A Pop Health Book Review of “In the Kingdom of the Sick: A Social History of Chronic Illness in America”

In 2009 I read "Life Disrupted: Getting Real about Chronic Illness in Your Twenties And Thirties".  Since the book inspired me personally and professionally, I was delighted that Twitter enabled me to connect directly with the author Laurie Edwards.  I was even more delighted when she asked to interview me for her new book, "In the Kingdom of the Sick: A Social History of Chronic Illness in America".  Since Pop Health focuses on health communication and the coverage of public health issues in the media, we had plenty of mutual interests to discuss!

"The very nature of chronic illness- debilitating symptoms, physical side effects of medications, the gradual slowing down as diseases progress- is antithetical to the cult of improvement and enhancement that so permeates pop culture." 
("In the Kingdom of the Sick", page 34)

Early in the book, I found this quote incredibly powerful.  It is true.  Our society values and spotlights those that overcome adversity- those that inspire us- those that beat the odds.  Before his fall from grace, we can all remember the worldwide cheering for Oscar Pistorius- making history last summer for being the first double-amputee to compete in the Olympic games.  Edwards highlights those societal values in her book by drawing on the imagery found in many commercials for breast cancer research and fundraising.  Those commercials show an unforgettable image, a "cancer survivor triumphantly crossing the finish line in her local fund-raising event surrounded by earnest supporters."  That triumphant image is a far cry from what Edwards and colleagues term the "Tired Girls" (i.e., female patients suffering with "invisible illnesses" like fibromyalgia, chronic fatigue syndrome, and migraines).  "The Tired Girl stands for so much that society disdains:  weakness, exhaustion, dependence, unreliability, and the inability to get better" (page 103).

The good news is that many of the "Tired Girls" (and Guys) are getting connected and getting empowered.  Edwards dedicates a significant portion of her book to the discussion of "patients in the digital age."  She describes the emergence of "e-patients" (those that are empowered, engaged, equipped, enabled) and how they are using technology to actively participate in the development of their care plans, connect with patients with similar diagnoses, give voice to their experiences, advocate for policy change, and debate controversial topics like vaccinations.

As a public health professional with significant interest in health communication, I was fascinated by a recurring theme that Edwards highlights from these conversations among empowered patients and writers:

"How does language influence the illness experience?"          

The reader is led through an intriguing discussion of the use and implications of terms such as:

• Illness vs. Disease
• Illness vs. Chronic Condition
• Illness vs. Disability
• Military Metaphors (e.g., "the battle against disease")
• Chronic Pain Patient vs. Patient with Chronic Pain
• Healthy Disabled vs. Unhealthy Disabled
• Patient (does it connote passivity?)

"In the Kingdom of the Sick" is a fascinating read for anyone with a personal and/or professional connection to chronic illness.  It begins by giving you a strong foundation in the history of illness, research, and patient advocacy movements.  It then challenges you to consider the impact of advances in patient rights, science, communication, and technology on the incidence, treatment, and perception of chronic illness.  I highly recommend this book to my Pop Health readers, friends, and colleagues.

If you are interested in connecting with Laurie Edwards:

10 Things Your Face Says About Your Health

(Thinkstock) Your face can reveal unexpected things about your health

Look in the mirror every morning, and you may notice a new fine line here, or a rogue pimple there (whoever said that acne stop after adolescence was a liar)—but did you know that chronic lines and spots can indicate something more serious about your overall health? The Daily Mirror tackles this hypothesis with an epic list of symptoms and manifestations, consulting health experts—but here are our top-10.

1. Those lines on your forehead might mean you have digestion problems. The Mirror's experts recommend drinking warm water with lemon juice first thing in the morning. We're thinking: juice cleanse or a colonic?

2. If you have itchy ears, you might have a Vitamin D deficiency. Yes, office-dwellers, you probably have a Vitamin D deficiency. Try to get out there and see the sunshine for 10 to 15 minutes each day! Or find a good supplement.

3. Zits on your forehead. Who hasn't battled forehead pimples in their lives? Apparently, a rash of forehead acne could be an indication of liver or stomach problems. Experts recommend eating more leafy greens and reduce the amount of processed food and caffeine consumed.

4. White spots on your eyes could mean a lymphatic problem. Persistent white spots on the outer rim of your eyes may indicate that you have a lymphatic congestion problem. The Mirror's experts recommend giving up dairy and cow's milk for while to see if it clears up.

5. Acne around your jawline might mean your hormones are in flux. If you always get zits on your chin around that time of the month, you're not alone. Apparently, jawline acne increases as you get older and your estrogen levels drop. Experts recommend eating more apricots, shiitake mushrooms, sweet potatoes, and mangoes to help your Vitamin A levels, which, in turn, help regulate your skin cell production.

6. Age spots might mean you're detoxing. Your skin might be purging toxins, so, to help support it, eat plenty of fresh foods and drink lots of water. Also, try massaging castor oil into existing age spots to help them fade.

7. Dry lips probably means you're dehydrated. While the most likely cause of dry lips is dehydration (drink more water!), there's also the possibility you're Vitamin B deficient or having problems absorbing iron. If you drink lots of water, but the problem persists, consult your doctor. If you're a mouth breather with dry lips, well, you're on your own.

8. The 11s may mean your liver's stressed out. According to the Mirror's experts, a serious frown line (or, the 11s, in between your eyes), may indicate that your liver isn't super-happy. "This could be for physical, environmental, and emotional reasons, or an allergy to foods/substances or loss and grief," said therapist Annie Day. "This leads to adrenal overload, known as burnout. Try gently massaging the brow area with circular moves."

9. Undereye circles might mean you have allergies.If you get plenty of sleep but still have persistent dark circles under your eyes, it might mean you have allergies. Try eliminating common allergens, like dairy and wheat, for a while to see if it helps. If you must, give up alcohol, because it can aggravate the situation.

10. Canker sores might mean you have a Vitamin B deficiency. If you have cold sores, sorry, you have herpes, see your doctor. But if you have those little white spots inside your mouth—canker sores—you might just be suffering from a Vitamin B deficiency. Try eating more whole grains, green veggies, or adding meat to your diet.