2004, 330 pp. ISBN 0 262 033151 Price: £18.95

Jonathan Cole, a neurophysiologist with many years experience in the area of spinal injuries, writes Still Lives. Although the narratives have been collated and transposed into a book of nonfiction, the focus of the experiences contained within has been handled both carefully and judiciously.

The book uses a narrative approach to explore the lived experience of 12 people who have experienced a spinal injury. However, they have been taken from a fairly limited cross-section of the British educational, social, cultural and economic communities. The discourses focus on the gathering and interpretation of experiences, allowing the reader to interpret those experiences with assistance from the author. Some of the chapters attend to the physical effects, while others predominantly consider the emotional and psychological effects of coping and living with a spinal injury. The reader is left to draw his or her own conclusions about the extent to which a spinal injury disrupts the lives of the individuals for whom this applies.

The introduction allows the reader to gain access to basic medical and neurophysiological mechanisms thereby enabling them to understand more fully the complexity of the potential impact a spinal injury might have on an individual's physical functioning. However, the use of the medical model is limited in that it can only go some way in addressing the needs of the individual on a social, emotional, and psychological level. Taken in context, these complex aspects of an individual's function are well addressed within the narrative framework.

The remainder of the book is structured in such a way that the reader is able to gain an insight into the lived experience and journey of an individual with a spinal injury, through a number of interviews carried out and conveyed within a logical progression of chapters. Occasionally the text does not define certain medical terms that for a ‘lay person’ might prove problematic although the meaning is often conveyed through the rich description provided through the experiences offered.

Throughout the book, the narratives are interspersed with the author's analysis and supported by researched text. This structure is juxtaposed between academia, with suggestions of qualitative methodology akin to that of a research project, and one of a nonfiction novel. This positioning at times leads the reader to wonder whether the book is aimed at an audience of health professionals, to those who have had a spinal injury, to the general reading population or all three.

Each chapter allows the reader to access aspects of the lives of the chosen individuals indicating a selection process of not only the individuals but also their experiences. This selection process does appear to concentrate on articulate, well-educated individuals for whom the experience of a spinal injury has subsequently had a revelatory effect on their lives. It could be suggested that a greater cross-section of people with a spinal injury might provide the reader with a more rounded and varied understanding of the multiplicity of difficulties, needs and problems encountered by such individuals. However, a wide gamut of subjects is addressed, no matter how tentatively, by the author, ranging from responses of depression, suicidal ideation and despair through to those who have taken on a positive approach to disability through activism and the education of nondisabled persons.

Individual accounts discussed and analysed within the main body of the book confirm that the devastation and re-education of the individual's life world is one which often equates to constant re-evaluation of the ‘self’, perceptions of others and the emotional adjustments required to maintain a sense of location within the able bodied and disabled person's world. More than one narrative highlights the individual's political and emotional reactions, as well as discussing the progression through a number of stages in order to find a voice within the context of disability.

Within the text, the interest for the reader lies in the responses and perceptions of the persons for whom the spinal injury has had a profound and significant positive effect on his or her life and conversely, in those for whom this effect has not been met with such positivity. While it is heartening to note that for some the experience has had a motivating effect, for others, their candid narratives provide interesting, although less positive, outcomes which provide the reader with an opportunity to consider the complexity of living with a spinal injury.

Alongside the activity of readjustment are the constant references to the physiological needs of the body. For the reader without a disability, this explicit approach might be difficult to envisage but the narratives are generally sensitively couched in order to allow the reader to adopt an empathetic rather than sympathetic response. For those readers who take their lives for granted, the discussion of sexuality, bladder control and bowel movements, bed sores, skin care, breathing, standing, walking, muscle spasms, pain, using upper limbs, washing, eating and dressing may prove an eye-opener on many different levels. While surviving the problems and joys of work, financial security and relationships, which are familiar to the majority of the population, the consideration of learning to live with these within the constraints of a redefined body can be seen through these narratives to provide a completely different perspective on life.

Cole adopts an eloquent writing style, using specific language, form and content to convey meanings. Although the book veers off at times, it provides a valuable source of personal disclosure, which could prove edifying for others in similar positions. By engaging with narratives as a textual vehicle, the reader is able to gain an insight into the values, beliefs, goals and barriers to individuals whose lives have been disrupted by life changing events leading to permanent disability. The complications each person faces functioning on a daily basis after the traumatic effect of a spinal injury is one of the most powerful messages of the book. The narratives provide a means by which the reader can engage at any level, thus being accessible to those who are training to be health professionals, relatives, PAs (as referred to in the book on numerous occasions), carers or those for whom the narrative is a reality.