Lovers and Livers: Disease Concepts in History (review)

With Lovers and Livers Jacalyn Duffin has provided a concise and useful model for understanding disease. She offers an unusual definition of disease—"I will try to convince you that diseases are ideas" (p. 3)—and argues that historians need to explore distinct aspects of the idea of disease: illness ("the subjective aspects of suffering," p. 5), its patients, its names, its outcomes, its cause, and its management. These domains, taken together, create a comprehensive model of disease, the "disease concept" (p. 10). Duffin shows how this framework can incorporate a wide range of phenomena. Attention to causes takes historians into the history of religious, environmental, and infectious theories of disease. Attention to management shows how new treatments can create new diseases by drawing attention to previously neglected concerns (e.g., sildenafil and erectile dysfunction, p. 18), or by creating new pathology (e.g., "Back To Sleep" campaigns and plagiocephaly, p. 35).

Some of the most useful parts of the book are the pedagogical tools that Duffin describes. In one exercise, she names a disease and asks her audience to list every association that comes to mind; a simple compilation of responses quickly demonstrates to the audience how substantially disease concepts vary from person to person. In another example, she draws a "Hippocratic Triangle" with observer, patient, and illness at its vertices (p. 23): if you move the position of the observer (e.g., two observers of the same patient-illness episode), or move the patient (e.g., one observer of pneumonia in two different patients), you get different triangles—that is, different disease concepts. These simple exercises demonstrate the contingency and malleability of disease far more clearly than the usual prose of social construction.

Duffin's models come alive in her discussions of lovesickness and hepatitis (hence the title). Moving fluidly between ancient poets and modern medical theorists (a rare talent in our world of academic specialization), she explores the classical notion of lovesickness (the "exquisite pain of unrequited longing," pp. 43–44), an illness that astute physicians could diagnose by noting how an anguished patient's pulse faltered at the mention of the lover's name (p. 48). Tracing the varied diseases of love through Ibn Sı\na\ to Robert Burton, Alfred Kinsey, and functional MRI, she speculates that love has always been associated with disease because it threatens otherwise rational people with a loss of control (p. 77). Shifting her focus from the individual to society, Duffin argues that we need to recognize current plagues of relationships, especially domestic violence, as social diseases produced by a culture that glamorizes male violence (p. 75).

The discussion of hepatitis also begins with ancient texts, starting with Hippocratic descriptions of jaundice, but moves much more quickly to twentieth-century efforts to crack the puzzles of infectious hepatitis. Duffin focuses on hepatitis C and the scandals about blood transfusion and liability that rocked Canada in the 1990s. How did a disease that is often asymptomatic and rarely fatal fuel an epidemic of lawsuits and media coverage? Who is responsible for a disease that could have been prevented? As she describes, hepatitis C has become two diseases in Canada: one a disease of innocent victims, infected through blood products, deserving compensation; and the other, a disease of illicit behaviors, scorned, stigmatized, and uncompensated. Again she argues that society should broaden its vision, accepting responsibility for the prisons, drug use, and sexual practices that allow hepatitis C to thrive.

Any book that covers so much ground is bound to develop complications. Scholars interested in either the biological or social aspects of disease will need to figure out where these fit into Duffin's disease concept. A more explicit comparison of her model to existing notions (e.g., framing disease) might help. The blow-by-blow narrative of the Canadian hepatitis scandals occasionally wanders from the book...