Lovers and Livers: Disease Concepts in History (review)

Jacalyn Duffin, the author of numerous articles and a number of highly acclaimed books—including History of Medicine: A Scandalously Short Introduction, To See With a Better Eye: A Life of R. T. H. Laennec, and Clio in the Clinic: History in Medical Practice—is one of a select group of historians of medicine who also have extensive clinical expertise. Her latest absorbing book, Lovers and Livers, explores the idea that diseases are concepts. Duffin's premise is that diseases are models and are thus subject to change. In addition to their critical biological underpinnings, diseases are also fundamentally "influenced by the tastes and preoccupations of society." In order to trace the history of any specific disease, one must understand the local culture and the philosophy of knowledge within a particular place and time. Diseases, Duffin writes, are not as much discovered as they are refined or reinterpreted. One of the most interesting topics that she explores is the medicalization of common phenomena, including normal age-related conditions. The physician's domain now includes such common conditions as insomnia, impotence, baldness, obesity, sexual dysfunction, domestic violence, anxiety, and wrinkles.

In her opening chapter, Duffin elaborates what she calls a "well-dressed disease concept." This includes a number of easily recognized and specific criteria: unique names, patients, diagnoses, outcomes, prognoses, and treatments. Latin names, like podagra or ague, evoke a bygone era with terms, while eponyms such as Hodgkin's disease or Sydenham's chorea evoke particular moments and themes in medical history. Prognosis has always been the focus of medical practice, however, unlike the modern emphasis on end-of-life care, ancient physicians did not target practice to those who were terminally ill. Medicine has seen a relatively recent movement away from symptoms—what patients experience—to signs reflective of objective evidence, and accurate diagnosis in the modern era has spawned whole new specialties such as radiology, pathology, and microbiology. But although our understanding of the scientific causes of diseases has undergone a dramatic transformation, cultural and humanistic aspects of disease remain important and relevant. Duffin explains several contemporary models of disease and emphasizes the critical role of the observer as part of the classic Hippocratic triangle of the illness. With this as background, she then chooses two radically different disorders to illustrate the interplay of science and social context: lovesickness, a disease that harkens to a bygone era, and hepatitis C, a contemporary and public issue.

The chapter on lovesickness illustrates the "medical and demedicalization of romantic love." Clearly, the experience of love, especially that of falling in love, is universal. It has easily identified physiological and psychological manifestations. Whether an adolescent crush, unrequited love, or a distracting torrid affair, love has power: it is the stuff of art and music. Duffin creates a compelling narrative of lovesickness as a legitimate disease. She traces this concept from its origin as a literary metaphor in the writings of ancient Egypt, Greece, and Rome, through the texts of great physicians such as Oribasius, Avicenna, Rhazes, and Constantine the African. Lovesickness has been variably called by terms such as "erotomania" or "amore insano." Over time, diseases of love moved beyond those of unrequited desire and encompassed diseases of sexual perversity, sexually transmitted diseases, and psychosocial illnesses related to sex, such as nymphomania and narcissism. A biological understanding of sex has helped to change our understanding and framework. Now, though sex is considered to be a normal bodily function, love still captures media attention with high profiles cases of stalking suitors and deadly love triangles. Duffin cleverly uses modern medical concepts from psychiatry, neurosciences, and addictions (for example, co-dependency) to understand the pathologic side of love. Finally, she argues that society has "sociocultural preconvictions" that determine whether something is bad enough to be called a disease. One needs to look no further than the modern explosion of the obesity "epidemic."

The last section of the book deals with hepatitis C. Duffin tracks our understanding...