#NotTheWellcomePrize 2020 reviews Constellations by Sinéad Gleeson and War Doctor by David Nott

With the Wellcome Book Prize on hiatus this year, an unofficial Not the Wellcome Prize is being run (with permission) to showcase some of the best health-themed literature of 2019. This has been organised by Rebecca Foster (@BookishBeck) who invited me to participate. My avoidance of blog tours was overcome by my fondness for the Wellcome Prize.

To find out how the winner of the Not the Wellcome Prize 2020 will be decided, read Rebecca’s post here.

Today, I am reposting my reviews of two fabulous books that are in contention.

 

Constellations by Sinéad Gleeson
(published by Picador)

Constellations is a collection of fourteen essays written by an eloquent storyteller. Each celebrates the imperfect body – its workings and failings. There are musings on wider attitudes to ownership and behaviour. The stories told are incisive and highly personal. They cover a variety of the author’s lived experiences including: bone disease, cancer treatment, pregnancy, motherhood, and death. As a woman growing up in Ireland she has shouldered a burden of expectation against which she quietly rebels.

Alongside periods of incapacitation, the aloneness of illness, are many joyous moments of freedom and adventure. The author writes of: music, dancing, travel, relationships. There is an underlying generosity in her attitude to the world she inhabits, “making wounds the source of inspiration, not the end of it.”

She expresses a wish that her children, especially her daughter, may live their lives to the full and not be curtailed by

 “Those who go out of their way to avoid your good news,
who flash facsimile smiles when the world smiles on you,
The people who are too afraid to try to do
what you will one day do.”

The essay titled ‘Hair’ explores society’s attitude to women who choose to grow or shave off their tresses:

“Every time I’ve shaved my head, or sported a suedehead of regrowth, there is always a response, especially from men. They are mostly horrified or bemused; some declared it attractive: but I was always asked to justify myself.”

These unasked for responses to changed looks, or to actions deemed unfeminine and therefore unacceptable, are recounted in many of the essays. Too many people appear to believe that women require guidance, that they cannot be expected to know what is best for them.

In 60,000 Miles of Blood’, the author explores attitudes to this vital liquid when it leaves a host’s body. A soldier shedding their blood in battle is regarded as heroic. A woman’s monthly menstruation is shameful. An artist using blood in their work is berated. There are always opinions on what may be done with one’s own body and its constituents.

“Art is about interpreting our own experience. Upon entering hospitals, or haematology wards, our identity changes. We move from artist or parent or sibling to patient, one of the sick. We hand over the liquid in our veins to have it microscoped and pipetted. Beneš used his art as tenancy. If hospital tubes could house his blood, so could his own work. Beneš knew that if his blood had to be anywhere other than in his veins, he might as well use it as an aesthetic agenda; a declaration of possession.”

Moving on to the subject of parenthood, the author writes of how this has brought with it both joy and pain. As children grow they travel ever further away, carrying their parents’ intense love for them lightly.

There is a thread on feminism running through many of the essays. A woman’s pain is not always taken seriously by medical professionals. A mother is expected to put her children’s needs before her own. ‘Twelve Stories of Bodily Autonomy’ looks at abortion in Ireland and the 2018 referendum on the issue. It wonders at the mindsets of those who oppose a woman’s right to choose a termination.

“Ireland is scornful of its girl children. The state can and does oppose what a family/a woman/a pregnant person believes is in their best interest. A born girl has no more rights than an unborn foetal one.”

“A writer friend overhears a group of twenty-something men talking on a train. One, full of swagger, says he doesn’t ‘want to give them that’, insinuating that women are uppity and asking for too much wanting to control their bodies.”

‘Second Mother’ tells of a beloved aunt who suffered from Alzheimer’s and how the family could only watch as the person they had known and valued faded away, mind before body.

‘Our Mutual Friend’ is a reminder of the precariousness of life and the pain of grief. It is an intensely moving tribute to a young man whose life ended unexpectedly.

The writing throughout is percipient and exquisitely rendered, arguments expressed with clarity and compassion. Although important and at times emotive, vital issues are presented with grace.

Every entry in this collection was a pleasure to read.

 

War Doctor by David Nott
(published by Picador)

In a growing field of medical memoirs War Doctor stands out for its purpose – to increase awareness of the reality of modern warfare on the individuals and communities directly affected. The author has volunteered his services as a trauma surgeon in active war zones including: Afghanistan, Sierra Leone, Liberia, Chad, the Ivory Coast, the Democratic Republic of the Congo, Sudan, Iraq, Pakistan, Libya, Gaza and Syria. He pulls no punches in his descriptions of the horrific injuries and personal dangers encountered in each of these places. By describing the treatments offered as he attempts to patch up bodies torn apart by weapons designed to inflict maximum damage, his story avoids polemic. Rather it is a humane account of the many good people risking their lives to help those caught up in evil deeds carried out by those seeking to gain or hold on to power in a region.

David Nott spent his early years in rural Wales before moving with his parents to England. He studied medicine at the Universities of St Andrews and Manchester, staying in the north of England for his Junior Doctor years. He realised during this time that he wished to work in war zones where his surgery could make a significant difference. He set out to gain relevant experience.

“I’d need a fantastic breadth of knowledge in general surgery, which I was on the way to achieving. And I realized it would also be good to know a lot about vascular surgery, too: if I was to spend time in dangerous places, I’d be seeing and dealing with a lot of injuries from bullets or bombs, and knowing how to clamp off blood vessels would be essential.”

Nott’s first consultancy post was at Charing Cross Hospital in London. Surgeon friends there told him about Médecins Sans Frontières, an organisation offering short placements abroad for medical personnel. With agreement from his employer, Nott was able to take unpaid leave from the NHS and go on his first mission – to Sarajevo in 1993.

Over the course of the following decades he would travel to sites of conflict gaining a wealth of experience working in the most challenging environments, often with minimal supplies and equipment. Chapters detail a number of these placements focusing on patients who left key impressions. As a reader it is difficult to comprehend how those who caused the injuries could inflict such pain and suffering on their fellow human beings.

Much of the book focuses on memorable surgeries carried out in makeshift hospitals. With a constant stream of all but destroyed bodies arriving, decisions needed to be made quickly about who it would be worth treating. On one occasion a man required every unit of blood available in the city. When he subsequently died the question of how many others would die for want of a blood transfusion lingered.

On a mission in Africa Nott treated pregnant girls as young as nine years old – victims of rape whose pelvises were not developed enough for full term births – who were brought to the camp hospital after many hours in labour to have their now dead babies removed in an attempt to save the mother’s life. In Afghanistan he witnessed the public spectacle of punishments meted out under Sharia law, Taliban style.

“women being stoned to death after being buried up to their necks in sand; women being placed beside a wall they had built with their bare hands and killed after a truck was driven at the wall at high speed. […] I was astonished and sickened by the cruelty that one human being could bring to bear on another, and it filled me with revulsion. The football stadium was full of people watching and I wondered what they all felt. Were they completely inured to it?”

The impressions left by such monstrous behaviour increasingly affected the doctor when he returned to his job in London. During a private consultation he all but lost it when a patient complained about how she suffered due to unsightly thread veins.

On a mission in Aleppo, Nott noticed that patients would arrive with similar injuries that changed each day.

“Abdulaziz told me that he’d heard that the snipers were playing a game: they were being given rewards, such as packs of cigarettes, for scoring hits on specific parts of the anatomy. […] This sick competition reached its nadir towards the end of my time there when it appeared that one particularly vicious and inhumane sniper had a new target of choice: pregnant women.”

The author treated several of these women whose babies had been shot in utero. It was this experience that finally drove him to try to publicize the horror of what was happening in Aleppo once he returned to London. The media showed interest and he began to offer interviews and share pictures taken. Harnessing his increasingly public profile, Nott sought to help those now trapped and in imminent danger in Syria.

Given the horrors recounted, this book could be challenging to read yet much of it comes across as hopeful due to the determination of the medical teams to continue to offer treatment whatever else is happening in their vicinity. Nott includes many instances when his efforts were unsuccessful, and examples of risks he took that with hindsight were foolish. He does not paint himself as a hero but rather as a man who relished the adrenaline rush of danger. Nevertheless, it is hard to do anything but admire the tenacity and bravery of all the medics.

The writing is precise and succinct but retains a compassion for the suffering of those whose lives have been stripped to a struggle to survive in unimaginable conditions. Details of the medical procedures are fascinating and described in accessible language. And yet, with so many wars included there is a feeling of despair when considering what man is capable of inflicting. Nott admits that his work has left him in need of therapy for PTSD.

I mentioned that the stated purpose of the book was to raise awareness and in this it succeeds. It is, however, difficult to know what to do with such awareness in a world controlled by the egocentric – venal governments willing to turn a blind eye to atrocities carried out by extremists. Whilst being a moving, balanced and insightful account of the horror of war and the commitment of medics, it is also a harrowing read.

 

Book Review: To Be a Machine

To Be a Machine, by Mark O’Connell, won the 2018 Wellcome Book Prize, one of my favourite literary accolades. It introduces the reader to transhumanism, a movement that aims, by various means, to allow humans to defeat the problem of aging and thereby death. As part of his investigation the author attended events and interviewed proponents of strands of the movement. Their faith in science and zeal to keep themselves alive is akin to a religion albeit with eternal life possible for those who can pay rather than as a reward for particular behaviours.

The first strand discussed is cryogenics which brought to mind ancient Egyptian burial rituals. Corpses are treated to prevent further decay and then stored in the hope that they may one day be reanimated in some new form, a type of reincarnation. Those who cannot afford the full body treatment are decapitated with a view to uploading only the brain. Promoters of this process regard the essence of a person as data, although how they hope to extract this data from the dead is unclear. They believe that the technology will one day be developed. I wondered why they thought future people would see value in bringing back to life those who had demonsrated a god complex.

“The mind is much more than information”

“brains constantly reorganise themselves, both physically and functionally, as a result of actual experience”

The brain is dynamic and there is as yet no precise scientific definition of consciousness. Those who rail against the frailty of their bodies, who wish to develop something more long lasting, regard humans as machines that require an upgrade. They wish to find a way to store the data in their brains that this may be moved elsewhere, enhanced and rejuvenated. The author ponders if only the mega wealthy would be able to afford a version that was ad free.

“I was increasingly aware of the extent to which my movements in the world were mediated and circumscribed by corporations whose only real interest was in reducing the lives of human beings to data, as a means to further reducing us to profit.”

The discussion moves on to the dangers of developing a super-intelligent machine that would view man in the way man now views animals, a useful resource to be farmed for the machine’s benefit. Unlike man, machines bear no malice, hatred or desire for vengeance.

“The fundamental risk […] was not that superintelligent machines may be actively hostile towards their human creators, or antecedents, but that they would be indifferent.”

In creating these machines we would be creating our successors, rendering ourselves obsolete (in 1863 Samual Butler wrote something similar in light of the industrial revolution – these ideas are not new, merely updated in the language of the computer age).

“Once we can automate computer science research and AI research the feedback loop closes and you start having systems that can themselves build better systems”

“It is unreasonable to think that machines could become nearly as intelligent as we are and then stop”

Caution is advised when creating machines and then setting them tasks. Ask a machine to obliterate cancer and it will obliterate every being that could suffer the disease. Harmful behaviours are intrinsic in goal driven systems. Living requires managing risk but it has yet to be worked out how to teach this to an acceptable level to a machine.

The author attends a show put on by those who fund research into robotic development. Many of the developers and those who fund them are based around Silicon Valley, watched closely by the Pentagon. Tasks set for the robots are obviously aimed at producing machines that could be utilised in war zones.

“This is what we did as a species, after all: we built ingenious devices, and we destroyed things.”

Watching as the robots attempt to complete their tasks, it is clear that whilst machines could easily defeat adult humans in intelligence tests, they struggled to match the skills of a one year old in perception and mobility. These robots are

“an instrument of human perversity, in the service of power and money and war.”

It was noted that Amazon are amongst those funding research into robotic development. Unlike human workers, robots do not need breaks, do not complain or form unions.

The author returns to the transhumanists, comparing their fundamentalism with religion. I pondered if heaven was invented because people couldn’t bear the idea of loved ones, including themselves, no longer existing anywhere, and if hell then followed as a means to coerce them into following codes of conduct prescribed by those who would thereby benefit. Religions tend to be overseen by men.

One of the young men talked of looking forward to the development of sexbots, always available for his pleasure and would never cheat on him. The vast majority of those involved in the movement were white and male.

Certain transhumanists look to a future when man as machine may go forth and colonise space – a new type of empire building.

“This is one of the problems with reality: the extent to which it resembles bad fiction.”

The writing style is thoughtful, informative and often humorous. There are many absurdities raised. Transhumanists cannot seem to comprehend how anyone could accept death as inevitable. They do not within these pages address the problem of overpopulation.

This is a fascinating and accessible read that raises many interesting questions. It is hard to comprehend why so many supposedly intelligent individuals have become involved in particular aspects of the research given where it leads. It is worrying to think that possible upgrades may further increase the inequalities in western capitalist society. Funded by the war makers and hyper wealthy, this may not be of any concern to them.

This book is published by Granta. My copy was borrowed from my local library.

Book Review: Behave

This review was written for and first published by Bookmunch.

Longlisted for the 2018 Wellcome Prize, Behave sets out to explain, from a rational and scientific perspective, why people behave as they do. As the author notes, it’s complicated. The reader must first learn about the neurobiology of how components of behaviour interact – the role of neurons, hormones, genes, evolution, culture, and ecological influences. There are many controlled studies to consider, the results of which offer better understanding but with limitations. The terms used are explained in some detail. Areas of the brain play different roles that must be understood before their impact on behaviour can be rationalised.

As an example of the writing style, from Neuroscience 101:

“some of the most interesting findings that help explain individual differences in the behaviours that concern us in this book relate to amounts of neurotransmitter made and released, and the amounts and functioning of the receptors, reuptake pumps, and degradative enzymes.”

Chapters explain the separate areas of the brain and how they function, reminding the reader that this is simplified as it is a continuum. It is then pointed out that all can change due to experience. Brain structure can adapt over time.

At close to 800 pages, around half of which is fairly technical, this is not a book that can be rushed. The main text regularly refers to notes at the back where the studies cited are detailed. There are also three appendices and an index. Footnotes elaborate on certain deductions reached by the author. It is dense but fascinating.

Examples of behaviours are given throughout, such as how a person reacts when they encounter another who is in pain. The distress this causes may render some incapable, unable to do more than deal with their own resulting suffering. Others will immediately rush to help. Individual reactions depend on brain function. How one judges another’s actions and needs, how they deserve to be treated, also varies depending on how ‘other’ they are judged to be.

Many of the studies detailed involve a variety of primates, some captive and others observed in more natural settings. The former allows changes in areas of the brain to be monitored, such as when processing rewards (the mesolimbic/mesocortical dopamine system). The results are familiar.

“What was an unexpected pleasure yesterday is what we feel entitled to today, and what won’t be enough tomorrow.”

Other studies of the brain’s reactions are more uncomfortable to consider, particularly when a subject observes those of a different race. The exploration of us/them is important and returned to frequently. At its most basic it is an innate desire to reproduce, to pass on copies of genes. The reader is reminded that subjects can learn and modify behaviour.

The topic is complicated as everything is linked to everything else, including the environment in which one exists. The difference between collective and individual cultures is explained along with the impulse markers of those who migrate. Psychology and anthropology have an effect but in drawing neurobiological conclusions there are limitations due to the size and makeup of historic sample data. Many recent human studies have been carried out on university students but did not balance for gender or race. In concluding the first half of the book the author states

“Instead of causes, biology is repeatedly about propensities, proclivities, interactions, modulations, contingencies, if/then clauses, context dependencies, exacerbation or diminution of pre-existing tendencies.”

The second half of the book, while still veering into technical explanations at times, is less demanding to read. The key points from the first half include what has been learned about the function of the amygdale and the frontal cortex – natural vs learned. The author notes of people

“we are just like other animals but totally different”

Moral decision making is explored along with the introduction of spirituality, the effects of proximity on moral intuitionism, entrenched bias, the impact of social groups and perceived beauty. It is clear that primates have us/them minds and that kinship matters. People act the way they do because of how their brain is structured, but brains can learn and change. Empathy is affected by attitudes to others, and if they are perceived to be to blame for their situation.

“our moral intuitions are neither primordial nor reflexively primitive. They are the end product of learning; they are cognitive conclusions to which we have been exposed so often that they have become automatic […] In the West we nearly all have strong moral intuitions about the wrongness of slavery, child labor, or animal cruelty. But that didn’t used to be the case. Their wrongness has become an implicit moral intuition, a gut instinct concerning moral truth, only because of the fierce moral reasoning (and activism) of those who came before us, when the average person’s moral intuitions were unrecognisably different.”

Aroused empathy, or tunnel vision compassion, such as raising money for cancer research after a loved one dies of the disease, is shown to do more harm than good in the broader measure of such things. Help is more likely to be offered based on emotion rather than rational decision making.

The Rwandan Genocide killed more people than the Nazi Holocaust yet garners less attention. Irrational behaviour, including such violence, often relies on dehumanising. The brain confuses reality with metaphor, supporting symbols over people. Contact can decrease willingness to inflict or passively accept other’s suffering. Justice is shown to be difficult to achieve. Even when dealing with individual transgressors in the West

“every judge should learn that judicial decisions are sensitive to how long it’s been since they ate”

Wealth and stability are shown to affect behaviour, although these may not lead to improved acceptance. After basic needs have been met, satisfaction depends not on what one has but on how this compares.

“When humans invented socioeconomic status, they invented a way to subordinate like nothing that hierarchical primates had ever seen before.”

The book concludes on a hopeful note pointing out how much has changed over time. Hateful behaviours still exist but many of these are viewed through a cultural lens. War may bring out the worst in participants but it has been shown that individuals struggle when ordered to kill. Studies prove that cooperation is more beneficial for all than aggression, and that greater equality improves economic growth and stability (if only our current leaders could understand this). Whatever our neurobiological makeup, change in behaviour is possible.

As a personal footnote, I cannot help but feel discomfort at the animals held in captivity and used in the many studies referred to within these pages. I ponder the benefits achieved at the cost of their suffering. The increase in understanding that they provide may be of interest but will people, as a result, change how they behave?

Any Cop?: This is a challenging but ultimately rewarding book to read. The topic is fascinating and explored in detail. The biases of the author are clear but do not detract from what may be learned. It will likely appeal most to those with a pre-existing interest in the science.

 

Jackie Law

Reading the 2016 Wellcome Book Prize Shortlist

wellcomebookprize

At the beginning of the summer, thanks to a competition run by Latitude Festival on Instagram, I was fortunate enough to win a complete set of the 2016 Wellcome Book Prize shortlist. I had only read one of these books previously, ‘Playthings’ by Alex Pheby. When another book on the list, ‘The Outrun’ by Amy Lipcot, subsequently won the Wainwright Prize I decided to abandon my reading plans for the summer – which had included finally getting round to reading ‘War and Peace’ – and work my way through this shortlist. It has been a rewarding experience.

My daughter is a second year medical student with a particular interest in neurology. She and her friends treated themselves to a visit to the Wellcome Collection in London at the end of the academic year, something I also hope to do in the future. She read several of the books alongside me and we have enjoyed discussing the topics explored.

“The Wellcome Book Prize is an annual award, open to new works of fiction or non-fiction. To be eligible for entry, a book should have a central theme that engages with some aspect of medicine, health or illness. This can cover many genres of writing – including crime, romance, popular science, sci fi and history.

At some point, medicine touches all our lives. Books that find stories in those brushes with medicine are ones that add new meaning to what it means to be human. The subjects these books grapple with might include birth and beginnings, illness and loss, pain, memory, and identity. In keeping with its vision and goals, the Wellcome Book Prize aims to excite public interest and encourage debate around these topics.”

My own interest is in psychology, a subject I have studied on line in recent years thanks to FutureLearn. Armed with this knowledge I eagerly delved in. You may click on each title below to read my reviews.

Playthings by Alex Pheby

Signs for Lost Children by Sarah Moss

The Outrun by Amy Liptrot

It’s All in Your Head by Suzanne O’Sullivan

The Last Act of Love by Cathy Rentzenbrink

Neurotribes by Steve Silberman

These books provided me with an opportunity to read genres that I would not normally choose. Although I do carefully select a small number of non fiction titles each year, I tend to avoid memoirs. I am glad that I was open to the contents of each and every one of the books on this list. I learned from them all.

The winner of the prize was ‘It’s All In Your Head’ by Suzanne O’Sullivan. When I posted my review I discovered that this was a controversial choice. For the first time I received negative feedback from sufferers of the disorders discussed who felt that the author was belittling their ailments by suggesting they were psychosomatic. I found their responses particularly ironic as this is exactly the problem she wrote the book to counter – the continuing and unreasonable stigma associated with psychosomatic illness.

Notwithstanding my brush with angry, on line readers, I thoroughly enjoyed my first experience of reading a complete book prize shortlist. So enamoured was I with the quality of the writing I have set myself the challenge of doing it again. In amongst my other planned posts in the coming months you may look out for reviews of those works currently vying for the 2016 Guardian Not The Booker Prize. I will also be reading the 2015 Young Writer of the Year Award shortlist, which has been sitting on my shelves tempting me since last year.