John Galloway

Getting the point across

Nurse clinician in emergency medicine Rob Jackson is visiting secondary schools to warn teenagers about the dangers of knife crime. As part of his presentation, Mr Jackson shows youngsters pictures of knife injuries, hospital resuscitation rooms and mortuaries to teach them about the reality of violence.

Crusades and rackets

Vitamin C and Cancer: Medicine or Politics.By Evellen Richards. St Martins Press/Macmillan: 1991. Pp. 269.

A severed thread

35, £35.

Myths and men

cultures from Mexico to Hungary. This is a substantial book in all senses: at 400 or so large-format pages on dense paper, it is not something to tuck in your briefcase. Nor does its attention to detail make for light reading. But those things do nothing to alter the fact that we need more books like this, unafraid to assume a degree of commitment and cultural understanding in the reader without ever losing clarity and accessibility. It will bring some colour into your life. ■ Philip Ball is a consultant editor for Nature. His latest book, Bright Earth: The Invention of Colour, is published by Penguin.

From trenches to couches

iatory actions between these countries would surely cause widespread harm. Other countries have agreements for bioprospecting,but these bring mixed benefits.It is not always clear, for example,who owns the intellectual property of the varieties. Brush’s forceful conclusion is that increasing ownership will abuse the rights of people who have long been involved in the common pool of genetic resources, but who now find themselves excluded by modern patent laws. ■ Stuart Pimm is in the Nicholas School of the Environment and Earth Sciences, Duke University, Durham, North Carolina 27708, USA.

Pairs of genes

When asked whether he believed in free will, Oxford philosopher Gilbert Ryle said, “Tell me what it is and I will tell you whether I believe in it.” When ill, he might have said to his doctor, “Tell me what the disease is and I will tell you whether I am suffering from it.” Historians of medicine are interested in how societies ‘invent’, define and then deal with diseases. Ruth Leys’ book is a study of psychic trauma’s family tree, its invention, constant reinvention and formal recognition as a named syndrome, in this case post-traumatic stress disorder (PTSD). The notion of disease specificity, its implications for care and its relationship to science, is close to the heart of medicine. In psychiatry, there is tension between the science-led game plan with its small number of disease categories — such as dementia and schizophrenia — and the psychoanalytical tradition with its tendency to multiply syndromes ad infinitum. In 1994 the American Psychiatric Association’s fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) listed almost 300 distinct syndromes. In A History of Psychiatry (Wiley, 1996), Edward Shorter suggests that, although vaguely referred to as disorders, all 300 were really intended to represent “distinct [that is, specific] disease entities”, however unlikely that seems. Leys’ starting point is the case brought by Paula Jones against President Bill Clinton for sexual harassment. Jones’s claim for damages rested on her assertion that, as a result of harassment, she was suffering from stress with “long-term symptoms of anxiety, intrusive thoughts and memories and sexual aversion”. Her lawyers argued a clear case of PTSD. This condition had been added to DSM in 1980 — in the words of one commentator at the time, because “a core of psychiatrists and veterans of the Vietnam War worked consciously and deliberately to put it there”. They argued that war had traumatized the veterans, leaving them with feelings of guilt, rage and alienation. Taken together, these feelings constituted a distinctive disorder caused directly by their experience. “Specific” hardly describes a condition with so many causes — ranging from Jones’s harassment by President Clinton at one extreme to the horrors of the battlefield (or Holocaust or torture chamber) at the other. Leys obviously suspects that the idea of trauma has not really evolved over the 100 or so years since its invention by Sigmund Freud. Trauma: A Genealogy is the result of her meticulous attempt to find out just what has been going on. Starting with Freud, she has worked her way up to the present day, taking in both world wars, the Holocaust and the Vietnam War and ending with Elaine Showalter’s Hystories: Hysterical Epidemics and Modern Media (Columbia University Press, 1997). At one level it is clear that things have changed little since Freud’s time. The Paula Jones/Vietnam veterans dichotomy was equally apparent in the past, with on one hand the psychological casualties of First World War trenches and on the other Freud’s rich, underoccupied young women patients who provided the clinical basis for his theories. Like Freud, psychotherapists and psychoanalysts presumably think their treatment can be successful; otherwise it is diffibook reviews

The health of nations

8 basic question: how could they extend the concept of marginal utility to the calculation of costs and benefits throughout the system without abandoning worthy public projects — such as basic research — which are often driven by intuitions and enthusiasms that defy calculation of marginal utility? And how can truly worthy public projects be distinguished from interests of power, or from ‘pork’ as Americans call appropriations by particular coteries of patrons and clients? As Josephson tells his stories, the painful complexity of these questions emerges less in the glory years of the reckless leap to Atlantis than in the aftermath, especially in the recent surrender to ‘the market’, a euphemism in post-communist Russia for enormously bloated pork-barrel politics. He points out that the market has even undermined intellectual freedom by the near destruction of state funding for science, obliging researchers to scramble for the support of profit-seeking sponsors. Josephson evokes the excitement of the heaven-storming years in the Siberian science city, before Khrushchev’s comrades cast him aside to enter the ‘period of stagnation’. Much of the book declines with its protagonists into obsessive concern for networks of patrons and clients and intricate intrigues, with a deadening effect not only on the vitality of the system but also on the reader’s interest. The challenge of such personal networks is to discover in their historical development patterns of institutional change that transformed elements of a ruling party into elements of a ruling class, while changing hard-driving scientist entrepreneurs of Lavrentev’s type into grey-faced survivors, profit-seeking hustlers or émigrés. I construe this oversimplified phylogeny from torrents of anecdotal evidence in Josephson’s book. Too often he seems unaware of a need to seek patterns of institutional evolution, whether through Baconian induction or wilful construction. He writes as if the institutions in question were, on one side, multitudinous bureaucratic structures such as the Academy of Sciences, its branches and institutes, and, on the other side, a single entity, ‘the Party’. Soviet rhetoric commonly invoked the bizarre image of a huge, complex society dominated by a monolith, and many people still talk that way, now blaming rather than revering ‘the Party’, but still avoiding acknowledgement that it too was a congeries in the process of change along with the organizations that were supposed to be controlled by ‘the Party’. The most amusing instance of such talk comes in an interview with the one-time Party boss of Akademgorodok. Josephson gives a vivid picture of a smooth, effective operator, who served his local constituents well until 1965, when the central bosses in the Politburo kicked out Khrushchev, downgraded the project of a ‘new Atlantis’ and abolished the Pairs of genes

Betrayers of trust

The Peoples Health: A Memoir of Public Health and Its Evolution at Harvardby Robin Marantz Henig National Academy Press: 1996. Pp. 256.

Madness to the method

29.95, £24.95

The imperial theme

The Power of Life or Death: A Critique of Medical Tyranny.By Fabian Tassano. Duckworth: 1995. Pp. 177. £12.95 (Pbk).Wrong Medicine: Doctors, Patients and Futile Treatment.By Lawrence I. Schneiderman and Nancy S. Jecker. Johns Hopkins University Press: 1995. Pp. 200.