A solid read but not a standout. I guess I'm the kind of person who, presented with an article about health disparities, would pretty much always clicA solid read but not a standout. I guess I'm the kind of person who, presented with an article about health disparities, would pretty much always click on it and read it. So one of the main themes of this book wasn't quite as informative for me as it should have been. I did enjoy it as a personal memoir of becoming a doctor--when people around him didn't always think he would succeed or even that that's who he was. It's interesting to see his careful way of thinking through how his personal experiences and medical practice connect....more
This book is similar to The Emperor of All Maladies in that it has a basic chronological structure, starting out with the primitive guesses of the ancThis book is similar to The Emperor of All Maladies in that it has a basic chronological structure, starting out with the primitive guesses of the ancients, then the attempts of Victorian gentlemen, and eventually getting to the work of modern scientists. It was more readable than his book about cancer because the contemporary science was split into understandable subsections, unlike his previous dive into cutting-edge molecular biology which gave me the intellectual bends. He covers epigenetics, gene therapy, and genetic testing, with the best explanation of CRISPR I've read so far. This is comprehensive and long, but Mukherjee's individual stories (including from his own family) keep the details from becoming untethered to real life....more
For once, I actually mean five stars in the sense of "everybody should read this book." This book is highly readable but contains stunning informationFor once, I actually mean five stars in the sense of "everybody should read this book." This book is highly readable but contains stunning information I'd never seen anywhere else (and includes numerous references to serious primary literature).
I was reminded (stay with me here) of ancient Egyptian funerary practices. After carefully embalming organs like the heart and liver, and placing them in canopic jars, the Egyptians pulled the brain out with a hook and threw it away, because they didn't really know what it was for. This is how most modern people approach sleep. We know it must be sort of important, because why else would it be there, but we're quite foggy on the specifics and tend to give it short shrift. At worst, we see it as an "annoying and enfeebling" obstacle to other uses of our time.
Some standout topics here: your natural day/night pattern and the buildup of a chemical called adenosine in your brain that makes you sleepy, which contribute independently to your sleep cycle; and how caffeine and jetlag get you off your rhythm. (This was particularly interesting to me because I read this on a long flight. I never sleep on flights to Europe and this book explains why: I'm not sleep deprived enough to have excess adenosine to make me sleepy, plus it doesn't feel like nighttime yet when we depart. So my brain isn't interested in sleeping. When I arrive, my goal is to stay awake until 9pm and at first, it's easy. That's the "day" part of the circadian rhythm giving me a bit of a boost. But soon, that fades away and the extra adenosine comes crashing down.) The role of sleep in processing memories and new information: sorting out what's important, solidifying newly gained understanding, and turning traumatic experiences into bearable memories. How all creatures sleep, but in different ways that make the brain-repairing effects of sleep compatible with their environments. Some things that we think aid sleep, like alcohol and sleeping pills, are only useful if your goal is to lie inert in bed; they don't lead to true, restorative sleep.
Oh, and the doctor who developed the system for medical residents, and insisted that long shifts and little sleep were essential training, was a big-time cocaine addict.
There's some genuinely frightening information here as well. Sleep deficits cannot be made up (sleeping in on the weekends doesn't help) and lead to shorter lifespans. Lack of sleep contributes to Alzheimer's disease, mental illness, and cancer. (The WHO categorizes night shift work as a probable carcinogen.) Drowsy driving is more common than drunk driving and more dangerous. We may be seriously harming the country's teens by forcing them to wake up and go to high school at an hour so inimical to the circadian rhythm of that age group.
I already follow the author's advice about "sleep hygiene" so I was mostly attuned to the scientific information and arguments here about social ills. Many people in my sleep-deprived cohort may be genuinely alarmed to read this book. But that doesn't mean you shouldn't! I read so many nonfiction books with titles like this one that are ho-hum--but this one's a humdinger.
This book has a riveting introduction containing a vivid description of a death by rabies. Then, however, the authors switch to spending 90+ pages recThis book has a riveting introduction containing a vivid description of a death by rabies. Then, however, the authors switch to spending 90+ pages recounting ancient and premodern stories and myths about rabies. Then they pick up the thread of actual science again, with good accounts of Pasteur's invention of a rabies vaccine and the recovery of the first patient to survive a full-on rabies infection. The book didn't feel that well organized and the material about how rabies is reflected in folklore (vampires, etc.) crops up throughout and felt repetitive.
The most interesting observation about rabies is a basic one: it's not a bloodborne disease but one that travels through the nervous system, which makes it both unusual (alongside tetanus) and slow-moving. After the bite of a suspect animal, there's a long period of waiting to see if symptoms appear.
Bottom line: an okay read, but I'd recommend Spillover before this book.
ETA: The Radiolab episode Rodney vs. Death is about half an hour long and covers a lot of the most interesting parts of this book (the authors participated in it)....more
This book exceeded my expectations in both form and content. The author assembles a devastating case against the low-fat diet that has been recommendeThis book exceeded my expectations in both form and content. The author assembles a devastating case against the low-fat diet that has been recommended by doctors and government agencies as a way to prevent heart disease. My interest was piqued because my family--dutiful "compliers" with health advice, one and all--zealously partook of the low-fat carb-fest that was the 1980s through 1990s. Several of my family members now have serious health conditions that I can hardly say were caused by this diet--but I'm sure it didn't help. Sample food selection from these days: unlimited snacking on low-fat pretzels. It's okay if they don't have surface salt!
What Teicholz shows is a cascade of inane decisions on top of each other, reminding me a bit of the episode of The Simpsons where they release lizards into the wild to kill birds, confident that they can then "unleash wave after wave of Chinese needle snakes" when the lizards proliferate, and then take care of the snakes with gorillas, who will "simply freeze to death" "when wintertime rolls around."
In this case, we have a weak association between cholesterol and heart disease, which turns into a frantic effort to lower cholesterol, which is achieved by eliminating saturated (animal) fats in favor of vegetable oils. These oils need to be made solid to be put in packaged food, so they got partially hydrogenated. Then we realized trans fats were bad for you so we replaced those with interesterated (sp?) oils, which turn out to be toxic when heated to high temperatures. No reliable evidence existed for many of these steps; for example, the vegetable-oil diet seemed to make heart-disease outcomes worse, but by that point, researchers were so religious in their quest to lower cholesterol, they didn't consider that important. In fact, any time researchers came up with evidence that ran counter to the "diet-heart hypothesis" they got shouted down, or their data was treated as a problem to be explained away rather than considered. Meanwhile, dietary fats got replaced with carbs, with results that we're all familiar with.
Some of the mistakes in this science are such boners that they're breathtaking. Remember the "Mediterranean Diet" that was supposed to be so ideal--lots of vegetables, grains, and olive oil, and not many animal products? The Europeans who followed this diet had low heart-disease and such natural lifestyles! It turns out that the original study about the Greek islanders was done during Lent.
As for the form of this book--it's almost entirely about heart-health rather than diabetes or obesity, and therefore contains zero-percent concern-trolling by volume. Nor is Teicholz very interested in providing actual diet advice to the reader (you could read some between the lines if you like). Instead, this is a story of the processes of science and publishing going wrong; of advocacy groups exerting disproportionate power; and of how extremely difficult it is to do ethical, conclusive research on such a complicated system as the human diet. The American Heart Association comes off particularly badly, and looking at this book alongside my recent read The Emperor of All Maladies you could become suspicious that correct scientific ideas don't need associations like this; the groups flourish when desperation to do something about a health problem outstrips knowledge of what is to be done. There's also one passage here--about how you can assert almost anything if you throw enough variables in the pot--that should be assigned in statistics classes.
Consider this not a diet guide but an analysis of a scientific community that lost its way and an indictment of government making recommendations without solid reasons. If it makes you feel free to enjoy a nice steak afterwards, that's just a bonus. ...more
I'm late coming to this book, but it was a great read that significantly updated my view of a difficult topic. Mukherjee pursues the history of three I'm late coming to this book, but it was a great read that significantly updated my view of a difficult topic. Mukherjee pursues the history of three ways of attacking cancer: eradication through surgery or toxic medicines, prevention, and thwarting cancer's progress with targeted molecular drugs. He marshals an incredible amount of historical, biographical, and scientific information, and it's only in the last part of the book where the weight of the complexity bows it down. There's no way for him to make the Ras-Mek-Erk pathway as easy to picture as the surgeries of the 19th century. (Which, after reading this book, you will be glad not to live in.)
Instead of just enumerating the relevant events, the author describes the worldview that affected the path of opinion, fact, questioning, and discovery. For example: "They lacked formal proof, and as they went further up the isolated promontories of their own beliefs, proof became irrelevant and trials impossible to run. The more fervently surgeons believed in the inherent good of their operations, the more untenable it became to put these to a formal scientific trial. Radical surgery thus drew the blinds of circular logic around itself for nearly a century." In this way, the advances he describes follow logically even for the non-expert reader.
I thought Mukherjee was an excellent writer who could be clear and simple as well as playful: "a pukka Englishman and his puckish counterpart" is how he describes one scientific partnership. His editor, however, does not deserve a Pulitzer and I'd use this work as a textbook example of why you need an author, a copyeditor (to prevent misspellings and other blatant errors), and a line editor, even with a really good writer. The first time Mukherjee used the word "retinue," I consciously remarked on this excellent word choice. The next few times it came up, I thought it was overused, and at one point it appears twice in back to back sentences. We hear about "the final rondo of legal assaults against tobacco"--he simply must mean "salvo." Elsewhere, "within three months of treatment, [a patient] gained nearly half his body weight and shot up two feet in height"--this does not seem possible, even as a medical miracle. I'm not suggesting that this spoiled my interest in the book; I'm just mentioning it because other people have already discussed the material so thoroughly, and I can't recall any comparably obvious mismatch of author (great) and editor (out to lunch)....more
I picked this up because I was actually a subject in one of Dr. Blaser's experiments a few years back when I worked at NYU--the study was about the miI picked this up because I was actually a subject in one of Dr. Blaser's experiments a few years back when I worked at NYU--the study was about the microbiome of people who do or don't have eczema and I was a control subject, which required me to walk downstairs to his lab every few months and have a grad student swab my elbow, cheek, and knee.
The book was worthwhile but I wish Blaser had put more effort into explaining the science at a deeper level. While he avoids the faux-peppy style I've complained about before, he explains binomial nomenclature and other topics that you'd think any adult bothering to pick up a book like this would understand. The "how" in "How the overuse of antibiotics is fueling our modern plagues" means "I'm going to assert that" instead of "I'm going to explain in detail the means by which."
To backtrack a little, here's Blaser's thesis in a nutshell. Humans are covered with zillions of bacteria that live in different mixtures in different parts of the body, like the skin, intestine, or vagina. (Whenever I think of this, I picture Mr. Burns's Spruce Moose freakout on The Simpsons.) We are overusing antibiotics in a variety of contexts: using them in a knee-jerk way when they're not even needed for minor complaints; giving them to livestock to promote growth; giving them to children in a critical window of their development; using broad-spectrum antibiotics which are efficient to develop and sell rather than narrow-range ones that don't cause as much collateral damage to the microbiome. Antibiotics don't kill all the bacteria, but they change the environment so that helpful ones may lose out or destructive ones get a leg up. Blaser tries to show how this imbalance could be implicated in all sorts of modern conditions like asthma, obesity, etc.
The research is still in early stages, so he doesn't yet have a pill full of specific bacteria to fiddle with your natural population and knock out your allergies. Still, the book could change your behavior in terms of what kind of food you buy (do you pay extra for the no-antibiotics chicken?) and what you ask your doctor for (do you beg for antibiotics, or start questioning whether they're really needed?). Also, he is trying to raise awareness of antibiotic-resistant bacteria and the possibility of a fast-moving superplague we're not equipped to fight.
This was a fine read, but I could have walked, not run, to read it....more
I found this book worth reading but I'm not confident it's more worth reading than the much shorter magazine article version. There are several ways oI found this book worth reading but I'm not confident it's more worth reading than the much shorter magazine article version. There are several ways of accounting for the patient deaths at Memorial during Katrina and it's not clear which is the established one and which is the upstart, so a big part of this book's contribution is trying to untangle the initial explanation from the politically motivated ones from the revisionist ones--from the facts. Overall, I think the moral of this story is that people generally do the right thing, given true information, and in this situation there was a lot of misinformation. Since I used to work in a medical library, even doing disaster preparedness work, I found that a motivating conclusion....more
This book was good enough, but could have been so much better. The overall theme is that there are significant parallels between human and animal healThis book was good enough, but could have been so much better. The overall theme is that there are significant parallels between human and animal health that have been overlooked due to the bifurcation of human and veterinary medicine; this is explored through chapters on problems like cancer, substance abuse, heart ailments, and self-harm. It turns out that some recent "discoveries" in human health have long been known, analogously, by vets; so we should look for more connections to improve health for members of every species. So far, so good.
The book was written by a doctor collaborating with a science journalist, and the dumbed-down additions to the text stand out so much they may as well have been printed in a different color: "In other words, a common genetic 'blueprint' instructed the embryos of Shamu, Secretariat, and Kate Middleton to grow different, yet homologous, limbs: steering flippers, thundering hooves, and regal, waving arms." I probably don't need to quote the sentence that came before to make it obvious that this gloss is unnecessary for comprehension. Now multiply that across the entire book. And yet, the paragraphs that I assume were written by the doctor are perfectly pleasant to read and don't require this kind of dressing up, unless you assume the audience consists of recalcitrant 10th graders.
I'm not entirely sure this book deserves to be damned with two stars instead of three, or my "magazine-article-as-book" tag. The central thesis is worthwhile and lots of the examples are interesting. But the presentation borders on Natalie-Angier-ish and the examples pile up in a way that tells you more about horses or koalas than the developing field of "one health." It did make me impatient and seemed less thoughtful than Spillover, which deals with similar material....more
I've been a re-reader all my life--because some books feel like places I enjoy revisiting, or maybe I think I've changed since I first read them--but I've been a re-reader all my life--because some books feel like places I enjoy revisiting, or maybe I think I've changed since I first read them--but no re-reading experience has ever compared to re-reading Spillover nine years later in the middle of a pandemic caused by a zoonosis.
This book is why, when I first heard the idea that covid-19 could have passed from a bat to a pangolin that was butchered by a human, I thought "Well, that makes sense." The book contains sections that use different diseases to make different points about zoonoses, and one of them is what Quammen here calls SARS-CoV, now known as SARS-CoV-1. His analysis of what allowed doctors and public health officials stop it before it became a full-blown pandemic is a chilling foreshadowing of the qualities of SARS-CoV-2. There's also a scene in China where Quammen accompanies an international group of researchers to trap bats and test them for coronaviruses--terrifying in retrospect because they don't wear PPE, reasoning that the risk is similar to riding in a cab without a seatbelt.
I stand by my original review except for the part at the end about humans being smart. Quammen actually qualifies this by discussing that humans are, well, pretty variable and not all of us would take the actions that would prevent a future pandemic. You can say that again.
Upgraded from 4 to 5 stars because this book did turn out to change my outlook permanently after all!
Original review:
This book is about zoonoses--illnesses that spread from animals to people. It describes the typical process: the virus or bacteria lives, long-term and harmlessly, in a reservoir species. When it infects an amplifier species, it can spread more quickly to humans. For example, the Hendra virus has its reservoir in flying foxes (large Australian bats), but when it infects horses, it can spread to people, who are in much closer contact with their sick horses than with bats.
Not only are zoonoses threatening because new ones can appear unexpectedly (like SARS or HIV), they are also essentially impossible to eradicate, unlike (say) polio, which is only found in humans, whom you can vaccinate. Bats come off rather badly in this book. In the past, I've learned that you should like them because they eat harmful insects. It turns out that they are the source of all sorts of nasty bugs, in the virus sense of the word.
Quammen writes quite a bit about his travels to research the book, or how one scientist introduces him to another. Not only does this give the book a bit of a travelogue feeling, it also acknowledges the essential contributions of the people who tranquilize angry macaques or go out in the middle of the night to rig up bat nets--without which none of the science would have happened. His style is vivid and entertaining, though there's one passage in the chapter about HIV/AIDS that is strangely novelistic. Not bad, just incongruous and unnecessary.
Nothing in this book will make you change your behavior, unless you are remiss about handwashing or routinely eat things bats have shat on. At the end the author emphasizes: "The purpose of this book is not to make you more worried. The purpose of this book is to make you more smart. That's what most distinguishes humans from, say, tent caterpillars and gypsy moths. Unlike them, we can be pretty smart." I didn't find this book particularly scary--just informative--so don't avoid it just on those grounds.
To the extent it contains a call to action, the book reminds us that human pressure on ecological systems creates havoc. A relatively short section deals with Lyme disease and reveals the startling conclusion that Lyme flourishes in isolated areas. Think the islands in a parking lot rather than a forest. It's where we come in contact with ecologies that we've disrupted that we find zoonoses.
P.S. Bonus points for sending me to the dictionary: "cadastral." P.P.S. Further bonus points for this sentence, even if the sentiment isn't new: "[A]nyone who favors Intelligent Design in lieu of evolution might pause to wonder why God devoted so much of His intelligence to designing malarial parasites."...more
I made the mistake of picking this up before seeing Clara's review (which you should read because she's an expert). The book is somewhat outdated. SinI made the mistake of picking this up before seeing Clara's review (which you should read because she's an expert). The book is somewhat outdated. Since it clearly predates the 2008 election, there's no discussion of Obamacare, its achievements, or its compromises. As a simple exposition of the downsides of overtreatment in our medical system, it would best be read by someone who's skeptical of the idea and wants as much treatment as they can get. As a member of the choir, I found that this book's preaching went on longer than I needed....more
I found the message of this book so exciting that it will be hard to review it qua book. It reads a bit like the disappointing memoir Remembering SmelI found the message of this book so exciting that it will be hard to review it qua book. It reads a bit like the disappointing memoir Remembering Smell, and I had already read the 2006 New Yorker article, Stereo Sue, which made me wonder about my vision. The book, which goes into much more detail, leaves me as convinced as a book (rather than a medical exam) could, that I do have this problem and that it is correctable.
The two conditions discussed in the book are strabismus (cross-eyedness) and amblyopia (lazy-eye), both of which I suffer from, although not to an extent that most people could notice by looking at my face. I've often thought that I don't have good depth perception--anyone who's tried to play tennis with me would concur. Barry spends a good bit of the book explaining to people with stereoscopic vision what it is like not to have it, and devotes less attention to describing stereoscopic vision to those who don't have it. Not only did these contrasting descriptions leave me thinking that, while I may have adapted to guessing distance, I can't actually see depth, but Barry's story also made me wonder about other symptoms. For example, she talks about how she hates driving. Anyone who knows me in person knows that I've consistently arranged my lifestyle to avoid driving and that I particularly dislike driving at high speed or in unfamiliar places--it makes me anxious, although I am not an anxious person in general. It's never occurred to me that I might not like it because I just can't see well enough to process all the information and react appropriately.
The amazing thing about the author's recovery is that most of the therapy was accomplished by the most low-tech means imaginable, such as computer printouts taped to a wall or beads hung on a string, which she had to focus on in different ways. The book also has an intriguing message about the pliability of the adult brain.
The takeaway for me: the link to the website for doctors who can perform vision therapy....more
This was a quick, engrossing read, in which the author's adventures investigating the story play a major part, à la Susan Orlean's "Orchid Thief." We This was a quick, engrossing read, in which the author's adventures investigating the story play a major part, à la Susan Orlean's "Orchid Thief." We get a tour through high, low, and weird points of psychiatry, such as a Canadian prison that experimented with nude, inmate-led, LSD-fueled psychotherapy in the 1960s. There are chapters that feel a bit off-topic, but I enjoyed the author's voice and was happy to follow along.
The most piquant observation is followed up in some other books that I may look up: the idea that 1% of the population consists of psychopaths who lack normal empathy; some experts viewing their brain scans even refuse to believe they're real human brain scans. Further, these psychopaths often rise to high positions in society and have significant effects on other people's lives, even when they're CEOs, not murderers. The idea that a category of people with totally different cognition--rather than, say, a vengeful God, or immoral secularists, or fate, or whoever--is responsible for bad things happening to good people is certainly a novel one to me....more
Great nonfiction that introduces the science of forensic toxicology against the backdrop of Prohibition. In the early 20th century, people could poisoGreat nonfiction that introduces the science of forensic toxicology against the backdrop of Prohibition. In the early 20th century, people could poison each other almost with impunity since there were few methods to confirm such a cause of death. Pioneering medical examiners based at Bellevue developed new methods to solve outlandish crimes--these stories make up a big part of the book. At the same time, though, the government was putting poisonous substances into all kinds of products containing alcohol to prevent people from redistilling them into liquor--which people did anyway out of ignorance or greed. Meanwhile, people were also threatened by medical and other products, in an age where there was no FDA to require testing or OSHA to monitor the workplace. Together this makes a coherent, informative, and entertaining story.
ETA: The first time I read this book, I was lost on a bus in rural Turkey. The second time, I was stuck at home during a pandemic. It was good both times. Everyone I know who has read this book, liked it--it should win some award for consistent popularity....more
An old blog post: Historical ideations of starvation and amputation.
The book I read yesterday was Joan Jacobs Brumberg's study of the history of anoreAn old blog post: Historical ideations of starvation and amputation.
The book I read yesterday was Joan Jacobs Brumberg's study of the history of anorexia nervosa, Fasting Girls. In it, she explores the nature of the disease by examining the different ways it has manifested itself through history. Not only is the book itself definitive, interpreting cases in their own contemporary idiom rather than imposing modern explanations, it also sheds light on the general question of why certain mental illnesses appear more frequently in specific times and places.
Brumberg begins her discussion with holy women and saints of the late middle ages, many of whom fasted and experienced ecstatic visions. Catherine of Siena, for example, stopped eating except for taking the Eucharist (and by the theory of transubstantiation, I don't suppose this would count as eating at all). Another saint, Columba of Rieti, actually died of starvation. Their condition was referred to as "anorexia mirabilis" by their contemporaries; their decision not to eat was seen as holy rather than pathological and thus no attempt was made to 'treat' them.
That attitude carried over into the 19th century, the next period that saw many cases. These sufferers were called "fasting girls," because, then as now, nearly all were adolescent girls. The fasting girls claimed to take no sustenance at all or to subsist on flower petals or tea. They attracted a great deal of attention (the New York Times covered one case extensively), and the public wanted verification that they truly did not eat. Thus doctors would watch over the girls to substantiate that they ate nothing--effectively supervising the deaths of anorectics who had been sneaking tiny morsels of food all along.
Only in the late Victorian period did doctors make the breakthrough of seeing through patients' misleading descriptions of their symptoms: they realized that the anorectics were in fact hungry, after all. They told doctors that they weren't hungry, but it was fruitless to pursue the matter as a digestive complaint because the primary cause was psychological. This opened the field to the Freudians (who had some interesting theories about the rejection of the father's phallus). More plausible investigations centered on family dynamics, and how adolescent girls could disrupt their bourgeois families' domestic routines with their refusal to eat.
Brumberg's analysis of how the perception of anorexia nervosa changed from a voluntary expression of holiness to a dangerous pathology, led me to re-examine an article, "A New Way to be Mad," that has long haunted me. A discussion of people who voluntarily amputate their limbs, it also broaches the question of why certain psychiatric disorders become prevalent in certain societies, though it frustratingly fails to reach a firm conclusion.
The author of the article, Carl Elliott, posits that the availability of a diagnosis either (a) causes people to interpret their pre-existing feelings accordingly or (b) actually spawns new incidences of the disorder. His example is the disorder called apotemnophilia, whose sufferers are so obsessed with the belief that one or more parts of their body are not supposed to be there that many eventually attempt to amputate the offending parts. The condition was not named until 1977, but now newsgroups and websites flourish, offering sufferers support and advice on how to effect the amputations. He compares the phenomenon to the late 19th century mini-epidemic of amnesia, or the more recent wave of multiple-personality disorder cases.
Elliott writes:
Ian Hacking uses the term 'semantic contagion' to describe the way in which publicly identifying and describing a condition creates the means by which that condition spreads. He says it is always possible for people to reinterpret their past in light of a new conceptual category. (Emphasis added.)
This is where the article begins to worry me, since the idea of language creating concepts is dangerous territory. The strong version of the Sapir-Whorf hypothesis would suggest that people whose languages have different words for light and dark blue should be more able to tell the difference than we, who call them both 'blue,' but of course that's not the case. So it seems that Elliott is saying something a little different and more believable: that the description and official sanction of apotemnophilia by doctors, not the mere concept of self-amputation, is what leads people to consider it.
Brumberg's explanation of why anorexia nervosa is prevalent in our society may help with this. She identifies two stages of the disease: the first, when the sufferer experiments with the restriction of her diet, and the second, where she becomes addicted to starvation as changes in her body actually lessen the hunger pangs she initially experienced. Once a "fasting girl" has reached the second stage, it is difficult to reverse the condition's pernicious effects on the body and mind. Brumberg shows that post-war American society became preoccupied with weight as an expression of health. Millions of Americans diet--more young women dieting means many more young women who are susceptible to sliding into the second phase of anorexia. Furthermore, America's interest in aerobic exercise masks one of the disease's other primary symptoms, hyperactivity. Sufferers have progressed farther into the disease when they are identified; those who are admitted to the hospital weigh ever less at the time of admission. Our society does not cause young women to refuse food, but it makes the disorder more dangerous.
Does all this mean that young Americans are expressing what might otherwise be a more generalized sort of depression or neurasthenia through anorexia nervosa? Brumberg's book led me to re-examine Elliott's article in a slightly different and more careful way: both appear to take the position that historical factors can create populations susceptible to interpreting their problems a particular way. The difference is in the disorder: Brumberg says that anorectics use the condition as a tool to make a point about their place in family and society; whereas Elliott suggests that the apotemnophiles turn within and use the diagnosis as a way to express their dissatisfaction with their bodies.
Elliott has written a book about how disorders becoming treatable makes them more prevalent, which I will now have to read. Obviously I am still trying to wrap my mind around this one; but in any case Fasting Girls uses its historical basis to present a particularly lucid description of anorexia nervosa and is well worth reading....more
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