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This novel recasts Charles Dickens’ David Copperfield for modern day as a literary take on the opioid addiction crisis in the U.S. during the 1990s and 2000s with apparent connections to Beth Macy’s nonfiction book, Dopesick, and the eight-part TV miniseries of the same name it spawned. The author, Barbara Kingsolver, assures potential readers that having read David Copperfield is not a prerequisite for comprehending and appreciating Demon Copperhead.   

Demon Copperfield, a name that evolved naturally enough in early childhood from his birth name, Damon Fields, was born into entrenched poverty in the heart of Appalachia, Lee County, Virginia. He tells his story starting from when he drops out of his drug-addicted mother’s womb onto the floor of a rented trailer, to when as a young adult, he makes a last-chance effort at breaking loose from the life-threatening clutches of Lee County. In between, his stepfather frequently beats him bloody, his mother dies from a drug overdose, he enters foster care, attends school off and on, and works assorted jobs, many of which involve illegal, unethical, and dangerous activities. All the while he is variously abused, starved, and exploited.  

Demon shares his plight with many others in the community, and though they help each other as best they can, nearly all of them become ensnared in the same traps—drug addiction, alcoholism, unemployment, hazardous occupations, unfinished education, familial disintegration, and societal abandonment. For Demon, these conditions and experiences obliterated any vision of a future free of entrapments, let alone one of prosperity and happiness. “Here, all we can ever be is everything we’ve been. I came from a junkie mom and foster care,” is how he assessed his prospects (p. 461).  

Amidst all this suffering and bleakness, an observant and caring teacher discovers Demon’s talent in graphic arts, and he gets a peek at a path to commercial success. He has to first fight off what he knows of “Lee County being a place where you keep on living the life you were assigned” (p. 460). His story turns to this fight and onto this path. 

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Anna Gasperini builds on existing scholarship by examining how Victorian ‘penny blood’ literature depicted working-class readers’ anxieties concerning medical dissection following the 1832 Anatomy Act. Within the historical context of Britain, a dearth of cadavers spurred the rise of various crimes, including body-snatching, graverobbing, and murder. While the families of the middle- and upper-class dead could finance a funeral and secure a place of safe rest, such as in an ancestral vault or tomb, the poor were often buried in shallow or mass graves. These burial sites were often unearthed, and the bodies were sold to (knowing and unknowing) medical men for anatomical examination. To quell these crimes, government authorities instated the 1832 Anatomy Act, which was “a law that allowed anatomists to source dissection material from the pauper” (xii). More specifically, Gasperini explains, “[w]hen it was passed, the Anatomy Act imposed that the bodies of those who were too poor, or whose families were too poor, to afford a funeral were to be handed over to the anatomy schools for dissection” (xii). The Anatomy Act, disregarding pauper consent and personal wishes, effectively targeted impoverished people who relied on workhouse support and alms, exploiting poor bodies to supply medical schools and advance research. The fear and disgust for the law were widespread: “. . . for them [working-class penny blood readers] dissection, bodysnatching, and forfeiture of one’s body to the anatomists after 48 hours under the Anatomy Act were a terrifying reality” (xiii). This fear oddly presaged Count Dracula’s remark in Tod Browning’s 1931 film: “There are far worse things awaiting man than death.” In other words, the finality of death may be incomprehensible, but posthumous desecration of the body through dissection provokes a deeper sense of horror.

Exacerbating the act’s legal conditions was the fact that “semi-literate” working-class people, although vaguely aware of the law’s significance, could not fully interpret the dense legal argot that described the new regulations—an example of cruel political skullduggery—which obscured what would happen to their bodies following death (12–13). Far from being a benevolent political gesture, the act “. . . was an exercise in rhetoric, against which the pauper—semi-literate, socially powerless, and politically underrepresented—could not possibly win” (15). Popular fears that predated and intensified following the act concretized suspicion and anger directed at physicians, the medical sciences, and mortuary practices.

These apprehensions, Gasperini argues, found vivid expression in the pages of the penny blood, a genre “churned out by underpaid hack-writers” and obsessed with storylines “involving murder, betrayal, gender-shifting, and the occasional supernatural event (not to mention scantily clad damsels in distress)” (4). While the penny blood’s serialized melodramas were derided as tawdry sensationalism by middle- and upper-class readers, the genre reflected working-class preoccupations about the Anatomy Act and how the bodies of the impoverished dead were subject to the posthumous medical gaze (4). The penny blood embraced a “generally more violent and graphic concept of entertainment that was popular among lower class individuals. . . .” (4) and constructed plots that directly tapped into long-entrenched suspicions about medical cruelty and physical dismemberment. While the era’s educated readership disdained the recognizable tropes of the penny blood—murderous graverobbers, devious surgeons, vampires, eldritch cemeteries, and cadavers—the narratives in which they figured elucidated the virulent classism and exploitation perpetuated by the Anatomy Act. 

Gasperini provides close readings of a range of penny blood texts, including Manuscripts from the Diary of a Physician (1840s), Varney the Vampyre; or: the Feast of Blood (1840s), The String of Pearls (1840s, popularly referred to as Sweeny Todd, The Demon-Barber of Fleet Street), and The Mysteries of London (1840s). Not all narratives have explicitly medical themes or characters who are physicians or anatomists, nor do the stories make overt reference to the Anatomy Act. Instead, as Gasperini’s analyses demonstrate, they all confront larger working-class anxieties concerning mortality and what might be regarded as the social afterlife of a human corpse, whether that be posthumous dissection, cannibalism, necrophagy, or some other horrific desecration of the body. Fundamentally, while the stories vary, they share a general preoccupation with the corpse’s “bodily integrity” (16), asking what forces act upon the body (or have the authority to) following death and expressing fear over the individuals and institutions that presume to disturb the repose of the dead. Indeed, for all the penny blood’s grotesquery, there is a tacit insistence on the sanctity of the corpse; however, as Gasperini illustrates, the genre does not flinch from revealing the grim consequences of disturbing this repose in the interests of greed and medical progress.

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Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

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The eight-part TV miniseries, Dopesick, is a nonfiction, scripted drama inspired by Beth Macy’s nonfiction book of the same title. The creator, Danny Strong, was a writer of all but one episode, director of two, and an executive producer of them all. Beth Macy served as an executive producer and contributed to the writing and updated the reporting. 

In a Kaiser Health News (KHN) panel discussion about the series with Danny Strong, Beth Macy, and three KHN staff members, Strong said his original goal “was to dramatize all this, was to create a clear record of what Purdue Pharma did.” But when Macy joined, his goal expanded “to show the victims and to hopefully redefine the stereotype of addiction...[and] ultimately our goal was to show a path forward.”

The miniseries conforms to these goals. Across the eight episodes, the drama mostly swirls around the direct connections among Purdue Pharma, one physician, one particular patient (and family), one small town in coal mining country, a Drug Enforcement Agency (DEA) investigator, and a U.S. Attorney (Western District of Virginia). In hewing to Strong’s original goal of portraying Purdue Pharma’s responsibility for igniting and fanning addiction to its product OxyContin® (oxycodone HCl), the drama reaches its climax when the company agrees to criminal charges for named executives and a financial settlement in 2007. 

Different episodes touch on other goals about the stigma associated with addiction and access to medication-assisted treatments. While Strong met his goals, he acknowledges the real-life drama didn’t end with the 2007 settlement. He previews what was to come: Purdue Pharma redoubling its sales efforts, the addiction crisis worsening over the subsequent fourteen years, and the continuing efforts to bring Purdue Pharma and its owners (the Sackler family) to their knees.

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In a future 2040, the church is considering the canonization of Pope Innocent XI. An unusual seventeenth-century manuscript is brought to the attention of the authorities and the bulk of the novel is its transcription in full.  

The manuscript is the diary of an intelligent, but inexperienced young orphan-apprentice who is working in a Roman hostel in September 1683. The Catholic Church is fighting the Ottoman Turks who have besieged Vienna. Tensions with France are high as that country and its king have long asserted their exemption from Church rule.

 A hostel guest dies, and the authorities, suspecting plague, impose a quarantine. The apprentice falls under the influence of another confined guest, Atto Melani, a famous castrato and spy for King Louis XIV of France. Believing that the deceased guest was murdered, they venture out each night into subterranean Rome searching for clues to support their theory and leading them to investigate poisons, panaceas, and political plots. Meanwhile, a physician also confined to the hostel attempts all remedies to prevent plague, while another guest, besotted with astrology, strives to reveal the future, and yet another plays soothing music. 

Like a baroque Agatha Christie novel, plausible suspicion is cast upon every guest until the truth emerges and with it many doubts about the saintliness of Pope Innocent XI. The 2040 writer invites the Holy Office to consider the implications of the manuscript before proceeding with the canonization.

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