In the 19th century, when gender roles were more confining, the dominant forms of psychosomatic illness were paralysis and hysteria. Today, when people experience confusion about the abundant possibilities available to them, when "all is permitted", the dominant complaint is fatigue. Edward Shorter's history shows how patients throughout the centuries have produced symptoms in tandem with the cultural shifts of larger society. He argues that newly popularized diseases such as "chronic fatigue syndrome" are only the most recent examples of patients' ailments that express the deepest truths about the culture in which we live.
Like other cultural phenomena, psychosomatic illnesses are subject to changes in fashion; here, Shorter (The Healthy Century, 1987, etc.) has applied his considerable skill in researching medical history to an examination of these trends from the mid-18th century to the present. Shorter defines psychosomatic illness as "any illness in which physical symptoms, produced by the action of the unconscious mind, are defined by the individual as evidence of organic disease and for which medical help is sought." He identifies doctors' attitudes and beliefs as major cultural factors in determining what symptoms the unconscious mind selects, and examines how doctors' ideas have changed as new theories about disease have evolved. He also looks at the changing doctor-patient relationship over the past two-and-a-half centuries, making clear why "the vapors" and hysteric fits of paralysis, once especially common among women, are now quite unacceptable (as are the horrific treatments devised by some doctors to deal with them). Shorter notes that today chronic fatigue syndrome (CFS) is perhaps the most fashionable psychosomatic complaint in a spectrum that includes yeast infections, food allergies, and what has been called the "twentieth-century disease," or "total allergy syndrome." Using CFS as an example, the author traces how a psychosomatic illness becomes fashionable as the mass media, supplanting medical authority, disseminate pseudoscientific information about genuine, difficult-to-diagnose organic diseases to suggestible individuals with quite different symptoms. Whereas the "stifling intimacy of family life" in Victorian times increased the propensity for certain psychosomatic illnesses, he explains, today social isolation and exposure to media sensationalism produce others. A fine, example-filled account of how different times and different mores produce different psychosomatic illnesses. (Kirkus Reviews)