by Tasha Suri
The Amrithi are outcasts; nomads descended of desert spirits, they are coveted and persecuted throughout the Empire for the power in their blood. Mehr is the illegitimate daughter of an imperial governor and an exiled Amrithi mother she can barely remember, but whose face and magic she has inherited.
When Mehr's power comes to the attention of the Emperor's most feared mystics, she must use every ounce of will, subtlety, and power she possesses to resist their cruel agenda.
Should she fail, the gods themselves may awaken seeking vengeance...
Empire of Sand is a lush, dazzling fantasy novel perfect for readers of City of Brass and The Wrath & the Dawn.
Tasha Suri's debut novel, Empire of Sand, reads like something out of 1001 Arabian Nights, both exotic and magical.
Mehr is the daughter of the high-ranking governor of the land of Irinah. She is also Amrithi, a clan of nomadic desert-dwellers who are despised and persecuted by the Irinah. Some of the Amrithi have the ability to communicate with daiva, a type of demi-god who appears during cosmic disturbances known as "dreamfire." Mehr has not only inherited this gift from her mother but is able to channel it in ways no one else can, and as a result she becomes the prey of those who seek to control the will of the gods.
Tasha Suri has used the history of the Indian subcontinent's Mughal Empire (1526 CE to 1857 CE) as a basis for her fantasy, in particular referencing the strong Mughal women who helped form the dynasty. Her heroine Mehr is named after Mehr-un-Nissa (later renamed Nur Jahan), one of the most influential Mughal rulers (See Beyond the Book). As a result, the book has both the feel of historical fiction as well as being an imaginative fantasy novel. Although the locations and characters are clearly products of Suri's imagination, various historically accurate details come across clearly, from the opulence and intrigue of court life to the harsh living conditions of the desert. Suri has also stated in an interview that "Amrithi rites and sigils were influenced by Indian classical dance… and by the depiction of the god Shiva creating and destroying the world with dance and cosmic fire." These allusions are vibrant throughout the narrative.
The plot is creative and kept my attention, although the pacing felt a little slow at times. A romance at the core of the novel between Mehr and a similarly-talented Amrithi man she's forced to marry adds to the tension. Mehr herself is the highlight, though; over the course of the novel she transforms from being a puppet conforming to the will of others to a strong, independent woman determining her own destiny and that of an entire empire.
Billed as an adult fantasy, the novel seems more appropriate to a younger crowd and wouldn't be an out-of-place recommendation for a young adult reader. The romantic interludes between Mehr and her husband are definitely PG-rated; teens can find more explicit (and illicit) partnerships on just about any prime-time TV show.
Overall Empire of Sands is one of those books to be treasured as a complete escape from present concerns; it's not a story one has to think about for a long time afterwards to completely comprehend its inner meaning, and sometimes it's a joy to just disconnect for a while. This novel is a great choice for that. It is the first book in what is expected to be at least a two-book series, and I'm sincerely looking forward to the sequel.
Book reviewed by Kim Kovacs
Tasha Suri's novel, Empire of Sand, features a heroine named after an influential Mughal woman.
Mehr-un-Nissa (whose name means "Sun Among Women") was born on May 31, 1577, in the province of Kandahar, Afghanistan, on the western edge of the Mughal Empire. Her parents, Mirza Ghias Beg and Asmat Begum, were both Persian nobility, but for reasons unknown had fallen on hard times and decided to relocate. Mehr was born during the journey, and by some recounts was almost abandoned after her family was robbed of their possessions, and saved only by the intervention of a friendly fellow traveler. Her father had apparently formed some influential contacts along the way and was soon appointed treasurer of the neighboring Afghan province of Kabul.
Because of her father's important position, Mehr received an excellent education. At the age of 17 she was married to a Turkish soldier named Sher Afgan, the governor of Bihar. They had one child together, Ladli Bagum, born in 1605. (Some sources claim Ladli was Mehr's step-daughter).
A bit of debate circles the next phase of Mehr's life. Some say the Emperor's son Salim (later Emperor Jahangir) fell in love with her while she was still married to Sher Afgan and that Salim arranged Sher Afgan's death, while others say they met years later and Sher Afgan's death was unrelated. Regardless, Sher Afgan died and Mehr was left a widow. After the death of Emperor Akbar and Jahangir's accession to the monarchy, Mehr and Ladli were selected to act as ladies-in-waiting to Ruqaiya Sultan Begum, Jahangir's mother. Mehr was perceived as a favorite and, some say, the Empress loved her the best.
What is known is that Mehr and (now Emperor) Jahangir met during the spring festival of Nowruz in 1611, and that he proposed almost immediately. On May 25, 1611, Mehr became Jahangir's 20th and last wife and was given the name Nur Mahal ("Light of the Palace") - which was changed in 1616 to Nur Jahan ("Light of the World").
Nur Jahan quickly took control of the empire. Jahangir was addicted to opium and alcohol and as a result wasn't really able to rule. While he did have final say on matters, Nur Jahan basically ran things. All decisions and appointments were run by her, and she had possession of the imperial seal (meaning she could issue edicts at any time). Her reign was marked by improvements in the condition of women throughout the empire; she granted land to many and financed dowries for orphan girls. She sponsored trade between her empire and European traders, and owned ships which took pilgrims and goods to Mecca. She also ruled the Emperor's zanana – the women's quarters – which meant control over not only the Emperor's wives, but their under-age children, concubines, slave and guards. She influenced fashion, cosmetics, food and artistic expression; she wrote poetry and encouraged other women to do so.
Jahangir died in 1627 without naming an heir, and long-simmering feuds between his children boiled over. The final conflict ended up being between Jahangir's third son, Shah Jahan, and his youngest son Shahryar. Nur Jahan backed Shahryar, who was married to her daughter Ladli, but her side lost the battle. Shahryar was executed, and Nur Jahan and Ladli were sent into confinement for the rest of their lives.
Nur Jahan died December 17, 1645, and was buried in a tomb next to Jahangir's – both of which she'd designed, along with the surrounding gardens.
First two pictures: Nur Jahan
Tomb of Nur Jahan
by Miranda Seymour
In 1815, the clever, courted, and cherished Annabella Milbanke married the notorious and brilliant Lord Byron. Just one year later, she fled, taking with her their baby daughter, the future Ada Lovelace. Byron himself escaped into exile and died as a revolutionary hero in 1824, aged 36. The one thing he had asked his wife to do was to make sure that their daughter never became a poet.
Ada didn't. Brought up by a mother who became one of the most progressive reformers of Victorian England, Byron's little girl was introduced to mathematics as a means of calming her wild spirits. Educated by some of the most learned minds in England, she combined that scholarly discipline with a rebellious heart and a visionary imagination. As a child invalid, Ada dreamed of building a steam-driven flying horse. As an exuberant and boldly unconventional young woman, she amplified her explanations of Charles Babbage's unbuilt calculating engine to predict - as nobody would do for another century - the dawn of the modern computer age. When Ada died, like her father, she was only 36, great things seemed still to lie ahead for her as a passionate astronomer. Even while mired in debt from gambling and crippled by cancer, she was frenetically employing Faraday's experiments with light refraction to explore the analysis of distant stars.
Drawing on fascinating new material, Seymour reveals the ways in which Byron, long after his death, continued to shape the lives and reputations both of his wife and his daughter. During her life, Lady Byron was praised as a paragon of virtue; within ten years of her death, she was vilified as a disgrace to her sex. Well over a hundred years later, Annabella Milbanke is still perceived as a prudish wife and cruelly controlling mother. But her hidden devotion to Byron and her tender ambitions for his mercurial, brilliant daughter reveal a deeply complex but unexpectedly sympathetic personality.
Miranda Seymour has written a masterful portrait of two remarkable women, revealing how two turbulent lives were often governed and always haunted by the dangerously enchanting, quicksilver spirit of that extraordinary father whom Ada never knew.
It's tempting to think that our age of celebrity worship coupled with the 24-hour news cycle is responsible for the double standard around men's abusive behavior towards women. The perpetrators' reputations are often rehabilitated; they go on to become box office film stars or government officials, while the women they have abused are harassed and slandered. The widespread rage surrounding this cultural norm has been a driving factor in the #MeToo movement.
And yet, this situation is nothing new — as long as there have been famous men acting badly, there have been apologists for them and impossible standards to which their female victims are held. Miranda Seymour's latest book, In Byron's Wake, shines a light on this aspect of celebrity through the biographies of Lord Byron's wife, Annabella Milbanke, and their daughter, Ada Lovelace, who both spent their lives with his shadow hanging over them. Though there are a few organizational flaws, this book reveals fascinating details about the painful legacy of a disastrous relationship and how these two women chose to define themselves in spite of, or because of it.
Annabella was a beloved only child, fêted debutante of English aristocratic society, and headstrong young woman who rejected numerous suitors in order to pursue Lord Byron. When he met her in 1812, the poet was already famous for his writing and infamous for his romantic involvements, frequently with married women. A long-distance courtship was conducted mostly through letters, until a reluctant Lord Byron agreed to marry Annabella, primarily since doing so would deflect attention from his suspicious relationship with his half-sister, Augusta Leigh, and Annabella's expected inheritance would assuage his financial problems.
It all fell apart quickly and spectacularly. The inheritance went to Annabella's mother, Byron continued his incestuous relationship, taunting Annabella with his affection for Augusta, who lived with them for much of their one-year marriage. Constantly threatening her with violence and getting involved with more mistresses, Byron made Annabella miserable until 1816 when she finally fled their home with their newborn daughter, Ada. The couple's separation became fodder for the press and Victorian society was scandalized.
Seymour tells the tale through their voluminous letter collections, allowing the reader to hear the unhappy couple in their own words. This meticulous archival research shows the sadness and even terror of an abusive relationship, without melodrama or rose-colored glasses. The account is grounded in historical data, not delivered in the bated-breath tone of celebrity gossip.
Byron soon left for continental Europe, never to return to England. Later that year he would be living on Lake Geneva with Percy and Mary Shelley while the latter was writing Frankenstein (see Beyond the Book). Byron had a string of lovers and mingled with writers and revolutionaries before dying at age 36 while fighting in the Greek War of Independence, while Annabella became a model of chastity and an ardent social reformer, remaining stoic in the face of whispers and rumors that followed her for the rest of her life. In an age when women were often criticized for being vocal, Lady Byron was scorned for her silence surrounding her marriage. In fact, her work as a dedicated abolitionist and education reformer became subsumed by her reputation as a cruel wife to the creative genius Byron.
After the drama of the marriage, the book focuses on the life of Ada Lovelace, the bright yet mercurial product of the union. A voracious learner, Ada was educated by tutors and mentors while overcoming serious health problems as a child. She became a fixture of scientific-minded circles, collaborating frequently with computer-science pioneer Charles Babbage. Ada's greatest work was an extended report on the intended capabilities of Babbage's Analytical Engine, a remarkable idea for a machine that could carry out numerous complex calculations, an early precursor to the computer. Anticipating punch cards and computer code itself, Ada's report on the Analytical Machine is now recognized as foreseeing the modern computing age — how these machines would move beyond mathematics. She saw, as Seymour notes, "the potential of technology to transform the way we function."
For an achievement that impressive, however, the author takes too much time getting to it. Ada's contribution to scientific knowledge is not described in any detail through the first half of the book, despite Seymour cataloging every country house she visited and every correspondence she shared. The reader would be better served by a deeper discussion of Ada's place in the developing world of science and the role of women (or lack thereof) in that world, rather than getting bogged down in minute details about her every movement between her mother's many estates. Despite this small defect, the book captures many important aspects of Ada's life without becoming hagiography. Ada's later years were marred by her own dysfunctional marriage and her involvement in an illegal gambling ring. It was only her mother's shrewd business acumen and vast fortune that kept her and her spendthrift husband from poverty.
Like her father, Ada died young, at age 36. Stricken with cervical cancer, she became too ill to pursue more scientific research or the mathematics that had always fascinated her. Annabella died eight years later in 1860, and both women's reputations evolved following their deaths. Lady Byron was decried as a cold and silent woman who drove her husband away, while Ada Lovelace went from being known as a bright yet eccentric minor aristocrat to being hailed as an early computer scientist. As Seymour demonstrates, both characterizations are oversimplified, and the women behind them were more three-dimensional than their reputations suggest. While the man who most impacted their lives remains a celebrity, their legacies — both built around their relationship to him — have always been more complex and nuanced than their detractors, or their fans, believed.
Book reviewed by Rose Rankin
Great art frequently evolves among talented people who share ideas with each other and who challenge themselves to greater and greater heights in the presence of fellow creatives. This was the case with one of the most famous works of Western literature, Frankenstein by Mary Shelley. Devised among her literary companions (including Lord Byron) and refined and edited over time, Shelley's creation benefited from her unconventional lifestyle and experience, and it remains one of the triumphs of the Romantic period.
In 1816, Mary Godwin was a nineteen-year-old unwed mother living with her lover Percy Shelley, with whom she had caused a major scandal in London society when he abandoned his wife and children to live with Mary and her half-sister, Claire. That year, the couple and their small entourage left England for Geneva, Switzerland, and in the summer they were joined by Lord Byron and John Polidori; the former a famous poet, the latter a struggling writer and Byron's physician. Claire had become romantically involved with the infamous Byron, whose ill-fated marriage had recently collapsed into scandal and recrimination. Needless to say, in 1816 all members of this literary circle were glad to escape England for a time.
Shunned by the English community vacationing in Geneva, the motley group rented a beautiful lakeside villa, where they hunkered down for a few weeks as unusually bad weather plagued the area. As a diversion from the rainy day boredom, Lord Byron suggested that everyone present should write a "ghost story," and Mary Shelley penned the first draft of Frankenstein in response. Byron himself didn't produce any notable ghost story that summer, but he, Shelley and Polidori believed Mary's tale was exceptional.
It is claimed that Mary's idea for this masterpiece came to her in a dream, though this is probably apocryphal. In the story, Dr. Frankenstein pieces together a man from human body parts and brings him to life. First told from the doctor's perspective, the narrative then shifts to the point of view of the creature, who goes in search of his "father." But the scientist pushes away his creation, and enraged, the creature kills all the people his father loves, an acting out of fury based on parental rejection. This was an issue Mary knew all too well, as her own father had disowned her when she and Shelley began their scandalous relationship.
After returning from Switzerland with Shelley, Claire, and their children, Mary added another layer to the story in the character of Robert Walton, a redeeming subplot alongside the destructive choices of the other characters. Walton listens to the reasoned arguments of his sister and abandons his quixotic search for the North Pole, likely saving the lives of the men under his command. This nesting of stories and perspectives results in a rich exploration of human nature. As Charlotte Gordon explains in her biography of Mary Shelley and her mother, Mary Wollstonecraft, "it gave Mary the opportunity to create a complex narrative that asked far more of her readers than if she had written a simple parable against the dangers of invention." It also reflected Mary's dysfunctional relationship with her father, her feelings about the legacy of her famous mother, who died giving birth to her, and her status as a social outcast.
Initially published in 1818, Mary revised Frankenstein and it was reissued in 1831. This version, which is the one most commonly read today, includes extended ruminations and different monologues by the characters that magnify the darker themes, like disillusionment with society. Mary had endured many hardships in the intervening years — harsh criticism of her writing, widely accepted accusations that Percy Shelley wrote the book, and the painful loss of children, her husband and many more loved ones. Inspired in the company of fellow writers and capturing the turmoil of her own life, Mary Shelley's Frankenstein remains a brilliant and complex contribution to the canon of Romantic literature.
Cover of Penguin Classics edition of Mary Shelley's Frankenstein Penguin Random House
by Helen Klein Ross
In 1908, sixteen-year-old Bridey runs away from her small town in Ireland with her same-age sweetheart Thom. But when Thom dies suddenly of ship fever on their ocean crossing, Bridey finds herself alone and pregnant in a strange new world.
Forced by circumstance to give up the baby for adoption, Bridey finds work as a maid for the Hollingworth family at a lavish, sprawling estate. It's the dawn of a new century: innovative technologies are emerging, women's roles are changing, and Bridey is emboldened by the promise of a fresh start. She cares for the Hollingworth children as if they were her own, until a mysterious death changes Bridey and the household forever. For decades, the terrible secrets of Bridey's past continue to haunt the family. And in the present day, the youngest Hollingworth makes a connection that finally brings these dark ghost stories into the light.
Told in interweaving timelines and rich with detailed history, romance and dark secrets, Helen Klein Ross' The Latecomers spans a century of America life and reminds us all that we can never truly leave the past behind.
The Latecomers is the third novel written by acclaimed author Helen Klein Ross, following What Was Mine (2016). The novel opens from the perspective of Emma, a teenager living in 2001 New York City receiving news that her father has been possibly killed in the attacks of 9/11. We then jump back in time nearly one hundred years to 1908 and are introduced to Bridey, an Irish teenager preparing to secretly immigrate to the United States with her sweetheart, Thom. Not long after boarding the ship, Thom catches a fever and dies, leaving Bridey alone, uncertain, and pregnant in New York City. Left with no options but to give up her child, Bridey leaves him in the care of an orphanage, certain that their paths will never cross again. However, upon taking up a position in the wealthy Hollingworth manor, she finds that this may not be the case.
Perhaps the most striking aspect of The Latecomers is how much meticulous care Ross put into her research. The novel spans more than a century and includes character perspectives from nearly every decade between 1900 and 2018. Ross carefully includes references to real events from each of these time periods, and how these events might have impacted her characters. These range from larger historical issues such as discussing how World War I impacted those left on the home-front in America to smaller tragedies such as the Triangle Shirtwaist Factory Fire. Similarly, she cleverly includes the use of slang from each time period; in one scene, Sarah Hollingworth, a wealthy member of East Coast society, refers to herself as not wanting to be a "Paul Pry" (or a nosy person). Despite its broad scope, the novel possesses a distinct and detailed sense of each time period.
It is a testament to Ross's writing skill that her finely-drawn characters feel equally as real as the eras into which she weaves them. Bridey, in particular, feels genuine, and the initial internal conflict between her Catholic faith and her love for Thom immediately endears her to the reader. Likewise, the relationship Ross develops between Bridey and Sarah is enthralling in its complexity. Sarah befriends Bridey upon meeting her at a home for unmarried mothers. Though the relationship is initially based upon Sarah's pity for Bridey, and her belief that she is in a position of superiority, the power dynamics between them begin to shift once Bridey becomes employed in the Hollingworth house. As Bridey is placed in a competitive position to Sarah, it becomes clear that their friendship can only survive as long as Sarah is in control.
The only area in which the story falls short is in its pacing. Though it is ostensibly a multi-generational saga, that label implies that a roughly equal amount of page time is to be shared by each generation. In actuality, the perspectives of Bridey, Sarah, and Vincent (Bridey's son) take up around seventy-five percent of the novel's length; once their respective stories are finished, the chapters following Ruth (Vincent's daughter) and Emma feel out of place given how long we have spent invested in the previous set of characters. However, it is a testament to Ross's writing skill that the characterization of both Emma and Ruth remains excellent; despite their shorter sections, both women feel fully fleshed out and their motivations are clear.
The Latecomers is an excellent blend of equal parts historical fiction and family drama, with just a hint of a mystery thrown in. It is a brilliant examination of friendship, family, and the ties that bind us together.
Book reviewed by Meara Conner
The Latecomers utilizes a multi-generational structure to bring the stories of the Hollingworth family members vividly to life. Here a few more novels I recommend that employ a similar narrative structure:
The House of the Spirits by Isabel Allende
Allende's first novel follows three generations of the Trueba family. Esteban, the patriarch of the Truebas, is a proud, unpredictable man who is voracious in his pursuit of power. The novel also follows his wife, Clara, a delicate woman with a mysterious connection to the spirit world; and his daughter, Blanca, a strong-willed girl who embarks upon a forbidden love affair. The House of the Spirits is an enchanting epic that spans lives and decades, weaving together the political and the personal into a story of love and fate.
White Teeth by Zadie Smith
This novel centers around two friends, Samad Iqbal and Archie Jones. Veterans of World War II, Samad and Archie become unknowing agents of England's march into the modern age. Archie marries beautiful Jamaican, Clara Bowden, a woman half his age, while Samad has an arranged marriage which produces twin sons who force him to reexamine his Islamic faith. Set against the intersection between London's cultural and racial backdrops, White Teeth explores the ways in which modern life is influenced by the expectations of the past.
Homegoing by Yaa Gyasi
Gyasi's debut novel opens in eighteenth-century Ghana with half-sisters, Effia and Esi. The sisters' lives diverge as Effia marries a British office and Esi is sold into slavery and shipped to the United States. Each chapter focuses on a new member of the sisters' respective family lines through eight generations, from the plantations of Mississippi to Jazz Age Harlem, up until the present day. Homegoing tackles issues of race, identity, and place through a variety of perspectives and time periods.
A Spool of Blue Thread by Anne Tyler
A Spool of Blue Thread opens with Abby Whitshank describing the day she met and fell in love with Red in the summer of 1959. However, the scope of this novel goes far past this one instance and these two characters. The novel spans from Red's parents, newly arrived in Baltimore in the 1920s, to their grandchildren carrying the legacy of the Whitshanks into the twenty-first century. It explores the dichotomy between a polished exterior and the imperfections that lie within.
Commonwealth by Ann Patchett
When Bert Cousins arrives at Franny Keating's christening party uninvited and proceeds to kiss Franny's mother, Beverly, he sets in motion the dissolution of marriages and the reformation of two families into one. Commonwealth spans five decades and explores the consequences of this decision for the two families' six children. As the children begin to get to know each other over several shared summers, they form a lasting bond based on their disillusionment with their parents. Commonwealth is a contemplation on the far-reaching ties of love and loss that bond us together.
by Edward Bullmore
In this game-changing book, University of Cambridge professor of psychiatry Edward Bullmore reveals the breakthrough new science on the link between depression and inflammation of the body and brain. He explains how and why we now know that mental disorders can have their root cause in the immune system, and outlines a future revolution in which treatments could be specifically targeted to break the vicious cycles of stress, inflammation, and depression.
The Inflamed Mind goes far beyond the clinic and the lab, representing a whole new way of looking at how mind, brain, and body all work together in a sometimes misguided effort to help us survive in a hostile world. It offers insights into how we could start getting to grips with depression and other mental disorders much more effectively in the future.
A Sunday Times (London) Top Ten Bestseller.
It is common knowledge that depression diminishes the quality of sufferers' lives, but few people realize its full collective impact. Depression is one of the most significant global health issues today, predicted to be the single most common cause of disability in the world by 2030. It also impacts economic growth; for example, it is estimated that depression reduces Britain's annual gross domestic product by 4% annually. In The Inflamed Mind: A Radical New Approach to Depression, Edward Bullmore declares it shocking that the medical establishment's approach to this condition has not changed since the 1990s, considering the pressing social and personal ramifications. The standard regimen of serotonin-changing drugs and psychotherapy remain the only therapeutic avenues available, despite clear signs that these treatments are not universally effective.
Bullmore was drawn to the threshold between body and mind - what is now called immune-psychiatry or neuro-immunology - in 1989 when he was training to become a physician. He consulted with a patient named Mrs. P who had rheumatoid arthritis, a chronic inflammatory joint disease. Veering from the script of questions doctors are told to ask patients about rheumatoid arthritis, Bullmore inquired about her mood, and Mrs. P reported the classic symptoms of depression, such as lowered energy, reduced pleasure, disrupted sleep, pessimism and guilt. Bullmore was eager to share his diagnosis with the senior physician on staff, hoping to more fully treat Mrs. P and improve her quality of life. However, the attending doctor was unimpressed: "Depressed? Well, you would be, wouldn't you?" Mrs. P is a recurring character throughout the book, a reminder of what immunodeficiency looks like and how it is regarded in the medical community. Patients like Mrs. P have been trapped in what Bullmore calls "medical apartheid," the divide between the treatment of the mind and body. The prevailing point of view in the medical field is that if Mrs. P was depressed because she was ill, it was her responsibility to work through the problem on her own by worrying less about her rheumatoid arthritis. Bullmore wonders: What if Mrs. P was not depressed because she was mentally fixated on her pain, but because of a more tangible and direct correlation between these two conditions? In other words, what if Mrs. P's depression was caused by her body instead of her mind?
To make this argument, Bullmore defies conventional medical wisdom, analyzing the philosophical foundations of modern medicine, most prominently René Descartes' mind-body dualism, which suggests that the mind and body are two separate and unrelated systems (this theory is known as Cartesianism, from Descartes' Latinized name, Cartesius). Bullmore explains the gravity of the Cartesian blind spot, suggesting that medical practitioners are positioned and trained to think that if something is caused by the mind, it is a problem of the mind, so it should be cured in the mind. This has created harsh barriers in the medical field that are detrimental to patients' health.
To prove this theory, Bullmore responds to two primary questions: 1. How exactly do inflammatory changes in the immune system modify the brain to make people depressed, and 2. What initially inflames a patient, and how does the immune system - which is designed to help people avoid disease - cause depression? To answer these questions, he compiles the results of surveys, case studies and labs. One key revelation from this research is that scientists have identified the first biomarker in psychiatry: cytokines. A biomarker is a measurable substance that, when present in certain ranges, indicates that something - whether it is disease, infection or exposure - is present in the body. This means that just as doctors can determine vitamin D deficiency through simple blood tests, they can also determine the likelihood and severity of inflammation-caused depression by looking at the number of cytokines present.
While most mass-market publications in the realm of psychology provide some sort of call to action, The Inflamed Mind lacks potential solutions for individuals. In fact, Bullmore clearly identifies the flaws of the slow-moving, conservative pharmaceutical industry, and walks readers through the disappointing reality of what would happen if you were to ask your doctor to consider the ideas presented in this book. Thus, the book ends in a quagmire: Here is all of this information that can positively affect the way depression, schizophrenia and Alzheimer's are treated, but these findings may never be put into practice. Readers like Mrs. P who have issues with inflammation and mental health may remain unempowered by the medical field, especially since no clear steps are detailed to promote these findings. It is implied that all readers can do is wait and see what happens.
One way that Bullmore could have incorporated patient autonomy is by analyzing branches of medicine that focus on a holistic, well-rounded treatment philosophy. This book analyzes Western medicine only, which is inextricably linked to Cartesian thought. Eastern medicine, and homeopathic and alternative approaches to healing are a sampling of practices that more thoroughly combine body and mind in treatment strategies. In 2012, Harvard researchers found that in the prior year, there was a 15% growth rate in the use of homeopathic remedies as a supplement to conventional Western medicine in the United States (though only 2% of Americans reported using homeopathic remedies). In countries such as Germany and Italy, 10-15% of patients supplement Western medicine with these methods. As a trend, people are opting for health and well-being practitioners who approach the mind and the body together, so a discussion on future areas of research that involve these types of treatments would have been an interesting counterpoint.
In light of the contradictions to Western medical ideology and funding cuts to mental health, Bullmore is hopeful but measured about the potential results of his findings, admitting that this connection between the immune system, stress and mind may not ever seep into standard medical practice. Still, he concludes with an optimistic image of what the future might look like if these revolutionary developments are embraced: new treatments, new medications, new biomarkers, new therapies, new doctors, less stigma, less guesswork and fewer blinders.
Book reviewed by Jamie Chornoby
Sometimes inventions are derived by chance. In The Inflamed Mind: A Radical New Approach to Depression, Edward Bullmore notes that the first antibiotic treatment of tuberculosis (TB) led to the creation of the world's most widely used antidepressant drug: Prozac.
Tuberculosis is an infectious bacterial disease that most severely affects the lungs. Globally, just over a million people die from TB per year. While this is a substantial number of fatalities, it is a fraction of the number that died before the advent of the Bacille Calmette-Guerin vaccine. In fact, at the start of the 20th century, it was the leading cause of death in the United States, known as the "white plague." To develop an antibiotic that could treat infected people, pharmaceutical companies sought a molecule that would target and kill the root cause, a germ known as Mycobacterium tuberculosis, without causing fatality.
This process started in test tubes. Which substances could kill the bacteria? Hydrazine - a stockpiled chemical used as fuel in World War II - surfaced as the answer. That one chemical compound was broken down into hundreds of new molecules that were tested on mice that had been infected with TB. One molecule - iproniazid - halted bacterial reproduction of the germ and prolonged the lifespan of the mice. A clinical trial was established to test whether or not iproniazid could cure human patients. The clinical trial took place at Seaview Hospital, a sanatorium in the New York City borough of Staten Island devoted exclusively to TB patients. It served as an isolated facility to quarantine the infected population. Since its opening in 1913, many people viewed the facility as a death sentence, a place where those with TB wasted away. However, the 1952 clinical trial of iproniazid demonstrated that it effectively halted the progression of the disease. For the first time, patients left Seaview Hospital alive. Moreover, patients receiving the treatment became more energized, active, sociable, and hungry.
It was clear that iproniazid had massive positive effects on patients with TB. However, some scientists were intrigued by the euphoria that coincided with use. Some wrote it off as a placebo effect, and noted that the study was neither blind nor controlled. However, reports about dancing in the ward led some to think that there might be unexpected benefits to the medication. Nathan Kline was one such doctor, referring to iproniazid as a "psychic energizer." Mental health treatment at this time was largely confined to Freudian thought and psychoanalysis, so the notion that a medication could have psychological benefits was fringe.
In 1957, 24 depressed, TB-free patients were given iproniazid in a five-week clinical trial. (Though many of these patients would be classified as schizophrenic by today's standards.) The researchers reported that 18 of those patients experienced improvements in their mood and social behavior. The study was flawed; there were no experimental controls or mechanisms to minimize placebo effect. The sample size was minute. The results were far from generalizable. However, despite these limitations, the drug dispersed into wider use for depression. Within one year, a shocking 400,000 depressed people were effectively treated with iproniazid. Kline collaborated with the pharmaceutical company that produced the iproniazid - Roche - to license the drug for the treatment of depression. Within a decade, around ten other anti-depressants were on the market, treating over four million people.
Although these medications offered relief to patients with depression, there was no understanding of the mechanisms - the hows and the whys - behind their results. In fact, they defied prevailing logic that mental problems should have mental cures (such as Freudian analysis). A contemporary of Freud's, Santiago Ramón y Cajal, now known as the founder of neuroscience, believed that nerve cells are distinct, individual entities that allow for communication in the gaps between one another. This idea was confirmed with the invention of the electron microscope. Scientists reflected on how, specifically, iproniazid functions in the brain to create anti-depressant effects, realizing that perhaps the answer was its ability to enhance the signaling across the gaps between nerve cells.
In 1965, Joseph Schildkraut examined the implications of these findings and proposed that anti-depressant drugs worked by boosting the effects of adrenaline and noradrenaline in the brain Believing that Schildkraut was only partially right, scientists at pharmaceutical company Eli Lily explored serotonin in their research as an anti-depressant target. They tested for molecules that increase serotonin transmission by limiting its absorption into the brain. This was the first clinical trial of an SSRI (selective serotonin reuptake inhibitor), but it was a failure; patients reported no change in their symptoms.
Eventually, a more effective molecule was pushed through a clinical trial, and it was remarkably successful relative to the placebo. In 1987, it was licensed as Prozac, the pioneer in a class of SSRI drugs. Prozac continues to be the most widely used anti-depressant, prescribed to 54 million people worldwide. A growing number of doctors believe that serotonin imbalance is only one of many potential causes for depression, so treatments targeting SSRIs will not help every depressed person. In The Inflamed Mind, Edward Bullmore explores cutting-edge research that suggests inflammation may be one of the other mitigating factors.
Nurses at Seaview Hospital, courtesy of silive
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