Science and serendipity

Shapeshifters

On Medicine and Human Change

Gavin Francis

Hachette

282 pages

Rs 599

In his new book, physician Gavin Francis focuses on the transformations that define human life, from momentous occasions such as birth and death to relatively small-scale events such as puberty and menopause, and even minor but intense moments such as the effect induced by hallucinogenic drugs.

Each chapter discusses how bodily and psychological transformations have been dealt with over the ages — and how medical innovations have brought a world of relief to modern patients. Mr Francis includes anonymous observations of his own patients and sprinkles his study with a liberal dose of references from the arts.

An early chapter on werewolves, for example, provides fascinating reading on the mythical beast borne of human longings, fear and ambition. The common perception about the moon’s ability to control our emotions, Mr Francis notes, finds surprising agreement among trained psychologists.

Yet, a “werewolf” may be suffering from acute porphyria, which Mr Francis defines as a blood disorder whose symptoms — insomnia, sensitivity to light, growth of hair on the forehead and cheeks — may lead one to suspect that something beastly is bothering the sufferer.

Similarly captivating is the chapter on bodybuilding, as Mr Francis dovetails the stories of Hercules and Arnold Schwarzenegger into that of his patient Harry whose abuse of anabolic steroids hindered his fertility. Mr Francis baldly includes Krishna in his strong man prototype, oblivious to the ubiquitous Indian perception of him as the mischievous God of love.

Mr Francis’ medical practice affords him the chance to observe up-close the real-life manifestations of heated political debates that surround some medical issues. One of the most interesting chapters in the book concerns gender, especially the case of a patient who detransitioned, that is, transitioned from man to woman and then back. 

With the increasing focus on LGBT rights, and the certainty that is now accepted as the norm for a desire to transition, the case of this patient brings out a much-needed pause in the conversation. Called Anthony in the book, he realised that gender reassignment did not resolve his anxiety about his gender, which he ultimately sought to quell through psychotherapy. 

“It is difficult being part of the psychological community that is so pro-transition right now, and being one of the few critics,” Anthony said, “but it feels like there are a lot more people speaking out about detransition, as well as clinicians who are interested in looking at alternative ways to deal with dysphoria.”

Other personal testimonies provide a painful look into eating disorders. The book takes a dark turn in the chapter on anorexia, which includes a quotation from French physician Charles Lasegue who defined the condition as the outcome of “a violence done to some sympathy”. Mr Francis’ test case, who successfully beat the condition and even learnt to laugh about it, described it as living “under a spell”. 

In more than one chapter, Mr Francis discusses the benefits of psychotherapy in relieving patients of long-buried stresses. Two cases that stand out pertain to recurrent dreams that the patients in question had. In both cases, merely the chance to speak about these disturbances paved the way for recovery.

One patient found himself nightly running through corridors opening and closing doors. On examination, it was revealed that he had lost his family to tragic circumstances, and the dreams signified his need for closure. Another case of a soldier suffering from post-traumatic stress and dreaming of his dead friend was relieved when the patient spoke about his condition and gave vent to his grief. 

For a medical practitioner, Mr Francis writes knowledgably about a host of artistic and cultural references. Given the subject matter, Ovid’s Metamorphoses is a recurring theme, and writers as diverse as T S Eliot and Ursula Le Guin find mention. Mr Francis is particularly good at ferreting the historical roots of such purportedly modern preoccupations as tattooing and the use of prosthetics.

The book is mostly a primer on anxieties that the modern patient may have about his health. Its choice of subjects — from jetlag to the desire for youthful skin — may suggest a bias towards a certain patient profile. But every now and then it takes a deep dive into other aspects that go into keeping good health, such as financial stability. 

In the chapter on bone-setting, for example, Mr Francis speaks about his time in Gambia where he, along with a team of doctors, operated on a poor local who had to be cajoled into accepting the treatment. With the most 

preliminary equipment, the doctors worked their magic and the boy recovered completely. 

And that, Mr Francis suggests, lies at the heart of the wondrous discipline of medicine. Informed by history and guided by ground reality, Shapeshifters is a tribute to the alchemic mix of science and serendipity that transforms disease into the throbbing force of life and good health.