From the Mind into the Body: The Cultural Origins of Psychosomatic Symptoms

Sarah Robertson is associate editor of the Canadian Book Review Annual.

This articulate and meticulously documented volume draws upon a wealth
of anecdotal sources from past and present to support its central
premise that “biology and culture interact in the production of
psychosomatic symptoms” and that this interaction can be elucidated
through examination of such variables as social class, gender,
ethnicity, and age. Shorter traces the evolution of various disorders
(most notably depression and anorexia nervosa) to show how patients in
their quest for medical validation subconsciously develop symptoms that
constitute legitimate disease in their particular cultures.
Nineteenth-century bed cases and invalids, 20th-century surgery addicts
and hyperactive anorectics—all vividly incarnate the author’s
historical view of the cultural specificity of psychosomatic illness.
Equally compelling, but disappointingly sketchy, is his discussion of
the social roles and expectations that drive individuals to become
symptomatic in the first place. For all their manifest differences, the
role models of Victorian shrinking violet and contemporary superwoman
elicited in the women who resisted them the same sad incapacitation.

The most controversial proposition in this engrossing book is that
anorexia nervosa is not a separate disease but merely “an item in the
symptom pool that the unconscious mind may call forth as an expression
of distress,” and that the disorder’s spread today is partially
attributable to an implicit collusion between doctors and patients in
medicalizing it. What Shorter dubs the “anorexia industry” is taken
to task for “evoking the very phenomenon it was designed to combat.”