Summary:

Laqueur argues that in the course of medical history there has been a shift from the one-sex to the two-sex model. Prior to the seventeenth century, scientists of all kinds believed that there was only one kind of human body. Men and women were the same.

In drawings made during dissections, for example, scientists from Aristotle to Galen identified female genitalia as male genitalia which were simply inside the body rather than outside of it. Thus, the vagina was identified as penis and the uterus as testes. Women’s organs were internal, it was believed, because they were colder (and therefore inferior). It was possible for a woman to turn into a man if she over-exerted herself and became hot. After the seventeenth century, this one-sex model slowly transformed into the two-sex model popular today according to which men and women have different bodies and different attributes that follow from those bodies.

Laqueur does not think that earlier scientists were mistaken. They carefully performed dissections and recorded what they saw. Their drawings are correct. However, because their world view did not allow for two sexes, the parts are identified differently. In later centuries it became politically necessary to create a greater, natural distinction between men and women, a distinction that could not be remedied by greater heat. The material evidence of the body was thus interpreted differently.

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Sontag argues against the use of illness as metaphor. She states her main point on the first page of this long essay : "The most truthful way of regarding illness--and the healthiest way of being ill--is one most purified of, most resistant to, metaphoric thinking."

Tuberculosis and cancer serve as her two central examples of the human tendency to use metaphoric thinking about illness. In the 19th century, tuberculosis was considered a disease of passion, of "inward burning," of the "consumption" of life force. Sufferers were thought to have superior sensibility; the illness purified them of the dross of everyday life. The romantic image of the TB sufferer became "the first widespread example of that distinctively modern activity, promoting the self as an image" (p. 29). Metaphoric thinking about TB declined in the early part of the 20th century as the disease succumbed to science and public health measures.

Cancer has now become the predominant disease metaphor in our culture. Cancer is considered a disease of repression, or inhibited passion. The cancer sufferer characteristically suppresses emotion, which after many years emerges from the unconscious self as malignant growth. As in Auden’s poem, Miss Gee, reproduced on page 49, (see annotation in this database): "Childless women get it, / And men when they retire . . . . " Sontag uses the 19th century view of insanity as another example of malignant metaphoric thinking, while metaphor related to syphilis was somewhat more benign. She concludes the essay with an eloquent prediction that, as we learn more about the etiology and treatment of cancer, its metaphorical system will die on the vine. (I wonder if Sontag would consider my "die on the vine" an appropriate metaphor here?)

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It is difficult to characterize this book, which consists of a series of roughly chronological chapters, each of which deals with a person or an event important in shaping (or representative of) "the American grain." Williams begins with Red Eric (Eric the Red), whose son Leif Ericsson "discovered" the North American continent, and continues with chapters on Columbus, Cortez, Ponce de Leon, De Soto, Walter Raleigh, the Pilgrims, Champlain, Cotton Mather, Daniel Boone, George Washington, and so forth.

In each case the focus is on character and impact--not so much "impact" on the historical panorama, but "impact" on the emerging and evolving American character (or grain). In that sense the book might be considered an impressionistic biography of the childhood and adolescence of the American spirit.

About halfway through the book in a chapter entitled "Père Sebastian Rasles" (p. 105), Williams steps into the narrative as a first person narrator describing events that occurred during "my six weeks in Paris." Here he connects the development of American literature, as exemplified by Gertrude Stein, Ezra Pound, H. D. and other expatriates, to American cultural history, in this case the evolving conflict between the New England puritan culture and a Catholic influence that filtered down from Quebec (personalized in the form of the Jesuit priest for whom the chapter is named).

The clearest statement of the American grain occurs in a chapter called "Jacataqua." Consider this: "The United States without self-seeking has given more of material help to Europe and to the world . . . than have all other nations of the world put together in the entire history of mankind." (p. 175) "It is this which makes us the flaming terror of the world . . . with hatred barking at us from every sea." (p. 176) "America adores violence, yes. It thrills at big fires and explosions." (p. 177) And so forth. Williams’s observations remain pretty much on target in 2003, nearly 80 years after he wrote them.

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This is an ambitious and far-ranging book, the result of years of thinking, teaching, and working with patients. An internist at the College of Physicians and Surgeons at Columbia University, Charon sees a wide range of patients in an urban setting. Also a Ph.D. in English literature, Charon has devised a "Parallel Chart" and other means for caregivers to write personally about the dynamics between healer and patient, to read texts--narratives in particular--and, as a result, to listen better to patients, thus improving the delivery of medical care.

Charon defines narrative medicine as "medicine practiced with these skills of recognizing, absorbing, interpreting, and being moved by the stories of illness" (4). She calls this a "new frame" for medicine, believing that it can improve many of the defects of our current means of providing (or not) medical care. Caregivers who possess "narrative competence" are able to bridge the "divides" of their relation to mortality, the contexts of illness, beliefs about disease causality, and emotions of shame, blame, and fear.

Charon finds that medical care and literature share five narrative features; she argues that careful reading of narratives builds skills that improve medical care, including intersubjectivity between caregiver and patient, and ethicality. Beyond the theory, there are powerful and persuasive examples of interactions between caregiver and patient, many from Charon's own practice. A mother of a sick daughter experiences stress that makes her ill; when she sees a narrative connection, she begins to heal.

Charon sees wider applications. As caregivers understand better concepts of attention, representation, and affiliation, they become more ethical, more community minded, and better healers to their patients. Patient interviews will be different: instead of following a grid of questions, physicians will converse with patients in an open-ended way. What is most important will emerge and emerge in ways that are most beneficial to the patient. Yes, this method will take more time but it will be more efficient in the long run. Bioethics, Charon argues, has been limited by legal approaches and philosophical principles. For her, narrative bioethics offers more human values in how people feel, experience reality, and relate to each other. Finally, there are implications for social justice: why are the poor underserved in this country and in many others?

One of the most exciting and radical formulations comes late in the book: ". . . practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument" (p. 215). This notion links up fruitfully with concepts of energy medicine (v1377v), therapeutic touch (Tiffany Field), and intentionality (Wayne W. Dyer).

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This densely packed book follows Oschman's Energy Medicine: The Scientific Basis (2000, see annotation) with applications to medical treatment and--very briefly--human performance (athletics, dance, music). Oschman, a cell biologist, shows how electroencephalograms, electrocardiograms, and pulsing electromagnetic fields (which can heal broken bones) are accepted medical technologies, while theoretically related Healing Touch, Therapeutic Touch, Qi Gong, Reiki, Reflexology, massage, etc. are widely used and effective but generally (and inaccurately) considered to be alternative medicine.

According to Oschman, contributions from quantum physics explain that the energies of the body are subtle, instantaneous, and highly efficient in regulation and healing at the cellular level. The body is best understood as a living crystal, which can semiconduct energy, translate physical energy (such as touch) to piezoelectricity, and maintain coherence and continuity. Given our evolutionary heritage, we can sense from healers their intention, empathy, and healing energy. Our bodies heal themselves with energy provided by both standard and nonstandard medicine.

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This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.

Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.

In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.

In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.

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Healy focuses on the social and cultural meaning of disease in Britain during the early modern period (roughly the sixteenth and seventeenth centuries). Her chapter on "The Humoral-Paracelsan Body" discusses how the humoral theory of Galen, at this time still dominant in constructing a notion of the human body and its functions, was challenged by a new Paracelsan medicine, with its emphasis on spirit and on experiment instead of book-learning, and by the emergence of syphilis. She also establishes the genre of the "regimen[t]," a text advising how to achieve personal and social order.

Her two chapters on "The Plaguy Body" review the late-medieval and Renaissance history of the plague and argue that the social meaning of the plague as a trope of violence and rebellion shifts over the course of the sixteenth century, from a judgment on Britain's "rich extortioners," careless of the welfare of the poor, to the threat represented by London's unruly urban underclass.

Healy's two chapters on "The Pocky Body" argue that the new disease of syphilis became another dominant metaphor for social disorder because it helped focus anxieties about cultural hypocrisy, corruption, and degeneration, linked to the problems of sin generally and excessive appetite in particular. Her final chapter examines "The Glutted, Unvented Body," another powerful figure of excessive appetite, threatening that the body (and its appetites) would dethrone the head (the site of reason).

Healy demonstrates the importance of debates over the glutted, headless body as a way for British writers to negotiate the problems of a trade imbalance and the tricky terrain of resistance against the intemperate Stuart monarchs, culminating in the execution of Charles I in 1649. In the book as a whole, Healy reads literary and historical texts by authors as diverse as William Bullein, Thomas Dekker, Lucretius, Erasmus, William Shakespeare (Measure for Measure and Pericles), and Milton (Comus).

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Moller is a sociologist who takes us into the world of the urban poor; he focuses on half a dozen individuals, giving intimate and moving portraits of them. An opening character is called Cowboy (a pseudonym); he lives under a bridge with his dog Cowgirl and dies a slow death of lung cancer. In an Epilogue (pp. 163-184) Moller calls him "an urban Thoreau." This respect for the dying poor pervades the book.

Besides descriptions of the characters, there is much dialogue, including extended quotations, but also some 100 small photographs, usually close-ups, inserted into the text. One photo shows a man in his coffin. Clearly Moller gets close to his characters, and so does the reader.

Moller argues that the dominant society--to its shame--neither supplies adequate care for this sector of society nor even recognition that such people exist. He calls the dying poor "an invisible world." It's a disturbing world, with the pain and neglect, but also an inspiring one, because of the caregivers such as social workers and nurses and the heroism and dignity of the patients presented.

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Among animals only humans have difficulty giving birth. While other primates deliver their babies with little fuss, women experience painful labor and childbirth. The explanation for this discrepancy lies in the size of the human head at birth. As hominids evolved ever larger and larger brains, the fetal head had to increase in size at birth. Eventually the head almost outstripped the female pelvis's ability to expand enough to allow it through the birth canal. This delicate balance between fetus and pelvis accounts for human fetal and maternal morbidity and mortality.

As a response to the growing threat of childbirth, human females evolved away from estrus (i.e. sexual receptivity only when ovulating) to the menstrual cycle and continuous sexual receptivity. The mysterious moon-related cycle led women to formulate the concept of "time" and make the connection between sex and pregnancy. It also allowed them to refuse sex when they were ovulating.

Women then taught time consciousness to men, and men used their growing self-consciousness to begin to establish control over nature (and women). The sense of being-in-time led inevitably to awareness of mortality. This, in turn, stimulated humans to create gods and religion in order to ward off death anxiety.

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Dr. Flaherty, a practicing neurologist, sets out to explore the act of writing and, more broadly, creativity, in the context of both neuroscience and emotion. She begins by describing several brain conditions that seem to enhance the need to write, even to the extent of obsessive hypergraphia. Next she turns to the opposite state, writer's block, looking at both psychological and neuroscientific perspectives.

Using some of the recent studies of the relationships between certain brain centers and language related phenomena, Flaherty further clarifies some of the cognitive bases for creating literature. Finally, the study turns specifically to the temporal lobe as the possible organic site of the perceived voice of the muse in religious and creative inspiration.

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