Summary:

Inspired by Stephen J. Gould’s study of Samuel Morton in The Mismeasure of Man, Christa Kuljian’s Darwin’s Hunch traces the story of the search for human origins while apartheid was taking hold of South Africa in the mid 20th century. Following the work of Charles Darwin, biologists and anthropologists of the 19th and 20th centuries were captivated by comparative anatomy, human classification, and the origins of mankind. Kuljian begins her book with the very origin of racialized thought in science: the distinction between monogenism and polygenism. These two schools of thought in the 18th and 19th centuries sought to explain the existence of human difference; the former arguing that all races stemmed from a single ancestor and the latter arguing that different races emanated from different species. Physicians and scientists were at the center of this discourse, creating names for different racial categories while debating whether races were different species in and of themselves. Eventually, well-known physicians and anthropologists created tools to measure anatomical differences between racial groups. Kuljian centers her book on the studies of the physicians and scientists who contributed to academic discourse, including Johann Friedrich Blumenbach, Robert Bloom, Raymond Dart, Hertha DeVilliers, and Phillip Tobias among others.   

In the search for the “missing link” between man and animal, South Africa became a living laboratory. Paleontologists, physicians, anthropologists and the like began a search for living fossils after the discovery of the Taung Skull by Raymond Dart. This discovery birthed the search for human origins in South Africa. For many scientists at the time, the living fossil was not only physical evidence of human evolution, but also supporting evidence for presupposed ideas about racial difference, and so “the most interesting specimens [became] the natives”. South African researchers like Robert Broom, Raymond Dart, and Phillip Tobias, among many others, began projects to study the anatomies of the Bantu, Khoikhoi, and other native people of South Africa. Some researchers embarked on expeditions to Bantustans, reserves that segregated the native population, and measured living native communities, others studied “skeletons from graves”, and still others examined “unclaimed bodies from South African hospitals”. 

The focus of this work in many ways was also a search for a pure racial type. These studies aimed to quantify racial differences by measuring the “brain size, skull shape, facial features, skin colour, hair texture and bone length” of native people. Other studies were reminiscent of previous investigations of difference, such as the objectification of Sarah Baartman, in that “Dart gave special attention to the external genitalia… and the accumulation of fat on many of the females’ buttocks”.  

Kuljian also traces the political history that coincides with this race for human origins by discussing the progression of the apartheid state of South Africa. Jan Smuts, who would later become Prime Minister of South Africa during the time of Dart’s early investigations, was also the president of the South African Association for the Advancement of Science which institutionally funded and supported the search for human origins. He continued supporting this research into his prime ministry, as increasingly “race [became] a national neurosis in South Africa”.  

In this captivating look at the personal stories of researchers, their sociopolitical context, as well as the stories of the people they studied, Kuljian dives into the tension between personal beliefs and scientific practice. She examines how bias, politics, and institutions shaped investigations into the search for human origins. 

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Mysterious Medicine:  The Doctor-Scientist Tales of Hawthorne and Poe is one in a series of books called Literature and Medicine dedicated to the exploration and explication of the intersection of the two titled disciplines.  This volume, edited by L. Kerr Dunn, looks at the short stories (mostly—it includes one sonnet) of Nathaniel Hawthorne and Edgar Allan Poe from the viewpoint of each author’s use of, and in some cases experiences with, doctors, diseases, and the medical profession.  The volume begins with an Introduction that situates the writings within the medical and social milieu of the period (the authors were contemporaneous) and illustrates the way in which the tales reflect the times.

The stories are grouped by author and arranged chronologically.  Among the nineteen entries included are “The Minister’s Black Veil,” “Lady Eleanore’s Mantle,” “The Birthmark,” and “Rappaccini’s Daughter” for Hawthorne, and “The Black Cat,” “The Fall of the House of Usher,” “Berenice,” and “Some Facts in the Case of M. Valdemar” for Poe; each entry is preceded by a brief introduction and followed by discussion questions.  An extensive list of scholarly references closes out the volume. 

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The Impatient Dr. Lange is a biography of Joseph “Joep” Lange, an HIV/AIDS researcher best known for his work in HIV transmission prevention and treatment, written by Seema Yasmin.  Yasmin is a journalist, doctor, and epidemiologist whose life path was forever altered by a run-in with Dr. Lange at age 17, when he said to her, “If you want to help people, first you need to learn how to take care of them.  Go to medical school.” (p. xiii).  The book’s narrative parallels that of the life of her inspiration, Lange; in addition, Yasmin details the evolution of HIV, how it came to spread around the globe, and a history of antiretrovirals.  

Coming of age professionally in the early 1980s, Joep Lange had a career defined by HIV and the advances to manage it.  Early on, he trained as a physician before pursuing a PhD.  During his PhD, he was a prolific researcher, producing “eleven papers on AIDS in his first years,” including an early case study on the appearance of acute HIV and the way in which the body’s antibody response changes in response to continued infection.  His commitment to rigorous scientific inquiry continued as a professional research scientist.  Most noted for his early trials about the use of antiretrovirals and their role in preventing mother-to-child transmission of HIV, he was intimately involved with much of the science used to treat and prevent HIV today.  Outside of research, he was an ardent advocate of health equity, starting the PharmAccess Initiative, a group initially developed to expand access to antiretrovirals in developing countries.  

Ultimately, the book is about how a life of great potential, drive, and success was tragically cut short.  Shadowing the narrative of the book is the specter of Lange’s unfortunate end on Malaysia Airlines flight MH17, a plane that was mistakenly shot down over the Ukraine by pro-Russian separatists, while he was en route to the twentieth International AIDS Conference in Melbourne.  The penultimate chapter reflects on all that was unfinished - projects on three continents, advising the next generation of PhDs, a novel - and ends with a prescient quote from Lange, in regard to mandatory retirement in the Netherlands at the age of 65:  that even if he had 10-15 more years, he declares “that is still not enough time” (p. 174).

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Described in minute detail by the narrator, the villagers - who have turned over every stone in the woods, dived many times in the river, and ridden to nearby villages to find Carlos - turn to an old man who requests a perfectly flat piece of wood and a stout candle. He then meticulously fastens the candle to the wood and carefully launches this raft of mystical exploration and recovery on the river. Every villager watches this ceremony with rapt attention. It is truly a riveting passage, for the raft travels under its own power from the river bank against the current, meandering slowly towards the bridge where it finally stops, despite the current, under the bridge, the only place no diver has yet looked:

"The board in the meanwhile has wandered farther under the bridge, but always in a right angle to the fifth post. Now it is under the middle of the bridge. From here it sails towards the fourth post, though only for about a foot. And here it stops as if it were nailed to the water. It does not mind the current nor the light breeze that sweeps softly across the surface of the river. The manner in which the board has halted is entirely different from that in which it stopped before. Now and then it trembles slightly, as if something were breathing against it from below. But it no longer whirls. ... The board begins softly to dance as if impatient. It seems that it wants to be relieved of its torture. It wriggles, swings about itself, though it does not move as much as two inches. One might think it is trying to go down to the bottom."

(page 110-1)

A villager dives and retrieves Carlos and hands his body to his mother:

"With an indescribable nobility and solemnity, and in his eyes that pitiful sad look which only animals and primitive people possess, he steps slowly forward. And Perez, the man whose daily task it is to fell the hard trees of the jungle and convert them into charcoal, lays that little water-soaked body in the outstretched arms of the mother with a tenderness that makes one think of glass so thin and fragile that a single soft breath could break it."
(page 113)

The villagers, in a procession that is tragicomic, take Carlos' body to the graveyard where a well respected teacher, now drunk from all the mescal others have offered him, gives an eulogy that suggests Christ's Sermon on the Mount. However, with inverted symbolism, this sermon is for, not by, Jesus and is delivered by a drunken priest-figure who is so drunk he falls into the open grave. To Traven's credit he introduces this farcical moment to emphasize how none of the villagers, much less the author, and, consequently, the reader, laughs at a decent man trying his best to honor Carlos. It is truly a most moving finale to a most moving book.

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Dr. Marina Singh, a pharmacologist and former obstetrician, is sent to a research site in the Amazonian jungle somewhere in Brazil that is operated by the company she works for, Vogel Pharmaceutical. The company chief executive officer, Mr. Fox, dispatches her there to check on the progress of the research and to get details on the reported death of her colleague, Dr. Anders Eckman, while he was there on a previous research trip. Eckman’s wife, uncertain that he was dead, asks Marina to find out what had happened to her husband. The plot centers on Marina’s dual missions at the Amazon jungle site. 

Marina’s trip reunites her with the legendary and imperious Dr. Annick Swenson, who is an obstetrician and the lead researcher at the site. Thirteen years before, Swenson was Marina’s supervisor during her obstetrics residency. A mistake Marina makes while she’s delivering a baby after disregarding Swenson’s advice drove her out of obstetrics and into pharmacology, and then eventually to Vogel. The company is supporting Swenson’s research hoping it will produce a blockbuster product. Mr. Fox is growing impatient having received only brief and vague communications from Swenson over the past five years.  

Decades earlier Swenson had followed her mentor to the jungle location where the Lakashi tribe lives, and after frequent visits over this time, resided there permanently to work on the research Vogel was funding. The research was based on observations Swenson and her mentor made about Lakashi women; they never go through menopause and they are fertile into their old age. Swenson’s project is to find out why, and provide the information to Vogel in order to develop a product that could give women the option to avoid menopause and to have babies much later in life. 

Swenson finds it is the bark of the (fictional) Martin trees when combined with excretions of the (fictional) Purple Martinet moth deposited in the bark Lakashi women ingest that extends their fertility after menopause. Trying it herself, Swenson becomes pregnant at age seventy–three. She also finds that the same bark protects the Lakashi women against malaria. Swenson eventually concludes that her research should not proceed to product development for fertility, but instead for prevention of malaria. Certain that no American pharmaceutical company would “foot the bill for Third World do-gooding,” Swenson decides to reallocate the fertility research funding to her malaria vaccine work without permission from the company (p. 289). A cat and mouse game ensues around the research funding, Swenson’s pregnancy ends, and the mystery of what happened to Anders Eckman is solved. Marina Singh’s life is changed, probably forever.

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A psychiatrist and PTSD (post-traumatic stress disorder) specialist, Dr. Shaili Jain has written a book on PTSD and its many angles, from diagnosis to treatment to a larger perspective on cultural and historic influences on the development of traumatic stress. She weaves the story of her own family’s experience with the Partition of India and Pakistan in 1947, particularly its effect on her father and grandparents, as a way to consider the effect of trauma on family, but also how those traumas become ‘unspeakable.’  

A brief but effective introduction outlines the seven parts of the book:
1. Discovering Traumatic Stress: historical perspective and the changing language to describe the effects of trauma.
2. The Brain: the physiologic and psychological underpinnings of PTSD, including effects on memory formation and retrieval.
3. The Body:  such as addiction, cardiac effects and concerns at different stages of life.
4. Quality of Life: domestic and sexual violence, socioeconomic factors.
5. Treating Traumatic Stress: programs, treatment strategies and psychopharmacology.
6. Our World on Trauma: global health, large scale tragedy, terror and war.
7. A New Era: An Ounce of Prevention: resilience, accessibility of care including early and preventative care. 

Additionally, almost 100 pages of notes, glossary, resources and an index provide an easy way to further explore, to use the book to look up specific topics, and underscore the heavily researched nature of the text.   The book is eminently readable, with numerous, well-placed stories of patient encounters and particular experiences and manifestations of PTSD.  These stories are illustrative of the concepts Jain ably explains. However, they also provide an insider’s view of what happens in the consulting room.  In the prologue, Jain describes a young Afghanistan War veteran, who has been hospitalized after a violent outbreak at a birthday party: “Josh’s PTSD was fresh, florid, and untreated…. His earlier poise caves in to reality, and his face falls to anguish.” (p. xvi) We are in the room, listening to the patient, witnessing the tears of the medical student, glimpsing the attending psychiatrist’s response, and relating to Jain, as a psychiatry chief resident, as she understands that the individual before her, even as he shows classic signs of traumatic stress, remains an individual, a person in need of care.   

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This is an important contribution that analyzes, critiques, and aims to correct structural inequalities (racism, sexism, capitalism) that influence contemporary medicine, with particular attention to the technical influences of computers, “big data,” and underlying values of neoliberalism, such as individualism, exceptionalism, capacity, and progress through innovation.  

Introduction: Theorizing Communicative Biocapitalism
Banner writes, “biocapitalism is comprised by the new economies and industries that generate value out of parts of human bodies” (p. 12). Parts include DNA, ova, and organs, but there’s also data from medical care, where patients are reduced to their physical bodies and/or to their “digital status” in medical records, research, even personal information volunteered on the Web, all which is indicated by the term “communicative.” As an example, Banner cites the large realm of patient on-line groups that are exploited by large companies as free labor, thus reducing the voice of the patients. Approaches of narrative medicine and medical humanities have not dealt with digital health, market forces, and the implied power relationships. Perhaps the new subfield of health humanities has promise to do so, if not also captive to “the logic of the market” (p. 17).   

Ch. 1. Structural Racism and Practices of Reading in the Medical Humanities
Banner writes, “Medical racism is a product of structural and institutional racism” (p. 25). She finds that current approaches from interpretive reading are insufficient because “the field’s whiteness has contoured its hermeneutics” (p. 25). Instead of the “reading-for-empathy” model, we should read for structures of racism, sexism, privilege, as well as economic and political inequality. She illustrates such reading with texts by Junot Dìaz, Audre Lourde, and Anatole Broyard.  

Ch. 2. The Voice of the Patient in Communicative Biocapitalism
 Patients have flocked to networking websites, voluntarily posting much personal information. Banner analyzes how technocapitalists mine these sites for data to use or sell. Patients’ information, given voluntarily, amounts to free labor and, even, work-arounds for companies that avoid expensive double-blind controlled studies. Rhetoric for these sites speak misleadingly of the “patient voice,” “stakeholder,” or “story sharing” and hide the exploitation involved. The chapter is specific for websites, drugs, and drug companies.  
Banner discusses (1) the “feminized labor” involved with sites for fibromyalgia and chronic fatigue syndrome (both “contested diagnoses”) and (2), more abstractly, the medicalization of the clinical gaze on patients who participate in websites and yearn for “an imagined state of purity,” and/or “an ableist vision of norms and reparative medicine” (p. 61). Overall, the digitalized-patient voice is colonized by forces of whiteness and should be decolonized. She discusses writing by Octavia Butler and Linda Hogan, both women of color.

Ch. 3. Capacity and the Productive Subject of Digital Health
This fascinating chapter describes and critiques “digital self-tracking,” or the use of devices such as Fit-Bits that help create and maintain the so-called “Quantified Self” (or “QS”). Banner finds this fad within the tradition of the Enlightenment (Ben Franklin) so that “exact science” may “optimize” individuals by being “responsibilitized” in a “self-sovereign” way. QS users understand that “Everything is data” (p. 83). She argues that this trend emphasizes “masculine objectivity” while “disavowing debility” (p. 85). Collected data may contribute to a “worried well” status or conditions of “precarity” or “misfitting.” She writes, “QS practice remains an inscription of the self as a self-surveillor, engaged in masculinized practices of neoliberal self-management” (p. 91). She discusses the technologies of the devices Scanadu, Melon, and Scarab. She provides and interprets photos of visual arts representations by Laurie Frick, who is a “self-tracker.”  

Ch. 4. Algorithms, the Attention Economy, and the Breast Cancer Narrative
Banner discusses Google Analytics, later Alphabet, which includes Calico and Verily, which have partnered with pharmaceutical companies. Such combinations of algorithms, capitalism, and media aim to capture the public’s attention, especially online. Messaging about breast cancer becomes reductive, emphasizing medical solutions, not prevention, and it avoids discussion of causes such as environmental pollution. Some critics decry “pinkification” of breast cancer. Public stories, such as Angelina Jolie’s, emphasize individual empowerment, a “hegemonic construction of illness”’ (p. 112), and these are amplified by mass media, both print and electronic. More diverse messages would value “heterophily over homophily” (p.121).   

Ch. 5.  Against the Empathy Hypothesis
Drawing on several commentators, Banner critiques the notion of empathy as a goal for caregivers as condescending to the patient and suspect when allied with productivity and efficiency for institutions. Further, the notion of “resilience” (in a “bleed” of neoliberal rhetoric into health humanities) has been misused in applied literature, parallel to notions of self-help and self-management. Some hermeneutics still support values of “state and capitalism” and ignore writers of color. Banner discusses the work of African-American poet Claudia Rankine, some of whose work is “postlyric,” and J. M. W. Turner’s painting “The Slave Ship” that illustrates “necropolitics.”  

Conclusion
Throughout the book Banner illustrates reading “for structure” in her interpretation of texts and visual images but also in medical institutions and practices and, still further, in the enormous and pervasive world of government forms and programs, big data, computers, and beyond. She finds structures of capitalism, sexism, and neoliberalism within existing “heteropatriarchal, ableist, and racist frameworks” (p. 154) despite claims of neutrality. She urges medicine and the humanities to develop new methods. She mentions specific collectives and communities that now challenge such norms (such as Gynepunk and CureTogether), and she calls for thinkers in many disciplines to confront demeaning technology and to “engender spaces in which care is more just, and more humane” (p. 156).      

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Fran, an aging but energetic expert on elder housing, drives around the English countryside visiting facilities and also friends and family.  She, herself, is not at all ready to go gentle into the good night so many others are facing.  But everywhere she encounters reminders of mortality--her son's fiancee suddenly dies; an old friend is dying a lingering death of cancer; others in her circle of family and friends are facing their own or others' mortality in various ways, including natural disasters like earthquake and flood.  The episodic story takes place in England and in the Canary Islands; the large cast of characters are linked by intersecting stories and by their mortality, of which they, and the reader, are recurrently reminded.    

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Set in the loosely fictionalized Jamaican town of Augustown (“loosely,” as it bears a strong resemblance to August Town, which was absorbed over time into the expansion of Kingston), the novel spans three generations of a single family.  The novel moves back and forth easily through different moments in time, from the birth of Rastafariansim in 1920 under British colonional rule, through the post-colonial division of the island and its citizens into turbulent threads, to the present day of 1982, where the same tensions run strong as ever.  

Ostensibly a family novel, the story centers on Ma Taffy, her niece Gina, and Gina’s son Kaia, and it boils down to several key moments in their lives.  But these moments are brief in the overall bulk of the novel, the majority of which is devoted to the fleshing out of the world that permits – and, as we ultimately realize, requires – that such moments come to pass.  There is the miracle of the preacher Alexander Bedward, who, as seen through the eyes of Ma Taffy, could have literally floated up to the Heavens; the comically doomed marriage and foiled aspirations of schoolteacher Emanuel Saint-Josephs; the errand run by Soft-Paw, a young gang member; the second chance that comes before the well-to-do Claudia Garrick; the friendship of Clarky and Bongo Moody, and their run-ins with the police.  As Miller moves between these characters, the forces pushing Ma Taffy, Gina, and Kaia to their conclusion become clearer and harder to resist.  

Despite the complexity of the novel’s structure, Miller easily weaves all of the component parts together.  The result is absorbing and affecting, a novel that is as much a family drama as it is an exploration of the legacy of colonialism, religion, class conflict, and violence.

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