Oxford University Press's Blog, page 1001

Musical ways of interacting with children

By Professor Jane Edwards

What does the baby have to learn in these first 12-18 months (before they can speak)? The list  includes what you do with your eyes when with another, how long to hold a mutual gaze, what turn-off head movements work, and with whom, how close you should let the other come to you… how to read body positions… how to enter into turn taking when vocalizing with another… how to joke around, negotiate escalate, back off… make friends, and so on.

Daniel Stern, Forms of Vitality (OUP, 2010) p. 110-111

As a music therapy scholar, teacher, and practitioner for more than 20 years, I have been able to learn from many sources about the crucial role our early years play in our lives. The ability to reflect on challenges experienced in our adult lives by linking back to childhood experiences is an essential aspect of the way that many music therapists practice. Rather than using descriptions of family histories to apportion blame, the therapist tries to understand the current experience of the patient and their worldview through the lens of past experience, to see if there is some way to make sense of self-destructive behaviours, or difficulties experienced in creating meaningful and satisfying relationships with others.

I began my early music therapy practice in mental health services and in nursing homes, working with people diagnosed with Alzheimer’s Disease or other types of dementia. Many people, whether in group or individual music therapy programmes, offered reflections on their early life, and described aspects of their parents’ availability or unavailability; referring to the quality of these first relationships in ways that helped me to understand something of what might have been unresolved or unsatisfying for them. Eventually I found myself very keen to work with people much earlier in life to see whether music therapy could ameliorate some of the issues my older patients were facing.

Although I worked in paediatric music therapy for seven years at a children’s hospital, it was only when I was writing the first proposal to found the (now) international parent-infant support programme Sing & Grow that I had the chance to bring all of my past experience to bear: to make a case for the importance of promoting loving, playful, and nurturing interactions between parents and infants where vulnerability was in evidence. Through my work in this field, I have become increasingly aware of an unrecognised field of practice in music therapy: parent-infant work. This involves the referral of vulnerable parents to a music therapy service. Parents usually attend with their infants and the music therapist provides a safe and accepting space in which the parent and infant pair or group can be encouraged to play and interact in supportive and mutually satisfying ways. This is not always ‘music’ as it might be generally understood; rather it is a musical way of interacting that the therapist encourages.

When adults speak to infants we use particular ways of interaction that seem to be the same across the world. But we should ask why do we use such an exaggerated, playful, and musical way of speaking to infants? The obvious answer is because the infants like it — they raise their eyebrows, fix their gaze on the speaker’s face, and sometimes smile quite quickly on hearing us say ‘ooohhh whooo is my little baaaby?’ This is especially true if the speaker is a family member but it also can occur in new encounters when the conversational partner knows and can offer this communication in a playful and experimental way.  However, there are many more powerful scientific and theoretical findings that indicate how this type of interaction builds the bonds of trust and love between parents and infants.

Work by psychobiologist Colwyn Trevarthen, the ethologist Ellen Dissanayake, and researcher Sandra Trehub and her team at the University of Toronto, has paved the way in showing how the functions of this interaction have less to do with entertaining and engaging the baby and are more aligned with the infant’s ability to evoke and interpret these signals from adults and their siblings within weeks of birth. For me, and for the researchers mentioned above, these interactions are easily identified as musical. Observations of the nature of these interactions between parents and infants led Stephen Malloch to coin the term ‘Communicative Musicality’, to capture the unique pitch and rhythmic structures that communicative partners use.

This type of interaction is, as the quote from Stern at the opening attests, playful, rich, and highly involved. It teaches the many skills we need in being able to be with people successfully in intimate relationships, in relationships involving teachers and students, and in work groups. When we do not have adequately rich and supported experiences of attachment in infancy there can be lifelong consequences. Therefore, offering support to parents and infants in difficulty can provide long term benefits. Music therapy is uniquely poised to make a useful contribution to this work as infants are receptive to musical and music-like interactions from sensitive and responsive adults.

Professor Jane Edwards is an Associate Professor at the University of Limerick where she directs the Music & Health Research Group and is co-ordinator of the MA in Music Therapy in the Irish World Academy of Music & Dance. She was formerly a guest professor at the University of the Arts in Berlin (2004-2011). She is President of the International Association for Music & Medicine. She has published extensively in the field of music therapy including Music Therapy and Parent-Infant Bonding (OUP, 2011), and is sole editor for the first Oxford Handbook of Music Therapy (forthcoming).

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Image credit: ‘Mother Kissing Baby’ By Vera Kratochvil (public domain via Wikimedia Commons).

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Personality disorders, the DSM, and the future of diagnosis

By Edward Shorter

Ben Carey’s thought-provoking article in the New York Times about the treatment of personality disorders in the forthcoming fifth edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association raises two questions:

1. Do disorders of “personality” really exist as natural phenomena, comparable to mania or dementia?

2. If they do exist, do they belong to the clinical specialty of psychiatry, or are they better considered characteristics of the human condition that have little to do with illness? Psychosis and melancholia are real illnesses, comparable to tuberculosis and mumps. Do personality disorders have that status?

Psychiatry’s involvement with personality disorders goes back to the early nineteenth century and the diagnosis of “hysteria”: the female character was considered weak and vulnerable. Women by virtue of their very personalities were deemed more vulnerable than men to feelings and emotional changability. Viennese psychiatry professor Ernst von Feuchtersleben wrote in 1845, “[The causes of] hysteria include everything that increases sensitivity, weakens spontaneity, gives predominance to the sexual sphere, and validates the feelings and drives associated with sexuality.”

In terms of the scientific assessment of personality and its breakdowns, this was not a promising beginning.

Things got worse. In 1888 German psychiatrist Julius Koch said there was such a thing as a personality that was “psychopathically inferior,” a product of genetic degeneration. Such degenerates were not exactly mentally ill, he said, merely unable to get their act together, and also showed “a pathological lack of reproductive drive.”

So psychiatry has always thought there were people who had something really wrong with their characters without being necessarily depressed or psychotic. But how to classify them?

Classification is obsessing the current debate. The struggle over what disorders to identify began with the great German classifier of disease (nosologist) Emil Kraepelin who, in the eighth edition of his Psychiatry textbook in 1915 expanded to seven types the list of “psychopathic personalities” with which he and his colleagues had been working. The list is interesting because it is very different from our own: the “excitable”; the irresolute; those driven by pleasure to seek out alochol, gambling, and who generally become wastrels; the eccentric; the liars and swindlers; and the quarrelsome, sometimes called the querulants.

Doesn’t sound very familiar, does it? That’s because each culture compiles a list of the personality traits it dislikes, or that are harmful to the further flourishing of things; and in Imperial Germany being querulous by challenging authority or being irresolute by not seeing France as the enemy were viewed as disorders.

There was lots yet to come, that I’m going to skip over. But what has most greatly influenced the current debate is the concept of personality disorders laid down by the psychoanalysts, the followers of Freud. Their list is quite different from Kraepelin’s because they were not interested in making war on France but on inner conflicts within the psyche. In 1908 Freud suggested the existence of an “anal” character, poeple who were orderly, tidy and meticulous and who in childhood had somehow come to dwell upon the anal region.

Freud’s followers came up with a whole list of character pathologies: Fritz Wittels’ “hysterical character,” Wilhelm Reich’s notion of “character armor” and its various guises, such as the “compulsive character,” the “phallic-narcissitic character,” and so forth.

We’re getting hot now. The modern concept of personality disorder comes directly to us from the psychoanalysts and from their current desperate desire to stay relevant. In 1938 Adolph Stern laid out a kind of personality disorder that was unresponsive to psychoanalysis, calling it “borderline personality disorder.”

Fourteen years later, in 1952, the American Psychiatric Association took a first cut at personality disorders, in its new DSM series, assigning them to three groups: (1) Those that were constitutional (inborn) in nature and unresponsive to change though psychotherapy, including “inadequate personality” and “paranoid personality”; (2) Those individuals with emotionally “unstable” and “passive aggressive” personalities; and (3) the sociopaths, such as the homosexuals, fetishists and other deviants.

American society in the early 1950s did not like those who deviated from the missionary position, who were inadequate to the challenges of empire-building, and who accepted authority but badmouthed it at the water-cooler.

Wilhelm Reich had laid out the concept of “narcicism” in 1933 and New York psychiatrist Heinz Kohut gave it pride of place in 1971. We are totally mired in the swamp of psychoanalysis here, a swamp that DSM-II in 1968 and DSM-III in 1980 failed to pull us out of, though DSM-III constructed an “axis II,” along which personality disorders could be arrayed, in addition to axis I for the real psychiatric disorders.

So this brings us to the current scene. The most recent edition of the DSM series, DSM-IV in 1994, had a whole slew of personality disorders, including histrionic, narcissistic, borderline, and so forth. The editor of DSM-IV, Allen Frances, was a psychoanalyst, and the list is a kind of last gasp. The problem is that patients who qualified for one, tended to qualify for almost all of them. The individual “disorders” were quite incapable of identifying individuals who had something psychiatrically wrong with them; the “disorders” had become labels for personality characteristics that are found in abundance in the population.

Moreover, who needed labels? Psychiatrists had a seat-of-the pants definition of a PD: “If your first impression of your patient is that he is an asshole, then he probably has a personality disorder.”

And what kind of disorder was this anyway, an illness in which the identified patient thinks he personally is fine but is making everyone around him unhappy? This is not like psychosis.

You can see why the drafters of DSM-V, due this May, have despaired. They wanted something clinically relevant and that also would sound vaguely like science (which psychoanalysis certainly didn’t). It will be interesting to see how the APA sorts this out. Personality disorders exist not as natural phenomena but as cultural phenomena: We as a society need some way of identifying people who can’t quite get it all together. But is this an illness that psychiatrists can treat? In the way that they treat schizophrenia with Zyprexa and depression with Prozac? What do we, as a society in 2012, do with people who can’t quite get it all together? I’m asking you.

Edward Shorter is an internationally-recognized historian of psychiatry and the author of numerous books, including A History of Psychiatry from the Era of the Asylum to the Age of Prozac (1997), Before Prozac (2009), and the forthcoming How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown. Shorter is the Jason A. Hannah Professor in the History of Medicine and a Professor of Psychiatry in the Faculty of Medicine, University of Toronto. Read his previous OUPblog posts.

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Otto Dix and The War

By Reinhold Heller

The German artist Otto Dix — born this day in 1891 — drew a remarkable image of himself in 1924 (the tenth anniversary of the beginning of World War I), simply rendered in bold lines of India ink, caricature-like in its exaggerated simplicity. In the drawing we see Dix as he gazes directly out at us through squinting eyes, sporting a small curving mustache, a cigarette dangling from his lips, wearing a battered steel helmet and tattered uniform while carrying a heavy machine gun. Directly above his self-portrait, he scrawled as an explanatory inscription: “This is how I looked as a soldier.” The drawing echoes in its conception innumerable propaganda images from all nations involved in the First World War, depicting wounded or exhausted soldiers who nonetheless stand tall and proud, resilient and strong as they gaze into an unknown distance. They are idealized heroic warriors, Greek gods in modern uniforms. Their images on posters and postcards were meant to inspire and reassure those at home that, despite all, their nation would triumph.

Dix’s self-portrait, however, is divested of these inspirational formulations and transforms them into an image of a bedraggled soldier in torn uniform and damaged helmet, unshaven and scarred. While the machine gun he holds serves as his identifying attribute, its massive, pristinely geometric and precisely drawn form also seems overwhelming; it is in contrast to the rumpled, disrupted contour of his uniform jacket and its burden causes him to list slightly, unsteadily. There are no heroics, no noble endurance in Dix’s self-portrait. Disheveled and dirty, supporting or supported by his massive weapon, Dix instead makes a simple statement: “Here I am.” Or, more correctly, as his 1924 inscription notes: “This is how I was.” At the same time, the very existence of the drawing also proclaims his survival of the war and his continuing life, not as the soldier depicted but as the artist who made the drawing.

Buried Alive (January 1916, Champagne) by Otto Dix. Source: Wikipaintings.

Dix made this self-portrait drawing to serve as the dedicatory image of Der Krieg (The War) – a sequence of 50 etchings, engravings, and aquatints in five portfolios – that he gave to his Berlin dealer Karl Nierendorf, who had commissioned the series. Der Krieg was published in an edition of 70 by Nierendorf, who also published accompanying pamphlets with depictions from the print series to publicize it among newspapers, labor unions and pacifist organizations. The prints offered a somber contrast to the numerous monuments honoring the fallen heroes of the conflict — often depicted in full uniform, sleeping peacefully, their noble bodies displaying no signs of wounds — being unveiled in numerous German cities in 1924, while German victories at the war’s beginning were being remembered and celebrated with elaborate military ceremonies. In contrast to these public displays, replete with fluttering flags and martial music, Dix’s Der Krieg offered a private recollection, silent but insistent in its focus on the everyday experience of the war and its multitude of horrors. With no sense of a sequential narrative, the 50 prints shift from scenes of a bomb- and artillery-shattered landscape ( Crater Field near Dontrien Lit by Flares ) to close-ups of wounded soldiers in the trenches ( Wounded Man [Baupaume, Autumn 1916] ), from soldiers in the company of prostitutes ( Visit to Madame Germaine’s in Méricourt ) to gas-masked, charging troops ( Shock Troops Advance under Gas ) and mud-covered soldiers eating, the decomposing bodies of their former comrades nearby ( Mealtime in the Trench [Loretto Heights] ). The series is a seemingly unending catalogue of terror, misery, horror, and death, inflicted on human beings, animals, and nature equally — one that not infrequently employs a sense of macabre, satirical humor. “I depicted primarily the horrible consequences of war,” Dix later stated. “I believe no one else has seen the reality of that war as I have: the privations, the wounds, the suffering. I chose a truthful reportage of war; I wanted to show the destroyed land, the corpses, the wounds.”

Dix’s war portfolio, its link to Nierendorf’s publicity campaign among unions and left-leaning groups, and his monumental painting The Trench (1920–3, destroyed), which was vehemently attacked for undermining the nobility of the German soldier and returned to Nierendorf by the museum that had purchased it, all tied Dix immediately and irrevocably to pacifist and leftist political attitudes in Germany in 1924. Although he insisted — perhaps somewhat ingeniously — that his war imagery was fundamentally apolitical and no more than an honest report of his memories of the war, the cacophony of nationalist criticism and military celebration drowned out his objections. Nierendorf sold only one complete Der Krieg portfolio.

Reinhold Heller is Professor emeritus of Art History and Germanic Studies at the University of Chicago. He has published extensively on modern German and Scandinavian art, including the entries on Otto Dix and Edvard Munch in Grove Art Online. He curated the exhibition The Birth of German Expressionism: ‘Brücke’ in Dresden and Berlin, 1905–1913 at the Neue Galerie, New York, in 2009, the first major American museum exhibition devoted to this group that initiated Expressionism in Germany.

Oxford Art Online offers access to the most authoritative, inclusive, and easily searchable online art resources available today. Through a single, elegant gateway users can access—and simultaneously cross-search—an expanding range of Oxford’s acclaimed art reference works: Grove Art Online, the Benezit Dictionary of Artists, the Encyclopedia of Aesthetics, The Oxford Companion to Western Art, and The Concise Oxford Dictionary of Art Terms, as well as many specially commissioned articles and bibliographies available exclusively online.

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Great Expectations: an audio guide

On 1 December 1860, Charles Dickens published the first installment of Great Expectations in All the Year Round, the weekly literary periodical that he had founded in 1859. Perhaps Dickens’s best-loved work, it tells the story of young Pip, who lives with his sister and her husband the blacksmith. He has few prospects for advancement until a mysterious benefaction takes him from the Kent marshes to London. Pip is haunted by figures from his past — the escaped convict Magwitch, the time-withered Miss Havisham, and her proud and beautiful ward, Estella — and in time uncovers not just the origins of his great expectations but the mystery of his own heart.

A powerful and moving novel, Great Expectations is suffused with Dickens’s memories of the past and its grip on the present, and it raises disturbing questions about the extent to which individuals affect each other’s lives. Below is a sequence of podcasts with Robert Douglas-Fairhurst, editor of the Oxford World’s Classics edition of Great Expectations, recorded by George Miller of Podularity.

Title page of first edition of Great Expectations by Charles Dickens, 1861

- What was going on in Dickens’s private life at the time?

[See post to listen to audio]

- Both Dickens and Pip were haunted by the ghosts of the past.

[See post to listen to audio]

- Are gentlemen in Victorian England born or made?

[See post to listen to audio]

- Why was Dickens persuaded to change his original ending to the novel?

[See post to listen to audio]

- Why does Great Expectations continue to hold such appeal for readers?

[See post to listen to audio]

- If you loved this novel, try…

[See post to listen to audio]

Charles Dickens was one of the most important writers of the 19th century and 2012 is the 200th anniversary year of his birth. The Oxford World’s Classics edition of Great Expectations reprints the definitive Clarendon text. Robert Douglas-Fairhurst’s new introduction ranges widely across critical issues raised by the novel: its biographical genesis, ideas of origin and progress and what makes a “gentleman,” memory, melodrama, and the book’s critical reception.

For over 100 years Oxford World’s Classics has made available the broadest spectrum of literature from around the globe. Each affordable volume reflects Oxford’s commitment to scholarship, providing the most accurate text plus a wealth of other valuable features, including expert introductions by leading authorities, voluminous notes to clarify the text, up-to-date bibliographies for further study, and much more.

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What makes this World AIDS Day different from all others?

1 December is World AIDS Day. Here Kenneth Mayer, MD, explains what makes the 2012 observance different from all those before – and, hopefully, those to come. Dr. Mayer is Co-Editor of Clinical Issues in HIV Medicine, Co-Chair of the HIVMA/IDSA Center for Global Health Policy’s Scientific Advisory Committee, founding Medical Research Director of Fenway Health, a visiting professor at Harvard Medical School, and an attending physician and director of HIV Prevention Research at Beth Israel Deaconess Hospital in Boston.

By Kenneth Mayer

Last year, on World AIDS Day, U.S. President Barack Obama set ambitious goals to reach more people with treatment and fundamental prevention. Echoing U.S. Secretary of State Hillary Clinton’s call for an “AIDS-free generation,” he envisioned a tipping point in a 30-year battle to subdue the world’s costliest epidemic.

This World AIDS Day, the administration’s release of a global AIDS roadmap takes the vision into practice. Outlining the U.S. government’s commitment to apply research to reality, with the efforts of affected countries and other donors, it is as much a promise as a challenge.

The plan serves as a solid indication that three decades into a struggle that began without direction, and that sometimes seemed futile, the U.S. has set a course to continue the pace it has achieved in the last year, while giving partners encouragement and reason to match those efforts. It underscores, at a time of worldwide economic challenges and competing concerns, that this investment will yield gains, this is a battle that can be won, and this is not the time to stand still.

[image error]The global health community and its researchers, policy makers, donors, field workers, and affected populations know what to do to begin to end this epidemic, and now need to do it. To realize the magnitude of this opportunity, compare where we are now to where we were 31 years ago when fear, ignorance, and prejudice stymied responses while AIDS’ death toll multiplied exponentially as it circled the world. With little clue as to how the virus was transmitted from 1981 to 1985 rumors and mistrust also spread. Through epidemiological research we overcame the terror of those years, understanding that without blood exchange or intimate sexual contact the virus was not readily transmitted. Researchers’ discovery in the mid-1990s that combinations of antiretroviral drugs could arrest the virus changed it from a death sentence into a manageable disease, for many. Shamefully, the cost of those drugs kept the benefit of that breakthrough from being shared in the poor countries where relief was most needed. Finally, in the last decade, with the importation of generic medicines, the establishment of The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief, work to confront the epidemic emerged from laboratories and wealthy countries, to what are now some of the most formidable front lines.

Yet we continue to fall short. We know that injection drugs are a major vector for HIV transmission, but many countries punish users of those drugs rather treat them with opioid substitution therapy and protect them with needle exchange programs. Homophobia and criminalization of gay sex threaten efforts to even count the toll in countries where HIV is most prevalent. Programs to prevent transmission of the virus from mothers to infants are hobbled by constraints on family planning commodities. Sex workers are marginalized by efforts that exclude their input. Treatment and prevention programs fail to reach people with physical and mental disabilities. While tuberculosis is the primary killer of people living with HIV, screening and treatment for the two diseases remain unlinked. While donors have imported some of the means to fight the epidemic, too often they have imported answers as well, failing to allow for the diversity of needs and affected populations in different countries.

With a plan that includes the needs of all affected populations, the tools we have now will be powerful. The study known as HPTN 052 showed that early initiation of antiretroviral therapy could decrease the transmission of HIV in couples in which only one partner was HIV-positive by 96 percent. The use of an antiretroviral drug as pre-exposure prophylaxis in combination with other risk-reduction measures, was shown to be effective in protecting men who have sex with men, and heterosexual men and women from acquiring the virus.

These discoveries will be useless, however, if people who need medicine to save their lives don’t get it. While eight million people are getting treatment, 34 million are living with the virus. Maintaining the momentum of treatment coverage that the U.S. has achieved in the last year in Africa is imperative to meet the original humanitarian mission of the response as well as to continued progress.

Then, with shared responsibility and political will, the next World AIDS Day can be one on which we can see the end of the road, far ahead but certain, when we can stop the further spread of HIV.

To raise awareness of World AIDS Day, Dr. Mayer and Daniel Kuritzkes, MD (Co-Editor of Clinical Issues in HIV Medicine) have selected recent, topical articles, which have been made freely available for a limited time by  The Journal of Infectious Diseases and Clinical Infectious Diseases. Both journals are publications of the HIV Medicine Association and the Infectious Diseases Society of America.

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Image credits: World AIDS Day press images via worldaidsday.org media centre.

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‘Zombie drugs’

By Dr Rosie Harding & Dr Elizabeth Peel

According to official statistics, a significant minority of people living with dementia are prescribed antipsychotic drugs. These are used to treat behavioural and psychological symptoms. The 2012 National Dementia and Antipsychotic Prescribing Audit suggests that there has been a fall in the prescription of these medications. However, less than half of GP practices in England participated and thousands of people with dementia are still prescribed antipsychotic drugs each year. What many perhaps don’t know is that only one antipsychotic (Risperidone) has actually been licensed for use in elderly people with dementia. The rest of these drugs are prescribed “off-label”.

Before any drug is prescribed to a patient, unless it’s being used in a clinical trial, it needs to have a marketing authorisation (commonly called a license) from either the Medicines and Healthcare products Regulatory Agency (MHRA) or European Medicines Agency (EMA). Before a manufacturer can get a license for a medication, the drug must be extensively tested for both safety and efficacy. But once a license has been granted, prescribers can use the drug to treat any condition, not just those that they have been tested for. This practice is called “off-label” prescribing. So, currently, thousands of people living with dementia are prescribed medication by their doctors that has not been tested for the purpose it is being prescribed. There is no reliable data about its effectiveness, and even more importantly, its safety in this group of vulnerable older people. In our research with 185 family carers of people living with dementia “off-label” prescription of antipsychotics was reported in the majority of instances where their loved ones had been given these drugs. Carers reported that the licensed drug was only given in 21% of cases.

Antipsychotics have a range of side effects, but perhaps most well-known is the risk of over-sedation, which is why they are often described as “zombie drugs” or a “chemical cosh”. Many carers in our research talked about the harmful impact their loved ones had experienced because of these drugs. “It left my dad in a zombie state,” said one daughter.  Another woman’s husband was “very much like a zombie because of the antipsychotic drugs”, and a daughter described her mother being left “catatonic”. Carers were very clear about the damage these drugs can do: “I was appalled at the use of anti-psychotic drugs … They are EVIL! … They make people worse not better”.

Clinical trials have shown that these drugs have high rates of ‘placebo effects’, raising serious questions about their effectiveness. Shockingly, it has been known for several years that antipsychotic drugs can be harmful to elderly people with dementia, because they increase the risk of stroke and death. Yet because of the lack of regulation of this form of prescribing, there are essentially no options for legal redress for anyone harmed by off-label prescription. Because antipsychotics are prescription-only drugs, there would be no claim against the seller or the manufacturer. The commonplace nature of these types of prescriptions also rules out a claim of clinical negligence through the operation of the Bolam test, which looks to a ‘respectable body of medical opinion’ to determine the appropriate standard of care.

It is essential to be clear that off-label prescription is an important tool for medical professionals, and can often be very helpful in taking forward new, effective and safe uses of licensed drugs. Prescribing off-label is also important in both paediatric and geriatric medicine, because clinical trials aren’t usually carried out on children or older people. We are not arguing that off-label prescription should be made illegal. Instead, we think that the best way to tackle the use of ineffective and potentially harmful antipsychotics to chemically control people with dementia would be to introduce some regulatory controls on the off-label prescription of pharmaceutical products. This would emphasise the need to warn patients of the risks, including the fact that a prescription is off-label, and provide a framework for documenting both adverse effects and effectiveness. It would help protect vulnerable people, especially those who lack the capacity to consent to treatment. Greater regulation would also provide a route to redress for people harmed by off-label prescriptions, through the duty that healthcare professionals have to warn of the risks of treatment, and could also protect healthcare professionals from liability by providing a record of consent to treatment.

If controls on the off-label prescription of antipsychotics were introduced, then there would be no impact on their prescription for licensed uses, such as schizophrenia and bipolar disorder. There would also be no effect on the use of the one antipsychotic that does have a license that covers behavioural and psychological symptoms of dementia. Controls on off-label prescriptions would also prevent prescribers from simply switching from using antipsychotics to using off-label prescriptions of other mind-altering drugs that are of similarly unproven effectiveness, or have different side effects. There are other benefits from introducing this kind of regulatory process.  Other vulnerable patient groups could be protected from potential harms associated with off-label prescription. Medical professionals would still have the flexibility to prescribe off-label where they think this is the best treatment for their patients. Introducing tighter legal controls on off-label prescribing practices could also encourage pharmaceutical companies to carry out the clinical tests necessary to determine the safety of alternate uses of their medications and so increase the licensed treatments available. Finally, it could encourage the development of more effective medications, and save the costs of ineffective and unnecessary off-label prescription.

Dr Elizabeth Peel is a Senior Lecturer in Psychology at Aston University, Birmingham UK, and Ageing Lives lead for the Aston Research Centre for Healthy Ageing (ARCHA). She was awarded a British Academy Mid-Career Fellowship for the ‘Dementia Talking’ project. Dr Rosie Harding is a Senior Lecturer in Law at the University of Birmingham, UK. Her research focuses on how law works in everyday life, from a socio-legal perspective. She is currently developing an interdisciplinary research network of scholars interested in ‘Re-Valuing Care’. Together, they are the authors of “‘He was like a zombie’: Off-label prescription of antipsychotic drugs in dementia” in the The Medical Law Review, which is available to read for free for a limited time.

The Medical Law Review is established as an authoritative source of reference for academics, lawyers, legal and medical practitioners, law students, and anyone interested in healthcare and the law.

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Image credit: Photograph of nurse giving patient medication by kali9 via iStockphoto.

The Day-Lewis Lincoln: (racial) frontiersman

By Jim Cullen

As anyone vaguely familiar with his work knows, Day-Lewis is legendary for the extraordinary variety of characters he has played, and the vertiginous psychological depth with which he has played them. I first became aware of Day-Lewis in early 1985, when, in the space of a week, I watched him portray the priggish Cecil Vyse in the tony Merchant-Ivory film adaptation of E.M. Forster’s Room with a View and then saw him play Johnny, the punk East End homosexual, in Stephen Frears’s brilliantly brash My Beautiful Launderette. Day-Lewis went on to have a distinguished career, winning an Academy Award for his portrayal of the handicapped Irish poet Christy Brown in My Left Foot in 1989.

But between 1988 and 2007 he played a string of American figures that ranged from a seventeenth century Puritan to a twentieth-century art collector. (He won his second Oscar for his performance as oil prospector Daniel Plainview in There Will Be Blood in 2008.) Yet for all for all the range, historical and stylistic, that has gone into these portraits, there’s been a surprising vein of consistency in this gallery of characters.

And that is this: the quintessential Day-Lewis protagonist is a frontiersman, even when that frontiersman is disguised as a gang member (or an elite lawyer) on a New York City street. He is, always, a man apart — someone at odds with the institutional arrangements that surround him (and I do mean surround in the military sense of “besieged”). If he is to survive, which in many cases he does not, his protagonists must move to the margins, finding a place on the outskirts of society. In this regard, Day-Lewis characters are remarkably like those of an actor who some cineastes may well consider his antithesis: John Wayne. Wayne is no one’s idea of a method actor, and his politics would appear to be a continent apart from a Day-Lewis who is widely regarded as a liberal darling. And yet both men have tended to play Moses figures who point the way toward promised (or lost) worlds they themselves can neither enter nor reclaim.

You can probably see how difficult it would be to insert Day-Lewis’s latest character — the lanky Abraham Lincoln of Steven Spielberg’s new biopic — into this framework. Lincoln was the ultimate institutionalist, a man who believed passionately in the ability of the people, in the form of democratically elected governments, to work together and solve social problems. (Tom Hanks typically embodies this view most vividly in contemporary cinematic culture.) Lincoln was deeply invested in the notion of compromise, a man who tried desperately to find common ground despite circumstances where Americans were more polarized than they ever had been. Even when Lincoln took a firm position regarding the Civil War, as he did immediately with preserving the union and ultimately in ending slavery, he continued to insist on striving toward malice toward none and charity for all. Other Day-Lewis characters are not that generous.

I loved Lincoln — how could anyone with a feeling for the man be moved, if not awed, by Day-Lewis’s performance? — but in watching the film I was reminded how hard it is to understand living figures who have the annoying habit of refusing to stand still and allow us to pigeonhole them. (I can be interpreted as referring to the immortal Lincoln, though my focus for the moment is the mortal Day-Lewis.) The actor may well have embarked on a new phase in his career, in which he plays kindly, optimistic people who offer a message of hope, even if they must be martyred. At least that part of the theory remains intact.

But when I awoke the morning after seeing the movie I saw that there was a way the general pattern still applied: Day-Lewis’s Lincoln was a racial frontiersman, one who farsightedly pointed the way toward a future where white people could begin to accept black people as citizens — and eventually much else. Although there are countless ways Spielberg could have rendered this story, the one he chose focused on a month-long period in 1865 where the Lincoln administration steered a recalcitrant House of Representatives to pass the bill that would eventually become the 13th amendment to the Constitution, which ended slavery. As we see, this was an extraordinarily difficult thing to do, not only because racism continued to prevail as the common sense of the day, but also because even Lincoln’s allies were suspicious of his motives. (Tommy Lee Jones plays a remarkably nuanced Radical Republican Thaddeus Stevens, who is typically cast as a villain — as he was in the thinly veiled portrait of D.W. Griffith’s Birth of a Nation — or lionized as a uniquely principled egalitarian. He and Lincoln exchange some wonderfully incisive and utterly believable volleys, thanks to Tony Kushner’s fine screenplay.)

This Lincoln understands, as few of his fellow Americans really do, that the amendment is crucial for the future of the republic. At one point in the movie, Kushner has Lincoln do something I’m not aware he ever in fact did, but which seems entirely in character: make a legal case against the Emancipation Proclamation he issued two years earlier as a wartime measure. Listening to this skilled lawyer make his opponents’ case, you begin to sense the Great Emancipator has something of a guilty conscience over having done something he himself believes may well have been illegal, even as he knew it was morally right. Lincoln knows the Emancipation Proclamation is as vulnerable in a court of law as it is in the court of public opinion, which is why he’s determined to exploit the fleeting moment of a lame-duck Congress and ram a bipartisan bill through it.

This Lincoln is no saint. One of the comic subplots of the movie (involving a surprisingly corpulent James Spader) involves the less than wholly savory tools of persuasion used to convince grasping legislators to see the light. In his willingness to engage in political dirty work, this Lincoln exhibits a rugged pragmatism that shows him to be more tough-minded than the Radicals led by Stevens as well as the Conservatives led by Preston Blair (Hal Holbrook, who himself has played Lincoln) who want peace at any price. Nor is this Lincoln portrayed as a paragon of racial enlightenment (one way in which Stevens gets his due). There’s a fine exchange Lincoln has with his wife’s African American dress designer, Elizabeth Keckley (Gloria Reuben) in which he freely professes his ignorance about black people. Day-Lewis achieves the miraculous feat of showing us a vitally alive Lincoln inhabiting the world in which he was given, while simultaneously confirming a perception, that many though not all of his contemporaries had, that he was a uniquely gifted man out of time. A Moses who let other people go. One of whom now inhabits that big white house.

I don’t want to press my point too far here. That’s not only because of its inherent limits — there are many ways to understand this movie and Daniel Day-Lewis’s place in it — but because artists and scholars are both diminished when the latter try too hard to slot the former into their theories about the way the world works. The point is to open windows, not shut people in. That’s what Lincoln did. That’s what Day-Lewis does. That’s what I, in my own small way, try to do in my own work.

A version of this article originally appeared on History News Network.

Jim Cullen teaches history at the Ethical Culture Fieldston School in New York City. He is the author of the forthcoming Sensing the Past: Hollywood Stars and Historical Visions (December 2012), The American Dream: A Short History of an Idea that Shaped a Nation, and other books. Cullen is also a book review editor at the History News Network. Read his previous OUPblog posts.

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Hard times no more: The Performers

By Liz Wollman

One of the largest — and, I admit, most disappointing — revelations I had while researching 1970s adult musicals for my book, Hard Times: The Adult Musical in 1970s New York City, was just how tame they all ended up being. Sure, there was frank talk about sex in most adult musicals. There were also a lot of naked bodies on display. Occasionally, there were simulated sex acts that were creative and acrobatic enough to make even the hippest, most solid of 1970s hepcats feel like a real chump and go on a serious bummer. This is precisely what I expected when I started looking into musicals with names like Stag Movie, Lovers, Le Bellybutton, and Let My People Come.

What I wasn’t prepared for, however, was just how traditional the subtext of most of these shows typically was. Indeed, lurking beneath the jiggling breasts, faked orgasms, and copious use of slang terms for genitalia was often an almost jarring adherence to conventional love relationships, and, more shockingly, even the occasional twinge of nostalgia for the social constrictions of the Eisenhower era. The moral of most adult musicals, even those featuring the nudiest, sluttiest, foul-mouthiest of characters, was that all the consequence-free, anonymous sex in the world — no matter how many swingers and far-out drugs were involved — was just never as fulfilling as good old-fashioned monogamous love. Preferably in the missionary position. After marriage. With the lights out.

Now, I was born a titch too late to experience the swinging seventies first-hand, unless you count the ribald (if surely heavily-edited, child-friendly) tales a particularly groovy babysitter would occasionally tell my sister and me as she helped us brush our teeth and get into our jammies. Nevertheless, I have always liked to think of that time as one of continued excess, during which a vast majority of American citizens turned on, freaked out, and had sex with one another as easily as we currently mutter “what’s up” to acquaintances we see on the street or run into on the subway. Thus, learning that the live entertainment form I’d decided to research — and that, at first glance, seemed to be the musical equivalent of hard-core porn, albeit with more jazz hands — were, in fact, really sort of tame and conservative, truly bummed me out at first.

But then again, recognizing the cultural conventionality in adult musicals was important, not only for the book’s narrative, but for my grasp of social history, which is, of course, never remotely as straightforward or uncomplicated as it is often depicted. My students always get an earful from me about how much I hate the overgeneralizations that get uttered all too frequently in documentaries and oral histories, especially those about rock music and pop culture that get broadcast on channels like VH1: “And then… everything changed.” “It was truly revolutionary… unlike anything… anyone… HAD EVER EXPERIENCED.” Hmph.

As it played out into the 1970s, the 1960s sexual revolution was enormous and confused and multi-tentacled, and meant many different things to as many different people. To be sure, some of us Americans had a great time: some of us did, indeed, jump wholeheartedly into the cultural orgy of drugs and excess that the era offered. And many of us did, indeed, find the strength to come out of the closet; or to leave unsatisfying marriages; or to change career paths, or spiritual, cultural, or social practices, in a quest for a more satisfying and liberated, and less stultifying life. But then again, just as many of us felt confused, threatened, left out, or even terrified by the many cultural disruptions of the time period. And I found ample evidence of enormously mixed emotions about the seismic shifts we lived through: a blend of almost palpable longing for the newly disrupted cultural codes we understood and felt safe enacting, which came part and parcel with — and directly contradicted — feelings of elation, joy, celebration, and a fervid embrace of cultural change.

Which is why, I guess, the adult musicals of the 1970s were so often a blend of the shocking and the conventional. The American stage musical has long made a practice of mixing the conservative and subversive, thereby appealing to the broadest possible audience. Stage musicals have always been, after all, a commercial entertainment form. Why should musicals depicting the sexual revolution, and the subsequent gay and women’s liberation movements, be any different? Shows like Oh! Calcutta! and Let My People Come enjoyed successful runs primarily because they allowed audiences the chance to experience the sexual revolution at a safe, even comforting, distance. Adult musicals helped ease doubt, ambivalence, and anxiety about rapidly changing cultural mores. They invited audiences to embrace the notions that sex could be fun and harmless, that naked bodies could be beautiful, and that sexual identity didn’t have to be so threatening. Adult musicals allowed spectators — some of whom were struggling with their own sexuality, some of whom were hoping to learn more about the rapidly changing sexual mores, some of them simply eager to find out exactly what all the fuss was about –to live vicariously without getting in too deep.

Their existence, otherwise, doesn’t make any sense, especially during a period in which there were so many other kinds of far more explicit sexual entertainment available. After all, why Oh! Calcutta! when Deep Throat was showing down the street? Why buy tickets to see simulated sex on stage when there were actual live sex shows going on a few avenues away? Why see an Off-Broadway comedy about swinging, or group sex, when you’ve heard whispers of a key party being planned a few towns over? Through the 1970s, Americans struggled mightily over issues of sexuality and gender in unprecedented ways; the result was a complex, if heady, blend of feelings of elation, confusion, frustration, and fear. Adult musicals didn’t so much challenge as they did educated, palliate, and ameliorate, by offering cheery, conventional messages to audiences who needed reassurance during a time of enormous, rapid change.

I recently thought a great deal about the function of 1970s adult musicals while watching David West-Read’s sex farce The Performers, which opened on Broadway at the Longacre Theatre on November 14th… and closed four days later. Sometimes, Broadway flops are squirmy, embarrassing affairs, but this one was great fun — I think even more so, since the star-studded cast clearly knew the show was on the chopping block, and was thus collectively far looser than most companies tend to be on Broadway immediately post-opening. I’m awfully glad I got to see The Performers. But I’m not surprised that it closed as quickly as it did.

While not a musical, The Performers, which takes place in Las Vegas during an adult-film awards show, has a lot of the same ingredients as the adult musicals of the 1970s. The show featured no nudity — it’s not really an entertainment trend these days. But there was plenty of skin (the first scene features the hilarious Cheyenne Jackson in a teeny suede… thing, which he eventually removes to reveal even teenier Superman underpants); a few simulated, if exceptionally goofy, sex acts and a lot of even goofier sex talk; a scene in which an enormous dildo was tossed across the stage; and a huge pair of prop breasts, gamely worn by the actress Jenni Barber in the role of Sundown LeMay. Many of the characters — who have stage names like Mandrew (Jackson) and Chuck Wood (Henry Winkler) — talk frankly about scenes they’ve filmed, sex positions they excel at, and movies they’ve shot, all of which have names like Planet of the Tits, Spontaneass, and Cum on My Bum.

In some ways, shows like this imply that nothing has changed much over the course of forty years. Buried under the sex jokes, flying dildos, and increasingly ridiculous euphemisms for genitalia lies a variant on the same old plot: Mandrew’s childhood friend Lee (Daniel Breaker) has come to Vegas to interview Mandrew for an article about adult films for The New York Post. Lee’s high-school sweetheart and fiancée, Sara (Alicia Silverstone), has come along, too. After spending time with Mandrew, Lee — who has only ever had sex with Sara — becomes concerned that he and Sara will become bored with their sex life as they grow older together. When he broaches the possibility of playing the field before they marry to Sara, she gets insulted and pretends to strike up a flirtation with Chuck Wood. Meanwhile, Mandrew learns that his wife, Peeps (Ari Graynor), also a porn star, is pregnant. This good news is soured, however, when Peeps discovers that Mandrew recently kissed Sundown LeMay on the mouth, which is an intimacy that she and her husband typically reserve for private, offscreen moments together. Amid the strife, the awards show happens, Chuck Wood delivers an absolutely hilarious monologue-as-acceptance-speech that I wish I could have taken home with me after the show, lots of alcohol is consumed, and drunken, heartbroken wackiness ensues.

Happy endings (the old-fashioned kind; not the pornographic kind) are experienced by all involved. Peeps and Sundown make up. Mandrew and Peeps make up. Sara and Lee make up. The porn stars all make it clear to Sara and Lee that sex is not nearly as important as love and commitment, and that they would all kill for the kind of love that Sara and Lee have for one another. Sara and Lee realize that they’ve never had sex with anyone but one another because they have never loved anyone else as deeply. Love conquers all, and monogamy rules — just like it did in adult musicals during the 1970s.

Yet for all the similarities, there are a couple of important ways that The Performers differ from adult musicals. Back in the early 1970s, for a few years at least, hard-core pornography was taken more seriously in the art world as a burgeoning genre with the potential for mainstream appeal, especially following the enormous — and, for many, surprising — commercial success of films like Behind the Green Door and Deep Throat. Yet hard-core porn never crossed over; it went, instead, to video. Thus, over the past several decades, as much as pornography has influenced the aesthetics of myriad forms of mainstream entertainment — from the fashion world to horror films to cooking shows — the adult film industry’s potential for a chance to edge into the mainstream is long gone, if it ever truly had a chance at all.

The Peformers makes this clear: While Lee and Sara feel like freaks for being so straitlaced, it’s their wacky, adult-film friends who are the true outsiders. Exceptionally stupid and self-centered, if also ultimately good-natured and well-meaning, the adult film actors in the show have their own rules, ideals, and aspirations, and live by their own warped code of conduct. Chuck Wood serves as the wise elder of the group. He’s been around since the 1970s, a time he frequently, reverently describes as one of both innocence and enormous excess, and he has come to realize that as he ages alone, all the sex he’s had has amounted to nothing. Not accidentally, then, Chuck is the character who is instrumental in getting all of the heartbroken, arguing couples into the same room together to talk it all out, sit-com style, at the end of the show.

But much more broadly, I think it’s the failure of The Performers to connect with audiences that points, at least in some small part, to the cultural differences between the 1970s and now. It’s easy to say that we are more prudish than we were back in the 1970s: that today’s audiences wouldn’t be able to handle stage nudity, or the kind of frank talk about sex that was a regular feature of so many shows that appeared on, Off, and Off Off Broadway back then. By that logic, maybe The Performers closed because of its very subject matter: audiences stayed away because they deemed it too crass or off-color for their tastes.

Then again, maybe not. In some ways, we’re really a lot savvier now than we were then, especially when it comes to human sexuality. After all, while some of the excesses of the 1970s have faded away over time, we’ve got lots more in the way of lasting, meaningful, truly progressive ramifications: more rights for women in both the domestic and the public sphere; more states recognizing the civil rights of gay men and lesbians; more citizens who, despite their political or religious affiliations, just aren’t too terribly concerned or bothered by the sexual preferences or private lives of their neighbors. Maybe, then, stage nudity is no longer trendy because we just don’t crave it like we did. Maybe jokes about dildos and crazy sex positions are cute, but ultimately not all that deep.

Near the end of The Performers, a sad, drunken Sara bursts out with a line that neatly sums up the feelings of the entire company: “I just wanna be me and be okay with it, and have everybody else be okay with it, too!” This is, in some ways, a quintessentially 1970s statement — boil it down to its essence and you get any number of platitudinous expressions that were so popular back then: “Go with the flow.” “Do your own thing.” “Whatever turns you on.” Maybe we just don’t need the same neat, tidy little messages anymore. Maybe a silly sex farce, while fun and cute, and even occasionally hilarious, is just not what we need right now. Maybe The Performers closed as quickly as it did because in the end, we’ve moved beyond it.

Elizabeth L. Wollman is Assistant Professor of Music at Baruch College in New York City, and author of Hard Times: The Adult Musical in 1970s New York City and The Theater Will Rock: A History of the Rock Musical, from Hair to Hedwig. She also contributes to the Show Showdown blog.

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Image credit: Poster for The Performers used for the pusposes of illustration under fair use. Source: theperformersonbroadway.com.

The Beatles and “Please Please Me,” November 1962

By Gordon Thompson

Fifty years ago, the Beatles recorded their arrangement of “Please Please Me,” a lilting lover’s complaint transformed into a burst of adolescent adrenaline. On 26 November 1962, after repeated attempts to capture just the right balance of frustration and anticipation, George Martin informed them over the studio intercom that they had just recorded their first number-one disc. But the path to the top of the charts would not be easy.

John Lennon remembered the afternoon he began writing the song, sitting in the bedroom at his Aunt Mimi’s, playing Roy Orbison’s “Only the Lonely” over in his mind, and beginning a song that would include word play from a Bing Crosby record. He had studied the architecture of Orbison’s music and the American’s affinity for torch-song “climbers” (e.g., “Running Scared,” 1961) in which melodies gradually ascend to a dramatic climax.  The young songwriter in “Please Please Me” shows he has learned the lesson well, the chorus and the refrains to the melody climbing to falsetto peaks.  Another technique comes from the Everly Brothers from whose records Lennon and McCartney had learned about “wedge” harmonies (where one voice holds the top note while the other descends against it). The principal verse phrase of “Please Please Me” illustrates the same device heard in “Cathy’s Clown” (1960), McCartney pinging the top note as Lennon’s declaration tumbles.

When they first played Lennon’s song for artist-and-repertoire manager George Martin on 4 September, the tempo would have more closely approximated an Orbison slow-rocker, with a dragging backbeat and wide-open spaces between phrases. The producer recommended that they increase the tempo, which surprised the band, both because the new speed worked and because the word “tempo” was unfamiliar to them.

When they returned a week later to record a new version of “Love Me Do” and “P.S., I Love You,” they brought out a faster and improved version of “Please Please Me,” probably with an introduction and coda that they had fashioned with George Martin on the earlier recording date. With Ringo Starr observing, session drummer Andy White now improvised tom fills in the gaps that the Beatles had left after the end of the second verse and after the first phrase of the chorus. Ron Richards, who sat in that day for George Martin, would have known that the performance had potential, but that it lacked essentials.

The Beatles needed to work on their arrangement, which they would do during a pre-arranged (but inconvenient) return to Hamburg where they would be appearing with American legend Little Richard. Lennon remembers rehearsing the song over and over again, speeding it up, changing the words, and generally tightening the arrangement until they were happy with it. Moreover, for sonic continuity with their first recording “Love Me Do,” Martin wanted Lennon’s harmonica to proclaim the song’s recurring motif. They would spend afternoon hours in the Star Club rehearsing in anticipation of their next visit to the EMI Recording Studios in St. John’s Wood.

Back in the UK, unimpressed with the promotion that publishers Ardmore and Beechwood and recording company EMI had given “Love Me Do,” Brian Epstein engaged music critic Tony Barrow to help create buzz for the band and their recordings. Barrow had been one of the first in the media that Epstein had contacted in his efforts to get a recording contract and he now hoped the writer could get the Beatles the attention of the press.

Returning to the UK from West Germany, the Beatles entered a small studio in EMI’s Manchester Square offices on 16 November to record an appearance for the program “Friday Spectacular” that the company would broadcast with time purchased on Radio Luxembourg. “Love Me Do” had defied expectations, continuing to climb the charts and leading EMI to take begrudging interest in the band and to book airtime on the one station where Britons could hear more than a few hours of pop music. As host Muriel Young began announcing the band to the studio audience, teens screamed and rushed the stage; Barrow rightly interpreted the event as portending something special.

On 26 November, with the tempo increased again, a vocal response added to replace an awkward gap in the chorus, and Lennon’s harmonica proclaiming the song’s motif, “Please Please Me” was ready to rock. Capturing the best performance would not be easy and the Beatles would work through eighteen takes to get the recording right. In the end, Martin felt sure they had a hit, but a hit requires more than a good recording: it needs promotion, and neither their record company nor their publishers had given “Love Me Do” much support. Manager Brian Epstein, new disc in hand, set out to find someone who could change his luck.

On 27 November, the day after the Beatles had recorded “Please Please Me,” Epstein headed to the heart of London’s publishing district in search of a publisher who could deliver. There, in a redbrick building at the corner of Denmark Street and Charing Cross Road, the manager walked into the offices of the publisher who would help the Beatles reach a national audience. As a singer in the 1950s, Dick James had scored a modest hit (with George Martin as his producer) with the television theme for Robin Hood; but as his teenage appeal and hairline receded, James proved more successful at finding good songs. Indeed, he had been responsible for Ron Richards (and subsequently George Martin) hearing Mitch Murray’s “How Do You Do It?”, and Epstein hoped that the eager new publisher would give the Beatles the attention they deserved.

Back in October, the band had appeared on People and Places, a regional television program out of Manchester. On 23 November, needing national exposure, they had auditioned for BBC Television, but were unsuccessful. Brian Epstein wanted another chance and Dick James would give it to him. Listening to “Please Please Me,” James immediately offered to publish the song; but Epstein remained true to his original goal of making the Beatles successful recording artists, not just successful songwriters. Picking up the phone and talking with Philip Jones, producer for the British ABC television show Thank Your Lucky Stars, James held the handset up to the record player in his office. After a short listen, Jones let the publisher know he would book them for January. James had secured a spot on the show for the Beatles and for himself in history.

Epstein rightly felt optimistic, but January now seemed oh so far away.

Gordon Thompson is Professor of Music at Skidmore College. His book, Please Please Me: Sixties British Pop, Inside Out, offers an insider’s view of the British pop-music recording industry. Check out Gordon Thompson’s posts on The Beatles and other music here.

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Image credit: Please Please Me single cover used for the purposes of illustration under fair use. Via Wikimedia Commons.

Pomegranates: did you know…

November is National Pomegranate Month and we thought it’d be interesting to highlight the fascinating history of this fruit. Here are some fun facts from The Oxford Encyclopedia of Food and Drink in America, Second Edition, edited by Andrew F. Smith. Plus, the “Pomegranates” entry in the Encyclopedia by David Karp.

(1) In Lebanon, a sweet syrup made from pressed pomegranate seeds is utilized in making Mouttabal, otherwise known as Baba Ghanoush.

(2) Ancient Hebrews revered pomegranates as one of seven special species along with wheat, grapes, figs, barley, olives, and date honey.

(3) Chinese New Year (Xinnian) is a lunar festival on the Chinese lunar calendar, falling between January’s end and early February. It begins with a feast on New Year’s Eve; children and elders gather to see the old year out and eat Buddha’s Delight, a dish of eight vegetables wishing for a lucky year. During this time, in some parts of China other symbolic foods fill the table including pomegranates, their seeds a wish for many children.

(4) Pomegranates are considered a subtropical fruit along with citrus fruits, such as grapefruit, lemon, lime, mandarin, and orange, and others, such as avocado, cactus fruit, date, fig, kiwifruit, mulberry, olive, and persimmon.

(5) Since most edible fruits have the potential to ferment without human intervention, wine-like fruit beverages have a global history dating back to humanity’s earliest origins. Ancient Egyptian pomegranate wines and Mesopotamian date wines are among the earliest documented examples.

(6) Functional foods, also known as “designer foods,” are not pills or elixirs. They are similar in appearance and usage to conventional foods — cereal products, dairy products, confectionery, prepared meals — but go beyond the nutrition and satisfying hunger purposes to also provide medical benefits to the body and mind. Pomegranate juice, for instance, is inherently functional with science-backed evidence of benefits for urinary tract infection.

(7) Old World fruits thrived in the American colonies. The colonists established orchards at an early date, and within twenty years of initial settlements, orchards were in full production in all colonies. Depending on climatic conditions and the region, colonists grew pomegranates, apples, cherries, currants, peaches, pears, plums, and quinces. Pomegranates, along with figs, nectarines, and oranges, grew on the coastal plain from South Carolina to Florida.

Pomegranates

The pomegranate (Punica granatum) originated somewhere in the region from Central Asia to Turkey, most likely in Iran, where it has been cultivated for five thousand years. Regally beautiful in its scarlet, leathery skin and turreted crown, it is like a treasure chest inside, with papery white membranes encasing hundreds of glistening garnet gems — seeds embedded in juice sacs. The flavor is sweet-tart and winy, intense but refreshing.

The pomegranate was introduced into Florida by the Spanish no later than the sixteenth century. Almost all of the American crop now comes from the San Joaquin Valley of California, where hot, dry summers mature sweet, attractive fruit. The main commercial variety is the modestly named Wonderful, propagated in 1896 from a Florida cutting. Since the 1990s plantings in California have increased eightfold to 24,500, as the fruit has enjoyed a vogue for its perceived health benefits. The season for fresh fruit runs from August through December, peaking in October and November. Pomegranates are used for decoration, eaten fresh (a rather messy affair), and juiced; the juice is used for making jelly, sorbet, cool drinks similar to lemonade, and a kind of wine.

bibliography

Hodgson, Robert W. The Pomegranate. Berkeley: University of California Press, 1917.

Levin, Gregory. Pomegranate Roads: A Soviet Botanist’s Exile from Eden. Forestville, Calif.: Floreant Press, 2006.

Seeram, Navinda P., Risa N. Schulman, and David Heber, eds. Pomegranates: Ancient Roots to Modern Medicine. Boca Raton, Fla.: CRC Press, 2006.

The second edition of The Oxford Encyclopedia of Food and Drink in America thoroughly updates the original, award-winning title, while capturing the shifting American perspective on food and ensuring that this title is the most authoritative, current reference work on American cuisine. Editor Andrew F. Smith teaches culinary history and professional food writing at The New School University in Manhattan. He serves as a consultant to several food television productions (airing on the History Channel and the Food Network), and is the General Editor for the University of Illinois Press’ Food Series. He has written several books on food, including The Tomato in America, Pure Ketchup, and Popped Culture: A Social History of Popcorn in America. The Oxford Encyclopedia of Food and Drink is also available on Oxford Reference.

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Image credit: Pomegranate tree in fruit. American Colony (Jerusalem). Photo Dept., photographer. [between 1925 and 1946, from a negative taken approximately 1900 to 1920]. Library of Congress Prints and Photographs Division.