The Great Pretender, Susannah Cahalan

I was fascinated by Cahalan’s previous book, Brain on Fire, which documents her hospitalisation for psychosis that turned out to have been caused by encephalitis, prompted by an immune disorder. For a while, Cahalan was lost, but she found her way back, and The Great Pretender is in part prompted by those experiences. Looking at patients with mental health issues, she’s found herself wondering how many might be suffering from brain inflammation in the way she was, and how many could be cured partially or wholly by the same treatment. That’s how she found out about David Rosenhan’s famous study, which was born from a very pertinent question: “How can we tell the sane from the insane?”

Rosenhan’s study sounds simple: he sent nine pseudo-patients, one of them being himself, into a psychiatric ward with a simple description of non-dangerous but troubling symptoms. They all claimed to be hearing voices which said things like “hollow” and “empty”, but they dropped these symptoms as soon as they were actually in the ward. They all emerged from the wards — some after nearly two months — with diagnoses of schizophrenia.

Cahalan found this electrifying: how could psychiatrists not tell the pseudo-patients were perfectly sane? For the same reason as she was originally diagnosed as psychotic, partially: there’s no actual physical diagnostic criteria you can run someone through to prove one way or another whether they are suffering from a mental health disorder. (The DSM, a diagnostic manual, was updated to include a lot more diagnostic criteria as a direct result of this study; the issues are different now, though there are still deep issues with subjectivity and bias.) And also because all kinds of ordinary actions could be interpreted as insanity when seen in the confines of a psychiatric ward. A person taking reams of notes on everything the nurses do might be a pseudo-patient, but your first thought is probably that they’re paranoid and keeping track of the nurses as part of their out of control fear and attempt to control the situation!

In any case, Cahalan found the study fascinating and began to dig in… which is where it all began to fall apart. This isn’t a small study that no one knew about; this shaped mental health policy for years, and despite the protestations of some mental health professionals reading this book, it’s still in people’s minds. (I knew about it as a layperson, and I only had to say “Rosenhan” for my mother, a psychiatrist, to know what I was talking about.) And yet Cahalan’s investigations call it into question. It seems very likely that Rosenhan faked much of the data, as very few of the pseudo-patients could be found. One who was had a markedly different experience in the wards to the one reported, and was allegedly removed from the study… though his data still remained in the published version.

There are all kinds of little inconsistencies that pointed Cahalan to this conclusion, and I think the length of my review shows my enthusiasm and interest for the digging work she’s done here, interviewing the study participants she could find and searching for the others. She calls into question the study’s truthfulness, but not, in the end, its validity. Rosenhan’s observations struck a chord for a reason, after all. Was it bad of him to lie and fake data like this? Of course it was. But maybe psychiatry needed that.

That said, the book also showcases how far the pendulum has swung the other way, with prisons in the US absorbing many of the people originally cared for in specialised wards. And Cahalan keeps putting her finger on the sore place, again and again: we still can’t tell the sane from the insane, not really. We still don’t know the physical causes of much mental ill-health, and diagnosis requires an experienced clinician with a checklist of behaviours — and even they can be fooled by an autoimmune disease.

It’s perhaps not as gripping as Brain on Fire, but I enjoyed it and highly recommend it, and find myself largely in agreement with Cahalan’s conclusions.

Rating: 5/5

When the Dogs Don’t Bark, Professor Angela Gallop

I picked this up on a whim because it looked like it could be my sister’s thing, and I never object to more random information about all kinds of topics. Angela Gallop is a well-known forensic scientist who has worked on several famous murder cases; this is a sort of professional memoir, barely touching on her personal life, but digging into her opinions on forensic science, her part in expanding forensic science services in the UK and eventually worldwide, and her involvement (sometimes tangentially) in various cases.

It’s a little bit of everything, really: she talks about setting up her business, and that butts up against the horrible details of bloody murders and the less than fascinating references to board meetings. It feels rather unfocused, sort of like there’s the kitchen sink at all: there’s certainly plenty of interesting anecdotes, but the wealth of examples sometimes bogs down her theme. Where you expect her to be contrasting two cases, they turn out to be remarkably similar and prove the same point. It’s not terribly written, but I’d tighten it up ruthlessly and make her add in an organising theme.

She does have something she wants to say about forensic science: “it’s more complicated than you think, it needs funding, it needs to be impartial, and it needs to be done in context”. But those cautionary notes for the understanding of and the future of forensic science get a bit lost when suddenly she’s complaining about the perils of borrowing money to start a company and how things could have gone wrong there. The book’s neither fish nor fowl; it’s not just about digging into the story behind investigating specific crimes, but it’s so heavy on those details that it feels like maybe that was the original point.

That said, the details are interesting and her style isn’t bad, just a bit flabby. I mildly enjoyed it, but felt it could’ve been more impactful if it knew what it was.

Rating: 3/5

West Nile Story, Dickson Despommier

I came across this because I was trying out various science podcasts and tried listening to some of the early episodes of This Week in Virology (link goes to the episode about West Nile virus). I was curious to dig in a little more, and lo and behold, this book was on Kindle Unlimited. It discusses the earliest outbreak of West Nile virus in the US, which happened in New York during a hot, dry summer, and was somehow transmitted there from Israel. The podcast actually fleshes out the theory a bit more, while this book focuses on a wider look at the virus, its ecology and implications.

It’s probably a fairly dry read if you’re not interested in emerging infectious diseases, but since I am, I quite enjoyed it; I found it fairly simple, so if you’re just interested in diseases for the sake of it without a professional interest, I think it’s completely understandable for a layperson. It was a little basic for me at times, in fact.

Overall, it was a little scatterbrained somehow; it wandered off into discussing other diseases like malaria, without really tying it into the discussion of West Nile very well. I’d probably recommend the podcast over the book for that reason, but it was still interesting to dig in a bit deeper on some of the points mentioned in the podcast.

Rating: 3/5

Sorting the Beef from the Bull, Nicola Temple & Richard Evershed

This book is about the science of food fraud — the way food fraud is committed, hidden, and detected. It has chapters on various staple foodstuffs, from meat (Horsegate, of course, but also other meat-related frauds like the injection of extra water into meat so that the consumer pays for water in the alleged weight), spices (you don’t want to know what happens with many ground spices), wine (mostly affecting rich people, but also some of the lowest end stuff), oil (olive oil is a big target), milk… Apparently it’s endemic in the UK, at least in Lancashire, that pizza takeaways almost universally do not use mozzarella — it’s not even cheese at all, with actual cheese only being added as a flavouring. And if you’re in the US, I have bad news about the likelihood that any red snapper is actually red snapper. 80% odds say it isn’t.

Most boggling to me, the idea that you can make a synthetic egg that fools people to the extent that they’ll crack the eggs, fry them up and consume them. (You can tell they aren’t real eggs because they lack a membrane inside the eggshell. That’s about it, to hear these authors tell it.)

It’s not just horror stories, of course: the authors also discuss the science at work in detecting these frauds, and the best ways for a consumer to avoid them. Mostly, it comes down to awareness, buying things whole (fish with the heads on; whole spices; recognisable cuts of meat, etc) buying seasonally, and buying locally from sources you can trust.

It’s all a bit horrifying, but fascinating as well. Definitely worth a read.

Rating: 4/5

Return of the Black Death: The World’s Greatest Serial Killer,Susan Scott, Christopher J. Duncan

Full disclosure: I was sceptical before I even picked this up from the sensational title. You’ve got to go a seriously long way to convince me that the Plague is the “world’s greatest serial killer”, even if we accept that a disease should be considered in such an anthropomorphic light. Let me introduce you to your friendly neighbourhood Influenzavirus A, my #1 vote for “disease most likely to have the means to suddenly eradicate humanity”.

I picked it up because an author tweeted a thread of things she would never let anyone change her mind about, and one of the items was that she doesn’t believe the Black Death was caused by Yersinia pestis. Now, infectious disease is one of my special interests, and I already happened to know that Yersinia pestis has, for example, been isolated from plague pits. So I asked her for evidence of the claim, and she pointed me to this book.

Well.

From the start, it was not very rigorous or scientifically accurate? They’ve claimed that HIV is completely understood and under control and causes no panic, for one thing. (I wrote my dissertation on tuberculosis, so I can guarantee you that no HIV isn’t fully understood, because if we could, for example, understand how it and tuberculosis enable each other, that would be really helpful. We have theories, but as of a year ago, we don’t really know for sure.)

And then they make absurd statements like this: “…by all the rules of infectious diseases, when the Black Death was finished it should have disappeared.”

What?! Have they never heard of animal reservoirs? Re-introduction from the original sources? Endemic diseases? Fast-adapting diseases like influenza that change their surface proteins and thus evade immunity? Infectious diseases almost never just “disappear”, though there may be an outbreak in a new species due to chance contact that doesn’t reoccur that might look like disappearance.

What rules of infectious diseases can they possibly be referring to?

I mean, how many diseases do you even know of that have been driven extinct after much effort by humans doing so deliberately? That’ll be two: smallpox and rinderpest. (Smallpox is the only human disease to be eradicated, and with the aid of a highly effective vaccine and extremely persistent vaccination campaigns, it took 11 years of intense campaigning. We have so far been unable to repeat the effect on other target pathogens.)

And there’s this one: “[Measles] is not a danger to well-nourished children in the developed world.” Measles, which can kill (yes, even in the developed world), and furthermore wipes out your immune memory as well as depressing your innate immune system. And they think that Ebola literally liquefies your internal organs.

And then, you know, I read the immortal words stating that “it came as a great surprise to learn” that Iceland had effective contact with the rest of Europe in the 15th century, and also suffered two major outbreaks of the Black Death. Do they just… know nothing of history? At all? Clearly not: they also referred to a manuscript from 1404 as “ancient”…

I had more quibbles. Honestly, I was made out of quibbles about this book. I do have some lingering questions from good points they raised about the vectors, since they claim that rats/fleas of the type that could transmit bubonic plague were not present in Britain and certainly not in Iceland. It’s clear that their claim it was simply too cold in Britain for bubonic plague to survive is untrue, since studies since the publication of this book with reliable controls have found Yersinia pestis in plague pit remains in Britain, but that still makes me wonder about the vectors.

I’d also like to see independent verification of their work on the incubation period of the Plague, which according to their calculations aren’t at all like the modern Yersinia pestis (which is not genetically that different from the medieval version). However, the shakiness of their grasp on facts elsewhere leads me to doubt just about everything they say.

Rating: 1/5

It’s All In Your Head, Suzanne O’Sullivan

The title of the book gives it away: this is a series of case studies, essentially, covering cases of psychosomatic disease. In it, as in O’Sullivan’s other book, she discusses the cases of various past patients and how she concluded their symptoms were not neurological disorders, but instead signs of a conversion disorder. I think the title is a bit of a disservice, because O’Sullivan is strongly against the kind of dismissal the phrase implies. She believes that (most of) her patients with this issue are truly distressed, truly experiencing pain and disability, and truly require medical help. Though it’s not a physical disorder of the nerves, it is something that should and must be treated in order to allow people to resume normal lives.

Understanding of psychosomatic illness and health anxiety is lacking in many doctors. Part of it is overwork: crowded clinics do not appreciate the sight of someone hoving into view with yet another anxiety-related illness of nebulous symptoms and solely psychological origin. But people like that, all the way along the scale from the lumps and bumps that trouble me to those whose brains paralyse themselves, all deserve compassion and treatment, and O’Sullivan’s book strongly advocates for that. She is firmly against the impulse to second guess a patient and assume they are faking.

That said, of course she makes herself come across as preternaturally patient with this kind of thing, and very sure about her diagnoses. She does discuss uncertainties now and then, but for the most part she is very certain of herself. Most of the cases she mentions are very clear-cut, and it makes it all seem very easy. In reality, things are muddier.

The chapter on ME/CFS has many detractors and as many people who shout that it is pure truth. Lacking the professional background or the academic reading on the topic, I can only say that I was under the impression that the graded exercise she recommends was in fact proven to be unhelpful, and that both sides in ME/CFS discussions can get very fraught and very disinclined to admit the truth of anything the other says. At the very least, O’Sullivan’s sympathy feels real, and she does intend to diminish the suffering of people with ME or CFS; she merely questions its source, and does not believe that a psychological source of issues means weakness or that you can just snap out of it.

It’s not deeply profound if you’re looking for the science of all this, though she does discuss what is known and the history of psychosomatic illnesses. It’s mostly of interest for really understanding the bananas things our brains can do to us. An enjoyable read, but not for me a groundbreaking one.

Rating: 3/5

The Gendered Brain, Gina Rippon

Gina Rippon and other writers like Cordelia Fine between them attempt to totally rip to shreds the idea that there are such things as “male brains” and “female brains”, writing convincing critiques of studies which are then just as convincingly critiqued in their turn. It’s difficult for someone outside the field (even someone with a biology degree that included modules on human biology and on “the science of the mind”) to know how to pick this apart, and I worry that a lot of the time we go looking for someone who supports our view, and then believe them because they sound most convincing. (And of course they do! It’s easy to convince someone of something they already believe.)

In terms of the book itself, Rippon’s not as engaging as Cordelia Fine; I actually got a little bored and bogged down at some points. It definitely wouldn’t be my first choice as a primer for a pop-sci book that’s sceptical of the pink-brain-blue-brain debate. There are some interesting sections: the discussion of attitudes toward menstruation is particularly interesting, as it suggests many of our negative ideas about menstruation (including PMS) are culturally received. (Then again, Rippon doesn’t engage with the genuine issues of people with conditions like PCOS or endometriosis, which very clearly make periods exactly the misery people fear.)

In terms of the evidence presented, I think some of the debunking is useful for sure, and the reminders that some of these differences are actually vanishingly small. However, Rippon uses examples of women with high testosterone, and possibly other intersex characteristics as well, without bothering to think about whether it’s the binary that’s serving us poorly. We know that biologically, sex is a spectrum with groupings around two points, not two separate and wholly discrete categories. I’d love to see more work dealing with that and what that might mean; this book ain’t it, because it tacitly accepts from the start that there are men and women, and that everyone can be sorted into one of those two boxes.

Rating: 3/5

Making Eden: How Plants Transformed a Barren Planet, David Beerling

I picked this up on the strength of The Green Planet: in that book, Beerling’s fascination with and passion for everything to do with plants was palpable. It was a really good book, and he wrote clearly for any audience. Making Eden is perhaps a little more technical, or just a little less polished: I honestly found it a little dry, overall, and I can’t say I loved it nearly as much. Obviously I’m a bad judge of what works for people without a scientific background, but once or twice I found myself getting lost, so my feeling is that it probably misses the target a bit.

It is fascinating to think about how plants made that step from the oceans to the land, though, and it was a worthwhile read to understand a bit more about that. The importance of fungi doesn’t surprise me, though I was pleased to get a chance to read a bit about the experiments that more or less proved it. That leads neatly into Beerling’s final chapter, which… discusses the impact of humanity on plant diversity.

I get it, it’s an important subject, but at this point with me you’re not just preaching to the choir, you’re trying to teach them a song they already know — and it’s not even a more specialist look than perhaps I might read elsewhere, because it’s just 20 pages at the end of a book on its own topic. It’s boring. I know why it’s there; perhaps it’s even irresponsible not to put it in there somehow. But… none of it is new to me, and this book didn’t excite me enough in general to really get over that.

So, overall a bit disappointing. It’s still readable, but I didn’t find it compulsive reading like The Emerald Planet, and it didn’t get me excited.

Rating: 3/5

The History of Life in 100 Fossils, Paul D. Taylor, Aaron O’Dea

This isn’t entirely a coffee table book, but it is a little sparing on details — sometimes I really wanted to know how a certain fossil was formed, and they don’t mention it, or their related text is barely related to the actual fossil they’re presenting. And of course, there are fossils I’d like to see discussed and aren’t, and some I wouldn’t have put in my personal lineup of the history of life. Nonetheless, it’s fascinating to see someone else’s choices, and follow the timeline of the development of life through their examples.

And of course, some of the fossils are just flat-out gorgeous.

Rating: 4/5

Making the Monster: The Science Behind Mary Shelley’s Frankenstein, Kathryn Harkup

I really enjoyed Harkup’s book on Agatha Christie’s use of poisons in her plots — I wasn’t a Christie fan, but the book gave me a whole new appreciation for her work — so I jumped on this the minute I saw it. It begins largely as a biography of Mary Shelley, to be quite frank; there’s very little science for at least half the book, and there’s rather too much re-describing the plot. I get that the actual book isn’t familiar to everyone, but this is billed as pop-sci, not Sparknotes.

Nonetheless, when she does eventually get down to it, it’s fascinating to hear about the science of the day and what Shelley may have been aware of. Calling it the first science fiction book sounds a bit odd, because it’s not really the aesthetic you think of — but Shelley did research and was careful to reflect the science of the day. Maybe it’s not hard SF, and there’s much that seems unlikely now, but it’s still based on the understanding of science that she could possibly have been aware of.

Still a bit too biographical, overall: I believe seeing books in their context is important, but Mary Shelley’s parentage and miscarriages were less than necessary to the overall narrative.

Rating: 3/5